26 EyeWorld Asia-Pacific | September 2024 CATARACT Identification While it might not be obvious on slit lamp examinations, Dr. Al-Hashimi and Dr. Tonk said fluorescein dye on the cornea can reveal areas of negative staining that are indicative of ABMD. Dr. Al-Hashimi also said that epithelial mapping is becoming more popular and can highlight areas that require further investigation. Dr. Tonk said the mires on Placido imaging allow you to get more information about the patient’s quality of vision. Interruptions in the mires clue you in to areas of ocular surface disease, such as ABMD or dry eye. Preop management Dr. Tonk said once he has identified ABMD, he asks the patient a variety of questions about ocular irritation, recurrent erosions, or visual fluctuation related to the ABMD. Further, he will assess if the patient has high expectations or refractive demands or is looking for increased spectacle independence with their cataract surgery. Even if the patient says they don’t have symptoms, Dr. Tonk stressed the importance of informing them of their condition and letting them know how it could affect their postop recovery outcomes. Areas of negative staining highlighted with fluorescein and cobalt blue filter. Source: Anthony Aldave, MD That said, just about every patient in general with ABMD deserves at least conservative medical management. This may involve lubricants, nighttime hypertonic saline ointment, topical anti-inflammatories, and management of co-morbid blepharitis. “In many cases, more aggressive or even procedural care may be indicated,” Dr. Tonk said. “This can involve superficial keratectomy with or without diamond burr polishing or phototherapeutic keratectomy.” While outcomes are generally good, he noted that the procedure can be taxing for older patients. To elaborate further, complications could delay cataract surgery, especially when rarely influenced by poor epithelial healing, particularly in older patients or those with ocular surface disorders. Dr. Al-Hashimi said he usually waits 6–12 weeks after a procedure for ABMD to move forward with cataract surgery, making sure there is regularization of the epithelium and repeatability/stability with biometry measurements. With patients, he said he emphasizes that their cataract surgery is a once-in-a-lifetime procedure that, with preop surface optimization, can lead to better outcomes. This, he said, gets them on board with the procedures they might need preoperatively, and the delay they could cause to their cataract surgery. Slit lamp photograph of map lines and epithelial cysts. Source: Anthony Aldave, MD
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