Eyeworld Supplements

MAY 2019 | SUPPLEMENT TO EYEWORLD | 3 Figure 1. The ocular surface disease experts who participated in this discussion think that more than 50% of their cataract patients have dry eye disease preoperatively. oral medications, still expe- rience flares throughout the year as well." Triggers Environmental influences, such as climate/weather con- ditions and seasonal allergies, are among the triggers that result in dry eye flares. Screen time, which is ubiquitous throughout society—and perhaps even more rampant among young people—is an- other contributing factor. "We are a digital-based society. Even young children are using laptop computers and smartboards during the school day, and I am increas- ingly seeing dry eye in children as young as 5 years old," Dr. Gupta said. "It's astounding how many young patients suf- fer from dry eye disease and meibomian gland dysfunction (MGD) today, and I think it's partly due to our digital lifestyle." Symptoms Often patients do not realize that what they are experi- encing is a dry eye flare, and the way they describe their symptoms can be confusing. "It can be greater fluctuations or blurring of vision that is their main concern rather than classic symptoms associated with dry eye, such as epipho- ra, redness, and foreign body sensation," said Elizabeth Yeu, MD. "Not only are they look- ing for acute onset of relief, they want a medication or a therapy that they don't have to maintain. They want some- thing that will provide reso- lution quickly without them having to be on additional medication long term." Dr. Holland pointed out that as far as dry eye flare symptoms go, many patients will complain of the classic dry eye symptoms such as irritation, foreign body sen- sation, and lacrimation, while many others have atypical complaints. "Younger patients tend to have the more symp- tomatic complaints, such as foreign body sensation and pain, whereas patients with chronic dry eye who then get a flare tend to be more neu- rotrophic. Their primary flare symptom may be decreasing vision. When we examine these patients, we see evapo- rative changes to their ocular surface and diffuse punctate epithelial keratitis (PEK) from their dry eye flare. Their eye is also going to be red, but they will not be experiencing as much pain as we see in the younger patients," Dr. Holland said. Visual fluctuations are a key aspect of episodic acute exacerbation of dry eye, as is asthenopia. "If they're continuously blurry you might see PEK, particularly in the inferior third of the cornea, but often you'll see a rela- tively rapid tear breakup time (TBUT)," Dr. Lindstrom said. Flares and surgery Chronic dry eye is seen among cataract and laser re- fractive surgery patients, and Dr. Yeu pointed out that the surgery can instigate flares. In these cases, staining of the cornea or conjunctiva and fluctuating and/or suboptimal vision may worsen as the day progresses, or they fatigue quickly when reading. Dr. Lindstrom provided a simple explanation regarding this dry eye/surgery relation- ship. "Surgery is a meaning- ful surface insult," he said. "Cataract surgery will prob- ably induce a flare in any dry eye patient. Surgery will move a patient up at least one if not two levels on the DEWS metric." Ultimately, Dr. Holland said, it's important to ac- knowledge that dry eye flares are a phenomenon that DED patients experience, and it is crucial to be prepared to recognize the signs and symp- toms and treat these patients in a way that will produce rapid results. n The ocular surface disease experts who participated in this discussion think that more than 50% of their cataract patients have dry eye disease preoperatively. In your clinic, what percentage of your cataract patients have dry eye disease preoperatively? More than 75% 33% 67% 0% 50–75% Less than 50% Following their discussion, the physicians completed a survey on ocular surface disease. Their answers to the survey questions are located throughout this supplement.

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