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2019 ASCRS CLINICAL SURVEY | 5 HIGHLIGHTS OF THE 2019 ASCRS CLINICAL SURVEY Ocular surface disease Ocular surface disease was also addressed in the survey, and respondents weighed in on their pref- erence of either DMEK or DSEK for a patient who needs a posterior cornea transplant. While 40.8% said they had "no opinion," 37.9% said they prefer DMEK, and 21.3% prefer DSEK. Respondents were also asked about what they employ for the treatment of meibomian gland dysfunction and what guidelines they follow when assessing the ocular surface. "I'm happy to see that the majority of respondents would recommend a DMEK. Although DSEK is an excellent technique and provides excellent vision and decreased risk, especially compared to a traditional PKP, I hope the trend continues and more would recommend DMEK moving forward. DSEK has its place, especially for my high risk, difficult, or complicated ocular conditions. DMEK has shown to provide reduced risk of rejection and overall more reliable and predictable postop refractive errors, which might be leading to improved vision. In my hands, DMEK, after a learning curve, is also a quicker procedure. "[For treatment of MGD], the slide shows some edu- cational gains, such as using hypochlorous acid and topical azithromycin but also mixed with traditional treatments, such as conventional warm compresses. There is a small but growing compendium of independent (i.e., not industry-sponsored) studies showing the benefit and superiority of commercially available agents for thermal pulsation therapy, including those that might be fully automated, partially automated, or manual, and intense pulsed light therapy. Probably the fact that these devices are not reimbursed by traditional insurance and there needs to be a discussion with patients that involves a fee-for-service procedure has made them less attractive to the majority of providers. Fur- thermore, there's typically a capital investment that again is for a fee-for-service procedure, which might seem risky to a practice not transitioned to this model. "I'm happy the newest algorithm, the ASCRS algorithm, is the second most commonly used guideline. The primary goal for the ASCRS Cornea Clinical Committee as we developed the algorithm was for members to have an easy, in-office algorithm that is a physician-extender driven, data-driven algorithm. Another goal was to highlight the critical importance of the ocular surface in outcomes surrounding any ocular surgery but especially anteri- or segment surgery." Francis Mah, MD ASCRS Cornea Clinical Committee FOR A PATIENT WHO NEEDS A POSTERIOR CORNEA TRANSPLANT, IS YOUR PREFERENCE TO PERFORM/RECOMMEND A DMEK OR DSEK PROCEDURE? FOR TREATMENT OF MEIBOMIAN GLAND DYSFUNCTION, WHICH OF THE FOLLOWING DO YOU EMPLOY? (Select all that apply.) DO YOU USE ANY OF THE FOLLOWING GUIDELINES WHEN YOU ARE ASSESSING AND TREATING THE OCULAR SURFACE? (Select all that apply.)

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