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SUPPLEMENT TO EYEWORLD OCTOBER 2020 ASCRS Incorporating the ASCRS Preoperative OSD Algorithm into practice Platinum sponsors: Allergan, Kala Pharmaceuticals, Novartis, and Sight Sciences Bronze sponsors: Eyevance and Johnson & Johnson Vision Introduction to the ASCRS Preoperative OSD Algorithm continued on page 4 Christopher Starr, MD, is an Associate Professor of Ophthalmology, Director of the Refractive Surgery Service, and Director of Ophthalmic Education at Weill Cornell Medical College in New York, New York. He has financial interests with Alcon, Allergan, BlephEx, Bruder, Dompe, Essiri Labs, Eyevance, Johnson & Johnson Vision, Kala Pharmaceuticals, Novartis, Quidel, Sun Pharmaceutical, TearLab, and Verily. Kenneth Beckman, MD, is the Director of Corneal Surgery at Comprehensive Eyecare of Central Ohio and Clinical Assistant Professor of Ophthalmology at The Ohio State University in Columbus, Ohio. He has no relevant financial interests. Terry Kim, MD, is a Professor of Ophthalmology, Chief of the Cornea and External Disease Service, and Director of the Refractive Surgery Service at Duke University School of Medicine in Durham, North Carolina. He has financial interests with Aerie Pharmaceuticals, Alcon, Allergan, Avedro, Avellino Labs, Azura Ophthalmics, Bausch + Lomb, Carl Zeiss Meditec, CorneaGen, Dompe, Eyenovia, Johnson & Johnson Vision, Kala Pharmaceuticals, Novartis, Ocular Therapeutix, Oculis, Omeros, Presbyopia Therapies, Sight Sciences, Simple Contacts, and Surface. Francis Mah, MD, is the Director of Corneal and External Disease and Co-Director of Refractive Surgery at the Scripps Clinic in La Jolla, California. He has financial interests with Allergan, Novartis, Bausch + Lomb, Kala Pharmaceuticals, TearLab, and Sight Sciences. Marjan Farid, MD, is a Clinical Professor of Ophthalmology and Director of Cornea, Cataract, and Refractive Surgery and the Ocular Surface Disease Program at the University of California, Irvine School of Medicine in Irvine, California. She has financial interests with Allergan, Bio-Tissue, CorneaGen, Dompe, Eyepoint, Eyevance, Johnson & Johnson Vision, Kala Pharmaceuticals, and Novartis. Preeya Gupta, MD, is an Associate Professor of Ophthalmology at Duke University School of Medicine in Durham, North Carolina. She has no relevant financial interests. T he last 15 years has been a new era for ocu- lar surface disease, but advances in diagnostics and treatment options have, according to recent ASCRS Clinical Surveys, left many ophthalmologists confused and overwhelmed, said Christopher Starr, MD. "The ASCRS Cornea Clin- ical Committee … decided to take this on as a very import- ant educational initiative, but first, why does ASCRS care so much about OSD?" Dr. Starr asked. There are several reasons: • Ocular surface disease (OSD) is present in the ma- jority of cataract patients, many of whom are asymp- tomatic. • OSD reduces the accuracy of preop and postop refractive measurements. • OSD reduces visual quality, quantity, and performance. • Anterior blepharitis may increase the risk of endoph- thalmitis. • Any eye surgery will worsen dry eye disease (DED)/OSD symptoms. In 2017, the ASCRS Clinical Survey found that 73% of respondents thought a practical, efficient preop diagnostic algorithm would be helpful. So that's what the Cornea Clinical Committee set out to create and provide to members. The goals were for the algorithm to be con- sensus- and evidence-based, integrated into the preop- erative surgery visit, reliant on techniques and objective testing to reduce chair time, and able to identify all visually significant subtypes of OSD, Dr. Starr said. The important steps of the algorithm created by the committee are as follows: Step 1. Noninvasive refractive preop measurements (ker- atometry, topography, optical biometry, aberrometry, etc.) Step 2. OSD screening battery (assessing for signs with tests—osmolarity and inflam- matory marker testing—and symptoms with the ASCRS SPEED II Preop Question- naire). If there is a positive screen, further OSD testing can be used if you've got it, Dr. Starr said. Step 3. Directed, quick exam to assess for visually signif- icant OSD (look, lift, push, pull, then stain) Step 4. OSD ruled in or out (if ruled in, determine visual significance) This supplement about the ASCRS Cornea Clinical Committee's algorithm for the preoperative diagnosis and treatment of ocular surface disorders is based off of discussion from a corporate-sponsored roundtable that took place at the 2019 ASCRS Annual Meeting. The supplement takes the discussion a step further with co-moderators of the roundtable, Christopher Starr, MD, and Francis Mah, MD, and the faculty, Kenneth Beckman, MD, Marjan Farid, MD, Terry Kim, MD, and Preeya Gupta, MD, giving new insights and practical applications for today's dry eye practice. Platinum sponsors: Allergan, Kala Pharmaceuticals, Novartis, and Sight Sciences | Bronze sponsors: Eyevance and Johnson & Johnson Vision Co-moderators Faculty tearcare.com

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