Eyeworld Supplements

OCTOBER 2020 | SUPPLEMENT TO EYEWORLD | 7 Platinum sponsors: Allergan, Kala Pharmaceuticals, Novartis, and Sight Sciences Bronze sponsors: Eyevance and Johnson & Johnson Vision level vision quality when we're talking about our refractive and cataract patients," Dr. Gupta said. If a practice were to consider integrating MMP- 9 or osmolarity testing as a new feature, Dr. Gupta said to get staff and administrators involved to streamline how it fits into your specific practice. She said it's certainly feasible to integrate one of these at a time into a practice in a finan- cially stable way. "From a clinician stand- point, it's not taking more time for me to assess for OSD. My staff is gathering the data and I'm doing the data anal- ysis," Dr. Gupta said. "I think this is a small change that makes a big impact." Terry Kim, MD, noted peer-reviewed studies that have identified a significant number of patients with OSD in the preoperative popu- lation, many of whom are asymptomatic. 1,2 "I think it's that asymp- tomatic population that's surprising and strengthens the reasons to look at and use the algorithm," Dr. Mah said. "Along with the literature on the asymptomatic patients, it's also the peer-reviewed literature that has grown in terms of the instruments that we now have available." If a practice already has its own dry eye questionnaire, should they switch to the ASCRS SPEED II Preop Ques- tionnaire? "I think there are many excellent questionnaires out there," Dr. Gupta said, adding later that she doesn't think any questionnaire is wrong. It's a mistake, however, to not use a questionnaire. The ASCRS SPEED II boils two questionnaires into one— the validated, easy-to-use SPEED questionnaire, along with questions important to understand a cataract and re- fractive patient's expectations and goals, Dr. Gupta said. "I would recommend physicians look at the ques- tionnaires available, see which ones resonate with you. You can participate with the algorithm using a different questionnaire," she said. For the direct slit lamp exam, the ASCRS Cornea Clin- ical Committee developed the LLPP mnemonic for look, lift, pull, push. Christopher Starr, MD, said the steps of the LLPP exam are nothing new, but he hopes giving it a catchy name reminds physicians to do it on every preoperative patient. Lifting the upper lid to exam- ine the superior cornea and conjunctiva, pulling to assess lid laxity and floppiness, and pushing to assess meibum quality are all valuable but sometimes overlooked, Dr. Starr said. In fact, Dr. Mah pointed out that 20% of re- spondents to the 2018 ASCRS Clinical Survey said they were not doing this diagnostic expression at the initial point of care. Not assessing for MGD is one of the main reasons dry eye patients might not be successfully managed, Dr. Starr said. The final step of the diag- nostic portion of the algorithm is for the surgeon to use the basket of data and the exam to make a judgment on visual significance and any potential adverse impact on the upcom- ing surgery, Dr. Starr said. Marjan Farid, MD, said in the preoperative setting that signs outweigh symptoms. Most patients who come in for cataract surgery are not com- plaining about dry eyes, and you won't identify it unless you look for it in their exam and diagnostic testing. "Relying on symptoms is not enough. We need to look at these signs in detail to be able to identify these pa- tients," she said. References 1. Trattler W, et al. The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017;11:1423–1430. 2. Gupta PK, et al. Prevalence of ocular surface dysfunction in patients present- ing for cataract surgery evaluation. J Cataract Refract Surg. 2018;44:1090–1096. OSD treatment tools FDA-approved medications • Cequa (cyclosporine ophthalmic solution, Sun Pharma) • Restasis (cyclosporine ophthalmic emulsion, Allergan) • Xiidra (lifitegrast ophthalmic solution, Novartis) OTC topical lubricants • Artificial tears • Gels • Ointments Devices • BlephEx (RySurg) • iLux (Alcon) • Intense pulsed light therapy • eyeXpress (Holbar Medical Products) • LipiFlow (Johnson & Johnson Vision) • NuLids (NuSight Medical) • Thermaflo (MiBo Medical) • TearCare (Sight Sciences) Other tools • Anti-inflammatories, such as Flarex (fluorometholone acetate ophthalmic suspension, Eyevance) • Bruder masks • Omega-3s • Punctal plugs • Scrubs and cleaners • Warm compresses *This list may not include all OSD treatment tools.

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