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OCULAR SURFACE DISEASE IN MY SURGICAL PRACTICE: BEST MANAGEMENT SOLUTIONS the Journal of Cataract & Refractive Surgery in 2019, and the modern update is being prepared. Dr. Starr walked through the steps of the algorithm. The preop surgical visit is the last opportunity to detect OSD that could impact surgical outcomes. The first step is to acquire the non-invasive refractive and biometric measurements, with the caveat that these tests might need to be repeated at a subsequent visit if VS-OSD is detected. For cataract surgery, these may include optical biometry, keratometry, to- mography/topography, etc., and for laser vision correction, aberrometry, tomography, etc. The second step of the algorithm is the OSD screening battery. We're trying to identify all subtypes of OSD, he add- ed, not just dry eye disease. "We decided we would come up with a new term—VS-OSD," he said. VS-OSD is any OSD that can lead to IOL errors or refractive surprises, decreasing patient satisfaction and reducing visual quantity, quality, and performance postoperatively; it can lead to a post-surgical infection like endophthalmitis and/or non-visually signif- icant OSD that may worsen after surgery and become visual- ly significant. In any DED/OSD assessment you must inquire about symptoms, Dr. Starr said, but we all agree that signs are more important than symptoms in this particular population A n EyeWorld Corporate Education event during the 2024 AAO Annual Meeting focused on ocular surface disease. Kicking off the session, mod- erator Marjan Farid, MD, introduced speakers Christopher Starr, MD, Brandon Ayres, MD, and Francis Mah, MD, noting that they were all involved in the development of the ASCRS Preoperative OSD Algorithm to help physicians determine a course of action for these cases. The program was sponsored by AbbVie, Bausch + Lomb, Dompé, Johnson & Johnson Vision, Théa, and Tarsus. ASCRS Preoperative OSD Algorithm Dr. Starr gave an overview of the ASCRS Preoperative OSD Algorithm, which was created by the ASCRS Cornea Clinical Committee. "In the last 15 to 20 years, there's been a tremendous explosion of new knowledge when it comes to ocular sur- face and dry eye diseases. It's exciting for all of us who love the ocular surface; this is a great time to be involved in this area, but it can be overwhelming for some," he said, adding that many people aren't aware of the current guidelines and consensus recommendations. "In 2019, the ASCRS Cornea Clinical Committee decided to take this on as a primary educational initiative." There is a lot of data showing that OSD is present in most cataract patients, but many patients are asymptomatic. Visually significant OSD (VS-OSD) can reduce the accuracy of preoperative refractive measurements and may reduce visual quality, quantity, and performance postoperatively. Anterior blepharitis and bacterial biofilms increase the risk of endophthalmitis, and we know that most ocular surgeries will worsen OSD, he added. Dr. Starr said that 83% of respondents to an ASCRS Clinical Survey asked for a practical, efficient preop diag- nostic and treatment algorithm for addressing OSD. The ASCRS Cornea Clinical Committee set a goal of creating an algorithm that was consensus- and evidence-based, that could be integrated into the preoperative surgery visit, that had reliance on technicians and objective testing to reduce surgeon chair time, and that would identify all visually sig- nificant subtypes of OSD, not just DED, prior to surgery. Dr. Starr was tasked with leading this project, and he said the evolution of the algorithm took multiple iterations and a few years to get it right. It was originally published in During the LLPP (look, lift, pull, push) exam, the patient looked down, and visually significant collarettes and Demodex blepharitis were diagnosed. Source: Christopher Starr, MD

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