Eyeworld Supplements

8 F or optimal visual results, all surgical patients should receive a thorough pre- surgical evaluation to identify or prevent dry eye. It is imperative to identify and prevent dry eye and blepharitis pre-surgery because these conditions can impact IOL calculations; limbal relaxing incisions or toric IOL axis and magnitude; and topography, which can affect visual results and surgical outcomes. Proper and thorough pre-op evaluation for dry eye/blepharitis can help ensure clini- cians detect dry eye cases and can lead to refractive success. A recent study of 200 eyes of 100 patients scheduled for cataract surgery at two centers found that 59% of patients were diagnosed with blepharitis. 1 Another nine-site, prospective, mul- ticenter study 2 that included 272 eyes of 136 scheduled cataract sur- gery patients demonstrated that most dry eye patients (87%) were asymptomatic and that dry eye signs were very common in patients (60%) scheduled for cataract surgery. Dry eye syndrome Dry eye syndrome (DES) is defined as a multifactorial disease of the tears and ocular surface, which results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface, according to the DEWS (Dry Eye Workshop) updated definition of dry eye. 3 Increased osmolarity of the tear film and inflammation of the ocular surface accompany DES. On a relative scale, normal value is <290 and abnormal is >300. Consider all the DES risk factors, including older age, female gender, post-menopausal estrogen HRT ther- apy, American "fast food" diet (low in omega-3 fatty acids and high in bad omega-6 fatty acids), LASIK/ other corneal refractive surgery, radiation therapy, hematopoietic stem cell transplantation, vitamin A deficiency, hepatitis C infection, androgen deficiency, low blink rate (Parkinson's disease), computers, cosmetic facial surgery (blepharo- plasty, facelifts), and contact lens wear. The effect of medications and systemic diseases (such as diabetes and autoimmune diseases such as lupus, thyroid, and rheumatoid arthritis) also should be reviewed. EW Chicago 2012 8 Ocular surface management by Mitchell A. Jackson, M.D. Evaluating surgical patients for dry eye Mitchell A. Jackson, M.D. " It is imperative to identify and prevent dry eye and blepharitis pre-surgery because these conditions can impact IOL calculations; limbal relaxing incisions or toric IOL axis and magnitude; and topography, which can affect visual results and surgical outcomes " While many patients are asymptomatic of dry eye, the condition can impact visual results and surgical outcomes Evaluation of the lipid layer includes a check for meibomian gland disease/posterior blepharitis. About half of the patients have MGD, and patients also usually have inflammation at the sebaceous meibomian gland level AMO Saturday supplement_Chicago 2012-USE THIS ONE_Layout 1 4/20/12 4:25 PM Page 8

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