Older dry eye diagnoses are beneficial for evaluating refractive surgery



Source / Disclosures


Holland EJ. Assessment of the ocular surface for the refractive surgery patient. Presented at: American Society of Cataract and Refractive Surgery meeting; July 23-27, 2021; Las Vegas.

Disclosures: Holland states that he is a consultant for Abingworth, Aerie Pharmaceuticals, Akros Pharma, Alcon, Aldeyra Therapeutics, Allegro, Allergan, Azura Ophthalmics, BlephEx, Brim Biotech, Claris Bio, CorNeat, CorneaGen, Expert Opinion, Dompé, EyePoint, Glaukos, Hanall , Invirsa, Kala Pharmaceuticals, Mati Therapeutics, Merck, Novartis NIBR, Novartis Pharmaceuticals, Ocular Therapeutix, Ocuphire, Omeros, Oyster Point, Precise Bio, Prometic Biotherapeutics, ReGenTree, Retear, Senju, Shire, Sight Sciences, Slack Inc. Lab, Tarsus , Tear Research, Vomaris, WL Gore and Associates, and Zeiss; and is part of the speakers bureau for Alcon, Mati Therapeutics, Novartis Pharmaceuticals, Omeros, Senju and Shire.

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LAS VEGAS – When evaluating a patient for dry eye before refractive surgery, older techniques may be important tools as well as newer tests, according to a presentation at the American Society of Cataract meeting and Refractive Surgery.

Edward J. Holland, MD, said on Refractive Subspecialty Day that dry eye is one of the leading causes of patient dissatisfaction after having refractive surgery.

“This does not include the effect on visual acuity. It’s just the comfort of the patient and the feel of their eyes after the surgery, ”he said. “If we add the impact on visual acuity of dry eye, it becomes much higher.”

Edward J. Holland

Dry eye affects several preoperative measures, such as those used to determine candidacy for refractive surgery and for selection of IOLs.

While there are several new point-of-care tests used to assess dry eye, Holland said it’s important to remember some of the traditional diagnostic tests, especially the eyelid exam and the eye test. corneal sensation.

The ASCRS ocular surface disease preoperative algorithm has five steps: look, lift, pull, push, and color.

“We want to take a close look at the lids,” Holland said. “Is there exposure to keratitis? … Looking at the eyelashes, could there be Demodex? “

He also said it was important to lift the lid to feel a looseness and to press on the meibomian gland to check for expression.

“Finally, don’t forget about lissamine staining, as opposed to just fluorescein staining,” he said. “We miss all patients with mild to moderate dry eye who will only be detected with lissamine stain.”

Adding these traditional methods to more modern techniques can help assess patients before refractive or cataract surgery, Holland said.

“A careful preoperative examination, incorporating some of the old tests that we have forgotten and certainly the new technology, will make you a better clinician and give you better results,” he said.


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