Dry eye assessment and treatment before surgery - raising awareness

[littlemermaid]

http://eyeworld.org/supplements/oct-...ctober2013.pdf 'Can improved ocular surface care really impact cataract and refractive surgery outcomes?' ASCRS Eyeworld Supplement Oct 2013
'If the dry eye is not treated preoperatively, it can reduce the quality of preoperative data and can have a negative impact on surgical outcomes.'
'Although surgeons know the importance of identifying and treating dry eye preoperatively, they often don’t spend enough time assessing and optimizing the ocular surface, which can contribute to less-than-optimal results.'
'It can be difficult to stay current with recommendations in this evolving field, but it behooves us all as surgeons to ensure that we are adequately screening for and addressing ocular surface problems in our surgical patients'
'While it is more common in older patients, it’s not uncommon to see patients in their teens and 20s with dry eye.'

[hankm9]

Thanks for the link. Interesting

[littlemermaid]

We don't have the brand you are talking about - Restasis - in UK, but we do use various formulations of cyclosporine, made locally.

I expect my daughter will need cataract surgery at some point, and I am interested in learning how to manage the eye surface before and after - she has had chronic eye inflammation a long time already from immune causes. Her condition would lead to blindness from corneal melt if left untreated with steroids or immunomodulators. We've not used cyclosporine while paediatric.

Some people reading Dryeyetalk are having, or have had, essential surgery with chronic eye inflammation including cornea grafts. Obviously steroids and immunomodulators and different inhibitors are needed for control. Lasers are used for conditions including cataracts and debridement, not just refraction. It's important to consider and respect people's different conditions.

Hankm, if you've got any useful information to share about inflammation control before and after surgery on a difficult eye surface with not much tear film, I'd love to hear it. These days, I guess some of the professionals might too. I think kindness should be our first premise and we must remove the fear by gentle honesty, like the very best medical professionals do. Medics and their families are patients too.

I read the article as people talking more openly about essential improvement in pre-op and post-op management, and raising professional awareness, rather than an Allergan or lasik ad - CME means Continued Medical Education, as far as I know. The confliction is obvious though. 'Patient dissatisfaction' doesn't begin to cover it though sometimes, does it.

There is also treatment examining and restricting nerve and vein regrowth (anti-VEGF). Also pain relief, especially where it has become neuropathic http://ophthalmologytimes.modernmedi...ic-ocular-pain

[littlemermaid]

Video on managing eye surface and tear film before cataract surgery and IOL, Eyeworld Video Reporter ReACT 2014 http://ewreplay.org/node/333?v=3266467120001

[littlemermaid]

Eyeworld Daily News, Tue April 29 2014, p30 'Pay attention to the ocular surface, experts say' by Michelle Dalton on the Eyeworld CME event 'The Neglected Refractive Interface: Impact of the Tear Film on Refractive Cataract Surgery Outcomes', ASCRS-ASOA meeting, Boston 2014 http://daily.eyeworld.org/i/303672 'But if you don't treat the surface you'll turn a marginally compensated eye to an overtly dry eye', Eric Donnenfeld, MD.

[DocwithDryEye]

Thanks for posting LM

This is an important issue that, as you noted, is often not addressed.

I know there are quite a few people on this forum who had LASIK performed, who probably should have had a through dry eye eval before.

I've been offered LASIK at no charge from an MD that I work with, but with dry eye, I wouldn't dream of doing it. Even if they paid me

DWDE