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28 EW SHOW DAILY Tuesday, April 23, 2013 Meeting Reporter Dry eye and surgery outcomes by Chiles Aedam R. Samaniego EyeWorld AP Senior Staff Writer D ry eye has a significant impact on cataract and refractive surgery outcomes, according to experts at an EyeWorld CME Education event, "Can Improved Ocular Surface Care Really Impact Cataract and Refractive Surgery Outcomes? Case Study Reviews." The condition itself is very common, with 14 to 33% of the general population affected, said William B. Trattler, MD, Miami. With 5 million Americans over 50 having dry eye, it isn't surprising to find that the condition is prevalent in cataract surgery patients. Dr. Trattler and his colleagues conducted the Prospective Health Assessment of Cataract patients' Ocular surface (PHACO) Study to determine the condition's prevalence in this population. They found that out of 272 eyes (136 patients), 47% had abnormal Schirmer's tests of ≤10 mm, 63% had tear breakup times (TBUT) ≤5 seconds, and 77% were positive for corneal staining, with 50% of those cases having central corneal staining. It is worth noting that the cataract patients with dry eye were often asymptomatic, with visual complaints more likely than discomfort or foreign body sensation. The corneal staining is particularly significant in that it distinguishes level 2 from level 1 disease; therapy, said Dr. Trattler, should be initiated at level 2. As a surgical consideration, he added that both a rapid TBUT and corneal staining have a significant impact on keratometry and topography. Dry eye has a more direct relationship with LASIK patients; although LASIK doesn't cause dry eye, said Dr. Trattler, dry eye often motivates people to seek LASIK. Many patients present for LASIK because they become contact lens intolerant. Since dry eye can lead to inaccurate preoperative wavefront and topography and can cause blurring or fluctuation of vision with a significant amount of discomfort, Dr. Trattler said, "Dry eye has real consequences for candidacy, visual outcomes, and patient satisfaction." Craig F. McCabe, MD, Murfreesboro, Tenn., agreed, saying that it should be diagnosed and managed both before and after surgery. "Both preoperative and postoperative treatment of dry eye can mean the difference between needing to perform an enhancement procedure on an unsatisfied patient and having a very satisfied premium lens patient," he said. "By correcting ocular surface disease through dry eye treatments ... the two most common causes of patient dissatisfaction, namely ametropia and dry eye, can be significantly reduced." This certainly represents more work for the surgeon. Francis S. Mah, MD, La Jolla, Calif., described three models for incorporating dry eye management into the surgical setting: the integrated model, in which dry eye management is performed during the preop exam using a streamlined method of diagnosis; the delegated model, in which dry eye management is passed on to a referring ophthalmologist, colleague, or junior associate; and the clinic/comprehensive model, in which the patient undergoes a full battery of tests prior to surgical planning. EW Editors' note: This event was supported by an unrestricted educational grant from Allergan (Irvine, Calif.). William B. Trattler, MD, Craig F. McCabe, MD, and George O. Waring IV, MD, speak at the EyeWorld CME Education event, "Can Improved Ocular Surface Care Really Impact Cataract and Refractive Surgery Outcomes? Case Study Reviews."