Eyeworld Daily News

ASCRS SYMPOSIA by Lauren Lipuma EyeWorld Contributing Writer The study found it is critical to review a patient's CD4 cell counts, viral loads, and whether they are on Highly Active Antiret- roviral Therapy (HAART), Dr. Justin said. Patients who have poor compliance with their HAART medications may have poor com- pliance with postop drops, he said. He recommends surgeons consid- er doing unilateral surgery in these patients because of the risk of infection. Editors' note: Drs. Fallah and Justin have no financial interests related to their comments. The new study analyzed refractive surgery frequency and outcomes in patients that were part of the Natural History Study, a cohort of HIV positive active duty service members and retirees from the Department of Defense started in the early 1980s. The study looked at patients from this cohort who had had LASIK, PRK, and other corneal refractive procedures after being diagnosed as HIV positive. The results showed that none of the patients who received LASIK had any complications, but several pa- tients who had received PRK and RK had complications involving corneal ulcers and keratitis. They hypothesized that Lipi- Flow treatment would decrease tear osmolarity and increase the lipid layer thickness and that these changes would correlate to im- provements in patients' symptoms as reported on the post-treatment questionnaire. The results, however, were surprising: The patients report- ed small improvements in their symptoms on the questionnaire, but the LipiFlow treatment had no significant effect on tear osmo- larity or lipid layer thickness. The results prompt further study into LipiFlow's efficacy as a treatment, Dr. Fallah said. Surgery in immunocompromised patients Grant Justin, MD, San Antonio, shared the results of a study on refractive surgery complications and risk factors for HIV posi- tive patients in the military. The objectives of the study were to assess the frequency of refractive surgery performed on HIV posi- tive active duty service members, retirees, and their dependents, and to analyze the incidence and risk factors for postoperative com- plications in these patients. The FDA recommends against refractive surgery in HIV positive patients or other individuals with immunodeficiencies, and the American Academy of Ophthalmology (AAO) says controlled autoim- mune diseases are a rela- tive contraindication for refractive surgery. How- ever, a web-based survey of 285 refractive surgeons found that about half of them consider HIV positive patients acceptable candidates for surgery, Dr. Justin said. M onday morning's military refractive surgery symposium gave attendees highlights from the Military Refractive Surgery Safety & Standards Symposium held in San Diego earlier this year. The session's presenters covered a wide range of topics, including cor- neal crosslinking, ocular surface disease, managing postoperative refractive errors, and address- ing astigmatism during cataract surgery. Evaluating dry eye treatments Shamis Fallah, DO, San Diego, shared the results of a recent study evaluating the effects of LipiFlow (Johnson & Johnson Vision) on treating dry eye symp- toms. Warm compresses and lid hygiene are the standard of care for dry eye disease due to meibo- mian gland dysfunction (MGD), but patient compliance is often an issue, Dr. Fallah said. LipiFlow is a promising alternative that removes the patience compliance issue, but few studies have evaluated its efficacy. The in-office treatment involves applying heat directly to the posterior eyelids to improve meibum secretion. Dr. Fallah described a recent prospective study of the efficacy of LipiFlow on MGD patients that she thinks is the largest study of LipiFlow outcomes to date. The researchers measured lipid layer thickness and tear osmolar- ity post-LipiFlow treatment and also evaluated study participants' responses to a post-treatment symptom questionnaire. Military refractive surgery updates MAY 7, 2019 | EYEWORLD DAILY NEWS | 43 Elizabeth Hofmeister, MD, moderates the Military Refractive Surgery Symposium.

• Cover