Eyeworld Daily News

12 | EYEWORLD DAILY NEWS | APRIL 6, 2024 ASCRS ANNUAL MEETING DAILY NEWS T his year's ASCRS Refractive Day likened a patient's refrac- tive journey to a triathlon. The first session covered the swimming portion of the triathlon, or "swimming the waves of corneal refractive and phakic IOL surgery." The lifelong refractive journey Eric Donnenfeld, MD, spoke about the refractive surgery triathlon and preoperative considerations with the end in mind. The refractive surgery preoper- ative evaluation is extraordinarily important, he said. If you make a diagnosis of an issue prior to surgery, the patient will be expecting this, but if you make a diagnosis after surgery, it will be your complication. Dr. Donnenfeld also discussed how the ocular surface can affect IOL calculations, topographic and wavefront ablations, postoperative healing, and quality of vision and patient satisfaction. Current treatments to improve the ocular surface, aqueous deficien- cy include: • Artificial tears (preserved/non-pre- served) • Nutritional supplements • Topical immunomodulators (cyclo- sporine/lifitegrast) • Topical steroids • Topical perfluorohexyloctane • Punctal occlusion • Nasal secretagogues • Serum tears What is the best treatment for dry eye? Dr. Donnenfeld said to stop glaucoma drops. There are new glaucoma therapies available, like Durysta (bimatoprost intracameral implant, AbbVie) or lasers. He also highlighted consider- ations for cataract surgery after laser vision correction. There are two significant concerns in a patient un- dergoing cataract surgery following previous refractive corneal surgery— one is choosing the correct power IOL, and the other is choosing the correct type of IOL. Dr. Donnenfeld said it's import- ant to be able to accurately measure the anterior and posterior corneal refractive power and effective lens position. In the meantime, surgeons can intraoperatively confirm the cor- rect IOL power, adjust the IOL power postoperatively, or do post-cataract surgery PRK if necessary. In terms of IOL selection after LASIK, he said that some of the most important things to consider are IOL calculations, the ablation, and patient expectations. Patients must be made aware of the increased need for refractive enhancement and pos- sible IOL exchanges. "With preoperative patient selection and optimization, a lifetime of refractive freedom is certainly possible," Dr. Donnenfeld said. Editors' note: Dr. Donnenfeld has financial interests with a variety of ophthalmic companies. The tear film Preeya Gupta, MD, presented "A Powerful Key to Succeeding in the Refractive Surgery Triathlon: The Tear Film." She discussed the modern-day prevalence of OSD in cataract pa- tients, noting a paper she contributed to in 2018 in the Journal of Cataract and Refractive Surgery with 120 pa- tients presenting for cataract surgery evaluation. Abnormal osmolarity was found in 56.7% and abnormal MMP- 9 in 63.3%. Additionally, 39.2% of patients had corneal stain on presen- tation. Questionnaire data showed 54 of 100 patients reported symp- toms suggestive of ocular surface dysfunction. In the asymptomatic group (46 patients), 85% had at least one abnormal tear test (osmolarity or MMP-9), and 48% had both tests abnormal. Overall, she said that 80% of the 120 patients had at least one abnormal test result suggestive of ocular surface dysfunction, and 40% had two abnormal results. In terms of the impact of dry eye on cataract and refractive patients, Dr. Gupta said that poor visual quality is the number one reason to treat dry eye. It can also result in refractive surprise and discomfort postoperatively. Dr. Gupta discussed how dry eye can cause higher order aberrations. While higher order aberrations don't necessarily cause vision loss, they cause image defocus and distortion that are hard to fix with glasses and contact lenses. As surgeons, we are creating dry eye often by doing surgery, Dr. Gupta said, so it's imperative to treat any mild underlying OSD prior to embarking on surgery. Dr. Gupta also shared risk factors for dry eye disease: • Female sex • Older age • MGD • Iatrogenic • Computer use • Asian race • Androgen deficiency • Hormone replacement therapy • Contact lens wear • Sjogren's syndrome and other auto- immune diseases • Environmental conditions • Systemic medications Editors' note: Dr. Gupta has financial interests with a variety of ophthalmic companies. Mastering all stages of the refractive journey

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