Eyeworld Daily News

EW SHOW DAILY 46 Sunday, May 8, 2016 A significant discovery in the pathology of DED is the contribu- tion of intracellular adhesion mole- cule-1 (ICAM-1) to inflammation in DED. ICAM-1 is a protein found on the epithelial and endothelial cells of ocular tissues. It contributes to the inflammatory response by bind- ing with a receptor called lympho- cyte functional associated antigen-1 (LFA-1), located on the surface of T-cells. Dr. Donnenfeld said that in DED patients, stress to the ocular surface leads to over expression of ICAM-1, and the binding of ICAM- 1 to LFA-1 on T-cells contributes to a self-perpetuating inflammatory cycle. Following Dr. Donnenfeld's talk, symposium faculty members Elizabeth Yeu, MD, Norfolk, Vir- ginia, and Terry Kim, MD, Durham, North Carolina, presented hypo- thetical refractive and cataract cases, respectively, that emphasized the impact of DED. In Dr. Yeu's hypothetical case, a 21-year-old patient with contact lens discomfort undergoes un- eventful, initially successful LASIK surgery; however, the patient begins to experience blurriness and fluc- tuating vision. This patient's risk for DED—mainly, her contact lens intolerance—was not identified prior to surgery. In Dr. Kim's hypothetical case, a 70-year-old patient is referred for evaluation for a toric lens implant who presented with cataract in the left eye. DED was identified in the patient prior to surgery, and an aspheric monofocal was implanted instead of the toric. The key pearls of surgical planning in this case, according to Dr. Kim, were: do not rush into surgery; it may take multiple visits; use caution with premium IOLs; and patient education is critical. The key takeaway? Evaluate the ocular surface before surgery. Ultimately, surgeons must think about DED in the evaluation of ev- ery patient, Dr. Donnenfeld said. EW Editors' note: This EyeWorld Corporate Education symposium was sponsored by Shire Pharmaceuticals (Lexington, Massachusetts). by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer surgical damage, inflammation, goblet cell loss, tear film distribu- tion, eye drops, and limbal relaxing incisions. DED symptoms, Dr. Donnenfeld said, can be disruptive and variable. Among them, Dr. Donnenfeld said his favorite is fluctuating vision. The only other patients who have this symptom in his experience are those who have had past radial keratotomy. A patient who has good vision in the morning, getting worse toward the end of the day, or blur- ring as a patient reads, watches TV or drives is suffering from DED until proven otherwise. Thus, he said, DED deserves increased attention. DED symp- toms are among the most common complaints of patients, may impair patients' abilities to perform daily activities, and are often chronic and may be progressive. Dr. Donnenfeld highlighted DED's impact on quality of life in particular, saying he thinks that DED is as significant a risk for, say, car accidents as loss of contrast sen- sitivity has been shown to be. Foremost among these trends is how "the face of dry eye disease (DED)" is changing—formerly a condition associated with aging, DED symptoms are now increasingly being seen in younger patients. The risk, he said, has always been multifactorial—age certain- ly remains 1 of the factors, along with female gender, environment, occupational factors, medication, autoimmune diseases, diabetes, and diet. Dr. Donnenfeld singled out diet in particular as a significant recent addition, as more and more pro- cessed foods are consumed by the average person. Modern risk factors, he added, make it likely that the DED popu- lation will continue to grow. These factors include contact lens use, the proliferation of digital devices, and ocular surgery. Notice how these "modern" fac- tors lean toward the involvement of younger individuals, at least partly rationalizing the demographic shift altering the face of dry eye. After surgery, multiple mecha- nisms may contribute to DED— A n EyeWorld Corporate Education event had ASCRS attendees staying in late on a Friday night in New Orleans—for a good reason. "We hope to make this 1 of the most valuable hours that you spend here at ASCRS," Eric Donnenfeld, MD, Rockville Centre, New York, said at the be- ginning of the session. "ASCRS, as you well know, is an extraordinarily well-rounded educational opportu- nity, but diagnosing and evaluating dry eye is among the most import- ant things we do." He led a faculty that aimed "to augment [attendees'] knowledge on diagnosing dry eye. "If you do a better job of diag- nosing dry eye, it's going to make you all better clinicians, better oph- thalmologists, and better surgeons," Dr. Donnenfeld said. "The key to success in our practice is managing the common things, and this is 1 of the most common reasons why patients walk into our office." Dr. Donnenfeld kicked off by discussing "Key Trends and Risk Factors." Meeting Reporter The changing face of dry eye Dr. Kim presents a hypothetical case illustrating how the successful management of dry eye disease prior to cataract surgery impacts the outcome of the procedure.

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