atsHels} Pes By ry @ event.on24.com © * Poor visual quality — PROOF Study: despite 20/20 vision, 56% of DED arm complained of moderate or worse blurry vision compared to only 14% of controls (p<.001) ¢ Refractive surprise — Hyperosmolarity can lead to variability in keratometry and IOL errors * Discomfort post-op@ event.on24.com Dry eye is one of the most common ¢ 28% of dissatisfied LASIK patients causes of © 15% of dissatisfied MF IOL dissatisfaction in patients surgical patients Patients blame —* Discomfort OSD symptoms on ¢ Visual fluctuations the surgery ¢ Poor vision quality18.08 Pei By @ event.on24.com ¢ Visual disturbance is a common DED symptom — patients do not know how to describe it nor do they know it is associated with DED ¢ A degraded tear film causes continual fluctuations in images and can account for more than 1-2 lines of eee AM Melle)18.10 es By VN WEN -laleto az Mexol ia) G * Prospective multicenter study (n = 136)* Tear break-up time (TBUT) < 5 seconds: 62.9% ett amore dase eae) Schirmer score with anesthesia s 5 mm: 18% ORT M me UML hatte el Hele kL) * Prospective case series (n = 180)? Asymptomatic patients with MGD: 50%18.10 es By ry @ event.on24.com © Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation * 120 patients presenting for cataract surgery evaluation — 69% women and mean age 69.5 years + 8.4 (SD) * Overall, 80% osmolarity, or cornea esis ste) had at least 1 abnormal test result (MMP9, aining) suggestive of ocular surface + 39.2% had corneal staining on presentationats Pasa ry @ event.on24.com © * Select wrong IOL power ¢ Inaccurate astigmatism measurement — incorrect plan for toric IOL or limbal relaxing incisions when not needed (or vice versa) Oelicleatiecien Cirle at saa@ event.on24.com An algorithm for the preoperative diagnosis and treatment of ocular surface disorders ea EN Penk:aromas] Pai ry @ event.on24.com © SCRS PREOPERATIVE OSD ALGORITHM CUR Dea aag aul >2week CL holiday / no drops Pole ual within 2 hours prior Coa eee coer Me UU Ue ce) fe jometry, keratometry, tomography/topography etc. Peart atelectasis + Possibility that these tests will need to be repeated if VS-OSD detectedaromas] Pai rv @ event.on24.com © CRS PREOPERATIVE OSD ALGO Cea Eeoaoneid oo ee es bers ba an ¥ Y Pre) Cac eet etc fel aL ae OSD LIKELY - any subtype of OSD can potentially be visually eae - Symptoms (novel questionnaire) + Signs (osmolarity & MMP-9)18.15 D ry @ event.on24.com © SCRS PREOPERATIVE OSD ALGORITHM + SPEED portion validated for DED (J&J) Been en en Tat em ae sa fea ance ri Mle Recut satis l) (ected nears 1c] Peete cet Etat sy aoa) elec) prereset retire caters Texel NAS] tae ol eee etac ris) ME Sam eels tora Caso cks POT Rae eo Ce) + Scored by tech: _/28 (SPEED) _/1818.16 Pas rv @ event.on24.com © SCRS PREOPERATIVE OSD ALGORITHM accel 0 rosa laacag SS DIS ert) POSITIVE SCREEN CU) (Any abnormality) OSD UNLIKELY ropa ng ede Tat ayaa AVI rimarily an assessment for DED Wh non-specific inflammatory marker * MMP-9 can be elevated in DED, but also in other subtypes of OSD18.16 es BD ry @ event.on24.com © Prospective study of 50 consecutive patients with py a PE eset loli weleelia oun emesis * Dryness, grittiness, redness, itching, FBS, etc. >. + Alternate diagnoses made on exam to explain symptoms>eeFni) ats Es} Pes WD ry @ event.on24.com © Pterygium MGD IN eraesay taste 13-1) Ptr eee ee UC elt PoPaN Lal cols [a 1) Pita se eis) Tete Ue i eh el) Pircete) Cees rus +MMP-9 associated with epithelial cell damage18.18 wil LTE @) rv @ event.on24.com © CRS PREOPERATIVE OSD ALGORITHM POSITIVE SCREEN (Any abnormality) OSD LIKELY BCoMaCl oR je-1ol leh) Pillage elle m Ale te Lali laloc} OPTIONAL NONINVASIVE OSD TESTS (e.g. meibography, topography, NI-TBUT, OCT TMH, OSI, aberrometry, LLT) Te Nae Ah { \ + NI-TMH (OCT, keratograph), lactoferrin Taare tea eels a Aye18.19 wil LTE @) ry @ event.on24.com © ASCRS PREOPERATIVE OSD ALGORITHM ¥ ¥ Cee Ret) ro fos Cate Sa nen nan! renee el nce esa neces cated18.20 wil LTE @) ry @ event.on24.com © CRS PREOPERATIVE OSD ALGORITHM i Coy Saakeote i Ta asuohaeuaauie te ae orioakainad Proeeseiece | Rabies onium a Re emma Sree itt.) Ce a Sions +s yy RS ee) Chae mamta’ pi eiiecipeeeneasatee mae abord CO Rano) ett tated beter name recntitd Step 4: OSD ruled in or out, if ruled in ... determine visual significance Sareea rice nur ee swar is Reine turd18.22 Pease iB ry @ event.on24.com © ASCRS PREOPERATIVE OSD ALGORITHM porouhcreransr era Eocene recs) Diem lg LEY Rela en d e therapy than routine OSD Beas se) Nie alae) A Cad .g. steroids, immunomodulators, antibiotics) amare idea)ats Wy2-5 Pe We ry @ event.on24.com © + Key principle: must relieve chronic obstruction and stasis in treating MGD * Lipiflow Thermal pulsation: Semel ems ean enl-a leer iete-} ele — Increases TBUT, reduces symptoms of MGD. * Intense pulsed light therapy — Application of broad-spectrum light to treat L: telangectasias to reduce inflammatory load to lid Ch ry Semmes lei-le MWA RUC] cele (218) gs18.28 Pe We ry @ event.on24.com © * In one study (Matossian et al ASCRS), pretreatment of MGD with LipiFlow prior to keratometry & topography measurements for cataract surgery correlated with 40% change in original surgical plan — Surgical plan changed from LRI or Toric to no intervention in 8% of cases — Surgical plan changed from a toric to an LRI in 4% of cases18.34 Pe WD ry @ event.on24.com © Preop Cataract Eval denies - crazti Clinical exam — 2+MGD pe LeN Ris — 1+ PEE — MMP-9 weakly positive OU — Osmolarity 328, 310 AST [Oi*] 1.57 @ 150 WTW [mm] 127018.35 Pe WD ry @ event.on24.com © * Dry Eye/MGD is causing abnormal topopgraphy r4 | * What would you do next? — Must optimize the ocular surface and repeat topography ay . and biometry prior to surgical planning * What do you tell the patient? — Must set realistic expectations > patient may not realize they have 2 diseases (cataract and MGD/Dry eye) S ; Tia : a 4 aa 018.36 «) LTE@) ry @ event.on24.com © * Clinical exam after treatment: ne on it Raney Cees ‘AD [rm] 2.60 A — TBUT 9 seconds OU noted 300 Bem eae Mt =<-1 5) 9 ST Geen 8ae ‘ inal a SMa eeu SEA) emi (1.57 -> 1.14D; axis change 150 > 9 degrees) | # * Normalization of topography Toric |OL power changed to T3 from TS KS 3 \ : 4 4 oO 0