Effective Diagnosis and Treatment of Ocular Surface Disease in Cataract and Refractive Surgery Patients
Duke Cornea Specialists Contribute to new ASCRS OSD Algorithm
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ailure to treat ocular surface dysfunction (OSD) prior to cataract surgery can have a significant adverse effect on surgical planning and outcomes. However, despite the poor correlation between the symptoms of OSD and objective measures of the condition, presurgical testing is not typically performed in the absence of patient-reported symptoms.
Recent findings suggest that more patients should be screened. In a 2018 study published in the Journal of Cataract & Refractive Surgery1, found that as many as 80 percent of patients who present for cataract surgery evaluation have ocular surface dysfunction. “There are a number of studies showing that ocular surface dysfunction can negatively affect outcomes at the time of cataract surgery,” explains the study’s first author, Preeya K. Gupta, MD, associate professor of ophthalmology and corneal specialist at Duke Eye Center. “We’re trying to identify who’s more likely to have this problem, and, if someone is susceptible, treat them beforehand by doing a Preeya K. Gupta, MD better job of diagnosing.” Associate Professor of The study included 120 patients from two physicians’ practices at Duke and Weill Cornell Medicine. Researchers examined several measures of OSD: slitlamp evaluation findings of the corneal surface, OSDI or SANDE questionnaire score, tear osmolarity, and tear matrix metalloprotease-9 (MMP-9) test results.
Ophthalmology
Of the 56.7 percent of patients who had no preexisting diagnosis of the condition, 81 percent had at least one abnormal tear film test.
Terry Kim, MD Professor of Ophthalmology
Interestingly, traditional methods of screening, such as looking for corneal staining or using questionnaires, failed to identify many cases of the condition. By contrast, 83 percent of patients who scored “normal” on their questionnaire had either an abnormal osmolarity or abnormal MMP-9 test (or both). These results confirm that newer point-of-care tests such as tear osmolarity and MMP-9 allow for rapid and objective assessment of the ocular surface. Based on this study and other previously published data, a new consensus-based practical diagnostic OSD algorithm has been developed to specifically address this population, aiding surgeons in diagnosing and treating visually significant OSD before any form of refractive surgery is performed. The algorithm, presented by the American Society of Cataract and Refractive Surgery (ASCRS) Cornea Clinical Committee at the 2019 ASCRS Annual Meeting2, emphasizes the use of efficient point-of-care testing for assessing OSD preoperatively. While a number of tests are available, it may not always be clear how clinicians should incorporate these tests into practice.
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