Catalytic Health

3 these cases, ocular surface disease, rather than cataracts, is what's impairing a patient's vision. Dominique Massicotte: I often ask patients to describe their eye challenges in their own words. Often, they tell me about redness in their eyes or eye fatigue. It's important to ask about their symptoms in detail because, in some cases, moving forward with cataract surgery could exacerbate their symptoms. At the slit lamp, I like to quickly measure the tear meniscus and breakup time and then look for rosacea and meibomian gland dysfunction. How do you treat the ocular surface prior to surgery? Hall Chew: I encourage warm compresses and preservative-free artificial tears. If there is ocular surface inflammation, I may suggest low-dose steroids, while making sure that patients don't have any issues with infection or pressure spikes. Then, I'll have patients come back after 2-4 weeks to recalculate. Sometimes I do serial calculations to see if I can find consistency. It can be important to make patients aware of the variability, and the challenges that this poses for cataract surgery. G.R.: We send letters to patients outlining specific lid hygiene routine, even before patients come into the office. We suggest warm compresses every day, tea tree oil cleansing, and artificial tears as needed. Many of the patients come in having already done this before they see us for an assessment. We tell patients to continue performing this routine until the time of surgery and then to start again one week post-surgery. S.Z.: Some patients only need a little bit of what I like to call "TLC": Teaching them about increased humidity and less screen time, Lubrication, and Compresses. I also recommend Omega-3 supplements. Dry eye disease is common as people age, and it's often asymptomatic. Ensuring the best outcomes, safety and patient satisfaction for cataract and other ocular surgeries requires careful examination and step-wise treatment of ocular surface disease. Bruce Jackson (Moderator): When we look at The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study, it revealed that most people who underwent cataract surgery had some degree of ocular surface disease. In the study, among patients with a mean age of 71, 60% to 87% with dry eye disease were asymptomatic. However, more than 70% had a tear breakup time (TBUT) of less than five seconds and 77% had corneal staining. Improving the ocular surface is necessary to determine whether patients indeed need surgery, and which surgical option will result in the best outcome. In your practice, how important is it to examine the ocular surface prior to surgery? Setareh Ziai: We know that ocular surface disease is more common in women, and with aging. We also know that much of cataract surgery happens in the older population. Lastly, we know that a poor ocular surface can affect short- and long-term outcomes of surgery. Knowing those facts makes it undeniable that we need to properly assess the ocular surface before any type of ocular surgery. Guillermo Rocha: With the advent of premium lenses, it is imperative to address the ocular surface. We noticed that the measurements that we took for intraocular lens implants prior to cataract surgery were not always accurate. In addition, people would say that they could read for a few minutes and then their vision "goes away". Or they would comment that they can watch TV or drive, but when they blink, their vision can become blurry. In MODERATOR PANELISTS W. Bruce Jackson, MD Maximizing the Ocular Surface Prior to Ocular Surgery PANEL DISCUSSION Setareh Ziai, MD Hall Chew, MD Guillermo Rocha, MD Dominique Massicotte, MD

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