Surface Matters Before Surgery

Cataract affects more than 22 million U.S. residents older than 40, and almost 800,000 undergo refractive surgical procedures each year.¹ But before moving to surgery, ophthalmologists must remember to look at the ocular surface.

When we are busy deciding if the patient should have a cataract removed or would do well with LASIK or PRK, we must go beyond the lens findings or refractive error and remember that the ocular surface is crucial to quality vision. We all have experienced driving with a foggy windshield—yes, the glass is clear, but our vision is not. The ocular surface can provide quality vision only if the tear film is normal and the interface of the corneal epithelium and tear film is intact and functioning normally.

The first step is to stop, listen and look. Stop: Evaluate before surgery, not later when the patient complains of less-than-optimal vision. Listen: Does the patient describe irritation, fluctuating vision, chronically red lids? Look: At the slit lamp exam, evaluate the tear film height and quality, fluorescein staining of the cornea, and tear break-up time. Then look at the lids for signs of neovascularization and abnormal meibum.

Take a few more seconds, and place mild pressure on the lower lid with a finger or applicator tip as you observe the meibomian gland orifices for meibomian gland dysfunction. As Richard L. Lindstrom, MD, states in these pages, if the patient starts out with moderate dry eyes, say a DEWS score of 2, after surgery you can count on the score becoming a 3, indicating more severe dry eye disease.

Diagnosing and treating in advance will prevent ocular surface disease and ensure good quality, stable vision after surgery.

Penny A. Asbell, MD, FACS, MBA

Reference

American Academy of Ophthalmology. Eye Health Statistics at a Glance. 2011. http://www.aao.org/newsroom/upload/Eye-Health-Statistics-April-2011.pdf. Accessed June 11, 2011.