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Treating dry eye before cataract surgery improves outcomes
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SAN DIEGO — Dry eye signs and symptoms, as well as higher-order aberrations, improved in patients scheduled for cataract surgery when treated preoperatively with Xiidra, according to a speaker here.
“There was a clear and significant improvement in [root mean square] higher-order aberrations when lifitegrast was used,” as well as improved accuracy of preoperative biometry, John A. Hovanesian, MD, FACS, said at the American Society of Cataract and Refractive Surgery annual meeting.
Hovanesian and colleagues measured biometry in patients with cataract and significant dry eye both before and after 4 weeks of treatment with Xiidra (lifitegrast ophthalmic solution 5%, Takeda). The researchers determined how lifitegrast affected the root mean square higher-order aberrations in the cornea measured with topography and the accuracy of preoperative biometry in predicting postoperative spherical equivalent, as well as SPEED scores and corneal stain.
Biometry was performed initially at presentation and again after a month of treatment with lifitegrast. Surgery was then performed, and refractive outcomes were evaluated 1 month postoperatively. In the first 17 patients of the 200-patient study, higher-order aberrations after lifitegrast were significantly reduced in 10 patients, remained unchanged in six patients and increased in one patient.
“We’re seeing an even more significant trend as this study nears completion. What that means is that RMS HOA is a predictor of patient satisfaction with premium IOLs,” Hovanesian said. “We almost double the likelihood that our patient will be happy with the outcomes after surgery when we treat dry eye in this manner.”
Regarding refractive accuracy, Hovanesian said there was a trend toward improvement as seen in the study’s early findings in 13 patients, and as the study approaches 100 patients enrolled, “there is now clearly a statistically significant trend toward greater accuracy.”
Additionally, patient-reported SPEED scores indicate that a majority of patients are asymptomatic for dry eye before cataract surgery; even so, SPEED scores improved by 62% in 21 patients, and as more data are compiled, results continue to show statistically significant improvement, Hovanesian said.
Of the 21 patients, corneal staining disappeared in 86%, conjunctival redness improved in 50% and tear breakup time improved in 90%, he said. – by Robert Linnehan
Reference:
Hovanesian JA. The effect of lifitegrast on refractive accuracy, higher order aberrations, and symptoms in dry eye patients undergoing cataract surgery. Presented at: American Society of Cataract and Refractive Surgery annual meeting; May 3-7, 2019; San Diego.
Disclosure: Hovanesian reports he is a consultant for Takeda and the study was funded by a grant from Takeda.