BLOG: If you do just one thing
Fellow cataract surgeons, do you really want your visual outcomes to be better? Are you actually willing to take extra steps that meaningfully improve visual quality?
If you’re willing to do only one thing to improve your results, recent studies show treating dry eye would be a good choice, and it’s easier than you think.
First, dry eye does matter to surgical outcomes by altering both preoperative measurements and visual quality after surgery. I recently led two studies with Alice Epitropoulos, Eric Donnenfeld, Gregg Berdy and Jack Holladay in which we treated eyes with cataract and dry eye with Xiidra (lifitegrast, Novartis) in one study and Cequa (cyclosporine, Sun Pharma) in the other, both for 28 days. Biometry was measured before and after treatment. Surgery was performed based on the post-treatment biometry, and we looked back to see which biometry reading (before or after medication treatment) better predicted the refractive outcome at 1 month. Not surprisingly, both studies and both drugs showed significant improvements in refractive accuracy. Both studies showed significant improvements in tear breakup time, corneal staining, conjunctival erythema and dryness symptoms. Both studies also showed significant improvements in objectively measured higher-order aberrations — a predictor of visual quality and satisfaction with multifocal lenses.
The regimen used in both studies didn’t alter the workflow or add visits to the surgical “journey.” We did not treat the dry eye and then reassess. We simply treated it and assumed that 1 month of therapy would make a difference. Indeed, the data supported this assumption. Importantly, if you’re a busy surgeon who wants better outcomes, all you have to do is prescribe one of these drugs for 28 days before your final biometry, and you’ll get a better result.
Could other treatments work instead? Of course. Many treatments exist for dry eye. These two products were studied because both are uniquely approved for improving signs and symptoms of dry eye. Both were well tolerated, and perhaps most importantly, both could easily be continued after surgery for a baseline dry eye condition that would otherwise worsen over time without treatment.
The PHACO study showed that dry eye occurs in more than 70% of patients before cataract surgery, often without symptoms. To me, that means most patients can benefit from these simple, easy-to-employ treatments with a lifelong benefit.
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