McDonald gives tips for screening cataract patients for DED
WAILEA, Hawaii — It is important to be ‘kind, but firm’ with patients who would benefit from getting dry eye under control before cataract surgery, according to a speaker at Hawaiian Eye 2021.
Upon arrival for their preoperative cataract evaluation, new patients should fill out a psychometric questionnaire to rule out symptoms or a history of dry eye disease, Marguerite McDonald, MD, FACS, said.
“A doctor can’t order a dry eye test for everybody who comes into the office,” McDonald said. If a patient exhibits one symptom of dry eye disease on the Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire or has a history of the disease, a technician can then administer a dry eye test.
“If you want to just simplify it, you just want to make sure your cataract patients do well, pick one objective test. I would say a tear osmolarity test,” McDonald said.
If the assessment shows the patient may have clinically significant dry eye, the technicians administering the test will stop the exam and bring the physician into the examination, McDonald said.
“Don’t let your techs proceed with dilation, biometry, OCT mac or topography at this time, because it is only going to have to be repeated after you do the dry eye treatment,” McDonald said.
McDonald then recommends having a “meet and greet” with the patient and conducting a short exam.
“Tell the patient you have diagnosed clinically significant dry eye and that it is going to adversely impact their preop measurements and their outcome unless it is treated first,” McDonald said.
Finally, reassure the patient that most respond quickly and schedule the preoperative examination for 2 to 4 weeks in the future.
“I have never met a patient who was not grateful for the extra care I have taken, and to my knowledge, I have never lost a patient with this approach,” McDonald said.
McDonald does not allow new, out-of-town, patients to schedule preoperative exams and surgeries in the same week.
“You don’t want to be in a situation where, there’s the patient and the adult children who have taken a week off from work,” McDonald said. “And now you have to tell them to go home, and there is screaming and there is pressure to proceed with surgery when you know you shouldn’t. You don’t want to be in that position.”
It is important to be “kind, but firm” with patients who will benefit from a delayed surgery, she said.
“Remember, if diagnosed preop, dry eye is their problem. Diagnosed postop, it is our problem,” McDonald said.
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McDonald M. My preop cataract patient has OSD: How do I proceed. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.
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