Older dry eye diagnostics beneficial for refractive surgery evaluation
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LAS VEGAS — When evaluating a patient for dry eye before refractive surgery, older techniques can be important tools along with newer tests, according to a presentation at the American Society of Cataract and Refractive Surgery meeting.
Edward J. Holland, MD, said at Refractive Subspecialty Day that dry eye is one of the leading causes of patient dissatisfaction after undergoing refractive surgery.
“That doesn’t include the effect on visual acuity. That’s just patient comfort and the way their eye feels after the surgery,” he said. “If we add in the impact on visual acuity that dry eye has, it becomes much higher.”
Dry eye has an impact on several preoperative measurements, such as those used for determining candidacy for refractive surgery and for IOL selection.
While there are several new point-of-care tests used to evaluate dry eye, Holland said it is important not to forget some of the traditional diagnostic tests, particularly examination of the eyelids and testing for corneal sensation.
The ASCRS preoperative ocular surface disease algorithm has five steps: look, lift, pull, push and stain.
“We want to look carefully at the lids,” Holland said. “Is there exposure to keratitis? ... Looking at the lashes, could there be Demodex?”
He also said it is important to lift the lid to feel laxity and to push on the meibomian gland to check for expression.
“Finally, don’t forget lissamine staining, as opposed to just fluorescein staining,” he said. “We’re missing all of the mild or moderate dry eye patients that will only be picked up with lissamine staining.”
Adding these traditional methods to more modern techniques can help evaluate patients before refractive or cataract surgery, Holland said.
“Careful preoperative examination, incorporating some of the old tests that we forgot about and certainly the new technology, is going to make you a better clinician and give you better outcomes,” he said.
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Holland EJ. Evaluating the ocular surface for the refractive surgery patient. Presented at: American Society of Cataract and Refractive Surgery meeting; July 23-27, 2021; Las Vegas.
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