Ocular surface evaluation may determine surgical outcomes in patients with dry eye disease
WAIKOLOA, Hawaii — Streamlined ocular surface evaluations in patients with dry eye disease can provide key information about eye health that may determine surgical outcomes, according to a presenter here.
Ocular surface disease and lid disease have been found to correlate with worse visual acuity and contrast sensitivity, so evaluation of the ocular surface before surgery can reveal important information relevant to the outcome of the procedure.
“Looking at the ocular surface before surgery, there are really two important things that you want to figure out. No. 1, the shape, and I think the reason for that is self-evident. No. 2, the stability and the quality of the tear film,” Julie Schallhorn, MD, MS, said at Hawaiian Eye 2022. “And this is something that we’re really coming to understand more and more how much it contributes to visual quality and the whole visual experience.”
The streamlined ocular surface evaluation involves examination, topography and patient-reported measures. According to Schallhorn, the ideal ocular surface test should also be easy to perform and interpret, be reliable and be of high predictive value.
In addition to looking at the lens during the exam, Schallhorn suggested pushing and pulling the eyelids, observing the blink, looking under the lids and examining the epithelium, particularly superiorly.
The second component, Placido disc topography, uses the cornea as a mirror to reveal information about corneal curvature as well as the quality of the reflecting surface.
“[Placido disc topography] gives us information about corneal curvature, which is great, but it tells us a lot about the reflecting surface,” Schallhorn said. “It tells us a lot about how good the cornea is acting as a mirror. The smoother the cornea is and the more stable the cornea is, the better mirror it is.”
Physicians should also consider using a standardized screening tool, such as the Ocular Surface Disease Index or the ASCRS SPEED II questionnaire, to assess dry eye symptoms and severity of symptoms, according to the presentation.
These patient-reported measures are important to the evaluation process, although they do not always correlate with the signs of dry eye syndrome. These measures, however, have been found to correlate with patient satisfaction, demonstrating the need for both subjective and objective measures, Schallhorn said.
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Schallhorn J. Streamlining the ocular surface evaluation. Presented at: Hawaiian Eye 2022; Jan. 15-21, 2022; Waikoloa, Hawaii.
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