Test for and treat dry eye before cataract surgery
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Testing and treating patients for dry eye are mandatory before the preoperative measurements for cataract surgery are performed, according to one speaker.
“Don’t move forward with surgery. Don’t be in a hurry. Step back, look for dry eye, treat dry eye and then bring your patient back for your presurgical measurements,” Cynthia Matossian, MD, said at Real World Ophthalmology.
The tear film is important to stabilize the refractive power of the eye, she said. An unstable tear film reduces the quality of corneal reflections, leading to compromised keratometry readings. This, in turn, affects accuracy of IOL calculations, resulting in suboptimal refractive outcomes.
“To achieve excellent outcomes, do LLPP (look, lift, pull and push) at the time of the slit lamp exam. Make the diagnosis besides cataract. Pull that joystick back a little bit. Start at the lid margin. Inspect the eyelashes. Look at the tear film, staining it with vital dyes,” Matossian said.
If tear film issues are detected, further tests should be performed, including MMP-9 testing (InflammaDry, Quidel), osmolarity testing (TearLab) or LipiView meibography testing (Johnson & Johnson Vision). These tests are important to not only initiate the therapeutic approach before surgery, but also to follow the patient postoperatively “because cataract will be cured and never recur, but dry eye disease is chronic and progressive, requiring lifelong treatment,” Matossian said.
In a study in patients with both cataract and dry eye disease, she performed the LipiFlow treatment (Johnson & Johnson Vision) preoperatively. IOL power and astigmatic correction were calculated before and after the treatment.
“Shockingly, post-LipiFlow, 24% of eyes had less astigmatism and 52% had more while the remaining quarter showed no change. I had to change 40% of my surgical plans. Had I not pretreated the surface, I would have ended up with a refractive surprise,” Matossian said.
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Matossian C. Promise you won’t forget me: Diagnostic tests to do before cataract surgery. Presented at: Real World Ophthalmology; April 2, 2022 (virtual meeting).
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