BLOG: Sand before you paint
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When my son was a 6-year-old Tiger Cub Scout, his friends came over to our house to prepare their Pinewood Derby cars for the big upcoming race.
Despite the use of saws and cutting tools, we never lost any fingers, but we did learn a number of lessons about how to “Be Prepared,” which is the motto for all Scouts. Eager young Cubs wanted to cut their cars to shape and immediately paint them to see that sleek, shiny finished product.
What happens when you paint wood before the surface is properly smoothed with sandpaper? The result is about as disappointing as doing cataract surgery before the ocular surface is properly treated for dry eye. And expecting satisfaction with a presbyopia-correcting lens on an untreated dry eye is about as hopeless as aiming for a glossy smooth finish on top of a cut with a circular saw.
We know from several studies that about two-thirds of patients presenting for cataract have dry eye, and about two-thirds of those are asymptomatic. Yet we’ve also shown how treatment of dry eye improves both the accuracy of surgery and the proportion of patients who are candidates for presbyopia-correcting lenses.
But which treatment should you use? Do immunomodulators like cyclosporine or lifitegrast make more sense because they can be taken long term, or do steroids more quickly rehabilitate the surface, making them a better first choice? Or do simple lubricants work quickly enough to make a difference? The answer is that any treatment is better than no treatment. Most of us are very comfortable treating dry eye and can develop our own effective protocols, but many of us don’t take the time to explain dry eye’s importance to patients and the very patient-centered reasons for treating it before biometry measurements.
What about impatient patients? Those who want surgery as quickly as possible? Does cataract surgery have to be an exercise in delayed gratification for people needing treatment for dry eye first? We have shown in a soon-to-be-published study that even lifitegrast can work in as little as 1 week to significantly improve the objective measures of dry eye in cataract patients. Again, any treatment is better than no treatment.
So, fellow Cub Scouts, please repeat after me: “I will do my best to do my duty to be prepared and sand my Pinewood Derby car to a smooth finish before painting. I will treat the ocular surface at all times before biometry, and I will not blame the IOL for the sins of the cornea.”
References:
Hovanesian J, et al. Clin Ophthalmol. 2020;doi:10.2147/OPTH.S264520.
Trattler WB, et al. Clin Ophthalmol. 2017;doi:10.2147/OPTH.S120159.
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