What is your go-to diagnostic tool before cataract surgery?
Click Here to Manage Email Alerts
Click here to read the cover story, "Preparation, setting expectations, backup plans: Meeting goals with premium IOLs."
Biometry, topography and meibography
There are certain things that are a must for me in the preop cataract setting from a diagnostic standpoint.
We use the latest-generation biometer we can, which is the IOLMaster 700 (Zeiss) in our practice. I always get a Pentacam (Oculus) topography/tomography scan to look for any irregularities on the cornea, to look at my astigmatism values, and to make sure there is consistency between my measurements there and my measurements on biometry.
I also look at topography mires, the anterior reflection off the cornea. I am looking for irregularity in the tear film that sometimes shows up as significant alterations in the mires rings. If there is a lot of dropout or irregularity in those rings, then I know there may be some tear film abnormalities that I need to address before surgical planning.
I always get a macular OCT scan to make sure there are no subtle changes in the macular contour before we do our IOL planning. If the patient wants a multifocal or presbyopia-correcting lens, I want to make sure they have a pristine macula.
Finally, the other tool I have embraced in the diagnostic setting is meibography. Meibomian gland dropout, specifically, gives me a good understanding of how the patient’s tear film and ocular surface will function in the long term. If there is any significant dropout, I know they are going to have lipid layer abnormalities chronically. That may also steer me away from using a diffractive optic IOL. For a multifocal IOL, a stable and smooth tear film is essential for long-term refractive success.
No matter what type of lens we go for, education is key with patients who have dry eye disease or ocular surface irregularities. To keep the visual quality pristine requires constant care of the ocular surface.
- For more information:
- Marjan Farid, MD, is a Healio | OSN Cornea/External Disease Board Member.
Tools to identify dry eye
The most critical presurgical diagnostic tools are focused on tear film analysis and ocular surface evaluation.
First is testing for tear osmolarity. Trukera makes a reusable handheld device that uses a new tip for each eye; therefore, two tips are required per patient. It provides a numerical value for both the patient and the eye care provider to review. Sharing objective data with patients can help them become engaged in their disease process. Many patients like keeping track of their tear osmolarity values over time.
MMP-9 testing is useful to determine the presence of inflammation on the ocular surface. MMP-9 testing is done with a disposable point-of-care test that has a reimbursement code. It resembles a pregnancy test; the blue line is the control. The presence of a red line indicates inflammation. Even the faintest red line is read as positive.
Another tool that I always found important is meibography. For one thing, it is easy for patients to understand. Patients do not need to have a science background to see the black and white images of the meibomian glands. If they are broken, truncated or missing, one can easily recognize the abnormalities. It is important to identify meibomian gland dysfunction (MGD) because it is the leading cause of evaporative dry eye. Fortunately, we have many tools and products available for the treatment of MGD because it will require lifelong intervention. It is very important to have this discussion with patients prior to surgery because maintenance of good quality vision post-surgery depends on a healthy tear film.
- For more information:
- Cynthia Matossian, MD, FACS, is a Healio | OSN Cataract Surgery Board Member.
Collapse
Read more about
Click Here to Manage Email Alerts