Address ocular surface disease before cataract surgery for better outcomes
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Ocular surface disease must be addressed before cataract surgery to ensure patient satisfaction and good surgical outcomes, according to a presentation at Real World Ophthalmology.
“Ocular surface disease is quite prevalent in cataract surgery patients, with or without symptoms,” and may negatively affect preoperative biometry and refractive surgical planning, as well as induce higher-order aberrations that degrade visual quality, Frank W. Bowden III, MD, FACS, said.
“It also can cause tear film disruption postoperatively that can result in refractive instability, discomfort, as well as cytokine-mediated T-cell inflammation,” he said.
Patients must be convinced that ocular surface disease exists, Bowden said, with the help of tools such as point-of-service testing, dry eye questionnaires and imaging including biomicroscopy photography. They may be unreceptive to optimization of the ocular surface because of a lack of symptoms or insurance coverage or impatience to proceed with surgery, but they need to understand the clinical significance of ocular surface disease.
Controlling ocular surface inflammation is necessary, with pulse topical steroids, immunomodulators and amniotic membranes “in my hands very useful measures for rapid recovery and stabilization of the ocular surface,” Bowden said.
In patients with significant meibomian gland dysfunction associated with meibomian gland obstruction, treatments include lid margin exfoliation, meibomian gland probing and thermal pulsation treatments.
In addition, it is important to reduce ocular surface exposure to glaucoma medications that contain preservatives and systemic medications with drying effects and to identify and address lid malposition, partial blinks and abnormal lid seal.
After surgery, Bowden recommended resuming ocular surface management as soon as possible and using omega-3 supplements.
“These measures are critical for toric, presbyopia-correcting, as well as Light Adjustable Lenses (RxSight),” he said. “Surgeons [and] surgical practices must commit sufficient time to educate patients and to address ocular surface disease in the perioperative period commensurate with the clinical severity of the presentation.”
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Bowden FW III. Ocular surface tips before cataract surgery. Presented at: Real World Ophthalmology; April 27, 2024 (virtual meeting).
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