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Carefully evaluate ocular surface of contact lens, cataract surgery patients
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LAS VEGAS – Contact lens dropout rates have not changed despite improved lens technology, Paul M. Karpecki, OD, said, and it is due to computer and smart phone use.
“We have to discover underlying disease early and treat it,” Karpecki said at the Ocular Surface Disease and Wellness Symposium here at Vision Expo West. Primary Care Optometry News co-sponsored the event.
“We did a study in our clinic where we tried to identify people who would drop out of contact lenses,” Karpecki said. “We found three things that helped us indicate that: They had meibomian gland dysfunction; they never had complete blinks due to digital device usage; and osmolarity was about 305 mOsm/mL. With those three, we could hit almost 90% confidence of who would drop out of lenses in the next year.”
“Vision is the #1 problem with dry eye disease,” Jack Schaeffer, OD, said. “Ask patients to blink to see if the chart appears differently. If it does, the patient has early dry eye disease.”
Progression will occur over time, he said, so be sure to use newer technology contact lenses.
“Patients have their own definition of what dryness is,” Marc Bloomenstein, OD, said, “so I stopped saying ‘dry eye.’ We are there to give our patients optimal or great vision.
“I tell patients that their ‘tear lens’ or tear quality is inhibiting them from getting the best possible vision,” he continued. “We need to stop it from happening before patients get symptomatic and perceive the dryness.”
Karpecki referred to research by the Tear Film and Ocular Surface Society where MRIs showed that contact lenses rub on the meibomian glands, causing upregulation, “meaning the gland has to work harder. The study shows we can cause structural damage with a contact lens. That doesn’t mean contacts are bad, but we are the ones who let the functional change happen because we don’t address the structural change first.”
Schaeffer also stressed the importance of conducting an ocular surface disease work-up on every cataract surgery patient.
“You book them with their medical insurance,” he said. “This will ensure better visual outcomes from the surgery and help prevent endophthalmitis.”
“My favorite study is one by Alice Epitropoulos and colleagues,” Karpecki said.
He explained that in a group of patients with tear osmolarity above 312 mOsm/mL, the researchers found that 17% would have received an IOL that was 1.5 D off-target.
“It has that much of an impact on calculations for an IOL,” Karpecki said.
“When you do this preop evaluation and care, it ingrains in the patient that you are in this together,” Bloomenstein said. “It’s critical to look at these patients differently before we send them off for surgery.”
“And you need to start treating them,” Schaeffer said. “There’s no rush in cataract surgery. Treat them for a couple months and then send them for surgery. You’ll have a better outcome.” – by Nancy Hemphill, ELS, FAAO
Reference s :
Epitropoulos AT, et al. J Cat Ref Surg. 2015;41(8):1672-1677. doi: http://dx.doi.org/10.1016/j.jcrs.2015.01.016.
Schaeffer J, et al. Ocular wellness and the ocular surface: Where do we go from here? Presented at: Vision Expo East; New York; Sept. 14-17.
Disclosures: Bloomenstein is on the speakers’ panel for Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, Better Vision Institute, BlephEx, Bruder, Macular Health and TearLab. Karpecki receives consulting fees from AcuFocus, Aerie Pharmaceuticals, Anthem, AMO, Alcon Labs, Allergan, Akorn, Bausch + Lomb/Valeant, BioTissue, Bruder Healthcare, Cambium Pharmaceuticals, Eyemaginations, Essilor, Eyes4Lives, Eye Solutions, Focus Laboratories, iCare USA, Johnson & Johnson Vision Care, OcuSoft, Freedom Meditech, Konan Medical, MacuLogix, Beaver-Visitech, Ocular Therapeutix, Reichert, Shire Pharmaceuticals, Regeneron, RySurg, Science Based Health, SightRisk, TearLab, TearScience, TLC Vision, Topcon and Vmax. He is on the speakers’ bureau for Glaukos and Oculus; has conducted research for Akorn, Allergan, Bausch + Lomb, Eleven Biotherapeutics, Fera Pharmaceuticals, Rigel Pharma and Shire; and has an ownership interest in Bruder HealthCare and TearLab. Schaeffer is a consultant for Alcon, Allergan, Bausch + Lomb, CooperVision, Essilor and Vistakon.