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    Treat, prevent dry eye prior to cataract surgery

    It is vital to identify and prevent dry eye and blepharitis pre-surgery because these conditions can affect IOL calculations (inaccurate keratometry can lead to incorrect IOL power); limbal relaxing incisions, or toric IOL axis and/or magnitude; and inaccurate topography, which can hinder visual results and surgical outcomes.

    Figure 1 Dry eye disease severity scale. (Figure courtesy of TearLab)
    Proper and thorough preoperative evaluation for dry eye/blepharitis, preoperative topography, preoperative optical coherence tomography of the macula, and a comparison of presbyopic IOLs can help clinicians catch dry eye cases and lead to refractive success. For example, one recent study of 100 patients (200 eyes) scheduled for cataract surgery at two centers found that 59% of patients had with blepharitis.6

    Figures 2 to 5 Topography is an excellent tool for diagnosing poor tear film before and after topography scans. (Figures 2 to 5 courtesy of William B. Trattler, MD)
    The Dry Eye Study: P.H.A.C.O.: Prospective Health Assessment of Cataract Patients Ocular Surface,7 a nine-site, prospective, multicenter study, included 136 patients (272 eyes) scheduled for cataract surgery with an average patient age of 70 years (range: 54 to 87 years). The study demonstrated that most patients with dry eye (87%) are asymptomatic.

    The study also showed that signs of dry eye are very common in patients scheduled for cataract surgery. More than 60% of patients had significantly abnormal tear break-up time (≤5 seconds); 50% had central corneal staining, and 21.3% had very low Schirmer's (≤5 mm).

    William B. Trattler, MD
    Dr. Trattler, a corneal specialist at Miami's Center for Excellence in Eye Care, Miami.

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