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    Ocular surface optimization key in refractive surgery management

    Dry eye disease (DED) is extremely common in the adult population and important to diagnose and treat in patients undergoing corneal and cataract refractive surgery because it can affect vision, quality of life, and surgical outcomes, said Edward J. Holland, MD.

    “For a long time, interest in DED among ophthalmologists was limited to cornea specialists who had to care for patients with advanced disease,” said Dr. Holland, professor of ophthalmology, University of Cincinnati, Cincinnati, OH. “Then, in the 1990s, refractive surgeons realized that DED was affecting the outcomes of their procedures, and their efforts drove the field to address DED.

    “Now we have new technologies that are enhancing our ability to properly and efficiently diagnose DED, and we have new effective treatments that we can offer to our patients,” he added.

    Further emphasizing the importance of diagnosing and treating DED prior to corneal or cataract refractive surgery, Dr. Holland cited studies showing that DED is a common cause for dissatisfaction in patients who had LASIK or multifocal IOLs. The explanation lies in the fact that irregularity of the tear film and ocular surface affect vision and the accuracy of preoperative measurements, including keratometry, topography, and wavefront aberrometry.

    “If the DED was not identified and managed preoperatively, the patient blames the surgeon,” Dr. Holland said. “Patients told their surgery has to be delayed in order to optimize their ocular surface may be disappointed, but they will not be upset with you.”

    DED diagnosis

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