Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Neel R. Desai, MD. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica.
Preoperative treatment of ocular surface disease (OSD) is an asset that many cataract surgeons tend to undervalue. I often talk to peers who treat OSD as a nuisance problem that gets in the way of them proceeding with the ultimate goal of cataract surgery, but for those of us who are outcomes-driven and see that those outcomes help build the reputation and good will we need to grow our practices, treating OSD prior to surgery is an important goal in itself, not a speed bump on the road to surgery.
Look at These Numbers
If you think treating OSD before surgery is a burden, consider these numbers:
- In Trattler’s landmark PHACO study,1 up to 76.8% of patients presenting for cataract surgery had some form of OSD. At least 50% of them had severe enough OSD central to the visual axis that could negatively affect surgical outcomes if it were left untreated.
- In my own practice, I treated patients with epithelial basement membrane dystrophy affecting pre-operative biometry with traditional dry eye therapies, superficial keratectomy, and placement of a cryopreserved amniotic membrane biologically active bandage (PROKERA, Bio-Tissue) for 5 days. After following this protocol, average Ks changed by at least 1D in 50% of patients and up to 2D in 19%. BCVA improved 1-2 lines. If we hadn’t treated the problem before surgery, inaccurate IOL powers would have led to refractive surprises after surgery.
As these studies help illustrate, by treating OSD, our practices accumulate better outcomes and happier patients, reduce costly postoperative chair time and enhancements, and get reimbursed for OSD treatment. It’s a win for patients, physicians, and our businesses.
Neel R. Desai, MD, is director of Cornea, Cataract, and Refractive Services at The Eye Institute of West Florida; medical director, Lions Eye Institute for Transplant Research; and president and CEO, Clarity Visionary Consulting. He is a consultant to Allergan, BioTissue, Lumenis, Johnson & Johnson Vision, and Shire.
1. Trattler WB, Majmudar PA, Donnenfeld ED, McDonald MB, Stonecipher KG, Goldberg DF. The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017;7(11):1423-1430.