ASCRS 2024: Refractive cataract surgery in DED afflicted eyes

Jennifer Loh, MD, sat down to discuss her presentation on major eye issues that can interfere with refractive cataract surgery, specifically dry eye disease, at this year's ASCRS meeting held in Boston, Massachusetts.

Video Transcript

Editor's note - This transcript has been edited for clarity.

David Hutton:

I'm David Hutton of Ophthalmology Times. ASCRS is holding its annual meeting this year in Boston. Joining me is Dr. Jennifer Loh, whose presentation at the event is titled dry eye disease. Thank you so much for joining us today. This certainly is an interesting topic. Could you share some highlights with us?

Jennifer Loh, MD:

Thanks so much, David. It's an honor to be speaking with you. And it was also an honor to be able to present and speak at ASCRS, during refractive day. I had the pleasure of speaking in this session, entitled "Refractive cataract surgery in the diseased eye" with Cathy McCabe and Kendall Donaldson as moderators. And what the focus was for this session was to discuss about major eye issues that can interfere with refractive cataract surgery. And of course, as we know, one of the biggest issues is dry eye disease. In dry eye disease, one of the main problems of course, is preoperative evaluation and diagnosis.

As we know from multiple studies, such as the PHACO study, or the study performed by Preeya Gupta and Chris Starr, many patients come in for cataract surgery not knowing they have a diagnosis of dry eye disease, and oftentimes a surgeon can miss it.

So in my talk, I discussed how better to evaluate dry [eye] disease efficiently in cataract surgery patients, and also how to evaluate why this may change your IOL selection. And also how to treat patients afterwards. We want to be careful when patients have severe untreated dry eye, at picking possibly a toric lens or a multifocal lens, if it may be inappropriate for them in case some of the testing is skewed or influenced by the dry eye disease.

So I discuss how it's important to treat the dry eye disease, reevaluate the testing, possibly consider dry eye disease when picking the best lens selection for the patient. Then, even if you've had perfect cataract surgery for your patient, and that's been a success, we still–it's really important. We still need to manage the dry eye afterwards. Because again, as we all know, even with perfect surgery, the ocular surface can remain untreated, and will worsen the patient's vision. I actually tell all my patients now just to expect dry eye disease for a minimum of three months after surgery and we need to be proactive rather than reactive and I will employ many of the same treatments pre and post operatively.

Preoperatively I like to treat the meibomian glands–hot compresses consider a thermal in office treatment. Consider hypochlorous acid spray. Consider topical therapies such as steroid, such as cyclosporine, lifitegrast. And then postoperatively I do the same. I get on the treatment right away. I encourage the patients to keep doing the treatment that we started preoperatively and I adjust as needed.