Dry eye treatment mandatory for proper astigmatic management in cataract surgery



Matossian C. Ocular surface management for astigmatism accuracy in cataract surgery. Presented at: OSN Italy; July 10-11, 2021; Rome.

Matossian reports she is a consultant for Johnson & Johnson Vision.

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ROME — Dry eye should be diagnosed and aggressively treated before cataract surgery because it may compromise presurgical keratometry readings and visual outcomes, according to one specialist speaking at OSN Italy.

“Treat every one of your cataract consults as a dry eye consult: Look for dry eye, diagnose it, treat it aggressively and bring them back for their surgical measurements once the surface is nicely tuned up,” Cynthia A. Matossian, MD, FACS, said.

An estimated three-quarters of eyes undergoing cataract surgery have astigmatism higher than 0.5 D and one-third have 1 D or more, according to studies. While correcting preoperative astigmatism is mandatory to achieve emmetropia, astigmatic outcomes are often suboptimal, particularly in patients with preexisting dry eye.

Cynthia A. Matossian

“The unstable tear film affects the quality of optical surface reflections from the cornea, altering K readings significantly, with manual keratometry or advanced devices,” Matossian said. “Fortunately, we have now a multitude of options to treat our dry eye patients and make them come back for more accurate preoperative measurements in as little as 2 weeks.”

In a pilot study, she evaluated how one of these options, the LipiFlow thermal pulsation treatment (Johnson & Johnson Vision), could potentially change keratometry and treatment planning. Presurgical measurements were performed in 25 eyes of 23 patients with visually significant cataract and concomitant meibomian gland dysfunction-associated dry eye. LipiFlow treatment was performed, and after a few weeks, the patients were brought back to have measurements performed again.

“It was my expectation that the dry eye treatment would reduce keratometric astigmatism, but to my surprise, the magnitude of astigmatism was actually higher post-LipiFlow in 52% of eyes, meaning that astigmatism was unmasked by the treatment. In 24%, astigmatism was lower, and in the remaining eyes, it was unchanged. In addition, a change in cylinder axis orientation was observed in seven eyes,” Matossian said.

In 40% of these patients, she changed her planned astigmatism management approach based on posttreatment data.

“Had I not done LipiFlow and had I used their pre-LipiFlow data, I would have ended up with statistically significant residual refractive astigmatism,” she said.

Her take-home message: Do not miss checking for dry eye, treat it if necessary and remeasure the eye before making a surgical plan for astigmatic management.

“Let your patients know they have two diseases, one that you can cure once and for all, meaning their cataract, and one that’s lifelong and will require forever treatment. This will lead to excellent refractive outcomes. That is what you and your patients deserve,” Matossian said.


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