Don’t Play Hot Potato

Manage DED in the cataract patient

Mark Stay/

When you were a kid, perhaps you played “hot potato.” In the game, kids form a circle and toss the “hot potato” between each other until the music stops. Whoever holds the potato at that time, loses. Unfortunately, some optometrists often view dry eye disease (DED) in cataract patients as a game of “hot potato,” avoiding it to be passed off to the next provider.

Here, I discuss the reason some O.D.s see DED in cataract patients as the “hot potato,” as well as why this view must change.


Traditionally, the primary care O.D. has always identified the visually significant cataract, explained the diagnosis and IOL options to the patient, referred the patient to an ophthalmologist and then provided the post-operative care. Identify the cataract, eliminate the cataract and done, right? Not so fast!


It behooves O.D. traditionalists to consider changing this view, both for the satisfaction of the cataract patient and the health of their practices:

The satisfaction of the cataract patient. Research shows that 77% of cataract patients have signs of DED (corneal staining), though only 22% of them received a diagnosis of DED.


A brief explanation sent to the surgeon and/or the surgical technician carries more weight than a detailed and lengthy dissertation about the patient’s plight with DED because the latter is likely to go unread, in my experience.

“Give them some tears after surgery, and it will resolve,” some O.D.s say. “Almost every post-cataract surgery patient has some amount of DED that lasts one to three months on average; par for the course.”

Yes, but by failing to either identify or treat it pre-surgery, O.D.s place these patients at increased risk of long-term DED, as well as long-term poor post-operative vision. With regard to the latter, a 2015 study in the Journal of Cataract & Refractive Surgery shows patients with increased osmolarity had less reliable biometry readings, the accuracy of which are essential in selecting the appropriate IOL for the patient.

The health of their practices. In identifying cataracts and then referring these patients to ophthalmologists, O.D.s play the role as “preparers,” engendering patient trust that everything in the O.D.’s power has been done to ready the patient for surgery and, thus, increase the likelihood of a successful outcome. The O.D. who treats DED in these patients before referral fulfills this patient expectation.

Something else to keep in mind: Just as cataract surgery itself is in the ophthalmologist’s wheelhouse, pre- and post-surgical co-management is in the O.D.’s wheelhouse. Yet because some view DED in cataract patients as the “hot potato,” many ophthalmologists are doing it, impressing patients, while also garnering the fees associated with DED diagnosis and treatment.

Yup! These O.D.s are doing their patients and their practices a disservice.


It’s incumbent upon O.D.s to identify DED in an already at-risk patient population and take appropriate action. This includes talking with the patient about DED and why it’s important to address for both the short- and long-term success of his surgery. This practice initiates treatment to position the patient for the best possible outcome and informs the surgeon of the diagnosis, so DED becomes a “pre-existing condition” vs. just part of the typical surgical post-op woes.

No one likes to be left holding the “hot potato,” especially the patient. OM