Article

CLINICAL: Dry Eye

Work in Progress

Educate dry eye disease patients about post-op risks

I recently decided to remodel a bathroom in my home, and it has been quite an ordeal. It has taken longer to complete than expected, due to a failure to order components in a timely manner, and the cost continues to escalate. I blame the contractor because he didn’t warn me about these possible pitfalls at the outset.

When we fail to educate pre-operative patients about the presence of dry eye disease (DED), we risk being the contractor in this scenario. After all, DED can have a negative impact on how the eyes see and feel post-surgery.

Here, I explain why this can happen and how we, as a profession, can fix it.

WHY IT CAN HAPPEN

Some optometrists subscribe to the “if it ain’t broke, don’t fix it” pre-surgical workup: The doctor notes signs of DED, such as superficial punctate keratitis and meibomian gland dysfunction, but doesn’t always relay these observations to the patient. This is because the patient doesn’t complain of DED symptoms, such as foreign body sensation.

Meanwhile, other O.D.s can be singularly focused on preserving vision and VFs in their glaucoma patients. (See https://bit.ly/2XvFSZn .) While this is both reasonable and commendable, missing the DED diagnosis in these patients can also place surgical success at risk, especially in patients scheduled for invasive glaucoma surgery, such as trabeculectomy and shunt surgery. This is because overexposure to ophthalmic preservatives can lead to conjunctival toxicity, which, in turn, can cause poor healing.

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HOW TO FIX IT

We must remember that DED clinical signs and symptoms don’t always correlate. Also, we must assess each and every pre-operative patient for DED, regardless of whether they present complaining of symptoms.

Consider this:

  • Preeya Gupta, M.D., et al. published “The Prevalence of Ocular Surface Dysfunction in Patients Presenting for Cataract Surgery Evaluation,” which shows just 54% of pre-surgical patients who had DED reported symptoms suggestive of DED.
  • The Prospective Health Assessment of Cataract Patients’ Ocular Surface (PHACO) Study reveals 77% of the 136 patients enrolled in the study had positive corneal staining, though only 22.1% had been previously diagnosed with DED, and none of them were on treatments.

REMODEL UPDATE

As I type this column, my bathroom remodel remains incomplete, and I remain angry at the contractor. If he had warned me about issues that could derail the timetable to completion before starting the project, my anger would be focused on the issues themselves and not the contractor. Will I use him again? Not likely. OM