Treatment of dry eye mandatory for proper management of astigmatism in cataract surgery


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

Disclosures: Matossian reports that she is a consultant for Johnson & Johnson Vision.

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ROME – Dry eye should be diagnosed and aggressively treated before cataract surgery, as it can compromise pre-surgical keratometry readings and visual results, according to a specialist speaking to OSN Italy.

“Treat each of your cataract visits like a dry eye visit: check for dry eye, diagnose it, treat it aggressively, and bring it back for surgical measurements once the surface is properly adjusted.” Cynthia A. Matossian, MD, FACS, noted.

It is estimated that three quarters of the eyes undergoing cataract surgery have astigmatism greater than 0.5 D and one third have 1 D or greater, according to studies. Although correction of preoperative astigmatism is mandatory to achieve emmetropia, the results of astigmatism are often suboptimal, especially in patients with pre-existing dry eye.

Cynthia A. Matossian

“The unstable tear film affects the quality of corneal optical surface reflections, dramatically altering K readings, with manual keratometry or advanced devices,” Matossian said. “Fortunately, we now have a plethora of options for treating our dry eye patients and getting them back for more precise preoperative measurements in as little as 2 weeks.”

In a pilot study, she evaluated how one of these options, LipiFlow thermal pulsation therapy (Johnson & Johnson Vision), could potentially alter keratometry and treatment planning. Presurgical measurements were performed in 25 eyes of 23 patients with visually significant cataracts and dry eyes associated with meibomian gland dysfunction. LipiFlow treatment was performed, and after a few weeks the patients were brought back for further measurements.

“I expected treatment for dry eye to reduce keratometric astigmatism, but to my surprise, the amplitude of the astigmatism was actually higher after LipiFlow in 52% of the eyes, which means that astigmatism was unmasked by treatment. In 24%, the astigmatism was lower and in the remaining eyes it was unchanged. In addition, a change in the orientation of the axis of the cylinder was observed in seven eyes, ”said Matossian.

In 40% of these patients, she changed her planned approach to astigmatism management based on post-treatment data.

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

Her take-home message: Be sure to check for dry eye, treat it if necessary, and re-measure the eye before making a surgical plan for astigmatism management.

“Let your patients know that they have two diseases, one that you can cure once and for all – their cataract, and one that lasts a lifetime and will require treatment forever. This will lead to excellent refraction results. It’s what you and your patients deserve, ”said Matossian.

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