Eyeworld CME Supplements

EW_JUL 2019_Supported by an unrestricted educational grant from Shire, Johnson & Johnson Vision, Sun Ophthalmics, and Allergan

This is a supplement to EyeWorld Magazine that doctors can take a test after reading and receive CME credits for.

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advancing surgical outcomes: Algorithm launches new era in preoperative OSD management 2 | SUPPLEMENT TO EYEWORLD | JULY 2019 Figure 1. Part 1 of ASCRS Preoperative OSD Algorithm continued from page 1 colleagues at Duke University, a majority of our preoperative cataract surgery patients had objective signs of OSD as measured by osmolarity and MMP-9. 4 Surprisingly, almost 50% of those who reported no symptoms had abnormal osmolarity and MMP-9. If results are positive on any of these screening tests, OSD is likely, and additional but non-essential point- of-care OSD tests can be performed if available in the office. While the OSD screen- ing battery helps identify the presence of OSD, it does not narrow down the various sub- types. Tests such as meibogra- phy, noninvasive tear breakup time, lactoferrin, tear me- niscus height, and lipid layer interferometry, among others, can aid in OSD subtype iden- tification when available. The next part of the algorithm involves a quick directed clinical exam called "LLPP"—look, lift, pull, and push. We look at the base of the lashes, eyelids, lid po- sition, blink position, tear meniscus, conjunctiva, and cornea. Then, we lift the upper eyelid to examine the superi- or cornea for lumps and/or bumps and the conjunctiva for superior limbic keratocon- junctivitis. Next, the upper eyelid is pulled away from the eye to assess laxity and flop- piness. Finally, we gently push on the lower lid to express the meibomian glands and deter- mine the quality and quantity of meibum. Staining with lissamine green, fluorescein, Figure 2. Part 2 of ASCRS Preoperative OSD Algorithm Start/End Diagnosis Optional Data Collection Essential Data Collection Decision/Informational CLINICAL EXAM (LLPP)

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