Eyeworld CME Supplements

EW OCT 2013 - Supported by 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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ASCRS Can improved ocular surface care really impact cataract and refractive surgery outcomes? This CME supplement is supported by an unrestricted educational grant from Allergan. Supplement to EyeWorld October 2013 The status of dry eye care in surgical practices by Neda Shamie, MD D ry eye is very common among patients presenting for cataract or laser vision correction surgery. If the dry eye is not treated preoperatively, it can reduce the quality of preoperative data and can have a negative impact on surgical outcomes. Just prior to ASCRS, we surveyed cataract and refractive surgeons about the incidence of dry eye in their surgical patients, their awareness of current guidelines for the diagnosis and treatment of dry eye, and how they typically screen patients for dry eye, in order to understand the current state of dry eye care in surgical practices. The results were quite illuminating. For example, although research shows that rates of dry eye are very high in cataract-age populations, most respondents (65.7%) said that fewer than 20% of their cataract patients have dry eye that requires treatment other than artificial tears. Most respondents (76.7%) also estimated that fewer than 20% of their laser vision correction patients required treatment other than tears for dry eye. These results suggest to me that dry eye is significantly underdiagnosed in surgical patients and may not be treated as aggressively as the literature recommends. Appropriate assessment is an ongoing challenge in busy surgical practices. Although surgeons know the importance of identifying and treating dry eye preoperatively, they often don't spend enough time assessing and optimizing the ocular surface, which can contribute to less-than-optimal results. When we asked survey participants how they routinely evaluate dry eye in surgical patients, the results were quite varied: • Corneal staining: 82.9% • Tear break-up time: 80% • Conjunctival staining: 51.4% • Schirmer's: 42.9% • Meibomian gland expression: 34.3% • Questionnaire: 28.6% • Topography: 22.9% • OCT: 8.6% Corneal and conjunctival staining and TBUT, not surprisingly, are leading diagnostic approaches. It is encouraging to see that topography is increasingly being used to assess the ocular surface, as it can be a powerful diagnostic tool. However, while many dry eye experts have abandoned the use of Schirmer's as a diagnostic tool, this is not reflected in general practice. Treatment We also asked how respondents would treat a 65-year-old patient presenting for cataract sur- gery with complaints of poor night vision and fluctuating vision, but no complaints of ocular irritation or foreign body sensation. A relatively low percentage (17%) said they were likely to treat that patient for dry eye, while 34% were somewhat unlikely and 26% very unlikely to offer dry eye treatment prior to surgery. This can be a mistake because dry eye in elderly patients is more likely to manifest as fluctuating vision than as foreign body sensation, as Dr. Trattler explains elsewhere in this supplement. In fact, we have very good evidencebased guidelines for diagnosis and treatment of dry eye. Divided into Levels 1 through 4, these guidelines have been published in the DEWS reports and elsewhere, yet most of our respondents were uncertain whether they were following the guidelines. It can be difficult to stay current with recommendations in this evolving field, but it behooves us all as surgeons to ensure that we are adequately screening for and addressing ocular surface problems in our surgical patients. Even mild to moderate dry eye can be treated effectively to improve postoperative outcomes. Dr. Shamie is from the Doheny Eye Institute, Keck School of Medicine, University of Southern California. She can be contacted at nshamie@yahoo.com. Financial Interest Disclosures: The faculty have disclosed the following financial interest relationships within the last 12 months: Francis S. Mah, MD, has received a retainer, ad hoc fees, or other consulting income from: Alcon, ForSight Labs, and ISTA. He is a member of the speakers bureaus of Allergan and Bausch + Lomb. Neda Shamie, MD, has received a retainer, ad hoc fees, or other consulting income from: Allergan, Bausch + Lomb, and Nicox. She is a member of the speakers bureaus of Allergan, Bausch + Lomb, and Merck. Craig McCabe, MD, PhD, FACS, is a member of the speakers bureaus of: Alcon Laboratories, Allergan, Bausch + Lomb, and Merck. William B. Trattler, MD, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Allergan, Bausch + Lomb, CXLUSA, Ferrara Ophthalmics, LensAR, and Lenstec. He is a member of the speakers bureau of Oculus. He has received partial or full research funding from Bausch + Lomb and Hoya Vision Care and has received travel expense reimbursement from Abbott Medical Optics. Continuing Medical Education (CME) Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Society of Cataract and Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this course will: • Understand the key study data on the prevalence rates of dry eye signs and symptoms in patients undergoing cataract and refractive surgery; • Identify the impact of DED on the various preoperative and postoperative elements of cataract and refractive surgery, and understand how this impacts outcomes; and • Develop palliative and therapeutic treatment strategies to manage DED patients in an anterior segment surgical setting, both preoperative and postoperatively. Designation Statement The American Society of Cataract & Refractive Surgery designates this live educational activity for a maximum of 1.0 AMA PRA Category 1 Credits.™ Physicians should claim only credit commensurate with the extent of their participation in the activity. George O. Waring IV, MD, FACS, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Alcon, Allergan, Allcerated Vision, ACE Vision Group, AcuFocus, Bausch + Lomb, FocalPoint Asia, Revital Vision, and SRD Vision. He has received travel expense reimbursement from Reichert. Staff member Laura Johnson has no financial interests to disclose. Staff consultant Jan Beiting has received a retainer, ad hoc fees, or other consulting income from AcuFocus, Abbott Medical Optics, Iridex, Johnson & Johnson Vision Care Inc., TearScience, and WaveTec Vision Systems. Claiming Credit To claim credit, participants may either fax in the post-activity test or visit www.CMESupplements.eyeworld.org to download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. When downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through February 28, 2014. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs.org or 703-591-2220.

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