Eyeworld CME Supplements

EW SEP 2014 - Supported by unrestricted educational grant from 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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by Neda Shamie, MD Current state of dry eye treatment in cataract practices ASCRS Clinical Survey results highlight treatment trends I n the 2014 ASCRS Clinical Survey, most anterior segment surgeons report that, prior to surgery, less than 20% of their cataract surgery patients have ocular surface disease (OSD) requir- ing treatment beyond artificial tears. However, evidence suggests that this estimate is too low. For exam- ple, in the P.H.A.C.O. study, more than 60% of patients presenting for routine cataract surgery had very rapid tear breakup time, and about half had central corneal staining. 1 Corneal staining (either central or peripheral) is the main differen- tiating factor between level 1 dry eye, which can be managed with artificial tears, and level 2, to which anti-inflammatory drops should be added. 2 As a result of this under- estimation, surgeons may be missing opportunities to improve outcomes by treating OSD before surgery. There were a number of other interesting responses related to dry eye from the 2nd annual ASCRS Clinical Survey, which drew responses from more than 1,500 ASCRS members. About two-thirds of respondents were unsure of the international Dry Eye Workshop (DEWS) or the Tear Film and Ocular Surface Society (TFOS) guidelines for treating dry eye and meibomian gland disease, indicating that many may not be aware of the suggested treatment protocols for a level 2 patient. Thus far, few have implemented advanced point-of-care diagnostics into their office protocols for screen- ing for OSD, and nearly 40% say they see no value in incorporating advanced testing. About 90% agree that staining and TBUT are useful in diagnosing OSD, while 25% to 50% believe that new techniques such as MMP-9 testing, lipid layer interfer- ometry, and osmolarity testing will increase diagnostic accuracy. Eighty-eight percent agree or strongly agree that mild to moderate dry eye significantly affects postop- erative satisfaction in cataract and refractive patients, and 87% agree or strongly agree that ocular surface inflammation is a key mechanism in the pathogenesis of dry eye disease. The survey indicates that rates of presbyopia-correcting IOL use have doubled since the 2013 survey, now making up 7.2% of cataract cases (up from 3.4% in 2013) and are expected to at least double again over the next 3 years. When com- bined with toric IOLs, that means premium lenses could soon make up nearly one-quarter of all cataract procedures. The treatment of OSD will be increasingly important in order to achieve the postoperative vision and satisfaction these premium IOL patients expect. In the following articles, our panel of experts will discuss the role of the tear film in refractive cataract surgery and ways that we can address dry eye to potentially improve our patients' visual function after surgery. References 1. Trattler W. Preoperative evaluation of the presbyopic IOL patient: Impact of dry eye and blepharitis. Course, American Academy of Ophthalmology, November 2012. 2. Behrens A, Doyle JJ, Stern L, et al. Dysfunctional tear syndrome. A Delphi approach to treatment recommendations. Cornea 2006;25:90–7. Dr. Shamie is associate professor, University of Southern California Eye Institute, University of Southern California Keck School of Medicine, Los Angeles. She can be contacted at nshamie@yahoo.com. Supported by an unrestricted educational grant from Allergan 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 through the joint providership of the American Society of Cataract & 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 activity will: • Describe how preoperative dry eye and tear film problems have a cascading effect on refractive cataract surgery, with significant consequences for surgical planning; • Discuss the contributions of the tear film to optical image quality and how changes in tear film structure can alter the eye's refraction, directly impact the visual quality following cataract surgery, and have particular optical and satisfaction consequences for presbyopia- correcting and toric IOL patients; and • Integrate more reliable, compliant, and impactful therapeutic approaches to support the integrity of the ocular surface in patients undergoing advanced IOL surgery. Designation Statement The American Society of Cataract & Refractive Surgery designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits.™ Physicians should claim only credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit online, participants must visit bit.ly/1sZoLtb to review content, complete 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. Alternatively, the post-test form included in this supplement may be faxed to the number indicated for credit to be awarded, and a certificate will be emailed within 2 weeks. When viewing online or downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the downloaded materials. CME credit is valid through February 28, 2015. 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 activity who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs.org or 703-591-2220. Financial Interest Disclosures Neda Shamie, MD, has received a retainer, ad hoc fees, or other consulting income and travel reim- bursement from: Allergan Inc., Bausch + Lomb Inc., and Nicox, and is a member of the speaker's bureau of Allergan Inc., Bausch + Lomb Inc., Merck Sharp & Dohme Corporation. Marjan Farid, MD, has received a retainer, ad hoc fees, or other consulting income from Abbott Medical Optics. Cynthia Matossian, MD, FACS, has received a retainer, ad hoc fees, or other consulting income from Abbott Medical Optics, Icon Bioscience, Imprimis, Lenstec, and Marco, and is a member of the speaker's bureau of Alcon Laboratories Inc., Allergan Inc., Abbott Medical Optics, Bausch + Lomb Inc., Marco, and Tearlab. She has research fully or partially funded by Lenstec and Physician Recommended Nutriceuticals and an investment interest in Checked Up, Physician Recommended Nutriceuticals, and Strathspey Crown. She earns a royalty or derives other financial gain from Physician Recommended Nutriceuticals. Eric D. Donnenfeld, MD, has received a retainer, ad hoc fees, or other consulting income from Abbott Medical Optics, AcuFocus Inc., Alcon Laboratories Inc., Allergan Inc., AqueSys Inc., Bausch + Lomb Inc., Cataract & Refractive Surgery Today, CRST, Elenza, Glaukos Corporation, Kala Pharmaceuticals Inc., LacriPen, LacriSciences LLC, Mati Pharma- ceuticals, Mimetogen Pharmaceuticals, NovaBay Pharmaceuticals, Ocular Therapeutix, Odyssey, SARcode Bioscience, Tearlab Corporation, TearScience, WaveTec Vision Systems Inc., and is a member of the speaker's bureau of Alcon Laboratories Inc. and Allergan Inc. His research is fully or partially funded by Bausch + Lomb Inc., Elenza, Ocular Therapeutix Inc., and WaveTec Vision Systems Inc. He has an investment interest in Glaukos Corporation, LacriPen, LacriSciences, Mati Pharmaceuticals, Mimetogen Pharmaceuticals, NovaBay Pharmaceuticals Inc., Rapid Pathogen Screening Inc., SARcode Bioscience, Strathspey Crown, TearLab Corporation, TrueVision Systems Inc., and WaveTec Vision Systems Inc. Neda Shamie, MD The neglected refractive interface: Impact of the tear film on refractive cataract surgery outcomes Supplement to EyeWorld September 2014 Click to read and claim CME credit

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