Eyeworld CME Supplements

EW_SEP 2016 Supported by Alcon Laboratories Inc., Allergan Inc., Shire Pharmaceuticals, TearLab, and TearScience

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

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EyeWorld September 2016 Supported by Alcon Laboratories Inc., Allergan Inc., Shire Pharmaceuticals, TearLab, and TearScience This monograph is part of a year-long curriculum focused on treatment of ocular surface disease and management. Accreditation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continu- ing Medical Education through the joint providership of the American Society of Cataract and Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medi- cal education for physicians. Educational Objectives Ophthalmologists who participate in this activity will: • Identify the true impact of a dysfunc- tional ocular surface on cataract and refractive outcomes, identify the conse- quences that accompany an unstable tear film, and discuss the presentation of symptomatic vs. asymptomatic OSD Designation Statement The American Society of Cataract and Refractive Surgery designates this enduring materials 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. Claiming Credit To claim credit, participants must visit bit.ly/2bfDuPS to review content and 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. Alterna- tively, the post-test form included in this monograph may be faxed to the number indicated for credit to be awarded, and a certificate will be mailed within two weeks. When viewing online or down- loading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through March 31, 2017. 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 FDA or have been ap- proved 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 partici- pant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs.org or 703-591-2220. Financial Interest Disclosures Marjan Farid, MD, has received a retainer, ad hoc fees or other consulting income from Abbott Medical Optics, Allergan, RPS, Shire, and TearScience. Edward Holland, MD, has received a retainer, ad hoc fees or other consulting income from: Alcon, Bausch + Lomb, Kala Pharmaceuticals, Mati Thera- peutics, PRN, RPS, Senju, Shire, Tear Science, and TearLab. He is a member of the speakers bureau of: Alcon, Bausch + Lomb, Kala, Mati, RPS, Senju, and TearLab. Dr. Holland has received research funding from Alcon, Mati, PRN, and Senju, and has received travel expense reimbursement from Alcon and Bausch + Lomb. Steven Schallhorn, MD, has received a retainer, ad hoc fees, or other consulting income from Abbott Medical Optics, AcuFocus, Carl Zeiss Meditec, and Ivantis. Elizabeth Yeu, MD, has an investment interest in: Modernizing Medicine, RPS, and Strathspey Crown. She has received a retainer, ad hoc fees, or other consult- ing income from, and is a member of the speakers bureau of: Abbott Medical Optics, Alcon Laboratories, Allergan, Bio-Tissue, i-Optics, Ocular Therapeutix, Shire, TearLab, and Valeant. She has received a retainer, ad hoc fees, or other consulting income from: Alphaeon, GlassessOff, RPS, and TearScience. She is a member of the speakers bureau of Omeros. Staff members: Kristen Covington, Laura Johnson, and Erin Schallhorn have no ophthalmic-related financial interests. 365 Curriculum Ocular surface disease (OSD) The ocular surface: The first refractive interface of the eye continued on page 3 by Steven Schallhorn, MD Refractive patient satisfaction: Expectations for postoperative vision but this percentage declined with increasing cylinder. The condition of the ocular surface critically impacts visual outcomes from refractive and cataract surgery. To achieve results that meet patients' high expecta- tions, surgeons need to evaluate the ocular surface and treat OSD before performing preoperative measurements. In the PHACO study, Trattler et al. found that nearly 77% of patients evaluated for cataract surgery demonstrated fluores- cein corneal staining, with 50% having central corneal staining. 1 However, dry eye had been diag- nosed in only 22.1%. In a multicenter clinical trial, Epitropoulos et al. found that average K readings and anterior corneal astigmatism varied more in patients with increased tear osmolarity, resulting in significant Express centers in the U.K., patients completed question- naires one month after surgery (Schallhorn SC, data presented at 2014 AAO annual meeting). A manifest refraction close to plano was closely associated with 20/20 uncorrected visual acuity. As ex- pected, the greater the refractive error, the less likely the patient's uncorrected distance vision would be 20/20. Likewise, increasing postoperative cylinder reduced the likelihood of 20/20 vision. Consequently, patients with increased residual refractive error after surgery were less likely to be satisfied with their outcomes. Nearly 71% of patients with no residual error were very satisfied with their results compared with 66.3% with 1.00 D MSE and 51.9% with 1.50 D MSE. Further- more, 73.2% of those with no residual cylinder and 66.9% with 1.0 D cylinder were very satisfied, Ocular surface disease may be an overlooked barrier P atients have high visual expectations of laser vision correction and re- fractive cataract surgery. Although surgical and technologic refinements contin- ue to advance our capabilities, surgeons need to address ocular surface disease (OSD) to deliver the results patients expect. Postoperative satisfaction Residual refractive error is a major driver of patient dissatisfaction because of its impact on visual acuity and quality of vision. In a study of more than 4,970 eyes (2,585 patients) un- dergoing refractive lens exchange with multifocal IOLs at Optical Practice pearl: Untreated ocular surface disease (OSD) associated with refractive surgery can lead to worse refractive outcomes, im- paired vision, and reduced patient satisfaction. Properly diagnosing and managing OSD, before surgery or if it develops after surgery, is critical to providing the best care and meeting patient expectations. –Steven Schallhorn, MD EyeWorld September 2016 Click to read and claim CME credit

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