Cataract surgery is one of the most common procedures performed worldwide, and it is also one of the oldest. As techniques and technologies improve, so does the recognition of other eye health issues that could interfere or complicate patient outcomes. Occasional dry eye is an ocular surface issue that can affect both pre-op and post-op outcomes for your patients, and it is more common in cataract patients than you may think.
In fact, a PHACO study found that almost two-thirds of patients preparing for cataract surgery had clinical signs of occasional dry eye. Edward Holland, MD, director of cornea, Cincinnati Eye Institute, Cincinnati, OH, believes that occasional dry eye is “one of the most underrecognized and neglected conditions.” However, he thinks that “In cataract surgery, the busy comprehensive surgeon is not always looking out for [occasional] dry eye.” For the best surgical outcomes, practitioners need to identify any additional ocular surface issues like occasional dry eye and offer solutions for relief.
Cataracts & Occasional Dry Eye
Occasional dry eye affects an estimated 55 million people, but there are only 16 million identified cases. When it comes to cataracts, occasional dry eye can not only postpone the surgery, but it can also surface post-operation. This can cause concern and doubt in patients’ minds – something no physician wants.
Identifying Occasional Dry Eye
The first step is preparing your technicians and other staff members and explaining what questions they can ask and what symptoms/indicators they should keep an eye out for. You can also include an occasional dry eye questionnaire as part of the patient pre-op paperwork. Additionally, there are several objective tests that can be performed independently or in any combination to identify occasional dry eye:
- Tear film osmolarity
- Matrix metalloproteinase-9
- Tear breakup time (TBUT)
- Corneal staining
- Phenol red thread
- Schirmer I
- Slit lamp exam
- Check eyelids for lagophthalmos
- Examine conjunctiva
- Analyze lid margins
- Assess Meibomian glands – is what comes out free-flowing, opaque and paste-like, or hard to express?
Addressing the Patient
After preparing for cataract surgery, it can be disheartening for patients to hear that their operation must be postponed. There are a few things to cover as you ease into this unfortunate but necessary news. First, ask your patients some additional questions about their symptoms. Elizabeth Yeu, MD, Virginia Eye Consultants, Norfolk, VA, always brings up intermittent blurred vision, as it is often a symptom of the patient’s dry eye, not their cataracts. “Creating awareness of the problem helps to establish common ground, so patients recognize the importance of dry eye treatment,” explained Dr. Yeu.
Another important factor in the occasional dry eye conversation is explaining that it is a life-long eye issue and that they’ll need to be invested and participate in the care regimen. Some patients believe that once they start to feel relief, they can stop the drops, masks, softgels, etc. that have been recommended. They need to know that this eye health issue is with them for life, even after cataract surgery. John Hovanesian, MD, clinical instructor, Jules Stein Eye Institute, University of California, Los Angeles, CA, emphasizes to his patients,
“I tell my patients ‘I can’t treat your [occasional] dry eye; you have to treat it.’ They understand that they bear responsibility for success.”
Patients should also understand that their dry eyes can worsen after surgery, but they should continue with their care regimen faithfully.
Occasional Dry Eye Care
There are several different ways to help patients find relief for their occasional dry eye, and often, the type of occasional dry eye can determine which remedies to recommend. Dr. Holland favors Omega-3 supplementation and strongly recommends thermal pulsation therapy. Dr. Hovanesian suggests the use of warm compresses and lid scrubs. Sometimes, ocular steroids could be necessary, according to Dr. Hovanesian, and he will also recommend prescription drops.
Vincent P. de Luise, MD, FACS, assistant clinical professor of ophthalmology, Yale University School of Medicine, New Haven, CT, likes to recommend cyclosporine for his patients, but he will also address environmental changes to make like humidifiers.
Though Omega-3s are a standard of care for many eye care professionals when it comes to occasional dry eye and other ocular surface issues, patients often need a multifaceted nutritional approach to find fast, lasting relief. EyePromise® EZ Tears™ is a daily eye health nutraceutical specifically designed to promote ocular surface health and relieve symptoms associated with occasional dry eye.
With only 2 softgels a day, your patients are getting high-quality, potent Omega-3s plus 7 additional soothing ingredients like evening primrose oil (containing gamma linoleic acid), turmeric extract, and green tea leaf extract. This formula is proven to alleviate dryness and irritation in as little as 1 week and guaranteed to relieve occasional dry eye in 30 days.
When it comes to cataract surgery, it is best to explore all avenues that can complicate patient outcomes, and that includes occasional dry eye. Because this ocular surface issue is with patients for life, Dr. Hovanesian encourages surgeons to find a clinician whose clinical focus is occasional dry eye and partner with them. They can then help manage and guide the patient throughout their occasional dry eye journey.