As many as 50 percent of older Americans needing cataract surgery and 30 percent of younger patients who desire elective LASIK eye surgery show some degree of ocular surface disease, says surgeon Richard L. Lindstrom, MD, in a recent article published in Ocular Surgery News.

Dr. Lindstrom, a board-certified ophthalmologist, is founder of Minnesota Eye Consultants (Minneapolis) and Adjunct Professor Emeritus at the University of Minnesota Department of Ophthalmology.

He believes there are four stages of ocular surface disease treatment that cataract and refractive surgeons should carefully manage to enhance their patients’ surgical outcomes:

1. Preparing the cornea prior to surgery
2. Protecting the cornea during surgery
3. Rehabilitating the eye surface after surgery
4. Long-term management of the condition of the eye surface after surgery

For optimum outcomes of patients with dry eye, blepharitis, eye allergies and other eye surface problems, Dr. Lindstrom recommends these general treatment strategies:

Prior to surgery. Treat pre-existing ocular surface disease with eye drop medicines four-times-a-day for 1 to 2 weeks prior to surgery. This treatment can be combined with artificial tears, punctual occlusion, lid hygiene, nutritional supplements and other appropriate therapies.

During surgery. Use a viscous lubricating gel to coat the exterior of the eye during surgery to prevent the corneal epithelium from drying out.

After surgery. A combination of frequent use of artificial tears with twice-daily use of prescription eye drops to improve tear production (Restasis). In some cases of post-LASIK dry eye, this regimen may need to be extended for months to ensure adequate lubrication of the eye is restored.

Long-term maintenance. Patients who have dry eye or other ocular surface disease prior to cataract or LASIK surgery generally will still have the problem after surgery. Dr. Lindstrom says eye doctors need to educate these patients about their problem and the need for long-term treatment.

In a related article published recently in Review of Ophthalmology, LASIK surgeon Karl Stonecipher, MD, agrees with Dr. Lindstrom’s assessment of the need for careful management of ocular surface disease prior to cataract and laser eye surgery.

Dr. Stonecipher, medical director for TLC Laser Eye Centers in Greensboro, N.C., says he routinely prescribes steroid and antibiotic eye drops for use 4 times a day for 3 days prior to cataract and LASIK eye surgery — even for patients with no overt signs of ocular surface disease.

He says this pre-operative regimen gives him greater confidence in eye measurements taken the day of surgery and also has increased the predictability of surgical outcomes.

Dr. Stonecipher also says that though this pre-operative regimen is not yet commonplace among LASIK surgeons, he feels the addition of medicines prior to surgery does not significantly increase LASIK eye surgery cost, and that the potential benefits of a healthier ocular surface prior to surgery outweigh concerns about added costs or patient compliance.

SOURCES:
1. Ocular surface disease needs to be managed before and after surgery. Ocular Surgery News, U.S. edition. December 10, 2009.
2. First things first: Maximizing corneal health preop. Review of Ophthalmology. November 2009.