Treatment of dry eye mandatory for good management of astigmatism in cataract surgery




Matossian C. Ocular surface management for accuracy of astigmatism in cataract surgery. Presented to: OSN Italy; July 10-11, 2021; Rome.

Disclosures: Matossian reports that she is a consultant for Johnson & Johnson Vision.

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ROME – Dry eye must be diagnosed and treated aggressively before cataract surgery as it can compromise preoperative keratometry readings and visual results, according to a specialist speaking to OSN Italy.

“Treat each of your cataract visits like a dry eye visit: check for dry eye, diagnose it, treat it aggressively, and bring them back for their surgical measurements once the surface is well adjusted,” Cynthia A. Matossian, MDFACS, noted.

It is estimated that three quarters of eyes undergoing cataract surgery have astigmatism greater than 0.5 D and one third have 1 D or more, according to studies. Although preoperative astigmatism correction is mandatory to achieve emmetropia, astigmatic results are often suboptimal, especially in patients with pre-existing dry eye.

Cynthia A. Matossian

“Unstable tear film affects the quality of optical surface reflections from the cornea, significantly altering K readings, with manual keratometry or advanced devices,” Matossian said. “Fortunately, we now have a wealth of options to treat our dry eye patients and have them back for more accurate preoperative measurements in as little as 2 weeks.”

In a pilot study, she evaluated how one of these options, LipiFlow Heat Pulse Therapy (Johnson & Johnson Vision), could potentially alter keratometry and treatment planning. Preoperative measurements were performed in 25 eyes of 23 patients with visually significant cataracts and concomitant dry eye associated with meibomian gland dysfunction. A LipiFlow treatment was performed, and after a few weeks the patients were brought back for re-measurements.

“I expected the dry eye treatment to reduce keratometric astigmatism, but to my surprise the magnitude of astigmatism was actually higher after LipiFlow in 52% of eyes, meaning that the astigmatism was unmasked by the treatment. In 24% of the cases the astigmatism was weaker and in the other eyes it was unchanged. In addition, a change in the orientation of the axis of the cylinder was observed in seven eyes,” Matossian said.

In 40% of these patients, she modified her planned astigmatism management approach based on post-treatment data.

“If I hadn’t done LipiFlow and had used their pre-LipiFlow data, I would have ended up with statistically significant residual refractive astigmatism,” she said.

His take home message: Be sure to check for dry eye, treat it if necessary, and re-measure the eye before making a surgical plan for astigmatism management.

“Let your patients know that they have two diseases, one that you can cure once and for all, ie their cataract, and one that is lifelong and will require permanent treatment. This will lead to excellent refraction results. It’s what you and your patients deserve,” said Matossian.

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