乌鸦传媒

In May 2019, in the Journal of Cataract & Refractive Surgery (JCRS) that presented physicians with a new algorithm for the preoperative diagnosis and treatment of ocular surface disorders. The review article was also highlighted at the 2019 American Society of Cataract & Refractive Surgery (ASCRS) annual meeting. This year, with attendance back in full swing, the ASCRS decided to re-promote the tool for its members.

In this exclusive 乌鸦传媒 video, lead author Christopher Starr, MD, of Weill Cornell Medicine and New York-Presbyterian Hospital in New York City, describes the tool and what it has meant to surgeons over the past few years.

Following is a transcript of his remarks:

There was a publication a few years ago in JCRS and sponsored by ASCRS written by the ASCRS Cornea Clinical Committee, and I was sort of the lead on the initiative. And it was to create a pre-surgical dry eye ocular surface algorithm for diagnosing and managing ocular surface disease prior to cataract surgery and refractive surgery in general. And so it was the big undertaking.

We published a paper, and over the last 3, 4 years, it has really gained a lot of traction. It is actually now one of the most cited, maybe the most cited paper in all of JCRS and one of the highest in all of ophthalmology. And so this last meeting, ASCRS decided to kind of promote it, re-promote it -- and a lot of educational seminars, and they created an enormous version of the algorithm itself, the flowchart, and put it out in public areas at the meeting. And so it's kind of nice -- somebody took the lead on that and worked so hard on it -- to have it resonate so well. And so I think that's, for me, that was the biggest take-home from ASCRS was seeing that.

This is an algorithm; this is a way to approach these patients. It's not the only way, and you don't have to utilize this exactly as it has been written, and if you don't you're deviating from standard of care ... and the take-home message ultimately was, look, the dry eye and ocular surface diseases can have visual impact on surgical outcomes. Plain and simple, period.

And a lot of doctors, busy surgeons didn't have the inclination, the interest, or the time to sort of tackle these things. It's complicated, and the pre-op visit is already complicated and time consuming. And there's a lot of stuff, a lot of data, a lot of discussion, a lot of informed consent, so on and so forth, IOL [intraocular lens] choices, yada, yada, yada. And it takes a lot of time. And then you throw in the ocular surface stuff, and it just makes it even more complex and time consuming.

But it can't be ignored. And the point of the article, the paper, the algorithm, was you gotta address this. You can't ignore it. You're gonna have big problems -- quote-unquote complications -- if it's not addressed. And so here is a way to address it and to incorporate it into your pre-surgical visit that minimizes the time and the burden to the surgeon and the practice. And so it was a way. But the take-home message is, you can use this, use it faithfully, adopt everything that we said, the exact methodology, the diagnostic point-of care-tests -- or not, but you have to address it.

And so that was the message, and that has resonated. And I know there are many practices out there that do follow the algorithm pretty faithfully, but not all of them do. But I would bet most practices are more aware of the ocular surface, more aware of the visual consequences of dry eye.

And the term that we coined for this paper was "visually significant ocular surface disease." And identifying that prior to surgery and treating it, managing it, delaying surgery if it needs to be delayed, to get this under control, but only proceeding with final refractive measurements, IOL calculations, astigmatism correction, once that visually significant ocular surface disease has been converted to non-visually significant ocular surface disease.

And that has, that message has certainly resonated in the 4 years since it was published. And ASCRS realizing that they, we had success on our hands with the paper and all the attention it's gotten and the citations, etc, that this meeting in San Diego, this most recent meeting, which was 4 years almost to the day where it was originally unveiled -- it was a San Diego meeting 4 years ago where we first unveiled the algorithm and they promoted it very heavily then, they had gigantic monolithic light boxes in the hallways at the meeting with the algorithm on it. And the paper had just been published that same month. So it was perfect timing.

And here we are 4 years later, we're back in San Diego, and we figured that was a perfect time to kind of re-promote it, get the message out there. They printed out the gigantic algorithm again, put it on the walls, people could see it. We gave talks and sort of just refreshed people's memories as to what it was and why it's so important.

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