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Mastering Accommodating IOL’s

By: Jeffrey Whitman, MD, Moderator; Nicholas Batra, MD; Jay Pepose, MD, PhD; P. Dee Stephenson, MD; and F. Toby Tyson, MD

This course has expired. You can still review the content but course credit is no longer available.

Webinar Credits: 1

Each member of the panel shares their methods for selecting patients for these IOLs. They also discuss the pros and cons of accommodating IOLs, give tips on how to talk to patients about these lenses, and share their respective experiences.

Expiration Date: Wednesday, November 30, 2016
Release Date: November 1, 2015

Learning Objectives

Upon completion of this activity participants should be able to:
• understand the differences between each level of dry eye disease and the recommended therapies; as well as the influence on k-readings and outcomes.
• differentiate between various different IOL calculation formulas and how to match them with different patient profiles
• feel comfortable with larger incision sizes and have effective strategies for proper positioning of the lens.
• be familiar with issues relating to posterior capsule opacification, how to help prevent it during surgery and how to trouble-shoot the effects post-operative should it occur.

Statement of Need

In order to reduce patient discomfort and improve ocular surface health, it is critical that practitioners address the various underlying causes of what is broadly known as Dry Eye Disease. In the last few years, numerous studies have demonstrated that the health of the ocular surface is a significant factor to success with any anterior segment patient, and much work has been done to establish the risk factors, symptoms, causes and treatment options for dry eye. However, the methodology preferences for evaluating and treating ocular surface disease remain disperse.

Our understanding of the role of inflammation in dry eye disease continues to expand. Environment, medication and contact lenses can all trigger a cycle of inflammation on the ocular surface that is difficult to extinguish. Small irritations, such as prolonged viewing of electronic screens, can reduce blinking and cause inflammation.5 Even small amounts of inflammation can impact the function of the tear glands and meibomian glands, reducing the quality and quantity of tears, leading to further inflammation.

Practitioners have myriad tools to adopt into their practice that aid in the diagnosis and treatment of dry eye. The ultra-short SPEED questionnaire has a mere 4 questions, with the results significantly correlated with ocular surface staining and clinical measures of meibomian gland function – clinical signs rather than symptoms.

In addition to the various stains (fluorescein, rose Bengal, and/or lissamine green), tear quality and quantity can be evaluated with newer technology such as tear osmolarity testing. Ocular surface inflammation specifically can be detected by the presence of matrix metalloproteinase, a known biomarker for dry eye disease, in the tear film.

Along side the tear film, the meibomian glands must also be evaluated. Interferometry can be used to measure the thickness of the lipid layer and then provides a quantitative assessment. Studies have found significant correlation between lipid layer thickness and SPEED scores.

Once a definitive diagnosis is made, clinicians are still tasked with finding the best treatment regimen. Depending on the underlying cause and the severity of dry eye, patients may require various levels of treatment. Nutritional supplements omega-3 and omega-6 fatty acids have been shown to help stabilize the tear film , and a clinician may need to evaluate other prescription drops depending on the case.

Inflammation has been shown to be a key component of dry eye. Long-term inflammatory modulators can be used to safely treat dry eye disease. To date there has only be one commercially available FDA approved immunomodulatory treatment for dry eye. It has been shown to prevent new T-Cell activity, which drives inflammation in response to a harmful stimuli to the body. However, a significant delay before effects are seen is a significant drawback to this therapy and can significantly affect patient compliance.

Many treatment strategies have been formulated to provide more efficient and effective treatments than have traditionally been available. Due to the large variability in the disease state, there has been little thought leader consensus on these newer treatment strategies. There has also been a lack of education between dry eye thought leaders and clinical doctors regarding these new strategies.

New educational material are needed to disseminate the updated understanding of the cycle of inflammation, MGD, and dry eye, as well as new development in therapy.

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Nelson JD, Shimazaki J, Benitez-del-Castillo JM, et al. The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2011;52(4):1930–1937.
Nichols KK, Foulks GN, Bron AJ, et al. The international workshop on meibomian gland dysfunction: executive summary.Invest Ophthalmol Vis Sci. 2011;52(4):1922–1929.
Bron AJ, Tiffany JM. The contribution of meibomian disease to dry eye. Ocul Surf. 2004;2(2):149–165.
The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007)Ocul Surf. 2007;5(2):75–92.
Ngo W, Situ P, Keir N, et al. Psychometric properties and validation of the Standard Patient Evaluation of Eye Dryness Questionnaire. Cornea. 2013;32(9):1204-1210.
Chotikavanich S, de Paiva CS, Li de Q, et al. Production and activity of matrix metalloproteinase-9 on the ocular surface increase in dysfunctional tear syndrome. Invest Ophthalmol Vis Sci. 2009;50(7): 3203-3209.
Blackie CA, Solomon JD, Scaffidi RC, et al. The relationship between dry eye symptoms and lipid layer thickness. Cornea 2009;28:7:789-94.
Rashid S, Jin Y, Ecoiffier T, et al. Topical omega-3 and Omega-6 fatty acids for treatment of dry eye. Arch Ophthalmol. 2008 Feb;126(2):219-25.
George D Kymionis, Dimitrios I Bouzoukis, Vassilios F Diakonis, and Charalambos Siganos, Clin Ophthalmol. 2008 Dec; 2(4): 829–836.Published online
2008 Dec.

 

Disclaimer

The views and opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of The Dulaney Foundation.

Mastering Accommodating IOLs

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