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Ocular Surface Cataract/Refractive the production of anti-inflammatory prostaglandins and the lipid component of the meibomian gland secretions 28–30 helping to stabilise the tear film. Patients who remain symptomatic despite aggressive therapy may benefit from preservative-free artificial tears. The use of autologous serum and moisture-chamber goggles are additional options for patients with severe DES. Conclusion Identifying and treating DES pre-operatively can help to avoid post-operative surprises. The early identification and treatment of postoperative DES will hasten patients’ recovery, prevent their frustration and enhance surgical outcomes. n Questionnaire We conducted a questionnaire with 20 surgeons in cataract and refractive surgery, to enquire about the importance given to the presence of OSDs in patients having ocular surgery. We sought to get their opinion on whether they performed pre-treatment, if new technologies were employed and if they manage these concerns themselves or prefer to refer the patient to a specialist in OSD. The responses were predictable up to a point. All gave importance to the presence of OSD and their treatment pre- and post-surgery, but 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 30 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. The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007), Ocul Surf, 2007;5(2):93–107. Lemp MA, Advances in understanding and managing dry eye disease, Am J Ophthalmol, 2008;146:350–56. Preferred Practice Pattern, Dry Eye Syndrome, San Francisco, CA: American Academy of Ophthalmology; September, 2008. Schein OD, Munoz B, Tielsch JM, et al., Prevalence of dry eye among the elderly, Am J Ophthalmol, 1997;124:723–8. Hikichi T, Yoshida A, Fukui Y, et al., Prevalence of dry eye in Japanese eye centers, Graefes Arch Clin Exp Ophthalmol, 1995;233:555–8. McCarty CA, Bansal AK, Livingston PM, et al., The epidemiology of dry eye in Melbourne, Australia, Ophthalmology, 1998;105:1114–19. Albietz JM, Dry eye: an update on clinical diagnosis, management and promising new treatments, Clin Exp Optom, 2001;84:4–18. Nichols KK, Foulks GN, Bron AJ, et al., The International Workshop on Meibomian Gland Dysfunction: executive summary, Invest Ophthalmol Vis Sci, 2011;52:1922–9. Hardten DR, Dry eye disease in patients after cataract surgery, Cornea, 2008;27:885–6. Ram J, Gupta A, Brar GS, et al.,Outcomes of phacoemulsification in patients with dry eye, J Cataract Refract Surg, 2002;28:1386–9. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. not all considered important new technologies; some do not treat the patients themselves, but would rather refer to another specialist. The final question looked at how surgeons believed ocular surface disorders affected the surgical outcomes. The mean score was 7.2 (scale given in question 5), which is a good score but we believe it is necessary to further raise awareness of the role that OSD plays in the success of cataract and refractive surgery among surgeons. 1.  Do you make some type of pre-operative study to rule out OSD before cataract or refractive surgery? 20/20: YES 2.  Do you consider the use of new technologies such as Dynamic Wavefront (sequential aberrometry between blinks), meibography, interferometry to study the tear film or confocal microscopy to study corneal inflammation necessary to analyse ocular surface before surgery? 12/20: YES 3. If ocular surface disorders exist pre-operatively, do you use specific treatment before surgery? 20/20: YES 4. As a cataract and refractive surgeon, do you manage the pre- and post-operative treatment yourself or do you prefer to refer to a specialist in OSD? 14/20: treat themselves and six surgeons refer patients to a specialist in OSDs. 5. How do you think the presence of ocular surface disorders affect the outcomes of surgery, on a scale from 0 (no importance) to 10 (extremely important)? Mean: 7.2 Donnenfeld E, Pflugflelder SC, Topical ophthalmic cyclosporine: pharmacology and clinical uses, Surv Ophthalmol, 2009;54:321–38. Toda I, LASIK and the ocular surface, Cornea, 2008;27(Suppl. 1):S70–S76. Lemp MA, Nichols KK, Blepharitis in the United States 2009:a survey-based perspective on prevalence and treatment, Ocul Surf, 2009;7(2 Suppl.):S1–S14. Korn BS, Kikkawa DO, Schanzlin DJ, Blepharoplasty in the post-laser in situ keratomileusis patient: preoperative considerations to avoid dry eye syndrome, Plast Reconstr Surg, 2007;119(7):2232–9. Liu Z, Luo L, Zhang Z, et al., Tear film changes after phacoemulsification [in Chinese], Zhonghua Yan Ke Za Zhi, 2002;38(5):274–7. Salomao MQ, Ambrosio R Jr, Wilson SE, Dry eye associated with laser in situ keratomileusis: mechanical microkeratome versus femtosecond laser, J Cataract Refract Surg, 2009;35(10):1756–60. Solomon R, Donnenfeld ED, Perry HD, The effects of LASIK on the ocular surface, Ocul Surf, 2004;2(1):34–44. 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Presented at World Cornea Congress, 2010, Boston, MA. Perry HD, Doshi-Carnevale S, Donnenfeld ED, et al., Efficacy of commercially available topical cyclosporine A 0.05% in the treatment of meibomian gland dysfunction, Cornea, 2006;25(2);171–5. Donnenfeld ED, Soloman R, Roberts CW, et al., Cyclosporine 0.05% to improve visual outcomes after multifocal intraocular lens implantation, J Cataract Refract Surg, 2010;36(7):1095–1100. Usea R, Purcell TL, Tan BU, et al., The effect of cyclosporine A (Restasis) on recovery of visual acuity following LASIK, J Refract Surg, 2008;24(5):473–6. Pinna A, Piccininni P, Carta F, Effect of oral linoleic and gamma linolenic acid on meibomian gland dysfunction, Cornea, 2007;26(3):260–64. Macsai MS, The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction, Trans Am Ophthalmol Soc, 2008;106:336–56. Brown NA, Bron AJ, Harding JJ, Dewar HM, Nutrition supplements and the eye, Eye (Lond), 1998;12(Pt 1): 127–33. 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