Dry-eye disease (DED) is a common cause of patients seeking medical advice and a frequent source of blurry orfluctuating vision.We know that patients who have DED and are considering keratorefractivesurgery, in particular, laser in situ keratomileusis (LASIK),should be cautioned that these surgeries might worsen their DED or other ocular surface conditions.2DEDshould be treated effectively before the patient has keratorefractive or phacorefractive surgery. DED can cause are reduced visual function and might compromise the overall results of corneal, cataract, and refractive surgery. The incidence of DED and ocular surface disease (OSD) in cataract surgery candidates who are asymptomatic is higher than previously thought. In one study, upwards of 60% of routine cataract patients were asymptomatic,yet 50% had central corneal staining. In another study,7the incidence of OSD in patients presenting for cataract surgery was over 80%, and in those who were asymptomatic, over 50% had an abnormal tear osmolarity or matrixmetalloproteinase-9 (MMP-9) level. The impact of DED and OSD on topography, biometry, keratometry, and higher-order aberrations is one of the major causes of disappointing postoperative outcomes.
The annual American Society of Cataract and Refractive Surgery (ASCRS) Clinical Survey of its membership identified DED and OSD as recurring general sources of confusion. In the past few years, more than 75% of respondents were unfamiliar with the TFOS DEWS II (Tear Film & Ocular Surface Society Dry Eye WorkShop II) and the Delphi Panel International Task Force recommendations. Although only 9% were using osmolarity and 5% were using MMP-9 testing, 91% felt that mild-to-moderate DED impacts patient satisfaction in cataract and refractive surgery. In 2017, 83% of respondents indicated they would find an algorithm for ocular surface diagnostics valuable, especially in relation to refractive surgical patients. These perceived gaps in clinical practice, lack of awareness of the most current OSD tools and guidelines, and the additional complexities of managing OSD in surgical populations motivated the ASCRS Cornea Clinical Committee to undertake this novel educational effort.