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Subspecialties Cataract, Cornea / Ocular Surface, Practice Management

OSD Decisions

At a Glance

  • Recent years have seen an influx in diagnostic and treatment regimens for ocular surface disease (OSD), with matrix metalloproteinases (MMPs) and osmolarity becoming increasingly important
  • MMPs are proteolytic enzymes produced by stressed epithelial cells on the ocular surface – and they destabilize the tear film
  • Identifying elevated MMP-9, which indicates inflammation, helps guide therapeutic decision making. For example, elevated MMP-9 may predict the patients most likely to respond to anti-inflammatory therapy
  • Incorporating these elements into your OSD algorithm can determine the severity of dry eye disease and dictate treatment, all while adhering to TFOS DEWS II, MGD Workshop, and CEDARS recommendations.

A groundswell of interest in the diagnosis and treatment of ocular surface disease (ODS) is reflected in the current array of algorithms aimed at simplifying the approach. These stepwise diagnostic and therapeutic recommendations seek to coalesce around the most recent clinical data and practical experience with consensus and clarity. Successful refractive cataract surgery hinges on the health of the corneal surface, which allows accurate and repeatable preoperative measurements, particularly with respect to biometry and keratometry. Precise data is crucial to guide the best IOL selection for the patient and ultimately, to ensure his or her overall satisfaction with the visual outcomes – driving ophthalmologists to present and hone OSD diagnostic and treatment regimens.

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About the Author

Marguerite McDonald

Clinical Professor of Ophthalmology at NYU Langone Medical Center, New York, and Clinical Professor of Ophthalmology at Tulane University Health Sciences Center, Louisiana. McDonald practices at Ophthalmic Consultants of Long Island, Oceanside, New York, USA.

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