Pre-Cataract Optimization

Don’t let Ocular Surface Disease affect your cataract surgery outcomes.

Did you know that Prokera is an effective pre-cataract surgery optimization treatment?

In the recent annual American Society of Cataract and Refractive Surgery (ASCRS) Clinical Survey, it was noted that Ocular Surface Disease (OSD), including Dry-Eye Disease (DED), can affect the visual quality of patients undergoing keratorefractive and phacorefractive surgery significantly.1

In a survey initiated by the ASCRS in 2017, 83% of people indicated an algorithm for ocular surface diagnostics would be valuable due to lack of awareness of the most current OSD tools and guidelines.1

Why is Ocular Surface Optimization important?

The consequences of not treating Ocular Surface Diseases prior to Keratorefractive and Phacorefractive Surgeries:

Intracular Lens (IOL) Calculation Errors

Preoperative lens measurements can be inaccurate, causing surgeons to implant the wrong type of lens, select the wrong lens power, misalign a toric lens, or even place astigmatism incisions at the wrong location.

Unsatisfactory Post-Surgical Visual Outcomes

A patient with a moderate to severe Ocular Surface Disease Index (OSDI) score can develop new visual symptoms in the postoperative period, which results in discomfort and overall dissatisfaction with the surgery.

New or Persistent OSD Signs & Symptoms

The ASCRS created a category of visually significant OSD with potentially adverse effects on visual quality and Snellen acuity, both pre & post-refractive cataract surgery. This new category determines whether the identified OSD sub-types will lead to refractive errors.

Evaluation Resources for Ocular Surface Optimization

Non-Visually Significant OSD (NVS-OSD)

e.g., Normal cornea, normal topography (regular astigmatism, no corneal stain, stable vision)

  • Does not impact preoperative measurements or post-surgical refractive outcomes
  • Surgery proceeds
  • Prophylactic treatment and patient education

Visually Significant OSD (VS-OSD)

e.g., corneal abnormality, central PEE, irregular irregular astigmatism, abnormal osmolarity, fluctuating vision, etc.

  • Can impact preoperative measurements and post-surgical outcomes
  • Surgery must be delayed & biometry rechecked
  • Requires intensive, rapid OSD treatment until condition is fully resolved

What are the benefits of using Prokera for OSD?

By consensus of the ASCRS Cornea Clinical Committee, the treatment of OSD, especially VS-OSD, in
the preoperative patient population generally requires a more aggressive, often multifaceted approach
with a targeted combination of prescription medications and procedural interventions to rapidly
reverse OSD and minimize surgical delays.1

The ability of Prokera to help normalize the ocular surface quickly in chronic dry eye patients and accelerate re-epithelialization after superficial keratectomy, or when there is evidence of limbal stem cell deficiency, makes it an essential part of the pre-cataract surgical regimen. To ensure the opportunity for the best outcome for your patients, use Prokera for pre-cataract optimization.

Learn more about pre-cataract optimization and how Prokera can help. 

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Trattler, W. B., Majmudar, P. A., Donnenfeld, E. D., McDonald, M. B., Stonecipher, K. G., & Goldberg, D. F. (2017). The prospective health assessment of cataract patients’ ocular surface (PHACO) study: the effect of dry eye. Clinical Ophthalmology (Auckland, NZ), 11, 1423.
Gupta, P. K., Drinkwater,O. J., VanDusen, K. W., Brissette, A. R., & Starr, C. E. (2018). Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. Journal of Cataract & Refractive Surgery, 44(9), 1090-1096.
Tutt, R., Bradley, A., Begley, C., & Thibos, L. N. (2000). Optical and visual impact of tear break-up in human eyes. Investigative ophthalmology & visual science, 41(13), 4117-4123.\
Schein, O. D., Vitale, S., Cassard, S. D., & Steinberg, E. P. (2001). Patient outcomes of refractive surgery: the refractive status and vision profile. Journal of Cataract & Refractive Surgery, 27(5), 665-673.
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John, T., Tighe, S., Sheha, H., Hamrah, P., Salem, Z. M., Cheng, A., … & Rock, N. D. (2017). Corneal nerve regeneration after self-retained cryopreserved amniotic membrane in dry eye disease. Journal of ophthalmology, 2017.
McDonald, M. B., Sheha, H., Tighe, S., Janik, S. B., Bowden, F. W., Chokshi, A. R., … & McMurren, B. J. (2018). Treatment outcomes in the dry eye amniotic membrane (DREAM) study. Clinical Ophthalmology (Auckland, NZ), 12, 677.
Starr, C. E., Gupta, P. K., Farid, M., Beckman, K. A., Chan, C. C., Yeu, E., … & ASCRS Cornea Clinical Committee. (2019). An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. Journal of Cataract & Refractive Surgery, 45(5), 669-684.