How do you get your patients ready for cataract and refractive surgery? Are many of them—or any of them—prepping weeks in advance? Could they be? Should they be? If it’s beneficial, who is going to ask them to do it and who will show them how?
“We all know that a healthy ocular surface that’s been hydrated and maintained over several weeks is preferable to a quick steroid tune-up alone, yet we often resort to the latter because we assume that patients aren’t going to bother with hygiene,” says Darrell E. White, MD, of Skyvision Centers. “But as the saying goes, you’ll miss 100% of the shots you don’t take.”
Optimal vision following surgery depends on good measurements, which can be off target in patients with ocular surface disease.1,2 Research also shows that ocular surface disease significantly affects astigmatism planning and post-operative comfort, while making patients more susceptible to infection.3,4 Notably, most patients presenting for cataract surgery in particular have pre-existing ocular surface disease, sparking numerous researchers and associations to recommend proactive management.5,6,7,8,9 Specifically, use of a moist heat eye compress, lid wipes, and hypochlorous acid solution have been shown to improve ocular surface health and limit bacteria and can be performed in the weeks leading up to cataract, refractive and other corneal surgeries.
Whether you’re working in an optometric practice or a surgical center, here’s how you can help prepare patients who express an interest in surgery—beginning the moment they call your practice to make an appointment.10
Help Patients Make the Most of Wait Times
Whether you practice in an optometry clinic or a surgery center, you have an important role in recommending pre-surgical prep. Unless you’re in the extreme minority of eye care providers offering same day surgical consultations, chances are there will be days—if not weeks—between the time that patients first call the office and their initial appointment. “Use that time to help patients get ready,” suggests Douglas Devries, OD, of Eye Care Associates of Nevada. “Your office staff can email a list of ocular hygiene products, or a hygiene kit, that patients can start using right away to increase the chances that they won’t experience long lag times before surgical measurements can be collected.”
Another common scenario is the patient who comes for their regular comprehensive eye exam and suddenly decides that they’re ready for that cataract surgery you’ve been nudging them toward for the past decade. Chances are you’re not going to collect measurements the same day, so why not send these patients home with a pre surgical prep kit, containing at-home products that will help clean up their lids and optimize the ocular surface.
Empower Your Patients to Do Their Part
We can’t expect patients to know what is involved in preparing for surgery … we need to spell it out.
A common barrier to recommending pre-surgical prep is that a misconception patients won’t engage in a daily eye care routines.
However, research shows that this is not necessarily an accurate assumption. A recent mixed methods survey of 278 age-matched adults showed that 87% of participants said they would use a presurgical prep kit if their doctor gave them one; 83% would be willing to buy one in the practice and 73% would purchase a prep-kit online and use it if their doctor asked them to do so.11
“Surgical patients are much more motivated to engage in short term healthy behaviors,” says Lisa Feulner, MD, PhD, of Advanced Eye Care. “Case in point: patients may not floss their teeth as directed by their dentist, but they will follow a surgeon’s orders to prep before a colonoscopy.”
“We’ve fallen into this trap where we’re buying into the narrative that, as long as we warn patients that they’ll have some dry eye after surgery, it places the fault on the patient,” says Paul Karpecki, OD, of Kentucky Eye Institute. “This may be true if we specifically ask them to do what we think would help them avoid this fate, but are we really, always recommending a structured intervention? We can’t honestly expect patients to know what this involves. We need to spell it out.”
What to Recommend and Why
The Bruder Pre-Surgical Prep Kit contains a lid wipe, hypochlorous acid spray and a moist heat compress. For practices that can’t inventory the necessary kits, Bruder offers a prescription pad that contains information for online purchase as well as instructs for easy use.
Several studies support the use of eyelid cleansing wipes as part of a pre-op hygiene routine.12,13 For example, one study of eyelid cleansing wipes used before cataract surgery found that ocular surface microbiota reduction using wipes was comparable with results following topical application of antibiotics, leading the authors to suggest prophylactic eyelid wipe use before any ocular surgery to reduce the risk of postoperative endophthalmitis.14
Bruder Eyelid Cleansing Wipes feature a leave-on, no-rinse formula that helps dissolve and remove excessive oils and debris from eyelids and lashes. The pre-moistened, individually-wrapped wipes are hypo-allergenic and free of harsh chemicals. Importantly, they don’t sting or burn and are gentle enough for daily use. Gently wiping a Bruder Hygienic Eyelid Cleansing Wipe across the eyelids and lashes is the optimal first step in a lid hygiene regimen and is also a great way to remove eye makeup. For patients who have Demodex, the wipes are also available with tea tree oil.
After cleaning the eyes with the eyelid cleansing wipes, advise patients to apply one to two sprays of Bruder Hygienic Eyelid Solution to closed eyes to reduce bacterial growth and other microorganisms. This spray includes 0.02% pure hypochlorous acid, which is a commonly used ingredient in lid hygiene sprays because it’s so effective against a wide range of microorganisms, helping to fight infection, reduce inflammation, control the body’s response to injury, and enhance its natural ability to heal. Hypochlorous acid works to support rapid and effective relief from dry eyes, styes, and red, itchy eyelids associated with conditions like blepharitis and meibomian gland dysfunction (MGD). In contrast to other lid sprays, the Bruder solution contains no alcohol, oil, sulfates, parabens or added fragrance, making it an ideal foundation for good eyelid health and a beneficial addition to a daily eye care routine.
Heat therapy has shown significant benefits in improving tear film stability as well as significantly better outcomes.15 When selecting a mask, keep in mind that the gold standard Bruder Moist Heat Eye Compress is not like other eye masks. The Bruder Moist Heat Eye Compress excels due to patented MediBeads technology that provides the moist, uniform, extended heat required to effectively liquify oil in the meibomian glands and release eyes’ natural hydration. The ordinary compresses rely on silica gel beads, gel, or grains that can dry out and deliver uneven heat, causing hot spots that are dangerous and reduce product performance. Conversely, the patented MediBeads in the Bruder Moist Heat Eye Compress provide clean, uniform heat. The unique, honeycomb molecular structure encourages complete absorption of water molecules and, when microwaved, releases moist heat in a controlled and consistent manner for 8 to 12 minutes. MediBeads are also infused with silver to repel bacteria and reduce the risk of infection. Importantly, the compress withstands the rigors of daily use and regular washing — the MediBeads will not break down like compresses made with inferior materials.
“I also remind patients that hydration is important — particularly in the weeks leading up to and immediately following surgery,” says Matthew Smith, MD, Of Williamson Eye Center. Water is a major constituent of the eye,16 so it’s no surprise why hydration is so important. Hydration affects the ocular physiology, morphology, ocular pathophysiologic processes and disease states found in both the front and back of the eye.17 Specifically, whole-body hydration is an important consideration in dry eye etiology and management.18 Unfortunately, average water intake falls far below recommendations.
To make adequate hydration easier for patients to achieve, Bruder Healthcare has introduced The Dry Eye Drink. This hyper-hydration drink was developed by optometrists and ophthalmologists who were specifically looking to help patients defend against dry eye signs and symptoms. It was specially formulated with anti-inflammatory ingredients, vitamins, and electrolytes to nourish and hydrate the eyes and the body. By addressing the underlying causes of dry eye disease, this hydration drink helps maintain optimal ocular health, and it does so without and sugar and without unhealthy amounts of sodium.
“In short, proper hydration therapy with the Dry Eye Drink treats the eyes from the inside out,” says Joshua Davidson, OD, FAAO, of Williamson Eye Center.
It’s Surgery Season: Is Your Practice Ready?
You’ve seen it before, and chances are you’ll see it again soon. As the end of year draws near, patients who are looking to use their flexible spending and other available healthcare fund dollars before they expire, start booking appointments for refractive and cataract surgeries. Unfortunately, some of them will be disappointed to learn that they need an ocular surface tune-up, which may cause them to miss their fiscal deadlines.
1 Epitropoulos AT, Matossian C, Berdy GJ, Malhotra RP, Potvin R. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41(8):1672-1677.
2 Starr CE, Gupta PK, Farid M, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45(5):669-684.
3 Matossian C. Impact of Thermal Pulsation Treatment on Astigmatism Management and Outcomes in Meibomian Gland Dysfunction Patients Undergoing Cataract Surgery. Clin Ophthalmol. 2020;14:2283-2289.
4 Starr CE, Gupta PK, Farid M, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45(5):669-684.
5 Epitropoulos AT, Matossian C, Berdy GJ, Malhotra RP, Potvin R. Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning. J Cataract Refract Surg. 2015;41(8):1672-1677.
6 Starr CE, Gupta PK, Farid M, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45(5):669-684.
7 Matossian C. Impact of Thermal Pulsation Treatment on Astigmatism Management and Outcomes in Meibomian Gland Dysfunction Patients Undergoing Cataract Surgery. Clin Ophthalmol. 2020;14:2283-2289.
8 Gupta PK, Drinkwater OJ, VanDusen KW, Brissette AR, Starr CE. Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation. J Cataract Refract Surg. 2018;44(9):1090-1096.
8 Trattler WB, Majmudar PA, Donnenfeld ED, McDonald MB, Stonecipher KG, Goldberg DF. The Prospective Health Assessment of Cataract Patients’ Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol. 2017;11:1423-1430.
9 Starr CE, Gupta PK, Farid M, et al. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45(5):669-684.
10 Hellem, A., LaBelle, S., Matossian, C., Karpecki, P. (2022). Interpersonal communication in eye care: An analysis of potential impacts on cataract surgery candidates’ expectations and behaviors. Clinical Ophthalmology, 16, 1003–1008. https://doi.org/10.2147/OPTH.S356895
11 Eom, Y., Na, K. S., Hwang, H. S., Cho, K. J., Chung, T. Y., Jun, R. M., Ko, B. Y., Chun, Y. S., Kim, H. S., & Song, J. S. (2020). Clinical efficacy of eyelid hygiene in blepharitis and meibomian gland dysfunction after cataract surgery: a randomized controlled pilot trial. Scientific Reports, 10(1), 11796. https://doi.org/10.1038/s41598-020-67888-5
12 Peral, A., Alonso, J., García-García, C., Niño-Rueda, C., & Calvo Del Bosque, P. (2016). Importance of lid hygiene before ocular surgery: qualitative and quantitative analysis of eyelid and conjunctiva microbiota. Eye & Contact Lens, 42(6), 366-370. https://doi.org/10.1097/icl.0000000000000221
13 Peral, A., Alonso, J., García-García, C., Niño-Rueda, C., & Calvo Del Bosque, P. (2016). Importance of lid hygiene before ocular surgery: qualitative and quantitative analysis of eyelid and conjunctiva microbiota. Eye & Contact Lens, 42(6), 366-370. https://doi.org/10.1097/icl.0000000000000221
14 Song, P., Sun, Z., Ren, S., Yang, K., Deng, G., Zeng, Q., & Sun, Y. (2019). Preoperative management of MGD alleviates the aggravation of MGD and dry eye induced by cataract surgery: A prospective, randomized clinical trial. BioMed Research International, 2019, 2737968. https://doi.org/10.1155/2019/2737968
15 Fischbarg J. Water channels and their roles in some ocular tissues. Mol Aspects Med 2012; 33: 638–41.
16 Sherwin JC, Kokavec J, Thornton SN. Hydration, fluid regulation and the eye: in health and disease. Clin Exp Ophthalmol. 2015 Nov;43(8):749-64. doi: 10.1111/ceo.12546. Epub 2015 Jun 19. PMID: 25950246.
17 Walsh NP, Fortes MB, Raymond-Barker P, Bishop C, Owen J, Tye E, Esmaeelpour M, Purslow C, Elghenzai S. Is whole-body hydration an important consideration in dry eye? Invest Ophthalmol Vis Sci. 2012 Sep 25;53(10):6622-7. doi: 10.1167/iovs.12-10175. PMID: 22952120.