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2024 OSD Algorithm

The ASCRS Preoperative OSD Algorithm outlines a systematic approach for assessing ocular surface disease (OSD) prior to refractive surgery. It includes a preoperative visit with noninvasive measurements, an OSD screen using questionnaires and tests, and a clinical exam to determine the presence and significance of OSD. Depending on the findings, surgery may proceed or be delayed, with a treatment plan tailored to the subtype and severity of OSD.

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14 views1 page

2024 OSD Algorithm

The ASCRS Preoperative OSD Algorithm outlines a systematic approach for assessing ocular surface disease (OSD) prior to refractive surgery. It includes a preoperative visit with noninvasive measurements, an OSD screen using questionnaires and tests, and a clinical exam to determine the presence and significance of OSD. Depending on the findings, surgery may proceed or be delayed, with a treatment plan tailored to the subtype and severity of OSD.

Uploaded by

joeroot000011
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© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

ASCRS PREOPERATIVE

OSD ALGORITHM
PREOPERATIVE VISIT
NONINVASIVE REFRACTIVE PREOP MEASUREMENTS
≥ 2 week CL holiday/
(e.g., keratometry, topography, optical biometry, aberrometry, etc.)
no drops within 2 hours prior

* START HERE
OSD SCREEN
symptoms? signs?
ASCRS SPEED II Preop Questionnaire Osmolarity Inflammatory Marker (MMP-9) Lactoferrin

NEGATIVE SCREEN (All normal) POSITIVE SCREEN (Any abnormality)


OSD UNLIKELY OSD LIKELY

To help establish OSD subtype and visual significance


OPTIONAL NONINVASIVE OSD TESTS
(e.g., meibography, topography, NI-TBUT, OCT TMH, OSI, aberrometry, LLT)

CLINICAL EXAM (LLPP)


Stain (dye instillation):
Look: Lift: Pull: Push: Corneal Nerve
Corneal staining?
Blink, lids, lashes, Upper lid, examine Assess lid laxity Meibomian gland Sensitivity Testing
TBUT? +/–Schirmer’s)
interpalpebral surface superior surface ‘floppy eyelids,’ fornices expression

OSD RULED IN
OSD RULED OUT
Any combination of abnormal signs and/or symptoms;
No symptoms/No signs/Normal exam/No corneal staining
visual significance based on results of above
+/- Symptoms

NEUROPATHIC PAIN VS. EARLY SITUATIONAL OSD/DED NEUROTROPHIC


Symptoms/No signs/Normal Exam/ Stain No Symptoms/ Signs/ Exam/ Stain

< Signs > Signs

NON-VISUALLY SIGNIFICANT OSD (NVS-OSD) VISUALLY SIGNIFICANT OSD (VS-OSD)


(e.g., normal cornea, normal topography/ (e.g., corneal abnormality, central PEE, irregularly irregular
regular astigmatism, no corneal stain, stable vision) astigmatism, abnormal osmolarity, fluctuating vision, etc.)

SURGERY PROCEEDS SURGERY DELAYED


Counsel patient OSD may worsen postoperatively; Refractive measurements unreliable;
start prophylactic treatment identify all OSD subtypes

EXPOSURE/LID MALPOSITION DRY EYE DISEASE LUMPS & BUMPS CONJUNCTIVITIS


(e.g., lagophthalmos, floppy eyelid) EDE (MGD) > ADDE (e.g., EBMD) (e.g., allergic, infectious)

OPTIONAL INVASIVE REFRACTIVE TESTS


(e.g., immersion and/or contact A, B scans, etc.)
Finalized refractive surgical plan (e.g., IOL, LRI, LVC, etc.) TREATMENT PLAN
Based on subtype and severity of each OSD;
combined medical and procedural interventions

NEXT VISIT IS SURGERY ONCE VS-OSD IS Next office visit in 2–4 weeks;
CONVERTED TO NVS-OSD start at beginning of algorithm.
* END HERE

This activity has been approved for AMA PRA Category 1 CreditTM.

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