General Misconception About Astigmatism And Dry Eyes

Conventional wisdom would show that an unstable tear film in patients with dry eye produces pseudo-astigmatism due to the following apparent and logical reasoning: that the dry, irregular surface makes the eye appear to have more astigmatism and therefore cylinder than it really does.
Once dealt with, the ocular surface must be becoming smoother, and also the patient will, for that reason have less astigmatism.
Or, at the very least, that’s just how we assumed it functioned. However, in a study we recently conducted, 52% of eyes had a greater magnitude of astigmatism when measured 6 weeks after treatment with thermal pulsation therapy for meibomian gland disorder (MGD) which had caused dry eye which would have resulted in a dry, irregular surface, than before therapy.
We were not able to predict the magnitude or direction of the cylinder change, which had appeared theoretically possible base on our earlier arguments and reasoning, based upon the baseline pre-treatment keratometry. That’s why it is so essential to treat the underlying MGD prior to performing biometry as well as IOL power computations for cataract surgery.

Results
For this research, we examined keratometry, refractive error, and also other measures at baseline and also 6 weeks after a single thermal pulsation therapy in patients with MGD that were arranged for subsequent cataract surgical procedure.
The post-thermal pulsation biometry was used to calculate Intra-ocular lens (IOL) power required for the implant and also determine our strategy to astigmatism treatment and management (toric IOL, limbal relaxing incision, or absolutely nothing).
Finally, the actual refractive results were comparable to those we would certainly have got had we relied upon the pre-treatment biometry.
It turned out that 56% of eyes had much less residual refractive astigmatism (far better outcomes) after surgery than they would certainly have had if they had actually undertaken cataract surgical procedure without having the LipiFlow treatment initially.
This is great proof that treating MGD is essential for optimum outcomes during cataract surgical treatment. Furthermore, it cannot be presumed that “real” astigmatism will consistently be less than what we see with an unstable tear film.

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