Esen Akpek, M.D., the Bendann Family Professor of Ophthalmology at Wilmer Eye Institute, Johns Hopkins Medicine, will be participating at Ophthalmology Times’ EyeCon 2022 in Marco Island, Florida, Dec. 16. Akpek will be speaking during a session entitled “Award-Winning (Tear) Film: Treating Dry Eye Disease.”

We spoke with Akpek prior to the conference to learn more about the topic.

Can you tell us about what you’ll be presenting on at EyeCon 2022?

I will be presenting a case where dry eye was not addressed prior to cataract surgery. Although the procedure was performed perfectly, the patient complained that she could not see well. She subsequently had several other procedures which didn’t help improve the vision, and then she was referred to me. I found that she had less than perfect tear film with inadequate stability.

What is the significance of tear film?

Tear film covers the top layer of the corneal surface where light rays enter the eye. About two-thirds of the refractive power of the entire eye is provided by the combination of tear film and the anterior surface of the cornea, so that is a very important optical structure. When you have less than adequate tear film, meaning unstable or thin or in any way optically not clear, it has a huge impact on vision. Inadequate tear film can result from dry eye, and if this had been addressed prior to the removal of the cataract, the patient would have been much happier with the outcome of the surgery. Unfortunately, however, dry eye is often overlooked.

Why could dry eye be overlooked?

Because it takes specific exams that are not part of a comprehensive eye evaluation, one could easily miss dry eye, so we always have to actively look for it, not just when the patients complain of dryness. We have to specifically examine the tear film.

Frequently, surgeons don't check for dry eye, or they think a patient is going to become upset if they have to go through dry eye treatment first, which can delay the surgery by several weeks to a few months. But I have yet to see a patient who declined dry eye treatment when I tell them their corneal surface is not good, and that we need to address this first. They're more than grateful.

How is dry eye treated?

It takes a concerted effort to restore the tear homeostasis. It's not unusual to use a combination of medical and procedural treatments. There's not a magic drug that can address all the components of the tear film, and it takes time and patient compliance.

What groups of people are at risk for dry eye?

They include postmenopausal women, patients with underlying autoimmune diseases, those who take glaucoma eyedrops, have had refractive surgery like LASIK, diabetic patients, contact lens wearers and patients who are on antidepressants or diuretics for high blood pressure. Dry eye should also be routinely screened for in older individuals and in patients who are being evaluated for cataracts.

What do you want attendees to take away from your presentation?

Regardless of a patient's symptoms, we should always examine for dry eye, especially if the patient belongs to a high-risk group.