Modern cataract surgery has reached new levels of precision and accuracy due to remarkable technological advancements in instrumentation and next generation IOLs. However, in spite of these advances, there remains a cohort of patients unhappy with visual quality outcomes, even when skilled surgeons hit target refraction within 0.25 to 0.50 diopters. Despite perfect surgical execution, a compromised, hyperosmolar tear film can directly and negatively impact post-operative visual quality.
Often referred to as the “tear lens”, loss of homeostasis in this primary refractive surface will degrade visual acuity by introducing fluctuations in vision, increased light scatter and loss of contrast sensitivity, all of which are independent of IOL parameters. Hyperosmolarity, the silent killer of visual quality, is not detectable at the slit lamp. This “visually significant” ocular surface disease is the result of uncontrolled dry eye disease, and is a contraindication to keratorefractive surgery per AAO and the ASCRS guidelines, which attribute risks of hyperosmolarity to include “imprecision of pre-surgical measurements” and “post-operative visual quality”.
Recent clinical data shows that advanced hyperosmolarity can create post-operative light scatter equivalent to a grade 2-3 cataract. Hyperosmolar patients may blame the surgeon when their vision fluctuates post-surgery, especially in premium and EDOF segments where there is a heightened expectation of spectacle-free or crisp near vision. Measurement of pre-operative hyperosmolarity enables proper expectation alignment and helps to avoid 20/20 unhappy patients, while management of the post-operative hyperosmolarity helps achieve optimal visual quality.
To this end, Trukera Medical has introduced the ScoutPro osmolarity measurement system, focused on meeting the needs of busy cataract surgeons. Almost one year into the ScoutPro launch, we have seen growing recognition of the direct link between hyperosmolarity and poor vision. Together with pioneering surgeons, Trukera aims to solve the puzzle of the 20/20 unhappy patient, with hyperosmolarity being an essential missing piece.