Comprehensive Dry Eye Treatment Before Cataract Surgery

Project Christmas Smile is a grassroots program that provides emergency dental care to people who can’t afford treatment. Its goal is to help people be pain-free for the holidays. Several years ago, while volunteering at one of the program’s events, Carol Dombrowski, DDS, learned about a unique opportunity for practicing dentistry. “One of the other dentists that day asked if I knew anybody who might want to work in a jail,” Carol remembers. “I said, Yeah, sure, I would. That’s how I came to provide dental care in our local jails. I really liked the work. I did it for 10 years. I also taught dental assisting and dental hygiene at Indian River State College in Fort Pierce.” Carol retired in 2015 and now devotes a lot of her time to quilting, sewing, reading and paddle boarding. There was a time, though, when all activities became increasingly difficult for her due to pain and discomfort caused by dry eye disease. Dry eye is a common condition in which the eyes fail to produce the right quantity or quality of tears to stay sufficiently lubricated. The symptoms can be uncomfortable and impair vision. “My eyes burned terribly, and I would experience double vision,” Carol laments. “When I tried to read, my eyes would get very dry, and my vision would blur. I had to keep blinking to try to see clearly. But the burning was really my biggest concern. It was quite severe.” At the same time, Carol was developing cataracts, a clouding of the lenses due to a buildup of protein deposits. In addition to blurring vision, cataracts can cause colors to fade and halos or starbursts to appear around lights at night. The only treatment for cataracts is surgery to remove the affected lenses, which are typically replaced with synthetic intraocular lenses, or IOLs. While the cataracts interfered with Carol’s daily activities, her bigger concern was her dry eyes. “I live on the east coast of Florida in the Treasure Coast area, and I saw several eye doctors there, but the response I typically got was, Your eyes are just dry. Put drops in them,” Carol recounts. “Because my dry eye was so severe, I started looking for someone with more expertise. I did a Google search, and Dr. Desai’s name kept popping up in the journals. Fortunately for me, he was just across the state.”

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Carol can see clearly and comfortably, which makes hobbies such as quilting and sewing more enjoyable.

Precise Measurements

Neel R. Desai, MD, is a board-certified, fellowship-trained ophthalmologist who specializes in corneal disease, LASIK and refractive surgery at The Eye Institute of West Florida. Dr. Desai assured Carol that he could help her with her dry eyes and cataracts. “In the process of doing a comprehensive exam, we discovered that Carol’s dry eye disease had resulted in the surface of her eye not being smooth,” Dr. Desai recalls. “She had lumps, bumps and an accumulation of scar tissue on the surface of her eyes, which is actually quite common. About 50 percent of cataract patients will have this condition. “But if a surgeon neglects this problem and rushes the patient to cataract surgery, a few bad things can happen. For one, the measurements used to plan the cataract surgery and determine the power of the replacement lens may be highly imprecise, misleading and outright wrong, which would lead to a poor visual outcome.” Another consequence of not treating dry eye disease before cataract surgery is that it limits the choice of replacement lens. This robs patients of the opportunity to take advantage of the latest lens technology that provides the best vision possible with little to no dependence on glasses or contact lenses. To avoid these situations, Dr. Desai treated Carol’s dry eye before her cataract surgery. “We started by performing a 30-second procedure to smooth out the bumps and polish the ocular surface,” Dr. Desai reports. “We then placed an amniotic patch to allow the eyes to heal regeneratively.” The amniotic patch is derived from the amniotic membrane that surrounds a baby in the womb, Dr. Desai explains. The tissue, which is rich in growth and healing factors that adults don’t have, is donated by mothers following healthy births. “My research over the last 20 to 25 years has allowed us to take that tissue, sterilize it, process it and cryopreserve it so that it retains all those healthy growth and healing factors,” the doctor says. “We create the patches and place them on the patient’s eye just like you do with a contact lens. “Amniotic patches were placed on Carol’s eyes for a few days, and her eyes miraculously healed and became as smooth as a baby’s bottom. At that point, we were able to achieve very precise measurements to plan the cataract surgery. “And because her measurements were so precise, we were able to place IOLs that are much more sophisticated. As a result, she is now glasses-free for most activities. “Carol’s vision is much better than if we had not treated her dry eye disease first, and helping patients get the best vision possible is my greatest joy as a professional.”

“Fantastic” Vision

Dr. Desai treated Carol’s dry eye disease, then removed and replaced her cataracts in 2021. For IOLs, Carol decided on an option called monovision, in which one eye is implanted with a lens that corrects for near vision while the other is corrected for distance vision. “I chose monovision because seeing close-up without glasses is very important to me because of my hobbies,” Carol reasons. “I’ve worn glasses since I was 10 years old, but now I don’t need glasses at all because my vision is fantastic. It’s even better than I expected, so I’m thrilled with the results.” “As for the dry eye disease, that is a chronic condition, so my eyes will always be dry. But the treatment Dr. Desai provided made a profound impact on my quality of life. I now function at a much improved level. The treatment has allowed me to enjoy my hobbies and be much more comfortable in general. It was an absolute success.” The retired dentist says Dr. Desai is “by far, one the best physicians I’ve ever seen.” “He’s a great listener,” she asserts. “He’s kind, patient, very compassionate and incredibly pleasant. When you walk into a room with him, you immediately feel at ease. He’s also very humble. “Even though I travel over three hours to get to The Eye Institute of West Florida, I wouldn’t trust my eye care to anybody other than Dr. Desai.”