At the 2026 ASCRS meeting on Friday, Marjan Farid, MD presented "The Importance of Treating OSD and Lid Margin Disease Preoperatively." Here, she shares key points from her presentation with Ophthalmology Management readers. The below transcription has been edited for clarity.

Hi, my name is Marjan Farid. I’m the director of cornea, cataract, and refractive surgery at the Gavin Herbert Eye Institute at UC Irvine. I’m excited to share with you today what we spoke about in the Cornea Day session at the 2026 ASCRS meeting. We looked at updates in ocular surface disease management. Specifically, I spoke about the importance of treating ocular surface disease preoperatively.

The ASCRS cornea clinical committee took initiative back in 2017 to [develop] an algorithm that emphasizes the importance of diagnosing ocular surface disease in the preoperative setting, to identifying these patients that are in our clinics all the time, to managing the ocular surface disease preoperatively.

We’re happy to announce at this year’s meeting that the algorithm has been updated to ASCRS OSD algorithm 2.0, which has some great updates. But again, the core importance of identifying ocular surface disease preoperatively is really emphasized.

So, what are the top 5 reasons to care about the ocular surface prior to surgery? Well, the first reason is that surgery will worsen dry eye symptoms and signs. This has been shown in several studies, including Bill Trattler’s PHACO Study, where 80% to 85% of preoperative patients are often asymptomatic. There was a second study done by Preeya Gupta, MD, and Chris Starr, MD, showing that most preoperative cataract patients will be asymptomatic, but if you actually look for signs of dry eye disease and ocular surface disease, 60% to 75% will have at least 1 sign of ocular surface disease. These are patients who are at high risk. If you don’t identify and treat these patients preoperatively, then you’re turning an asymptomatic dry eye patient into a symptomatic dry eye patient after cataract surgery. Of course, that results in patient dissatisfaction, and they often blame the surgeon for causing dry eye disease where the patient felt that they did not have any preoperatively. The mechanisms are multiple for why patients get worse dry eye disease after surgery.

The second reason is that if you don’t catch ocular surface disease and there is irregularity in the tear film, then you’re going to have errors in your biometry measurements and refractive outcomes. The tear film is the most important refractive interface of the eye; the refractive index between the air and the tear film is the highest change in refractive index. And when there’s rapid tear breakup time, you’re going to create irregularities in that tear film, which are going to increase your higher-order aberrations.

A great study by Alice Epitropoulos, MD, looked at dry eye patients vs non-dry eye patients, with biometry measurements done twice, 3 weeks apart, showing that patients with preoperative dry eye or ocular surface disease had a much higher variability in their keratometries, a much greater difference between readings, and a greater difference in their IOL power selection. So, if you go with patients with dry eye disease and you don’t treat those symptoms, you can often get errors in your postoperative refractive outcomes and more refractive surprises.

The third reason is that preoperative treatment of ocular surface disease improves outcomes. There are several studies that show that if you take the time 1 month to 6 weeks preoperatively, and manage that ocular surface, you’re going to get improved prediction error in your biometry readings.

The fourth reason is that untreated lid margin disease is really important as well. Having patients look down and examining them for collarettes and blepharitis will improve your ability to diagnose patients at high risk for infection. Treating the lid margin disease preoperatively can reduce that risk of postoperative infection.

Finally, the most important reason for catching ocular surface disease and treating it preoperatively is that ocular surface smooth tear film is really the underlying critical factor for getting quality vision and patient satisfaction.

We’re looking forward to going through the updates to our ASCRS algorithm with you all and hope you had a wonderful meeting. Thank you.