The unfortunate reality for the cataract surgeon today is that while reimbursement is going down per case, patient expectations are going up. To meet these expectations, more expensive preoperative screening is required to practice at the highest level.
Besides the usual careful full ocular examination and ultrasonic biometry, evaluation of the ocular surface with a dry eye screening questionnaire, tear film osmolarity, MMP-9 and meibomian gland imaging can discover as many as 50% of preoperative patients have asymptomatic dry eye disease. Properly identified and treated before surgery, it is
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