You first need to assess the severity of the dry eye since this can get worse after cataract surgery and should therfore be assessed preopertively to secure proper Treatment and prevent decompensation after surgery. If this has been done with lubrication and/or punctum plugs you can proceed to surgery. Be sure that what you have diagnosed is not Fuchs corneal dystrophy since then a triple procedure might be consiedered.

Hi Peter

Map, dot, fingerprint dystrophy affects the epithelium basement membrane and your biggest risk here would be recurrent corneal erosion if the dry eye is not managed properly before surgery. As Kirsten advises make sure its not Fuch's which tend to make things go pear shaped in a hurry. Is the drop in VA due to the cataract or the dystrophy? Is there any other health issues to consider that may complicate things? His visual needs may also help you with your decision, is he a pilot or driver that needs great acuity or can he cope well with 6/9?

A "minor degree lens opacity" sounds like the visual loss may be mainly due to MDF dystrophy related complications (subepithelial scarring after recurrent erosions) rather than cataract. Assessment of the fellow eye can help pinpoint the main problem in the discussed eye. If cataract and vision loss worsens to 20/40 without progression of corneal changes, perform cataract surgery as outlined above.

If you have access to one, it may be helpful to get an aberrometry examination. You can divide the straylight parameters into the corneal and total internal eye parameters and that may help you divide the corneal optical effect from the cataract effect. It's not without problems and the corneal elements are predominantly from the curvature rather than the dystrophic proportion but if you see a major lens effect that may help you inform your patients and assist decision making.