Dry Eye

Did you ever consider that those tools in your dry eye arsenal are also good for acutely sick eyes? I recently had a patient who drove this point home…even to my ophthalmology partner.

Shire plc obtained U.S. Food and Drug Administration (FDA) approval for Xiidra (lifitegrast ophthalmic solution) 5%, a twice-daily eye drop indicated for the treatment of the signs and symptoms of dry eye disease in adult patients.

Blepharitis is an inflammatory condition of the eyelids leading to red, irritated, itchy, and dandruff-like scales that form on the eyelashes.

Ron Melton, OD, FAAO, and Randall Thomas, OD, MPH, FAAO, discussed common practices for treating dry eye, meibomian gland dysfunction (MGD), and blepharitis at the American Optometric Association (AOA) annual meeting. Here are a few medical management pearls from their discussion.

Certainly, one would assume that nothing could be safer than a product designed for use with children. Television commercials with smiling, happy babies covered in frothy bubbles imply the product is harmless. Ubiquitous marketing alone creates a subconscious sense of safety for both doctor and patient.

I was once characterized as an “information parasite” by a colleague. I must admit that I do troll the Internet, particularly Pub Med, for new, intriguing information especially when its related to one of my two favorite ocular phenomenon that are pseudoexfoliation syndrome and the lid margin.

Point-of-care (POC) diagnostic laboratory testing is not common in eye care. This is not due to any lack of clinical need-it is rather the result of a lack of specific tests known to demonstrate diagnostic and/or treatment relevance to the optometrist and a general resistance to adopting new diagnostic technologies.

It’s been a busy week for ophthalmology research and news after both the Association for Research in Vision and Ophthalmology (ARVO) annual meeting in Seattle and the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting in New Orleans.

Dry eye represents a major opportunity with more than 25 million people suffering from the condition in the U.S.,1 and meibomian gland dysfunction (MGD) is thought to be the most common cause of dry eye.2 During a session at SECO, Walt Whitley, OD, MBA, FAAO, shared his tips for making the most of this opportunity in your practice.

Mass media and medical publications have been warning for years that the incidence of diabetes is rising rapidly and predicting a “health catastrophe” in which more than 10 percent of the U.S. population would be living with this disease.

While many eyecare practitioners (ECPs) are just now learning about Demodex infestation of the eyelids and adnexa, the fact is that this condition has been around for as long as mankind. The entomologists Johannsen and Riley from Cornell University first described the species in detail anatomically as early as 1915, but it wasn’t until the 1960s that clinical reports of demodex-related blepharitis began to emerge in the literature.

First acquired during birth from the mother and rapidly thereafter from the surrounding environment, bacteria colonize our conjunctiva and lacrimal systems. It is estimated that more than 200 species of bacteria commonly inhabit the human conjunctival mucosa.

Clark Chang, OD, MSA, MSc, FAAO, recently shared what he considers to be the top-five innovations in eye care during a session at SECO 2016.

Anyone who treats ocular surface disease (OSD) recognizes the important role oral antibiotics play in therapy, especially in patients with meibomian gland dysfunction (MGD). Yet the existing evidence is insufficient to conclude the effectiveness of oral antibiotic therapy, according to a report published in Ophthalmology.

Dr. Scott Schachter discusses using dry eye testing in your practice to identify dry eye patients.

Dry eye disease (DED) has long been thought to be a progressive condition, but a study published in Ophthalmology found that most of its participants who were diagnosed with DED reported no change or some level of improvement.

Nowadays, you are unlikely to read a journal or go to a meeting without hearing the importance of dry eye disease in our practices and for our surgical patients. This was not always the case. I want to introduce you to the Tear Film and Ocular Surface Society (TFOS) and the brains behind it: David Sullivan, PhD, and his family- Rose, Ben, and Amy-who dedicate their lives to help us better understand dry eye disease.

my fellow shared with me that after I left the room, the patient complained about me being a “salesman.” Awestruck, I came away realizing that my best intents and clinical knowledge had been taken the wrong way and that the cost of the best treatment for this patient were overshadowed by the fact that she was going to have an out-of-pocket cost.

A common barrier to many practitioners is the concern that their practice does not have the patient foundation to make investment in the services economically profitable. I assure you that OSD management will profit the patient in many ways that includes clearer, more comfortable vision, enhancing their productivity and overall wellbeing.

Scott Schachter, OD, says there have been a lot of advancements in technology that helps diagnose and treat dry eye, but he says there's still more optometrists can do.

Several weeks ago, I learned of a more recent, somewhat concerning trend. Since the Allergan and Actavis merger, sales reps are now promoting Restasis to primary care doctors, internist and allergists.

I think that most of us would agree that new technologies generally mean better patient outcomes. But those outcomes always come with an added cost.

Leaders in their respective specialties came together at the American Academy of Optometry 2015 meeting in New Orleans to share their latest research in dry eye and glaucoma.

Over the last few years, there have been several advancements in ocular surface disease diagnostic and treatment technology. Not sure which ones are right for your practice? Milton Hom, OD, FAAO, and Ben Gaddie, OD, FAAO, share their advice.

While there are a myriad of associated concerns due to ocular surface inflammation, a few eyelash-related complications of note are trichiasis, acquired distachiasis, local madarosis, and poliosis. Each of these is in some way connected to dry eye.

Check out our interview with Dr. Leslie O'Dell.

The lipid layer prevents evaporation of aqueous tears and prevents drying. Lipid deficiency due to meibomian gland dysfunction (MGD) is the most common cause of symptoms associated with dry eye disease.

Focusing on dry eye management is a great practice builder, but is not without challenges. These challenges lie in making the proper diagnosis, implementing new technology, properly training staff, developing an effective treatment plan and the time it takes to properly educate patients.

Warm compresses (WCs) are commonly recommended as supplementary therapy for MGD as well as a number of other conditions of the eyelid. While the core therapy for MGD is to remove obstruction, which requires an in-office procedure, the therapeutic goal of adjunctive WC use is to heat the eyelids to help soften and partially melt any remaining material obstructing the glands.

How often are you using punctal plugs in your practice? If your answer is similar to mine, it’s “not as often as I used to.” Classically, punctal plugs were a go-to treatment for dry eye patients. If artificial tears failed to yield relief, plugs were a logical next choice.