Tuesday, March 7, 2017

ABSTRACT: Acute corneal epithelial debridement unmasks the corneal stromal nerve responses to ocular stimulation in rats: Implications for abnormal sensations of the eye.


J Neurophysiol. 2017 Mar 1:jn.00925.2016. doi: 10.1152/jn.00925.2016. [Epub ahead of print]
Hirata H1, Mizerska KK2, Dallacasagrande VA2, Guaiquil VH3, Rosenblatt MI3.


Abstract 
It is widely accepted that the mechanisms for transducing sensory information reside in the nerve terminals. Occasionally, however, studies have appeared demonstrating that similar mechanisms may exist in the axon to which these terminals are connected. We examined this issue using the cornea where nerve terminals in the epithelial cell layers are easily accessible for debridement, leaving the underlying stromal (axonal) nerves undisturbed. In isoflurane-anesthetized rats, we recorded extracellularly from single trigeminal ganglion neurons innervating the cornea that are excited by ocular dryness and cooling: low threshold (<2 and="" cooling="" high="" oc="" threshold="">2 oC) cold-sensitive plus dry sensitive (LT-CS+DS and HT-CS+DS) neurons, playing possible roles in tearing and ocular pain. We found that the responses in both types of neurons to dryness, wetness, and menthol stimuli were effectively abolished by the debridement, indicating that their transduction mechanisms lie in the nerve terminals. However, some responses to the cold, heat and hyperosmolar stimuli in LT-CS+DS neurons still remained. Surprisingly, the responses to heat in ~ half of the neurons were augmented after the debridement. We were also able to evoke these residual responses and follow the trajectory of the stromal nerves, which we subsequently confirmed histologically. The residual responses always disappeared when the stromal nerves were cut at the limbus, suggesting that the additional transduction mechanisms for these sensory modalities originated mostly likely in stromal nerves. The functional significance of these residual and enhanced responses from stromal nerves may be related to the abnormal sensations observed in ocular disease. 
Copyright © 2016, Journal of Neurophysiology.

ABSTRACT: The impact of dysfunctional tear films and optical aberrations on chronic migraine.

Eye Vis (Lond). 2017 Feb 21;4:4. doi: 10.1186/s40662-017-0070-1. eCollection 2017.
Shetty R1, Deshpande K1, Jayadev C1, Wadia K1, Mehta P1, Shroff R1, Rao HL1.
Author information
Abstract
BACKGROUND:
Migraine is a multifactorial disorder with complex neuronal and vascular mechanisms that encompasses a wide clinical spectrum of symptoms, including ocular manifestations. Dry eye disease and dysfunction of ocular somatosensory pathways have been implicated in the pathogenesis. The current study investigates the association between a dysfunctional tear film and ocular aberrations with migraine.
METHODS:
Sixty eyes of 30 patients with migraine and 60 eyes of 30 controls were studied. Dry eye evaluation included Schirmer's test, tear film break-up time, corneal esthesiometry and lipid layer analysis using Lipiview® interferometer. Wavefront aberrations were measured using Optical Path Difference before performing the dry eye evaluation. The intraocular light scatter was quantified using the objective scatter index (OSI) of the optical quality analysis system. Measured parameters were compared between the migraine and the control group using independent sample t-test. Statistical analysis was performed using commercial software. A p value of ≤ 0.05 was considered statistically significant.
RESULTS:
There were 19 females and 11 males in each group. Statistically significant difference was found between the two groups with respect to total aberrations (p = 0.049), higher order aberrations (p = 0.009), coma (p = 0.03), spherical aberrations (p = 0.018), Lipiview interferometric coloric units (p < 0.001) and OSI (p < 0.001). Trefoil (p = 0.26) and TBUT (p = 0.398) were not significantly different between both groups.
CONCLUSIONS:
Ocular aberrations are higher in patients with migraine as compared with controls. Tear film abnormalities add to the aberrations in otherwise asymptomatic patients and may also be associated with migraineous attacks. Treating the ocular surface to obtain a healthy tear film might introduce a potential modifiable factor in the prevention of migraneous attacks.

ABSTRACT: Alterations in Tear Biochemistry Associated with Postanesthetic Chronic Dry Eye Syndrome.


Biochemistry (Mosc). 2016 Dec;81(12):1549-1557. doi: 10.1134/S0006297916120166.
Zernii EY1, Golovastova MO, Baksheeva VE, Kabanova EI, Ishutina IE, Gancharova OS, Gusev AE, Savchenko MS, Loboda AP, Sotnikova LF, Zamyatnin AA Jr, Philippov PP, Senin II.

Abstract
Perioperative dry eye syndrome (DES) is a common ocular complication of long-term general anesthesia. Chronic DES can lead to permanent damage to the cornea and disturbance of visual function, up to total loss of vision. Here, a relationship between the duration of general anesthesia and the risk of chronic DES in patients was demonstrated. Using an experimental model of perioperative corneal abrasions in rabbits, it was found that introduction of animals to 3-h general anesthesia resulted in clinically significant chronic damage to the cornea in 50% of cases. The development of the complication was not associated with irreversible or long-term impairment of tear secretion, but it was accompanied by a decrease in tear film stability and growth of the total protein content as well as decrease in total antioxidant activity of the tear induced by low molecular weight antioxidants. In addition, anesthesia-induced changes in activity of tear antioxidant enzymes including superoxide dismutase and enzymes providing homeostasis of reduced glutathione (glutathione peroxidase, glutathione-S-transferase, glutathione reductase) were observed. All these alterations were protracted (up to 1-2 weeks) and therefore might account for transition of the perioperative DES into the chronic form. These findings can be useful in the development of novel approaches for the prevention and treatment of chronic forms of DES in the postanesthetic period.

 ABSTRACT: Effect of pulsed laser light in patients with dry eye syndrome.

Abstract
OBJECTIVES:
The objective of this study was to determine the clinical benefits of pulsed light therapy for the treatment of Dry Eye Syndrome (DES) due to the decrease in aqueous tear production (aqueous deficient DES) and/or excessive tear evaporation (evaporative DES) due to Meibomian Gland Dysfunction (MGD).
METHODS:
A study was conducted on 72 eyes corresponding to 36 patients with DES. Out of these 72 eyes, 60 underwent refractive surgery (48 with femtosecond laser, 6 were operated with a mechanical microkeratome, and 6 with refractive photo-keratectomy[RPK], 6 treated with phacoemulsification, and 6 with no previous surgical treatment. Pulsed laser light (Intense Pulsed Light Regulated [IRPL®]) was use to stimulate the secretion of the Meibomian glands during 4 sessions, one every 15 days.
RESULTS:
Patients with aqueous deficient DES did not show any improvement. Eyes with no previous surgery and those treated with phacoemulsification and PRK had a favourable outcome. On the other hand, less conclusive results were observed in the eyes treated with excimer laser.
CONCLUSIONS:
This treatment could be very helpful to treat evaporative DES produced by MGD. On the other hand, it is not helpful for those cases related to an isolated damage in the aqueous phase, or the mucin phase.

Arch Soc Esp Oftalmol. 2017 Feb 28. pii: S0365-6691(17)30034-5. doi: 10.1016/j.oftal.2016.12.018. [Epub ahead of print]
[Article in English, Spanish]
Guilloto Caballero S1, GarcĂ­a Madrona JL2, Colmenero Reina E2.
Author information

Blepharoplasty: An abstract, and perspectives on social media and patient expectations

This abstract is the kind of language that makes me weep and gnash my teeth. Well, at least gnash my teeth:
Upper Eyelid Blepharoplasty: Evaluation, Treatment, and Complication Minimization
Upper eyelid blepharoplasty is one of the most common procedures performed worldwide for both functional and cosmetic indications. There is a high rate of patient satisfaction; however, in this era of social media, patient expectations are higher than ever. Today's digitally savvy patients expect perfect outcomes with no complications and rapid recovery. To achieve optimal results, a careful preoperative evaluation and sound surgical technique is essential for minimizing complications. Here the authors review their approach to the management of the blepharoplasty patient.
Yang P, Ko AC, Kikkawa DO, Korn BS.Semin Plast Surg. 2017 Feb;31(1):51-57. doi: 10.1055/s-0037-1598628. Review.

It's not just because I field so many calls from people who have dry eye after blepharoplasty without having been warned of the possibility this might happen. (For those who aren't familiar with this, a particularly painful form of dry eye can occur after eyelid surgery due to eyelids ending up too short - much more likely to happen when done by a plastic surgeon than an oculoplastic surgeon, the latter being an eye doctor who knows skin and muscle, as opposed to the former, whose knowledge of eyes and the lacrimal system in particular will be much more limited.)

It's just, simply, what it says.

"This era of social media" obviously does not make it MORE incumbent upon a surgeon to screen carefully, use good technique and minimize complications. I presume all surgeons would want to do that whether or not their patient were likely to blab about their results to all their Facebook friends.

Of course, I do get that there is a context here. This is just an intro to what, for all I know (I'm not a subscriber so I don't have the actual study), is probably a thoroughly excellent review of technique.

Nevertheless, this kind of thinking and language... makes me gnash my teeth.

When you talk about patients having expectations of perfect outcomes - where do you think they get them from? You don't think it might have something to do with your glossy brochures, your perfunctory informed consent process and your failure to have serious conversations with them about specific complications that can ensue, including what they mean and how they are managed? 

Surgeons performing elective surgeries have a role to play in setting patient expectations, and they should own it and embrace it. They need to be especially cognizant of the uphill work undoing the effects of slick media upon patient expectations. 

Does sleep position affect dry eye?

Effect of Sleep Position on the Ocular Surface


Alevi D, Perry HD, Wedel A, Rosenberg E, Alevi L, Donnenfeld ED.

Cornea. 2017 Mar 1. doi: 10.1097/ICO.0000000000001167. [Epub ahead of print]

Abstract
PURPOSE:
Dry eye disease is a multifactorial disease with numerous well-documented risk factors. However, to date, sleep position has not been associated with this condition. After observing patients in our practice, we believe that the sleep position in some cases may significantly affect dry eye and meibomian gland dysfunction (MGD).
METHODS:
This is a single-centered, cross-sectional, noninterventional, institutional review board-approved, single-masked, nonrandomized study of 100 patients whose complaints were related to dry eye disease and a control group of 25 age-matched asymptomatic patients. Two questionnaires were used: one to analyze patients' sleep habits and the other to assess patients' Ocular Surface Disease Index. Dry eye severity was graded based on the MGD stage, fluorescein corneal staining and lissamine green staining, Schirmer 1 testing, tear osmolarity levels, and clinical examination.
RESULTS:
A statistically significant difference was shown with back sleeping compared with left side sleeping using lissamine green staining (analysis of variance, P = 0.005). The Ocular Surface Disease Index score was also found to be elevated in patients who slept on their right or left side (36.4 and 34.1, respectively) as opposed to back sleepers (26.7) with P < 0.05. There was no statistically significant correlation found between the sleep position and degree of MGD.
CONCLUSIONS:
In addition to current treatment, patients who sleep on their side or face down might see a reduction in dry eye and MGD if they change their sleep pattern to the supine position.
This is an interesting topic... While it doesn't attempt to address the causes, I would imagine it's all about greater exposure, especially if lids aren't fully closing. It would be interesting to know more about the extent to which lubricant and physical barrier protection improve this - comparatively - for the different sleep positions.

Thursday, February 23, 2017

Miraflow Miraflow on the shelf (or not)... daily cleaners and confusion in our midst!

(For PROSE and Scleral lens users)

Miraflow was discontinued years ago to the dismay of faithful longtime users. There are two generics on the market that I know of - Sof/Pro2 (made by Lobob Labs, who also make Optimum by Lobob ESC which is probably the most popular daily cleaner for PROSE and scleral lenses) and Walgreens Extra Strength Daily Contact Lens Cleaner which, I'm told, is equivalent as well.

Sof/Pro2 in its turn has been subject to a protracted manufacturer backorder situation. We haven't been able to get any for quite some time though some stores still have it. Latest word from Lobob is, possibly 1 to 2 months before they have more.

Lobob ESC meantime, which is a stable for a lot of us, has had some major ups and downs with very long backorders in the past several months. We've got ours now at the DryEyeShop and aren't anticipating further trouble... we hope!

But for you Sof/Pro2 and former-Miraflow lovers, did you know that someone licensed the name and is now making the same thing? Yes, an eye doctor of course. See Miraflow.com. I'm also bringing it to the DryEyeShop shortly to make it a little easier to purchase (the miraflow.com site has quite a few broken page links).

Friday, October 30, 2015

Coming soon to an ECP near you: Cheaper Lipiflow?

Seems probable...

TearScience® Announces New Pricing Strategy For Core LipiFlow®Technology Used For Treatment Of Dry Eye From Meibomian Gland Disease (MGD)


MORRISVILLE, N.C.--10/28/15 - ()--TearScience, a privately held medical device company, has announced a 50% price cut, effective immediately, on the single-use activators used with the LipiFlow treatment platform for Meibomian Gland Disease (MGD). The move is just one component of an overall strategy to make the LipiFlow and LipiView® Technologies more accessible to Eye Care Professionals (ECPs), who can then, in turn, use them to evaluate and intervene earlier in MGD for the benefit of the millions of individuals suffering from this chronic and progressive obstructive gland disease.

After recent unprecedented growth in use of its LipiFlow technology, TearScience is achieving the economies of scale necessary to reorganize and expand its supply and manufacturing capabilities. Furthermore, TearScience brought on board a new management team with a renewed mission to meet a market need of technology and treatment accessibility. Earlier this year, TearScience lowered the price of its technologies and removed imaging fees....

Wednesday, October 28, 2015

Way to save money on eyedrops?

SimplyTouch eyedrop applicator...

$12.50 is awfully steep for a little bitty thing. On the other hand, if you're spending $300 a month on Restasis, it could pay for itself on the very first use....


Better symptom results from latest study of Shire's Lifitegrast dry eye drug

Shire will be resubmitting its application to the FDA early next year on the strength of these improved results.

Shire's OPUS-3 Phase 3 Trial with Lifitegrast Meets Primary and Key Secondary Endpoints, Significantly Reducing Patient-Reported Symptoms for Dry Eye Disease


...."The results from OPUS-3, where lifitegrast demonstrated symptom improvement as early as two weeks, provide compelling efficacy data that contribute to the totality of evidence from the lifitegrast clinical development program, now the largest for an investigational stage compound in dry eye disease with more than 2,500 patients," said Philip J. Vickers, Ph.D., Head of Research & Development, Shire. "We believe the data from OPUS-3 will satisfy the FDA's request for an additional clinical study. We welcome the opportunity to share these positive data with the regulatory authorities."

Recent study: TBUT lower in women with PCOS

Eur Rev Med Pharmacol Sci. 2015 Oct;19(19):3556-62.

Abstract

OBJECTIVE:

Complaints of dry eye are prevalent worldwide and are known to be associated with insulin resistance (IR) and hyperandrogenism. However, dry eye is often overlooked in the context of polycystic ovary syndrome (PCOS). The aim of the present study was to evaluate whether or not there is any relation between tear functions and PCOS, which is a multifaceted disorder associated with IR or hyperandrogenism.

PATIENTS AND METHODS:

A total of 35 women with polycystic ovary syndrome (PCOS) were enrolled in this study, along with 27 healthy controls. Body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and free testosterone levels on the third day of menstruation were recorded, as well as hirsutism score (using the Ferriman Gallwey scoring system), insulin resistance (homeostasis model assessment), neutrophil-to- lymphocyte ratios (NLR), platelet-to-lymphocyte ratios (PLR), and mean platelet volumes (MPV). A complete ocular examination was followed by administration of the ocular surface disease index (OSDI) questionnaire and Schirmer and tear break-up time (TBUT) tests.

RESULTS:

Schirmer and OSDI results were similar between groups, but TBUT was significantly lower in the PCOS group (p = 0.002). There were negative correlations between FG score and TBUT test (r = -0.406, p = 0.001) and between NLR and Schirmer test (r = -0.294, p = 0.025).

CONCLUSIONS:


Although subjective dry eye symptoms do not present in all patients, these results confirm that tear reduction, which can cause further complications in patients with PCOS, can be detected by careful examination and sensitive tests.

PuriLens Plus in place of Unisol 4

Just a quick update to my last - 

There is a product that is apparently identical to the quickly-disappearing Unisol 4: 

PuriLens Plus. 
Sold in a 4 oz bottle. 
$2.95 to $3.95 depending on quantity.

Tuesday, October 6, 2015

Unisol 4 being discontinued

Alert for PROSE & scleral lens users who use Unisol 4 to fill their lenses:

I had been getting reports from customers that Unisol 4 is getting scarce or has been discontinued. I called Alcon today to get the skinny. They said yes, it is being discontinued, officially as of December this year and at this time they have no plans for a replacement.

Obviously it's already disappearing from shelves. Those who use it... it's definitely time to stock up unless you have an acceptable alternative that you already know of.

I have a couple of alternatives in the DryEyeShop - Addipaks (5mL), and Modudose (5mL and 15mL) which I sell in small quantities for people to try. If you need a Unisol replacement though be sure to check with your eye doctor first.

Thursday, August 27, 2015

Ointment recall alert: Refresh PM, Lacri-Lube, FML, Blephamide



FOR IMMEDIATE RELEASE - Dublin, Ireland – August 24, 2015 – Allergan plc, today announced that it is conducting a voluntary recall down to consumer level of specific lots of its REFRESH® Lacri-Lube® 3.5g and 7g for dry eye, REFRESH P.M.® 3.5g for dry eye, FML® (fluorometholone ophthalmic ointment) 0.1% (sterile ophthalmic ointment topical anti-inflammatory agent for ophthalmic use, 3.5g), and Blephamide® (sulfacetamide sodium and prednisolone acetate ophthalmic ointment, USP) 10%/0.2% sterile topical ophthalmic ointment combining an antibacterial and a corticosteroid, 3.5g.
Allergan chose to initiate this recall based on a small number of customer complaints which reported a small black particle at the time of use. This black particle, which is part of the cap, can be created by the action of unscrewing the cap from the aluminum tube, and potentially introduced into the product. Reported adverse events include Foreign Body in Eye (12), Eye Irritation (2), Ocular Discomfort (2), Product Contamination (2), Superficial Injury of Eye (2), Eye Pain (1), Eye Swelling (1) and Vision Blurred (1).
Specific lots are being voluntarily recalled in the interest of patient safety. If the particle gets into the eye, potential adverse events may include eye pain, eye swelling, ocular discomfort or eye irritation. Please contact your physician or healthcare provider if you have any of these symptoms when using these products. The lot number and expiration date may be found on the bottom flap of the carton with the safety seal and on the crimp seal of the product tube.
Specific information on product and lots that are being voluntarily recalled are below:
NDCDescriptionLot NumberExpiration Date
0023-0312-04REFRESH® Lacri-Lube® 3.5 g84746 Apr-17
0023-0312-04REFRESH® Lacri-Lube® 3.5 g84987May-17
0023-0312-04REFRESH® Lacri-Lube® 3.5 g85087May-17
0023-0312-04REFRESH® Lacri-Lube® 3.5 g85359Jun-17
0023-0312-04REFRESH® Lacri-Lube® 3.5 g85721Jul-17
0023-0312-04REFRESH® Lacri-Lube® 3.5 g86045Aug-17
0023-0312-04REFRESH® Lacri-Lube® 3.5 g86406Sep-17
0023-0312-04REFRESH® Lacri-Lube® 3.5 g86594Oct-17
0023-0312-04REFRESH® Lacri-Lube® 3.5 g87021Nov-17
0023-0312-07REFRESH® Lacri-Lube® 7g86470Sep-17
0023-0312-07REFRESH® Lacri-Lube® 7g86829Oct-17
0023-0312-07REFRESH® Lacri-Lube® 7g87105Nov-17
0023-0240-04REFRESH P.M.® 3.5 g85165May-17
0023-0240-04REFRESH P.M.® 3.5 g85228May-17
0023-0240-04REFRESH P.M.® 3.5 g85244Jun-17
0023-0240-04REFRESH P.M.® 3.5 g85351Jun-17
0023-0240-04REFRESH P.M.® 3.5 g85374Jun-17
0023-0240-04REFRESH P.M.® 3.5 g85397Jun-17
0023-0240-04REFRESH P.M.® 3.5 g85561Jul-17
0023-0240-04REFRESH P.M.® 3.5 g85676Jul-17
0023-0240-04REFRESH P.M.® 3.5 g85694Jul-17
0023-0240-04REFRESH P.M.® 3.5 g85834Aug-17
0023-0240-04REFRESH P.M.® 3.5 g85977Aug-17
0023-0240-04REFRESH P.M.® 3.5 g85985Aug-17
0023-0240-04REFRESH P.M.® 3.5 g86073Aug-17
0023-0240-04REFRESH P.M.® 3.5 g85599Sep-17
0023-0240-04REFRESH P.M.® 3.5 g86290Sep-17
0023-0240-04REFRESH P.M.® 3.5 g86325Sep-17
0023-0240-04REFRESH P.M.® 3.5 g86411Sep-17
0023-0240-04REFRESH P.M.® 3.5 g86427Sep-17
0023-0240-04REFRESH P.M.® 3.5 g86506Sep-17
0023-0240-04REFRESH P.M.® 3.5 g86515Sep-17
0023-0240-04REFRESH P.M.® 3.5 g86517Sep-17
0023-0240-04REFRESH P.M.® 3.5 g86746Oct-17
0023-0240-04REFRESH P.M.® 3.5 g86792Oct-17
0023-0240-04REFRESH P.M.® 3.5 g86789Oct-17
0023-0240-04REFRESH P.M.® 3.5 g86809Oct-17
0023-0240-04REFRESH P.M.® 3.5 g86822Oct-17
0023-0240-04REFRESH P.M.® 3.5 g86822AOct-17
0023-0240-04REFRESH P.M.® 3.5 g86932Nov-17
0023-0240-04REFRESH P.M.® 3.5 g87100Nov-17
0023-0240-04REFRESH P.M.® 3.5 g87068Nov-17
0023-0240-04REFRESH P.M.® 3.5 g87156Dec-17
0023-0240-04REFRESH P.M.® 3.5 g87261Dec-17
0023-0240-04REFRESH P.M.® 3.5 g87493Jan-18
0023-0240-04REFRESH P.M.® 3.5 g87494Feb-18
0023-0240-04REFRESH P.M.® 3.5 g87731Feb-18
0023-0240-04REFRESH P.M.® 3.5 g (Professional Sample Pack)85165May-17
0023-0240-04REFRESH P.M.® 3.5 g (Professional Sample Pack)86789Oct-17
0023-0316-04FML® (fluorometholone ophthalmic ointment) 0.1%, 3.5 g
 
86258Sep-17
0023-0316-04FML® (fluorometholone ophthalmic ointment) 0.1%, 3.5 g
 
87189Dec-17
0023-0316-04FML® (fluorometholone ophthalmic ointment) 0.1%, 3.5 g
 
87514Feb-18
0023-0313-04Blephamide® (sulfacetamide sodium and prednisolone acetate ophthalmic ointment, USP) 10%/0.2%, 3.5 g86430Sep-17
0023-0313-04Blephamide® (sulfacetamide sodium and prednisolone acetate ophthalmic ointment, USP) 10%/0.2%, 3.5 g87806Feb-18
0023-0313-04Blephamide® (sulfacetamide sodium and prednisolone acetate ophthalmic ointment, USP) 10%/0.2%, 3.5 g88147Mar-18
Allergan has informed the U.S. Food and Drug Administration of this voluntary recall. The recall only applies to specific lots of the REFRESH® Lacri-Lube®, REFRESH P.M. ®, FML® (fluorometholone ophthalmic ointment) 0.1%, Blephamide® (sulfacetamide sodium and prednisolone acetate ophthalmic ointment, USP) 10%/0.2%. This recall does not affect any other REFRESH or Allergan product.
Allergan is contacting retailers and wholesalers who have been shipped affected product lots to initiate the recall and is informing them of the steps needed to return affected product.
The company is asking consumers who currently have product from any of the affected lots of REFRESH® Lacri-Lube®, REFRESH P.M. ®, FML® (fluorometholone ophthalmic ointment) 0.1% , Blephamide® (sulfacetamide sodium or prednisolone acetate ophthalmic ointment, USP) 10%/0.2%, to stop using the product and return it to Allergan.
If there are questions or if assistance is required in response to this recall, please use the contact information below.
CONTACT INFORMATION  
Product Returns
Contact GENCO at:
877-674-2087
7 am to 5 pm CST
Credit/Reimbursements
Contact Allergan at:
1-800-811-4148
7am to 5pm PST
Allergan
Medical Inquiries
:

1-800-433-8871 option 2 8am - 5pm PST

Adverse Events/Products Complaints:

1-800-624-4261 Option 3 (8am - 5pm CST)
FDA contact information for reporting adverse events/quality complaints:
Online at www.fda.gov/medwatch/report.htm or call FDA at 1-800-FDA-1088
 


Tuesday, October 29, 2013

How local rags are reporting on Lipiflow

Classic example below… Same old same old.... New eye treatment comes along, doctors who invest in it drum up publicity. They used to do the same thing with every new version of LASIK that came along. Still, I thought there were a few interesting (albeit more or less predictable) features….

October 26, 2013 – DesMoinesRegister.com

Chronic dry eye forced Doug Pagel to shut the overhead vent and make sure fans weren’t blowing on him at work. He’d even tried punctal plugs to reduce symptoms.
Two months ago, he underwent a new procedure at Eye Care of Iowa, where he works as office manager, that helped relieve those problems. The 12-minute procedure, called LipiFlow, helped restore moisture to his eyes and eliminate the hassle of keeping track of a bottle of eye drops. It also has opened up the possibility of him wearing contact lenses.
“I haven’t used any drops since the procedure,” said Pagel, adding that his condition continues to improve….

Ah. I’m happy for Doug, of course. But… now we’re touting Lipiflow as an ALTERNATIVE to eyedrops, and dangling the carrot of renewed contact lens use? Ugh.

….Symptoms of dry eye include watering or a burning, gritty, sandy sensation toward the end of the day. Many times, that is a result of computer vision syndrome, where eyes become strained and tired from staring at a screen all day.
Two main types of dry eye can affect patients. The most common is “evaporative” dry eye, where the eyes make tears, but they don’t last long. Blocked glands can cause the problem and contribute to lipid deficiency in the tears. Others suffer “aqueous deficient” dry eye, where the eyes don’t make enough water.
A variety of traditional treatments are available — eye drops, punctal plugs and lubricants. But research shows that only 15 percent of all dry eye patients benefit from artificial tears and are able to make the oil to prevent evaporation. For the remainder of patients, those with evaporative dry eye, the oil isn’t produced properly….

Well, one must admit the press are at least starting to talk a lot more about evaporative dry eye. Don’t know that I like the price we’re paying for it but at least it’s happening.


….Following treatment, patients are asked to perform daily blinking exercises and take a triglyceride-based fish oil to maintain eye health….
Interesting. But if the point is to get rid of those “annoying” eyedrop bottles (sheesh, as if any of us actually use bottles anyway… it’s handfuls of vials for most), um, I’d be interested to know how happy these patients are about trading drops for blink exercises. Just sayin’. I think the blink exercises are a great idea. I just don’t think people whose only complaint is the “hassle” of using eyedrops are going to be crazy about it. Most people I know who have had Lipiflow got it because they were desperate and in pain and would be happy to use infinite drops if they’d only work. On the other hand, one of my many biases is that… I know far too many desperate dry eye patients.

…. “Anyone who has dry eye is a potential candidate. What we need to do is have them come in and do an evaluation in the office,” he said.
Ward didn’t want to discourage patients by disclosing the cost of the procedure, but noted that it would be less than the average spent to treat dry eye — roughly $2,500 a year. Insurance does not cover the treatment….

Very interesting. I wonder where they came up with the $2500. No casual dry eye patient spends anywhere near that… only the ones who have some seriously bothersome persistent symptoms.