Friday, January 25, 2008

Newsblurb: From ASCRS, on blepharitis/MGD

Excerpt from an Eyeworld email blast reporting on the ASCRS meeting in Hawaii

Discussing the classification of blepharitis, James McCulley, M.D., noted four basic types: staphylococcal, seborrheic, primary meibomitis (MKC), and meibomian gland dysfunction. The pathophysiology of chronic blepharitis can be attributed to both biochemical abnormalities of the meibum as well as bacterial lipolytic exoenzymes, but not to a single bacterium. Dr. McCulley stressed that therapy should not be used to cure the disease but to provide relief and control. Mechanical and hygienic measures include hot compresses, massage, and lid scrubs. Recommended topical antibiotic treatments include bacitracin, fluoroquinolones, aminoglycides, and tetracyclines. Systemic antibiotics are only indicated in severe cases of acute bacterial blepharitis, secondary meibomianitis, and MKC. Recommended systemic antibiotics include tetracycline analogues (including minocycline), and macrolides.

Nothing new here that I can see but I think that this is a nice overview for patients and doctors alike. I really appreciate the acknowledgment of the importance of compresses, massages and scrubs in these lid diseases. I was also relieved to see Restasis NOT on the list of treatments. I've been hearing rumors of it being promoted for MGD treatment but to date I have seen no medical literature demonstrating efficacy for such an indication.

Rebecca's journal: A visit to Barleans

Yesterday I played hooky.

It was a breathtakingly beautiful day. I drove up to Kingston, took the ferry across the Sound, and drove from Edmonds up to Ferndale, which is not far from the Canadian border. My destination was the Barleans farm in Ferndale where the celebrated flaxseed oils are made.

The Barlean family lives on the property and before touring their business facilities I was treated to a lovely lunch of fresh salmon, enjoyed in the company of three generations of Barleans plus my wonderful sales rep Patti. As some of you fans of their products may have read. Bruce Barlean is a man of many trades and was a fisherman before getting the oil business going. They still run a famous fish market right there on site.

It was great fun to see their operation and learn about its history... and was a very interesting and informative visit. And when I finally got back in my car, laden with all kinds of samples and a couple of books, and headed east towards the freeway, there was Mount Baker right smack in front of me, closer than I've been to it in at least 20 years. Absolutely stunning.

Other than temporarily releasing myself from the ball and chain, meeting some nice hospitable people and loading up with loot, the more serious purpose of my trip was to get started on one of my recent resolutions: To let go of my longstanding willful ignorance of the dreaded "dry eye and nutritional supplements" topic and make something resembling an honest attempt to understand enough of it to form something resembling an actual opinion, without, hopefully, having to learn any more actual Information than absolutely necessary.

The fact is, I'm tired of squirming, mumbling incoherently and rapidly changing the subject when asked for advice about fish oil, flaxseed oil, EPA/DHA, Biotears, Theratears Nutrition or whatever. I have developed the bad habit of ignoring the whole subject simply because I despise the extremes, from the enormous generic bottles of Fish Oil (goodness knows what mutated species of farmed fish that crud comes from) to the elite "black-box" formulae on the market all claiming to be THE only formula scientifically proven to work for dry eye.

So, I'm going to attempt to grapple with dry eye and essential fatty acids, with the help of a few friends. Logically, there must be good information to be had somewhere in this mess, and surely with a little effort I can pick up enough of it to not hurt myself and perhaps even to equip myself to say something slightly more intelligent than my usual reluctant "Well... they can't hurt, they might help, and everyone agrees they're good for general health."

As I learn, you'll no doubt be seeing some changes to what I offer in The Dry Eye Shop as a result.

Up till this point, the Omega 3 EFAs section of the shop has been markedly different than the other sections of the shop: All others are based on my and others' actual experiences with dry eye products plus my personal opinions about what kinds of products are critically important to dry eye patients. Omega 3s were more of a reluctant nod to the fact that everyone agrees we "ought" to take them. I sold - and, mind you, faithfully used and always liked - Dry Vites for quite some time. When that got too expensive for my taste, I just went out and looked for the best company I could find that offered multiple types of Omega 3s at what seemed to be a reasonable price. I fell in love with Barleans and am convinced their quality and service are tops, so I stuck with them. Visiting their facility yesterday confirmed all that and also helped motivate me to stick with my resolution to dig further.

Wish me luck, and if you have any good pointers to send my way, feel free. Try to stick with words of three syllables or less though. :-)

Industry news: Lacriserts website / distributor info

No, Lacriserts have NOT gone away, although they've been quiet for so long that it isn't any wonder people think so. As noted in a previous posting, Merck sold this product to Aton Pharma awhile back.

Yesterday Aton put out a press release and announced the launch of their new website,

If you're a past Lacrisert user and are having trouble finding them or have been told they are no longer available, please see Aton's page with distributor information... you may want to print off the page and take it to your pharmacist:

If you're a patient who has never heard of Lacriserts, they're basically hypromellose (the stuff some artificial tears are made of) put into a little pellet that gets shoved down into your lower lid for a 'slow release' effect during the day. They are sold only by prescription. They have never been very popular but they are one of those dry eye products that has a loyal albeit very small following. Since that is the case, I'm pleased to see that they are being kept on the market and promoted rather than falling victim to the "If we can't make a big enough line item on our financials from it, we won't bother producing it" syndrome that dominates most pharmaceuticals.

If you're a doctor and thought Lacriserts were off the market, please note that they are still around and you can get prescribing info at this link.

If you're a patient and you're now mad at your doctor for erroneously telling you Lacriserts can't be had anymore, go easy on the poor guy/gal - it's impossible to keep up with all this stuff. Instead, how about politely suggesting to him/her that they subscribe to my free Monday Dry Eye Bulletins so that they can keep up with new dry eye products more easily. They can call 1-877-693-7939 x2.