Thursday, September 23, 2010

Abstract: Lacrisert

Correlating Patient-Reported Response to Hydroxypropyl Cellulose Ophthalmic Insert (LACRISERT(®)) Therapy with Clinical Outcomes: Tools for Predicting Response.
Curr Eye Res. 2010 Oct;35(10):880-887.
McDonald M, D'Aversa G, Perry HD, Wittpenn JR, Nelinson DS.

Ophthalmic Consultants of Long Island, Lynbrook, New York.
To determine whether patient-reported improvement in symptoms of dry eye syndrome, activities of daily living, and other quality-of-life measures after treatment with hydroxypropyl cellulose ophthalmic inserts correlates significantly with physician assessment of clinical outcomes.

Patient registry of those treated for 1 month with inserts as monotherapy or in combination with existing treatments for moderate-to-severe dry eye syndrome. A total of 520 participants were enrolled. Of those, 418 patients completed the study. Results of this registry were evaluated and correlations were calculated to determine whether patient-reported symptoms, quality of life, and changes in disease severity based on the Ocular Surface Disease Index, and activities of daily living outcomes are predictive of physician assessment of clinical signs, symptoms, and adherence to therapy.

Most patients reported overall improvement in their condition. Patient-reported improvements in the symptoms of dry eye syndrome and activities of daily living were significant predictors of physician assessment of compliance with insert therapy, improvement in symptoms and clinical signs, effectiveness of therapy, and acceptance of use as adjunctive therapy.

Patient-reported symptoms and activities of daily living are predictors of patient compliance and treatment success with the use of inserts, as reported by treating physicians. The benefits were additive to the standard of care that was continued during the course of the study. These predictors, along with clinical diagnostic tests, can be used by eye care professionals to assess the efficacy of treatment for moderate-to-severe dry eye syndrome quickly and reliably.

Monday, September 20, 2010

Abstract: Using a confocal to diagnose Demodex

In vivo evaluation of Ocular Demodicosis using Laser Scanning Confocal Microscopy.
Invest Ophthalmol Vis Sci. 2010 Sep 16. [Epub ahead of print]
Kojima T, Ishida R, Sato EA, Kawakita T, Ibrahim OM, Matsumoto Y, Kaido M, Dogru M, Tsubota K.
Keio University School of Medicine, J&J Ocular Surface and Visual Optics, Tokyo, Japan.

To investigate the applicability of in vivo laser scanning confocal microscopy in the diagnosis and follow up of ocular demodicosis infestation in a prospective controlled study

Fifteen right eyes of 15 patients with blepharitis associated with cylindrical dandruff (10 males, 5 males; mean age: 62.9±9 years) and 8 right eyes of 8 age and sex matched control subjects underwent HRTII/ RCM, evaluation of ocular symptom scores, tear function tests including vital stainings, Schirmer test, tear clearance test and evaluation of mite numbers in the eye lids.
In vivo confocal microscopy effectively disclosed the mites in the terminal bulbs of the eyelashes which were not observed after treatment. Eyelids with Demodicosis infestation showed marked inflammatory infiltrates around the meibomian glands and conjunctiva which cleared with tea tree oil treatment.

Laser scanning confocal microscopy seems to be an efficient non-invasive tool in the diagnosis and follow up of ocular demodicosis infestation.

Abstract: GvHD and the eyes


I hope that the "possible strategies" for ocular GvHD discussed in the full article had the BOSP at the top of the list. I think it is unconscionable to fail to educate GvHD patients on the potential of this treatment, given how serious the complications can be for the eyes when other treatments fail.

Ocular Involvement in Chronic Graft-Versus-Host Disease: Therapeutic Approaches to Complicated Courses.
Cornea. 2010 Sep 15. [Epub ahead of print]
Koch KR, Joussen AM, Huber KK.
From the Department of Ophthalmology, University of Duesseldorf, Duesseldorf, Germany.

Chronic graft-versus-host disease (cGvHD) is a major concomitant phenomenon in recipients of allogeneic hematopoietic stem cell transplantations, affecting multiple organ systems including the eye. Ocular structures, such as lacrimal gland, conjunctiva, and eyelids with meibomian glands, are frequently involved with clinical features ranging from dry eyes and common inflammatory conjunctival disease to severe complications like corneal ulcerations or even perforations. We present 2 patients with complicated courses of ocular cGvHD. In both cases, keratoconjunctivitis sicca refractory to systemic immunosuppressive therapy and to conventional topical treatment resulted in progressive binocular corneal melting and finally repeated perforations. According to our 2 cases and to the current pathophysiological understanding, we discuss possible strategies for the treatment and prevention of ocular cGvHD complications.

Abstract: Report from Lacrisert patient registry

Efficacy of Hydroxypropyl Cellulose Ophthalmic Inserts (LACRISERT) in Subsets of Patients With Dry Eye Syndrome: Findings From a Patient Registry.
Cornea. 2010 Sep 15. [Epub ahead of print]
Luchs JI, Nelinson DS, Macy JI; for the LAC-07-01 Study Group.
From the *South Shore Eye Care, Wantagh, NY; †InterQuest Medical and Scientific, LLC, Parsippany, NJ; and ‡Macy Eye Center, Los Angeles, CA.

PURPOSE: To determine acceptability and efficacy of hydroxypropyl cellulose ophthalmic inserts in patients with dry eye syndrome (DES) and additional comorbidities.

DESIGN: A multicenter, 2-visit, open-label, 4-week registry study.

PARTICIPANTS: Five hundred twenty patients were recruited to the intent-to-treat group. Four hundred eighteen patients completed the study including 86 contact lens wearers, 79 with cataract diagnosis, 52 with prior cataract surgery, 22 with prior laser-assisted in situ keratomileusis, and 15 with glaucoma.

METHODS: Patient questionnaires were completed at baseline and after 4 weeks of treatment to assess mean change in severity of DES symptoms, ocular surface disease index (OSDI) scores, frequency of occurrence of DES symptoms, occurrence of difficulty when performing activities of daily living (ADLs), and frequency of discomfort in various environmental conditions. Mean change was measured from visit 1 to visit 2.

MAIN OUTCOME MEASURES: Symptoms, OSDI scores, and measure of degree of difficulty when performing ADLs.

RESULTS: Four hundred eighteen patients completed the study. Compared with baseline, this population of patients demonstrated statistically significant improvements in mean OSDI scores (P = 0.0215) and symptoms of discomfort, burning, dryness, grittiness, stinging, and light sensitivity (P < 0.05). Mean improvement in OSDI scores of patients in the 5 identified subsets of patients with comorbid conditions were significant for patients using contact lenses (P < 0.025), who had undergone prior cataract surgery (P < 0.04), and with prior laser-assisted in situ keratomileusis surgery (P < 0.05). Patients diagnosed with cataracts or glaucoma did not show significant changes in any measures in this study. Patients with DES and comorbid conditions experienced relief of symptoms and benefit to ADLs and quality of life similar to patients without comorbid conditions.

CONCLUSIONS: In subsets of patients with moderate to severe DES and comorbid conditions, hydroxypropyl cellulose ophthalmic inserts improve the symptoms of DES, ability to perform ADLs, and quality of life. The reported benefits may be additive to those seen with patients' existing therapies.

Abstract: How often MGD (and other stuff) coincide with DE

The Association of Meibomian Gland Dysfunction and Other Common Ocular Diseases With Dry Eye: A Population-Based Study in Spain.
Cornea. 2010 Sep 15. [Epub ahead of print]
Viso E, Gude F, Rodríguez-Ares MT.
From the *Department of Ophthalmology, Complexo Hospitalario de Pontevedra, Pontevedra, Spain; †Clinical Epidemiology Unit and ‡Department of Ophthalmology, Hospital Clínico Universitario de Santiago; and §Department of Ophthalmology, University of Santiago de Compostela and Instituto de Investigaciones Sanitarias de Santiago, Santiago de Compostela, Spain.

PURPOSE: To investigate the relationship of meibomian gland dysfunction (MGD) and other prevalent ocular diseases with dry eye (DE) in a general adult population.

METHODS: An age-stratified random sample of 1155 subjects aged ≥40 years was selected in O Salnés, Spain. From 937 eligible subjects, 654 (69.8%) participated (mean age (SD): 63.6 (14.4) years; range: 40-96; and 37.2% males). A standardized DE questionnaire was administered. Objective evaluation included the Schirmer test, tear film breakup time (TBUT), fluorescein staining, and rose bengal staining. DE was defined as the simultaneous presence of symptoms and at least one sign. The relationship of MGD and other ocular diseases with DE was investigated. A design-based analysis was performed, and all calculations were weighted to give unbiased estimates.

RESULTS: DE and MGD prevalence were 11.0% [95% confidence interval (CI), 8.6-13.3] and 30.5% (95% CI, 26.9-34.1), respectively. MGD was present in 45.8% (95% CI, 34.8-57.2) of subjects with DE and was associated, after controlling for age and sex, with DE [adjusted odds ratios (ORa), 1.81]; with symptoms (ORa, 2.26); and with TBUT (ORa, 1.97), fluorescein staining (ORa, 2.09) and rose bengal staining (ORa, 3.25). The remaining ocular diseases were not associated with symptoms. However, pterygium was significantly associated with fluorescein staining (ORa, 1.89); cataract surgery with TBUT (ORa, 2.79); trauma and pseudoexfoliation with rose bengal staining (ORa, 2.75 and ORa, 4.04); and glaucoma with TBUT (ORa, 3.26), fluorescein staining (ORa, 3.40), and rose bengal staining (ORa, 3.46).

CONCLUSIONS: DE and MGD are common diseases in this population. MGD is strongly associated with symptoms and signs of DE. Nearly half of the subjects with DE have MGD. Pterygium, trauma, cataract surgery, pseudoexfoliation, and glaucoma are associated with signs of DE.