Friday, August 31, 2012

Abstract: Maskin probe study in rosacea patients

Rosacea is a significant cause of ocular surface disease, and our current therapeutic armamentarium is often ineffective. Intraductal meibomian gland probing is a novel technique to address dry eye syndrome, although its use has not been described in the management of ocular surface disease from rosacea.
"Armamentarium". Just in time to be my Word of the Day.
Patients with ocular rosacea, meibomian gland dysfunction, and surface disease, which was refractory to conventional management, underwent intraductal meibomian gland probing. Each patient completed the Ocular Surface Disease Index (OSDI) questionnaire before the procedure and at the 1- and 6-month postoperative visits.
Does was need to be were, the third comma need to be ditched, or something else altogether done to that sentence? Sorry (slapping forehead) I'll stop picking nits now, I promise. I really am glad to see a study published about probing and this one looks quite positive:
Forty eyelids of 10 patients (5 men, 5 women; mean age = 42.1 years) underwent intraductal meibomian gland probing. All patients reported subjective improvement in their symptoms of discomfort, tearing, and blurred vision. The mean preoperative, 1-month, and 6-month OSDI scores were 78.11 (standard deviation [SD] = 5.33), 37.54 (SD = 7.25), and 43.00 (SD = 5.49), respectively. The differences between the preoperative and one- and six-month scores were statistically significant (p < 0.05). Nine of the ten patients in this study were able to discontinue their doxycycline use after surgery, and 10 out of 10 patients reported decreased frequency of artificial tear use. No complications were identified in the 6-month follow-up period.
Intraductal meibomian gland probing is a safe, effective technique to address the ocular surface disease, tearing, and discomfort associated with ocular rosacea, and this intervention results in a dramatic improvement in these symptoms. This study provides the first documentation of these findings and represents the first quantitative demonstration of the use of intraductal meibomian gland probing in the peer-reviewed literature.

Ophthal Plast Reconstr Surg. 2012 Jul 25. [Epub ahead of print]
Department of Ophthalmology, Ophthalmic Plastic Surgery, Lions Eye Institute, Albany Medical College, Slingerlands, New York, U.S.A.

Abstract: Co-managing dry eye and glaucoma...

This study talks about glaucoma management yielding better results when the ocular surface is well managed. I am so used to thinking of this the other way around (i.e. glaucoma being treated without reference to dry eye, resulting in damage to the ocular surface) that I kind of gave it a double take as it's suggesting IOP can be decreased by better managing the cornea part of the equation. Still scratching my head a little. The only "duh" in it for me is that patients will be more compliant with their glaucoma medication if their corneas aren't hurting (esp. from the glaucoma medication). I'd like to understand more about other connections between OSD and glaucoma.

But in any case, anything that gets the glaucoma doc talking to the cornea doc is a big plus in my book. Treating the whole eye, rather than compartmentalizing the front and the back... what a concept! Good going.

To describe a series of 4 patients with inadequately controlled primary open angle glaucoma and ocular surface disease (OSD) in whom a combination approach was used to manage the OSD resulting in improved intraocular pressure (IOP) control.
A retrospective review of the clinical notes of 4 patients referred to a tertiary surgical glaucoma service was performed. At the initial visit, measures to control the OSD were employed in all patients; twice-daily lid hygiene measures, a 3-month course of 50 mg daily oral doxycycline, topical carmellose sodium (celluvisc) 0.5% 4 to 6 times daily, and preservative-free equivalents of topical antiglaucoma medications as deemed appropriate, depending on the perceived severity of the OSD.
Patients were reviewed for a maximum of 24 months after intervention. In all patients treatment resulted in a marked symptomatic and clinical improvement in the ocular surface with a reduction in hyperemia, meibomian gland dysfunction and superficial keratopathy. A reduction in the IOP also occurred in all patients, obviating the need for glaucoma drainage surgery during the study period.
Patients with severe OSD often have glaucoma that is refractive to medical therapy. Furthermore, the surgical success of glaucoma filtering surgery is compromised in patients with scarring and inflammation of the conjunctiva. The term we postulate is "OSD exacerbated glaucoma." This is the first study to suggest that the use of a combination approach comprising medical treatment to manage the OSD in patients with primary open angle glaucoma may lead to an improvement in the IOP control and the management of glaucoma.

J Glaucoma. 2012 Jul 23. [Epub ahead of print]
University Hospitals Birmingham, Birmingham, UK.

Abstract: Osmolarity lower in epiphora

Nothing particularly exciting here but it's interesting that people with epiphora (watery eyes) without dry eye or other disease present also seem to have lowered tear osmolarity.

To examine whether patients complaining of epiphora have tears of a lower osmolarity.
Sixty-three eyes of 39 patients attending an oculoplastic clinic with a primary complaint of epiphora, had their tear osmolarity recorded. Subjects were excluded if they had current or recent topical eye therapy, active ocular infection or allergy, ocular surface scarring, evidence of dry eye, previous laser eye surgery, or a contact lens worn within the previous 12 hours. Patients were divided into 2 groups. The first included those whose primary complaint was of epiphora due to either punctal stenosis, nasolacrimal duct obstruction (partial or complete), or eyelid laxity (without evidence of frank ectropion or entropion). The second group formed the controls, and consisted of the second eye of some of the above patients, or those attending the clinic for other oculoplastic procedures not related to epiphora. Testing of tear osmolarity was performed in the clinic using the TearLab osmometer.
Sixty-three readings were obtained, of which 32 were from patients with a primary complaint of epiphora and 31 were allocated to the control group. Patients with epiphora had a mean tear osmolarity of 291.8 mOsms/l (range, 269-324, standard deviation 16.6), compared with the control group mean of 303.7 mOsms/l (range, 269-354, standard deviation 24.1). This difference was found to be statistically significant (p = 0.025).
Patients complaining of epiphora in the absence of other ocular surface pathology have a significantly lower tear osmolarity.

Ophthal Plast Reconstr Surg. 2012 Jul 19. [Epub ahead of print]
*Oculoplastics, Moorfields Eye Hospital, Bedford; †The National Institute of Health Research Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital/UCL Institute of Ophthalmology, London; and ‡Ophthalmology Department, Addenbrookes Hospital, Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom.

Wednesday, August 29, 2012

Abstract: Soft contact related dryness

PURPOSE.: To report demographics, wearing patterns, and symptoms from soft contact lens (SCL) wearers with significant SCL-related dryness symptoms with and without significant ocular signs of dryness.
 METHODS.: In a multicenter, prospective observational clinical trial, symptomatic SCL wearers reported significant SCL-related dryness via self-administered questionnaire of frequency and intensity of dryness after a dry eye (DE) examination. DE etiology was assigned post hoc by an expert panel, and those with and without significant DE-related signs were analyzed by univariate logistic regression. Possible DE etiologies were aqueous tear deficiency, SCL-induced tear instability, meibomian gland dysfunction, or "other." Wearers without signs that qualified for any DE etiology were designated as No DE Signs (NDES).
 RESULTS.: Of the 226 SCL symptomatic wearers examined, 23% were without signs, 30% had aqueous tear deficiency, 25% had SCL-induced tear instability, 14% had meibomian gland dysfunction, and 8% had "other" diagnoses. The NDES wearers had significantly longer pre-lens break-up time (9.8 vs. 6.6 s, p < 0.0001), better lens wetting (3.4 vs. 2.4 0 to 4 scale, p < 0.0001), lower levels of film deposits on lenses (0.45 vs. 0.92, 0 to 4 scale, p < 0.0001), and of most slit lamp signs. The NDES wearers were significantly more likely to be male (36% vs.19%, p = 0.013), were less likely to have deteriorating comfort during the day (81% vs. 97%, p = 0.001), reported longer average hours of comfortable wear (11 ± 3 vs. 9 ± 4 h, p = 0.014), had older contact lenses (18 ± 14 vs. 13 ± 12 days, p = 0.029), and greater intensity of photophobia early and late in the day (p = 0.043 and 0.021).
 CONCLUSIONS.: Symptoms of dryness in SCL wearers stem from a variety of underlying causes. However, nearly one-quarter of these symptomatic SCL wearers appear to be free of signs of dryness. The effective management of CL-related dryness requires a comprehensive range of clinical assessments and the use of a diverse range of management strategies.

Optom Vis Sci. 2012 Aug;89(8):1125-32.
*PhD, FCOptom, FAAO †OD, FAAO ‡PhD §PhD, MBA ‖MSc ¶MSc, MCOptom, FAAO Visioncare Research Ltd, Farnham, United Kingdom (GY, CH), Clinical Trial Consultant, Atlanta, Georgia (RC), Alcon Research, Fort Worth, Texas (LN, JK), and Centre for Contact Lens Research, University of Waterloo, Waterloo, Ontario, Canada (KD).