Thursday, December 13, 2012

Night eye protection sale

Four-day-special... 15% off night eye protection items at the Dry Eye Shop. 

Click on this coupon or type "NightStuff" in the coupon code box.


Abstract: Dry eye--is inflammation just the tip of the iceberg?

Slightly melodramatic title but more reports or studies on platelet-rich plasma are always welcome...

Dry eye syndrome (DES) has been described by The International Dry Eye WorkShop as ''multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear instability with potential damage to the ocular surface.'' Inflammation has been recognized as a primary contributor to the disease and was a tremendous step forward in the description and treatment of DES. Although most treatments of DES treat inflammation, the signs and symptoms of DES usually return shortly after discontinuing the use of the anti-inflammatory agent;
We present a case of a 70-year-old patient who presents with significant dry eye symptoms for 2 years. She reports the need to wear sunglasses during all waking hours, both indoors and out, and had discontinued her hobby of gardening. She had ocular rosacea diagnosed at a previous ophthalmology practice and did not respond to any past treatments. The patient was treated with 25% platelet-rich plasma (PRP) and experienced significant improvement and a return to a normal quality of life that has continued for more than a year after discontinuing treatment;
Our group is investigating the use of biologic therapeutics in the treatment of various forms of DES. We suggest that a clinically acceptable dosage of PRP provides the ocular surface with the components necessary to restore normal cellular tensegrity and provides a foundation to eliminate the recurrence of the inflammation associated with DES.

Optometry. 2012 Mar 30;83(3):111-3.
Jarka ES, Kahrhoff M, Crane JB.
Universityof Missouri-St. Louis College of Optometry, One University Blvd., St. Louis, MO 63121-4400. Email:

Dry Eye Shop now accepts Discover

Don't ask me why, for some reason I just never got around to adding it. Anyway, to all those who have asked me to add it, I finally have!

Wednesday, December 12, 2012

Is this part of why...

...we have so many "treatment failures"?

Superficial discussion of medical stuff in the press totally sets people up with unreasonable expectations. Here's a classic example (article below, headline rather). Lipiflow = the twelve minute miracle? Good grief. Though I think Lipiflow has a really important role to play, it's much more complicated than that and we all know it, yet... we'd all like to believe there's a magic bullet to fix things. 

So people read articles like this, or worse, get over-sold on something by a doctor who's more concerned with amortizing an expensive machine than educating patients, and they get an expensive treatment and when it isn't a miraculous permanent cure for the common cold they talk about what a waste of money it was. Sigh.

…NEW TECHNOLOGY:  A revolutionary way to help treat dry eye syndrome is the LipiFlow Thermal Pulsation System.  It helps treat dry eyes by opening and clearing blocked glands, which in turn will allow the eyes to resume the natural production of oils (lipids) needed for the tear film. It’s a fast procedure that works by applying heat and light pressure to the inside of the eye lid, allowing lipids to be released from the Meibomian glands….

Abstract: The peptides in our tears...

Just for fun... part of our tears you hardly ever hear about:

Tear fluid is a complex mixture of biological compounds, including carbohydrates, lipids, electrolytes, proteins, and peptides. Despite the physiological importance of tear fluid, little is known about the identity of its endogenous peptides. In this study, we analyzed and identified naturally occurring peptide molecules in human reflex tear fluid by means of LC-MALDI-TOF-TOF. Tandem MS analyses revealed 30 peptides, most of which have not been identified before. Twenty-six peptides are derived from the proline-rich protein 4 and 4 peptides are derived from the polymeric immunoglobulin receptor. Based on their structural characteristics, we suggest that the identified tear fluid peptides contribute to the protective environment of the ocular surface.

Peptides. 2012 Dec 7. pii: S0196-9781(12)00483-4. doi: 10.1016/j.peptides.2012.11.018. [Epub ahead of print]
Hayakawa E, Landuyt B, Baggerman G, Cuyvers R, Luyten W, Schoofs L.
Research Group of Functional Genomics and Proteomics, KU Leuven, B-3000 Leuven, Belgium. Electronic address:

Abstract: Testosterone & keratinization of MGs

Another interesting study in the world of hormones and dry eye...

[Article in German]

Extensive keratinization appears to play a major role in the dysfunction of the Meibomian gland. This article presents the potential impact of androgens on limiting keratinization in this tissue, thus, contributing to normal Meibomian gland function and a healthy ocular surface.
Orchidectomized mice were systemically treated with either testosterone or placebo for 2 weeks. The mRNA was then extracted from the Meibomian glands and differential gene expression was investigated by microarray hybridization and evaluation with GeneSifter software as well as gene ontology information from the Gene Ontology (GO) Consortium.
By z-score calculations, keratinization was the most significantly gene ontology term influenced by testosterone based on down-regulated genes in the mouse Meibomian gland. In particular, under the influence of testosterone the genes coding for small proline-rich protein (Sprr) 2a, Sprr 2b, Sprr 3, keratins 6a and 17 and periplakin were significantly down-regulated, while Sprr 1a and Sprr 2f were significantly up-regulated.
Testosterone down-regulates the expression of genes promoting keratinization in the Meibomian gland. This may help to prevent Meibomian gland dysfunction by limiting excessive keratinization of this tissue and the adjacent lid margins. The findings elucidate, at least in part, the beneficial impact of androgens on Meibomian gland function and thus on the health of the ocular surface.

Ophthalmologe. 2012 Dec 8. [Epub ahead of print]
Schirra F, Gatzioufas Z, Scheidt J, Seitz B.
Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 1, Geb. 22, 66421, Homburg/Saar, Deutschland,

Abstract: Dry eye slows down your reading

Gosh, couldn'ta guessed that one ;-)

Visual disturbance is a common symptom reported by patients with dry eye disease (DED). The purpose of this study was to evaluate visual performance, including reading speed and contrast sensitivity, in control and DED subjects.
 Fifty-two DED patients (mild, n = 17; moderate, n = 22; severe, n = 13; based on corneal staining and the Ocular Surface Disease Index ≥20) and 20 control subjects (Ocular Surface Disease Index <13 18="18" 19="19" 45="45" 84="84" adjusting="adjusting" age="age" among="among" analysis="analysis" and="and" automated="automated" between="between" br="br" characteristics="characteristics" clinical="clinical" coefficients="coefficients" compare="compare" conducted="conducted" contrast="contrast" control="control" corneal="corneal" correlation="correlation" covariance="covariance" ded="ded" determined="determined" for="for" from="from" groups="groups" holladay="holladay" in="in" linear="linear" measure="measure" measured="measured" no="no" of="of" parameters.="parameters." part="part" partial="partial" patients="patients" ranges="ranges" rate="rate" reading="reading" regression="regression" relationship="relationship" respectively.="respectively." sensitivity="sensitivity" sex="sex" site.="site." speed="speed" staining="staining" study.="study." study="study" subject="subject" system="system" test.="test." the="the" this="this" to="to" took="took" used="used" using="using" was="was" were="were" while="while" wilkins="wilkins" with="with" years="years"> RESULTS:
The log of the minimum angle of resolution visual acuities and contrast sensitivity were not significantly different across subject groups. The DED patients (134.9 ± 4.95 words per minute) exhibited slower reading speeds than the control subjects (158.3 ± 8.40 words per minute, p = 0.046). As DED severity increased, the reading speed decreased (141.0 ± 7.96 words per minute, 136.8 ± 7.15 words per minute, and 127.0 ± 9.63 words per minute in mild, moderate, and severe groups, respectively). Reading rate was found to correlate weakly with corneal staining based on a partial correlation coefficient (-0.345, p < 0.001) but not with other DED parameters.
The reading rate was lower in DED subjects than that in control subjects. As the DED severity increased, the reading rate decreased. This finding is consistent with patient-reported symptoms and provides direct evidence for the impact of DED on reading performance. These findings suggest that reading speed may be used to monitor treatment benefit in DED.

Optom Vis Sci. 2012 Dec 4. [Epub ahead of print]
Ridder WH 3rd, Zhang Y, Huang JF.
*OD, PhD, FAAO †PhD Southern California College of Optometry, Fullerton (WHR); and Pfizer, Inc., La Jolla (YZ, J-FH), California.

Abstract: Clobetasone butyrate

New to me.

To study the effects of a low administration rate and low concentration (0.1%) of clobetasone butyrate eyedrops in patients with Sjögren syndrome (SS).
This prospective, double-masked, randomized, placebo-controlled study included 40 subjects divided into 2 treatment groups: group 1 (2% polyvinylpyrrolidone eyedrops and placebo) and group 2 (2% polyvinylpyrrolidone and 0.1% clobetasone butyrate, 1 drop BID). The treatment lasted for 30 days, with visits at enrollment, baseline, day 15, day 30, and after 15 days of treatment discontinuation. At each visit, symptoms questionnaire, tear film break-up time, corneal fluorescein stain, lissamine green stain, conjunctival impression cytology for human leukocyte antigen-DR (HLA-DR) expression, intraocular pressure (IOP) measurement, and fundus examination were performed.
No changes in IOP or fundus examination were observed in either group at each time point. Group 1 patients showed at day 30 a statistically significant amelioration of symptoms and reduction of HLA-DR expression. No changes in other parameters were detected. Group 2 patients showed at day 15 a statistically significant improvement of corneal and conjunctival stain versus baseline values and group 1 at the same time; after 30 days the symptoms score was statistically significantly better than baseline values and group 1 at the same time. The HLA-DR expression and the epithelial cells area were statistically significantly reduced versus baseline and group 1 at the same time.
Anti-inflammatory therapy is critical for the treatment of SS dry eye. Clobetasone butyrate, at low dosage, proved to be safe and effective in treating this condition.
Eur J Ophthalmol. 2012 Nov 19:0. doi: 10.5301/ejo.5000229. [Epub ahead of print]
Aragona P, Spinella R, Rania L, Postorino E, Sommario MS, Roszkowska AM, Puzzolo D.
Ocular Surface Unit, Department of Surgical Specialties, University of Messina, Messina - Italy.

Abstract: Phytoestrogen supplementation for dry eye

Effects of phytoestrogen supplementation in postmenopausalwomen with dry eye syndrome: a randomized clinical trial.
To evaluate the correlation between tear osmolarity and blood levels of 17-β estradiol, estrone, and testosterone in postmenopausal women with dry eye syndrome, and to assess the efficacy and safety of oral supplementation with phytoestrogens, lipoic acid, and eicosapentaenoic acid in this population.
Cross-sectional study including 66 postmenopausal women with dry eye syndrome.
Sixty-six postmenopausal women with dry eye syndrome were enrolled in a randomized, double-blind, placebo-controlled, crossover study. Patients were divided into 2 groups (groups A and B) and treated, respectively, with phytoestrogen (Bioos, Montegiorgio, Italy) tablets or placebo tablets for 30 days. The 2 treatment periods were separated by a 30-day washout. Patients were examined on days 0 and 30 of each period. Assessments included blood levels of sex hormones, the Schirmer test for tear production, and measurement of tear osmolarity and tear film break-up time.
At baseline, all patients had low sex hormone levels, which were correlated with high tear film osmolarity values (r = -0.59,-0.61,-0.58, respectively). After 30 days of therapy, the group treated with Lacrisek® (Bioos) had significantly decreased tear osmolarity (P < 0.005) and significantly increased tear production evaluated with the Schirmer test and tear film break-up time values (P < 0.001) compared with the placebo-treated group.
Our study confirms that steroid hormones play an important role in ocular surface equilibrium and functions. Consequently, reduced blood levels of these hormones can produce changes at the ocular surface. Phytoestrogen supplementation can significantly improve the signs and symptoms of dry eye syndrome in postmenopausal women.

Can J Ophthalmol. 2012 Dec;47(6):489-92. doi: 10.1016/j.jcjo.2012.08.019.
Scuderi GContestabile MTGagliano CIacovello DScuderi LAvitabile T.
Ophthalmic Clinic II, University of Rome "La Sapienza" San't Andrea Hospital, Rome;; Ophthalmic Clinic II, Medical University of Catania, Catania, Italy. 

Abstract: Restasis the second time around

If at first you don't fricassee, then fry, fry an egg.

Or a hen. Or whatever.

Or so my sister used to (mis)quote.

Might be true for eggs, but I don't know about Restasis. Complicated.

Chronic dry eye disease often requires long-term therapy. Tear film alterations in the setting of dry eye may include reduced tear volume as well as an increase in inflammatory cytokines and osmolarity. Topical cyclosporine ophthalmic emulsion 0.05% (Restasis(®); Allergan Inc, Irvine, CA) is indicated to increase tear production in patients with dry eye and reduced tear production presumed to be due to ocular inflammation. This study was designed to evaluate the efficacy of a second trial of topical cyclosporine in patients with dry eye who were previously considered treatment failures.
This multicenter (three cornea practices) retrospective chart review evaluated clinical outcomes in patients with dry eye who received a second trial of cyclosporine after a prior treatment failure, defined as prior discontinuation of topical cyclosporine after less than 12 weeks.
Thirty-five patients, most of whom were female (71.4%) and Caucasian (62.9%), were identified. Prior discontinuation was most commonly due to burning/stinging (60%). The median duration of second treatment was 10 months (range 1 week to 45 months). Physician education was provided in the second trial in 97.1% of cases. At initiation of the second trial of cyclosporine, 10 (28.6%) patients received courses of topical corticosteroids. Physicians reported on a questionnaire that 80% of patients achieved clinical benefit with a second trial of cyclosporine.
A repeat trial with topical cyclosporine can achieve clinical success. Direct patient education via the physician and staff may be key to success. Proper patient education may overcome adherence issues, particularly with respect to the need for long-term treatment of chronic dry eye. This study has the usual limitations associated with a retrospective chart review, and future prospective studies are warranted.

Clin Ophthalmol. 2012;6:1971-6. doi: 10.2147/OPTH.S30261. Epub 2012 Nov 28.
Mah FMilner MYiu SDonnenfeld EConway TMHollander DA.
University of Pittsburgh, Pittsburgh, PA.