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.

Abstract: Plugs after LASIK

I have a better idea: Don't cut into healthy corneas.

To evaluate the effect of punctal plug use in preventing dry eye after laser in situ keratomileusis (LASIK).
 Materials and Methods:
A randomized clinical trial at a tertiary eye care center, Riyadh, Saudi Arabia. Participants underwent LASIK for myopia in both eyes and a lower punctal occlusion in one eye only while the other eye served as control. Both eyes received the same postoperative medications except for lubricant duration (subject eye: four times per day for one week; control eye: four times per day for 6 months). Participants were evaluated at 1 week, 2, and 6 months after surgery for signs and symptoms of dry eye. The main outcome measures were visual acuity; ocular surface parameters; and Ocular Surface Disease Index questionnaire.
Seventy-eight eyes of 39 patients were included in this study. The Ocular Surface Disease Index scores of eyes with punctal plugs were better at all follow-up visits, and the differences between both eyes were statistically significant (1 week, p<0.0001; 2 months, p<0.0001; 6 months, p=0.008). At the final follow-up visit, the percentage of normal eyes was higher in eyes with punctal plugs for all ocular surface parameters (Schirmer 1 test, 94.9%; tear breakup time, 77.8%; punctate epithelial keratitis score, 71.8%) compared to eyes without occlusion (Schirmer 1 test, 92.3%; tear breakup time, 58.3%; punctate epithelial keratitis score, 53.8%); however, such differences were not statistically significant.
Punctal plug insertion after LASIK surgeries may minimize the need for frequent lubricant application and hence improve patient satisfaction.

Curr Eye Res. 2013 Oct 22. [Epub ahead of print]
Alfawaz AM, Algehedan S, Jastaneiah SS, Al-Mansouri S, Mousa A, Al-Assiri A.
Department of Ophthalmology, College of Medicine, King Saud University , Riyadh , Kingdom of Saudi Arabia .