Evidence for Technology in the Treatment of Advanced Dry Eye

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Damian Harrell
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1 Evidence for Technology in the Treatment of Advanced Dry Eye COPE AS Chris Lievens, OD, MS, FAAO

Evidence for Technology in the Treatment of Advanced Dry Eye COPE: 44435-AS Chris Lievens, OD MS FAAO Professor Chief of staff Southern college of optometry Dry Eye Disease inflammation of the ocular

2 Evidence for Technology in the Treatment of Advanced Dry Eye COPE: AS Chris Lievens, OD MS FAAO Professor Chief of staff Southern college of optometry Dry Eye Disease inflammation of the ocular surface and increased osmolarity of the tear film common and is often under diagnosed negatively impact vision quality, fluctuating vision, reduced contrast sensitivity, and increased glare Significant psychological impact Patients have reported a willingness to trade years at the end of life to be free of dry eye disease Dry Eye Disease Risk Factors The prevalence of dry eye increases with: Age Female gender 1 and menopause 2-5 medications Anti-histamines, anti-psychotics, anti-depressants, and antihypertensives Autoimmune inflammatory disease Contact lens wear LASIK and refractive surgery [1] Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol 2003;136(2): [2] Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA 2001;286: [3] Albietz JM. Dry eye; an update on clinical diagnosis, management and promising new treatments. Clin Exp Optom. 2001;84:4 18. [4] Hovanesian JA, Shah SS, Maloney RK. Symptoms of dry eye and recurrent erosion syndrome after refractive surgery. J Cataract Refract Surg. 2001;27: [5] Altintas O, Caglar Y, Yuksel N, Demirci A, Karabas L. The effects of menopause and hormone replacement therapy on quality and quantity of tear, intraocularpressure and ocular blood flow. Ophthalmologica 2004;218:

3 Symptoms of Dry Eye Disease 1 Symptoms of dry eye include: Dryness Itching Irritation Blurred vision Light sensitivity Foreign body sensation Excessive tearing Symptoms are often exacerbated by: Environments Decreased blink rate from prolonged visual concentration [1] Multi-sponsor Surveys, Inc. Gallup study of dry eye sufferers. Princeton, NJ, Types of dry eye Evaporative dry eye: Caused by meibomian gland dysfunction leading cause of dry eye worldwide Aqueous-deficient dry eye: Decreased tear production at the lacrimal gland Prevalent in autoimmune disease What are the dry eye personalities that we are dealing with? 2

4 Personality 1 Personality 2 Personality 3 3

Tear osmolarity Tear lab osmolarity system (tear lab) single-use microchip embedded with gold electrodes 50 nl collected Tear osmolarity Osmolarity increases with advancing dry eye disease Asymmetry

5 Tear osmolarity Tear lab osmolarity system (tear lab) single-use microchip embedded with gold electrodes 50 nl collected Tear osmolarity Osmolarity increases with advancing dry eye disease Asymmetry of findings also indicative of problems InflammaDry Identifies elevated levels of MMP-9 in tear fluid Rapid: 10 minute results In-office: point-of-care immunoassay test aids in diagnosis at the time of office visit 4

6 Dry Eye Disease and MMP-9 Matrix metalloproteinases (MMP) are proteolytic enzymes that are produced by stressed epithelial cells on the ocular surface 1 MMP-9 in Tears Normal range between 3-41 ng/ml Correlates with clinical exam findings 1 [1] Chotiakavanich S, de Paiva CS, Li de Quan, et al. Invest Ophthalmol Vis Sci 2009; 50(7): Oculus Keratograph 5M Tear film analysis by non-invasive (non-contact) scanning NIKBUT Tear meniscus height Non-contact meibography (meiboscan) Tear dynamics Bulbar redness topography TearScience Lipiview Lipiflow 5

LipiView Calculated on a frame-by-frame basis and

Challenges of Current MGD Therapies 17 Therapy

expression Challenges External heat application is

compliance Only the upper portion of the glands

Pulsation System LipiFlow safely and effectively

7 LipiView Calculated on a frame-by-frame basis and plotted for ~1 billion data points per eye 16 Challenges of Current MGD Therapies 17 Therapy Warm compresses Eyelid scrubs Manual gland expression Challenges External heat application is inadequate Significant discomfort Limited compliance Only the upper portion of the glands are treated or expressed 17 LipiFlow Thermal Pulsation System LipiFlow safely and effectively treats Meibomian gland obstruction in both upper and lower eyelids simultaneously 6

LipiView Uses interferometry to measure lipid layer thickness between blinks Quantitative assessment in interferometric color units (ICU) Pilot study: 137 consecutive patients completed SPEED test,

dandruff @ Base of lashes Most common ecoparasite Microscopy for patient education Upper 1/3 has four pairs of legs that allows it to move from one follicle to the next Remaining body is an

8 LipiView Uses interferometry to measure lipid layer thickness between blinks Quantitative assessment in interferometric color units (ICU) Pilot study: 137 consecutive patients completed SPEED test, then measured LLT by Lipiview SPEED >10, 74% had LLT of 60nm or less SPEED = 0, had LLT 75nm or greater As LLT increases, symptom score decreases microscopy Demodex visible at slit lamp Cylindrical Base of lashes Most common ecoparasite Microscopy for patient education Upper 1/3 has four pairs of legs that allows it to move from one follicle to the next Remaining body is an abdomen-tail Demodicosis Demodex folliculorum Buries within hair follicle (tail protrudes) Demodex brevis Favor sebum-rich environments like Meibomian glands Organisms inhabit hair follicles & glands Feed on sebaceous oils & dead skin cells; carry pathogenic bacteria Avoid light: most active at night Overpopulation causes localized inflammation 7

9 Demodicosis Demographics: More prevalent in elderly Male > female More common in rosacea patients Symptoms: Grittiness and/or burning Itching of eyelids Crusting of eyelashes Poor cosmesis (i.e. eye & eyelid redness) 8

10/27/2017. Evidence for Technology in the Treatment of Dry Eye COPE: AS. Dry eye. Dry eye

10/27/2017. Evidence for Technology in the Treatment of Dry Eye COPE: AS. Dry eye. Dry eye Evidence for Technology in the Treatment of Dry Eye COPE: 44090-AS Chris Lievens, OD MS FAAO Professor Chief of staff Southern college of optometry Dry eye Chronic Multifactorial Characterized by disturbances