Eyeworld

Supported by an unrestricted educational grant from Johnson & Johnson Vision 3 continued on page 4 Preeya Gupta, MD, has received a retainer, ad hoc fees, or other consulting income from: Alcon, Aller- gan, Bausch + Lomb, BlephEx, Focus Labs, NDC, NTK, Oculus, OCuSOFT, Orca Surgical, and Shire. D. Rex Hamilton, MD, has received a retainer, ad hoc fees, or other consulting income from Alcon, Carl Zeiss Meditec, and Johnson & Johnson Vision. Edward Holland, MD, has received a retainer, ad hoc fees, or other consulting income from: Aerie, Alcon/Novartis, Azura, Glaukos, Katena, Kala, Mati, Omeros, Precision Lens, Senju, Shire, Sight Sciences, SightLife Surgical, TearLab, and Vomaris. He has received research funding from: Alcon/ Novartis, Mati, Omeros, and Senju. He is a member of the speakers bureau of Alcon/Novartis, Omeros, Senju, and Shire. Paul Karpecki, OD, has received a retainer, ad hoc fees, or other consulting income from: Akorn, Alcon, Allergan, Bausch + Lomb, Beaver-Vis- itec International, BioTissue, BlephEx, Bruder, Cambium, EyeGate, Eyemaginations/Rendia, Focus Labs, Imprimis, Johnson & Johnson Vision, Oasis Medical, Oculus, OCuSOFT, Science Based Health, Shire, Sun Pharmaceuticals, TearFilm, and Topcon. He is a member of the Board of Directors of Silk Technologies and TearLab. Terry Kim, MD, has an investment interest in: Johnson & Johnson Vision, Kala, NovaBay, Ocular Therapeutix, Omeros, SightLife Surgical, and Simple Contacts. He has received a retainer, ad hoc fees or other consulting income from: Acucela, Aerie, Alcon, Allergan, Avedro, Avellino, Bausch + Lomb, BlephEx, CoDA/Ocunexus Therapeutics, Kala, NovaBay, Ocular Therapeutix, Omeros, Pow- erVision, Presbyopia Therapies, Shire, SightLife Surgical, Simple Contacts, and TearLab. Donald Korb, OD, is one of the patent holders for relevant ophthalmic devices; however, he has no financial interests related to the patents. W. Barry Lee, MD, is a member of the speakers bureau of BioTissue and Shire. Marguerite McDonald, MD, has received a retain- er, ad hoc fees, or other consulting income from Alcon, Allergan, Altaire, and Johnson & Johnson Vision. She is a member of the speakers bureau of Allergan and Johnson & Johnson Vision, and her spouse has a financial relationship with Alcon. John Sheppard, MD, has an investment interest in: 1-800-DOCTORS, Alphaeon, EyeGate, EyeRx Research, LacriScience, LayerBio, Mati, NovaBay, Noveome, OcuHub, OcuCure, Okogen, RPS, Shire/ SARcode, Stemnion, Strathspey Crowne, and TearLab. He has received a retainer, ad hoc fees, or other consulting income from, is a member of the speakers bureau of, and has received research funding from: AbbVie, Alcon, Allergan, Avedro, Bausch + Lomb, EyeGate, Inspire/Merck, and Santen. He has received a retainer, ad hoc fees, or other consulting income from and is a member of the speakers bureau of: Bio-Tissue, Eleven, MedEdicus, Nicox, Omeros, Science Based Health, Talia Technology, and TearScience. He has received a retainer, ad hoc fees, or other consulting income and research funding from: Aldeyra, ArcScan, Clearside, Clearview, Clementia, Hovione, Isis Pharmaceuticals, Kala, LacriScience, Lux Biosci- ences, Novaliq, Ocular Therapeutix, Okogen, Pari- on, RPS, Shire/SARcode, and Vistakon. He has re- ceived a retainer, ad hoc fees, or other consulting income from: 1-800-DOCTORS, BioLayer, Bruder, Imprimis, LayerBio, Lenstain, Mati Therapeutics, NovaBay, Noveome, OcuCure, Ocugen, Portage, Stemnion, Sun Pharmaceuticals, Synedgen, and Topivert. He is a member of the speakers bureau of Pfizer, Topivert, Lumenis, Pentavision, and Sjo/ Nicox. He has received research funding from: EyeGate, Glaukos, InSite Vision, Rutech, Senju, Tear Solutions, and Xoma/Servier. William Trattler, MD, has an investment interest in ArcScan, Avedro, CXLO, and Iantech. He has received a retainer, ad hoc fees, or other consult- ing income from: Alcon, Allergan, Avedro, Bausch + Lomb, BlephEx, Guardian Health, Johnson & Johnson Vision, LENSAR, Ocular Therapeutics, Sun Pharmaceuticals, and Shire. He has received research funding from Allergan, Bausch + Lomb, and Johnson & Johnson Vision. He is a member of the speakers bureau of Allergan, Avedro, Bausch + Lomb, Johnson & Johnson Vision, NovaBay, Oculus, Sun Pharmaceuticals, and Shire. Elizabeth Yeu, MD, has an investment interest in Modernizing Medicine and Ocular Science. She has received a retainer, ad hoc fees, or other consulting income from: Alcon, Allergan, Bausch + Lomb, BioTissue, Beaver-Visitec International, iOptics, Johnson & Johnson Vision, Kala, Ocular Therapeutix, OCuSOFT, Omeros, Science Based Health, Shire, TearLab, and TearScience. She is a member of the speakers bureau of: Alcon, Allergan, BioTissue, iOptics, Johnson & Johnson Vision, Shire, and TearLab. She has received research funding from BioTissue, iOptics, Kala, Ocular Science, and TearLab. Staff members Brad Fundingsland and Laura Johnson have no ophthalmic-related financial interests. Jan Beiting has received a retainer, ad hoc fees, or other consulting income from: AcuFocus, Allegro Ophthalmics, Beaver-Visitec International, Imprimis, Johnson & Johnson Vision, Novaliq, and TearScience. Weighing MGD diagnostic techniques at the health of the eyelids and lashes and the quality of oils that are expressed, and if I iden- tify MGD, I initiate treatment," he said. If patients do not re- spond to the initial treatments, he performs meibography. "They have the terminolo- gy 'non-obvious MGD' and 'ob- vious MGD.' It's only non-ob- vious if you don't express the meibomian glands," said Douglas Devries, OD. "Once you have expressed the glands Paul Karpecki, OD, thinks questionnaires lead patients to share symptoms they may not mention otherwise, prompting additional testing. He exam- ines the lashes first, looking for scalloped eyelid margins, capped glands, telangiectasia, frothy tears, and lid thickening. At the slit lamp he searches for early biofilm. Then he performs expression with a meibomian paddle. William Trattler, MD, thinks function is key. 2 "I look cannot only rely on your clin- ical exam of the lid margin," said Elizabeth Yeu, MD. Before meibography, she thought structure and function were always coexistent and aligned. "In fact, they are not. You can have poorly functional mei- bomian glands. That does not mean there is already structural damage," she said. Assessing function Figure 2 shows Meibography Summit participants' opinions of routine eyelid evaluation. Form and function play an important role in diagnosing MGD E ighty-one percent of Meibography Summit participants think structure and function are equally significant in the development of symp- toms related to meibomian gland dysfunction (MGD) (Figure 1). 1 "Each is individually significant, and this is why you Figure 1. Most Meibography Summit participants think structure and function are equally significant in the development of MGD-related symptoms. Generally, what do you think is more significant in the development of MGD-related symptoms? Meibography Summit Figure 2. Most participants think a routine eyelid evaluation should include assessment of meibomian gland structure and function. Should a routine eyelid evaluation include an assessment of meibomian gland structure and function? Meibography Summit

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