OCT 2018

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Supported by Johnson & Johnson Vision 7 of dry eye disease. N Engl J Med. 2018;378:1681–1690. 4. Hagen KB, et al. Comparison of a single-dose vectored thermal pulsation procedure with a 3-month course of dai- ly oral doxycycline for moderate-to-se- vere meibomian gland dysfunction. Clin Ophthalmol. 2018;12:161–168. 5. Epitropoulos AT, et al. Effect of tear osmolarity on repeatability of keratom- etry for cataract surgery planning. J Cataract Refract Surg. 2015;41:1672–7. References 1. Geerling G, et al. The Internation- al Workshop on Meibomian Gland Dysfunction: report of the subcommit- tee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2011;52:2050–64. 2. Cochener B, et al. Prevalence of mei- bomian gland dysfunction at the time of cataract surgery. J Cataract Refract Surg. 2018;44:144–148. 3. Dry Eye Assessment and Manage- ment Study Research Group. n-3 fatty acid supplementation for the treatment and teratogenicity," he said. A topical minocycline preparation has shown promise in recent investigations, and subsequent Phase 2 and early Phase 3 trials are planned, he said. Topical doxycycline proved effective for dry eye patients during a Phase 2 protocol 10 years ago by Alac- rity Bioscience, he added. Newer modified thermal pulsation devices are also being developed, which may reduce patient expense, Dr. Sheppard said. In addition, several startup companies are taking novel approaches to MGD, derived from other specialties including dermatology, he said. Conclusion In the last decade, eye care providers have increasingly recognized the importance of diagnosing and treating MGD. "As diagnostics improve, such as the revolution created by meibography, as therapeutics improve, such as the recently decreased activator cost for thermal pulsation therapy, and delivery systems improve for useful drugs like the tetracy- cline class, life will only become better for our patients," Dr. Sheppard said. surgery—or surgeon. 5 A majori- ty of Summit participants think symptomatic MGD should be treated prior to proceeding with cataract or refractive surgery (Figures 2 and 3). Dr. Epitropoulos recom- mended assessing patients for anterior blepharitis and initiat- ing lid cleansers before cataract surgery to help optimize the ocular surface and reduce the risk of endophthalmitis. Microblepharoexfoliation may also significantly reduce the risk of postoperative en- dophthalmitis potentially by lowering the lid margin bacteri- al presence, Dr. Bowden said. Antibiotics and future developments Because of the systemic side effects of oral tetracyclines, researchers are investigating topical preparations, John Sheppard, MD, said. "With topicals, we have some great advantages, and those include a higher local concentration, the absence of systemic toxicity, and the ability to use prolonged therapy without some of these concerns, including phototox- icity, gastrointestinal irrita- bility, esophagitis, gastritis, Pioneers lay groundwork for MGD intervention M ore than three decades ago, Donald Korb, OD, and Antonio Henriquez, MD, PhD, and their research team sought to find the reason for contact lens intolerance despite advances in lens technology. They discovered a syndrome where patients had reduced mei- bomian gland secretions and dry eye symptoms. 1 They coined the term meibomian gland dysfunction (MGD), stating that it resulted from meibomian gland obstruction, leading to a reduction in oil secretion and an inflammatory process. It is now known that the inflammation can lead to atrophy of the glands. "Since then we know that MGD is the leading cause of not only dry eye throughout the world, but we know that it is the major cause of contact lens discomfort with all contemporary contact lenses," Dr. Korb said. It is also the major cause of patients terminat- ing contact lens wear, he added. MGD treatment can improve comfort and lengthen contact lens use. Blackie et al. reported that when MGD was treated with thermal pulsation, contact lens wear increased by 4 hours. 2 However, Dr. Korb explained, MGD may not be obvious. 3 "Number one, you have to look for it," he said. "Number two, you have to know how to look for it. There are two ways: structure and function." He recommended meibography to assess structure and a handheld device that applies the pressure of a blink to the meibo- mian glands to assess function. References 1. Korb DR, Henriquez AS. Meibomian gland dysfunction and contact lens intolerance. J Am Optom Assoc. 1980;51:243–51. 2. Blackie CA, et al. A single vectored thermal pulsation treatment for meibomian gland dysfunction increases mean comfortable contact lens wearing time by approxi- mately 4 hours per day. Clin Ophthalmol. 2018;12:169–183. 3. Blackie CA, et al. Nonobvious obstructive meibomian gland dysfunction. Cornea. 2010;29:1333–45. Editors' note: Dr. Korb is one of the patent holders of LipiScan, LipiFlow, and the Meibomian Gland Evaluator (Johnson & Johnson Vision) but has no financial interest. Figure 3. Most participants think that symptomatic MGD should be treated before corneal refractive surgery. Should we be treating symptomatic MGD before or after corneal refractive surgery? Meibography Summit

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