Eyeworld

124 | EYEWORLD | APRIL 2019 C ORNEA Contact information Nubile: m.nubile@unich.it by Stefanie Petrou Binder, MD EyeWorld Contributing Writer PRESENTATION SPOTLIGHT O cular surface complications associated with diabetes may be easy to over- look, thanks to the clinician's focus on well-known and serious diabetic side effects and comorbidities, such as di- abetic retinopathy, cataract, and glau- coma. The effects of diabetes on the ocular surface are poorly understood, however, virtually all components of the ocular surface can be influenced by diabetic complications, according to a presentation given at the 36th Congress of the European Society of Cataract and Refractive Surgeons. "Seventy percent of diabetic patients, during the long history of the disease, may suffer from diabetic keratopathy or ocular surface involve- ment of some kind," said Mario Nubile, MD. "The involvement and the severity of this clini- cal condition is strictly related to the age of the patient, duration of the diabetic disease, and poor glycemic control. It can go from very mild dry eye disease to a very severe form of neurotrophic corneal ulcerations." The impact of diabetes on the ocular surface can result from several mechanisms that include defective wound healing in the corneal epithelium, abnormalities of sub-basal nerves, and loss of the corneal endothelial pump function. 1 "Patients with diabetes are at a higher risk of suffering from dry eye disease, and the reason is because peripheral neuropathy secondary to hyperglycemia and microvascular damage to the corneal nerves can block the feedback mechanism that controls tear secretion," Dr. Nubile explained. "Insulin in- sufficiency that disrupts the metabolic balance of the corneal and lacrimal tissues results in ocular dryness, and hyperglycemia triggers inflammation that may help in maintaining this vicious circle." Symptoms and mechanisms Patients can have a wide range of symptoms, including an itchy sensation, stinging/burning, a gritty/sandy sensation, light sensitivity, excessive tearing, or blurry vision/poor night vision, with at least 50% of diabetic patients experiencing them. The lids and the conjunctiva can be affected, as well, with these patients prone to infections like blepharitis or conjunctivitis. Ocular surface and diabetes Diagnostics and evolving treatments Meibomian gland dysfunction leads to an evaporative type of dry eye syndrome. Patients complain of pain, discomfort, and burning. Source: Esen Akpek, MD About the doctor Mario Nubile, MD Excellence Eye Research Center University Gabriele d' Annunzio of Chieti Pescara, Italy continued on page 126 tear production for the first time. In particular, this may be an option for those who have not responded well to other treatments or who want to minimize or do away with drops. "You can use it when other treatments have either failed or are not acceptable for the patient," Dr. Sheppard said. "Major exceptions to recommendation include patients with severe tremors, cardiac pacemakers, nasal septum deviation, nasal polyps, or a history of recurrent epistaxis." The TrueTear treatment is likely to be syner- gistic with all of the currently available modes of therapy, Dr. Sheppard pointed out, adding that it has a unique mode of action, " providing a drop- free, surgery-free intervention that is completely directed and regulated by the patients them- selves," he said. "This creates a new niche for the treatment of moderate to severe dry eye." continued from page 122

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