Eyeworld

Supported by an unrestricted educational grant from Shire, Johnson & Johnson Vision, Sun Ophthalmics, and Allergan SEPTEMBER 2019 | SUPPLEMENT TO EYEWORLD | 3 Diagnosing meibomian gland dysfunction A s awareness of meibo- mian gland dysfunction (MGD) increases, the range of diagnostic technologies has expanded, offering clinicians numerous ways to detect MGD. To guide clinicians in integrating diagnosis and treatment of OSD into their preop evaluation, ASCRS introduced the Preoperative Ocular Surface Disease (OSD) Algorithm. 1 It provides a sequence of steps to help clinicians diagnose ocular sur- face disease in a standardized manner. The algorithm begins with three essential screening tests—the ASCRS SPEED II questionnaire to assess symp- toms and tear osmolarity and MMP-9 to identify signs. If results are positive on any of these tests, additional assess- ments are performed. Subse- quently, the clinician performs the LLPP (look, lift, pull, push) portion of the clinical exam, followed by diagnostic staining. One benefit of LLPP is that all clinicians can perform it because it does not require additional diagnostic tech- nologies, which will offer the impetus for clinicians to use it, said Paul Karpecki, OD. Role of symptoms Screening questionnaires help detect symptoms. "Patients with MGD, when it is active and inflamed, are the ones who complain of a burning sensation, particularly in the morning and redness upon awakening," said Elizabeth Yeu, MD. Fluctuating vision is another major symptom of MGD. However, there may be no symptoms. "There is a variant of MGD that is known as non-obvious MGD, and by acknowledging that it exists, it prompts you to look for it," said Frank Bowden, MD. Strategic testing Based on dry eye question- naires and point-of-care tests, eyecare professionals may per- form additional assessments if they are available. 1 Meibography is useful in assessing meibomian gland structure, and clinicians can correlate findings with other tests. "While tear osmolarity and MMP-9 will help us diag- nose dry eye, I do not think they are that useful in differ- entiating the causes," said Eric Donnenfeld, MD. "Meibography has become the linchpin for our practice in differentiating the form of dry eye, which then dictates treatment later." In addition, meibogra- phy helps clinicians monitor treatment response. At the 2019 ASCRS ASOA Annual Meeting, Alice Epitropoulos, MD, and Arjan Hura, MD, presented a report indicating that visible gland structure may increase after thermal continued on page 4 Edward Holland, MD, is a member of the speaker's bureau for Aerie, Azura, Glaukos, Kala, Katena, Preci- sion Lens, Shire, Sight Sciences, SightLife, TearLab, and Vomaris. He is a member of the speaker's bureau and has received research support from Mati, Novartis, Omeros, and Senju. Paul Karpecki, OD, has an investment interest in Bruder Healthcare. He has received a retainer, ad hoc fees, or other consulting income from Akorn, Alcon, Allergan, Ametek, Anthem, Avellino, Beaver-Visitec, BioTissue, BlephEx, Focus Labs, Glaukos, iCare USA, Imprimis, Johnson & Johnson Vision, Konan Medical, MacuLogix, Oasis Medical, OcuSoft, Rendia, RxSight, Science Based Health, Shire, Sun Pharmaceuticals, Tear Film Innovations, TelScreen, Visionix, and VMax. He is a member of the speaker's bureau for Aerie. Terry Kim, MD, has an investment interest in and has received a retainer, ad hoc fees, or other consulting income from CorneaGen, Eyenovia, Kala, NovaBay, Ocular Therapeutix, Omeros, Presbyopia Therapies, and Simple Contacts. He has received a retainer, ad hoc fees, or other consulting income from Aerie, Alcon, Allergan, Avedro, Avellino, Bausch + Lomb, BlephEx, Dompé, Johnson & Johnson Vision, Shire, Sight Sciences, and Carl Zeiss Meditec. W. Barry Lee, MD, is a member of the speaker's bureau and has received a retainer, ad hoc fees, or other consulting income from Shire. He has received travel support from Georgia Eye Bank. He has earned royalty from Elsevier. Cynthia Matossian, MD, has an investment interest in Checked Up, PRN, and Strathspey Crown/Alphaeon. She has received a retainer, ad hoc fees, or other consulting income from Aerie, Allergan, Bausch + Lomb, BioTissue, Bruder Health, Eyepoint, Eyevance, GuardiOn, Imprimis, iOptics, Johnson & Johnson Vision, Kala, Lenstec, Marco, MDbackline, Mentho- latum Company, Ocular Science, Ocular Therapeutix, Omeros, PRN, Quidel, Shire, Sun Pharmaceuticals, TearLab, and Carl Zeiss Meditec. She is a member of the speaker's bureau for Aerie, Allergan, Bausch + Lomb, Bruder Health, EyePoint, Johnson & Johnson Vision, Kala, Marco, Ocular Science, Ocular Therapeu- tix, Omeros, PRN, Quidel, Shire, Sun Pharmaceuticals, TearLab, and Carl Zeiss Meditec. She has received re- search support from Bruder Health and Shire. She has provided practice management or marketing consulting services to EyePoint and Carl Zeiss Meditec. Marguerite McDonald, MD, has received a retainer, ad hoc fees, or other consulting income from Alcon, Allergan, Altaire, Bausch + Lomb, BlephEx, Dompé, Eyevance, Johnson & Johnson Vision, Oculus USA, OcuSoft, Paragon BioTeck, Shire, Stroma, and Sun Pharmaceuticals. Henry Perry, MD, is a member of the speaker's bureau and has received a retainer, ad hoc fees, or other consulting income from BlephEx and NovaBay. He has received a retainer, ad hoc fees, or other consulting income from Novaliq. He is a member of the speaker's bureau for Alcon, Allergan, Bausch + Lomb, and Omeros. John Sheppard, MD, has an investment interest in Clearside, EyeGate, NovaBay, and TearLab. He has received a retainer, ad hoc fees, or other consulting income from AbbVie, Aerie, Alcon, Aldeyra, Allergan, Bausch + Lomb, BioTissue, Clearside, EyeGate, Johnson & Johnson Vision, Kala, NovaBay, Omeros, Parion, Portage, Santen, Science Based Health, Shire, Sun Pharmaceuticals, TearLab, and Topivert. He is a member of the speaker's bureau for AbbVie, Alcon, Allergan, Bausch + Lomb, BioTissue, EyeGate, Johnson & Johnson Vision, Omeros, Santen, Science Based Health, Shire, Sun Pharmaceuticals, and TearLab. He has received travel support from AbbVie, Alcon, Allergan, Bausch + Lomb, BioTissue, Clearside, EyeGate, Johnson & Johnson Vision, Kala, NovaBay, Omeros, Portage, Santen, Science Based Health, Shire, Sun Pharmaceuticals, TearLab, and Topivert. He has received research support from Alcon, Aldeyra, Allergan, Bausch + Lomb, EyeGate, Kala, Parion, Santen, and Shire. William Trattler, MD, has an investment interest in ArcScan, CXLO, Heakthe, and RxSight. He has an investment interest in and has received a retainer, ad hoc fees, or other consulting income from Sun Phar- maceuticals. He has received a retainer, ad hoc fees, or other consulting income from Dompé and LENSAR. He is a member of the speaker's bureau for Oculus. He is a member of the speaker's bureau and has received a retainer, ad hoc fees, or other consulting income from Allergan, Avedro, Bausch + Lomb, Iantech, NovaBay, and Shire. He is a member of the speaker's bureau, has received a retainer, ad hoc fees, or other consulting income from, and has received travel support from Johnson & Johnson Vision. Elizabeth Yeu, MD, has an investment interest in Mynosys, Modernizing Medicine, and Ocular Science. She has received a retainer, ad hoc fees, or other consulting income from Alcon, Allergan, Aurea, Bausch + Lomb, BioTissue, BVI, EyePoint, GuidePoint, iOptics, Johnson & Johnson Vision, Kala, Merck, Mynosys, Ocular Therapeutix, OcuSoft, Omeros, Prevision Lens, Science Based Health, Shire, TearLab, and Carl Zeiss Meditec. She is a member of the speaker's bureau for Alcon, Allergan, BioTissue, iOptics, Johnson & Johnson Vision, Shire, and TearLab. She has received research support from BioTissue, iOptics, Kala, Ocular Science, TearLab, and Topcon. EyeWorld staff members Jessica Donohoe and Stacy Jablonski have no financial disclosures. Supported by an unrestricted educational grant from Shire, Johnson & Johnson Vision, Sun Ophthalmics, and Allergan

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