Eyeworld

EW ASCRS PREVIEW 34 March 2011 by Michelle Dalton EyeWorld Contributing Editor Dry eye remains a complicated issue Dry eye—with and without meibomian gland dysfunc- tion—is the topic of an entire session at this year's annual meeting A s diagnostics become bet- ter and technology im- proves to allow surgeons to visualize problems in the eye earlier, treating surface abnormalities before allow- ing patients to undergo surgery is becoming the norm. During this year's ASCRS Annual Meeting, sev- eral physicians will be addressing the topic in a session devoted solely to dry-eye management. Among some of the papers being presented: C. Palomino and colleagues from Madrid, Spain, will discuss their findings from a study of three groups of patients—those who un- derwent LASIK, those who under- went PRK, and those who underwent cataract—comparing how the ocular surface was altered by each of those surgeries. In all measured parameters (including tear break-up time, Schirmer's scores, and osmolarity testing), cataract sur- gery induced less alteration to the surface than either refractive proce- dure. Two antibodies as well as inter- leukin-17 may be prognostic factors in evaluating the clinical severity of keratoconjunctivitis sicca in patients already diagnosed with Sjogren's syndrome, a group of Korean physi- cians plan on detailing, according to Y. Lee and colleagues from the Seoul National University College of Medi- cine, South Korea. Three presentations will concen- trate on meibomian gland dysfunc- tion (MGD). In the first, James P. McCulley, M.D., professor and chair, ophthalmology department, University of Texas Southwestern Medical Center, Dallas, will discuss the impact of a PEG/PG/phospho- lipid containing artificial tears in de- creasing aqueous tear evaporation in those diagnosed with aqueous tear deficient dry eye associated with MGD. In his study, "there was a strong downward trend of decrease aqueous tear evaporation after the instillation of 40 uL of the PEG/PG/ phospholipid containing tear that persisted at 60 minutes, but did not reach statistical significance." D. Rex Hamilton, M.D., direc- tor, University of California, Los An- geles LASIK Refractive Center, Jules Stein Eye Institute, plans to describe a new ocular surface interferometer and methods developed for the quantitative assessment of lipid layer thickness. The LipiView OSI (TearScience, Morrisville, N.C.) em- ploys a spatially modulated light source that allows removal of un- wanted background images and stray light, according to Dr. Hamil- ton. The device can then analyze each pixel once the tear film is iso- lated and blinks removed. Although the device is not yet approved in the United States, internationally it is the "first imaging device to objec- tively quantify lipid layer thickness using interferometry," Dr. Hamilton said. "It has the potential to signifi- cantly affect diagnosis and monitor- ing of lipid-deficient evaporative dry eye." In another study, a single ther- mal pulsation treatment provided "sustained improvement in clinical signs and symptoms of MGD and dry eye for up to 12 months," ac- cording to Jack V. Greiner, D.O., Ph.D. Research from Schepens Eye Research Institute, Boston, will re- port on the efficacy of the LipiFlow system. In this study, heat was ap- plied to the inner eyelid surfaces while the meibomian glands of both lids were being expressed. A total of 130 eyes underwent one treatment and follow-up was at weeks 2 and 4. A subset group was followed at 9 and 12 months after treatment. Mei- bomian gland function was graded on a scale of 0-3; other outcomes in- cluded tear break-up time and pa- tient questionnaire responses. In the subset group, mean meibomian gland scores improved from 4.43 at baseline to 7.28 at 12 months. Sub- jective scores from the question- naires were reduced by about half. Dr. Greiner believes further research is needed to determine the duration of effect. Finally, Parag A. Majmudar, M.D., associate professor of ophthal- mology, Rush Medical Center, Chicago, will report on a prospec- tive, randomized, open-label crossover study on two systems—the LipiFlow and the iHeat (Advanced Vision Research, Woburn, Mass.). In this study, 138 eyes (group 1) re- ceived a single in-office treatment with the LipiFlow while 140 eyes (group 2) used a commercially avail- able warm compress system (the iHeat) for 5 minutes daily over 2 weeks. The LipiFlow group had im- provement in meibomian gland scores from 6.3 at baseline to 14.3 at the 2-week follow-up, while the iHeat group had a meibomian gland score increase from 5.6 at baseline to 6.1 at 2 weeks. Tear break-up time was unchanged in the iHeat group, while improvement from 5.5 sec- onds to 6.9 seconds was found in the LipiFlow group. There were no significant changes between the groups in device-related adverse events, corneal/conjunctival stain- ing, intraocular pressure change, best corrected visual acuity, or over- all adverse events. The free paper session 4-A will be presented on Tuesday, March 29, at 8 a.m. EW San Diego, March 25-29, 2011 Dry eye will be a hot topic at this year's ASCRS Annual Meeting Source: Peter J. McDonnell, M.D., and the Delphi Task Force

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