Eyeworld

Dr. Holland said. "It's a frustrating relationship ophthalmologists have with the FDA; we're still trying to figure out the right test that can show how this drug is effective." Dr. Starr agreed, noting that MGD and blocked glands are major players in dry eye. "Just treating the lids won't be enough. I recommend azithromycin off label for blepharitis for 2-4 weeks." In fact, "any compo- nent of lid disease" should be pre- scribed azithromycin, but not as a standalone treatment until clini- cians have more information. "The MGD Workshop findings are going to do for MGD what the DEWS report did for dry eye and will lead us to (hopefully) realize even more about what we don't know yet," he said. A relatively unexamined area "is inflammation we cannot see with the slit lamp," Dr. Blackie added. "Non-obvious inflammation needs tools we don't necessarily have avail- able to diagnose." For instance, con- focal microscopy may help identify areas of inflammation in the lids and cornea not visible with the slit lamp, she suggested. In short, "we need better tests and better tools," she said. Non-obvious MGD "explains why so many people under 40 have dry eye," Dr. Korb said. "We're mak- ing progress in correlating the signs and symptoms, but we are not quite there yet." February 2011 Diagnosing continued from page 33 EW FEATURE 34 OCULAR SURFACE April 2011 Dry eye and ocular surgery A diagnosis of dry eye need not pre- vent someone from undergoing ocu- lar surgery, but surgeons should be aware that the state of the ocular surface will dictate those "who are likely to have tear instability prob- lems after the stress of surgery or who might have more complaints about visual outcomes," Dr. Foulks said. In moderate-to-severe dry eye, patients are more likely to have complications post-op, he added. "The threshold for performing surgery on someone with dry eye needs to be higher," he said. The key, Dr. Starr said, is to sta- bilize the ocular surface before tak- ing any pre-op measurements for premium IOLs or laser vision correc- tion. "If you get patients to a point where they have an optimized and stable ocular surface, not only before doing the surgery but before taking your final pre-op measurements, your outcomes will be much better and your patients will be happier," he said. EW Editors' note: Dr. Blackie has a finan- cial interest with TearScience. Dr. Foulks has financial interests with Alcon (Fort Worth, Texas), Acucela (Seattle), Bausch & Lomb (Rochester, N.Y.), Inspire Pharmaceuticals, InSite Vision (Alameda, Calif.), Merck (Whitehouse Station, N.J.), Pfizer (New York), Santen (Napa, Calif.), and Tear- Lab. Dr. Holland has financial interests with Bausch & Lomb and Inspire Phar- maceuticals. Dr. Korb has financial in- terests with Alcon and Ocular Research of Boston. Dr. Lemp has financial inter- ests with numerous companies investi- gating dry eye treatments. Dr. Starr has financial interests with Allergan (Irvine, Calif.) and Inspire Pharmaceuticals. Contact information Blackie: 781-229-2020, CBlackie@tearscience.com Foulks: 502-852-6150, gnfoul01@louisville.edu Holland: 859-331-9000, eholland@holprovision.com Korb: 617-426-0370, drkorb@aol.com Lemp: 202-255-6842, malemp@lempdc.com Starr: 646-962-3370, cestarr@med.cornell.edu EyeWorld factoid In some patients with dry eye, supplements or dietary sources (such as tuna fish) of omega-3 fatty acids (especially DHA and EPA) may decrease symptoms of irritation Source: National Eye Institute, National Institutes of Health 032-047 Feature_EW April 2011-DL_Layout 1 4/10/11 8:00 AM Page 34

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