Eyeworld

The rst objective and quantitative measurement of Dry Eye Disease The TearLab ® Osmolarity System delivers fast and accurate results in seconds using only a 50nL tear sample to diagnose Dry Eye Disease. * Incorporating osmolarity into the standard of care gives the best indication of early stage disease. And TearLab enables discussion with patients around a number they can relate to, improving compliance. 335 MANAGE DRY EYE WITH CONFIDENCE For more information call 1-855-TearLab (832-7522) or visit us online @ www.tearlab.com. In Canada call 1-905-486-1163 ©2011 TearLab Corp. *The TearLab Osmolarity System is intended to measure the osmolarity of human tears to aid in the diagnosis of Dry Eye Disease in patients suspected of having Dry Eye Disease, in conjunction with other methods of clinical evaluation. 920049 REV A FDA 510(K) CLEARED (K083184) r TearLab is designated as CLIA Moderately Complex. What's Your Number? e v i t c e j b o t s r e h T u s a e m e v i t a t i t n a u q d n a e e s i D e y E y r D f o t n e m e r u e s a e i t a p h t i w n o i s s u c s i d s e v i g e r a c f o d r a d n a t s o t e l p m a s r a e t L n 0 5 a r a l o m s O ® b a L r a e h T c n o i t a m r n i e r o m r o F 0 1 5 A D F a c y e h t r e b m u n a d n u o r a s t n s y l r a e f o n o i t a c i d n i t s e b e h t s * . e s a e s i D e y E y r D e s o n g a i d o c a d n a t s s r e v i l e d m e t s y S y t i r o 2 5 7 - 2 3 b a a - 5 5 8 - 1 l l a e T r ) 4 8 1 3 8 0 K ( D E R A E L C ( 0 p m o c g n i v o r p m i , o t e t a l e r n a n e b a L r a d n A . e s a e s i d e g a t s t n i y t i r a l o m s o g n i t a r o p r o c n I * n i s u s d n o c e s n i s t l u s e r e t a r u c c o c . b a a e t . w w w @ e n i l n o s u t i s i v M A I L C s a d e t a n g i s e d s i b a L r a e . e c n a i l s e l b a n e h t o t y l n o g 1 - 6 8 4 - 5 0 9 - 1 l l a c a d a n a C n I . m o . x e l p m o C y l e t a r e d o M 3 6 1 1 t c e p s u s s t n e i t a p n i o m s O b a L r a e T e h T * m r e h t o h t i w n o i t c n u o c n i , e s a e s i D e y E y r D g n i v a h f o d e u h f o y t i r a l o m s o e h t e r u s a e m o t d e d n e t n i s i m e t s y S y t i r a l o . n o i t a u l a v e l a c i n i l c f o s d o h t e m e s a e s i D e y E y r D f o s i s o n g a i d e h t n i d i a o t s r a e t n a m u . p r o C b a L r a e T 1 1 0 2 © 4 0 0 2 9 A V E R 9 EW FEATURE 40 said, Dr. Latkany said the products can provide temporary relief to some patients. There has been a resurgence in Lacrisert (hydroxypropyl cellulose, Aton Pharma, Bridgewater, N.J.), a product that has been around for decades, Dr. Latkany said. It seems to work best in patients with aque- ous-deficient dry eye, he said. For example, he finds patients with Sjogren's syndrome find relief from Lacrisert more than patients with oc- ular rosacea. Recommending Restasis Restasis (cyclosporine ophthalmic emulsion, Allergan, Irvine, Calif.) continues to be the drug of choice for many dry eye sufferers. "With the initiation of Restasis, over 80% of patients seem to have an outstanding result in 3 to 6 weeks," Dr. Sheppard said. "Patients can tolerate their contact lenses bet- ter, stay up later, and they have less irritation." He will usually see pa- tients for a 6-week follow-up after introducing Restasis. To reduce symptoms such as stinging and burning with Restasis, Dr. Sheppard often also prescribes loteprednol (Lotemax, Bausch & Lomb, Rochester, N.Y.). Uses for Restasis have expanded, and now patients with even mild dry eye may use the medication to prevent their inflammation from increasing, Dr. Akpek said. Addition- ally, ophthalmologists are prescrib- ing Restasis more frequently before cataract or refractive surgery to max- imize the ocular surface. Omega-3 fatty acids and diet Although the benefits of a diet rich in omega-3 fatty acids or omega-3 supplements is well documented, the body of literature for ophthalmic benefits is only just starting, Dr. Sheppard said. However, he is con- vinced that omega-3 fatty acids are a great adjunctive therapy—not just an alternative therapy—for a num- ber of dry eye patients. This therapy seems to work well because it re- duces inflammation. "For a surpris- ing number of patients, omega-3s are all they need," Dr. Sheppard said. He usually recommends that pa- tients spend the extra money to in- vest in quality omega-3 products that are mercury-free, distilled, phar- macy grade, and from freshwater or deep sea (versus farm-raised) fish. Some that he recommends include HydroEye (ScienceBased Health, Houston), TheraTears (Advanced Vi- sion Research, Woburn, Mass.), and Lovaza (GlaxoSmithKline, Middle- sex, U.K.), the latter of which is by prescription. Dietary changes, such as in- creasing omega-3 intake and reduc- ing fat, can also make a difference in dry eye symptoms, Dr. Sheppard said. Newer treatments Some of the so-called newer treat- ments for dry eye are actually older drugs used for different purposes. For example, NSAIDs are now used more often in dry eye patients as they do not have the same side ef- fects as steroids (another option de- pending on dry eye severity), Dr. Latkany said. Bromday (bromfenac ophthalmic solution, ISTA Pharma- ceuticals, Irvine, Calif.) is a newer medication to be used once a day for pain after cataract surgery. "Not an insignificant number of dry eye pa- tients find it helpful, and not as many feel the side effects as with steroids," he said. Nevanac (nepafenac, Alcon, Fort Worth, Texas) is another NSAID that Dr. Latkany prescribes to some dry eye patients. Combination antibiotic/steroid drops like Tobradex (tobramycin/ dexamethasone, Alcon) also seem to work well in some patients, Dr. Akpek said. She finds their use par- ticularly helpful toward the begin- ning of treatment. Other antibiotics that help some patients include oral doxycycline, azithromycin, and tetracycline, Dr. Sheppard said. There is some research on the use of serum tears for severe dry eye, Dr. Akpek added. Intense pulse light treatment is also on the radar screen of a growing number of ophthalmologists who treat dry eye, Dr. Latkany said. "Not a day goes by when someone doesn't call me and ask about it," he said, adding that he does not per- form the treatment. EW Editors' note: Dr. Akpek has financial interests with Allergan. Dr. Latkany has financial interests with Alcon. Dr. Sheppard has financial interests with Alcon, Allergan, Bausch & Lomb, and Vistakon (Jacksonville, Fla.). Contact Information Akpek: 410-955-5494, esakpek@jhmi.edu Latkany: 212-689-2020, relief@dryeyedoctor.com Sheppard: 757-622-2200, docshep@hotmail.com February 2011 OCULAR SURFACE April 2011 The only one-size fits all punctal plug for dry-eye treatment One-size-fits-all eliminates sizing and simplifies stocking Pre-stretched shape (on inserter) avoids dilation and facilitates insertion Expanded shape (once inserted) assures snug fit and virtually eliminates pop-out Soft collar prevents migration and provides patient comfort ™ FCI-Ophthalmics.com 800.932.4202 Plug into FCI for Dry Eye Treatment and watch the SnugPlug insertion video. Visit PlugintoFCI.com for promotional pricing Treating continued from page 39 032-047 Feature_EW April 2011-DL_Layout 1 4/10/11 8:01 AM Page 40

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