EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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September 2012 Treat the cause. "If you treat with a probe and open up the glands, treat any co- morbid disease that may be present, patients may go more than a year without needing their glands probed again," he said. "But if the patient returns 2-3 months later, invariably it's a comorbid local, regional, or systemic disease that has acted up, exerting an adverse impact on the meibomian glands." He also likes the LipiFlow System (TearScience, Morrisville, N.C.), which first analyzes the tear film quality (through the LipiView); the LipiFlow slowly heats the glands from the conjunctival side in order to express them. LipiView analyzes the lipid component in tears; the more colors present, the healthier the tear film. "It raises the temperature, which makes the oils easier to ex- press after probing," Dr. Maskin said. Dr. Majmudar believes the LipiFlow "expresses better than any- thing else" he's tried, and he prefers to use it in cases of evaporative dry eye with subsequent blepharitis or MGD. Pricing, however, may be an issue, as the system is not currently reimbursable, Dr. Starr said. For some patients with moderate to severe MGD, however, "spending $2,000 a year to not have to massage and heat their lids daily might be worth it." Down the road Dr. Starr said Bascom Palmer is work- ing on an ultrahigh resolution opti- cal coherence topographer that will be capable of imaging the precorneal tear film and the integrity of the corneal epithelium; he also believes specialized topographers that can capture the quality of the interblink tear film over time are promising. "Those are providing a very sophisticated way of measuring tear breakup times—a quantifiable, reproducible, objective number in a non-invasive manner that is prefer- able to using fluorescein dye," he said. Dr. Majmudar said the OQAS (Visiometrics, Terrassa, Spain) de- tects the optical quality of the eye "and converts the images into a metric that's quantifiable. It may hold promise for dry eye as well." Dr. Maskin is currently using intraductal microtubes (Rhein Medical) that can be inserted directly into the meibomian glands as drug delivery devices. "The tests that are in develop- ment are easy to use and non-inva- sive," Dr. Starr said. "Welcome to the modern era of dry eye diagnostics." EW EyeWorld factoid The annual economic impact of major vision problems among the adult population 40 years and older is more than $51 billion Source: Centers for Disease Control and Prevention Editors' note: Dr. Majmudar has financial interests with RPS, SARcode Bioscience (Brisbane, Calif.), and TearScience. Dr. Maskin has financial interests related to pending patents on meibomian gland probing and related diagnostic and treatment apparatus, and a royalty interest in the Maskin Meibum Expressor. Dr. Starr has financial interests with Allergan (Irvine, Calif.), Bausch + Lomb (Rochester, N.Y.), Merck (Whitehouse Station, N.J.), and RPS. Contact information Majmudar: 847-275-6174, pamajmudar@yahoo.com Maskin: 813-875-0000, drmaskin@tampabay.rr.com Starr: 646-962-3370, cestarr@med.cornell.edu LipiFlow® is indicated for treatment of Meibomian Gland Dysfunction and evaporative dry eye. In clinical trials, gland secretions more than doubled, on average, following a single LipiFlow® treatment.2 Visit tearscience.com for complete product and safety information. 86% of dry eye patients have signs of Meibomian Gland Dysfunction (MGD).1 Visit us at AAO 2012 Booth #4362 1 2 Lemp MA, et al. Distribution of aqueous deficient and evaporative dry eye in a clinic-based population. Cornea. 2012 May;31(5):472-8 Lane SS, et al. A New System, the LipiFlow, for the treatment of Meibomian Gland Dysfunction (MGD). Cornea. 2012;31:396-404 LipiFlow is a registered trademark of TearScience, Inc. Copyright © 2012 TearScience, Inc. All rights reserved.