Eyeworld

EW CORNEA 46 June 2018 by Liz Hillman EyeWorld Senior Staff Writer layer of tears from the meibum, Dr. Kading explained, tears evaporate quicker and the contact lens gets dry during the day and scrapes when the eyelid moves or blinks, which is called lid wiper epitheliop- athy. This, Dr. Kading explained, is highly correlated with dryness and contact lens wear. "If we can show that after LipiFlow we improve the coefficient of friction on contact lens wear for a longer period of time, we're going to be able to show the longevity in the ability to wear contact lenses," he said. He thinks evaluating the re- sponse and quality of life changes after LipiFlow in subgroups of pa- tients who are likely to drop out of their contact lenses would be useful as well. With the strong dropout rate of contact lens wear and age around which it occurs, Dr. Kading said these patients need to be treated aggressively in their 30s and 40s before their meibomian glands get clogged to the point of atrophy. A separate study also published in Clinical Ophthalmology com- pared one LipiFlow treatment to a 3-month course of oral doxycy- cline in patients with moderate to severe MGD. 3 Hagen et al. looked at the effect of both treatments at baseline and 3 months post-treat- ment on SPEED scores, meibomian gland function (evaluated by the number of glands excreting liquid), tear breakup time, and corneal and conjunctival staining. Overall, the researchers found that the LipiFlow treatment was sig- nificantly more effective than oral doxycycline at improving dry eye symptoms according to the SPEED scores. LipiFlow and doxycycline were at least equally as effective in improving meibomian gland func- tion and other MGD metrics. This research, Leslie O'Dell, OD, director, Dry Eye Center of Pennsylvania, Wheatlyn EyeCare, Manchester, Pennsylvania, who was not involved with this study, said is important because it validates LipiFlow against a longer-standing treatment. "The rate of contact lens dropout has not changed in the last 20 years," Dr. Kading said. "We've ranged between 16% and 20% of all patients dropping out of contact lens wear every single year. In the last 20 years, we've innovated with silicone hydrogels, new contact lens solutions, new contact lens mate- rials, and daily disposables, yet the dropout rate for contact lenses has not gone down. Of all the people who are wearing contact lenses, 70% of them are under the age of 42. That means that only a small fraction of people still wear contact lenses after the age of 40. The top two reasons people stop wearing contact lenses are because of dis- comfort and dryness. "We've got a major problem that the contact lens industry has not resolved," he continued. "They haven't been able to figure it out, and they're telling us to switch to a new lens, a new solution, a new material, and it has not fixed the problem in 20 years. There has got to be something else going on, and that's dry eye. According to a research study we did in our office, about 78% of our dry eye patients have MGD where less than six mei- bomian glands were flowing. Lemp et al. did a study in 2011 where they found 86% of all dry eye patients in the practice had MGD, so we know that discomfort and dryness are the top reasons why people are dropping of out contact lens wear. Between my study and his, 80–90% of patients have MGD, and I think we found our golden ticket. We've got to find a way to stop MGD in contact lens wearers." 2 When it comes to improve- ment of MGD though, Dr. Kading said this has nothing to do with symptomatic relief. "Improvement of MGD is the improvement of function," he said. "You know it's improving if there is more oil being secreted." This research shows actual improvement in function of the glands in the treatment group. Dr. Kading thinks more work should be done to understand the effect of thermal pulsation on the coefficient of friction on a con- tact lens wearer. Without the oily who were randomized into experi- mental and control groups, evaluat- ed each patient's meibomian gland secretion (MGS) score and Standard Patient Evaluation of Eye Dryness (SPEED) score at 1 and 3 months post-treatment. At 3 months, those treated with thermal pulsation had significantly better MGS and SPEED scores over baseline. The researchers also found a significantly better improvement in tear breakup time, lid wiper epitheliopathy, and frequency of over-the-counter drop use in the experimental group. Patients in the LipiFlow group reported increased comfortable contact lens wear time, 4 hours on average. This, according to David Kading, OD, Specialty Eyecare Group, Seattle and Kirkland, Washington, one of the study's principal investigators, could make the difference in getting contact lens wearers through their workday comfortably. One study compared thermal pulsation in a contact lens wearing group, the other to a 3-month course of doxycycline R ecently published studies are further supporting the efficacy of thermal pulsa- tion treatment for patients with meibomian gland dysfunction (MGD). LipiFlow (Johnson & Johnson Vision, Santa Ana, California) is an in-office procedure that heats (and thus liquefies) thickened meibum in the glands and pushes it out. One of the studies, published in Clinical Ophthalmology, evaluated the effect of one LipiFlow treatment on contact lens wearers with MGD and symptoms of dry eye. 1 The research, which included 55 patients Studies show value of thermal pulsation compared to other MGD therapies Research highlight LipiFlow is an in-office procedure that heats and liquefies thickened meibum in the glands and pushes it out. Source: Johnson & Johnson Vision continued on page 48 " We've got to find a way to stop MGD in contact lens wearers. " —David Kading, OD

• Cover