Dry Eye Dx and Tx

The OSD Explosion

By Jack L. Schaeffer, OD

The specialty of ocular surface disease (OSD), especially dry eye disease (DED), is in a stage of amazing growth. Why? There comes a time in the life of a medical entity when the clinical, research and practical applications of the process become understood, and we are now entering that period with OSD. We have a definition to guide us, new research to educate us and equipment and pharmaceuticals to diagnose and treat with accuracy. We also have dedicated practitioners who are willing to spend the time to understand the disease process and to properly treat affected patients.

What's New in OSD

The research, procedures, organizations and new technologies arising today in OSD specialty practice can only be described as a metamorphosis of a modality— a true explosion of ideas and treatment regimens. Let's look at a few of these.

Organizations The Ocular Surface Society of Optometry (OSSO) has grown to 218 members and represents an optometric voice for OSD. You can join OSSO at www.ossopt.com.

The Tear Film and Ocular Surface Society (TFOS) continues to be a leader in the research and understanding of OSD.

Research The TFOS-sponsored Meibomian Gland Dys-function (MGD) Workshop has been completed. After 2 years and hours of work by many dedicated people, you can download the results at www.tearfilm.org. Learn all there is to know about MGD. Be sure to also download the newest definition of dry eye from the 2007 report of the International Dry Eye Workshop.

Technology We can now evaluate tear osmolarity using the TearLab Osmolarity System (TearLab Corp.), treat MGD, measure the tear film and monitor our treatment plans with accuracy.

MGD treatment includes multiple devices that can affect the viability of the glands. New MGD diagnostic and treatment devices include the LipiView Ocular Surface Interferometer and the Lipi-Flow Thermal Pulse system for MGD (both TearScience). I believe the only remaining issue is determining if there is an actual presence of inflammation of the glands and the method of secretion. Prevention is now the goal.

Punctal plugs, while not new, are now being used more than ever as an adjunct therapy.

Medications Some of the many medications that can be used in treating OSD include Azasite (Merck), Restasis (Allergan), TobraDex ST (Alcon), Zirgan (Bausch + Lomb [B+L], Lotemax ung (B+L), Lastacaft (Allergan), Bepreve (Ista Pharmaceuticals), Pataday (Alcon), Systane Balance (Alcon), Blink Contacts (Abbott Medical Optics [AMO]) and FreshKote (Focus Laboratories), among many others. Some of these products may not be new, but anterior segment eyecare practitioners continue to be a driving force in their growth.

Contact Lens Solutions We now have many improved choices for lens care solutions including Biotrue (B+L), RevitaLens Ocutec (AMO), Opti-Free Pure-Moist (Alcon), and All In One Lite (Sauflon Pharmaceuticals).

Contact Lenses Scleral lenses are the ultimate dry eye treatment modality. These medical devices change patients' lives by providing vision and comfort otherwise lost due to corneal disease. Custom silicone hydrogel lenses now allow any parameters for any prescription in a higher-Dk material. SynergEyes recently launched its Duette Multifocal for those who have presbyopia and astigmatism.

Staining still matters, and Fluramene (Noble Vision Group) now allows us to check two stains simultaneously.

Don't Get Left Behind

Eyecare professionals are truly embracing the specialty of OSD and especially DED. Join the revolution! CLS

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Dr. Schaeffer practices in Birmingham, Ala., where he is also president of a 15-location, 17-doctor group practice and a refractive laser center. He is a consultant or advisor to Allergan, AMO, Vistakon, CooperVision, Optovue, B+L and Essilor. He has received educational grants from Hoya and Ista Pharmaceuticals, and he has received lecture or authorship honoraria from Allergan, AMO, Zeiss, Essilor, Hoya, Vistakon and Alcon.