David R. Hardten1, Mark Milner2, Jai G. Parekh3, Neda Shamie4, Darrell E. White5 and Michael Schiewe6

Financial Disclosures:Dr’s Hardten, Milner, Parekh, Shamie and White are consultants for Inspire. Mr Schiewe is an employee of Inspire.

Affiliations: 1University of Minnesota; 2Yale University Medical School; 3The New York Eye and Ear Infirmary; 4Doheny Eye Institute and the USC Keck School of Medicine; 5Skyvision Centers; 6Inspire

2

The purpose of this retrospective study was to identify trends in the diagnosis, recorded findings and treatment of patients presenting with symptoms of Ocular Surface Disease (OSD).

3

This study was a multi-center, retrospective study 52 sites were involved in the study, emphasizing general

practice Eye Care Professionals (77% MD and 23% OD). 1157 patient charts Patients presented with symptoms of ocular surface

disease consecutively at the site over an 8 week period. Retrospective chart review Inclusion criteria – a primary diagnosis of either

bacterial/viral conjunctivitis, blepharitis or dry eye Exclusion criteria – patients diagnosed with allergic

conjunctivitis were excluded from the study in order to avoid a bias due to allergy season

4

Data collection form utilized to capture information from patient charts: OSD symptoms (severity ratings) OSD signs (severity ratings) Assessments & Tests (visual acuity, staining, tear

break-up time, Schirmer and cultures) Treatments (mechanical therapy, OTC, nutraceuticals,

pharmaceuticals)

5

Blepharitis alone

Dry Eye alone

Conjunctivitis (Bacterial/Viral) alone

Blepharitis and Dry Eye

Other mixed diagnosis

n = 1157

33%

6%

29%

6%

26%

6

* includes subjects with a primary diagnosis of Conjunctivitis

35%35%

28%28%

37%37%

ConjunctivitisConjunctivitis

n = 72

BacterialBacterial

ViralViral

UndeterminedUndetermined

7

* includes subjects with a primary diagnosis of Blepharitis or Dry Eye

BlepharitisBlepharitis

Dry EyeDry Eye

Anterior

n = 300

22%

n = 384

Anterior and Posterior

Posterior

Non-differentiated

18%

24%

36%

10%

4%

32%54%

Non-differentiated

Evaporative

Aqueous Deficient and Evaporative

Aqueous Deficient

8

0

20

40

60

80

BlepharitisDry EyeConjunctivitis

% o

f S

ub

jects

* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72

9

Debris

Hyperemia

Swelling

MG Plugging

MG Expression

Secretion Q

uality

Hyperemia

Telangiectasia0

20

40

60

BlepharitisDry EyeConjunctivitis

% o

f S

ub

jec

ts

AnteriorAnterior PosteriorPosterior

* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72

Evaluation of the EyelidEvaluation of the Eyelid

Evaluation of the EyelidEvaluation of the Eyelid

10

0

20

40

60

80

BlepharitisDry Eye

Conjunctivitis

% o

f S

ub

jec

ts

* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72

11

0

20

40

60

80

100BlepharitisDry Eye

Conjunctivitis

% o

f S

ub

jec

ts

* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72 ** “Other” includes: patient education, referral, MG probing and intense pulsed light

* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72 ** “Other” includes: patient education, referral, MG probing and intense pulsed light

12

Ocular surface disease encompasses a broad range of diagnoses.

Results indicate that symptoms of the various forms of OSD overlap to a large degree on initial presentation.

Although symptoms are important to the patient, proper identification of clinical findings provides the basis for a differential diagnosis and for identifying optimum management. Corneal staining was the most common assessment utilized in the diagnosis of

primary conditions of Conjunctivitis, Dry Eye and Blepharitis. Signs of patients with the primary diagnosis of blepharitis or conjunctivitis share

signs from the anterior evaluation of the eyelids (debris, hyperemia, swelling). However, this is not true of signs from the posterior evaluation of the eyelids.

Management practices were dependant on the primary diagnosis.