fall 2015 - creating a dry eye center of excellence
TRANSCRIPT
Creating a Dry Eye
Center of Excellence
October 26, 2015
Cynthia Matossian, MD, FACS
Matossian Eye Associates
Disclosures:
• Abbott Medical Optics
• Alcon
• Allergan
• ALPHAEON
• Bausch + Lomb
• Checked-Up
• Imprimis Pharmaceuticals
• i-Optics
• Lenstec
• Marco
• Ocular Therapeutix, Inc.
• OMEROS
• Physician Recommended Nutriceuticals (PRN) – Shareholder
• Progressive Tech Training
• RPS Diagnostics
• Shire
• Strathspey Crown – Shareholder
• TearLab
In the US, an estimated 3.2
million women age 50 and
over, and 1.68 million men
age 50 and over are
affected by dry eye
syndrome.
MGD is the leading cause of
evaporative DED. Patients who
suffer from this disease produce
an abnormal meibum that is more
viscous than the usual olive oil
like secretion. These patients can
have inflammation and bacterial
overgrowth that exacerbate the
problem.
Meibomian Gland Dysfunction
Standard Treatments
• Warm Compresses &
Lid Scrubs
• Anti-Inflammatory
Drops or Ointments
• Oral Antibiotics
DED Diagnostic Tools
OSDI Questionnaire
Speed Questionnaire
Tear Osmolarity Machine
Tear Osmolarity Being Performed
Tear Osmolarity Being Performed
• TO on all pre-cataract surgical patients
• TO on all patients who are expressing
Dry eye issues -- gritty eyes, fluctuating
vision, sandy sensation, tired eyes, etc.
• TO on all patients who wear contact
lenses who complain of an inability to
wear them as long as they would like,
etc.
Matossian Eye Associates
Tear Osmolarity (TO) Criteria
Tear Osmolarity Card
Two Numbers Crucial to
Understand Osmolarity
The MAXIMUM of the two eyes: 314
Tears higher than 300 mOsm/L demonstrate loss of homeostasis and likely become pathogenic > 308
The DIFFERENCE b/w two eyes: 24
This tells you how stable the tear film is. Normal tears are stable and near 300 mOsm/L bilaterally. A difference of > 8 mOsm/L is a hallmark of tear instability.
Osmolarity & Tear Film Instability
in DED
InflammaDry™
Lissamine™ Green Stain
Treatment Regimen
Artificial tear solution and/or ointment
Bruder moist heat mask
Omega 3 oral supplements
Punctal plugs
Cyclosporine ophth emulsion 0.05%
Avenova™ lid cleanser with hypochlorous acid
IPL / Lipiflow
Oral antibiotics
Serum tears
Artificial Tears
Bruder Moist Heat Compress
Omega 3 Oral Supplement
Punctal Plugs
Cyclosporine
Ophthalmic
Emulsion
0.05%
Avenova Lid Cleanser
Daily lid and lash
cleanser containing
non-stinging
Hypocholorous Acid
(0.01%)
Doxycycline vs Azithromycin
Doxycycline Tablets AzaSite
Doxycycline is a broad-
spectrum antibiotic
synthetically derived.
Available in:
50, 75, 100 & 150 mg
AzaSite (azithromycin
ophthalmic solution) is a
1.0% sterile aqueous
topical ophthalmic
solution.
IPL
FITZPATRICK CLASSIFICATION
SKIN TYPE DESCRIPTION
ICaucasian: Very light complexion, light eyes, freckles,
usually blonde or reddish hair color.
IICaucasian: Light complexion, light eyes, occasional to
frequent freckles, blonde, reddish, light brown hair color
IIIDarker Caucasian, light Asian: Medium complexion, light to
dark eyes, hair color usually brown to dark.
IVMediterranean, Asian, Hispanic: darker complexion, dark
eyes, dark brown to black hair color.
VMiddle Eastern, Latin American, light-skinned black, Indian:
Dark complexion, dark eyes, usually black hair color.
VIDark-skinned black: Black complexion, black eyes, black
hair color.
Contraindications for IPL
• Tanned skin (active tan)
• Pregnancy
• A history of keloid scarring
• Use of medication that may induce photosensitivity
to the skin
• Any inflammatory skin condition at the treatment site
• A history of skin cancer
• A history of poor wound healing including Type I
Diabetes
• Vitiligo
• Treatment over certain skin areas such as tattoos,
moles, semi-permanent make-up, lip vermillion or
mucous membranes
How the IPL Device Works
A Xenon flashlamp emits (like a camera flash) energy in a
band from the base of the visible spectrum (500 nm) to the
border between the near and mid-IR (1,300 nm). The flashlamp
is filtered to allow light of 500 to 800nm to pass through. The
light is pulsed in milliseconds depending on the setting.
100 nm 400 nm 700 nm
InfraredUltraviolet Visible
100,000 nm
papillary dermis
Visible light
epidermis
dermis
penetrates to the deeper dermis
subsurface heating is variable
From 500 nm to 800 nm
Who are IPL candidates?
• Patients with MGD
• Patients with OSD
• Patients with evaporative DED
• Patients with Ocular Rosacea
IPL Demonstration
IPL
Every 4 – 5
Weeks
for a series of 4
Maintenance
Treatment is
Individualized
Every 4 – 6 Months
Serum Tears
The cost to the patient is $286 + $40 shipping + cost of
the blood draw if not covered by insurance.
The cost of serum tear preparation by Leiter's
Compounding Pharmacy in California ($286) and
shipping ($40) are not covered by insurance.
Questions?
Cynthia Matossian, MD, FACS