Optometric Management Supplements

DRY EYE 2016

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receive, MGD is chronic, progressive, and ob st r u c t ive. For t h is g roup, expression of the glands is necessary. Manual expression can be efective for some, but it usually needs to be done frequently, which isn't pleasant for the patient or the doctor. Alternatively, many of my patients opt for LipiFlow. Te in-ofce LipiFlow treatment uses precisely controlled thermal pulsation applied to the eyelids to unblock the meibomian glands and encourage the natural, normal production of lipids for the tear film. In clinical studies, 79% of patients reported improvement, ranging from 10% to 100%, of their overall dr y eye symptoms within 4 weeks of a treatment. 3,4 The results my LipiFlow patients achieve range from signifcant to life- changing. My dry eye practice would be incomplete without it. Amniotic Membrane F o r a p a t i e n t w h o s e c o r n e a i s s i g n i f i c a n t l y c o m p r o m i s e d d u e t o c h r o n i c d r y e y e a n d r e l at e d c o n d i t i o n s , a m n i o t i c m e m b r a n e (AM) is a game-changing solution. Prokera (Bio-Tissue) is a proven option that addresses even severe disease. In Prokera, the cryopreserved amniotic membrane wraps around a polycarbonate ring, allowing easy in-office placement onto the cornea. The propr iet ar y cr yopres er vation method used for Prokera ensures that the HC-HA/PTX3 biologic signaling matrix, growth factors, and proteins responsible for AM's healing and anti-inflammatory properties remain intact. Prokera is uniquely positioned for possessing both protective and regenerative properties. In some cases, I may use Prokera to heal a patient's cornea before I begin to address the underlying dry eye issues. The Science and the Art W h i l e my s t r e a m l i n e d d r y e y e algorithm reflects the treatments I've found to be most successful, it refects the art in addition to the science. First, I choose natural treatments whenever possible. Pure hypochlorous acid, nutritional support, amniotic membrane — all o ccur naturally. S e c on d , I l o ok for s y n e rg y. For example, when I prescribe Restasis, I also prescribe a steroid to rapidly ramp up anti-inflammatory activity. I also use doxycycline as an initiator for nutritional supplementation, which may take several weeks to begin to take effect. I believe that looking at the situation holistically has been very helpful for my patients. Also, I aim to manage my MGD patients much like dentists manage their patients. Since fuoride came into the picture decades ago, they shifted from filling cavities to concentrating on oral health and cosmesis. As a result, dental patients are programmed to have their teeth cleaned every 6 months. They dutifully make those appointments, usually before leaving their current appointment. Similarly, if I have my patients return at regular intervals to address their ocular health issues, I can prevent progressive, chronic MGD from leading to dr y eye. That, along with making key products available for sale in the ofce that bring real beneft to my patients, is the best way to provide them with what they need while helping to maintain practice viability. • REFERENCES 1. Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-defcient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-478. 2. Sheppard JD, Singh R, McClellan AJ, et al. Long- term supplementation with n-6 and n-3 PUFAs improves moderate-to-severe keratoconjunctivitis sicca: A randomized double-blind clinical trial. Cornea. 2013;32(10):1297-1304. 3. Lane SS, DuBiner HB, Epstein RJ, et al. A new system, the LipiFlow, for the treatment o f m e i b o m i a n g l a n d d y s f u n c t i o n . C o r n e a . 2012;31(4):396-404. 4. TearScience. Data on fle. Dr. Epstein is a co-founder of Phoenix Eye Care and The Dry Eye Center of Arizona, where he serves as director of Cornea/ External Disease, Clinical Research and The Dry Eye & Ocular Surface Disease Center. Continued from p. 10 WHAT HAVE YOU READ TODAY? Powerful Information and Real-World Solutions for Vision Care Professionals clspectrum.com eyecarebusiness.com optometricmanagement.com ophthalmologymanagement.com retinalphysician.com ophthalmicprofessional.com

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