The Basics Jack L Schaeffer OD FAAO Marc Bloomenstein OD FAAO Paul Karpecki OD FAAO Ocular Surface Wellness Ocular surface wellness means reenvisioning our role as eye care practitioners ECPs ID: 401238
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Slide1
Ocular Surface Wellness The Basics Jack L Schaeffer OD FAAO Marc Bloomenstein OD FAAO Paul Karpecki OD FAAOSlide2
Ocular Surface Wellness
Ocular surface wellness means
re-envisioning our role as eye care practitioners (ECPs)
to include helping patients maintain good ocular surface health—not just treating the ocular surface when it’s
compromised
Wellness requires a proactive stance to maintain ocular surface healthCurrently we live in a reactive treatment mode
2Slide3
Prevention: Action to Maintain WellnessPrimary prevention
— reducing incidence of disease
1
Prevent initiation of disease process
Vaccination, healthy habits, smoking cessation
Secondary prevention — early detection1 Ideally before symptoms occurScreening, check-ups, early intervention Tertiary prevention — improving outcomes1
Help for those with manifest disease
1
Glycemic control for diabetics, nutritional supplementation for AMD
3Slide4
Wellness TodayThe conventional medical model is
disease-oriented
Patients interact with medical system to regain health, not to maintain health
And that’s a problem!
The US is in the midst of a chronic disease epidemic
2Many costly chronic diseases linked to modifiable lifestyle factors—smoking, diet, activity, sustained stress2,34
Less than ¼ of Americans consume
5 or more servings of fruits and vegetables daily
1 in 5 US adults smokes
1 in 3 US adults is obeseSlide5
Ocular Surface Wellness: The OpportunityActive maintenance of OS health supports patients’ long-term
Vision quality – Healthy-looking eyes
Ocular comfort – Successful CL
wear
Contact lenses change the tear film dynamics and the ocular surface
Young adults are the demographic that will benefit the most
5Slide6
Optimizing VisionEfforts to prevent or slow OS pathology help preserve vision
Tear film irregularity can affect retinal image
quality
16
DE patients experience
Reduced contrast sensitivity17Fluctuating vision Impact on ease of daily activities (eg, reading, computer, driving, TV)18
Discomfort with contact lenses
19
6Slide7
Optimizing Vision for Contact Lens Wearers
Estimated 37 million US contact lens wearers
20
To perform optimally, CLs need a robust tear
film
21Dissatisfaction with vision is the second most common reason for CL dropout22,23Age-related changes to the tear film and OS, combined with changes in refractive needs, can make CL wear more challenging and lead to dropout
20,24
7Slide8
Optimizing Vision for Ocular Surgery Candidates
Refractive and cataract surgery patients have high expectations for postop comfort and
vision
Visual outcomes (and postop comfort) influenced by preop OS conditions
25-
29 It is our responsibility to prepare our patients for surgery
8Slide9
Threats to Ocular Surface Wellness: AllergyPrevalence of allergic conjunctivitis increasing globally Affects 15% to 40% of US population40-42 Typically mild, but interfere with quality of life42
Significant overlap between presentations of DE and allergy
40
Eye exams may not coincide with seasonal allergy symptoms—proactive questioning important
9
Itch
42.2%
Dryness
54.6%
57.7% Itch
45.3% DrynessSlide10
Threats to Ocular Surface Wellness: Dry Eye and Blepharitis
DE and blepharitis among the most common conditions eye physicians encounter
43,44
Using a very restrictive definition, DE affects nearly 5 million Americans aged 50 and older
44
Eye care practitioners may see blepharitis in ~40% of patients4510Slide11
Threats to Ocular Surface Wellness: Dry Eye and Blepharitis
11
Blepharitis comprises a number of inflammatory eyelid conditions and
comorbidities
46
Dry eye ChalazionHordeolum
Conjunctivitis
Keratopathy
MGD
(a form of blepharitis) may be the most common cause of evaporative DE
45,47,48Slide12
© 2014 NovartisThreats to Ocular Surface Wellness: Medication UseSome common
systemic meds
increase risk of DE symptoms
Antihistamines
62-64
Antianxiety medications63,64Antidepressants63,64Diuretics62,64Oral corticosteroids63
12Slide13
Ocular Surface Wellness In PRACTICE
My practice is looking broadly at wellness; our approach includes:
Regular
yearly
eye
examsChildren with refractive error evaluated every 6 monthsComprehensive contact lens exam and follow-up visit for all contact lens
patients
Monitoring contact lens
compliance
Adopting myopia prevention treatment strategies
13Slide14
Ocular Surface Wellness In PRACTICEDR KARPECKIDR BLOOMENSTEINSlide15
OSW: Revising the Office Medical Strategy
In my office:
Most of my patients come to the practice for
vision care
Specifically, they want the glasses or contact lenses their vision plan
allowsBut OSW is essentially medical, which requires that patients and doctors have a new mind-setECPs offer more than glasses: we help maintain ocular surface health—which has value
A healthy ocular surface can help optimize vision, comfort, and cosmesis
15Slide16
Integrated Health Care Model “
Medical model”
is overused—“integrated health care model” is a better
term
Integrated
Health Care Model is the essence of proactive vs reactive careHelp patients understand use of medical insurance
and the value of
communication between OD and patient’s other providers
, eg:
Primary care physician
Endocrinologist
Dentist
Neurologist
Dermatologist, etc.
16Slide17
© 2014 NovartisStart Young, Use Demographic DataThe ocular surface changes over a lifetime, and not for the better
1
Goal: keep the ocular surface in optimal condition by changing patient behavior
Requires starting as young as possible—ideally before aging changes can create symptoms & signs of ocular surface problems
Bring OSW up with young patients, even those without signs or symptoms.
OSW is especially important in young contact lens wearers, who may want to wear lenses for the next 50 years—contact lens wear is contraindicated in the presence of an unhealthy ocular surface17Slide18
See Children at Appropriate IntervalsIn my practice
,
C
hildren
and Teens
with vision or ocular surface problems are seen every 6 monthsChildren’s eyes change rapidly and need reassessmentFrequent monitoring & counseling on compliance (if contact lens wearer)Instill and reinforce good habits while patients are young
18Slide19
Contact Lens Compliance is Important at All Ages
Contact lenses affect
the tear film
and ocular surface
5
Goal is to minimize that effect and maintain long-term ocular health in all patientsChoice of contact lens solution is importantAppropriate lens care is criticalRub and rinseClean lens cases and replace them as instructedLens disposal at the correct interval
On follow-up use fluorescein stain to evaluate lens/solution compatibility
6,7
Always use the latest technologies and lenses
19Slide20
Check for Ocular Surface Conditions in All Patients
Ocular surface conditions are very common
2
Provide intervention before signs & symptoms become significant
Explain the importance of ocular surface care, including the doctor’s examination
Annual or 6-month visits to check on condition of ocular surfaceHave patients report symptoms when they occurRecord changes in ocular surface signs20Slide21
Check for Ocular Surface Conditions in All Patients
Understand that although ocular surface issues can affect vision, this is
medica
l
care, not vision
careCommunicate with patient’s primary care physician regarding chronic medical conditions (eg, Sjogren’s syndrome) 21Slide22
© 2014 NovartisTo Maintain and Restore Wellness Look for and Treat Problems
22
Meibomian gland dysfunction
Lagophthalmos
Epithelial membrane basement dystrophy
Conjunctivochalasis Aqueous-deficient dry eyeBlink pattern deficienciesKeratitisStem cell deficiencyTear film abnormalitiesSlide23
© 2014 NovartisMake Use of New Ocular Surface Diagnostic TechnologyNew tests add useful information
Tear osmolarity
Tear MMP-9 level
Interferometry
Incomplete blink
Gland expressionSjogren’s antibody testingTopographyMeibographyEnable detection of early-stage disease processes and monitoring of the tear film
23Slide24
© 2014 NovartisTreatment ModalitiesPunctal occlusion
Pharmaceuticals (including oral meds)
Thermal pulsation/meibomian gland expression
Lid hygiene
Antibiotics/anti-inflammatories
Lipid enhancing and mucomimetic tears 24Slide25
© 2014 Novartis Contact Lenses and the Ocular Surface
Develop a
OSD protocol
for your office as part of a comprehensive Contact lens evaluation
Medical billing protocol
for those with Ocular Surface issuesCharge a separate fee for the OSD work up NEVER as part of the vision care managed care exam
25Slide26
© 2014 NovartisContact Lenses and the Ocular Surface
Ocular Wellness means understanding of
preventive measures
and the patients overall Ocular and systemic Health
GP lenses
are considered the safest lens modalityThere is an inherent responsibility to ensure long term eye and corneal healthThere is also a responsibility to create the best Vision possible for our patients
26Slide27
Contact Lenses and the Ocular Surface: Challenges
Staining
Corneal
Conjunctival drying/ goblet cell destruction
3 and
9 desication ( nasal temporal)Limbal changes topographical changesLid abnormalities
GPC
deposits
warped lenses
27Slide28
GP Lenses and the Ocular SurfaceScleral Lenses
These modalities create their own challenges and complications
Replacement schedules
Debri
Long term effects on the cornea , Limbus, and Conjunctiva
Clearance28Slide29
© 2014 NovartisGP Lenses and the Ocular Surface
3 and 9 staining
10 years ago OK
Wellness : Corneal Desiccation is not an acceptable clinical finding
What are you going to do
29Slide30
© 2014 NovartisGP Lenses and the Ocular SurfaceWhy would anyone wear a GP lenses longer than one year?
Structure changes
Deposits
Scratches
What about 6 months
30Slide31
© 2014 NovartisContact Lenses and Vision
Multifocals VS Monovision
New materials: change yearly
Over refractions : every visit : .25 diopter
Toric and bitoric designs
31Slide32
© 2014 NovartisInvolve the Entire OfficeSuccess with OSW in the practice requires buy-in from the entire
staff
Staff buy-in to OSW efforts requires ongoing staff education so they understand:
Types of ocular surface conditions
Ocular surface treatments
Importance of treating ocular surface conditionsImportance of proactive history taking by technicians32Slide33
© 2014 NovartisAdvise patients about medications that can cause ocular surface dryingConsider diet and potential value of dietary supplements
During computer use:
take breaks to rest eyes
blink often
use artificial tears
Wear glasses or sunglasses outdoorsLook at environment for dryness triggers—eg, sitting all day by an air ventPrescreening with OSDI in reception area before examinationComprehensive pediatric evaluations
Prevention Steps
33Slide34
Practice Impacts of Preventive CareAdditional staff training creates a more
skilled staff
Staff pride
: Staff feels elevated by working in an
integrated health care
modelIncreased referrals by patients who appreciate comprehensive approach to health careGreater patient acceptance of lens replacement schedules
Increased referrals from primary care physicians
as a result of open communications
34Slide35
© 2014 NovartisThe FutureThe profession must commit to wellness and providing medical eye
care
Industry
and ECPs must jointly commit to public education about ocular
wellness
The public needs to hear: “See your eye doctor yearly for wellness!” 35Slide36
Best Practices in Dry Eye Patient ManagementBloomenstein Draft 12-4-14Slide37
Screening, diagnosing, and treating early signs of dry eye is a relatively new thought processMost ODs wait for a symptom or significant corneal involvementNot thinking proactively The multifactorial nature of the disease creates confusion and different interpretationsIs a consensus a best practice?Can there be only one?What Is a Best Practice?Slide38
Is it one that catches the majority of persons with the disease?One that makes it easy for providers to diagnose the disease?One that makes treatment easy and effective?For the provider?For the patient?For both?Should a best practice be one that solves all the problems above?Simplicity!What Is a Best Practice?Slide39
LWE OPITBUTTFOSDEDOSDIFerningMGDCChWe have made things worse! Not easier! WTFBreaking the Cycle of White NoiseSlide40
AOA Guidelines (2002)Delphi Panel (2006)The Dry Eye Workshop (2007)OD Canadian Consensus (2014)Published Attempts at Best PracticesSlide41
A Lot Has Changed Since The Last Protocol…Slide42
Technology Innovations: 2002–2005 Facebook
Palm Treo PDA
BlackBerrySlide43
New Dry Eye Treatments and Diagnostic Tools: 2002–2005
MeibographySlide44
Care of the Patient With Dry Eye (AOA Quick Reference Guide). St. Louis, MO: American Optometric Association; 2003.2003: AOA Optometric Clinical Practice Guideline on Care of the Patient With Ocular Surface Disorders Slide45
Care of the Patient with Dry Eye (AOA Quick Reference Guide). St. Louis, MO: American Optometric Association; 2003.Care of the Patient With Dry Eye (AOA Quick Reference Guide). St. Louis, MO: American Optometric Association; 2003.AOA 2003: Symptoms ListCommon Signs, Symptoms,
and Complications of Dry Eye
Condition
Symptoms
Signs
Complications
Mild
Scratchiness, burning, or stinging
Mild blurring of vision
Decreased tear
volume, scanty lower lid tear meniscus
Rapid tear film breakup time
Debris in tear film
Reduced contact lens tolerance
Irritation-induced
reflex tearing
Moderate
Marked ocular discomfort
Reduced vision
All of the above, and:
tear film instability
Subtle corneal superficial punctate staining
Conjunctival staining
Reduced antibacterial function of tear film
Superficial punctate keratopathy
Severe
Severe irritation, burning
Significantly blurred vision
All of the above, and:
Mucous strands, filaments, furrows, dellen, staining, or erosion of cornea
Lack of corneal luster
Hyperemia of conjunctiva
Increased viscosity of preocular tear film (POTF)
Superficial punctate keratopathy
Filamentary keratitis
Secondary lid infectionsSlide46
Care of the Patient With Dry Eye (AOA Quick Reference Guide). St. Louis, MO: American Optometric Association; 2003.AOA 2003: Evaluation and ManagementFrequency and Composition of Evaluation
and Management Visits for Dry Eye
Degree of Involvement
Frequency of Evaluation
History
External
Evaluation and Slit Lamp Biomicroscopy
Supplemental Testing
Management Plan
Mild
Annually or as necessary
Yes
Yes
Fluorescein staining, Rose
Bengal
staining, BUT
Preserved or unpreserved
tear supplement p.r.n.
Patient counseling and education
Moderate
Every 6–12 months or as necessary
Yes
Yes
Fluorescein staining, Rose
Bengal
staining, BUT,
Schirmer test
Unpreserved
tear supplements 4–5 times a day up to p.r.n.
Patient counseling and education
Severe
Every 3–6 months or as necessary
Yes
Yes
Fluorescein staining, Rose
Bengal
staining, BUT,
Schirmer test
Unpreserved
tear supplements p.r.n.,
ointment h.s.
Punctal occlusion
Patient counseling and education
Associated with systemic disease
Every 1–6 months or as necessary
Yes
Yes
Fluorescein staining, Rose
Bengal
staining, BUT,
Schirmer test
Unpreserved
tear supplements p.r.n.,
ointment h.s.
Punctal occlusion
Refer to primary physician
Patient counseling and educationSlide47
What happened?Were the protocols too simple?Why was this not adopted?Who failed? The AOA? The “experts”?The AOA protocol, in 2003, did not change behavior!Let’s not make the same mistakeAOA Had It Going in the Right Direction…Slide48
Technology Innovations: 2006–2007 Nintendo Wii
Fingerprint Reading Technology
Human Genome Project codes last gene sequence
iPhoneSlide49
New Dry Eye Treatments: 2006–2007Slide50
Behrens A et al. Cornea. 2006;25:900-907.17 preselected international dry eye specialists2-round Delphi panel approachUsed a 2/3 majority for consensus building on the responsesTreatment algorithms were calculated as the primary endpointTreatment recommendations for different types and severity levels of dry eye diseaseNew terminologyDysfunctional tear syndrome (DTS)2006: Dysfunctional Tear Syndrome: A Delphi Approach to Treatment Recommendations (Delphi)Slide51
Behrens A et al. Cornea. 2006;25:900-907.Level 1Mild to moderate symptoms, no signsMild to moderate conjunctival signsLevel 2Moderate to severe symptomsTear film signsMild corneal punctate stainingConjunctival stainingVisual signsLevels of Severity Without Lid Margin Disease (Delphi)Slide52
Behrens A et al. Cornea. 2006;25:900-907.Level 3Severe symptomsMarked corneal punctate stainingCentral corneal stainingFilamentary keratitisLevel 4Severe symptomsSevere corneal staining, erosionsConjunctival scarringLevels of Severity Without Lid Margin Disease (
cont’d
)Slide53
aWith clinically evident inflammation.Behrens A et al. Cornea. 2006;25:900-907.Treatment (Delphi)Level
1
Education and environment modification
Preserved artificial tears
Allergy control
Level
2
Unpreserved tears/Gel ointment at night
Steroids/Cyclosporine A/Secretagogues/Nutritional
supplements
a
Level
3
Tetracyclines
Autologous serum
Punctal plugs
Level
4
Contact lenses
Acetylcysteine
Moisture goggles
SurgerySlide54
More detailed treatmentCherry-picking screening tools and treatmentTOO TIME CONSUMINGDIFFICULT TO DIFFERENTIATENOT ADOPTED BY ALL EXPERTSNO BEHAVIOR CHANGES!Delphi RecommendationsSlide55
International Dry Eye WorkShop. 2007 Report of the International Dry Eye WorkShop (DEWS). Ocul Surf. 2007;5:61-204.The Management and Therapy Subcommittee of the International Dry Eye WorkShop (DEWS) Reviewed the Delphi Panel approach to the treatment of dry eye disease and suggested some modificationsThe DEWS treatment recommendations are stratified according to the severity of the disease2007 Report of the International Dry Eye WorkShop (DEWS)Slide56
International Dry Eye WorkShop. 2007 Report of the International Dry Eye WorkShop (DEWS). Ocul Surf. 2007;5:61-204.“Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability, with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface”Dry Eye Defined (DEWS)Slide57
International Dry Eye WorkShop. 2007 Report of the International Dry Eye WorkShop (DEWS). Ocul Surf. 2007;5:61-204.Cycle of Ocular Surface Inflammation (DEWS)
Dry eye
Altered tear
film stability
and composition
Dysfunction
of lacrimal
functional unit
Inflammation and
apoptosis on
ocular surfaceSlide58
Etiopathogenesis of Dry Eye Disease (DEWS)Altered lipid, aqueous, protein, and
mucin distribution
Increase cytokine production
T-cell activation
Matrix metalloproteinases
Apoptosis
Discomfort
Tear film instability
Dry eye disease
Altered tear composition
Ocular surface inflammation
LFU dysfunction
LFU, lacrimal function unit.
International
Dry Eye WorkShop. 2007 Report of the International Dry Eye WorkShop (DEWS).
Ocul Surf
.
2007;5:61-204
.Slide59
Diagnosis of Dry Eye Disease (DEWS)The DEWS Dry Eye Diagnosis Grid* (modified from The Ocular Surface 2007)
Dry Eye Severity Level
1
2
3
4
Discomfort, severity,
and frequency
Mild/Episodic
environmental
stress
Moderate/Episodic/Chronic
environmental stress or no stress
Severe/Frequent/
Constant without stress
Severe and disabling, constant
Visual symptoms
None or episodic mild fatigue
Annoying and/or activity- limiting episodic
Annoying, chronic, and/or constant limiting activity
Constant and/or possibly disabling
Lid/meibomian glands
MGD variably present
MGD variably present
Frequent
Trichiasis, keratinization, symblepharon
TFBUT (sec)
Variable
≤10
≤5
Immediate
Corneal staining
(NEI Scale 0–15)
None to mild
Variable
Central
Severe punctate erosions
Conjunctival staining
(NEI Scale 0–18)
None to mild
Variable
Moderate to marked
Marked
Schirmer test
(no anesthesia)
(mm/5 min)
Variable
≤10
≤5
≤2
Recommended management
Patient education, diet modification and lid therapy, artificial tear/
gel supplements, environmental control
Add anti-inflammatories, tetracyclines, punctal plugs, moisture chamber spectacles
Add autologous serum, bandage or large-diameter rigid contact lenses, permanent punctal occlusion
Add systemic anti-inflammatory agents, surgical intervention
*The order of the tests represents a common dry eye exam sequence. Recommended management is listed below each grade
.
International Dry Eye WorkShop. 2007 Report of the International Dry Eye WorkShop (DEWS).
Ocul Surf
.
2007;5:61-204
.Slide60
Severity Level
1
2
3
4
Symptoms
Mild to moderate
Moderate to severe
Severe
Severe
Conjunctival Signs
Mild to moderate
Staining
Staining
Scarring
Corneal Staining
Mild punctate staining
Marked punctate staining;
central staining;
filamentary keratitis
Severe staining; corneal erosions
Other Signs
Tear film; vision (blurring)
Treatment Options
Patient education
Environmental modification
Preserved tears
Control allergy
Unpreserved tears
Gels, ointments
Topical prescription therapies
Secretagogues
Nutritional support
Oral tetracyclines
Punctal plugs (once inflammation is controlled)
Systemic anti-inflammatory therapy
Oral cyclosporine
Acetylcysteine
Moisture goggles
Surgery (punctal cautery)
If no improvement,
add level-2 treatments
If no improvement,
add level 1-3 treatments
If no improvement,
add level-4 treatments
Meibomian gland disease treatment options: lid hygiene, thermomassage, oral tetracyclines.
International Task Force (ITF) Dry Eye Treatment Recommendations
1. Behrens et al.
Cornea.
2006.Slide61
aTreatments in bold are DEWS modifications. In general, DEWS recommends more aggressive treatments at lower severity levels than did ITF.International Dry Eye WorkShop. 2007 Report of the International Dry Eye WorkShop (DEWS). Ocul Surf. 2007;5:61-204.Dry Eye Workshop (DEWS) Treatment Guidelines Build Upon the ITF Recommendations
1. Management and Therapy Subcommittee of the International Dry Eye 2007.
Severity Level
1
2
3
4
Treatment
a
Patient education
Environmental
and dietary
modifications
Eliminate offending systemic medications
Artificial tears, gels/ointments
Eyelid therapy
Anti-inflammatories
Oral tetracyclines
Punctal plugs
Secretagogues
Moisture chamber spectacles
Serum
Contact lenses
Permanent punctal occlusion
Systemic anti-inflammatory therapy
Surgery (lid surgery, tarsorrhaphy; mucous membrane, salivary gland, amniotic membrane transplantation
)
If no improvement,
add level-2 treatments
If no improvement,
add level 1-3 treatments
If no improvement,
add level-4 treatmentsSlide62
Where is the widespread acceptance?Which of us is adhering to these protocols? Telling our colleagues to adhere to this?NO CHANGE IN BEHAVIOR…AGAIN!DEWSSlide63Slide64
Technology Innovations: 2008–2014
Tesla Roadster
iPad
CERNS Hadron Collider
HTC Dream
(1
st
Android Phone)Slide65
New Dry Eye Treatments and Diagnostic Tools: 2008–2014
MiBoFloSlide66
Solution for Early Diabetes Detection
More Appeal than Blood Draw
Non-Invasive
6 Seconds
Immediate Results
Diabetes & Eye-Care
100M eye exams in US annually
Diabetes = changing vision
Medical model of optometry
Can Avoid Complications
Can identify diabetes
7 years prior
to complications
Disclaimer: For investor use only
ClearPath DS-120 is the only FDA-cleared non-invasive diabetes detection system available for sale in the United States. The only other way is invasive blood draw.Slide67
National Dry Eye DISEASE Guidelines
for Canadian Optometrists
Canadian Journal of Optometry
Revue Canadienne d’Optométrie
Vol. 76, Suppl. 1
2014ISSN 0045-5075Slide68
CASE HISTORY including 4 specific questionsDo your eyes feel uncomfortable? Do you have watery eyes? Does your vision fluctuate, especially in a dry environment? Do you use eye drops?Canadian Dry Eye Consensus Canadian Association of Optometrists. National Dry Eye Disease Guidelines for Canadian Optometrists. Can J Optom.
2014;76(Suppl
. 1
):1-32
.Slide69
Canadian Dry Eye Consensus TypeManagement
Episodic
Tear supplements/
lubricants
Consider composition of available agents (lipid-based, products that restore the mucin layer, overall)
Ocular
Hot compresses, lid hygiene, moisture chamber glasses, modifications to CL wear (switch to daily disposables)
Non-ocular
considerations
Environmental (ambient humidity, air movement, computer use), systemic medications and supplements, alcohol, smoking, hormonal status, sleep apnea
Chronic
Episodic management +
Short-term
Topical corticosteroid
Long-term
Topical cyclosporine
Essential fatty acids
Supportive
Oral tetracycline/macrolide, lacrimal occlusion, meibomian gland expression (in-office), sleep mask/lid taping
Recalcitrant
Ocular
Scleral lenses, filament removal, autologous serum eye drops, amniotic membranes,
tarsorrhaphy, other surgical techniques
Systemic
Secretagogue, systemic
immunosuppressive therapies
Canadian Association of Optometrists. National Dry Eye Disease Guidelines for Canadian Optometrists.
Can J Optom
.
2014;76(Suppl
. 1
):1-32
.Slide70
Canadian Dry Eye Consensus Canadian Association of Optometrists. National Dry Eye Disease Guidelines for Canadian Optometrists. Can J Optom. 2014;76(Suppl. 1):1-32.Slide71
Improving the Screening, Diagnosis, and Management of Dry Eye DiseaseSlide72
Current guidelines (eg, DEWS, AOA) are perceived as being too complex or inaccessible Limited awareness of guidelinesRecommendations from “the experts” are not being incorporated into everyday practice by community ECPs for multiple reasonsNeed to SIMPLIFY by setting minimum recommendations that all ECPs can commit toWhy Do We Need Recommendations for Dry Eye Disease? Slide73
Discussed clinical data on dry eye disease and the role of ocular surface wellnessIdentified current gaps in management through survey sent to “experts” and >1000 ECPs1.5-day discussion and debate (ECPs and industry) on best practices for screening, diagnosing, and managing dry dye diseaseUsed interactive polling system to establish consensus (minimum 2/3 agreement needed)The Dry Eye Summit 2014: How Did We Develop Recommendations? Slide74
Experts are much more likely to recommend treatment for dry eye disease.Identifying Gaps in Care: “Expert” vs Community ECP PracticesFor What Percentage of Your Dry Eye Disease Patients
Do
You Recommend Any Treatment?Slide75
DiseaseDiabetesAllergiesContact lens wearMedicationsAntihistamines/DecongestantsAgeDigital device useCell phonesTabletsComputersKnow the Risk FactorsSlide76
Do you think your eyes look healthy?Do your eyes feel healthy?Are there times when your vision is not as clear as you want it to be?Do your eyes ever feel
dry or uncomfortable
?
Consensus on Screening QuestionsSlide77
Detailed patient historyStainingOsmolarity levelsConsensus on Baseline Diagnostic Options for Entry Level Dry Eye DiseaseSlide78
For all patients:Ocular lubricationLid hygieneNutritionTopical anti-inflammatoriesConsensus on Baseline Management