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    Treating ocular surface disease


    Ahmad Fahmy
    "In my experience, careful attention to the lids, tear film and staining the ocular surface is the key to finding the right combination of treatments," said Dr Ahmad Fahmy, staff optometrist at Minnesota Eye Consultants, Minneapolis, USA, when discussing the findings of his recent study on ocular surface disease (OSD) treatments.

    "Breakthroughs in clinical research, involving the pathophysiology of OSD have fundamentally changed the physician's approach to treatment," he revealed. "Although few topical alternatives are FDA approved in the treatment of OSD, there are numerous additional topical medicines and new devices that correlate with breakthroughs in our understanding of the disease state."

    In their recent paper Dr Fahmy and colleague, Dr David Hardten, reviewed recent developments in the field of ocular surface treatment.1 Their findings demonstrated that although there are still numerous treatment options that need to be approved by the appropriate regulatory bodies, there is active interest by the external disease/corneal community and pharma companies to provide better options for patients.

    "The potential to offer significant relief (clinical as well as subjective improvement) is well within our reach as we gain more knowledge and experience with treatment options that may fall outside of what is traditionally 'on-label'. Awareness of the pipeline medications under investigation is critical in providing our patients with the best treatment available," Dr Fahmy added. "Even though many of the medications we reviewed have been stymied in various drug development and approval stages, understanding the mechanisms certainly improves the clinician's management of OSD in its many presentations."

    Understanding OSD

    "OSD is a dynamic and multifactorial disease entity," said Dr Fahmy. "Perhaps the most useful finding in a recent clinical study is that 65% of what we previously called dry eye syndrome, is related to Meibomian Gland Dysfunction (MGD)."

    The level of understanding of MGD has been amplified by the work performed by the Tear Film and Ocular Surface Society and the International Workshop on MGD, which gave detailed information on the theory and management of the disease. "Supplementing this detailed report with what we've learned from the Delphi panel and the DEWS report strengthens and deepens the clinician's understanding of OSD," added Dr Fahmy.

    "As such," he continued, "having the ability to treat by heating and expressing the meibomian glands safely and effectively in the office, for example with the LipiFlow system (TearScience, Morrisville, North Carolina, USA), has been very useful."

    However, Dr Fahmy noted that there is a definite need to select appropriate patients for this form of treatment. In cases where there are OSD signs, including meibum turbidity, hypo or hyper secretion, deficiency of the tear film lipid layer (TFLL), incomplete lid closure, and MGD pouting or capping, lid warming and meibum expression is very effective.


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