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Use of diagnostic, therapeutic tools improves dry eye detection and management
Integration of LipiView and LipiFlow in cataract and refractive surgery practices can improve outcomes, according to one surgeon.
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The TearScience LipiView imaging device and LipiFlow system provide an efficient means to diagnose, treat and monitor progress in patients with evaporative dry eye syndrome and is a worthwhile investment for every ophthalmology practice, according to one surgeon.
“I am not a dry eye specialist, but thanks to this technology, I have learned to look at dry eye from a different perspective, to learn more and to consider it as a treatable condition,” Matteo Piovella, MD, OSN Europe Edition Board Member, said.
According to Piovella, dry eye is an underestimated condition in Europe. While in the U.S. dry eye attracts considerable investments and is the second largest business after cataract surgery, in Europe it is considered a marginal, low-impact topic in ophthalmology. The majority of eye doctors have no specific interest in managing this condition and do not treat it properly.
“There are many patients who present with symptoms like red, irritated eyes, foreign body sensation, watery eyes, pain and disturbed vision. Many of our colleagues here believe there is nothing to do and send them home with a few tear drops, the first found in their closet of pharmaceutical samples. If the patient wants to have something on prescription, there is only one tear substitute that is reimbursed,” Piovella said.
And yet, he said, it is a well-known fact that tear drops are not a one-size-fits-all answer. Several different combinations target specific types of dry eye.
No-contact, noninvasive diagnostic tool
The LipiView ocular surface interferometer analyzes the concentration of the various components of the tear film on the eye surface, allowing for more targeted treatment.
“When you start using this technology, it is surprising to see the number of patients who have some kind of tear film dysfunction. Among contact lens wearer, it is 90%,” Piovella said.
LipiView examination is no-contact, noninvasive and atraumatic.
“You can repeat it as many times as you like to monitor the patient during the treatment. Improvement of ocular surface disease is long term and very difficult to assess subjectively. This technology allows us for the first time to have an objective evaluation of changes,” Piovella said.
Gentle, long-lasting treatment
The LipiFlow thermal pulsation system provides relief of meibomian gland-related dry eye symptoms. Meibomian glands provide the lipid component of tears, and dysfunction of the glands is the leading cause of evaporative dry eye.
“For a number of reasons, particularly in women, the oily secretions of meibomian glands may undergo changes and become as thick and dry as toothpaste when you leave the tube open. People 40 to 45 years of age may have as much as 70% of the glands obstructed,” Piovella said.
The LipiFlow system applies heat and a gentle pulsated massage to the eyelids to remove blockage and restore the healthy oil flow from the glands. No special preparation is needed for the patient. Before applying the treatment, Piovella suggested gently scraping the lid margins with Desmarres forceps on the slit lamp to remove the more superficial concretions.
“The treatment lasts about 12 minutes and is a painless procedure. The patient might experience some discomfort in the following 24 to 48 hours as the glands continue to secrete. This happens without affecting vision and can be handled with a few tear drops to wash out the surface,” Piovella said.
In the first month after the treatment, while the meibomian glands are gradually recovering their normal function, artificial tears and corticosteroids may be needed for lubrication. The effects of the treatment are long lasting, although some patients might be more predisposed than others to relapse.
“Only in three of my patients I have repeated the treatment after 3.5 years,” Piovella said.
Optimizing results
In a poster presented at the Asia-Pacific Academy of Ophthalmology meeting this year, Piovella showed the results of 100 eyes of 50 patients treated with LipiFlow. In all eyes the symptoms had significantly decreased at 1 month after treatment. The mean ocular index of lipid interferometric color unit increased by 20.6%, from 53.61 ± 19.11 before treatment to 88.50 ± 4.95 at 4 years after treatment. Patients reported no discomfort or pain during or after the treatment.
“The LipiView and LipiFlow system has brought a tremendous improvement into my practice. I implant more than 50% of my patients with presbyopia-correcting IOLs, which require very accurate biometry data to perform at their full potential,” Piovella said.
If not addressed, tear film dysfunctions can lead to errors in biometry and IOL power calculation.
“Here you have a very effective technology, which is easy to use and can improve accuracy, success rate and patient satisfaction. I believe that every cataract surgeon and refractive surgeon should integrate this system into their practice,” Piovella said. – by Michela Cimberle
- For more information:
- Matteo Piovella, MD, can be reached at C.M.A., Via Donizetti 24, 20052 Monza, Italy; email: piovella@piovella.com.
Disclosure: Piovella reports he is a consultant for Abbott Medical Optics, Abbott, Carl Zeiss Meditec, TearLab and AcuFocus and receives lecture fees from TearScience, Ocular Therapeutix and BVI Beaver-Visitec International.