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BLOG: Thoughts on LipiFlow
I attended the 2015 Caribbean Eye Meeting in San Juan, an annual highlight on my calendar. You can think of it as a “poor man’s Royal Hawaiian”; I’d call it the “Royal Caribbean,” but I understand that name may be taken.
The beauty of the Caribbean Eye Meeting is the informal nature of the sessions. There is an open exchange of ideas and a long history of speakers being called on the carpet when audience members disagreed with a position taken from the podium. Sometimes the organizers specifically and consciously throw speakers with opposing viewpoints together on stage.
That’s what happened to me!
My one speaking commitment was to participate in a panel discussion on creating a dry eye clinic. After a quick blurb from a practice administrator about creating a protocol-driven clinic (a proposal I’ve long endorsed), the panel became a de facto infomercial for LipiFlow (TearScience). My position, oft stated and reiterated from the stage, is that LipiFlow is the result of good science, is clearly effective, and is now a part of the most complete version of a comprehensive dry eye practice.
It is not the single most important piece of the clinical care of DES as implied from the podium, nor is it mandatory that LipiFlow be included in an otherwise successful DES practice.
DES is a multifactorial, chronic, progressive disease with an inflammatory etiology. One source of inflammation is certainly the meibomian glands, and one effective treatment for this is almost certainly LipiFlow. One must ask if LipiFlow, presently proposed as a one-time treatment, or one that is repeated after a year or more has passed, is effective enough. We know that chronic low-dose azithromycin (AzaSite, Akorn) is effective in many cases of meibomian gland disease, especially when combined with high-dose omega-3 fatty acid supplements from marine sources (fish oil).
Having said that, any meeting is successful if it prompts you, the doc, to re-evaluate your own protocols. The fervor with which my co-panelists talked about LipiFlow has prompted my group to evaluate it in our DES clinic. I’ll report back.
Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Nicox, Shire and Eyemaginations and on the speakers board for Bausch + Lomb and Allergan.