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Dry eye requires diverse treatment strategy
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As I write this month’s editorial we are within days of the NFL draft, an event that has become almost as epic as the Super Bowl itself. From the moment the clock expired at this year’s championship game, the football world turned its attention to the draft. It has become an annual ritual full of intrigue, strategy and hope.
This year’s draft centers around two high-profile quarterbacks, the position that often defines the fate of today’s NFL franchise. Given that defensive players these days are huge, agile and lightning fast – and given recent rule changes favoring receivers – it stands to reason NFL offenses have morphed into aerial shows. Quite simply, a smart, decisive, strong-armed quarterback is often the difference between making the playoffs or not.
Arguably, the biggest casualty of this ground-to-air evolution has been the running back. Once the keystone of every team’s offensive attack, today’s running back is viewed more as an interchangeable commodity. While still important, the ground game is no longer the foundation of many NFL offenses. In fact, in this year’s draft, only one or two running backs are projected in the first round. Yes, to succeed in today’s NFL, you need to do more than run the football.
In much the same way, eye care providers are witnessing an evolution in how we think about and manage dry eye. No longer viewed as a simple tear deficiency, we have come to appreciate dry eye as a much more complex entity – an entity in which roughly 80% of symptomatic patients suffer from meibomian gland dysfunction (MGD) and associated tear evaporation. Much like defensive personnel and rule changes have necessitated more complex offensive schemes in the NFL, our recognition of MGD-induced evaporative dry eye has necessitated a more complex treatment scheme. Yes, to succeed in managing today’s dry eye, one needs more than a ground game. One needs an aerial attack as well.
Michael D. DePaolis
As I see it, successful dry eye management will always require a solid ground game. This is what takes place in the patient’s home and includes an ongoing commitment to lid hygiene, hot compresses, tear film stabilizers and essential fatty acids. The aerial attack, on the other hand, is what takes place in-office. Technologies such as Keratograph 5M (Oculus) and LipiView 2 (TearScience) provide a truer assessment of MG anatomy and function and, therefore, a better measure of therapeutic efficacy.
From a treatment perspective, in-office BlephEx (RySurg) MG exfoliation provides an immediate and tangible improvement in MG orifice appearance. In addition, procedures aimed at MG expression, such as the Mastrota Paddle (OcuSoft) and Maskin MG Intraductal Probe (Rhein) allow us to more quickly evacuate inspissated MG glands. Finally, technologies such as LipiFlow (TearScience) result in greater symptomatic relief and a longer duration than that which can be accomplished at home.
In this issue of Primary Care Optometry News, I encourage you to read our article, “Intense pulsed light effective for dry eye, MGD, studies show” for a better understanding of yet another in-office treatment modality. While each of us must ultimately decide which technologies best fit our respective practices, it is never too early to formulate a draft strategy and build your aerial attack.