The Hunt for Dry Eye Instigators
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RCCL MAY 2014 REVIEW OF CORNEA & CONTACT LENSES EARNARN 2 CECE CREDITSREEDITDITS The Hunt for Dry Eye Instigators Treatment optionsns thatththatt targettarargeet inflininfl ammatoryamammamatotory mmediatorseeddiai totorsr in the tear fi lm may help clinicians achieve victory over this often diffi cult to manage condition. Supplement to Controlling the ocular immune response • bring sjÖgren’s out of the shadows 001_rcl0514_cover.indd 1 4/25/14 2:47 PM THIS IS WHY our new daily disposable multifocal contact lens is designed to perform at every distance and refreshes with every blink—no matter what the day may bring. PRECISION PROFILE Design WITH BLINK-ACTIVATED MOISTURE NEAR IN TE NEW DAILIES® AquaComfort Plus® Multifocal TERMEDIA contact lenses are designed to deliver clear binocular vision and refreshing comfort. 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See product instructions for complete wear, care, and safety information. © 2013 Novartis 11/13 DAM13014JAD RCCL0514_Alcon Dailies.indd 1 4/15/14 2:09 PM contents Review of Cornea & Contact Lenses | May 2014 departments 4 News Review A New Treatment for Allergic Conjunctivitis?; features A Balanced Dry Eye Diet Controlling the 6 My Perspective Ocular Immune Response LSCD—It May Be the Lenses We must strive to limit its untoward eff ects without undermining its essential role in By Joseph P. Shovlin, OD protection and healing. 12 By Aaron Bronner, OD 7 Lens Care Insights Wash Away Your Old Hygiene Strategy It’s Time to Bring Sjögren’s By Christine W. Sindt, OD Out of the Shadows This autoimmune disease can go undiagnosed for years. By working closely with other health Pharma Science & Practice care providers, we may be able to detect it in 8 its earliest stages. 16 By Arthur B. Epstein, OD, The Source of the Irritation By Elyse L. Chaglasian, OD, and Paul M. Karpecki, OD and Tammy P. Than, OD, MS 10 The GP Expert Surveyor of the Surface By Stephanie L. Woo, OD 20 Corneal Consult 30 CE — The Hunt for Stemming the Tide Dry Eye Instigators By James Thimons, OD Treatment options that target infl ammatory mediators in the tear fi lm may help clinicians achieve victory over this often diffi cult to manage condition. Derail Dropouts 32 By Michelle M. Hessen, OD Patch It Up By Mile Brujic, OD, and Clinical image on the cover courtesy of Mark Abelson, MD/Ora, Inc. Jason R. Miller, OD, MBA 34 Out of the Box Can’t We All Just Get Along? By Gary Gerber, OD REVIEW OF CORNEA & CONTACT LENSES | MAY 2014 3 /ReviewofCorneaAndContactLenses #rcclmag 003_rccl0514_TOC (v2).indd 3 4/25/14 4:57 PM News Review IN BRIEF A New Treatment for • Google has applied for a pat- Allergic Conjunctivitis? ent to fit a camera into a contact lens. According to the application, inserting the camera into the lens se of tacrolimus score decreased to 5.9. The mean will not dramatically increase the 0.1% eye drops is total score of clinical symptoms thickness of the lens. The addition of cameras will allow the lenses highly effective in decreased from 8.1 at baseline to process images and collect a treating refractory to 1.8 at fi nal observation. Ad- variety of data, such as motion, U allergic conjuncti- ditionally, both giant papillae colors, face, etc. Additionally, the vitis, according to a study pub- and corneal lesions were reduced contact lenses may include sen- lished in the April 2 online British signifi cantly (p<0.001) following sors that would be used to track blinking, which could be used to Journal of Ophthalmology. use of tacrolimus 0.1%. control or trigger devices remote- The prospective observational Prior to initiating tacrolimus ly via blinks. study evaluated the eyes of 1,436 therapy, 239 patients were treated patients with refractory aller- with cyclosporine 0.1% eye drops • Johnson & Johnson announced gic conjunctivitis who did not for at least one month; these pa- that the company is now accept- respond favorably to prior treat- tients exhibited giant papillae or ing research proposals related to meibography and tear film ment with conventional allergy corneal epithelial disorder scores stability with contact lens wear. drugs, topical steroids and/or greater than two at initiation of Specifically, J&J is looking for topical cyclosporine. treatment. Following one month research proposals in the areas During the trial, tacrolimus of tacrolimus use their clinical of correlating clinical findings to 0.1% drops were administered signs score decreased from 16.8 to meibomian gland image analysis and tear film stability, and cat- twice daily to each patient. The 6.7, and their clinical symptoms egorizing the magnitude of mei- researchers rated 10 clinical signs score decreased from 9.1 to 1.9. bomian gland changes to contact (palpebral conjunctiva hyperemia, The researchers noted adverse lens type or length of wear. To diffuse edema, follicles, papillae, reactions in 117 patients, with the inquire about proposal submis- giant papillae, bulbar conjunctiva only major reaction being a burn- sion, contact the Clinical Research Administrator at RA-VISUS- hyperemia, bullous edema, limbal ing sensation (45 cases). [email protected]. trantas’ dot, swelling and corneal Additionally, two cases of epithelial signs) and six clinical bacterial keratitis, two cases of • Smoking tobacco has a nega- symptoms (itching, discharge, herpetic keratitis and one case of tive impact on the healing lacrimation, photophobia, foreign bacterial corneal ulceration were process of corneal insults. In a body sensation and eye pain) on a observed. Atopic dermatitis or study published in the May 2014 Cornea, researchers reviewed the four-grade scale (0=none, 1=mild, asthma was noted as an underly- charts of 87 patients with corneal 2=moderate and 3=severe). ing condition in these cases. abrasions and 52 patients with Patients were graded at base- Initially developed as an immu- keratitis between 1990 and 2010. line, one month, two months, nosuppressant for use following The study demonstrated that three months and six months. The organ transplantation, tacrolimus epithelial healing is delayed 1.1 days on average in smokers vs. total score of both the 10 clinical is now used clinically for multiple non-smokers, and 23.9 days on signs (range 0-30) and six clinical immune-mediated conditions. The average in smokers with keratitis. symptoms (range 0-18) decreased researchers suggest that the use of Additionally, neurotrophic corneas signifi cantly from baseline to the topical tacrolimus is both safe and and fungal infections also exhib- one-month evaluation (p<0.001), effective in treating patients with ited a prolonged healing period in smokers. indicating the agent’s ability to severe allergic conjunctivitis. provide rapid relief. Fukushima A, et al. Therapeutic effects of Jetton JA, et al. Effects of tobacco At baseline, the mean total 0.1% tacrolimus eye drops for refractory aller- smoking on human corneal wound gic ocular diseases with proliferative lesion or healing. Cornea. 2014 May;33(5):453-6. score of clinical signs was 15.3; at corneal involvement. Br J Ophthalmol. 2014 fi nal observation, the mean total Apr 2. [Epub ahead of print] 4 REVIEW OF CORNEA & CONTACT LENSES | MAY 2014 004_rccl0514_news.indd 4 4/25/14 5:11 PM RCCL REVIEW OF CORNEA & CONTACT LENSES JOBSON PROFESSIONAL PUBLICATIONS GROUP 11 Campus Blvd., Suite 100 Newtown Square, PA 19073 Telephone (610) 492-1000 A Balanced Dry Eye Diet Fax (610) 492-1049 Editorial inquiries (610) 492-1003 Advertising inquiries (610) 492-1011 E-mail [email protected] Mediterranean diet D was inversely correlated with EDITORIAL STAFF may actually have a the infl ammatory marker soluble EDITOR-IN-CHIEF negative effect on dry interleukin-2 receptor. Jack Persico [email protected] eye symptoms, while Each patient was asked to fi ll ASSOCIATE EDITOR A Frank Auletto [email protected] increased intake of vitamin D may out a 2005 Block Food Frequency CLINICAL EDITOR have a small but positive effect, Questionnaire and the 5-item Dry Joseph P. Shovlin, OD, [email protected] EXECUTIVE EDITOR according to a study published in Eye Questionnaire. Additionally, Arthur B. Epstein, OD, [email protected] the May 2014 Cornea. an ocular surface examination ASSOCIATE CLINICAL EDITOR Two hundred forty-seven male consisting of tear osmolarity Christine W. Sindt, OD, [email protected] CONSULTING EDITOR patients between 55 and 95 years evaluation, tear break-up time, Milton M. Hom, OD, [email protected] old (mean age 69) at the Miami corneal staining, Schirmer’s test SENIOR ART/PRODUCTION DIRECTOR Joe Morris [email protected] Veteran’s Affairs eye clinic with was conducted on each patient. GRAPHIC DESIGNER normal eyelid, corneal and con- Patients who adhered to the Matt Egger [email protected] junctival anatomy were recruited Mediterranean diet were actually AD PRODUCTION MANAGER Scott Tobin [email protected] to undergo dry eye testing follow- found to have an increased risk of BUSINESS STAFF ing dietary changes. dry eye (p=0.007). Patients who VICE PRESIDENT OPERATIONS The subjects adhered to the reported a higher Mediterranean Casey Foster [email protected] Mediterranean diet, which in- diet score on the food frequency SALES MANAGER, NORTHEAST, MID ATLANTIC, OHIO cludes a relatively high intake of questionnaire (i.e., those who James Henne [email protected] fruits, vegetables, monounsaturat- adhered to the plan) demonstrated SALES MANAGER, SOUTHEAST, WEST Michele Barrett [email protected] ed fat, fi sh, whole grains, legumes abnormal meibum quality, abnor- and nuts, as well as moderate mal staining and higher Schirmer’s EDITORIAL BOARD Mark B.