Meibomian Gland Dysfunction Understanding and Implementing the New Consensus Definition and Treatment Regimens Into Your Optometric Practice PROCEEDINGS FROM AN EXPERT PANEL DISCUSSION Course Directors and Co-Chairs Gary N. Foulks, MD, FACS Kelly K. Nichols, OD, MPH, PhD, FAAO Faculty Alan G. Kabat, OD, FAAO Paul M. Karpecki, OD, FAAO Jason J. Nichols, OD, MPH, PhD, FAAO ORIGINAL RELEASE DATE : M AY 2012 | E XPIRATION DATE : M AY 31, 2015 This course is COPE approved for 3 credits. This continuing educational activity is supported by unrestricted COPE Course ID: 34224-AS educational grants from Alcon, Inc; Bausch + Lomb Incorporated; and Santen Pharmaceutical Co, Ltd. Jointly sponsored by the State University of New York College of Optometry Part 2 of 2 Administrator: May 2012 COURSE DIRECTORS FACULTY and CO-CHAIRS Alan G. Kabat, OD, FAAO Associate Professor Gary N. Foulks, MD, FACS College of Optometry Professor Emeritus Nova Southeastern University Department of Ophthalmology & Visual Sciences Fort Lauderdale-Davie, Florida Director of Corneal/External Disease and Refractive Surgery Paul M. Karpecki, OD, FAAO Kentucky Lions Eye Center Clinical Director University of Louisville Corneal Services and Ocular Disease Research Louisville, Kentucky Koffler Vision Group Lexington, Kentucky Kelly K. Nichols, OD, MPH, PhD, FAAO FERV (Foundation for Education and Research Jason J. Nichols, OD, MPH, PhD, FAAO in Vision) Professor Kevin McDaid Vision Source Professor University of Houston College of Optometry College of Optometry University of Houston Houston, Texas Houston, Texas LEARNING METHOD AND MEDIUM Kelly K. Nichols, OD, MPH, PhD, FAAO , has had a financial agreement or affiliation This educational activity consists of a supplement and 30 study questions. The participant during the past year with the following commercial interests in the form of Honoraria/Promotional : should, in order, read the learning objectives contained at the beginning of this supplement, Alcon, Inc; Allergan, Inc; and Inspire Pharmaceuticals, Inc; Consultant/Speaker : Alcon, Inc; read the supplement, answer all questions in the post test, and complete the evaluation form. Allergan, Inc; Bausch + Lomb Incorporated; Celtic Pharma; Forest Laboratories, Inc; ISTA To receive credit for this activity, please follow the instructions provided on the post test and Pharmaceuticals, Inc; InSite Vision Incorporated; Merck & Co, Inc; SARcode Bioscience, Inc; evaluation form. This educational activity should take a maximum of 3.0 hours to complete. and TearLab Corporation; Contracted Research : Alcon, Inc; Inspire Pharmaceuticals, Inc; and TearLab Corporation. CONTENT SOURCE This continuing education (CE) activity is based on a review of the literature and an expert DISCLOSURE ATTESTATION panel discussion. Each of the contributing physicians listed above has attested to the following: 1) that the relationships/affiliations noted will not bias or otherwise influence his or her TARGET AUDIENCE involvement in this activity; This educational activity intends to educate optometrists. 2) that practice recommendations given relevant to the companies with whom he or she has OVERVIEW relationships/affiliations will be supported by the best available evidence or, absent Previously, there had not been a consistent and thorough discussion of meibomian gland evidence, will be consistent with generally accepted medical practice; and anatomy and pathophysiology. An international working group of the Tear Film and Ocular 3) that all reasonable clinical alternatives will be discussed when making practice Surface Society (TFOS) convened and developed a new definition and new terminology on recommendations. meibomian gland dysfunction (MGD), clarifying the differences between it and other ocular surface diseases, and introduced a new diagnosis and management algorithm. This CE OFF-LABEL DISCUSSION monograph captures proceedings from a roundtable discussion of a group of optometrists, This activity includes off-label discussion of azithromycin for MGD, steroids for MGD and some of whom were directly involved in the MGD workshop, others who were not, who for dry eye. gathered to evaluate the clinical relevance of the TFOS MGD Workshop’s findings, particularly as they apply to patients seeking treatment for contact lens-related or general ocular surface PEER REVIEW DISCLOSURES complaints, as well as to those patients cared for before and after ocular surgery. Katherine M. Mastrota, OD, has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Advisory Board : Allergan, Inc; LEARNING OBJECTIVES Bausch + Lomb Incorporated; Focus Laboratories; ISTA Pharmaceuticals, Inc; and Merck Upon completion of this activity, optometrists will be better able to: & Co, Inc; Board Member : Noble Vision Group, LLC; and OCuSOFT, Inc; Ownership • Describe new terminology and classifications of blepharitis and meibomian gland dysfunction Interest : TearLab Corporation. • Distinguish blepharitis/meibomian gland dysfunction from other ocular conditions Leo Semes, OD, has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Consultant : Alcon, Inc; Allergan, Inc; and • Describe treatment implications for meibomian gland dysfunction with or without the Merck & Co, Inc; Speaker : Optovue, Inc. presence of additional ocular surface disorders EDITORIAL SUPPORT DISCLOSURES ACCREDITATION DESIGNATION STATEMENT Michelle Dalton, ELS; Cynthia Tornallyay, RD, MBA, CCMEP; and Barbara Lyon This course is COPE approved for 3.0 hours of CE credit. COPE Course ID: 34224-AS. have no relevant commercial relationships to disclose. Check with your local state licensing board to see if this counts toward your CE requirement for relicensure. GRANTOR STATEMENT This continuing educational activity is supported by unrestricted educational grants from DISCLOSURES Alcon, Inc; Bausch + Lomb Incorporated; and Santen Pharmaceutical Co, Ltd. Gary N. Foulks, MD, FACS , has had a financial agreement or affiliation during the past year with the following commercial interests in the form of Honoraria : InSite Vision Incorporated; TO OBTAIN CE CREDIT and Santen Pharmaceutical Co, Ltd; Consultant/Advisory Board : Bausch + Lomb Incorporated; We offer instant certificate processing and support Green CE. Please take this post test and Inspire Pharmaceuticals, Inc; and Scynexis, Inc; Contracted Research : Alcon, Inc. evaluation online by going to www.Mededicus.com and clicking the Educational Alan G. Kabat, OD, FAAO , has had a financial agreement or affiliation during the past Activities & Post Test Center box. Upon passing, you will receive your certificate year with the following commercial interests in the form of Consultant/Advisory Board : Alcon, immediately. You must answer 21 out of 30 questions correctly in order to pass, and may Inc; Essilor of America, Inc; Inspire Pharmaceuticals, Inc; and ISTA Pharmaceuticals, Inc; take the test up to 2 times. Upon registering and successfully completing the post test, your Contracted Research : TearLab Corporation. certificate will be made available online and you can print it or file it. There are no fees for Paul M. Karpecki, OD, FAAO , has had a financial agreement or affiliation during the past participating and receiving CE credit for this activity. year with the following commercial interests in the form of Consultant : Alcon, Inc; Allergan, Inc; Bausch + Lomb Incorporated; Inspire Pharmaceuticals, Inc; ISTA Pharmaceuticals, Inc; and OCuSOFT, Inc. The views and opinions expressed in this educational activity are those of the faculty and do Jason J. Nichols, OD, MPH, PhD, FAAO , has had a financial agreement or affiliation during not necessarily represent the views of the State University of New York College of Optometry; the past year with the following commercial interests in the form of Advisory Board/Speaker : Bausch MedEdicus LLC; Alcon, Inc; Bausch + Lomb Incorporated; Santen Pharmaceutical Co, Ltd; + Lomb Incorporated; and Vistakon; Honoraria/Editorship : Wolters Kluwer; Contracted Research : or Review of Optometry . Please consult products for all approved administration and Alcon, Inc; CIBA VISION Corporation; Inspire Pharmaceuticals, Inc; and Vistakon, Inc. safety information. © 2012 MedEdicus LLC 2 Meibomian Gland Dysfunction: No Longer in the Shadows In the mid 1990s, research in ocular surface disease was in its diseases, proposed a new consensus definition for MGD, and infancy, with disjointed descriptions of patient-reported symptoms introduced a new diagnosis and management algorithm. It was failing to correlate well with clinically observed signs. Terminology the hope of the steering committee to advance the study of MGD was intermingled and not qualified, or sufficiently specific. Around in one large uniform step. To our knowledge, the MGD Workshop the world, clinical studies devised their own sets of inclusion report represents the first time a global consensus has been criteria, limiting the ability to generate consensus. The pathogenic reached on the definition of MGD, and as such, allows a general relationship of dry eye alone or in conjunction with contact lens consensus on how to diagnose and treat patients with MGD. (CL) wear was uncertain. In an important update to a pivotal Previously, there had not been a consistent and thorough report on dry eye published in 1995, 1 the 2007 Dry Eye Workshop discussion of meibomian gland anatomy and pathophysiology.