Dry Eye, MGD, and Blepharitis Update From Optometry's Academy Meeting
This past weekend, we attended the American Academy of Optometry meeting in San Antonio, TX. The Academy is committed to promoting the art and science of vision care through lifelong learning, and this is seen in the vast amount of high quality lectures available to us covering all aspects of vision care.
Not surprisingly, dry eye disease, meibomian gland dysfunction (MGD), blepharitis, and other ocular surface diseases were well covered at this meeting. As optometrists, we see patients who suffer from these conditions every single day. It's so important for us to stay up to speed on the latest treatments available, so that we can help you find relief. Below you'll find our recap of some of the lectures we attended at this meeting!
Meibomian Gland Dysfunction (MGD) Treatment Options Update and Lipiflow Alternatives
TearCare System by Sight Sciences (coming in 2019)
This system is a new device that will be available in many dry eye practices soon. The wearable eyelid technology provides adjustable heat treatment to the upper and lower eyelids without the need for closed eyes. This is important because it is able to use the full functionality of the blink to release meibum onto the eye. You can even scroll Facebook while you're having the treatment done! The thin films used in this procedure attach to the eyelids and are adjustable to reach every meibomian gland. The treatment has, so far, been shown to be much more effective in relieving the symptoms of MGD vs. warm compresses alone.
iLux Dry Eye Treatment Device by Tear Film Innovations
This neat device uses an LED light-based heat source to heat your meibomian glands in your doctor's office. After warming the glands, the technician will apply gentle pressure with the device onto your glands, helping to express them. Throughout the procedure, the technician is able to view your glands and oil secretions through a small magnifying lens on the device. The process is usually performed on two areas of the lower lids (nasal and temperal) and two areas of the upper.
MiBo Thermoflo by MiBo Medical Group
Similar to other procedures discussed here, MiBo Thermoflo uses heat to help loosen the oils of the meibomian glands so that normal, healthy oil can continue to be released onto the eyes. It uses a proprietary thermoelectric heat pump to deliver consistent heat to the glands, and this is done in the comfort of your doctor's office. A technician will perform the procedure on your upper and lower eyelids, and this device does not make the use of anything actually attached to the eyelids, so it might be better for those who get squeamish with devices close to the eyes. If you want to learn more, you can watch this video we did about MiBo.
umay Dynamic Thermal Meditation and Thermal Cooling Device
One of the most exciting devices we saw at Academy was the umay device. This eye "mask" combines the benefits of thermal heat with meditation, and it's done at home. You simply lie back on a bed or couch, place the device over your closed eyelids, and start the device. It's designed to make you take time away from your busy day on your smart phone and computer...and it works to heat up the meibomian glands as well. This device also has a cooling feature for allergies and sinus pressure, so we think it's pretty versatile.
The big emphasis of this years Academy meeting was on the fact that cleaner eyelids play a role in EVERYTHING from dry eyes to meibomian gland dysfunction to blepharitis to demodex. We heard multiple times that eyelid hygiene should be emphasized by eye care practitioners as much as brushing your teeth is emphasized by dentists, and this regimen should be started in childhood.
This was a pretty amazing statement and a testament to what we talk about all the time. Clean your eyelids and feel much better. The reason for this is that bacteria and biofilm build-up on your eyelids, and this leads to a plethora of problems including:
Demodex, which live on your oil, skin cells, and, yes, biofilm.
MGD, because bacterial biofilm on your eyelids is going to clog your meibomian glands.
Blepharitis, because an increase in bacteria leads to even more biofilm, which leads to inflammation of your eyelids.
Dry eyes, because without your meibomian glands and other glands of your eyelids working well, this creates less oily tears for your eyes (which means more discomfort and irritation).
The eyelid cleanser of choice that was talked about the most was hypochlorous acid eyelid cleanser. As anything gains in popularity, so does the competition. Here are a list of the hypochlorous acid eyelid cleansers that we saw at the Academy meeting:
This, of course, is our own brand of hypochlorous acid, but we were mentioned a few times at lectures. We are one of the most accessible hypochlorous acid eyelid cleansers on the market and make it easy for our patients to obtain and use it. It's as simply as spraying it onto your closed eyelids, rubbing it in, and letting it dry!
This one is available through your eye doctor and is one of the newer prescription or physician-dispensed formulas on the market (similar to Avenova). The formula looks to be around $150/month via the pharmacy (according to GoodRx.com) and may run about $40-50/month if you get it through a doctor who carries it in their office.
We've talked a lot about Avenova on our blog and in our videos because it is a great hypochlorous acid cleanser! However, the price can be prohibitive if your doctor does not dispense it in their office. According to GoodRx.com, you're still going to pay around $300/month without insurance at the pharmacy. Learn more about Avenova here.
Over-The-Counter Ocusoft Hypochlor
Ocusoft is a well-known company that makes a hypochlorous acid cleanser, and this one is very commonly recommended by eye doctors. Is it the best one? We believe there are purer formulas on the market and formulas that have less potential to irritate the eyes.
Over-The-Counter Zenoptiq Gel
We actually like this one because it's different than a spray we normally see (although they do have a spray formulation as well). This formula is a hypochlorous acid gel, so instead of spraying it onto your closed eyelids, you'll wet a cotton round with it before rubbing into your eyelids and lashes. Both formulations run about $30.
Prescription Autlogous Serum Eye Drops and Vital Tears
Many of you may have tried autologous serum eye drops, and they've been specifically shown to be beneficial for those with dry eyes due to Sjogren's Syndrome. But these aren't just normal artificial tears, and they're not designed to lubricate the eyes. They're designed to repair tissue, meaning that they can provide relief for those with Recurrent Corneal Erosions (RCE), exposure keratitis, aqueous deficient dry eye, and other conditions that negatively affect the ocular surface. The pH, osmolarity, and many growth factors are roughly the same as your tears, meaning that they do a wonderful job at healing the surface of the eyes. You can read more about autologous serum drops here. Also, a new company, Vital Tears, is making it easy to order autologous serum drops even if you don't have access to a compounding pharmacy near you. We expect them to do well, as this is the future of healthcare!
We've discussed Cequa on our blog and Dry Eye Show before and basically, Cequa is cyclosporine (like Restasis) although in a much higher concentration. It also boasts a nanomicelle delivery vehicle, meaning that it should penetrate into the ocular tissues more easily and much more quickly. For you, this means you'll feel relief sooner than with Restasis (some studies have shown effectiveness in relieving symptoms as early as two weeks...vs. the six months with Restasis). Coming out in 2019, we expect this to do well in optometry practices around the nation. We didn't learn much more at Academy than we already knew, so make sure to check out our blog post on Cequa!