Eyetube Roundtable Blepharitis in the United States, 2009: A - PowerPoint PPT Presentation

Eyetube Roundtable Blepharitis in the United States, 2009: A Perspective on Prevalence Marguerite McDonald, MD, FACS Clinical Professor of Ophthalmology NYU School of Medicine New York, New York Adjunct Clinical Professor of Ophthalmology Tulane University Health Sciences Center New Orleans, Louisiana Ophthalmic Consultants of Long Island Lynbrook, New York

Prevalence Data  Study: Prevalence of Blepharitis  Design: meibomian gland expression performed on 398 randomly selected “apparently normal” patients presenting for routine vision examinations  Results: 155 patients (39%) were judged to have MGD based upon absent or cloudy meibomian gland secretions on expression Hom MM, Martinson JR, Knapp LL, Paugh JR. Optom Vis Sci . 1990 Sep;67(9):710-2.

Prevalence Data  Study : Chronic Blepharitis; Treatment Patterns and Prevalence  Design : Venturino and colleagues prospectively collected and analyzed data from 1,148 consecutive patients seeking an eye examination because of ocular discomfort or irritation  Results : It was noted overall, that treatment in use was not specific to the diagnosis and gave poor clinical results. Diagnoses presented:  Posterior Blepharitis 24%  Dry Eye Disease 21%  Anterior Blepharitis 12% Venturino G, Bricola G, Bagnis A, Traverso CE. Chronic Blepharitis; Treatment Patterns and Prevalence. Invest Ophthalmol Vis Sci . 2003;44: E-Abstract 774.

Mattson Jack Methodology  Computer-assisted telephone interviewing using a questionnaire designed to elicit information on symptoms suggestive of blepharitis  Questions were asked regarding  History of bumps on eyelids  Styes  Thinning of eyelashes  Contact lens use  Blepharitis or dry eye diagnosis

Mattson Jack Methodology  Respondents were also asked to rate the frequency of symptoms occurring in the last 12 months: 1. Itching or burning of eyelids 2. Eyes felt irritated after computer use of >3 hours 3. Eyelids felt heavy or puffy 4. Crust or flakes on eyelashes upon waking 5. Eyes felt dry or irritated 6. Eyelids stuck together upon waking 7. Eyes watery, especially in a.m. 8. Eyes red upon waking

Prevalence and Frequency of Symptoms Extrapolated Prevalence* Percent At least 1 symptom in past 12 mo 79.3 182 million More than 1 symptom in past 12 mo 63.2 145 million At least 1 symptom in past 12 mo at 32.3 74 million least half the time History of bumps on eyelids 4.5 10 million History of styes 17.8 41 million Thinning of eyelashes within past year 9.1 21 million *Based
on
percentage
of
US
population
of
~229
million
≥18
years
of age
in
2008.

Symptom History 15% experienced at least 1 of the 3 symptoms most associated with blepharitis ½ of the time in the past year Itching/ Eyelids Eyes Eyes Eyes Crust or Eyelids Eyelids Irritated, Flakes on Stuck Teared/ Burning Heavy/ Dry/ Red Computer Eyelashes Together Watery, Eyelids Puffy Irritated Upon Use >3 h Upon Upon esp. in Waking Waking Waking a.m.

Gender Distribution of Symptoms Eyelids Itching/ Eyelids Eyes Eyes Eyes Crust or Eyelids Red Irritated, Flakes on Stuck Burning Heavy/ Dry/ Teared/ Upon Computer Eyelashes, Together, Eyelids Puffy Irritated Watery, Use >3 h Waking Waking Waking esp. in a.m.

Blepharitis-Associated Symptoms in Past Year

Mattson Jack Conclusions  1% of respondents had been diagnosed with blepharitis; 11% had been diagnosed with dry eye  Symptoms of blepharitis were frequently reported by respondents who had not been diagnosed with this disorder  Among respondents diagnosed with blepharitis, 40% had concomitant dry eye  Respondents who reported symptoms consistent with blepharitis also frequently reported difficulty wearing contact lenses Blepharitis may be a frequently over looked condition in the United States.

Campbell Alliance Survey: 120 MDs & 84 ODs in September 2008 1. What is the prevalence of blepharitis? 2. Over the course of a year, how many blepharitis patient visits are reported by eye care specialists? 3. Over the course of a year, how many blepharitis patient visits require a prescription as part of the treatment regimen? 4. What is the importance of posterior blepharitis as a comorbid condition and an underlying disease state?

Campbell Alliance Survey: 120 MDs & 84 ODs in September 2008 7. Within the treatment flow for blepharitis, where and how can patients be leveraged, and where are they lost? 8. After a preliminary market segmentation analysis, what are the various patient and physician segments that emerge as potentially valuable? 9. Based on a number of scenarios, what does a patient-based forecast estimate look like?

Patient Presentation: Initial Motivation for Seeking Data derived from free-response questions. Chart may not equal 100%.

Diagnosis:
Which
Pa.ents
are
Likely
to
be Diagnosis:
Which
Pa.ents
are
Likely
to
be Predisposed
to
Posterior
Blephari.s Blephari.s? ? Predisposed
to
Posterior


Office Visits and Treatment, Prescription Dispensation Result in Treatment Result in (Any Form) Prescription* *Issuance of prescriptions does not equate to percent of patients who fill their prescriptions.

Perspective on surgeries and perioperative strategies Karl Stonecipher,MD Medical Director for TLC Greensboro Co-Medical Directory for TLC Raleigh Greensboro, North Carolina

What is the biggest ocular surface challenge regarding a successful outcome with cataract surgery/premium IOLs/refractive? Historically how was this treated? With what success ?

Differential Diagnosis of Blepharitis Common Signs and Symptoms:  Itchy eyes  Foreign body sensation  Photosensitivity  Dry, gritty ocular  Hyperemia surface  Chemosis  Transient blurred  Tearing vision  Lid swelling

Blepharitis Impact on Patient Health & Surgical Results William Trattler, MD The Center for Excellence in Eye Care Miami, Florida Assistant Professor of Ophthalmology, Bascom Palmer Eye Institute Financial Disclosure: Consultant/Research Funding/Speaking Honoraria for: Allergan, Inspire, Ista, AMO, Vistakon, Lenstec, Glaukos, Sirion Therapeutics

New Generation IOLs and the Ocular Surface  Visual acuity begins with the ocular surface and tear film.  With the advent of new generation presbyopic and toric IOLs, cataract surgery is now considered a refractive procedure.

Impact of Blepharitis 64 yr old female interested in cataract surgery with Presbyopic IOL

Impact of Blepharitis After 2 weeks of treatment of the blepharitis

Impact of Dry Eye 58-year old male with visually significant cataract OS, interested in a premium IOL.

Impact of Dry Eye The next day, after treatment with artificial tears Q3-4 hours

Dry eye & Blepharitis

Dry eye & Blepharitis Combo of Blepharitis & Dry Eye

Importance of Treating Blepharitis in the Pre-operative Patient Jodi Luchs, MD, FACS Director, Department of Refractive Surgery Cornea Service North Shore/Long Island Jewish Health System Assistant Clinical Professor Department of Ophthalmology Albert Einstein College of Medicine

Blepharitis and the Surgical Patient  Two enemies of a successful surgical outcome  Infection  Inflammation  Pre-existing blepharitis exposes the surgical patient to both of these risk factors

Blepharitis & Surgical Outcomes: Rationale for Treatment  Prevention of Infection:  Lid margin bacteria from blepharitis presents risk for post-operative infection/complication  Causal organisms for post- operative infections arise from lids & lashes 1  Gram positive organisms  94% of endophthalmitis Courtesy of Jodi Luchs, MD cases 2  55% of post refractive 1 Speaker MG et al.: Ophthalmology 1991;98(5):639-649 surgical infections 3 2 EVS Study Group: Arch Ophthalmol 1995;113(12):1479-1496 3 Results presented by Terry Kim, M.D., and Eric Donnenfeld, M.D., on behalf of the ASCRS Cornea Clinical Committee at ASCRS 2008  Staph,Strep Cornea Day, Chicago

Physicochemical Changes in Blepharitis  Thickening of meibomian gland secretion  Decreased stability of tear film  Pro-inflammatory lipid products in meibomian secretion (free fatty acids and diglycerides)  Altered composition: more unbranched fatty acids

Tear Film Instability, Regardless of Cause:  Results in a breakdown in the homeostatic interblink tear film stability 1,2  Leads to increased evaporative tear loss, repetitive interblink dry spots, and epithelial desiccation 2  Leads to disruption of the interblink tear film with degradation of visual image, increased higher order aberrations, and loss of contrast sensitivity 1,2 1 Stern
ME,
et
al.
 The
Ocular
Surface .
2004;2:124‐130. 2 Albietz
JM,
et
al.
 Clin
Exp
Optom .
2001;84(1):4‐18.

Blepharitis & Surgical Outcomes: Rationale for Treatment  Stabilize the Tear film:  Unstable tear film due to blepharitis/lid margin disease:  Pre-op:  Inaccurate pre-op measurements:  Keratometry  Topography  Wavefront measurements

Blepharitis & Surgical Outcomes: Rationale for Treatment  Post-op:  Fluctuation of visual acuity  Delay of visual recovery  Potential delay of healing  Clear corneal cataract wounds  Post LASIK or surface ablation