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
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
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.
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.
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
Respondents were also asked to rate the frequency
hours
Percent Extrapolated Prevalence*
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 least half the time 32.3 74 million 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.
Itching/ Burning Eyelids Eyelids Heavy/ Puffy Eyes Dry/ Irritated
Eyes Teared/ Watery,
a.m.
Eyes Irritated, Computer Use >3 h Crust or Flakes on Eyelashes Upon Waking Eyelids Stuck Together Upon Waking
Eyelids Red
Upon
Waking
15% experienced at least 1 of the 3 symptoms most associated with blepharitis ½ of the time in the past year
Itching/ Burning Eyelids Eyelids Heavy/ Puffy Eyes Dry/ Irritated Eyes Teared/ Watery,
a.m.
Eyes Irritated, Computer Use >3 h Crust or Flakes on Eyelashes, Waking Eyelids Stuck Together, Waking
Eyelids Red Upon Waking
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
blepharitis patient visits are reported by eye care specialists?
blepharitis patient visits require a prescription as part of the treatment regimen?
as a comorbid condition and an underlying disease state?
and how can patients be leveraged, and where are they lost?
what are the various patient and physician segments that emerge as potentially valuable?
patient-based forecast estimate look like?
Campbell Alliance Survey: 120 MDs & 84 ODs in September 2008
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 Predisposed to Posterior Blephari.s Blephari.s? ?
Result in Treatment (Any Form)
Result in Prescription*
*Issuance of prescriptions does not equate to percent of patients who fill their prescriptions.
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
IOLs/refractive? Historically how was this treated? With what success?
Foreign body
sensation
Dry, gritty ocular
surface
Transient blurred
vision
Itchy eyes Photosensitivity Hyperemia Chemosis Tearing Lid swelling
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
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.
64 yr old female interested in cataract surgery with Presbyopic IOL
After 2 weeks of treatment of the blepharitis
58-year old male with visually significant cataract OS, interested in a premium IOL.
The next day, after treatment with artificial tears Q3-4 hours
Combo of Blepharitis & Dry Eye
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
Two enemies of a successful surgical
Infection Inflammation Pre-existing blepharitis exposes the
surgical patient to both of these risk factors
Prevention of Infection:
Lid margin bacteria from
blepharitis presents risk for post-operative infection/complication
Causal organisms for post-
from lids & lashes1
Gram positive organisms 94% of endophthalmitis
cases2
55% of post refractive
surgical infections3
Staph,Strep
1Speaker MG et al.: Ophthalmology 1991;98(5):639-649 2EVS 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 Cornea Day, Chicago
Courtesy of Jodi Luchs, MD
Thickening of meibomian gland
Decreased stability of tear film Pro-inflammatory lipid products in
Altered composition: more unbranched
Results in a breakdown in the homeostatic
interblink tear film stability1,2
Leads to increased evaporative tear loss,
repetitive interblink dry spots, and epithelial desiccation2
Leads to disruption of the interblink tear
film with degradation of visual image, increased higher order aberrations, and loss of contrast sensitivity1,2
1Stern ME, et al. The Ocular Surface. 2004;2:124‐130. 2Albietz JM, et al. Clin Exp Optom. 2001;84(1):4‐18.
Stabilize the Tear film:
Unstable tear film due to blepharitis/lid
margin disease:
Pre-op: Inaccurate pre-op measurements: Keratometry Topography Wavefront measurements
Post-op: Fluctuation of visual acuity Delay of visual recovery Potential delay of healing Clear corneal cataract wounds Post LASIK or surface ablation
Stabilize the Tear film: Post-op: Worsening of post-LASIK dry eye Implications for cataract and refractive
surgery
Presbyopic IOLʼs Patient expectations Post operative comfort
Treatment of blepharitis Reduces bacterial load on the ocular surface Reduces inflammatory mediators on the
Stabilizes tear film Improves wound healing Reduces lipases in the tear film Reduces inflammogenic free fatty acids in
tear film
Restores integrity of the lipid layer of the tear
film
Warm compresses/lid scrubs Antibiotic ointments
Bacitracin, erythromycin
Poorly tolerated, blur vision Difficult to apply Limited compliance
Posterior blepharitis Warm compresses/lid massage Oral tetracyclines
Poorly tolerated Long duration of onset of action Systemic side effects
Antibiotic/steroid combinations
Short term relief of symptoms Limited use due to steroid related
side-effects