Lubricity feature enhances SLK management

Abstracts / Contact Lens & Anterior Eye 38 (2015) e13–e46

35 Dry eye tests and treatment: A transnational online survey Marion Beck 1 , Anna Nagl 2 , Heiko Pult 1,2,3 , Thomas Hofmann 3 1

University of Applied Science Aalen, Aalen, Germany 2 Optometry & Vision Research, Stamitzstr. 7, 68167 Mannheim, Germany 3 Optometrie Zentrum, Basel, Switzerland Purpose: To estimate the prevalence of dry eye tests use and treatment recommendation of optometrists in Germany (D), Austria (A) and Switzerland (CH). Method: Optometrists of D, A and CH were queried regarding use of dry eye tests and treatment by an online survey. Results: 254 optometrists responded to the online survey (D = 51%, A = 14%, CH = 35%). The median frequency of use of dry eye tests was 2, 1.5 and 2 (D, A, CH respectively, 1 = always, 4 = never; p = 0.395). Median duration of dry eye testing was 7, 5, 5 min (D, A, CH respectively; p = 0.061). Most frequent used objective tests were the observation of lids, hyperaemia and tear film instability (TF-BUT) (>90%), followed by staining, TF viscosity, conjunctival abnormalities, blinks and tear meniscus height (TMH) (>80%). Frequency of evaluation of lid-parallel conjunctival folds and lipid layer was each 69%. Less frequently applied tests were lid-wiper epitheliopathy (22%), osmolality (19%), meibomian gland expression (16%), meibography (10%) and Schirmer (6%). This was different between countries. The top three tests in D were hyperaemia and TF-BUT (95%), lids (91%) and TF viscosity (86%). Those of A were lids (94%), staining and TMH (each 88%), TF-BUT, TF viscosity, conjunctival abnormalities and hyperaemia (85%). The top three tests in CH were staining and hyperaemia (97%), conjunctival abnormalities (96%) and tear film instability (90%). 89% used an own questionnaire or were doing interviews. Top three treatments were lid hygiene, eye drops and liposomal eye sprays. Conclusions: Overall most common tests were TF-BUT, viscosity and TMH and the evaluation of the ocular surface including lids, hyperaemia, conjunctival abnormalities and blinks. Preference of tests was different between countries. Dry eye history was taken by interview or own questionnaire and preferred treatments are lid hygiene and eye drops or liposomal sprays. Marion Beck has worked as Store Manager for Eye Catcher AG, Mannheim since 2014. She graduated in Germany in 2012 with a Masters Degree in Science in Vision from the Science and Business degree program, University of Applied Science Aalen, Germany. http://dx.doi.org/10.1016/j.clae.2014.11.035 36 Efficacy and safety of a commercially available eyelid warming device for the treatment of meibomian gland dysfunction related evaporative dry eye Paramdeep Bilkhu, Shehzad Naroo, James Wolffsohn Aston University Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham B4 7ET, United Kingdom Purpose: To investigate the efficacy and safety of an eyelid warming device, the MGDRx EyeBag (The Eyebag Company, Hali-

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fax, UK), for the treatment of meibomian gland dysfunction (MGD) related evaporative dry eye. Method: Twenty-five patients with confirmed MGD related evaporative dry eye (16 female, 4 male; 28.7 ± 7.8 years old; age range 19–42 years) were enrolled in to a randomised, examiner masked, controlled clinical trial. Efficacy (ocular symptomology, non-invasive break up time (NITBUT), tear film lipid layer thickness, tear film osmolarity, meibum quality, meibomian gland expressibility, meibomian gland dropout) and safety (visual acuity, corneal topography, conjunctival hyperaemia and ocular surface staining) measurements were taken at baseline and after 2 weeks treatment, where only one eye received the heated device (test), and the fellow eye a non-heated device (control) for 5 min twice a day. Results: The difference between test and control eyes at baseline was not statistically significant for all measurements (p > 0.05). After the 2-week treatment period, there was a statistically significant improvement in all efficacy measurements in test eyes (p < 0.05), but not control eyes except for meibomian gland expressibility (p < 0.05). Although visual acuity and corneal topography were unaffected in both eyes (p > 0.05), conjunctival hyperaemia and ocular surface staining decreased in test eyes only (p < 0.05). Adverse events were limited to 1 report of transient stinging upon application of the heated device on the first 2 days, with no further episodes thereafter. Conclusions: The MGDRx EyeBag is a safe and effective treatment for MGD related evaporative dry eye. Further study is required to determine duration of the treatment effect and the optimum treatment protocol for this condition. Paramdeep Bilkhu is a postdoctoral research assistant and module leader for the Independent Prescribing course at Aston University, with research interests in ocular allergy, dry eye and presbyopia. In addition to his research duties he helps to teach and lecture in clinical optometry, contact lenses and anterior eye disease for the Aston University undergraduate optometry course. http://dx.doi.org/10.1016/j.clae.2014.11.036 37 Lubricity feature enhances SLK management Etty Bitton Ecole d’optometrie, Universite de Montreal, PO Box 6128, Downtown Station, Montreal, Quebec, Canada H3C 3J7 Purpose: Superior Limbic Keratoconjunctivitis (SLK) typically presents as an asymptomatic bilateral inflammation of the superior bulbar conjunctiva, associated with thyroid disease in woman aged 20–60. Although the pathophysiology of SLK is unknown, it is believed that swelling of the conjunctiva results in mechanical irritation/friction with the lid. This case report highlights a 43-year old female who was referred for what was believed to be chronic dry eye (DE), and who was treated with a new CL on the market. A full DE workup revealed a stable and sufficient tear film, with a positive and asymmetric upper lid margin staining (ULMS), conjunctival hyperemia (gr 2) with severe DE symptoms (OSDI 40/100). Artificial lubricants provided temporary relief during periods of exasperation. A closer look at the superior limbal area revealed elevated nodules along the limbal edge, with mild punctate staining. A thyroid work-up proved to be negative. Targeted therapy involved copious lubrication and a water gradient silicone hydrogel CL (delefilcon A, Alcon) with an elevated lubricity (1.0), which was chosen to reduce the friction between the lid and the cornea. Patient education was important to explain

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Abstracts / Contact Lens & Anterior Eye 38 (2015) e13–e46

the specifics of the lens chosen to adhere to the treatment. Symptoms (OSDI 22/100), ULMS and SLK all improved after 3 months of wear. Although initial presentation was DE, a full workup was needed to unveil the true cause of the discomfort. Staying abreast of new CL materials with specific characteristics (enhanced lubricity) maintained the patient in CL wear while improving her condition. Dr. Etty Bitton is an associate professor and the Director of the Clinical Externship Program and the Director of the Dry Eye Clinic at the École d’optométrie, Université de Montréal. Her research interests include tear film evaluation, dry eye and contact lens wear. She is a Fellow of both the American Academy of Optometry (AAO) and the BCLA, as well as a member of several regional and international professional organizations. She lectures extensively on the subject of dry eye and the evaluation of the tear film. http://dx.doi.org/10.1016/j.clae.2014.11.037 38 A case of mistaken blepharitis identity: Staph or demodex? Etty Bitton, Samantha Kronish Ecole d’optometrie, Universite de Montreal, PO Box 6128, Downtown Station, Montreal, Quebec, Canada H3C 3J7 Purpose: Anterior blepharitis is usually caused by a staphylococcus aureus (SA) infection, and expressed clinically as “crusty debris” on inflamed lid margins. Conventional therapy includes antibiotics to reduce the bio-burden. When patients are unresponsive to treatment, one must look at other potential causes. A meticulous observation of the type of debris and its placement on the eyelash may give us a clue. SA-blepharitis has golden yellow crusting at the base of the lash which progresses along the lash when it grows. Demodex, on the other hand, is a parasite, giving rise to gelatinous debris, which surrounds the base of the lash, described as a dandruff cuff (DC). The Demodex mites are light sensitive so their heads are buried in the lash follicle with only their tails visible at the eyelash base. Their small size makes them difficult to identify with a biomicroscope, hence only epilation of lashes with DC and observation under a micros cope confirms the diagnosis. The true prevalence of Demodex is unknown but is reported to be abundant in the elderly. This report describes 3 cases presenting with dry eye (DE) symptoms including discomfort and mild itching, which at first was mistaken for SA-blepharitis and turned out to be Demodex infestation. The case provides an overview of the Demodex mite, its clinical presentation and examination technique and tea tree oilbased treatment options. It has been reported that Demodex may be more common than we think and clinicians should consider it in their differential diagnosis of any ocular discomfort. http://dx.doi.org/10.1016/j.clae.2014.11.038

39 Evaluation of the potential therapeutic benefit of a contemporary portable warm compress treatment Jennifer P. Craig 1 , Zenia Jaitley 2 , Sarah Lord 2 1

Department of Ophthalmology, NZ-National Eye Centre, The University of Auckland, Auckland, New Zealand 2 Department of Optometry and Vision Science, NZ-National Eye Centre, The University of Auckland, Auckland, New Zealand Purpose: Meibomian gland dysfunction (MGD) is a leading cause of evaporative dry eye on account of its adverse effect on the tear film lipid layer. Warm compress therapy can improve the tear lipid layer, but perceived inconvenience often results in poor patient compliance. The convenience of a portable device containing self-activated warming units is appealing, but it has yet to be demonstrated whether such a device can offer the same level of symptomatic relief and improved tear film quality, as a conventional, microwave- heated flaxseed bag. Methods: Forty-one participants (66% female), with mild dry eye (OSDI) and with MG drop out of ≤20%, were included in this prospective evaluation. Participants were randomised to receive treatment with the flaxseed bag (MGDRx EyeBag, UK) on one eye and the portable eye mask (Eyegiene, USA) on the fellow eye for 10 min. Non-invasive break up time (NIBUT), lipid layer grade (LLG), tear meniscus height (TMH), and ocular surface temperature (OST) were measured at baseline and post-treatment by a masked investigator. Participant preference was also noted. Results: Both treatment methods significantly increased NIBUT, TMH, LLG and OST relative to baseline (p < 0.05). There was no significant difference between treatments in their effect on NIBUT, TMH and LLG (p > 0.05), but a statistically significant difference on OST (p < 0.0001), with a significantly greater increase produced by the flaxseed bag (3.5 ± 0.7 ◦ C) than the eye mask (2.4 ± 0.8 ◦ C). Preference was expressed by 78% for the flaxseed bag and 17% for the eye mask treatment. The remainder expressed no preference. Conclusions: Both treatments showed potential as evaporative dry eye treatments for mild MGD. However, the lesser temperatures effected by the eye mask cautions extrapolation of the clinical outcomes to more severe dry eye states where the melting point of MG secretions might be significantly higher. Jennifer P. Craig is a therapeutically qualified optometrist and Associate Professor in Ophthalmology at the University of Auckland in New Zealand. Her main research interest is in dry eye and tear film dysfunction since completing her PhD in this area, in 1995, from Glasgow Caledonian University. She regularly delivers continuing education and research lectures internationally and publishes in both the scientific and clinical press. She is co-author of the book ‘The Tear Film’ and has contributed to the Tear Film and Ocular Surface Society’s International Workshops on Meibomian Gland Dysfunction and more recently, on Contact Lens Discomfort. http://dx.doi.org/10.1016/j.clae.2014.11.039