Download Is Healthy Gland Function the Missing Piece of the Surgical Puzzle?

Is Healthy Gland Function the
Missing Piece of the Surgical Puzzle?
“You cannot optimize, maintain or rehabilitate the ocular
surface without healthy meibomian gland function.”
Caroline A. Blackie, OD, PhD, FAAO
See It and Treat It Daily
Dear Surgical Colleague,
For many years now, ophthalmic surgeons have
experienced remarkable technological surgical
advancements.
From Harold Ridley’s day to our own cataract
surgery technology has continually evolved.
Charles Kelman ushered in a new era with his
invention of phacoemulsification for cataract
extraction. Femtosecond laser-assisted cataract
extraction has become a reality. These and many
more remarkable technologies have been joined
by proliferating astigmatism management
technologies and techniques.
Surgeons have been battling dry eye with various
tear film enhancement techniques, but with
limited success. A growing number of surgeons
are taking a different approach realizing that
Wolfe was correct in 1946 when he revealed
that the ocular surface cannot be optimized,
maintained or rehabilitated without healthy
meibomian gland function.
These perceptive surgeons are leading the
charge by going beyond tear film enhancement
techniques to ocular surface management
that features an emphasis on meibomian
gland function.
I heartily commend this movement and bring
these materials to your attention.
Edward J. Holland, MD
Director of Cornea Services
Cincinnati Eye Institute
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Healthy Meibomian Gland Function
is Foundational to Ocular Surface Health
Assess Function and Structure
Evaluate gland function
with MGE
Test gland structure with DMI
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“If you don’t tell them pre-surgery –
they will blame you.”
S. Jacob Montgomery, MD, Montgomery and Riddle EyeCare
Meibomian Gland Dysfunction (MGD) Affects
Ocular Surface Management Pre-Surgery
MGD BY THE NUMBERS:
• 86% of Dry Eye patients have MGD1
•Over 63% of pre-cataract patients have the signs and symptoms of Dry Eye2
• Pre-existing MGD can double a
patient’s risk of developing Dry Eye
disease, especially after ocular surgery, which can negatively affect outcomes3
• Optimization of the ocular surface prior to surgery decreases the incidence and severity of post-operative symptoms
of the condition4
86%
63%
86% of Dry Eye patients have MGD
63% of pre-cataract patients have
the signs of Dry Eye
Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-478.
Trattler WB, Reilly CD, Goldberg DF, et al. ASCRS 2011.
3
Verges C. Ocular Surface Disorders and Cataract and Refractive Surgery Success. European Ophthalmic Review. 2013;7(1):28–30.
4
Ambrosio R et al. LASIK-associated Dry Eye and Neurotrophic Epitheliopathy: Pathophysiology and Strategies for Prevention and Treatment. J Refract Surg. 2008; 24:396-407.
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“How many times have you had a patient
come back and say to you, “Doctor, I didn’t
have this before surgery.”
Preeya Gupta, MD, Duke Eye Center
MGD Affects Ocular Discomfort – Post-Surgery
POST-SURGERY IMPACT:
• Significant increase in ocular
discomfort that persisted for 3-months post-surgery5
• >70% showed plugging of meibomian glands at 1-month post-operatively5
70%
• Patients with minimal to moderate levels of MGD pre-surgery showed an increase in MGD grade post-surgery6
•Significant increase in Dry Eye
symptoms post-surgery6
>70% showed plugging of meibomian
glands at 1-month post-operatively
Han KE, Yoon SC, Ahn JM, et al. Evaluation of dry eye and meibomian gland dysfunction after cataract surgery. Am J Ophthalmol. 2014 Jun;157(6):1144-1150.
Jung JW et al. Meibomian gland dysfunction and tear cytokines after cataract surgery according to preoperative meibomian gland status. Clin Experiment Ophthalmol. 2016.
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A New Focus? What Doctors are saying…
“MGD can have a significant impact not only on patients’
comfort, but also on their quality of vision. Left untreated,
it can be a major cause of dissatisfaction after surgery, so
it serves both patients and surgeons to address it.”
Preeya Gupta, MD, Duke Eye Center
“Treatment of MGD prior to cataract surgery promoted
post-surgical significantly greater improvement in
meibomian gland function and ocular comfort.”
Mitchell A. Jackson, MD, Jacksoneye
“I think discussing meibomian gland disease, ocular
surface disease, dry eyes, should be a part of every
cataract surgeon’s work up now.”
S. Jacob Montgomery, MD, Montgomery and Riddle EyeCare
“If not addressed, tear film dysfunctions can lead to
errors in biometry and IOL power calculation.”
Matteo Piovella, MD
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A New Focus? What Doctors are saying…
“With the patient demographic that you’re looking at,
whether it’s refractive lens exchange, or cataract surgery,
we know a significant amount of these patients will have
reduced meibomian gland function, or atrophied
meibomian glands.”
Derek Cunningham, OD, Dell Laser Consultants
“In my practice, MGD is the most prevalent diagnosis –
85% of my patients have MGD. When a patient presents
with the typical symptoms of dryness, bogginess, lid
redness and especially fluctuations in vision, the diagnosis
is most likely MGD, even in postoperative refractive and
LASIK patients.”
Stephen S. Lane, MD
MGD risk factors
“Preparation and optimization of the ocular surface is an
absolutely critical precursor to refractive cataract surgery
planning and execution.”
Neel R. Desai, MD, The Eye Institute of West Florida
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Treat and Optimize.
Treat all your MGD Patients to Restore Gland Function
and Optimize Ocular Surface
Treat with Vector
Thermal Pulsation
Obstruction is the primary mechanism for the
majority of MGD. Thus, it is important to prioritize
treating obstruction.
It is a core therapy for MGD
• Obstruction can be treated via:
– Repeated manual expression of the glands
– LipiFlow
LipiFlow® is a FDA-cleared medical
device for MGD shown to restore
gland function.
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