Download Dear Eye Care Professionals, We are writing to you today to bring to

Dear Eye Care Professionals,
We are writing to you today to bring to your attention a fact that is slowly
and agonisingly ruining our lives. It is a fact that has led to undue pain,
suffering, and debilitation for men and women all over the country. The
simple fact is this: Treatment of dry eye (keratoconjunctivitis sicca) in
Australia lags far behind the standards in much of North America and
Europe. Eye care professionals in Australia are failing dry eye patients
every single day by not adopting or pursuing the best-practice
treatments currently emerging or established in the global medical
community. This is not an opinion. It is a fact.
Many of us have spent thousands of dollars visiting countless
specialists who, after lengthy waiting periods, have often dismissed or
ignored our symptoms and clinical picture, offering minimal, out-dated,
ineffective treatments not specific to our condition. It’s depressing
enough to suffer with such a chronic and embarrassing disease. To
receive no sympathy, along with repeatedly hearing the line, ‘It’s all in
your head’—it’s demoralising.
We feel it is time to do something about it instead of sitting back,
allowing our symptoms to worsen, and wasting valuable time and
money with archaic treatments. We often find ourselves educating the
doctors we pay to see, who then find it offensive that we know more
about dry eye than they do. We say the above not to demean our eye
specialists, but rather in the hope that it will send a message to all
health care professionals that we need additional help—that there are
more sophisticated treatment options than the usual ‘plug and drop’.
As dry eye sufferers, we suffer from escalating anxiety and stress,
debilitating physical pain, and an overall decrease in quality of life. It
affects our ability to drive, use a computer, read, work outdoors, or do
any fine detail work. This, in turn, affects our ability to support ourselves
in employment or even enjoy basic recreational and social activities,
which has a profoundly negative impact on our mental health. We
understand that co-morbid diseases play a role in many cases and that
there is no proven cure for each different type of ocular surface disease,
but we believe there are better supportive treatments available to help
us cope better on a day-to-day basis instead of suffering under constant
duress.
Many of us are members of the rapidly growing online dry eye support
community. We have immersed ourselves in the many personal
opinions, clinical reports, reviews, and well-received studies supporting
the use of new, advanced, and even experimental treatments for dry
eye. These treatments can help patients in Australia who are
unresponsive or contraindicated to the conventional treatments in this
country. We hope the following information will provide some valuable
insight into the emerging and established treatments currently used in
other countries, particularly the United States, with the hope that they
may become available to us sooner rather than later.
Every day that passes is a day we lose to this malady. We cannot delay
this any longer, and we need your help.
The Problem with Current Protocols
Dry eye is a multi-factorial condition and must be treated as such. There
is no one-size-fits-all treatment for us. Unfortunately, it seems very few
doctors are willing to take a personal interest in managing the unique
attributes of each of our specific cases, or do anything to help us
research different therapies to improve our symptoms. We feel forgotten
because our disease is not properly understood or extensively
researched in this country. The consensus seems to be simply, ‘As long
as you can see, then we can’t do anything more.’ This isn’t good
enough—in fact, it is a dangerous and irresponsible practice.
Many of us have also faced the problem of dry-eye-induced epiphora.
Because of the lack of attention and consideration given to dry eye, the
root of this epiphora can be (and has been) missed. This has led to
DCR (dacryocystorhinostomy) surgeries being performed when they, in
reality, should have been contraindicated. The result is the return of the
original dry eye, compounded with the increased drainage caused by
DCR—in other words, the most painful and severe dry eye imaginable.
This is even worse if the puncta have been over-dilated. The problems
with protocols for epiphora are another letter entirely, however.
Current first-line treatments typically prescribed to dry eye patients in
Australia are artificial tears, steroids, punctual plugs, basic lid hygiene,
and (rarely) scleral lenses. While artificial tears may provide short-term
relief, they do not address underlying pathophysiology, and in some
cases can cause worsening of symptoms rather than improvement due
to the lack of investigation into the original cause of the dry eye. In
addition, many over-the-counter drops contain harmful preservatives,
which patients are not instructed to avoid.1 Even if they are
preservative-free, dosage of any drops in a chronic fashion can be
detrimental rather than beneficial to the natural tear film structure and
corneal epithelium.
Prescription steroids and mass cell stablizers used to combat
inflammation in vulnerable dry eye patients such as Flarex, FML, and
Patanol are preserved with benzalkoniumchloride (BAK), a chemical
used in detergents. BAK can puncture the corneal epithelium, denature
corneal protein, and cause irreversible damage to the eye. Steroid
drops are usually prescribed with little concern for their toxicity to the
ocular surface, and can cause significant worsening of symptoms in
some cases, even in the short term.2
There are many tests and equipment that can be used to evaluate a dry
eye patient’s specific conditions and severity, such as fluorescein breakup time measurement, meibography, Schirmer’s test, TearLab
osmolarity, evaluation of the lid margin, and bacterial analysis to
determine staphylococcal/seborrhoeic dermatitis—most of which are not
routinely performed in Australia.
Meibomian Gland Dysfunction and Blepharitis
Regardless of whether a patient has an aqueous tear deficiency (ATD)
or not, complaints of dry eye symptoms are usually accompanied by
mild, moderate or severe meibomian gland dysfunction (MGD), a
common, under-diagnosed disease of the oil producing glands in the
eyelid. Meibomian gland dysfunction can occur for various reasons,
most commonly blepharitis.3 If there is an ATD, this prevents proper
protection for the eyelids, causing a build up of bacteria on the lid
margin. The result is a combination of both ATD and MGD, an unstable
tear film culminating in dry eye syndrome (DES).
As you hopefully already know, blepharitis takes on two forms: anterior,
which occurs when a build-up of excess oil produced by the meibomian
glands develops on the outer lids creating a breeding ground for
bacteria; and posterior, which develops when the meibomian glands
become inflamed and a thick paste-like meibum is secreted, or no oil is
produced at all. This lack of oil on the tear film causes the middle
aqueous layer to evaporate, resulting in a condition called ‘evaporative
dry eye’. Each type requires different treatments, and only anterior
blepharitis seems to be the focus in Australia. Posterior blepharitis is far
more difficult to treat, but there are now new technologies available that
are proving to combat it.
Instructing patients with ATD and MGD to chronically dose themselves
hourly (or up to four times an hour) with artificial tears and inserting
punctal plugs isincorrect and potentially harmful. Retaining abnormal
tears with high concentrations of pro-inflammatory cytokines can cause
further inflammation.4 MGD must be treated vigorously first before
punctal plugs are used.
It is estimated that up to 80% of dry eye sufferers have some form of
MGD on top of ATD, which begs the question, ‘Why are the majority of
treatments only aimed at treating the aqueous layer?’ Many of us have
been into numerous ophthalmologists suites, with high hopes and a
price tag to match, only to find out they don’t even know what a
meibomian gland is! This is absolutely appalling and entirely
unacceptable.
New Potential Solutions
Meibomian Gland Related Treatments
Current treatment options advised for blepharitis and meibomian gland
dysfunction in Australia are lid hygiene, warm compress, eyelid
massage, and oral supplementation of omega-3 fatty acids. While these
may help patients with mild MGD, studies on omega-3s are largely
equivocal. Patients with chronic MGD, moderate to severe evaporative
dry eye, and even aqueous deficient patients can benefit from newer
much more effective treatment options.
LipiFlow: This is a thermal pulsation system that bypasses the tarsal
plate to directly apply heat to the meibomian glands and their contents,
allowing for easier flow of oil.5 Dr. Jim Kokkinakis at The Eye Practice in
Sydney CBD rented the equipment on a trial basis in June 2012.
Following this news, he immediately began taking frantic appointments
from over 40 desperate patients, from all over Australia and even New
Zealand, indicating our widespread desperation and the travel-burden
required for better treatment.[6,7] The use of LipiFlow to treat MGD is
vastly superior to home remedies such as lid massage and warm
compress, of which the latter can be dangerous due to potential
overheating. Currently, only the Wilson Eye Center in Bundaberg, QLD
offers LipiFlow for it's dry eye patients.
Meibomian Gland Probing (MGP): Dr. Colin Chan at the Vision Eye
Institute in Bondi, New South Wales, is one of the few doctors in
Australia that offers MGP. The procedure and equipment were
developed by Dr. Steven L. Maskin in Tampa, Florida.8 It has been
proven to be highly successful as an initial treatment to unclog blocked
meibomian glands along the lid margin. In chronic MGD patients,
inflammation causes periductal fibrosis, and only an MG probe can ‘pop’
open these scars that wrap around the ducts, allowing oil to flow
naturally.[9,10,11,12,13] This procedure is widely used across North
America and Europe. It has become standard practice to help chronic
MGD patients. There is a misconception that probing is ‘dangerous’ or
‘painful’, but, in fact, many patients with MGD find it extremely relieving.
Maskin Probes are simple to use, inexpensive, and can be purchased
from Rhein Medical or their Australian Distributor, Ellex.14
Meibomian Gland Expression: This is the easiest and most costeffective option to help patients with chronic MGD. As of this writing, we
are not aware of any doctors in Australia that utilise meibomian gland
expression in their toolbox of treatments for MGD patients. Dr. Malcolm
McKellar from Christchurch, New Zealand, has performed this treatment
in-office with great success. His eye centre website offers instructional
information on how to perform the procedure. The idea is to massage
the eyelids with forceps to express solidified contents in the meibomian
glands, which will encourage production of newer, thinner secretions. In
McKellar’s words: ‘It’s not sexy, but it does work.15
There are adjunct tools developed by doctors in the US such as the
Mastrota Paddle and Gulden Expressor Kit, both of which are designed
specifically for in-office expression, and are economical and
uncomplicated to use. They recommend expression as a first-line,
weekly treatment. Subsequent conventional treatments such as
Omega-3 supplementation, warm compress, etc., can form part of a
wider long-term strategy. Meibomian gland expression is also regularly
practiced across North America and Europe. The technique can and
should be adopted by all eye care professionals treating patients with
MGD.[16,17,18,19]
Haemotherapy Related Treatments
Autologous Serum Drops: Serum drops are prepared from a patient’s
blood and can be used in different solutions (20–100%). It should be
prepared under sterile conditions in a certified laboratory unit. It
contains several growth factors, vitamin A, and fibronectin, and also has
an anti-inflammatory effect. Therefore, it has been beneficial in
advanced and severe cases of dry eye.20
Serum drops are usually reserved for patients with significant corneal
problems. This is a misguided approach, as many dry eye patients
benefit from the non-allergic nature of the drops and also find the
properties that help promote a healthy tear film, leading to a reduction in
dry eye symptoms.
Eye Platelet Rich Plasma (E-PRP): Goblet cell density is low in dry
eye patients, particularly in cases of aqueous tear deficiency and cases
with chronic inflammation.[21,22] Known as the ‘ball bearings’ of the
tear film, it makes sense that, with a deficient goblet cell density, we
experience a gritty sensation. Low goblet cell density is also associated
with a mucin layer problem in the tear film. Artificial tears do not treat
this layer of the tear film.
Similar to autologous serum, E-PRP has shown to be highly effective in
treating dry eye patients. Clinical studies report significant improvement
on lachrymal meniscus and conjunctival hyperaemia and a decrease of
corneal fluorescein staining. Post treatment, impression cytology
reveals significant increases in conjunctival goblet cells.23 E-PRP has
been extensively researched by Dr. Edward Jarka and Dr. John Crane,
in St. Louis, Missouri, in the United States. Renowned Australian
Optometrist Dr. Brian Holden has also worked with these doctors on this
therapy.24
To obtain PRP for therapeutic use, a small amount of blood is collected
from the patient. The sample is then centrifuged for several minutes to
separate the red blood cells, platelets, and serum. The platelets are
then removed and prepared for use in eye drop form. Importantly, when
platelets are ‘activated’ (either by coming into contact with collagen,
heating to body temperature, or mixing with thrombin), hundreds of antiinflammatory molecules are released into the local tissue environment.
While the very complex mechanisms of interaction between these
growth factors, cytokines, hormones and other molecules are just
beginning to be elucidated, they are proving to work in concert to
restore tissue homeostasis in cases of chronic
inflammation.[25,26,27,28]
In correspondence with Dr. Jarka, he stated:
‘We believe that the concentrated growth factors that are released when
the platelets are activated on the ocular surface have the ability to
restore the normal cellular structural architecture that may have
changed from a number of environmental or internal factors that deplete
these components over time. The result is a continuous intracellular and
intercellular signalling that culminates into a chronic dry eye. ‘The
procedure involves the collection of your blood and concentrating it in a
cell separator. We use the Harvest Smart PReP System. We then
prepare a concentrate into a solution form to be applied to the eye at
least twice a day.29 ‘We have had enough success with this procedure
that we now receive referrals from local physicians and ophthalmic
surgeons. We have treated people from many states including
Oklahoma, Arkansas, Virginia, and an American citizen currently
working in Afghanistan. The cause of these dry eyes has usually been
from many contributing factors.’
Amniotic Membrane Related Treatments
Amniotic Membrane (AM) and ProKera: It is widely regarded that one
common theme throughout all dry eye patients, regardless of the type,
is that we all suffer from recalcitrant inflammation of the ocular surface.
As such, anything that possesses anti-inflammatory actions could help
us, and should be investigated. The use of amniotic membrane in
ophthalmology dates back to the early 90s, where it was discovered that
the foetal wound healing strategy could be applied to the eye to help
reduce inflammation and minimize scarring.30
World renowned pioneer Dr. Scheffer Tseng in Miami, Florida,
developed the use of AM to heal damaged ocular surfaces on patients
with acute chemical burns, Stevens-Johnson Syndrome, and even
pterygium removal with very high success rates. Due to this success,
Dr. Tseng now treats moderate to severe dry eye patients with a selfretaining contact lens containing AM, called ProKera.
ProKera is listed by the FDA as a Class II medical device.31 As per his
correspondence, Dr. Tseng has successfully treated patients with dry
eye using ProKera. He states:
‘Yes, ProKera can help dry eye patients in several ways. I have used it
successfully for them. In short, its potent anti-inflammatory action can
surpass steroids and Restasis and more importantly circumvent the
potential side effect known to both of them. The membrane also
contains abundant nerve growth factor that is known to promote
innervations that may help correct the ocular surface deficit caused by
dry eye and inflammation so that the neuronal reflex can be improved.
The hydration of the membrane instantly helps maintain the preocular
tear film stability. For those eyes where the eyelid blinking is
incomplete, it also prevents exposure-induced dryness. Once improved,
the patient will normally have a “prolonged” period of remission.
Because the underlying causes of dry eye are multiple and may not be
fully corrected, dry eye can return later on. Nonetheless, the treatment
can be repeated.’
Dr. Allan Panzer of Houston, Texas, has also treated dry eye patients
with ProKera, claiming it relieved their pain immediately. One of his
long-term dry eye patients was interviewed by Fox News in the US,
stating, ‘It felt like I took a pain pill.’32 Numerous other ophthalmologists
have been using AM for many years to help dry eye patients, such as
Dr. Steven Maskin of the Dry Eye and Cornea Treatment Center in
Tampa, Florida; Dr. John Hovanesian of the Harvard Eye Associates;
and Dr. M. Wang of the Wang Vision Institute in Nashville, Tennessee.
While it may be difficult to ship cryopreserved AM from the US, the
Centre For Eye Research (CERA) located at the Royal Eye & Ear
Hospital in Melbourne has been distributing amniotic membrane tissue
every year, primarily in corneal transplant patients.33 Attempting this
type of treatment for dry eye is just a matter of harnessing the material
for modification for a different purpose. If not used in a self-retaining
contact lens, AM can be easily temporarily sutured with nylon stitches or
fibrin glue to the eyelid margin for the same effect by covering the
ocular surface as a ‘biological bandage’.34 We are excited to see that it
appears CERA is organising a study for the development of a
therapeutic contact lens to culture and deliver corneal epithelial cells, to
be compared to AM transplantation.
Amniotic Membrane Extract (AMX): AMX is a novel method of
applying amniotic membrane to the eye without the need for surgery or
contact lenses. Inventor Dr. Emliano Ghinelli, from Rome, patented the
use of lyophilized amniotic membrane for topical application promoting
the same biological factors, corneal epithelial regeneration, and
inflammation suppression.35 AMX contains an abundance of growth
factors, neurotrophins, interleukin antagonists, plus fibronectin and
collagen.
In correspondence with Dr. Ghinelli, he gave the following statement:
‘As inventor I would certainly recommend you AMX to increase your
Conjunctival Goblet Cells Mucin secretion and in this way “hold tighter”
the aqueous part of your few tears on your ocular surface. Regarding
availability: FDA does not allows AMX to be on the US market yet. On
the EU field, AMX its currently under evaluation to have the green light.
Regarding ProKera: AM or PROKERA are both clever and innovative
ways to approach the same diseases.’
Dr. Kenneth R. Kenyon from the Massachusetts Eye Infirmary has
worked closely with Dr. Ghinelli, stating AMX has application in
moderate to severe dry eye.[36,37,38,39,40] The use of AMX has also
been clinically studied in the US by Dr. Hosam Sheha in Miami, Florida.
His studies confirm that:
‘Although one may attribute AMX’s effect in relieving pain to its antiinflammatory action, we suspect that such a rapid action in pain relief
might be mediated by a yet unknown anti-pain action that deserves
further investigation. Ocular surface inflammation was markedly
reduced in all cases after treatment. Although the exact action
mechanism remains to be determined, the aforementioned effect may
be associated with early delivery of AM’s anti-inflammatory active
ingredients, which are retained in AMX.’ [41,42,43]
Please view this video on Amniotic Membrane at the recent Hawaii Eye
Convention, presented by Dr. Kenneth R. Kenyon.
Other Treatment Options
Tetracycline: Oral tetracycline exhibits antibacterial, anti-inflammatory
and anti-angiogenic properties, and can be used systematically.44 The
dosing varies between 20 and 100 mg/day and usually lasts for three
months in an intermittent modality. Studies confirm that low dose
doxycycline improves Schirmer’s and Tear Break-Up Time Scores
(TBUT).45 A common side effect is stomach pain, but many patients
have claimed this to be far less than the pain experienced from their dry
eye.46
AzaSite: The use of AzaSite (topical azithromycin) has been proven to
treat eyelid inflammation in both anterior and posterior blepharitis
patients, with results indicating more than 50% effectiveness over
conventional lid hygiene and warm compresses therapy.47 The
presence of lid margin telangiectasias is commonly overlooked leading
to further mis-diagnosis. Many eye doctors do not even perform basic
lid eversion tests. AzaSite as well as Lotemax (loteprednol) have also
shown to reduce the inflammation in lid wipers commonly seen in
patients with lid margin disease.48
Testosterone Eyelid Cream and Drops: This has been studied for
over a decade in the US by Dr. David A. Sullivan, Dr. Charles G.
Connor, and the now retired Dr. Charles Haines. Transdermal
application of 3% testosterone to the eyelid twice a day promotes both
tear production and reductions in meibomian gland dysfunction, leading
to improved tear film stability. The research has found that testosterone
regulates both lacrimal and meibomian glands and direct application to
the eyelids allows for direct treatment of both glands.49 When
ineffective as an eyelid cream, testosterone can be delivered as an eye
drop or even as a sublingual drop.50 Not currently FDA approved,
testosterone cream is only used off-label in the US with impressive
results in Schirmer’s tests, Ocular Surface Disease Index (OSDI), and
contact lens wearing time. Many doctors in the US currently prescribe
this cream for their patients, including the renowned Dr. Boxer
Wachler in Los Angeles, California, and Dr. Allan Panzer in Houston,
Texas.[51,52]
Dehydroepiandrosterone (DHEA): Administered in drops, DHEA
works along similar principles as testosterone, since we know that
androgens play a role in the function of lacrimal and meibomian
glands.[53,54] Although DHEA has substantially less androgenic activity
than testosterone, a study by C.G. Connor and J. Fender demonstrated
that 1% DHEA drops produced improvement in TBUT and Schirmer’s
test results. In fact, participants felt that the DHEA drops were more
effective at relieving symptoms than either plain artificial tears or 1%
testosterone drops.55 Although it’s not registered with the TGA, we can
use a compounding pharmacy to produce the medicine for us as long
as a prescription is provided. While we’re aware of the potential risks of
using a compounding pharmacy, we believe that as long as we choose
our pharmacy with care (with the help of our doctors), we can get safe,
effective medicine.
Lacritin: Early studies into Lacritin as a potential dry eye therapy have
been promising. Lacritin is produced by the lacrimal gland, cornea and
conjunctiva of the eye as a tear protein that appears to be selectively
downregulated in dry eye. Although a tear protein, it helps stimulate
creation of the protective three-layer tear film as it flows through tear
ducts onto the surface of the eye. It also acts as a shield
against inflammation-associated cell death by promoting the health of
the ocular surface. Lacritin can be easily and safely produced. The
growing research on lacritin is notable for the detail by which
lacritin's mechanisms have been explored, and by the collaborative
'Lacritin Consortium' of investigators that have
contributed. Researcher Dr. Gordon Laurie of the University of Virginia,
Cell Biology department states "New exciting studies from Nancy
McNamara's lab at UCSF revealed that lacritin is also effective in dry
eye. In a mouse dry eye model, lacritin stimulated tearing, and
both reduced inflammation of the lacrimal gland and ocular surface
staining. Thus Lacritin appears to address the disease upstream of
inflammation". Currently seeking $3 million in funding for human clinical
trials. Corporate interest in this research could transcend dry eye
treatment around the world forever and provide incomparable profits for
investors.
In Closing, a Solemn Plea
This writing is the culmination of years of experience and research from
many individuals, sufferers and advocates alike. We are pleading that
you take the time to read our references, gain an understanding into the
collective mind of dry eye patients first hand, connect with each other,
and bring much needed attention to our plight. We cannot treat
ourselves at home. We need your help to have a chance at getting our
lives back. None of the aforementioned treatments are regularly
practiced in Australia, and we believe they should be. We cannot afford
to travel overseas for treatment, as we are already under huge financial
pressure because of our horrible dry eye symptoms. Australia has great
scientific and medical capacity, and we can overcome any bureaucratic
or technological stumbling blocks through the focus, ingenuity, and
support of our eye care professionals.
The Digital Revolution seems to have caused a new epidemic of Dry
Eye Syndrome across the developing globe. An estimated 50 million
people in the US alone suffer with dry eye of varying severity and
estimates put Australia at around 200,000 sufferers. The potential
market for proper dry eye treatments is vast, and most of us are
willing to spend whatever it takes and to risk ourselves as guinea pigs in
the hope a particular new treatment can provide relief from the agony. If
we have this open mind about treating ourselves, why shouldn't our eye
care professionals allow us to pursue it?
As of October 2012, a very promising drug called Lifitegrast had just
completed a Phase III study in the US.56 A small-molecule integrin
antagonist designed specifically for the treatment of dry eye, Lifitegrast
improved corneal staining scores and the mean discomfort and dryness
scores in the 588 patients involved in the study.57 If this type of
research was being conducted in Australia, we could have had the
opportunity to be among the 588 patients involved in this exciting study,
and could be seeing results. We want these opportunities.
In Australia, the only promising treatment for blepharitis is being
developed by Dr. Stephanie Watson and Dr. Kenneth Ooi at the Save
Sight Institute, University of Sydney. Using topical Atorvastatin,
studies have shown significant improvement's in symptoms and
inflammation. They are currently looking for commercial funding to
enable their treatment to become available for sufferers of blepharitis
and are hoping to formulate the treatment into a topical eye drop
and/or lid cleaning solution.
For pharmaceutical companies, the market value for better Dry Eye
treatment is worth billions. At this point in time, the only prescription
drug available for dry eye patients is Restasis, and in it's first 5 years on
the US market (since 2003) sales reached $1.5bn. Unfortunately, many
Restasis users have reported side effects, worsening of symptoms and
the few that have success only report minimal improvements after 6
months. Many researchers have found more effective methods to treat
dry eye, and we are urging our pharmaceutical partners to recognise
this unique monopoly market opportunity, to support these new
developments through the clinical pipiline and into dry eye patients
hands as soon as possible.
The severe impact of dry eye is very real to us, not theoretical. It
impacts our lives as much as other, better-studied ophthalmological
conditions. We want some recognition, and we want the best help
available. We’re tired of reading about patients in other countries with
easy access to these treatments, fantasizing about the possibilities. The
US and Europe are leading the way in helping dry eye patients.58 We
must adopt the same strategies, and even form our own innovative
methods to counteract this disease before it leads to a spike in mental
health problems and disabilities like blindness down the road.
We might consider the formation of specialised ‘Dry Eye Clinics’ (similar
to Dr. Colin Chan in Bondi or the Dry Eye Center of Arizona), located in
each capital city. In this setting, doctors would have access to the
correct tear film diagnostic equipment on a regular basis and thus would
be able to help patients attain the latest best-practice treatments. Even
if it is an intermittent clinic that operates once a month, this is still better
than nothing. We would gladly pay to have a few professionals taking
an interest in us, helping us try newer more advanced options and
monitoring our progress.
For further education on Dry Eye, please watch this video recorded at
the recent Hawaii Eye Convention 2013.59
If there are any ophthalmologists, optometrists, oculoplastic surgeons,
or general practitioners that would be able to help dry eye sufferers try
any of these treatment options, please contact us:
[email protected]. There are many of us who suffer
together, and we rely on each other for hope, support, and solutions.
Let us rely on you, too.
Thank you for your time and your help,
—Dry Eye Sufferers of Australia
To Download a Hard Copy of this Letter, please click here.
References
1 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958436/
2 http://www.ncbi.nlm.nih.gov/pubmed/22529703
3 http://www.iovs.org/content/52/4/2006.full
4 http://www.eyeworld.org/article.php?sid=3059
5 http://www.ncbi.nlm.nih.gov/pubmed/22222996
6 http://www.theeyepractice.com.au/_blog/OptometristSydney/post/LIPIFLOW_Our_First_Impressions_with_treating_Dry_Eye
s/
7 http://eyeworld.org/article.php?sid=6279
8
http://www.modernmedicine.com/modernmedicine/article/articleDetail.js
p?id=741058
9 http://www.dryeyezone.com/talk/showthread.php?16457-MeibomianGland-Dysfunction-and-Chalazia-Cured&highlight=probing
10 http://www.eyeworld.org/article-new-devices-for-ocular-surfacedisease
11 http://eyeworld.org/article.php?sid=6212
12 http://eyeworld.org/article.php?sid=5897
13 http://www.healio.com/Optometry/Cornea-ExternalDisease/news/print/primary-care-optometry-news/%7BCF8C52E37DB9-4574-805B-6F09D78B7E05%7D/Aggressive-treatmentsdeveloped-for-meibomian-gland-dysfunction
14 http://www.ellex.com/australia
15 http://www.drmalcolmmckellar.co.nz/meibomian-glandexpression1.html
16 http://www.guldenophthalmics.com/images/MG%20Expressor3.pdf
17 http://bmctoday.net/advancedocularcare/2010/10/article.asp?f=anew-paradigm-for-treating-dry-eye-patients
18 http://www.ocusoft.com/for-eye-care-professionals/surgical/miscsurgical-instruments/mastrota-meibomian-paddle.html
19 http://www.revoptom.com/content/d/therapeutics/c/36087/
20 http://www.ncbi.nlm.nih.gov/pubmed/18813071
21 http://www.ncbi.nlm.nih.gov/m/pubmed/1123285/
22 http://m.iovs.org/content/43/4/1004.short
23
http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstr
actBuch&ArtikelNr=100933&ProduktNr=233014
24 http://www.evrgstl.com/Doctors/WhatWeDo.html
25 http://www.ncbi.nlm.nih.gov/m/pubmed/17146574/
26 http://www.iovs.org/content/52/9/6066.full.pdf
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