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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 2 Healthy Meibomian Gland Function is Foundational to Ocular Surface Health Assess Function and Structure Evaluate gland function with MGE Test gland structure with DMI 3 “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. 1 2 4 “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. 5 6 5 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 6 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 7 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. tearscience.com | 919-459-4880 | [email protected] See It and Treat It Daily © 2017 Tear Science, Inc. All rights reserved.