SPECIAL FEATURE: DRY EYE AFT PHARMACEUTICALS EYELOGIC OIC The systematic approach to eye lubrication HYLO-FRESH and HYLO-FORTE eye drops provide a systematic approach for dry eye treatment through a revolutionary multi-dose device. The patented COMOD (COntinuous MOno Dose) application system protects the sodium hyaluronate solution from contaminated ambient air, and ensures the precisely measured delivery of at least 300 completely sterile drops without the use of preservatives. This ingenious airless system provides long-term stability for up to 6 months after opening, and with at least 150 treatments (both eyes) it provides at least five times more treatments per pack than single-use preservative-free eye drops currently available in New Zealand.* The HYLO range is also phosphate-free which is important for patients suffering pronounced damage to the corneal surface. The use of phosphate-containing eye preparations can result in corneal calcification as a result of the precipitation of calcium phosphate in patients suffering extensive corneal damage, and can be avoided through the use of the phosphate-free HYLO range. HYLO-FRESH eye drops (sodium hyaluronate 0.1% w/v, 10mL) offer long-lasting lubrication for dry eyes of moderate or medium severity, and are fully funded under Special Authority criteria (see the Pharmaceutical Schedule for details). The increased sodium hyaluronate concentration in HYLO-FORTE eye drops (sodium hyaluronate 0.2% w/v, 10mL) results in a higher viscosity solution for long-lasting, intensive and soothing relief of severe or chronic dry eye. Both products are also suitable for use following surgery, and can be used with all contact lenses. For enquiries about HYLO-FRESH and HYLO-FORTE eye drops contact Corneal Lens Corporation. O *Based on the largest available pack size of single use preservative-free eye drops available in New Zealand as at July 1, <strong>2015</strong>. OPTREX ACTIMIST Dry eye is described as aqueousdeficient or evaporative dry eye, the latter being the most common type (78%). 1 The Lipid layer of the tears plays an important role in inhibiting tear film evaporation. 2 Optrex ActiMist is applied to the closed eyelids via a spray and supplements phospholipid-liposomes to the lid margin, where the phospholipids mix with present lipid reservoir from the meibomian glands. A certain part of the lipid reservoir spreads over the film and forms the tear film lipid layer. Improving symptoms, visual acuity, lipid layer thickness, tear film stability, eyelid margin inflammation, tear production and lid parallel conjunctival folds. 3,4 The liposomal spray Optrex ActiMist is a tear film supplement containing phosphatidylcholine deriving from highly purified soylecithin. The major phospholipid, phosphatidylcholine is delivered in a stable form of liposome to the closed eyelid. From there, they migrate with blinking across the eyelid margins to combine with the tear film. Compliance is always the biggest bug bear of any practitioner dispensing a solution for the treatment of evaporative dry eye. Patients just don’t like putting in their drops. Optrex ActiMist provides a spray solution that makes the delivery of their dry eye preparation simple and easy thus improving patient compliance and addressing your patient’s dry eye symptoms. For further clinical information please contact our office at admin@eyelogic.com.au. O 1. Heilgenhaus A,Koch JM,Kruse FE, Schwatz C,WaubkeTN. Diagnosis and differentiation of dry eye disorders. Der Ophthalmologe 1995:92 (1):6-11 2. Mishima S,Maurice DM. The oily layer of the tear film and evaporation from the corneal surface. Experimental Eye Research 1961;1:39-45 3. Craig JP, Purslow C Murphy PJ,Wolffsohn JS. Effect of a liposomal spray on the pre-ocular tear film. Contact Lens and Anterior Eye 2010;32 (2)83-7. 4. Dausch D, Lee S Dausch S Kim JC, Schwert G, Michelson W. Comparative study of treatment of the dry eye syndrome due to disturbances of the tear film lipid layer with lipid containing tear substitutes. Klinische Monatsblatter furAugenheilkunde 2006;223(12):974-83 OIC introduces Avenova to NZ Avenova, a new daily lid and lash cleanser that’s garnering a lot of attention in the United States, will be available in New Zealand from the end of <strong>Sep</strong>tember. The product, made by biopharmaceutical company NovaBay, is the only one to contain Neutrox, a pure, proprietary, stable formulation of hypochlorous acid (0.01 per cent) in saline. Hypochlorous acid is a naturally occurring substance produced by white blood cells to fight microbial invaders and has a very low toxicity—1000 times lower than Betadine, according to NovaBay. In a recent study, Dr Arthur Epstein, director of clinical research and head of Phoenix Eye Care’s Dry Eye Center of Arizona, compared six leading lid and lash cleansers with Avenova. He found Avenova was the only one to neutralize the bacterial enzyme lipase—a major cause of blepharitis and meibomian gland dysfunction. In vitro studies of Avenova have shown the product is effective against most microorganisms commonly found on eyelids and eyelashes, including Demodex. It has an antimicrobial time-kill of less than a minute. The new product will be available from the Ophthalmic Instrument Company (OIC) from the end of <strong>Sep</strong>tember. Managing director Tim Way says he’s delighted to add Avenova to OIC’s growing list of premium Dry Eye products. “Dry Eye is a very common patient complaint, so it’s great to be able to offer them this exciting new product. Avenova has the potential to make a huge difference to a dry eye sufferers’ quality of life.” OIC’s other Dry Eye products include the Polaris, a slit lamp accessory made by Italian company CSO for advanced tear film analysis; the RPS InflammaDry Detector, the first and only rapid point-of-care test to detect MMP-9 (an inflammatory marker that is elevated in the tears of patients with dry eye disease); and the Medmont E300 USB Corneal Topographer, which has just had a comprehensive tear film package released free of charge for existing Medmont Studio Version 6 users. O NEW VISION FX S U P P O R T S H E A L T H Y V I S I O N A N D E Y E M O I S T U R E For a FREE practitioner sample* please call 0800 147 325 or email ceo@realvitamins.co.nz *Limited stock: first come, first served Assessment and diagnosis of Sjögren’s syndrome A useful concept in dry eye disease management is to consider the parts that maintain the ocular surface as one unit. This “Lacrimal Functional Unit” consists of the ocular surface (cornea, conjunctiva, accessory lacrimal glands, and meibomian glands), the main lacrimal gland, and the interconnecting innervation and chemical signals between them. If any portion of this functional unit or communication is compromised, then the ocular surface can be damaged. Some diseases affect one part of this unit more than others. Sjögren’s syndrome (SS) is a chronic autoimmune problem that affects the function of the exocrine glands, including the lacrimal and salivary glands. The effect on these glands is characterised by focal, mononuclear cell infiltrates that surround the ducts and replace the secretory units. SS is usually categorised as either primary (presents by itself) or secondary, if it appears in association with other well-defined connective tissue autoimmune diseases. As you would expect from a chronic incurable condition, SS can lead to significantly degraded quality of life. As well as causing the grittiness and discomfort of dry eyes it also impacts on the quality of vision and can cause significant long term damage to the mouth. The pathogenesis of SS is still not fully understood, but is thought to involve a BY THE DRY EYE & ALLERGY SPECIALISTS AT EYE INSTITUTE* combination of genetic and exogenous factors. Studies have postulated that infection with Epstein-Barr, Coxsackie B, or cytomegalovirus, amongst other viruses, could be a trigger. SS is also known to have a higher prevalence in women and in some families. Many cases of SS are detected by a patient’s eye care provider, which perhaps comes as no surprise given that Henrik Sjögren (1899–1986), a Swedish ophthalmologist, was the first to identify a group of affected women and to connect the triad of keratoconjunctivitis sicca, xerostomia and polyarthritis. DIAGNOSIS When a GP or medical practitioner suspects SS, they should ask about dry eye symptoms. Similarly optometrists and ophthalmologists need to ask dry eye patients about any oral symptom, such as dry mouth, swollen salivary glands, or the need for liquids to aid swallowing. To confirm the diagnosis, objective criteria are needed, including tear and saliva flow, autoantibody status (including SS-A), and minor salivary gland histology. Because SS may be just one contributing factor to the dry eye status, all of the normal ocular investigations for dry eye should be performed. Meibomian gland dysfunction is not uncommon in Sjögren’s syndrome. Even if the diagnosis is aqueous deficiency secondary to Sjögren’s, a complete understanding of that patient’s Lacrimal Functional Unit helps us find ways to improve overall tear quality. Other special investigations and tests are usually coordinated by a rheumatologist. Radiographic examination of the salivary glands involves the injection of a small amount of contrast medium into the salivary duct of a single gland, followed by X-rays—called a sialogram. A biopsy of a salivary gland can be examined for lymphocytic infiltration and acinar loss, and the presence of autoantibodies can also be used as a diagnostic tool. TREATMENTS FOR DRY EYE IN SJÖGREN’S SYNDROME There are some specific considerations when treating dry eye for Sjögren’s patients. Inflammation of the ocular surface is a key feature of all dry eye disease, but especially so in severe SS, so judicious use of topical, non-preserved steroids is helpful. Secretagogues are a class of drugs that increase mucin secretion, improve tear film stability, and decrease ocular surface inflammation. Two examples of these are oral pilocarpine and cevimeline. Both stimulate secretion of lacrimal gland fluid (tears) and saliva, but have side effects of excessive sweating and cramps. More recently, topical secretagogues such as diquafosol have been developed, although these are currently commercially available only in Japan. Topical application reduces the occurrence of the side effects commonly associated with oral secretagogues. Autologous serum drops have been shown to be useful for patients with severe aqueous deficiency. They contain several key components of the tear film such as epidermal growth factor, vitamin A, and lysozyme. The use of autologous serum overseas is often limited by the challenges of frequent drawing of blood, preservation of sterility, and appropriate facilities willing to prepare them. We are fortunate here that the NZ Blood Service will make these drops from the patient’s plasma and supply them at no charge. O * The Eye Institute in Auckland is a provider of eye surgery and ophthalmic care, employing a team of 10 ophthalmologists and 50 dedicated staff. REFERENCES: • Clinical Guidelines for Management of Dry Eye Associated with Sjögren Disease, THE OCULAR SURFACE / APRIL <strong>2015</strong>, VOL. 13 NO. 2 / www. theocularsurface.com • Terry G Coursey, Cintia S de PaivaClinical: Managing Sjögren’s Syndrome and non-Sjögren Syndrome dry eye with anti-inflammatory therapy, Ophthalmology 2014:8 1447–1458, • http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4128848/pdf/opth-8-1447. pdf • Michael Voulgarelis & Athanasios G. Tzioufa: Pathogenetic mechanisms in the initiation and perpetuation of Sjögren’s syndrome. • Nature Reviews Rheumatology 6, 529- 537 (<strong>Sep</strong>tember 2010) |doi:10.1038/ nrrheum.2010.118, http://www.nature. com/nrrheum/journal/v6/n9/abs/ nrrheum.2010.118.html 14 NEW ZEALAND OPTICS <strong>Sep</strong>tember <strong>2015</strong>
Avenova for daily lid and lash hygiene NEW Avenova with Neutrox Gentle, refreshing and soothing for everyday eyelid and eyelash cleansing Ideal as part of any lid hygiene regimen for: - Dry Eye - Blepharitis (including Demodex) - Contact lens wear - Ocular surgery and procedures Because what we do every day matters The E300 Advantage • Largest coverage of any placido ring topographer, limbus to limbus • The GOLD standard for fitting specialty lenses • Exceptional accuracy with a standard deviation of 2 µm • Comprehensive new tear film package, understand and analyse tear film break-up The RPS InflammaDry Detector is the first and only rapid, point-of-care test to detect for MMP-9, an inflammatory marker that has consistently been shown to be elevated in the tears of patients with Dry Eye disease Distributed by: phone: 09 443 0072 email: <strong>Sep</strong>tember info@oic.co.nz <strong>2015</strong> NEW ZEALAND OPTICS 15
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