Dry Eye 2016

SPECIAL FEATURE: DRY EYE
To IPL or not?
BY ALLY XUE*
The current mainstay therapies for
meibomian gland dysfunction (MGD) are
either palliative, providing only transient
relief from dry eye symptoms, or they are
unsuitable for long-term use in chronic cases.
One novel treatment to emerge in recent years,
however, is intense pulsed light (IPL), which was
discovered, serendipitously, to provide relief
from symptomatic MGD, around a decade ago.
Despite the dearth of scientific evidence
supporting its anecdotal positive ocular effects,
IPL therapy is now being offered in more than
100 practices across Australasia. The rising
popularity of IPL as a treatment for evaporative
dry eye prompted the Ocular Surface Laboratory
(OSL) at The University of Auckland to conduct
the first randomised, double-masked, placebocontrolled
pilot study (published in IOVS last
year). The research team, led by Associate
Professor Jennifer Craig, demonstrated
significant and cumulative improvements
to the lipid quality and stability of the tear
film, as well as reduced symptoms following
IPL application. However, it was deemed that
further study was necessary to establish the
underlying mechanism(s) and determine
applicability in different patient sub-groups to
improve prognostic value and enable further
therapeutic refinements.
CONTINUED FROM P4
poorest prospects in my opinion. My other
criticism is that it is actually expensive for
patients in an unsubsidised environment. I
had visions of using it more often, and I find it
frustrating that I don’t use it more frequently.
I probably need sales training!
References
Differentiation of Lipid Tear Deficiency Dry Eye by
Kinetic Analysis of Tear Interference Images; Eiki Goto,
MD; Scheffer C. G. Tseng, MD, PhD; Arch Ophthalmol.
2003;121:173-180
Assessment of the Tear Film; Jane Veys MSc MCOptom
FBCLA FAAO, Education Director, Vision Care Institute
Classic meibomian gland dysfunction
In a few weeks’ time, under the supervision of
A/Prof Craig, I will begin conducting a second
IPL study to validate the promising results
demonstrated by the prospective pilot trial.
The aim is to refine and expand upon the pilot
research methodology by tracking its efficacy
over a longer time period and collect data
to help investigate the potential underlying
mechanisms. Specifically, myself and the other
researchers will be evaluating the effects of IPL
therapy on neurobiological and inflammatory
pathways, eyelid microflora and the tear film
lipidome. The OSL is currently recruiting eligible
dry eye patients with symptomatic MGD
from Auckland optometric clinics, and it is
expected that recruitment will be ongoing until
December 2016. In exchange for a few hours
of their time, participants are offered free IPL
treatments and a contribution towards travel
costs. Therefore, if you believe your patient may
be a suitable candidate for this study, please
send referrals to me at a.xue@auckland.ac.nz
or email me for further information.
*Ally Xue is a PhD student with OSL.
Johnson & Johnson Vision Care: www.jnjvisioncare.
co.uk/sites/default/files/public/uk/tvci/eclp_
chapter_4.pdf
Computer-Synthesis of an Interference Color Chart of
Human Tear Lipid Layer, by a Colorimetric Approach;
Eiki Goto, Murat Dogru, Takashi Kojima and Kazuo
Tsubota; IVOS. Nov 2003: 44:11
Tear film dynamics and lipid layer characteristics—
Effect of age and gender; Cécile Maïssa, Michel
Guillon, Contact Lens and Anterior Eye; August 2010,
Volume 33, Issue 4, Pages 176–182.
* Greg Nel has practiced optometry in both South Africa
and New Zealand and is a partner with Total Eyecare.
He is passionate about specialised contact lens fitting,
corneal refractive therapy (CRT) and paediatric/
development optometry, plus he’s a keen photographer,
surfer and home-brewer.
Dry eye in NZ
With our aging population, the
current state of dry eye disease
(DED) diagnosis and management in New
Zealand needs to be examined. Recently,
an anonymous, web-based questionnaire
was distributed to New Zealand eye
care clinicians (optometrists n=614,
ophthalmologists n=113). The questionnaire
sought information about practitioners’
interest in DED, their practice experience,
practice modality, preferred diagnostic and
management strategies and the evidencebase
they use to guide patient care.
The survey revealed both professions
(optometrist response rates: 26%,
and ophthalmologist: 26%) possess
similarly strong knowledge of tear film
assessment. Consistent with evidencebased
guidelines, New Zealand eye care
professionals use subjective and objective
techniques to diagnose DED. Almost all
respondents considered patient symptoms
and meibomian gland evaluation as the
most valuable and commonly performed
diagnostic techniques. However,
standardised grading scales and validated
dry eye questionnaires were infrequently
adopted.
Most respondents indicated eyelid
hygiene and non-preserved lubricants
as the mainstay therapies, nevertheless
DED management was tailored to disease
severity. There’s increased recommendation
for omega-3 fatty acids intake (see p18),
topical corticosteroids and systemic
tetracyclines in moderate to severe DED
relative to mild disease, highlighting
recognition of inflammation as a feature
associated with dry eye, particularly in more
advanced cases.
Lastly, it was concluded that dissemination
of research evidence relating to clinical bestpractice
for DED could be further improved,
potentially through mechanisms focussed
upon continuing education conferences, as
this was the preferred method to inform their
management approach, clinicians report.
* Submitted by the OSC
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5 NEW ZEALAND OPTICS October 2016