The dryness of the eyes to fuel the explosion of eye care

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Once considered a marginal subspecialty of eye care, the dry eye is now a multi-billion dollar global industry. MATTHEW WOODLEY examines the seemingly increasing prevalence of the disease and the potential impact it could have on eye care.

Estimates vary, but the dry eye would affect at least 344 million people worldwide.

if this is due to better diagnosis, environmental factors, or a combination of both. However, what we can not argue, is that the better understanding of the disease has changed the perception of a slight inconvenience limited almost exclusively to aging women, to something very much more significant.

The current consensus among researchers and clinicians is that the eye is a widespread disease that can have serious and lasting consequences, especially with regard to quality of life. To complicate efforts to contain this disease, it is likely that the nature of modern life, especially in developed countries, worsens the situation rather than it does help

Exposure to air conditioning, Increased screen time, high air pollution, and higher rates of use of contact lenses and laser eye surgery are recent developments that are believed to increase the chances of contracting the disease. For this reason, Professor Mark Willcox, researcher at UNSW, stated that it was important that clinicians adopt the increased importance given to the treatment of disease

"The old concept according to "For example, children and young people get it a lot more often, and this is probably related to watching computers or phones and not blinking." enough to look at the screen.

"It's important to ask younger people when they have more on dry eye because you will find patients who are affected but who are not necessarily aware that they have the disease.

Diagnosis and Management

Willcox chaired the tear film subcommittee for the DEWS II report of the Tear Film and Ocular Society (TFOS), which covered 150 international clinics. Fundamental and fundamental research experts, who have used an evidence-based approach to reach a global consensus on some of the major aspects of the disease. He said that despite the seemingly increasing prevalence of dry eye, the report, released in July of last year, had simplified the way it is diagnosed and treated

" The new DEWS II probably made it easier to diagnose, and once you've made that diagnosis, it's easier to think about what kind of treatment you might want, "he says.

According to Professor Fiona Stapleton, Head of School of Optometry and Vision Science One of the ways the report helps clinicians diagnose dry eye is to provide a framework for separating the disease into its main ones subtypes.

"We have learned to accept that for a dry eye to be diagnosed, we must have a sign and symptoms that may be symptoms of discomfort or dryness. , or visual symptoms, "said Stapleton." In term In terms of pathophysiology, there is still much that we do not know, but in terms of clinical diagnosis and management, Dr. Stapleton chaired the DEWS II Epidemiology Subcommittee and stated that the research conducted over the past 10 years had stimulated efforts to quantify some of the risk factors associated with the disease, which also helped the diagnosis.

"Eye care practitioners go to DEWS II if they have a problem, we are able to put a label on it now and we better understand the risk factors and ask the right questions a bit more, so that we improve the diagnosis and understanding of the disease, "she said.]" Some of those things for which we did not really have any evidence, such as wearing contact lenses , have now become likely risk factors, so we have more evidence. "

Another Australian who contributed to the DEWS II report, Dr. Laura Downie, from UniMelb, agrees, but it's important to evaluate each case individually.

"We see many more clinicians interested in best practices for dry eyes and trying to provide the best clinical care to their patients." 39 is a pretty hot topic in optometry, in part Many of the clinicians have a real interest in the management of ocular surface disease, "said Downie

. . The goal of DEWS II was to summarize the information in a way that allows clinicians to follow an evidence-based approach without being prescriptive.

"The nature of care will vary considerably for different patients. Trying to identify the relevant contribution of evaporative dry eye versus aqueous deficiency is important, as is tailoring therapy for the individual patient. "

Quality of Life

One of the reasons dry eye treatments, such as those offered in Auckland Eye, have proven popular can be found in the impact of disease on quality Professor Willcox thinks that despite the accumulation of evidence, the impact of dry eye on a patient has been somewhat neglected.

"People have been researching the quality of life with the dry eye and shown that it affects as much people as other debilitating conditions, such as moderate angina. This can therefore have a very significant effect on people's lives, "said Willcox.

" This is not just a dry eye, it really affects their whole lives and often they are consumed. "

So severe that a recent Korean study showed a patient diagnosed with dry eye showed an odds ratio (OR) of 1.32 for depression and 1.24 for suicidal ideation compared to those who do not have the disease.The research, which was published in PLOS One, used data from 16,408 participants who participated in the fifth national survey on health and nutrition, and applied a logistic regression to examine the associations between dry eye, depression and suicidal ideation.] A similar cross-sectional study undertaken by researchers at the University of California also found that women with dry eye symptoms were more likely to suffer from depression than patients without symptoms.The research involved 3,514 patients who had enrolled in the Sjögren International Clinical Alliance Clinical, of which 1,110 were e diagnosed with moderate to severe depression

According to the new Healio medical site, participants answered "yes" to the question feeling dry? "Was 1.82 times more likely to have depression compared to those who answered" no ". In addition, participants who reported a specific eye sensation, such as sensitivity to light or burning sensation, were 2.45 times more likely to develop depression than those who had no symptoms.

Dr. Downie warned that a potential trend to underestimate the impact of dry eye.

"Certainly, when one sees patients severely affected by dry eye, it is not enough to prescribe an artificial tear to treat this disease," Downie said.

"For people with severe dry eye disease, the burden of the disease is similar to very important health conditions.These types of comparisons emphasize that dry eye can have negative impacts on quality of life." [19659018] Industry Response

Ophthalmic Market Analysis Market Scope estimates that dry eye products will generate $ 4.5 billion US) by 2020, due to the increase Treatment based on the procedure for Meibomian gland dysfunction New Rx drugs for dry eyes are also expected to enter the market in 2020, while other experimental treatments are underway.

Currently, Allergan's flagship drug, Restasis (ciclosporin), is by far the largest producer of sales worth US $ 1.47 billion (US $ 1.99 billion) in 2017, according to the annual report of the company. However, patent challenges and geographic barriers (which are still not available in the EU, Australia, or New Zealand) mean that its market stranglehold may soon loosen up.

year, while the multinational pharmaceutical company Shire is already generating hundreds of millions of annual sales of its own treatment – Xiidra (lifitegrast) – which was approved by the FDA in 2016 specifically for the treatment of the eye dry.

The most recent additions to the selection of dry eye treatments are Novaliq NovaTears, which became available at the end of June. Registered in Australia via AFT Pharmaceuticals, this product is considered the first and only topical treatment specifically designed to treat patients with dry eye.

Hartley Atkinson, CEO of AFT, told Insight that optometric practices, especially the opportunity to distinguish themselves by taking a holistic approach to the treatment of dry eye, including thermal masks for eyes, eye wipes and eye drops appropriate for the specific diagnosis.

"Developing a Diagnostic and Treatment Program" In reality, if an optometrist effectively manages the dry eye of their patients, this will help build the relationship with their clients, which will allow optometrists to differentiate themselves and their patients. add value to their customers, "said Atkinson. and then interact with them about all of their eye needs, including eyeglasses and contact lenses. "

The National Product Manager of Optometry The Designs for Vision team, Mr. William Robertson, was further emphasizing the fact that the dry eye was very important to optometrists According to Mr. Robertson, the offer of a full set of dry eye treatment is essential to allow independents to compete with large optometry chains, particularly because it's important This is a highly skilled area

an accurate diagnosis, an effective internal treatment, a home care plan, and a follow-up and care of patients, "he said.

"Having the right range of products and equipment is essential to this strategy, which also requires a high level of patient confidence and a solid foundation of knowledge and support for the provider."

this time, the director of France Medical and national director of v In fact, Gary Bosert, explained that patients were looking for specialists able to diagnose treating conditions such as dry eye. For this reason, he suggested that it was important for optometrists and ophthalmologists to continue to invest in new technologies and support them, so that eye care remains at the forefront of the future. 39, medical innovation

. that the priorities of more and more patients began to look for solutions that were not necessarily the least expensive, but that provided long-term solutions to their eye problems.

"In a modern world where technology and artificial intelligence anticipate our needs, patients want the same from their specialists. They want them to act before it's "too late": they are looking for early detection and preventative treatments, "said Bosert.

"Talking is not enough in 2018. Your patients need to visualize and want to be able to interpret the situation to validate all the options consciously. This means that vision care professionals need tools that can generate diagnostic reports, but also involve their staff, when required, to speak with one voice. "

New and Unique Services

the growing variety of treatments that are now available in the market.A clinic that has taken a unique approach to the disease is the Auckland Eye of New Zealand, which established its own Oasis Spa for ophthalmologically dry patients – the only one of its kind in the country.

Surekha Parag, Clinical Optician under the supervision of Dr. Dean Corbett, and she told Insight that the concept behind this new approach was to make the experience more attractive for people with chronic diseases

"Because dry eye is a chronic disease, it will go away. with one or two treatments – but you're not going to be blind either, or at least not because of the usual dry eye. It's something that people choose to do something, so we thought we could also make the experience more enjoyable. "Instead of making it more clinical, we decided to make it more like a spa experience. So we have pretty illustrations on the wall, diffusers and candles, whale music in the background and herbal teas.

"In the treatment room, we have two options: Optima IPL and LipiFlow.We also have a large body massage chair, while patients receive LipiFlow treatment, they can also do a body massage "

The spa opened in March and relied solely on the recommendations of internal ophthalmologists rather than advertising, but Parag said that he had already had to double the number of sessions that he executes to meet the demand. The LipiFlow spa equipment, which is currently the only one available in New Zealand, is another obvious asset: "With IPL, people have to come back for multiple sessions, which takes a lot of time and takes a little time .

Sometimes it can take up to 12 treatments, so it's a lot to ask someone to do it, especially during the summer months because it all depends on the skin – they can not tan too much, they can not go on vacation, all these considerations fall into that, "said Parag.

" With LipiFlow, there are no such restrictions. This does not matter if you are sunbathing, and you only need a treatment in the office, because apart from that, it can be managed off-site with stuff like heatpacks to maintain the effect of the treatment. Patients who are not always ready to come here often too, and sometimes that is what we are basing ourselves on. If they do not want to keep coming back, it will be LipiFlow.

Snapshots of Research

The ever-increasing demand for new and improved eye treatments has prompted companies and researchers to work tirelessly to achieve the next breakthrough. One possible treatment that has been shown to be promising but has not yet been approved is to stimulate electrical activity in the eye to relieve symptoms in the short term.

Donald Puro, of the University of Michigan, studies the bioelectrical responses of mucous membrane cells that line the eyelids (goblet cells), and he found that electrical activity in goblet cells increases at as the hyperosmolarity (too much salt and not enough water) increases in the tear film

. cells to produce more mucin. However, this surge is short-lived, which means that even if the salt / water ratio of the tear film remains unbalanced in the long term, the electrical activity of the goblet cells returns to normal levels without producing additional mucin. [19659003"Lapertedecetteaugmentationdetensionpendantlasécheresse/hyperosmolaritéàlongtermepeutexpliquerl'énigmecliniqueselonlaquellelescellulescaliciformesdanslesyeuxchroniquementsecspeuventresterrempliesdemucinemêmesilefilmlacrymalesthyperosmotiqueetdéficientenmucine"AmericanJournalofPhysiology

"Continued progress in the & # 39; elucidation bioelectric mechanisms by which the ocular surface reacts to drought [and] hyperosmolarity should provide new strategies to improve & # 39, uncomfortable discomfort of the dry eye. "

However, while Puro's research has shown promising results, another high-profile study has had a disappointing outcome for people with dry eye. A multicentre clinical trial involving 535 patients found that oral omega-3s were no better than a placebo for relieving the signs and symptoms of dry eye.

Patients in the study conducted at Mount Sinai received omega-3 fatty acid of marine origin, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), or a placebo of 5,000 mg of 39, olive oil.

According to the results, the mean change in symptom score was similar in both groups, whereas there were no significant differences between groups for changes in the signs of dry eye, which were measured with conjunctival staining, corneal staining, tear tear time, and Schirmer's test

The Dry Eye Assessment and Management (DREAM) study was the first randomized, double-blind clinical trial and large-scale, realized in the real world on the long-term effectiveness and safety of omega-3 supplementation for symptomatic dryness of the eyes.

"The results of DREAM do not support omega-3 ionic acid supplement for dry eye disease." The author of the study, Penny Asbell, said: [TRADUCTION]

Azura Ophthalmics, an Australian and Israeli biotech start-up, raised US $ 16 million (US $ 20 million) to fund meibomian gland dysfunction research, while UNSW will begin the research. 39, next year to try to discover a reliable biomarker for dry eyes.

The wave of activity of dry eye problem and potential opportunities for eye care professionals to help Patients cope with this growing phenomenon.And even though there is still a lot to learn about the dry eye, one aspect of the disease is indisputable: the dry eye is here to stay. [19659003]

Gallery: Aussie Suppliers with Dry Eye Products

Vi ta-Pos

VitA-POS (retinol palmitate 138 μg / g, 5g) is a smooth, preservative-free, phosphate-free ophthalmic ointment containing vitamin A for the night.

It stabilizes the tear film and protects the ocular surface by preventing evaporation during sleep, and spreads easily over the ocular surface.

Lipiflow Thermal Pulsation System

The LipiFlow Thermal Pulse System is a medical device cleared for the dysfunction of the Meibomian Gland (MGD) shown to improve gland function.

It consists of a console and a sterile device for single use, known as the activator, and has a drug-free mechanism of action. A phase pressure profile with adaptive force equalization and proximal to distal peristaltic movement discharges the contents of the gland when the inner eyelid is gently warmed

Blink Intensive Tears

Eye protection drops ideal for people suffering from mild to moderate dry eye. computer users, the elderly or long-term drug users. They are preservative-free in the eyes and safe for contact lenses.

Blink Intensive Tears improves tear film stability with a unique moisture retention formula containing polyethylene glycol 400 and sodium hyaluronate (HA 0.20%). IPL

IPL EYE LIGHT is a synergy between two medical technologies and optimizes the treatment of pathologies related to dry eyes. OPE (IPL) treats the Meibomian glands of the lower eyelid. Applied to the periorbital areas and cheekbones, various neurological studies verify that the emission of powerful light pulses causes neurotransmitter stimulation.

They solicit the Meibomian glands to produce higher secretion thereby increasing the natural lipid flux that reduces evaporation. The addition of low intensity light therapy (LLLT) using an LED mask directly treats the top lid for an even greater effect.

Ocusoft Lid Scrub

For dry, scratchy and irritated eyes, the problem may not be solved by the eyes, but rather by the eyelids. The OCuSOFT Exfoliator effectively removes excess oil and eyelid debris, which can lead to eye irritation, including dry eyes. It is recommended for daily eyelid hygiene, while OCuSOFT Lid Scrub PLUS is an extra-strong no-rinse formula recommended for moderate to severe conditions with bacterial involvement.

Patients can choose from convenient pre-moistened tampons (30 Ct.), Instant foam pump (50 mL), or economical compliance kit (includes a 50 mL bottle of OCuSOFT Original Foaming Eyeliner and 100 dry and lint-free compresses)

SBM Sistemi Ocular Surface Analyzer

ICP Ocular Surface Analyzer is a multifunctional device mountable on Slit lamp to analyze the lacrimal layers and stability, and advanced imaging of meiography infrared with automatic detection and quantification of Meibomian glands.

It provides scales and reports of DED classification by Evaporation and Meibomian Gland Dysfunction (MGD). Reports include lipid layer thickness, tear meniscus height, noninvasive rupture time (NIBUT), analysis and classification of absence of Meibomian gland

Novatears

NovaTears (Perfluorohexyloctane 100%, 3mL) is a new unique condom without ocular lubricant and tear film stabilizer in a multi-dose vial, specifically designed to relieve the dysfunction of dry evaporative eyes and meibomian glands.

NovaTears spreads quickly and easily to the eye with lasting effect; and has a pleasant sensation of heat and silky without blur or tingling. It does not contain preservatives, phosphates, surfactants or water and can be used for 6 months after opening.

Sterilid Eyecare Solutions

SteriLid is a scientific solution for the daily hygiene of the eyelids, important for patients with dry blepharitis.

SteriLid is a convenient and effective way to clean eyelids and eyelashes and is the first eyelid cleanser that kills Gram-positive and Gram-negative bacteria.

19659100] One out of two contact carriers suffers from a dry eye symptom; Blink Contacts eye drops contain 0.15% sodium hyaluronate which provides lasting hydration to the lens and to the eye.

A gentle condom that helps maintain the integrity of the cornea for healthy use of lenses. prolonged wear.

Oculus K5M

The OCULUS K5M is an advanced corneal topograph with a color camera optimized for external imaging. It can help to accurately diagnose the origins of DED and document the results of the Jenvis Dry Eye report, eliminating guesswork because the results indicate the treatment regimen to be undertaken for each patient. Once treatment is complete, the K5M can compare the results to evaluate the success of the treatment.

The results summarized in the Jenvis Dry EyeReport can be printed and sent to your patient and other health care professionals, or emailed. K5M can image meiography, NIKBUT (noninvasive rupture time), tear meniscus height, lipid layer, OSDI or McMonnies Dry Eye Questionnaire and automatically quantify bulbous rash

Systane Balance Lubricant for the eyes

Support and restore the delicate lipid layer of your patient by restoring the essential hydration of the eyes.

This intensive clinical strength therapy provides long-lasting relief of moderate to severe dry eye symptoms. Available in 10 mL bottles for the home or on the go.

E-Eye Dry Eye Treatment

The E-Eye is the first IRPL (Regulated Intense Pulsed Light) device specifically developed and certified for the treatment of dry eyes in Australia and New Zealand. Zealand. A new version of its technology has recently been released, improving the patient experience by 32% with a unique patented flash.

The device emits a light that targets and stimulates the nerves attached to the Meibomian glands. The treatment is mild and rapid and a significant improvement in dry eye is felt after only three sessions in more than 86% of patients according to the latest studies conducted with the equipment.

LipiScan Dynamic Meibomian Imager

With LipiScan with Dynamic Meibomian Imaging (DMI) was designed to make high definition meibography accessible to any ophthalmic practice.

This is the first HD imager dedicated to meibomian glands designed for efficiency and versatility. The durable and lightweight device has been designed to maximize workflow and facilitate integration into busy practices. The lower two eyelids can be imaged in about a minute.

Hylo Fresh and Forte

HYLO-FRESH preservative-free (sodium hyaluronate 0.1% w / v, 10mL), provides lubrication for dry eyes of moderate or moderate severity, while HYLO-FORTE plus Viscous (0.2% w / v sodium hyaluronate, 10mL) is ideal for the treatment of severe or chronic dry eyes.

HYLO drops offers a systematic approach to the treatment of dry eyes through the unique COMOD. Dose), delivering at least 300 sterile drops per vial. Both can be used with all contact lenses, are suitable for postoperative use and do not contain phosphates.

Systane Ultra Ultra Lubricant Eye Drops

SYSTANE ULTRA Eye Drops are clinically proven for extended protection and high performance. relief of the symptoms of dry eye dryness

It is available in 10 mL bottles and in "home and away" packaging consisting of two 10 mL bottles. SYSTANE ULTRA Lube Ophthalmic Drops are also available in a preservative-free formulation for sensitive eyes

Evolve Carmellose & Hypromellose Drops

Both drops provide soothing relief to patients with mild to moderate dry eye conditions. severe. It is a unique system designed to combine the benefits of unit-free preservative-free eye drops with the convenience of a standard eye drop bottle.

Once opened, the bottle can be used up to one day. three months.

SBM Sistemi Tearscope for Dry Eye

The ICP Tearscope is a tear film screening device for layer analysis and stability. It analyzes tear break time – with or without fluorescein staining, as well as lipid layer thickness and meniscus height.

The ICP Tearscope is a lightweight portable device attached to an iPad.

Blephasteam

Le chauffage Blephasteam permet de chauffer jusqu'à 42 degrés sur une période de 15 minutes, le traitement ne prend que 10 minutes

Le Blephasteam nécessite des anneaux jetables que vous humidifiez avec une solution saline pour créer un environnement humide qui prévient le dessèchement pendant le traitement.

Expression de la glande de Meibomius immédiatement après Le traitement par Blephatseam est recommandé, dans le but d'obtenir une huile claire des glandes

Blink Intensive Tears Plus

De plus, ils conviennent à une utilisation de jour comme de nuit et aident à soulager durablement les yeux secs et irrités.

Tous les avantages de Blink Intensive Tears, le Plus off Il contient une formulation hypotonique à viscosité plus élevée comprenant un mélange synergique de polyéthylèneglycol 400 et de hyaluronate de sodium (HA 0,38%)

The Eye Doctor Mask

Le Eye Doctor Mask est une compresse ophtalmique conçue pour traiter la dysfonction des glandes de Meibomius. principale cause de la maladie des yeux secs. Après avoir chauffé le masque dans le micro-ondes, il est placé sur les yeux pendant 7-10 minutes. La sangle de confort peut être ajustée pour convenir à l'individu et le masque est réutilisable et peut être rangé dans une pochette de voyage pratique.

Il a une housse lavable à des fins hygiéniques et constitue une première étape essentielle pour les personnes souffrant de sécheresse oculaire. Ce masque a même été voté en tant que produit n ° 1 dans le test de préférence des patients et des opticiens et également lauréat du Prix Reine Elizabeth pour l'innovation

Manuka Drops and Gel

Optima Manuka + Drops sont un traitement de première ligne pour les yeux secs . La concentration du miel de Manuka de haute activité est de 16% dans une solution saline avec de l'acide benzoïque comme conservateur.

Cette goutte est idéale pour les yeux secs mais aussi les yeux irrités, rouges et irrités. D'autre part, la formulation de gel antibactérien Optimel Forte contient 98% de miel Manuka et est idéale pour les maladies chroniques, modérées à sévères des yeux secs, en particulier la maladie des glandes de Meibomius et les personnes atteintes de rosacée oculaire.

chaque pratique à avoir, mais pas pour chaque patient à utiliser en raison de la piqûre importante sur l'instillation. Il est essentiel d'être proche du praticien, c'est pourquoi il n'est pas vendu par les pharmacies.

Antarès Topographe

Antares est un dispositif tout-en-un qui effectue la topographie cornéenne, l'analyse NIBUT, la classification lipidique, la méiographie infrarouge, la pupillographie et le contact. des lentilles s'ajustant comme une caméra / mesure de la lumière bleue et des minuscules lacrymaux.

Grâce à son logiciel intégré, il permet une analyse précise du temps de rupture et de la méiographie avec une imagerie qui peut facilement être expliquée aux patients. En utilisant Antares avant et après chaque session IRPL pour les yeux secs, les patients peuvent suivre l'amélioration de leur état avec des résultats visibles.

TheraTears Lubrifiant Eye Drops

TheraTears Lubrifiant Eye Drops 'osmocorrect' le microenvironnement lacrymal, réduisant la concentration de le sel qui peut mener à l'irritation et à l'inflammation de surface oculaire.

Les gouttes pour les yeux sont hypotoniques, ainsi elles abaissent l'osmolarité augmentée de larme – non seulement mouillant et lubrifiant, mais réhydratant réellement les yeux secs. TheraTears est la seule goutte de lubrifiant qui non seulement corrige l'osmolarité, mais simule également l'équilibre électrolytique de la déchirure humaine.

Interféromètre de surface oculaire Lipiview II

Interféromètre de surface oculaire LipiView II avec mesures Dynamic Meibomian Imaging ™ (DMI) l'épaisseur de la couche lipidique (LLT) avec une précision nanométrique, capte la dynamique des clignements, et la structure des glandes de Meibomius images.

Il dispose d'une technologie brevetée qui fournit une évaluation sophistiquée des facteurs qui contribuent à la sécheresse oculaire. Compelling visuals and video captures provide a unique opportunity to educate patients about their personal ocular health.

Systane Gel Drops Lubricant Eye Gel

SYSTANE GEL DROPS Lubricant Eye Gel is for night time protection and offers the thickest gel formulation to coat the eye with a strong layer of dry eye symptom protection.

It provides your patient with long-lasting protection while they sleep. Available in 10mL bottles and can be used in conjunction with SYSTANE ULTRA Lubricating Eye Drops or SYSTANE BALANCE Lubricant Eye Drops for extra relief.

Lumecare Singles Carmellose

Lubricant eye drops for lasting and soothing relief, and protection against burning, irritation and discomfort due to ocular dryness or exposure to environmental factors.