This week in KeratoScoop: Studies, studies and more studies! Catching up on everything of dry eye interest that's been published in the peer-reviewed journals lately. So many reasons for encouragement and hope in the midst of all this research. - Also, $10 coupon for the Dry Eye Shop. Oh, and did you know we're on Instagram?

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KeratoScoop

April 8, 2019   Newsletter  -  Volume 11 - Issue 8

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DryEyeZone
The Dry Eye Zone
Dry Eye Blog
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demodex mites

It's Journal Roundup time!

There have been a ton of studies published recently on everything, and I do mean everything, related to dry eye:

  • From demodex to depression
  • From osmolarity to oral antibiotics
  • From GvHD to glaucoma
  • Even a seawater versus Celluvisc study!

So, the majority of this issue is dedicated to catching up with what's going on in the peer reviewed world. (All also available on my DryEyeZone blog.) Plus, a Monday-morning reflective moment about the implications of all this research.

For the DryEyeShop deal-hunters, there's also a $10 coupon buried down there somewhere. Hate to disappoint on a Monday morning.

Demodex mites

Demodex mites and eye discomfort: An Austrian study found that mites were associated with discomfort, but it was harder to find a relationship with specific signs of MGD. Also, a Chinese population study looks at demodex in kids and adults with bleph.
To pluck or not to pluck? They don't have to pull out your lashes to diagnose mites as the cause of your blepharitis. It's actually pretty simple to count them in place. On the other hand, if you want to get fancy (I mean spendy) you can use a confocal microscope, as another study points out.

Dry eye, computers and phones

"Blind working time": A study looked at what happens when computer users just close their eyes for the very brief periods when they don't absolutely have to have their eyes open. - Another study looked at the long-term impact of computer use on dry eye but... forgot to say how long. Oops.
iPhones can capture your blink dynamics: Blink rate matters! Maybe even your iPhone can help figure out where you stand with blink dynamics and whether or how they play into your dryness.
Blind working time
Blink dynamics on an iphone

Ocular allergy

There's always been a troubling overlap between allergy and dry eye that isn't always the easiest to sort out. Make sure to keep it in mind in conversations with your eye doctor, especially at the height of the season!

Ocular allegy
Treat ocular allergy with a contact lens? Using contact lenses to deliver drugs is the topic that's getting hotter and hotter. A recent study looked at a contact releasing an antihistamine. Is this preservative-free, I wonder? Also, another study looks at whether a liposomal spray is just as good as an antihistamine.
Allergy drops and preservatives: Yes, the latest study about a drop sent me straight into my umpteenth rant about the use of BAK in eyedrops - without warnings - drops that are used most frequently by people who have dry eye and eye redness. We need better warnings, and we need preservative-free alternatives.

Graft-v-host disease

Graft v host disease
I had known about GvHD for a long time, but 2016 - year of the Unisol crisis - was when I became much more acutely aware of how MANY people have this condition (which can happen as a result of a bone marrow transplant). The numbers of people with GvHD that I spoke to personally that year about saline and scleral lenses went well beyond how many I imagined even existed. All that to say, I like to keep an eye out for studies about this particularly acute form of dry eye.
This blog post covers a few different studies: One, a broad review about all the research work that's been done and what some of the emerging and surgical treatments are for those who don't respond to conventional treatment. Two, a study of a new drop developed specifically for ocular GvHD. Three, a comparion of MGD in GvHD patients vs Sjogrens Syndrome patients.

Osmolarity and the ever-moving cheese

Osmolarity
Osmokinetics: A Next Big Thing? Maybe.  What if it's not about your tear film osmolarity at this moment in time, or the trendline over the last few doctor visits, but instead about the details of how, how much and when it changes?

Meibomian gland dysfunction

oral antibiotics for dry eye

Oral azithromycin?

Oral doxycycline is commonly prescribed in the US for MGD and especially rosacea. It also commonly has gastric side effects, and there's a lot of people that it doesn't seem to help. (But then, with dry eye, that's par for the course - so much variability.) This recent study looks at oral azithromycin compared to oral doxy, over a 9 month period. Worth a read, maybe even a conversation.

Drops. Drops. Drops.

TOP1630 - some fresh results were announced a month or two ago and now we're seeing them in print. Maybe this drug is finally inching across the chess board (I mean the pipeline list).

Sulglycotide, apparently a New Thing, may be useful for mucin secretion in dry eye. Then there's a nerve growth factor Phase Ii study, and last and least, xanthan gum

Wait, wait, hold everything! There's another drop! It's, it's, ... seawater. Harvested from the Altantic, filtered, watered down with spring water. Sold as a bedtime drink. And compared to Celluvisc. (As a drop, not a drink!) Only you can decide whether I threw this in for entertainment value or in all seriousness, and only you can decide whether the point of the study is that saline works, or that polymers ain't all they're cracked up to be, or both.

Glaucoma and dry eye

Study #1: It took just 6 weeks for glaucoma patients to improve when switched to a med without BAK.

Study #2: This one reviewed studies on the impact of glaucoma meds on the ocular surface.

Study #3: A look at the quality of life impact of dry eye from glaucoma meds.

BAK is BAD

Pain matters

migraines and dry eye

Is there any association between dry eye disease and migraine headaches? This study looked at records of 73,000 patients to find out.

Can we get a proper tool to quantify eye pain please? Don't look now, but we're getting closer... see this study on a modified pain inventory.

Dry eye, anxiety and depression

Anxiety, depression and dry eye

A recent study from UNC looks at dry eye symptom severity and how it correlates with anxiety and depression. The bottom line? If somebody would please help our eyes then yes, that will help our heads, because dry eye really does significantly impact mental health. It is important that we continue getting studies like this that debunk harmful assumptions about mental health and its relationship to medical conditions, rather than randomly deciding who's the chicken and who's the egg.

Epidemiology (the numbers)

21% of Canadians have dry eye? Phew.

MGD vs dry eye epidemiology: Interesting Japanese study looked at the breakdown, what they had in common, and what the top risk factors were.

We're almost done! There's still...

Contacts and dry eye

...Contacts...

This recent study compared daily disposable hydrogel with daily disposable silicone hydrogel and then reusable silicone hydrogel, from an ocular surface damage perspective.

Disposable is better.

Surprised? Me neither.

...And cataracts.

Two different studies came up recently about cataract surgery and dry eye:

#1, comparing dry eye after phacoemulsification versus manual small incision. Phaco won.

#2, looking at tear film osmolarity after cataract surgery. Unfortunately I don't feel much wiser, especially after what I just read about the limits of osmolarity testing.

cataract surgery and dry eye

But...but... there's so much more!

So many studies, so little. That's all for this week. Phew!

 

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PROSE & Scleral lens supplies
Newsflash: In case you didn't get my direct email about this recently - LacriPure and Unique pH are now available direct from the manufacturer. They are restricting quantities to distributors so we do not have any yet but we hope to have it back in stock soon, but if you're in need, I wanted you to know they're both available again direct.

Did you know?

You can reach out for help at any time via email, text, phone, chat or Facebook message. 

Some random highlights:

  • We track industry shortages, from ointments to salines, recent discontinuations and recalls.
  • Our return policy is available online. In a nutshell? Yes, you can return your moisture goggles used because they didn't fit or weren't comfortable; no, I'm so sorry you can't send back your eyedrops or lid scrub just because you didn't like them; of course you can send back the product you ordered in the wrong size accidentally. Details
  • Purchasing regularly? Why not save with "Subscribe & Save"? Best kept secret: People change the timing and frequency and quantities and shipping constantly. Subscribe & Save doesn't mean you're locked into a particular schedule.
  • Got dry eye? Have you read Dry Eye 101 yet?

Dry eye got you down?

Remember: We have solid reasons for hope.

Such as:

1) The sheer volume of work being done.

I was behind on dry eye studies. But I didn't think I was all that behind. In fact, it was only about a month worth of PubMed notifications. Considering that I only write about, at most, one out of every ten or fifteen studies that pop up in my feed about dry eye, blepharitis, etc, I was astonished at how long it took me to catch up.

Because there were so many, I printed out all the abstracts that interested me. Large stack. I had to get a fold-out table in addition to my desk just to sort them all out. The sheer volume of studies made me sit back and think about how long it's been that I have felt chronically behind with my reading. New plan needed, for sure.

Deo volente, journal review will henceforth be a regular weekly exercise with Chaidie doing the initial filtering and sorting.

Why do I mention all this? It's not a workload gripe - I loved every minute of it.

But do you realize what all these masses of studies amount to? There's a TON of work, brains, money, experience, attention, expertise and time going into an amazing variety of types of dry eye research all over the world.

When I think back ten years, then fifteen, how deep I had to dig to find meaningful studies, how few studies there were in general beyond cyclosporine and over-the-counter drops on the one hand and hardcore unpronounceable science with no obvious immediate application on the other... thinking of all these things, I'm just so grateful. We've come a very, very long way.

2) The wide range of treatments available.

I have my moments of a sense of unreality. I see data all the time about treatments, and talk with doctors about the specialty treatment options they're employing, and with patients about the latest boutique treatment that's helping them. On the other hand, we regularly get calls from people who report that they were given several artificial tears to try, then maybe some plugs, and maybe Restasis. Then they were told "That's pretty much all there is." Good Lord. That's just so... 2004. I mean, this is 2019 and no dry eye patient should be treated like that. If that describes your experience, you may need another doctor, but even more, you need to start doing your own research. Start here.

3) The nature of the advances being made.

If I had the proverbial buck for everyone on social media who has ever complained "They're just treating symptoms, not causes!"

You know what? That's not true. Of course, we need symptom treatments, because we have to be able to get through the day in tolerable comfort and seeing decently. But so often, the things that help our symptoms are consumer stuff rather than medical stuff anyway - goggles and glasses, compresses and whatnot. And yes of course, OTC drops.

On the medical side, though, the emphasis is most definitely not on symptomatic relief. I'm going to quote from O'Neill et al's recent review of dry eye treatments published in Current Opinion in Ophthalmology this year: 

"As we better understand the multifactorial mechanisms leading to dry eye disease, treatments increasingly focus on the amelioration of the underlying deficiencies and inflammation, rather than on transient symptomatic relief alone. Most topical medications seek to replace deficient growth factors and/or decrease inflammation on the ocular surface. The majority of new devices and procedures seek to treat meibomian gland dysfunction, with one new device stimulating tear production through utilizing the nasolacrimal reflex pathway."

So, if you have a hard time this week with your eyes, please remember these things and BE ENCOURAGED, because progress is happening all around us.

Your turn to benefit is coming!

Rebecca

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