A
weekly e-journal by Art Epstein, OD, FAAO
I just received a Facebook message from an OD who shared with apparent glee that he had kept
a young ophthalmologist, new to town, in his waiting room for two hours, only to give him a minute of his time.
I winced when I read the note, feeling the discomfort and perhaps humiliation of the young MD, whom I assume
came just to introduce himself and perhaps to ask for help in establishing his new practice.
|
|||||
|
|
Optimizing Evaluation of Lissamine Green Parameters for Ocular Surface Staining | ||||
The recently published seminal dry eye workshop proceedings defined Lissamine Green (LG),
an organic dye, as a gold standard for demonstrating ocular surface staining. The purpose of the current study was
to determine the optimal parameters of 1% LG instillation for the ocular surface examination in dry eye
patients. A quality improvement study evaluated 16 eyes from eight dry eye patients with different levels of
severity. LG (1%), in three volumes (5, 10, and 20 µl) was instilled into the conjunctival cul-de-sac,
and four masked observers with different levels of clinical expertise examined the patients with and without
red filter. The staining pattern of the conjunctiva and cornea was documented with the Oxford scale within 4 min
of LG instillation. Optimal volume and inter-observer reliability were assessed.
All dye volumes were tolerated well by all patients. Experienced observers preferred 10 µl volume because of the ease of examination and accuracy. Although instillation of 20 µl yielded similar scores as 10 µl, it resulted in overflow of the lid and facial skin staining. The use of red filter significantly improved reading scores. Inter-observer reliability was higher for conjunctival scores than for corneal scores for all patients. The highest reliability was demonstrated with 10 µl volume and increased with greater experience of the observer. Ocular surface examination with instillation of 10 µl 1% LG has good inter-observer reliability and is well tolerated. Observation through a red filter facilitates the examination. |
||||
SOURCE: Hamrah P, Alipour F, Jiang S, Sohn JH, Foulks GN. Optimizing evaluation of lissamine green parameters for ocular surface staining. Eye (Lond). 2011;Aug 12 [Epub ahead of print]. |
The Effect of Oral Supplementation of Omega-3 and Omega-6 Fatty Acids on a Conjunctival Inflammatory Marker in Dry Eye Patients | ||||
This 3-month, double-masked, parallel-group, controlled study was conducted in nine centers
to determine whether oral supplementation with omega-3 and omega-6 fatty acids can reduce conjunctival
epithelium expression of the inflammatory marker human leucocyte antigen-DR (HLA-DR) in patients with dry
eye syndrome (DES). Eligible adult patients with mild to moderate DES were randomized to receive a placebo
containing medium-chain triglycerides or treatment supplement containing omega-3 and omega-6 fatty acids,
vitamins and zinc. Treatment regimen was three capsules daily. Impression cytology (IC) was performed at baseline
and at month 3 to assess the percentage of cells expressing HLA-DR and to evaluate fluorescence intensity,
an alternate measure of HLA-DR. Dry eye symptoms and objective signs were also evaluated.
In total, 138 patients were randomized; 121 patients with available IC were included in the FAS, and of these, 106 patients had no major protocol deviations (PPS). In the PPS, there was a significant reduction in the percentage of HLA-DR-positive cells in the fatty acids group (p = 0.021). Expression of HLA-DR as measured by fluorescence intensity quantification was also significantly reduced in the fatty acids group. No significant difference was found for the signs and symptoms, but there was a tendency for improvement in patients receiving the fatty acids treatment. This study demonstrates that supplementation with omega-3 and omega-6 fatty acids can reduce expression of HLA-DR conjunctival inflammatory marker and may help improve DES symptoms. |
||||
SOURCE: Brignole-Baudouin F, Baudouin C, Aragona P, et al. A multicentre, double-masked, randomized, controlled trial assessing the effect of oral supplementation of omega-3 and omega-6 fatty acids on a conjunctival inflammatory marker in dry eye patients. Acta Ophthalmol. 2011; Aug 11 [Epub ahead of print]. |
Serial Measurement of Tear Meniscus by FD-OCT After Instillation of Artificial Tears in Patients With Dry Eyes | ||||
The lower tear meniscus of 16 consecutive patients with dry eyes was imaged by a
Fourier-domain optical coherence tomography (FD-OCT) system to study the effect of artificial tears on the
tear meniscus in patients with dry eyes. Baseline and five serial pairs of measurements were taken after
the instillation of artificial tears at 1, 2, 5, 10 and 15 minutes. The lower meniscus height, depth, and
area were measured with a computer caliper.
Baseline meniscus measurements were 235.5 ± 150.0 µm, 138.1 ± 78.7 µm and 0.020 ± 0.022 mm² for height, depth, and area, respectively. After instillation of artificial tears, all lower tear meniscus parameters remained significantly elevated for 5 minutes and returned to baseline by 10 minutes. FD-OCT is able to quantify a dramatic initial increase in tear meniscus, followed by a decay back to baseline values after approximately 5 minutes. FD-OCT may be useful in objectively quantifying the dynamic efficacy of dry eye treatments. |
||||
SOURCE: Bujak MC, Yiu S, Zhang X, Li Y, Huang D. Serial measurement of tear meniscus by FD-OCT after instillation of artificial tears in patients with dry eyes. Ophthalmic Surg Lasers Imaging. 2011;42(4):308–13. |
News & Notes | ||
NOVARTIS, ALCON AND FALCON PRODUCTS STOLEN. Novartis and its Alcon Division are working with the FDA, industry cargo thefts organizations and law enforcement officials to recover Novartis, Alcon and Falcon (a line of generic eye-care pharmaceuticals from the Sandoz Division of Novartis) products that were stolen on July 18, 2011 during delivery to a customer’s distribution center in Florida. The products stolen are listed here and represent a small portion of each product lot, which have already been distributed within the United States, Puerto Rico and its territories. Novartis, Alcon and Falcon products are delivered in tamper-evident packaging to protect product integrity. Novartis, Alcon and the FDA advise physicians, retailers and consumers to purchase product only from trusted and reliable sources and to check all products for signs of tampering or damage prior to purchase and/or use. Anyone who has information regarding the incident, or has received suspicious or unsolicited offers for the specified products after the date of the theft, is encouraged to contact the FDA Office of Criminal Investigations at (800) 551-3989 or at www.fda.gov/OCI. | ||
iCO THERAPEUTICS INITIATES STUDY OF DME DRUG. iCo Therapeutics Inc. has announced the initiation of a U.S. physician-sponsored Phase II clinical trial involving the its antisense drug, iCo-007, which targets c-Raf kinase and is in development for the treatment of diabetic macular edema (DME). The company successfully completed a Phase I trial with iCo-007 in the United States in 2010. The iDEAL Study will be conducted across multiple sites throughout the United States and will be led by the clinician scientists who are investigators in the trial. Click here to learn more. | ||
REICHARDT TAKES ON ROLE AS SENIOR VP OF EUROPEAN REGION AT TEARSCIENCE. TearScience, Inc. has appointed Diethart Reichardt as senior vice president of the European region including Europe, Middle East and Africa. In this role, Reichardt will be based in Germany, where he will be responsible for sales, marketing, operations and customer service teams based in the European region as well as a distributor network in Africa and the Middle East. Most recently, Reichardt was director of global business development for Sauflon Pharmaceuticals, where he re-launched the business in central Europe and focused on market entry strategies for the United States and Japan. | ||
|
Optometric Physician™ is distributed by the Professional Publications Division of Jobson Medical Information LLC (JMI), 11 Campus Boulevard, Newtown Square, PA 19073.
HOW TO ADVERTISE
|