This document discusses the role of diet in ocular surface disease. It notes that 14-33% of the US population has dry eye, and while aqueous deficiency accounts for 34% of dry eye cases, 95% of products on the market treat evaporative dry eye which accounts for 65-86% of cases. Dietary changes, hormonal effects, aging population, electronic device use, and better diagnostics all contribute to rising dry eye rates. Treatment options discussed include cyclosporine, steroids, nutritional supplements containing omega-3s and GLA, and procedures like LipiFlow. The document emphasizes the importance of addressing underlying inflammation and meibomian gland dysfunction in dry eye treatment.
7. Dry Eye
in the US
14 to 33%
Of The Population
Has Dry Eye
Dry Eye Disease: The Clinician’s Guide to Diagnosis and Treatment. P Asbell
8. Why Are We Seeing So
Much Dry Eye?
Dry Eye Disease: The Clinician’s Guide to Diagnosis and Treatment. P Asbell
Dietary changes
Hormonal effects
Aging population
Awareness
Electronic devices
Better diagnostics
Treatments are
now available
9. Ocular Surface Disease
Dry Eye
Disease
Aqueous
Deficient Dry Eye
Evaporative Dry
Eye
Other
Non-Dry Eye
Disease
Lid-related
Disease
MGD
Anterior
Blepharitis
Other
Other OSD
Allergic
conjunctivitis,
Chronic infective
and non-infective
Keratoconjunctivitis,
Post-refractive
Prodromal
States
Symptomatic
10. Dry Eye
in the US
Aqueous Deficiency:
34% Of Problem But
95% Of Products On The Market
2012 Annual Report on Dry Eye Diseases, Contact Lens Spectrum
11. Dry Eye
in the US
Lipid Deficiency:
65-86% Of Problem But Only
5% Of Products On The Market
Lemp MA, et al. Distribution of aqueous deficient and evaporative dry eye in a clinic-based
patient population. Cornea, 2012; 31(5):472-478
17. Tear Osmolarity
Performance of tear osmolarity compared to previous diagnostic tests
for dry eye diseases. Versura et al. Curr Eye Res 2010 Jul;35(7):553-64
34. LipiFlow® Mechanism of Action
Activator
Applies
intermittent
pressure to the
outer eyelid
Inflatable air
bladder
Shields eye from heat
and
vaults above the
cornea to prevent
corneal contact
Heats comfortably
to liquefy the
Meibomian gland contents
Lid warmer
Applies directional
heat to inner eyelid
35.
36. Restasis (Cyclosporine 0.05%)
Improves ocular surface health
Increases goblet cells
Improves LASIK & Premium IOL
outcomes
Good safety profile
Decreases artificial tear use
37. Adapted from Holland EJ. Ophthalmol Times. 2007;32:3-11.
Lotemax® QID
(loteprednol etabonate
Ophthalmic suspension 0.5%)
Lotemax® BID Lotemax® prn
Restasis® BID
(cyclosporine ophthalmic emulsion 0.05%)
Thereafter
The Asclepius Panel:
Recommended Treatment Model
for Ocular Surface Inflammation
40. A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef, CA Daley et al, Nutr Jour, 2010 9:10
41.
42. Contains unique omega (GLA) – clinically backed in
6 controlled dry eye trials
Not found in diet/flax/fish. Provides other
omegas, nutrient cofactors
Stimulates tear production, eases inflammation
Effective for almost any Dry Eye (i.e. contact
lens, post-refractive, post-menopausal, allergy-
related, Sjögren's, other types)
Guaranteed relief within 60 days or money back;
works for 80-85% of users
HydroEye®
Oral Supplement
45. Supplemental GLA: Controlled Trials
Significant Improvement
• Dry Eye patients GLA vs placebo (n=26)
– Dry Eye Symptom Scores, Lissamine Green,
Ocular Surface Inflammation (HLA-DR
Expression).
• PRK patients GLA vs no treatment (n=60)
– Subjective Symptoms, Schirmer 1 test,
Fluorescein Clearance Test
• Sjögren's patients GLA vs placebo (n=40)
– Tear Anti-Inflammatory PGE 1 levels, Dry Eye
Symptoms, Corneal Fluorescein Staining
1. Barabino S et al. Cornea 22): 97–101, 2003.
2. Macri A et al. Graefes Arch Clin Exp Ophthalmolol 241:561-6, 2003.
3. Aragona P, et al. Ophthalmol Vis Sci 46:4474-9, 2005.
46. HydroEye Clinical Trial
• ARVO 2012: Multi-center, randomized, double-blind, placebo-
controlled, prospective trial, 38 postmenopausal women with Dry
Eye Syndrome.
• Investigators:
• Findings: HydroEye improves symptoms & signs of dry eye and
impedes progression of ocular surface inflammation significantly
better than placebo.
John D. Sheppard MD MMSc
•Eastern VA Medical School.
Stephen C. Pflugfelder MD
•Baylor College of Medicine
49. Known or Suspected Autoimmune Diseases
That Also Present With a Leaky Gut
Disease Tissue/Organ Citation
1. Allergies Various Liu et al. Acta Paediatrica 2005, 94, 386-93
2. Ankyllosing Spondylitis Skeletal system Vaile JH et al. J. Rheumatol. 1999, 26, 128-35
3. Apthous stomatis Mouth Veloso FT et al. Hepatogastroenterol. 1987, 34, 36-7
4. Asthma Lungs Benard A et al. J. Allergy Clin. Immun. 1996, 97, 1173-8
5. Autism Nerve/Brain White JF. Exp. Bio. Med. 2003, 228, 639-49
6. Autoimmune gastritis GI Tract Greenwood DL et al. Eur. J. Pediatr. 2008, 167, 917-25
7. Autoimmune hepatitis Liver Terjung B Clin. Rev. Allergy Immunol. 2009, 36, 40-51
8. Behcet’s Syndrome Small blood vessels Fresko I et al. Ann. Rheum. Dis. 2001, 60, 65-6
9. Celiac Disease Gut Schulzke JD et al. Pediatric. Res. 1998,43, 435-41
10. Chronic Fatigue Synd Multiple Maes M et al. Neuroendol. Lett. 2007, 28, 739-44
11. Crohn’s disease Gut Caradonna L et al. J. Endotoxin. Res. 2000, 6, 205-14
12. Depression Brain Maes M et al. Neuroendocrinol. Lett. 2008, 29, 117-24
13. Dermatitis herpetiformis Skin Kieffer M et al. Br J. Dermatol. 1983, 108, 673-8
14. Diabetes, Type 1 Pancreas Sapone A et al. Diabetes 2006, 55, 1443-49
15. Eczema Skin Hamilton et al. Q. J. Med. 1985, 56, 559-67
16. Gut migraine children Gut Amery WK et al. Cephalalgia 1989, 9, 227-9
17. Hashimoto’s Thyroiditis Thyroid Sasso FC et al. Gut 2004, 53, 1878-80
“Dietary Mechanisms of Autoimmunity”, Loren Cordain, PhD, Christiaan Barnard Memorial Hospital, Jan 24, 2013
50. Known or Suspected Autoimmune Diseases
That Also Present With a Leaky Gut
Disease Tissue/Organ Citation
18. IgG Nephropathy Kidney Rostoker G et al. Nephron. 1993, 63, 286-290.
19. Intrahep cholest pregnancy Liver Reyes H et al. Hepatology 2006, 43, 715-22
20. Juvenile Arthritis Collagen/joints Picco P et al. Clin. Exp. Rheumatol. 2000, 18, 773-8
21. Lupus erythematosis Multiple Apperloo HZ et al. Epidemiol. Infect. 1994, 112, 367-73
22. Multiple sclerosis Nerve/Brain Yacyshyn B et al. Dig. Dis. Sci. 1996, 41, 2493-98
23. Pemphigus Skin Kieffer M et al. Br J. Dermatol. 1983, 108, 673-8
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25. Psoriasis Skin Hamilton et al. Q. J. Med. 1985, 56, 559-67
26. Rheumatoid arthritis Joints Smith MD et al. J. Rheumatol. 1985, 12, 299-305
27. Rosacea Skin Kendall SN. Exp. Dermatol. 2004, 29, 297-99
28. Schizophrenia Brain Wood NC et al. Br. J. Psychiatry 1987, 150, 853-6
29. Scleroderma Connective tissue Caserta L et al. Rheumatol. Int. 2003, 23, 226-30
30. Sclerosing Cholangitis Liver Terjung B Clin. Rev. Allergy Immunol. 2009, 36, 40-51
31. Spontaneous abortion Uterus Friebe A Int. J. Biochem. Cell Biol. 2008, 40, 2348-52
32. Ulcerative colitis Gut Caradonna L et al. J. Endotoxin Res. 2000, 6, 205-14
33. Urticaria Skin Buhner S et al. Allergy 2004, 59, 1118-23
34. Uveitis Eye Benitez JM et al. Eye 2000, 14(pt 3A), 340-3
“Dietary Mechanisms of Autoimmunity”, Loren Cordain, PhD, Christiaan Barnard Memorial Hospital, Jan 24, 2013
TearScience® Meibomian gland evaluator could be a new standard for Meibomian gland evaluations.This is a small handheld instrument, used by a physician, to evaluate these glands during routine eye examinations.It provides a standardized method to apply consistent gentle pressure to the outer skin of the lower eyelid while visualizing the secretions from the meibomian gland orifices through a slit lamp biomicroscope.
This table shows the correlation between the number of glands that will express liquid and the symptom level patients have for their dry eye concerns.The SPEED questionnaire is used to gather information on the type of symptoms a patient has, the frequency of the symptoms and their severity. Score range from 0-28 and the mean value of the data collected is presented here with the standard deviation. (Standard Patient Evaluation of Eye Dryness)MGYLS – meibomian glands yielding liquid secretions.the TearScience Meibomian Gland Evaluator was placed on three separate regions of the lower eyelid to uniformly express the glands. Evaluation was done with patients chosen from those presenting for a routine eye examination. The number of glands that expressed any type of liquid were counted. The mean score of this data is presented with the standard deviation next to the mean value.The study found a correlation between symptoms and number of glands secreting liquid to have a P value of P =.0002The last column contains information on normal healthy individuals for comparison.