Creating a Dry Eye

Center of Excellence

October 26, 2015

Cynthia Matossian, MD, FACS

Matossian Eye Associates

Disclosures:

• Abbott Medical Optics

• Alcon

• Allergan

• ALPHAEON

• Bausch + Lomb

• Checked-Up

• Imprimis Pharmaceuticals

• i-Optics

• Lenstec

• Marco

• Ocular Therapeutix, Inc.

• OMEROS

• Physician Recommended Nutriceuticals (PRN) – Shareholder

• Progressive Tech Training

• RPS Diagnostics

• Shire

• Strathspey Crown – Shareholder

• TearLab

In the US, an estimated 3.2

million women age 50 and

over, and 1.68 million men

age 50 and over are

affected by dry eye

syndrome.

MGD is the leading cause of

evaporative DED. Patients who

suffer from this disease produce

an abnormal meibum that is more

viscous than the usual olive oil

like secretion. These patients can

have inflammation and bacterial

overgrowth that exacerbate the

problem.

Meibomian Gland Dysfunction

Standard Treatments

• Warm Compresses &

Lid Scrubs

• Anti-Inflammatory

Drops or Ointments

• Oral Antibiotics

DED Diagnostic Tools

OSDI Questionnaire

Speed Questionnaire

Tear Osmolarity Machine

Tear Osmolarity Being Performed

Tear Osmolarity Being Performed

• TO on all pre-cataract surgical patients

• TO on all patients who are expressing

Dry eye issues -- gritty eyes, fluctuating

vision, sandy sensation, tired eyes, etc.

• TO on all patients who wear contact

lenses who complain of an inability to

wear them as long as they would like,

etc.

Matossian Eye Associates

Tear Osmolarity (TO) Criteria

Tear Osmolarity Card

Two Numbers Crucial to

Understand Osmolarity

The MAXIMUM of the two eyes: 314

Tears higher than 300 mOsm/L demonstrate loss of homeostasis and likely become pathogenic > 308

The DIFFERENCE b/w two eyes: 24

This tells you how stable the tear film is. Normal tears are stable and near 300 mOsm/L bilaterally. A difference of > 8 mOsm/L is a hallmark of tear instability.

Osmolarity & Tear Film Instability

in DED

InflammaDry™

Lissamine™ Green Stain

Treatment Regimen

Artificial tear solution and/or ointment

Bruder moist heat mask

Omega 3 oral supplements

Punctal plugs

Cyclosporine ophth emulsion 0.05%

Avenova™ lid cleanser with hypochlorous acid

IPL / Lipiflow

Oral antibiotics

Serum tears

Artificial Tears

Bruder Moist Heat Compress

Omega 3 Oral Supplement

Punctal Plugs

Cyclosporine

Ophthalmic

Emulsion

0.05%

Avenova Lid Cleanser

Daily lid and lash

cleanser containing

non-stinging

Hypocholorous Acid

(0.01%)

Doxycycline vs Azithromycin

Doxycycline Tablets AzaSite

Doxycycline is a broad-

spectrum antibiotic

synthetically derived.

Available in:

50, 75, 100 & 150 mg

AzaSite (azithromycin

ophthalmic solution) is a

1.0% sterile aqueous

topical ophthalmic

solution.

IPL

FITZPATRICK CLASSIFICATION

SKIN TYPE DESCRIPTION

ICaucasian: Very light complexion, light eyes, freckles,

usually blonde or reddish hair color.

IICaucasian: Light complexion, light eyes, occasional to

frequent freckles, blonde, reddish, light brown hair color

IIIDarker Caucasian, light Asian: Medium complexion, light to

dark eyes, hair color usually brown to dark.

IVMediterranean, Asian, Hispanic: darker complexion, dark

eyes, dark brown to black hair color.

VMiddle Eastern, Latin American, light-skinned black, Indian:

Dark complexion, dark eyes, usually black hair color.

VIDark-skinned black: Black complexion, black eyes, black

hair color.

Contraindications for IPL

• Tanned skin (active tan)

• Pregnancy

• A history of keloid scarring

• Use of medication that may induce photosensitivity

to the skin

• Any inflammatory skin condition at the treatment site

• A history of skin cancer

• A history of poor wound healing including Type I

Diabetes

• Vitiligo

• Treatment over certain skin areas such as tattoos,

moles, semi-permanent make-up, lip vermillion or

mucous membranes

How the IPL Device Works

A Xenon flashlamp emits (like a camera flash) energy in a

band from the base of the visible spectrum (500 nm) to the

border between the near and mid-IR (1,300 nm). The flashlamp

is filtered to allow light of 500 to 800nm to pass through. The

light is pulsed in milliseconds depending on the setting.

100 nm 400 nm 700 nm

InfraredUltraviolet Visible

100,000 nm

papillary dermis

Visible light

epidermis

dermis

penetrates to the deeper dermis

subsurface heating is variable

From 500 nm to 800 nm

Who are IPL candidates?

• Patients with MGD

• Patients with OSD

• Patients with evaporative DED

• Patients with Ocular Rosacea

IPL Demonstration

IPL

Every 4 – 5

Weeks

for a series of 4

Maintenance

Treatment is

Individualized

Every 4 – 6 Months

Serum Tears

The cost to the patient is $286 + $40 shipping + cost of

the blood draw if not covered by insurance.

The cost of serum tear preparation by Leiter's

Compounding Pharmacy in California ($286) and

shipping ($40) are not covered by insurance.

Questions?

Cynthia Matossian, MD, FACS

cmatossian@matossianeye.com