Comments for The Dry Eye Review http://thedryeyereview.com Industry Experts blogging about Dry Eye Disease Thu, 15 Dec 2011 20:33:56 +0000 hourly 1 http://wordpress.org/?v=3.3 Comment on TearLab Achieves Equal Reimbursement Across All States by Richard C. Rashid http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/kW4p0q3cYKw/ Richard C. Rashid Thu, 15 Dec 2011 20:33:56 +0000 http://thedryeyereview.com/?p=1277#comment-87 Congratulations on the CLIA waiver! WE as others had problems with COLA and were ready to throw in the towel,but now we can do what we should be doing, TREATING DRY EYES. As a DRY EYE NUT ,I see this as a major MILESTONE!! Congratulations on the CLIA waiver! WE as others had problems with COLA and were ready to throw in the towel,but now we can do what we should be doing, TREATING DRY EYES. As a DRY EYE NUT ,I see this as a major MILESTONE!!

]]> http://thedryeyereview.com/2011/12/tearlab-achieves-equal-reimbursement-across-50-states/comment-page-1/#comment-87 Comment on It’s just Dry Eye Disease. Who Cares? by Rebecca Petris http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/mgko6skAWEg/ Rebecca Petris Thu, 22 Sep 2011 07:06:09 +0000 http://thedryeyereview.com/?p=656#comment-71 This is an issue I deal with constantly. I spend my days on the phone with people who are suffering extremes of anxiety and depression from constant severe eye pain and whose doctors are surprisingly unhelpful. I spend hours helping them navigate the practical steps towards getting pain under control - too often without any help or support or guidance from their doctor. To me, it's become sadly routine. Considering that the cornea is just about the most innervated tissue in the body, WHY is there such a disconnect? It defies reason. Why are ophthalmologists as a body so slow to grasp the reality of eye pain? I tell patients that it is just a reality they have to accept - but I wish, oh how I wish, that I could tell them why. Sigh. This is an issue I deal with constantly. I spend my days on the phone with people who are suffering extremes of anxiety and depression from constant severe eye pain and whose doctors are surprisingly unhelpful. I spend hours helping them navigate the practical steps towards getting pain under control – too often without any help or support or guidance from their doctor. To me, it’s become sadly routine.

Considering that the cornea is just about the most innervated tissue in the body, WHY is there such a disconnect? It defies reason. Why are ophthalmologists as a body so slow to grasp the reality of eye pain? I tell patients that it is just a reality they have to accept – but I wish, oh how I wish, that I could tell them why.

Sigh.

]]> http://thedryeyereview.com/2011/08/its-just-dry-eye-disease-who-cares/comment-page-1/#comment-71 Comment on Omega 3′s and Omega 6′s. What’s the right Balance? by mgross http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/HGK1HjCcVZg/ mgross Tue, 02 Aug 2011 20:59:07 +0000 http://thedryeyereview.com/?p=639#comment-68 There are certainly many points of misinformation in this article, but the 1:1 balance of Omega-3 and Omega-6 is NOT one of them. As Omega-6 is pro-inflammatory and Omega-3 is anti-inflammatory this equation is as simple as "for every action there is an equal and opposite reaction." Axiomatic in nature and physiologic in our bodies. It is true that at a 1:4 ratio we begin to get some therapeutic anti-inflammatory response. The problem is that Western diets are 15-20 times more laden with pro-inflammatory Omega-6 and we certainly don't need to add more Omega-6 in the form of GLA to this equation which ultimately cascades down the conversion pathway into pro-inflammatory Arachadonic Acid. What is needed is to balance the patient with a therapeutic dose of Omega-3 EPA/DHA in the correct FORM. We now know through the Omega-3 Index evidence that this therapeutic dose is between 1-3 grams daily of Triglyceride form EPA/DHA. Finally, it should be noted that fish oil in Triglyceride form does not impact clotting (Am J Cardiol 2007; 99[suppl]:44C-46C) and that flax oil (ALA) has little or no Omega-3 value especially when compared to EPA/DHA (J.Lipid Research 2001. 42:1257-1265). There are certainly many points of misinformation in this article, but the 1:1 balance of Omega-3 and Omega-6 is NOT one of them. As Omega-6 is pro-inflammatory and Omega-3 is anti-inflammatory this equation is as simple as “for every action there is an equal and opposite reaction.” Axiomatic in nature and physiologic in our bodies. It is true that at a 1:4 ratio we begin to get some therapeutic anti-inflammatory response. The problem is that Western diets are 15-20 times more laden with pro-inflammatory Omega-6 and we certainly don’t need to add more Omega-6 in the form of GLA to this equation which ultimately cascades down the conversion pathway into pro-inflammatory Arachadonic Acid. What is needed is to balance the patient with a therapeutic dose of Omega-3 EPA/DHA in the correct FORM. We now know through the Omega-3 Index evidence that this therapeutic dose is between 1-3 grams daily of Triglyceride form EPA/DHA. Finally, it should be noted that fish oil in Triglyceride form does not impact clotting (Am J Cardiol 2007; 99[suppl]:44C-46C) and that flax oil (ALA) has little or no Omega-3 value especially when compared to EPA/DHA (J.Lipid Research 2001. 42:1257-1265).

]]> http://thedryeyereview.com/2011/07/omega-3s-and-omega-6s-whats-the-right-balance/comment-page-1/#comment-68 Comment on Omega 3′s and Omega 6′s. What’s the right Balance? by eyexam http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/sWOcmsz3aPA/ eyexam Mon, 25 Jul 2011 04:25:19 +0000 http://thedryeyereview.com/?p=639#comment-67 We DO know the proper balance between Omega-3 and Omega-6 EFAs and it's NOT the 1:1 that this article alludes to. It's 1:4 (more Omega-6) and just throwing some pills at the problem is not enough. We (eye doctors) need to address diet issues with patients, because they don't know how to balance things properly. Hopefully, the doctors do..... Jeff Anshel We DO know the proper balance between Omega-3 and Omega-6 EFAs and it’s NOT the 1:1 that this article alludes to. It’s 1:4 (more Omega-6) and just throwing some pills at the problem is not enough. We (eye doctors) need to address diet issues with patients, because they don’t know how to balance things properly. Hopefully, the doctors do…..

Jeff Anshel

]]> http://thedryeyereview.com/2011/07/omega-3s-and-omega-6s-whats-the-right-balance/comment-page-1/#comment-67 Comment on In My Practice: TearLab, a year in review – Jerry Nolfi, OD by William Trattler http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/9VyJgzj5RAU/ William Trattler Mon, 25 Apr 2011 02:53:02 +0000 http://thedryeyereview.com/?p=500#comment-65 Thank you Dr. Nolfi - I appreciate your thoughts and comments. As you are aware - inflammation is important in the underlying cause of both aqueous deficient dry eye and meibomian gland dysfunction. Numerous studies, beginning with studies by Steve Pflufgfelder more than 2 decades ago, have shown that topical steroids can play an important role in reducing the signs and symptoms of dry eye. A short course of topical steroids will reduce inflammation, reduce corneal staining, improve tear break up time, and also help with patient symptoms. I typically jump start many of my patients that I put on Restasis with a short course of topical steroids. One of the beautiful things about using Tear Lab is that you can track the improvement of patients with different therapies. I believe that you will find that patients placed on a short course of topical steroids plus hypotonic tears will have a more dramatic reduction in tear film osmolarity than using hypotonic tears alone. If you give this regimen a try and get some tear lab data - please let me know via email. Best regards Bill Trattler, MD wtrattler@gmail.com Thank you Dr. Nolfi – I appreciate your thoughts and comments.
As you are aware – inflammation is important in the underlying cause of both aqueous deficient dry eye and meibomian gland dysfunction. Numerous studies, beginning with studies by Steve Pflufgfelder more than 2 decades ago, have shown that topical steroids can play an important role in reducing the signs and symptoms of dry eye. A short course of topical steroids will reduce inflammation, reduce corneal staining, improve tear break up time, and also help with patient symptoms. I typically jump start many of my patients that I put on Restasis with a short course of topical steroids.
One of the beautiful things about using Tear Lab is that you can track the improvement of patients with different therapies. I believe that you will find that patients placed on a short course of topical steroids plus hypotonic tears will have a more dramatic reduction in tear film osmolarity than using hypotonic tears alone.
If you give this regimen a try and get some tear lab data – please let me know via email.
Best regards

Bill Trattler, MD
wtrattler@gmail.com

]]> http://thedryeyereview.com/2011/04/tearlab-in-my-practice-a-year-in-review/comment-page-1/#comment-65 Comment on In My Practice: TearLab, a year in review – Jerry Nolfi, OD by Dr. Jerry Nolfi http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/0a-ivfucO60/ Dr. Jerry Nolfi Wed, 20 Apr 2011 02:19:54 +0000 http://thedryeyereview.com/?p=500#comment-64 Dr. Trattler, Thank you for your comments. My treatment approach to dry eye patients has really evolved due to the DEWS report and the introduction of TearLab. As you know, the DEWS report noted elevated tear osmolarity as a pro-inflammatory factor for the ocular surface. Consequently, my treatment approach to dry eye was not only reactive (sign or symptom driven) but also significantly more proactive and osmolarity driven. If I could identify patients EARLIER in the disease process I could limit the effect of elevated tear osmolarity on the ocular surface. This is exactly what I have done with a number of patients in my clinic. Here is a simple treatment plan for a patient with elevated osmolarity: 1. detailed case history to identify any pro-dry eye behaviours and modify as necessary 2. comprehensive slit exam to identify any other pro-dry eye conditions - e.g. MGD - and treat as necessary 3. introduce a hypotonic ocular lubricant - I usually get patients to dose at least 2 to 4 times per day 4. book a 1 month follow-up exam Most of the follow-up exams proved quite successful and reinforced my approach. I found these asymptomatic patients were much more compliant when they were aware of a quantitative benchmark. They were eager to reduce their osmolarity number and were active participants in their treatment like a co-operative glaucoma patient. They appreciated my proactive and preventative strategy and TearLab made that clinically and scientifically possible. Restasis has just been approved in Canada and for now is limited access to ophthalmologists only. I do believe topical steroids have a significant role to play in treating symptomatic patients with dry eye-related inflammation and returning the ocular surface to a more normal state. But, in my opinion, they do not deal with the underlying cause of dry eye. Once I get the patients more comfortable, I really try to address the underlying cause and TearLab has been a useful and complementary part of that strategy. Dr. Nolfi Dr. Trattler,

Thank you for your comments. My treatment approach to dry eye patients has really evolved due to the DEWS report and the introduction of TearLab. As you know, the DEWS report noted elevated tear osmolarity as a pro-inflammatory factor for the ocular surface. Consequently, my treatment approach to dry eye was not only reactive (sign or symptom driven) but also significantly more proactive and osmolarity driven. If I could identify patients EARLIER in the disease process I could limit the effect of elevated tear osmolarity on the ocular surface. This is exactly what I have done with a number of patients in my clinic. Here is a simple treatment plan for a patient with elevated osmolarity:

1. detailed case history to identify any pro-dry eye behaviours and modify as necessary
2. comprehensive slit exam to identify any other pro-dry eye conditions – e.g. MGD – and treat as necessary
3. introduce a hypotonic ocular lubricant – I usually get patients to dose at least 2 to 4 times per day
4. book a 1 month follow-up exam

Most of the follow-up exams proved quite successful and reinforced my approach. I found these asymptomatic patients were much more compliant when they were aware of a quantitative benchmark. They were eager to reduce their osmolarity number and were active participants in their treatment like a co-operative glaucoma patient. They appreciated my proactive and preventative strategy and TearLab made that clinically and scientifically possible.

Restasis has just been approved in Canada and for now is limited access to ophthalmologists only. I do believe topical steroids have a significant role to play in treating symptomatic patients with dry eye-related inflammation and returning the ocular surface to a more normal state. But, in my opinion, they do not deal with the underlying cause of dry eye. Once I get the patients more comfortable, I really try to address the underlying cause and TearLab has been a useful and complementary part of that strategy.

Dr. Nolfi

]]> http://thedryeyereview.com/2011/04/tearlab-in-my-practice-a-year-in-review/comment-page-1/#comment-64 Comment on In My Practice: TearLab, a year in review – Jerry Nolfi, OD by William Trattler http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/NGmy91IEm4I/ William Trattler Tue, 19 Apr 2011 14:34:20 +0000 http://thedryeyereview.com/?p=500#comment-62 Dr. Nolfi, Very nice article. Can you share a few case stories where tear lab actually altered the way you treated a patient. Obviously we have many tools for diagnosing dry eye, and it is nice to have an objective test like tear film osmolarity But I am specifically curious as to cases where the tear film osmolarity result has altered the way that you have treated a particular patient - maybe by extending or shortening treatment with topical steroids or topical cyclosporine. I appreciate your thoughts Best regards William Trattler, MD Miami, FL Dr. Nolfi,
Very nice article. Can you share a few case stories where tear lab actually altered the way you treated a patient. Obviously we have many tools for diagnosing dry eye, and it is nice to have an objective test like tear film osmolarity But I am specifically curious as to cases where the tear film osmolarity result has altered the way that you have treated a particular patient – maybe by extending or shortening treatment with topical steroids or topical cyclosporine.
I appreciate your thoughts

Best regards

William Trattler, MD
Miami, FL

]]> http://thedryeyereview.com/2011/04/tearlab-in-my-practice-a-year-in-review/comment-page-1/#comment-62 Comment on ASCRS presentations confirm the importance of Pre-operative care for Dry Eye Patients by David Eldridge, OD, FAAO http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/7Vs4Vl97lk4/ David Eldridge, OD, FAAO Thu, 07 Apr 2011 15:10:01 +0000 http://thedryeyereview.com/?p=459#comment-56 This was a great presentation. Nutritional Therapies are absolutely an area in both Anterior Seg and Retina that many are now finding beneficial to their patients. Keep up the good work! D Eldridge This was a great presentation. Nutritional Therapies are absolutely an area in both Anterior Seg and Retina that many are now finding beneficial to their patients.
Keep up the good work!
D Eldridge

]]> http://thedryeyereview.com/2011/04/ascrs-presentations-confirm-the-importance-of-pre-operative-care-for-dry-eye-patients/comment-page-1/#comment-56 Comment on ASCRS presentations confirm the importance of Pre-operative care for Dry Eye Patients by eyexam http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/gWDAw28dDyg/ eyexam Wed, 06 Apr 2011 15:14:43 +0000 http://thedryeyereview.com/?p=459#comment-55 There was also a great presentation by Dr. Jeffrey Anshel and Dr. Stuart Richer of the Ocular Nutrition Society on: "Nutritional Therapies to Enhance Your Surgical Outcomes" presented at ASCRS as well. This presentation dealt with both anterior (cornea/tear film) and posterior (retina) concerns regarding surgical intervention. OK, so I was one of the presenters....but still heard it was a great presentation!! Jeff Anshel There was also a great presentation by Dr. Jeffrey Anshel and Dr. Stuart Richer of the Ocular Nutrition Society on: “Nutritional Therapies to Enhance Your Surgical Outcomes” presented at ASCRS as well. This presentation dealt with both anterior (cornea/tear film) and posterior (retina) concerns regarding surgical intervention.

OK, so I was one of the presenters….but still heard it was a great presentation!!

Jeff Anshel

]]> http://thedryeyereview.com/2011/04/ascrs-presentations-confirm-the-importance-of-pre-operative-care-for-dry-eye-patients/comment-page-1/#comment-55 Comment on TearLab Osmolarity – a New Gold Standard, VALIDATED! by Tweets that mention TearLab Osmolarity – a New Gold Standard, VALIDATED! | Dry Eye Disease Review -- Topsy.com http://feedproxy.google.com/~r/CommentsForTheDryEyeReview/~3/rTJuP2i0hGg/ Tweets that mention TearLab Osmolarity – a New Gold Standard, VALIDATED! | Dry Eye Disease Review -- Topsy.com Tue, 08 Feb 2011 17:09:54 +0000 http://thedryeyereview.com/?p=409#comment-50 [...] This post was mentioned on Twitter by simovisionbv, TearLab. TearLab said: #TearLab #Osmolarity – a New Gold Standard, VALIDATED! http://goo.gl/fb/e9MfA #dryeyedisease #generalpractice [...] [...] This post was mentioned on Twitter by simovisionbv, TearLab. TearLab said: #TearLab #Osmolarity – a New Gold Standard, VALIDATED! http://goo.gl/fb/e9MfA #dryeyedisease #generalpractice [...]

]]> http://thedryeyereview.com/2011/02/tearlab-osmolarity-%e2%80%93-a-new-gold-standard-validated/comment-page-1/#comment-50