O.D.S REVEAL HOW MANAGING THEIR OWN DRY EYE DISEASE INCREASED PATIENT CARE

Sarah Mackie, Whitney Hauser and Margie Recalde not only have an optometry degree in common, they also share dry eye disease (DED) and, as a result, experiences with DED diagnostic testing and treatments. The bonus of these experiences: strong bonds with their DED patients — something all credit with instilling patient confidence in their care and practitioner loyalty.

DED BEGINNINGS

Dr. Mackie says her DED started 12 years ago after she underwent LASIK.

“Immediately after that, my eyes were dry, which is normal. A year later, however, they felt severely dry, so I had a colleague test me, and he said I had a lot of superficial punctate keratitis,” she explains.

Dr. Hauser says she underwent tear osmolarity, phenol red thread testing, meibography and meibomian gland expression about three years ago after experiencing situational exacerbations of ocular dryness, such as from long flights. The outcome of the tests: moderate DED.

“My DED started about 10 years ago as mild and worsened to moderate after I had LASIK,” explains Dr. Recalde. “I underwent staining, TBUT testing, osmolarity and meibomian gland expression, all of which showed evaporative DED.”

TREATMENT DECISIONS

In formulating their individual management plans, all say they used their knowledge of DED and the specific treatments available to determine what to use.

Dr. Mackie says she’s used artificial tears, ointment before bedtime (to deal with a recurrent corneal erosion), a chewable omega-3 supplement for children (which she later replaced with a nutritional supplement that includes omega fatty acids), a prescription drug, b.i.d., and punctal plugs. (For a listing of ocular nutritional supplements, see p.27.)

“I’ve taken artificial tears, a prescription drug, a nutritional supplement that includes omega fatty acids, and I, occasionally, use a silicone-beaded mask,” explains Dr. Hauser.

Dr. Recalde says she’s used artificial tears, punctal plugs, a prescription drug, ointment at bedtime (during flare-ups), a nutritional supplement that includes omega fatty acids and an eye-friendly make- up remover.

“For each patient, it’s going to be a custom treatment,” explains Dr. Mackie, “so you have to figure out the right mix, which can take some time.”

STRONG PATIENT BONDS

Drs. Mackie, Hauser and Recalde credit their personal experiences with DED for providing their DED patients with a high level of care.

“Since telling patients that I, too, have DED, I find they listen better and are more amenable to the treatments I prescribe,” explains Dr. Mackie. “They feel like, ‘OK. She’s asking me to do all this stuff that sounds miserable and time-consuming, but she’s doing it too!’”

Dr. Hauser adds that when she talks to her DED patients and says, “In my case…” she can see a certain level of confidence and peace that statement brings them because they feel like they’re not only talking to a doctor, but a peer who shares their plight.

“DED can make patients absolutely miserable, so in having that experience myself and having reached my goal of relief, I feel like that gives them hope to not give up,” explains Dr. Recalde.

The take home about diagnosing and treating DED:

“Take the time with DED patients. They need you to explain everything you’re doing with them, and give them written instructions, because it can be overwhelming at times when we discuss various treatments for their dry eyes,” explains Dr. Recalde. “Everyone wants a magic pill, but there is no one magic pill for everyone, so you need to reassure the patient that you’ll work with him or her until you find the magic treatment for him or her.” ■.

Dr. Mackie has no relationships to disclose.

Dr. Recalde is speaker for Allergan, Bausch + Lomb and Shire.

Dr. Hauser is a consultant, speaker or board member for: Akorn, Allergan, BioTek, BioTissue, Lumenis, NovaBay, Paragon Vision Sciences, Rysurg, TearLab, TearScience, Shire, ScienceBased Health and DryEyeCoach.com . She is also the author of Optometric Management’s “Dry Eye” column. Read more from her on p.36.

DUAL-FOCUS CONTACT LENS SLOWS MYOPIA PROGRESSION IN CHILDREN BY MORE THAN 50%

A dual focus one-day soft contact lens, from CooperVision (MiSight, not approved for myopia control in the United States), decreased myopia progression in children 59%, as measured by mean cycloplegic spherical equivalent, and 52%, as measured by mean axial elongation of the eye, vs. a single vision one-day contact lens worn by children in the control group of a prospective, multi-center, double-masked, randomized three-year study.

The study, presented at the British Contact Lens Association Clinical conference in Liverpool, England, June 9 to June 11, was comprised of 144 myopic children, ages 8 to 12 from Singapore, Canada, England and Portugal.

“The dual-focus lens is the first and only product recognized by a major Health Agency (CEE) as a myopia control device, and it tells the importance of the clinical results reported here,” says Langis Michaud, O.D., M.Sc., F.A.A.O, F.S.L.S., a myopia control expert, professor and chief of the contact lens department at École d’optométrie de ’Université de Montréal. “We have now multiple evidences that this lens, orthokeratology and other optical devices are able to significantly slow myopia and axial length progressions. In my opinion, every myopic child at risk should be offered a myopia control strategy. Ignoring what science tells us should be certainly considered malpractice but, most importantly, infringes any code of ethics (do not harm) I know.”

The lens did not negatively affect the wearer’s daily activities vs. the control group, and all subjects reported greater satisfaction with contact lenses vs. spectacles, reports the study. Also, most parents said they were “extremely at ease” with their children wearing contact lenses after one month of wear and on, and that their children could “mostly” manage their lens wear alone. ■

DAILY CONTACT LENSES EXCEED MONTHLIES IN DOLLAR SALES

The monthly sales of daily contact lenses were greater than monthly lenses in dollar sales for the first time, as of January 2017, comprising 38.1% market share, reveals GfK Point-of-Sales (POS) Tracking Data. (Gfk is a marketing research firm). In addition, these data show the daily lens segment is continuing to increase at a faster pace vs. any other modality, growing 21% in dollar volume year over year.

The reasons:

• New products and innovation in the segment. A total of 42% of the growth in daily contact lenses in 2016 was due to product launches in the year prior, these data reveal. Also, more than 77.9% of the growth in multifocal lenses alone (45.4%) was driven by 2015 product launches.
• Rising cost. The average cost of a daily contact lens has grown by more than 10 cents since 2012 due, in part, to higher-costing silicone hydrogel, multifocal and toric lenses within the space.

GfK data also show weekly, biweekly and monthly contact lens dollar data. (See http://bit.ly/2sJAdA9 )

Gfk POS data comes from U.S. brick-and-mortar opticians, independents and large chains. ■