Alternative Dry Eye Treatments
Acupuncture is among the oldest healing practices in the world. As part of traditional Chinese medicine, acupuncture aims to restore and maintain health through the stimulation of specific points on the body. The procedure has been touted as a treatment for low back pain, lung cancer and Attention Deficit Disorder. Thus it seems logical to investigate if there is any benefit in dry eye disease. A team of researchers from the U.S. Army performed acupuncture on seventeen volunteers with dry eye and found "there was no significant improvement in the measured clinical indicators of dry eye after acupuncture treatment.
The traditional method is to use lissamine green staining for the diagnosis of conjunctivitis. However, this dye then to dissipate over time and becomes less effective. Common protocol for sodium fluorescein staining usually entails immediate viewing after immediate instillation, but this study showed immediate viewing of lissamine green after instillation resulted in higher mean staining grades than at the two minute time point. The study concluded that a “false staining appearance occurs upon immediate instillation of lissamine green.
Economics of Dry Eye Treatment
The rising cost of prescription medications is a concern to all patients, and doctors alike, and dry eye medications are no exception. Prescirption eye drop is costly even after insurance payments to the patients. A group from Bascom Palmer retrospectively analyzed trends in dry eye medication use and expenditures from 2001 to 2006 and found the mean expenditure per patient per year increasing from $55 in 2001 to $299 by 2006 and now over $300 in 2013.. "The study found that women spent twice as much as men on dry eye medications ($244 versus $122) and that patients with greater than a high school education spent on average 2.5 times as much on dry eye medication as those with less than a high school education ($250 versus $100).
Another interesting study of dry eye economics came from Duke University where researchers studied punctual plug usage and reimbursement in Medicare patients. The group sought to determine whether changes in Medicare reimbursement for punctual plug insertion were associated with a decrease in the incidence of plug insertion. The group found that while the Medicare population-adjusted incidence of dry eye diagnosis increased by 28.5% in their study period of 2001-2008, first-time punctual plug insertion rates declined by 23.6%.7 The researchers also found that Medicare reimbursement for punctual plug insertion decreased 55.3% during the same time period. The authors concluded that the decline in punctual plug insertion “may be associated with the decrease in Medicare reimbursement” but in fact is more likely tied to their second reason for the reduction, “the introduction in 2003 of prescription eye drop.”
More recently, LipiFlow is now on the market to treat people with clogged meibomian glands. The cost is not reimbursable by healthcare insurance. It may require multiple treatments in order to keep the meibomian glands open.
Ocular Infections and Dry Eye
People with dry eye seem to have more ocular infections than the normal population. A study in Australia found the “antimicrobial effects of tear proteins decrease in hyperosmolar ( low tear viscosity) conditions leading to enhanced bacterial growth,” indicating that “people with hyperosmolar tears or dry eye will have decreased antibacterial defense at the ocular surface.”
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