Recent
dry eye research looked into the various ways of treating dry eye and
weather if they actually worked. The categories included: Acupuncture,
Diagnostics and Economics of dry eye treatment.
This is a summary of what is being discussed in the ARVO abstracts published in the journal
Investigative Ophthalmology and Visual Science. The information can also be found online at
www.IOVS.org.
Alternative Treatments
1. Acupuncture
Acupuncture
is among the oldest healing practices in the world. 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. Acupuncture is great in reducing stress and anxiety which can
cause dry eyes.
Diagnostics
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. A study showed immediate viewing of lissamine
green after instillation resulted false staining appearance. Viewing
after 2 minutes is a getter choice.
Common protocol is for sodium fluorescein staining which requires immediate viewing after instillation gives accurate results.
Economics of Dry Eye Treatment
Prescription Eye Drop treatment cost tripled
The rising cost of prescription medications is a concern to all
patients, and doctors alike, and dry eye medications are no exception.
Prescription 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. The group’s finding was "strongly driven by the
introduction of Prescription Eye Drop in 2003 as 84% of prescriptions
filled and 91% of expenditures in 2005-06 were related to Prescription
Eye Drop. By now 2013, the cost of this prescription eye drop has
tripled.
The study also 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).
Punctal Plug Usage Declined
Another
interesting study of dry eye economics came from Duke University where
researchers studied punctual plug usage and reimbursement in Medicare
patients. 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.”
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 proliferation,” indicating that “people
with hyperosmolar tears or dry eye will have decreased antibacterial
defense at the ocular surface.”
Treatment Efficacy
Azithromycin more effective than Doxycycline for Meibomian Gland Dysfunction and Contact Lens Dry Eyes
There
are several studies concerning the use of topical azithromucin in
ocular surface diseases. . Dr. Gary Foulks and his group at the
University of Louisville compared the effectiveness of topical
azithromucin versus oral doxycycline therapy in meibomian gland
dysfunction ( Belpharitis) Twenty-two subjects were treated with topical
azithromycin solution for one month and seven subjects were treated
with oral doxycycline for two months. The study concluded that while
both topical azithromycin and oral doxycycline improved clinical signs
and symptoms of meibomian gland dysfunction, the "response to
azithromycin is more rapid and more robust than doxycycline."
Yet
another study from the Ohio State University School of Optometry
evaluated the efficacy of a four-week treatment with topical 1.0%
azithromycin solution versus rewetting drops in patients with contact
lens related dry eye. An over two-hour improvement in comfortable
contact lens wear time was noted throughout the four-week study period
with azithromycin solution use.
Glaucoma Therapy not related to Dry Eyes
Several
studies explored the effect of topical glaucoma therapy on dry eye. A
French group found tear osmolarity increased in patients treated for
glaucoma or ocular hypertension (glaucoma), particularly in those using
eyedrops with multiple preservatives. Another study from France found
the chronic administration of eyedrops containing preservatives may
decrease corneal sensitivity in patients treated with intraocular
pressure lowering medications. This decrease in corneal sensitivity
could explain the absence of correlation between signs and symptoms of
dry eye disease in patients treated for glaucoma or ocular hypertension.
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