EyeWorld India March 2018 Issue

March 2018 57 EWAP PHARMACEUTICALS shows the most efficacy,” Dr. Hol- land said. Probing the glands can also be useful in Meibomian gland disease patients. “There are some patients in which the glands are capped, so uncapping the gland makes sense,” Dr. Holland said. “Any time we do a LipiFlow treatment, we’ll uncap any keratinization.” For this, you could use the Maskin probe or the tip of a needle, he explained, add- ing that you can do mild expres- sion of the oil to prepare the gland for LipiFlow. Practitioners are much more likely to realize that Meibomian gland disease is a huge part of dry eye these days. “In the past, if you said ‘dry eye,’ clinicians and patients would automatically think aqueous tear deficiency, and many of them still do,” Dr. Holland said. “But Meibomian gland disease is a much more common form of dry eye than aqueous deficiency.” Practitioners are finally now realiz- ing the importance of Meibomian gland disease and the strategies for treating this, he concluded. Neurostimulation therapy (True Tear, Allergan, Dublin, Ireland) was recently approved for the improvement of tear produc- tion in patients with dry eye. This handheld, external, low voltage device produces signals through the anterior ethmoidal nerve that emulate natural afferent trigeminal stimuli for the constitutive produc- tion of all three major components of the tear film. Because neuro- stimulation is neither surgical nor pharmaceutical, it provides a novel, unique, and potentially synergistic modality for dry eye patients utilizing other regimens, said Dr. Sheppard. Ultimately, each individual patient will require a targeted evaluation by an inquisitive eye care provider to determine the best combination of treatments for their condition. Dry eye is a multifactorial disease, necessitating a carefully orchestrated and often multimodal therapeutic attack directed by consistent visits to the same managing ophthalmologist or optometrist, said Dr. Sheppard. EWAP References 1. Sheppard JD Jr, et al. Long-term supple- mentation with n-6 and n-3 PUFAs improves moderate-to-severe keratoconjunctivitis sicca: a randomized double-blind clinical trial. Cornea. 2013;32:1297–304. 2. Epitropoulos AT, et al. Effect of oral re- esterified omega-3 nutritional supplementa- tion on dry eyes. Cornea. 2016;35:1185–91. 3. Jones L, et al. TFOS DEWS II Manage- ment and Therapy Report. Ocul Surf. 2017;15:575–628. 4. Deinema LA, et al. A randomized, double-masked, placebo-controlled clinical trial of two forms of omega-3 supplements for treating dry eye disease. Ophthalmol. 2017;124:43–52. Editors’ note: Dr. Downie has finan- cial interests with Alcon (Fort Worth, Texas), Allergan, and CooperVision (Lake Forest, California). Dr. Holland has financial interests with Physician Recommended Nutriceuticals (Blue Bell, Pennsylvania). Dr. Sheppard has financial interests with Johnson & Johnson Vision and ScienceBased Health. Contact information Downie: ldownie@unimelb.edu.au Holland: eholland@holprovision.com Sheppard: jsheppard@vec2020.co