Dry Eye Blog
Welcome to the first dry eye blog on the web. My research on dry eye began as a medical student in 1976 and I have been productively obsessed with the subject, to the benefit of dry eye patients, ever since. I also maintain an educational web
New Study Shows TheraTears Prevents Dry-Eye Dry Spots Best
In a new study presented last week at the annual meeting of the Association for Research in Vision and Ophthalmology (ARVO 2007) Jacob, Edwards and Gianelloni from the LSU Health Sciences Center tested the majority of artificial tear solutions available today and found that TheraTears lubricant eye drops prevented tear film rupture and dry spot formation better than any other drop tested. TheraTears maintained normal tear film stability for 30 minutes after the instillation of a single drop, even though it was the least viscous eye drop tested. Genteal and Celluvisc maintained normal tear film stability for only 15 minutes, Refresh Plus for only 10 minutes, and Tears Naturale Free for only 5 minutes. Bion Tears never improved tear film stability to the level seen in normal eyes.
In the past doctors and scientists believed that the thicker an eye drop was, the better it would improve tear film stability. Now this new data suggests other properties of the eye drop may be more important in stabilizing the tear film, and that, currently, TheraTears is the best choice for dry eye patients who have unstable tear films.
The study was funded by a Core Grant to the LSU Eye Center from the National Eye Institute, and an unrestricted grant from Research to Prevent Blindness.
New Study Shows Restasis Offers no Dry-Eye Relief following LASIK
Previously the FDA, after reviewing Restasis data from a large prospective, randomized, double-masked, vehicle-controlled clinical trial involving over 1,200 patients, concluded that Restasis (cyclosporine 0.05%) has no effect on dry-eye symptoms or surface staining (data and FDA discussion available in full at www.fdarestasisdata.org
Now a new study reports that Restasis has no effect on patient symptoms (as indicated by the Ocular Surface Disease Index Questionaire) or surface staining, verses control, in the dry eye that results after LASIK. The prospective, double-masked, placebo-controlled clinical trial of Restasis has been published in the Journal of Cataract and Refractive Surgery (Salib GM; McDonald MB; Smolek M: Safety and efficacy of cyclosporine 0.05% drops versus unpreserved artificial tears in dry-eye patients having laser in situ keratomileusis. J Cataract Refract Surg 2006 May;32(5):772-8).
Cyclosporine is an immunosuppressant that suppresses inflammation. This paper adds to the accumulating evidence that ocular surface inflammation does not contribute to dry-eye patient symptoms, and suggests that patients looking for dry-eye relief after LASIK should look to other therapies.
New Treatment for Blepharitis
Blepharitis, inflammation of the anterior or posterior eyelid margin, has been shown to be associated with bacterial overgrowth on the lids.
For anterior blepharitis, lid hygiene with baby shampoo has been standard practice, but has been disappointing in managing this condition. Baby shampoo is not antibacterial and with regular use can dry the skin.
For posterior blepharitis (meibomitis), treatment with hot compresses to the lids and, in more severe cases, systemic tetracylines are commonly used. More recently, TheraTears Nutrition (omega-3 supplement with flaxseed and fish oil) has proven useful in mild to moderate cases and, in severe cases, it has proven useful in conjunction with a short course of a low dose tetracycline (i.e. 50 mg of minocycline for 1 month). TheraTears Nutrition decreases the inflammation of posterior blepharitis, while tetracyclines decrease inflammation and decrease the associated bacterial overgrowth.
Tetracycline treatment in women is now recommended to be low dose and short term, in cases where no alternative is available, given that long-term use may be associated with increased risk for breast cancer. To read more about this possible association click HERE. There is no known association between cancer and antibiotic use in men.
Now a new treatment, presented last week at the Annual Meeting of the Canadian Ophthalmological Society promises to be helpful in the treatment of all blepharitis patients. SteriLid, a new foam eyelid cleanser containing a natural plant oil called linalool, was shown to be bactericidal for the gram positive and gram negative bacteria commonly found on the lid margin is patients with blepharitis. SteriLid is available without a prescription.
Study Suggests Majority of Dry-Eye Patients Have No Eye Surface Inflammation
In a new study published this month in Investigative Ophthalmology (2006:47:2445-2450), Narayanan and co-workers report the results of a study of patients with moderate dry eye. This is an important group because according to a paper by Lemp and referenced by the authors, "nearly two thirds of persons with dry eye have a moderate form of the disease, NS KCS (non-Sjögren's dry eye)." In other words, the authors are reporting on the type of dry eye most people with dry eye have.
They found that although these patients had a significant level of dry-eye irritation, increased tear film osmolarity (increased salt concentration in their tears), definite eye surface damage as evidenced by flourescein and lissamine green vital dye staining, shorter tear-film breakup times (instability of their tear film) and delayed tear clearance (with decreased tear production the tears stay in the eye longer), there was no increase in inflammatory cytokine expression on the eye surface.
They conclude, ""Even though this small amount of ocular surface damage was adequate to cause significant dry eye symptoms in our study, it might not have been enough to up regulate IL-1b and the other inflammatory cytokines to a detectable level...In summary, the results of the present study indicate that the role of IL-1b inflammation in the pathogenesis of ocular surface damage in moderate dry eye is questionable."
This paper provides yet more evidence that inflammation of the eye surface does not cause symptoms of dry eye, and continues to support the theory that elevated tear film osmolarity causes the symptoms of dry eye, and drives the changes that subsequently develop on the ocular surface. Earlier studies that had found increased expression of inflammatory cytokines on the ocular surface had studied a rarer group of patients with more severe disease. We can hypothesize that in these patients the inflammatory process represents part of the ocular surface healing response.
In addition the paper decreases the rationale for the broad use of topical anti-inflammatory treatments in the majority of dry-eye patients. To read the paper, click HERE
Clinical Trial Demonstrates TheraTears Nutrition (omega-3 supplement) Helps Dry Mouth
In a prospective, double-masked, randomized, placebo-controlled clinical trial in Sjogren's patients, Drs. A. Singh, M.L. Sing and A.S. Papas have found that TheraTears Nutrition, a unique patented omega-3 supplement that blends flaxseed oil and fish oil to provide both short chain and long chain omega-3s, produces a significant improvement in salivary flow in these patients with dry mouth(P<0.025). The findings were presented at the The IXth International Symposium of Sjogren's Syndrome, held in Washington, DC between April 27th and 29th.
This is the first treatment for dry mouth that has been shown to increase baseline rates of saliva production while having additional health benefits. TheraTears Nutrition is also helpful for relief of dry eyes and arthritis in patients with Sjogren's syndrome.
Major pharamaceutical companies debate dry eye and dry-eye treatment
Several months ago the the directors for the dry-eye research and development programs at Advanced Vision Research, Alcon, Allergan and Alimera Sciences (the guys who develop the artificial tears, nutritional supplements and prescription medications for dry eye) sat down around a table for a lively discussion about dry eye and its treatment. The format was like the presidential debates--the moderators developed questions that were kept secret until asked at the roundtable, each director had 2 minutes to answer each question in turn, and then there was the opportunity for a 30-second rebuttal. The whole proceeding was taped, transcribed and then published by "Review of Cornea & Contact Lens." This is the first time anyone has ever done this, and provides a unique opportunity to hear, unfiltered, from the people behind the treatments. And just like when you watch the presidential debates, you get to decide who "won." Except rather than voting for someone, you will know just how you want to treat dry eye. Click HERE
to read the debate.
Omega-3s May Fight Dry Eye Syndrome
Dry eye syndrome in women may be caused by a dietary deficiency of omega-3s—essential fatty acids usually provided in the diet by fish such as tuna or salmon, according to a new U.S. study published in the American Journal of Clinical Nutrition. To read the article click HERE
.Consuming sufficient omega-3s may reduce dry eye risk by 68 percent. The study analyzed data from surveys collected from more than 37,000 women enrolled in the Brigham and Women’s Hospital-based Women’s Health Study.
Specifically, the study found:
Given the warnings by the FDA regarding mercury and tuna fish, I don’t recommend dry eye patients eat tuna 5 or more times per week. Salmon and anchovies are very low in mercury, and would be a better choice. For those of his patients who find this difficult or impossible, I recommend TheraTears Nutrition, a purified omega-3 supplement that has been very successful clinically.
- Women with the highest levels of dietary intake of omega 3 reduced their risk of dry eye syndrome by 20 percent, compared to women with the lowest levels of omega 3 in their diets.
- A dietary ratio of omega 6 to omega 3 greater than 15:1 was associated with a 2.5 times increased risk of dry eye syndrome. Currently, the average American diet has a similar ratio of omega 6 to omega 3, the study noted.
- Women who reported having at least five servings of tuna per week were at a 68 percent reduced risk of dry eye syndrome, compared to women who had one serving of tuna per week.
- Other kinds of fish that contain lower levels of omega 3 didn't seem to help protect against dry eye syndrome.
Increased tear osmolarity (salt concentration) causes eye surface inflammation
New research confirms elevated tear osmolarity (increased salt in the tears) causes dry-eye surface disease. In an article published this month in Eye & Contact Lens Luo, Li, Corrales and Pflugfelder demonstrate that ocular surface inflammation in dry eye is caused by elevated tear film osmolarity. Click HERE
to read this important article.
Some had believed that there was a direct inflammatory attack on the eye surface independent of the decrease in tear production or increase in tear film evaporation that is characteristic of dry-eye disease. We now know this is untrue.
I had the opportunity to write an editorial on this paper that highlights the important treatment ramifications of this research. Click HERE
to read this editorial.
Dry Eye Blog
Welcome to the first dry eye blog on the web. My research on dry eye began as a medical student in 1976 and I have been productively obsessed with the subject, to the benefit of dry eye patients, ever since. I also maintain an educational web site at www.dryeyeinfo.org
. I hope patients and doctors find this blog a useful way to keep up to date on the latest thoughts, news, research and information on dry eye.
Jeffrey P. Gilbard, MD
Clinical Assistant Professor of Ophthalmology, Harvard Medical School
Director of the Dry Eye and Ocular Surface Disease Clinic,
New England Eye Center
Founder, CEO & Chief Scientific Officer, Advanced Vision Research
Inventor of TheraTears (www.theratears.com)