Catch up on what happened in optometry during the week of August 21-August 25.
Catch up with what Optometry Times®' shared this week:
Mohammad Rafieetary, OD, FAAO, FORS, Dipl ABO, ABCMO
Until recently, when most eye care professionals encountered a patient with age-related macular degeneration (AMD), there was a true/false dilemma: Is it “wet” or not? Everything else got swept under the rug.
True, we discussed lifestyle modifications, dietary supplements, self-monitoring or remote monitoring of monocular vision, and low-vision aids, but we shied away from any meaningful discussion about dry AMD.
Euin Cheong, OD
Age-related macular degeneration (AMD) is a common condition that damages the central portion of the retina and affects vision over time. With AMD, observable characteristics such as accumulation of drusen, geographic atrophy, changes in the retinal pigment epithelial (RPE) layer, bleeding, and choroidal neovascularization (CNV) may occur.
Various macular dystrophies can resemble AMD due to the variety of clinical signs and symptoms. Clinicians may find it challenging to differentiate between the retinal conditions. Examples that are commonly confused with AMD include adult-onset foveomacular vitelliform dystrophy (AOFVD), polypoidal choroidal vasculopathy, butterfly-shaped pattern dystrophy, and cone dystrophy.
AMD is frequently misdiagnosed as AOFVD. Although there are distinguishing features, it is challenging to tell them apart due to similarities in the early stages. We will concentrate primarily on the distinctions and similarities between AOFVD and AMD.
Selina R. McGee, OD, FAAO, Dipl ABO
Patients with Sjögren syndrome present some of our toughest dry eye disease (DED) cases, with recalcitrant aqueous deficient DED, often accompanied by evaporative disease and/or blepharitis. This chronic autoimmune disease that affects function of lacrimal and salivary glands1 is present in up to 1% of the population, primarily women (a 9:1 ratio over men), with signs and symptoms that usually appear in middle age.2 In roughly half of cases, Sjögren syndrome occurs alongside other autoimmune conditions such as rheumatoid arthritis or lupus.2
Because my colleagues and I have worked hard to raise awareness of how Sjögren syndrome affects the eyes, we see referrals from many doctors in our community, as well as patients who seek us out for DED treatment, unaware that they have Sjögren syndrome. These patients are often suffering terribly, so we ask the right questions and take an aggressive approach to treatment. Here are some insights from a recent case, as well as diagnostic tips and a 3-step approach to treatment.
Emily Kaiser, Assistant Managing Editor
Tarsus Pharmaceuticals announced that lotilaner ophthalmic solution (Xdemvy) 0.25% is now ready for prescription as it is available at pharmacies nationwide. The eye drop Xdemvy received FDA approval on July 24, 2023, making it the first and only approved treatment for Demodex blepharitis.
“We are delighted that within weeks of FDA approval, XDEMVY is now available to millions of patients with Demodex blepharitis,” Bobak Azamian, MD, PhD, Chief Executive Officer and Chairman of Tarsus, said in a press release.
“The efforts of our team have created incredible interest in XDEMVY, the first and only approved solution for this highly prevalent disease. I’m so appreciative of our team and our partners who’ve worked diligently to bring this product to eye care providers and patients quickly and seamlessly following regulatory approval. We are proud to introduce XDEMVY to the eye care community and look forward to its potential to significantly change the way this disease is treated.”
Beeran Meghpara, MD
Dry eye disease (DED) is a common ocular condition characterized by the loss of ocular surface homeostasis, inflammation, neurosensory abnormalities, and tear film instability and hyperosmolarity.1,2
Prolonged stress and unresolved inflammation can cause a vicious cycle that worsens the condition, leading to chronic DED.3 DED may also disrupt neural signaling from the ocular surface to the central nervous system, leading to progressive loss of corneal nerve density and eventual formation of neurotrophic keratitis (NK).2
NK is a degenerative corneal disease caused by impaired corneal sensory innervation.4 At the ocular surface, the trigeminal nerve contributes to sensation, controls blinking and tearing, and secretes trophic factors that support epithelial homeostasis and regeneration after damage.5 In NK, corneal nerve degeneration disrupts these processes and can lead to desiccating conditions that promote DED.2 There are significant overlaps in the pathology of the 2 conditions, including persistent epithelial defects and, in severe cases, corneal ulcers.