Why has Demodex gone viral?

Although the Demodex mite is not a recent discovery, you might not realize that by the rapid rise of demodex in the ophthalmic professional sphere. From peer-reviewed journal articles to lectures at professional meetings to chatter on the exhibit hall floor to thought-leader informational videos, Demodex has been a popular topic for the past 12-18 months.

In the spirit of full disclosure, I acknowledge that Optometry Times has played a role by adding content to the mix. We deployed a series of 5 OD expert videos and published several articles on Demodex, with likely more to come.

Going viral

So why did Demodex become a clinical hot topic?

Optometry Times Associate Optometric Editor Katherine M. Mastrota, OD, FAAO, says one reason might be the desire to solve a clinical problem. “Part of it is the quest for the cure for blepharitis and dry eye-we all are searching for the magic bullet. Everyone has a gizmo or drop or treatment for something within the unknown,” she says. “Then you have these critters. Is ‘curing’ Demodex the holy grail of ocular surface disease and dry eye? We have a diagnosis and possible treatment that piqued everyone’s interest. Identifying Demodex is concrete, like lid wiper epitheliopathy, in those cases with symptoms but no clinical signs. We have a visual indication of a diagnosis. In both cases we don’t see it until someone shows us how to see it.”

Related: A different approach to treating demodex blepharitis

For something to go viral, says Scheffer Tseng, MD, you need to reach a critical mass and a tipping point. “The evidence has to accumulate, and it has from 2005 until about a year ago,” he says. “Key opinion leaders begin to take the first move to see if they agree with the findings in the literature. Dr. Milton Hom has significantly contributed to the field by saying he’s seen enough evidence, has his own personal experience, and is now willing to share with others. That has created the viral effect.” Dr. Tseng serves as research director of Ocular Surface Foundation, director of research and development of TissueTech, Inc., medical director of Bio-Tissue, Inc., and director of research and development of Bio-Lipid, Inc.  

Optometry Times Editorial Advisory Board member Joseph P. Shovlin, OD, FAAO, expresses surprise at what he calls “mass hysteria” because some practitioners have described Demodex as a niche phenomenon. “When something is being discussed, mass hysteria occurs when people may not have been aware of what has transpired in the past,” he says. “People have been discussing Demodex for the past century, this is nothing new. What is new is making the connection that this parasite has the ability to be a proxy for bacteria. Most people are missing that.”

Phoenix, AZ, OD Art Epstein says there are two reasons why this clinical presentation became a hot topic so quickly. “First, there is commercial support for it,” he says. “There are products that specifically target Demodex, especially with smaller companies which aren’t dealing with regulatory burdens. Second, everyone is looking for the next big thing. Communication these days is much faster than it’s ever been, it’s almost viral. Something that is seen in California is a hot topic in New York almost instantaneously. A fevered frenzy about an infrequent pathogen tends to distract from the real issues that actually cause problems. It’s like many other things. Why do we see hula hoops become a craze in the ‘60s? Why do people become interested in chewing gum? Yo-yos were a craze. People tend to do what other people do.”

Related: Diagnosing Demodex

Today’s technology has played a major role in allowing Demodex to move to the forefront, according to Optometry Times Editorial Advisory Board member Milton M. Hom, OD, FAAO. Practitioners have smart phones to take video of the mites and text and e-mail colleagues. More affordable LED microscopes allow more practitioners to use such equipment. So knowledge of the mite may have been around for a long time, but the technology to study it has not.

“Call it mass hysteria, the next big thing, whatever you want,” says Dr. Hom. “The truth is, the more awareness we have, the better we are able to diagnose, treat and serve. After all, isn't all about the patient?”

So is Demodex the next big thing? Says San Antonio, TX, OD Mario Gutierrez: “It’s not the next big thing. It’s a thing. It went viral because some heavy hitters in optometry took the ball and ran with it. Demodex infestation needs to be treated. All blepharitis patients deserve to be treated. Infested patients need to be treated in a different way. It’s a cool thing. We can really help our patients who have this condition. I think it’s important, but it’s not glaucoma or AMD.”ODT

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