TEAR FILM ORIENTATED THERAPY

Serge Doan MD, of the Hôpital Bichat, Paris, France, discussed tear film oriented therapy (TFOT), a treatment approach that he adapted from the Dry Eye Society of Japan, at the 6th EuCornea Congress in Barcelona.

“TFOT allows for targeted treatment of specific components of the tear film, the epithelium, and the underlying sensory nerves,” said Dr Doan, speaking during yesterday’s Dry Eye Diagnosis & Management Focus session.

Regarding the tear film lipid layer, “tetracyclines are still a mainstay of treatment for meibomian gland dysfunction (MGD), although azithromycin has a longer half-life and greater safety,” said Dr Doan.

“Lipiflow, a heated ocular surface device with a pump mechanism designed to express meibomian gland secretions during a 12-minute treatment session is promising,” said Dr Doan. “The effects at two weeks are superior to lid hygiene and 80 per cent of patients respond,” he said.

“Despite all the advances, I believe scleral lenses are among the best treatment options, offering protection, hydration and analgesia.”

Moving to the aqueous layer, Dr Doan discussed the oral secretagogues pilocarpine and cevimeline, and topicals such as diquafosol and rebamipide. 

“Osmoprotectants such as Optive® and Thealoz Duo® protect macromolecules and membrane proteins from hyperosmolarity, while autologous serum 20 per cent eye drops contain trophic factors beneficial to the epithelium,” he said.

Dr Doan advocated the use of cyclosporin eye drops such as Ikervis 0.1%®, approved in Europe since March this year. “The cationic emulsion of Ikervis offers electrostatic attraction, leading to higher corneal concentration of cyclosporin in animal models,” he said.

“Don’t forget paint treatments such as analgesics, antidepressants and antiepileptics,” Dr Doan reminded the delegates.