David R. Hardten1, Mark Milner2, Jai G. Parekh3, Neda Shamie4, Darrell E. White5 and Michael Schiewe6
Financial Disclosures:Dr’s Hardten, Milner, Parekh, Shamie and White are consultants for Inspire. Mr Schiewe is an employee of Inspire.
Affiliations: 1University of Minnesota; 2Yale University Medical School; 3The New York Eye and Ear Infirmary; 4Doheny Eye Institute and the USC Keck School of Medicine; 5Skyvision Centers; 6Inspire
2
The purpose of this retrospective study was to identify trends in the diagnosis, recorded findings and treatment of patients presenting with symptoms of Ocular Surface Disease (OSD).
3
This study was a multi-center, retrospective study 52 sites were involved in the study, emphasizing general
practice Eye Care Professionals (77% MD and 23% OD). 1157 patient charts Patients presented with symptoms of ocular surface
disease consecutively at the site over an 8 week period. Retrospective chart review Inclusion criteria – a primary diagnosis of either
bacterial/viral conjunctivitis, blepharitis or dry eye Exclusion criteria – patients diagnosed with allergic
conjunctivitis were excluded from the study in order to avoid a bias due to allergy season
4
Data collection form utilized to capture information from patient charts: OSD symptoms (severity ratings) OSD signs (severity ratings) Assessments & Tests (visual acuity, staining, tear
break-up time, Schirmer and cultures) Treatments (mechanical therapy, OTC, nutraceuticals,
pharmaceuticals)
5
Blepharitis alone
Dry Eye alone
Conjunctivitis (Bacterial/Viral) alone
Blepharitis and Dry Eye
Other mixed diagnosis
n = 1157
33%
6%
29%
6%
26%
6
* includes subjects with a primary diagnosis of Conjunctivitis
35%35%
28%28%
37%37%
ConjunctivitisConjunctivitis
n = 72
BacterialBacterial
ViralViral
UndeterminedUndetermined
7
* includes subjects with a primary diagnosis of Blepharitis or Dry Eye
BlepharitisBlepharitis
Dry EyeDry Eye
Anterior
n = 300
22%
n = 384
Anterior and Posterior
Posterior
Non-differentiated
18%
24%
36%
10%
4%
32%54%
Non-differentiated
Evaporative
Aqueous Deficient and Evaporative
Aqueous Deficient
8
0
20
40
60
80
BlepharitisDry EyeConjunctivitis
% o
f S
ub
jects
* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72
9
Debris
Hyperemia
Swelling
MG Plugging
MG Expression
Secretion Q
uality
Hyperemia
Telangiectasia0
20
40
60
BlepharitisDry EyeConjunctivitis
% o
f S
ub
jec
ts
AnteriorAnterior PosteriorPosterior
* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72
Evaluation of the EyelidEvaluation of the Eyelid
Evaluation of the EyelidEvaluation of the Eyelid
10
0
20
40
60
80
BlepharitisDry Eye
Conjunctivitis
% o
f S
ub
jec
ts
* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72
11
0
20
40
60
80
100BlepharitisDry Eye
Conjunctivitis
% o
f S
ub
jec
ts
* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72 ** “Other” includes: patient education, referral, MG probing and intense pulsed light
* Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72 ** “Other” includes: patient education, referral, MG probing and intense pulsed light
12
Ocular surface disease encompasses a broad range of diagnoses.
Results indicate that symptoms of the various forms of OSD overlap to a large degree on initial presentation.
Although symptoms are important to the patient, proper identification of clinical findings provides the basis for a differential diagnosis and for identifying optimum management. Corneal staining was the most common assessment utilized in the diagnosis of
primary conditions of Conjunctivitis, Dry Eye and Blepharitis. Signs of patients with the primary diagnosis of blepharitis or conjunctivitis share
signs from the anterior evaluation of the eyelids (debris, hyperemia, swelling). However, this is not true of signs from the posterior evaluation of the eyelids.
Management practices were dependant on the primary diagnosis.