Dry Eye Disease and Meibomian Gland Dysfunction: Early Diagnosis and Comprehensive Management

Dry Eye Disease and Meibomian Gland Dysfunction: Early Diagnosis and Comprehensive Management - Pre-Activity Survey

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Pre-Activity Survey
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Post-Activity Survey
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Monica is a 49-year-old patient who presents with symptoms of dryness, irritation, burning, and foreign body sensation in both eyes. She currently wears monthly contact lenses that she changes regularly according to the prescription. She currently takes prescription and over-the-counter (OTC) therapies to manage her anxiety disorder, asthma, and seasonal allergies.

After looking at her clinical history, her ophthalmologist begins screening the patient for DED. Which of the following would confirm a diagnosis of DED in this patient?* Tear breakup time (TBUT) of < 10 seconds
Schirmer’s test result of 14 mm/5 min
Tear osmolarity value of 305 mOsm/L
Ocular Surface Disease Index (OSDI) score of 12
Not sure
For this 49-year-old patient, when would it be most appropriate to prescribe lifitegrast or cyclosporine to relieve the symptoms of DED according to TFOS DEWS II recommendations?* As a first-line therapy
As a surgical punctal occlusion
After failure of OTC ocular lubricants and proper lid hygiene
After a trial of allogenic serum drops
Not sure
Which of the following statements is correct regarding the presentation and characterization of DED?* Evaporative DED is associated with Sjogren’s syndrome.
Most cases of evaporative DED are caused by MGD.
Patients typically present with either aqueous deficient or evaporative subtypes, but they do not coexist.
The discomfort from symptoms is always associated with tissue damage, even in early disease.
Not sure
Which of the following recommendations is an appropriate first-line approach to treating symptoms of DED with MGD?* Applying cold compresses with gentle massage
Maintaining proper lid hygiene, including daily makeup removal
Switching from disposable contact lenses to rigid scleral lenses
Using preservative-containing artificial tears
Not sure
How confident are you in your ability to diagnose and manage DED and MGD in patients?* Not confident
Slightly confident
Moderately confident
Mostly confident
Very confident

Save and Proceed

Dry Eye Disease and Meibomian Gland Dysfunction: Early Diagnosis and Comprehensive Management

Eric D. Donnenfeld, MD

Release Date: April 7, 2022
Expiration Date: April 7, 2023

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Activity Description

Dry eye disease (DED) is one of the most common ophthalmic complaints; it results from the activity of various pathways and is considered a multifactorial disease. An important factor that contributes to the onset of DED is meibomian gland dysfunction (MGD), which causes a disruption in the tear film lipid layer and affects the rate of tear evaporation. As such, DED and MGD are strongly associated with each other, such that many of their risk factors, signs, and symptoms overlap. In this educational podcast, join our expert faculty, Eric D. Donnenfeld, MD, as he reviews the clinically meaningful association between DED and MGD, and provides evidence-based recommendations on best practices for assessment, diagnosis, and management.

Learning Objectives

Upon completion of this activity, learners should be better able to:

REVIEW the recommended processes in diagnosis and management of DED and MGD
DISCUSS the appropriate diagnostic protocol to accurately identify both symptomatic and asymptomatic patients with early DED and MGD
LIST the variety of pharmacologic and nonpharmacologic treatment options for the management of patients with DED and MGD

Faculty

Eric D. Donnenfeld, MD

Founding Partner, Ophthalmic Consultants of Long Island

Garden City, NY
Clinical Professor of Ophthalmology
New York University Medical Center

New York, NY

Faculty Biography

Eric D. Donnenfeld, MD

Eric D. Donnenfeld, MD, is an internationally recognized expert and pioneer in refractive, cornea, and cataract surgery and one of the leading refractive and cataract surgeons in the United States. He is a founding partner of Ophthalmic Consultants of Long Island. Dr Donnenfeld graduated magna cum laude from Dartmouth College in 1977 and first in his class at Dartmouth Medical School in 1980. He was Chief Resident at Manhattan Eye, Ear & Throat Hospital and completed a Cornea and Refractive Fellowship at Wills Eye Hospital. Dr Donnenfeld is on the Board of Overseers of Dartmouth Medical School and a Clinical Professor of Ophthalmology at New York University Medical Center.

Dr Donnenfeld was the 2013-2014 President of the American Society of Cataract and Refractive Surgery (ASCRS). He is the Chief Medical Editor of EyeWorld, the official publication of the ASCRS. He is on the Executive Boards of ASCRS and the American College of Surgeons (ACS) and is a member of the Refractive Committee of ASCRS and Cornea section of Ocular Surgery News. Dr Donnenfeld is a National Medical Director of TLC Laser Eye Centers and Surgical Director of the Lions Eye Bank for Long Island. He is a past president of the Ocular Microbiology and Immunology Group. Locally, Dr Donnenfeld has also served as a board member of the Nassau Academy of Medicine, the ACS Long Island Chapter, and the Nassau Surgical Society, and is a past president of the Nassau Surgical Society, where he is the youngest person to ever receive their Lifetime Achievement Award.

Dr Donnenfeld has served as Resident Instructor at Manhattan Eye, Ear & Throat Hospital and as Program Director at North Shore University Hospital. He has designed and patented 6 instruments for refractive surgery use. He has authored more than 190 papers on cornea, external disease, and cataract and refractive surgery, 500 scientific articles, and 40 books and book chapters on a range of subjects pertaining to corneal transplants, cataract care, and laser vision correction.

Dr Donnenfeld is on the editorial board of 9 journals and has participated in over 40 FDA studies. He is one of the first 5 people in the world to perform both laser vision correction and laser cataract surgery. Dr Donnenfeld is a Fellow of the American Academy of Ophthalmology and has received its Honor Award, Senior Honor Award, Life Achievement Honor Award, and Secretariat Award. He has performed laser vision correction on over 70,000 patients and more than 1000 eye doctors and their families. The Journal of Cataract & Refractive Surgery Today has named Dr Donnenfeld as one of the Top 50 Most Influential Ophthalmologists in the United States. The Ophthalmologist, an internationally recognized magazine, named him to their Power List in 2018. Recently, Newsweek named Dr Donnenfeld America’s Best Eye Doctor in 2021 with a near perfect score for quality of care, continuity of care, and the quality of the technology used in his practice.

Disclosure Statements

Global Education Group (Global) adheres to the policies and guidelines, including the Standards for Integrity and Independence in Accredited CE, set forth to providers by the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All persons in a position to control the content of an accredited continuing education program provided by Global are required to disclose all financial relationships with any ineligible company within the past 24 months to Global. All financial relationships reported are identified as relevant and mitigated by Global in accordance with the Standards for Integrity and Independence in Accredited CE in advance of delivery of the activity to learners. The content of this activity was vetted by Global to assure objectivity and that the activity is free of commercial bias.

All relevant financial relationships have been mitigated.

Faculty

Eric D. Donnenfeld, MD

Disclosures:
Consulting Fees (eg, Advisory Board): Alcon; Allergan, plc; Bausch & Lomb Inc; BlephEx; Johnson & Johnson; Ocular Science; PRN Pharmacal; Tarsus Pharmaceuticals, Inc
Speakers’ Bureau: Allergan, plc; Johnson & Johnson
Shareholder: BlephEx; Ocular Science

Educational Planning Committee

Global Education Group
Lindsay Borvansky; Andrea Funk; Liddy Knight; Ashley Cann: No relevant financial relationships with any commercial interests.

Spire Learning
Mairead Early, Chris Washburn, PhD, Andrew Kim, PharmD, and Kimberly Miniter have nothing to disclose.

Reviewer
Lindsay Borvansky: No relevant financial relationships with any commercial interests.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Global Education Group (Global) and Spire Learning do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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Supported Phones & Tablets:
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Target Audience

This activity has been designed to meet the educational needs of ophthalmologists, optometrists, primary care physicians, nurse practitioners, and physician assistants.

Accreditation and Credit Designation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of Global Education Group (Global) and Spire Learning. Global is accredited by the ACCME to provide continuing medical education for physicians.

Physician Credit Designation
Global Education Group designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Participation and Credit

There are no fees for participating and receiving CME credit for this activity. To receive CME credit participants must:

Read the objectives and other introductory CME information
Complete the preassessment prior to the start of the activity
Participate in the DED/MGD activity
Submit the postassessment and evaluation at the conclusion of the activity
Receive a passing score of at least 70% on the postassessment
Certificates will be emailed to the participant

If you are seeking credit, you must complete the evaluation at the conclusion of the activity.

This educational activity is jointly provided by Global Education Group and Spire Learning.

Funding for this activity provided by J&J Vision.

References for Dry Eye Disease and Meibomian Gland Dysfunction: Early Diagnosis and Comprehensive Management

Akpek EK, Amescua G, Farid M, et al. Dry Eye Syndrome Preferred Practice Pattern^®. Ophthalmology. 2019;126(1):P286-P334.
Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017;15(4):802-812.
Farid M. Dry eye disease: let’s start thinking outside of the artificial tear box. Ophthalmol. 2017;124(11)(Suppl):S1-S3.
Goel P, Zadeh O, Ghiam BK, Hemmati HD. Treating Evaporative Dry Eye Associated With Meibomian Gland Dysfunction. American Academy of Ophthalmology. September 2019. Accessed February 22, 2022. https://www.aao.org/eyenet/article/treating-evaporative-dry-eye#disqus_thread
Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628.
Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012;31(5):472-478.
Milner MS, Beckman KA, Luchs JI, et al. Dysfunctional tear syndrome. Curr Opin Ophthalmol. 2017;28(Suppl 1):1-47.
Nichols KK, Foulks GN, Bron AJ, et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci. 2011;52(4):1922-1929.
O’Neil EC, Henderson M, Massaro-Giordano M, Bunya VY. Advances in dry eye disease treatment. Curr Opin Ophthalmol. 2019;30(3):166-178.
Opitz D, Harthan J, Fromstein S, Hauswirth S. Diagnosis and management of meibomian gland dysfunction: optometrists’ perspective. Clin Optom (Auckl). 2015;7:59-69.
Phadatare SP, Momin M, Nighojkar P, Askarkar S, Singh KK. A comprehensive review on dry eye disease: diagnosis, medical management, recent developments, and future challenges. Adv Pharm. 2015;articleID704946:1-12.
Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II epidemiology report. Ocul Surf. 2017;15:334-365.
Starr CE, Gupta PK, Farid M, et al. ASCRS Cornea Clinical Committee. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg. 2019;45(5):669-684.
Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II Diagnostic Methodology report. Ocul Surf. 2017;15(3):539-574.