Eyeworld Daily News

48 | EYEWORLD DAILY NEWS | MAY 5, 2019 ONSITE ASCRS ASOA ANNUAL MEETING by Rich Daly EyeWorld Contributing Writer a low side effect profile, such as loteprednol. In cases of significant ocular rosacea and lid margin inflamma- tion, Dr. Farid highlighted benefits from tetracyclines. Among their benefits are decreased bioactivity of cytokines in the inflammatory pathway and a decrease in bacte- rial lid flora. She begins treatment with tetracyclines 1 month preop. Among lid margin treatments are the use of warm compresses or lid hygiene. However, they have low compliance and at-home ex- pression of glands can be difficult, especially for the elderly, Dr. Farid said. Warm compress treatment also rarely raises temperatures for sufficiently sustained periods. D espite a major study casting doubt on the efficacy of omega-3 fatty acids to treat dry eye disease, surgeons at an EyeWorld CME Ed- ucation event said they continue to use the supplement for a variety of reasons. The results of the Dry Eye Assessment and Management (DREAM) study, published in 2018, focused on a multicenter, double-blinded prospective clinical trial with dry eye patients ran- domly assigned to omega-3 fatty acids versus olive oil placebo for 12 months. The trial found no significantly different mean change in the score on the Ocular Surface Disease Index between the active supplement group and the placebo group. However, a recently published meta-analysis of multiple studies found "there is a significant ben- efit of oral omega-3 supplemen- tation in terms of the symptoms and signs of meibomian gland dysfunction and dry eye disease, and in terms of reducing inflam- mation," said Marjan Farid, MD, Irvine, California. "I have gone back to recommending omega-3 fatty acid supplementation for these patients for chronic treat- ment." Christopher Starr, MD, New York, said he does not use ome- ga-3 fatty acids as much as he did before the DREAM study. "But I still consistently use omega-3s as an adjunctive treat- ment in my MGD patients," Dr. Starr said. "While it might not be a primary treatment for dry eye dis- ease, it's certainly supportive," said Preeya Gupta, MD, Durham, North Carolina. Eric Donnenfeld, MD, Rockville Centre, New York, said that the results of the study "looked like an outlier, so I'm all in" on the use of omega-3s. Overall, Dr. Farid urged sur- geons finding ocular surface dis- ease in their patients to first treat the inflammation and lid margin. Anti-inflammatory treatments include longstanding use of cyclo- sporine and the newer lifitegrast, which can improve vision in as little as 2 weeks, compared to the several weeks needed for clinical effects from cyclosporine. The most rapid effect is provided by topical steroids, on which Dr. Farid starts refractive patients 6 weeks before surgery. She suggested using a steroid with Surgeons continue to use omega-3 fatty acids by Vanessa Caceres EyeWorld Contributing Writer C omprehensive ophthal- mologists likely will use subconjunctival MIGS procedures earlier in the treatment continuum for glaucoma patients, reported presenters at Friday evening's "50 Shades of Subconjunctival MIGS: Interven- tional Glaucoma, The Who, What, Why, and How." The session was an EyeWorld CME Education event. There is broader thinking now about treating glaucoma patients, even mild to moderate ones, earli- er with MIGS instead of waiting, said program chair Iqbal "Ike" Ahmed, MD, Toronto, Canada. This is in contrast with adding a third or fourth medication and observing what happens, which usually has no meaningful effect and only complicates the medi- cation compliance issues patients often have, Dr. Ahmed thinks. Performing MIGS earlier also can help patients and surgeons shift IOP targets, Dr. Ahmed added. Surgeons who were part of the session shared and discussed cases that had subconjunctival MIGS, including one patient shared by Sahar Bedrood, MD, Pasadena, California. Her 58-year- old patient had advanced glauco- In your hands: Patient selection and management pearls for subconjunctival MIGS continued on page 49 ma on maximum medical therapy with no family history of glau- coma. Although her visual acuity was 20/25 and 20/20 and her exam was normal, her nerve was cupped, and she had a deep inferi- or notch observed via visual field. Dr. Bedrood performed selective Dr. Farid explains the reasons surgeons continue to use omega-3 supplements for some ocular surface disease patients. continued on page 50 Dr. Ahmed discusses treating glaucoma patients with MIGS earlier.

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