Australian Dry Eye Summit 2022 Sydney Session 4 Dr Jason Holland introduced by Dr Rick Wolfe скачать в хорошем качестве

Australian Dry Eye Summit 2022 Sydney Session 4 Dr Jason Holland introduced by Dr Rick Wolfe

Dry Eye Summit 2022 Sydney Session 4 Dr Jason Holland - introduced by Dr Rick Wolfe Dr Rick Wolfe introduction - why treating the root cause of Dry Eye is so important 0.31 Understanding fundamentals 0.58 2015 purchased first E-Eye IPL - 7 yr journey of IPL 1.09 Where it all started. 28 px study done by E-Eye IPL. 5 second TBUT to 14 seconds 1.50 Research kept going and supports over time 2.15 TFOS DEWS 2 study - with step approach to DED at step 2 should be considering IPL 2.40 2018 M22 by Lumenis replaced E-Eye machine 3.50 Earlier treatments focused on symptoms - eye drops don't treat anything 4.07 IPL worked on root cause of disease and fixed core problem 4.23 Inflammatory aspect is under discussed 5.00 Introducing steroids - eyes finally feel better after 2 years of drops and compressors 5.22 Blephasteam and expression does not treat inflammation 5.47 IPL Study - 3 treatments 4 weeks apart 6.20 Reduction of interleukin 17, reduction interleukin 6 (inflammatory markers on ocular surface) 6.50 Root cause - reducing inflammation coming for patient's own gland 6.56 Own glands are self perpetuating DED. Every blink produces cloudy meibum with bacterial endotoxins, laden with inflammatory mediators. 7.24 Study - Changes to Meibomiam Gland after exposure to IPL in MGD patients 7.25 35 MGD patients half traditional tx- eyelid hygiene 1* day hot compress, massages for 3 months 7.47 Other group IPL treatment once per month for 3 months 8.07 At end of 3 months both groups improved, better OSDI, TBUT, Meibum quality, MG expressibility, MG drop out improved in both groups. MG Microstructure improved in IPL group and inflammatory cells were reduced. 8.20 No change to appearance of gland or inflammatory mediators in non IPL group 8.38 IPL group after 3 treatments - glands are less inflamed and Acinar diameter is reduced 9.07 First group compress treatment etc needs to go on forever or symptoms come back 9.14 IPL changes (improves) appearance of gland 9.38 IPL fixes the problem - costs are irrelevant because you are providing value 9.54 You can hang up your hot compress and hang up lid scrubs - put in the bin with drops 10.10 When you are recommending IPL for your patients research gives you confidence 10.13 Recommending things based on really good science 10.16 Improvements in MG Macro-Morphology of 24 yr old and 76 yr old after IPL 10.43 Rockstar IPL px - 38 IPLs over 7 years. "I was miserable and back to living a normal life again" - 29 year old accountant. Glands are longer and straighter after IPL 11.52 Get to root cause of MGD 12.05 Demodex - big part of DED management - ofter concurrent anterior blepharitis 12.17 Extracted single hair follicle with active mite, put under glass plate, single zap of M22 and observed 12.39 Observed demodex feet stopped moving and mite atrophied. Observed up to 24 hours no change or movement 13.02 Fantastic secondary benefit with demodex infestation 13.07 Tea tree oil foams, twice a day for at least 6 weeks. Demodex wiped out with single shot of IPL 13.17 Fantastic way to get to the root cause. A contributing factor in DED is lid hygiene and demodex is so often involved in many people's cases 13.34 IPL Treatment for DED due to MGD - 3 yr Retrospective Study (Toyos, McGill, Briscoe) 13.52 How many treatments ? 5 tx - 95% improved TBUT. 93% px happy with result 14.22 Top up treatments- Everyone is different. Meibum tells everything 15.01 Between 4-8 treatments - give yourself some breathing. Meibum may be clear after 5 treatments but it may take 8. At 8 treatments 9/10 px will be happy. Some need 12 15.35 Harder and harder referrals 15.47 IPL is not about quick fix but it does get to the root cause of the problem 16.01 Improved TBUT. Quality of oil improves 16.03 Refractive surgery and trifocal 80% IOLs. Respect the tear film 16.45 Patients have to earn their MF stripes before Dr will operate on them 16.55 Your eyes are too dry I wont do it 17.19 After IPL treatment - only when meibum is clear than the dr does 2nd measure and IOLs 17.36 Cataract surgery inflames meibomian glands - long road back. cloudy vision 17.38 Following IPL treatment meibum changes to pearl like 18.06 If you add any degree of additional scatter in the tear film to the defractive optics of an interocular lens their performance goes way down. You have to respect the tear film 18.23 You're not just making more meibum, you're improving the quality of the meibum, which from a vision point of view is so important 18.44 Arm yourself with the science- recommendations are so much more powerful 18.48 Anything else you can do with dry wont achieve the same long term results that you can achieve with IPL.