Purpose:To assess the characteristics of patients presenting to American-European Congress of Ophthalmic Surgery (AECOS) member practices for vision correction procedures and determine how age, refractive error, and ophthalmic anatomical characteristics determine the choice of refractive procedure. Patients and Methods:This retrospective multicenter cohort study included data of myopic patients who underwent bilateral refractive surgery in 2023 at 18 refractive surgery practices. Study parameters included the procedure performed, surgical location, manifest refraction (MRSE), Pentacam D value, anterior chamber depth, and central pachymetry. Results:Overall, 1,866 eyes of 933 patients were included. LASIK was the most common refractive surgery procedure (65.5%), followed by ICL (13.3%), PRK (12.1%), and KLEx (8.6%). Of all the procedures, 59.4% were performed in a laser suite, 26.3% in an in-office operating room (OR), 13.8% in an ambulatory surgery center (ASC), and 0.5% in a hospital OR. The mean MRSE was -4.36 D. Among laser vision correction procedures (LASIK, PRK, and KLEx), 43.6% had low myopia (MRSE range: -0.25 to -3.00 D), 43.1% had moderate (-3.01 to -6.00 D), and 13.3% had high myopia (>6.00 D). Among all ICL cases, 3.6%, 21.0%, and 75.4% were performed in low, moderate, and high myopes, respectively. Among eyes that underwent LASIK or KLEx, 2.8% had thinner corneas (central pachymetry <500 µm), which was significantly lower than 12.4% of eyes undergoing PRK (p<0.001) and 11.7% of those undergoing ICL surgery (p<0.001). Conclusion:The study's findings help to understand and better define the refractive surgery choices made by patients and surgeons. LASIK contributed to almost two-thirds of the refractive surgery procedures.
Perfluorohexyloctane ophthalmic solution (PFHO) is indicated for the treatment of signs and symptoms of dry eye disease (DED) and targets excessive tear evaporation. This study evaluated patient-reported outcomes early in treatment with PFHO. This prospective, multicenter, open-label, phase 4 study enrolled adults with a history of DED for ≥ 6 months. PFHO was instilled in both eyes four times daily for 14 days. Patients completed early outcome surveys during four clinic visits (day 1 [pretreatment; 5 and 60 min post-PFHO instillation] and days 3, 7, and 14). Symptom severity, symptom frequency, and treatment satisfaction were rated on visual analog scales (range 0–100). The primary endpoint was mean change from baseline in overall DED symptom severity at day 7. Secondary endpoints included change in severity of individual DED symptoms (eye dryness, blurred vision, eye irritation, light sensitivity, eye tiredness, burning/stinging, eye itching, eye pain); change in frequency (measured as percentage of time experienced) of the most bothersome symptom, awareness of dry eye symptoms, and fluctuation in quality of vision; and treatment satisfaction. Ninety-nine patients enrolled (85.9
SIGNIFICANCE:Localized heat therapy with manual expression has been effective for meibomian gland dysfunction-associated dry eye disease in clinical studies including two randomized controlled trials, and in the present report, provides long-lasting relief from signs and symptoms for moderate-to-severe dry eye disease associated with meibomian gland dysfunction. PURPOSE:Meibomian gland dysfunction is a disease with high prevalence and accounts for most dry eye disease. Localized heat therapy with manual expression, an office-based intervention, has demonstrated effectiveness in improving the signs and symptoms of dry eye disease. The aim of this third phase of the Sahara randomized controlled trial was to study the durability of the treatment benefits. METHODS:Subjects randomized to localized heat therapy in Sahara and receiving second treatment at month 5 continued follow-up for an additional 19 months. Ocular signs including tear break-up time and meibomian gland secretion score, and symptoms including ocular surface disease index were assessed at months 6, 9, 12, 15, 18, and 24. Subjects could be retreated when tear break-up time was within 2 seconds of study baseline and ocular surface disease index increased by 15 points from the previous visit. RESULTS:One hundred sixty-six subjects entered this phase of the study. All measures of signs and symptoms (for the overall group of subjects) remained statistically significantly better than study baseline at all time points. Thirty-two subjects required additional treatment. Median time for retreatment was 8 months. Six-month retreatment-free survival probability was 92%. There were a few adverse events and none related to the localized heat therapy procedure. CONCLUSIONS:Localized heat therapy with manual expression has been shown to be an effective treatment for meibomian gland dysfunction, providing durable relief from dry eye disease signs and symptoms. Treatment twice per year can provide meaningful improvement and symptomatic relief for patients with moderate-to-severe dry eye disease.
BACKGROUND:Meibomian gland disease (MGD) is a leading cause of dry eye disease (DED), yet current treatments like over-the-counter and prescription drops do not address this root cause. TearCare is an FDA-cleared, in-office procedure that directly targets MGD, but its cost-effectiveness has not been previously evaluated. RESEARCH DESIGN AND METHODS:We conducted a cost-utility analysis (CUA) comparing TearCare with topical cyclosporine 0.05% (CsA) for moderate-to-severe MGD-related DED. A U.S. payer perspective and 1-year time horizon were used. A Markov model with 3-month cycles evaluated transitions across four Ocular Surface Disease Index (OSDI)-defined health states. Transition probabilities and persistence rates were derived from the SAHARA trial and literature. RESULTS:TearCare provided better outcomes (e.g. more patients improving to mild/no symptoms) and was less costly ($4,916 vs $5,819), with a quality-adjusted life year (QALY) gain of 0.014. This corresponds to approximately 5.1 additional days in perfect health over 1 year. The incremental cost-effectiveness ratio (ICER) showed TearCare to be dominant (more effective and less costly). CONCLUSIONS:TearCare is a cost-effective treatment for MGD-related DED, offering both clinical benefits and cost savings over CsA.
