TearScience Newsletter WINTER 2012
TREAT THE CAUSE
ISSUE ONE
Refocusing on Evaporative Dry Eye
The Evaporative Dry Eye Experts Four Thousand LipiFlow® Treatments Completed for Evaporative Dry Eye Disease Morrisvile, N.C.,—June 14, 2012—TearScience®, a privately-held m e d i c a l d e v i c e c o m p a n y, t o d a y announced that 4,000 treatments of its LipiFlow® Thermal Pulsation System for evaporative dry eye have been performed to date. These treatments were perfor med largely by the first 20 eye care practices to adopt LipiFlow® as of February, 2012. As of early June, TearScience has more than 40
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Are your eyes bothering you?
eye care practices using the LipiFlow® system with multiple, new installations scheduled with a lead time of up to eight weeks. LipiFlow® uses heat and gentle pressure to unblock obstructed Meibomian glands located in the eyelids during an in-office procedure. The goal of unblocking the glands is to allow them to resume their natural production of lipids needed for a healthy tear film. “Given our recent success with this new treatment, we are seeing LipiFlow® emerge as a new standard of care for evaporative dry eye patients,” said John A. Hovanesian, MD, of Harvard Eye Associates in Laguna Hills, California. “How we approach dry eye is evolving because of LipiFlow®. It has become a very positive advance for both patients and physicians alike.”
“In a randomized, controlled, multicenter clinical study, at four weeks after a single LipiFlow® treatment, 84 percent of patients experienced an improvement
Dry Eye-23 million sufferers in the U.S. costing $3.8 billion annually.
in the number of Meibomian glands secreting lipids,” said Stephen Lane, MD, of Associated Eye Care in Stillwater, Minnesota.
The keys to healthy eyes LipiFlow: Revolutionary treatment for dry eyes
Evaporative Dry Eye If your eyes feel scratchy and dry and eye drops or warm compresses never seem to provide enough help, you may have a chronic condition know as Evaporative Dry Eye.
Patients Value LipiFlow®
Lack of Lubrication Your discomfort may be a result of Evaporative Dry Eye, which occurs when the water in tears evaporates faster than normal, due to an insufficient lipid (oil) layer on the tear film.
Revolutionary Technology In a clinical study, 79% of patients reported improved overall dry eye s y m p t o m s (ranging from 10% to 100% improvement) within four weeks of a single LipiFlow treatment.
The procedure, performed in a doctor’s office, is virtually painless and some patients consider it somewhat like a spa experience.
Find Relief Physicians equipped with the new LipiFlow technology are now located across the U.S. and Canada. They will evaluate y o u r symptoms, t e a r fi l m and gland function to determine the underlying cause of your Dry Eye symptoms. It’s important to treat this chronic disease early, to avoid permanent loss of gland function, additional cell damage, or visual deterioration. Candidates for LipiFlow can complete treatment immediately.
Of the millions of dry eye sufferers in the U.S., approximately 86 percent have evaporative dry eye, which is caused by Meibomian gland dysfunction (MGD) and a lipid deficiency of the eye’s natural tear film. In the U.S. alone, an estimated $3.8 billion is spent annually in treating dry eye. At 38 percent of the total patient population, dry eye sufferers represent the l a rg e s t g ro u p o f p at i e n t s v i s i t i n g ophthalmologists and a market opportunity exceeding $9 billion in the U.S. Studies show that the average annual spending for moderate dry eye sufferers using wetting drops, prescription medications, and punctal occlusion to manage their dry eye symptoms is $2,959. Te a r S c i e n c e ’ s 4,000th treatment milestone demonstrates how dry eye sufferers are embracing the value of LipiFlow®. The treatment is currently a patient-pay procedure and on average, the LipiFlow® treatment r a n g e s f ro m $ 7 5 0 -
$1,000 per eye in North America. “My patients have experienced the benefits of LipiFlow®,” said Mujtaba Qazi, MD, director of clinical studies at Pepose Vision Institute in Chesterfield, Missouri. “It is an effective treatment that addresses the root cause of evaporative dry eye, as chronically blocked tear glands are reopened and gland function is restored. When patients add up the costs and hassles they incur for managing dry eye and the negative impact that this disease has on their lifestyle, they appreciate the true value of LipiFlow®.” TearScience is investing millions of dollars in tooling and manufacturing equipment with leading medical device contract manufacturers to ensure the availability of LipiFlow® Activators, the disposable eye piece used during the LipiFlow® treatment.
“We anticipate high demand for the treatment and have made this investment to support our current and future customers who adopt the TearScience® System as the new standard of care for their dry eye patients,” said Tim Willis, CEO and co-founder of TearScience.
effectively address a root cause of e v a p o r a t i ve d r y eye, o b s t r u c t e d Meibomian glands. For additional information, visit www.tearscience.com.
TearScience’s system includes two medical devices, the LipiView® Ocular S u r f a c e I n t e r f e ro m e t e r a n d t h e LipiFlow® Thermal Pulsation System, and a handheld tool for evaluating Meibomian gland function, called the Korb Meibomian Gland Evaluator. L i p i Vi e w ® c a p t u re s, a rch i ve s, manipulates, and stores detailed digital images of a dry eye patient’s tear film. Evaporative dry eye occurs when Meibomian glands in the eyelids become obstructed and do not secrete the oily lipids needed to keep the water portion of tears from evaporating too quickly.
Nerve damage and need to be reset from years of dysfunctional glands – lotomax tx x5 days qid. To quite and stabilize and reset the nerves, if the pt. remains symptomatic, pt. will need to be treated with a stronger steriod 3 days qid continue with lid scrubs and artifical tears - (lotomax is a low grade steroid that is not absorbed at the cellular level)
1 Yu J, Asche CV, Fairchild CJ. The economic burden of dry eye disease in the United States: A decision tree analysis. Cornea 2011; 30 (4):379-87. Media Contact: Mary Hecht-Kissell TearScience mhkissell@tearscience.com (919) 459-4803 About TearScience, Inc. Headquartered in Morrisville, North Carolina, TearScience has pioneered devices that provide significant clinical improvement in the treatment of evaporative dry eye. Of the more than 100 million dry eye sufferers worldwide, a p p r o x i m a t e l y 8 6 p e r c e n t h av e evaporative dry eye, which is caused by Meibomian Gland Dysfunction (MGD) and a lipid deficiency of the eye’s natural tear film. The Tear Film and Ocular Surface Society (TFOS) workshop, involving two years of work by 50 leading ex p e r t s f ro m a ro u n d t h e wo rl d , concluded that MGD is an underestimated condition and is very likely the most frequent cause of dry eye disease. Common symptoms of the disease include eye irritation, dryness, redness, tiredness, and visual disturbances. TearScience’s integrated, in-office system enables eye care professionals to
Considerations unsuccessful outcomes
for
A.) systane balance (alcon) mineral oil based (has preservatives) B.) optive advanced (allergan) cod liver oil based (has preservatives) C.) retain mgd (occusoft) mineral based (no preservatives) D.) soothe ointment (bausch and lomb) -post regimen red eyes use b&l soothe or if you awake with red eyes soothe ointment -patient probed more than 6 x (confirm prior to tx) -mg drop-out -poor candidate due to no oil secretion pre tx -poor placement of adaptors – place adaptor nasally and down for best treatment nasal and medial -adaptor did not heat to 42.5 degrees -partial blinker – pt could have the best oils and not using the oils to coat the cornea which is using old or used oil -to test for a complete blink: a. lipiview test 2 blinks if good done if not verify by 3rd (30-50% of pts with mgd are partial blinkers) blink protocol – close 1, 2 squeeze 1, 2 sec. q 15 min. for 30 days to retrain the brain for a complete blink
-aqueous deficient as well 30-40% will be aqueous and oil deficient -seasonal allergy induced -pre-existing conditions The highest direct costs are incurred by patients who undergo punctal occlusion and use cyclosporine drops. These patients, regardless of symptom severity level, have direct costs of nearly $3,000 annually. The highest indirect costs are incurred by those with the most severe symptoms. Nonetheless, the impact of dry eye disease on workplace productivity, even among the 40% of patients who are self-treating with artificial tears and nutritional supplements, is more significant than previously thought. Mild and moderate dry eye sufferers incurred a productivity loss valued at more than $12,000 annually, while severe dry eye patients lost about $18,000 in workplace productivity. The vast majority of lost productivity was due not to missed days of work but to impairment or reduced productivity at work (“presenteeism”).
How Big a Burden is Dry Eye? Dry eye may be costing your patients more than you think. The first study to measure the cost of dry eye disease in the U.S. indicates that the economic burden of dry eye is significant—$3.84 billion in direct health care costs each year*. When the indirect costs of lost productivity are included, the societal burden of dry eye rises to $55.4 billion annually. In this recently published, prevalence-based cost-of-illness analysis, the authors assess the cost of a typical stepwise treatment regimen of ocular lubricants followed by topical cyclosporine and punctal plugs. The average annual direct cost per patient was $678 for patients with mild dry eye; $771 for moderate, and $1,267 for severe. In addition to the severity of symptoms, direct and total societal costs also vary based on whether or not the individual visited an eye care provider for treatment of dry eye and the treatments prescribed (Table 1).
The highest direct costs are incurred by patients who undergo punctal occlusion and use cyclosporine drops. These patients, regardless of symptom severity level, have direct costs of nearly $3,000 annually. The highest indirect costs are incurred by those with the most severe symptoms. Nonetheless, the impact of dry eye disease on workplace productivity, even among the 40% of patients who are self-treating with artificial tears and nutritional supplements, is more significant than previously thought. Mild and moderate dry eye sufferers incurred a productivity loss valued at more than $12,000 annually, while severe dry eye patients lost about $18,000 in workplace productivity. The vast majority of lost productivity was due not to missed days of work but to impairment or reduced productivity at work (“presenteeism”).
The direct and indirect costs of dry eye reaches $55.4 billion annually in the U.S. alone.
About the study This was an Internet-based survey of 2,171 employed U.S. adults with a diagnosis of Sjögren’s syndrome, dry eye disease, or an abnormal OSDI score (>12 out of 100). More than 50% of respondents characterized their dry eye symptoms as mild. Among those who sought professional care, 31.4% had moderate symptoms, and 8.7% had severe symptoms. Direct costs included ocular lubricants, nutritional supplements, cyclosporine, punctal plugs, and doctor visits. Indirect costs were based on days of lost work (absenteeism) and hours of lost productivity (presenteeism) due to dry eye symptoms, with costs based on an average wage of $15.95/hour. Detailed methods for calculating the cost, compliance, and usage of each type of resource are provided in the paper. Leo vitae diam est luctus, ornare massa mauris urna, vitae sodales et ut facilisis dignissim, imperdiet in diam, quisque adipiscing.
Results were compared to a validation model that used claims database inputs. Patient-reported resource usage in the study was similar to actual claims for punctal occlusion and cyclosporine prescriptions in a similar dry eye population.
Table 1: Direct and Total Costs of Dry Eye Disease per Person per Year, by Severity of Symptoms Mild Direct No medical care
Moderate Total
Direct
Total
Severe Direct
Total
$133
$3,538
$111
$8,692
$127
$18,292
No prescription therapies
$452
$13,138
$452
$13,021
$688
$18,856
Plugs only
$744
$13,430
$744
$13,313
$980
$19,148
Cyclosporine only
$2,672
$15,357
$2,667
$15,236
$2,406
$20,574
Plugs + cyclosporine
$2,964
$15,649
$2,959
$15,528
$2,698
$20,866
Medical care
Adapted from: Yu J, Asche CV, Fairchild CJ. The economic burden of dry eye disease in the United States: A decision tree analysis. Cornea 2011;30(4):379-87. The cost of treatment with the LipiFlow速 Thermal Pulsation System for MGD is within the range of existing direct costs of managing dry eye especially for those sufferers using cyclosporine or multiple therapeutic approaches. LipiFlow has the potential to significantly reduce the total economic burden through improvement of symptoms that contribute to lost productivity.