A Multi-Center, Retrospective Study of Initial Clinical Practice Patterns in the Assessment and Treatment of Ocular Surface Disease Patients David R. Hardten1, Mark Milner2, Jai G. Parekh3, Neda Shamie4, Darrell E. White5 and Michael Schiewe6 Financial Disclosures: Dr’s Hardten, Milner, Parekh, Shamie and White are consultants for Inspire. Mr Schiewe is an employee of Inspire. Affiliations: 1University of Minnesota; 2Yale University Medical School; 3The New York Eye and Ear Infirmary; 4Doheny Eye Institute and the USC Keck School of Medicine; 5Skyvision Centers; 6Inspire
Purpose • The purpose of this retrospective study was to identify trends in the diagnosis, recorded findings and treatment of patients presenting with symptoms of Ocular Surface Disease (OSD).
Methods • This study was a multi-center, retrospective study • 52 sites were involved in the study, emphasizing general practice Eye Care Professionals (77% MD and 23% OD). • 1157 patient charts • Patients presented with symptoms of ocular surface disease consecutively at the site over an 8 week period. • Retrospective chart review • Inclusion criteria – a primary diagnosis of either bacterial/viral conjunctivitis, blepharitis or dry eye • Exclusion criteria – patients diagnosed with allergic conjunctivitis were excluded from the study in order to avoid a bias due to allergy season
Outcome Measures • Data collection form utilized to capture information from patient charts: • OSD symptoms (severity ratings) • OSD signs (severity ratings) • Assessments & Tests (visual acuity, staining, tear break-up time, Schirmer and cultures) • Treatments (mechanical therapy, OTC, nutraceuticals, pharmaceuticals)
Results: General Diagnosis 6% Blepharitis alone 29% 26% Dry Eye alone Conjunctivitis (Bacterial/Viral) alone Blepharitis and Dry Eye Other mixed diagnosis 6% 33% n = 1157
Subclassification of Primary Diagnosis* Conjunctivitis 35% Bacterial 37% Viral Undetermined 28% n = 72 * includes subjects with a primary diagnosis of Conjunctivitis
Subclassification of Primary Diagnosis* Blepharitis Anterior 22% 24% Anterior and Posterior Posterior Non-differentiated Dry Eye 18% 54% 32% 36% Aqueous Deficient n = 300 Aqueous Deficient and Evaporative Evaporative * includes subjects with a primary diagnosis of Blepharitis or Dry Eye 4% Non-differentiated 10% n = 384
Results: Symptoms* * Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72
Results: Signs* Posterior Anterior Evaluation of the Eyelid Evaluation of the Eyelid * Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72
Results: Assessments Utilized in Diagnosis* * Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72
Results: Management* * Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72 ** “Other” includes: patient education, referral, MG probing and intense pulsed light
Conclusions: • Ocular surface disease encompasses a broad range of diagnoses. • Results indicate that symptoms of the various forms of OSD overlap to a large degree on initial presentation. • Although symptoms are important to the patient, proper identification of clinical findings provides the basis for a differential diagnosis and for identifying optimum management. • Corneal staining was the most common assessment utilized in the diagnosis of primary conditions of Conjunctivitis, Dry Eye and Blepharitis. • Signs of patients with the primary diagnosis of blepharitis or conjunctivitis share signs from the anterior evaluation of the eyelids (debris, hyperemia, swelling). However, this is not true of signs from the posterior evaluation of the eyelids. • Management practices were dependant on the primary diagnosis.