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Dr Korb's Diagnostics & Treatments incl: Osmolarity, MMP-9, Avenova, Tea Tree Oil

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  • #16
    Found these tips are very useful
    Experts offer top allergy tips - Nov. 9 2017

    particularly interesting parts:

    Art Epstein, Phoenix
    ''Allergy also increases surface inflammation. This can worsen the misery of dry eye.
    Treating both at the same time can be prudent.''---- Now I know such approach is important - my strategy: avoid triggers

    Michael Cooper, Willimantic, CT----We better tell doctors these as most doctors do not ask.
    ''Never forget that the allergy season is year round. As part of our battery of questions,
    we always ask patients if their allergies are spring, fall, a combination, or perennial.
    ...so I ask how much mold is present in their houses to gauge whether this may have an impact on allergy status.''

    Michael Raizman, MD Boston
    1.Encourage your patients not to rub their eyes. Eye rubbing brings allergens from the hands to the face and eyes.
    Rubbing also mechanically degranulates mast cells in the lids and conjunctiva and contributes to ocular inflammation and swelling.

    2. Remind patients when they come in from outdoors on a day with high pollen counts to wash their faces and hands, brush or comb their hair, and change their clothes.

    3. Artificial tears that are chilled in the refrigerator feel especially good when applied to an itchy, irritated eye.
    Cooling the ocular surface may reduce inflammation and discomfort as well.

    Len Koh, OD, PhD Spokane, WA
    1. Avoid allergens.
    Pollen: Pay attention to pollen counts; they are highest in mid-morning and early evening.

    Mold: Keep humidity low (30 to 50 percent) to prevent mold growth with dehumidifier use as needed. Clean high-humidity areas, basements, bathrooms, and kitchens regularly.

    Dust: Use allergen-reducing covers for bedding. Wash bedding frequently in hot water temperatures >130° F to kill dust mites. Use damp mop or rag instead of dry dust mop or broom to trap allergens.

    Milton M. Hom, Azusa, CA
    1. Watch the weather. We have found that high temperatures combined with high humidity and high pollen counts are allergy triggers. Keep watch on the weather forecast to predict the big allergy days.

    2. Asthma is a red flag for allergy and allergic conjunctivitis. We know that the eye (allergic conjunctivitis) and nose (allergic rhinitis) are connected, but do we think about the other direction to the lungs? Its all about the entire airway, not just one part. If you see asthma, think of rhinitis and ocular allergy.

    3. Look at the plant life around you. Most seasonal allergies are due to pollen, and pollen comes from plants. If allergies are bothering your patients, have them look around their environment for flowering plants or pollen anthers. A tree or plant can be perfectly quiet in terms of allergy when not flowering. But when the flowers appear, pollen Armageddon happens. Beware the anthers.


    http://www.optometrytimes.com/allerg...p-allergy-tips
    Last edited by MGD1701; 04-Nov-2018, 07:41.

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    • #17
      Great video - baby shampoo/detergent
      This doctor invented the MGDRx EyeBag (warm compress)
      Most doctors do not recommend baby shampoo but some still do.

      https://www.youtube.com/watch?v=BqjXLS_AZS0&t=3s
      Last edited by MGD1701; 15-Nov-2018, 13:57.

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      • #18
        very impressed with this professor from Canada, Prof. Etty Bitton
        following makes her a great expert. The red parts are the biggest problems in treating dry eyes, in my view.

        associate professor, director of externships, and director of the Dry Eye Clinic at the School of Optometry, University of Montréal

        ''Why is it important for ODs to have a strategy for patient’s a dry eye work up?
        We are slowly unraveling the many facets of dry eye. It is a disease that affects many tissues, so that complexity has made it difficult to be simplistic in our approach.
        You need to show the evidence and how to educate the patient.
        One example is the warm compress. Everyone has a facecloth at home. But we’ve shown now that it is inefficient at providing the heat that is necessary to help.That proof has to take time to trickle down through the evidence to get the word out to the optometrist so they understand it and tell the patient.

        Another is lid hygiene. Everyone says just use baby shampoo. Now it’s potentially harmful to the tear film.
        We shouldn’t be advocating that, but we say it without questioning. Now we have to be more evidence-based.
        Do I have data to back this up, and has this data changed over the years?
        It’s my job as a clinician to be at the forefront of that change.
        I need to educate myself to make sure I know the latest thing that I’m recommending to my patients
        .

        How did you get interested in demodex mites?
        I went to a conference at the American Academy of Optometry, and they threw up a lot pictures of demodex. I sat there going, “Wow! I don’t think I’ve ever seen this!” Yet, when they showed picture of lids, I said, “But I’ve seen this.” We don’t typically pull out a lash and look at it under a microscope. What made the difference for me is if you have patients over 70, the likelihood of having demodex as a cause of blepharitis is nearly 100 percent. I may have missed this for a long time —I felt guilty as a practitioner but also curious. ''

        full text
        http://www.optometrytimes.com/qas/qa...-axes/page/0/1
        Oct. 2018
        Last edited by MGD1701; 15-Nov-2018, 13:59.

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        • #19
          This is what I have heard from all top experts in USA and now found this article (published Nov. 20, 2018) to share.

          Plugs vs Inflammation

          MMP-9

          Usually, dry eye treatment involves artificial tears and, possibly, punctal plugs.
          But if the patient has an inflammatory component,
          practitioners need to think twice about plugs and instead consider anti-inflammatory agents.


          The MMP-9 Rapid Pathogen Screening InflammaDry test (Quidel) is a non-specific measure of the presence of matrix metalloproteinase-9 (MMP-9), an enzyme that is elevated in dry eye patients.10

          MMP-9 testing should be performed before administering ocular anesthetic, topical dyes or Schirmer test.''

          from
          https://www.reviewofoptometry.com/ar...ls-for-dry-eye

          Dr. Sherman is an instructor in Optometric Science (in Ophthalmology) at Columbia University Medical Center, NY. She specializes in complex and medically necessary contact lens fittings and ocular disease.

          Dr. Shuja is an optometrist at New York-Presbyterian Hospital.
          ----------------------------
          I posted this a few days ago.
          Most experts in USA will only put plugs in when there is no (or very low?) inflammation.
          Some do not like the idea (as when there is inflammation, they need to remove plugs).
          Some like, Professors Edward Holland (USA) and Clara Chan (Canada), only use it as the last step as plugs could make eyes more red/inflammed.

          Even Dr Toyos mentioned (often) doctors do not check/treat inflammation,
          yet inflammation is the most important issue.
          Last edited by MGD1701; 07-Dec-2018, 05:38.

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          • #20
            Someone asked about tear volume issue. I remember several experts in USA mentioned that
            OCT (Optical Coherence Tomography) can measure Tear Meniscus Height (Tear volume) and tear film thickness.
            They consider it is objective. Most clinics have such tool but not sure if they know how to utilize/interpret it for this purpose.



            Anterior segment OCT can be used to measure tear meniscus height.
            Left: healthy tear production. Right: Low tear production

            images copied from

            https://www.reviewofophthalmology.co...s-step-by-step
            Last edited by MGD1701; 07-Dec-2018, 17:16.

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            • #21
              Famous Dr. Sandra Cremers, USA, has her 1st Lipiflow done, 2019. Jan
              She explains how/why it works etc.

              https://www.youtube.com/watch?v=nVV_eYK8A4E
              Last edited by MGD1701; 12-Jan-2019, 11:08.

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