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

[MGD1701]

I am always curious/interested in learning the latest strategies and right informaion from top experts from USA in diagnosing/treating MGD. These have helped me put my condition under control - mainly
mastering compress (constant/wet heat, about 43C),
Pure HOCL, NatraSan (I've foundmore than 1.5 years ago),
omega 3 + GLA although all doctors said no present of inflammation.

I believe in objective testing & accurate diagnosis = results & stop the progression, NOT trial & error.

Here is data from Dr Korb company website http://www.korbassociates.com/eyecare-services/dry-eye
I have also found his latest videos (2016 - published May 2018) & posted in another posting on Blephasteam (warm compress)
in case someone wants to learn more. https://www.youtube.com/watch?v=vSShGZfxiFg&t=7s

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DRY EYE DIAGNOSTICS

Important tests for dry eye, which were developed through a partnership with Tearscience, Inc., include:

• Meibography - Enables critical analysis of the structural integrity of the lipid producing glands of the lid.
• Lipiview Ocular Surface Interferometer - Captures detailed digital images of the lipid content of the tears and quantifies the blinking reflex.
• Meibomian Gland Evaluator - Measures the function of the glands during normal blinking.
• Light Test - Diagnoses whether the lids are properly sealing to prevent exposure desiccation.
• Evaporative Stress Test - Diagnoses whether improvement in symptoms occurs when evaporation of the tears is reduced.
• Diagnostic Gland Expression - Examines the quality of the meibomian secretions and helps to establish a course of treatment.

Other diagnostic tests include use of vital dyes, tear osmolarity testing (TearLab) and testing for inflammatory markers (Inflammadry), as well as testing for Sjogren's syndrome and conjunctival chalasis/CCH.

DRY EYE INTERVENTIONS
We offer state of the art treatments for dry eye including:

• LipiFlow Thermal Pulsation System - Treats evaporative dry eye disease, using precisely controlled heat and gentle pressure applied to the eyelids, to unblock obstructed Meibomian glands during a 12 minute, in-office procedure. LipiFlow allows Meibomian glands to resume there natural production of lipid needed for a healthy tear film.
• Lid Margin Debridement - Removes material from the lid margin, enabling secretions from the Meibomian glands to spread across the ocular surface.
• Scleral Contact Lenses - Provide a fluid reservoir over the ocular surface which can promote healing of the ocular tissues and protect the surface of the eye from desiccation.
• EyePrint Pro- is an optically clear prosthetic scleral cover shell designed to match the exact contours of the individual eye.
• Custom Moisture Chamber Spectacles - Can provide relief from severe symptoms by enabling a high humidity micro-environment. These are also available in personalized prescriptions.
• Eyelid Cleaning Service- Similar to a dental procedure, the lashes, lid margin, eyebrows and skin of the lids are thoroughly cleaned to control Demodex infestation and blepharitis.
• Serum/amniotic fluid drops- for severe cases of dry eye these compounds contain growth factors which can promote ocular surface healing and normalization of corneal nerves.
• Amniotic membrane bandage contact lenses- have been shown to promote healing of severely compromised ocular surfaces, including dry eye.

These treatments are used in concert with more traditional methods of dry eye management including
anti-inflammatory medications, lubricants, ointments and punctal occlusion therapy.

DRY EYE PRODUCTS
Donald Korb is the inventor of two commonly used dry eye products: Systane Balance™ and Soothe XP™

Onyix™ sleeping mask http://www.cpap.com/productpage/eyeeco-onyix-eye-s...
Panoptyx™ dry eye glasses http://www.7eye.com/home.php
Lid cleansing products such as Tea Tree oil lid shampoos and Avenova™ cleanser http://avenova.com/
Warm compress towels

Learn more about dry eye with this intractive website https://www.oscb-berlin.org/
(this link is provided in Dr Korb webstie - seems they work together??)

[MGD1701]

Treatment Options for MGD

This is what I have prepared some weeks ago. Seems many doctors, even in USA, still do not know several (new) options/tests, I therefore decide to compile this, hopefully it can help you achieve more.

Below is based on my daily learning/experiments & experience, in the last 2 years (since one & the only dr told me, 'Sorry, I can not help you,') from various American opinion leaders. Remember:
only right order & combination can achieve (the best) results and save money/glands.

Wise to Master warm compress (not easy - one American dr even says most people do it wrong. It took me 3 months to realize the tricks. A MGD expert, Dr Caroline Blackie and her team found that so-called Bundle Method, 45C (& re-heat every 2 min), proved to be the most effective.

Many doctor recommend: Burder/microwave or *Blephasteam/electronic (constant/wet heat of 42.5C) - People have Rosacea/inflammation, be careful with the temperature. In short, the best indication, in my view: should feel 1) oil flowing & 2) great aftwards. But it only works if the obsruction is removed.

*Dr Korb also considers Blephasteam helps. More please read
http://forum.dryeyezone.com/forum/dr...ueeze-lids-etc

or watch Dr Korb's 4 videos (2016, published in 2018) I have found
https://www.youtube.com/watch?v=mZyXyQi-5MQ&t=5s

Add omega 3 (+ GLA works more effective, that is why most doctors recommend HydroEye.
Some recommend PRN, formulation of 3:1 re-esterified EPA and DHA only.

perform Lid hygiene
(with pure HOCL to control bacteria overgrow, like *Avenova, only availabe in USA,
or Heyedrate (from USA) but I have managed to find an alternative, **NatraSan, on the 3rd attempt - so you could try your luck too.). The beauty of it: no resistance like antibiotics.
**http://forum.dryeyezone.com/forum/dr...eyelid-hygiene
(my post #9)

I have discovered all these (compress, omega 3+ GLA, pure HOCL) by myself which help my eyes fit. If I had knew all these, I should be able to reach to this stage in about 2 months not 10.

Artifical tear for MGD
with Hyaluronic Acid/HA sometimes work better than oil-based for some people, especially advanced level, new research shows.
Oil based: Retain MGD and Systance Balance, recommended by most doctors.
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LipiFlow vs warm compress
LipiFlow
1) constant heat can go inside the lids
2) can massage ---- both of which warm compress can NOT achieve.
Blephasteam has constant wet heat but the heat can not go inside the lids nor massage
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Above are just some NEW/basic but important tools.

PS
Treatments normally involved 4 areas and should be treated at the same time & in a RIGHT order/combination for the best results

1) obstruction: IPL, LipiFlow, Mibo etc.
2) bacterial biofilm: BlephEx, debridement, pure HOCL spray like Avenova
3) & 4) tear film stability & inflammation/allergy/demodex

[Guest]

If you want my opinion...some of the tests are unimportant. MMP9, if you have lid disease, then you're going to have high MMP9. I think wjat the test told me was that restasis wasn't controlling my inflammation. So it's not a worthless test, but it's important in what context you use it. Osmolarity, again, I have dry eye and my osmolarity was under 300. Again, I guess it tells me my tears are "normal" saltiness. What you can extrapolate from that I'm not sure. Maybe it signifies that my main problem is not the lacrimal gland, it's just MGD.

There are a couple on there there that aren't done very often. Testing lid closure I think is huge and rarely done.

Nice write up.

[MGD1701]

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[MGD1701]

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[Guest]

Tear Meniscus Height, TMH to measure tear volume to identify if Aqueous deficiency

I have been sick of doing schirmer, curious and searching for hard evidences and found out 1) & 2) below.
I just did one again with anesthesia at a big hospital - first I declined saying it should be done at the end and presented all 9 results (from 0-30) in the past. But the junior dr insisted who had no clue about gland images when I showed míne so I explained what normal glands should look like. Later, the professor decided more tests should be performed. I waited for about 30 minues, I guess it was because I expressed my concerns several times that anesthesia would make results unrelaible. However, I think should wait for 2 hours - professor Starr mentioned similiar things (for the osmolarity test).

I actually found a dr with Keratograph 5M to check TMH but she did not know how - seems many doctors do not know how so I have included the video. If doctors do not even realize schirmer is not objective and should be done at the end and without anesthesia - that is a very big problem.

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Just added
1) the video on TMH
HOW? watch: TFOS DEWS II Diagnostic Videos - Tear Volume (2018 Jan)
Clinical assessment of tear volume via lower tear meniscus height measurement .....
https://www.youtube.com/watch?v=3a8JO45j9wI&t=61s

2) Schirmer’s without anesthesia (≤5 mm at 5 min) is one of the indicators to classify as Sjogren per
the American European Consensus Group, Table 5.1

youre right the schirmer isn't accurate as far as my dr was concerned. He added 50 microliters of saline to my eye and washed it, then retrieved 4 vials of fluid to test for inflammatory markers. My schirmer was 2mm left eye and 3mm right eye. He said to me, you have tears, I added 50 microliters and got back much more. So he believes my schirmer will increase and that the initial results didn't match his findings.

[MGD1701]

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[MGD1701]

The problem is there are NO standards doctors could follow.
Aqueous issue is related to (inflammation and) eventually will develop to Evaporative dry eye per TFOS 2017 report.

[MGD1701]

Just read this *article from Dr Laura Periman, dryeyemaster, Jul 25, 2018

''the traditional measurements used (like OSDI and Schirmers) have limited sensitivity and specificity.
We are limited by the measuring sticks we currently have.
If we don’t get the results we expect, are we looking at a treatment that doesn’t work,
or are we just not using the right measuring stick?''

If doctors can not dectect such important aqueous deficiency issue accurately,
how can they treat us?? How can we stop progression?

Dr Periman measures Tear Meniscus Height.

*full text
http://www.ophthalmologytimes.com/nu...e-beyond-dream

[MGD1701]

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[MGD1701]

Found this useful.
https://www.ophthalmologymanagement....-eye-treatment

[MGD1701]

Just read this interesting/useful article,

Why osmolarity should be the top test for tear film evaluation

by Marc Bloomenstein, OD, FAAO Sep 26, 2018

in particular,
''The Schirmer’s test, for example, is limited from the perspective that all it does is give us a volume of tears coming out of the eye with no information about the quality or property of those tears. Few doctors perform the test because it is not very predictive,...

For a patient with aqueous deficiency or an underlying systemic disease such as Sjögren’s syndrome, the Schirmer’s test could be beneficial to demonstrate the basal tear rate. However, we know that dry eye disease is multifactorial, so tear volume limits our ability to understand what is going on. Osmolarity is more definitive of the homeostatic nature of the tear and disease state.

Tear break-up time (TBUT) is somewhat informative, but it is not precise and lacks a strong predictive value. If I know that my patient’s tears are breaking up, I do not know the severity or underlying cause of the problem. Frankly, I can look at the meibomian glands and note the apparent lack of uniformity that is most likely occurring. In addition, although low TBUT implies a problem, patients with poor tear quality can have a high TBUT.

One of the best metrics for early dry eye disease is fluctuating vision, which is one of the first signs of a decrease or change in tear quality. I ask patients if their eyes get watery—can they see better if they blink? With the increased use of monitors, phones, and streaming videos, we see more and more symptoms at younger ages.

http://www.optometrytimes.com/dry-ey...ation/page/0/1

[MGD1701]

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[MGD1701]

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[Guest]

https://www.ncbi.nlm.nih.gov/m/pubmed/27438542/

based on on what I read of dynamic objective scatter index...it’s used to measure how light passes through the tear film post blink. It’s a way to discover early variance in the tear film in asymptomatic dry eye patients. So it may be able to predict dry eye before it becomes evident to the patient.