InflammaDry Q&A

During a recent webinar, Dr. Matossian fielded a variety of questions from listeners. Below are some highlights from the Q&A session.

Q: DO YOU TEST BOTH EYES WITH INFLAMMADRY? IF SO, CAN YOU BILL FOR BOTH EYES?

A: I test both eyes. Sometimes, surprisingly, one eye is positive while the other eye is not. Or you may see a faint red line, which indicates less inflammation, for one eye, and a brilliant red line, indicating more MMP-9 markers are present in the other eye. Knowing this, you can titrate the treatment for each eye. Often, when one eye is positive, I assume both eyes have inflammation and design a treatment regimen for both eyes. And yes, you can bill for both eyes.

Q: DO YOU USE THE INFLAMMADRY TEST FOR PATIENTS WHO ARE USING CYCLOSPORINE?

A: Yes, for several reasons. Sometimes, a patient’s inflammation is so severe that cyclosporine alone may not be adequate to treat it, or a patient may have had an exacerbation of his ocular surface disease, requiring a short course of a steroid. First, however, I want to establish that the patient has been adhering to the cyclosporine regimen. If he admits to missing doses, I emphasize the importance of using the cyclosporine twice a day. If the patient has been using the cyclosporine as prescribed and the InflammaDry test is positive, I know an additional treatment is needed to address the level of ocular surface inflammation.

Q: A RECENT STUDY¹ FOUND THAT ELEVATED MMP-9 WAS ASSOCIATED WITH KERATOCONUS AND ITS PROGRESSION. DO YOU THINK PREOPERATIVELY TREATING PATIENTS WHO HAVE ELEVATED MMP-9 WITH CYCLOSPORINE MIGHT HELP REDUCE THE RISK OF POST-LASIK ECTASIA?

A: The study showed that patients with keratoconus had elevated MMP-9 markers and that treating them with cyclosporine helped stabilize the progression of keratoconus and helped flatten their corneas. Additional studies are needed in this area, but the use of cyclosporine is showing positive results in patients with keratoconus. It would be beneficial to use InflammaDry to identify patients who should undergo targeted dry eye treatment before scheduling LASIK.

Q: DO YOU USE INFLAMMADRY ONLY IF THE OSMOLARITY READING IS ABOVE 308?

A: I use InflammaDry as an independent tool, not related to a specific tear osmolarity reading. If a patient is symptomatic but his tear osmolarity is in the normal range, I still perform the InflammaDry test. I recently had a patient whose tear osmolarity readings were 285 and 287, yet his InflammaDry test was strongly positive. You should view InflammaDry as an independent test and treat accordingly, because tear osmolarity readings can fluctuate greatly, depending on the instability level of the tear film and when after the blink cycle the reading is taken. The InflammaDry test is important to ensure you’re not missing ocular surface inflammation.

Q: HAS USING INFLAMMADRY HAD ANY EFFECT ON YOUR CHAIR TIME?

A: Yes, it has — a positive effect, because I now have an objective test result to share with patients while they’re in my examination chair. The InflammaDry test confirms the existence of ocular surface inflammation. Patients love getting a yes-or-no answer right away. When we have confirmation that inflammation IS present, we focus on how we’re going to treat it.

Q: DOES THE TEST HURT? DO YOU USE ANESTHETIC BEFORE PERFORMING THE TEST?

A: The test doesn’t hurt at all. You gently pull down the lid and dab the sampling fleece along the tarsal conjunctival surface, starting laterally and moving nasally toward the inner canthus. In fact, do not use an anesthetic drop before performing the test, because it will invalidate the result.

Q: WHEN TREATING TO STABILIZE TEAR FILM PRIOR TO SURGERY DO YOU RETEST WITH INFLAMMADRY BEFORE PERFORMING KERATOMETRY AGAIN? ALSO, PLEASE COMMENT ON YOUR STEROID PROTOCOL FOR THAT SITUATION.

A: I’m very particular with my preoperative testing. If a patient’s keratometry and topography readings don’t show consistency among four or five different pieces of equipment, there’s a reason; so I stop. If the InflammaDry test is positive, I start the patient on re-esterified oral omega-3 (Physician Recommended Nutriceuticals^®, PRN), a microwaveable hot mask, and cyclosporine. If the InflammaDry test isn’t positive, but the patient has signs of ocular surface disease, I start loteprednol etabonate ophthalmic gel (LOTEMAX^®, Bausch + Lomb) twice a day for a short course, about 2 weeks instead of starting cyclosporine. I then bring the patient back to repeat the measurements. If the InflammaDry test is negative at this visit, I am confident my data will be reliable. I look at the patient’s keratometry and topography readings, and make sure they’re consistent, that there’s less than 0.50D change between the different measurements in the magnitude of the astigmatism, and that the axis is no more than 10 degrees apart.

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