DEWS II: The sequel

Findings from the 250-page report will be presented at ARVO

By Ophthalmology Management staff

The May 7, 1:30 p.m. daily program slot in ARVO’s 2017 annual conference doesn’t say much: Dry Eye. But for the 150 or so researchers, clinicians and industry leaders comprising the 13 subcommittees that have labored on the TFOS Dry Eye Workshop (DEWS) II for the last 2.5 years, those two words say it all: We did our job.

“Anniversaries and vacations were postponed and canceled,” during this time, says Amy Gallant Sullivan, executive director of the Tear Film & Ocular Surface Society, an organization that promotes ocular surface disease awareness and research. “People [were] dedicated and very, very hardworking.”

On that Sunday afternoon in Baltimore, attendees will hear what the subcommittees have been up to since TFOS announced in June 2014 that there would be a DEWS sequel. (According to Ms. Gallant Sullivan’s blog, TFOS received the names of more than 300 people who wanted to be nominated to the subcommittees.)

TFOS DEWS II, says the TFOS website, will “update the definition, classification and diagnosis of dry eye disease, critically assess the etiology, mechanism, distribution and global impact … and address its management and therapy.” The first report was released in 2007.

With the new report, says Ms. Gallant Sullivan, the “emphasis is on everything … there isn’t one section that is more important than the other.”

She declined to say more about the report’s contents. The release at ARVO, chosen for its research and science focus, will present the report’s findings in advance of publication in the July issue of The Ocular Surface.

Ms. Gallant Sullivan chatted about TFOS’ global ambassador program, a new initiative to help promote TFOS’ educational mission. TFOS is in the process of vetting ambassador candidates; the plan is to recruit ambassadors from more than 200 countries and dependent territories.

If you’re interested in applying, here are the qualifications and responsibilities: Ambassadors will have a graduate degree (PhD, MD and/or OD) and expertise in the field of the ocular surface. There will be one ambassador per country/territory, and possibly associate ambassadors, she says.

Ambassadors will coordinate the organization of regional symposia, and create reports on scientific and clinical advances, along with the unmet needs, of their region.

The full DEWS II report is well over 1,000 pages, edited down to about 250 for publication.

Members of the subcommittees didn’t exactly live in the same zip code. They hailed from Tokyo, Turkey, Toronto — and New South Wales.

As for the extent of the research, they looked at epidemiology, iatrogenic ocular surface disease, clinical trials, definitions and classifications, pain and more. The work submitted by the subcommittee on sex, gender and hormones alone had 1,300 references.

“This report, we could have spent three years on it,” Ms. Gallant Sullivan says. “Dry eye is much better understood than 10 years ago — but there is still much to be learned!” OM

For more information, please go to http://www.tfosdewsreport.org/index.html

Attention all glaucoma specialists

New book available by Constance Okeke, MD, MSCE

Veteran glaucoma surgeon Constance Okeke, MD, MSCE, shares her seven years of insight and clinical experience with the Trabectome (NeoMedix) in the just-launched The Building Blocks of Trabectome Surgery: Patient Selection. Available through the publisher’s website, www.kuglerpublications.com , the book was slated to be listed in late March on Amazon. May’s issue of Ophthalmology Management will feature an interview with Dr. Okeke and a short review of her book.

Besides her glaucoma specialty, Dr. Okeke is a cataract surgeon, practicing at Virginia Eye Consultants. She is also assistant professor of ophthalmology at Eastern Virginia Medical School. OM

Tech connects patients, caregivers

New app lets sighted ‘walk’ in ‘shoes’ of visually impaired

By Robert Stoneback, associate editor

Technological advances are giving caretakers and medical providers an up-to-now rare gift: the chance to see life through the eyes of their visually impaired patients.

And maybe some more empathy.

Virtual and augmented reality programs can now simulate conditions such as cataracts and retinopathy, allowing those aside from the visually impaired to experience those conditions.

One of the most recent examples was released in January by Regeneron, a smartphone app for iPhone and Android platforms called In My Eyes.

The inspiration for Regeneron’s app was to fulfill “an unmet need in patient education,” says Keith Baker, MD, medical director for Regeneron.

Traditionally, doctors’ offices had access to paper-based education tools, but with the greater penetration of smartphones, “there was a great opportunity to improve on traditional technology and generate more empathy among the caregivers” who assist people with vision impairment, Dr. Baker says.

Regeneron felt the importance of early detection and follow-up could be driven home if physicians, technicians, caregivers and patients had a sense of what it meant to live with these impairments, says Dr. Baker.“Studies have shown that early detection leads to better outcomes.” ^1,2

An app for AMD, DME and ME

In My Eyes simulates the conditions of wet AMD, DME and macular edema following retinal vein occlusion. The app user holds the phone in landscape view, and the phone’s camera displays the user’s surroundings as if he or she were afflicted with the chosen conditions. There is also a “story mode” that puts the user in everyday situations, such as visiting a park or restaurant, while dealing with these symptoms.

While conditions included in the app can be treated by Regeneron’s Eylea, Dr. Baker clarifies it is meant to be a “broad-based education tool,” and not just for prospective Eylea patients.

While In My Eyes was not designed as a diagnostic tool, Regeneron heard an anecdote of a clinic technician showing the app to a person with vision problems. After seeing the symptoms displayed on the smartphone, the patient confirmed that he had a similar problem and scheduled an appointment with a retina specialist.

Smartphones in the clinic

Regeneron isn’t the first to use a smartphone to further patient education.

Lately, a few journal articles have discussed the smartphone’s place in the clinic. The conclusion drawn by many of these papers is that a smartphone and its apps can help the clinic in a wide variety of ways, including education.

One article, published in 2012 in the British journal Eye, focused on the iPhone, saying its portability and pocket-size makes it ideal for providing information to patients in the clinic. In addition, patients can download educational applications to their own phones; showing these educational apps to friends and family “[relieves] them of the burden of translating the sometimes complicated explanations of their ophthalmological condition.”³

Research conducted at the University of Missouri collected metadata from 55 other studies, ultimately discussing 83 ophthalmic smartphone apps. Among the researchers’ conclusions: the wide adoption of smartphones allows for greater opportunities for patient education, disease self-management and remote monitoring of patients.⁴

Empowering patients

In My Eyes isn’t the first educational tool of its kind; others are available both on smartphones and websites.

VisionSim, by the Braille Institute, is available on the iPhone and iPad, and simulates nine degenerative eye diseases.

The website Sight Simulator lets visitors type in an address and then look at a “street view” of that location while affected by cataracts, glaucoma or retinopathy. Sight Simulator (www.simulator.seenow.org ) was created by the See Now charity, which raises money to fight avoidable blindness.

Dr. Baker hopes there will be more such tools available in the future to teach people about vision impairment.

“Knowledge is power, so hopefully this is empowering patients to seek appropriate care.” OM

REFERENCES

1. Jimenez-Baez MV, Marquez-Gonzalez H, Barcenas-Contreras R, Morales Montoya C, Espinosa-Garcia LF. Early diagnosis of diabetic retinopathy in primary care. Colomb Med (Cali). 2015;46:14-18.
2. Loewenstein A; Richard & Hinda Rosenthal Foundation. The significance of early detection of age-related macular degeneration: Richard & Hinda Rosenthal Foundation lecture, The Macula Society 29th annual meeting. Retina. 2007;27:873-878.
3. Bastawrous A, Cheeseman RC, Kumar A. iPhones for eye surgeons. Eye (Lond). 2012;26:343-354.
4. Mosa AS, Yoo I, Sheets L. A Systemic Review of Healthcare Applications for Smartphones. BMC Med Inform Decis Mak. 2012;12:67.