Attending the Association for Research in Vision and Ophthalmology (ARVO) meeting for the first time in my career was an eye opening experience. Upon arrival to the exhibit hall I could tell right away this was the crème de la crème of eye research. Many different special interest groups were represented. Reviewing each poster abstract in advance before attending the conference is a necessity. This allows you to plan your specific “poster route” and budget your time accordingly to discuss the specifics of each poster with the presenter. Remember, there are over 6,500 posters presented from researchers around the world so visiting each poster would be almost impossible!
Each day at ARVO presents a specific poster topic session. I highly recommend finding out which day your area of concentration is presented. For the purpose of this article, I will focus on a review of dry eye and contact lenses.
Dry Eye—Paper Session
Paper presentations are different from poster sessions in that various researchers showcase their findings within a 15-minute presentation. Poster sessions ask the researcher to stand beside their poster for approximately two hours while attendees read and ask questions regarding their research. I attended a Special Interest Group (SIG) paper session presented by several researchers titled, “To Do or Not to Do: Does an Anti-Inflammatory Approach in Dry Eye Disease Make Sense?”
Most researchers agree that dry eye can be challenging because symptoms do not equal signs. With dry eye, there is a lack of surrogate markers or known clinical endpoints. The presenters discussed strategies for measuring inflammation within the eye by culturing tears, cells and tissues. For example, in Sjögrens syndrome, CD4 cells, which are inflammatory markers, are in high levels throughout the conjunctiva. Non-Sjögren’s dry eyes also exhibited high levels of CD4.
Another inflammatory marker, HLA-DR, has been correlated to levels of corneal staining in dry eye patients. It seems that as HLA-DR increases, so does corneal staining. TearLab has been shown in clinical studies to have a high correlation with increased HLA-DR and increased osmoloarity.1 After examining inflammatory markers to detect dry eye, methods for both inflammation and treatment of dry eye were discussed.
The three ways inflammation can occur include ocular surface inflammation, dry eye secondary to inadequate lubrication and lid margin disease. Treatment methods include cyclocsporine, steroids, tetracyclines and fatty acid intake.
Cyclosporine decreases T-cell mediation, thus decreasing pro-inflammatory mediators; however, clinical results can take anywhere from two to six months.
Just three papers are cited in research literature for treating dry eye with steroids using prednisolone acetatate and they included long-term side effects warnings. In 2004, Stephen Pflugfelder, M.D., published a paper in the American Journal of Ophthalmology examining loteprednol etabonate 0.5% q.i.d. therapy for patients with KCS. The results concluded loteprednol etabonate 0.5% benefits patients with at least moderate inflammation due to dry eye.2 The presenter recommended a soft or smart steroid for long-term use.
Currently, there are no research papers on human subjects that show a decrease in inflammatory markers with use of tetracyclines.
Fatty acid intake was also mentioned: Omega-3 decreases inflammation and alters endogenous hormone metabolism, while omega-6s have been shown to decrease inflammation when used in the proper quantity.3
Current clinical trials for dry eye include, but are not limited to, a JAK3 inhibitor (immunosuppressant, Pfizer) and the NSAID, bromfenac 0.09% (ISTA Pharmaceuticals).4-5
Dry Eye—Poster Session
One of the most relevant clinical applications for dry eye was found in poster D949, Gary Foulks, M.D., F.A.C.S., and colleagues’ “Comparative Effectiveness of Azithromycin and Doxycycline in Therapy of Meibomian Gland Dysfunction.” The findings suggested that azithromycin treatment ameliorated the signs and symptoms of dry eye; azithromycin was more effective than doxycycline in reducing foreign body sensation and azithromycin was more effective in improving the degree of meibomian gland plugging and character of secretion.
Contact Lens—Myopia Control
The big buzz in the eye care world right now is myopia control. Current mainstream hypotheses agree that while the central retina is in focus with the proper spectacle/contact lens correction, hyperopic peripheral defocus drives eye elongation (axial length) and refractive error. Helen Swarbrick, Ph.D., M.Sc., Bsc.Opt., presented poster D686, “Changes in Axial Length and Refractive Error During Overnight Orthokeratology for Myopia Control.” The study examined refractive error and axial length over a year in 26 subjects wearing orthokeratology (OK) lenses in one eye vs. gas-permeable (GP) lenses in the other eye. Of the 32 subjects enrolled at the beginning of the study, two subjects dropped out because they were unable to adapt to daily GP lens wear. There were no adaptation dropouts due to OK discomfort. Results showed eye growth was faster in the GP group vs. the OK, however it was not statistically different and it took into account corneal compression of 15µm to 20µm from the OK effect.
Bifocal soft lenses have also been employed for myopia control. Brien Holden, Ph.D., D.Sc., presented poster D982,“Central and Peripheral Visual Performance of a Novel Contact Lens Designed to Control Progression of Myopia,” which describes a soft silicone hydrogel lens with a “central aperture that corrects for foveal refractive error and a peripheral zone designed to reduce peripheral hyperopic defocus.” The poster compared this novel technology to a single vision soft contact lens. The results demonstrated good central visual acuity in both groups, but improved peripheral visual acuity and contrast sensitivity with the new technology. Dr. Holden concluded that improved peripheral vision will likely cause less peripheral blur and potentially slow myopic growth.
Contact Lens—Special Applications
Contact lenses employed as special applications have been discussed recently. Contact lenses used to measure tear glucose levels in diabetics are coming to fruition. Poster D1100, “Disposable Nanostructure-laden Lens Sensor for Monitoring Tear Glucose,” by Jin Zhang, Ph.D., reviewed a nanostructured optical probe that is incorporated in the hydrogel material to measure glucose levels in the tears. The tears are then analyzed and a portion of the lens changes color based on the glucose level. Further studies are needed to show biocompatibility, however this would be a great benefit for patients to manage diabetes in a convenient and comfortable way.
Contact Lens—Corneal Infiltrative Keratitis
The posters on this topic yielded different results. For example, poster D985, “Case Characteristics of Persons Presenting with Contact Lens-associated Infiltrative Keratitis (CLAIK) with Multipurpose Solutions and Contact Lens Combinations,” by Thomas Kislan, O.D., performed a chart review over a 22-month period of 86 subjects. The study found a high correlation (87.5%) of subjects had CLAIK with use of Opti-Free RepleniSH MPS (Alcon) and senofilcon A lenses (Acuvue Oasys). All cases were daily wear subjects, with the exception of one subject who slept in the lenses. Other solutions and lenses were listed in his poster but had low correlations to CLAIK.
A second poster, D952, “Risk Factors for Corneal Infiltrative Events in Soft Contact Lens (SCL) Wearers: A Case Control Study in 2010,” by Robin Chalmers, O.D., analyzed five academic eye centers and chart reviews, performed by a masked expert panel of clinicians. Daily disposable and extended wear modalities were taken into account. Charts from 166 subjects were identified with CIEs and, of the 166 subjects, there was no correlation between a specific solution/lens combination. Results from her data concluded that younger patients are at higher risk for CIEs, followed by extended wear and reusable soft contact lens wearers—specifically silicone hydrogel contact lenses.
In summary, my first time ARVO experience was a success. While a bit overwhelming at first, if you do your homework and make a game plan of poster abstracts you specifically want to discuss with each author, it will be an enriching experience—both clinically and scientifically.
Dr. Mayers, a fellow of the American Academy of Optometry, practices in Powell, Ohio where he founded Mayers Eye Solutions, LLC.
1. Versura P, Profazio V, Schiavi C, Campos EC. Hyperosmolar stress upregulates HLA-DR expression in human conjunctival epithelium in dry eye patients and in vitro models. Invest Ophthalmol Vis Sci. 2011 Apr. [epub ahead of print]
2. Pflugfelder SC, Maskin SL, Anderson B, et al. A randomized, double-masked, placebo-controlled, multicenter comparison of loteprednol etabonate ophthalmic suspension, 0.5%, and placebo for treatment of keratoconjunctivitis sicca in patients with delayed tear clearance. Am J. Ophthalmol. 2004 Sep;138(3):444-57.
3. Barabino S, Rolando M, Camicione P, et al. Systemic linoleic and gamma-linolenic acid therapy in dry eye syndrome with an inflammatory component. Cornea. 2003 Mar;22(2):97-101.
4. West K. CP-690550, a JAK3 inhibitor as an immunosuppressant for the treatment of rheumatoid arthritis, transplant rejection, psoriasis and other immune-mediated disorders. Curr Opin Investig Drugs. 2009 May;10(5):491-504.
5. Ista Pharmaceuticals. A dose ranging study to evaluate safety and efficacy of bromfenac ophthalmic solution in dry eye disease. 2010 Sep. Available at: www.clinicaltrials.gov/ct2/show/NCT01212471.