In part one of a two-part series, Patti Barkey, CEO, Bowden Eye & Associates, in Jacksonville, Fla., discusses why they decided to implement Cliradex in their practice, how it fits into their “Dry Eye Disease" toolbox, and how it is used.
Q: How long have you used PROKERA in your practice?
A: We have used PROKERA as our amniotic membrane tissue of choice to treat Dry Eye Disease (DED) and other ocular surface diseases for over four years. At least 70 percent of the patients that walk through the door of our practice have some sign or symptom of DED that has been left untreated; and the majority, if not all, have some degree of blepharitis. Based on this track record, when Bio-Tissue introduced Cliradex, we knew it would be a high-quality product we could trust. We decided to implement it in our practice.
Q: How does Cliradex differ from other treatments?
A: In our practice, Cliradex towelettes are recommended as a targeted treatment for Demodex. We place a significant emphasis on DED, of which many symptoms stem from Meibomian Gland Disease (MGD) and blepharitis. When patients present symptoms in our office, we examine the lash line and look for debris on the lashes. If there are collarettes, that’s a sign to our providers to pull a lash and look for signs of Demodex under the microscope.
We also recommend Cliradex Light – a hygienic and preventative-care foaming cleanser – and mild-to-moderate ocular irritation. When helping patients find relief from blepharitis, it is essential to remember that there is no cure for blepharitis. It is a recurring condition that is sometimes related to hygiene habits. Current therapies may temporarily alleviate symptoms but are not great tools for preventative care. Cliradex Light meets this need for the patient and helps the patient break the cycle of blepharitis.
Q: How does Cliradex fit into your practice “toolbox” for Dry Eye Disease?
A: Microbial activity disrupts the tear film and can release pro-inflammatory components that will irritate the ocular surface. Blepharitis and MGD go hand in hand, and lead to most symptoms associated with DED. This is also where Demodex can “live” hence treatment is extremely important. It is important for us to address blepharitis as it is the gateway to more severe conditions, such as dry eye.
For the patient with lid debris only, we typically recommend Cliradex Light. We also talk to all of our patients about the importance of ocular hygiene, using Demodex as an example of the most severe example if you don’t take care of your eyelids. We have illustrations in each room of a normal lid margin, an abnormal lid margin, and what a lid margin with Demodex looks like so to help educate patients. My providers often explain to patients that taking care of your eyelids is really no different than brushing your teeth.
But, when our doctors see the collarettes, we know more than likely there is Demodex. Our providers will epilate a lash; use a microscope to look under the lash for the movement of the mites; and in many cases, will take a picture and share it with the patient. If Demodex is present, typically our doctors will recommend immediately starting Cliradex. Because it is very targeted toward the elimination of inflammation and getting rid of Demodex mites, Cliradex is our “big gun.”
Q: Once the doctor recommends Cliradex, what is the next step?
A: Once we determine that a patient has Demodex, or the appearance of what looks like mites, we start with a BlephEx® cleaning. Once we finish cleaning the lids, we do an initial treatment of Cliradex in the office, and demonstrate for the patient how to use Cliradex towelettes properly. Before the patient leaves the office, we have them purchase enough Cliradex to use twice a day for 6-to-8 weeks.
At the four-month mark, we see the patient back in the office, at which time in most cases, the patient will present with clean and clear lashes. However, if there is any evidence of remaining mites, collarettes, or debris, we will restart the Cliradex treatment. And, seeing many of these patients have issues related to DED, we will see them in other follow-up appointments; and will continue to monitor them to make sure that we don’t see a recurrence. If we do, the patient may benefit from Cliradex Light and changing their ocular hygiene habits.
Patti Barkey, who is a Certified Ophthalmic Executive (COE), is CEO for Bowden Eye & Associates in Jacksonville, Fla, where she manages several locations, including a specialty eye surgery center. She is also the Director of Dry Eye University and Dry Eye Partners, both of which help other practices with the successful implementation of Dry Eye care. Barkey was recently elected to the ASOA Board of Directors.
BlephEx® is a registered trademark of BlephEx® LLC.