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Blepharitis in the United States 2009: A Survey-based Perspective on Prevalence and Treatment

Authors:

Abstract

ABSTRACT Like dry eye disease 15 years ago, blepharitis today is a poorly defined condition about which there is considerable misunderstanding. For a variety of reasons, there is little good data on either the prevalence of blepharitis or how eyecare practitioners currently treat it. The work reported herein consists of two recent studies: a telephone survey of a representative sample of the adult US population (n = 5,000) whose purpose was to discover the frequency of common ocular surface symptoms associated with blepharitis; and a study that queried a selected group of ophthalmologists (n = 120) and a similarly selected group of optometrists (n = 84) about the frequency of blepharitis in their practices, the existence comorbid conditions, and their management strategies. This data suggests that blepharitis symptoms are very common in the US population, with younger individuals reporting more, and more frequent, symptoms than older people, contrary to clinical dogma. Ophthalmologists and optometrists report that blepharitis is commonly seen in clinical practice in 37% and 47% of their patients, respectively, and it is widely agreed that meibomian gland dysfunction (MGD) is the most common cause of evaporative dry eye disease. In addition, management paradigms are shifting away from more traditional management with antibiotic ointment and warm compress therapy to prescription therapy for anterior and posterior blepharitis.
Outline for Perspective on Deciencies in Systematic Literature
Reviews
Goal: To identify problems in peer and editorial evaluation of systematic literature
reviews and to recommend solutions.
I. The Problem: perpetuation of misinformation and faulty science through
inadequate peer review and editorial oversight of systematic literature
reviews
a. Recognition of inadequacies of peer review in science and medical
literature
i. Cochran review on peer review
ii. Cardiology editorials
iii. Science editorial
b. Reasons for impairment of peer review
i. Increasing number of submitted publications
ii. Increasing demand for qualied peer reviewers
iii. Increasing challenge for editors to select qualied peer
reviewers and vet them
II. Examples from recently published systematic reviews regarding
measurement of tear lm osmolarity demonstrating the problem
a. Baeninger article
i. Identify bad science
1. Verifying instrument selection and methodology (eg,
Garcia paper)
2. Selection bias (eg, Esperjesi paper, Szalai paper)
3. Spectrum bias (eg, Esperjesi paper, Szalai paper)
4. Flawed statistical analysis
5. Omission of relevant data
6. Regression to the mean
ii. Note the inclusion of Szalai manuscript without recognition of
prior critique of letter to editor.
b. Szalai article
i. Identify bad science
1. Selection bias
2. Spectrum bias
ii. Note prior critique and lack of reference
III. Other examples
a. Omega-3 EFA systematic review
b. Studies outside of dry eye (?)
i. Downie article in JAMA Ophthalmology
IV. Possible Solutions
a. Awareness of the problem
i. Authors
ii. Peer reviewers
iii. Editors
b. Citation index options
i. Including citation of critiques and comments in the listing of
primary publication
ii. Including citation of letters to the editor in the listing of the
primary publication
c. Vetting of evidence (?)
i. Develop a vetting system to assure that peer reviewers are
aware of published critiques via available citations
ii. Use of independent expert opinion
d. Withdrawal of publications
i. Specic recommendations for adjudication
V. Conclusion
Suggested format:
I. Title: Deciencies in Published Systematic Literature Reviews
II. Authors
III. Abstract
IV. Table of contents
V. Introduction and statement of goal
VI. Text
VII. References
VIII. Disclosures
... Confusion on the differential diagnosis of blepharitis and its frequent association with dry eye disease complicates to achieve clear information from prevalence studies. A survey of clinicians in the United States showed that 37-47% of adults patients had findings of blepharitis (2). Venturino et al. studied ocular discomfort in 1148 patients and found that 12% of the subjects had anterior blepharitis, 24% had posterior blepharitis, and 21% had dry eye (3). ...
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Objectives: The purpose of the study was to determine interobserver and intraobserver agreement, repeatability, and intrasubject variation of the detection of Demodex infestation in eyelids of blepharitis patients using in vivo confocal microscopy (IVCM). Methods: Eighty-three eyes of 42 blepharitis patients were included in the study. All eyelids were evaluated from temporal to nasal with IVCM using section mode and 10 lashes with their follicles were imagined, and every image with suspicion of Demodex infestation was recorded. Two experienced and two inexperienced ophthalmologists were masked for the diagnosis and interpreted the IVCM images regarding the presence of Demodex infestation with a 3-week interval. Interobserver and intraobserver agreements were calculated with Cohen's kappa and its variant statistics between and within experienced observers and between inexperienced observers. Results: While average sensitivity for the diagnosis of demodicosis in IVCM images was 83.35% for experienced and 51.35% for inexperienced observers, the average positive predictive value was 88.6% for experienced observers and 91.05% for inexperienced ones. Interobserver agreement between experienced observers was moderate (κ = 0.529) and intraobserver agreements within experienced observers were perfect (κ = 0.918 for observer-1; κ = 0.958 for observer-2). Interobserver agreement between inexperienced observers was poor (κ = 0.162) and intraobserver agreements within inexperienced observers were fair (κ = 0.427 for observer-3; κ = 0.475 for observer-4). Conclusion: The sensitivity, interobserver and intraobserver agreements in IVCM image analysis for the detection of Demodex infestation were highly associated with the clinical experience on IVCM imaging. In the hands of an experienced clinician, IVCM could be reliable for the diagnosis of ocular demodicosis.
... 4 Pada sebuah survei, para dokter mata di Amerika Serikat melaporkan bahwa 37% hingga 47% pasien menderita blefaritis. 5 Pada studi kohort di Korea Selatan menggunakan data Korean National Health Insurance Service selama periode 2004-2013 ditemukan bahwa 1.116.363 individu terdiagnosis blefaritis dengan insiden keseluruhan adalah 1,1 per 100 orang per tahun dan perbandingan antara pria dan wanita adalah sekitar 1,3:0,9. ...
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p>Blefaritis merupakan kondisi oftalmologis yang ditandai dengan inflamasi pada margo kelopak mata. Secara anatomis, blefaritis dibagi menjadi blefaritis anterior dan posterior. Pilihan terapi blefaritis telah mengalami perkembangan dalam beberapa tahun terakhir. Kompres hangat dan membersihkan kelopak mata masih menjadi regimen pengobatan dasar; penggunaan antibiotik, steroid, dan inhibitor calcineurin menunjukkan efikasi yang baik. Suplementasi dan berbagai prosedur intervensi mungkin dapat dipertimbangkan di masa depan. Blepharitis is an ophthalmological condition characterized by inflammation of the eyelids. Anatomically, blepharitis is divided into anterior and posterior blepharitis. Therapeutic options for blepharitis have evolved in recent years. Warm compresses and eyelid hygiene are still the basic treatment regimen, but the use of antibiotics, steroids, and calcineurin inhibitors has shown good efficacy. Supplementations and various possible intervention procedures may be considered in the future.</p
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Craig McArthur continues his series on developing a specialist care service for common ocular surface disorders with an in-depth look at an individual case of management of blepharitis and meibomian gland dysfunction
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