Article Date: 8/1/2013

Profession PULSE

profession PULSE

OUR EXPERTS DISCUSS THE HOT TOPICS IN OPTOMETRY

DEMODEX TREATMENT
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Milton Hom, O.D., F.A.A.O.: We have been diagnosing a lot of demodex this year. I think it’s due to my lack of awareness in past years, as opposed to a greater prevalence. I used to think it was a rare occurrence, but that was before I learned to look for it. Now, it seems everyone has it.



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Ben Gaddie, O.D., F.A.A.O.: Just like the nirvana of awareness that settled on me 10 years ago with MGD and blepharitis, this infestation phenomenon has me simply amazed. I tried to ignore my colleague’s enthusiasm for identifying and treating this microorganism akin to lice. Thanks to the excellent work of Milton and Katherine Mastrota, O.D., we have an easy and novel way to clinically diagnose these critters.1 The technique of using a cylindrical cuff to circularly “grind” the eyelash follicle makes it easy to find demodex and demonstrate it to patients. I’ve been amazed at how many MGD/blepharitis patients, who have been recalcitrant to treatment with steroids and antibiotics, actually have demodex infestation.



M.H.: Here is my story. It all started on a bike ride. By chance, I saw Scott Schachter, O.D., from Pismo Beach, Calif., on the ride. He told me all about demodex (it’s a long ride). When he told me he saw at least one case a day, I almost fell off my bike. Prior to this, I thought demodex was rare and like lice — was I ever wrong. With Scott’s mentoring, I got a microscope and epilated. I went through angst, because I realized I had been misdiagnosing ocular surface disease all these years. At times, I would bury my head in my hands wishing I never learned about the mite. But, it changed the way I practice and unlocked many mysteries for me, and my patients have surely benefited. Its like a veil has been lifted from my eyes. I’ll never go back to how I practiced before.

In addition, I enjoyed sending video of live, moving mites to my friends and colleagues in the early days. Just ask Kirk Smick, O.D., and Leonard Bielory, M.D., how many nightmares I caused them.



B.G.: After reading about this new technique, I employed it and yielded four positive patients in the first day. I can’t emphasize enough the value of slit lamp video and photography to demonstrate the infestation to patients and their subsequent buy-in to the in-office treatment with tea tree oil. In addition, the investment in a LED microscope further increases your yield and influence of patients to treat the condition. Kudos to you and Dr. Mastrota for this important and enduring contribution to a daily problem.


M.H.: I liken the whole event to a scene out of The Matrix. Morpheus tells Neo to take either the blue pill or the red pill. The blue pill returns Neo back to the fabricated reality in which he now lives (or, a life without mites.) The red pill opens your eyes to the real truth. Ben, you have taken the red pill. OM



1. Hom MM, Mastrota KM, Schachter SE. Demodex. Optom Vis Sci. 2013 Jul;90(7)

Dr. HOM PRACTICES IN AZUSA, CALIF. HE IS A MULTI-AWARD WINNER, MOST RECENTLY WINNING THE 2012 AOA CLCS LEGEND AWARD. E-MAIL HIM AT EYEMAGE@MMINTERNET.COM.

DR. GADDIE IS THE OWNER AND DIRECTOR OF THE GADDIE EYE CENTERS, A MULTI-LOCATION, FULL-SERVICE PRACTICE IN LOUISVILLE, KY., AND IS CURRENTLY THE CHAIR OF THE CONTINUING EDUCATION COMMITTEE FOR THE AMERICAN OPTOMETRIC ASSOCIATION. E-MAIL HIM AT IBGADDIE@ME.COM, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.

The authors report no financial interest in the products mentioned.



Optometric Management, Volume: 48 , Issue: August 2013, page(s): 49