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Punctal plugs may help presbyopic dry-eye patients

Punctal plug placement in presbyopic patients is investigated.

Punctal plugs may help improve the uncorrected near visual acuity of presbyopic dry-eye patients, said Robert Latkany, M.D., founder of the Center for Ocular Tear Film Disorders, New York, assistant professor, New York Medical College.
Dr. Latkany and Mark Speaker, M.D., Laser and Corneal Surgery Associates, were slated to present research to back this conclusion at last month’s ASCRS•ASOA Symposium & Congress.
“Punctal plugs improve uncorrected near vision in the presbyopic age group pretty much across the board,” he said.

Clearer vision

Punctate corneal erosions with
fluorescein dye staining in
a moderately dry eye patient.


Punctate corneal erosions with
fluorescein dye staining in a
moderately dry eye patient.
Source: Robert Latkany, M.D.

Dr. Latkany’s results included 34 eyes with plugs and 16 control eyes. The study focused on testing uncorrected and best-corrected near visual acuity in patients over the age of 40 with mild to severe dry eye.
After plug insertion, 20.6% of patients had zero or one line of visual acuity improvement, 59% had two lines of improvement, and 20.6% had three lines of improvement or greater. The P value of the results was .0001.
The uncorrected and best-corrected near visual acuity were tested before and after punctal plug placement. They were also measured when an artificial tear drop was placed in the eye after the punctal plugs were inserted.
Visual acuity was reassessed every minute until it returned to its pre-tear drop acuity. The artificial tear drops also helped extend how long patients’ visual acuity improved.
The punctal plugs and artificial tear drops help decrease aberrations on the optical tear film, which improves image quality, said Dr. Latkany. In turn, visual acuity improves.
Dr. Latkany wanted to study a way to improve dry eye that would not be as temporary as artificial tear drops, which is why he investigated punctal plug placement.
This research is particularly relevant as baby boomers age and will likely report dry-eye problems, said Dr. Latkany.
“We’ve got a tremendous group of dry-eye patients coming our way,” said Dr. Latkany.

Diagnosing dry eye

In a related presentation at the ASCRS•ASOA Symposium & Congress, Dr. Latkany and Dr. Speaker presented a functional test that may help detect dry eye.
Titled “Functional Test to Detect Dry Eye Syndrome,” the presentation highlighted the results of a study that compared the best corrected distance visual acuity of 40 dry eyes, and 40 eyes that were not dry.
The goal was to improve how practitioners detect dry eye, which is often misdiagnosed and underdiagnosed. Dr. Latkany calls the test the Tear Normalization Test.
Practitioners may be able to determine if a patient has dry eye by testing uncorrected distance visual acuity before and after instillation of an artificial tear drop, Dr. Latkany said. If the drop helps improve visual acuity, the patient most likely has dry eye.
As part of the study, patients filled out an Ocular Surface Disease Index questionnaire form to determine the extent of their dry eye. All patients had a detailed slitlamp examination and Schirmer testing.
Eighty-three percent of the time, the test was able to detect dry eye. The best dry-eye indicator was two lines or more of visual acuity improvement after artificial tear drop was instilled, said Dr. Latkany.
“The test is simple and helps nail down a diagnosis,” he said.

Editors’ note: Dr. Latkany has no financial interests related to his comments.

Contact Information
Latkany: 212-832-2020, relief@dryeyedoctor.com