AJMC ® : Demodex blepharitis has a high estimated prevalence in the United States. However, few US studies of this disease exist. Why is this particular disease so understudied here?

JACKSON: The main reason Demodex blepharitis is understudied is that we don’t have a good treatment for it—at least, all of us don’t have one yet. Hopefully, we all will soon have the good therapy for this disease in the usa, based on the results of clinical trials and FDA approval.

Demodex blepharitis also can be hard to diagnose. Most eye care professionals forget to tell patients to look down [while performing the eye exam] to observe the upper lashes. We look at the eyes and the particular lower lids, but we forget to look at those upper lashes where the collarettes are located. Collarette presence defines infestation with Demodex mites for diagnostic purposes.

AJMC ® : During the 2022 ASCRS [American Society of Cataract and Refractive Surgery] Annual Meeting held in April 2022, you presented the results of the particular Atlas Continuation study, which examined the clinical burden of Demodex blepharitis. 1 Before the study, what was known about how this disease impacts patients?

JACKSON: Demodex mites, which are among the particular most common ectoparasites detected in humans, come in 2 forms. The particular first is D folliculorum, that are found in clusters in the lash root and lash follicle, where they feed on sebum and follicular epithelial cells. The second is D brevis , which are usually shorter in length, more solitary, plus prefer in order to reside in the particular meibomian glands. D brevis is associated with blepharitis, meibomitis, meibomian gland dysfunction, recurrent chalazion, blepharokeratitis, blepharoconjunctivitis, and pterygium—all things on the ocular surface. That’s the impact it has in terms of the ocular world. D brevis has some implications within nonocular illness, as well, such as folliculitis rosacea, seborrheic dermatitis, perioral dermatitis, scalp hair loss, and even basal cell carcinoma. It has a lot of implications throughout the body besides just the ocular implications.

AJMC ® : What prompted you to study Demodex blepharitis?

KNUTSON: Currently, all of us use a variety of products to [manage] the condition, but these products are not indicated for the treatment of Demodex blepharitis. These products can work partially or on a short term, and they might give some symptom relief, but they may not eradicate the particular Demodex itself. The Atlas Continuation study’s main purpose was in order to evaluate the impact associated with Demodex blepharitis on visual function, daily activities, and motivations for seeking care. 1 The investigators looked at the impact and problem of Demodex blepharitis on a patient’s quality of life and visible function. All of us wanted to know if it will be really worth finding a treatment for Demodex blepharitis. We all wanted in order to see if [the disease] is really impacting life, visual function, and day to day activities in a way in which a person really realize, “We have to look for a therapy for this particular, because there’s an impact. ”

AJMC ® : How did you select the particular patients with regard to the Atlas Continuation research?

JACKSON: A total of 20 ophthalmic plus optometric eye care professional centers in the United States were recruited regarding this observational study; clinicians at these centers screened for patients with Demodex blepharitis. The patient criteria included having at least 1 mite per eyelash, more than 10 collarettes, and mild or more severe erythema of the top lid margin. Patients then filled out a questionnaire about symptoms, impact on daily living, and [disease] management experience.

The results of this Atlas Extension study were presented in the ASCRS Annual Meeting; it is usually a continuation of the Atlas study presented from the 2021 ARVO [Association for Research in Vision and Ophthalmology] Annual Conference, which incorporated 311 individuals. An overall total associated with 524 sufferers qualified plus participated within this Atlas Continuation research with the mean age of 66 years (± 14 years); 56. 7% of the particular patients had been women.

We found that patients were seeking treatment because no one has been diagnosing [the disease], and these were symptoms patients were experiencing for with least 2 years. Patients had been really struggling with the disease, but they were not really being diagnosed. That’s the main thing. About 68% of patients experienced signs and symptoms associated with Demodex blepharitis over two years, 32% of patients saw their eye doctor at least twice, and 20% of these individuals saw their own doctor a minimum of 4 times, yet nearly 60% never received a diagnosis associated with blepharitis or even Demodex blepharitis.

This is definitely why it’s so important for every vision care expert to have sufferers look down during their attention examinations to look intended for collarettes. It’s crazy how many patients experience signs or symptoms for that will long without being identified, and most of the individuals had reported their signs and symptoms. The top 3 symptoms reported were itchy eyes or eyelids, dry eye, plus foreign entire body sensation. Some 55% of patients had itchy eyelids or itching eyes, 46% had dried out eye, and 23% experienced foreign body sensation. 1 There were a variety of other symptoms as well—tearing, blurred vision, red eye, gritty eyes, puffy eyelids, flaking from the eyelids, loss of eyelashes, plus eyelids sticking together—but the top 3 were itchy eye, dry eyes, and foreign body sensation.

This really showed us that sufferers had Demodex blepharitis, they were struggling, and no one had been diagnosing this, never mind treating it. This can be a good discovery. These study results really showed the need for diagnosis and a way to diagnose it. There will be a need for the treatment when eye care professionals are better trained to make the diagnosis.

AJMC ® : How does Demodex blepharitis effect patients’ every day lives?

JACKSON: In the particular Atlas Continuation study, we all observed that the most common burdens upon patients had been difficulty driving at night, which 47% of patients reported, and feeling conscious of their particular eyes all day, which also was documented by 47% of individuals. This means that patients’ eyes itched or they felt like Demodex blepharitis caused a negative appearance of their eyes all day. Overall, 80% associated with patients said the illness negatively affected them in some way. 1

Further, 34% of the women said that will they had difficulty wearing makeup, and 30% of all sufferers said that these people needed additional time for their daily hygiene routine, because their eye required a lot more care compared to did those of the average individual due to Demodex blepharitis. 1 It definitely impacts their own lives.

AJMC ® : The particular Atlas Extension study discovered that almost half the patients (46%) were using warm compresses or wipes, and nearly half (47%) were making use of artificial tears. Still, 43% of patients had discontinued these or even other treatments due to adverse effects or low efficacy. one Is this particular consistent with your clinical experience?

JACKSON: Yes, because nothing is actually treating Demodex blepharitis. In the study, the particular [management options] most people tried were lid baby wipes or tea tree oil, and almost everyone was already using artificial tears. Of all these types of [management options]—whether it was artificial holes, warm compresses, lid wipes, an antibiotic-steroid combination, green tea tree essential oil, or an oral antibiotic like doxycycline, which is certainly good for meibomian gland function—46% of individuals who stopped their regimen did therefore because of effectiveness or tolerability issues. None of these options, as we discovered, are effective in mitigating or eliminating Demodex blepharitis. That’s the problem. These are all the [management options] we use now, because all of us don’t possess anything else. This shows the particular need to get the treatment, due to the fact these [management options] don’t function, patients aren’t diagnosed properly, and it can affecting their particular lives plus activities associated with daily living negatively.

The outcomes of the Atlas Continuation study showed the psychosocial and functional influence of the particular disease. All of us have in order to continue along with eye treatment professional education on how to identify Demodex blepharitis and make sure that it’s getting diagnosed plus not missed. Once we all have a treatment for Demodex blepharitis, eyesight care professionals will be more likely to look for it, because they then will be able to treat this and hopefully say, “Hey, that’s why a few of these types of people not necessarily getting better! We’ve been [managing] it with all these other regimens, and the patients really had Demodex . ”

AJMC ® : Given the multitude associated with products currently being used to manage Demodex blepharitis, what are the costs connected with the particular misdiagnosis of this disease?

KNUTSON: If patients are coming back [to their providers] at least 2 to 4 occasions, there are extra costs. There is several ancillary testing associated with cost, this kind of as tear osmolarity or even dynamic meibomian imaging, and then there’s the cost of pharmaceuticals, devices, thermal pulsation device remedies, or intense pulsed light. There are usually a lot of different [management options] being offered.

AJMC ® : What could be the value of a treatment pertaining to Demodex blepharitis?

JACKSON: If 80% associated with patients within this Atlas Continuation research said that will Demodex blepharitis affected them negatively in their activities of everyday living, then the treatment could help improve quality of life meant for 80% of the population, in general. 1 Visual function, such as night traveling, was one of the biggest concerns, so [a treatment] could have got a big impact. one

Dr Jackson is the founder and owner of Jacksoneye in Lake Villa, Illinois.


1 . Jackson MA, Yeu E, Matossian C, Kannarr SR, Wesley G, Periman LM. Effect of Demodex blepharitis on patients: outcomes of the particular Atlas trial. Abstract presented at: 2022 American Society of Cataract and Refractive Surgery Yearly Meeting; 04 22-26, 2022; Washington, DC. Accessed August 18, 2022. https://ascrs.confex.com/ascrs/22am/meetingapp.cgi/Paper/81946

For some other articles and videos in this AJMC ® Perspectives publication, please visit “ The Evolving Landscape of Demodex Blepharitis Management.

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