Results of a study using optical coherence tomography to quantify the tear meniscus provide objective evidence that punctal plugs provide rapid and durable benefits when used from treatment of dry eye.
"Refractive surgery and the growth in premium IOL options for cataract patients have focused attention on the importance of the ocular surface and tear film on the quality of vision [because] patients undergoing these procedures have high expectations for excellent functional results," Dr. John said. "The surgeon can perform a technically flawless procedure, but the patient may not fully benefit from the surgeon's expertise if ocular surface and tear film irregularity are compromising vision."
"The benefit of punctal plugs demonstrated in the present study indicates that surgeons should consider lowering their threshold for the potential use of this modality in [patients with] dry eye [and] a compromised ocular surface," Dr. John added. "I contend it is far better to insert the plugs earlier postoperatively to assure a good tear meniscus that will allow patients to enjoy faster visual rehabilitation and greater satisfaction with their postoperative outcome than to wait until the patient is already dissatisfied and one has lost valuable time."
Assessment of effects
Although punctal plugs have long been a mainstay in the management of dry eye for increasing tear retention on the ocular surface, Dr. John and his co-author, Alissa Poulos, initiated the study to investigate how quickly the effects occur and if they persist. Advances in diagnostic imaging and analysis with the availability of anterior segment OCT enabled the research, he explained.
The study enrolled a total of 20 patients (40 eyes), including 10 patients with diagnosed dry eye syndrome who received punctal plugs in the inferior punctum bilaterally and 10 patients without dry eye composing a control group. OCT imaging to capture the inferior tear meniscus was performed at baseline and after 1 and 2 weeks post-punctal plug insertion in the patients with dry eye and weekly for 3 weeks in the control group.
Tear meniscus area and volume were calculated using digital image analysis software. The results for the dry eye group showed inferior tear meniscus area increased significantly at 1 week after punctal plug insertion (p < 0.001), and the benefit was maintained at the second evaluation.
In the control group, the mean tear meniscus measurements did not vary over time.
Thomas John, MD
Dr. John received no industry funding for his research and has no financial interest in any aspect of this study.