David R. Hardten 1, Mark Milner 2, Jai G. Parekh 3, Neda Shamie 4, Darrell E. White 5 and Michael Schiewe 6 Financial Disclosures: Dr’s Hardten, Milner, Parekh, Shamie and White are consultants for Inspire. Mr Schiewe is an employee of Inspire. Affiliations: 1 University of Minnesota; 2 Yale University Medical School; 3 The New York Eye and Ear Infirmary; 4 Doheny Eye Institute and the USC Keck School of Medicine; 5 Skyvision Centers; 6 Inspire

2  The purpose of this retrospective study was to identify trends in the diagnosis, recorded findings and treatment of patients presenting with symptoms of Ocular Surface Disease (OSD).

3  This study was a multi-center, retrospective study  52 sites were involved in the study, emphasizing general practice Eye Care Professionals (77% MD and 23% OD).  1157 patient charts  Patients presented with symptoms of ocular surface disease consecutively at the site over an 8 week period.  Retrospective chart review  Inclusion criteria – a primary diagnosis of either bacterial/viral conjunctivitis, blepharitis or dry eye  Exclusion criteria – patients diagnosed with allergic conjunctivitis were excluded from the study in order to avoid a bias due to allergy season

4  Data collection form utilized to capture information from patient charts:  OSD symptoms (severity ratings)  OSD signs (severity ratings)  Assessments & Tests (visual acuity, staining, tear break-up time, Schirmer and cultures)  Treatments (mechanical therapy, OTC, nutraceuticals, pharmaceuticals)

5 Blepharitis alone Dry Eye alone Conjunctivitis (Bacterial/Viral) alone Blepharitis and Dry Eye Other mixed diagnosis n = % 6% 29% 6% 26%

6 * includes subjects with a primary diagnosis of Conjunctivitis 35% 28% 37% Conjunctivitis n = 72 Bacterial Viral Undetermined

7 Subclassification of Primary Diagnosis* * includes subjects with a primary diagnosis of Blepharitis or Dry Eye Blepharitis Dry Eye Anterior n = % n = 384 Anterior and Posterior Posterior Non-differentiated 18% 24% 36% 10% 4% 32% 54% Non-differentiated Evaporative Aqueous Deficient and Evaporative Aqueous Deficient

8 * Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72

9 Anterior Posterior * Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72 Evaluation of the Eyelid

10 * Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72

11 * Primary Diagnosis Only - Blepharitis: n=300; Dry Eye: n=384; Conjunctivitis: n= 72 ** “Other” includes: patient education, referral, MG probing and intense pulsed light

12  Ocular surface disease encompasses a broad range of diagnoses.  Results indicate that symptoms of the various forms of OSD overlap to a large degree on initial presentation.  Although symptoms are important to the patient, proper identification of clinical findings provides the basis for a differential diagnosis and for identifying optimum management.  Corneal staining was the most common assessment utilized in the diagnosis of primary conditions of Conjunctivitis, Dry Eye and Blepharitis.  Signs of patients with the primary diagnosis of blepharitis or conjunctivitis share signs from the anterior evaluation of the eyelids (debris, hyperemia, swelling). However, this is not true of signs from the posterior evaluation of the eyelids.  Management practices were dependant on the primary diagnosis.