Delphi Panel Consensus Regarding Current Clinical Practice Management Options for Demodex blepharitis

Abstract

Purpose

To obtain consensus on Demodex blepharitis (DB) treatment using a modified Delphi panel process.

Methods

Literature search identified gaps in knowledge surrounding treatment of DB. Twelve ocular surface disease experts comprised the Demodex Expert Panel on Treatment and Eyelid Health (DEPTH). They completed a live roundtable discussion in addition to 3 surveys consisting of scaled, open-ended, true/false, and multiple-choice questions pertaining to the treatment of DB. Consensus for scaled questions using a 1 to 9 Likert scale was predefined as median scores of 7–9 and 1–3. For other question types, consensus was achieved when 8 of 12 panelists agreed.

Results

The experts agreed that an effective therapeutic agent for treatment of DB would likely decrease the necessity of mechanical intervention, such as lid scrubs or blepharoexfoliation (Median = 8.5; Range 2–9). When treating DB, panelists believed that collarettes serve as a surrogate for mites, and that eliminating or reducing collarettes should be the main clinical goal of treatment (Median = 8; Range 7–9). The panelists would treat patients with at least 10 collarettes, regardless of other signs or symptoms and agreed that DB can be cured, but there is always the possibility for a reinfestation (n = 12). There was also consensus that collarettes, and therefore mites, are the primary treatment target and the way by which clinicians can monitor patient response to therapy (Median = 8; Range 7–9).

Conclusion

Expert panelists achieved consensus on key facets of DB treatment. Specifically, there was consensus that collarettes are pathognomonic for DB, that DB patients with >10 collarettes should be treated even in the absence of symptoms, and that treatment efficacy can be tracked by collarette resolution. By increasing awareness about DB, understanding the goals of and monitoring treatment efficacy, patients will receive better care and, ultimately, better clinical outcomes.

Keywords:

• collarettes
• cylindrical dandruff
• ocular surface disease
• eyelid disease

Acknowledgments

The authors would like to thank the team at i2Vision for designing and administering this Delphi Panel and supporting the writing of this paper. The authors would also like to thank Tarsus Pharmaceuticals, Inc. for providing an unrestricted grant to fund this endeavor.

Disclosure

All of the authors serve as consultants to Tarsus Pharmaceuticals, Inc. Dr Brandon D Ayres is a consultant for Alcon, Tarsus, Bausch and Lomb, and Carl Zeiss Meditech; a consultant and speaker bureau for Allergan, outside the submitted work. Dr Eric Donnenfeld reports personal fees from Tarsus and Blephex, during the conduct of the study. Dr Ian Benjamin Gaddie reports personal fees from Tarsus, during the conduct of the study; personal fees from Bausch and Lomb, Orasis, and Ocusoft, outside the submitted work. Dr Preeya K Gupta reports personal fees from Tarsus, during the conduct of the study. Dr Richard Lindstrom reports personal fees from Tarsus and is also a less than 0.1% equity owner. Dr Paul M Karpecki reports personal fees from Tarsus Pharmaceuticals, Oasis Medical, Azura Pharmaceuticals, OcuSoft, Bruder Healthcare, BioTissue, Thea, B+L, and Alcon, outside the submitted work. Dr Kelly K Nichols reports personal fees from Tarsus, during the conduct of the study; personal fees from Allergan/AbbVie, Aerie, Alderya, Bruder, B+L, Dompé, HanAll Bio, Iveric, Kala Pharmaceuticals, Novartis/Shire, Osmotica/RVL Pharmaceuticals, Oyster Point Pharma, Inc., Palatin, SightSciences, Inc., Tarsus, Tear Film Innovations/Alcon/Acquiom, TearSolutions, Thea, Versea, Visionology, Xequel, and YuYu Pharmaceuticals; research grants from Aramis, Kowa, Sylentis, TearScience, and Science Based Health, outside the submitted work. Dr Christopher E Starr reports personal fees from i2Vision, during the conduct of the study. Dr Elizabeth Yeu is a consultant and participated in research for AcuFocus, BioTissue, New World Medical; consultant for and owns equity from Advanced Vision Group, BlephEx, Expert Opinion, Tarsus, Visus; speaker bureau and research for Alcon; consultant for Allergan, Bausch & Lomb/Valeant, BVI, Bruder, Dompe, EyePoint Pharmaceuticals, Glaukos, Guidepoint, Iveric, J & J Vision, Kala Pharmaceuticals, LENSAR, Merck, Novartis, Ocusoft, Omeros, Sight Sciences, STAAR, Surface, Thea, Zeiss; consultant for and owns equity from Aurion, Avellino, CorneaGen, LayerBio, Melt, Ocular Science; owns equity from Centricity, Equinox, Mati, Modernizing Medicine, Orasis, Science Based Health, outside the submitted work. Elizabeth Yeu, MD, is also on the Board of Directors of Tarsus Pharmaceuticals, Inc. The authors report no other conflicts of interest in this work.