Irritated by the lack of awareness

[Guest]

You know, what's interesting, so many people actually have dry eyes but they do not understand they do. When I started having dry eye issues, a lot of complaints I have heard from other people, started to make sense to me. I hear a lot about the dry eye industry being driven by the baby boomers' demands. However, I actually think, it's the young people who will drive the research and the industry because millenials and those who are children now, have been using screens since they learned to poke on Ipads or since they went to elementary/middle school. I started staring at screens at the age of 13, my sibling at the age of 6.

I remember when we first got a computer in my third grade class, late 80s. We played wheel of fortune and stuff on it. Then toward the end of high school, I got AOL dial up. Then the Xbox and playing call of duty and blinking maybe 5 times in a 15 minute session...for hours a day. I smoke pot...and even though I ate healthy, drank a gallon of water a day, worked out, I was setting myself up for this problem and never knew it. What put me over the edge was the abrasion, but I had dry eye before that and just didn't realize it. It was so mild, I actually just thought I needed new glasses...apparently not.

Check out Dr Cremers...she has 7 and 11 year olds with no glands at all from staring at iPads. I agree with farmgirl, it's going to become an epidemic. There will be warnings on iPads like there are on cigarettes...at least there should be.

[diydry]

Yes, the generation growing up is in trouble. I haven't looked at the incidence of dry eye from a public health perspective, but I imagine it is increasing in the population. I spent an enormous amount of time playing video games growing up (4 hours a day or more) which I'm sure contributed to my MGD. I've read Dr. Cremers blog on this issue as well. Generation Z is in trouble unless there is greater awareness, lifestyle changes, and treatment advances for this disease. Does anybody know any studies looking into this? It is interesting that academic studies from a search for "dry eye" or "meibomian gland dysfunction" on the health website PubMed have increased each year.

I found this petition posted on this site from 2 yrs ago. Please sign... are there other petitions/foundations/NGOs out there trying to raise awareness about this issue? Academic institutions investigating this issue from a societal/economic/public health perspective? This is of course in addition to the incredible work Rebecca and others in this online community are already doing!

https://www.change.org/p/provide-urg...n=petition_nav

Note that the "Make a difference: Publicity for dry eye" section of this forum under "Community & Resources" hasn't had a new post in 9 months!

[MGD1701]

I hope all eye doctors read/watch these:

Quote from

''DryEyeCoach
The vast number of cases of dry eye disease result only in occasional pain but
it can also be incredibly severe and lead to a significant increase in the risk of infection and possible blindness.''

-------------------------
Interview with Vision Eye Institute's Dr Michael Lawless, where he discusses the latest on dry eye disease and its management.--2016, 5 min

See, he also mentions, dry eye is largely preventable
but only possible if doctors do their job properly
It is really very simple/easy.

https://www.youtube.com/watch?v=9dLHueBWPhA

[MGD1701]

Found this interesting (long) article,

Who has dry eye in 2018: an update
Over the years, the DED population exploded as the disease definition expanded.
Ocular Surgery News U.S. Edition, June 25, 2018
Darrell E. White, MD

interesting part is, Dr White wrote:

''You could simply declare that everyone who comes to your clinic has dry eye, drop the mic and walk off the stage to a standing ovation. While that is probably not entirely true, it is actually pretty close to reality.''

Full text bit.ly/2JPgK8W

[Blue96]

It's really hard to get people to understand how debilitating it is. I've been in constant pain for almost three years now and I pray for an end to it every single day. Family thinks I'm exaggerating and doctors are dismissive. I don't enjoy life anymore.

I've tried reaching out to many people about this issue but no one seems to care all that much.

[MGD1701]

sorry about your pain. If you
have rapid/short TUBT,
you can tell exact location of the pain
coupled with inflammation & watery
good to check if you have CCH
which is very common but under diagnosis -

Well, I warn others (even strangers), show gland images and tell them why it is important and share some basic tips, such as lid hygiene.
Only people who are suffering show appreciation
Most dont care - but it is their (big) loss.

[MGD1701]

[QUOTE=DesertWind;n212058]
Thanks, it is very worrying to me to go professionally undiagnosed, but I am doing all of those things. I take fish oil + Hydro Eye morning/night, trying to get off wheat (inflammation), sanitize eyelids every now and then, periodically do the eye compresses (though I should probably do them more often). I'm not sure if this would be considered aggressive treatment.
-----------------------------------------------

Hi DeserWind

You seem to be on the right track.

Accurate tests would be very useful. For example, some doctors in USA (for example, Marguerite McDonald, M.D. who is top opinion leader) prescribe Restasis when osmolarity is 296. (maybe this is so-called aggressive treatment?)

My results were similiar and once a bit higher yet none of 10 doctors (only 2 have such tool) prescribed me Restasis - which I think it is a mistake, when I have learnt more. They probabaly think because no inflammation presented. But the fact is some (low) inflammation is hard to detect with slit lamp.

Some doctors in USA even say
if doctors only recommend lubricant drops = NO treatment!

[edmunder]

sorry about your pain. If you
have rapid/short TUBT,
you can tell exact location of the pain
coupled with inflammation & watery
good to check if you have CCH
which is very common but under diagnosis -

]

What is CCH?

[MGD1701]

CCH= Conjunctivochalasis

[Rebecca Petris]

Hi Blue96

It's really hard to get people to understand how debilitating it is. I've been in constant pain for almost three years now and I pray for an end to it every single day. Family thinks I'm exaggerating and doctors are dismissive.

Yes that aspect is really hard. People don't understand. And to a large extent we're powerless to change that. I think that people who have exceptional capacity to understand will be the ones to ask questions and need no persuading... but they're the exceptions. That's why it's so important to focus on ensuring you've got plenty of support from people who actually do get it, keeping connected with them, and finding strategies for communicating with those who don't understand, in ways that don't just hurt you more.

I've tried reaching out to many people about this issue but no one seems to care all that much.

We care

I don't enjoy life anymore.

Sigh. Depression is a really hard part of the dry eye journey "package" though thankfully it doesn't stay like that... Important to know that it's part of the course and do everything you can to take good care of yourself through it. You deserve the best

[MGD1701]

This article by Prof. Preeya Gupta, one of opinion leaders in USA, reveals the biggest problems WHY more people suffer from dry eye yet 'the treatment do not have to be complicated', as she mentioned.

So, if we do not have such luck in finding a respectful doctor like Prof. Gupta, what can we do?

Good to note:
''They (patients) might be in the moderate or severe stage of this chronic, progressive disease, yet no one had told them.
I made a commitment to raise disease awareness and part of that commitment is to always tell patients about each problem they have, be it big or small.''

-----------------------------------------------------
Managing the asymptomatic dry eye patient: Tips for every doctor
July 9, 2018

We'’ve made so much progress in our knowledge, diagnosis and treatment of dry eye and its most common cause, meibomian gland dysfunction. Today, with all our current capabilities, it can be frustrating for doctors to detect dry eye not only in patients who are suffering, but also in asymptomatic patients, only to find that those asymptomatic patients don’t always accept the diagnosis. Now that we as doctors have accepted that dry eye is real and we need to treat it, our new test is to get patients to agree. Here’s how I approach this challenge.

1. Screen everyone. Whether patients come in for a routine eye exam or a cataract evaluation, they should all be screened and examined for dry eye. A questionnaire such as the OSDI, SANDE or SPEED can be helpful to identify symptoms. Responses to these questions drive our choices of point-of-care testing. I find even asymptomatic patients tend to answer yes to some questions such as vision fluctuation, which they don’t associate with dry eye disease.

We test tear osmolarity (TearLab osmolarity test, TearLab) and perform meibography (LipiView, Johnson & Johnson Vision). Point-of-care testing has really increased our ability to identify asymptomatic patients. An abnormal osmolarity test, for example, is a great tool for helping patients understand the basis of their diagnosis, both because it’s highly specific for dry eye and because it offers concrete numbers patients can understand. Corneal or conjunctival staining and meibomian gland abnormalities are easy to highlight to patients, and I think that understanding these components helps to set expectations with the patient for the disease’s severity.

2 . Explain everything. A few years ago, so many patients were coming into our clinic for a dry eye evaluation, learning their diagnosis and asking me, “Why didn’t anyone ever tell me I had this?” I found it just as jarring as they did. They might be in the moderate or severe stage of this chronic, progressive disease, yet no one had told them. I made a commitment to raise disease awareness, and part of that commitment is to always tell patients about each problem they have, be it big or small.

I think some doctors get wrapped up in the idea that if they raise the subject of dry eye, then they are obligated not only to get deeply involved in treatment, but also, more immediately, to take on a major uphill battle in patient education. But the conversation and, in most cases, the treatment do not have to be complicated.

For example, I might start by simply stating, “Here are all the things I found in your exam today: You have age-related cataracts that are not impairing your vision as yet. You also have early signs of a common problem called dry eye disease. This is caused by an imbalance in tear composition, which may be due to not enough water, not enough oil or both.”

Patients often don’t think that symptoms such as tearing or fluctuating vision mean that they have dry eye disease. It is important to tie those symptoms to the disease so they can break the stereotypical association of redness and irritation being the primary symptoms of dry eye.

If the patient is truly asymptomatic, I explain that this disease starts out in the background because the body can compensate for the tear imbalance, but over time, compensation becomes more difficult to achieve. That’s when symptoms occur. I tell my patients that I would rather be proactive than reactive and treat dry eye early, before they have symptoms, which means better long-term eye health. I compare asymptomatic dry eye to high blood pressure, for which doctors screen patients because the problem is often asymptomatic but can lead to real health problems. Once I have finished with the patient, a motivated and personable staff member reviews what the patient can expect from dry eye disease and how to improve symptoms, including how to follow suggested treatments.

3. Treat every time. Because dry eye is progressive, it is important to treat everyone who has the disease, even if it is very early. For patients who are asymptomatic, with just a little staining or MGD, I offer a “homework sheet” that details the over-the-counter options. I want to offer the tools they need to empower them if symptoms occur, but because asymptomatic patients with early disease generally don’t comply with daily dry eye treatments, I don’t force it.

Patients with moderate disease get the sheet, as well as a prescription for lifitegrast (Xiidra, Shire) or cyclosporine (Restasis, Allergan). If they have significant MGD, I recommend thermal pulsation therapy (LipiFlow, Johnson & Johnson Vision) because it helps to restore the functional anatomy. I tell patients that just like they get their teeth cleaned to prevent a cavity, thermal pulsation can clear the glands and prevent atrophy.

It isn’t always easy to get asymptomatic patients on board for dry eye therapy. Most patients do want to treat the problem early, but if not, at least they’ve gotten a diagnosis and explanation. When symptoms ultimately occur, they know what’s happening and where to turn for help.

https://www.healio.com/ophthalmology...-doctor?page=1

[MGD1701]

Found this ineresting article. It is scaring to learn
''Young patients with severe dry eye are turning out in alarming numbers,
and there is no sign of this trend reversing.''

------------------------------------------------

Three new truths about dry eye

John A. Hovanesian, MD, FACS July 31, 2018

Just a few years ago, many clinicians considered dry eye an afterthought to the “real” care that we provided patients in our offices. Many of us looked upon the condition with indifference or even disdain. With limited tools, some felt that there was little we could do for patients with this condition, that it didn’t really affect their quality of life and that it was very time-consuming to treat. In fact, a study by TearScience showed that the average clinician spent 10% of his time treating dry eye but earned only 2% of his income from the condition.

Now, everything has changed. It’s difficult to keep pace with all of the new dry eye drugs and devices that are available or soon to be. For three reasons, the old paradigm of running away from dry eye is out, and we are now running toward this special disease entity. Here’s why:

1. In treating dry eye, everyone wins. I have long believed that technologies become popular when they bring success for patients, physicians, and the drug and device industry. Many of the new dry eye treatments allow reimbursement for the clinician caring for the patient. Many are not covered by Medicare or private insurance. Nevertheless, most are priced fairly, especially when you consider that the average patient with moderate dry eye currently spends more than $200 a month out of pocket between lubricant drops and medications. With these new treatments, clinicians can get paid at a level that more closely manages their time spent. And the drug and device industry also receives fair compensation, considering the high cost of bringing these new treatments to market.

2. Patients benefit most. The new emphasis on dry eye has brought attention to this previously ignored condition and brought true innovation to the space. A 2003 study by Rhett Schiffman taught us that patients who suffer from moderate to severe dry eye have a condition as crippling as heart failure because they are unable to participate in activities that make life meaningful. Offering them treatment is the right thing to do.

3. Every practice must get involved. Some clinicians will never be excited about treating dry eye, no matter how the landscape is changing. Candidly, I am one of these. A few years ago, I coached one of my optometrist colleagues to consider taking up dry eye as a specialty when she wanted to grow her practice. She not only embraced my suggestion, she dove into the subject and has become one of the country’s most skilled practitioners in treating dry eye. I would encourage every colleague who is hesitant to spend more time on dry eye to do the same. If you run a small office, consider bringing another doctor in periodically to spend a half day seeing these patients. It will benefit your practice, and you will win the loyalty of your patients forever.

Maybe the biggest reason to embrace dry eye in your practice is because the population is growing enormously. As the cover story in this issue of OSN discusses, we are just seeing the tip of the iceberg of this condition. Young patients with severe dry eye are turning out in alarming numbers, and there is no sign of this trend reversing. It’s time to roll up our sleeves and take care of these patients.

quote from healio