Taking Dry Eye Seriously

In this podcast Denise Balch from Connex is joined by Dr. Michelle Lane, a practicing optometrist in Fredericton, New Brunswick, and the President of the New Brunswick Association of Optometrists.

Ocular Surface Disease, or "Dry Eye", is a condition that slips under the radar for many people. In this episode, Dr. Lane speaks to the causes, symptoms and treatment options for the disease, as well as coverage options.

This podcast is free and delivers valuable information for you and your clients about the role of optometrists, the importance of adequate vision care coverage, and healthy lifestyles in visual health. Look for more in this series on the modernization of vision care, Don’t Lose Sight, from the Canadian Association of Optometrists.

To speak with the CAO, contact info@opto.ca. Learn more about how vision care is changing by requesting your copy of the White Paper on Vision Care Benefits in Canada and the Best Practices Guide for Vision Care Benefits from the Canadian Association of Optometrists at dontlosesight.ca. Plus look for more podcasts, blogs and posts on vision care, comprehensive eye examinations and best practices coming to you throughout 2022.

Other resources mentioned in the episode:

Canadian Association of Optometrists website:
https://opto.ca/

My Dry Eye:
https://mydryeye.ca/

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Brought to you by the Canadian Association of Optometrists in association with Connex Health Consulting. 

Find out more information on upcoming podcasts and webinars at www.connexhc.com.

Transcript

Denise Balch: 0:00

Hi, my name is Denise Balch and I'd like to welcome you to the Canadian Association of Optometrists Podcast Series. Today I'm speaking with Dr. Michelle Lane about ocular surface disease, commonly referred to as dry eye. And our topic today is Taking Dry Eye Seriously. As a brief introduction to Dr. Lane, she has spent her time growing up in Weyburn, Saskatchewan and Belleville, Ontario and has been practicing in Fredericton, New Brunswick since her graduation After earning her Bachelor of Science and Doctor of Optometry degrees from the University of Waterloo. Dr. Lane has a special interest in treating dry eye so we're lucky to have her with us today. She has taken extra training and presented optometric continuing education and shared roundtable discussions with other optometrists on the topic of dry eye disease. As well as practicing full scope optometry, she is excited to be able to offer a dry eye disease clinic with leading edge diagnosis and treatment. She has been a council member of the New Brunswick Association of Optometrists since 2015, and is currently president of the association. She is also currently sitting on a committee of the Canadian Association of Optometrists, which is working to modernize insurance coverage of vision care. Welcome, and thank you for joining us, once again on our podcast series Dr. Lane and to bring a greater understanding to the plan sponsor and benefits community about eye disease and the gaps in vision care plans. So as I said, we're going to be talking about why folks should be taking dry eye seriously. So maybe you can talk to us a little bit about that, because the name doesn't really sound all that serious. So maybe you can explain to us what dry eye is.

Dr. Michelle Lane: 1:50

Yes. So in simple terms, a dry eye or ocular surface disease occurs when the eyes either are not producing enough tears, or actually more commonly, when the tears that are being produced aren't the right chemical composition. So there's not the right balance in the tears that can lead to tear film instability.

Denise Balch: 2:13

Oh, interesting. So who's at risk for this? Is there a demographic or ethnic background that's more likely to suffer from dry eye?

Dr. Michelle Lane: 2:20

Yeah, well, historically, we've seen that women and postmenopausal ages because of hormonal changes over time are at risk. But you know, people who work in an office environment and spend lots of times in front of screens are also at risk. So we're seeing that this, you know, becoming more and more prominent in our patient base as people spend so much time in front of screens, we're seeing younger and younger people developing dry eye issues. Another segment of the population that can be affected are people who are affected by autoimmune inflammatory conditions, such as arthritis or other autoimmune diseases. So it affects a wide range of the population. But there are some key demographics that we watch out for when we see them in our practice.

Denise Balch: 3:12

Yeah, very interesting. So what are some of the symptoms?

Dr. Michelle Lane: 3:15

So typically, the symptoms are can be stinging, burning, scratchy, and believe it or not, watery eyes. Watery eyes is a really big symptom, and that is the hallmark of a tear film instability issue.

Denise Balch: 3:34

So if an individual, particularly if they're working in an office, may be postmenopausal, and they're getting a lot of eyewatering, it sounds like they should make an appointment to see their optometrist to get that checked out.

Dr. Michelle Lane: 3:48

Yes, definitely, you know, dry eye disease, it's more than a nuisance. It's has a real impact on people's quality of life, and their productivity. So if you're, you know, sitting in front of a screen and your eyes are stinging, and burning, and watering, and you're grabbing tissues, and you know, it's on your mind, it's constantly a bother. It's something that should definitely be treated and should be taken seriously. And, you know, for your quality of life and quality of vision. It's a very important condition to actually take seriously.

Denise Balch: 4:21

So what happens if an individual doesn't seek treatment from their optometrists?

Dr. Michelle Lane: 4:27

Well, dry is a condition that tends to be progressive and tends to get worse, the more you ignore it. So lots of dry eye, really the hallmark of dry eye, what's causing these issues is inflammation. And so if you can imagine, if your eyes get dry, they get inflamed, and then you produce less tears. And then your eyes get more dry and they get more inflamed. So it's a bit of a vicious cycle that can progress if intervention isn't taken, and you can end up in big issues with corneal scarring and irritation, which can affect your quality of vision, it's the type of issue that the earlier we deal with it and get it under control, the better the prognosis is. If you, people wait until they're feeling terrible, it's harder to get things under control and reined back into a comfortable and healthy state. In some cases, people may benefit from prescription medications that reduce inflammation on the eyes. A lot of these medications are covered by people's insurance. So that is helpful. But yes, you know, dry eye disease is a significant enough issue, there are prescription medications that some people qualify to be treated with.

Denise Balch: 5:46

But to get those, you got to get a diagnosis. So it's important to go see your optometrist, if you are experiencing those watery eyes, I actually had a girlfriend that, that was the case, she had the watery eyes chronically. And, and there was it was quite serious at that point. But there was an opportunity to have it fixed. And she said, What do you think, I said, go get it done. You don't want to live like this for there. It's not only is it you know, from a medical perspective, you should get it done. But it was constant. I mean, she couldn't wear makeup at all, because it was just, it would just run all over her face. It was terrible.

Dr. Michelle Lane: 6:23

Yeah, it's a huge quality of life issue. Like if you're uncomfortable and thinking about your eyes all the time, you know, that's just one more thing we don't need to have on our mind all the time, is how our eyes are feeling. And people mention it. You know, if your eyes are watering all the time, everyone's like, why are you crying? What's wrong? Why are your eyes so red? And you know, so people can be self conscious about it. And it can really play on people's minds like there is a link with some mental health issues and dry eye as well.

Denise Balch: 6:59

Yeah, I believe it, I believe it. So it sounds like it's a bit of an oxymoron. So you've got dry eyes, but your eye will be watering more?

Dr. Michelle Lane: 7:10

Yes, yes, because the watering is a very common symptom. And so dry eye, it's kind of the term that has stuck. It's the thing that people can recognize as a term for this issue. But ocular surface disease maybe more accurate. But if your tears are flowing down your face, they're not on your eyes where they need to be.

Denise Balch: 7:36

So presumably, you know, if an individual notices, you know, over a period of time that they've got the fluid coming out of their eyes, and when they're sitting at their desk or doing other activities, then they should make that appointment to see their optometrist.

Dr. Michelle Lane: 7:55

Certainly, yes, you know, make an appointment like that. Let the receptionist know what your issue is some optometrists that have some extra technology and diagnostic equipment, they may book you in for a specific dry eye assessment. You know, in my practice, oftentimes, I see people every couple years as their benefits cover, and they come in for a regular exam and I ask probing questions, because I want to identify these people who have dry eye. But when I do identify these people, it's a lot to take in during a regular eye exam. I prefer to have them come back, so I could do some extra testing to really pinpoint what is the cause of their dry eye disease and to come up with a proper plan and treatment regimen. So it's, you know, depending on the optometrist, they may have a particular protocol that addresses dry eye, because it is a bit of a complex issue, because there's so many different causes. So there's not a one size fits all treatment. So to do the proper assessment in the first place to see what the causes are for each individual is very important.

Denise Balch: 9:16

So once an individual has that diagnosis, say, you know, either you rebook them after a comprehensive exam, or they call in, because they're concerned about all the watering that's taking place in their eye, and maybe they've got some irritation in their eye as a result. So you see them first for that first visit and you provide a diagnosis. How often do they have to come back and see you after that?

Dr. Michelle Lane: 9:41

That can be variable, but typically, when the diagnosis is first made, I will start with a sort of a baseline treatment plan because it can be overwhelming, all treatments that are available. We don't want to just throw everything at someone right off the top. So I use this sort of stepwise approach. So I may recommend, you know, if it's a tear film dysfunction, warm compresses with an eyemask, eyelid cleansing, artificial tears, Omega three supplements, I'll explain the condition, explain why these treatments are necessary, get people started on those treatments, and then I want to see them back four to six weeks later, to see how they're making out and is there anything else that we need to go to? Because there are some in office treatments that can also be offered, that if that first line of treatment isn't completely successful, we can add on steps. So it's really individualized as to what the scheduling is. But especially in the beginning, when we first get the diagnosis and start with the treatments, we're going to want to follow up every four to six weeks, until we can come up with a good plan that gets the issue under control.

Denise Balch: 10:57

Right. And it sounds like at least in the early stages, if it's diagnosed early. Some of the treatments, as you mentioned, are as simple as warm compresses. So that doesn't really cost anything.

Dr. Michelle Lane: 11:13

Right. Right. Well, and you know, when it comes to warm compresses, there can be better ways to do it than others. You know, I always say historically, we used to tell people to use a hot face cloth. But ideally, you'd have the heat on your eyes for a good 10 minutes. So there are masks now. So you buy masks, they have beads and, throw them in the microwave for 25 seconds, put it in your eyes for a good 10 minutes. So you know some of the dry assessment and diagnosis is also having these discussions about the best practices for forgetting good treatment. So but when it comes to like, you know, what's the cost for dry eye treatments, that can be quite variable, because it depends on what level the patient is at. Other things that can be quite straightforward is, you know, when you're on the computer, our blink rate changes. So typically, we blink about 16 to 20 times a minute. Put us in front of a screen, it goes down to four times a minute. That's 25% of normal. So, having a conversation with our patients to say no, I know you spend a lot of time in front of the screen, let's be aware that your blink rate is being affected. Just be aware of that. And you know, every 20 minutes, take a couple of good big blinks. Because it's the blinking action that actually squeezes the oil out of those oil glands that then helps to rebalance the tear film. So there's some behavioral things we can talk about, and those don't cost anything.

Denise Balch: 12:43

No, that's great, and what's the next level up in terms of treatment?

Dr. Michelle Lane: 12:49

So as I was saying, when it comes to dry disease, a lot of the time it's a tear film insufficiency or an imbalance, so there's not the right components in the tear film. And a lot of times we'll be talking about the oil glands in the eyelids being at issue. So we'll start off and with warm compresses and blinking, Omega three supplements have also been shown to be helpful, and eyelid cleansing. So if those oil glands get clogged, bacteria can grow in there, those bacteria lead to more inflammation. So by having a nighttime routine of cleaning your eyelids with either a specific eyelid wipe or a spray, that tends to be my basis for starting off on dry eye treatment.

Denise Balch: 13:41

Oh, that's interesting. So some of the treatments are either you know, almost cost nothing or relatively inexpensive and it's really sort of incumbent upon the patient to kind of get into a routine.

Dr. Michelle Lane: 13:57

Yeah, and some of these routines, you know, it is about getting into routine it can be difficult to sometimes adjust our lifestyle to add all these things in. So we do have some in office treatments that can be available as well. As I was trying to, now I remember where I was trying to go with the whole eyelid cleansing issue, which is that we some practices do offer in office eyelid cleansing. It's kind of what people refer to it as IG, it's almost like going to your dentist for a cleaning. You come to your optometrist for cleaning of your eyelids, because yes, you can do the home techniques but if things have been going on for a while, sometimes you need a really deep cleaning to clean the eyelids. So some optometrists will offer different eyelid cleansing services in their practice. Other things that can happen, those blocked oil glands, warm compresses at home can be helpful but sometimes it's just not quite enough to really clear those blockages. So there are a couple of really good technologies that do a thermal expression where we actually heat the eyelids, melt that oil, get those blockages cleared. So then when you go home and do your warm compresses, it's much more effective. And then there's the next level of treatment. There's light therapy, there's a process called intense pulse light, IPL, it's it's known in the aesthetic world as things used for photofacials. Where it helps with dry eye, is it was found that people that had rosacea, and had these treatments done, it helped with their dry eye as well. So the doctor who discovered this studied it further and has come up with protocols for actually treating around the eyes with the Photofacial type treatment. And so that's been found to be quite helpful for people, but it's looking at like a stepwise approach as to what's working for people, do we need to take it to the next level? And what type of technologies can we offer?

Denise Balch: 16:02

Yeah, and it sounds like, you know, if people are aware that, you know, if they've got a lot of this excess watering of their eyes, particularly if they're on a screen most of the time during the day, that if they take sort of an early intervention approach, and seek out their optometrist that it's going to be a lot better for them in the long run, than waiting and leaving it until it gets really bad.

Dr. Michelle Lane: 16:28

Yes, yes. And you know, you get the stinging and the burning that goes around, goes along with it, which in the redness and, you know, other people noticing like, why are your eyes so red? Why are your eyes watering all the time? Why are you crying? So, it can be something that really affects people, and the earlier in the disease process that we take it seriously and start treating it, the more effective those treatments are going to be. And the more comfortable the patients are going to be with their eyes.

Denise Balch: 17:04

What are the gaps in current vision care plans? Because it sounds like this may be something where there's a gap in care.

Dr. Michelle Lane: 17:14

Mm hmm. So we find with a lot of the vision care plans, they're quite basic in that they'll cover an eye exam and perhaps have some coverage for glasses once every couple of years. And so it doesn't really take into account that, as optometrists, we're doing more than just routine eye care, we're doing these treatments for people with specific conditions. So a lot of the dry eye assessments and treatments, the patients often have to pay out of pocket. There are some insurance companies that if you write a letter or ask special permission, they may offer some coverage, but I find those to be in the minority.

Denise Balch: 17:56

Interesting. So what would you like to see in terms of changes, or anything implemented with respect to diagnosis and treatment of dry eye disease?

Dr. Michelle Lane: 18:07

I'd like to see the condition taken more seriously. Because it does have a real impact on people's lives. And when it's taken more seriously, and knowing that we as optometrists, we do have the tools and the expertise to recommend good treatment programs. For patients, it will improve their quality of life, improve their productivity. You know, where I have a special interest in dry eye, I have a Yeah, no, absolutely. I guess my final question would be, if an dry eye clinic within my practice, oftentimes, I see people who've been suffering for years. So by the time they come to see me, you know, it's more difficult to get things under control. If we can treat this at its earlier stages, take it seriously earlier, then people won't get into those situations where we have a very difficult time controlling the condition. individual is diagnosed with ocular surface disease, does it put them at higher risk for other eye diseases? Well, you can have irritation of the cornea, which can lead to scarring and vision compromise. And, you know, even just in general with having a tear film dysfunction, it affects your quality of vision. So you know, people come to see us for us to help them with their vision, we prescribe glasses, they invest in a good pair of glasses, but if their tear film isn't stable, if their tears aren't functioning normally, they're not going to see very well. So there's more to it than just the inconvenience, and it can be more than just a slight discomfort, it can be a significant discomfort. There's also quality of vision and health of the front surface of the eyes. As I was talking about before with those little oil glands in our eyelids, if they're chronically clogged and chronically inflamed, they will die off and stop being functional, and we won't be able to bring them back. So we need to treat them effectively at a stage where they're treatable, so we can keep, you know, healthy, comfortable vision for a patient's lifetime.

Denise Balch: 20:29

Yep, absolutely. And it's actually sort of a good news story because ocular surface disease, it sounds like, you know, for me as a layman, you know, it's something that's easy to diagnose and treat and manage, if it's caught early, and the individuals committed to looking after it. But if you leave it, that's when you know, you risk having other complications, and it's harder to treat.

Dr. Michelle Lane: 20:57

Yes, yes. It's complicated. It gets much harder to get good results from the treatments if it's been going on for a while.

Denise Balch: 21:07

Great. Well, I think you've certainly answered our question of the day, which is why we should take dry eye disease seriously. So I want to thank you for your time today. In our preparation, I think you mentioned a couple of websites that people want more information about dry eye that they can get some reliable information.

Dr. Michelle Lane: 21:29

Yes, the Canadian Association of Optometrists has a great website with lots of resources. Their website is www.opto.ca, OPTO dot CA. And if you search in the search bar for dry, there's a good amount of information there. Another great resource and website is www.mydryeye.ca. So again, a lot of information about dry eye and some information about if you're trying to seek out practitioners that are using particular technologies, there is a search feature there to look for dry eye interested optometrists in your area, the thing that, you know, all optometrists are trained to recognize and diagnose dry eye, but some optometrists do go to the next level with the technologies they have available in their practice.

Denise Balch: 22:26

Great. Well, that's super, I think that's all great information, and I really appreciate you spending the time with us today. Thanks very much, Dr. Lane.

Dr. Michelle Lane: 22:34

Great, thanks. It was my pleasure to come on and speak with you Denise.