Question: What is Dry Eye?
Dr. Miranda: Dry Eye is a multifactorial disease, that often has symptoms, but in some cases, the symptoms may not be readily apparent to the patient until it really becomes a problem. During the course of our comprehensive eye examination, we do some tests that can determine if the patient has signs and symptoms of dry eye.
If we see they do indeed have dry eye, then we go over our dry eye protocol, which we like to call the Dry Eye Boot Camp. We call it that because it does take some time and attention from the patient to listen to our recommendations so they can feel better with their eyes: less watering, less redness, less dry eye. Part of this protocol is over the course of 6 months, so we can rehabilitate the tear film, which often improves vision, but also improves comfort with whiter healthier looking eyes.
Question: Do you check for Dry Eye during every exam?
Dr. Miranda: Yes. We will look at your tear film - the breakup time of your tears is how long your tears reside on your cornea. We look at the cornea, glands in the eyelids, the stability of the tear film, and then we will ask you questions about how they are feeling, such as "How dry do your eyes feel?" or "Do your eyes water frequently?" Sometimes people can't spell out that they have dry eye even though they have symptoms of dry eye. So just having a conversation with the patient can bring those symptoms to the fore.
It's so important to check for dry eye at every exam because it is a disease that can be progressive and chronic in nature. We inform the patient that if you don't address their dry eye now, it can become worse and cause damage to your eyes in the future. It can truly be vision and lifestyle threatening in your future. It can also be emotionally disturbing because your eyes hurt all the time.
If we see signs and symptoms then we can perform more in-depth tests, which we call the "Full Dry Eye Workup".
Question: What are the different tests you run during this Full Dry Eye Workup?
Dr. Miranda: We have the Tear Osmolarity Test. This test takes a sample of the tears and looks for hyperosmolarity in the tears. this is an indicator of an inflammatory response that leads to dry eye.
As part of our Dry Eye Protocol, we use Blephex, which is a micro lid cleaning method along the eyelids. This cleans right at the base of the meibomian glands. We heat the glands and express them. For example, you know when you have a toothpaste tube for a while, you see caked-on toothpaste around the top, and you can't squeeze the toothpaste out. Then all of a sudden you get a whole glob of toothpaste squirt out. This is the same idea with your eyelids. You get plugging of the glands, and then maybe every once in a while, you get a burst of gunk that will come out rather than clear meibom. That disturbs people's vision. They will complain of filmy vision, or having to rub their eyes to get them clear. These are all signs and symptoms of a meibomian gland dysfunction.
Question: About how many of the people that come for a regular eye exam, not knowing they have dry eye, you find actually have dry eye?
Dr. Miranda: I would say about 20% of patients who come for our routine eye exams, we find they have dry eye.
Question: Can I lose my sight from Dry Eye?
Dr. Miranda: It's possible to lose your best vision because of it. For instance, the purpose of the tears is to coat the cornea, and the nerves in the cornea. The cornea has more nerves per square area than anywhere else in the body, making it the most sensitive part of your body.
If the tears dry up and evaporate, then the nerves are exposed. The cornea becomes inflamed and desiccated. That inflammation, called Keratitis, disturbs your vision and definitely can reduce your best-corrected vision. It doesn't mean it cannot be corrected, but it does threaten your vision and makes your vision sub-optimal.
A lot of people don't realize that the tear film plays a significant role in the refraction of your vision. Therefore, without stable tear film often you won't have stable vision.
Question: Who is most likely to get dry eye?
Dr. Miranda: More females are affected by dry eye. Also, seniors because as people age they don't produce as many tears. People who work on the computer or on electronic devices for long periods of time also have a higher chance, because they will naturally blink less, or will be partial blinkers. The blink reflex is to distribute the tears evenly across the corneal surface.
Therefore, if you are concentrating on reading, or looking at digital devices, you blink a lot less. We are supposed to blink 14,000 times a day, and these folks might blink 1/3 of the amount. This can cause issues with the glands, which produce the lipid part of the tears (the oily part of the tear) because you are not blinking fully. We are also seeing dry eye in younger people now, and I believe it's because they are staring at these digital devices more than ever.
Question: Will wearing blue light protection glasses while on digital devices prevent me from getting dry eye from them?
Dr. Miranda: This is two different things. The blue light glasses protect from the blue light radiating from the devices LED screens. That's more of a future of your vision protection rather than a counter to dry eye. It won't remind you to blink. Two different issues. When we need to focus, we naturally blink less.