It’s once again that time of year when your eyes can feel like the Sahara desert or your vision may seem blurrier than usual. It may just be seasonal dry eye.
The most common type of dry eye is evaporative dry eye – which can often be worse in the wintertime. Evaporative dry eye is caused by inflammation on the eyelids – which is called blepharitis. This can lead to a poor tear film and quicker evaporation of tears, which are the eyes’ natural moisturizer Winter can make this condition worse because the air is dry and heaters are on. Symptoms can include blurry and fluctuating vision, a gritty feeling like sand in your eyes, and even excess tearing.
Tips To Help Relieve Seasonal Dry Eye
- Reduce reading or heavy computer use, which can worsen dry eye because you don’t blink as often.
- Have humidifiers on in the house and office.
- Don’t have the car heater blowing directly on your face.
- Take omega-3 as fish or flax seed oil – 1000-1500 milligrams of DHA/EPA – to help improve the quality of the tear film.
- Use over-the-counter artificial tears or lubricant eye drops up to four times a day.
- Contact lenses can make dry eye worse, so minimize contact lens use if possible.
It can take six to eight weeks to notice improvement, but if the symptoms last longer than that you should see a doctor to be sure nothing else is going on and to discuss alternative forms of treatment for dry eye. “A key point is that all dry eye treatments take time to work,” says Michelle D. Patel, M.D., assistant professor of ophthalmology at Wake Forest Baptist Medical Center. “There aren’t any quick fixes. Each intervention can take a few months to make a significant difference and often you need a combination of treatments for relief.”
Beating Dry Eye Syndrome
Symptoms of dry eye syndrome – dry, red, itchy, gritty, sore eyes – are more common among contact lens wearers. Some relief appears to be on the horizon. A group of Stanford University researchers are exploring the mechanical interactions between the eye surface, the cornea, and contact lenses, with a goal to create better contact lenses that maximize comfort and alleviate dry eye symptoms.
When developing biomaterial-based devices that are in direct contact with cells – like contact lenses – their mechanical interaction with cells, biomaterial adhesion to cells and biocompatibility are all extremely important factors. “Our system, a live-cell monolayer rheometer, is built on a standard inverted microscope for cell biology,” says Juho Pokki, a postdoctoral research fellow in the chemical engineering department at Stanford University. “It can simultaneously observe the cells and test cell mechanisms and adhesion.”
The group also created an automated system to enable controllable experiments at the microscale. Cornea cell surfaces consist of a mechanically complex, soft material which you can think of as nature’s “smart material.” “It has properties that depend on stress-strain conditions and time,” Pokki says. “Corneal cell mechanics and cell adhesion are altered for different corneal surface conditions, such as changes caused by disease, and different contact lenses.”
By measuring mechanics and cellular or bacterial adhesion-related information, the group can compare biocompatible materials that are most suitable for contact lenses or for developing new biomedical devices such as prosthetic electronic skin. To date, one of the group’s key findings is that corneal surface cells, which have adapted to protect the eye surface, are mechanically complex.
“Their effective mechanical behavior is different between small and large strain conditions,” Pokki said. This behavior may be caused by changes within the cells, which the group plans to study in the future. “In terms of applications,” Pokki added, “beyond developing better contact lenses, our system can be used to screen and find optimal contact lens solutions or eye drops for people who have dry eye symptoms. This would allow people with dry eye syndrome to use contact lenses while maintaining corneal mechanics and adhesion similar to those of users without dry eye symptoms.”
A New Kind Of Eye Dropper
A new kind of eyedropper can deliver tiny droplets of medication to treat the eye more precisely than traditional eyedroppers while reducing waste and avoiding dangerous side effects, says the American Academy of Ophthalmology. This technology may prove to be especially advantageous in the treatment of dry eye and glaucoma, for which patients require daily use of medicated eye drops that can cost hundreds of dollars for a bottle that lasts only a month.
Researchers at New York Eye and Ear Infirmary of Mount Sinai showed that a microdose delivery system achieved a treatment effect comparable to a conventional eyedropper, while delivering less than four times the amount of drug. Microdosing also reduced the eye’s exposure to the drug and preservative by 75 to 80 percent. Patients experienced reduced side effects, leading to a gentler treatment.
Delivering drugs in very small, precise dosage volumes not only avoids spillage, it can also decrease tearing and blinking, thereby limiting dilution of the medication. The hand-held system evaluated in the study could deliver precise, single-digit microliter doses of medication to the eye’s surface within 80 milliseconds, quicker than the blink of an eye.
While glaucoma treatment preserves sight by reducing pressure inside the eye, it can also cause painful, irritating side effects for patients. A conventional eyedropper’s opening creates a drop that’s four to five times larger in volume than the human eye can actually hold. When drops are too big, the overflow runs down the face or drains into the body through the ducts in the corner of the eye.
Oversized eye drops don’t just waste medication, they overdose the eye with medication and toxic preservatives that cause side effects, such as redness, itching, irritation, and dry eye. Some topical medications can cause the heart to beat too fast, too slow, or irregularly when too much is absorbed into the body.
Testing The System
To test the safety and effectiveness of microdosing, the researchers delivered a common drug ophthalmologists use to dilate the pupil and examine the back of the eye. Microdosing was used to treat one group of patients, while a conventional eye dropper was used to deliver the drug to another group.
They found that high-precision microdosing dilated the pupil as well as the conventional eye dropper method. At the same time, microdosed patients showed lower levels of the drug in their bloodstream. They also experienced a significantly lower rate of side effects – eight percent compared with 66 percent for patients treated with conventional eye drops.
“We believe that we have developed a viable 21st-century microdosing technology to transform the 100-year old eyedropper paradigm with modern, high-precision smart technology,” said lead researcher, Tsontcho Lanchulev, M.D. MPH, professor of ophthalmology at the Icahn School of Medicine at Mount Sinai and director of the Ophthalmic Innovation Technology Program at New York Eye and Ear Infirmary of Mount Sinai Hospital.
Lanchulev expects additional clinical trials to begin within the next 12 months to further evaluate the technology for treating patients with glaucoma, as well as for pupil dilation. He believes the first micro-therapeutic formulations could be available for consumers by 2020. Lanchulev added that the microdosing approach could eventually be used to treat a wide variety of eye diseases and conditions, such as dry eye, allergic eye disease, and infections. He also believes that the smart electronics of the platform will be used for digital health applications, such as compliance monitoring by both patients and physicians.
Ask More Questions For Better Eye Care
Compare a patient’s self-reported eye symptoms to their electronic medical record and clear discrepancies can be seen. A study from the University of Michigan Kellogg Eye Center revealed wide disparities in the content of pre-appointment patient questionnaires and what a clinician wrote down to document the visit. The study, published in JAMA Ophthalmology, analyzed the symptoms of 162 Kellogg patients. Each completed a 10-point survey while waiting to see a physician; questions came from sources including the National Institutes of Health Toolbox.
“We found pretty noticeable differences between the two,” says Maria Woodward, M.D., M.S., an assistant professor of ophthalmology and visual sciences at U-M. “I think certainly the biggest takeaway is when people are presented things in different ways, they tell you different things.”
The doctors treating these patients weren’t told about the surveys, or that their record-keeping would be reviewed for comparison. The contrast was stark: Of the study’s group, “exact agreement” between an individual’s survey and what appeared on their medical record occurred in only 38 patients.
A Need For Focus
Symptom reporting drove the inconsistencies between surveys and medical records, the study found. The top discordant issue: glare. Of patients reporting concern about glare on their surveys, 91 percent didn’t have it on their medical record.
Eye redness was second-most common – 80 percent had no medical record mention – followed by eye pain – 74.4 percent. Blurry vision was the only symptom to tilt the scales with more instances of inclusion in medical records than in questionnaires.
As a result, other doctors treating the same patient in future visits could have an incomplete picture of their symptoms. Perhaps more risky, because digital medical records are increasingly used to guide clinical practice or research, the collective data may be shortsighted or misleading in some scenarios. “Many parties in health care use the electronic health records now and they expect the data to accurately reflect the interaction with the doctor,” Woodward said.
Explanations for the medical record/doctor-patient disconnect are understandable, with neither party at fault. The doctor-patient relationship is more nuanced than what is reflected in the medical record. A patient might not choose to mention all of their symptoms. Doctor dialogue may follow a conversational path versus a point-by-point checklist.
Time constraints of record keeping in the electronic chart can also be an issue. And not every detail of a given appointment — particularly minor concerns — is necessarily worth documenting. “The concern highlighted by this research is that important symptoms may be overlooked,” Woodward added. “If a patient has severe symptoms, all of those symptoms should be documented and addressed.”
Gaining Greater Clarity
The study highlights an opportunity to improve lines of communication between patients and doctors. For example, implementing pre-appointment eye symptom questionnaires similar to those in the study could prove simple and effective. A similar pilot program is underway in Woodward’s clinic. “This is definitely a pathway I see as very feasible to resolving this disconnect in the near future; the infrastructure is already there,” she says.
The concept also could help bring more clarity to what ends up on a patient’s medical record. Because the surveys Woodward and her team used asked participants to assess their conditions’ severity on a numeric scale, results could help practitioners better evaluate the depth of a patient’s symptoms — and even identify concerns that might have gone unnoticed.
The use of a self-report system before seeing the doctor could really change the conversation between the doctor and the patient. Rather than spending time identifying symptoms, doctors and patients could be talking about how to manage severe symptoms.