The National Eye Institute Dry Eye Workshop (DEWS) defines ocular surface disease (OSD) as follows:
Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.1
There are a few keywords I would like highlight in this definition:
Multifactorial: Long gone are the days where optometrists can say a patient simply has dry eyes and give out samples of artificial tears. The reasons behind the dryness can be caused by a cornucopia of factors that can be categorized into Dry Eye Disease and Non-Dry Eye Disease. The chart below is an excellent resource to reference to remember the components of OSD.
Ocular Surface: This is not candidly the cornea, but the entire ocular surface, which includes the bulbar and palpebral conjunctiva, tear film, and the cornea. The lids and lashes also indirectly influenced by the ocular surface and must be considered during evaluation and treatment.
Here’s a 36 page guide on understanding dry eye and meibomian gland dysfunction. Learn how you can treat MGD using LipiFlow, and how to bring this technology to your practice.
There are four main categories I would like to address in this article that fall under the precise, but open, definition of Ocular Surface Disease (OSD). Amazingly, there is one device that can provide daytime shelter from all these factors that may result in “symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface.”
- Aqueous and Evaporative Dry Eye Disease
- Pterygium/Pinguecula
- Allergic Conjunctivitis
- Post Refractive Surgery
Aqueous and Evaporative Dry Eye Disease
This may be the most obvious form of ocular surface disease for most optometrists. It is one of the largest growing areas of optometric study due to the difficulties in treatment and incongruity of signs and symptoms, but mostly because of the vast prevalence. Twenty-five percent of patients visiting an ophthalmic office have complaints of dry eye symptoms. 2
Treatment can range from artificial tears and lid hygiene to topical and even oral medications.
EyeEco’s Moisture Relief Eyewear (MRE) is an affordable option that should be considered for all patients with OSD. These comfortable and cosmetically minded glasses were designed by a board certified ophthalmologist and are an effective treatment option to protect the ocular surface from aqueous deficient and evaporative dry eye disease.
Their mechanism of action is simple: create a long-lasting moisture chamber using built in, wettable sponges in the temple of the glasses. Soaking these replaceable sponges in water for 30 seconds can provide hours of water retention. For even greater moisture, lubricating eye drops can be applied to the eyes directly before the moisture relief eyewear is worn.
EyeEco’s Moisture Relief Eyewear come in ten frame and lens combinations and two different eyesizes (57mm and 60mm). The small eyesize frame comes with adjustable temples and can correct prescriptions up to +/- 4.00D in any meridian. The large eyesize can accommodate a prescription up to +/- 3.00D. Patients with large astigmatic corrections may benefit from wearing plano MRE with corrective contact lenses or slim profile glasses under the moisture chamber eyewear.
Pterygium/Pinguecula
The prevalence of ptergyium in the world is estimated to be 10.2% and that number can increase based on geographic location.3 If you’re practicing in Tucson, Arizona, for example, that number is as high as 16 percent.3
These numbers do not even include pingueculas, which could grow and develop into pterygiums. Palliative treatment of lubrication, avoidance of dust/irritants/smoke, and UV protection are often recommended to our patients to retard growth.
Solutions for lubrication and UV protection are readily accessible and of low impact on lifestyle; however, the avoidance of dust/irritants/smoke is easier said than done.
A patient who is a farmer cannot avoid dust. A patient living in a populated city cannot avoid the smog and irritants that surround them. An everyday smoker not willing to quit cannot avoid the smoke from their cigarettes.
As optometrists we finally have a practical solution for this conundrum: moisture release eyewear.
EyeEco’s Moisture Release Eyewear provides all three aspects for daytime shelter and protection of the anterior surface and lens of the eye. It has a soft rubber gasket that provides a seal from the harsh surrounding environmental factors including: dust, wind, irritants, and smoke.
The cosmetically sealed sponges in the temple of the frame provide long lasting dry eye relief and lubrication. The lenses block 100% UV-A and UV-B light. Lastly, the sunglasses have an excellent frame wrap and large temples to block UV rays from reflecting off the back surface into the eye and onto surrounding conjunctival tissues. Conventional daily wear sunglasses do not provide adequate protection from these posterior reflections.
Surgical removal of pterygium is a functional and cosmetic treatment modality; however, the cost of surgery can be surmountable and the recurrence rates are as high as 40-50 percent.3 This makes preventative measures a better and more cost effective treatment.
Allergic Conjunctivitis
Seasonal and perennial allergic conjunctivitis (SAC and PAC) has a prevalence of 15-25% in the United States, meaning 50-85 million Americans are battling this condition.4
This is equivalent to, if not greater than, the estimated number of Americans battling dry eye disease. Patients should not only be routinely asked if they have any symptoms of dry eyes, but also if there is any itchiness, seasonal or perennial.
New research has identified a new type of allergy referred to as urban allergy. Testing of conjunctival epithelium has shown release of pro-inflammatory IL-4, IL-10, and IL-17 when exposed to hydrocarbons and automotive exhaust particulates. Interleukin-17 (IL-17) has been associated with chronic allergic conjunctivitis.
Research at the University of British Columbia in Vancouver, British Columbia, Canada has estimated that 89% of people in the world live in areas where pollutant particulate levels are above the level of air quality set by WHO.4 This provides an opportunity for optometrists to help relieve and protect our patients' eyes against pollution, pollen, animal dander, mold spores and other allergens. EyeEco’s MRE again is an excellent option for protecting the ocular surface from these air particulates.
Post Refractive Surgery
It is no secret that dry eye is the highest adverse effect following PRK and LASIK. Luckily, the dryness only lasts for a few months after surgery, but those prone to DED prior to refractive surgery may struggle with dryness for longer periods after surgery.
No matter the situation, lubrication and mechanical ocular surface protection are important for proper corneal healing post refractive surgery. EyeEco’s MRE provides both of these elements. LASIK patients must especially be protected from mechanical trauma that could result in displacement of the flap and severe complications.
Wearing the MRE throughout the day provides a mechanical barrier to the front surface while creating a moist and pro-healing environment for the corneal epithelium.
Conclusion:
There are many factors inherent in ocular surface disease, all of which need to be addressed and treated appropriately. Along with traditional treatment therapies, moisture release eyewear is a commonly overlooked, practical and cost-effective treatment for many of the components causing OSD.
EyeEco’s MRE provides optometrist with an effective tool to not only treat dry eye disease, but also ptergyium/pingucula, allergic conjunctivitis, and post-refractive surgery patients.
Mini-Case Study:
85 YO white female presented to the clinic:
· Previously diagnosed with Aqueous Deficient Dry Eyes
· Bilateral temporal/nasal pingueculas
· Bilateral age-related, combined form cataracts
· Uses hot compresses with digital message QD
· Uses Systane Balance tears BID
· Longstanding watery eyes, worse when outdoors. Patient likes to take daily walks outside.
Patient reported the following after a weekly trial with EyeEco’s MRE:
“Thank you for introducing me to ways to relieve my dry eye condition. I …noticed that my eyes were not tearing uncontrollably during my walk.”
Check out the Moisture Release Eyewear and some of EyeEco’s other great products to treat ocular surface disease by visiting their website.
