Thank you so much for giving me the opportunity to speak to the South Oldham Lions Club this evening. As Gary said, my name is Jeremy Fowler. I am originally from Indianapolis, Indiana, but I have lived here in Crestwood, Kentucky, since 2010. My wife and I have been married for 16 years, and we have 3 wonderful children. I have worked in the optometric field for almost 20 years, and my practice, Derby City Eye Care, is located just up the hill at the new Walmart. We’ve been there since it opened nearly three years ago, and we plan on being there for a long time to come. If you’re ever in the store, please stop by and say hello. I’d love to meet you.
Tonight we’re going to discuss three common age-related eye conditions that occur in the United States. The first condition we’re going to talk about is Dry Eye Disease. This condition affects the tears on the front surface of the eye. When you don’t have good tears on your eyes, you don’t see well. About 85% of our vision is determined by glasses or contacts, but 15% is through our tears. If you don’t have good quality tears, your vision will be blurry.
Dry Eye Disease is something that has become much more prevalent in our society as electronic devices have become more common. Over the last 20 years, we have seen dry eye increase across the board – not only our mature population, but also in people who are in their 30s and 40s. Now we’re even seeing it in our teenagers and pre-teen kids that spend extensive amounts of time on their devices every day.
Dry eyes or insufficient wetting of the eyes can happen in several different ways. If the tears aren’t mixing properly your eyes can become dry. If the tears aren’t being produced properly you can also get dry eyes. If you have inflammation on the front surface of your eyes, either on the eyelids themselves or the ocular surface, you can have dry eyes. The latest studies show that about 10% to 25% of Americans have dry eye disease, but up to 70% of Americans may experience dry eye symptoms. Dry Eye Disease is two times more likely in women than it is in men, and a lot of that is hormonal. There are other reasons, of course, but hormone fluctuation plays a significant role.
There are several different causes for dry eye disease. Age, of course, is one that is common among all the conditions we discuss tonight – it’s a big deal. Certain autoimmune disorders, like rheumatoid arthritis and lupus, will also cause disruption to the tear film. Diabetes, ocular inflammation and allergies can also cause dry eye – especially in Kentucky. Many different types of medications dry the eyes out, as well as certain environmental conditions like wind, smoke, and dry air. If you’ve ever been out in the Western United States – in places like Colorado, Utah, and Arizona – you know what I’m talking about.
Let’s talk about dry eye symptoms. I have these every morning – sandy, gritty, scratchy eyes, and sometimes stinging and burning eyes. If you wake up in the morning and notice that your vision is blurry, then you rub your eyes a bit to get them going – to wake them up – you have dry eyes.
What about watery eyes? A lot of my patients say, “Dr. Fowler, I don’t have dry eyes – my eyes water.” Well, guess what? Watery eyes are a side effect of dry eyes – when the eyes get too dry, they send a signal to the brain that says, “we’re dry – we need more tears!” So the tears flood the eyes, but because they aren’t mixed properly – we’ll get to that in a minute – they go right down the side parts of the eyes, face, and nose. So watery eyes are actually a symptom of dry eyes.
How do we treat dry eyes? For starters, you want to get a good eye exam to find out what is causing the dryness, but usually, artificial tear eye drops are the first line therapy in dry eye treatment. The eye drops don’t necessarily stop the dryness, but they do add lubrication to the front surface of the eye and help the tears mix together so they can stay on the eyes longer. They also help to heal inflammation on the eye surface which is a frequent underlying cause of eye dryness. Making sure that your lids are healthy and clean is also helpful in treating dry eyes.
There are three types of tears: a sticky, mucousy tear, a watery tear, and an oily tear. All three of these tears have to mix well for you to see clearly and not have dry eyes. A lot of times the tear glands along the base of our eyelashes that make the oily tears can get clogged – especially in us guys who don’t wear makeup and don’t spend a lot of time cleaning our eyelids. When those glands get clogged with dirt, sweat, old skin cells, and dried up tears, we can’t produce new tears efficiently and our eyes become dry. I often tell my male patients with this condition to go home and watch a chick flick with their wife, girlfriend, or significant other, and just have a good cry with them. Not only will they feel better – they will see better too because their tear glands will open up and work properly!
I also have a lot of patients who are receptionists, office assistants, or desk job people that sit and stare at a computer all day long. Many studies have shown that the longer we concentrate on a specific object (like the computer), the less we blink. If we blink less, we make fewer tears. If we make fewer tears, our eyes get dry, and when our eyes get dry our vision gets blurry. To avoid this, I tell a lot of these patients to get a bright yellow or pink sticky note and write the word “blink” on it, then put it on their monitor to remind them to blink throughout the day. In reality, it’s the blinking action, when the two eyelids come together, that makes the tears. So the more you blink, the more tears you make and the less dryness you have.
Some of you guys were talking to me earlier about hopping on the motorcycle or getting in the car with your wife on the weekend and going for a nice six or eight hour drive through the country. After a while, you noticed your eyes getting a bit tired and your vision didn’t seem as clear. This happens because we don’t blink as much when we are concentrating on the road and our tears are drying up. So, just like my office people, I will tell you to blink a bit more as you drive down the road and that will help you avoid dry eyes.
What are some other ways to treat dry eyes? We give medications. Steroid eye drops help control inflammation, and different kinds of gels and ointments help keep the eyes moist. For the later stages of dry eye – how many people have heard of Restasis or seen the commercials for Restasis? Restasis was originally developed as a colon cancer medication. I don’t know who figured out that it was good for the eyes but it does help the eyes produce more of their own tears, so that can be a helpful treatment for those who need it.
What are some things you can do to prevent dry eyes? The main thing is environmental modification. If you know you have dry eyes it’s probably not a good idea to live in Arizona, California, Utah, or Colorado. If you do, make sure that you wear sunglasses and a hat to protect your eyes from the drying effects of the sun and wind in your face. Also, take frequent breaks from electronics, drink lots of water, and make sure that you eat a healthy balanced diet with fish oil or omega-3 supplements. It helps prevent the tears from evaporating. You all know that oil and water don’t mix well, so when that fish oil mixes with the tears, it provides an extra layer of protection. Actually, the very first patient I ever recommended to take fish oil was a sweet little 87-year old lady. She called me that same night and was quite concerned with my recommendation. She said, “Dr. Fowler, I don’t know how to break the capsule to get the oil into my eyes.” So I reassured her and explained, “you don’t break the capsule – you take it by mouth with water.”
A lot of people like to have fans on at home, especially in the summer at night when they’re sleeping. Fans dry out the eyes, and some people don’t close their eyes completely when they sleep at night so I recommend a sleep mask for them to protect their eyes at nighttime. For very severe dry eye patients, I’ll even tell them to tape their lids shut at night to prevent the eyes from drying out.
Pulse light therapy is a new dry eye treatment that has come out in the last few years. They’re doing it a lot in the western US, and it seems to work especially well for people that have dry eyes associated with rosacea which is an autoimmune condition that causes inflammation in blood vessels on the front surface of the eye, the nose, and the face. When we focus light on the blood vessels along the eyelids in these patients, it can decrease the inflammation that is causing their dry eye condition, and this helps them see and feel better over time.
So, that is dry eye.