There are so many causes of dry eye disease, so many treatments available to those who need them, and therefore so many myths surrounding this condition. We could spend all month talking about these myths, but we're going to concentrate on a few important ones in this article. At the recent American Academy of Optometry (AAO) meeting, Dr. Alan Kabat spoke about many of these myths, and we thought it would be helpful to bring out the facts so that those suffering from this disease can know where to turn.
Myth: Restasis doesn't work
Oh, how often we've heard this! Restasis (cyclosporine A 0.05%) is an immunomodulator which works to decrease inflammation on the eyes. It works by targeting activated T Cells and helps your eyes to produce more of their own high-quality tears. This takes time! Restasis is not meant to be an expensive artificial tear that you use when you feel like it. It's meant to be consistently used twice per day every single day.
The process that Restasis uses may take 3-6 months before you or your doctor will notice a difference in your signs or symptoms of dry eye disease. Clinical trials galore have demonstrated the efficacy of Restasis, and it absolutely does work when given enough time to do its job. Did you give it enough time?
That being said, anyone can react badly to anything at any time. This is how allergies work, and some people just do not tolerate Restasis well (past the usual side effects of blurred vision and burning of the eyes). If this is you and you gave it a real chance, Xiidra may be of benefit to you because it uses a quicker mechanism of action and is an entirely different dry eye medication.
Myth: Artificial Tears are not a viable dry eye therapy
Artificial tears are arguably the main therapy used by both doctors and patients when treating dry eye disease. But are they actually treating this condition, or are they merely masking symptoms? This is a huge debate in the eye care space, and it's one we'd like to clear up.
These lubricating drops come in many forms. From bottles of gels and drops to preservative free vials, there are so many choices. But when you find one that works for you (and hopefully it's one that is preservative free!) we recommend you stick with it. Why?
Artificial tears can be very beneficial in Level 1 of dry eye. The Dry Eye WorkShop (DEWS II) defines Level 1 as the mildest form of dry eye, characterized by episodic, but not constant, blurred vision and discomfort. Those in Level 1 may have mild redness of their eyes and eyelids, mild corneal and conjunctival inflammation, and mild meibomian gland issues. They may or may not have an abnormal Tear Breakup Time (TBUT) or Schirmer Score. If this sounds like you, artificial tears can actually help treat your problem.
They not only help to mask the symptoms of this disease (the burning, foreign body sensation, and general irritation), but they actually do help heal corneal inflammation (corneal staining) when used together with other dry eye therapies.
Now, does this mean that artificial tears are not beneficial for those in Levels 2, 3, or 4? Not necessaily. Nonpreserved artificial tears are still beneficial for symptom relief and they may still help the cornea heal to a mild extent when combined with other therapies. The main point is, if they're giving you relief, you should stick with them and continue using the one that is working for you. That being said, you should also continue with warm compresses, proper eyelid hygiene, hydration, and diet changes to keep inflammation under control. You can check out all of the products from Heyedrate here.
Myth: Dry Eye has no visual complications
Anyone who suffers from dry eye disease should know this is a myth. Think about the last time your eyes were dry and you had to drive at night (hello, halos!) or you had to work all day on your computer. This can be torture, and these are just a few examples of instances where dry eye affects visual function.
Functional Visual Acuity (FVA) measures visual ability over a period of time, without blinking. This measure of vision is important because it correlates well with a person's ability to perform many different tasks (driving, reading, etc). FVA basically looks at how well the tear film is working, and we know that dry eye disease can greatly disrupt the tear film.
So, why do we see those halos at night? And why is it that your computer gets blurry when you're staring at it all day? This all comes down to how stable your tear film is. If your tears evaporate too quickly, they're not spreading evenly over the surface of your eye and this is causing intermittent blurred vision. A dysfunctional tear film causes light scatter, leading to halos at night, and we blink much less while on digital devices (which impairs the tear film and makes it difficult to see your screen).
There is a lot of debate around this topic. Punctal plugs work by plugging the puncta in the eyelids (you have one in each upper and lower eyelid, for a total of four puncta). This often means that the tears are better able to coat the eye instead of draining out like they normally would. But does plugging up the drainage holes in your eyelids have the potential to cause the inflammation on your eyes to stagnate and make dry eyes worse? Well, it depends.
First of all, all dry eye is not caused by inflammation, so there are many people out there who would not need to worry about this. Studies have shown that punctal plugs can help improve both the signs and symptoms of dry eye disease, and this makes punctal plugs a viable option for those suffering from this condition.
According to DEWS II, punctal plugs may work well for you if you have any of the following conditions:
Aqueous-deficient dry eye caused by systemic conditions such as Sjogren's syndrome
Dry eye disease due to systemic medication use (high blood pressure medication, antihistamines, antidepressants, etc)
Dry eye due to previous refractive surgery or LASIK
Contact lens induced dry eye
Abnormalities with eyelid closure
Dry eye disease caused by increased tear evaporation
Corneal issues that affect tear film stabilty
As you can see, punctal plugs can be very helpful. The time to be careful with them is when your eyes are incredibly inflamed from severe meibomian gland dysfunction or blepharitis that is uncontrolled. This means that the plugs could potentially stop up the inflammation on your eyes, making things worse.
Myth: Contact Lenses cannot be worn by those with dry eyes
It is true that older and higher water content materials used to make contact lenses can exacerbate dry eye in those with even mild dry eye symptoms. Obviously, we want to avoid this as doctors and ensure that our patients are comfortable should they decide to wear contact lenses. The great news here is that there are newer, healthier materials on the market that can make wearing contact lenses a viable option for those suffering with even moderate dry eye disease.
In discussing soft, disposable contact lenses first, the best options for those with dry eye are going to be daily disposable lenses. Nearly all of the big brands currently manufacture daily disposable lenses that can be worn by patients with dry eyes. Our best choices include Acuvue Oasys 1-Day and Dailies TOTAL1, and we've had many dry eye patients wear these with success.
Now, we do know that every dry eye patient is not the same and not everyone will be able to tolerate contact lenses (even the newer materials). By all means, if you find a contact lens that works for you, continue to wear them comfortably! But if you can't tolerate them, scleral lenses may be something to look into. These large diameter hard lenses are made to vault the cornea on the front of the eye and are filled with saline solution before use, giving the wearer clear vision and bathing their eye in tears all day. If you want to be free of glasses but have yet to find comfortable wear with even daily disposable lenses, scleral lenses may be a wonderful option and one that can even give you dry eye relief.
Myth: Staring at a computer screen won't hurt my child's eyes
There are so many reasons to get your kids outside to play, and one of them is because computer screens can actually be harmful for their eyes. It is well known that evaporation of the tears is a huge cause of dry eyes, and stressors such as computer screens, smartphones, low humidity, and contact lens wear can exacerbate this issue.
A study from 2014 showed that chronic exposure to stressors such as this depletes meibocyte stem cells and can therefore cause meibomian gland atrophy. Of course, we're concerned about lengthy computer use in adults too, but in children the effects are incredibly alarming. A study from children in 12 different countries showed that the average time spent in front of a screen per day was 8.6 HOURS. In addition to this, we blink less when we're on our computers and phones, meaning that the oils within the meibomian glands are becoming stagnant.
As all of this contributes heavily to meibomian gland dysfunction and dry eye, we want to do everything we can to protect our kids. Can you imagine having meibomian gland atrophy before the age of 18? One small study showed that some atrophy was present in nearly 80% of all children studied. Yikes! Do your kids a favor and push them outside for some fresh air, because it'll do their eyes some good and prevent future issues.
Myth: Treating children for dry eyes is a waste of money
This couldn't be further from the truth. At the Academy meeting, we heard over and over the importance of everyone (children and adults) cleansing their eyelids twice per day, just like they brush their teeth. Just as brushing prevents cavities, eyelid cleansing prevents blepharitis and dry eye.
As we stated in the previous myth, dry eye, meibomian gland dysfunction, and blepharitis are becoming more common at younger and younger ages, largely due to the use of digital devices. By implementing time away from the screen and an eyelid hygiene regimen now, much of this can be prevented. For example, home therapy for children as young as eight (or younger, if you are comfortable) should include: