Is Dry Eye Real?

Last night, my wife woke up at 4am because her eyes hurt. She has dry eye. This is one of the reasons that we started Peeq Pro. From almost personal experience, I can unequivocally state - “yes, dry eye is real…and it stinks to have!”

But, we consistently get push back from the general population AND eye doctors about dry eye. “Is it real?” - they ask.

The short answer is yes.

The longer answer is also yes, and it depends on how you define it. The variation in definition over the last twenty years has been significant. 

The challenge is that the definition and therefore the research has dramatically changed as dry eye disease incidence has steadily increased.

TFOS DEWS II

Seeing the increase in incidence, the eye doctor community (both optometrists and ophthalmologists) created a working group to better define and measure dry eye. Thus, 

most current studies use the 2017 TFOS Dews II protocol definition:

“Dry eye is a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and accompanied by ocular symptoms, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities play etiological roles.”

This is why there is so much debate. Using only the definition, the research would suggest that about 8% of Americans have dry eye disease. These people generally are women, older than fifty, and with additional environmental or co-morbidities (i.e. they smoke, have been treated for cancer, had eye surgery, or wear contact lenses).  Biological functions of tear film - PubMed

Why is dry eye happening more now?

However, this also undervalues the process by which people start to develop dry eye disease. Current research points to many 21st century technologies. One primary one is the reliance on smart phones and computer screens. This appears to lower blink rates or lead to incomplete blinks - creating an environment where dry eye incidence in younger adults is almost as high as over 50 year old women. Historically, this was not the case.  Blink Rate and Incomplete Blinks in Six Different Controlled Hard-Copy and Electronic Reading Conditions | IOVS

There are also articles associated with changes in contact lens wear, eye surgeries, new prescription medications, and other factors. The challenge is that these overlap research with smart phones. This is the “multifactorial” part of the disease. In other words, lots of stuff we are doing now is hard to measure as a single variable. When it is measured in that way, it frequently illustrates some negative effects on dry eye. Is there a relationship between the severity of disease in major depressive disorder patients and dry eye disease? - PubMed

 

Change in office protocols

In office evaluation of dry eye symptoms is becoming the standard of care. While not every office tests for dry eye, it is becoming an important part of many comprehensive eye exams.

There are two different primary ways that eye doctors test for dry eye indicators. These indicators are primarily measured using two tests - a triage environmental and symptom survey (such as the Ocular Surface Disease Index test or the SPEED test) or some form of evaluation of the meibomian glands (often as part of a string of other tests - such as a tear break up time or fluorescein stain test). These tests tend to provide a status on symptoms and discomfort and physiologically the state of the meibomian glands. Meibomian glands are evaluated for meibomian gland dysfunction (“MGD”) which is usually a precursor of dry eye disease and the degradation of the physical glands. [Adaptation of the Standardized Patient Evaluation of Eye Dryness Questionnaire to European Portuguese (SPEED-Vp) in a Non-Clinical Sample] - PubMed

Dry Eye tests are full of wide ranges of incidence.

Current estimates place MGD in the adult population of Americans at between 30-70%. And, this is one of the problems. Ranges of 50% lead to uncertainty within populations of doctors, patients, and others. We want uncertainty ranges of 3% - not 50%.

But, the reason for the range has three primary characteristics:

1. Our behavior is changing the results. By looking at smart phones, incidence rates are increasing rapidly. This means that older tests ACTUALLY have different results - making new tests look less reliable. Modifiable lifestyle risk factors for dry eye disease - ScienceDirect
2. Definitions have changed. DEWS II came out in 2017, but most doctors did not adopt this evaluation technique until the last three years. Thus, optometry schools and other “experts” did not even begin to categorize dry eye and its precursor in a consistent way.
3. Treatments have evolved. As treatments have evolved, reporting characteristics and data have also evolved. Thus, a study from 2000 references incidence rates based on treatment using punctal plugs - not drug prescriptions.

Collectively, this has created great uncertainty inside of the scientific literature as providing a firm percentage is difficult because backwards facing analysis is consistently murky. 

 

What does this mean for a patient with dry eye?

 

What this means is essentially a patient may attempt to do online research and find a wide array of research and reports that are inconsistent or even incorrect.  For example, WebMD still references baby shampoo as a standard dry eye treatment. This is no longer considered correct - but one of the most searchable, foremost articles has it as a reference. This leads to incorrect assumptions about a wide variety of treatments. Essentially, this is an excuse for a patient to be non-compliant on simple treatments.

 

Simply put, Peeq Pro is in the business of compliance, so we have unique data collected on this specific topic. So, we have data that others don’t. People fail to comply for four primary reasons:

 

1. They never buy the correct products for taking care of their eyelids and eyes. Those products are generally oil (okra and tea tree are the most common) based cleansers that kill demodex or hypochlorous acid. 
1. Most of this failure is buying anything
2. The second part is buying the wrong thing
2. If they purchase the product, they do not integrate it into a daily routine. Like brushing one’s teeth, eyelid hygiene is everyday.
3. They stop after they have exhausted their sample or current supply as it is inconvenient to repurchase, have not been educated well about the permanent daily need for eyelid hygiene, or they don’t “feel” the symptoms.
4. They fail to return to the eye doctor for further evaluation regarding the extent or progress of the disease. In so doing, they prevent themselves from receiving additional preventative treatments - such as an intense pulse laser or pharmacological treatment.

 

I’ve been diagnosed - what should I do?

 

If you have been diagnosed with dry eye or meibomian gland dysfunction, we recommend three simple things:

 

1. Start an eyelid hygiene routine. We would recommend a tea tree oil cleanser (unless you have false eyelashes or eyelash extensions). Place this cleanser where you wash your face - either the sink or shower. Wash every time you wash your face or hair. It is simple and quick. You should place cleanser on your finger or a sponge and massage your top and bottom eyelid with the soap. This will both help you to ensure good flow from your eyelid glands and limit demodex infestations on your lids. Foaming Eyelid & Facial Cleanser for Eyelid Hygiene – Peeq Pro
2. Change your environment. Reduce the number of fans in your vicinity including any vents. This may mean changing the orientation of your desk or favorite chair. This will help prevent that moving air from drying out your eyes and eyelids. This may also include changes to your working environment (specifically where your chair is in relation to your computer screen).
3. Change your behavior. Drink more water. Take a fish oil supplement. Follow the 20/20/20 rule. Break up screen time into smaller chunks to alleviate eye strain.

 

We would love for you to buy our products.

 

If you want to be a Peeq customer, we recommend a Good, Better, Best Routine.

 

Good - Eyelid wash and sponges. This is a good starting point for someone who wants to prevent or at least stave off dry eye. If you do not yet have symptoms, this is a good place to start. Bishop Sponges Pack of 5 – Peeq Pro

 

Better - Add warm compress and short-term relief eye drops. If you are female, have had surgery, wear contacts, or have additional risk factors, start here. Use the warm compress as part of a “spa” treatment. This means wearing the compress should be part of something that you like to do - such as drink a cup of coffee or wine, meditate, or listen to music or an audiobook. Peeq Pro Silica Bead Heat Mask Warm Compress

 

Best - Use our Peeq Waiva. This is the best-in-class eyelid washing system. Like an electric toothbrush, the Waiva provides vibration that helps stimulate your eyelids and breaks up make-up, making it easier to remove. If you want a better clean, the Waiva is better. Waiva Eyelid Cleaning System – Peeq Pro

 

Ultimately, even if you do not buy our products, the goal is to get your eyelids washed every day. It requires more than letting water run over them because you need the massage of the oil glands. We call this massage and using the right cleansers - “peeqing”. 

 

Let us know if and how this article has helped you. Follow and tell your dry eye story on social - we will amplify it.

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