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Paul Sallaway:
Welcome to the Dry Eye Treatment Podcast. We interview eyecare industry professionals who have experience in treating dry eye disease. Please remember that the content shade on this podcast is based on personal experiences and opinions. It is not intended as medical advice. Always consult your healthcare professional for any medical concerns. Now sit back and enjoy the podcast.
Welcome to the Dry Eye Treatment podcast. If you suffer from dry, itchy, or irritated eyes, you could be experiencing dry eye syndrome. And if that’s the case, then stick around because on this podcast we interview eye care professionals who specifically deal with dry eye disease. Over the next 20 to 30 minutes, you’re going to get actionable tips on what you can do to manage your dry eyes. But first of all, who am I? My name’s Paul Sallaway. I’m the owner of Optics Digital, which is a digital marketing agency that helps eyecare practitioners to grow their business. I’m not repeat, not an optometrist, but as a dry eye sufferer myself, I’m here to ask all the questions to the experts so that you don’t have to. And as my very first expert, I’m proud to invite a gentleman who I’ve known for about a year now.
My guest is a qualified eyecare professional. He studied optometry at University of Melbourne in Australia and did a clinical externship at Illinois College of Optometry. He has given lectures to hundreds of optometrists about dry eyes. He was part of Optometry Australia’s inaugural Dry Eye Guide. This guide is the first of its kind to list all the products and treatments available in Australia. He regularly writes for Optometry Industry Magazine, my Vision on Dry Eye Topics. He’s a full-time clinical optometrist and sees people every day with dry eye disease. Last but not least, he is the owner and initiator behind the Dry Eye Directory, a site that connects dry eye sufferers with dry eye specialists around the world. A site incidentally that Optics Digital had a role in relaunching last year. So with that resume, as long as Snellan eye chart. Hi Leigh, how are you doing?
Dr Leigh Plowman:
Hi Paul. Thanks so much for having me.
Paul Sallaway:
Good to have you back again. Well, so welcome. And maybe just to kick things off before we get into the topic, perhaps the listeners would like to know a little bit more about you. So could you give us the 32nd lightning round version of your backstory and why you became interested in dry eye disease in particular?
Dr Leigh Plowman:
Yeah, thanks Paul. So I think for me, dry eye disease started when, back in 2006, 2007, I wanted to be able to give my patients lasting relief. They’d come to me with irritated, dry, itchy, watery eyes, and they’d struggle to find relief. And I’d try to find the ultimate eye drop for them. And it was a search and I thought I’d found a really good drop. And then some people would tell me, oh, it’s just not that good, it’s not that lasting. And then I started talking about other things, surprising things like baby shampoo. And that didn’t really help either. And for me, it drove me to try and find a solution for patients. How can we get to the underlying cause and really help people to get their quality of life back again? And that’s also being a dry eye sufferer myself. I’ve got a personal interest in dry eyes and how to improve it.
Paul Sallaway:
So you’ve been on this quest for quite a while then. So what did you say? Since about 2006, 2007.
Dr Leigh Plowman:
Yeah, that’s right. It’s been a while of working through dry eye disease and being a guinea-pig for my own patients.
Paul Sallaway:
You got to eat your own dog food there. So I know you try a lot of the products that you recommend, don’t you yourself?
Dr Leigh Plowman:
Yeah, absolutely.
Paul Sallaway:
Alright, well maybe just like to break it down for a lay person like myself. So what is dry eye disease? Exactly? What are the mechanics, what’s going on with my eyes? If they’re feeling itchy and red and irritated, what is it exactly?
Dr Leigh Plowman:
Most people actually come to an optometrist thinking that their glasses aren’t working properly. They might think sometimes their reading glasses work, they can say, well, other times they feel like they’re not working and they’ve come to have an eye test feeling like there’s a problem with their glasses. And other people might just put it down as my eyes feel tired, I’m just stressed, I’ve been working heaps. And they just write it off as it’s end of day tiredness. But the blurred vision and tired eyes, they’re some of the most common symptoms of dry disease
To protect our eyes and to lubricate them. We have a fluid over them called the tear film. And the tear film’s a little bit like a wetsuit. So when it works well, it’s nice and thick protective helps to protect us from the environment, from evaporation, from air flow, from dust particles, other debris. So it works really well to protect us a bit like a wetsuit. When the tears dry out, they tend to evaporate more quickly and we’re left with more like a business shirt and it doesn’t protect us well. So we are missing that barrier that helps our eyes to function properly. And it’s also that same barrier that creates the clarity of vision. So most of the focusing actually comes from the tear film. So if that tear film isn’t stable or is thinned out, then that also makes things blurry. So dry eye diseases, that lack of the right ingredients in the tear film, there’s actually over around 2000 ingredients to the tear film. So when we think about, there’s lipids, so an oil content, there’s a mucus content and there’s a water content and there’s thousands of other components that go together to make the tears cohesive and a good structure. So more than just being salt water or saline, there’s a whole lot of complexity there. So dry disease is really where there’s an imbalance of those factors, or not enough being produced or there’s some other factors that are getting in the way of this cohesiveness working together.
Paul Sallaway:
So if I understand you correctly, there are glands in your eye or in your eyelids that produce a kind of oily film that covers the moisture, the tears of your eyes, and it prevents that moisture from evaporating like a pool of water on a hot day. It’s going to evaporate in the sun. A lot of people, if they have in-ground pools, they put a cover over the top, I think partly for that reason to stop the water evaporating. So it’s the same kind of thing, isn’t it? Yeah,
Dr Leigh Plowman:
And that’s a great analogy, Paul, with the pool covering. So the oily layout is literally only a few micrometers in thickness. So it’s a really thin layer. Again, it’s very complex with some of the oils, there’s polar oils, non-polar oils, and they all cohesively work together. And around 86% of people with dry eyes have a dysfunction of these oil glands. So that means that these glands might get clogged up stagnant, they don’t produce like they should, and we end up with the pool covering coming off.
Paul Sallaway:
Right, okay. And alright, so there are glands that produce this good oil. It’s kind of like when you’re a teenager, maybe lot us have problems with oil glands producing more oil than we needed, but in this case, actually the oil’s good. We want it, don’t we, to keep our eyes moist. Is that fair enough?
Dr Leigh Plowman:
Yeah, yeah, definitely. And there’s a lot of similarities between the oil glands in our skin that overproduction, as you say, with acne and the oil glands in our eyes, very similar structures. And we’re also learning more about how relevant the skin is to the eyes because that skin environment and around the eyelids can also affect those oil glands.
Paul Sallaway:
Well, so dry eye disease is something that I’ve been hearing more and more about in recent years, but who does it typically affect? Does it affect a particular age range more than others, a particular gender more than others, people with particular lifestyles, people with particular occupations, maybe in your own clinical experience, who tends to be overrepresented in the dry eye population?
Dr Leigh Plowman:
Dry eyes is certainly prevalent. So between 5% to 50% of the population has dry eyes depending on the population you look at. And certainly some countries tend to have an overrepresentation of dry eye disease. It tends to affect more common in age and more common in women. And that’s the traditional understanding that we’ve had for dry eyes, even up till early two thousands that we thought it was an older people, older population disease. And now we’re starting to realize that with our lifestyles, digital lifestyles of screen time, smartphones, tablets, laptops, that this change in our lifestyle pattern. Maybe we’re sitting, staring at a screen more than we would be going out and enjoying a walk outside, going for a run around the block, going for a bike ride. So we are being more sedentary in our behavior now. And certainly with the pandemic we had no option. We were forced to sit in front of a screen if we wanted to work, socialize, do most things, we’d have to sit in front of the screen. So it wasn’t pandemic, wasn’t ideal for dry eyes.
Paul Sallaway:
Yeah, that’s one of the things I was going to ask you actually. Did you see something of a spike in dry eye complaints during the pandemic
Dr Leigh Plowman:
And also the masks as well from the pandemic? The masks tended to direct airflow from the mouth,
Paul Sallaway:
Of course
Dr Leigh Plowman:
Up towards the surface of the eyes. And there was a new condition termed called mask. Mask associated dry eyes or M.A.D.E. And so
Paul Sallaway:
It’s a catchy acronym. Yeah.
Dr Leigh Plowman:
So this condition made has started to help us become even more aware of the role of masks and dry eyes.
Paul Sallaway:
So if I suspect that I have dry eyes, by the way, let’s just get a little vocabulary out of the way. So what do you tend to call it? Is it dry eye syndrome, dry eye disease, dry eye? What do the professionals tend to say when they talk about this topic?
Dr Leigh Plowman:
Yeah, I like to say dry eyes because it’s easier and people can bounce it around in their minds. One interestingly, dry eyes can also lead to watery eyes, and that’s one of the oddities about
Paul Sallaway:
That. That’s just the irony, isn’t it? So dry eyes can lead to anything but dry eyes, you can get very sort of teary reactions, can’t you?
Dr Leigh Plowman:
Yeah, that’s right. And so when we were talking about the oil and water and mucus before, if we’re missing the oil layer, the body tends to overproduce either water as a compensation or mucus and you get that stickiness. So it’s technically an ocular surface disease, what we’d use to describe it better, but for some reason we ended up choosing eyes a long time ago. And so we’ve stuck with that.
Paul Sallaway:
Sure. Okay. Well, if I think I have dry eye, eye disease, let’s call it that, what should I do? What are the steps that I should take? Should I just talk to my GP, my general practitioner about it or go down the local chemist or go see the optometrist? What do you suggest?
Dr Leigh Plowman:
Yeah, some people tend to do accommodation of those. So they might see their GP or go and visit their pharmacist, the people that they’re used to talking with and dealing with every day. And usually the doctors and pharmacists might suggest try this particular eye drop for dry eyes. And if you’ve been to a pharmacy and you’ve looked at how many different brands and types of eyedrops there are, it’s almost like cereal. There’s so many different options now, and it can be tough to decide. Some people have their go-to eye drops that they prefer. And so the doctor or pharmacist might start you off on some particular eye drops.
Sometimes they can be give you relief. And particularly if you just have dry eyes that are very infrequent, putting a lubricating drop in can be enough to get you with the relief you need. For some people though, those particular drops aren’t enough. And it’s disappointing that some people have to go through almost the whole shelves of eyedrops and they still can’t find enough relief for their eyes. And for them, I’d recommend trying to understand, stepping back and thinking what’s the real causes for my dry eyes? Sometimes that means that you have to be almost like an advocate for yourself. You have to ask more questions to the practitioners, to the gp, to the pharmacist, the optometrist or ophthalmologist. That might mean that you have to try and go into bat for yourself. That way the better that you can understand what’s causing your dry eyes, the better that you can find more tailored solutions that’ll be effective for you. And going back to that 2006, 2007, since then we’ve had, there’s been a significant increase in the diagnostics that we have now. So the ways that we can scan your eyes, we can look at the oil glands, we can see how quickly the tears are evaporating or leaving the surface of your eye.
We can look at how well you’re blinking if your eyelids do actually touch together, which is ideal, or if there is a gap that you’re unaware of. And we can also measure that saltiness of the tears, look at the oil layout, how thick it is, even press on the oil glands so that we can see this gland’s really thick and toothpaste and not working well. And this one next to it is flowing just like olive oil. So these sort of tools, the hands on, can really give us an idea of what’s working for your eyes and what we need to improve.
Paul Sallaway:
So your local eyecare professional, it sounds like they have a lot of advanced diagnostic tools that your local GP wouldn’t necessarily have and certainly your local pharmacist wouldn’t have. So if you haven’t had any luck with off the shelf eyedrops, it sounds like getting a proper assessment done would be a good course of action.
Dr Leigh Plowman:
Yes. And more and more practitioners are choosing to become specialized in certain areas like dry eyes. And these particular practitioners would tend to have more diagnostics available and they might even have a longer appointment. So that gives you more time to talk about your eyes, explain your symptoms, and to have a holistic approach to finding relief for your eyes.
Paul Sallaway:
And some of them have some very advanced treatment options as well, don’t they? And I want to get into talking about your Dry Eye Directory, but perhaps you could just talk us through what are some of the more advanced treatment therapies that they have? For example, IPL is something that seems to be coming fairly popular with practitioners who do specialize in dry eye treatment. Can you tell us a little bit about that?
Dr Leigh Plowman:
Yeah, IPL treatments, it was discovered back about 20 years ago, Dr. Rolando Toyos was treating patients for rosacea, and that’s those little spider vessels, redness, flushing, and you can get it in around different parts of the face. And he did treatments for the patient to treat their rosacea. And they actually said, you’ve treated my skin, but my eyes actually start to feel better too. And that led him to try and tailor the treatment that’s not only for rosacea, but also for meibomian gland dysfunction. And so IPL helps to work. There’s flashes directly on the skin, so there’s flashes on the top and bottom eyelids. We have a shield to protect the eyes and also flashes around the cheeks, nose, forehead, all around the face. The light travels through the skin and it enters into my glands. Inside those glands, it then goes into the energy part of the cells and it starts to switch them on.
So it’s boosting them up, making them more effective younger, their metabolism higher. So for the 86% of the population that have meibomian gland issues, intense pulse light can be a real valuable tool to be able to treat patients. And it’s also beyond that. It also works by reducing those little red spider vessels, tolan tasers in ocular rosacea. And the intense bo light helps to reduce the saltiness of the tea film. So that’s one of the ways that the tea film gets more inflamed because the moisture is evaporated and we get this salty mix, which is aggravating to the ice. So it reduces the saltiness. And the intense false light also helps to kill bacteria and demodex on the surface. I’ve seen a robot set up in a surgical room as an intense pulse light, and they put it in the center of the room and leave the room and switch on the intense pulse light and it kills all the bacteria inside the room.
Paul Sallaway:
Wow. So yeah. So it sounds like a great treatment. Sounds like there’s a lot of benefits, those little mites, what do you call them, demodex?
Dr Leigh Plowman:
Yes. Yeah, demodex.
Paul Sallaway:
Demodex, yeah. That’s quite an eyeopener once you, no pun intended, but when you realize that they’re actually microscopic organisms that are living in and around our eyelids that can in fact be contributing to the eye dry eye issues themselves. And so IPL treatment can deal with all of that apparently.
Dr Leigh Plowman:
Yes. Yeah, it’s very helpful for killing those demodex that are having some is quite normal, but having an overpopulation, that’s when they can contribute to problems.
Paul Sallaway:
So it sounds like that if I want to get serious treatment done, I should look for a dry eye practitioner who is a specialist or who specializes in dry eye treatment. And that’s probably a good segue for us to talk about the Dry Eye Directory, which is your project. So can you tell us in your own words how the Dry Eye Directory website can help somebody like me who’s looking for answers and treatments and recommended products for dry eye syndrome?
Dr Leigh Plowman:
Yeah, a lot of people try those initial drops from the pharmacist and they might struggle to find relief, and then they might maybe turn to a friend or they’ll hop onto Google and type in dry eye treatment into Google, and that’s when they can find the Dry Eye Directory. So the goal of the Dry Eye Directory is to be able to educate people about dry eyes, about the causes for dry eyes and about treatments. So the more that people understand dry eyes and their dry eyes, the more that they can find treatments that work. So the websites set up to be able to educate people about their condition and help them to connect with a specialist near them. There’s a search function on the website that helps them to find the specialist near them. And these are people that have invested in these advanced treatments such as IPO, LIF Flow and other treatments. So these are people that they’ve definitely got an interest in helping you to find relief your eyes?
Paul Sallaway:
Yeah, so there are a lot of, I think last time I checked, there’s a 170 or so practitioners that are listed on your directory. The majority of them are in Australia, New Zealand, North America. But I think that’s probably going to grow over time. So that is a good way for people to find the nearest specialist who offers some of these advanced diagnostics and advanced treatments. But there are other things on your website as well. You you’ve got an online shop where you actually promote some of the products that you’ve tried yourself. So do you have any favorites, any favorite home treatment that I could buy online today and start trying out? I think I do have some issues with, because I spend probably too much time in front of a computer, my eyes feel a bit sort of scratchy. I’ve got something stuck in them at the end of the day. So what do you recommend for somebody like me?
Dr Leigh Plowman:
Yeah, definitely. It’s good to have something that’s very accessible and easy to do. One of my favorite treatments is a hypochlorous spray. What we often don’t realize that just like you can get plaque on your teeth, you can also get plaque on your eyelids. And so you get normal bacteria that like to overgrow and they produce a lot of protein to try and protect themselves on the surface of the skin. So that’s called a biofilm. And the biofilm then starts to invade and gradually migrate from the lashes onto the edge of the eyelids, into the surface of the eye and also into the oil glands. So if we can try and reduce this migration of the bacteria by using a simple spray for your eyes, and it’s similar to the dental analogy of brushing your teeth. So if we use it morning and night and spray it onto closed eyelids, it feels refreshing to use. You’re not adding drugs or other prescription products into your eyes. And it’s a great way to give your eyes a break and feel refreshed after using the spray. And by keeping it up, just brushing your teeth every day, you’re going to get your eyelids in better shape and help reduce the impact of the bacteria in causing dry eyes.
Paul Sallaway:
So it comes in a spray bottle dispenser, does it? Or how big are the actual bottles that I would get?
Dr Leigh Plowman:
Yeah, the spray comes in around about a 40 ml to 60 ml bottle and it fits in your hand easily. It’s a similar size to a glasses spray bottle. You use the nozzle and then hold it up and close your eye and spray it on the outside.
Paul Sallaway:
And how many days would I get out of one of those one bottle? How many days treatment?
Dr Leigh Plowman:
With the spray? Most people get around at least six weeks from one bottle. So you don’t have to use a lot of it, but it’s enough that it does give that refreshing relief.
Paul Sallaway:
Okay. I’m sorry, what’s it called again?
Dr Leigh Plowman:
So it’s hypochlorous acid and some of the most popular products are Avenova, Hyclear and HypoChlor, some of the most common ones on the market today.
Paul Sallaway:
And so we can pick that up through your website, online store. Is that right?
Dr Leigh Plowman:
Yes, that’s right.
Paul Sallaway:
Okay, good. Alright, sounds interesting. I’m going to check it out, but we can get some other things, some more information. I think from your Dry Eye Directory as well, you have a quiz I believe. Can you tell us a little more about the quiz?
Dr Leigh Plowman:
Yeah, a lot of people search for dry eye symptoms. So because there’s so many different symptoms, it could be blurred vision, red eyes, itchy eyes, there’s a good dozen or more different symptoms that can actually be the result of dry eyes. And this quiz is one of the ways to be able to see is my dry eyes, do I have dry eyes? And so it’s a simple five questionnaire, five question questionnaire, and it takes about 30 seconds to do. And at the end of the questionnaire you’ll get a result, you get an instant score. So you can see if you have minimal to no dry eyes, all the up to mild, moderate, or severe dry eyes.
Paul Sallaway:
So you can get some kind of objective yardstick of how severe your situation is. And from there, the side on the severity of it and what action you should take from there. Yes,
Dr Leigh Plowman:
And it also questionnaires like this, especially when we do them in an these sort of questionnaires, help us to gauge the success of the treatment. So we know if your score was high initially and then it’s dropped down, we know that the actions we’re taking are helping your eyes.
Paul Sallaway:
So these are similar to the types of questions that a dry eye practitioner would actually ask you in your initial consultation. Is that it?
Dr Leigh Plowman:
Yes, they’d have a thorough consultation including a questionnaire.
Paul Sallaway:
Alright, well that sounds good. And also I think you’ve got an ebook or an e booklet that people can get through your website as well, which includes some basic tips on managing dry eye as well. So I might just mentioning again, it’s DryEyeDirectory.com and you’ll see that ebook on Leigh’s homepage. So I highly recommend that for free. Just have to put in your email address in and it’ll get delivered to your inbox. Alright. Well Leigh, I don’t know, is there anything else that you wanted to mention? If people want to get in contact with you to talk about your work with dry eyes or if they want to learn more about the topic, what’s the best way for them to do that?
Dr Leigh Plowman:
Yes, and we also run a group on Facebook called Dry Eye Care and Support. And one of the problems with dry eyes is that it can be hard for other people to relate to your condition. It can almost be like a mental health concern. Mental health is so invisible, you could walk past 10 people and not realize that any of them had a mental health condition. And that’s why it’s helpful to be able to connect with other people with dry eyes. So to be able to bounce questions, does anyone else feel the same as this or has anyone tried this treatment? Or help me find a good specialist that you’ve seen near you so people can connect Hopland Facebook to Dryer Care and Support and join the group. And so that would be one way to connect and they can also reach out to me through email Leigh at dryer directory com and happy to have a chat and answer questions over email.
Paul Sallaway:
Alright. Okay. Well thanks Leigh. Well, on that note, we might wrap up for this week. So I hope people who listen to this get some value from our discussion. I’m to get helpful insights into managing dry eyes from other professionals. Likely if you are a dry eye professional yourself and you’d like to take part in this podcast project, then feel free to reach out to me directly at the moment. You can do that through my LinkedIn profile or check the podcast show notes because there will be some additional contact information that will be there. But I think that should do us for this week. So yep. So stay well everyone take care of those eyes. So that’s all for now from the Dry Eye Treatment Podcast. Catch you all again soon. Bye for now. Bye Leigh.