Read an Excerpt
What’s the Big Deal About Dry Eyes?
An estimated 30 percent of adult Americans are afflicted with dry eye, a disorder that adversely affects the tear film, which is the essential coating that protects the surface of the eye,washes away debris and irritants, and creates a crystal-clear window through which we see.
Those tens of millions of dry eye sufferers are the tip of the iceberg. For it is considered likely if not inevitable that everyone will experience the discomfort, irritation, displeasing appearance, and potential visual blurring of dry eye disorder at some point in their lives–if they haven’t already.
In other words, we’re all susceptible, and the categories of people deemed particularly susceptible are as wide-ranging as the population. Contact lens wearers, people with allergies, peri-menopausal women, people who have undergone laser eye surgery or cosmetic eye surgery: all of these–and others–may be said to be especially prone to dry eye disorder.
Do you work in front of a computer all day? Spend your evenings glued to the television set? Have difficulty reading even a page-turner of a novel or your local newspaper? Find that you need a new prescription for your eyeglasses every two years? Notice that the whites of your eyes are kind of red?
Chances are good you have or will develop dry eye.
Do your eyes sometimes feel “gritty”? Are they crusty in the morning till you have your shower? Are there bags under your eyes that make you look a lot older than you are?
These, too, are symptoms of dry eye.
There’s one certainty about these symptoms: untreated, they will only get worse. For dry eye is a progressive disorder. In fact, one reason we are hearing so much more about it today is that the first wave of Baby Boomers is just now coming into its 60s and just now beginning to feel the effects of dry eye, and the legendary refusal of the Boomer generation to accept the effects of growing older is often expressed vocally and loudly. Since the elderly are the fastest-growing population sector in the country, that decibel level is unlikely to go down any time soon.
The lesson, however, is clear: Don’t wait. Don’t put off treatment of dry eye till you’re ready to scream along with the Baby Boomers.Whatever your age, you would be wise to start now to deal with the symptoms of dry eye. Begin today to do the things that can make you feel and look better so you break the back of this disorder before it robs you of vision or ages the appearance of your eyes well before time–and while it’s still relatively easy for treatment to make a difference.
For while there is as yet no cure for dry eye, there are many, many options for dealing with the disorder so as to keep the eyes as healthy and youthful–looking as possible.
That’s what this book is about.
Symptoms and Effects
Dry eye is almost a stealth disorder.Your eyes are tired, or they feel irritated, or they’re looking red-and you tend not to give it a second thought.You suppose it’s normal, and you get yourself some drops from the drugstore and forget all about it.
You shouldn’t. Eye discomfort is not normal, and what you assess as minor irritation could be a signal of a deeper disorder or could grow into a major problem. Sensations of stinging, burning, grittiness, and itching in the eyes; sensitivity to light; the feeling that there is something in the eye; soreness, redness, the inability to wear contact lenses for very long; an aged and wrinkled appearance and the area around the eyes: these may all be symptoms of dry eye disorder.All should be reported to your doctor. All should be dealt with medically–and all are most certainly covered by health insurance plans.
But dry eye is more than discomfort. The clinical term for what these symptoms represent is “thief of sight,” as the instability the disorder causes to the eye’s tear film impairs quality of vision bit by bit. At the same time, the disorder’s intermittent but chronic irritation saps the person’s energy and robs the body of its natural vigor. All of this can erode the individual’s ability to read, drive at night, or even use the phone or an ATM machine.
It can also affect more than your eyes. One patient of mine, a high-level corporate executive I’ll call Philip, told me his dry eye was such a persistent annoyance–so utterly preoccupying when he was trying to work–that he actually forgot the names of co-workers. Pain in the eye, after all, is pain you cannot get away from; it can be distracting, and it can affect your state of mind, your mood, and your productivity, as Philip’s case makes clear.
Think about people who work all day in front of a computer screen–and there are more and more such people with every passing year.They’re concentrating hard, focusing on the screen. And although the work may not be particularly stressful, by 3:00 in the afternoon, they feel exhausted, and the pace of their work ebbs, slows, then crashes to a halt. The problem? We tend to blink less when we concentrate. Less blinking means the tear film isn’t coating and protecting the eye. Result: you feel tired, you soon can’t concentrate, you lose focus–your productivity takes a nosedive. Can dry eye be blamed for lowered productivity in today’s offices? For some of it, certainly.
Dry eye can also affect the way you look.You tend to rub your tired or irritated eyes.The rubbing exacerbates the irritation. You squint to get rid of the irritation.You look at yourself in the mirror and see lines, wrinkles, bags, redness that were never there before.
Or maybe you’re an allergy sufferer–and the number of allergy sufferers, so great as to be impossible to estimate, continues to increase. Allergies tend to locate in the eyes, where they cause inflammation. Unhappily, most anti-allergy medicines only worsen the dry eye dysfunction. Result? Allergy sufferers rub their eyes almost automatically; over the long term, this stretches and wrinkles the skin, causing a telltale old-eyes look.
No one wants to look that way. No one wants to feel the tiredness, irritation, and discomfort that dry eye produces. And certainly no one wants to neglect the health of their eyes such that they may damage their appearance, feel chronic discomfort, or imperil their vision.
You don’t have to.
Dry Eye and Me
My experience with dry eye is both personal and professional. I was diagnosed with the disorder when I was in my early 20s, so I can empathize, virtually symptom for symptom, with other dry eye sufferers. But it’s what I’ve seen as a practicing ophthalmologist that has prompted me to specialize exclusively in dry eye–and to write this book.
I’ve seen this pervasive disorder affect people’s lives in profound ways, and I’ve seen it all too often go unnoticed, undiagnosed or under-diagnosed, unmanaged and under-treated. A patient I’ll call Bill came to my office after getting his sixth new eyeglass prescription in seven years. After spending $500 per new pair of glasses, Bill’s wallet was feeling as deprived as Bill was feeling befuddled. Bill told me that his vision sometimes turned blurry–”I can be reading the paper, and suddenly it’ll go all blurry on me,” he said, but it would then just as suddenly return to “normal.”
Bill assumed that his fluctuating vision was a matter of visual acuity; in fact, it sounded to me like a typical symptom of dry eye. It wasn’t an imperfect prescription that was blurring his vision; it was something altering the state of the tear film that coats the surface of the eye. I performed my proprietary diagnostic test and found that to be the case. Bill’s blurry vision was due to just such a dysfunction on the surface of his eye, not to the state of his eyesight.At least five of his new eyeglasses had probably been unnecessary; as long as his dry eye went untreated, his vision would never be truly “corrected.” But a simple course of treatments, such as you’ll read in the pages that follow, solved Bill’s vision problem and potentially stalled the decline in the health of his eyes.
Emily had undergone LASIK surgery five years ago, but now the sharpness of her vision was starting to slip just a bit, and she was contemplating “touch-up” surgery. Still, Emily knew that any kind of surgical procedure presented the possibility of side effects, so she asked for a second opinion and was referred to my office.
This was a sensible move on Emily’s part–and to some extent, a surprising one; so many patients who have undergone the expense and trouble of surgery simply want their surgeons to “fix it.”This is perhaps a natural reaction: patients who choose LASIK often think they are buying perfection, although perfection is rarely possible. Emily’s willingness to consider alternative approaches was both refreshing and smart.Together,we decided to try an alternative course of treatment first, and I designed a series of simple therapies to improve Emily’s vision by improving her ocular surface.The safer alternatives worked, and Emily saved herself both the expense and the potential risks of further surgery.
Dan told me his boss had ordered him to “see an eye doctor.” Dan’s eyes were intermittently bloodshot; the boss’s view was that Dan was “out partying too much” and would soon be unable to work productively. For the wrong reason, the boss was right: Dan’s eyes were angry-looking and red, not from late nights on the town, but from the chronic irritation dry eye can produce. Untreated, Dan’s eye condition would indeed soon lower his productivity as his feelings of fatigue and discomfort increased. But with simple treatment, we were able to decrease the irritation in Dan’s eyes, which in turn cleared up the redness, which made Dan feel invigorated and enabled him to work in a highly productive manner. It also convinced his boss that he was a sober and serious young man and a conscientious employee.
Bill, Emily, and Dan are just some of the reasons why I now see only patients with symptoms related to dry eye–because I can make a difference in the way they feel and look and in the long-term health of their eyes. In fact, although I have performed perhaps a thousand laser eye and cataract surgeries, I no longer do so; I treat dry eye exclusively.
I also lecture on the subject, publish frequently, present findings on dry eye both nationally and internationally, serve on panels on the subject at medical conferences, and sit on advisory committees for related conditions.
Over the years, I have treated dry eye disorders of varying intensity and deriving from varied first causes. I have devised my own classifications for the many, varied effects of dry eye, have created my own diagnostic test for the disorder–which is gaining ground as a possible standard for ophthalmologists around the country–and have even designed a set of eye care products specifically for dry eye sufferers.
I’ve used traditional treatments and pioneered new ones to alleviate the discomfort, manage the disease, and treat the disorder. I know how to help patients deal with dry eye so that they feel and look better–and so that they improve the health of their eyes.
That’s my message, and now I want to bring it to a wider audience. Hence this book.
The Goal:Not a Dry Eye in the House
My aim has been to offer a complete handbook to the disorders of the eye surface and how to deal with them. The book is aimed not just at those who know they are afflicted with dry eye but also at those who are concerned about the health of their eyes and want to know what they can do to improve it. For the health of your eyes is the real issue.
That’s why Part One begins with a discussion of healthy eyes and how they work, so that when you then learn what can go wrong, you will understand how dry eye affects the health of your eyes and what it may mean for your overall health.
You’ll also learn here how you can work with your doctor to find the precise origin of your dry eye disorder and to come up with the best course of action for treating your symptoms. So many other factors affect your eyes–allergies, contact lenses, the medicines you may be taking for another health condition, to name just a few–that it is essential to draw a complete picture of your eye health before you proceed to treatment. Part One of the book ends with a discussion of how dry eye has traditionally been treated–and the limits of those traditional treatments.
Part Two presents my own program for restoring the health of your dry eyes. Here you’ll find adjustments you can make in your environment–home, workplace, even in your car–and tips for nutrition and lifestyle that can bring substantial relief from the discomforts of dry eye while helping to keep your eyes as healthy as possible. In addition, you’ll learn here my Home Eye Spa procedure–a simple but highly effective cleansing and soothing procedure you can do at home. It’s a way of both gaining immediate relief and taking direct responsibility for the long-term health of your eyes.
In Part Three, you’ll learn about the growing list of medicines for dry eye–those that can help and those that might harm–and about other kinds of interventions to treat the disorder, including the potential for hormone therapy, punctal plugs, and surgery.
Finally, I’ll put it all together for you in Part Four by profiling some typical courses of therapy that encompass the state of the art for treating dry eye disorders today.These are programs that have worked well for my patients and that, in one form or another,may work well for you.
At the back of the book, you’ll also find a list of resources you can turn to for more information or for direct help with your dry eye disorder or related conditions.
Some of you may find that there is too much detail in the early chapters that explain the workings of the healthy eye and the origins of dry eye disorder, or that the discussion is too technical. Others, of course, will assess the book as not technical or detailed enough.There are tens of millions of dry eye sufferers out there, and I have tried to strike a middle path to reach as many of you as possible. Certainly, whatever your tolerance for technical detail, you all want the same thing: a better way to relieve your dry eye discomfort and improve the health of your eyes.
But there is yet another reason for this book. Incurable, progressive, potentially damaging to vision, uncomfortable, disfiguring, and psychologically distressing for its impact on the individual’s abilities and appearance, dry eye constitutes a debilitating and harmful condition, and when 30 percent of the adult population suffers a debilitating and harmful condition, in my view, that is nothing short of a public health problem.
I hope this book will raise awareness of the problem among patients, doctors, and the general population, which, as the number of elderly grows, will increasingly be at risk for dry eye. Remember: the one thing we know for sure about this disorder is that if you do nothing, it will get worse. Even if you are in your twenties or thirties with mild symptoms, it is easier and certainly more effective to establish a treatment therapy or maintenance regime now than twenty years from now, when the condition may be far more severe. So now is the time to act, and in the pages that follow, I hope you will find the understanding and information you need to create an action plan that is right for you.
Robert Latkany, M.D.
New York 2006