to-the-point
To The Point
Episode 11

Don't Forget About At-Home Dry Eye Care

No matter how hard you may try to rehabilitate the ocular surface of your dry eye patients, if you don't get good at-home regimens in place, they may fail treatment. In this episode of To the Point, Leslie and Jackie review the three categories of at-home care products available for chronic dry eye: cleansers, heat products, and nutraceuticals. They discuss different examples from each category and offer advice on how to ensure your patients follow their treatment plan.

Leslie O'Dell (00:06):

Ocular surface disease. It's complex, chronic, and progressive but rife with opportunity for the enterprising optometrist.

Jackie Garlich (00:14):

The mission of this podcast is to make this condition more understandable and accessible to those interested in specializing in it. So let's get to the point.

Jackie Garlich (00:25):

Welcome to another episode of the To the Point Podcast. Today we are going to be talking about the various at-home treatment options for your patients with dry eye. We are going to be covering mostly three main buckets of at-home treatment options. 1. cleansing, 2. heating, and 3. nutraceuticals. My name is Jackie Garlich, and I'm joined by my co-host Leslie O'Dell. Hi, Leslie.

Leslie O'Dell (00:51):

Hey, Jackie. This is gonna be an interesting topic, because no matter how hard we try to rehab the ocular surface, if we don't get good at-home regimens in... um, in place for our patients, they often can fail our treatments, so the at-home care for chronic dry eye patient is something that's really important to their overall success.

Jackie Garlich (01:12):

Yep. Agreed. Let's start by talking about the, um, cleansers that are out there. I mean, we're, we're gonna be talking about... And there's a lot of different cleansers, honestly, out there, and this is... Anything we mention here is certainly not an exhaustive list. They're changing all the time. But certainly cleaning those lids in c-... in some cases, will you need tea tree oil? Other times you don't. Let's kind of t- start talking about the various ways that... the various over-the-counter options for cleansers.

Leslie O'Dell (01:38):

Well, like you said, that list is continuing to grow. We see a lot of companies coming into this space, because much like, um, at-home care of your teeth and needing to brush your teeth daily to keep them healthy in between your dental checkups, we know that if we can reduce bacteria overgrowth of the lid margin that we are going to be protecting the ocular surface and the meibomian gland health in general. And that's why we've seen this list grow and grow over the past, you know, 10 years, really. Um, when I look at cleansers, I think about them almost as specific as I think about the tears I'm gonna choose when I'm supplementing tears for a patient who has dry eye.

Leslie O'Dell (02:17):

So I kind of group them, like you were saying, into these different buckets of tea tree oil cleansers, um, when I know I have a Demodex patient and I need that tea tree oil to help reduce the Demodex infestation. Um, I need sometimes just a daily cleanser, um, much like you are brushing your teeth every day, and that's really where I put all of the hypochlorous acid products that we have available to us right now. And then sometimes you do need a detergent-based cleanser, you know, with something that's gonna foam and suds up on the lid just to give you a little bit more, uh, of the ability to remove maybe sometimes like a seborrheic-type blepharitis.

Jackie Garlich (02:54):

Yeah, absolutely.

Leslie O'Dell (02:55):

But there's a lot to choose from. And, you know, in my mind, and I'd love to hear what you say, you know, in my mind, bringing these into the practice, I usually have quite a variety of products. Um, I like to try everything that is new. I like my patients to try things that are new. And then that kinda helps me fall into the pattern of, you know, what I am moving out of the office more, you know, one product over the other.

Jackie Garlich (03:19):

Yeah, I like to carry... Um, I carry a foaming cleanser, and I also carry hypochlorous spray in the office, too. And I mostly do that, um, for convenience. And sometimes I'm recommending something different to the patient, but, for me... and it's... I c-... I don't want to, like, house all of these products in my office, so I usually just carry one that I feel, like, works in most circumstances, and then, um, you know, just send out for the others or tell them where to get them over the counter. But, but I, um, I am a big fan of the daily hypochlorous spray, certainly for... to, to maintain, um, good lid hygiene. That's definitely one of my go-tos.

Leslie O'Dell (03:56):

Yeah, and we've seen that kind of evolve over... You know, we had just one product when we started, um, at least the way that I remember (laughs). It was Avenova. You know, and that had an-

Jackie Garlich (04:06):

(laughs)

Leslie O'Dell (04:06):

... an interesting model where it first was in the doctor's office, then was kind of prescription-

Jackie Garlich (04:10):

Right.

Leslie O'Dell (04:10):

... and now is back in our hands. Um, a great product.

Jackie Garlich (04:13):

Yes. Oh, I gotta tell you this. I, um... This is a side note. I was on... I went on Avenova's website. I don't know if you've seen them recently. I remember when they came out, and the bottle was very-

Leslie O'Dell (04:24):

Opaque. Mm-hmm (affirmative). Yeah.

Jackie Garlich (04:25):

... medicationy-

Leslie O'Dell (04:26):

Yeah.

Jackie Garlich (04:27):

... looking, and then n-... You gotta Google it. Now it looks, like, beautiful. It looks very, like, all natural. They have this website where it looks to co-... You gotta look it up.

Leslie O'Dell (04:37):

Yeah.

Jackie Garlich (04:38):

I- it's like av-... It's avenova.com. I, I just was on there earlier when we were talking about this, and I was like, "Oh my God. This is, like, such a different feel." They've certainly taken the more all natural looking approach. They rebranded. They, you know, compare theirs to other, you know, various hypochlor sprays on the market, but they blur the picture so that you can actually still kinda still tell what it is.

Leslie O'Dell (04:59):

(laughs)

Jackie Garlich (04:59):

(laughs) It's, it's kind of interesting. But, yeah, they, they, um... I s-... I do love that product. I- it's, it's easy to get for patients. I mean, they sell that on Amazon. Um, I don't know if they sell that in a CVS or not but-

Leslie O'Dell (05:11):

I haven't seen it there.

Jackie Garlich (05:12):

...you know.

Leslie O'Dell (05:13):

Um, but speaking of CVS, you know, our fellow, um, optometrist Tanya Gill in her line We Love Eyes, I didn't realize also had a-

Jackie Garlich (05:20):

Yeah.

Leslie O'Dell (05:20):

... hypochlorous acid, you just said. Is that-

Jackie Garlich (05:23):

Yeah.

Leslie O'Dell (05:23):

... available-

Jackie Garlich (05:24):

Yeah.

Leslie O'Dell (05:24):

... at the CVS where, you know, or do you know if that's just available to the doctors, or how's that working?

Jackie Garlich (05:29):

No, I know that she did... she was able... I think CVS has her products now. Um, I... I'm not sure if the hypochlorous spray is in there or not. I mean, that's the line that I carry in my office, but I know that you can get some. I feel like maybe, maybe it's just the foaming cleanser right now. I'm not... I'm not 100% on that, but...

Leslie O'Dell (05:46):

Another great, um-

Jackie Garlich (05:47):

Yeah, that... there is availability there.

Leslie O'Dell (05:48):

You know, for a couple of reasons, it's always nice to support someone within our own industry who's, you know, taken the leap of faith to start a company like, like Tanya Gill has. Um, but also packaging. Uh, you know, I've been super impressed with everything she's done. Attention to detail with her, her line of-

Jackie Garlich (06:05):

Mm-hmm (affirmative).

Leslie O'Dell (06:05):

... We Love Eyes. Um, keeping on the topic of hypochlor, another one that I do like, um, when I'm looking at... And, and I actually kinda got to this one because of some of the early frustration with Avenova and the prescription versus selling in my office.

Jackie Garlich (06:19):

Mm-hmm (affirmative).

Leslie O'Dell (06:19):

And it sounds like-

Jackie Garlich (06:20):

Yeah.

Leslie O'Dell (06:20):

... that is all, you know, changing, an- and it even sounds like the packaging I... is, you know, changing as a result of that, but the um, OCuSOFT line has kind of just a hypochlorous acid, and then they also have this hypochlorous acid gel, um, which I really like. Uh, when it sprays onto a cotton round, it's a little bit thicker, and so it doesn't, like, kind of just get lost into the cotton round if I'm using it that way. It... You, you actually can kind of see it sitting up, because it is a gel base, and I like that a lot, um, as well for my patients with the need for hypochlorous acid.

Jackie Garlich (06:57):

I haven't seen those. I, I knew they had a hypochlorous spray. I didn't realize they had a gel.

Leslie O'Dell (07:00):

Yeah.

Jackie Garlich (07:00):

That's interesting.

Leslie O'Dell (07:01):

See? We learn so much from each other, 'cause that's-

Jackie Garlich (07:02):

(laughs)

Leslie O'Dell (07:03):

... that's one of my favorites. Um, you know, and another one, and I don't know... and actually if it's... I, I actually don't think that their product's gonna come into the States, but Scope is working on a hypochlorous acid because one of the things you don't realize is that, you know, just being sometimes in our country here in the US that we're, we're fortunate enough to have hypochlor. Scope has other products in the US, um, but they are launching hypochlorous acid in their, um, I think England for the first time, so those doctors are just gonna be having-

Jackie Garlich (07:31):

Oh wow.

Leslie O'Dell (07:31):

... exposure to that, you know, for the first time now, which seems crazy.

Jackie Garlich (07:35):

Oh.

Leslie O'Dell (07:35):

Yeah.

Jackie Garlich (07:35):

That does seem crazy, yeah.

Leslie O'Dell (07:36):

You know, another totally different kind of line of cleansers that goes into, um, you know, maybe... before we get to maybe a foam or even a little bit more of a harsher chemical with the tea tree oil, would be the Zocular line. So, Zocular is developed by an ophthalmologist, Peter Pham, and that is an okra-based line of cleansers. Um, and I find that that is very tolerable to patients. It feels good on their skin. They've also gone from wipes to foams to almost like a gel-based cleanser. Um, and I've seen that getting paired with some of the other treatments we'll talk about in a minute, which is the NuLids. But we'll get to that soon.

Jackie Garlich (08:17):

Yeah. I- I've never used any of the products in the Zocular line, but, um... Do they have a... like a tea tree oil pad within that line?

Leslie O'Dell (08:25):

No, so Zocular is tea tree oil free. It's, um, all okra based. So okra, you know-

Jackie Garlich (08:30):

Oh, okra based. Sorry.

Leslie O'Dell (08:30):

... that funny little green vegetable that was-

Jackie Garlich (08:32):

Yep.

Leslie O'Dell (08:32):

... in your vegetable soup growing up?

Jackie Garlich (08:33):

Mm-hmm (affirmative). (laughs)

Leslie O'Dell (08:34):

(laughs) I've never... Maybe you've cooked okra other ways, but I just remember like, "Oh, that was in that vegetable soup my mom made."

Jackie Garlich (08:41):

(laughs)

Leslie O'Dell (08:41):

Who knew it was gonna be good for our eyes? (laughs) Who knew?

Jackie Garlich (08:46):

I... For some reason, I was associating... I, I knew they had that, but I also thought they had some sort of tea tree something, but I'm confusing... There's so many tea tree options out there.

Leslie O'Dell (08:53):

Right, and, I mean, that is. So, with tea tree, we know that, um, if you do ha-... Wi-... So, first of all, tea tree oil is appealing to all of the companies because it's not only anti-Demodex, it's anti-bacteria, it's anti-fungal. So it has a lot of great medicinal properties, and it's all natural as well, which is a big selling point to patients and, um, you know, doctors, too. We want to be giving patients things that are not going to be harming.

Jackie Garlich (09:20):

More chemicals.

Leslie O'Dell (09:21):

Right. More chemicals. So I think that that was the appeal, so you'll see that in different percentages in foam-based cleansers, in pads. Um, but it sometimes, you know, can be a little bit irritating to the eye. You know, depends on...

Jackie Garlich (09:36):

Mm-hmm (affirmative).

Leslie O'Dell (09:37):

A- and that sometimes is like... I feel like patient dependent. Um, and this is where I tend to have a few different options for patients, um, and that's just because if I'm treating Demodex and I need them on a daily lid cleanser, for some patients, Cliradex, you know, by Bio-Tissue, is too harsh. Um, they now have-

Jackie Garlich (09:57):

Yeah.

Leslie O'Dell (09:57):

... Cliradex Light, but at the beginning of my treatment with Demodex, I do want more of a full-strength type of treatment, so, you know, I've, I've used other products like the Blephadex line, the OCuSOFT Oust. Um, and I really find that sometimes it's just nice to be able to, you know, kind of just get your hand on a few of them. And, you know, one way to, to see is if the company has any samples that you can have in your office to kinda try it out that way. Um, an- and then I know that sometimes we're using the tea tree oil just as, like our makeup-wearing patients that are using, you know, their makeup every day, and we want to make sure they have a clean face to go to bed.

Jackie Garlich (10:36):

Yep. Absolutely. Um, should we talk about... We... Well, you mentioned this briefly a little bit earlier, but NuLids. That's relatively newer.

Leslie O'Dell (10:45):

Yeah, so NuLids, I think, maybe is out for, like, the past three years. Um...

Jackie Garlich (10:48):

Mm-hmm (affirmative).

Leslie O'Dell (10:49):

But it really has become a lot more appealing to me in the past eight months, you know, with... I'm thinking outside the box as much as I can an- and thinking, like, what can I do at home in all realms of eye care? You know, because of things like we, you know, the shutdown with the pandemic, it really makes you think about how can you continue the care if you aren't visibly there for the patient? Um, and so NuLids, for me, actually, um, I think is gonna be, you know, something I hope my patients really do embrace. So this is not like our micro-exfoliation tools that we have in the office, you know, a spinning brush. Um, that was one of my first concerns, is am I gonna, you know, sell this to a patient, and they're gonna give themselves a corneal abrasion, and now-

Jackie Garlich (11:34):

(laughs)

Leslie O'Dell (11:34):

... they think now I'm to blame? Um, but it's more... Like, the eye is shut, and it's an oscillating, so it's kind of a back-and-forth motion over the eyelid when the eyelid is closed. Um, and, and it's a disposable tip, so each day the patient is using a new tip. Really, I, I think that how I would... how I'm going to talk to patients about it is the electric toothbrush versus the traditional toothbrush and, you know, just the evolution of how much cleaner your teeth are gonna get with an electric toothbrush. So if we're smearing all the cleansers over the eyes alone, you know, it might be good to pair it with something like NuLids that's really helping to, you know, get rid of some of that debris.

Jackie Garlich (12:17):

So NuLids has this, um, statement that says, like, "The tip works by gently stimulating and rejuvenating the patient's meibomian glands." But I sort of picture NuLids as more of, like, removing all of that debris. I guess is that another way to say that that's maybe more understandable to a patient?

Leslie O'Dell (12:36):

Y- yeah, I think so. I... And maybe they st-

Jackie Garlich (12:38):

Stimulating?

Leslie O'Dell (12:39):

I think maybe they say that because it's this oscillation. You know, there's some new research that's kind of showing vibration near the meibomian glands can be good for stimulating secretion. Um, so it could be a... Maybe that's how they got to that wording, you know, but it, it is more of this oscillation, um, of the tip.

Jackie Garlich (12:59):

I think of it as like an electric toothbrush-

Leslie O'Dell (13:01):

Yeah, exactly.

Jackie Garlich (13:01):

... for your lids. (laughs)

Leslie O'Dell (13:02):

Yeah. And that's really what we have to do. I mean, all of these lectures, I've got... You know, what an, uh, amazing time to b-... to be able to learn, so I've been able to listen to a lot of Korb's, um, lectures through Academy and also, um, Amy Nau. Dr. Amy Nau. Um, and, you know, the eyelids, uh... Really what they're saying is the new paradigm of dry eye is how are the lids performing? And if you're jumping right to the cornea and the conjunctiva and you're not paying attention to the lids, you're really missing most of what's contributing to the under-performance of how the tears are distributing, where that bacteria is, the meibomian gland stasis, and, you know, all of that. So, um, I do think that embracing any at-home care as it pertains to lid cleansing is going to set you leaps and bounds ahead of, you know, the guy next door.

Jackie Garlich (13:54):

Can you speak on, like, what the cost of this is to the patient? Do you know any of this information? And, like, the patient gets it from you?

Leslie O'Dell (14:00):

Y-

Jackie Garlich (14:00):

NuLids?

Leslie O'Dell (14:01):

So, actually-

Jackie Garlich (14:01):

They get it from you?

Leslie O'Dell (14:02):

And, like, most of the companies, I think they've all sort of, um, really changed their model. You know, a lot of times, we were housing most things in the office. That was expense to us, right? We have to put our money out until we sold things to make our money back. Um, but that's changing. A lot of these companies, um, even the cleansers that we were speaking to earlier, have a drop ship, so instead of maybe sending them to y- to their website, you, you almost, like, email the patient a link after you see them, and they get it directly from, you know, the, the company. Um, but then there's money back to the doctor, um, for that sale.

Leslie O'Dell (14:38):

So with NuLids, you have both options. You could stock it if you feel like, you know, you know, that impulse buy is gonna be what your patient needs and they're... you're gonna sell it more that way, or they do a drop ship where the patient gets it in a few days. Um, and I think it's roughly around, and don't quote me on this, but I think it's around $300. And that is the unit and maybe 90 days of tips. And then they do have to subscribe to re-... you know, renewing the tip that is, um, disposed of. So...

Jackie Garlich (15:11):

Okay.

Leslie O'Dell (15:12):

Um, you know, because of that, sometimes I guess you could share it with... Not like your electric toothbrush. You're never gonna share that thing.

Jackie Garlich (15:19):

(laughs)

Leslie O'Dell (15:20):

But this is a little different because the tip is unique. Um, so I don't know if maybe two people in the same household could share?

Jackie Garlich (15:25):

(laughs)

Leslie O'Dell (15:26):

That's something... (laughs) That's something to think about.

Jackie Garlich (15:28):

(laughs) Something to think about.

Leslie O'Dell (15:30):

Yeah.

Jackie Garlich (15:31):

You're gonna get an email from NuLids right after this airs.

Leslie O'Dell (15:34):

Yeah. (laughs)

Jackie Garlich (15:34):

That's like-

Leslie O'Dell (15:34):

Do not...

Jackie Garlich (15:34):

... a horrible idea.

Leslie O'Dell (15:35):

Bad idea.

Jackie Garlich (15:36):

(laughs)

Leslie O'Dell (15:36):

Thanks for talking about us, but don't.

Jackie Garlich (15:38):

(laughs)

Leslie O'Dell (15:40):

Um, you know, another quick thing I will say, too, because you... You know, thinking along the lines of the more things that you can get in the hands of your patient, the better the, you know, the control you have over all these little things that maybe would, um, set them back. Like, so, for example, you tell the patient you want them to use a certain tear. They go to the pharmacy, and now they buy the generic, right? Or now they buy a completely different one because on the shelf, it looks like it's comparable. Um, or the pharmacist sometimes tells them, you know, that the store brand is okay. So really embracing all of the companies that allow for in-office sales. Um, and, again, like, the drop ship, I think, is another great option, um, for us. You know, it really helps. If you have a website that you can really build out and, you know, the patients just kind of shop from you, that's good. The... Um, Allergan's working really hard to get all of their Refresh products in our hands. They just launched-

Jackie Garlich (16:36):

I saw that.

Leslie O'Dell (16:36):

Yeah.

Jackie Garlich (16:36):

Yeah.

Leslie O'Dell (16:37):

They just launched Refresh Digital, so if it wasn't already gonna be knocking on our doors... (laughs) I feel like that marketing was, like, brilliant, right?

Jackie Garlich (16:45):

Per... I know. I said the same thing. (laughs)

Leslie O'Dell (16:47):

Yeah. Um, and then we talked about Freshkote before and how that's a unique tear. You can't actually find that at a store, um, and it's hard to buy online, so having that, you know, either through you in your office or through you and a website. Um, Oasis Tears is another brand that I like that's a preservative-free option, and then, you know, Retaine MGD by the OCuSOFT, um, line is... Those are... Those are kind of my f- go-to. But also having a gel, um, and an ointment that's readily available. Because maybe your patients, you know, are doing more online shopping, so why not build out a website that allows them to online shop from your practice versus going to Amazon or CVS or, you know, wherever else.

Jackie Garlich (17:29):

Right. All right. Let's talk about some of the different, um, masks that are out there. Um, warm compresses are, like, such a mainstay in dry eye treatment and meibomian gland dysfunction. So, we've got a few different ones. Bruder... There's certainly the Bruder mask, which I feel like has been around forever. I happen to have these in my office. Um, and I should say the, the reason I mostly have these in my office is really for convenience. I don't feel like it's just like a huge money maker situation, me selling these things out of my office. I mostly do those things for convenience, but I, I have Bruder mask. I know you're, um, a fan of the Eye Eco. You use them, right?

Leslie O'Dell (18:07):

Mm-hmm (affirmative). Yeah. Um, and I did start with Bruder. What I liked about Eye Eco was just that, um, that company has a variety of heat, um, products, so when I'm thinking about heat, again, another essential when we're doing dry eye management, if you're not helping to warm the meibum and help keep the secretions thin, if you're doing a treatment, LipiFlow, TearCare, iLux, IPL, it's going to have less of an effect. I know some doctors actually even pretreat at home, um, up until their treatment with a warming mask. And having different timelines matters. So, again, going back to all the research of Dr. Korb and Dr. Blackie, um, heat matters, and the duration of heat matters. So Bruder, Eye Eco has a mask called a DERM Mask. And l-, you know, honestly, Quidel now has a mask.

Leslie O'Dell (18:58):

Um, there... You know, there's a lot of these entry-level masks that are definitely a great starting point for patients. Some of them stay just hot. Some of them have hot and cold, uh, um, options for your allergy patients. But, but they really only hold the heat for about six to 10 minutes, and so if you have, you know, a patient that you're pushing against the glands and oil is secreting but they have symptoms, they're a great option. But once you start seeing more of, like, obstruction, I really like Eye Eco because they give me longer duration heat, and now actually we even have a new company, um, TearRestore, that's providing longer duration heat with an open eye. So if you have a patient that doesn't need to wear glasses, really, um, and they could be working on their computer while they're heating their eyelids, I like that for convenience. Eye Eco has, um, TranquilEyes and TranquilEyes XL, and they can hold heat for 15 to 20 minutes, which is sometimes needed for that more moderate to advanced dry eye patient.

Jackie Garlich (20:00):

Yep. I... Have you tried on this TearRestore mask?

Leslie O'Dell (20:03):

Yeah, it's like you're sp-, um, a superhero.

Leslie O'Dell (20:06):

Yeah.

Jackie Garlich (20:07):

(laughs) Yeah, it absolutely is.

Leslie O'Dell (20:07):

I do really like the colors that they went with. Um, it looks good.

Jackie Garlich (20:10):

I know. Yeah. Yeah. It's, uh... I think for, for me, um, you know, warm compresses are something that I tell all... like, so many of my patients to do, but whether they actually do them... It just requires someone to really sit down and do these masks, and it means that you're also not being able... like not able to do anything when you have on the other masks, the more traditional ones, and so TearRestore, I liked their concept of having this open-eye mask. And, um, they sent me, like, these, like, thermal imaging just so you could see exactly how much heat and that's it getting around the eye, and I don't know that they know the temperature that it's getting to the meibomian glands, but they at least... If I... If it... If I have to compromise a little on that but I know my patient will do it because they could still work on their computer... Not that I really want them staring at another screen, but listen. We have to compromise. Like, if they're actually gonna just gonna do it now because they can, like, work while they do it, uh, I'm sold.

Leslie O'Dell (21:00):

Well, I, I've seen some patients actually take, uh, another product that is by Eye Eco called... Uh, she calls it the stye kit. Um, it's a patch that heats.

Jackie Garlich (21:10):

I... Yes.

Leslie O'Dell (21:11):

Uh, and I've seen people do that, and, and then their treatment just takes twice as long, but they are doing one eye at a time, kind of like a pirate patch, um, type thing.

Jackie Garlich (21:18):

Yes. I've seen that, too. Yeah. Yeah. Yeah, okay. So lots of options, then, in the masks.

Leslie O'Dell (21:23):

And, you know, we probably did the podcast backwards, now I think about it, 'cause a lot of times it's better to heat and then cleanse, so...

Jackie Garlich (21:29):

(laughs)

Leslie O'Dell (21:29):

Maybe we thought about this wrong.

Jackie Garlich (21:31):

All right. Let's... Let's start over. Let's start over. All right. Um, anything else on masks?

Leslie O'Dell (21:35):

You know, masks, maybe just for the protective, right? So we talked a lot about in the past episodes about nocturnal, um, exposure and how important that is. And so, you know, masks, sometimes I think of them also as a protective eyewear, um, and that being said, like, uh, an Eyeseals 4.0 or another product that allows for some kind of sealing around while the patient's sleeping so that you can help with any of that nocturnal lag that they might have.

Jackie Garlich (22:07):

So, the probably final thing we should talk about with at-home treatments is nutraceuticals, which we know we have a lot of evidence now on how omega-3s really impacts the meibomian glands. So we should talk a little bit about that.

Leslie O'Dell (22:19):

Absolutely. So, I... You know, again, my go-to resource for all of these things tends to be the TFOS DEWS II report, so if I'm looking at that and what they say as far as dietary modifications, because you are what you eat, I guess, um, there's a growing evidence that diet and nutritional supplements play a role in dry eye disease. So, first, having the conversation about, you know, what i-... what are our patients doing at home? Are they kind of fast food nation? Are they trying to be healthy? Are they doing things that are plant based? You know, kinda just getting a feel for their overall nutrition to begin with. Um, even general hydration. You know, that's something very simple to talk to a patient about, is how hydrated are they through the day? And, you know, a lot of times they don't even realize that their tears are predominantly water. If they're not drinking the right amounts of water, they're... You know, their body's gonna be saving that for other more important, um, organs.

Leslie O'Dell (23:15):

But then when I kind of get a feel for their nutrition, um, and w- at least what they're revealing to me about how they're eating, y- then we start the conversation about supplementation. So nutraceuticals, um, mostly revolve around this essential fatty acid topic. So, essential fatty acids are what we know as, um, the omega-3s and the omega-6, um, in our diets and also through supplements. In our country, the problem is that we have a very skewed, um, ratio of this balance of, of fats in our diet. Um, and then that then promotes inflammation, you know, throughout our body. So if we're supposed to have a four to one ratio, omega-6 to omega-3, that's the ideal ratio. In, um, the Western world, the ratio can be typically, that's even on average, about 15 to one. You know, and sometimes we'll see that spread even wide-... you know, bigger.

Leslie O'Dell (24:15):

So a lot of times you might... You know, patients might not be that open to eating fish. We now know that even diet sources of our omegas can be contaminated with things, so it's actually really a good thing to offer up, um, some kind of nutraceutical supplementation.

Jackie Garlich (24:31):

Yeah. I completely agree. I, um... I think you could spend, um, several podcasts talking about nutrition and omega-3 supplementation. There are a lot of good nutraceuticals out there. I've had experience with HydroEye. I am now more recently using, uh, PRN, their, uh, dry eye formula. And this is like, I think, a confusing topic for a lot of ODs, and if there is anyone listening that is... has some confusion or wants more in-depth knowledge, I would suggest reaching out to Dr. Gross, who is one of the f-... uh, is the founder of PRN. He is actually, um, will do these one-on-one calls with, um, with optometrists just to explain more of the science behind omega-3 supplementation and how that actually impacts the meibomian gland. So if you are confused and want more information on that, that's certainly one very good source to look.

Jackie Garlich (25:28):

Okay, Leslie. This was good. I think we covered a lot of the good at-home treatments that we can either carry in our office or recommend to our patients. I think the important thing is to... For me, I always have a handout to give to the patients, if I don't have something in my office, to make it clear on where they can get it, what exactly they're getting. Um, because, as you mentioned earlier, it's easy to go to the store and then get overwhelmed or, or just pick something that's a little lower cost-

Leslie O'Dell (25:53):

Or just get misguided altogether. You know, that's the part that you don't want-

Jackie Garlich (25:56):

Yeah.

Leslie O'Dell (25:56):

... to see happen, and, um, keeping that in, in our hands, because even though these treatments are at home, they're still the doctor's recommendation, and making sure that they get to the best solution, um, whatever that might be, is, is going to optimize their outcome, so... But lots of-

Jackie Garlich (26:13):

Yeah. Absolutely.

Leslie O'Dell (26:13):

Lots of home care. Um, I think, you know, making that dental analogy for your patients really helps them understand that. Um, and just, you know, pay attention to the eyelids.

Leslie O'Dell (26:30):

And now for the To the Point wrap-up. When treating your chronic dry eye patients, don't forget at-home care. It will sabotage your outcomes if you don't think about this. You can break your at-home care into a few different categories. Heat masks to help with softening debris on the lids and lashes as well as loosening up the meibum from the meibomian glands. Cleansing. With a plethora of different cleansers available, we can do anything from hypochlorous acid to tea tree oil to our foam detergent as needed. And then nutraceuticals. It's very important to kind of combat dry eye from all these angles and make sure that at-home care is part of your treatment plan.

11/19/2020 | 27:29