Tuesday, October 29, 2013

How local rags are reporting on Lipiflow

Classic example below… Same old same old.... New eye treatment comes along, doctors who invest in it drum up publicity. They used to do the same thing with every new version of LASIK that came along. Still, I thought there were a few interesting (albeit more or less predictable) features….

October 26, 2013 – DesMoinesRegister.com

Chronic dry eye forced Doug Pagel to shut the overhead vent and make sure fans weren’t blowing on him at work. He’d even tried punctal plugs to reduce symptoms.
Two months ago, he underwent a new procedure at Eye Care of Iowa, where he works as office manager, that helped relieve those problems. The 12-minute procedure, called LipiFlow, helped restore moisture to his eyes and eliminate the hassle of keeping track of a bottle of eye drops. It also has opened up the possibility of him wearing contact lenses.
“I haven’t used any drops since the procedure,” said Pagel, adding that his condition continues to improve….

Ah. I’m happy for Doug, of course. But… now we’re touting Lipiflow as an ALTERNATIVE to eyedrops, and dangling the carrot of renewed contact lens use? Ugh.

….Symptoms of dry eye include watering or a burning, gritty, sandy sensation toward the end of the day. Many times, that is a result of computer vision syndrome, where eyes become strained and tired from staring at a screen all day.
Two main types of dry eye can affect patients. The most common is “evaporative” dry eye, where the eyes make tears, but they don’t last long. Blocked glands can cause the problem and contribute to lipid deficiency in the tears. Others suffer “aqueous deficient” dry eye, where the eyes don’t make enough water.
A variety of traditional treatments are available — eye drops, punctal plugs and lubricants. But research shows that only 15 percent of all dry eye patients benefit from artificial tears and are able to make the oil to prevent evaporation. For the remainder of patients, those with evaporative dry eye, the oil isn’t produced properly….

Well, one must admit the press are at least starting to talk a lot more about evaporative dry eye. Don’t know that I like the price we’re paying for it but at least it’s happening.

….Following treatment, patients are asked to perform daily blinking exercises and take a triglyceride-based fish oil to maintain eye health….
Interesting. But if the point is to get rid of those “annoying” eyedrop bottles (sheesh, as if any of us actually use bottles anyway… it’s handfuls of vials for most), um, I’d be interested to know how happy these patients are about trading drops for blink exercises. Just sayin’. I think the blink exercises are a great idea. I just don’t think people whose only complaint is the “hassle” of using eyedrops are going to be crazy about it. Most people I know who have had Lipiflow got it because they were desperate and in pain and would be happy to use infinite drops if they’d only work. On the other hand, one of my many biases is that… I know far too many desperate dry eye patients.

…. “Anyone who has dry eye is a potential candidate. What we need to do is have them come in and do an evaluation in the office,” he said.
Ward didn’t want to discourage patients by disclosing the cost of the procedure, but noted that it would be less than the average spent to treat dry eye — roughly $2,500 a year. Insurance does not cover the treatment….

Very interesting. I wonder where they came up with the $2500. No casual dry eye patient spends anywhere near that… only the ones who have some seriously bothersome persistent symptoms.

Abstract: Plugs after LASIK

I have a better idea: Don't cut into healthy corneas.

To evaluate the effect of punctal plug use in preventing dry eye after laser in situ keratomileusis (LASIK).
 Materials and Methods:
A randomized clinical trial at a tertiary eye care center, Riyadh, Saudi Arabia. Participants underwent LASIK for myopia in both eyes and a lower punctal occlusion in one eye only while the other eye served as control. Both eyes received the same postoperative medications except for lubricant duration (subject eye: four times per day for one week; control eye: four times per day for 6 months). Participants were evaluated at 1 week, 2, and 6 months after surgery for signs and symptoms of dry eye. The main outcome measures were visual acuity; ocular surface parameters; and Ocular Surface Disease Index questionnaire.
Seventy-eight eyes of 39 patients were included in this study. The Ocular Surface Disease Index scores of eyes with punctal plugs were better at all follow-up visits, and the differences between both eyes were statistically significant (1 week, p<0.0001; 2 months, p<0.0001; 6 months, p=0.008). At the final follow-up visit, the percentage of normal eyes was higher in eyes with punctal plugs for all ocular surface parameters (Schirmer 1 test, 94.9%; tear breakup time, 77.8%; punctate epithelial keratitis score, 71.8%) compared to eyes without occlusion (Schirmer 1 test, 92.3%; tear breakup time, 58.3%; punctate epithelial keratitis score, 53.8%); however, such differences were not statistically significant.
Punctal plug insertion after LASIK surgeries may minimize the need for frequent lubricant application and hence improve patient satisfaction.

Curr Eye Res. 2013 Oct 22. [Epub ahead of print]
Alfawaz AM, Algehedan S, Jastaneiah SS, Al-Mansouri S, Mousa A, Al-Assiri A.
Department of Ophthalmology, College of Medicine, King Saud University , Riyadh , Kingdom of Saudi Arabia .

Wednesday, October 16, 2013

Drug news: Mimetogen MIM-DE enrolling for Phase III

14 October 2013

Mimetogen Pharmaceuticals has started enrolment of patients in its Phase III clinical trial of MIM-D3 ophthalmic solution to treat patients with dry eye syndrome.
The new drug, which is the first in a class of molecules called TrkA agonists, stimulates the production of mucins that are necessary for lubrication, removal of allergen, pathogens and debris, as well as corneal epithelial healing to reduce ocular surface damage.
Additionally, MIM-D3 will help in improving neural function, which might enhance corneal sensitivity and integrity, compared to the existing dry eye therapies.
Around 400 patients will be randomized to receive 1% MIM-D3 ophthalmic solution or placebo twice daily over an eight week period during the trial which is aimed at further assessing the safety and efficacy of the drug.
The safety and comfort of the drug compared to placebo will also be assessed in the trial, while its primary endpoints are corneal fluorescein staining score in the CAESM and ocular dryness....

Abstract: Contacts and tear lipid layer

Thought this abstract from a literature review is a good reminder of how (ahem) healthy contact lenses are for our eyes:

This review describes the impact of contact lens wear on the tear film lipid layer and how changes in the lipid layer might modulate contact lens-related discomfort. Relevant clinical, functional, and biochemical aspects of the tear film lipid layer are reviewed. Contact lens wear modulates these aspects of the lipid layer, specifically the prelens lipid layer thickness is reduced; tear evaporation rate is increased; tear breakup time is reduced; and the concentration of lipid components such as cholesterol esters, wax esters, and phospholipids varies. The full implications of these changes are unclear; however, there is some evidence that contact lens-related discomfort is associated with a thinner prelens lipid layer, increased lipid degradation, and greater secretory phospholipase A2 activity. Certain fatty acids appear to be associated with maintaining the structural stability of the tear film but their role in retarding tear evaporation and modulating contact lens-related discomfort remains to be elucidated.

Eye Contact Lens. 2013 May;39(3):247-53. doi: 10.1097/ICL.0b013e31828af164.
Rohit A, Willcox M, Stapleton F.
Brien Holden Vision Institute, University of New South Wales, Sydney, New South Wales 2052, Australia. a.rohit@brienholdenvision.org.au

Abstract: Autologous serum eyedrops - impact on signs & symptoms of DES

To assess the impact of autologous serum (AS) eye drops on the ocular surface of patients with bilateral severe dry eye and to draw a comparison between the clinical and laboratory examinations and the degree of subjective symptoms before and after serum treatment.
 Materials and methods:
A three-month prospective study was conducted on 17 patients with severe dry eye. AS eye drops were applied a maximum of 12 times a day together with regular therapy. Dry eye status was evaluated by clinical examination (visual acuity, Schirmer test, tear film breakup time, vital staining, tear film debris and meniscus), conjunctival impression cytology (epithelial and goblet cell density, snake-like chromatin, HLA-DR-positive and apoptotic cells) and subjectively by the patients.
The application of AS eye drops led to a significant improvement in the Schirmer test (p<0.01) and tear film debris (p<0.05). The densities of goblet (p<0.0001) and epithelial cells (p<0.05) were significantly increased, indicating a decrease of squamous metaplasia after AS treatment. A significant decrease (p<0.05) was found in the number of apoptotic, HLA-DR-positive and snake-like chromatin cells on the ocular surface. A significant improvement was found in all evaluated subjective symptoms. Altogether, the clinical results were improved in 77%, the laboratory results in 75% and the subjective feelings in 63% of the eyes.
We found that three-month AS treatment led especially to the improvement of ocular surface dryness and damage of the epithelium. The improvement of dry eye after AS treatment correlated well with the clinical, laboratory and subjective findings. From the patients' subjective point of view, the positive effect of AS decreased with time, but still persisted up to three months after the end of therapy.
Curr Eye Res. 2013 Sep 27. [Epub ahead of print]
Jirsova KBrejchova KKrabcova IFilipec MAl Fakih APalos MVesela V.
Laboratory of the Biology and Pathology of the Eye, Institute of Inherited Metabolic Disorders, General Teaching Hospital and First Faculty of Medicine Charles University in Prague , Czech Republic .

Tuesday, September 24, 2013

Dry eye and my spam folder

Just out of curiosity I clicked on something that eluded my spam filter.

Subject line: EyePromise EZ Tears: 30-Day Dry Eye Relief Guarantee


Relief in 30 days, guaranteed.

Dry eye omega 3 supplements are a dime a dozen, every huckster has one now. Now, I'm not really bored or twiddling my thumbs, but I guess I must be needing some distraction from a burgeoning list of calls & emails I'm getting behinder on every hour, because I actually clicked on the image to get to the URL

...Where I searched in vain for
a) An ingredient list
b) The terms of the 30 day guarantee offer (n.b. The offer is not for consumers but for eye doctors who want to shill, I mean sell this stuff.)
c) Absolutely any other information about the product or the offer. In fact the only thing there IS on the site is a page to submit your practice information so you can get a free promo kit and $100 per case discount. Even the "Terms of Use" and "Privacy Policy" links at the bottom point back at it.

I googled the company (ZeaVision) and product (EyePromise EZ Tears) and found their main product page. The ingredients list is quite respectable, I must say. The testimonials, hm. Mostly along these lines:
I began taking EZ Tears after visiting their booth in Orlando @ Disney World. I noticed a difference with couple weeks. There is no need for any eye drops. It is the best thing I could ever imagine!!! Thanks soooo much.

Impressively, there are no negative comments from people for whom it didn't work. LOL.

Friday, September 20, 2013

UK dry eye market... someone's noticing us....

I was reminded today of a comic one of my siblings reproduced artistically for one of our parents on their birthday when I was little. I don't remember the picture but the caption read, "If you feel like no one cares you're alive, try missing a few car payments."

Well, UK dry eye patients, if you feel like no one cares about you, (grin) at least the stock pickers do. If your doctor doesn't seem to, find another doctor... thankfully more and more doctors who give a fig for dry eye really are emerging.

By Reportlinker
Published: Tuesday, Sep. 17, 2013 - 7:55 am
NEW YORK, Sept. 17, 2013 -- /PRNewswire/ -- Reportlinker.com announces that a new market research report is available in its catalogue:

GlobalData has released its new Country report, "PharmaPoint: Dry Eye Syndrome - UK Drug Forecast and Market Analysis to 2022". Dry eye syndrome (DES), or keratoconjunctivitis sicca, is a multifactorial disease of the eye caused by dryness, decreased tear production, or increased tear film evaporation. DES, which is often referred to simply as dry eye, is the most prevalent form of ocular discomfort and irritation. The most common symptoms of DES are ocular irritation and discomfort, foreign body sensation, fatigue, and visual disturbances, which interfere with daily activities. In the elderly population, it is the most common reason for seeking eye care, and this is expected to increase exponentially with an aging demographic.
The DES market in the UK is projected to grow substantially during the forecast period. During the forecast period, the primary growth driver of the DES market in the UK will be the launch of the EU's first prescription product for DES, as well as the rapidly increasing population of DES patients.
Overview of the DES including epidemiology, etiology, symptoms, diagnosis, pathology and treatment guidelines as well as an overview on the competitive landscape. - Detailed information on the key drugs in the UK including product description, safety and efficacy profiles as well as a SWOT analysis. - Sales forecast for the top drugs in the UK from 2012-2022. - Analysis of the impact of key events as well the drivers and restraints affecting the UK DES market.

Newsblurb: Try laying off the i-whatever....

Thank you, thank you Dr. Feinerman for drawing attention to this issue, which in my opinion is a HUGE contributing factor to the epidemic of dry eye in the young. I'm thinking especially of all the youngsters who were practically born with a device in their hand.

LOS ANGELES (KABC) -- Do your eyes feel irritated, dry or itchy at the end of the day? Your computer and smart phone may be to blame. Eye doctors say thanks to technology, what used to be a problem for the old is now becoming an epidemic among the young.
An estimated 3.2 million women and 1.7 million men older than 50 suffer from dry eye symptoms each year. Now ophthalmologists say they're seeing a new generation of younger patients walk through their office doors.
"In the past, 90 percent of our patients were over the age of 50 with dry eye symptoms," said Newport Beach ophthalmologist Dr. Gregg Feinerman. "Now 50 percent of our patients are 20- to 30-year-olds."
Experts say these new dry eye cases aren't due to eye disease. but rather addiction to technology.
"People are staring at their iPhones, and their laptops and not blinking, which is causing evaporation of the tear film," said Feinerman. "They're staring at their devices for 12-hour periods and not taking breaks. and that's causing the burning and the tearing and blurry vision."
Particularly appreciated this note... have been doling out this advice for a long time but don't often see it mentioned elsewhere:
Doctor Rachel Bishop with the National Eye Institute says even something as simple as the position of your computer monitor could be to blame.
"I advise them to try to position the computer so it's a little bit lower, their eyes don't have to be open quite so wide to be looking at the screen comfortably," said Bishop.
And I LOVE seeing attention drawn to the pitfalls of shopping for drops on your own! If you don't already know the dangers of (a) vasoconstrictors and (b) benzalkonium, you CERTAINLY wouldn't learn from the labels - especially now with the masses of 'combo' drops - antihistamine and/or vasoconstrictor which might have something about lubrication on the label, leading you to think it will be OK for someone with dry eye. It's absolutely terrible and an area of labeling where the FDA has badly fallen down on the job.
And if you feel symptoms use artificial tears regularly to lubricate the eyes and reduce discomfort.
"Look for ones that say for lubrication, not other reasons, not looking to get the red out, not looking for allergy symptoms," said Bishop.
While occasional dry eye is probably not serious, more severe cases can lead to complications.
If artificial tears and taking breaks aren't clearing up your symptoms, it may be time to consult your eye doctor.

Wednesday, September 18, 2013

Abstract: Emerging MGD treatments

Meibomian gland dysfunction (MGD) is one of the most common diseases observed in clinics; it influences a great number of people, and is the leading cause of evaporative dry eye. Given the increased recognition of the importance of MGD, a great amount of attention has been paid to therapies targeting this condition. The traditional treatments of MGD consist of warm compresses and lid hygiene for removing an obstructed meibum, as well as antibiotics and anti-inflammatory agents to improve the quality of the meibum. However, each of these treatments has a different shortcoming and the treatment of MGD remains challenging. Despite the numerous possible treatment options for MGD, it is still difficult to obtain complete relief of signs and symptoms. This review focuses on current emerging treatment options for MGD including intraductal meibomian gland probing, emulsion eye drops containing lipids, the LipiFlow® thermal pulsation system, N-acetyl-cysteine, azithromycin, oral supplementation with omega-3 essential fatty acids, and cyclosporine A.

Clin Ophthalmol. 2013;7:1797-1803. Epub 2013 Sep 9.
Qiao J, Yan X.
Department of Ophthalmology, Peking University First Hospital, Key Laboratory of vision Loss and Restoration, Ministry of Education, Beijing, People's Republic of China.

Abstract: "Bringing comfort to the masses"

Jimminy. When's the last time you saw a study with something like that in the title?

Rather long on repetitiveness and short of actual information, this one, but it's kind of comforting to know somebody studying something cares about how drops FEEL.

Ocular comfort agents are molecules that relieve ocular discomfort by augmenting characteristics of the tear film to stabilize and retain tear volume and lubricate the ocular surface. While a number of clinical comparisons between ocular comfort agent solutions are available, very little work has been done correlating the properties of specific comfort agents (species, molecular weight, and water retention) and solution properties (concentration, viscosity, zero shear viscosity, and surface tension) to the performance and effectiveness of comfort agent solutions. In this work, comfort-promoting properties related strongly to comfort agent concentration and molecular weight, the first objective demonstration of this relationship across diverse comfort agent species and molecular weights. The comfort agents with the greatest comfort property contributions (independent of specific molecular weight and concentration considerations) were hyaluronic acid (HA), hydroxypropyl methylcellulose (HPMC), and carboxymethylcellulose (CMC), respectively. The observed, empirical relationships between comfort property contribution and comfort agent species, solution properties, comfort agent molecular weight, and solution concentration was used to develop novel comfort agent index values. The comfort agent index values provided much insight and understanding into the results of experimental studies and/or clinical trials and offer potential resolution to numerous conflicting reports within the literature by accounting for the difference in comfort agent performance due to molecular weight and concentration of comfort agents. The index values provide the first objective, experimental validation and explanation of numerous general trends suggested by clinical data.

Cont Lens Anterior Eye. 2013 Aug 30. pii: S1367-0484(13)00088-X. doi: 10.1016/j.clae.2013.07.004. [Epub ahead of print]
White CJ, Thomas CR, Byrne ME.
Biomimetic & Biohybrid Materials, Biomedical Devices, & Drug Delivery Laboratories, Department of Chemical Engineering, Auburn University, 212 Ross Hall, Auburn, AL 36849, United States.

Tuesday, July 9, 2013

A day in the life....

It all started when I was putting in my PROSE lenses this morning.

It's a quick routine... normally. I was too lazy to clean them last night. So I cleaned the right one, rinsed it and put it in with the little insertion plunger as usual. Then the left. Only, when the left lens was in it felt all wrong and I couldn't see. It almost felt like I'd put a lens on top of a lens (yes, I've put 2 lenses in the same eye on one or two absent-minded occasions) - but I was sure I hadn't and sure enough the right lens is in the right eye. Hmmm. Bubble, maybe? Anyway I took it back out with the other plunger, filled it back up and put it in again. Same thing. That's odd. Hmmmm.

So I took it out again intending to clean it off really well. That is when I discovered the gaping HOLE right in the center of the lens! 


My thoughts ran from....

Holy cow. When did it break? I wonder where the fragment is... and I'm so thankful it isn't in my eye! How on earth did I not scratch my cornea on that ragged hole?


Groan. How on earth am I going to replace it. With mounting bills for my recent appendectomy (yes, no insurance) there's no way I'm making room for a new lens in the budget. At least it's the left lens... I can get by wearing only the right one if need be.

And eventually to....

Hm, I think I have an old pair sitting around for emergencies. Yup, sure enough, right there in the drawer.

So I'm now wearing a lens that is several years old - quite possibly one of the very earliest lenses I got from BFS, judging from the design which is completely different from the current lenses. And wonder of wonders I can see better than I've seen in years!

My current set of lenses were from a visit about 3-4 years ago when - long story short - I ended up accidentally with "monovision" - that is, my left eye deliberately undercorrected - I didn't want to make a fuss about and and figured I'd just live with it and who knows maybe my near vision would be better that way. In practice I discovered I actually hate monovision. Works great for some people but definitely not for me. I really hate not being fully corrected for distance in both eyes but I wasn't motivated enough to do something about it.

I don't know if this spare lens will work out - after several hours wear I think it's probably a lens that ended up too tight and gave me headaches - but I'll tell ya, in the meantime I am totally relishing this wonderful vision. I can see detail I haven't seen in years. ...Which is especially helpful since my iPhone is dying and I have to drive more than an hour away to the nearest apple store.

That's my silver lining of the day!

Wednesday, July 3, 2013

Tuesday, July 2, 2013

7Eye AirShields - improved lens options

7Eye Airshield glasses (the ones with the deep foam eyecup) are now available with 8 different lenses each, no matter which framestyle or color you choose. I particularly like that you can get CLEAR lenses now... great for people who want them mostly for indoors. Of course, with clear lenses the aesthetics aren't so nice - more goggly - but for so many of us, function trumps form :) and since the price of these glasses has dropped over the years, they're a pretty good deal.

Here's the lens options. Pricing is for any AirShield frame

$99 - SharpView Copper, SharpView Grey
This is a great choice for normal outdoor use, especially for the light-sensitive amongst us.

$99 - SharpView Clear
Great choice for primarily indoor use plus driving.

$129 - ColorAmp Copper (limited time)
7Eye says: "ColorAmp lenses have been specially formulated to boost your eyes recognition of primary colors. We call this formula Amplified Color Technology and the lenses ColorAmp because you can react sooner to visual stimuli, like brake lights, if you can see color with greater clarity. Most sunglasses drown out color, but ColorAmp restores the vibrancy and richness of color while still providing soothing protection."

$129 - Polarized Copper or Grey
Polarized lenses are the best choice for maximum glare control.

$169 - Photochromic Contrast or PhotoChromic Eclypse
Photochromic lenses darken in UV light. "Contrast" darkens to copper tones while "Eclypse" darkens to grey. These are a great choice for general purpose indoor-outdoor use. They do not get as dark as normal sunglasses however so they are not the best choice for bright sunlight for people with light sensitivity.

In terms of AirShield framestyles, we have the Buran, Bora, Churada, Diablo, Briza and Cyclone (note Cyclone is a fix eyecup frame with lower pricing). Stay tuned though as 7Eye is bringing out a few new ones shortly (I'm waiting on some samples to try out) and also reviving an oldie but a goodie, the Chubasco of Panoptx yore which like the Cyclone is one of the original fixed-eyecup frames.

Ziena Oasis glasses with the silicone shield are also available with all of those lens options.

Thursday, June 27, 2013

Spring...Summer.... and a poppy

And time keeps on passing by. I was just set to get caught up on my blog when I came down with the nastiest bug, that has laid me low all week. Sinus infection, ears, chest, headaches,  you name it, I got it. Blech.

BUT on a positive note I wanted to share this beautiful sight that's been emerging between the curb and the parking space in front of my office. I've been tracking it with photos from my phone for awhile. My landlord who waters it faithfully told me what to expect so that I wouldn't accidentally tread on what in its early stages might have just looked like another weed growing up at the curbside but in reality is a gloriously unusual poppy:

Wednesday, June 19, 2013

Abstract: Blink Intensive vs. Optive

They both did something, but Blink did it better & faster.

To analyze tear osmolarity over time after instillation of two commercially available eyedrops.
This prospective, nonrandomized, simultaneous, comparative, open-label, unmasked study included 40 eyes of 20 consecutive subjects (mean age, 34.8 ± 11.8 years) with a diagnosis of moderate dry eye. Subjects were instructed to administer contralaterally controlled lubricants to the right ([RE] Blink Intensive Tears, Abbott Medical Optics, Santa Ana, CA) and left ([LE] Optive Eye Drops, Allergan Inc., Irvine, CA) eyes three times daily for 21 days. The impact of hypoosmotic (RE) and osmoprotective (LE) drops on tear osmolarity (TearLab Osmolarity System, TearLab Corporation, San Diego, CA) was measured before and 30, 60, 90, 120, and 180 minutes after instillation of the first set of drops. Follow-up measurements were performed 22 days later, 1 day after the subjects stopped using the drops.
In RE, compared with baseline, tear osmolarity values were significantly reduced at all time points after instillation, including at 180 minutes (p < 0.01). In LE, osmolarity was significantly reduced from baseline at all time points through 120 minutes (p < 0.01) but returned toward baseline at 180 minutes (p < 0.11). The minimal value reached at 90 minutes after instillation or the average reduction from baseline osmolarity was 27.6 ± 9.5 mOsm/L for RE as compared with 22.1 ± 12.3 mOsm/L for LE. Both groups showed significantly lower tear osmolarity at 21 days compared with that at baseline (hypoosmotic, 307.8 ± 11.9 mOsm/L vs. 329.4 ± 8.4 mOsm/L, p < 0.001; osmoprotective, 316.1 ± 12.5 mOsm/L vs. 327.6 ± 8.4 mOsm/L, p < 0.002).
Our results showed that both eyedrops reduced tear osmolarity within a short time frame after drop instillation (i.e., up to 120 minutes) and after a longer time frame (i.e., 21 days of application). However, hypoosmotic drops with sodium hyaluronate reduce tear osmolarity at a greater and more sustained rate than glycerin and carboxymethylcellulose-based osmoprotectants.

Optom Vis Sci. 2013 Apr;90(4):372-7. doi: 10.1097/OPX.0b013e318288bdbe.
Montani G.
Course of Optics and Optometry, University of Salento, Salento, Italy. montani.gc@libero.it

Tuesday, June 18, 2013

7Eye AirShield and Ziena Oasis glasses available with CLEAR lenses now

All 7Eye AirShield frames are available with clear lenses now, I'm pleased to say... Prior to this, to get clear lenses for primarily indoor use you had to either get the much more expensive 24:7 lenses or incur the additional cost of getting a local optician to put in clear lenses.

$99 all frames.

Oh yes, and the Ziena Oasis is now available with clear lenses too, which should be helpful for those wanting them for the workplace.

Don't forget, the 15% pre-summer eyewear coupon is still good through end of the day Friday!

Abstract: More dry eye in psoriasis patients

Dry eye and tear film functions in patients with psoriasis.

To evaluate dry eye symptoms, tear film function and ocular surface changes in patients with psoriasis.
The Dry Eye Questionnaire and ophthalmic examination including the Schirmer test, tear break-up time, corneal fluorescein test, meibomian gland obstruction and conjunctival impression cytology were assessed in patients with chronic plaque psoriasis. Results were compared between 30 patients and 30 healthy controls.
The rate of positive responses in the Dry Eye Questionnaire and staining of corneal fluorescein test were significantly higher in the patients (P = 0.030) than in the controls (P = 0.012). The tear break-up time in patients was significantly lower than in the controls (P < 0.001). However, there were no differences in the Schirmer test and meibomian gland function between the patients and controls. In the impression cytology analysis, more cell alteration and decreased goblet cell density were observed in the patients (P < 0.001) compared with those obtained from controls (P = 0.003).
The dry eye symptom was more common in patients with psoriasis. In addition, the patients showed a higher tear film instability and significant degeneration on the ocular surface when compared with the normal controls.

Jpn J Ophthalmol. 2013 Mar 23. [Epub ahead of print]
Her Y, Lim JW, Han SH.
Department of Dermatology, Hallym University Chuncheon Sacred Heart Hospital, Chunchon, Republic of Korea.

Abstract: Don't (ab)use saline as an artificial tear?

To determine and compare the effects of single and frequent topical applications of saline solution on tear protein concentration in clinically normal subjects.... 
Even a single application of saline solution resulted in significant changes in major tear protein and sialic acid concentration in the tears of normal subjects. Differences in the recovery of tear protein concentration may be related to the process of protein production and secretion. A balance between normal tear function and the therapeutic effects of ophthalmic solutions should be considered when deciding the frequency of application, particularly in patients with dry eye.

The first thing I thought of reading this was... wish I could see the exact same study using, say, Refresh Plus PF or some other typical non viscous CMC drop. Obviously, saline is NOT a lubricant and should not be thought of or used as such... yet... I've known so many people who overused artificial tears (say every 10 minutes or so) and never had any doctor suggest it might not be good for them, though one would think the 'washout' effect described here ought presumably to apply to those too I would think?

I confess I am a proponent of occasional use of saline drops by dry eye patients – but for specific reasons and ONLY within reasonable limits.

1) As an alternative eyewash. Better to use saline (0.9% sodium chloride) than a BAK-preserved commercial eyewash product (as they virtually all are).
2) As an occasional drop for the soothing effect. There are a lot of dry eye patients who report that all polymer artificial tears make their eyes feel worse… temporarily wet, for sure, but less comfortable. Some of them have developed sensitivities to certain ingredients. Many of those who can afford it are on serum tears instead. Most pursue alternatives to keeping comfortable such as moisture chamber glasses, cold compresses or what have you. But now and then they just need some way to feel nice and wet without introducing irritating stuff. There's nothing more soothing when your eyes feeling like they're burning holes in your head than a stream of chilled saline. But not as a habit, please!!!!
3) As a buffer for more irritating drops. A handy trick for rendering a highly irritating Rx drop (Restasis a commonly cited one…) is to put in a teeny drop of saline 10-15 minutes earlier.

Curr Eye Res. 2013 Jul;38(7):722-8. doi: 10.3109/02713683.2013.777967. Epub 2013 Mar 22.
Shigeyasu C, Hirano S, Akune Y, Mochizuki H, Yamada M.
National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center , Meguro-ku, Tokyo , Japan.

Friday, June 14, 2013

Pre-summer eyewear sale!

One more thing before I jump into dry eye news and studies:

Wiley X AirRage ($90 to $144)
Summer is exactly one week away! We're all spending more time out of doors... make sure your eyes are well protected not just UV wise but from the drying effects of wind and sun. Eyewear doesn't have to be expensive - Dustbusters are less than $20. On the other hand if you've been contemplating some of the pricier ones, the best time to get them is during a DryEyeShop sale because the brand name ones are not usually ever discounted at dealers.

Click on this coupon for a 15% discount, good now through end of the day June 20th:

15% off coupon

Or if you have any trouble with the link, click on the Coupon link in the shopping cart at dryeyeshop.com and type in "Eyewear2013". Enjoy!

7Eye AirDam low-profile eyecup
By the way, if you want good dry eye protection but feel like those deep right-to-your-skin type eyecups are just too goggly-looking for you, take a look at the 7Eye AirDam products which I recently added to the shop. They have a shallower eyecup - still lots more protection than ordinary eyecups, but without the goggly appearance.

Back in the saddle

It has been two or three months at least since I blogged with any regularity. Sorry, dry eye friends!

I just looked at the email folder marked "Blog". That's where all the automated emails I get with new dry eye studies, drug news and so on get filed. As of today it stands at a record 244 unread entries (gasp).

So what have I been doing all this time that has kept The Dry Eye Digest" stuck in endless limbo between the bottom of my "gotta do" and the top of my "wanna do" lists?

North edge of our property last fall. The sheep have done
a great job clearing land for us since then, but we have
to keep them away from the alders because they strip
the bark in no time flat.
First, for those who haven't already noticed from my occasional personal blog posts... I moonlight as a sort of modern day homesteader. We've been hobby farming for a few years now on rented land, but late last year we finally were able to buy some land of our own. Raw land needing everything done. I mean everything. We started from scratch and are substituting labor and love for cash, which is a wonderful workout for our creativity. It's a ton of work and I've never been happier.

Winter was a long battle trying to scrape together enough daylight hours to keep clearing 8-foot overgrowth - in areas that weren't flooded by heavy rains - for some reasonably dry pasture for my sheep and poultry. Then with spring came a host of projects.

Spring also brought our first lambing season! It has been so exciting. We have 7 lovely icelandic lambs. Two are ewe lambs we will keep for breeding. Of the five ram lambs, one (now a wether) will be kept as a companion to the new breeding ram that we are trading a second for, and three will eventually go in the freezer. Next year I'm planning to build a stanchion and start milking our ewes to make feta. Sheeps milk feta is simply the best.

May arrived, and the lambs were all doing well, and we had most of our permanent fencing done or nearly, and other projects were all moving along nicely including planning for the tiny house we're
Noah and her lambs, Tiger and Sugarlips. They were
both born black but Sugarlips had the telltale white
wool around his lips that showed he had a white
undercoat and at 2.5 mths old he now looks like his mom.
planning to build, barn-raising style, in August. And I thought, great, I can finally get organized and back into some of my routines like blogging. Then, out of the blue, I got appendicitis. Nothing like an emergency abdominal surgery to remind you that "the best laid plans...." I remember cringing when the ER doc looked at me with a smile and said, "You'll need to clear your schedule for the week." Sigh. I had my appendix out more than three weeks ago and I'm still not caught on emails.

But I really have no right to complain at all. If you're going to be unlucky enough to get appendicitis at all, may you get it like I did! (If you're not familiar with it... a belly pain that starts generalized or around your belly button and then moves to your right side is The Big Red Flag.) I was quietly at work on a Tuesday afternoon. My abdomen started hurting. I gave it a couple of hours to settle down and it only got worse. Two hours after that when I could barely walk or talk, I had a friend drive me to ER. Straightforward diagnosis. Laparoscopic appendectomy several
"Spot the cow", with his mom, Mahlah.
Spot was born looking like a miniature
holstein. His spots have faded now.
hours later. And yes what they found sure confirmed I needed that thing out. Only mini-complaint was that it was 4 hours after arriving at ER before I even saw a doctor, but I think that was my own fault for inadvertently understating the pain... which was like one endless contraction.

I rested at a friend's house for a couple of days and took it pretty easy at work the following week and since then I've been more or less back to normal.... I am so thankful, seriously. Seems like everyone who hears about it has some horror story to tell about a family member or friend who didn't get diagnosed in a timely manner for some reason and had a perforated appendix,

The surgeon was adamant that I not lift anything greater than 10 lbs for SIX WEEKS. Oh. My. Gosh. Are. You. Serious. How do you farm without lifting anything? My daughter thankfully can do all the routine stuff, but all my late May and month of June projects, like digging a curtain drain across the pasture for better drainage next winter, have become July projects.
Lion, our bottle-fed lamb (we kept him in
diapers at the office at first).

Ah well, that means at least now I have time to start getting caught up on things like my blog.

Apropos of the appendix thing, isn't it amazing what a different world we live in from what it was just ten years ago? I started hurting on a Tuesday at 3pm. By the time I got to ER at 7pm, I had spent an hour or so googling, knew what was wrong with me (or at least pretty sure, and I was right) and also knew roughly how much the surgery and hospital stay were going to cost. - Although that actually turned out to be not quite right... I remember poring over forums seeing a lot of quotes between $18k and $30k. When I finally worked up the nerve to visit my PO box the other day, I had $40k of bills waiting. (No, I'm not insured.) But anyway, the availability of information makes everything so different. There is nothing that has not been discussed on the internet. Just try googling "Can't poop after appendectomy" and you'll see what I mean.

Now, back to dry eye at last. After one last lamb picture....

Thursday, May 9, 2013

How dry is your office?

I was horrified to hear from someone recently that when requested, their employer tested their office humidity level and determined average humidity to be 7%.


Do you know what the humidity level in your office is?

The US's OSHA says:
The following are general recommendations which, where relevant, should be standard procedure. If followed, they will help prevent or alleviate many indoor air-quality problems...
3. Air Treatment. Air treatment is the removal of air contaminants and/or the control of room temperature and humidity. Recommendations for air treatment include:
  • The use of filtration, electronic cleaners, chemical treatment with activated charcoal or other sorbents;
  • Humidity control in the range of 20%-60%; and
  • Temperature control in the range of 68-76 F.
Frankly, you can be pretty miserable at 20% and would be justified in pushing for an improvement on this.

Canadian OHS says:

Are there any standards on office temperatures?
The CSA Standard CAN/CSA Z412-00 (R2011) - "Office Ergonomics" gives acceptable ranges of temperature and relative humidity for offices in Canada. These values are the same as recommended by the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) Standard 55 - 2010 "Thermal Environmental Conditions for Human Occupancy". The recommended temperature ranges have been found to meet the needs of at least 80% of individuals. Some people may feel uncomfortable even if these values are met. Additional measures may be required.
Temperature / Humidity Ranges for Comfort
ConditionsRelative HumidityAcceptable Operating Temperatures
Summer (light clothing)If 30%, then
If 60%, then
24.5 - 28
23 - 25.5
76 - 82
74 - 78
Winter (warm clothing)If 30%, then
If 60%, then
20.5 - 25.5
20 - 24
69 - 78
68 - 75