The Dry Eye Zone

Rebecca's Blog

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SSF (Friday afternoon, 3/3)

Steve Cohen, optometrist in Scottsdale AZ and SSF's Chairman of the Board, gave a talk next on what's new in Sjogrens dry eye. A talk.... peppered plentifully with slides titled "Points to Ponder" such as "What was the best thing BEFORE slided bread?" and "If love is blind, why is lingerie so popular?" Anyway. Dr Cohen didn't waste too much time on dry eye 101 type basics, sprinting pretty quickly through ADE vs EDDE and diagnostic tests (with brief digressions on diet - he too is a fan of diet to minimize inflammation - and on the too-often overlooked visual blurring that comes with dry eye.

He talked about most of the pieces that can go into a personalized treatment plan, including:

  • lid hygiene
  • omega 3
  • lifitegrast
  • OTC lubricating drops
  • steroids/nsaids
  • antibiotics
  • warm compresses
  • punctal plugs
  • cyclosporine
  • water intake
  • corneal bandage
  • orbital shields (only, this was in the presentation but he didn't talk about it, mental note to ask him what he meant! Moisture chambers? Something totally different?)
  • lipiflow
  • autologous serum

Incidentally, ALL eye doctors treating someone for dry eye ought to have a list at least that long that gets discussed with their patient - as opposed to just plugs and drops - so their patient knows the rationale of what they're doing.

On artificial tears, he sounds like a pretty big fan of Systane Balance (was involved in trials) and also mentioned a recent study of a Rohto drop in Sjogrens patients. Must get link... I've been searching and haven't found it yet. Thankfully, he warned AGAINST the use of redness reliever drops, but did mention that they're using Alphagan P, diluted in artificial tears, off label and occasional use only, for eye whitening. 

On water intake, he said the new guideline is 1oz daily per 2 lbs body weight. Mentioned phone apps to track your water intake. 

On supplements, he mentioned the disappointing results of the DREAM study being presented back east today (in fact I got a tweet from a friend about that just an hour or two before). This was an extensive study with a large cohort, and it failed to show any difference between omega 3 supplementation and placebo, in this case, olive oil. But hey, maybe there's something to olive oil we haven't tapped yet! He advocates for PRN and Nordic Naturals, as you should use triglyceride form of Omega 3s for maximal absorption.

I was glad to hear him advocate Tranquileyes as well.

He talked about amniotic membrane treatments Prokera and Ambiodry a bit (prefers the former).

He went over plugs, but suggested testing first with inflammadry because of the concern about retaining too many inflammatory cells on the cornea.

He went over several practical tips on computer use - keeping the screen low so eyes aren't open as wide; angling the screen slightly for less glare; and following the 20/20/20 rule

Hypochlorous acid was up next. He's a Avenova fan - until their disillusioning move of going Rx and high priced, and now recommends Ocusoft's HypoChlor because the pricing is so much better. I was glad to hear him talk about lid scrubs, including the above but also Ocusoft wipes, rather than baby shampoo because of the studies that have shown it has some negative effects alongside the benefits. 

Then Lipiflow, Blephex, dry eye friendly contacts, scleral lenses and serum drops... it really was a very through and well rounded presentation. I was so glad to hear sclerals included. I think that's more likely, in general, in optometry talks than ophthalmology talks, which is unfortunate.

I got chilled in the conference room and had to disappear after that for awhile so I missed Steve Taylor's talk about the state of Sjogrens and work that's being done. But, it's been a great day.