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Dry Eye Treatments at Nvision Eyecare
What is Dry Eye Disease?
The surface of your eyes is protected by a tear film; a layer of tears produced by glands in your eyelids. The tear film is important for a number of different reasons:
It has antimicrobial properties which protect your eyes from infection
It creates a smooth optical surface for the front of the eye to give you clear vision (just as you would need a smooth surface with no scratches on your glasses or windscreen to allow you to see clearly)
The liquid layer is full of nutrients that feed the outer layers of the eye
Dry Eye Disease (DED) is a chronic condition where the tear film produced by your eyelids is either of a poor quality, or not enough of it is being produced. This causes a number of irritating and sometimes painful symptoms:
Sore, red eyes
In severe cases it can lead to a higher risk of eye infections
There are three parts to your tear film. The mucous layer is the one closest to the eye, then above that comes the aqueous or water layer, and finally the top layer is the lipid or oil layer. Dry Eye Disease is caused by a problem in the top two layers – either the water layer, the oil layer, or both.
Dry Eye Disease treatments are aimed at improving the quality of your tear film, and they range from 'beginners' to 'advanced', depending on the severity of your condition.
The optometrist begins by diagnosing your particular type of dry eye – whether it is caused by lack of the aqueous (water) layer, or not enough of the lipid (oil) layer, the Aukland, NZ optometrist prescribes a treatment regimen on that basis. This is done during your initial dry eye evaluation (click here to learn more).
Aqueous-Deficient Dry Eye Disease
Aqeuous-deficient Dry Eye Disease is a deficiency in the aqueous (watery solution) part of your tear film, which is produced by glands in the top lids.
Eye drops: Artificial tears are not a treatment in themselves, as they do not fix the cause of the disease. However, artificial tears are important in the short-term to provide symptom relief, and help make your eyes feel more comfortable and reduce redness and inflammation. Click here to learn more about the different types of artificial tears and their uses.
Punctal plugs: The aqueous (watery) layer is produced by glands in the top lid, and more of this solution should be released onto the surface of the eye every time you blink. In addition, as you blink, the older tears drain out through small openings, or “puncta”, in the inner corners of your eyelids. As your eyes are not producing enough of this solution, in order to 'save' the small amount of tears your eyes produce, your optometrist may recommend punctal plugs. These plugs are inserted into the small opening, effectively blocking the drainage of the tears and 'holding on' to that solution to keep your eyes moist.
A newly released device, Rexon-Eye, found exclusively in New Zealand at Nvision Eyecare, may be considered to treat your condition. Early studies have found Rexon-Eye to be the only device available to health professionals, which may enhance the ability of your tear glands to produce more tears. However, as this device is new, further studies are needed to confirm the evidence, and the success rates are not definitive as yet. This is an exciting new area in Dry Eye Disease therapy and your local optometrist will be happy to discuss this treatment with you further.
Meibomian Gland Dysfunction: a problem with your lipil (oil) layer
The lipid (oil) layer is produced by glands called the meibomian glands. They are the white squiggly lines imaged with infrared in the lower eyelid above.
Meibomian Gland Dysfunction (MGD) causes the oil in the glands to become thick and pasty (like butter) and block the glands' opening onto the eyelid. Over time this can lead to gland atrophy. MGD treatments aim to improve the quality of the oil, returning it to a smooth and runny consistency (think vegetable oil vs butter).
Eye drops: Artificial tears are not a treatment in themselves as they do not fix the cause of the disease. However, artificial tears are important in the short-term to provide symptom relief, and help make your eyes feel more comfortable and reduce redness and inflammation. Click here to learn more about the different types of artificial tears and their uses.
Nutrition: Studies have found that increasing the Omega-3 in your diet helps to improve the consistency of the oil produced by the glands. Omega-3 is a naturally occurring fat found in many foods, particularly in oily fish varieties, including salmon and tuna. Your optometrist may recommend a small tin of tuna a day, or alternatively esterified Omega-3 capsules taken daily to ensure you meet the required recommended daily dose for your dry eye therapy.
Hot compresses and lid massage: As mentioned above, MGD causes the oil in the glands to become thick and pasty like butter. Hot compresses, using specialized heatpads from your optometrist or a warmed wheatbag, applied to the eyelids help to 'melt' the oil in the glands. The now smooth and runny oil can be expressed from the glands by gently massaging the eyelids. Your optometrist would demonstrate and explain this procedure.
Studies have shown that a strict three-month regimen of daily hot compresses not only provides immediate comfort, but can also lead to long-lasting improvement of your condition.
Antimicrobial lid cleansing: MGD is often associated with blepharitis, a chronic infection of the eyelids that causes microscopic dandruff-like material to build up at the base of the eyelashes. This material then blocks the glands and causes MGD to worsen. If you have blepharitis, your optometrist will recommend regular lid cleansing to help reduce the bacteria and material build-up. The latest clinical evidence recommends lid-cleansing products containing manuka honey or tea tree oil. Your optometrist will advise you of the best local products available to you.
For patients with more severe MGD where conventional therapies are failing to provide enough relief, our clinic has the most cutting-edge technologies available on the world market to aid in your treatment.
Lipiflow has obtained the well-deserved title 'game-changer'. It has truly revolutionised MGD therapy. Small applicators are applied to the eyelid, hugging the inside and outside of the eyelid with a gentle clamp, which allow the device to apply heat deep within the eyelids (click here to learn more). Studies have shown that a single 12 minute session can provide symptom relief for up to 1-2 years. Lipiflow has provided much-needed relief to many of our patients with severe dry eye disease, who had suffered for many years with their condition without any effective therapies.
Intense-pulse light therapy has been used widely by dermatologists for a variety of uses including reducing the appearance of scars and blemishes. Recent ground-breaking studies from the University of Auckland have confirmed that IPL applied in a band across the cheek area provides long-term improvement to the quality of your tear film as well as lasting symptom relief. IPL treatment involves four sessions, each 30 minutes long, over a period of 2-3 months. Click here to learn more.
Nvision Eyecare is the exclusive provider of Rexon-Eye in New Zealand. This device is the latest advancement in dry eye treatment and was only recently launched at Nvision Eyecare. Rexon-Eye's state-of-the-art technology, Quantum Molecular Resonance (QMR®), stimulates natural cellular and tissue regeneration via low-power, high-frequency electric fields (1).
Despite the complex science behind it, the treatment itself is comfortable and very easy to apply, with a mask placed over your closed eyes, and feels like a gentle warm compress. The treatment involves four 20 minute sessions over a four week period.
Rexon-Eye is the only device to date shown to provide improvement for both aqueous-deficient and MGD dry eye patients.
For severe dry eye patients, your optometrist may design a combined treatment regimen involving more than one of the above devices. This would be discussed at your Dry Eye Evaluation.
Dry Eye Evaluation
At NVISION Eyecare ® we offer a comprehensive dry eye evaluation to determine the type of dry eye you have, and its level of severity. This allows your optometrist to recommend the best treatment option for you. The evaluation takes one and a half hours and involves an in-depth assessment with advanced equipment only used by dry eye specialists. Some of the tests that will be done by your optometrists during the evaluation:
- Assess your tear volume and tear evaporation using the Oculus Keratograph, to find out whether you are aqueous-deficient or have MGD (see above), and the severity of your condition.
- Image your oil producing glands in your eyelids.
- Measurement of the quality and thickness of the oil layer of your tears.
- Assess your blinking rate and blink completeness.
- The optometrist may also measure how 'salty' your tears are, using the tear osmolarity device, i-Pen®. Patients with dry eyes have more concentrated or 'saltier' tears.
The optometrist will then plan and discuss with you a treatment regimen suited to your unique condition.
Unsure if you need a dry eye evaluation? Take the test!
Dry Eye Questionnaire
This quick five minute test is one of the tools used by dry eye specialists to determine the level of severity of your dry eye syndrome. It will give you an immediate result at the end of the test with a recommendation as to whether to book in for the full evaluation, and whether you will benefit from the more advanced treatments: