California’s Orange County Dry Eye Support Group 2020 meetings will be on May 4 and November 9, 1-3 p.m., P.T.
Both meetings will be held at Grace Hills Church, Fellowship Hall, 24521 Moulton Parkway, Laguna Woods CA, 92637. The schedule includes a speaker and presentation by the sponsoring organization. For meeting information and to RSVP: call Judi at (949) 933-2417 or email email@example.com.
The featured speaker in May will be Laura Periman, M.D., an ophthalmologist and the “doc with a heart.” Dr. Periman specializes in cornea and external disease. She is a frequent speaker at ophthalmology meetings on various Dry Eye topics and treatments.
Harvey Fishman, M.D., Ph.D., an ophthalmologist who practices in Palo Alto, will address the group in November. He specializes in cornea and external disease, glaucoma, macular degeneration, and same day emergency visits.
Both doctors have experience treating patients with severe Dry Eye.
Jonathan Pirnazar, M.D., an ophthalmologist at the University of California, Irvine, started the Orange County Dry Eye Support Group (OCDESG.) It was and is the only Dry Eye support group in the U.S. In the early days, 10 members would meet at a local library. Since then the group has grown to over 200 members. Today an average of 50 to 60 people attending twice-yearly meetings. The non-profit group is not affiliated with any religious or healthcare organizations.
Meetings are free and open to anyone interested in learning about Dry Eye. A $3 suggested donation covers room rental, printing, and mailing.
OCDESG aims to help Dry Eye patients feel better, to give them hope and a better quality of life. The group answers patients’ questions about how and where they can get help for their symptoms.
Dr. John A. McAree, a board certified physician of Internal Medicine, first became aware of having eye problems at the age of 18 when he tried wearing contact lenses. He never found them comfortable and could tolerate them only for short periods of time. About 10 years later during his residency program, an astute ophthalmologist offered to administer a few tests. Dr. McAree’s Schirmer’s test result was zero in both eyes but his tear break-up time was normal. The diagnosis was Dry Eye Syndrome. He had no additional Dry Eye tests for the next 25+ years, and the only therapy suggested was giving up his contact lenses. Remarkably, his eyes remained fairly asymptomatic during that entire time.
That all changed on August 21, 2017 when Dr. McAree and some friends were boating on a small inland lake in Michigan. It was the day of the solar eclipse. Although he did not look directly at the sun, its rays reflected off the water directly into Dr. McAree’s eyes. By the next morning, his eyes were extremely painful. He assumed that he had developed solar keratitis (similar to “snow blindness”) and would recover quickly. Still in pain a week later, he sought the care of an ophthalmologist who said that except for dryness there was nothing wrong with his eyes, prescribed a one-week course of a non-steroidal anti-inflammatory drop, and suggested using a lubricating drop. Unfortunately, nothing helped.
Dr. McAree then begged the ophthalmologist for punctal plugs and a RESTASIS prescription. When these treatments didn’t help, the ophthalmologist offered to partially sew his eyes up, at which point Dr. McAree decided to find a different ophthalmologist.
The new ophthalmologist put Dr. McAree on a regimen of steroid drops and resumed RESTASIS. These measures helped a little bit but his eyes remained uncomfortable and his vision blurry. Thankfully, at least the new ophthalmologist was positive and encouraging. Having hope meant a lot.
After several months and no significant improvement in symptoms, Dr. McAree consulted a Dry Eye specialist at a local university who offered little else besides serum tears. One month later there was still no improvement. It was time to takes things into his own hands.
With some understanding of the pathophysiology of his disease, Dr. McAree diagnosed himself with Meibomian gland dysfunction (MGD). After reading reviews and about available treatments, he decided his best option would be Dr. Steven Maskin in Tampa, Florida who had developed intraductal probing of the Meibomian glands and is very well published.
Dr. Maskin thoroughly evaluated Dr. McAree and diagnosed:
possible allergies contributing to the tear deficiency
Dr. McAree first had Meibomian gland probing in August of 2018 which provided subtle but important improvements in symptoms, the most important being increased tear film stability and therefore less visual blurring.
Because of continued foreign body sensations due to conjunctivochalasis, in early 2019 Dr. McAree had amniotic membrane transplant surgery in both eyes. With surgery the comfort in both eyes improved considerably. A second Meibomian Gland probing in June of 2019 improved comfort even more.
Today Dr. McAree accepts that his eyes are not yet “normal” and will require ongoing treatment. However, he is grateful that an extremely painful and disabling condition is now much more manageable. Work requires time at a computer screen and can cause some discomfort, but he is again able to enjoy hobbies like bird watching and kayaking.
These days Dr. McAree uses RESTASIS daily, scrubs his eyelashes with tea tree oil to control demodex mites, rinses his eyes with saline to eliminate allergens, and still uses lubricating drops, but only occasionally. Plus, he is having injections to combat allergies. He is very hopeful that he will continue to experience improvement in his symptoms, and encourages anyone with debilitating Dry Eye symptoms not to give up hope.
Dr. McAree received his medical degree from Duke University School of Medicine in Durham, North Carolina and has practiced medicine for many years in Grand Haven, Michigan. He joined the Not A Dry Eye Foundation Board to emphasize the importance of accurate diagnosis of Dry Eye, MGD, and related comorbidities, and their treatment with targeted, effective therapies.
My name is Sue VandePanne, and it’s been nearly three years since I shared my story of hope. I suffered with Dry Eye, but with the right care, I overcame my struggles. I’m writing again today to say to those of you still struggling, don’t give up hope.
Over the last three years my eyes have continued to improve. It has been a slow process but today they feel better than ever. In fact, a few months ago it suddenly occurred to me that I had been going outside on windy days. A few short years ago I never would have even imagined it possible. Surprisingly, even in all that cold, Michigan, winter wind, my eyes were feeling just fine. I felt triumphant. Dry Eye was no longer running the show.
Watching Out for Fans
Even though the wind outdoors hasn’t been a problem, I’ve learned that my eyes feel better when I avoid overhead fans. For some reason air that blows from above is harder on my eyes. So now I have a mental map of all the overhead fans in my favorite restaurants and I choose very carefully exactly where I sit. Another problem solved!
I still wear wet contact lenses because enough oil from my Meibomian glands doesn’t reach my tear film, so my own tear film evaporates quickly. The wet contacts feel great. They’ve become so much a part of my daily routine that I don’t even think about them unless it’s time to order more. To maximize the amount of oil I do produce and secrete, I have my Meibomian glands probed once a year. This opens a channel for the oil to flow out and is something my doctor in Tampa, Florida will be doing once a year for the foreseeable future.
Miraculously, A Fully Functioning Individual
Miraculously, I’m now a fully functioning individual (who will never take her eyes for granted anymore). Sometimes I hear horrific stories from people who are suffering terribly and feel hopeless — a feeling that I remember well. Life with Dry Eye can seam hopeless, but I’m writing this to assure you that it doesn’t need to. Help is available. I was blessed to find a great ophthalmologist, Dr. Steven Maskin, who truly understands Dry Eye and knows how to treat it. You will find a great doctor too.
A few weeks ago I attended a social luncheon and noticed a friend had a stye on the upper left corner of her right eye. Her stye probably went unnoticed by everyone there.
But ever since my own years-long battles with Meibomian gland dysfunction and chronic Dry Eye I’ve become hyper-aware of the eyes around me. So, now I notice red eyes, inflamed eyelids, what might be anterior blepharitis, scaly skin around the eyes, dandruff in eyebrows, and yes, styes.
A few days after the luncheon I woke up with a small bump smack inside the middle of my left lower eyelid. I tried not to panic. Was it a stye, I wondered?
Breathe and Think!
“Breathe and think,” I reminded myself. I had to think!
Did I do anything out of the ordinary, like touch my eyes without washing my hands first?
Did something blow into my eyes?
A good possibility.
Should I call my ophthalmologist?
It’s Saturday morning. Oh no!
And with that thought my mind panicked and bounced even faster from thought to thought.
Maybe I should e-mail him. Is this stye a setback? Will it require another intraductal probing of the Meibomian glands in that lid? Maybe the gland is atrophied…
“Stop it,” I commanded myself. “Breathe and think!”
So I stopped, took a breath, and called a friend who happens to be a very experienced Dry Eye patient. Then I did some research on styes. This is what I learned.
A Stye in My Eye
First, a stye — sometimes spelled sty — is an infection localized to the eyelids, in glands at the base of the eyelashes or in the Meibomian glands. The infected gland swells and causes a bump. Styes can be painful, red, and tender. They’re usually caused by an overgrowth of staphylococcal bacteria and are contagious, so it’s best not to share towels or pillows with someone who has one.
How are they treated? Keeping eyelids clean is super important. First wash your hands then wash the lids with a mild cleanser. Applying warm compresses helps a lot. With those impeccably clean hands, roll up a clean wash cloth and run warm to hot water over a corner of it. Without applying pressure, hold the warm, wet corner of the wash cloth against the stye for at least five minutes. Some doctors recommend applying warm compresses from 10 to 15 minutes, three to four times a day.
Whatever you do, don’t pop a stye. Plus, avoid eye makeup for a while, at least until the stye goes away, and throw away any makeup that might be contaminated. Over-the-counter pain medications won’t speed up healing, but they might reduce the pain. And if the stye doesn’t heal within a few days, it’s best to see an eye doctor.
Ok, I was breathing again. No full-blown panic attack this time. All it took was a reminder to breath, a call to a good friend, some research, and a bit of common sense.
But in a week, if that stye isn’t gone, guess where I’ll be.
My name is Judi Beatty and I’ve had Dry Eye for nearly 20 years. Until last year my symptoms included a rough feeling at the top of my eye lids, dryness, headaches, itching, depression and persistent burning in both eyes — the worst symptom of all.
But last year I finally decided to step out of my comfort zone and reach out to a well known Dry Eye doctor out of state. So in July of 2018 my husband and I flew from our home in Orange County California to see Dr. Steven Maskin in Tampa, Florida.
Judi Beatty, Orange County California Dry Eye Support Group Coordinator
I’m one of the three volunteer coordinators of the Orange County California Dry Eye Support Group. Twice a year we invite a Dry Eye doctor to speak to our 200 members. Over the last 15 years, looking for doctors to speak to our group, I have seen more doctors than I can count and I am grateful for each one of them for taking the time to learn about Dry Eye. It can be a debilitating, depressing, life-changing disease. But last year Dr. Maskin made the biggest difference in how my eyes feel.
Talking to Patients
Before my husband and I finally decided to make the trip to see Dr. Maskin, I did my homework. (Flying to Florida from California wasn’t an easy decision to make at 74, or something I wanted to do, but I did want to get better.) I read posts written by his patients on various websites. And I spoke with many of them. They were from across the U.S. and all had severe Dry Eye.
Some patients told me they hadn’t been able to find relief and their lives had been destroyed by the disease. They became housebound. Some even said they wanted to die. But when they found Dr. Maskin, and he restored their quality-of-life, they got their lives back.
While sitting in his waiting room I noticed a map with pins that showed where Dr. Maskin’s patients had come from. The map was covered with pins because people had flown from all over the world to see him. And I thought California was far away!
On the first day of appointments, Dr. Maskin examined my eyes and performed a series of tests. While I sat at the slit lamp, he looked all over my eyes carefully, did a flourescein clearance test, and pressed on my upper and lower lids to determine the number of functioning Meibomian glands.
For the test of aqueous deficiency (dryness), after placing a numbing drop in each eye, a technician dried my eyelid margins, then put Schrimer strips in the lower pouch of each eye, being careful not to touch the corneas to prevent reflex tearing which would skew the test results. After five minutes, the technician removed the Schirmer strips. She noted the how far moisture had travelled up the strip, then repeated the test two more times, leaving the Schirmer strips in my eyes each time for five minutes.
Meibography revealed the state of my Meibomian glands –their structure (length, width, and overall shape), whether or not they could function, or if they had atrophied. The confocal microscope showed my glands at a microscopic cellular level. Dr. Maskin explained inflammation, an underlying factor in Dry Eye, often starts here.
Next came the diagnosis. It was based on the exam and the test results, and would be confirmed after probing my eyelids. This is what Dr. Maskin said I had:
Greater occipital neuralgia — that caused my headaches for five years!
It was amazing to have such a thorough diagnosis. No wonder my eyes felt so bad for so long!
Probing, Expression, and Cautery
That same day Dr. Maskin probed the Meibomian glands in my right eye. First the technician applied an ointment containing lidocaine and jojoba oil to numb the lids and minimize discomfort during the procedure. After a few minutes Dr. Maskin started probing the glands, inserting a small metal probe into each gland as I sat at the slit lamp.
He noted the sound made by the probe as it entered each gland — spongy, pop, gritty, or no sound – while the technician took notes. After probing both lids, Dr. Maskin used an expresser tool that cleared the glands with a squeezing, rolling motion, remarking that a lot of debris was coming out of the glands. Amazingly, the number of functioning Meibomian glands more than doubled immediately after probing.
I learned a lot from Dr. Maskin on day one, and on day two I returned to have my left eyelids probed and a superficial cautery of the lower left punctum. There was no real severe pain during probing. I felt mainly pressure just like the day before. Unfortunately, there wasn’t enough time to express the glands in my left eye because we had a flight to catch.
Tweaking the Judi Beatty Daily Regimen
For the next month Dr. Maskin stayed in contact with me via e-mail — sometimes daily — helping me tweak my care program. He felt that now that my glands were open I should stop using all of my facial products because of allergies or sensitivities. So I did. No more face or eye makeup, and no more moisturizers. He had me stop Bepreve drops and Retaine ointment for the same reasons, and prescribed other products until I found something that worked but didn’t cause irritation. He also had me try various eyelid cleaners and face washes, and prescribed sterile saline for flushing my eyes periodically.
My Daily Routine
Currently I use only Oasis Tears eye drops once or twice a day and autologous serum 100% in the morning and evening. I apply warm, moist compresses twice a day, use Free and Clear Shampoo on my hair, Soothe ointment at night, and Glad Wrap to keep my lids closed while I sleep. Plus I drink lots of water, which is critical. (Dr. Maskin told me to keep a daily record of how my eyes feel, notice if they are bothersome, and “ask myself what did I just do differently” that may have caused it.)
I am still searching for a safe moisturizer for my face and something that I can tolerate to clean my eyes to reduce blepharitis and styes, and possibly a concealer to hide the dark circles under my eyes. Thankfully, I am free of the burning in my eyes but still have occasional dryness which is easily remedied by Oasis eye drops (which I love). I continue to carefully monitor anything I put on my face or in my eyes, keeping a daily journal to help me determine if anything I use could be causing my symptoms to return.
The Best My Eyes Have Ever Felt
I have to say, that in 20 years, this is the best my eyes have ever felt, and I owe it to Dr. Maskin. Other doctors along the way also helped me a lot and I am grateful for their care.
Today my eyes aren’t perfect, but for the last nine months they’ve been 80% better most of the time. I still feel the roughness in the upper part of my eyes occasionally, probably due to the conjunctivochalasis Dr. Maskin found. Someday I may decide to have it fixed. And although I still have some dryness, it’s minimal and resolved with my daily regimen and drinking lots of water. Thankfully the burning is completely gone.
Dr. Maskin is a brilliant teacher, ophthalmologist, scientist, detective, and someone who really cares about helping people. He diagnosed my complex condition and addressed my symptoms. Plus he helped me figure out the many things that I needed to change in my daily routine. He taught me that for me “the less I put on my face and eyes the better my eyes feel.” I have no words to express my gratitude because I am beyond grateful and so glad that I took a chance and went to see Dr. Maskin.
In Part 4 of Reading Between the Drops we look at the journals that publish research papers. And we discuss studies that look at metadata.
Scholarly journals publish research papers. Sometimes the journals are peer-reviewed. Peer-reviewed means the paper was judged and approved by a jury of experts before publication. The review process gives credibility to the paper.
It’s not always obvious which journals are, and which journals aren’t, peer-reviewed. You can check the journal’s masthead, the section with the names of the editors. But you might have to dig deeper to find out for sure. Usually peer-reviewed journals display their status prominently. So if you’re searching, and not finding any evidence of peer-reviewing, it’s probably not peer-reviewed.
Even so, not all peer-reviewed journals are created equal. That’s because there’s no standard process all journals follow to ensure the quality of their reviews. So one journal might have a rigorous peer-review process. But another one’s might be more lax.
It might start with something as simple as independence.
Independence means different people perform different roles. Authors, for example, can’t be editors or reviewers.
But not all journals require independence. That means you could be the author and the reviewer of your own paper.
Can you imagine what could happen if you were judging your own paper. Would you challenge your hypothesis? Would you challenge your methodology or your conclusions?
In two words: probably not.
Or more accurately, definitely not.
As a result, you’d be able to publish whatever you want. There’d be no one to challenge your assumptions or the design of your study. No one would question your conclusions, or anything else about what you’re saying.
Reading Between the Drops – 7 Questions to Ask
1. Does the hypothesis make sense?
2. How the research was conducted, does that make sense?
3. Does the conclusion make sense
4. Who are the authors?
5. Did the authors make any financial disclosures?
6. Is the journal peer-reviewed?
7. Is the journal independently peer-reviewed?
And sometimes a lack of independence means important studies don’t get published. This sometimes happens when editorial boards have their own agendas. If a study comes along that challenges these agendas, the study might end up collecting dust. Lots of it.
To be sure, sometimes a lack of independence happens for a very good reason or it’s unavoidable. There just might not be enough experts in the field to go around, for example. Something like that might happen if it’s a new field or if there are only handful of experts. Even so, it could indicate a problem.
Metadata. Studies about data in other studies. Metadata studies look at all of the available data on a particular topic. They aggregate, filter, and make sense of the data. Simple enough, unless it’s not.
Because, as noted above, there’s always the potential for bias. Editors might block some papers or make publishing all but impossible. Unfortunately, it happens all the time.
So by definition, a meta analysis can only consider published, not suppressed, data.
And that means just one previously suppressed study could throw a metadata study out the window.
Wow! That could change things… a lot!
Just think about it.
And with that thought, we conclude our 4-part series on Dry Eye studies.
In Part 3 of Reading Between the Drops, our series on Understanding Dry Eye Research, we look at the people who conduct studies and publish papers. We’ll ask first, who are the authors? And then, who paid for the study?
Who Are the Authors?
When you look at the authors of a study, sometimes you’ll see their first and middle initials, sometimes their full names, or sometimes their credentials, like PhD or MD. What’s displayed is based on the convention used by the journal that published the study.
But did you know the order of the names might also be important?
Traditionally, at least in bio-sciences, the first position is reserved for the individual who originated the idea for the study and is its primary author. The last person listed is sometimes reserved for an honorary authorship, or someone who oversaw the study. In between are individuals who contributed to it in some way, usually in diminishing order. So, the further down the list, the less they contributed.
The ordering of names in this way is just a rule of thumb and in fields other than bio-science other conventions are used. But sometimes life doesn’t make it so easy to assign a first and last position.
Sometimes two or more people share equal responsibility for an idea. And maybe there’s more than one person in charge. Anything else might happen too, like the departure of a primary author. Where does her name go then? Or what if two people contributed equally but one person thinks they contributed more?
So position might be important.
But it’s also important to ask who are the authors affiliated with? Is it a reputable organization? Where did they study? Where are they working? For a drug company, for example? Which drug company?
And once you know their names and affiliations, go ahead and google their names. You might find a detailed bio, areas of research, or other info that might give you a little more insight into who they are.
Here’s another very important question to ask.
Who Paid for the Study?
That’s right. Who paid for it? And what, if any, financial disclosures did the authors make?
As of 1999 the FDA has required that clinical investigators disclose any financial relationships they may have. That’s to ensure that any data submitted isn’t affected by money.
But not all studies are submitted to the FDA. So where can you find the financial disclosures?
Sometimes financial disclosures are included in the author information section, and they’re easily found in the summary of a paper.
But not always.
Sometimes the financial disclosures will all be in a section called, of all things, Financial Disclosures. But this section isn’t always released with a summary, so you might have to dig deeper.
If you can access the full publication (sometimes they’re free), you should be able to find the financial disclosures somewhere. They might even be in a footnote.
We’re not saying that just because a researcher has a financial relationship of some sort with some entity the research is bad, or wrong, or misleading. We’re just saying, financial disclosures are something to be aware of.
Who funded a study, for example, is one of those somethings.
Because, as it turns out, awareness is everything when it comes to Dry Eye.
Next time we’ll talk about where studies are published, because, as that turns out, not all journals are created equal. Surprised?
So remember, whenever you read a research study, ask yourself these questions. Next time, we’ll add a few more questions to the list.
Reading Between the Drops – 5 of 7 Questions to Ask
Does the hypothesis make sense?
How the research was conducted, does that make sense?
Does the conclusion make sense
Who are the authors?
Did the authors make any financial disclosures?
50 Years Ago, Sugar Industry Quietly Paid Scientists To Point Blame At Fat
Camila Domonske NPR
September 13, 2016, 9:59 AM ET View the Full Report
Here’s another question you can ask yourself. It might help you read between the drops and become an even better consumer of medical research.
3. Does the conclusion make sense?
Let’s say you’re reading a study about a new treatment. Pretty soon you skip to the conclusion because there are so many medical and statistical terms that your head is spinning. And because you have Dry Eye, your eyes hurt too.
So what do you find in the conclusion? The researchers probably say the product they studied is an effective treatment for the disease.
Should you be concerned or surprised?
No. Not if patients who participated in the study really improved.
But how do you know the researchers aren’t making outsized claims? How can you tell they’re not overstating the facts? How can you tell if patients really improved?
One way to verify what the researchers conclude is to check their numbers. You’ll find the numbers in the Results section of the summary.
Yes, most of the time the numbers will be extremely confusing. You’ll be tempted to skip over them. It’s statistics after all. And since most of us haven’t studied statistics we’re not going to get into a long lesson in statistical analysis.
But we will say this. The numbers have to add up.
Here’s what we mean.
1 + 1 = 2, Always
If the results indicate that 90% of patients improved, great. 90% is practically 100%, and that’s a lot of people who feel better.
But what if the math looks like this.
Of 100% of people studied:
15% of people improved with treatment
5% of people improved without treatment
What about the other 80 – 85%, because
100% – 15% = 85% – 5% = 80%
Here’s a real-world example of a study with math exactly like that.
…in approximately 1,200 patients with moderate to severe …Dry Eye…This effect was seen in approximately 15% of treated patients versus approximately 5% of vehicle-treated patients.
(Vehicle just means a drop without the product being tested added).
So it’s the exact same math. Math is math. 1 + 1 = 2. That never changes.
You get the exact same equation:
100% – 15% = 85% – 5% = 80%
What About the Other 80%?
But now, ask yourself, what about the other 80% that didn’t improve? What about them? After all, 80% is a lot of patients who don’t feel better, especially if the researchers conclude that xyz is an effective treatment.
And what if the 80% are prescribed a treatment that only helps the 15%?
That’s a lot of unnecessary prescriptions, a lot of wasted money (if you’re a patient – not if you’re the drug company), and something serious to think about.
Finding a cure is something many Dry Eye patients wish for. That’s why whenever a new study promising remarkable results is published it’s hard not to get excited.
This, we hope, will be the treatment that will cure me once and for all.
But all too often the excitement is short-lived. We may find a doctor who provides the revolutionary new treatment (or diagnosis). But when our symptoms don’t improve it can be disappointing. Eventually, our faith in the entire medical profession may erode. We may even lose hope of ever finding relief.
Unfortunately, it’s easy enough for researchers to make all sorts of claims. They often have a vested interest in the study’s success. Either it’s to continue funding for their research projects or because there’s money to be made when a product is commercialized. (Sometimes enormous amounts of money, but not always).
Sometimes the claims are truthful and accurate. But sometime not so much.
That’s why it’s up to each of us, individually, to learn how to read between the drops and become a discerning consumer of medical research.
But where should you begin? Today, and in upcoming blogs, we’ll provide food for thought and other tips that can help with reading between the drops.
Question 1 – Does the Hypothesis Make Sense?
One of the biggest challenges for Dry Eye patients is simply figuring out what makes sense and what doesn’t. Most of us aren’t trained researchers or scientists. We’re not familiar with the anatomy of the eye or the eye lid. We’ve never observed the formation of tear film up close, even though we may have heard about its three arguably distinct layers.
How does a meibomian gland actually produce meibum?What does the inside of lacrimal gland look like and how does it secrete? As patients we’re mostly in the dark here.
This lack of knowledge puts us at a distinct disadvantage. Anyone can tell us just about anything and who are we to argue?
Well, we’re patients. These are our eyes and our lives. So let’s not be afraid to challenge medicine. Let’s go ahead and ask those hard question. One good place to begin is at the beginning, the researcher’s original hypothesis a.k.a. assumption.
All Research Starts With a Hypothesis
All research studies start with a hypothesis. They end with a conclusion. In between is where the research happens.
But what happens if the hypothesis is wrong? Won’t the research be flawed? What about the conclusion. Won’t that be totally off base too?
The answer to all of these is probably yes.
In Dry Eye care, all too often, an erroneous hypothesis is the source of treatments that don’t really work (complicated by the many different co-morbidities that Dry Eye patients face, no doubt).
So when you read the summary, or reporter’s account, of any Dry Eye study, ask yourself first, does the underlying hypothesis make sense?
For example, let’s consider the assumption that Dry Eye pain is psychosomatic or caused by neuropathy.
Ask yourself, does that make sense? Maybe it does.
But does it also make sense that a part of the body that has 300 to 600 times more nerves than any other part of the body doesn’t feel something that can cause pain? Why not?
With such a high concentration of nerves, isn’t it more likely that your eyes are able to detect a miniscule defect that your doctor can’t, or doesn’t know how to, detect? (Incidentally, applying Occam’s razor here might lead to the same conclusion).
So question the hypothesis. If the hypothesis doesn’t make sense, maybe it’s time to look for answers somewhere else.
Question 2 – Does the Experiment Make Sense?
Sometimes studies really do cause us to question the medical profession. Or at least the medical research profession. Take this one.
A recent study suggested that mistletoe extract combined with carboxymethyl cellulose eye drops was an effective treatment for Dry Eye.
So far so good.
But the control – what the mistletoe drop was compared to – was saline drops.
That’s where the study, in our opinion, fell apart. In fact, it left us utterly bewildered. (Nevertheless, it was reported by a reputable source. More on that in future posts).
Back to the study at hand. Let’s examine it in detail.
Mistletoe extract was added to a lubricating eye drop containing carboxymethyl cellulose. The lubricating drop itself is a treatment for Dry Eye. This combination of mistletoe in a lubricating drop was compared to saline drops (of unspecified concentration), something that’s not a treatment for Dry Eye. (Sterile 0.9% saline is sometimes used to flush out eyes. But it’s not used as a replacement for tear film or as a lubricating agent. Let us stress again, sterile saline is not, and should never be, considered a treatment for Dry Eye).
Reading Between the Drops
Despite this puzzling comparison, the researchers concluded that mistletoe was an effective treatment for Dry Eye because patients felt better after using the mistletoe/lubricating drop combination and worse after using the saline drop.
Why didn’t the researchers compare the mistletoe/lubricating drop compound to a “virgin” lubricating drop? Or to nothing? (This is what we mean by reading between the drops).
Only they can answer that question.
But at least their study confirmed that saline drops shouldn’t be used as a treatment for Dry Eye, although they never really said so.
It’s this kind of thing that leaves us completely and utterly puzzled while wondering, why are these scientists conducting such a poorly designed experiment (and who are the editors who let something like this get published?)
So feel free to question researchers and their experiments. And if they prove to be nutty, then go ahead, by all means, lose faith them.
And who knows. Maybe mistletoe extract really will be the next new thing in Dry Eye treatment. But it’s going to take a better designed study to prove it.
There’s a lot more to consider when it comes to Dry Eye research or any medical research for that matter. In upcoming posts we’ll be looking at other ways that can help when you’re reading between the drops.
Effect of mistletoe combined with carboxymethyl cellulose on dry eye in postmenopausal women
Nan Jiang, Lin-Hong Ye, Lei Ye, Jing Yu, Qi-Chen Yang, Qing Yuan, Pei-Wen Zhu, and Yi Shao International journal of ophthalmology
2017; 10(11): 1669–1677
Published online 2017 Nov 18. doi: 10.18240/ijo.2017.11.06 View the full report
There are no shortages of easy-to-find, over-the-counter Dry Eye treatments. Just go to your local pharmacy and check out the staggering variety of lubricating drops they offer. But are those drops really what you need?
There are no shortages of doctors who treat Dry Eye either. Ophthalmologists, optometrists, even primary care physicians. It’s easy enough to find one and get some sort of diagnosis. They’ll typically prescribe one of the standard treatments. You already know what those are. Lubricating drops, warm compresses, anti-inflammatory drops, lid wipes. These will help a lot of patients. But not everyone will find relief.
Finding a doctor with more that just the typical tools in his medicine bag is a bit harder. In many parts of the world, including the US, those doctors just don’t exist. Patients sometimes end up travelling hundreds – or even thousands – of miles for the care they need.
Sometimes the treatments work. Sometimes they don’t. Why not?
Because treatment is the last thing Dry Eye patients need. Yes, the last. And that should come as no surprise.
Crack Team of Doctors
Have you ever watched the medical drama House? According to IMDb, House is “an antisocial maverick doctor who specializes in diagnostic medicine [and] does whatever it takes to solve puzzling cases that come his way using his crack team of doctors and his wits.”
In just about every episode, a patient shows up at the hospital with strange symptoms. Dr. House and his team examine the patient. They listen to the patient’s story, run a bunch of tests, and pronounce a diagnosis. Then they prescribe something. The first treatment usually doesn’t work. They realize they’ve misdiagnosed the patient. It’s a medical mystery.
The team reconvenes, ponders, discusses, and gets yelled at by Dr. House. What is this a sign of? What is that a sign of? Could it be this? Could it be that? Let’s run some more tests. After a few more nail-biting tries, Dr. House finally has an aha moment. He figures out what all of those strange symptoms mean and pronounces a different diagnosis. Then, finally, the patient gets the right treatment and begins to improve. We, the audience, breathe a collective sigh of relief and the episode ends.
But not just any kind of diagnosis. What Dry Eye patients really need first is a thorough, comprehensive, and accurate diagnosis that accounts for every symptom.
Every burn, every pain, every discomfort. All of them.
Then, after the doctor has a complete understanding of a patient’s symptoms and what’s causing all of them, treatment – that’s effective – can start. Dr. House would probably agree.
This process, incidentally, is what should happen during every first appointment or follow-up visit thereafter. What’s going on? What do you feel? What does it mean?
It’s a pretty well accepted process, followed by most good practitioners and expert diagnosticians, just like Dr. House.
Treatment is the Last Thing Dry Eye Patients Need
They start with a diagnosis. Then they refine that diagnosis as things progress.
It’s no different with Dry Eye doctors. The really good ones start with a comprehensive diagnosis. They may already have some idea about what’s going on based just on your symptoms. But the tests they administer give a more comprehensive picture, which leads to an even more precise diagnosis.
Then finally, after that all-important accurate diagnosis, effective treatment – the last thing Dry Eye patients need – can start.
To everyone who tried to register for the Dry Eye Retreat, we apologize for any inconvenience.