Reading Between the Drops Part 4 – Understanding Dry Eye Research

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.

Reading Between the Drops – Part 4

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 So if you’re searching, and not finding any evidence of peer-reviewing, it’s probably not peer-reviewed.

(If you have access to it, Ulrich’s ( let’s you check if a journal is peer-reviewed).

No Standard Peer-Review Process

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.

How so?

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.

Analyzing Metadata

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.


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Reading Between the Drops Part 3 – Understanding Dry Eye Research

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.

Reading Between the Drops Part 3

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?

Any Affiliations?

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?

By now many of us are acutely aware that the sugar industry funded studies on fat and health. Is it any surprise that those studies reported that fat was the enemy?

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

    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?


50 Years Ago, Sugar Industry Quietly Paid Scientists To Point Blame At Fat
Camila Domonske
September 13, 2016, 9:59 AM ET
View the Full Report

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Reading Between the Drops Part 2- Understanding Dry Eye Research

Becoming better consumers of medical research is something all patients can try to do. Last time we suggested asking these two questions when you read a study.

1. Does the hypothesis make sense?

2. Does the experiment make sense?

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.

Reading Between the Drops Part 2
Reading Between the Drops Part 2

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.

Find out which Dry Eye treatment was the subject of this study.

So if you see a study, and it’s about a product your doctor recommends, don’t be afraid to ask, “Am I going to be in the % that improves, or in the % that doesn’t benefit from the treatment at all?”

Then together, you and your doctor can decide if this treatment makes sense for you to try. Are you a candidate or not? Will it help you, or not? And if yes, how much?

Next time we’ll look into financial disclosures, where studies are published, and what it all means. And we promise, there won’t be any math…maybe.

Registration for Dry Eye Retreat 2018 is now available on Eventbrite.


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Reading Between the Drops – Understanding Dry Eye Research Part 1

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.

Reading Between the Drops - Part 1
Reading Between the Drops – Part 1

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).

Mistletoe Research - Reading Between the Drops
Mistletoe, the Next New Dry Eye Treatment?

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.

Next Time

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


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Why Treatment is the Last Thing Dry Eye Patients Need

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.

Why Treatment is the Last Thing Dry Eye Patients Need

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.”

An Accurate Diagnosis - The First Thing Dry Eye Patients Need
Dr. House and His Crack Team of Diagnosticians

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.

The First Thing Every Dry Eye Patient Needs

So what’s the first thing Dry Eye patients need?

The answer is, a diagnosis.

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.

The event has been cancelled. 

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If You Have Dry Eye, This Post is for You

This post is for anyone suffering with bouts of Dry Eye that just never seem to go away.

Yep, there are a lot of us. Way too many in fact.

If You Have Dry Eye, This Post Is For You

It’s also for anyone with Dry Eye who’s ever heard, “but your eyes look fine.” (So annoying).

And it’s for anyone whose doctor prescribed another standard treatment while saying, “you’ll learn to live with it”. (Thanks for… not much).

If you had a good eye-day one day. But the next morning you woke knowing it was going to be a bad eye-day, this post is for you too. (Doesn’t everybody measure their days by how good their eyes feel?)

If you’ve seen lots of doctors — too many to count — for Dry Eye symptoms that don’t go away, this post is for you.

If You Have Dry Eye, This Post is for You

Anyone with Dry Eye who’s tried HRT or a different diet, all because you’re seeking relief from Dry Eye, we’ve thought about you.

If you have autoimmune or other diseases that cause Dry Eye, or take medicines that help another condition but cause Dry Eye, this post is for you too. (Sometimes it seems like you can’t win).

You might have strange Dry Eye symptoms. Your doctors don’t talk about them and you never hear about them (except maybe on this website). This post is definitely for you.

If You Have Dry Eye, This Post Is For You

Do you think you’ve run out of treatment options? This post is most definitely for you.

If you’re starting to feel desperate, we were thinking specifically of you.

If you’ve had suicidal thoughts, (or if you’re having them now, please immediately contact your local or national suicide prevention hotline), this post is especially for you, more than anyone else.

And even if you’ve found one of those rare doctors who actually understands what’s going on with your eyes, you’ve found relief, and you’re getting your life back, this post is for you too.

Because there are just two things that Dry Eye patients need to understand and embrace whole-heartedly.

First, you are not alone.

There are lots of us out there with some version of Dry Eye. It’s usually a condition that’s a lot more complex than just dry eyes. But still, it’s Dry Eye.

And second, there’s always hope.

Whatever you do, hang on to hope. You’ll have to persevere. You’ll have to find that rare, great doctor who can really help you. But you will.

And when you do, you’ll get better. You’ll get you’re life back.


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There’s Something in My Eye

When I woke up the other morning my first thought was, as it is every morning, “how are my eyes going to feel today?”

My second thought was, “there’s something in my eye.”

Susan Howell With One of Her Blond Pets

I sipped my coffee, still groggy from a night’s sleep, trying to ignore the foreign body sensation in my right eye. But soon it had me rushing to my panic room (the bathroom).

I stared into the lighted 10x mirror searching for what I thought might be an eyelash. Looking in that mirror was scary enough, but finding no eyelash was even scarier. So I proceeded to clean my eyes the way I do every morning, with Ocusoft Lid Scrub using organic cotton rounds, then flushing them out thoroughly with a few squirts of sterile saline solution.

Still, this foreign body sensation persisted. I flushed my eye out again with saline. Finally, out came a light blond hair, about an inch long. It wasn’t mine (probably belonged to one of my many pets). But I didn’t even care. It was finally out!

My Early Dry Eye Days

There’s Something in My Eye

My earliest symptoms of chronic Dry Eye began years ago with a periodic sensation of something in my right eye. Something was stuck on my cornea. I could see in it in the mirror. It caused severe irritation, tearing, pain, and swelling. Not having any clue at the time about what I was dealing with I would try to dislodge this foreign body by pretty much any means possible: flushing with water, a piece of tissue — two approaches I now know are NOT good and NOT smart!

Usually after a few days of torture the thing in my eye would disappear. That was until one evening when it decided to stay. Thus I began life as a Dry Eye patient.

Eventually I learned this thing was a filament. Filaments are strands of mucus with epithelial cells attached. The strands are connected to the corneal surface, a condition called filamentary keratitis.

Thankfully, ever since I was diagnosed with filamentary keratitis, and now that I’m under the care of a really good ophthalmologist, plus with daily management, my eyes have been filament-free for the past three years.

Everyone Gets Something in Their Eyes

All of us at some point will say, “I think there’s something in my eye.” We usually know right away because our eyes are sensitive to anything that lands in them. In my case, I spend a lot of time outdoors and something always seems to find its way into my eyes. I even recall, years before my eye problems with Dry Eye, when a beetle flew into my eye. I thought I’d flushed it out only to find it lodged under my lower lid the next day. It was like being on the TV show Monster Inside Me. Thankfully, I got the beetle out eventually, and life went on.

But for those of us who live with chronic Dry Eye, or any other eye disease that causes pain and inflammation, a foreign body sensation can leave our already tragic eyes flying off the Dry-Eye-pain Richter scale. Something as insignificant as a lose eyelash can have me scrambling to my mirror. Sound familiar?

Eye pain mixed with a foreign body sensation is nothing to laugh about. Now that I know better, if I could go back to that first bout with filamentary keratitis I wouldn’t hesitate to seek treatment immediately. I might have saved myself years of agony and discomfort. But I didn’t.

These days, the way I see it, life is about learning and the more we educate ourselves about Dry Eye the better we’ll be able to manage it.

Susan Howell
Chronic Dry Eye Patient

One Size Doesn’t Fit All

Last year Susie Brockman shared with all of us her remarkable Story of Hope. Today she follows up with what she calls “the most important piece of advice I can give anyone with Dry Eye.”

Susie Brockman
Susie Brockman shares the most important piece of advice she can give.

As Dry Eye sufferers we’re desperate to find relief from pain. We sign up for support groups, purchase every new over-the-counter drop we can find, join any number of online forums, and seek out other Dry Eye sufferers. We modify our lives to accommodate our disease.

But all too often, nothing seems to work.

That’s because Dry Eye is extremely complex. Many different things can cause Dry Eye and there are lots of variations of it. So treating the disease takes a lot of finesse. Or, in other words, one size doesn’t fit all.

Each Dry Eye Case is Unique

Each Dry Eye case is unique and there are many causes. For example, various diseases can contribute to, or cause Dry Eye, e.g.: diabetes, collagen vascular diseases, autoimmune diseases like Sjogrens syndrome, rheumatoid arthritis, scleroderma, lupus, or Hashimoto’s thyroiditis.

Many medications can cause Dry Eye or make it worse, e.g.: antihistamines, pain pills, blood pressure meds, birth control pills, antidepressants, or hormones, to name a few. Other causes of Dry Eye include aging, radiation treatment, Lasik surgery, inflammation, and allergies. The list goes on. In many cases, a patient has a combination of these problems which makes diagnosing complex.

The Most Important Piece of Advice

One Size Doesn’t Fit All

Nevertheless, an accurate diagnosis is the first step in finding relief for anyone with Dry Eye, and especially anyone with an advanced case. That’s why the most important piece of advice I can give is to find an ophthalmologist. Preferably the doctor will specialize in cornea and external disease and sub-specialize in Dry Eye, because all ophthalmologists aren’t alike. There are different sub-specialists and even sub-sub-specialists. So, even if an ophthalmologist specializes in cornea and external disease, he may not be a Dry Eye specialist.

A general ophthalmologist will typically prescribe over-the-counter eye drops, prescription eye drops, warm compresses, some type of lid wipe, and maybe eventually punctal plugs. Unfortunately, if these treatments don’t work, they don’t prescribe other treatments. It’s only those who specialize in Dry Eye, and have experience with the complexities of the disease, that will figure out what’s really going on and give you hope.

It All Begins with Finding the Right Doctor

Once you find a Dry Eye specialist, he’ll examine your eyes carefully and put you through a series of tests – Schirmer tests, meibography, tear break-up, and so on. Afterwards you’ll get a diagnosis and treatment plan. You’ll finally find out what’s causing your symptoms. It might not be what you expected, and it might be something you’ve never even heard of. But at least then you’ll start treating the conditions you have and the diseases that are causing you pain. Doing that will restore your hope.

If you’re one of those who’s tried different treatments, but none of them helped, this is especially important for you to understand. It’s not that the treatments are bad (although some might be questionable), it’s that the treatments aren’t working on your specific set of conditions. There might be systemic or environmental causes. You might have meibomian gland disease or something entirely different. Just because someone else has success with a treatment plan, doesn’t mean you’ll require the same regimen to solve your Dry Eye issues and relieve your pain.

Remember, it all begins with finding a doctor, then getting tested properly, getting a comprehensive and accurate diagnosis, and following your Dry Eye specialist’s plan of action. That’s how I found hope, and you will too.

Susie Brockman, Chronic Dry Eye Patient

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Diana Adelman Answers Readers’ Questions

Diana Adelman Answers Readers’ Questions

I’d like to thank everyone for their questions. It’s important to remember that my routine – the things I do every day, my treatment plan – is specific to me and my set of conditions. They won’t necessarily work for everyone. Even so, learning what I do may help you develop a routine that keeps your eyes comfortable and works for you.

Question 1:

It sounds like you do a lot each day to stay comfortable. How much time does all of that take?

In the morning my routine takes maybe 10 minutes including a shower. Lid wiping takes 30 seconds. Irrigating takes something like 20 seconds. Drops are just seconds.

Steaming takes three minutes while I brush my teeth. Plus steaming is good for my skin.

Sleeping with moisture chamber goggles is a non-issue and washing them takes maybe a minute.

It’s not the length of time, it’s the discipline of doing it that matters. We’re all supposed to brush our teeth two times a day. So I wash my eye lids two times a day too.

Question 2:

What do you mean by steaming? What do you actually do?

Answer: I use a facial steamer. I fill the steamer with two cups of water (using the measuring cup that comes with the steamer) and turn it on. The water gets hot in about three minutes. I put my face close to the steamer, a couple of feet away, and close my eye for three minutes. Since I use the steamer while brushing my teeth, it doesn’t really add much time to my daily routine.

Question 3:

How much better are your meibomian glands?

Diana Adelman Answers Readers’ Questions

Answer: I had probing just a few days ago, on January 30, and had more glands open than ever before. There were 37 open glands in the left upper lid, 31 in the right upper. (My lids have a double fold. With 60 glands in the upper lids I’m a virtual oil factory). I tend to develop fibrosis in the glands, and probing pierces through that tissue.

I still had some aqueous deficiency in the right eye, so during my appointment the doctor partially cauterized the lower tear duct in that eye.

Question 4:

Do your eyes feel better in Seattle or in Florida?

Answer: My eyes definitely feel better in Florida. It could be the heat, the humidity, maybe allergies, or all of the above, or who knows what.

Question 5:

Do you work? Are your eyes comfortable enough to hold down a job?

Answer: Yes, I work full time. But without my daily routine and my annual appointments, I think it would be uncomfortable and difficult to hold down a job. There’s nothing like really bad eye discomfort. I’ll never forget it!

I’d like to add that no one should ever lose hope. In the beginning, until you find the care you need, it might seem daunting, especially when your eyes feel bad. It can be hard to search for anything – or do anything at all – when your eyes are uncomfortable. But these days, there are many effective treatments for many of the conditions that can happen under the Dry Eye ‘umbrella’ – like conjunctivochalasis or MGD. It’s a question of getting a really good diagnosis first, so you know what you have, and then treating what you have accordingly.

An Event That Will Stir Your Heart

(Please note: as of September 5, 2018, this event has been cancelled. We apologize for any inconvenience.)

Finally, I’d like to remind everyone about our first ever Dry Eye Retreat for patients, their families, and friends, in Williston, Florida, November 9-11, 2018.

Two Hawk Hammock, Williston, FL

We’ve created an event that will stir your heart. You’ll have a chance to connect with Dry Eye sufferers just like you, participate in face-to-face support groups, and make a difference. Register early to reserve your spot.

Note  – the event fee does not include accommodations, but there are plenty of hotels, B&B’s, and rentals in the area. Just book early because our event is during college football season. And if the Gators are having a home game that weekend, it might be hard to find a room.

I hope to see many of you there.

Diana Adelman
Executive Director, Not A Dry Eye Foundation

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Diana Adelman’s Story of Hope, Part 2

I shared my Story of Hope back in May 2016, and am happy to report that today my eyes are still comfortable. Since then, I’ve learned to avoid the triggers that make my eyes feel worse. I now know what to do each day to keep my eyes comfortable and moist. And I also had another meibomian gland probing.

At home my daily regimen includes cleaning my eye lids, anti-inflammatory and allergy drops, steam, and moisture chamber goggles.

My Daily Regimen

“My hope and my faith in the healing process is renewed.” Diana Adelman’s Story of Hope, Part 2

This is regimen I follow daily.

In the morning when I get up I use a solution containing hypochlorous acidAvenova lid cleanser prescribed by a local ophthalmologist, or Heyedrate — on both eyes. I squirt the solution two or three times on a cotton pad, wipe it on my eye lids, and leave it on.

Then I irrigate my eyes with sterile saline, squirting half a tube in each eye. After irrigating I take a shower and make sure my lids are really clean.

Next, I use a drop of Restasis in each eye, capping the tiny tube for the next use until it’s empty. Ten minutes later I put a Pataday drop in each eye. At noon I use Restasis again.

In the evening I repeat the steps, and add steaming with a facial steamer for three minutes.

After steaming, I clean my lids with the hypochlorous solution, irrigate with sterile saline, and apply Restasis. Plus, I take another shower.

The day ends with moisture chamber goggles. I sleep in them, then wash and dry them carefully each morning.

It may sound like a lot of steps, but it’s completely worth it to me, because my eyes feel just fine practically all the time.

Doctors and Life Style Changes

I’ve changed my diet, avoiding coffee and sugar while eating more fish, vegetables, and organics when possible. Lots of doctors recommend these changes to their patients. To me, it just makes sense to eat healthier.

Diana Adelman’s Story of Hope, Part 2

I see a local eye doctor at least once a year for general eye health. And at least once I year I see the specialist in Florida who first diagnosed and treated all of my Dry Eye conditions.

At my annual visits the specialist administers a variety of tests: Schirmer tests, meibomian gland exams, tear break-up time, eye pressure, and sometimes a meibography to see if my meibomian glands are changing. Then, depending on what he finds, he may adjust my treatment plan.

About once a year I have meibomian gland probing, which keeps the glands open and functioning. By the time the one year period rolls around my eyes are usually a little less comfortable than usual. They might be getting a bit gritty or sometimes have foreign body sensations. After probing these symptoms go away and my eyes feel great. After each probing my glands have stayed open longer and produced more oil. Meibographies have even shown that my glands are getting longer, which I think is remarkable.

To some it may seem like a long way to travel just to see a doctor (I live in Seattle and he’s in Florida), but I feel it’s an important step to make sure my eyes stay comfortable. In time, these visits may become even less frequent, but for now I’m sticking with once a year. Each time I go, my hope and my faith in the process of healing is renewed.

I hope sharing the steps I take to make my eyes comfortable inspires you to learn how to take care of your eyes. And I also hope to see you at the Dry Eye retreat this November 9-11, in Williston, Florida. Registration will be opening soon, but space will be limited so please register early. See you in November!

Diana Adelman
Executive Director, Not A Dry Eye Foundation

Send your questions and comments to

Subscribe to our blog to keep up with Not A Dry Eye. It’s FREE!

Support Not A Dry Eye Foundation. When you shop at, Amazon donates 0.5% of your purchase at no additional cost to you.

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