The Dry Eye Treatment PODCAST

If you’ve been told to “just use drops” for your dry, gritty, or burning eyes — this episode will change your understanding of what’s possible. Dr Shaina Zheng, Vice-President of the Dry Eye Society and Clinical Lead at EyeCare Plus Mermaid Beach, reveals how two breakthrough treatments — Envision by InMode and Rexon-Eye — are restoring comfort and confidence for patients who’d given up hope. Discover how one therapy melts blocked oil glands and soothes inflammation (patients say it feels like a hot-stone massage for the eyelids), while the other uses gentle electrical stimulation to help the eye regenerate from within. In this conversation, Dr Zheng shares: Which types of eye conditions respond best to each treatment How realistic recovery timelines differ for mild vs. chronic cases The role of at-home “dry-eye homework” in lasting relief From children struggling with styes to adults facing decades of discomfort, this episode shines a light on what modern, patient-centred care for dry eye disease really looks like. 👉 Tune in on Spotify or Apple Podcasts to learn how these technologies are redefining what’s treatable in dry eye care.

Dr. Erica Darian-Smith, co-founder of Eagle Eye Surgeons in Sydney, joins us to unpack the link between eye surgery and dry eye. We explore why screening is vital before LASIK, how advanced therapies prepare the ocular surface, the differences between LASIK, SMILE, and PRK, and how cataract or lens-based surgeries can also impact tear health. If you’re considering surgery—or simply looking for dry eye relief—don’t miss this practical, eye-opening conversation.

Today’s guest is Sharon Flora, principal optometrist at Wood Street Opticians and founder of The Eye Retreat Medispa in the UK. With over 20 years of experience — and named Dry Eye Practitioner of the Year by the BCLA — Sharon brings a unique blend of clinical expertise and holistic care. In this episode: Why you might have dry eye… even if you don’t know it How AI and imaging tech are changing diagnosis The truth about cosmetics, makeup removers, and eye irritation Treatments that go beyond eye drops — like IPL and radiofrequency What it’s like to visit a medispa designed just for dry eye sufferers 👁️ If your eyes feel dry, gritty or tired — don’t miss this one. 🔗 Connect with Sharon at The Eye Retreat Medispa or book via Wood Street Opticians 🎙️ Subscribe on Spotify or Apple Podcasts for more expert insights on dry eye relief. #DryEye #OptometryPodcast #IPL #AIinOptometry #DryEyeSyndrome #EyeHealth #TheEyeRetreat

In this episode of The Dry Eye Treatment Podcast, we sit down with Dr. Victor El-Khoury, the owner and principal optometrist at The Eye Lab in Newport, Melbourne. He’s passionate about optometry (and his surprising hobby!) He’s a dry eye specialist who co-founded his clinic from scratch with his sister. 👁️ If you’ve ever struggled with dry, itchy, irritated eyes, you won’t want to miss this deep dive into some of the most innovative treatments available today, including: ✅ IPL Therapy – How Intense Pulsed Light is changing the game for Meibomian Gland Dysfunction ✅ Red Light Therapy a.k.a. Low Level Light Treatment (LLLT) – What it is, how it compares to IPL, and who it works best for   Dr. El-Khoury shares fascinating insights into his unique process for helping new patients who come into his practice seeking dry eye relief. 🎧 Hit play now and take the first step toward clearer, more comfortable vision.

[00:00:01.080] - Paul Welcome to the Dry Eye Treatment podcast. We interview eye care industry professionals who have experience in treating dry eye disease. Please remember that the content shared on this podcast is based on personal experiences and opinions. It is not intended as medical advice. Always consult your health care professional for any medical concerns. Now sit back and enjoy the podcast. If you suffer from dry, itchy or irritated eyes, you could be experiencing dry eye syndrome. If that's the case, then stick around because on this podcast, we interview eye care professionals who specifically deal with dry eye disease. Welcome to the Dry Eye Treatment podcast. Over the next 20 to 30 minutes, you're going to get actionable tips on what you can do to manage your dry eyes. Who am I? My name is Paul Sallaway. I am the owner of Optics Digital, which is a digital marketing agency that helps eye care practitioners to grow with your business. I'm not an optometrist, but as a dry eye sufferer myself, I'm here to ask all the questions to the experts, so you don't have to. And my guest today is the owner and principal optometrist of Junic Eye Care, an optometry practice and low vision Clinic in Canberra. [00:01:16.530] - Paul She obtained her doctor of optometry degree in 2006. She completed a master's degree in public health at the University of Sydney in 2014. And following that, she obtained a master of orthoptics from the University of Technology in Sydney in 2017. She regularly treats patients of all ages who come to her practice suffering from dry eyes. Welcome to the Dry Eye Treatment podcast, Dr Juliet Menakaya. Hello, Juliet. [00:01:40.690] - Juliet Hi, Paul. How are you? [00:01:42.210] - Paul Very good, thanks. Thanks for coming on the podcast. So can you give us the 30 second Juliet Menakaya story so we know a little bit more about your background? [00:01:52.250] - Juliet Thank you for that. So this is me, Juliet, a young lady that came to Australia from Nigeria, but in 2008. So I did my degree or doctor of optometry degree in Nigeria. I came to Australia. I have ever seen seeing the eye health sphere. I started off in Melbourne. I have been in Sydney where I got my extra education, if you like. And I currently live in Canberra with my three beautiful kids and my husband. I call him my fourth child. So Canberra is home now. And I like to refer to myself as eye care practitioner. I like to be the best point of contact for my patients if they have anything to do with their eye. So I think that's me in a nutshell. [00:02:47.420] - Paul So, yeah, I've been to Canberra once and it seemed like a very nice place to be. It's a beautiful city. And as our nation's capital, it's got all the federal departments there. And I think also a lot of other industries have been moving to Canberra in recent times as well. So which means, of course, that there are a lot of office workers in Canberra. And one of the issues with office work these days is something called computer vision syndrome or CVS for short. So in this podcast, I'd like to talk to you, Juliet, about computer vision syndrome and how that interplays with dry eye disease and dry eye symptoms. So maybe could you tell us What is computer vision syndrome and what are the symptoms of CVS? [00:03:34.600] - Juliet So Paul, you're right. Canberra is... We have a lot of Australian public servants, lots of different departments. So most of my patients I see, they work in an office environment. And to answer your question, what is computer vision syndrome and its symptom? So computer vision syndrome is a term used to describe a collective of ocular symptoms that is related to prolonged computer use. These symptoms are, you have your eye strain, tired eye station, redness, lured vision. Some people complain of double vision. That is amongst others. It is a repetitive, strained disorder. That seems to be going rapidly amongst office workers that use a three hours day. These symptoms are usually temporary and some will disappear at the end of the day of the working day. I have a minority of workers that may experience continuity of symptoms after work. What we found is no intervention is initiated. Majority of these symptoms will reoccur and also worsen. [00:04:41.210] - Paul So you said it's a repetitive strain injury. So could you explain that a little more? I mean, within your eye, you've got the lens and there are muscles that control the focus of the lens, aren't there? Is that the strain? Are these what's being strained through continuous office work? [00:05:03.890] - Juliet So I think we're going to... So there's a lot of factors that cost me a vision, continue me a vision. So we have a reputation in this order. I want people to think about it in terms So you can't do without going to work without using our screen or the computer now. So we over time, every day, expose ourselves to this computer and the mechanism and some other things that are invariably you affect our eyes or ocular health. That's why we say it's a repetitive stream. We thought it was more something... Some people will come in and say, I've got a foreign body in my heart. So it's on a peak. But this is something It's continuous. Some people cannot help, but you use the computer every day because that's the nature of their job. So that's what I mean or meant by a repetitive stream disorder. [00:05:57.110] - Paul Okay. And so why does computer vision syndrome often lead to dry eyes, or why does it aggravate the symptoms of dry eyes? [00:06:06.520] - Juliet So the computer vision syndrome has different mechanisms or causes, or what would lead to, or what is going to cause it. You have your osteoocular mechanisms, you have your accommodative mechanisms, and then you have the ocular surface mechanism. If you allow me, let me just delve in a little bit about this order, different causes of drug, computer vision syndrome. In the extraocular mechanisms, it's caused by the most post-skeletal symptoms such as your stiff neck pain, headache, backache, shoulder ache. These are associated in improper placement of computer screen when the patient is working or the individual is working. Then you have the accommodative mechanism. So changes in accommodative and vergence function of the eyes have been reported after a prolonged use of the computer. So there's a reduction in ability for our eyes to accommodate effectively. There's a reduction in our near point of convergence, which is our ability to effortlessly pull our eyes and ears together, and there is a reduction in Functional Convergence measurement. These changes, they have been proposed as an objective indicator of subjective visual fatigue. Invariably many people, a lot of people will have slight problems, accommodative problems or binocular problem. [00:07:39.910] - Juliet But because of prolonged use of the computer, these accommodative issue which means it will cause blurry of the vision, will now cause double vision, and will cause a bit of slowness in changing focus when people are working at that station. Then let's talk about the ocular surface mechanism. You have symptoms like dryness of the eyes, redness, greater sensation, burning sensation after prolonged computer use. That leads me to my... If I can answer the question when you asked me, how does tears lead to dry eyes? This is multifactorial. You have different factors that come together and cause dry eyes from using the computer. Firstly, you have tonia dryness. Most times this comes from environmental factors. So think about the offices where these workers are working. The office air, ventilation fans at the workplace. Some workplace will have airborne paper dust. There was a patient, a young girl I saw, I've been seeing for the past four weeks now. And while I was taking the case history, I said, Where do you work? She worked in one of these government departments and arranging paper. And guess what? She came back last week, she was down with flu. [00:09:06.380] - Juliet She didn't go to work. Because I've asked her, Could you tell your workplace if you could get protective eye wear? And for the fact that she didn't go to work for a couple of days, she came back smiling because some of our workplaces, the air is not actually good for the ocular surface. Then you have reduction in blink rate. Normally, individuals will blink for about 10 to 15 times per minute, but this is sometimes reduced with continuous staring at the computer while working. Then you have the increased surface of cornea exposure, which is caused by, for horizontal gain at the computer screen. So think about when you're reading a text on a paper, you do that by looking downwards. But a worker who is always working at the computer has this horizontal gaze Yes, looking at the computer. Therefore, invariably, the cornea is more exposed than you think. Then you have the issues of reduction in tear production due to ageing. You have contact lens use. You have some systemic medications as well that affect the quality of your tears. Then you have the ocular condition. When people already have meibomian gland dysfunctions or anterior blepharitis, and then you put them in those environments or other factors I've already mentioned, obviously, they're going to have dry eyes and forcing their condition and computer vision syndrome. [00:10:43.910] - Juliet So All these, and again, you have some cosmetics. When people apply cosmetics not properly, they plug up the mebumium glands, and invariably, all these factors will tie in together and will lead to dry eyes in office worker or someone using the computer often more than 30 hours every day. [00:11:08.830] - Paul So it sounds like our eyes were just not meant to operate inside modern offices. There's a lot of... There's some things there you mentioned I didn't even think of, like people are working around paper all day. So there's probably a lot of dust and debris from the paper themselves that's in the air that can irritate people's eyes. And the horizontal gaze thing, that's something I never considered either. So you said your cornea is exposed a lot more when you're looking at something that way as opposed to looking down at a book. And I think in previous podcasts, we have talked about meibomium glands and what they do. So just to refresh our memory on that. So Juliet, can you tell us again, what are meibomium glands and what role do they have in dry eye syndrome? [00:11:58.590] - Juliet So the meibomium glands around your lid, inferior and superior eyelid, we have a number of meibomium glands or openings. So they are meant to excrete the lipid or oily material which is necessary for the briquette in our eyelid. If for any reason your leads are not clean, if you have the variety, if you have any issues around the leads, that will plug up the mebumium gland. Think about it, you don't have that moisture. It's just like when you apply cream on your body. If you don't, it looks a bit dry. So if those lipids or those oily layer of fluid is not properly relieved, your eyes are going to be dry. [00:12:55.160] - Paul So there are little oil glands that you've got just inside the Just inside your eyelids, which secrete these good oils that keep the front of your eye covered and stop your eyeballs from drying out. That's essentially it. So what are some of the things that we can do then within our work environments to address dry eye? I've heard some people talk about the 2020-20 rule. Are you familiar with that one? [00:13:27.320] - Juliet Yeah. You have your 2020 rule for every 20 minutes. So you work find a spot that is 20 feet away from you and look away for 20 seconds. Just take a break away from staring at the computer. All One modifiable external environmental factor people have tried to reduce the symptoms of CVS. One important factor is light. Bright lights, windows, overhead fluorescent lights, they often contribute to this comfort, glad patients were coming complaining about. These bright light sources, they need to be controlled with proper blinds, philtres, adjusting the room arrangements. I've had this conversation multiple times with my patients. I was just like, Okay, how do you see it? I need to know. Can we move things around? They come back saying, Thank you, Juliet. I didn't think about that. We can do all that. Another important Another factor is the imbalance of light between the computer screen and the surroundings. We can fix this by adjusting our digital or computer device setting to dark mode. What it does is provide the balance between the room light and give you maximum visibility and make it easier for you to work. The muscle, musculoskeletal problems that people have from the neck pain and all that, we can prevent that by proper workstation adjusting. [00:15:06.490] - Juliet So computer users, often, they assume on comfortable position in order to have a good view of the screen without realising that the posture they have might lead to muscular stress after prolonged duration of work. I advise my patients to have proper distance from the screen, proper adjustments of the image side Most screens, you can be like 77 to 110 centimetres away from your heart. Very important. The level of where you place the computer as well, about 20 degrees low eye level. That's very important. Overall, there's been some studies that found that physical economics of computer workstation have actually proven to reduce discomfort, so-called discomforts have obviously improved performance. But let's delve in deeper from the eye care professional or practitioner perspective. Like I said before, 20, 20, 20. Take every 20 minutes, find a spot, look at 20 feet away for 20 seconds. Another thing is blink. It's very simple, but I find a lot of people don't blink enough. [00:16:27.230] - Paul And sometimes people don't blink completely, do they? That's another issue I've heard is that if you're working intently on something that you might not do a full blink and you don't realise it. So that could be something else as well to consciously remember to do a full blink. [00:16:46.540] - Juliet I've had some patients behind this sleep lamp, and when you say blink, just realise that they do have links. So I always say to them, you need to consciously And sometimes I say, put a sticky note on your computer. I think there might also be apps you can download that give you an alert every 20 minutes to do a blink. [00:17:14.620] - Paul So I haven't tried them, but it sounds like it's worth a go.  [00:17:19.760] - Juliet Anything that works, really. And then another low hanging fruit is your artificial tears. Use your artificial tears, refresh your eyes when they feel dry. And we now have computer eye glasses. Professional computer glasses are very, very helpful. They reduce eye strain and they allow you to focus your eyes specifically at the computer screen distance and obviously help in shifting your focus in at near things and looking at computer as well. [00:18:02.960] - Paul Are you talking here about blue light glasses? [00:18:06.780] - Juliet So some of the, specifically, computer prescription glasses will have the blue light protection, great inside the lensing as well. So we try to differentiate the two. Some people will say blue light glasses You have many websites online promising, I don't have anything against that. But when a patient comes in, we put everything into perspective. How many screens do you work with? Then we tell her that and give them a four-part computer prescription glasses. I think When a patient adhere to all these things I've mentioned, I think it will help to mitigate the ocular symptoms. That would definitely arise because, like I said earlier, our lives we can't do without digital devices. But if we can help ourselves doing some of those things I've mentioned, it will help to reduce the But sometimes they'll come out of this. [00:19:34.340] - Paul Okay, all right. Well, some great ideas there. So Juliet, in general, what dry eye treatments do you provide within your clinic? You've got different treatments that you offer there at Junic Eyecare. Could you tell us about those? [00:19:53.230] - Juliet So first and foremost, at Junic Eyecare Clinic, we believe that treatment begins with getting a thorough understanding of what's going wrong with your eyes before we offer solution. And for that, we have the very latest in advanced dry eye health diagnostic equipment. This is your oculous keratograph 5M. It's a pretty special equipment. I can't live without, I tell you. What it does is, it It also allows us to visualise and assess the health of your ocular surface and your lumbar glands. We take pictures and scans before we start any treatment. Then while you're undergoing any treatment, we take progress photos so you can see the progress, how you're progressing with the treatment. At the end of the treatment, we also You are not up to photos and scan. Some of the treatments we regularly provide, we have your... Of course, we give advice on artificial tears, lead hygiene at home, how to do them. We do therapeutic meibomian gland expressions. We use the expressor paddle to make sure the meibomian gland expressions is expressed. We do Blefex in-office clean. [00:21:36.510] - Juliet Blefex, it is a small handheld device with a disposable soft microsponge tip. It spins in very high speed. It looks like a small electric toothbrush, but it's designed to allow for precision screening of delicate angles around the eye. We used to offer Blefra steam. We're just waiting on the latest model to come in. So Blefra steam is beautiful. Think about it as your spa. You have your mini spa with your- It's like a spa bath for your eyes, right? Exactly. It's actually cold. So it provides a consistent gentle steam that hits the eyelid area and softens the oil in the meibomian glands we've been talking about, making it easier for those oil to be secreted and to come out. So it's very crucial for the healthy Those are the main treatments that we offer now. And hopefully we're hoping to add a few more in the future. [00:22:57.730] - Paul Do you offer those What are they called? Is it Bruda? Bruda eye masks? Do you still sell those? [00:23:05.210] - Juliet We give out Bruda masks. And then there's another one which is fantastic as well, eye doctor masks. Beautiful I think made in the UK. So my patients, they've read about that as well. So depending on which one the patient is used to, so we So we put a mask for the eye dust, doctor mask. [00:23:34.370] - Paul All right. Well, aside from those those wonderful treatments, do you have any tips for what people can do for themselves if they have severe dry eyes at home, like any home remedies that you recommend, even preventative things like staying hydrated, wearing wrap around, sunglasses. Do you think all those ideas are good suggestions for people to manage the your own dry eyes? [00:24:02.520] - Juliet Definitely, I think they do. But my professional advice will be, firstly, get it checked out. To get the proper diagnosis. Like you know, there are two forms of dry eyes. We want to know which one are you managing. Is it the aqueous deficiency of the one, or is it the evaporative form of dry eyes? So please get it checked by an optometrist. And of course, Paul, like you mentioned, be aware of your environment. Avoid blowing air direct into your eyes. If you can wear the wrap Down glasses to block off wind and dry air, especially when you're outdoors, it helps a lot. Proper lead hygiene, make sure you get the proper lead wipes, the cleansers, the heated eye mask we talked about. Try get omega-3 fatty acids in your diet or in form of supplements. You have very good as well. Lastly, I'll say stay hydrated. Drink lots of water throughout the day. It's going to help everywhere, including And stay hydrated by using Ophala lubricants or. [00:25:36.430] - Paul Yeah, well, in the last episode, I talked to Dr. Rhiannan Richer, and she said that we should cut down on caffeine and cut down on our coffee, so which is a bit of a deal breaker for me, unfortunately. But yes, staying hydrated is very, very important, right? [00:25:52.120] - Juliet Yes, definitely. [00:25:55.140] - Paul Okay, well, so for anyone in camera, if you're If you are suffering dry eyes, especially now, as we head into the dry Canberra winter, if they want to talk to you, Juliet, what's the best way that they can get in touch with you You can check us out, check us the website. [00:26:18.330] - Juliet You have JuniceEyecare.com.au from there, you can book online or you can call the clinic. The number is on there. We are on social media, Facebook, Instagram, where we put out very useful content about your eye health almost every week. Yes. [00:26:46.570] - Paul I know you do. All right, we might wrap it up there, I think. So thanks for sharing that advice, Juliet. That was very, very informative. I know I learnt a lot of things out of today. So if you are a dry eye professional and would like to take part in this podcast project, then feel free to reach out to me directly. You can contact me via my website, that's opticsdigital.net So take care of your dry eyes, everyone out there. So thanks again, Juliet, for coming on. [00:27:18.880] - Juliet Thank you for having me, Paul. Thank you. [00:27:22.500] - Paul So until our next episode. Bye for now. Bye.bye..

[00:00:01.120] - Paul Welcome to the Dry Eye Treatment podcast. We interview eye care industry professionals who have experience in treating dry eye disease. Please remember that the content shared on this podcast is based on personal experiences and opinions. It is not intended as medical advice. Always consult your health care professional for any medical concerns. Now sit back and enjoy the podcast. Welcome to the Dry Eye Treatment podcast. If you suffer from dry, itchy or irritated eyes, you could be experiencing dry eye syndrome. And if that's the case, then stick around because on this podcast, we interview eye care professionals who specifically deal with dry eye disease. Over the next 20 to 30 minutes, you're going to get actionable tips on what you can do to manage your dry eyes. But first of all, who am I? My name is Paul Sallaway. I'm the owner of Optics Digital, which is a digital marketing agency that helps eye care practitioners to grow their business. I'm not an optometrist, but as a dry eye sufferer myself, I'm here to ask all the questions to the experts, so you don't have to. And today, I'm very lucky to have an optometrist who is working in Western Australia at Ezekiel Eyes, which is an optometry practice in Perth, renowned for its expertise with contact lenses.   [00:01:21.410] - Paul My guest graduated with a Master's degree from the Queensland University of Technology in 2017. She's worked in various roles since then in Queensland and Western Australia. At Ezekiel Eyes, she's working alongside Damon Ezekiel, who is well known in the Australian optometry community as the very first Australian to become the President of the International Society of Contact Lens Specialists. Welcome to the Dry Eye Treatment podcast, Dr. Rhiannan Richer. Hello, Rhiannan.   [00:01:47.830] - Rhiannon Hi, Paul. Thanks for introducing me.   [00:01:50.180] - Paul Yeah, thanks for coming on the podcast. So maybe just to kick us off, can you give us the 30 second lightning round version of your backstory so we know a bit more about you.   [00:02:00.100] - Rhiannon Do you want the personal or the professional version?   [00:02:02.730] - Paul Whatever you feel comfortable with!   [00:02:04.910] - Rhiannon Sure. So I have lived in Western Australia for about six years since graduating from university. And I've worked in various different roles. Prior to this, I was locuming, so that took me all over the country, mostly in Western Australia. And I got to see very different demographics and areas of what I would argue is the better side of the country.   [00:02:30.110] - Paul You just alienated all the East Coasters! LOL.   [00:02:32.220] - Rhiannon I think it's the most windiest, the most isolated and has the biggest urban sprawl in the world. So, yeah, it's a wonderful place to live. And I feel very blessed to have found a career path and also a place in the world that I really enjoy.   [00:02:53.720] - Paul Sounds great. Well, you mentioned windy, and so that's something that we might actually talk more about.   [00:03:00.420] - Rhiannon Windy and dry.   [00:03:01.530] - Paul Windy and dry, yeah. So that's probably something that we are going to explore a bit more later in the podcast. So one of the reasons I was excited to get you on is because in your practice there, Ezekiel Eyes, I know that you see a lot of contact lens wearers and in addition to having, dry eye patients in general. And so from what I understand, there are potentially some special challenges for contact lens wearers who do have dry eye conditions. So that's what I would like to delve into a bit today. But just to get started on that, can you explain to me, as a layperson, what is the difference between rigid contact lenses and soft contact lenses? So I've personally tried soft contact lenses back in the day, but I've never actually experienced the rigid contact lenses. The RGPs, I think you call them, aren't they?   [00:03:58.490] - Rhiannon We do, yeah. Correct. So we say RGP for short, just a bit less of a mouthful. So the main difference is the material. The soft lenses, you can squash it between your fingers. You can feel it's got a jelly-like consistency to it and it's very moldable. So whatever you put that onto, it will drape over that surface, typically being the front surface of an eye. A rigid lens is fast, stiffer, so you cannot fold or swish that lens at all. It almost feels like a hard in between your fingers if you were to play around with it. And it used to be, they used to be far more popular than they are now before soft lenses came to the market because they were one of the only options for many people. But now with the option of soft lenses, if the eye is suitable for a soft contact, most people will migrate themselves over to the soft contacts, often because the soft lenses are much more comfortable. They have a superior comfort to patients. But then we also have some patients whose prescription or eye shape doesn't allow them to wear soft lenses. And so they need to wear the hard contacts if they want them to be an option.   [00:05:12.660] - Paul Right. Yeah, actually. Yes. That's something I wanted to ask you about, are there certain patients or are there certain people who don't have any options other than to wear the rigid lenses? Like, are there certain people who maybe because of the shape of their cornea or whatever, just don't have the option of soft contact.   [00:05:31.660] - Rhiannon Yes, definitely. So there are some people who have got very high, what we call corneal astigmatism. So a lot of people have heard the word astigmatism being thrown around. And there is a portion of the eye which sits on the very front, over the colour part of the eye, we call the cornea. And if that eye has a significant amount of astigmatism, often soft lenses are very irritating and unstable. So the patients don't have very good vision with contact lenses. So then a hard contact lens doesn't have the instability that comes with a soft lens with a highly astigmatic eye. Now, that's what we would call regular astigmatism. There is another group of people who have a condition called k erythritonus. And this is what causes irregular astigmatism. And soft contacts or glasses can only correct for regular astigmatism. And so for these These patients who have got k erythritonus, the irregular astigmatism causes a significant amount of blur to their vision. But if they were to put a soft contact on, sorry, a soft contact lens or glasses on, it sometimes is as good as nothing. And the power for them comes in these hard contacts.   [00:06:48.640] - Rhiannon And so because of the rigidity of the lens, it essentially creates a new front surface to the eye. And it uses a tear layer underneath, which corrects a lot of the irregularity. And you see these lenses change people's lives. They get driving licences back. They can hold down a job. They can go back out into the world and see what they used to see before the condition took away a lot of their vision So I've had it described to me that k eryotoconus is a bit like the pointy end of a football, like the cornea starts to like, bulge. Yeah, that's what it looks like if you were to look at the tissue physically or if you looked at the corner, it's almost like a rugby tip of a ball poking out of the front of that eye. But the person who has the condition, the way that they see the world is very, very distorted. Often, if they were to look at a light, they get these significant halos and glow. And basically the light enters in their eye in an almost arguably infinite or at least unknown number of ways. And so glasses or soft contacts can only correct that two ways.   [00:08:01.620] - Rhiannon And so the hard contacts are really powerful for those eyes.   [00:08:07.760] - Paul Okay, so from what I hear you saying, then there are some people who just don't have the option of soft contacts. They do have to wear rigid contacts. Now, do you feel that rigid lenses are more challenging for people who suffer from dry eye?   [00:08:23.210] - Rhiannon They are more challenging than somebody who doesn't have dry eye. But whether it's a hard or a soft contact lens, where a dry eye always presents just a little bit of an extra challenge, it can, in specifically applying it to a rigid contact lenses, it can create issues with us assessing the fit of the lens. So making sure that we've got the right shape and size for the patient, as the lenses are heavily reliant on a tear exchange beneath the lens. And so if you don't have enough tear exchange, then And the lens can sometimes cause all sorts of problems, from fitting to irritation and all the regular dry eye symptoms that people experience.   [00:09:11.920] - Paul Okay. Are there things that Are there things that people can do to make contact lenses more comfortable if they if they do have chronic dry eye conditions? Like are there things like eye drops, for example, lubricating drops that that would help in that situation?   [00:09:29.510] - Rhiannon Yes, Definitely. Whenever we're using our contact lens, we want to use lubricants which are either contact lens compatible. So the bottle will specifically tell you that you can use them with your lenses or if they're non-preserved lubricants. Those are ones that usually come in little tubes. But nowadays they're getting quite clever and putting them into a multi-dose bottle. But it will say very clearly often in a nice big yellow banner on the front that they're And if they're preservative free, then they're absolutely fine to be used with contact lenses, even if they don't specifically sedate it.   [00:10:07.750] - Paul So not all drops are going to be good for your eyes. If you're wearing contacts, you do have to get particular drops.   [00:10:16.730] - Rhiannon If you're wearing- Some of them, the main risk is just that if they're a bit thick, they'll potentially blur out your vision and potentially ruin pair of contacts for the day. You'll have to take them out and rinse the lubricant off because it's created a bit of a hazy film on the lens. But majority of the time they're there. They don't cause any issues.   [00:10:42.060] - Paul Sure. Okay. Yeah. Well, I know that contact lenses come in a lot of varieties these days. You've got like daily disposables. I think those are the ones I had where you just pop them in during the day, take them out, throw them in the garbage before you go to bed at night. So you're always getting a fresh pair of lenses the next day. But there are other types of contact lenses that you can wear for longer. And I think maybe there are some that you can just leave in and not even remove from your eyes, aren't there? So they're extended wear lenses, aren't they? So are they more problematic for people with dry eyes?   [00:11:19.430] - Rhiannon Definitely. An extended wear lens, one that you... Some people can sleep in. There are a few lenses which are approved to be slept in and others which you still take out at night, but you wear the same lens for one month or sometimes it can be two weeks. It just depends on the design and manufacturer. They can dry with the length of use because the material over time just starts to dry out. And so how the lens feels on day one and how it feels on day 30 can be drastically different. And if you've already got dry eyes, your eye can start to really try to pull the moisture out of that lens. And then you can have issues with the vision being blurred in the contact lens and uncomfortable. And for some of my patients, they would... I've had a lady who was absolutely burning through her monthly lenses because she would only get about a week out of them before they would go completely blurred on her. And we switched her into a daily lens. And because you're using a new lens every day, she was very happy and we were able to get some stable, clear vision.   [00:12:32.220] - Rhiannon And she wasn't going through a monthly lens every week.   [00:12:36.370] - Paul Right. Well, okay. Well, as I mentioned, I think there are many types of contact lenses. The one that I find particularly interesting is something called scleral lenses. And I think that's that's something that you do a lot of in Ezekiel Eyes, isn't it? The scleral lens, the sclera contacts. Can you tell us a bit more about those?   [00:12:55.450] - Rhiannon Yeah, of course. So the sclera lenses, they're a type of rigid lens is a type of rigid And they're bigger than an RGP because they sit on the white push and die, which we call the sclera, hence sclera lenses. And these lenses are filled with non-preserved saline. And then it gets vaulted So it gets onto the eye and essentially creates a sealed system around the edge.   [00:13:20.460] - Paul So it just covers the hole. It covers a much greater area of the eye than the normal contact lenses would.   [00:13:27.330] - Rhiannon Yes, it does. So a regular So let's start with an RGP. An RGP lens in diameter is typically anywhere from eight and a half to 10 millimetres in diameter. A soft lens, you're looking closer to about 14 millimetres, which is what most people are familiar with. And we do a lot of what are called mini scleros, and they can be anywhere from 15 to 17 millimetres in diameter.   [00:13:54.200] - Paul And so I guess one of the big plusses of scleros for dry eye sufferers is that you basically you've got a layer of tears, like there are tears underneath the lens themselves. Is that right? Exactly. So it's like this fluid under there that's between your eye And the harsh environment.   [00:14:16.730] - Rhiannon Yeah, so because the eye is put in a basically a fluid filled chamber for the whole day, people who've got chronically dry eyes, it can sometimes be a reason that we put them into sclural lenses Because they suddenly have a barrier between the eye, the front of the eye, which is called the cornea, where it gets very, we call it desiccated, which is another word for dry and the atmosphere. So you've got this fluid layer basically protecting the eye from the dry environment or the air.   [00:14:51.980] - Paul And so there are a lot of reasons, or there are other reasons why people would have scleral lenses, aren't there? I mean, it's not It's not just a dry eye solution.   [00:15:02.580] - Rhiannon Correct. Yes. So we use them for dry eye or like I was saying before, keratoconus. We fit a lot of our keratoconus patients and scleral lenses. And then there are a few of our other patients who have had a disruption to their cornea, also causing an irregularity, like keratoconus in a sense, but it will have a different cause. So it might have been a trauma, if they'd had an injury to the eye, it just created some scarring on the or if they had an eye infection, again, creating the scarring, or if they had a laser complication, which again creates this irregularity to the cornea.   [00:15:43.560] - Paul Okay, well, You mentioned laser, like I know LASIK procedures are quite popular, aren't they, these days? So tell us a little bit about what is LASIK? What is LASIK treatment, first of all? And is there any, are there any side effects for getting LASIK treatment related to dry eyes.   [00:16:02.760] - Rhiannon So LASIK is one of a few different corrective procedures that people can choose to have the prescription of their eye corrected. And depending on the amount of tissue which is present and the amount of prescription which needs to be corrected, we'll determine which procedure you have. So LASIK is one of the most common, and this is because It's got the quickest, but that's a decision that often happens between the patient and the ophthalmologist. Essentially what LASIK is, is it's removing a portion of the cornea to correct for the vision. And because it's a surgical procedure which is done on the cornea, it can exasperate dry eye symptoms. And it's often a really smart move to have the eyes in a really call it moist position before going in for any eye surgery, really, because it would just help you on the other side with the dry eye gets exasperated in any procedure on the cornea, and it would just help you with your your comfort on the healing.   [00:17:20.180] - Paul Okay, all right. Well, yet another type of contact lens that people may have heard of is something called Ortho-K lenses, which comes from orthokeratology, I believe. Tell us more about that. What is it and why could that be a good option for people who have dry eyes?   [00:17:40.180] - Rhiannon So the Ortho-K lens is correct for the prescription of the eye through reshaping the cornea while you sleep. And the benefit is that during the day in the waking hours, you are glasses and contact lens free. So contact lenses make dry eye worse. And wearing them while you sleep because the eye is closed, it doesn't have any influence to exasperating the dry eye. So the benefit is that you get to see the world with absolutely nothing on your face or in your eye.   [00:18:14.550] - Paul I like to think of them as like my daughter wears braces when she goes to bed at night and the braces correct her teeth. They gently reshape her teeth while she's sleeping. And like the way I think about Ortho-K is that they do the same thing with your cornea, don't they?   [00:18:31.160] - Rhiannon They do. And it's reversible. So as soon as you stop wearing the lenses, the tissue just bounces back to its original shape and the original prescription. Right.   [00:18:39.990] - Paul That's really a non-invasive way of controlling your your your vision. A lot of people I know, I get interested in Ortho-K as a solution for myopia for their children. But Ortho-K is also beneficial for adults as well, isn't it? It's not limited to just kids.   [00:18:57.330] - Rhiannon Yes, we have. I have many adult patients in Ortho-K and they absolutely love it. It can create glasses and contact lens free for anyone of any age. The main limiting factor is prescription. And you're just not going to know until you go and have an assessment and you have your cornea scans and a discussion with an optometrist.   [00:19:22.380] - Paul And so your optometrist will order basically a custom pair of contacts for you, just like getting a custom made suit. They're going to be contacts that are made specifically for the shape of your cornea. Yes?   [00:19:35.510] - Rhiannon Yeah. So, yeah, every lens is custom made because no two eye shapes are the same.   [00:19:53.500] - Paul Okay. Well, we've talked a lot about contact lenses, but does Ezekiel Eyes have any other in-clinic dry eye treatments available?   [00:20:02.620] - Rhiannon Yes, we do. There's a few that we offer. So the first one we call IPL, which is Intense Pulse Laser. And it's a broad spectrum laser, which improves the functionality of the, we call them the meibomian glands, which are the little oil glands that secrete the oil layer of the tears. And what can happen commonly is that the meibomian gland, where they open on the lid margin just behind the eye lashes becomes inflamed. And so IPL treatment, it helps to improve the oil within the meibomian glands.   [00:20:43.830] - Paul Any other treatments you have in there?   [00:20:47.290] - Rhiannon So we also offer something called Zest. Zest is made by a company called Zocular. And the Zest is a gel formulation And its main active ingredient is derived from an okra complex. And we take this gel product and we use it to give the eyelid margin a very deep cleanse. And what it does is it works on the biofilm created by bacteria, which are often present in many of these inflammatory dry conditions, one of those being dry eyes. It also helps with a condition called blepharitis or styes. And I've also had a couple of my patients who've had very bad ocular eczema, who have responded extremely well to the product. We've actually managed to get them off their steroids. It surprised me, and they're very happy. So basically what the Zocular does is it enacts on this bio film, which in turn helps to decrease the inflammation, which is a big driver in the dry eye. And then for patients who suffer from what we refer to as aqueous deficient dry eye, which is essentially they have a very low volume of tears. So this is different to the meibomian gland.   [00:22:21.600] - Rhiannon The meibomian gland creates the oil layer, which is the surface layer of the tear. These patients often lack the water layer, the bulk volume of the tear. And what I can do here is put some, we call them punctal plugs. Essentially, they block the tears where they drain and it retains what little tear volume they have in the eye   [00:22:47.800] - Paul Do they need to go to an ophthalmologist for that?   [00:22:50.120] - Rhiannon No, we can do it here. It's quite quick, minimally invasive and painless. You often I put them in and then they say, are they in? Yeah, we're finished. Yeah, you can't really feel them when they're in properly.   [00:23:06.970] - Paul Good. Well, if it's painless, that gets a checkmark from me! So I said we'd get to the dry, windy weather of Perth eventually. A lot of people do live in places where the conditions are a bit drier, a bit windier, a bit dustier. I was talking to someone some months ago who's up in Port Headlands. And if you know anything about the north-west area of Australia, you're right on the edge of the desert there. And on top of that, you've got all the mining stuff going on around that creates extra dust as well. So some environments are more challenging than others. Do you have any tips on what people can do to really take care of their in challenging environmental conditions?   [00:24:03.380] - Rhiannon Yeah, of course. So as you've mentioned, there's an environmental component to the dry eye. And the things that make that worse will be wind, your digital screens, computer, mobile phone, TV, air conditioning and reading. So taking regular breaks when we know we're going to be sat on our computer, which is most of us for our working day. Just remembering to blink Because when we have a prolonged near task, our focussing creates a decreased blink rate, which then drives our eyes out even more. Just being very mindful of your hydration. So we want water intake up, coffee and alcohol down, which isn't always possible. I know. I definitely wouldn't want to give up my daily coffee, or coffees some days. So it's just being mindful around making sure you've had enough And you've got the lubricants, which are typically over the counter or even just off the shelf at the supermarket, which can be effective in helping the symptoms of dry eye, but they don't necessarily address the cause or at all, really. And so if you want to help get to the bottom of some of the more physical drivers, then you're best going to see an optometrist and having an assessment done on whether something like IPL or the Zest treatment or the punctal plugs would suit your eyes, because it depends on what type of dry eye you have to where you benefit the most.   [00:25:37.420] - Paul Well, so it sounds like you've got all the options there, Rhiannon. So I think if anyone in Perth who is, who needs help with dealing with their dry eyes. They should get along and see you or Damon to Ezequielize there. So we might wrap up, I think. So do you have anything you'd like to add or any last tips for us?   [00:26:04.150] - Rhiannon Well, I just like to thank you for having me on. This has been exciting. It's my first podcast, which is been... I really enjoyed it. So I appreciate it. And thank you.   [00:26:15.320] - Paul Good. Well, thanks. I was just going to say thanks for contributing. I think there's a lot of good information that you've added today.   [00:26:23.780] - Rhiannon Thank you. I appreciate it. It was very good questions.   [00:26:28.360] - Paul All right. Well, so on that note, let's wrap up, I think. So if you are a dry eye professional yourself and you'd like to take part in this podcast project, then feel free to reach out to me directly. You can contact me via my website at opticsdigital.net or connect with me through LinkedIn. So all right. Well, thanks a lot, Rhiannan. And take care. And yeah, thanks a lot. Thank you, Paul.   [00:26:55.420] - Rhiannon Thank you, Paul. Bye, bye. Bye.bye. Bye.  

[00:00:01.060] - Introducer Welcome to the Dry Eye Treatment podcast. We interview eye care industry professionals who have experience in treating dry eye disease. Please remember that the content shared on this podcast is based on personal experiences and opinions. It is not intended as medical advice. Always consult your health care professional for any medical concerns. Now sit back and enjoy the podcast.   [00:00:30.590] - Paul Welcome to the Dry Eye Treatment podcast. If you suffer from dry, itchy or irritated eyes, you could be experiencing dry eye syndrome. And if that's the case, then stick around because on this podcast, we interview eye care professionals who specifically deal with dry eye disease. Over the next 20 to 30 minutes, you're going to get actionable tips on what you can do to manage your dry eyes. But first of all, who am I? My name is Paul Sallaway. I'm the owner of Optics Digital, which is a digital marketing agency that helps eye care practitioners to grow their business. I am not, repeat, NOT, an optometrist, but as a dry eye sufferer myself, I'm here to ask all the questions to the experts so that you don't have to. And as my very first expert, I'm proud to invite a gentleman who I've known for about a year now. My guest He's a qualified eye care professional. He studied optometry at University of Melbourne in Australia and did a clinical externship at Illinois College of Optometry. He has given lectures to hundreds of optometrists about dry eyes. He was part of Optometry Australia's inaugural Dry Eye Guide.   [00:01:52.930] - Paul This guide is the first of its kind to list all the products and treatments available in Australia. He regularly writes Optometry Industry magazine, MiVision on dry eye topics. He's a full-time clinical optometrist and sees people every day with dry eye disease. Last but not least, he is the owner and initiator behind the Dry Eye Directory, a site that connects dry eye sufferers with dry eye specialists around the world. A site, incidentally, that Optics Digital had a role in relaunching last year. So with that resume, as long as a Snellen Eye Chart, hi Leigh, how are you doing?   [00:02:30.140] - Leigh Hi, Paul. Thanks so much for having me.   [00:02:32.360] - Paul Good to have you. Welcome. And maybe just to kick things off before we get into the topic, perhaps the listeners would like to know a little bit more about you. So could you give us the 30 second lightning round version of your backstory and why you became interested in dry eye disease in particular?   [00:02:54.480] - Leigh Yeah, thanks, Paul. So I think for me, dry disease started when, back in 2006, 2007, I wanted to be able to give my patients lasting relief. They'd come to me with irritated, dry, itchy, watery eyes, and they'd struggled to find relief. And I'd try to find the ultimate eye drop for them. And it was a search and I'd try and I thought I'd found a really good drop. And then some people would tell me, it's just not that good. It's not that lasting. And then I started talking about other things, surprising things like baby shampoo. And that didn't really help either. And for me, it drove me to try and find a solution for patients. How can we get to the underlying cause and really help people to get their quality of life back again? And that's also being a dry sufferer myself. I've got a personal interest in dry eyes and how to improve it.   [00:03:59.410] - Paul So you've been on this quest for quite a while. So what did you say, since about 2006, 2007?   [00:04:08.030] - Leigh Yeah, that's right. It's been a while of working through dry disease and being a guinea pig for my I'm wearing patients.   [00:04:16.820] - Paul You've got to eat your own dog food, they say. So I know you try a lot of the products that you recommend, don't you, yourself?   [00:04:25.300] - Leigh Yeah, absolutely.   [00:04:26.460] - Paul All right. Well, maybe just to break it down for a layperson like myself. So what is dry eye disease exactly? What are the mechanics? What's going on with my eyes if they're feeling itchy and red and irritated? What is it exactly?   [00:04:45.270] - Leigh Most people actually come to an optometrist thinking that their glasses aren't working properly. They might think, sometimes their reading glasses work. They can see, well, other times they feel like they're not working. And they've come to have an eye test feeling like there's a problem with their glasses. And other people might just put it down as, my eyes feel tired. I'm just stressed. I've been working heaps. And they just write it off as it's end of day tiredness. But the blurred vision and tired eyes, they're some of the most common symptoms of dry disease. To protect our eyes and to lubricate them, we have a fluid over them called the And the tear film is a little bit like a wetsuit. So when it works well, it's nice and thick, protective, helps to protect us from the environment, from evaporation, from air flow, from dust particles, other debris. So it works really well to protect us, a bit like a wetsuit. When the tears dry out, they tend to evaporate more quickly and we're left with in this more like a business shirt and it doesn't protect us well. So we're missing that barrier that helps our eyes to function properly.   [00:06:12.550] - Leigh And it's also that same barrier that creates the clarity of vision. So most of the change of, most of the focussing actually comes from the tear film. So if that tear film isn't stable or is thinned out, then that also makes things blurry So dry disease is a lack of the right ingredients in the tear film. There's actually over around 2000 ingredients to the tear film. So when we think about this, there's lipid, so an oil content, there's a mucus content and there's a water content. And there's thousands of other components that go together to make the tears cohesive and a good structure. So more than just being salt, water or saline, there's a whole lot of complexity there. So dry eye disease is really where there's an imbalance of those factors or not enough being produced or there's some other factors that are getting in the way of this cohesiveness working together.   [00:07:20.450] - Paul Right. So if I understand you correctly, there are like glands in your eye or in your eyelids that produce a an oily film that covers the moisture, the tears of your eyes. And it prevents that moisture from evaporating. Like a pool of water on a hot day, it's going to evaporate in the sun. Like a lot of people, if they have ingrown pools, they put a cover over the top, I think, partly for that reason to stop the the water evaporating. So it's the same thing, isn't it? Yeah.   [00:08:00.360] - Leigh Yeah. And that's a great analogy, Paul, with the pool covering. So the the oily layer is literally only a few micrometres in thickness. So it's a really thin layer. Again, it's very complex with some of the oils. There's polar oils, nonpolar oils, and they all cohesively work together. And around 86 % of people with dry eyes have a dysfunction of these oil glands. So that means that these glands might get clogged up, stagnant. They don't produce like they should. And we end up with the pool covering coming off.   [00:08:41.620] - Paul Right. Okay. And all right. So there are glands that produce this good oil. It's like when you're a teenager, maybe a lot of us have problems with with oil glands producing more oil than we needed. But in this case, actually, the oil is good. We want it, don't we? To keep our eyes moist. Is that fair enough?   [00:09:09.330] - Leigh Yeah, definitely. And there's a lot of similarities between the oil glands in our skin, that overproduction, as you say, with acne and the oil glands in our eyes, very similar structures. And we're also learning more about how relevant the skin is to the eyes, because that skin environment around the eyelids can also affect those oil glands.   [00:09:36.050] - Paul Okay, well, so dry eye disease is something that I've been hearing more and more about in recent years. But who does it typically affect? Does it affect a particular age range more than others, a particular gender more than others, people with particular lifestyles, people with particular occupations? Maybe in your own clinical experience, who tends to be overrepresented in the dry eye population?   [00:10:09.770] - Leigh Yeah, it tends to dry. It's certainly prevalent. So 5% to 50 % of the population has dry eyes, depending on the population you look at. And certainly some countries tend to have an overrepresentation of dry disease. It tends to affect It's more common in age and more common in women. And that's the traditional understanding that we've had for dry eyes, even up to early 2000s, that we thought it was an older people, older population disease. And now we're starting to realise that with our digital lifestyles of screen time, smartphones, tablets, laptops, This change in our lifestyle pattern, where maybe we're sitting staring at a screen more than we would be going out and enjoying a walk outside, going for a run around the block, going for a bike ride. So we're being more sedentary in our behaviour now. And certainly with the pandemic, we had no option. We were forced to sit in front of a screen if we wanted to work, socialise, do most things. We'd have to sit in front of the screen. So it wasn't, pandemic wasn't ideal for dry eyes.   [00:11:39.700] - Paul Yeah, that's one of the things I was going to ask you, actually. Did you see something of a spike in dry eye complaints during the pandemic?   [00:11:50.410] - Leigh Yeah, and also masks as well from the pandemic. The masks tended to direct airflow from the mouth. And up towards the surface of the eyes. And there was a new condition termed called mask associated dry eyes or MADE.   [00:12:11.670] - Paul So a catchy acronym.   [00:12:14.970] - Leigh Yeah. Yeah. And it's so this this condition made has started to help us become even more aware of the role of masks and dry eyes.   [00:12:29.560] - Paul Okay. So if I suspect that I have dry eyes, by the way, let's just get a little vocabulary out of the way. So what do you tend to call it? Is it dry eye syndrome, dry eye disease, dry eye? What do the professionals tend to talk, tend to say when they talk about this topic?   [00:12:53.750] - Leigh I like to say dry eyes because it's easier and people can bounce around in their minds. Interestingly, dry eyes can also lead to watery eyes. And that's one of the oddities.   [00:13:10.770] - Paul That's the irony, isn't it? So dry eyes can lead to anything but dry eyes. You can get very teary reactions, can't you?   [00:13:20.310] - Leigh Yeah, that's right. And so when we were talking about the oil and water and mucus before, if we're missing the oil layer, the body tends to overproduce either water as a compensation or mucus, and you get that stickiness. So it's technically an ocular surface disease. That's what we use to describe it better. But for some reason, we ended up choosing dry eyes a long time ago, and so we've stuck with that.   [00:13:54.460] - Paul Sure. Okay. Well, if I think I have dry eye disease, that's Let's call it that. What should I do? What are the steps that I should take? Should I just talk to my GP, my general practitioner about it, or go down the local chemist or go see the optometrist? What do you suggest?   [00:14:16.560] - Leigh Yes, some people tend to do a combination of those. So they might see their GP or go and visit their pharmacist, the people that they're used to talking with and dealing with every day. And usually the doctors and pharmacists might suggest, try this particular eye drop for dry eyes. And if you've been to a pharmacy and you've looked at how many different brands and types of eye drops there are, it's almost like cereal. There's so many different options. And it can be can be tough to decide. Some people have their go to eye drops that they prefer. And so the doctor or pharmacist might start you off on some particular eye drops. Sometimes they can give you relief, and particularly if you just have dry eyes that are very infrequent Frequent putting a lubricating drop in can be enough to get you the relief you need. For some people, though, those particular drops aren't enough. And it's disappointing that some people have to go through almost the whole shelves of eye drops, and they still can't find enough relief for their eyes. And for them, I'd recommend trying to understand stepping back and thinking, what's the real causes for my dry eyes?   [00:15:50.560] - Leigh Sometimes that means that you have to be almost like an advocate for yourself. You have to ask more questions to the practitioners, to the GP, to the pharmacist, the optometrist or ophthalmologist. That might mean that you have to try and go in to battle for yourself that way. The better that you can understand what's causing your dry eyes, the better that you can find more tailored solutions that will be effective for you. And you're going back to that 2006, 2007. Since then, we've had there's been a significant increase in the diagnostics we have now. So the ways that we can scan your eyes, we can look at the oil glands, we can see how quickly the tears are evaporating or leaving the surface of your eye. We can look at how well you're blinking if your eyelids do actually touch together, which is your ideal, or if there is a gap that you're unaware of. And we can also measure the saltiness of the tears look at the oil out, how thick it is, even press on the oil glands so that we can see this gland's really thick and toothpasty and not working well.   [00:17:10.070] - Leigh And this one next to it is flowing just like olive oil. So these tools, the hands-on, can really give us an idea of what's working for your eyes and what we need to improve.   [00:17:24.780] - Paul So your local eye care professional, it sounds like they And we have a lot of advanced diagnostic tools that your local GP wouldn't necessarily have, certainly your local pharmacist wouldn't have. So if you haven't had any luck with off the shelf, eye drops, it sounds like getting a proper assessment done would be a good course of action.   [00:17:54.530] - Leigh Yes, and more and more practitioners are choosing to become specialised in certain areas, like dry eyes. And these particular practitioners would tend to have more diagnostics available, and they might even have a longer appointment. So that gives you more time to talk about your eyes, explain your symptoms, and to have a holistic approach to finding relief for your eyes.   [00:18:21.770] - Paul Yeah, and some of them have some very advanced treatment options as well, don't they? And I want to get on to talking about your dry air directory, but perhaps you could just talk us through what are some of the more advanced treatment therapies that they have, for example, IPL is something that seems to be coming fairly popular with practitioners who do specialise in dry eye treatment. Can you tell us a little bit about that?   [00:18:52.290] - Leigh Yeah, IPL treatments, it was discovered back about 20 years ago. Dr. Rolando Toyos was treating patients for rosacea. And that's those little spider vessels, redness, flushing. And you can get it in around different parts of the face. And he did treatments for the patient to treat their rosacea. And And he actually said, you've treated my skin, but my eyes actually start to feel better, too. And that led him to try and tailor the treatment that's not only for rosacea, but also for meibomian gland dysfunction. And so IPL helps to work. There's flashes directly on the skin. So there's flashes on the top and bottom eyelids. We have a shield to protect the eyes. And also flashes around the cheeks, nose, forehead, all around the face. The light travels through the skin and it enters into the meibomian glands. Inside those glands, it then goes into the energy part the cells and it starts to switch them on. So it's boosting them up, making them more effective, younger, their metabolism higher. So for the 86 % of the population that have meibomian gland issues, intense pulse light can be a real valuable tool to be able to treat patients.   [00:20:23.980] - Leigh And it's also beyond that. It also works by reducing those little red spider vessels, telangiectasis in ocular rosacea. And the intense pulsal light helps to reduce the saltiness of the tea film. So that's one of the ways that the tea film gets more inflamed because the moisture is evaporated and we get this salty mix, which is aggravating to the eyes. So it reduces the saltiness. And the Intense Pulse light also helps to kill bacteria and demodex on the surface. I've seen a robot set up in a surgical room as an Intense Pulse light, and they put it in the centre of the room and leave the room and switch on the Intense Pulse light And it kills all the bacteria inside the room.   [00:21:19.030] - Paul Wow. So it sounds like a great treatment. Sounds like there's a lot of benefits. Those little mites, what do you call them? Demidox? Demodex?   [00:21:33.540] - Leigh Yes. Demodex.   [00:21:35.620] - Paul Demodex, yeah. That's quite an eye opener once you, no pun intended, but when you realise that they're actually microscopic organisms that are living in and around our eyelids that can, in fact, be contributing to the dry eye issues themselves. And so IPL treatment can Can deal with all of that, apparently.   [00:22:02.580] - Leigh Yes, it's very helpful for killing those demodex that are... Having some is quite normal, but having an overpopulation, that's when they can contribute to problems.   [00:22:15.300] - Paul So it sounds like that if I want to get serious treatment done, I should look for a dry eye practitioner who is a specialist or who specialises in dry eye treatment. And that's probably a good segue for us to talk about the dry eye directory, which is your project. So can you tell us, in your own words, how the dry eye directory website can help somebody like me who's looking for answers and treatments and recommended products for dry eye syndrome?   [00:22:52.770] - Leigh Yeah, a lot of people try those initial drops from the pharmacist, and they might struggle to find relief. And then they might maybe turn to a friend or they'll hop on to Google and type in dry eye treatment into Google. And that's when they can find the dry eye directory. So the goal of the dry eye directory is to be able to educate people about dry eyes, about the causes for dry eyes and about treatments. So the more that the more that people understand dry eyes and their dry eyes, the more that they can find treatments that work. So the website is set up to be able to educate people about their condition and help them to connect with a specialist near them. And there's a search function on the website that helps them to find the specialist near them. And these are people that have invested in these advanced treatments, such as IPL, lipophilo, and other treatments. So these are people that are the So I've definitely got an interest in helping you to find relief for your eyes.   [00:24:06.030] - Paul So there are a lot of, I think last time I checked, there's like 170 or so practitioners that are listed on your directory. The majority of them are in Australia, New Zealand, North America. But I think that's probably going to grow over time. So that is a good way for people to find the nearest specialists who offers some of these advanced diagnostics and advanced treatments. But there are other things on your website as well. You've got an online shop where we actually promote some of the products that you've tried yourself. So do you have any favourites, any favourite home treatment that I could buy online today and start trying out? I think I do have some issues with because I spend probably too much time in front of a computer, my my eyes feel a bit scratchy, like I've got something stuck in them at the end of the day. So what do you recommend for somebody like me?   [00:25:12.750] - Leigh Yeah, definitely. It's good to have something That's very accessible and easy to do. One of my favourite treatments is a hypochlorous spray. We often don't realise that just like you can get plaque on your teeth, you can also get plaque on your eyelids. And so you get normal bacteria that like to overgrow and they produce a lot of protein to try and protect themselves on the surface of the skin. So that's called a biofilm. And the biofilm then starts to invade and gradually migrate from the lashes onto the edge of the eyelid, into the surface of the eye, and also into the oil glands. So if we can try and reduce this migration of the bacteria by using a simple spray for your eyes. And it's similar to the dental analogy of brushing your teeth. So if we use it morning and night and spray it onto closed eyelids, it feels refreshing to use. You're not adding drugs or other prescription products into your eyes. And it's a great way to give your eyes a break and feel refreshed after using the spray. And by keeping it up, just like brushing your teeth every day, you're going to get your eyelids in better shape and help reduce the impact of the the bacteria in causing dry eyes.   [00:26:42.230] - Paul And so it comes in a spray bottle dispenser, does it? Or how big are the actual bottles that I would get?   [00:26:53.680] - Leigh The spray comes in around about a 40 milli to 60 milli bottle, and it's It's very small, so it fits in your hand easily to be able to spray it on. It's similar size to a glasses spray bottle. And use the nozzle and then hold it up and close your eye and spray it on the outsides.   [00:27:18.010] - Paul And how many days would I get out of one of those? One bottle? Like, how many days treatment?   [00:27:26.280] - Leigh With the spray, most people get around at least six weeks So it's a treatment from one bottle. So it's not a... You don't have to use a lot of it, but it's enough that it does give that refreshing relief.   [00:27:41.320] - Paul Okay, I'm sorry, what's it called again?   [00:27:44.410] - Leigh So It's hypochlorous acid. And some of the most popular products are Avanova and HighClear, and Hypochlor. So they're some of the most common ones on the market today.   [00:27:59.270] - Paul Okay And so we can pick that up through your website online store, is that right?   [00:28:06.740] - Leigh Yes, that's right.   [00:28:07.770] - Paul Okay, good. All right. Sounds interesting. I'm going to check it out. But we can get some other things, some more information, I think, from your dry eye directory as well. You have a quiz, I believe. Can you tell us a little more about the quiz?   [00:28:25.300] - Leigh Yeah, a lot of people search for dry eye symptoms. So because there's so many different symptoms, it could be blood vision, red eyes, itchy eyes. There's a good dozen or more different symptoms that can actually be the result of dry eyes. And this quiz is one of the ways to be able to see, is my dry eyes, do I have dry eyes? And it's a simple five question questionnaire, five question questionnaire. And And it takes about 30 seconds to do. And at the end of the questionnaire, you'll get a result. You get an instant score. So you can see if you have minimal to no dry eyes all up to mild, moderate or severe dry eyes.   [00:29:17.230] - Paul Okay, so you can get some objective yardstick of how severe your situation is and from there, decide on the severity of it and What action you should take from there?   [00:29:33.980] - Leigh Yes. And it also questionnaires like this, especially when we do them in appointments, these questionnaires help us to gauge the success of the treatment. So we know if your score was high initially and then it's dropped down, we know that the actions we're taking are helping your eyes.   [00:29:55.250] - Paul Right. So these are similar to the types of questions that I a dry eye practitioner would actually ask you in your initial consultation. Is that it?   [00:30:06.240] - Leigh Yes. They'd have a thorough consultation, including a questionnaire.   [00:30:12.540] - Paul All right. Well, that sounds good. And also, I think you've got an e-book or an e-booklet that people can get through your website as well, which includes some basic tips on managing dry eye as well. So So I might just mention again, it's dryidirectory. Com, and you'll see that e-book on Lee's homepage. So I highly recommend that. It's for free. Just have to put in your email address in and it'll get delivered to your inbox. All right. Well, Lee, I don't know. Is there anything else that you wanted to mention? If people want to get in contact with you to talk about your work with dry eyes or if they want to learn more about the topic, what's the best way for them to do that?   [00:31:09.190] - Leigh Yes. And we also run a group on Facebook called Dry Eye Care and Support. And one of the problems with dry eyes is that it can be hard for other people to relate to your condition. It can almost be like a mental health concern. Mental health is so invisible. You could walk past 10 people and not realise that any of them had a mental health condition. And that's why it's helpful to be able to connect with other people with dry eyes. So to be able to bounce questions, does anyone else feel the same as this or has anyone tried this treatment? Or help me find a good specialist that you've seen near you? So people can connect Hoplin Facebook to dry care and support and join the group. And so that would be one way to connect. And they can also reach out to me through email, [email protected] And I'm happy to have a chat and answer questions over email.   [00:32:17.470] - Paul All right. Okay. Well, thanks, Leigh. Well, on that note, we might wrap up for this week. So I hope people who listen to this get some value from our discussion. I'm sure they will. And so I hope to bring you a new podcast episode, roughly every fortnight. And the intention is that we'll have a chance to get helpful insights into managing dry eyes from other professionals, like Lee. If you are a dry professional yourself and you'd like to take part in this podcast project, then feel free to reach out to me directly. At the moment, you can do that through my LinkedIn profile or check the podcast show notes because there will be some additional contact information that will be there. But I think that should do us for this week. So stay well, everyone. Take care of those eyes. So that's all for now from the Dry Eye Treatment podcast. Catch you all again soon. Bye for now. Bye, Leigh.   [00:33:24.590] - Leigh Thanks, Paul.