Eyedolatry

Meet TrueTear, the Intranasal Device That Could Revolutionize Dry Eye

Allergan TrueTear neurostimulation device 5:22 PM

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Is Your Lash Growth Serum Causing Lasting Damage?

What do women want? The results of a 2014 Allergan survey showed 75% of women age 18-65 want longer, thicker and darker eyelashes. It was that kind of overpowering demand from market research that drove Allergan to bring Latisse to market, their blockbuster lash growth serum that shows clinically significant changes to lash length, thickness, and darkness within 16 weeks of use. The results speak for themselves:

via

But what is the real price of longer lashes? Latisse has well documented side effect potential. The main active ingredient bimatoprost is a chemical known as a prostaglandin analogue. Prostaglandins are chemical compounds found in naturally within almost all of our body's tissue that are responsible for signaling inflammation within the body. As such, it's no surprise that Latisse has been associated with common symptoms of inflammation around the eyes like swollen lids (also called chemosis), redness, itching, and watering. FDA clinical testing show about 4% of Latisse users experience itching, redness, and watering, while a much lower number experience an allergic reaction causing the eyelids to swell. In addition to chronic irritation, Latisse has also been known to darken the eyelid skin and the color of the iris in people with light brown or hazel eyes, as well as potentially causing a sunken eye appearance by shrinking the layers of orbital fat around the eye socket.

Popular beauty blogger Kate of The Small Things Blog shared the dry eye side effects that made her quit Latisse on her blog. via

It's easy to brush off eye irritation as no big deal, but ocular surface dysfunction and chronic dry eye can take a permanent and lasting toll on your vision quality and ocular comfort. Prostaglandin analogues have been used for decades in glaucoma treatment (including bimatoprost - the main active ingredient in Latisse), and studies have confirmed that they are strongly related to lasting dry eye issues. In fact just under 50% of all patients on prostaglandin analogue eye drops for the treatment of glaucoma also have a diagnosis of clinically significant chronic dry eye disease. While the preservatives in medications like Latisse or glaucoma drops have historically been blamed as the main culprit in causing dry eye, we know now that prostaglandin analogues in and of themselves can cause significant dry eye disease.

By promoting inflammation on the ocular surface, prostaglandin analogues can disrupt tear film production and expression at all layers. This includes the water layer of our tear film expressed by the lacrimal gland and the mucin layer expressed by the goblet cells on the surface of the conjunctiva. Inflammation also promotes thickening of the oil secretions (sebum) expressed by sebaceous glands in our eyelids. The meibomian (sebaceous) glands run vertically through our top and bottom eyelids and are responsible for secreting the top coat oils that hold the water and mucin layers of our tear film onto the surface of the eye.

Inflammation causing dry eye can disrupt the ocular surface at every level. via

Every time we blink, the meibomian glands secrete their oil. If that oil is too thick, it's difficult for the eyelids to spread it evenly over the surface of the eye --more like toothpaste than olive oil. It may even get so thick that the oil blocks and backs up in the gland. This will slowly but surely damage the gland permanently. If the meibomian glands atrophy or die off, the body is not able to repair the tissue and the gland becomes permanently nonfunctional. The result is irreversible and often severe dry eye. A 2015 study showed a shocking 91.7% of patients treated with prostaglandin analogue drops for glaucoma had meibomian gland disease, versus only 57.7% of patients being treated for glaucoma on a different category of medication.

via

What's gotten more press than the possible risk of permanent and irreversible dryness and ocular surface damage caused by Latisse or other prostaglandin analogue agents is the financial cost. At around $130 per month, prescription lash growth isn't cheap. Over the counter alternatives have increasingly gained popularity due to this price point, but unfortunately the fact that they are not prescription leads some to falsely feel they must also be safer. A list of the ingredients of one of the most popular over the counter lash growth serum, Rodan and Fields Lash Boost, shows a not-so-friendly potential dry eye culprit:

Ingredients: Water, Butylene Glycol, Hydroxyethylcellulose, Keratin, Hydrolyzed Keratin, Biotin, Sodium Hyaluronate, Isopropyl Cloprostenate, Octapeptide-2, Allantoin, Panthenol, Copper Tripeptide-1, Pantethine, Polypeptide-23, Cucurbita Pepo (Pumpkin) Seed Extract, Glycerin, Sea Water, Malus Domestica Fruit Cell Culture Extract , Hydrolyzed Glycosaminoglycans, Prunus Amygdalus Dulcis (Sweet Almond) Fruit Extract, Backhousia Citriodora Leaf Oil, Dipotassium Glycyrrhizate, Rhizobian Gum, Styrene/Acrylates/Ammonium Methacrylate Copolymer, Xanthan Gum, PVP, Lecithin, PEG-12 Dimethicone, Alcohol Denat, Chlorphenesin, Phenoxyethanol, Sorbic Acid, Sodium Hydroxide

What is Isopropyl Cloprostenate? It's a synthetic prostaglandin analogue. As such it has the same method of action described above, and yes all the same potential side effect profile. In fact, the FDA issued a warning to OTC lash serum makers back in 2011 about the potential dangers of including a synthetic version of a prescription product with known FDA-studied side effect profile in their formulations. Statements from companies claiming that they "contain no active medical ingredient" like this from the FAQ for Rodan and Fields Lash Boost makes it all the more confusing for potential patients trying to do their due diligence if they know they have a previous diagnosis of dry eye or are at increased risk.

The advertising claims that this product is safe, but it contains a synthetic version of the same chemical category (prostaglandin analogues) that have proven dry eye and ocular surface side effects in glaucoma medications.

Here's a list of the most popular OTC lash growth serums using synthetic prostaglandin analogues in their formulas:

Xlash Eyelash Enhancer
Neulash
NeuveauBrow
RevitaLash
Nutraluxe MD Lash
M2 Lashes Eyelash activating serum
Peter Thomas Roth Lashes to die for Platinum
Rodan and Fields Lash Boost

Take Home: If you have chronic dry eye, or experience any increase in redness, watering, or eye irritation using these products, understand that you may be causing permanent damage to your delicate tear film and ocular surface. Listen to your body and discontinue use immediately if you experience any symptoms. There is a major push within the medical community to have the FDA put stronger regulations on beauty products that are using chemicals with known side effects without disclosing the risks involved, but regulation and oversight may be many years away. Just because a product is over the counter, doesn't mean that it is safe. Make sure you read the ingredients closely on all cosmetic and facial products that you use, and if you spot Isopropyl Cloprostenate in any product you are using around your eyelid, consider that lasting dry eye issues could result as a side effect.

Want to learn more? Check out this podcast with Dr. Leslie O'Dell, Dr. Laura Periman, and Amy Gallant Sullivan, the executive director of the Tear Film and Ocular Surface Society.

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Women In Focus: Jane of Bright Eyed Blog

#womeninfocus 8:48 AM

Back in 2011 when I started blogging, there weren’t many optometrists sharing their experiences online. Fast forward to 2017 and it’s been so great seeing how many OD voices are creating content and spreading their interests and expertise with the world. Jane is one of these pioneering optometrists, sharing witty and refreshingly candid insights into life as a optometrist in Australia on her BrightEyedBlog. Optometry on the other side of the globe shares many of the same challenges we face in the States, and her experiences as a young female doctor resonate loudly. Check out Best Ways to Annoy Your Optometrist if you aren't believing me that our professional annoyances are universal.

BrightEyed specializes in both direct to patient communication on topics like Glaucoma or glasses wear, but also on sharing advice on navigating real world optometry issues for young new grads like gaining patient's trust in the exam room.

Tell us about yourself and how you got started in optometry!

I'm 27 years old and I live in Melbourne, Australia. I graduated from the University of Melbourne in 2012 with a Bachelor of Optometry. My graduate job was out in the middle of nowhere in a small town in rural Victoria. It paid well and I got to see lots of cool ocular pathology but it was a 4 hour drive from Melbourne where my friends and family are, and after 2 years I thought I had better move back before I eventually fell asleep at the wheel one day driving up and down! I now work in metro Melbourne just on the outskirts of the city for a private health insurance company. It's a healthcare center which means I also work alongside other healthcare practitioners such as dentists and remedial massage therapist (which is great because it means I can have a sneaky massage between patients!). Aside from Dr.L: Just for the record, I’m extremely jealous. One about massages and two about “between patients” which is a forgotten luxury most days.

In Victoria, during our final year of high school, year 12, we have to submit university preferences. Which offers we receive will be determined by our final score calculated across all our subjects for that year and the required entry score into each course changes every year depending on the demand of that particular university course. During my year 12, I was tossing up between dentistry and optometry. I knew I wanted to do a health science because I like helping people but I didn't want to deal with the hours of a medical degree; nursing and paramedic was also on the list (as well as a really random choice of forensic science). Ultimately, I was accepted into Melbourne University's Bachelor of Optometry course. In hindsight it was a pretty good option - good pay, ability to have flexible working hours, I can make a positive difference in the lives of my patients, and I don't have to pull out any teeth!

Jane and her sister on graduation day!

What inspired you to start BrightEyedBlog?

I can't even remember how I stumbled across Eyedolatry blog but I realized it was actually kind of useful haha! Even though optometry in Australia is slightly different, particularly with medication prescribing and even some contact lenses, I found that that I could learn useful bits and pieces from the articles. The vision for my blog (good pun) is to provide information for patients, optometry students, and also other optometrists, about various aspects of optometry and present it in such a way that's engaging, easy to read, and possibly even entertaining. I intend for it to be a mix of both cold hard clinical and less clinical posts, such as an article on glaucoma but also about bedside manner and communicating with patients. In a way the blog partly serves for me to share things I've learnt along the way during my rather short career so far, things they don't necessarily teach you at university.

What is optometry as a profession like in Australia?

Optometry school in Victoria has changed in recent years. My degree was a 5 year Bachelor degree that I could enter into immediately after high school. Since then at Melbourne University it has changed to become a post-graduate course known as the Doctor of Optometry (I think similar to the degree in the US), which requires the student to undergo a 3 year Bachelor degree in something like science or biomedical science, and then continue on for another 4 years to become an OD (so lucky I was the second last intake of the 5 year Bachelor course!). The actual content of the courses are the same and the scope of practice between a Bachelor degree and OD degree is also exactly the same though an OD grad may be more inclined to use the title of Doctor while you won't find many BOptom grads using that; legally we are all permitted to use the title Doctor as long as we specify optometry but the practice is not widespread. Different optometry schools will conduct their curriculum differently. For example, Deakin University in Geelong, Victoria, operates in trimesters, which means they cram everything into 3 years but have almost no holidays. After graduating we can go straight into work as fully qualified optometrists.

My class was about 50 people, and roughly equal in ratio for guys to girls. It meant that we got to know each other well (for better or for worse) and build a sense of camaraderie. For Australian citizens the Commonwealth government provides fee assistance, which meant that my school fees amounted to approximately $16,000 AUD a year ($12,305 USD a year with the current exchange rate). I know for my international friends their fees were more in the vicinity of $100k annually!

There are currently opportunities to do further study in a specialist field of optometry such as pediatrics, low vision, or contact lenses, in the form of a Masters degree or a specialist certificate. Not possessing such a certificate has no impact on an optometrist's scope of practice though and at the moment also doesn't even guarantee an increase in salary. There are also laws surrounding the use of the word "specialist", so even if an optometrist obtains a specialist certificate in something like anterior ocular disease, we can only say we have a "special interest in anterior ocular disease" rather than being able to claim we are a specialist in the field.

As an optometrist in Australia we are primary healthcare providers, and are able to diagnose and manage certain eye diseases as well as prescribe glasses and contact lenses. All new graduates nowadays are therapeutically endorsed to prescribe topical medications and for those whose course didn't include therapeutics there is an additional certification they can apply for after undergoing extra study. Unfortunately, current training and legislation doesn't permit us to perform any surgical or laser procedures, nor prescribe oral medications - for such situations we refer the patient upward to an ophthalmologist. The word on the street is that one day optometrists will be able to perform procedures such as LASIK or iridotomies, but for the time being these treatments remain in the realm of ophthalmology. When it comes to spectacles and contact lenses though, we're the bees knees!

What are some of the challenges you've faced in patient care as a young female OD?

The main challenge I've encountered in regards to patient care is patients not believing the advice I give them or questioning whether I know what I'm doing. I'm sure all optometrists across all ages and in both genders have to deal with this at some point, but being short and female and looking like I should still be in high school doesn't work in my favor when it comes to commanding respect from certain patients (usually those from my parents' generation). I've spent time in the room talking to patients about their cataracts and then after the consult they'll go to the reception desk and ask the dispenser (a big tall late-30s Caucasian male) what they should do about their cataracts. I've learnt not to take it personally but sometimes if I feel doubt radiating from the patient as to my competence then I show off my knowledge a little bit more and hit them with some big words then explain to them in full what I actually meant.

Aside from Dr. L: This is a situation that most young female grads face in the exam room in the States too! Whether you approach it with humor or with extra confidence like Jane, my advice to any young women reading this post is to remember the underlying cause. The patient is anxious and concerned; they aren’t trying to personally offend you, they are just nervous. Have empathy with their situation and you’ll soon find that these patients that show mistrust will be extremely loyal and thankful to you for going the extra mile to give them an excellent eyecare experience. Check out Jane's post about dealing with critical patients aptly titled Quit Yer Whinin'.

Do you have any advice for young female ODs entering the workplace and navigating working with colleagues or staff?

The issues I've faced with colleagues are similar to what I imagine all human beings encounter in a workplace. I've found majority of conflicts arise from discrepancies between communication styles and differing personalities. For example, I've made comments that are intended to be a matter-of-fact statement or a straightforward question but my colleague has interpreted it differently and tried to read between the lines something that I didn't mean to say. The longer I am in the workforce the better I become at altering my communication style for different people and also at understanding what my colleague means when he or she says something peculiar.

At school and university and within our circles of friends we get to choose who we spend time with, and of course we would gravitate towards the people we naturally click with, but in the workplace we're put together with a group of diverse individuals that we may never have chosen to ever speak to of our own volition, and we're expected to work together and be productive! (Ridiculous, I know). I think it's a great opportunity for personal growth to learn how to work together peacefully and get the best out of each other despite differing personalities, opinions, or modus operandii.

A recent poll in the US found less than 50% of ODs wouldchose to enter the profession if they could travel back in time. What is the feeling around Optometry in Australia?

At the moment things are looking a little bleak in regards to employment options for optometrists. The industry in all the major cities of the east coast (in the states of Victoria, New South Wales, and Queensland) are saturated due to an over-supply of new graduate optometrists from recently opened schools. Meanwhile, areas such as the west coast and rural parts of the state are still under-serviced, and there is still a call for better provision of eye care for indigenous Australians.

There is the constant war between corporate optometry chains and small independent practices. The bigwigs such as Specsavers and OPSM are able to provide lower cost care in the form of cheap frames and lenses, and can more easily absorb expenses such as practice warranties and free additional testing not covered by health insurance such as fundus photography. It means many private practices struggle to survive the competition with what is essentially a duopoly in the industry. Despite this, I think many patients are beginning to realize that cheap prices often equate to cheap quality, and on more than one occasion I've had a patient attend to me complaining that their glasses from one of the optometry chain practices weren't made right or they weren't given proper instruction on contact lens use before they were sent away with lenses that they didn't even know how to insert!

Another battle we're facing as a profession at the moment is with Medicare. Medicare is Australia's public health insurance system which involves the government funding certain health care procedures such as blood tests, x-rays, doctor consultations, and optometry exams. In 2016 the Australian government announced a Medicare rebate freeze, which meant that there would be no further indexation of the Medicare payments to keep up with wage levels and CPI (consumer price index) until 2021. For health care practitioners this impacts on our ability to provide sustainable patient care as we still need to purchase consumables, pay rent and bills, service equipment, pay staff wages, etc, but the rebate for providing our services doesn't match with the increasing cost of everything else. The effect of the Medicare freeze, in some instances, has been passed on to patients in the form of a co-payment for consultations that used to be entirely bulk-billed and covered by Medicare. Fortunately, in 2015 the Medicare cap was removed from the optometry profession, which meant that we were actually permitted to set our own private billing fees rather than being limited to the Medicare schedule of fees. The current Medicare rebate for a comprehensive initial consultation is $56.80 AUD (only $43.68 USD with the current exchange rate). Professional bodies such as Optometry Australia continue to lobby on the industry's behalf for the indexation freeze to be lifted and for fairer and more realistic rebates.

Head over to Jane’s BrightEyedBlog to learn more about optometry in Australia and her advice for young female ODs navigating their new careers!

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Put Down the Baby Shampoo

baby shampoo eyelid cleanser blepharitis 8:27 PM

Picture one of those typical doctor intake forms. Would you check a box beside any of these?

Red, scaly, crusty eyelids
Flaky debris along the lashes
Frequent and recurring styes or inturned eyelashes
Chronic redness, itching, watering, or irritation

If you answered yes to any of the above, you likely have blepharitis. Blepharitis simply translates as inflammation of the eyelid skin, but it's commonly associated with conditions like ocular rosacea and dry eye syndrome. And it's extremely common - studies suggest as many 47% of all patients that are seen by an eye doctor have some degree of blepharitis.

Blepharitis caused by Demodex colonies have a classic appearance of cylindrical dandruff or collarettes along the base of the lash root. via

For decades the go-to treatment recommendation for chronic blepharitis was eyelid hygiene with baby shampoo. The concept? The most common causes for blepharitis are skin bacteria like Staphylococcus epidermis and Staphylococcus aureus or eyelid mites Demodex brevis and Demodex folliculorum. These strains of bacteria are found naturally on human skin, and Demodex mites are also extremely common: studies confirm 70% of 18 year olds have Demodex mites living on their facial skin and over 84% of healthy adults over 60 have mites. Both skin bacteria and Demodex colonies thrive when there are more dry skin flakes and skin oils hanging around the eyelid surface, growing rapidly and often causing chronic irritation as their populations explode. It's a dangerous feedback circle: the more the body inflames in response to bacterial growth or Demodex infestation, the more it sheds the surface layers of skin, giving bacteria and mites more of what they love to live on.

Microscopic view of demodex mites at the base of hair and eyelash follicles via

Getting rid of dry skin and abundant skin oils is essential to minimizing the habitat for bacteria or Demodex, so doctors historically turned to baby shampoo as a "no tears" way to clean the sensitive eyelid area. The issue with baby shampoo is that the detergents and preservatives found within can actually promote skin irritation. Preservatives in baby shampoo like quaternium-15 chemically release formaldehyde, a known skin and eye irritant. Some research suggests that baby shampoo can interact with the eyelid's natural oil expression (meibum), turning it into a pro-inflammatory soap-like expression that is irritating to the eye and eyelid, a process called saponification.

A Better Alternative?
OCuSOFT lid cleansing products have the cleansing power to knock out skin bacteria and Demodex colonies, but are far more gentle and less irritating to the delicate eyelid skin than baby shampoo. Studies assessing ocular irritation on OCuSOFT products found that OCuSOFT Lid Scrub Plus was "practically non-irritating" to the ocular surface if not rinsed off in 1 hour based on Draize score data. Baby shampoo was rated category 3 or "mild irritation" on LVET (low volume eye test) Draize testing. OCuSOFT products are graded as 16 x milder than baby shampoo for eye irritation!

Not only were OCuSOFT products found to be more comfortable to the eye than baby shampoo, they also have significantly better bacterial kill rates. Studies on skin wound cleansing scored Johnson and Johnson Baby Shampoo as non-antibacterial at 24 hours against Staph. aureus at "cell-safe" levels, and additionally scored it with a high cytotoxicity index score (meaning it was considered highly irritating and damaging to healthy cells as well). OCuSOFT Plus lid scrubs have exceptional kill rates against common skin bacteria that are known causes of blepharitis, including Staph. epidermis, Staph. aureus, and even MRSA.

Our recommendation? For chronic blepharitis put down the baby shampoo and reach for a specific eyelid hygiene product. In my personal practice I recommend daily use of OCuSOFT Lid Scrub Plus for bacterial-based blepharitis until the eyelid inflammation is controlled, and then recommend use of daily lid cleansing products like OCuSOFT Original pads or foam longterm to help promote a skin environment that would be inhospitable to bacteria or Demodex infestation. Eyelid hygiene is part of my patients' everyday routine for clear vision and healthy eyes; you can't take a night off from caring for your eyes and delicate eyelid skin and expect your eyes to perform at their best level. OCuSOFT is gentle enough to be used as a daily cleanser for even sensitive skin types, and its strong enough to neutralize skin bacteria and help prevent chronic conditions like blepharitis and recurrent styes.

Wanting to learn more about all the products in OCuSOFT's line of lid cleansers? Head here

OCuSOFT is a platinum sponsor for Eyedolatry but all opinions are my own.

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Building the American Brand: Behind the Scenes at Gazal Eyewear

American eyewear 10:27 AM

Back in 2015 we profiled the story of husband and wife team Gazal and Saeed Tabrizipour, eyewear designers based out of Atlanta who were breaking on to the blossoming American eyewear scene. Two years later, they’ve continued to push boundaries and expectations as they launch new collections and work to open their first Gazal Eyewear flagship optical store in historic Roswell, Georgia. As private practice optometrists are increasingly embracing independent eyewear in the face of mergers and consolidations of name brand wholesalers that reduce competition, American consumers are also increasingly looking towards products with local origin stories and a focus on quality and craftsmanship. Here’s how the couple behind Gazal Eyewear is making a stand for independence in eyewear and inspiring other designers and eyewear enthusiasts with a dream to jump in!

Designer Gazal Trabrizipour and her husband Saeed are the dynamic duo behind Gazal Eyewear. You can follow their personal story - designing eyewear, outfitting their new flagship optical, and jetsetting around the world to trade shows with behind the scenes looks at the insider's world of optical design on their instagram account @gazal_eyewear

“I design only when I am inspired; when there is true feeling and love for something I would love to see and something that I would enjoy wearing myself,” says Gazal Tabrizipour about her process. “I always keep in mind the quality when trying to bring the drawings to life. I have worn glasses since I was a child and the comfort and durability level is just as important as the look.”

Her focus is clearly evident in their new 2017 collection, aptly titled Wicked. The inspiration? “To create something Wickedly comfortable, that keeps a clean yet luxurious look.” The collection features un-apologetically bold shapes that are statement making but still entirely wearable, and a focus on mixed metals and acetates that allow a pop of color without the bulky, heavy frame weight of a full acetate frame.

While the designs are created by Tabrizipour in Georgia, the material sourcing and manufacturing for her frames happens in Japan, the go-to manufacturing hub for high quality and light weight titanium metals. “We use a lot of titanium because the weight of the frames and durability compared to other metals makes a remarkable difference. I am very focused on the intricate details of each frame design so it is important to utilize the skillset of Japanese manufacturing to bring these details to life.”

Their latest photoshoot featuring Amy Roiland (@afashionnerd) was a collaboration introduced to Trabrizipour by Maarten Weidema. " It was great seeing Amy in all of our designs, she is the first model outside of my husband and I that has been part of the Gazal Eyewear collection."

2017 will be one of the biggest for Gazal Eyewear. They recently participated in a globe-trotting luxury eyewear marketing campaign with Maarten Weidema of the Eyewear Forum and model Amy Rolland. If their first major campaign shoot wasn’t enough, this year they are opening Gazal Eye Care Boutique in Roswell, GA. The flagship location will feature not only Gazal Eyewear designs, but also many of the best know names in the industry. “We are proud and eager to reveal the collections to the local community where the initial idea and history for Gazal Eyewear began. My husband and I met and lived in Roswell for years and dreamed of creating the eyewear line and the flagship boutique in historic Downtown Roswell for years. The community is fun, lively, and very artistic and we could not be happier to take part and add some additional history to its’ richness.”

The flagship Gazal boutique optical store will open later this year in Roswell, Georgia, but already the design aesthetic that has made Gazal Eyewear a success is on display. Exam rooms look sleek with sliding black doors embossed in gold, and the main optical space creates a pure luxury feel with recessed display shelves and uniform white walls and ceilings that let the frames take center stage.

Thinking about adding independent American eyewear design to your optical this year? Check out Gazal Eyewear in NYC at Vision Expo East this spring. “We would love to share all of our exciting news about our plans ahead of time, but we also hate to ruin a good surprise,” Tabrizipour says about their plans for Vision Expo. Like the best designers in the industry, she has us on the edge of our seats!

You can contact the Trabrizipours personally here to get more details about bringing this craftsman American designer brand to your optical.

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