Center for Eye Care & Surgery founder and director Silviano Matamoros, MD, believes that everyone should have access to appropriate eye care. It’s a belief that he regularly puts into action with international mission trips. One condition the doctor regularly provides treatment for both locally and abroad is chronic dry eye syndrome.
“Dry eye syndrome is caused basically by a change in the tear film,” informs Dr. Matamoros. “It’s a matter of either having insufficient or poor-quality tears. The tear film is that thin layer of liquid that constantly washes over the eyes to keep them moist and protected. Basically, the tear film is made of three layers. When one of these layers becomes depleted, that’s when dry spots occur on the cornea.
“Chronic dry eye syndrome is a medical condition that needs continuous therapy,” confirms Dr. Matamoros. “It can be caused by multiple factors including, but not limited to, advanced age, side effects from medications (antihistamines, nasal decongestants, and blood pressure and acne medications), hormonal changes (pregnancy or menopause), eye diseases (rosacea, blepharitis, meibomian gland dysfunction), and medical conditions (rheumatoid arthritis, systemic lupus, and other autoimmune disorders).”
Who is affected?
Dry eye can affect anyone at any age; however, it is much more common as people age. It has been estimated that more than 5.5 million people in the US suffer from some type of symptom associated with dry eyes. Of these, more than 3 million are women and more than 2 million are men. It is also estimated that there are tens of millions more who suffer from this condition and still have not been diagnosed.
“For most people with occasional symptoms,” says the doctor, “treatment involves over-the-counter eye drops. However, it is important to determine what is causing the dry eyes and treat the
Dry eye symptoms may be secondary to aqueous tear deficiency, in which the lacrimal glands fail to produce enough watery component to maintain a healthy eye surface. Or the condition could also be due to meibomian gland dysfunction, an excessive evaporation of the natural tears.
Accredited care Dr. Matamoros and the staff at the Center for Eye Care & Surgery have in place a comprehensive approach to dry eye syndrome. Center for Eye Care & Surgery participated in a clinical trial with TearLab to help measure the concentration of tear fluid. As an accredited dry eye center, staff follows strict protocols to diagnose, manage, and treat this disease. Patients fill out a questionnaire about their symptoms
and afterwards review thoroughly their medical history with staff. Once this part of the process is complete, the doctor will then recommend the most appropriate diagnostic tests.
“At the Center for Eye Care and Surgery dry eye clinic, staff measure tear osmolarity with the TearLab™ test, among other diagnostic tests such as ocular surface staining with fluorescein and lissamine green,” states Dr. Matamoros. “This helps us diagnose, treat, and monitor a patient’s dry eyes. We are dedicated to providing the highest quality of dry eye care, using advanced ophthalmic diagnostic techniques and treatments.”
In terms of severity, only 12 percent of those affected by dry eye suffer from severe disease, while the greater proportion have mild disease, 58 percent, or moderate disease, 30 percent. The severity scale of the TearLab osmolarity test places the diagnosis in context. The higher the osmolarity, the more severe the disease. Patient confidence and comprehension are enhanced when they see where their condition falls in the range of severity.
The doctor explains: “Knowing the osmolarity of a patient’s tear film is essential to the proper management of dry eye disorders. This test also measures the therapeutic response of a patient.”
Treatment is prescribed based on the measurements from the Center for Eye Care & Surgery-designed protocols. Depending on the particular case, patients may be prescribed omega-3 supplements, topical or oral antibiotics, punctal plugs, and/or anti-inflammatory drops. Staff works with primary care physicians if it is determined that an underlying condition is causing the ocular symptoms.
“As we evaluate patients, it’s also important to consider lid margin assessment, as lid condition plays a contributing factor in this pathology,” emphasizes Dr. Matamoros. “We follow guidelines recommended by the International Workshop of Meibomian Gland Dysfunction (MGD), and actively express these glands in some dry eye patients.”
The doctor continues: “A consultation in our dry eye clinic will give the patient a clear understanding of the etiology of their condition and a regimen to follow to participate in the management of dry eye syndrome (DES).
“In the past, the disease was defined as a disorder of the tear film caused by tear deficiency or excessive evaporation. Patients were given samples of over-thecounter artificial tears, and were advised to try them. Of course, this approach, we’ve learned, does not always work.
Dry eye and cataracts
“In our practice,” adds Dr. Matamoros, “we are very proactive in testing and treating our cataract patients. We realize that even mild dry eye can affect cataract surgical outcomes. An irregular cornea will degrade the optics of the captured image and this may cause inaccurate wavefront aberrometry. Subsequently, this can also affect intraocular lens calculations and surgical results.”
Clinical studies have shown that most cataract patients are not symptomatic of dry eye syndrome, even though they may have it. Patients with pre-operative hyperosmolarity demonstrated worse visual acuity after surgery. Optimizing the ocular surface prior to implantation of an intraocular lens will help ensure success with these lenses.
“At the Center for Eye Care and Surgery,” says Dr. Matamoros, “we have the OPD Scan 3, which we use with all of our pre-cataract patients for preoperative evaluation. This is a third-generation, stateof-the-art diagnostic instrument that allows us to gather detailed information about the patient’s eye condition. This is an excellent tool for identifying corneal dryness.”
Treatment improves vision
“Dry eye not only causes redness, irritation, and tearing, but it also affects vision,” concludes Dr. Matamoros. “Many patients experiencing a fluctuation in vision will attribute these symptoms to tired eyes or age, but the reality is that treating the disorder will substantially improve not only their discomfort but also their vision.
“Dry eye continues to be among the most common complaints that we encounter in our clinical practice, and the frequency of dry eye conditions will likely increase in our aging, multi-medicated population. Successful management requires a complex treatment response, as the condition is multifactorial in origin. By employing the latest developments in diagnostic techniques and products to help patients, we’re able to more effectively treat dry eye.” FHCN