April 14, 2025 • 33 mins
Dry eye syndrome is a common yet often overlooked condition that can significantly impact a patient’s quality of life. This episode explores the causes, symptoms, and latest treatment options, equipping pharmacists with the knowledge to provide effective counseling and recommend appropriate therapies. Tune in to enhance your expertise and help patients find relief from this chronic and frustrating condition.
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact
GUEST
Jennifer Salvon, BSPharm, RPh
Clinical Pharmacist, Medical Writer
Salvon Scientific
Pharmacist Members, REDEEM YOUR CPE HERE!
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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the causes, symptoms, and risk factors associated with dry eye syndrome.
2. Identify evidence-based treatment options and counseling strategies pharmacists can use to help patients manage dry eye symptoms effectively.
0.05 CEU/0.5 Hr
UAN: 0107-0000-25-115-H01-P
Initial release date: 4/14/2025
Expiration date: 4/14/2026
Additional CPE details can be found here.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:09):
Hey CE Impact subscribers.
Welcome to the Game ChangersClinical Conversations podcast.
I'm your host, josh Kinsey, andas always, I'm super excited
about our conversation today.
Dry eye syndrome is more thanjust an annoyance.
It can significantly impactvision, comfort and overall
quality of life.
In this episode, we'll explorethe causes, latest treatment
(00:33):
options and how pharmacists canplay a key role in helping
patients find lasting relieffrom dry eye syndrome.
It's so great to have our guestexpert with us today, jennifer
Salvan.
Thank you so much for joiningus, jen.
Speaker 2 (00:46):
Thank you, I'm excited to be here.
Speaker 1 (00:48):
Yeah, we appreciate you taking time out of your
schedule to join us.
So, for our listeners out there, if you can just give us a
little bit of brief introductionto yourself, tell us a little
bit about your background andyour practice setting and maybe
your passion for today's topic.
Speaker 2 (01:05):
Great Thank you.
I'm a clinical pharmacist at asmall hospital in Western
Massachusetts.
I've worn a lot of hats overthe years, including over 15
years as a community pharmacist.
A lot of times I'd havepatients come in struggling with
their dry eye disease and askme what to take and what to do,
and I've always found the dozensof products out there a little
(01:25):
daunting.
Hopefully, our discussion todaywill provide some insight on
dry eye disease and thetreatments and the artificial
tear products that are out thereyeah, that's great.
Speaker 1 (01:35):
Yeah, I can agree, it's been a while since I've
practiced in pharmacy officiallybut, yeah, having on my own
store and you and spent a lot ofmy career in community practice
and ever since I was 16 yearsold and working in a community
pharmacy, I feel like that thisis one of the most daunting
(01:55):
aisles in the pharmacy.
Otc section is the eye area,because it just there's so many
products and they all seem likethey're the same and everybody
makes a version of something and, yeah, I completely agree.
So I've I've been really,really excited about this
conversation today because Ithink it's it's something that
all pharmacists struggle with,in my opinion, and so we're
(02:15):
going to give them some, somegreat tips to take back.
So this is great.
So, again, thank you forjoining us.
I really appreciate it.
Let's jump into our first kindof topic.
So I always like to lay thefoundation, so let's just review
exactly what is dry eyesyndrome.
So, you know, maybe let's talkabout the prevalence, what are
(02:35):
some of the causes and just alsohow does it impact patients
daily life?
Speaker 2 (02:42):
Excellent.
You know, I sometimes like tostart with the anatomy involved,
because that helps usunderstand why it happens.
So, on your eye.
Yeah, there's a tear film andit's a coating that keeps the
eyes moist, and when it becomesunbalanced, the tear film breaks
down, leading to inflammationand damage to the eye surface.
So it's important for that tostay in homeostasis to the eye
(03:04):
surface.
So it's important for that tostay in homeostasis.
There's actually three layersto the tear film.
There's the outer layer, whichis a lipid layer, and the
meibomian glands take care ofthis layer.
Now, the meibomian glands, youmay not know, they're on the
inside of the eyelid and theyproduce lipids to keep your eye
moist.
Speaker 1 (03:21):
Okay.
Speaker 2 (03:22):
There's a middle layer that's basically water and
the lacrimal glands producethose and those are located on
the outer edges of your eyesocket and then there's an inner
layer that are produced.
It's called the mucin layer andit's produced by goblet cells
and that's in your conjunctiva.
So altogether that kind oflubricates and keeps your eye
safe from everything in ourenvironment.
(03:43):
Our eyes are open and there'sjust dirt and everything blowing
in your face and getting inthere, so this tear film is
essential for your eye health.
Speaker 1 (03:52):
So it's almost like, even like a three-part checks
and balances system, like if apiece of debris gets through one
, maybe the other is going tocatch it and sweep it out and
whatever.
So that's great, that's a greatfoundation.
Speaker 2 (04:04):
Yeah, okay, hopefully .
Speaker 1 (04:06):
Yeah, I don't necessarily remember that.
There's three parts of that, sothat's, this is great.
Yeah, keep going.
Tell me more.
Speaker 2 (04:12):
Well, and that's I think I like to know about stuff
like that because that helps usguide us on what could be used
to treat something you know,where is it breaking down?
Myobian gland disease issomething that people have, so
if you know it's that, then youmay approach the treatment in
one way versus another.
Speaker 1 (04:31):
That makes sense, okay, yeah.
Speaker 2 (04:33):
There's a lot of different risk factors to
developing dry eyes.
People divide them intomodifiable and non-modifiable.
The thing you can't modify isage.
As we get older, our eyes getdrier, so there's something we
have to deal with.
Usually, there's a higherprevalence in people over 50,
but what we've been finding isthe age group of 18 to 49,.
(04:55):
The incidence is rising, andcan you guess why?
Speaker 1 (05:00):
I would assume environmental factors, and also
staring at screens.
Speaker 2 (05:04):
Staring at screens.
That's exactly it.
One of the things that they'refinding is causing it is
everyone's got a screen in frontof them and we're just on them
all day long, like we're on ascreen here.
You're on a screen and you'rewriting, you're on a screen and
you're filling prescriptions.
I mean, it's hard to get awayfrom being on a screen.
So that's one of the biggestrisk factors or biggest things
that cause dry eye disease.
(05:24):
So, knowing about that and Ican give you some ideas about
you know how to mitigate that.
You know as we talk.
Yeah that's great the otherthing is it's more common in
females versus males, so it'sprimarily because there's
(05:45):
hormonal changes in women thattake dry eye disease.
Also, cosmetic use women put onmakeup and so that you know,
having that on their eyes andgetting in their eyes can, can
damage the tear film.
So that's another avenue.
Yeah, Another.
Well, those are non-modifiable.
The computer screen ismodifiable, but the other thing
is wearing contact lenses.
Speaker 1 (06:10):
That can precipitate dry eye disease.
Speaker 2 (06:11):
So a lot of people I find are switching to glasses
versus wearing their contactsall the time, especially if they
have dry eye disease.
The environment being in an airconditioned environment, being
out in the wind, the sun at thebeach, with the sand blowing.
Caffeine consumptionunfortunately precipitates dry
eye disease or contribute to it.
Yeah, and then a lot of meds,which we can talk about later,
(06:32):
but there are medications thatpredispose you to having dry
eyes.
Speaker 1 (06:36):
Okay, yeah, that's great, you lost me at sand.
One of my biggest fears in theworld is sand.
I hate sand, I can't.
It feels like it getseverywhere and you can never get
rid of it.
So, yeah, the whole idea oflike sand blowing in my eyes.
I just went down this wholelike rabbit hole of just
freaking out.
Speaker 2 (06:56):
The first time I go to the beach each summer, I'm
like I can't.
It takes me like a half an hourto get used to having sand on
everything.
Speaker 1 (07:02):
That's the worst, the absolute worst.
I mean, I love the beach, but,man, I wish it didn't have so
much sand.
So, yeah, okay.
So that's great If you can alsolet us know what's the
prevalence for our patients indry eye syndrome.
Speaker 2 (07:19):
Well, it's actually pretty prevalent and it's hard
to tell the exact prevalence.
Estimates say over 16 millionpeople adult people in the US
have dry eye disease.
But some feel this is on thelow side because dry eye disease
can be underreported andundertreated, because people
just go out and buy dry eyedrops and no one even knows that
they have it.
Speaker 1 (07:40):
Or they just push through.
They're just like oh, let meblink some more or let me take
my contacts out my eyes arereally dry today or something
billion a year in direct medicalcosts, which I thought was an
interesting number.
Speaker 2 (07:52):
that's huge yeah, and then indirect medical costs,
which is lost productivity,which is huge for this as well.
If you can't see as well,you're not going into work.
(08:12):
If you have to go to doctor'soffices or you're out picking up
medications, you know you'renot as productive and that
doesn't even get into thequality of life impact.
So say you are having troublewith your eyes, you can't read,
you can't drive, you can't watchTV and you can't be on your
phone.
You know it's.
It's got far reachingrepercussions.
Speaker 1 (08:33):
It's a lot, yeah, and I mean even thinking about, too
, how that could translate downinto being, you know, a barrier
or a challenge for your patientsto get medication, because,
like, what if?
Like you said, what if theycan't drive anymore and so they
don't have a way to get to thepharmacy and they don't have a
way to get to their doctor andyou know, then they don't have a
way to get their meds or stayadherent and whatever.
(08:55):
So just a lot of differentthings that could be kind of
compounded with just the fact of, you know, dry gets out of hand
or whatever.
So, yeah, yeah, so what aresome of the common symptoms that
we're going to see of someone?
So what are we looking for tosay maybe this is dry, maybe
this is more severe than just Igot something in my eye and I've
(09:18):
rubbed it and now it hurts alittle bit.
Speaker 2 (09:20):
Right, I mean, that's kind of the way it starts.
You know, you have a burningsensation under your eyelids.
It's uncomfortable, sometimesit feels like there's dirt or
sand underneath your eye.
Yeah, they can be itchy and red.
(09:40):
You can start having visualchanges.
You may think you need glassesor it could feel like your
allergies are coming on, andthat's a hard thing because to
differentiate dry eye diseasefrom other things like allergies
can be difficult.
Speaker 1 (09:58):
Dr Justin Marchegiani .
Yeah, so when we're talkingwith patients and we're seeing
them maybe looking at things inthe aisle or whatever, if
they're maybe trying toself-medicate or whatnot, what
are some of the?
I guess, what are some of thethings we would ask for to be
able to confirm, like maybe thisis dry syndrome, you know?
(10:18):
Like that would guide us intothe direction of which
medication to choose, I guess.
Speaker 2 (10:24):
Well, I think that's um, that can be hard, but it you
could ask them questions about.
You know, is it allergy season?
Do you get allergies all thetime?
Does this continue throughoutthe year?
Do you find that it's worsewhen you go into work or when?
You go into a movie theater orwhen you go into a cold
environment, you know you cantry to ask questions about
what's triggering it.
(10:44):
Do they notice what'striggering it?
Are there any foods or anything?
You know there's a lot to gointo it.
You can also ask if they haveany underlying conditions,
because a lot of timesautoimmune conditions will cause
dry eye.
So that's one of the things.
As you're asking questions, youcould find out that they have
other symptoms and one of thetimes you might refer them to an
(11:07):
eye care specialist or theirPCP.
Just to have some tests run tomake sure there isn't more going
on there.
Speaker 1 (11:13):
Right, right, exactly .
Yeah, you mentioned autoimmunedisease.
Is it all autoimmune diseasesor are there specific ones that
we should be looking out for?
That put our patients atgreater risk.
Speaker 2 (11:23):
Yeah, not all of them , but there's a couple that come
to mind.
I'm not sure I'm going to sayit right Sjogren's syndrome,
that's a big one, that'll do it,and rheumatoid arthritis is
another one.
But Sjogren's syndrome affectsthe salivary and lacrimal glands
.
So you're going to have drymouth but you'll also have dry
(11:44):
eyes.
So that's one that comes tomind.
I think dry eyes go withSorgeant syndrome, but you can
have dry eye disease withouthaving that and vice versa.
Sure, of course, of course, yeah, okay, but just knowing that
some autoimmune diseases maycause, yes, yes, someone is
picking up their yeah, therheumatoid arthritis med and
(12:06):
mentioned that they're you knowtheir eyes are killing them and
you, you know they're itchingthem all the time.
They're rubbing them.
You know what can they do.
Speaker 1 (12:12):
Yeah, okay, great.
So, um, touching on the fact of, obviously we're pharmacists
and we want to know how, how wecan help.
So what, what's your take on,you know, the role, of role of
pharmacists in helping to manageand treat dry disease?
Speaker 2 (12:30):
Well, I think pharmacists can be key.
I mean, we're one of the mostaccessible healthcare providers.
We're right out there.
Whether we actually have thetime is debatable to spend time
talking to a patient, but Ithink, if we can, it's important
to.
I think we have a huge role inpatient education and patient
education is a big part oftreating dry eye disease.
(12:51):
There's a lot of environmentalfactors, lifestyle modifications
.
The first steps of treating dryeye disease involve patient
education over the counter,artificial teardrops and lid
hygiene, which we can talk abouta little more.
That's one of the things thatcan help with dry eye disease
yeah.
Speaker 1 (13:09):
That's interesting.
I don't think I've ever heardthat phrase lid hygiene Okay,
that's good, so, yeah, so that'sactually a perfect segue.
So that's what I wanted to gointo.
Next was kind of focusing moreon the opportunities that we
have as a pharmacist.
So you mentioned educatingpatients on lifestyle
modifications and preventativemeasures.
So what are some of thosethings that we can talk about
(13:32):
with our patients?
Speaker 2 (13:33):
Well, I mean, we mentioned before how the
environment can cause dry eyedisease.
So something as simple aswearing sunglasses can help a
lot and I think some people justdon't wear them.
Know, if you have a heavierbrow you, you know the sun might
not affect your eyes.
I don't need heavy sunglasses.
The sunglasses I use are kindof light, but I've started
wearing darker ones and makingsure they're big enough to cover
(13:56):
your eyes and that'll helpprotect them.
Um, in your house you could usean air humidifier you know,
especially this time of year,the air in our, our house, you
know, with the heat running,depending on where you are, the
heat running it's very dry, andso I noticed my eyes are more
watery in the winter, and I tryto have an air humidifier going.
Conversely, if you have airconditioning running, you know I
(14:19):
think people that live downSouth have have it harder
because they're you know, youcan't go outside as much because
it's so hot, so minimizing yourexposure to air conditioning.
Speaker 1 (14:29):
Okay.
Speaker 2 (14:31):
If you're a smoker, this smoke, can you know, dry
out your eyes and irritate them.
So that's something um, interms of lifestyle modification,
um, dehydration is huge, orhydration proper hydration.
So people who are dehydrated andI run into people all the time
that say, oh God, I haven't hadanything to drink all day.
You know, and I'm like well, ingeneral, I mean with so many
(14:53):
things in our life, butespecially if you have any kind
of dry dryness, you know, dryeye disease, you know they say
that you're supposed to drink asmany ounces of water as you
weigh in kilograms.
So say you weigh 75 kilos,which isn't that a lot.
You know, that's 150 pounds,that's 75 ounces of water and
that's hard, I think it's hard.
Speaker 1 (15:19):
It's a lot.
Yeah, it's a lot, and it'sinteresting too to think I mean
it.
It makes sense.
It's not like it's well, that'sodd, but the fact that
hydrating your body makes youreyes less dry, I mean, you know,
like the fact that thattranslates into you know making
sure that your eyes are hydratedtoo, so you just don't think
about that being where thatwater goes, I guess.
Speaker 2 (15:37):
So so that makes sense.
Yeah, I think about it, becausethat film I talked about a lot
of it is aqueous and so, if thatis, it increases the osmolarity
of it.
Speaker 1 (15:46):
So there are things in there and they just get more
concentrated and that's not asgood for your eye yeah, makes
sense now that you gave us thatgreat introduction and the
reminder of the, the uh, thestructure of the eye.
Speaker 2 (15:57):
That was so good dietary supplementation oh yes,
I have a passion for dietarysupplements so I've done a lot
of studying on it.
But one of the things in dryeye disease you can do and this
helps you in a lot of ways issupplement with omega-3 fatty
acids.
Okay, and there are studies outthere.
Right now the studies areinconclusive, but some have
(16:18):
really shown promise and whenyou think about how omega-3
fatty acids blockpro-inflammatory substances in
the body, that can help with theinflammation cycle of the eye.
So that's one of the thingsthey're studying.
And another avenue they'restudying is topical omega-3
supplementation or application.
It hasn't gotten there yet, butthat's something that's out
(16:39):
there.
Speaker 1 (16:40):
Interesting.
That is definitely somethingI've never heard before.
That's great.
Okay, I'm glad you added that.
That's super interesting.
Yeah, that's, that isdefinitely something I've never
heard before.
That's great.
Okay, I'm glad you.
I'm glad you added that.
That's super interesting.
Yeah, that's great.
So one of the things I want tobe sure we jump into is is the
over-the-counter treatmentoptions.
So I know that that can be verydaunting, so let's kind of talk
about.
I'd love for you to share some,maybe tips and tricks of like.
(17:01):
Again, that aisle is so there'soverwhelming.
So many products.
They all kind of seem the same.
You know, everybody makes aversion of everything.
So how can we approach that?
Yeah, how can we approach thatas the pharmacist and make it
manageable so that we canactually, you know, relay that
information accurately to ourpatients?
Speaker 2 (17:21):
Because I always thought this when I went down
the coffin cold aisle.
When you finally look at thepackages, there's like a dozen
ingredients and that's it, butthere's hundreds of products out
there and it's similar toartificial tears.
So artificial tears I'll spendtime talking about, because
that's really the OTC productthat patients need help with,
and in artificial tears there'ssix different categories of
(17:44):
ingredients, but the biggest oneis a Demelson and that's
something that increases theviscosity of the drop to
increase the time that it stayson your eye and helps add that
lubrication.
And that can be kind of a trickything to balance, because if
it's got too much in it it'sgoing to be more of a gel and
you're not going to see anything.
Speaker 1 (18:05):
You're going to be blurring, yeah, yeah.
Speaker 2 (18:09):
And then there could be ones that just don't help at
all.
So a lot of products I justwant to see.
Thicker is not always better.
I wanted to give some examplesof DemoSense, the Ohio uronic
acid, propylene glycol andcarboxymethylcellulose.
Those are three of the mostpopular.
Another ingredient are oils wetalked about.
(18:33):
There was an oily layer to thetear film.
And so adding an oil likemineral oil or flaxseed oil.
That can help restore the lipidlayer, if that's an issue, and
it can help prevent tearevaporation.
One thing I do want to mentionthat's in them is preservatives.
Now, the most commonpreservative is benzalkonium
chloride, and the conundrum hereis you need them in multi-dose
(18:56):
bottles to decreasecontamination, and yes, but they
actually contribute to cornealdamage and can precipitate dry
eye disease and disrupt the tearfilm.
So one thing that's new that Iwant to mention is these
disappearing preservatives, andthat's sodium chloride and
(19:17):
sodium perboate.
These don't have the sameeffect on the tear film, so
there's a lot of interest inproducts that contain these
preservatives instead.
That said, preservative-free isthe best thing to do.
Speaker 1 (19:30):
Sure, sure, but again , remembering that
preservative-free usually meansthat it's going to be like a
one-time use kind of thing,which is probably going to make
it more expensive because it'snot a multi-dose vial.
Yeah right, so yeah.
So again, just remembering andweighing those options.
But I think it's important tounderstand the impact of the
(19:51):
preservatives and, you know, ifyou're explaining that correctly
to the patients, maybe they'rewilling to pay a little bit more
so that they're not addingsomething more dangerous to
their eyes.
So, yeah, yeah.
Speaker 2 (20:03):
Another thing is, wherever you practice and
depending on your location,keeping your eye out for sales.
You know if there's apreservative free and you know
you have patients that arestruggling dry eye disease and
letting them know that that canbe something that will be
helpful for them.
Speaker 1 (20:15):
Yeah, that's great.
That's great.
So, basically, what you'resuggesting, advocating for, is
to fully understand the activeingredients and and and make
your choices based on that, asopposed to just like I have a
favorite product, it's in thered box or whatever.
So it's more about like alsounderstanding too.
(20:35):
As you mentioned, some of thosethings treat the different
aspects of it.
So is it a, is it a lipid issue, or is it a, you know, whatever
?
So understanding which ones toadd that add, that's super
helpful, yeah.
Speaker 2 (20:52):
I think it would be important for pharmacists to
look at the products availableat their location and pick three
or four that they know have thecarboxymethylcellulose or
hyaluronic acid or propyleneglycol and one of those newer,
disappearing preservatives orpreservative-free, and just have
those as their go-tos.
Speaker 1 (21:08):
Then they're not out there wondering.
Speaker 2 (21:10):
You know what I mean.
It takes a little bit ofhomework, but in the long run.
If you've got those three orfour products, then you'll feel
like you've got something inyour armamentarium that you can
actually do and not take as muchtime.
Speaker 1 (21:20):
Well, and let's be honest, I mean, if you go out
there with a plan, your patientis probably going to trust you
more because you're going toknow exactly what you're talking
about, as opposed to being like, oh I don't know, let's see,
let's turn this around and seewhat's in this one and let's
touch this one Right, that's nota good look.
Speaker 2 (21:36):
Hang on, yeah, it doesn't yeah.
Speaker 1 (21:38):
Let me just double check and then I can talk to you
about it.
You know, I think you're right.
I think it would make ourconversation more impactful with
a patient.
I think it would really drivehome the point that we know what
we're talking about.
So, yeah, so, like you said, doa little work on the front end,
a little bit of homework, andbe prepared and research, and
that way you're better able toto answer the patient's
(22:00):
questions and to recommend aproduct easily.
Yeah, yeah.
Speaker 2 (22:03):
Another thing to keep in mind is when you have that
product and you're recommendingit um, consistency and patience
is key.
Patients are going to use thisand think like tomorrow their
eyes are going to feel betterand really that's, that's not an
expectation, that it's good toum.
What do I say?
Get rid of that expectation ormake the expectation clear.
Yeah, I have to use this forthree or four times a day for
(22:26):
almost a month to see if it'sgoing to work or not, and
unfortunately the first productyou pick might not be the right
one.
You know, say you start with ahyaluronic acid one and it's got
a preservative in it and it'snot working.
Maybe you progress to a productthat has two.
You know there are combinationproducts that might have the.
(22:48):
C and C, thecarboxymethylcellulose and the
hyaluronic acid.
That might work.
So unfortunately there is alittle bit of trial and error
with it, but having a directionto point the patient in can be a
lot better, because one of thebiggest problems from I would
hear from patients and what whatthey have is trying 100
(23:08):
different products, spending allthis money, having all these
bottles on their shelves andnothing's working.
Speaker 1 (23:13):
Yeah, well, and I think it's.
It's good to point out that youknow it's not.
I do not like putting drops inmy eyes, so I would be that
person that's like oh yeah, Idid it once and I hated it, you
know.
So I feel like it would.
It's really important to setthe stage and to say you know,
this is it's going to have to beX number of times a day, it's
(23:34):
going to have to be for a month,you're going to have to make
sure, or whatever.
But, like you mentioned too,patients are all different.
So it makes sense that some ofthe products are not going to
work for some patients becausethey're you know, some of them
may need the lipid replenishmentand some of them may not, and
some of them may not need, youknow, the, the one that glazes
over, the carboxymethasalose andwhatever.
So, so yeah, it's.
(23:56):
It's going to unfortunately bea little bit of trial and error
for patients.
I think that expectation isimportant to set up as well.
Speaker 2 (24:03):
Yes, and they may need the ones that I said that
coat your eye more.
That's something you couldactually recommend for someone
at nighttime.
So put it on close your eyes,go to bed.
Then by the morning you cankind of rinse your eyes off and
hopefully you've retained themoisture from sleeping with the
gel on your eyes.
Speaker 1 (24:20):
Oh yeah, that's a great idea.
That's great.
One thing just really quickwhen we're talking about
treatments, there are someprescription treatments.
I don't want to spend a ton oftime on them because I felt like
the majority of our time neededto be on the OTCs, but just so
that we're aware what are someof those prescription meds that
would treat your eye.
Speaker 2 (24:36):
There's several eye drops out there that I'm sure
people are used to filling.
Cyclosporine eye drops havebeen around for a couple of
decades.
The hard part is iscyclosporine is not easy to get
into solution so and it causes alot of the same symptoms you're
trying to get rid of.
So it causes burning in youreyes, redness.
(24:56):
About 50 percent of patientsdon't continue with it because
of that if you can 10%.
here the side effects do get alittle better and people find
improvement.
They are working on newformulations, a nano emulsion,
so that kind of increases thetime and decreases the side
effects.
So, that'll be coming.
Laphitigras is another onethat's been around for a few
(25:19):
years.
It's another.
You know, all these productsaffect the inflammatory cycle
kind of from different avenuesso the fit of grass.
So if something doesn't work fora patient, they could try
another one.
So cyclosporine is working.
They progress past artificialtears.
Cyclosporine didn't work.
Lefitographs could be an optiontoo, because it has a slightly
different mechanism of actionand it actually has fewer side
(25:40):
effects than cyclosporine.
Speaker 1 (25:42):
Okay.
Speaker 2 (25:43):
A newer one is and hopefully I say this right
perfluorohexyl octane.
This was approved about twoyears ago and it decreases tear
evaporation from the ocularsurface.
They don't know exactly how,but it has great success with
some patients with dry eyedisease.
That's another eye drop.
Speaker 1 (26:04):
Okay, yeah, and so I think it's really also.
I'm going to reiterate what youstated it's really important to
note that if patients do trythe OTC formulas and they don't
get relief, that there areprescriptions, options to try
and there are also a couple ofdifferent ones.
It's not like, oh well, you'vetried this one, so you're out of
(26:25):
luck, there's nothing else.
So it's important to note thatthere are some steps and there
are some ways to kind of getrelief, even if they don't see
it with a certain product.
So one of the things we talkeda little bit about, some of the
challenges, so differentiatingit from other ocular conditions.
So you mentioned how it kind ofmimics allergies as well.
(26:47):
So if you want to talk a littlebit more about how you know
making sure that you're framingthe questions correctly, because
it could be that you know apatient, if you're using
something to treat allergies, itcould be causing dry eyes,
right, Right, right.
That's a good segue.
Speaker 2 (27:03):
Actually I did want to mention medications.
Be causing dry eyes, right?
So Right, right.
Speaker 1 (27:06):
That's a good segue into actually.
Speaker 2 (27:09):
I did want to mention medications.
You know here we are.
You know we fill prescriptionsall day, every day, and there
are a lot of medications thatcan contribute to dry eye
disease.
So if you have someone that'scomplaining about it.
It could be something they'retaking, like allergy medications
there's also, but someantidepressants will cause it.
The triceplex and the SSRIswill cause.
You know, can cause dry eyedisease.
(27:30):
Beta blockers cause dry eyedisease as a side effect.
Diuretics, of course thatbrings back the whole hydration
and a diuretic is decreasingyour water load.
So proton pump inhibitors a lotof people out there are on, you
know, omeprazole orpantoprazole and and have
problems with reflux.
Um and then another thing thatkind of touches upon the the
(27:52):
female side of it is hormonetherapy.
Oh, sure, so you know, whenwomen are taking estrogen, that
can affect the um your eyes andthe lubrication in your eyes.
Speaker 1 (28:01):
Okay, yeah, no, that's, that's great information
.
The TCAs make sense as well,because they're you know what
they do in general and they dryup everything in general, so
that makes sense.
So, yeah, that's.
It's great to kind of pointthose out, because they may not
necessarily be something that'sjust on the forefront of your
mind, is a prescriptionmedication may actually be
causing it.
So, yeah, right, right, that'sgreat.
(28:24):
So then, touching on a littlebit too, with the fact that, as
you mentioned, treatingallergies within histamines can
also precipitate dry disease aswell, right, so Right.
Speaker 2 (28:37):
Because hay fever causes running eyes.
It's like a double-edged sword.
You got to decide which.
You know it's going to makeyour mouth dry and your eyes dry
, but now your eyes aren'trunning.
Speaker 1 (28:48):
Yeah, yeah.
So now it's a.
It's a again.
It boils down to asking theright questions, getting to the
root cause of what the patientis experiencing, so that we know
the best treatment option forthem.
Speaker 2 (28:59):
Right, when do they work?
Where do their yeah?
What's their environment?
Speaker 1 (29:05):
Exactly.
Lifestyle, yeah, exactly.
Where do they work, where dotheir?
Yeah, what's their environment?
Exactly lifestyle, yeah,exactly.
Speaker 2 (29:09):
so one of the things too um, because I can't believe,
but we're already running outof time.
Speaker 1 (29:12):
I literally say it every episode.
I'm like where does you knowwhen you're waiting for your
water to boil for dinner orwhatever, and it you know, those
five minutes take forever, andthen, all of a sudden, these 30
and they're just gone.
So, yeah, yeah, it always blowsmy mind.
So I just want to reiterate toowhat are some of those things
we can talk about and educatepatients on.
From the environmental sideObviously decreased screen time,
(29:33):
wearing glasses instead ofcontact lenses, like what are
some of the other things.
Speaker 2 (29:39):
I'll just interject on that decreased screen time.
I did want to mention the20-20-20 rule.
Have you heard of that?
No, please share Every 20minutes of screen time.
Speaker 1 (29:51):
You should look away from your screen for 20 seconds
and focus on something.
Speaker 2 (29:54):
20 feet away.
Wow, okay, and that's thathelps you.
You know cause you're staringat a screen.
You you have an incompleteblink rate, so you're not.
You know the when you blink,you're lubricating your eye, so
if you're staring at a screen,you blink less and you blink
incompletely.
So this 20 minute, 20, 20, 20,you know, if you want to advise
patients, just to try that 20,20, 20 rule, and I have to do it
myself.
I'm on a screen all the time.
Speaker 1 (30:14):
Yeah, so again it was .
If you're staring at a screenfor 20 minutes, look away every
20 minutes for seconds and focuson something 20 feet away.
Speaker 2 (30:21):
Yes.
Speaker 1 (30:22):
Okay, interesting, I like that.
I mean, I'm definitely going todo that and I'm going to turn
to my left and look out of mywindow and I'm going to find
something in the snow.
Speaker 2 (30:31):
Yeah, okay, don't do it every 20 minutes, try to do
it regularly.
I mean 20 minutes sounds like.
Three times in an hour Soundslike a lot.
Speaker 1 (30:39):
It's a lot, I know.
I know it seems a littledaunting, but I'm definitely
going to do it, at least ever sooften when I think of it.
Speaker 2 (30:45):
Right right.
You know you have to get up andwalk every hour.
You know when your watch buzzesyou to get up and walk every
hour.
This is true.
This is true they're doingsomething different.
Yep, that's a great that's agreat time to do it.
Yeah, that we wanted to talkabout?
(31:05):
I don't think so.
I think, you know, having thatstable of three or four products
giving them lifestyle.
You know, quick lifestyle stufflike that Twenty twenty, twenty
wearing sunglasses, humidifierand and coaching perseverance
and patience in the treatmentand letting them know I think
those are the biggest things.
Speaker 1 (31:29):
Take homes.
Yeah, that's great, that'sgreat.
Well, I think that kind ofsegues into my typical wrapping
it back up and asking the guestswhat the game changer is.
So if you could summarize, youknow what's the game changer
that we talked about today?
What would you say it is?
Speaker 2 (31:39):
I think the game changer is having a plan.
It's hard because no one hasany time, but having that plan
that I just talked about, thosecouple of products, you go to
training your staff, the rest ofyour team, to be aware of all
this.
I think that helps us and Ithink we can really help
(32:00):
patients through education andtreatment.
Speaker 1 (32:03):
Yeah, yeah, and I think I love the idea also of
sharing you know, like otherthings, like where your contact
lens is less, do the 20-20-20,like other things that they can
modify, as opposed to just, youknow, squirt this in your eyes
four times a day and you knowwhatever.
So I love the idea of making ita complete package and really
(32:24):
kind of as a pharmacist I'm aless is better in terms of
absolutely I really like thesedifferent.
Speaker 2 (32:29):
You know hacks, lifestyle they're not big ones,
it's not a big change.
You know exactly to give upmeat, or you know, or?
Speaker 1 (32:37):
go lose 20 pounds and then come back later and tell
me you know, yeah, every day,exactly, exactly, yeah, no, this
is great, so good.
Well, jen, thank you so much.
This was very informational,very informative, it was just,
it was great.
So I really appreciate yourtime today, thank you.
Speaker 2 (32:54):
Thank you, I appreciate it.
Speaker 1 (32:55):
Yeah, thank you.
If you're a CE plan subscriber,be sure to claim your CE credit
for this episode of GameChangers by logging in at
ceimpactcom.
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all next week.
Hey CE Impact subscribers.
Welcome to the Game ChangersClinical Conversations podcast.
I'm your host, josh Kinsey, andas always, I'm super excited
about our conversation today.
Dry eye syndrome is more thanjust an annoyance.
It can significantly impactvision, comfort and overall
quality of life.
In this episode, we'll explorethe causes, latest treatment
(00:33):
options and how pharmacists canplay a key role in helping
patients find lasting relieffrom dry eye syndrome.
It's so great to have our guestexpert with us today, jennifer
Salvan.
Thank you so much for joiningus, jen.
Speaker 2 (00:46):
Thank you, I'm excited to be here.
Speaker 1 (00:48):
Yeah, we appreciate you taking time out of your
schedule to join us.
So, for our listeners out there, if you can just give us a
little bit of brief introductionto yourself, tell us a little
bit about your background andyour practice setting and maybe
your passion for today's topic.
Speaker 2 (01:05):
Great Thank you.
I'm a clinical pharmacist at asmall hospital in Western
Massachusetts.
I've worn a lot of hats overthe years, including over 15
years as a community pharmacist.
A lot of times I'd havepatients come in struggling with
their dry eye disease and askme what to take and what to do,
and I've always found the dozensof products out there a little
(01:25):
daunting.
Hopefully, our discussion todaywill provide some insight on
dry eye disease and thetreatments and the artificial
tear products that are out thereyeah, that's great.
Speaker 1 (01:35):
Yeah, I can agree, it's been a while since I've
practiced in pharmacy officiallybut, yeah, having on my own
store and you and spent a lot ofmy career in community practice
and ever since I was 16 yearsold and working in a community
pharmacy, I feel like that thisis one of the most daunting
(01:55):
aisles in the pharmacy.
Otc section is the eye area,because it just there's so many
products and they all seem likethey're the same and everybody
makes a version of something and, yeah, I completely agree.
So I've I've been really,really excited about this
conversation today because Ithink it's it's something that
all pharmacists struggle with,in my opinion, and so we're
(02:15):
going to give them some, somegreat tips to take back.
So this is great.
So, again, thank you forjoining us.
I really appreciate it.
Let's jump into our first kindof topic.
So I always like to lay thefoundation, so let's just review
exactly what is dry eyesyndrome.
So, you know, maybe let's talkabout the prevalence, what are
(02:35):
some of the causes and just alsohow does it impact patients
daily life?
Speaker 2 (02:42):
Excellent.
You know, I sometimes like tostart with the anatomy involved,
because that helps usunderstand why it happens.
So, on your eye.
Yeah, there's a tear film andit's a coating that keeps the
eyes moist, and when it becomesunbalanced, the tear film breaks
down, leading to inflammationand damage to the eye surface.
So it's important for that tostay in homeostasis to the eye
(03:04):
surface.
So it's important for that tostay in homeostasis.
There's actually three layersto the tear film.
There's the outer layer, whichis a lipid layer, and the
meibomian glands take care ofthis layer.
Now, the meibomian glands, youmay not know, they're on the
inside of the eyelid and theyproduce lipids to keep your eye
moist.
Speaker 1 (03:21):
Okay.
Speaker 2 (03:22):
There's a middle layer that's basically water and
the lacrimal glands producethose and those are located on
the outer edges of your eyesocket and then there's an inner
layer that are produced.
It's called the mucin layer andit's produced by goblet cells
and that's in your conjunctiva.
So altogether that kind oflubricates and keeps your eye
safe from everything in ourenvironment.
(03:43):
Our eyes are open and there'sjust dirt and everything blowing
in your face and getting inthere, so this tear film is
essential for your eye health.
Speaker 1 (03:52):
So it's almost like, even like a three-part checks
and balances system, like if apiece of debris gets through one
, maybe the other is going tocatch it and sweep it out and
whatever.
So that's great, that's a greatfoundation.
Speaker 2 (04:04):
Yeah, okay, hopefully .
Speaker 1 (04:06):
Yeah, I don't necessarily remember that.
There's three parts of that, sothat's, this is great.
Yeah, keep going.
Tell me more.
Speaker 2 (04:12):
Well, and that's I think I like to know about stuff
like that because that helps usguide us on what could be used
to treat something you know,where is it breaking down?
Myobian gland disease issomething that people have, so
if you know it's that, then youmay approach the treatment in
one way versus another.
Speaker 1 (04:31):
That makes sense, okay, yeah.
Speaker 2 (04:33):
There's a lot of different risk factors to
developing dry eyes.
People divide them intomodifiable and non-modifiable.
The thing you can't modify isage.
As we get older, our eyes getdrier, so there's something we
have to deal with.
Usually, there's a higherprevalence in people over 50,
but what we've been finding isthe age group of 18 to 49,.
(04:55):
The incidence is rising, andcan you guess why?
Speaker 1 (05:00):
I would assume environmental factors, and also
staring at screens.
Speaker 2 (05:04):
Staring at screens.
That's exactly it.
One of the things that they'refinding is causing it is
everyone's got a screen in frontof them and we're just on them
all day long, like we're on ascreen here.
You're on a screen and you'rewriting, you're on a screen and
you're filling prescriptions.
I mean, it's hard to get awayfrom being on a screen.
So that's one of the biggestrisk factors or biggest things
that cause dry eye disease.
(05:24):
So, knowing about that and Ican give you some ideas about
you know how to mitigate that.
You know as we talk.
Yeah that's great the otherthing is it's more common in
females versus males, so it'sprimarily because there's
(05:45):
hormonal changes in women thattake dry eye disease.
Also, cosmetic use women put onmakeup and so that you know,
having that on their eyes andgetting in their eyes can, can
damage the tear film.
So that's another avenue.
Yeah, Another.
Well, those are non-modifiable.
The computer screen ismodifiable, but the other thing
is wearing contact lenses.
Speaker 1 (06:10):
That can precipitate dry eye disease.
Speaker 2 (06:11):
So a lot of people I find are switching to glasses
versus wearing their contactsall the time, especially if they
have dry eye disease.
The environment being in an airconditioned environment, being
out in the wind, the sun at thebeach, with the sand blowing.
Caffeine consumptionunfortunately precipitates dry
eye disease or contribute to it.
Yeah, and then a lot of meds,which we can talk about later,
(06:32):
but there are medications thatpredispose you to having dry
eyes.
Speaker 1 (06:36):
Okay, yeah, that's great, you lost me at sand.
One of my biggest fears in theworld is sand.
I hate sand, I can't.
It feels like it getseverywhere and you can never get
rid of it.
So, yeah, the whole idea oflike sand blowing in my eyes.
I just went down this wholelike rabbit hole of just
freaking out.
Speaker 2 (06:56):
The first time I go to the beach each summer, I'm
like I can't.
It takes me like a half an hourto get used to having sand on
everything.
Speaker 1 (07:02):
That's the worst, the absolute worst.
I mean, I love the beach, but,man, I wish it didn't have so
much sand.
So, yeah, okay.
So that's great If you can alsolet us know what's the
prevalence for our patients indry eye syndrome.
Speaker 2 (07:19):
Well, it's actually pretty prevalent and it's hard
to tell the exact prevalence.
Estimates say over 16 millionpeople adult people in the US
have dry eye disease.
But some feel this is on thelow side because dry eye disease
can be underreported andundertreated, because people
just go out and buy dry eyedrops and no one even knows that
they have it.
Speaker 1 (07:40):
Or they just push through.
They're just like oh, let meblink some more or let me take
my contacts out my eyes arereally dry today or something
billion a year in direct medicalcosts, which I thought was an
interesting number.
Speaker 2 (07:52):
that's huge yeah, and then indirect medical costs,
which is lost productivity,which is huge for this as well.
If you can't see as well,you're not going into work.
(08:12):
If you have to go to doctor'soffices or you're out picking up
medications, you know you'renot as productive and that
doesn't even get into thequality of life impact.
So say you are having troublewith your eyes, you can't read,
you can't drive, you can't watchTV and you can't be on your
phone.
You know it's.
It's got far reachingrepercussions.
Speaker 1 (08:33):
It's a lot, yeah, and I mean even thinking about, too
, how that could translate downinto being, you know, a barrier
or a challenge for your patientsto get medication, because,
like, what if?
Like you said, what if theycan't drive anymore and so they
don't have a way to get to thepharmacy and they don't have a
way to get to their doctor andyou know, then they don't have a
way to get their meds or stayadherent and whatever.
(08:55):
So just a lot of differentthings that could be kind of
compounded with just the fact of, you know, dry gets out of hand
or whatever.
So, yeah, yeah, so what aresome of the common symptoms that
we're going to see of someone?
So what are we looking for tosay maybe this is dry, maybe
this is more severe than just Igot something in my eye and I've
(09:18):
rubbed it and now it hurts alittle bit.
Speaker 2 (09:20):
Right, I mean, that's kind of the way it starts.
You know, you have a burningsensation under your eyelids.
It's uncomfortable, sometimesit feels like there's dirt or
sand underneath your eye.
Yeah, they can be itchy and red.
(09:40):
You can start having visualchanges.
You may think you need glassesor it could feel like your
allergies are coming on, andthat's a hard thing because to
differentiate dry eye diseasefrom other things like allergies
can be difficult.
Speaker 1 (09:58):
Dr Justin Marchegiani .
Yeah, so when we're talkingwith patients and we're seeing
them maybe looking at things inthe aisle or whatever, if
they're maybe trying toself-medicate or whatnot, what
are some of the?
I guess, what are some of thethings we would ask for to be
able to confirm, like maybe thisis dry syndrome, you know?
(10:18):
Like that would guide us intothe direction of which
medication to choose, I guess.
Speaker 2 (10:24):
Well, I think that's um, that can be hard, but it you
could ask them questions about.
You know, is it allergy season?
Do you get allergies all thetime?
Does this continue throughoutthe year?
Do you find that it's worsewhen you go into work or when?
You go into a movie theater orwhen you go into a cold
environment, you know you cantry to ask questions about
what's triggering it.
(10:44):
Do they notice what'striggering it?
Are there any foods or anything?
You know there's a lot to gointo it.
You can also ask if they haveany underlying conditions,
because a lot of timesautoimmune conditions will cause
dry eye.
So that's one of the things.
As you're asking questions, youcould find out that they have
other symptoms and one of thetimes you might refer them to an
(11:07):
eye care specialist or theirPCP.
Just to have some tests run tomake sure there isn't more going
on there.
Speaker 1 (11:13):
Right, right, exactly .
Yeah, you mentioned autoimmunedisease.
Is it all autoimmune diseasesor are there specific ones that
we should be looking out for?
That put our patients atgreater risk.
Speaker 2 (11:23):
Yeah, not all of them , but there's a couple that come
to mind.
I'm not sure I'm going to sayit right Sjogren's syndrome,
that's a big one, that'll do it,and rheumatoid arthritis is
another one.
But Sjogren's syndrome affectsthe salivary and lacrimal glands
.
So you're going to have drymouth but you'll also have dry
(11:44):
eyes.
So that's one that comes tomind.
I think dry eyes go withSorgeant syndrome, but you can
have dry eye disease withouthaving that and vice versa.
Sure, of course, of course, yeah, okay, but just knowing that
some autoimmune diseases maycause, yes, yes, someone is
picking up their yeah, therheumatoid arthritis med and
(12:06):
mentioned that they're you knowtheir eyes are killing them and
you, you know they're itchingthem all the time.
They're rubbing them.
You know what can they do.
Speaker 1 (12:12):
Yeah, okay, great.
So, um, touching on the fact of, obviously we're pharmacists
and we want to know how, how wecan help.
So what, what's your take on,you know, the role, of role of
pharmacists in helping to manageand treat dry disease?
Speaker 2 (12:30):
Well, I think pharmacists can be key.
I mean, we're one of the mostaccessible healthcare providers.
We're right out there.
Whether we actually have thetime is debatable to spend time
talking to a patient, but Ithink, if we can, it's important
to.
I think we have a huge role inpatient education and patient
education is a big part oftreating dry eye disease.
(12:51):
There's a lot of environmentalfactors, lifestyle modifications
.
The first steps of treating dryeye disease involve patient
education over the counter,artificial teardrops and lid
hygiene, which we can talk abouta little more.
That's one of the things thatcan help with dry eye disease
yeah.
Speaker 1 (13:09):
That's interesting.
I don't think I've ever heardthat phrase lid hygiene Okay,
that's good, so, yeah, so that'sactually a perfect segue.
So that's what I wanted to gointo.
Next was kind of focusing moreon the opportunities that we
have as a pharmacist.
So you mentioned educatingpatients on lifestyle
modifications and preventativemeasures.
So what are some of thosethings that we can talk about
(13:32):
with our patients?
Speaker 2 (13:33):
Well, I mean, we mentioned before how the
environment can cause dry eyedisease.
So something as simple aswearing sunglasses can help a
lot and I think some people justdon't wear them.
Know, if you have a heavierbrow you, you know the sun might
not affect your eyes.
I don't need heavy sunglasses.
The sunglasses I use are kindof light, but I've started
wearing darker ones and makingsure they're big enough to cover
(13:56):
your eyes and that'll helpprotect them.
Um, in your house you could usean air humidifier you know,
especially this time of year,the air in our, our house, you
know, with the heat running,depending on where you are, the
heat running it's very dry, andso I noticed my eyes are more
watery in the winter, and I tryto have an air humidifier going.
Conversely, if you have airconditioning running, you know I
(14:19):
think people that live downSouth have have it harder
because they're you know, youcan't go outside as much because
it's so hot, so minimizing yourexposure to air conditioning.
Speaker 1 (14:29):
Okay.
Speaker 2 (14:31):
If you're a smoker, this smoke, can you know, dry
out your eyes and irritate them.
So that's something um, interms of lifestyle modification,
um, dehydration is huge, orhydration proper hydration.
So people who are dehydrated andI run into people all the time
that say, oh God, I haven't hadanything to drink all day.
You know, and I'm like well, ingeneral, I mean with so many
(14:53):
things in our life, butespecially if you have any kind
of dry dryness, you know, dryeye disease, you know they say
that you're supposed to drink asmany ounces of water as you
weigh in kilograms.
So say you weigh 75 kilos,which isn't that a lot.
You know, that's 150 pounds,that's 75 ounces of water and
that's hard, I think it's hard.
Speaker 1 (15:19):
It's a lot.
Yeah, it's a lot, and it'sinteresting too to think I mean
it.
It makes sense.
It's not like it's well, that'sodd, but the fact that
hydrating your body makes youreyes less dry, I mean, you know,
like the fact that thattranslates into you know making
sure that your eyes are hydratedtoo, so you just don't think
about that being where thatwater goes, I guess.
Speaker 2 (15:37):
So so that makes sense.
Yeah, I think about it, becausethat film I talked about a lot
of it is aqueous and so, if thatis, it increases the osmolarity
of it.
Speaker 1 (15:46):
So there are things in there and they just get more
concentrated and that's not asgood for your eye yeah, makes
sense now that you gave us thatgreat introduction and the
reminder of the, the uh, thestructure of the eye.
Speaker 2 (15:57):
That was so good dietary supplementation oh yes,
I have a passion for dietarysupplements so I've done a lot
of studying on it.
But one of the things in dryeye disease you can do and this
helps you in a lot of ways issupplement with omega-3 fatty
acids.
Okay, and there are studies outthere.
Right now the studies areinconclusive, but some have
(16:18):
really shown promise and whenyou think about how omega-3
fatty acids blockpro-inflammatory substances in
the body, that can help with theinflammation cycle of the eye.
So that's one of the thingsthey're studying.
And another avenue they'restudying is topical omega-3
supplementation or application.
It hasn't gotten there yet, butthat's something that's out
(16:39):
there.
Speaker 1 (16:40):
Interesting.
That is definitely somethingI've never heard before.
That's great.
Okay, I'm glad you added that.
That's super interesting.
Yeah, that's, that isdefinitely something I've never
heard before.
That's great.
Okay, I'm glad you.
I'm glad you added that.
That's super interesting.
Yeah, that's great.
So one of the things I want tobe sure we jump into is is the
over-the-counter treatmentoptions.
So I know that that can be verydaunting, so let's kind of talk
about.
I'd love for you to share some,maybe tips and tricks of like.
(17:01):
Again, that aisle is so there'soverwhelming.
So many products.
They all kind of seem the same.
You know, everybody makes aversion of everything.
So how can we approach that?
Yeah, how can we approach thatas the pharmacist and make it
manageable so that we canactually, you know, relay that
information accurately to ourpatients?
Speaker 2 (17:21):
Because I always thought this when I went down
the coffin cold aisle.
When you finally look at thepackages, there's like a dozen
ingredients and that's it, butthere's hundreds of products out
there and it's similar toartificial tears.
So artificial tears I'll spendtime talking about, because
that's really the OTC productthat patients need help with,
and in artificial tears there'ssix different categories of
(17:44):
ingredients, but the biggest oneis a Demelson and that's
something that increases theviscosity of the drop to
increase the time that it stayson your eye and helps add that
lubrication.
And that can be kind of a trickything to balance, because if
it's got too much in it it'sgoing to be more of a gel and
you're not going to see anything.
Speaker 1 (18:05):
You're going to be blurring, yeah, yeah.
Speaker 2 (18:09):
And then there could be ones that just don't help at
all.
So a lot of products I justwant to see.
Thicker is not always better.
I wanted to give some examplesof DemoSense, the Ohio uronic
acid, propylene glycol andcarboxymethylcellulose.
Those are three of the mostpopular.
Another ingredient are oils wetalked about.
(18:33):
There was an oily layer to thetear film.
And so adding an oil likemineral oil or flaxseed oil.
That can help restore the lipidlayer, if that's an issue, and
it can help prevent tearevaporation.
One thing I do want to mentionthat's in them is preservatives.
Now, the most commonpreservative is benzalkonium
chloride, and the conundrum hereis you need them in multi-dose
(18:56):
bottles to decreasecontamination, and yes, but they
actually contribute to cornealdamage and can precipitate dry
eye disease and disrupt the tearfilm.
So one thing that's new that Iwant to mention is these
disappearing preservatives, andthat's sodium chloride and
(19:17):
sodium perboate.
These don't have the sameeffect on the tear film, so
there's a lot of interest inproducts that contain these
preservatives instead.
That said, preservative-free isthe best thing to do.
Speaker 1 (19:30):
Sure, sure, but again , remembering that
preservative-free usually meansthat it's going to be like a
one-time use kind of thing,which is probably going to make
it more expensive because it'snot a multi-dose vial.
Yeah right, so yeah.
So again, just remembering andweighing those options.
But I think it's important tounderstand the impact of the
(19:51):
preservatives and, you know, ifyou're explaining that correctly
to the patients, maybe they'rewilling to pay a little bit more
so that they're not addingsomething more dangerous to
their eyes.
So, yeah, yeah.
Speaker 2 (20:03):
Another thing is, wherever you practice and
depending on your location,keeping your eye out for sales.
You know if there's apreservative free and you know
you have patients that arestruggling dry eye disease and
letting them know that that canbe something that will be
helpful for them.
Speaker 1 (20:15):
Yeah, that's great.
That's great.
So, basically, what you'resuggesting, advocating for, is
to fully understand the activeingredients and and and make
your choices based on that, asopposed to just like I have a
favorite product, it's in thered box or whatever.
So it's more about like alsounderstanding too.
(20:35):
As you mentioned, some of thosethings treat the different
aspects of it.
So is it a, is it a lipid issue, or is it a, you know, whatever
?
So understanding which ones toadd that add, that's super
helpful, yeah.
Speaker 2 (20:52):
I think it would be important for pharmacists to
look at the products availableat their location and pick three
or four that they know have thecarboxymethylcellulose or
hyaluronic acid or propyleneglycol and one of those newer,
disappearing preservatives orpreservative-free, and just have
those as their go-tos.
Speaker 1 (21:08):
Then they're not out there wondering.
Speaker 2 (21:10):
You know what I mean.
It takes a little bit ofhomework, but in the long run.
If you've got those three orfour products, then you'll feel
like you've got something inyour armamentarium that you can
actually do and not take as muchtime.
Speaker 1 (21:20):
Well, and let's be honest, I mean, if you go out
there with a plan, your patientis probably going to trust you
more because you're going toknow exactly what you're talking
about, as opposed to being like, oh I don't know, let's see,
let's turn this around and seewhat's in this one and let's
touch this one Right, that's nota good look.
Speaker 2 (21:36):
Hang on, yeah, it doesn't yeah.
Speaker 1 (21:38):
Let me just double check and then I can talk to you
about it.
You know, I think you're right.
I think it would make ourconversation more impactful with
a patient.
I think it would really drivehome the point that we know what
we're talking about.
So, yeah, so, like you said, doa little work on the front end,
a little bit of homework, andbe prepared and research, and
that way you're better able toto answer the patient's
(22:00):
questions and to recommend aproduct easily.
Yeah, yeah.
Speaker 2 (22:03):
Another thing to keep in mind is when you have that
product and you're recommendingit um, consistency and patience
is key.
Patients are going to use thisand think like tomorrow their
eyes are going to feel betterand really that's, that's not an
expectation, that it's good toum.
What do I say?
Get rid of that expectation ormake the expectation clear.
Yeah, I have to use this forthree or four times a day for
(22:26):
almost a month to see if it'sgoing to work or not, and
unfortunately the first productyou pick might not be the right
one.
You know, say you start with ahyaluronic acid one and it's got
a preservative in it and it'snot working.
Maybe you progress to a productthat has two.
You know there are combinationproducts that might have the.
(22:48):
C and C, thecarboxymethylcellulose and the
hyaluronic acid.
That might work.
So unfortunately there is alittle bit of trial and error
with it, but having a directionto point the patient in can be a
lot better, because one of thebiggest problems from I would
hear from patients and what whatthey have is trying 100
(23:08):
different products, spending allthis money, having all these
bottles on their shelves andnothing's working.
Speaker 1 (23:13):
Yeah, well, and I think it's.
It's good to point out that youknow it's not.
I do not like putting drops inmy eyes, so I would be that
person that's like oh yeah, Idid it once and I hated it, you
know.
So I feel like it would.
It's really important to setthe stage and to say you know,
this is it's going to have to beX number of times a day, it's
(23:34):
going to have to be for a month,you're going to have to make
sure, or whatever.
But, like you mentioned too,patients are all different.
So it makes sense that some ofthe products are not going to
work for some patients becausethey're you know, some of them
may need the lipid replenishmentand some of them may not, and
some of them may not need, youknow, the, the one that glazes
over, the carboxymethasalose andwhatever.
So, so yeah, it's.
(23:56):
It's going to unfortunately bea little bit of trial and error
for patients.
I think that expectation isimportant to set up as well.
Speaker 2 (24:03):
Yes, and they may need the ones that I said that
coat your eye more.
That's something you couldactually recommend for someone
at nighttime.
So put it on close your eyes,go to bed.
Then by the morning you cankind of rinse your eyes off and
hopefully you've retained themoisture from sleeping with the
gel on your eyes.
Speaker 1 (24:20):
Oh yeah, that's a great idea.
That's great.
One thing just really quickwhen we're talking about
treatments, there are someprescription treatments.
I don't want to spend a ton oftime on them because I felt like
the majority of our time neededto be on the OTCs, but just so
that we're aware what are someof those prescription meds that
would treat your eye.
Speaker 2 (24:36):
There's several eye drops out there that I'm sure
people are used to filling.
Cyclosporine eye drops havebeen around for a couple of
decades.
The hard part is iscyclosporine is not easy to get
into solution so and it causes alot of the same symptoms you're
trying to get rid of.
So it causes burning in youreyes, redness.
(24:56):
About 50 percent of patientsdon't continue with it because
of that if you can 10%.
here the side effects do get alittle better and people find
improvement.
They are working on newformulations, a nano emulsion,
so that kind of increases thetime and decreases the side
effects.
So, that'll be coming.
Laphitigras is another onethat's been around for a few
(25:19):
years.
It's another.
You know, all these productsaffect the inflammatory cycle
kind of from different avenuesso the fit of grass.
So if something doesn't work fora patient, they could try
another one.
So cyclosporine is working.
They progress past artificialtears.
Cyclosporine didn't work.
Lefitographs could be an optiontoo, because it has a slightly
different mechanism of actionand it actually has fewer side
(25:40):
effects than cyclosporine.
Speaker 1 (25:42):
Okay.
Speaker 2 (25:43):
A newer one is and hopefully I say this right
perfluorohexyl octane.
This was approved about twoyears ago and it decreases tear
evaporation from the ocularsurface.
They don't know exactly how,but it has great success with
some patients with dry eyedisease.
That's another eye drop.
Speaker 1 (26:04):
Okay, yeah, and so I think it's really also.
I'm going to reiterate what youstated it's really important to
note that if patients do trythe OTC formulas and they don't
get relief, that there areprescriptions, options to try
and there are also a couple ofdifferent ones.
It's not like, oh well, you'vetried this one, so you're out of
(26:25):
luck, there's nothing else.
So it's important to note thatthere are some steps and there
are some ways to kind of getrelief, even if they don't see
it with a certain product.
So one of the things we talkeda little bit about, some of the
challenges, so differentiatingit from other ocular conditions.
So you mentioned how it kind ofmimics allergies as well.
(26:47):
So if you want to talk a littlebit more about how you know
making sure that you're framingthe questions correctly, because
it could be that you know apatient, if you're using
something to treat allergies, itcould be causing dry eyes,
right, Right, right.
That's a good segue.
Speaker 2 (27:03):
Actually I did want to mention medications.
Be causing dry eyes, right?
So Right, right.
Speaker 1 (27:06):
That's a good segue into actually.
Speaker 2 (27:09):
I did want to mention medications.
You know here we are.
You know we fill prescriptionsall day, every day, and there
are a lot of medications thatcan contribute to dry eye
disease.
So if you have someone that'scomplaining about it.
It could be something they'retaking, like allergy medications
there's also, but someantidepressants will cause it.
The triceplex and the SSRIswill cause.
You know, can cause dry eyedisease.
(27:30):
Beta blockers cause dry eyedisease as a side effect.
Diuretics, of course thatbrings back the whole hydration
and a diuretic is decreasingyour water load.
So proton pump inhibitors a lotof people out there are on, you
know, omeprazole orpantoprazole and and have
problems with reflux.
Um and then another thing thatkind of touches upon the the
(27:52):
female side of it is hormonetherapy.
Oh, sure, so you know, whenwomen are taking estrogen, that
can affect the um your eyes andthe lubrication in your eyes.
Speaker 1 (28:01):
Okay, yeah, no, that's, that's great information
.
The TCAs make sense as well,because they're you know what
they do in general and they dryup everything in general, so
that makes sense.
So, yeah, that's.
It's great to kind of pointthose out, because they may not
necessarily be something that'sjust on the forefront of your
mind, is a prescriptionmedication may actually be
causing it.
So, yeah, right, right, that'sgreat.
(28:24):
So then, touching on a littlebit too, with the fact that, as
you mentioned, treatingallergies within histamines can
also precipitate dry disease aswell, right, so Right.
Speaker 2 (28:37):
Because hay fever causes running eyes.
It's like a double-edged sword.
You got to decide which.
You know it's going to makeyour mouth dry and your eyes dry
, but now your eyes aren'trunning.
Speaker 1 (28:48):
Yeah, yeah.
So now it's a.
It's a again.
It boils down to asking theright questions, getting to the
root cause of what the patientis experiencing, so that we know
the best treatment option forthem.
Speaker 2 (28:59):
Right, when do they work?
Where do their yeah?
What's their environment?
Speaker 1 (29:05):
Exactly.
Lifestyle, yeah, exactly.
Where do they work, where dotheir?
Yeah, what's their environment?
Exactly lifestyle, yeah,exactly.
Speaker 2 (29:09):
so one of the things too um, because I can't believe,
but we're already running outof time.
Speaker 1 (29:12):
I literally say it every episode.
I'm like where does you knowwhen you're waiting for your
water to boil for dinner orwhatever, and it you know, those
five minutes take forever, andthen, all of a sudden, these 30
and they're just gone.
So, yeah, yeah, it always blowsmy mind.
So I just want to reiterate toowhat are some of those things
we can talk about and educatepatients on.
From the environmental sideObviously decreased screen time,
(29:33):
wearing glasses instead ofcontact lenses, like what are
some of the other things.
Speaker 2 (29:39):
I'll just interject on that decreased screen time.
I did want to mention the20-20-20 rule.
Have you heard of that?
No, please share Every 20minutes of screen time.
Speaker 1 (29:51):
You should look away from your screen for 20 seconds
and focus on something.
Speaker 2 (29:54):
20 feet away.
Wow, okay, and that's thathelps you.
You know cause you're staringat a screen.
You you have an incompleteblink rate, so you're not.
You know the when you blink,you're lubricating your eye, so
if you're staring at a screen,you blink less and you blink
incompletely.
So this 20 minute, 20, 20, 20,you know, if you want to advise
patients, just to try that 20,20, 20 rule, and I have to do it
myself.
I'm on a screen all the time.
Speaker 1 (30:14):
Yeah, so again it was .
If you're staring at a screenfor 20 minutes, look away every
20 minutes for seconds and focuson something 20 feet away.
Speaker 2 (30:21):
Yes.
Speaker 1 (30:22):
Okay, interesting, I like that.
I mean, I'm definitely going todo that and I'm going to turn
to my left and look out of mywindow and I'm going to find
something in the snow.
Speaker 2 (30:31):
Yeah, okay, don't do it every 20 minutes, try to do
it regularly.
I mean 20 minutes sounds like.
Three times in an hour Soundslike a lot.
Speaker 1 (30:39):
It's a lot, I know.
I know it seems a littledaunting, but I'm definitely
going to do it, at least ever sooften when I think of it.
Speaker 2 (30:45):
Right right.
You know you have to get up andwalk every hour.
You know when your watch buzzesyou to get up and walk every
hour.
This is true.
This is true they're doingsomething different.
Yep, that's a great that's agreat time to do it.
Yeah, that we wanted to talkabout?
(31:05):
I don't think so.
I think, you know, having thatstable of three or four products
giving them lifestyle.
You know, quick lifestyle stufflike that Twenty twenty, twenty
wearing sunglasses, humidifierand and coaching perseverance
and patience in the treatmentand letting them know I think
those are the biggest things.
Speaker 1 (31:29):
Take homes.
Yeah, that's great, that'sgreat.
Well, I think that kind ofsegues into my typical wrapping
it back up and asking the guestswhat the game changer is.
So if you could summarize, youknow what's the game changer
that we talked about today?
What would you say it is?
Speaker 2 (31:39):
I think the game changer is having a plan.
It's hard because no one hasany time, but having that plan
that I just talked about, thosecouple of products, you go to
training your staff, the rest ofyour team, to be aware of all
this.
I think that helps us and Ithink we can really help
(32:00):
patients through education andtreatment.
Speaker 1 (32:03):
Yeah, yeah, and I think I love the idea also of
sharing you know, like otherthings, like where your contact
lens is less, do the 20-20-20,like other things that they can
modify, as opposed to just, youknow, squirt this in your eyes
four times a day and you knowwhatever.
So I love the idea of making ita complete package and really
(32:24):
kind of as a pharmacist I'm aless is better in terms of
absolutely I really like thesedifferent.
Speaker 2 (32:29):
You know hacks, lifestyle they're not big ones,
it's not a big change.
You know exactly to give upmeat, or you know, or?
Speaker 1 (32:37):
go lose 20 pounds and then come back later and tell
me you know, yeah, every day,exactly, exactly, yeah, no, this
is great, so good.
Well, jen, thank you so much.
This was very informational,very informative, it was just,
it was great.
So I really appreciate yourtime today, thank you.
Speaker 2 (32:54):
Thank you, I appreciate it.
Speaker 1 (32:55):
Yeah, thank you.
If you're a CE plan subscriber,be sure to claim your CE credit
for this episode of GameChangers by logging in at
ceimpactcom.
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all next week.
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