Dry eye interview with Phyllis Knapp et al

The following is posted with Phyllis Knapp's permission, and with full copyright information.

Dry Eye Syndrome a Rapidly Growing Health Problem
BY DRU SEFTON
c.2005 Newhouse News Service

Dry eye sounds like a slight annoyance, and sometimes it is. But for a rapidly growing number of Americans, it's a huge lifestyle issue.

Phyllis Knapp of Kalamazoo, Mich., endures hours of a complicated daily regime to care for her dry eyes. And Linda Mistretta of Lodi, N.J., was once in so much pain while out to dinner, "I had to go sit in the car and close my eyes, just to get some relief."

Treatment for the malady, technically known as dry eye syndrome, includes drops, ointments, mists, duct plugs, eye compresses, lid scrubs, moisture-retaining glasses and nutritional supplements.

As many as 20 million Americans cope with some level of dry eye, according to Market Scope, an ophthalmological market research firm in suburban St. Louis. Worldwide, sufferers spend some $522 million annually on dry eye products; Market Scope estimates that will jump to $1 billion by 2010.

Experts agree the causes are many and the problem is increasing. Aging, air conditioning, pollution, prescription side effects, contact lens use, laser eye surgery and hours spent in front of computers all contribute.

Among the symptoms are burning, itching, pain and even excess tearing -- yes, too many tears may signal dry-eye syndrome.

Tear film is made up of three layers: mucus, which helps tears adhere to the eye; water; and oil, which keeps the water layer from evaporating. In bright sunlight or strong wind, dry-eye sufferers often find their eyes actually producing too much water in the form of reflex tears, upsetting the balance of tear composition.

Glands in the eyelids and above the eyes that produce each layer may become clogged, which also leads to problems.

William Mathers, an ophthalmology professor at Oregon Health Sciences University in Portland, has studied dry eye for more than 20 years. He said that tear film is "very complex. And the concentration of nerves on the surface of the eye is higher than anywhere else on the body, so any disturbance is felt."

Phyllis Knapp first felt it in early 2000, about a month after having LASIK surgery to correct her vision.

"Something wasn't right," Knapp said. "My eyes burned all the time. The doctor just said I was still healing."

But months and years later, her eyes kept getting drier. Now there are eroded areas on their surfaces. "Dry eye does a lot to impair your vision if it's severe, and mine is," she said.

After subsequent cataract surgery led to further dry eye complications, she left her job as a secretary in the president's office at a community college. She can no longer drive. In addition to a clinic in her own city, she's been to Dallas, Atlanta and Boston in search of relief.

Knapp describes the pain: "It feels like a grittiness in my eyes -- that's called foreign-object sensation. It feels like I haven't slept for three days, or I've been staring at a computer for 12 hours and can't focus my eyes."

She uses warm compresses, drops, ointments and other prescriptions to manage the condition -- every day, 12 different steps. Insurance covers some but not all of the cost.

Linda Mistretta also watches her diet, which is helpful for some patients. "I can't have caffeine or anything high in fat," she said. "This really changes your life. Last night I had wine, and today I'm suffering."

Mistretta's problems also began after LASIK surgery, in November 2002.

"You can't wear eye makeup, your eyes are always ugly," she said. "I was an avid reader and I had to stop reading."

She even resorted to punctal plugs, tiny silicone tubes inserted into tear-duct openings to seal in moisture. Unfortunately, those also irritated her eyes. She ultimately had the openings cauterized closed, which helped somewhat.

Now Mistretta does daily lid scrubs to keep glands in her eyelids clear, and takes flaxseed oil.

Mathers, in Portland, said he has found that flaxseed or fish oil taken orally helps reduce inflammation. "If you can suppress this inflammation, then you can restore the surface of the eye to a happier state," he explained.

Such techniques are often topics of conversation at the Dry Eye Support Group that meets every other month at the University of California, Irvine.
Facilitator Kathy McCaleb, a licensed clinical social worker, oversees the first half of the 90-minute session. About 30 participants exchange ideas and frustrations.

"Dry eye isn't something simple to cure," McCaleb said. "Lots of people in the group have had to quit jobs and curtail daytime activities due to light sensitivity. They need to put drops in their eyes every hour."

The second half of the meeting is a question-and-answer session with group founder Jonathan R. Pirnazar, an assistant professor in the university's department of ophthalmology and a dry eye sufferer himself.

"It's amazing how much dry eye I see every day," he said of his practice. "I'll see around 45 patients a day. Probably three to five of those will be getting punctal plugs. And I'm just one doctor."

Both Knapp and Mistretta say that although their eyes are not back to normal, with attention and work the discomfort is tolerable.

That's the good news, said Portland ophthalmologic researcher Mathers. Dry eye "can be treated. It's not inevitable that you'll be left with irritation that you can't do anything about."

And as experts better understand the syndrome, more treatments will become available. "Then people will not have to be bothered with this," Mathers said.

Aug. 31, 2005

(Dru Sefton can be contacted at dru.sefton@newhouse.com)