Title: Dry Eye Disease: What Your Eyes Are Telling You | An Optometrist Explains
Downloaded: 2025-12-30 09:27:39

[music] Welcome back everybody to another episode of the AutoAccon Attorneys podcast brought to you by the Auto Accident Attorneys Group where our motto is simple. We take care of you. We're known for helping people navigate the aftermath of auto accidents. However, this podcast, as you already know, is about so much more. Last week, we had a broker of auto insurance policies. The week prior, we were talking about life insurance. Today, we are going to speak to an optometrist and bring you direct to consumer information that you may not otherwise have access to.

I am blessed to have Dr. Jonathan Chen of Vision Source Insight Eye Care from Sandy Springs with me here today. Dr. Chen, thank you so much for coming on to the podcast. >> Yeah, thank you very much for having me here. >> Let me give you an opportunity to inform myself and our listeners uh how you got into what it is that that you do and give us a brief introduction about yourself. >> Yeah, happy to. Um so Jonathan Chen um I'm Atlanta born and raised. I grew up in Lilurn, Georgia and uh attended University of Georgia for undergrad.

Um dogs. >> Yeah. Part of my journey was trying to figure out what I wanted to do and um originally I went to UG with the thoughts of doing pharmacy. found out I'm not the biggest fan of organic chemistry and um so I had an idea of doing healthcare and so I had shadowed a bunch of different professions looked at it and um as the story I say is funny as it is I started wearing glasses since I was in like fourth grade but still never really thought about it until I think someone had mentioned it and I was like oh like curious on it shadowed some optometrists sort of see their day by day um it seemed like it had a pretty good work life balance per se.

And so I started working in a pra uh like a group practice with opthalmologists and optometrists there. And a long story short attended a optometry program in University of Houston and uh spent a good four years there. Found out I guess I like studying so much. So I spend an extra year my quote unquote uh I say super senior year of doing a elective extra one year for residency >> in St. Louis. Uh there is a University of Missouri St. Louis optometry school there um specialized more in cornea and contact lenses and so that area is what I dealt with was there are some patients that their let's say their front of their eye the cornea that clear portion of their eye it they cannot see well with typical glasses or soft contact lenses >> and so we utilize what we call like medically necessary um lenses which are usually like a harder lens and that helps provide some type of re vision rehabilit meditation to allow them to see better and function during their day.

>> That is like a specialty that you went and studied for that particular symptom, I guess. >> Yeah, precisely. Um, I guess the journey on that was the first patient that actually went to go see in shadow um from an optometrist. Uh, this is like undergrad, just like had no idea was what for the eyes. um came in to see a patient and I just remember he was getting tested for his vision and like like people say like the quintessential like a biggie on on the chart >> and then like but this was like with them putting the machine over their uh in front of their face and trying like ask like one or two.

I'm just like >> that's not how I usually thought things would go. And then uh but then she explained that this patient had a certain conditional called keraticonus um which deals with the thinning of the front of the eye. So I make the analogy of let's say imagine like a car tire when it gets thin it sort of bulges a little bit that distortion can cause distorted vision when light tries to focus. Um, so I didn't think about it in the beginning, but eventually as I went through school, um, I learned that there were so many more specialties that I could go into and one of my rotations, uh, with now my one of my mentors, um, was heavily involved with that and that just got my curiosity into it and like I think that would have been a nice thing to learn more about and my journey sort of ended up in there with that extra year.

Uh had a great time, really good enjoyable experience. Learned a lot. U met a lot of uh great colleagues and friends that lasted through. Yeah, >> that's amazing. What was that called? The thinning of the pupil. >> Uh the cornea. Front of your eyes. >> Thinning of the cornea. >> Yeah. Keraticonus. So >> how do I spell that? >> K E R A T O C O N U S. So kerido in the front is the cornea and then conis is like a cone. >> Okay. >> So they sort of described if you look at on um like a web online search is basically it sort of protrudes a little bit and becomes almost like a cone.

>> Keraticonis is the thinning of the cornea. >> Yeah. It's a condition that causes thinning and causes distortion. >> Oh, it's a condition that causes the thinning. Is it degenerative because of age or is it something that's biological like somebody's body just does it whether they're 15 or 50? >> Great question. So um in essence from what we can understand um there is a seems like there could be a genetic component um and well there is a genetic component from studies and it causes some type of when we're taught some type of like non-inflammatory degeneration.

Some people have a a school of thought is also like excessive eye rubbing for people that are more susceptible causes some type of integrity um breakdown. Um and so it genetically I think as more studies come out it is ranged from in the beginning it was like maybe someone with a gene was like one in 5,000 and then now with more recent studies I think one in like Denmark was like maybe potentially one in like 300ish. >> Oh wow. That had a genetic factor. But I think with many diseases it ends up being you may be having a little predisposition but it's also how the environment and your lifestyle affects your health.

>> Right. I see. Uh is there anything in in terms of the medical literature that's out is there anything that like when we're talking about genetic predisposition is it anything that we could see like people with brown hair. Is it like that or is it in the in like the DNA like you can't tell? I wouldn't be able to tell if my child is more susceptible to this or not. >> I think it's probably more on the latter. I mean, there are some associations, but just because you have that, it's not guaranteed that you will get X condition.

>> Got it. >> Um, but it just Yeah, in terms of that note. >> Okay. So staying on the topic of of symptoms and some issues uh the catalyst for me to reach out to you uh and ask you to come on was because when we were going through my uh diagnostic testing I had mentioned to you that my mother who always listens to my show by the way she's my number one listener. So mom I usually do this at the end of the episode but I'm sure you're really interested in this episode. So I'll jump in right now and say I love you and thank you for watching.

Uh my mom is always she's one of those like a helicopter moms even at my age. She's like, "Hey, make sure you mention this to your doctor." So when she found out I was going to go get my eyes checked, she wanted me to ask about dry eyes. And I was like, "I don't have dry eyes, but she does." And she said, I don't know if it's correct or not, but she was like, "Well, you might be you might have a predisposition to dry eyes." I didn't even know what dry eyes were. Can you kind of give our listeners a little bit of insight into what what dry eyes are and what might cause it?

>> Yeah. And so with dry eyes, right, a lot of it, I think the naming of it is a little tough because when you think of dry eyes, it's just like, oh, I got to feel something. And so what we're sort of in the the profession is sort of have to realize that but also as we learn more about it there's so many different factors that can influence it. So from symptom side some people can experience the dryness of their eyes some people may actually experience tearing which is also like sounds off to them.

It's like you're telling me I have dry eyes but but my eyes just keep tearing up right. Um but then the the thing is like well your eyes were probably dry and your body was trying to respond and that's produced more tears. >> And so um and it's also ranged from other symptoms such as like fluctuating vision. The tears on your eyes do not stay on as long as normal. So then as that sort of breaks down the quality of vision sort of deteriorates and it becomes a little fluctuated. >> Refreshing a little bit of my recollection from my last conversation with you.

You're telling me about uh when we blink, we're we're moisturizing the surface of our eye. How do I ref what is do I just call this my eye? Is there like a a name for the the surface of the eyeball? >> Yeah. So, I think you could say it from there. I know from some of in the profession they'll say like ocular surface. >> Ocular surface. >> Correct. So like some people use instead of dry eye disease, it's ocular surface disease cuz that's why it's a sort of catch on everything that could affect the front of the eye.

>> Okay. And how the tears and and it's a huge realm. Um just for instance I guess I'll say that recently um there was like an international group of people that come in basically experil ocular society tas and they come together and they create a a dryey like almost like workshop type of deal and that's what it's called the dues um workshop and each paper that they publish um the most recent one's pretty recent and they talk about like symptoms, genetics, environmental factors, treatment plans, and everything that could be related.

And if you look at that, like your this stack of paper that you'll be looking through all those studies will basically be just like a good amount. >> Yeah. >> And so in terms of dry eye, I guess for most people, I'll talk about like the a very common one just like you mentioned with the blinking of their eyes. Mhm. So, I'll start off in in general is that our eyelids do a lot and helps uh protect our eyes. Every time we blink, I tell people it's sort of like a windshield wiper. It spreads, clears things out, but it also spreads our tears.

We also got these tear producing glands basically on the top of our eyelids. As they produce and our eyelids go over, it's spreads that also in our eyelids are these oil glands, what we call mayomian glands. But these oils um every time you do a complete blink and your eyelids sort of close together. If you imagine these oil glands as like vertically aligned s like cylinders, >> okay, >> um that the gland and at the very end is basically at the end of our eyelids. When we and there's this sort of small muscular ring around each of these glands.

Every time we do a complete blink, those muscles sort of squeeze a little bit to express those oils. on every blink >> pretty much. Yeah. Well, I say a complete blink because um I can mention later is that we some for some of us we don't actually completely blink. We do partial blinks. So you imagine sort of going like 70% of the way and then sort of opening back up. >> I see. When it's a partial blink, the it does not secrete that oil. From what I can understand with the studies, yeah, it's not as um effective in times of expressing these um because it needs to sort of contract together and then those muscles um sort of constrict and then it squeezes these oils and those oils act to prevent your tears from drying up as quickly >> um to circle around um are actual tears.

It has probably multiple layers, but to keep it simple and most of like what I was taught was you got oil, water, and mucus in general. Mucus keeps the water on the eye. The water component provides the moisture, and then you got an oil layer trying to prevent that water from like evaporating as quickly. >> Yeah. And so our blinking is important to help express those oil glands. And that is what we call an evaporative type of dry eye disease if it's affected. And that is one of the most common forms of dry eye disease that we see out in the population here.

And so in our this day and age um with our digital devices, our computer, our phones and all that that we look at that we have to be utilizing our eyes from our vis all these visual tasks that we have to do. >> Um our concentration and focus our blink rate tends to go down from what we naturally do. Um I think a recent can't say recent study but some studies have shown that more like when you read your blink rate tends to go down it's and especially when you're concentrated and focused that blink rate goes down and so if you imagine do having a blink rate that may be decreased by 40 50% consistently when you are working and we work for many decades on long time that can cause those oil glands to get more affected.

Yeah. And I usually describe those oils. Ideally, we want to sort of look like olive oil. Nice liquid, clear. Um, but because there's fats in those oils, it can some for some people it looks like butter. And when butter cools down, it can harden, thicken, and clog these glands and cause damage. >> Is that what I'm waking up to in the morning right here in this corner? >> Possibly from there. But a lot of times what can happen is you accumulate a lot of stuff in your eyes. Your tears and my analogy is like when you're at the side of the beach and the waves sort of crash right along to the sand of the beach is that your tears the water come out sort of evaporates and you're left over with that little crust.

Sometimes that can be but it could also be accumulations from some of the oils that are also around that eye. This might be a very pedestrian question, but I've been working since it's been about 7 hours now. How come there's nothing in the corner, but if I go to sleep and I wake up in the morning, >> there'll be something there? >> Yeah. Um, in terms of that, uh, could be a couple factors that I would be thinking about. Um, one, normally your blink rate during the day, you're blinking and you have these drainage ducts along towards your nose that could be properly draining out >> when you're out.

So, it's being sort of being flushed out. You could say when you're sleeping, it's not moving around as much. >> Your eyelids are usually closed, but there also is a a subset of people where their eyelids actually don't close all the way in when they're asleep. >> Correct. So, you have this little gap. My analogy is some people have like a overbite or underbite with their teeth. So, all you need is a little crack >> and basically air just keeps getting exposed to your inside your eye. And so, all the tears will basically dry them.

You got some gunk on there. >> You have a really great way of explaining difficult concepts for me to you you paint the picture in the mind's eye. All of your metaphors have worked so far. >> Yeah, thanks. Um, yeah, I try to think about that, but also utilize from, you know, uh, much smarter colleagues that have also utilized that. Yeah. >> Hey, it's working. Um, so I feel like I'm spending too much time on this, but I'm personally super curious. Is it uh when when you're asleep and assuming your eyelids are closed, are those glands still expressing oil through your sleep or do they shut off when you're your eyes are just closed?

>> Good question. I have not actually fully thought about that. Um in terms of it, um I guess theoretically by it wouldn't be as expressing as much >> just because now that constant it would be like like a blink rate. Um but I'll have to look into that. Get back to you. >> Well, we'll do a second episode. Yeah. Um, Dr. Chad, going back to the dry eyes, sort of the same question I had about uh keraticonus, is the dry eye symptom or is it considered a disease? If you have dry, it's a disease. >> Correct. Um, so it's like severity.

Um, some people may feel like it's not bad, >> but there is definitely when it gets severe, it can definitely affect um the the front of the eye and cause damage to a level where um it definitely needs therapy and such. >> I see. And so is that disease is it again is it is it a degenerative thing or is it genetic? >> Probably more of a degenerative type condition. Can it also be caused by any sort of acute trauma? >> Yes. Um good thing that you mentioned that um like many things can affect the surface of the eye.

So you have in trauma by like injury let's say chemical spills, accidents um direct impact on it um based by surgeries around the eye. Now we're not exly designed for it. if they become a little more evasive and they get complications that can definitely cause that as well. um you have certain severe conditions for people where um for instance there's a condition called Stevens Johnson syndrome where they developed a a really bad reaction to let's say having like penicellin treatment and their their entire body sort of just like becomes inflamed up and those patients can really suffer from a dry eye disease from >> penicellin could trigger in some patients a reaction that is really bad dry eyes >> correct wow >> um I mean dry guys from life let's think of more more mild thing just say um there are actually many medications that can lead to more symptoms and feelings of dryness so antihistamines for instance like our claritin and such benadryil um it's an antihistamine just by naturally on that it can sort of make our body a little bit more dry in general >> so I'm I'm starting to gather aside from like an acute trauma surgery which I'll get to in a second a lot of the things that change the I didn't go to medical school so I'm just going to say the chemical composition sort of of the of the system can dry you out.

Is there any correlation between dry eyes and uh any other symptom of another body part like your you have dry eyes because of lack of liquid maybe like your urine is is not as clear because there's not enough liquid. Is there any sort of correlation like that in anything? there can be from like uh certain conditions of the body that right um I also tell patients like your eyes are attached to your body so right if your body is not healthy it can be easily transfer over yeah >> um one disease that might have gotten a little bit more um can't say popularity but more people might have understood one's called Shogun syndrome um I play tennis so the reason I know a little bit more is Venus Williams >> she has Shogun syndrome and that's been shown um for her And uh that is a condition that can affect sort of like almost all like the mucous areas around your body.

So eyes, mouth, gut, >> like around the whole body that it can be affecting. >> What kind of symptoms would you experience with the eyes with Shogun? Shogrin. >> Shoggrrens. I think it's like apostrophe s. >> Okay. Shoggrin syndrome. What does that look like in the in the eyes or what are the symptoms like? A lot of times with dry disease uh symptoms can be very similar um but they can be caused by different reasons. Um so for them it can be the sensation of dryness all the time. They they just don't feel like they produce enough tears because that the condition can start can be basically damaging to their tear producing glands and so that can be a big factor.

>> What is the solution for this? Is it like visine? >> Keep your eyes wet. >> And so it becomes really difficult um because with a lot of dry disease at least to this point I wish we did there's no necessary cure. There's no silver bullet that can just be like we do this and it'll be it'll be great. >> Um so what we do is best to manage the condition. Um and so a lot of times I tell the patients I work with is like my goal is to basically make you think less about this dryness. Sometimes they come in with me just like, you know, I'm I'm dealing with this all day.

And as we get better over time with our treatments, it's like if if I only get you thinking about or worry about this like an hour of the day, that's great cuz some of them are like this is constant. I'm putting those artificial tears. I'm doing it like every hour. >> Yeah. >> And stuff like that. >> That makes sense. I I'm immediately thinking about my mother. She's got that tiny little bottle. Um What do you know about that? That they're artificial tiers. That little bottle. It's prescription based, right?

>> Um the artificial tears are a lot of them are over the counter. Well, pretty much they're all over the counter. >> And I get it. It gets confusing when I walk through there. It's like the cereal aisle. Like you have so many things to select through. >> Yeah. >> And so they all get made with some of them add a little different um like AB or C. We got a little little different unique touch to it. But in general, I would say it is sort of like lotion for the skin. Helps lubricate. It won't cure anything, but for a lot of people, you just need that added moisture and it gets you that extra boost during the day, which can work out fine.

Um the other, I guess, uh hint or tidbit that I'll I'll say is that um usually for a lot of these bottled artificial tears, there is a slight preservative to them. Mhm. >> And so I usually say is like if you can use those drops on average for about like less than four times a day, that's okay to use. But if you're using it like pretty frequently, more than that, and you're using it, let's say that every hour of the day, um I usually advise to use a preservative free artificial tier. >> That's a good tip.

Are there prescription strength drops as well? There's medication. >> Good question. Um for artificial tears, I there isn't. Um, but with dry therapies, there are medication drops to treat dry disease. And there's quite a a number and they're growing, which is great for to allow us more tools to better serve our patients. Yeah. >> Okay. And then going back to I won't delve too deep on the prescription stuff because he didn't go to pharmacy school. Um, we said one of the causes of dry eyes could be uh acute trauma.

One of the methods of acute trauma could be surgery. So is there a surgery that might be common for I I'll just say for example like it is it do you see that somebody wants to get LASIC and they get LASIC and then they end up with dry eye disease. >> Yeah. So that can happen. Um what we usually say is there's a fine line between like if one caused the other. Um but I would think is a lot of times people that had dry eye beforehand and they get the procedure itself they do not they will continue to have that or maybe a little bit worse from LASIC.

Um a lot of times they'll say is there can be some symptoms of dryness for a number of people like after 6 months they tend to resolve itself. Um, so I think in the community is like we need to be better at being able to detect it beforehand and deal with it, >> prime the surface and provide the best ser ocular service. >> Um, so that when they do a surgery, they're better better recovery, better visual outcome. >> So I love that response. So now I'm wondering, is there a way are there diagnostic tests to see if somebody is more susceptible to dryey disease?

Yeah. So there's uh fortunately a number of diagnostic tests that we utilize to look um for dry disease. Um if we want to start from the beginning um a lot of things is what our patients tell us and so that is the biggest um thing that we can utilize. History is important um as in your profession as well is like what they tell you, >> right? >> Um and in terms of that, we look at for symptoms and such. There are questionnaires that are designed to help speed streamline it, elicit what we think could be more dry disease related type of um issues.

Mhm. [clears throat] >> But then um so like at the office that I'm at basically we have the ability to sort to image the oil glands on your eyelids so we can see the structure. >> If you imagine sort of like a long like a tube of sorts. Um if it's the full length that's healthy but then some people it's like shorter. Let's say imagine half that length or a quarter. or unfortunately some people it's a stubble >> and just like a really short amount and that gives us an idea of how that is. Um we can also test for instance we can take a video see how quickly the tears on your eyes dry up.

>> You'll have little small pockets of um of the front surface that sort of dry up there and then we can see how much tears sort of collect on the bottom of your lid. There are other tests that can measure I'll say quote unquote like the salt content of your tears the osmalerity with people that have high or or have dry disease that osmarity value is actually higher and so there and we also utilize to look at the eye if there is damage to the surface um something called sodium florosine but sort of like this orange I don't know if you saw like an orange like almost like food coloring thing that they put in the eye and we shine it with the blue light.

What that happens is basically it glows green. >> Mh. >> And so what that allows us to do is it makes [snorts] it easier for us to see like small little areas of like damage on the front surface or whatnot. >> On the ocular surface. >> Ocular surface. Precisely. Yeah. >> Yeah. I'm trying to keep up. >> What was that last test called? >> Um >> with the with the drop the dye. The D is called sodium florosine, but we could just say you can say like I die test or anything. >> How invasive? I'm I'm thinking if I'm a consumer considering doing this, you a lot of people like I get patients patients, excuse me, I get clients that need MRIs and they're terrified of the MRI machine.

These tests, these diagnostic tests, how how invasive, how long, is there pain? talk to me a little bit about what that looks like for for your patients >> in terms of the testing mostly are in general I would say pretty non-invasive. Um so like the imaging for instance uh that is basically flipping your lid down or flipping your lid up. >> Okay. >> The the upper lid flipping some people may feel a little funky from that because that's not something that's common. Yeah. >> The lower lid majority of people are pretty good with.

Um, with the upper lid, I joke with some people just like, "Oh, maybe you just did this did this as a kid and try to flip your eyelids over there." Um, and then like imaging from like how quickly your tears dry up. That's as long as just can you play a staring contest >> from there. For some people that could be tough. >> Yeah. >> Um, but that would be the extent. And then like the adding that little dye to the front of the eye, it's like an eye drop pretty much. >> Okay. >> From that side. So, I'm thinking for me personally, I think the most difficult would be the the die just because I I can't I've never been able to get an eye drop.

I freak out. My I have to blink a bunch of times and hope that it goes in on one of the open moments. >> Yeah. So, it's like targeting that. The advantage of that is I would I the doctor usually applies that. So, all you have to do is sort of lean back, just look up and they sort of just add a little bit there >> to get through from that. >> All right. So, if I'm going through the next step of that, if if we get these diagnostic tests and it turns out that uh the patient has shorter glands uh or or stubs, so they're more susceptible, would their course of therapy change or the way you would treat that patient change?

Are there are there things that somebody could do proactively to stave off dry eyes? So, a lot of the treatment, yeah, it ends up being individually tailored just by like just like you're saying, severity, symptoms, how interested are they doing about wanting to do something about it. >> Um, and u, but I do like the proactive approach of even if I see small changes, um, I'd rather deal like work proactively than try to deal with something way on the back end. Um, because especially with dry eye disease, many people may not feel symptoms until it gets to a severe point.

And then also one of the issues that we have to sort of deal with with dry eye disease is that the nerves of the eyes, the cornea, sometimes with long-term chronic dry disease, the nerves aren't as healthy >> and so they don't actually have that sense um to feel it and that leads to the body not having that feedback mechanism to like being able to respond. My analogy would be like sort of like with diabetics and like the foot ulcers and stuff like that. They don't the body doesn't really feel that anymore.

And so that is a issue that we have to deal with um with dry disease patients as they because I tell them that this is what I see and there's like I don't feel that so I don't >> and if they don't feel it they're they're less inclined to do something but physically there's or physiologically rather there's changes that are being degenerative changes occurring and >> correct and so that's a big factor. Um, I think pictures, scans, photos definitely help because it provides some type of imagery for them to do it.

But a lot of times, yeah, like if they don't feel it, like what are you talking about? I feel great. It's like the hard uh high blood pressure person is like, I feel great. >> Um, their blood pressure could be really high. You just wouldn't know, >> right? >> Yeah. >> I got to do an episode on that. I have high blood pressure. [laughter] >> So, it does make sense. the what I'm the information I'm gathering, the way I'm thinking about it, it does make sense for individuals to get proactive diagnostic tests done to see if they're more susceptible to this or if something is presenting because there are treatments available that can uh not cure it, but but at least slow it down and you're not you're not making Well, does it slow it down that can you prevent it from getting worse or is it going to happen regardless of what you do >> and you're just treating symptoms, >> you can slow it down.

Um or reduce the irritating factor like let's say um some people I mean stare at a computer all day. >> Mhm. >> And then they some people have changed jobs not like because of this purpose but like that helps reduce that risk factor. >> I see medications they could they might have switched from there. Um, and so I think from being proactive, I I like that idea of working well at the practice I'm at. Um, we basically screen all our annual exams um, on the lower lids just to get an idea so we're best able to educate them.

And so I spend I spend the time basically trying to talk about them and and provide them with the information, best educate them, and they get to decide on how they want to pursue with that. Um, so a couple things that we to I guess to answer your question a little bit a few minutes ago was how what are some proactive stuff that we can do very similar to what I had discussed with you um on our first time when we met um as funny as it sounds being mindful of blinking is important um cuz like uh had mentioned early in the podcast is that our blink rates can be affected by concentration our reading how much time we spend on a computer and so trying to be mindful of that and having good complete blinks and then studies also show having like warm compresses are beneficial.

People probably most likely have heard of that. So the idea I make the analogy of like the butter analogy is that >> it's like nice and thick pasty. Use heat therapy to try to soften those glands and let them easier to express. It gets pretty warm for those warm compresses. I would say a washcloth is not great because it gets warm but it cools down in like less than a minute. >> Yeah. >> So there are like beaded masks um that our office has uh had for patients where you microwave it and you can put over your eyes.

Ideally we would like 8 to 10 minutes over the eyelids and you want it at least the studies show at least 104 degrees Fahrenheit which is pretty hot. And so I usually tell people is using the back of their hand as guidance. You don't want it to be scalding where it burns that >> right? >> But you also want a good amount of consistent heat so that it will go through your eyelids into the oil glands. Fortunately, our eyelids are one of the thinnest skin areas. >> Um but it also does need some heat to be able to penetrate and get through there.

>> Is that 8 to 10 minutes a day >> ideally? Um, I try to be reasonable where it's like we all have busy lives. So, if we can't get it all, it's like working out. If we can get it in, it'd be ideal. >> I want to be clear on this. What I'm wondering, I'm sitting here. I don't have uh symptoms of dry eyes. At least I don't believe I have symptoms of dry eyes. Would it make sense for me to be proactive and get that diagnostic test done just to be sure? So I think that'll be helpful to get an idea because many people like you said they don't feel it but their glands might already been changing and you just don't realize it.

Um my analogy is then was like importance of like eye exams. It's like similar to having a physical and getting your blood test. >> You don't check there's a I mean it could be fine. >> Yeah. >> But you don't really know. Um so at least get yourself a baseline, get an understanding what's going on and then you can work from there. >> Like everything else. Correct. have the data and then that way you may not do anything with the data today but five years from now you'll you've got five years of data and you can see what's going on.

That makes sense. You may not be able to answer this question, Dr. Chen, but it's this is sort of like the administrative stuff because of what I do. I'm acutely aware of uh the reimbursements and what health insurance pays for and what whatnot. Let's say I've got no issues with my eyes. Uh, but I I'm I'm listening to this podcast and I'm like, "Oh, you know what? I haven't been to the optometrist in a decade." And I decide to go and I I request testing for dry eyes. Uh, do you know if health insurance covers that as like a routine exam or do they ask the doctor, you know, why is this necessary?

>> So, that is a very commonly uh dealt with issue at at an eye clinic. I'll put it that way. Um you have your vision plans and you have your medical insuranceances and vision plans um I usually sort of describe them as like a discount plan. Um because if you look at the all the fine print and everything, they'll provide you like uh sort of like a screening examination like a wellness examination like a physical and then a discount on glasses and contacts the hardware as I quote unquote tell people and but if you look at it like anything medically comes up it actually doesn't cover anything and you get that one exam you don't get anything else.

>> Yeah. So it may not be like true insurance in terms of like insuring like if you got into some big something bad it will continually help pay out and cover a thing for you >> right >> so with dry disease that ends up being utilizing your medical insurance >> and those the examination itself will cover it um depending on for I guess providers we have to in order to get reimbured from insuranceances we have to prove like medically necessary that these tests were done because we saw some type of disease and we want to know more about it.

>> Mhm. >> And so that sometimes is not always happen. Um and different clinics operate a little differently. Some may employ what I think would be almost like a screening uh fee to provide this for anyone beforehand. Um but allows that. But so from their operation side, that's how they operate. >> I see. Yeah. So, it it will probably differ depending on which clinic you go to. >> Yeah. >> Yeah. >> I've just become really accustomed to seeing insurance be like mm- [laughter] the insurance um I don't know analysts or whoever it is the representatives they're making a lot of medical decisions without holding those specialized degrees.

>> It becomes very tough for us. uh um like dry disease medications for instance um the a number of the patients that I see are in Medicare age that have Medicare insurance >> and like dry disease medications under that has not been very favorable for them >> and sometimes these quotes are excessively high >> and it becomes a challenge where it limits providers from trying to provide the best care that they can for their patients and then I'm pretty sure it limits the pharmacists because they have to deal with this.

>> I'm trying to dispense this, but then patient gets quoted X amount and they're like, I can't afford like pay that >> consistently from there. >> I'm now I'm curious about the the pricing. What on on the not the over-thec counter, but like the prescription medications, what what do those typically range? What does that look like if somebody has to take it for in perpetuity, for example? It's a whole range because um as you realize as well is that all these insurance plans even though it has the one name of one large company, it doesn't mean that they're all the same, right?

They have each I guess each u HR company or that provided that purchase that plan for their employees or whatnot or even if you're individual healthcare, they're all different alakart, right? >> Type of things. >> I would say it could range from anything from not paying anything to it could be like 600 a month dollars a month. Yeah. >> The cost of the medication or what? >> Correct. >> Okay. So there >> utilizing their insurance like what it could cost. There are some companies in the realm that I guess saw the struggle and so they may have self-pay pricing.

>> Mhm. >> And so that becomes a little more middle ground. It could be ranging anywhere from like $60 to to $100 a month type of deal >> for the medication. >> Correct. So it can be a really expensive endeavor if somebody is struck with this disease. >> It can and it becomes uh it stinks on that end because they're trying to for some people that are like fixed income and trying to purchase these type of medications and they're they also got other stuff with their body that could be happening and they got to deal with that and so a lot of things to navigate through.

>> Is there an age component with dry eyes? Is it is it mostly older people >> USA in general? Yeah. Uh, age is one of those factors as I tell people as we get wiser things change a little more and our body does. Um, hormone changes plays a big factor. So with dry disease studies show that women get more affected more often on that side. >> And so yeah, those are some of those risk factors as well. >> I had asked earlier I brought up LASIC as an as an example to ask. Is there something that uh I'm looking for like a golden nugget here.

Is there something that people would routinely do in this industry that they I'm talking from the patient side that they decide I was looking for lasic but obviously that's not it but is there something that people will do for surgery or a type of glass or contact lens that has a statistical higher probability of causing whether dry eyes or degeneration or any sort of injury that people don't really consider. um and they do it and then after the fact they're they're dealing with something. I'm just like creating this scenario wondering if if there is such a thing.

>> Probably is something there. Um maybe we haven't looked through I haven't looked through the data to really go through that, but um I think some that maybe unintentionally have occurred. I'm not saying that this happens to everyone, but a common one that I also just ask and screen patients that have dry disease or with their gland oil glands that are really shortened. Um I'll ask if they had used like Accutane for acne. That can be common for a lot of people. >> Acne works great. I mean Accutane works great for that.

Um it gets those oil glands. Um the issue is they're not selective. So it can affect other parts of the body. >> Yeah. >> Um I the reason that I remember that just like one of my classmates um if you imagine like we have about let's say 30 to 40 oil glands um on our upper lids and a little bit fewer on the lower lid. Um my classmate when we were in school got them imaged and she had like one. Wow. One of the thoughts was possibly like the utilization of Accutane when she was a teenager had contributed that.

So I'm not saying this not to get not to use it. It's just be mindful of maybe screen beforehand get an idea if that is something that could cause changes. >> I don't know who the manufacturer of Hacutane is but we're nobody's making any accusations. >> Correct. But that was that's exactly the type of thing I was looking for honestly. So I'm I'm really appreciative that you had it sort of the thing that where people don't associate and until like after the fact and be like oh there's possible correlation there because of it affecting the yeah oil glands.

>> Um another one sort of indirect as well uh sleep apnnea. I think more and more people are being discovered to have that. I think it's definitely more more people in the population that have it than we than we think. >> Yeah. >> Um and so there's a lot of people with sleep apnnea uh have CPAP devices that they utilize and so you have this airflow around when you're sleeping. >> Um and if they don't have like a great mask that helps provide definitely has a good seal with the air basically got air just blowing around on your face.

I have a number of patients I had that complaint um cuz I had I dealt with one where I saw a lot of irritation and dryness cuz he that's what he came in for and it was just all around and was getting him better but we really had to figure out like what was going on. And so this is when like uh for us is like looking through the history asking these uh pointed questions seeing what's going on and in the end it was sleep apnnea. He used a CPAP device. So, we got him he got a different um I guess air intake or over his mouth and nose in there >> and it definitely [clears throat] cleared up much better.

>> It's almost silly because it has nothing to do with medical history. It has nothing to do with what's going on. It's it's because of the mask and the air is going up. But I guess this is exactly where you were talking about how much you rely on patient information like to to share like are you on a a CPAP machine? >> Yeah, >> that's that's interesting. So you Okay guys, sleep apnnea Accutane possibly. But it makes sense because it's attacking oil glands. Um I really appreciate your time. I hate to wrap up because I've got so many questions.

My last question is going to be I I took my eyesight for granted. You you said you started wearing glasses really early. I thought I would never need glasses. Um and I'm pretty new to them. It's been a couple years. They're supposed to be readers. Now I have to wear them all the time and it's getting worse on my readers. And when I saw you, I got my prescription upped a little bit. I'm not accustomed to wearing glasses. These things get smudged all the time. What do people do that have glasses? What's Do you have any tips, practical tips to keep your lenses from being smudged or keeping them clean more often?

Cuz I feel like um you're talking about the eye drops one hour a day. I I have a box of those disposable little wipes. Every hour I got to pull them out and wipe them clean. >> Oh man, you are not alone in this aspect. I deal with this as well. Um but it's like as one factor with glasses is when we have that anti-glare coating. um and trying to have that anti-cratch and such. It's very sometimes those coatings can be very easily to get those smears and >> dust on it. >> I wish if someone can get that like some type of solution for that, that'd be an incredible idea from it.

>> That was just a selfish question for myself to be like, how can I deal with this? Um Dr. Chen to wrap up. Is there I I tend to at this point in time turn it over to our guest if there's anything that you feel like we should have discussed that we didn't or there's some piece of information that you think our listeners could really benefit from or anything in your heart that you want to share with. >> There's with dry disease there's so much stuff um I think we just sort of >> like cracked the surface in a way.

Yeah. um from that. But I would think in general uh for like our oral glands for instance being mindful of blinking um utilizing warm compresses I would say is uh be mindful of breaks I usually say is um from a routine don't stare at a computer screen all the time. Easier said than done. >> Yeah. >> Um I would say is like but try to allow a little break and pause. So I think your body would like it to walk around, right? >> Um instead of our my sedentary lifestyle, you could say and um oil glands also studies have shown that having good amount of omega-3s are beneficial >> from omega-3s.

>> Yeah. So a lot of times if we can get it from diet, that'd be great. Um but the amount of omega-3s, a lot of people utilize like fish oil supplementation for that or like algae like component for the ones that are not like more vegan. >> Yeah. Type of lifestyle. Yeah. >> Awesome. You were chock full of great information. I personally got a lot out of it. I know my mom is listening. She's probably going to watch this twice. She's going to ask for your contact information. Mom, it's going to be in the description of the YouTube video.

So, you can reach out to Dr. Chen. Uh, got you a new patient. I know that already. >> Appreciate it. But thank you again for having me here. >> Absolutely. It's been a blast. >> I appreciate your time. All right, everyone. Thanks for tuning in. Please, as always, I'm going to ask you to like, comment, and share as it helps me out. Mom, I love you. I'll see you all next week. Take care.