Dry Eye Coach

Dr. Whitley talks about neurological dry eye with Dr. Diana Driscoll. Learn more about Parasym Plus Eyes™ and Vagus nerve support at: https://vagusnervesupport.com/parasym-plus-eyes/ Click Here to read the transcript of this podcast.

This podcast presents a discussion with Dr. Caroline Blackie, Senior Medical Director for Johnson & Johnson Vision, where she shares her thoughts on where we’ve been and where we are going to effectively address meibomian gland dysfunction. Caroline Blackie: Well, thank you, Walt. It’s great to be here today. And in particular, it’s wonderful to […]

Eysuvis, a new FDA-approved corticosteroid that is indicated for the short-term treatment, up to two weeks, of the signs and symptoms of dry eye disease. Patients often have periods of exacerbation called dry eye flares, where their dry eye symptoms can be triggered by digital screen time, seasonal allergies, contact lens wear, and AC use. […]

Dr. Whitley talks with Dr. Bobby Azamian, co-founder, president and CEO of Tarsus Pharmaceuticals, about a topic that we haven’t addressed before on the Dry Eye Coach Podcast, which is addressing an unmet need for 25 million Americans: Demodex blepharitis. Tarsus is developing TP-03, which is a drug that has the potential to be the […]

Walt: Hi, welcome to Dry Eye Coach podcast. My name is Walt Whitley. Today we’re going to talk about ways for practices to start running dry eye trials. Clinical research is a critical element to improving the options and solutions available for patients. For some practices, there are so many unknowns and question mark they don’t […]

Walt Whitley: Hi. I’m Dr. Walt Whitley with Dry Eye Coach podcast. Thank you all for joining us. Today our topic will be a conversation with innovators in the dry eye space. Our guests include three key industry executives from small, innovative companies focused on dry eye. Our first guest is Zac Denning, director of […]

Over the past several years, various algorithms seeking to simplify the diagnosis and treatment of DED have been developed. The ASCRS algorithm for the preoperative diagnosis and treatment of ocular surface disorders is the first one that is targeted specifically to surgical patients. Listen as Dry Eye Coach chats with Jill Showalter about how she […]

Dr. Whitney Hauser: Hi, I’m Dr. Whitney Hauser, and thank you for joining us for Dry Eye Coach Podcast. Today I’m joined by Shannon Bream, who is the anchor of Fox News at Night. Welcome Shannon. S. Bream: Thank you so much for having me. Dr. Whitney Hauser:Absolutely. Absolutely. You’re going to give us some great insight into the patient perspective today. And as doctors, we often hear from our patients about the symptoms of dry eye, but sometimes our patients, I think have a little bit of a difficult time conveying the real heart of the message to us. So I really appreciate you joining us today. S. Bream:I am happy to. It’s a topic that I think more people need to hear about to help folks on all sides of the equation. Certainly physicians who can be lifesavers in this, but just for people who feel discouraged out there and are looking for help too. Dr. Whitney Hauser:Yeah, absolutely. And you’re right. It is a two-sided coin, because as doctors, sometimes you hear patients, but do you really listen? Kind of thing. And as patients, I think your story is going to illustrate for us it can be really frustrating and beyond frustrating to a point where you just don’t know what you’re going to do. So tell us, when did this become a problem for you? When did it all start? S. Bream:I was one of those little kids who wore glasses, like in elementary school, I was very early on. I needed help. I started contacts in middle school and I don’t know if everybody would now say that’s the greatest idea, but I was desperate to get rid of my glasses. And so I’d been in contacts for decades by the time I started having the dry eye trouble, which was late thirties, getting close to my 40th birthday. And I really didn’t know what to do with it. S. Bream:I would have situations where my contacts would get dried out and I would take drops and that kind of thing. That was never a real problem for me. But when I started having erosion, and that coupled with the dryness was just a really bad combination for me, and that was getting close to my 40th birthday. Dr. Whitney Hauser:Yeah. Yeah. So you said you tried drops. What all did you try over the years? S. Bream:I would try any kind of re-wetting drop, anything specifically for contacts. And then I was having conversations with my doctor about, should I be wearing them less? I went through a period of, when the extended wears came out, I wore those, which seems crazy now. And there are so many other options now and they’re much thinner and seem more breathable, but as a teenager, you’re not the most responsible person in the world sometimes with your contact care. Dr. Whitney Hauser:True, or anything else. S. Bream:Right. I had a lot of dried out contacts. But generally I would just use re-wetting drops and things when it would spring up, if I would have times where I’d probably worn them too long, needed to get them out. And it was around that time that my doctor was also encouraging me like, “Hey, maybe you do more time with your glasses, less times with the contacts.” But he also told me, “This is part of the aging process and women often …” he has patients that, around that 40th birthday, really start to have more of the trouble with the dry eye. Dr. Whitney Hauser:Right. That’s a true story. But how did you feel being on camera and they’re telling you, “Wear your glasses,” that’s the solution that they’re providing to you? How did that make you feel? S. Bream:Well, I knew there was a lot of time off-camera that I could do that and that it would be better for my eyeballs to probably get some rest. And that did seem to help me in some respects, and then I was having trouble

Whitney Hauser: Hi. I’m Dr. Whitney Hauser with Dry Eye Coach Podcast. And today I am joined by Dr. Walt Whitley. Dr. Whitley is the director of Optometric Services at Virginia Eye Consultants. And he also oversees the Dry Eye Center there with some of his colleagues. So, welcome to our program today, Walt. How are you? Walt Whitley: I’m doing excellent. How are you, Whitney? Whitney Hauser: I’m doing great. I’m doing great. We’re going to be talking today about educating patients about treating their dry eye disease and including a feature called flares. I’m going to kind of dive into some questions and then we’re going to get some of your perspective on how you talk to your patients about this particular aspect of dry eye disease. To kind of kick us off, why is there a need for a short-term treatment for dry eye? I mean, we have a lot of chronic therapies out there. Why do you think there’s a need for a short-term treatment for dry eye disease? Walt Whitley: That’s a great question, Whitney. And when it comes to the need, it’s because patients are suffering. You just mentioned the word chronic. We’ve always heard about a chronic inflammatory condition that gets worse over time. However, patients, they’re suffering. What we need to do is have treatments that are available that can help provide them rapid relief. You mentioned dry eye flares. With the flares, when is this going to occur? Oftentimes patients don’t know. How often does it occur? They don’t know either. But they know it does happen. Unfortunately, some patients feel that it’s pretty, pretty common. They don’t realize that it’s actually dry eye or maybe associated with dry eye. We’re all familiar with the various symptoms with dry eye, the sandiness, burning that patients may have. We know the [1:58] is inflammation as well that leads to that chronic vicious cycle that we’ve talked about. But when it comes to the flares… Whitney Hauser: You know… Walt Whitley: Go ahead. Whitney Hauser: No. You hit on a great point, Walt, and that’s, they don’t know when it’s going to happen. We don’t know when it’s going to happen. But the education component of at least talking to them about it. The fact that they’re already, probably, experiencing it and now kind of putting a name on it. If they’re not already experiencing, what might happen is really important because, by the time it’s happening, it’s hard to get into our offices, sometimes. Especially with what we’re seeing right now with COVID-19, you can’t just jump into your optometrist’s office at the drop of a hat. It takes some time. The education, I think, probably is more important than ever. Walt Whitley: Oh, definitely. The sandiness, the grittiness, that’s what we always think of. Whitney Hauser: Right. Walt Whitley: But what matters to patients is looking at the quality of vision. Patients, they do experience blur, and you and I have talked about this before, that blur or fluctuations in vision is a sign of dry eye disease. If patients are suffering from that, they definitely want treatment for that. I mean, there’s numerous reasons why there’s a need for this. You mentioned chronic, once again. Chronic means long-term therapy. But when we look at compliance, yes, we can tell a patient what to do, do they do it? Yes or no. Short-term is going to be much easier than long-term management because we know the data shows that over time, patients are going to be, not necessarily compliant, but adherent and that’s what we want when it comes to our patients; them owning their condition, owning their disease state and their treatment. When we look at the adherence data, within a year, about 60% of patients may have discontinued their therapy. Whitney Hauser: Right. Walt Whitley: We need to get, we need shorter therapy to get in, get out, address their concerns,

Dr. Paul Karpecki discusses the identification and management of acute dry eye in clinical care. Patients treated for chronic dry eye disease may have flares triggering an increase in symptoms. Listen to Dr. Kapecki’s perspective and practical pearls for managing these challenging cases in ocular surface disease.

Drs. Scott Hauswirth and Marc Bloomenstein discuss how meibography influences their diagnosis and treatment of dry eye disease. Learn why and how meibography makes a real difference in patient care. Dr. Whitney Hauser: Hi. I’m Dr. Whitney Hauser with Dry Eye Coach Podcast. Thank you for joining us. Today we’re going to be talking to Dr. Mark Bloomenstein of the Schwartz Laser Eye Center. We’ll also be talking with Dr. Scott Hauswirth, Assistant Professor and Director of the Ocular Surface Clinic at the University of Colorado. Welcome, gentlemen. How are you today? I’m great, Whitney. Fantastic. Dr. Whitney Hauser: Good. Good. Well, thanks for joining us. This is a first for Dry Eye Coach Podcast. Typically, we feature one doctor at a time. So, we’re going to really, we’re really going to take a look at our skills today and see if we can not talk over each other too much. So, I’m going to go ahead and start the questions. And we’re going to be talking about meibography today and the role that it plays in your practice. So, just to start off, you know, Dr. Hauswirth, can you tell us how you’re using meibography in your practice right now? And really, what patients you’re typically using it on? Dr. Scott Hauswirth: Yeah. So, meibography is an essential part of our dry eye evaluations. Anyone that’s coming in who’s either referred, either internally or from the external community, into the Ocular Surface Clinic, receives meibography. Generally speaking, we’re using that to image the lower glands, or the glands of the lower lids first. And if there’s significant change or drop-out, then we’ll image the uppers. We also use it following any type of meibomian gland procedures to check for changes either in [obstructure] or how it matches up to function. So, we do it on our initial evals and then anything that we do that may affect the meibomian gland function. We’ll reimage them usually about six months later. Dr. Whitney Hauser: Now, I guess the follow-up that I would have to that, and I think a lot of our colleagues who are listening might want to know is, why lowers most often and sometimes why lowers only? Dr. Scott Hauswirth: Yeah. That’s a good question. I think, first off, time does play a role. Even though we have a little bit longer appointment slots for our patients, the lower lids typically are where we’re going to see the majority of early dropout occur. And so, we’re targeting that first. It also saves our technicians, and me, a little bit of time. And again, like I said, if there’s significant change there then we’ll go and image the upper lid. There can be a striking difference between the lowers and the uppers in some patients. Dr. Whitney Hauser: So, Dr. Bloomenstein, what about you? How are you using meibography in practice? Dr. Mark Bloomenstein: Yeah. I take a little bit different approach. I think my practice and Scott’s practice is probably a little bit different. You know, him being in a university setting and having a dry eye moniker, I think he’s probably seeing a little bit more challenging cases. The practice that I’m in, we’re essentially, you know, doing comprehensive eye exams and we’re doing patients who are referred in for cataract surgery or refractive surgery. My goal, now, of late, and actually probably the last eighteen months, is really to kind of carpet bomb every patient. Just to look at every person’s meibomian glands, and draw a distinction between, as Scott said, form and function. And to be quite honest with you, he probably is the person, I heard that years ago, we can look at the glands and that doesn’t always tell us what they’re really doing or what’s coming out of them. Dr. Whitney Hauser: Right. Dr. Mark Bloomenstein: And so, for me, every patient that comes in the door now for a comprehensive eye exam or anybody who’s considering having surgery, and

Whitney Hauser : Hi. I’m Dr. Whitney Hauser. And welcome to Dry Eye Coach podcast. Today we’re going to be talking about tips for doctors just starting out in dry eye. So, if you’re looking for some new pearls about how to add dry eye in your practice, this may be the podcast for you. Today I’m joined by assistant professor at the University of Colorado Department of Ophthalmology, Dr. Rich Mangan. Welcome, Rich. Rich Mangan : Oh, thanks, Whitney. It’s great to be here. I appreciate it. Whitney : You bet. You bet. We’re kind of excited to get to know, you know, what you think are some of the greatest things that new practitioners, or practitioners that are just trying to bring dry eye into their practice might want to add in as they develop. So, I’m going to jump in with some questions for you… Rich : Okay. Whitney : … right off the bat. And, what are the benefits to doctors and their patients for getting started, or treating dry eye disease? You know, there’s benefits on both sides, so give us a little bit… Rich : Right. Whitney: … of your thoughts there. Rich : Right. You know, certainly, the benefit for me as a doctor in getting started was just to have a greater appreciation for the fact that ocular surface disease is in fact a real disease and not just a symptom. To be honest with you, years ago I used to hate dry eye. You know, I would go and see LASIK evals and cat evals and I was really enjoying that. And then I’d pull out a chart and it’d say dry eye and, you know, I’d just shrug in agony thinking about it. But then I went to a speaker training many years ago, in fact, this was around 2002 when Restasis came out, and it really, the panel did an excellent job of just really impressing upon the attendees that, you know, the quality of life scores of dry eye can really mimic, you know, even severe things like angina or disabling hip fracture. So, when I took that to heart, and I decided that it was time to come back to my practice and truly treat it like a disease. And so, I spent some time educating my key technicians, my team leader, and we actually carved out dedicated time just to really focus and concentrate on these patients. And what it did was, after they got to hear, you know, my walking the walk and talking the talk, you know, my dry eye practice really became more efficient because they knew what I was going to say before I was going to say it. And, but they truly developed appreciation for the fact that this is a disease. Whitney : Yeah. You raise a good point, you know, about the kind of parallels that are between more serious, as they would be noted, diseases and dry eye disease. I think that’s where a lot of the disconnect is. It’s not so much that the doctors don’t believe it exists. I think that most eyecare providers do. But it’s the gravity of it. So, the patient sitting across from them I think is oftentimes what’s missing. Rich : Yeah. Whitney : So, I think you probably latched onto that well in advance of a lot of our colleagues, including myself. So… Rich : Well, I’ve been around longer than you, Whitney. I’ve had a little bit of a head start in that respect. (laughs) Whitney : Unfortunately, not by as much as one would think. (laughs) You feel like this has a positive impact on new referrals as well? Bringing new patients into your practice? Rich : You know, it really does. Keep in mind, when I first started my dry eye practice I was in a co-management, a referral center, and one of the concerns we had when I brought this idea up was, how were our referring doctors going to look at this? Would they look at it like I was competing with them? And, in fact, the response was the complete opposite. They loved the fact that they had a resource in the area that really took this seriously. Patients could

Whitney Hauser : Hi, I’m Dr. Whitney Hauser and welcome to Dry Eye Coach podcast. Today I’m joined by Dr. Selina McGee. Selina is a private practitioner and owner of Precision Vision of Edmond and she’s also the president of the Oklahoma Association of Optometric Physicians. Welcome, Selina. How are you today? Selina McGee :I’m great. Thank you. Thank you for having me. Whitney Hauser :Good. I love that we both are on the line together talking and we’re both going to have accents, and we just say that right out of the gate. It’s so true. So hopefully the listeners will not need translators for this, but I love having that shared accent with you. We’re going to go ahead and get started. I’m just going to ask you a couple of questions and just to get your perspective on things, I think what’s interesting is a lot of experts in the field, particularly of dry eye, work in a lot of different areas. They work in tertiary dry centers, which I’ve been affiliated with. They work in ophthalmology practices. Some of them work in private practice, but we don’t hear quite as much of that voice. So I’m really anxious to kind of get your perspective on that today. The first question I’m going to jump in with is why, from your perspective, is patient education on dry eye so important? How does that fit into what you do with your patients every day? Selina McGee :It’s a great question, and I’m glad you led with the fact that I’m in private practice because I think honestly it makes so much sense in private practice, maybe even more so than in a tertiary setting or a co-management setting, simply because most patients don’t recognize their symptoms with dry eye disease and it affects every piece of private practice. What I mean by that is if you have an optical like I do, if you don’t treat their dry eye, they’re going to come back with a glasses RX check. We all know that time is money, and so when you spend that on a glasses RX check and in fact it’s ocular surface disease that we missed, then that’s a huge piece of that. Contact lens patients, lots of private practices have huge contact lens practices, mine included. So if we don’t do a good job of assessing the ocular surface and making sure that is stable, then your contact lens patients are going to suffer and you’re going to spend more chair time doing refits. Selina McGee :Then if you’re co-managing your surgical patients, and the patients that I work with and a lot of cataract patients these days, they have such good premium options. But if we don’t have a premium surface to deal with, once they get to the surgeon, they’re not going to have a premium outcome. Then of course in private practice, we have patients with glaucoma. We have patients that we’re the first line of defense. So if we don’t do a good job of [inaudible 00:03:06] and teaching our patients what dry eye disease looks like and what the symptoms are, then we can miss a lot of things including even something like a pass down of the disease of Sjogren’s. We know how dangerous that is because those patients unrecognized are much more likely to get lymphoma. So I think there’s such a huge opportunity for private practitioners to really embrace this and set themselves apart. Whitney Hauser :The education, as I asked that question was really kind of directed at how does education play a role with the patient directly? But really there’s almost two different ways that you can see that question. I think that you sort of embraced both angles of it, which is one, we’re educating the patient in dry eye disease about all the things that optometry can offer to them even if they’re not highly symptomatic. I think that’s an important piece because when you

We continue our discussion with Mike Berg, VP of Regulatory for TearLab about Reimbursement within a primary care eye care setting.

Reimbursement for point of care diagnostic testing can be confusing and frustrating. Mike Berg, Vice President of Regulatory at TearLab, discusses how to appropriately Bill for testing and receive payment. Take a listen to Part 1 of our interview with Mike and learn how your practice can solve the billing mystery to POC testing.

Having a clinical protocol in place can make the journey of clinical decision-making and consistency so much clearer. Whitney Hauser, OD, now director of clinical affairs at Keplr Vision, talks about the ways that developing and using a clinical protocol for dry eye and other ocular conditions can help.

Dr. Alice Epitropoulis discusses the necessity of pre-operative diagnosis and treatment dry eye disease. Find out more about research validating the need for dry eye evaluation as well as clinical pearls.

Dr. Doug Devries discusses how intense pulse light fits into his clinical practice. Find out about patient selection, presentation and treatment protocols.

Whitney Hauser: Hi, I’m Dr. Whitney Hauser with Dry Eye Coach podcast and we welcome today Dr. Tal Raviv, Founder and Medical Director of the Eye Center of New York. Welcome, doctor. Tal Raviv: Thanks for having me. I’m a fan of your podcast. Whitney Hauser: Oh, very good. Very good. Thanks so much. We really enjoy doing them and we rely on experts like yourself to provide us some content and clarity on a lot of interesting issues in dry eye disease. Today we’re going to be talking about dry eye treatment pre and post cataract surgery. And this, I know, is impactful for our patients and for our practices both in optometry and ophthalmology. So we’re just gonna kind of get the ball rolling here in a few minutes with some questions, but is there anything just sort of off the top of your head that comes to mind about pre and postop for eye disease that listeners need to consider? Tal Raviv: I think we’ll get into the conversation, but certainly the fact that we have a whole podcast on this just highlights the importance of it and we’ll get into why that is, and it’s an issue that I talk about every day. In fact, my last patient today was someone who was post op with dry eye, and we got into this conversation. The more we speak with them before, the better prepared we are to speak with them after. Whitney Hauser: Right, right. I think we’ve all heard that before. You know, it’s your fault if it happens afterwards. Otherwise, if you’ve diagnosed on the front end, you know, it’s really something that the doctor and patient really try to conquer together. Tal Raviv: Exactly. Whitney Hauser: To kind of set the foundation, in the Trattler’s Landmark PHACO study that was published a few years ago, we found that about three quarters of patients presenting for cataract surgery had ocular surface disease and at least half have ocular surface problems that alter the results of biometry or could otherwise negatively affect surgical outcomes. So, like you said, there’s such an impact to the patient in terms of the numbers and in terms of their ultimate outcome with the surgery. I guess the first question really to kind of get things going is, those numbers are very large. So let’s talk about what they mean. What is the impact or what could dry eye have on the outcomes of cataract surgery if it went untreated? Tal Raviv: Well, I think that study, the PHACO study, was really a great paper in documenting what many of us already know, but actually documenting even worse than what we thought. He found up to 78 percent, and, you know, I think Dr. Gupta had a study that found up to 80 percent of patients coming in for cataract surgery, had some signs and symptoms of dry eye disease. Now, how does it affect us? It impacts cataract surgeons in three ways. Not the surgeons, but patients and then their conversations with their surgeons, that is. Number one, as you mentioned, is getting poor biometry or keratometry which is a key part of our calculations. Keratometry is exquisitely sensitive to dryness and if we don’t pay attention to that, the studies have shown – Alice Epitropoulus has great study showing as well – that with high osmolarity, we’re likely to have an error in our biometry. So that’s a very specific, long lasting effect on those patients — they end up with a refractive error that we don’t desire. Number two is that dry eye signs, such as punctate kerotopathy and corneal staining also have a negative effect on the visual quality, so if we place an advanced technology lens, such as a presbyopic IOL in the patient and they revert back to their worn out cornea that’s dry, they’re going to have poor visual outcome. They won’t see far

Whitney Hauser, OD, says that doctors don’t need to invest in expensive technologies to start diagnosing and treating patients with dry eye symptoms. As doctors become more familiar with it and assess their community’s need, they can scale up.

At the Dry Eye Coach Podcast, we recently sat down with pioneering expert Neel R. Desai, MD, to discuss his views on dry eye’s present and future. Dr. Desai is the Director of Cornea, Cataract, and Refractive Surgery at the Eye Institute of West Florida, Founder and Director of the Dry Eye Center of Excellence, […]

She discusses where ocular surface disease has been historically and where it’s headed in the future. Listen as this dedicated clinician and researcher talks about her passion for dry eye and why you should share her enthusiasm.

Zac Denning, Product Science Specialist at Science Based Health, lends his perspective on the results of the DREAM study.  The study has sparked some controversy in the eye care community.  Listen to what Zac thinks some of the takeaways are for practitioners.

Dr. Scheffer Tseng of TissueTech discusses how stem cells and cryopreserved amniotic membranes evolved into clinically applicable therapies used today.

Dr. Donald Korb, a pioneer in meibomian gland dysfunction research, talks about where MGD began and the direction diagnosis and treatment are moving.  Listen to the expertbehind innovations like including well known oil based dry eye drops and LipifFlow and LipiViewto better understand why and how to treat dry eye disease.  Dr. Korb believes it may be easier than many […]

Whitney Hauser, OD, has built a very visible brand as the Dry Eye Coach. With a website, podcasts, and sizable following on social media, she is building a platform that can help promote new treatments and fellow eye care providers. In this podcast, Dr. Hauser discusses new technology that can help treat patients. But she […]

Dr. Paul Karpecki Explains How Amniotic Membranes Fit into Clinical Practice

Dr. Paul Karpecki, ocular surface disease expert, talks about how he diagnoses dry eye in clinic and provides insightful tips on how he motivates asymptomatic patients to begin treatment

you were putting together a Who’s Who list of optometric leaders in ocular surface disease, Dr. Whitney Hauser would undoubtedly make the cut. In addition to masterminding the launch of the TearWell Advanced Dry Eye Treatment Center at the Southern College of Optometry where students get dedicated ocular surface disease clinical hours, she launches the […]

Dr. Scott Schachter Talks about MGD and Nutrition

Join Dry Eye Coach as we talk with contact lens expert, Dr. Melissa Barnett, about how contact lens wear is impacted by dry eye disease. Find out tips to keep patients happier in their lenses and build your contact lens practice.

Join Dr. Whitney Hauser for our latest podcast as she talks with dry eye expert, Dr. Laura Periman, about how she uses Intense Pulse Light in her practice to treat OSD. Visit www.DryEyeCoach.com for more info.

Many doctors want to “do dry eye” in their practice, but that lack one key ingredient. Dr. Walt Whitley discusses how passion builds patient referrals for your dry eye practice.

Dr. Scott Schachter discusses how he added dry eye care into his practice. Over the last several years, this portion of his business has shown the greatest growth and profitability. Listen to how Dr. Schachter made the addition by incorporating technology incrementally and having frank discussions with patients.