Optician Mr Nat Vaja was unsure how to advise his patients suffering from gritty and itchy eyes, but after receiving a diagnostic kit as part of a trial run by Altacor, the ophthalmic products specialists, and No7 the contact lenses manufacturer, he has now developed a strong diagnostic procedure which gives him confidence to identify symptoms of dry eye.
Mr Vaja of Nu-Sight Opticians, Aylesbury explains that the diagnostic kit contained stains to highlight the problematic parts of the eye and a simple dry eye questionnaire to assess the degree of dry eye.
“Before participating in the trial I used to offer some non-specific eye drops to soothe the irritation. Now having used the diagnostic kit I am more confident in understanding the cause of the problem and have seen the benefits of eye drops and lubricants that are specifically designed to target the different parts of the tear layer to treat dry eye.
“The kit contained Lissamine green - a stain I hadn’t used before. I had only used Fluorescein to show up damaged epithelial cells and to assess tear film break up time. I found the Lissamine Green stain very useful in revealing dry areas on the bulbar conjunctiva and also to show up lid wiper anomalies – a very common cause of discomfort among contact lens wearers due to increased friction along the lid margin. Together these stains provide a good indication of what is going on.
“A significant part of my patient base is the elderly and they often complain of gritty and/or watery eyes. Many of my contact lens wearing patients have also complained of blurred vision and a burning sensation during lens wear and some have even considered discontinuing lens wear. Using the stains and the questionnaire supplied in the Altacor/ No7 kit I am able to narrow down the problem areas and it feels good to then recommend a product that is more likely to help relieve the symptoms.
“Unlike Fluorescein, Lissamine Green needs to be applied in much larger quantity and the degenerative conjunctival cells show up after a couple of minutes. The patient then ends up with very green eyes afterwards and may need to be reassured that this will clear up shortly.”
Gareth Thomas of Altacor, which is the company behind the Clinitas range of dry eye products, explains that tears have three different layers: oily (on top, prevents evaporation of the watery layer), watery (bulk of tears), mucus (on the surface of the eye).
“Fluorescein stains the cells on the cornea and reveals damage here. Just as dry skin is eased with hand cream these cells also benefit from lubrication. The Lissamine shows degeneration of the conjunctiva.”
Mr Vaja says he finds the Fluorescein useful to check if the tear film is breaking up.
“If the tear film breaks up it creates dry spots and this could suggest an insufficient lipid in the oily layer. Another sign to check for lipid anomalies is looking at the lid margins. Pressure applied to the lid margin should produce a series of drops of clear lipid through the meibomian openings. Both the quantity and quality of these meibomian secretions is important in maintaining the tear film.
“Patients with meibomian gland anomalies often benefit from warm compress using something like an eye bag. These patients also often complain of gritty eyes in the morning so Clinitas Hydrate is useful as it can be applied the night before.”
“Lissamine can also reveal mucus deficiency, and the gel is more appropriate as it helps restore the integrity of the corneal surface and hence allow a more stable tear film.”
Tony Hodgson, Sales Executive from No7 Contact Lenses has been analysing feedback from the trial and said that many of the opticians, like Mr Vaja, have since gone on to set up dry eye clinics themselves following their experiences with the kit. He says:
“The test is very quick, and easy to do, providing instant results and a potential solution. We had anticipated that we would keep the cards after the opticians returned them but they have found them so useful that they want to retain them to include in the patient’s records. Some practitioners have also amended the cards to add their own questions and incorporate the procedure as part of a dry eye clinic, which is excellent.
“Often opticians don’t realise that a problem with the tear layer may make a patient’s eyes uncomfortable and instead offer replacement lenses. However using Clinitas Soothe or Hydrate may be sufficient to solve the problem.”