Envision Optical - Gold Coast Dry Eyes Center
About Gold Coast Dry Eyes Center
Gold Coast Dry Eyes Center is dedicated to the concept of getting to the cause of your dry eyes and seeking preventative approaches to minimize future disease and symptoms. As you’ll learn, around 70-80% of dry eyes is highly preventable, and the treatment options are much greater than simple eye drops.
Andrew Bowden - Envision Optical Director
Focused on preventative eye health and wellness, optometrist Andrew Bowden was frustrated that for many patients, their experience of dry eye care was:
“here, try these eye drops. And if they don’t seem to work we’ll try some others”.
Most eye care professionals see dry eyes as an afterthought: a minor eye complaint that can’t be cured, and can only be “managed” by eye drops. The reality is far more complex, and the effects of the disease can have significant negative impact on the sufferer’s quality of life, as well as their eye comfort and clarity of vision.
At the Gold Coast Dry Eyes Center, we offer a comprehensive suite of dry eye diagnostic tests to accurately diagnose whether you have dry eyes, and both the type and severity of your dry eyes. These test results then form the basis for monitoring your improvement and the true success of your treatment plan. Your dry eye management plan is therefore based on science and data, and not guessing. The success of the plan can then be accurately measured and monitored using scientifically proven testing protocols that are used by the world’s leading dry eye scientists and treatment centers.
What is Dry Eyes?
Normal Tear Film
Tears have several important functions:
- Ensure clear vision by keeping the cornea clear and smooth
- They wash away debris and waste products from the eye surface
- Thyroid problems
- Contact Lens Wear: Contact lens wear can alter tear film stability. Many people stop wearing contacts because of dry eye symptoms.
The tears consist of three layers, each produced by a different set of glands located on the conjunctiva and the eyelids. The layers need to mix in just the right balance, otherwise the tears will either not lubricate the eyes correctly or evaporate from the eye surface too quickly.
What are the symptoms?
- Blurred vision, especially after concentrated work like reading and driving
- Burning or irritated eyes
- Sandy, gritty, scratchy
- Sore or stinging
- Persistently watery eyes
- Redness
- Sensation of dryness
- Decreased comfort with contact lens wear
Why do my eyes water if they’re dry?
If the tears are not lubricating the eyes effectively, then the eyes will not be moist and comfortable. This will cause irritation and stimulate more tear production. These reflex tears are more watery due to the gland that secretes them, so they are much more unstable and tend to run off the eye surface very easily..
What causes Dry Eyes?
- Aging: The level of tear production decreases with age. At 65, we produce about 40% of the tears as at 18
- Meibomian Gland dysfunction: clogging up of the oil gland tubes leading to evaporative dry eyes
- Environment: Dry, windy weather, heaters and air conditioning all cause greater evaporation of tears from the eye surface.
- Hormonal changes: Pregnancy and menopause both see hormonal changes that will alter tear production
- Concentrated tasks: When we concentrate we blink up to 50% less. This means fresh layers of tears are not washing across the eye as regularly, and the tear oils are stagnating and clogging up.. This can occur with driving, reading, computer use and TV.
- Medications: many medications can cause dry eyes including the contraceptive pill
- Arthritis: dry eyes are common with arthritic conditions
- Thyroid problems
- Contact Lens Wear: Contact lens wear can alter tear film stability. Many people stop wearing contacts because of dry eye symptoms.
1. Aqueous tear Deficiency
Aqueous Tear Deficiency (ADDE) is one of the two main categories of dry eyes related to under production of tears. Dryness results from reduced lacrimal tear secretion and volume. This causes tear hyperosmolarity (increased saltiness), because, although the water evaporates from the ocular surface at normal rates, it is from a reduced aqueous tear pool. Tear film hyperosmolarity causes hyperosmolarity of the ocular surface epithelial cells and stimulates a cascade of inflammatory events. It is uncertain whether evaporation is reduced or increased in ADDE. It is possible that this is determined by the stage of the disease.
ADDE has two major subclasses, SS dry eye (SSDE) and non-SS dry eye.
a) Sjogren Syndrome Dry Eye:
Sjogren syndrome is a general disease in which the lacrimal and salivary glands are targeted by an autoimmune process; other organs are also affected. Dry eyes, mouth and other orifices are common.
b) Non-Sjogren Syndrome Dry Eye:
Non-Sjogren syndrome dry eye is a form of ADDE due to lacrimal dysfunction. There are no systemic autoimmune features characteristic of SSDE. The most common form is age-related dry eye.
2. Evaporative Dry Eyes
Evaporative dry eyes is a result of Meibomian Gland Dysfunction(MGD): a common, chronic disorder of the meibomian glands, which are the small oil secreting glands that line the inside of the top and bottom eyelids. These glands secrete oily compounds, which are an essential component of our tear film that lubricates the surface of the eye, providing clear vision and ocular comfort. MGD is where the glands start to malfunction and not secrete appropriate amounts or consistency of these oily compounds.
Most commonly they under-secrete leading to poor tear film quality, quick evaporation of tears, and “dry eyes”. They may also over-secrete leading to excessively oily tears with possible associated dermatitis conditions causing discomfort and inflammation around the eyelids. MGD is now considered to be the leading cause of dry eyes: 70-80% of cases.
Structures Involved in Tear Production - National Eye Institute
What is the cause?
MGD may be caused by obstruction of the fine meibomian gland ducts that line the interior edge of the eyelids, by skin debris blockage or hardening of the oily matter effectively forming plugs. Scarring can also cause damage to the duct openings. The process is also influenced by age, sex, and hormonal disturbances, and may be associated with skin conditions like dermatitis and acne rosacea. The end result is a reduced delivery of the meibum oils to the lid margin and tear film lipid layer; leading to tear film instability, increased evaporation, dry eyes, ocular surface inflammation and damage.
Who suffers from dry eyes?
Dry eyes may affect any age group, but it is more common in females aged 30+ and increases in incidence with age. It is also more common in contact lens wearers, and with some medications. Due to the massive increase in volume of computer and screen-based activities, increasing numbers of younger patients are presenting with Meibomian gland dysfunction dry eyes.
Can I prevent Dry-Eyes?
Following are some simple preventative measures you can do every day to minimise the chances of developing dry eyes
- Never apply eye makeup to the edge of the eyelid BEHIND the eyelash line
- Carefully remove all make up around the eyelids at the end of each day
- Perform warm compresses for 5 minutes followed by gentle finger roll massage across the eyelids several times a week
- Eat a diet with 3-4 serves of oily fish each week like tuna, salmon or other darker flesh fish: high in omega 3. Otherwise take a high quality Omega supplement like Dry Eyes Forte
- Remember to blink regularly when doing extended periods of computer of other near tasks. Poor blinking is increasingly being found to be a leading cause of meibomian gland dysfunction with the age of onset being much younger than previous due to increased use of screen based activities
Diagnostic Testing
Usually, a patient is told they have “dry eyes” after a quick look through the microscope by their eye care practitioner. At the Gold Coast Dry Eyes Center, we believe utilizing the latest technology and the latest scientifically validated assessment protocols leads to a more accurate diagnosis, and thus a more suitable treatment plan can be implemented that is customized to your personal condition.
We utilize the following detailed testing procedures to fully understand the nature of your condition and ensure we start your care, knowing what we are truly dealing with.
- Ocular Surface Disease Index (OSDI) patient symptom questionnaire used by the worlds leading dry eyes scientists
- Tear Analysis Digital Scan to measure the rate of evaporation of your tears
- Tear Volume Testing
- Comprehensive biomicroscope assessment of the ocular surface, eyelids and tear ducts
- Vital dye staining and photography to assess the extent of ocular surface dryness
- Assessment of the Meibomian Glands and their secretions: the root cause of the majority of dry eyes
After completing the suite of diagnostic tests, our optometrists have an accurate understanding of your current dry eye status and can formulate an appropriate customized treatment plan to start your journey back to comfortable eyes. We thus gain a comprehensive picture of the health of your ocular surface and tear film.
About IPL Therapy
IPL for dry eyes is a relatively new treatment option, developed over the last 8 years and commercially available the last 3 years or so. We have been successfully treating patients with IPL for dry eyes since 2015.
What is it?
E-Eye is a device that generates a polychromatic pulsed light by producing perfectly calibrated and homogenously sequenced light pulses. The energy, spectrum and time period are precisely set to stimulate the Meibomian glands in order for them to return their normal function. Many patients are familiar with IPL technology in the treatment of skin conditions and hair removal. E-Eye IPL is a dry eye specific machine that utilizes the same proven, safe technology, at an energy setting specific to dry eyes.
The E-Eye is thought to work in several ways
- By helping melt the congealed lipids clogging the gland tubes
- Indirectly by stimulating nerve conduction which then activates the glands for secretion and contraction.
- Possibly by reducing bacterial growth in the glands and around the lids
The treatment effects is cumulative and lasts
- 1 week after the 1st session
- 2 to 3 weeks after the 2nd session
- 6 to 12 months after 3 to 4 sessions
- IPL E > Eye
Who can use it?
IPL therapy is particularly applicable to patients who are suffering from evaporative dry eyes or showing signs of it developing. The initial evaluation will establish the suitability of a patient for therapy
Where is it available?
E-Eye Therapy is available at the Gold Coast Dry Eyes Center clinics located at Envision Optical Tweed Heads South and Burleigh Waters. Step one is booking for a comprehensive dry eye evaluation to determine your suitability for therapy.
Why is it so effective?
Published studies have shown an 87-90% treatment success rate. Earlier intervention will lead to greater success BEFORE permanent damage occurs leading to gland atrophy. The established treatment protocol is 4 sessions conducted at Day 1, 15, 45 and day 75.
The E-Eye IPL device has been registered at the Australian Therapeutic Goods Administration for the treatment of dry eye syndrome.
There are a number of other treatments available if E-eye IPL is not an option for you.
1) Blephasteam Heat Therapy and Gland Expression
This therapy forms the mainstay of our treatment programs for evaporative dry eyes caused by Meibomian Gland Dysfunction. This in office procedure involves wearing the Blephasteam goggles for 15 minutes. This creates a “heat chamber” environment that softens the solidified oils blocking the openings of the glands . You will then see your optometrist who will perform debridement of the eyelid margins, clearing debris and dead skin from the openings of the glands. This is followed by expression and massage of the eyelids to force the oil blockages out of the gland tubes. Once these blockages are fully cleared, normal function can start to occur again.
You will usually require at least 2-3 initial sessions of Blephasteam Therapy to clear all blockages. Follow up sessions are then performed at 3-6 month intervals.
2) MGDRx Eyebag Home therapy:
Traditionally we tell patients to heat a face washer, hold against your lids and maybe gently massage the lids and this will help stop the glands get blocked. This is usually ineffective for most patients as the heat does not last long enough to soften the oil blockages in the glands. Scientific studies have indicated that the MGDRX EYEBAG is the most effective heating option to give the heat levels for long enough to soften the blockages and promote good oil flow from the glands. We include an Eyebag as part of our take home treatment pack.
3) Nutrition for Dry Eyes:
The mainstay of nutritional therapy for dry eyes is a high quality omega 3 supplement. The omega 3 has an anti-inflammatory effect and will take at least 3 months to start to reach full effect, so you must be patient. We recommend Dry Eyes Forte supplement which has high concentrate Omega 3EPA and DHA, Omega 6 GLA, Vit D3, Vit E which have important anti-inflammatory effects. Patients usually have 3 capsules for 8 weeks then 2 a day maintenance dosage. Detailed advice will be provided in your management plan
4) Blephadex Wipes and Demodex
Demodex mites are naturally occurring on our skin but sometimes get out of control and cause blepharitis, an irritating reaction of the skin along the eyelids, particularly around the base of the eyelashes. If signs of this exist, then initial treatment in the clinic with Blephadex scrubs are performed, followed by home therapy with daily Blephadex wipes, which contain teatree oil in concentrations known to effectively kill demodex mites.
5) Eye Drops:
Eye drops or artificial tears have always been the first line therapy for dry eyes. The logic is that if the eyes are dry, add moisture. Tears however are far more complex and lack of moisture is not the only reason for dry eyes. Simple tear drops rarely offer adequate long term relief for patients. Modern eyedrops target specific abnormalities of tear structure. Not all tear drops are the same, and we use the diagnostic technology to select the most appropriate drop for your specific type of dry eyes. These can include:
- Systane Ultra which mimics the natural mucins of the tears
- Systane Balance contains phospholipids which bond the tears outer lipid layer to the underlying tear structure
- HyloFresh and Hyloforte
- Tear gels for more severe forms of dry eyes
- Tear sprays are designed to replenish the outer oily layer and enhance tear stability
Many tears are available in preserved and non-preserved forms. We believe avoiding preserved drops where possible has the greatest long-term comfort benefits and minimises preservative sensitivity.
Oculocin Propo Eye Drops
Oculocin Propo eye drops are a natural based dry eye treatment with no known side effects. The key ingredients are: Propolis, Aloe Vera, and Chamomilla. They provide dry eye relief and comfort, while also providing a mild anti-septic action which helps in cases of blepharitis related dry eyes.
Optimel Eye Drops
Optimel drops contain antibacterial Manuka honey and are a preservative free advanced option for moderate to severe dry eyes. They help improve ocular surface health and reduce inflammation., by a strong antibacterial effect. These bacteria are seen in higher levels in MGD and so Optimel is particularly effective in these patients. Studies showed that one drop 3x/day significantly reduced the bacterial count. The only downside is significant stinging when the drops go in for some patients. Some patients also report some redness after the drops go in.
6) Lacrimal Lavage:
Some patient’s watery eyes are caused by narrowing of the tear draining ducts. We are able to investigate to detect any narrowing or blockages and then perform treatment to widen up and flush out the tear drainage ducts to ensure they are draining normally. If necessary we will refer to eye surgeons who sub-specialise in the correction of tear duct problems.
7) Punctal Plugs:
Some patients eye irritation is produced from aqueous deficient dry eyes or not enough tears. We are able to insert small plugs into the tear drainage ducts to help more tears stay on the ocular surface and provide more lubrication for the eyes.
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Practice Locations
Contact Information
If you prefer, you can contact your local store directly – We have 4 optometrist locations on the Gold Coast:
Address:
Shop 19,7 Classic Way
Burleigh Waters QLD 4220
Opening hours:
Mon to Sat – 9.00am to 5.30pm
Thurdays – 9.00am to 7.00pm
Phone: 07 5593 7844
Fax: 07 5522 0078
Email: treetops@envisionoptical.com.au
Address:
4/33-35 Corporation Circuit,
Tweed Heads South NSW 2486
Opening hours:
Mon to Sat – 9.00am to 5.30pm
Thursday – 9.00am to 7.00pm
Phone: 07 5524 9659
Email: tweed@envisionoptical.com.au
PO Box 2136
Burleigh BC QLD 4220
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