Vision impairment or problems of the eye impact a staggering number of Americans each year. This number is only set to increase as the population lives longer, thus exposing more individuals to issues including cataracts and age-related macular degeneration.
As one can imagine, many sufferers of these issues have countless questions. Suburban Life turned to Sanjay Kamat, D.O., of Bucks Eye Specialists for answers to problems including dry eye, cataracts, vision impairment and more.
What are some of the causes of dry eye?
Dry eye is a pretty broad category of problems people can experience. Years ago, when I first started practicing, there was a very simplistic approach: “Oh, you have dry eye, here’s some artificial tears,” but, it’s a little more complicated than that. We now talk about lid margin disease, Meibomian gland dysfunction and lipid problems of the eye or fat volume of the tear film and then liquid deficiency.
There are many causes; probably the most common cause is for a woman to be postmenopausal. Hormone changes that occur in the body can cause a lack of tear quality and production.
Then there’s also trauma, mild trauma, like contact lens wearers who have something sitting in their eye that without lubrication—they get the dry eye symptoms.
The use of tablets and computers and iPhones and smartphones definitely has something to do with it too, because we now know that with staring at computer screens, the amount of times that the eye blinks per minute is reduced so that is a factor.
Then there are all sorts of regular factors—medical problems, diseases, environmental factors like animals, pets, smoke, being in an outdoor work environment. I think those are the top.
How does your office go about diagnosing dry eye?
Historically there were a number of tests that could be done to show tear production. There was a little paper that would measure, like a ruler, how many millimeters of water your eye would produce—Schirmer’s test— but technology has caught up to 2017. Now we have testing of tear films that allows us to measure what’s called osmolarity, or the amount of salt content. This test comes from a company called TearLab. The higher the number, the higher the osmolarity, the more salt there is—that implies that there’s not enough liquid. So you actually have a state where you don’t have enough production of tears. This technology is going to be present in both practices.
The other test is for inflammation. That test comes from RPS. It is called InflammaDry®. You take a small volume of tear, a sample from both eyes, and it basically looks for an enzymatic marker called MMP-9 to show for corneal inflammation.
What are consequences of a patient leaving dry eye untreated?
Left untreated, the problem that can occur is chronic inflammation, loss of the glands in the eyelids; potentially, chronic red eyes, eyes that are burning, itching, tearing, mucous congestion, fatigue, not being able to hold their eyes open, light sensitivity, distorted vision, and then ultimately the final end point s with corneal scarring, potentially. ... The cornea gets damaged and turns cloudy. And then patients can get into a lot of trouble where they may, in order to get their vision better, need to be forced into a major eye surgery such as a corneal transplant. That’s taking it to the extreme, but that’s the full gamut from hopefully easier, treatable, simple, preventable to the other end.
What means of treatment are there for this condition?
There’s actually quite a host of treatments over the years that have been available. When we first started, it was tear supplements or plugs in the tear ducts to well up or maintain the volume of tear in the eye.
Early on—14, 15 years ago—RESTA- SIS® hit the market and really kind of changed everything, looking at how some low-grade inflammation was really at the root of many dry eye patients’ problems. ... Now, jumping forward 14, 15 years from RESTASIS® and you have a new product, Xiidra® , that just hit the market a couple of months ago. ... The plugs have changed over the years from silicone permanents to 3-month or 6-month disposable collagen plugs that are very popular now.
Omega-3 supplements with fish oils and primrose oil, sprays for the eyelids, warm compresses. We were the first practice in the Philadelphia market, the tri-state area, to have an IPL about six years ago—an Intense Pulsed Light machine. The sister therapy, which is from a company called TearScience ®, is LipiFlow, which is now the only FDA- approved procedure, to help correct Meibomian gland dysfunction which is now 85 percent of all dry eye, according to current research.
Speaking of state-of-the-art treatments, your office also offers Lasik. Can you share a bit about Lasik, and the conditions it can be used to treat?
Lasik is a wonderful opportunity for folks who are interested in being as close to free from glasses, spectacles or contact lens correction as possible. There are some general rules about Lasik that have remained steadfast for many, many years: someone has to be over the age of 18; nearsighted folks do better than farsighted folks; you can have some astigmatism, but not too much; they have to have a thicker cornea; they need to have small pupils; so all those things haven’t changed.
We’re really heading in a direction where the results are more programmatic, the healing time is less, the damage to the eye or potential thinning of the cornea for risk of glaucoma later is less, and more and more people can qualify for treatment now.
It’s wonderful, but it’s not a permanent fix; I always tell my patients that. You have someone who’s pretty young and active and looking to get rid of their glasses and they’re 30 now but they could still develop a cataract at 60, 70, 80, and Lasik won’t fix that.
Your office also offers cataract surgery. What are the underlying causes of cataracts, and how can these be treated?
Cataracts are a natural evolution in time with the natural lens material of the eye. When we’re born, it’s more fat, cholesterol, and less protein, and that ratio flips during our lifetime—you get more protein deposits that are a little more dense and light hits that lens instead of sharply focusing on the retina for nice clear sharp vision, it gets cloudy and fuzzy.
In the very beginning, when cataracts start, you can potentially sharpen someone’s vision by changing their prescription in their glasses or their contact lenses; but, invariably, over time, the change in prescription for glasses or contacts no longer sharpens the vision.
When the objective findings of cataracts on my exam and the subjective symptoms from the patient match up, then it’s time for intervention, for the cataract surgery.
We have all the diagnostic equipment here at the practice to scan an eye and go over all the options of routine cataract surgery, possibly premium cataract surgery, which would be treatment of the astigmatism through two or three methods, potentially, and/or multifocal or accommodative lenses.
The most important thing for us here is that it’s open book, that it’s full disclosure, and that all the options that are available are given to a patient so that they can make a fully informed decision about what they want to do.
BucksEyeSpecialists
301 Oxford Valley Road, Suite 801-A
Yardley, Pa. 19067
(215) 493-7330
BucksEyeSpecialists.com
Briggs Eye Specialists
2026 B Briggs Road Mount Laurel, N.J. 08054
(856) 235-1211
BriggsEyeSpecialists.com
Published (and copyrighted) in Suburban Life Magazine, February, 2017.
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