Ocular Surface Disease Index for Dry Eye Assessment

 

How do you know how severe your dry eyes are, and if you are receiving the proper care?

Typically, your eye doctor will diagnose your dry eyes by using clinical exam, your response of yes or no to self-reported symptoms of dryness or burning.  Frequently, eye drops are prescribed and if drops don't work, there are very few other options.  Inadequate diagnosis can lead to delayed diagnosis or even subpar therapeutic management.

This Ocular Surface Disease Index¹ (OSDI, developed by Allergan) is a questionnaire that has been tested in clinical trials as an accurate and effective tool to differentiate normal and temporary ocular discomfort from chronic dry eyes. It consists of 12 questions that rates the frequency of symptoms, task-related limitations due to ocular discomfort, and environmental irritants. For each item, the range of patient responses are from "none of the time" to "all of the time," corresponding to a numerical 0-to-4 scale. The values are then summed, and the calculated OSDI score ranges from 0 to 100 with cut-off values for mild (13-22), moderate (23-32), and severe (33-100) dry eye.

The OSDI questionnaire can be used as a screening tool to identify people who would benefit from a self-referral for a full dry-eye work-up.  All existing people with dry eyes should also complete the OSDI at each follow-up to monitor for progression and track for response to therapy.

Print out a copy for yourself and track your own symptoms while you take TheraLife Eye for improvement.  Bring a copy to your next visit to your eye doctors.  email us at: info@theralife.com to get a copy of this questionnaire.

Theralife Can Help
1. Tell us your symptoms and dry eye history, what you have been doing so far for dry eye relief- we will give you:

• Realistic expectations on how long it will take you to recover.

• What other regimen you should be using in addition to taking TheraLife Eye. e.g. Hot Compresses, eye lid cleaning, antibiotics, steroid eye drops etc.

Theralife will stay with you every 2 weeks until you recover.

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email us to get a copy of the questionnaire.  info@theralife.com

New Research Indicates Stress Causes Chronic Dry Eyes

The stress level in today's world is much higher than before.  Working 10 hour days are common.  Instant messaging that just can't wait, grabbing dinner and lunch on the go, not enough exercise, over eating, insomnia, you get the picture. 

Can stress cause dry eyes?  Yes!

There is a body of scientific evidence that links STRESS to chronic dry eye syndrome.  Stress seems to cause cellular damage which leads to conjunctivitis, dry eyes, macular degeneration (AMD).  UV light and tobacco smoke can result in epithelial damages to the cornea.   Oxidative stress results in many cellular changes which eventually leads to cell death.  

In animal models, inhibition of oxidative stress (such as using steriods), and inflammation can interrupt and break the cycle of cell death.  We now have several animal models that demonstrate this phenomena is true.  Inflammation is a major culprit.  Inflammation is seen in every severe dry eye cases which leads to cornea damage. 

This creation of numerous cell and animal models that selectively target the effects of oxidative stress and inflammation to the specifically affected eye region in these diseases has greatly advanced our understanding of the involvement of oxidative stress in eye disease.

How can TheraLife Help?- TheraLife Fatigue and TheraLife Eye

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TheraLife Eye to prevent cornea damage, restore tear secretion glands and deliver balanced sustainable tears all day long.

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Reference: Here is an abstract from an article published in Cornea: October 2009 - Volume 28 - Issue 11 - pp S70-S74

Elimination Diet- treatment for your eye allergies.

People who suffer from dry eyes and come to TheraLife often describe their symptoms as itchy, dry, irritated, burning.   The symptom "Itchy" is a sure sign of allergies.

Allergies could be caused by environmental elements such as pollen, mold, trees, animal dander and more.  However, there are many food allergies that can be eliminated through this "Elimination Diet"  One of our customers who had itchy dry eyes tried it and alas it worked in 2 weeks.

She would like to share her story with you, because she also finds it so easy to implement.

I have been taking TheraLife Eye for dry eyes for 7 years.  My eyes are much improved, but I still have some itchy eyes.  So I decided to try this "Elimination Diet" and see if I can get further improvement. 
This diet includes:

• No Gluten, 
• No refined sugar, 
• No dairy
• No caffeine
• No GMO corn products. 

After two weeks on this diet, I had a significant improvement in my eye health - Eyes always moist and no itching sensation. This diet is easy to follow both at home and at many restaurants who provide great choices which allow you to stay on this diet.  Starbucks even has no caffeine passion ice tea.   I continue to take TheraLife Eye for dry eye relief.  Adding this diet has allowed me to be food allergy free. "
KA  Thousand Oaks, CA


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Punctal Occlusion for Dry Eyes Treatment

In people where eye drops did not work, eye doctors may use punctal plugs as a modality of dry eyes treatment.  The idea of punctal plugs is to shore up what ever little tears are produced by preventing it from draining through the tear duct.  In people with moderate to severe dry eyes, who can still produce tears, this treatment may increase the quality of their lives.  The negative aspect is, using punctal plugs may result in allergic reactions to the materials used in the plugs causing the plugs to fall out, or result in eye infections. 

Punctal Occlusion for Dry Eyes

There are different ways to plug up tear drainage.
1. Punctal Plugs
2. Thermocautery - use heat to close off the tear ducts permanently
3. Electorcautery - use electronic tool to seal off tear ducts
4. Laser ablation
5. Surgical cauterization- to close up tear duct.

Punctal plugs can be removed if neccessary, in case the person is allergic to the plug material or the plugs can fall out by themselves.  About 50% of the plugs fall out within the first year.  Methods 2-5 are permanent and cannot be reversed.

Punctal occulusion should be performed after surface inflammation is under control. ¹
Before performing a procedure to occlude a punctum permanently, many eye doctors suggest a trial of temporary punctal occlusion using various plugs.⁴ While this is advised, being able to tolerate the temporary plugs does not give an accurate prediction of side effects of the permanent plugs.

The reported results of punctal plugs vary. It seems to work for people with dry eye of mostly mild to moderate severity. The magnitude of the treatment effect was more striking following implantation of non-dissolvable silicone plugs, but occlusion with temporary collagen plugs also had an apparent relief dry eyes.

Punctal Occlusion and Inflammation

Punctal plus has been shown to improve objective and subjective measures of dry eye¹² ,  but may increase ocular surface inflammation in subjects with high levels of clinical inflammation.¹³ Because of this issue, an international panel of experts developing comprehensive treatment guidelines for ocular surface disorders recommended that the inflammatory condition be treated before punctal occlusion.¹⁴

Punctal Plugs and Increased Ocular Bacterial Infections

Because puntal plugs back up tears – which does not allow debri and bacteria from draining. Some people will see an increase in eye bacterial infections, which require anti-biotic eye drops for treatment.

Complications
Although punctal occlusion is an effective therapy for chronic dry eyes, there are complications related to punctal plug insertions.  Some of these complications aree

• epiphora - over flow of tears onto the face.  
• punctal ring rupture,
• abrasion of the corneal and conjunctival surface,
• suppurative canaliculitis - infection of lacrimal gland ( located at the upper and lower eye lids) causing surface abnormalities that sometime require surgical interventions.

The retention rates for the different kind of silicone punctal plugs have been reported to be about 50% after one year,extrusion of silicone plugs is common, occurring within three months in up to 50% of cases.

Conclusion

For the right person, punctal plugs could work.  Careful selection is critical evaluating risks and benefits.  A variety of techniques are available. Punctal occlusion can dramatically improve the quality of life in many people with moderate cases of dry eyes and can prevent visual loss in people with severe cases of dry eyes
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How TheraLife Eye can help!
TheraLife Eye is clinically proven to be 80% effective in dry eye relief for first time users.  TheraLife Eye is effective when puntal plugs, prescription eye drop, eye drops failed. The reason is because TheraLife Eye work on restoring normal cell functions to tear secretion glands,  intracellularly.


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REFERENCES
1. American Academy of Ophthalmology. Punctal occlusion for the dry eye. Ophthalmology 1997; 104: 1521.
2. Freeman JM. The punctum plug: Evaluation of the new treatment for the dry eye. Trans Am Acad Ophthalmol Otolaryngol 1975; 79: 874–87.
3. Dohlman CH. Punctal occlusion in keratoconjunctivitis sicca. Trans Am Acad Ophthalmol Otolaryngol 1978; 85: 1277-1281.
4. Cohen EJ. Punctal occlusion. Arch Ophthalmol 1999; 117: 389–90.
5. Glatt HJ. Failure of collagen plugs to predict epiphora after permanent punctal occlusion. Ophthalmic Surg 1992; 23: 292–3.
6. Redmond JW. Correspondence: Punctal occlusion with collagen implants. Ophthalmic Surg 1992; 23: 642.
7. Ervin AM, Wojciechowski R, Schein O. Punctal occlusion for dry eye syndrome. Cochrane Database Syst Rev 2010 Sep 8;(9):CD006775.
8. Geldis JR, Nichols JJ. The impact of punctal occlusion on soft contact lens wearing comfort and the tear film. Eye Contact Lens 2008 Sep; 34(5): 261-5.
9. Nava-Castaneda A, Tovilla JL, Rodriguez L, et al. Effects of lacrimal occlusion with collagen and silicone plugs in patients with conjunctivitis associated dry eye. Cornea2003; 22: 10-14.
10. Yazdani C, McLaughlin T, Smeeding JE, et al. Prevalence of treated dry eye disease in a managed care population. Clin Ther 2001;23:1672–1682.
11. American Academy of Ophthalmology Preferred Practice Patterns. Dry Eye Syndrome. 2003. Available at: http://www.aao.org/aao/education/library/ppp/upload/Dry-Eye-Syndrome.pdf.
12. Dursun D, Ertan A, Bilezikci B, et al. Ocular surface changes in keratoconjunctivitis sicca with silicone punctum plug occlusion. Curr Eye Res 2003; 26: 263–269.
13. Pflugfelder SC. Anti-inflammatory therapy for dry eye. Am J Ophthalmol 2004; 137: 337–342.
14. Behrens A, Doyle JJ, Stern L, et al. The Dysfunctional Tear Syndrome Study Group. Dysfunctional tear syndrome: a Delphi approach to treatment recommendations. Cornea 2006; 25: 900–907.
15. Yang H, Fujishima H, Toda I, et al. Lacrimal punctal occlusion for the treatment of superior limbic keratoconjunctivitis. Am J Ophthalmol 1997; 124:80–7.
16. Sugita J, Yokoi N, Fullwood NJ, et al. The detection of bacterial biofilms in punctal plug holes. Cornea 2001; 20: 362–365.
17. Murube J, Murube E. Treatment of dry eye by blocking the lacrimal canaliculi. Surv Ophthalmol 1996; 40: 463-480.
18. Kojima K, Yokoi N, Nakamura Y, et al. Outcome of punctal plug occlusion therapy for severe dry eye syndrome. Nippon Ganka Gakkai Zasshi 2002; 106: 360–364.
19. Balaram M, Schaumberg DA, Dana MR. Efficacy and tolerability outcomes after punctal occlusion with silicone plugs in dry eye syndrome. Am J Ophthalmol 2001; 131: 30-36.