Advanced Dry Eye Disease Clinic

At Prism Eye Center, we pride ourselves on being one of the only offices in the area offering advanced dry eye testing and treatment. Our doctors have been extensively trained and are ready to provide dry eye sufferers with an unparalleled level of care!

It is estimated that dry eye disease affects around 5-15% of the US population (that’s 16-49 MILLION people!) However, the true number is likely much higher than that but many dry eye patients go undiagnosed.

How can that be?

Dry eye is a complex disease with a multitude of causes and intricate treatment plans that are extremely unique to each patient. Many offices do not have the instruments necessary to properly diagnose the primary cause of each patient’s dry eye. At Prism Eye Center we are proud to offer the most advanced dry eye equipment and treatment options to fit each individual's needs.

Those suffering from dry eye disease may experience a range of the following symptoms:

• Eyes that feel sandy/gritty

• Redness

• Burning

• Itching

• Watering

• Intermittent blurred vision that improves with blinking or eye rubbing

• A quick stinging pain followed by tearing

• Eyes that feel heavy or fatigued

You may have discussed these symptoms in the past and were told to use artificial tears 3-4 times per day. While these drops may help alleviate your symptoms for a short time, in many cases this treatment is just not enough and in all cases, it is just a temporary fix to a chronic, progressive disease.

Our doctors understand the complex nature of dry eyes and treat it for what it is: a disease. Chronic dry eyes are not simply an irritating inconvenience. If left untreated, dry eye disease will progress, risking irreversible damage.

How Our Approach is Different

In our office, dry eye symptoms are much more than just a few checkboxes on a patient questionnaire. These symptoms are indicators of a much larger disease process, and our doctors always address this with the attention that it deserves. We strive to provide the best possible visual and medical eye care to our community and are proud to have the equipment necessary to thoroughly manage your eye health.

In order to treat each patient’s dry eye disease properly, we must first understand the exact mechanism that is causing it in that individual. For most people, the disease is multifactorial, and discovering the root cause(s) is essential to treatment success. After gathering a thorough history of your medical health, lifestyle, and symptoms, we will use the 5M Oculus Keratograph and a microscope called a slit lamp to evaluate your eyelids, the front structures of your eye, and assess the function, structure, and quality of the tear film components. Based on these findings, we will then perform more testing as needed to determine the underlying cause(s) and develop an appropriate, personalized treatment plan.

Rest assured that our doctors have the experience and technology to determine the cause of your dry eye and treat your disease effectively. Proper dry eye testing takes time, so we always ensure to schedule this appointment slots that are long enough to fully discuss your test results and treatment plan. You will leave our office with a written plan and have regular follow-up appointments to ensure your eyes stay as healthy and comfortable as possible!

We know that medical testing may cause some anxiety, and we want every patient to feel at ease when visiting our office. Keep reading below to learn more about the different tests you may have performed at your dry eye evaluation!

Our In-Office Dry Eye Testing

Vital Dyes

Every medical eye exam includes a microscopic view of the structures of the eye using an instrument called a slit lamp. Typically, slit lamp examination is performed under standard white light, but topical dyes and colored lights can also be utilized to better evaluate for any damage to these structures.

These dyes are stored on paper strips that are individually sealed and activated by inserting a drop of sterile saline solution onto the strip. We can then transfer that dye to the surface of your eye and use the slit lamp to examine the health of your ocular structures. In dry eye disease, we are particularly looking at your eyelid margins and oil glands (called meibomian glands), the white part of the eye (called the conjunctiva), and the clear surface layer of the eye (called the cornea). This helps us to diagnose the quality and severity of your disease and monitor for changes over time.

Oculus 5M Keratograph

The Oculus 5M Keratograph is an exceptionally valuable instrument for diagnosing and managing our patients with dry eye disease. This device creates a collage of images and scans we use to gather information on the problem areas and monitor for change over time, including intensity of redness, presence of bacteria or tear film debris, tear volume and evaporation rate, and the quality of meibomian gland health and oil excretion. We are able to show you all of these reports (which may be in image or video format) so you can truly visualize how your eye health has changed throughout treatment.

​​​​​​​Meibomian Gland Imaging and Expression

Meibomian glands lie along the surface of both the upper and lower eyelids and are responsible for releasing the oil layer of the tear film. If these glands are not functioning properly, the tear film will not have the right amount of oil. This causes the tears to evaporate too quickly, resulting in dry eye symptoms or watering eyes due to reflex tearing. This is why many people feel dryness relief from blinking or rubbing their eyes. These actions force a little oil out of these glands, temporarily stabilizing the tear film enough for improved comfort.

Additionally, if the oil is not the right consistency, the glands will become clogged, leading to inflammation and damage. If left untreated, these glands will become irreversibly damaged, which is why it is essential to unclog them as quickly and efficiently as possible. Thankfully, with our advanced technology, we are able to accomplish this in-office, and can even capture images and videos to monitor the effectiveness of your meibomian gland expression!

InflammaDry

One of the primary underlying causes of dry eye is the presence of inflammation. MMP-9 is an inflammatory marker that is present in our tear film and is consistently elevated in patients who have dry eye disease.

InflammaDry is the first and only in-office test that can detect high levels of MMP-9. This simple test takes only 10 minutes to complete and can help us identify patients who are at a higher risk of developing a dry eye disease, even before signs or symptoms of the disease are present!

Blood Work

In some cases, it may be necessary to have blood work completed to help rule out any underlying conditions. Remember, inflammation is a primary cause of dry eye disease, and inflammation anywhere throughout the body can affect your eyes!

If you have any symptoms of joint pain, dry mouth, dry skin, or fatigue, or if your eyes are not responding to ocular anti-inflammatories, it is crucial to have blood work completed to rule out any additional underlying causes such as Sjogren’s syndrome.
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Advanced Dry Eye In-Office Treatments

After performing a thorough examination of your ocular health using a combination of the testing strategies above, our doctors will discuss your results and develop a personalized treatment plan for you. This plan will be provided to you in written form so you can refer to it at home, and any in-office treatments they recommend will be discussed in detail.

At Prism Eye Center, home remedies and artificial tears only scratch the surface of our dry eye treatment plans! Specialized cleansers, heat or sleep masks, and nutraceuticals or pharmaceuticals may be prescribed, or one or more of the following in-office treatments may be recommended:
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Lipiflow

LipiFlow is a breakthrough FDA-approved therapy that helps the glands naturally resume their natural production of oil for the tear film. The in-office and medication-free procedure uses a cutting-edge device to heat and unblock obstructed meibomian glands and release trapped oil. A single 12-minute session can offer significant relief to patients suffering from dry eyes and meibomian gland dysfunction (MGD). It is estimated that around 86% of dry eye sufferers have abnormal meibomian gland function (MGD), so LipiFlow is a crucial asset to any dry eye disease clinic.
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LipiFlow uses disposable applicators that are placed onto the surface of the eye like a contact lens. This applicator will heat the meibomian glands from underneath, which is proven to be much more effective than heating from the outside, such as with a heated eye mask. Additionally, the instrument will apply pressure to the outside of the lids to help massage the trapped oil out into the tear film. The process is simple, quick, and comfortable and addresses the most common cause of dry eye disease. One study involving contact lens patients found that a single LipiFlow treatment increased contact lens wearing time by more than 4 hours per day in comparison with pretreatment levels! Click here to learn more about Lipiflow.
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Intense Pulsed Light Therapy (IPL)

Intense Pulsed Light Therapy is a series of treatments in which pulses of light are used to thin hardened oil that is trapped within the meibomian glands. IPL also helps reduce abnormal blood vessel growth and inflammation of the eyelids, causing less eyelid redness and healthier gland function. It can also help reduce the population of Demodex mites on the eyelids and offers cosmetic benefits such as decreased redness, and pigmentation and boosted collagen production.

Maximum benefit from IPL requires 4 initial treatments that occur 2 or more weeks apart. Initial relief may take up to 1-2 months depending on the severity of the disease process and benefits are not normally noticed until after the 3rd and 4th treatments. Maintenance treatment is recommended every 6-12 months. In many cases, IPL may be used in conjunction with LipiFlow to achieve maximum clearing of meibomian glands. Learn more here about this novel and natural approach to treating dry eye disease.
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Prokera

Prokera is made from an amniotic membrane which has natural anti-inflammatory and anti-scarring properties. It is the only FDA-cleared therapeutic device used by eye doctors to provide fast-acting symptom relief and reduce inflammation associated with the ocular surface disease. It helps restore your cornea and return your eye to a normal, healthy state. Amniotic tissue is rich with healing nutrients and proteins and can heal corneal damage by helping stem cell and nerve regeneration. The amniotic membrane is attached to a small ring and fits onto the surface of the eye like a contact lens. The amniotic tissue used must pass a rigorous evaluation in order to be approved for a membrane. Prokera is fit one eye at a time and takes only minutes to insert in-office. It is only necessary to wear Prokera for 3-5 days, after which our doctors will remove it.

Punctal Occlusion

Everyone has four puncta (tear duct openings), one on each bottom lid and one on each top lid. The puncta is responsible for draining excess tear film through the nasolacrimal system, like a sink.

In patients who have a dry eye disease, we want to keep as much of the natural tears on the surface of the eye as possible. One way we can accomplish this is through punctal occlusion. This simple procedure involves inserting a small collagen or silicone plug into the two bottom puncta. This effectively slows down the drainage of the tear film, allowing it to stay on the surface of the eye longer, which helps to maintain a healthier ocular surface and prevent dry eye symptoms.

Autologous Blood Serum

Autologous blood serum is a big phrase that means we are simply taking the serum from your blood to create eye drops that are made specifically for you. This serum is highly concentrated with natural defense proteins and growth hormones that help to heal the ocular surface and is the most similar solution to your natural tears that is available. Find more information on serum tears here.

ZEST Blepharoexfoliation from Zocular

Another common culprit in dry eye and meibomian gland disease is the overgrowth of bacteria and debris (blepharitis) at the base of our lashes. Our eyelashes and lids play an extremely important role in protecting the eye with every blink. If the build-up of biofilm and debris occurs, it can clog the meibomian glands and contaminate the tear film, exacerbating dry eye symptoms and causing red, irritated eyes. This also creates an opportunity for Demodex Mites to take up residence. These microscopic bugs are commonly present in the base of our lashes in small numbers but can create a huge problem when present in large quantities. Symptoms may include flakes or dandruff on your eyelashes, burning or discomfort, itchy eyes or eyelids, gritty feeling, redness of eyes or eyelids, loss of eyelashes or misdirected lashes, tearing, or styes.

During a dry eye evaluation, we look for any signs of blepharitis and eyelid margin disease. If detected, we may recommend a daily at-home lid hygiene protocol. Similar to brushing teeth daily, the eyelids often require extra care as well! This is especially true in patients who wear make-up or lash extensions. If the problem is more extensive or not resolved with home treatment, we perform an in-office blepharoexfoliation called ZEST (Zocular Eyelid System Treatment). This comfortable treatment uses a solution specifically designed to eradicate Demodex Mites and remove the debris built up on the eyelid margin, leaving the eyes clear, clean, and comfortable.

Ready to Tackle YOUR Dry Eye Disease?

Do you feel like you have tried it all? Have you been using artificial tears all day long with no relief? Have you given up on contact lens wear because your eyes feel too dry?

We are here to help! Call us today to schedule a dry eye evaluation! We are excited to provide you with our advanced testing options and help you create a personalized treatment plan. We look forward to working together to help slow down the progression of this chronic disease before it causes irreversible damage and put an end to the irritating symptoms of dry eye!
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