Dr. Joseph Tauber and all the staff at Tauber Eye Center are proud of the care we provide our patients. We have dedicated ourselves to delivering the very best medical care, and we are proud to be recognized as a center of excellence in Kansas City
What does blinking have to do with dry eye? Blinking is important for eye health and visual function. Like breathing, we can voluntarily blink or choose not to blink, but at some point, our bodies force us to blink. We generally don’t think about blinking. Humans blink about 8-22 times per minute with the average blink lasting about 1/10th of a second. However, when we are reading, looking at a computer screen or staring, the blink rate goes down as low as 4 per minute. Why is blinking so important? 1. Blinking washes away environmental dirt, irritants, allergens and even germs. 2. Blinking spreads the tear film evenly to cover the surface of the eye, supporting proper refraction of light (“focusing”) that travels to the retina and allows us to see. This spreading action also distributes oils (produced by eyelid glands) that act to slow evaporation of tears. 3. A healthy tear film also covers and protects the delicate corneal nerves, preventing them from being exposed which can cause pain, discomfort, or dryness. Healthy tear film = Clearer Vision = Better comfort. 4. Blinking draws oils from the eyelid glands into the tear film, by a vacuum-like force. Reduced blinking (more time with eyes open) increases the time for tears to evaporate. Such “evaporative dry eye” results in a cycle of dryness, irritation, and blurry vision. Incomplete or partial blinking causes dryness. People with incomplete blink patterns are found to have more variable vision and worse dry eye disease than normal blinkers, because the tear film needs to be smooth and even to maintain clarity and comfort. Though it may seem unlikely, blink exercises can improve incomplete or defective blinking when incorporated into a daily routine. Repetition results in change. There are several training programs that can be downloaded onto a computer or as a phone app, helping to increase your conscious effort to blink and therefore improve the quality of vision. eyeleo.com / www.regularbreaks.com / Donald Korb Blink Training (iOS app) / Blink Blink (Windows) Fun Fact: Some animals can blink their eyes independently of each other, Humans can too, we learn how to, to communicate in the form of a wink. 😉 #tauberteachings #dryeyedisease #taubereyecenter... See MoreSee Less
Dry Eye Over The Years The notion that “dry eye” is a medical problem is one that has evolved dramatically and surprisingly recently. While some understanding of the existence of tears dates to Egyptian texts from 1500 BC, it was not until the 1850s that a mechanism for tear production was proposed, when researchers found they could produce saliva and later tear secretion by electrical stimulation. For most of the 1900s, dry eye was understood as an age-dependent decrease in tear production by the lacrimal gland. Blepharitis was understood as either “squamous” (like dandruff) or “ulcerative (caused by infection) without consideration of the nature of the meibomian gland secretion itself. I have a 1959 Eye Disease textbook written by the renowned physician Sir Stewart Duke-Elder that does not even mention dry eye. It was not until the 1970s when the separate components of tears (such as mucin) and their role in tears began to be understood. It was not until the 1990s that the roles of elevated tear osmolarity or inflammation in dry eye was widely discussed. The past 20 years have added recognition of the roles of hormones and nerve stimulation of tear secretion as important aspects of dry eye. Even more recent is recognition of the importance of blinking as it related to tear film instability. The even more recent idea that “dry eye” is a form of “pain” has opened much study of neuropathic dry eye conditions. Like phantom limb syndrome and other regional pain disorders, some dry eye is understood to result from abnormal function of nerves (at the eye or within the brain). This complex idea (to be discussed in a separate blog segment) may be explained in a very basic way to our patients as a “false alarm” signal carried by nerves to our brains, telling us that something is wrong even when there is not. Treatments for these conditions often involve oral medications and not topical treatments to the eye itself. I often say “diagnosis before treatment” because how we understand a problem directs how we treat it. The idea of dry eye as a deficiency of production explains the use of supplemental tear products and devices (punctum plugs) to prevent the rapid drainage of tears from the eye surface. The idea that tears have different components drives efforts for more specific replacement of tear components. Inflammation can be treated with anti-inflammatory medications. Blinking problems are tougher to rectify and treating neuropathic pain is still in rapid evolution in clinical studies. Have we finally figured out dry eye? As a cruciverbalist (someone who loves crossword puzzles) – it feels like something is still missing - and that is why research continues. #tauberteachings#taubereyecenter #dryeyedisease ... See MoreSee Less
A stable tear film is necessary to maintain good vision and ocular surface health. Tears contain (mostly) water, lipid (oil) and mucin. Beyond these three major components, other factors help regulate the growth and maturation of the cells that maintain a smooth and healthy ocular surface. In patients with severe dry eye, these factors (such as epidermal growth factor, vitamin A, TGF-β and others) are reduced or absent, and this may explain, in part, the difficulty of keeping the ocular surface healthy. Because these factors are also present in the serum (the fluid component of blood that remains after clotting.), doctors since 1984 have treated severe dry eye using a patient’s own serum diluted with saline solution. “Serum tear” eye drops (sometimes called “biologic tears”) are prepared in a sterile environment from a small volume of a fresh blood donation. They are by nature non-allergenic (a patient receives only their own blood product) and, once diluted (between 20-75%), their biomechanical and biochemical properties are similar to normal tears.
Many published studies have shown that serum tears are beneficial in treating many types of dry eye, including severe cases, and for generally promoting epithelial healing when unusual problems develop. Serum tears are not the solution to every dry eye problem, and eyelid-related issues generally require treatments specific for that issue.
Procedures vary between centers, but generally follow the same steps. Patients are first assessed for their suitability to donate blood, including testing for infectious conditions. Blood is drawn under sterile conditions, centrifuged to remove the solid components (red cells, white cells and platelets) yielding serum. After dilution of serum, “serum tears” are prepared in individual bottles. Bottles are kept frozen until use and each bottle must be discarded after one week. Serum tears are used between 4-8 times daily, according to need.
Potential disadvantages of serum eye drops are the limited shelf stability and the risk of infection arising for patients and others handling serum. Once inconvenient to obtain, companies (such as Vital Tears™) have made getting serum tears about as easy as filling a prescription. There are even options to get blood drawn directly at one’s home with serum tears delivered several days later.
Serum eye drops are a prescription product (not over the counter) and must be prepared according to the doctor’s specifications (dilution and dosing frequency).
While commercially available lubricants offer little to no “nutritive value,” eye drops made from serum have a unique character and supply anti-inflammatory and nutritional components. For patients who require advanced treatment for severe ocular surface problems, serum tears can be a very helpful option. #tauberteachings #dryeyedisease #taubereyecenter... See MoreSee Less
Scleral lenses can help people suffering from dry eye disease. They work by resting on the white part of the eye (sclera) completely vaulting over the cornea (the clear central “window” through which we see). Scleral lenses have been a remarkable advance in contact lens design for patients with medical problems resulting in irregularly shaped (for, example, keratoconus) or scarred corneas. Scleral lenses are also helpful for patients with normally shaped corneas but very dry eyes. Scleral lenses have three main features that set them apart from conventional contact lenses: 1. Size 2. Rigid gas permeable material 3. Fluid filled 1). Scleral lenses are bigger than “conventional” contact lenses, about the size of a nickel. Because they are bigger they don’t move, fall out or fold up, all things that can happen with soft contact lenses. With a little practice, anyone can learn to use a scleral lens. The sclera has fewer nerve endings than the cornea, which makes these large lenses very comfortable and stable. Many patients who cannot tolerate soft contact lenses can tolerate and have much improved comfort wearing scleral lenses. 2) Scleral lenses are rigid enough to hold their shape, and they cover the entire cornea. The plastic material is highly oxygen permeable - even more oxygen permeable than soft contact lenses - and this makes scleral lenses a very healthy contact lens option. 3) The greatest benefit of a scleral lens is that it can be filled with fluid, essentially keeping the eye lubricated for the entire time that the lens is worn. This helps with dryness and also improves vision. Imagine a lubricating surface that will never drain or blink out of the eye! Another advantage is that this fluid layer fills in any irregularities, creating a perfectly rounded surface. Like conventional contact lenses, a scleral contact lens can contain any prescription, including options for multifocal (near and far vision) correction. Scleral lenses also work for astigmatism, corneal scarring or after surgeries. Fitting for these lenses must be done by an eye care practitioner trained in their use, as proper fitting is critical for success. #tauberteachings#taubereyecenter #dryeyedisease ... See MoreSee Less