Lifestyle and diet are major contributors to the rising incidence of dry eye disease (DED) in the community and something within eye care professionals’ power to change, according to Dr Rolando Toyos, founder of intense pulsed light treatment (IPL) for dry eye disease.
“It used to be that the demographic for people with dry eye disease was women over 50 (years of age). Now we’re seeing teenagers, people in their 20s, and it’s all down to poor health, diet, and lifestyle. Until we clean this up, we’re going to see a rising trend.
“Untreated, dry eye progresses from mild to moderate to severe. To stop this inflammatory disease from getting worse, we need to act early and be aggressive in our approach.”
Dr Toyos, who was lecturing in New South Wales in early May, said a holistic approach to dry eye must include diet, lifestyle advice, and skincare products in addition to IPL.
Having been at the forefront of DED treatments for over two decades, undertaken extensive research, and helped hundreds of patients with ‘hard to treat’ DED from across America, Dr Toyos is not afraid to promote his ‘aggressive’ approach to the disease.
“It took 20 years for doctors to believe me on intense pulsed light and low-level light for DED. It took me and a group of Doctors from the American Academy of Ophthalmology to change the definition of DED to include inflammation,” he wrote in his latest book, Toyos Dry Eye Diet: What to Eat to Heal Your Dry Eyes.
Dr Toyos believes the need for global practitioner consensus has watered down the definition of DED as a multifactorial disease and does not reflect the pain and suffering that can occur with this disease.
“DED is a chronic inflammatory skin and gland disease that is also affected by the systemic problems resulting from poor tear production. An abnormal tear film can devastate the ocular surface, leading to decreased vision, pain, and disruption of daily activities. DED could be an isolated eye problem or a local manifestation of widespread system disease,” he wrote.
Managing Diet
Dr Toyos said a healthy gut supports a strong immune system, which is vital to reduce inflammation that can cause DED. However, common diets that are high in processed foods and chemicals negatively affect gut health, reducing good gut bacteria. While people often turn to probiotics, Dr Toyos said having undertaken extensive research and looked at stool samples of patients, these “don’t work because an acidic gut kills probiotics. We need to develop a neutral gut”.
He said, “patients know intuitively they should be working on their health and wellbeing”, however simply advising them to adopt a healthier way of living is not enough. A prescriptive approach is required.
“I’m embarrassed to say that I didn’t realise the impact of being specific. As a doctor I should have. But it’s also about providing information about the reasons for the recommended diet. Mushrooms, for example, have been shown to reduce the effect of allergies and to be a great source of prebiotics and probiotics.
“Once you make specific explanations – when they understand why making the changes we’re recommending will make a difference – they are more likely to comply. So, talk about how (and why) to break the habit.
“Patients won’t listen to family or friends, but their doctor has the greatest power to influence change. So, take advantage of that power to persuade them to lead a better life”.
Dr Toyos’ prescriptive diet includes a two-month elimination diet, after which certain foods are reintroduced.
“We apply the 90:10 rule followed by people who live in ‘Blue Zones’ – those areas where people live the longest and healthiest lives. Ninety per cent of food is good for them and 10% is not good in terms of being inflammatory to the body.”
Referencing other lifestyle changes needed to control DED, he said cosmetics and technology are high risk factors.
Examples he proffered included extensive time spent on computer devices and smart phones without adequate blinking. This causes rapid tear evaporation, which clogs the meibomian glands, causing the ocular surface to become more inflamed. Dry spots on the cornea can, over time, lead to scarring and permanent damage.
While face creams with retinoids can stimulate fibroblasts, giving the skin a more youthful appearance, they can inflame the meibomian glands. Eyelash extensions and the glues used to hold the extensions in place, can speed the evaporation of tears affecting the meibomian glands.
“So, IPL is great, but there is more we need to do to combat DED in these patients,” he said.
Article by Mivision.