By Ava Kikut
Scheie Vision Summer 2018
Dry Eye Disease (DED) is a common chronic condition that disproportionately affects women. DED occurs when an individual does not produce enough quality tears to protect and lubricate the eye. A lack of protective moisture causes severe irritation and sensitivity to light, and it can lead to scarring in the cornea and visual impairment. DED has many causes, including aging, hormonal changes, dry environments, contact lenses, certain medications, and autoimmune diseases. Treatments vary depending on the cause and severity of the condition. The Penn Dry Eye and Ocular Surface Center at the Scheie Eye Institute is dedicated to meeting the specific needs of each patient.
Led by Giacomina (Mina) Massaro-Giordano, MD and Vatinee Bunya, MD, the Dry Eye and Ocular Surface Center expanded in 2016, becoming one of a dozen centers nationwide approved to offer customized scleral lenses. Scleral lenses are designed to treat symptoms of severe DED by holding soothing saline solution against the eye. Scheie's contact lens service has a full team of highly trained optometrists and technicians that specialize in scleral lens fittings. With grant support from the Board of Women Visitors, Scheie was equipped with a new slit lamp and special camera for fitting scleral lenses and recording the degree of dryness on the surface of the eye. The grant has also helped assist patients whose insurance does not cover the cost of the lenses.
"Scleral lenses may be better for a subset of patients who have nerve pain and are exquisitely sensitive to evaporation of the tear film. They can also help correct the vision if there are corneal irregularities," explained Dr. Massaro. For patients with these symptoms, the availability of scleral lenses and fittings at Scheie has made a world of difference.
In 2012, Deborah Pley was diagnosed with Sjogren's syndrome, an autoimmune disease that attacks the body's moisture glands, causing particularly severe symptoms of DED. "It feels like sand is in your eye — itchy, scratchy, blurred vision," she described. After being diagnosed with Sjogren's, Deborah sought specialized DED treatment from Dr. Massaro. Dr. Massaro started Deborah on immunosuppressive drops, which helped reduce inflammation and increase tear production for a few years.
In December 2015, Deborah had an exacerbation of a viral infection in her left eye, which precluded her from continuing her immunosuppressive drops. Until the virus healed, Deborah had to rely on antiviral drops and over-the-counter drops to lubricate the outer surface of the eye. While artificial tears are a common remedy for DED, they are less effective and require very frequent application for patients like Deborah with severe symptoms.
As a pharmacist, Deborah works in front of a computer screen for a significant portion of the day, which exacerbates her DED symptoms. During the few months she was using artificial tears, Deborah had to pause from work every 15 minutes to reapply the drops. Additionally, the dryness caused sensitivity to light, limiting her ability to drive and participate in outdoor activities. "I really didn't go outside that much. I have wraparound sunglasses, and I would have to make sure I had them on. The brightness of the sun was just irritating." The sensitivity to light and dependence on artificial tears was isolating. "I didn't do as much socially because you just don't feel good. You can't see, you don't feel like going out. You don't want to go someplace and be putting drops in your eyes every 10-15 minutes," Deborah explained. During this period, the virus caused scarring in her cornea, damaging her vision.
When the virus subsided, Dr. Massaro prescribed customized scleral lenses, which were fitted in the new scleral lens center. For Deborah, scleral lenses have been even more effective and convenient than the treatment she used before the virus. She can now see better than she has in years. "Scleral lenses made life 100% better," Deborah said. "I'm not uncomfortable at work anymore," Deborah said. "I can work a ten hour shift and it doesn't bother me…I like going outside when it's nice out — doing anything, washing the car, yardwork." Deborah expressed gratitude for the individualized care she received at Scheie. "Dr. Massaro and her team are very supportive and helpful and try to do whatever they can to get people to a better place."
Deborah's testimony illustrates that each experience with DED is unique and changes over time. In addition to scleral lenses, there are a number of treatments for DED, including anti-inflammatory steroid drops, inserts (lacriserts), punctal plugs, specialized contacts with amniotic membranes, autologous serum, nasal stimulating devices (True Tear), and oral neuromodulating drugs. While the same treatment may not work for everyone, the Dry Eye and Ocular Surface Center at Scheie is committed to finding and providing the most effective approach for each patient.