June on our high street has finally seen some proper summer weather, with what is reported to have been the hottest prolonged spell of weather since the drought of 1976. It makes me smile how the British are never happy with the weather. Despite our practice being fully air conditioned the subject of conversation has repeatedly been about it being ‘far too hot’ and I cannot get over how many of our patients think they are being helpful by opening the windows upstairs in the fully air-conditioned waiting area.
This hot spell seems to have increased the number of patients we are getting into practice reporting problems with dry eyes. Discussion in practice this month among colleagues has centred around how common dry eyes are and is it a new condition? We certainly seem to see a lot more patients nowadays suffering from this condition, particularly during the hotter spells of weather. The majority of people with sore eyes entering the practice at this time of year seem to be either hayfever sufferers or those suffering with dry eyes, with a few not falling into either category and being a bit more challenging.
You only need to look at the market for the vast range of dry eye products to see how prevalent the condition has become. However, something seems to have changed, as back in the 80s, when I first qualified, it was rarely mentioned. The only time we recorded dry eyes on a patient record was when they were unsuccessful with contact lens wear and, very rarely, if a severe Sjogren’s syndrome was suspected. However, today we seem to be diagnosing a high percentage of patients with some degree of dry eye syndrome. Working in the corneal clinic one day a week at our local eye hospital, I also see a large number of referrals for such conditions, a small percentage of whom are so severe that vision is compromised due to corneal involvement.
I recently had a 48-year-old female patient in practice who complained of the usual symptoms of dry eyes. It can be quite debilitating for some of these patients and in her case it was causing some corneal problems. We started to discuss the question as to whether this has always been a problem, but we were not as good at diagnosis and maybe patients were more tolerant and didn’t moan as much? She could not accept that there was not something that was the cause of this condition – why had her parents and grandparents never experienced it? She also wanted an instant cure for this condition (as many do) so that she could just go away and continue with her busy life.
Maybe patients did not live as long, but we do see a large number of patients such as this lady with dry eyes who do not fall into the older age groups.
I do think our modern lifestyle must have a lot to answer for as regards the dry eye complaints, when you consider how much people are exposed to air conditioned environments. Shopping, at work, (in our practice), in our cars, all give exposure to that blast of cold air to dry our eyes. We also know that computer use is a big cause and I do not think there will be a change in the near future that stops us constantly staring at our computer and phone screens both at work and at play.
There is also much research to suggest our diet may be a factor in dry eye syndrome, as may hormone changes, so is this another condition caused by our poorer, more processed, higher-sugar diets? Is it even to be blamed on the fact that we no longer spend as much time outdoors and remain in our homes or offices for the bulk of our day?
A high percentage of these patients (as applied to this patient) cannot accept that this is a longstanding condition for which they will always need to treat themselves. The modern answer to a problem is to find a treatment that cures the condition in a week or two and I am sure we have all seen many patients for whom we suggested drops for dry eyes at the previous appointment, they used them until they ran out and then said it was no better when they stopped using the drops ‘so the treatment didn’t work’. Many of these patients will end up under the HES looking for that ‘magic cure’ –the cost of this to the NHS must be phenomenal and I am sure a lot could be done to save money by setting up schemes within optometry to properly advise and recommend treatments for these patients.
This lady who I saw, due to her corneal problems, did need referral to the corneal clinic and has been successfully treated, initially with bandage contact lenses and then with punctal plugs. After explaining her condition to her, she understands now that this will need ongoing treatment and she will not have a magic cure. With the correct advice in practice I am sure many of these patients can be successfully treated and fully understand their condition in order to manage it within community optometry.
Judy Lea is optometrist director of Specsavers, Longton, Staffordshire.