Worldwide, dry eye disease (DED) affects between 5% to 50% of adults, and the prevalence rises with age and is greater in women than in men.1 The TFOS DEWS II study describes dry eye disease as a multifactorial ocular surface illness characterized by a loss of tear film homeostasis and ocular discomfort.
DED harms the corneal epithelium and can be caused by persistent ocular surface irritation and inflammation, tear film instability and hyperosmolarity, corneal nerve damage, and adverse environmental conditions that result in worsening dry eye signs and symptoms over time.2
Patients with severe dry eye and decreased pain thresholds frequently require more than regular pharmacological therapy to improve their symptoms. Which brings us to the question: what adjunctive therapies can be considered along with pharmacological therapies in DED management for these patients?
Moisture chamber glasses
Moisture chamber glasses are a commonly underutilized treatment for DED. They can help patients cope with dry eye symptoms, including epiphora and foreign body sensation, by reducing the impact of wind and environmental stressors on the ocular surface. This specialized eyewear can contain a multi-layer eyecup that gently surrounds the eyes and fills the gap between the face and the front frame of the glasses, producing a seal around the eye and efficiently blocking light, wind, and other irritants.
Many moisture chamber glasses are sports wrap-around sunglasses with foam on the frame that protect the eyes from wind, dust, pollen, and air conditioning. Overall, these glasses prevent tears from evaporating from the ocular surface.3 Moisture chamber glasses are created with a discrete, soft, and latex-free silicone eyecup that can be routinely worn without drawing attention to the frame. They include a variety of lens choices, such as photochromic lenses, and come in a variety of styles.
“Moisture chamber eyeglasses are a great choice for everyday wear since they seem like a typical pair of glasses with clear lenses.”
Every pair of glasses can have the lens type, frame color, and eyecup color adjusted because the eyecup is held in place magnetically. Furthermore, each lens choice provides complete protection against UVA and UVB radiation.4
The mild silicone eyecups make them comfortable to wear, even during outdoor sports such as cycling, hiking, and other high-velocity activities.4,5 Lastly, moisture chamber glasses are commonly claimed to a health savings account or flexible spending account when purchased.
Tinted and blue light filter glasses
While the relationship between blue light and ocular health is somewhat controversial, research has shown that blue light exposure reduces the survival rate of corneal epithelial cells in animal models and cell culture experiments.6 Blue light has been demonstrated to enhance the generation of reactive oxygen species (ROS) in corneal epithelial cells, which eventually causes inflammation. Ocular inflammation can be exacerbated by oxidative damage and apoptosis.6
Niwano et al. used an in vitro cell culture experiment to determine the phototoxicity of blue light on corneal epithelial cells. According to the findings, blue light appears to alter the mitotic phase of corneal epithelial cells in a dose- and time-dependent way. The microvilli on the epithelial layer of the corneal epithelium lose their support and stability, resulting in dry eye.
However, blue light's effects on the cornea are not restricted to corneal epithelial cells, as it may also have a considerable inhibitory influence on corneal stromal cell activity.7 Furthermore, it was shown that blue light-induced oxidative damage was decreased by efficient antioxidant extracts, alleviating clinical symptoms of the ocular surface in a dry eye mouse model and further indicating that blue light is involved in the establishment of dry eye.7 Tinted and blue light filter glasses are becoming popular care tools for people with dry eye who spend a lot of time in front of a computer screen.
“Still, research has not yet verified this approach for reducing dry eye and improving ocular surface morbidity.”
Although some studies have demonstrated that blue light exposure might cause increased inflammation and oxidative damage in epithelial corneal cells, this has not yet been fully verified in human clinical research. This is also the case with the claim that blue light has a dose-dependent and time-dependent impact on epithelial cells, resulting in the loss of microvilli and tear film support, which can deteriorate with prolonged screen time.
Therefore, the use of blue filter glasses is not yet evidentially indicated for use in dry eye therapy. As this area is investigated further, the use of blue filter glasses may be a future consideration as a viable supplementary treatment option for people suffering from dry eye disease.6,7
Scleral lenses
Therapeutic contact lenses have been known to improve tear film stability on the ocular surface in patients with chronic lid exposure or irregular corneal surfaces leading to tear film instability. Scleral contact lenses are a form of rigid contact lenses that vault the entire cornea and limbus with a fluid reservoir that helps to hydrate the cornea, regenerate the corneal surface, maintain epithelial stability, and protect the ocular surface against the mechanical shearing forces of the eyelids.
These features make scleral lenses an ideal option for treating ocular surface diseases, and hence, is the reason why they are more widely used today for severe dry eyes patients or patients with severe ocular inflammatory conditions, such as ocular graft versus host disease (GVHD), Stevens-Johnson syndrome (SJS), and Sjogren's disease.8
Scleral lenses are a great example of an available technology that allows for modification of the ocular surface ecosystem that helps in providing better management for severe dry eye cases.
Scleral lens innovations include:
- Utilizing scleral and corneo-scleral topographers to custom-fit lenses.9
- Simplifying fits over anatomical obstacles and reducing suction.9
- Alleviating effects of higher-order aberrations and improving visual acuity.9
Final thoughts
Dry eyes can be significantly disruptive to many people’s daily routines, and these therapeutic eyewear and lens options can provide patients relief within minutes. These treatment options can easily be added to a patient’s current dry eye treatment/management plan, so that vision and overall quality of life and comfort can be improved.
It is important for eyecare professionals to be aware of all the different DED treatment options and research being discussed to set up their dry eye patients for success.
