Dry Eyes and Contact Lenses - Interview with Dr Rhiannon Richer, Optometrist

[00:00:01.120] - Paul

Welcome to the Dry Eye Treatment podcast. We interview eye care industry professionals who have experience in treating dry eye disease. Please remember that the content shared on this podcast is based on personal experiences and opinions. It is not intended as medical advice. Always consult your health care professional for any medical concerns. Now sit back and enjoy the podcast. Welcome to the Dry Eye Treatment podcast. If you suffer from dry, itchy or irritated eyes, you could be experiencing dry eye syndrome. And if that's the case, then stick around because on this podcast, we interview eye care professionals who specifically deal with dry eye disease. Over the next 20 to 30 minutes, you're going to get actionable tips on what you can do to manage your dry eyes. But first of all, who am I? My name is Paul Sallaway. I'm the owner of Optics Digital, which is a digital marketing agency that helps eye care practitioners to grow their business. I'm not an optometrist, but as a dry eye sufferer myself, I'm here to ask all the questions to the experts, so you don't have to. And today, I'm very lucky to have an optometrist who is working in Western Australia at Ezekiel Eyes, which is an optometry practice in Perth, renowned for its expertise with contact lenses.

 

[00:01:21.410] - Paul

My guest graduated with a Master's degree from the Queensland University of Technology in 2017. She's worked in various roles since then in Queensland and Western Australia. At Ezekiel Eyes, she's working alongside Damon Ezekiel, who is well known in the Australian optometry community as the very first Australian to become the President of the International Society of Contact Lens Specialists. Welcome to the Dry Eye Treatment podcast, Dr. Rhiannan Richer. Hello, Rhiannan.

 

[00:01:47.830] - Rhiannon

Hi, Paul. Thanks for introducing me.

 

[00:01:50.180] - Paul

Yeah, thanks for coming on the podcast. So maybe just to kick us off, can you give us the 30 second lightning round version of your backstory so we know a bit more about you.

 

[00:02:00.100] - Rhiannon

Do you want the personal or the professional version?

 

[00:02:02.730] - Paul

Whatever you feel comfortable with!

 

[00:02:04.910] - Rhiannon

Sure. So I have lived in Western Australia for about six years since graduating from university. And I've worked in various different roles. Prior to this, I was locuming, so that took me all over the country, mostly in Western Australia. And I got to see very different demographics and areas of what I would argue is the better side of the country.

 

[00:02:30.110] - Paul

You just alienated all the East Coasters! LOL.

 

[00:02:32.220] - Rhiannon

I think it's the most windiest, the most isolated and has the biggest urban sprawl in the world. So, yeah, it's a wonderful place to live. And I feel very blessed to have found a career path and also a place in the world that I really enjoy.

 

[00:02:53.720] - Paul

Sounds great. Well, you mentioned windy, and so that's something that we might actually talk more about.

 

[00:03:00.420] - Rhiannon

Windy and dry.

 

[00:03:01.530] - Paul

Windy and dry, yeah. So that's probably something that we are going to explore a bit more later in the podcast. So one of the reasons I was excited to get you on is because in your practice there, Ezekiel Eyes, I know that you see a lot of contact lens wearers and in addition to having, dry eye patients in general. And so from what I understand, there are potentially some special challenges for contact lens wearers who do have dry eye conditions. So that's what I would like to delve into a bit today. But just to get started on that, can you explain to me, as a layperson, what is the difference between rigid contact lenses and soft contact lenses? So I've personally tried soft contact lenses back in the day, but I've never actually experienced the rigid contact lenses. The RGPs, I think you call them, aren't they?

 

[00:03:58.490] - Rhiannon

We do, yeah. Correct. So we say RGP for short, just a bit less of a mouthful. So the main difference is the material. The soft lenses, you can squash it between your fingers. You can feel it's got a jelly-like consistency to it and it's very moldable. So whatever you put that onto, it will drape over that surface, typically being the front surface of an eye. A rigid lens is fast, stiffer, so you cannot fold or swish that lens at all. It almost feels like a hard in between your fingers if you were to play around with it. And it used to be, they used to be far more popular than they are now before soft lenses came to the market because they were one of the only options for many people. But now with the option of soft lenses, if the eye is suitable for a soft contact, most people will migrate themselves over to the soft contacts, often because the soft lenses are much more comfortable. They have a superior comfort to patients. But then we also have some patients whose prescription or eye shape doesn't allow them to wear soft lenses. And so they need to wear the hard contacts if they want them to be an option.

 

[00:05:12.660] - Paul

Right. Yeah, actually. Yes. That's something I wanted to ask you about, are there certain patients or are there certain people who don't have any options other than to wear the rigid lenses? Like, are there certain people who maybe because of the shape of their cornea or whatever, just don't have the option of soft contact.

 

[00:05:31.660] - Rhiannon

Yes, definitely. So there are some people who have got very high, what we call corneal astigmatism. So a lot of people have heard the word astigmatism being thrown around. And there is a portion of the eye which sits on the very front, over the colour part of the eye, we call the cornea. And if that eye has a significant amount of astigmatism, often soft lenses are very irritating and unstable. So the patients don't have very good vision with contact lenses. So then a hard contact lens doesn't have the instability that comes with a soft lens with a highly astigmatic eye. Now, that's what we would call regular astigmatism. There is another group of people who have a condition called k erythritonus. And this is what causes irregular astigmatism. And soft contacts or glasses can only correct for regular astigmatism. And so for these These patients who have got k erythritonus, the irregular astigmatism causes a significant amount of blur to their vision. But if they were to put a soft contact on, sorry, a soft contact lens or glasses on, it sometimes is as good as nothing. And the power for them comes in these hard contacts.

 

[00:06:48.640] - Rhiannon

And so because of the rigidity of the lens, it essentially creates a new front surface to the eye. And it uses a tear layer underneath, which corrects a lot of the irregularity. And you see these lenses change people's lives. They get driving licences back. They can hold down a job. They can go back out into the world and see what they used to see before the condition took away a lot of their vision So I've had it described to me that k eryotoconus is a bit like the pointy end of a football, like the cornea starts to like, bulge. Yeah, that's what it looks like if you were to look at the tissue physically or if you looked at the corner, it's almost like a rugby tip of a ball poking out of the front of that eye. But the person who has the condition, the way that they see the world is very, very distorted. Often, if they were to look at a light, they get these significant halos and glow. And basically the light enters in their eye in an almost arguably infinite or at least unknown number of ways. And so glasses or soft contacts can only correct that two ways.

 

[00:08:01.620] - Rhiannon

And so the hard contacts are really powerful for those eyes.

 

[00:08:07.760] - Paul

Okay, so from what I hear you saying, then there are some people who just don't have the option of soft contacts. They do have to wear rigid contacts. Now, do you feel that rigid lenses are more challenging for people who suffer from dry eye?

 

[00:08:23.210] - Rhiannon

They are more challenging than somebody who doesn't have dry eye. But whether it's a hard or a soft contact lens, where a dry eye always presents just a little bit of an extra challenge, it can, in specifically applying it to a rigid contact lenses, it can create issues with us assessing the fit of the lens. So making sure that we've got the right shape and size for the patient, as the lenses are heavily reliant on a tear exchange beneath the lens. And so if you don't have enough tear exchange, then And the lens can sometimes cause all sorts of problems, from fitting to irritation and all the regular dry eye symptoms that people experience.

 

[00:09:11.920] - Paul

Okay. Are there things that Are there things that people can do to make contact lenses more comfortable if they if they do have chronic dry eye conditions? Like are there things like eye drops, for example, lubricating drops that that would help in that situation?

 

[00:09:29.510] - Rhiannon

Yes, Definitely. Whenever we're using our contact lens, we want to use lubricants which are either contact lens compatible. So the bottle will specifically tell you that you can use them with your lenses or if they're non-preserved lubricants. Those are ones that usually come in little tubes. But nowadays they're getting quite clever and putting them into a multi-dose bottle. But it will say very clearly often in a nice big yellow banner on the front that they're And if they're preservative free, then they're absolutely fine to be used with contact lenses, even if they don't specifically sedate it.

 

[00:10:07.750] - Paul

So not all drops are going to be good for your eyes. If you're wearing contacts, you do have to get particular drops.

 

[00:10:16.730] - Rhiannon

If you're wearing- Some of them, the main risk is just that if they're a bit thick, they'll potentially blur out your vision and potentially ruin pair of contacts for the day. You'll have to take them out and rinse the lubricant off because it's created a bit of a hazy film on the lens. But majority of the time they're there. They don't cause any issues.

 

[00:10:42.060] - Paul

Sure. Okay. Yeah. Well, I know that contact lenses come in a lot of varieties these days. You've got like daily disposables. I think those are the ones I had where you just pop them in during the day, take them out, throw them in the garbage before you go to bed at night. So you're always getting a fresh pair of lenses the next day. But there are other types of contact lenses that you can wear for longer. And I think maybe there are some that you can just leave in and not even remove from your eyes, aren't there? So they're extended wear lenses, aren't they? So are they more problematic for people with dry eyes?

 

[00:11:19.430] - Rhiannon

Definitely. An extended wear lens, one that you... Some people can sleep in. There are a few lenses which are approved to be slept in and others which you still take out at night, but you wear the same lens for one month or sometimes it can be two weeks. It just depends on the design and manufacturer. They can dry with the length of use because the material over time just starts to dry out. And so how the lens feels on day one and how it feels on day 30 can be drastically different. And if you've already got dry eyes, your eye can start to really try to pull the moisture out of that lens. And then you can have issues with the vision being blurred in the contact lens and uncomfortable. And for some of my patients, they would... I've had a lady who was absolutely burning through her monthly lenses because she would only get about a week out of them before they would go completely blurred on her. And we switched her into a daily lens. And because you're using a new lens every day, she was very happy and we were able to get some stable, clear vision.

 

[00:12:32.220] - Rhiannon

And she wasn't going through a monthly lens every week.

 

[00:12:36.370] - Paul

Right. Well, okay. Well, as I mentioned, I think there are many types of contact lenses. The one that I find particularly interesting is something called scleral lenses. And I think that's that's something that you do a lot of in Ezekiel Eyes, isn't it? The scleral lens, the sclera contacts. Can you tell us a bit more about those?

 

[00:12:55.450] - Rhiannon

Yeah, of course. So the sclera lenses, they're a type of rigid lens is a type of rigid And they're bigger than an RGP because they sit on the white push and die, which we call the sclera, hence sclera lenses. And these lenses are filled with non-preserved saline. And then it gets vaulted So it gets onto the eye and essentially creates a sealed system around the edge.

 

[00:13:20.460] - Paul

So it just covers the hole. It covers a much greater area of the eye than the normal contact lenses would.

 

[00:13:27.330] - Rhiannon

Yes, it does. So a regular So let's start with an RGP. An RGP lens in diameter is typically anywhere from eight and a half to 10 millimetres in diameter. A soft lens, you're looking closer to about 14 millimetres, which is what most people are familiar with. And we do a lot of what are called mini scleros, and they can be anywhere from 15 to 17 millimetres in diameter.

 

[00:13:54.200] - Paul

And so I guess one of the big plusses of scleros for dry eye sufferers is that you basically you've got a layer of tears, like there are tears underneath the lens themselves. Is that right? Exactly. So it's like this fluid under there that's between your eye And the harsh environment.

 

[00:14:16.730] - Rhiannon

Yeah, so because the eye is put in a basically a fluid filled chamber for the whole day, people who've got chronically dry eyes, it can sometimes be a reason that we put them into sclural lenses Because they suddenly have a barrier between the eye, the front of the eye, which is called the cornea, where it gets very, we call it desiccated, which is another word for dry and the atmosphere. So you've got this fluid layer basically protecting the eye from the dry environment or the air.

 

[00:14:51.980] - Paul

And so there are a lot of reasons, or there are other reasons why people would have scleral lenses, aren't there? I mean, it's not It's not just a dry eye solution.

 

[00:15:02.580] - Rhiannon

Correct. Yes. So we use them for dry eye or like I was saying before, keratoconus. We fit a lot of our keratoconus patients and scleral lenses. And then there are a few of our other patients who have had a disruption to their cornea, also causing an irregularity, like keratoconus in a sense, but it will have a different cause. So it might have been a trauma, if they'd had an injury to the eye, it just created some scarring on the or if they had an eye infection, again, creating the scarring, or if they had a laser complication, which again creates this irregularity to the cornea.

 

[00:15:43.560] - Paul

Okay, well, You mentioned laser, like I know LASIK procedures are quite popular, aren't they, these days? So tell us a little bit about what is LASIK? What is LASIK treatment, first of all? And is there any, are there any side effects for getting LASIK treatment related to dry eyes.

 

[00:16:02.760] - Rhiannon

So LASIK is one of a few different corrective procedures that people can choose to have the prescription of their eye corrected. And depending on the amount of tissue which is present and the amount of prescription which needs to be corrected, we'll determine which procedure you have. So LASIK is one of the most common, and this is because It's got the quickest, but that's a decision that often happens between the patient and the ophthalmologist. Essentially what LASIK is, is it's removing a portion of the cornea to correct for the vision. And because it's a surgical procedure which is done on the cornea, it can exasperate dry eye symptoms. And it's often a really smart move to have the eyes in a really call it moist position before going in for any eye surgery, really, because it would just help you on the other side with the dry eye gets exasperated in any procedure on the cornea, and it would just help you with your your comfort on the healing.

 

[00:17:20.180] - Paul

Okay, all right. Well, yet another type of contact lens that people may have heard of is something called Ortho-K lenses, which comes from orthokeratology, I believe. Tell us more about that. What is it and why could that be a good option for people who have dry eyes?

 

[00:17:40.180] - Rhiannon

So the Ortho-K lens is correct for the prescription of the eye through reshaping the cornea while you sleep. And the benefit is that during the day in the waking hours, you are glasses and contact lens free. So contact lenses make dry eye worse. And wearing them while you sleep because the eye is closed, it doesn't have any influence to exasperating the dry eye. So the benefit is that you get to see the world with absolutely nothing on your face or in your eye.

 

[00:18:14.550] - Paul

I like to think of them as like my daughter wears braces when she goes to bed at night and the braces correct her teeth. They gently reshape her teeth while she's sleeping. And like the way I think about Ortho-K is that they do the same thing with your cornea, don't they?

 

[00:18:31.160] - Rhiannon

They do. And it's reversible. So as soon as you stop wearing the lenses, the tissue just bounces back to its original shape and the original prescription. Right.

 

[00:18:39.990] - Paul

That's really a non-invasive way of controlling your your your vision. A lot of people I know, I get interested in Ortho-K as a solution for myopia for their children. But Ortho-K is also beneficial for adults as well, isn't it? It's not limited to just kids.

 

[00:18:57.330] - Rhiannon

Yes, we have. I have many adult patients in Ortho-K and they absolutely love it. It can create glasses and contact lens free for anyone of any age. The main limiting factor is prescription. And you're just not going to know until you go and have an assessment and you have your cornea scans and a discussion with an optometrist.

 

[00:19:22.380] - Paul

And so your optometrist will order basically a custom pair of contacts for you, just like getting a custom made suit. They're going to be contacts that are made specifically for the shape of your cornea. Yes?

 

[00:19:35.510] - Rhiannon

Yeah. So, yeah, every lens is custom made because no two eye shapes are the same.

 

[00:19:53.500] - Paul

Okay. Well, we've talked a lot about contact lenses, but does Ezekiel Eyes have any other in-clinic dry eye treatments available?

 

[00:20:02.620] - Rhiannon

Yes, we do. There's a few that we offer. So the first one we call IPL, which is Intense Pulse Laser. And it's a broad spectrum laser, which improves the functionality of the, we call them the meibomian glands, which are the little oil glands that secrete the oil layer of the tears. And what can happen commonly is that the meibomian gland, where they open on the lid margin just behind the eye lashes becomes inflamed. And so IPL treatment, it helps to improve the oil within the meibomian glands.

 

[00:20:43.830] - Paul

Any other treatments you have in there?

 

[00:20:47.290] - Rhiannon

So we also offer something called Zest. Zest is made by a company called Zocular. And the Zest is a gel formulation And its main active ingredient is derived from an okra complex. And we take this gel product and we use it to give the eyelid margin a very deep cleanse. And what it does is it works on the biofilm created by bacteria, which are often present in many of these inflammatory dry conditions, one of those being dry eyes. It also helps with a condition called blepharitis or styes. And I've also had a couple of my patients who've had very bad ocular eczema, who have responded extremely well to the product. We've actually managed to get them off their steroids. It surprised me, and they're very happy. So basically what the Zocular does is it enacts on this bio film, which in turn helps to decrease the inflammation, which is a big driver in the dry eye. And then for patients who suffer from what we refer to as aqueous deficient dry eye, which is essentially they have a very low volume of tears. So this is different to the meibomian gland.

 

[00:22:21.600] - Rhiannon

The meibomian gland creates the oil layer, which is the surface layer of the tear. These patients often lack the water layer, the bulk volume of the tear. And what I can do here is put some, we call them punctal plugs. Essentially, they block the tears where they drain and it retains what little tear volume they have in the eye

 

[00:22:47.800] - Paul

Do they need to go to an ophthalmologist for that?

 

[00:22:50.120] - Rhiannon

No, we can do it here. It's quite quick, minimally invasive and painless. You often I put them in and then they say, are they in? Yeah, we're finished. Yeah, you can't really feel them when they're in properly.

 

[00:23:06.970] - Paul

Good. Well, if it's painless, that gets a checkmark from me! So I said we'd get to the dry, windy weather of Perth eventually. A lot of people do live in places where the conditions are a bit drier, a bit windier, a bit dustier. I was talking to someone some months ago who's up in Port Headlands. And if you know anything about the north-west area of Australia, you're right on the edge of the desert there. And on top of that, you've got all the mining stuff going on around that creates extra dust as well. So some environments are more challenging than others. Do you have any tips on what people can do to really take care of their in challenging environmental conditions?

 

[00:24:03.380] - Rhiannon

Yeah, of course. So as you've mentioned, there's an environmental component to the dry eye. And the things that make that worse will be wind, your digital screens, computer, mobile phone, TV, air conditioning and reading. So taking regular breaks when we know we're going to be sat on our computer, which is most of us for our working day. Just remembering to blink Because when we have a prolonged near task, our focussing creates a decreased blink rate, which then drives our eyes out even more. Just being very mindful of your hydration. So we want water intake up, coffee and alcohol down, which isn't always possible. I know. I definitely wouldn't want to give up my daily coffee, or coffees some days. So it's just being mindful around making sure you've had enough And you've got the lubricants, which are typically over the counter or even just off the shelf at the supermarket, which can be effective in helping the symptoms of dry eye, but they don't necessarily address the cause or at all, really. And so if you want to help get to the bottom of some of the more physical drivers, then you're best going to see an optometrist and having an assessment done on whether something like IPL or the Zest treatment or the punctal plugs would suit your eyes, because it depends on what type of dry eye you have to where you benefit the most.

 

[00:25:37.420] - Paul

Well, so it sounds like you've got all the options there, Rhiannon. So I think if anyone in Perth who is, who needs help with dealing with their dry eyes. They should get along and see you or Damon to Ezequielize there. So we might wrap up, I think. So do you have anything you'd like to add or any last tips for us?

 

[00:26:04.150] - Rhiannon

Well, I just like to thank you for having me on. This has been exciting. It's my first podcast, which is been... I really enjoyed it. So I appreciate it. And thank you.

 

[00:26:15.320] - Paul

Good. Well, thanks. I was just going to say thanks for contributing. I think there's a lot of good information that you've added today.

 

[00:26:23.780] - Rhiannon

Thank you. I appreciate it. It was very good questions.

 

[00:26:28.360] - Paul

All right. Well, so on that note, let's wrap up, I think. So if you are a dry eye professional yourself and you'd like to take part in this podcast project, then feel free to reach out to me directly. You can contact me via my website at opticsdigital.net or connect with me through LinkedIn. So all right. Well, thanks a lot, Rhiannan. And take care. And yeah, thanks a lot. Thank you, Paul.

 

[00:26:55.420] - Rhiannon

Thank you, Paul. Bye, bye. Bye.bye. Bye.