CEimpact Podcast

A Pharmacists Guide to Dry Eye Relief

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Dry eye syndrome is a common yet often overlooked condition that can significantly impact a patient’s quality of life. This episode explores the causes, symptoms, and latest treatment options, equipping pharmacists with the knowledge to provide effective counseling and recommend appropriate therapies. Tune in to enhance your expertise and help patients find relief from this chronic and frustrating condition.

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Jennifer Salvon, BSPharm, RPh
Clinical Pharmacist, Medical Writer
Salvon Scientific

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CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the causes, symptoms, and risk factors associated with dry eye syndrome.
2. Identify evidence-based treatment options and counseling strategies pharmacists can use to help patients manage dry eye symptoms effectively.

0.05 CEU/0.5 Hr
UAN:  0107-0000-25-115-H01-P
Initial release date: 4/14/2025
Expiration date: 4/14/2026
Additional CPE details can be found here.

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Speaker 1:

Hey CE Impact subscribers. Welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and as always, I'm super excited about our conversation today. Dry eye syndrome is more than just an annoyance. It can significantly impact vision, comfort and overall quality of life. In this episode, we'll explore the causes, latest treatment options and how pharmacists can play a key role in helping patients find lasting relief from dry eye syndrome. It's so great to have our guest expert with us today, jennifer Salvan. Thank you so much for joining us, jen.

Speaker 2:

Thank you, I'm excited to be here.

Speaker 1:

Yeah, we appreciate you taking time out of your schedule to join us. So, for our listeners out there, if you can just give us a little bit of brief introduction to yourself, tell us a little bit about your background and your practice setting and maybe your passion for today's topic.

Speaker 2:

Great Thank you. I'm a clinical pharmacist at a small hospital in Western Massachusetts. I've worn a lot of hats over the years, including over 15 years as a community pharmacist. A lot of times I'd have patients come in struggling with their dry eye disease and ask me what to take and what to do, and I've always found the dozens of products out there a little daunting. Hopefully, our discussion today will provide some insight on dry eye disease and the treatments and the artificial tear products that are out there yeah, that's great.

Speaker 1:

Yeah, I can agree, it's been a while since I've practiced in pharmacy officially but, yeah, having on my own store and you and spent a lot of my career in community practice and ever since I was 16 years old and working in a community pharmacy, I feel like that this is one of the most daunting aisles in the pharmacy. Otc section is the eye area, because it just there's so many products and they all seem like they're the same and everybody makes a version of something and, yeah, I completely agree. So I've I've been really, really excited about this conversation today because I think it's it's something that all pharmacists struggle with, in my opinion, and so we're going to give them some, some great tips to take back. So this is great. So, again, thank you for joining us. I really appreciate it.

Speaker 1:

Let's jump into our first kind of topic. So I always like to lay the foundation, so let's just review exactly what is dry eye syndrome. So, you know, maybe let's talk about the prevalence, what are some of the causes and just also how does it impact patients daily life?

Speaker 2:

Excellent. You know, I sometimes like to start with the anatomy involved, because that helps us understand why it happens.

Speaker 2:

So, on your eye. Yeah, there's a tear film and it's a coating that keeps the eyes moist, and when it becomes unbalanced, the tear film breaks down, leading to inflammation and damage to the eye surface. So it's important for that to stay in homeostasis to the eye surface. So it's important for that to stay in homeostasis. There's actually three layers to the tear film. There's the outer layer, which is a lipid layer, and the meibomian glands take care of this layer. Now, the meibomian glands, you may not know, they're on the inside of the eyelid and they produce lipids to keep your eye moist.

Speaker 1:

Okay.

Speaker 2:

There's a middle layer that's basically water and the lacrimal glands produce those and those are located on the outer edges of your eye socket and then there's an inner layer that are produced. It's called the mucin layer and it's produced by goblet cells and that's in your conjunctiva. So altogether that kind of lubricates and keeps your eye safe from everything in our environment. Our eyes are open and there's just dirt and everything blowing in your face and getting in there, so this tear film is essential for your eye health.

Speaker 1:

So it's almost like, even like a three-part checks and balances system, like if a piece of debris gets through one, maybe the other is going to catch it and sweep it out and whatever. So that's great, that's a great foundation.

Speaker 2:

Yeah, okay, hopefully.

Speaker 1:

Yeah, I don't necessarily remember that. There's three parts of that, so that's, this is great. Yeah, keep going. Tell me more.

Speaker 2:

Well, and that's I think I like to know about stuff like that because that helps us guide us on what could be used to treat something you know, where is it breaking down? Myobian gland disease is something that people have, so if you know it's that, then you may approach the treatment in one way versus another.

Speaker 1:

That makes sense, okay, yeah.

Speaker 2:

There's a lot of different risk factors to developing dry eyes. People divide them into modifiable and non-modifiable. The thing you can't modify is age. As we get older, our eyes get drier, so there's something we have to deal with. Usually, there's a higher prevalence in people over 50, but what we've been finding is the age group of 18 to 49,. The incidence is rising, and can you guess why?

Speaker 1:

I would assume environmental factors, and also staring at screens.

Speaker 2:

Staring at screens. That's exactly it. One of the things that they're finding is causing it is everyone's got a screen in front of them and we're just on them all day long, like we're on a screen here. You're on a screen and you're writing, you're on a screen and you're filling prescriptions. I mean, it's hard to get away from being on a screen. So that's one of the biggest risk factors or biggest things that cause dry eye disease. So, knowing about that and I can give you some ideas about you know how to mitigate that. You know as we talk.

Speaker 2:

Yeah that's great the other thing is it's more common in females versus males, so it's primarily because there's hormonal changes in women that take dry eye disease. Also, cosmetic use women put on makeup and so that you know, having that on their eyes and getting in their eyes can, can damage the tear film. So that's another avenue. Yeah, Another. Well, those are non-modifiable. The computer screen is modifiable, but the other thing is wearing contact lenses.

Speaker 1:

That can precipitate dry eye disease.

Speaker 2:

So a lot of people I find are switching to glasses versus wearing their contacts all the time, especially if they have dry eye disease. The environment being in an air conditioned environment, being out in the wind, the sun at the beach, with the sand blowing. Caffeine consumption unfortunately precipitates dry eye disease or contribute to it. Yeah, and then a lot of meds, which we can talk about later, but there are medications that predispose you to having dry eyes.

Speaker 1:

Okay, yeah, that's great, you lost me at sand. One of my biggest fears in the world is sand. I hate sand, I can't. It feels like it gets everywhere and you can never get rid of it. So, yeah, the whole idea of like sand blowing in my eyes. I just went down this whole like rabbit hole of just freaking out.

Speaker 2:

The first time I go to the beach each summer, I'm like I can't. It takes me like a half an hour to get used to having sand on everything.

Speaker 1:

That's the worst, the absolute worst. I mean, I love the beach, but, man, I wish it didn't have so much sand. So, yeah, okay. So that's great If you can also let us know what's the prevalence for our patients in dry eye syndrome.

Speaker 2:

Well, it's actually pretty prevalent and it's hard to tell the exact prevalence. Estimates say over 16 million people adult people in the US have dry eye disease. But some feel this is on the low side because dry eye disease can be underreported and undertreated, because people just go out and buy dry eye drops and no one even knows that they have it.

Speaker 1:

Or they just push through. They're just like oh, let me blink some more or let me take my contacts out my eyes are really dry today or something billion a year in direct medical costs, which I thought was an interesting number.

Speaker 2:

that's huge yeah, and then indirect medical costs, which is lost productivity, which is huge for this as well. If you can't see as well, you're not going into work. If you have to go to doctor's offices or you're out picking up medications, you know you're not as productive and that doesn't even get into the quality of life impact. So say you are having trouble with your eyes, you can't read, you can't drive, you can't watch TV and you can't be on your phone. You know it's. It's got far reaching repercussions.

Speaker 1:

It's a lot, yeah, and I mean even thinking about, too, how that could translate down into being, you know, a barrier or a challenge for your patients to get medication, because, like, what if? Like you said, what if they can't drive anymore and so they don't have a way to get to the pharmacy and they don't have a way to get to their doctor and you know, then they don't have a way to get their meds or stay adherent and whatever. So just a lot of different things that could be kind of compounded with just the fact of, you know, dry gets out of hand or whatever. So, yeah, yeah, so what are some of the common symptoms that we're going to see of someone? So what are we looking for to say maybe this is dry, maybe this is more severe than just I got something in my eye and I've rubbed it and now it hurts a little bit.

Speaker 2:

Right, I mean, that's kind of the way it starts. You know, you have a burning sensation under your eyelids. It's uncomfortable, sometimes it feels like there's dirt or sand underneath your eye. Yeah, they can be itchy and red. You can start having visual changes. You may think you need glasses or it could feel like your allergies are coming on, and that's a hard thing because to differentiate dry eye disease from other things like allergies can be difficult.

Speaker 1:

Dr Justin Marchegiani. Yeah, so when we're talking with patients and we're seeing them maybe looking at things in the aisle or whatever, if they're maybe trying to self-medicate or whatnot, what are some of the? I guess, what are some of the things we would ask for to be able to confirm, like maybe this is dry syndrome, you know? Like that would guide us into the direction of which medication to choose, I guess.

Speaker 2:

Well, I think that's um, that can be hard, but it you could ask them questions about. You know, is it allergy season? Do you get allergies all the time? Does this continue throughout the year? Do you find that it's worse when you go into work or when? You go into a movie theater or when you go into a cold environment, you know you can try to ask questions about what's triggering it. Do they notice what's triggering it?

Speaker 2:

Are there any foods or anything? You know there's a lot to go into it. You can also ask if they have any underlying conditions, because a lot of times autoimmune conditions will cause dry eye. So that's one of the things. As you're asking questions, you could find out that they have other symptoms and one of the times you might refer them to an eye care specialist or their PCP. Just to have some tests run to make sure there isn't more going on there.

Speaker 1:

Right, right, exactly. Yeah, you mentioned autoimmune disease. Is it all autoimmune diseases or are there specific ones that we should be looking out for? That put our patients at greater risk.

Speaker 2:

Yeah, not all of them, but there's a couple that come to mind. I'm not sure I'm going to say it right Sjogren's syndrome, that's a big one, that'll do it, and rheumatoid arthritis is another one. But Sjogren's syndrome affects the salivary and lacrimal glands. So you're going to have dry mouth but you'll also have dry eyes. So that's one that comes to mind. I think dry eyes go with Sorgeant syndrome, but you can have dry eye disease without having that and vice versa.

Speaker 2:

Sure, of course, of course, yeah, okay, but just knowing that some autoimmune diseases may cause, yes, yes, someone is picking up their yeah, the rheumatoid arthritis med and mentioned that they're you know their eyes are killing them and you, you know they're itching them all the time. They're rubbing them. You know what can they do.

Speaker 1:

Yeah, okay, great. So, um, touching on the fact of, obviously we're pharmacists and we want to know how, how we can help. So what, what's your take on, you know, the role, of role of pharmacists in helping to manage and treat dry disease?

Speaker 2:

Well, I think pharmacists can be key. I mean, we're one of the most accessible healthcare providers. We're right out there. Whether we actually have the time is debatable to spend time talking to a patient, but I think, if we can, it's important to. I think we have a huge role in patient education and patient education is a big part of treating dry eye disease. There's a lot of environmental factors, lifestyle modifications. The first steps of treating dry eye disease involve patient education over the counter, artificial teardrops and lid hygiene, which we can talk about a little more. That's one of the things that can help with dry eye disease yeah.

Speaker 1:

That's interesting. I don't think I've ever heard that phrase lid hygiene Okay, that's good, so, yeah, so that's actually a perfect segue. So that's what I wanted to go into. Next was kind of focusing more on the opportunities that we have as a pharmacist. So you mentioned educating patients on lifestyle modifications and preventative measures. So what are some of those things that we can talk about with our patients?

Speaker 2:

Well, I mean, we mentioned before how the environment can cause dry eye disease. So something as simple as wearing sunglasses can help a lot and I think some people just don't wear them. Know, if you have a heavier brow you, you know the sun might not affect your eyes. I don't need heavy sunglasses. The sunglasses I use are kind of light, but I've started wearing darker ones and making sure they're big enough to cover your eyes and that'll help protect them.

Speaker 2:

Um, in your house you could use an air humidifier you know, especially this time of year, the air in our, our house, you know, with the heat running, depending on where you are, the heat running it's very dry, and so I noticed my eyes are more watery in the winter, and I try to have an air humidifier going. Conversely, if you have air conditioning running, you know I think people that live down South have have it harder because they're you know, you can't go outside as much because it's so hot, so minimizing your exposure to air conditioning.

Speaker 1:

Okay.

Speaker 2:

If you're a smoker, this smoke, can you know, dry out your eyes and irritate them. So that's something um, in terms of lifestyle modification, um, dehydration is huge, or hydration proper hydration.

Speaker 2:

So people who are dehydrated and I run into people all the time that say, oh God, I haven't had anything to drink all day. You know, and I'm like well, in general, I mean with so many things in our life, but especially if you have any kind of dry dryness, you know, dry eye disease, you know they say that you're supposed to drink as many ounces of water as you weigh in kilograms. So say you weigh 75 kilos, which isn't that a lot. You know, that's 150 pounds, that's 75 ounces of water and that's hard, I think it's hard.

Speaker 1:

It's a lot. Yeah, it's a lot, and it's interesting too to think I mean it. It makes sense. It's not like it's well, that's odd, but the fact that hydrating your body makes your eyes less dry, I mean, you know, like the fact that that translates into you know making sure that your eyes are hydrated too, so you just don't think about that being where that water goes, I guess.

Speaker 2:

So so that makes sense. Yeah, I think about it, because that film I talked about a lot of it is aqueous and so, if that is, it increases the osmolarity of it.

Speaker 1:

So there are things in there and they just get more concentrated and that's not as good for your eye yeah, makes sense now that you gave us that great introduction and the reminder of the, the uh, the structure of the eye.

Speaker 2:

That was so good dietary supplementation oh yes, I have a passion for dietary supplements so I've done a lot of studying on it. But one of the things in dry eye disease you can do and this helps you in a lot of ways is supplement with omega-3 fatty acids.

Speaker 2:

Okay, and there are studies out there. Right now the studies are inconclusive, but some have really shown promise and when you think about how omega-3 fatty acids block pro-inflammatory substances in the body, that can help with the inflammation cycle of the eye. So that's one of the things they're studying. And another avenue they're studying is topical omega-3 supplementation or application. It hasn't gotten there yet, but that's something that's out there.

Speaker 1:

Interesting. That is definitely something I've never heard before. That's great. Okay, I'm glad you added that. That's super interesting. Yeah, that's, that is definitely something I've never heard before. That's great. Okay, I'm glad you. I'm glad you added that. That's super interesting. Yeah, that's great. So one of the things I want to be sure we jump into is is the over-the-counter treatment options. So I know that that can be very daunting, so let's kind of talk about. I'd love for you to share some, maybe tips and tricks of like. Again, that aisle is so there's overwhelming. So many products. They all kind of seem the same. You know, everybody makes a version of everything. So how can we approach that? Yeah, how can we approach that as the pharmacist and make it manageable so that we can actually, you know, relay that information accurately to our patients?

Speaker 2:

Because I always thought this when I went down the coffin cold aisle. When you finally look at the packages, there's like a dozen ingredients and that's it, but there's hundreds of products out there and it's similar to artificial tears. So artificial tears I'll spend time talking about, because that's really the OTC product that patients need help with, and in artificial tears there's six different categories of ingredients, but the biggest one is a Demelson and that's something that increases the viscosity of the drop to increase the time that it stays on your eye and helps add that lubrication.

Speaker 2:

And that can be kind of a tricky thing to balance, because if it's got too much in it it's going to be more of a gel and you're not going to see anything.

Speaker 1:

You're going to be blurring, yeah, yeah.

Speaker 2:

And then there could be ones that just don't help at all. So a lot of products I just want to see. Thicker is not always better. I wanted to give some examples of DemoSense, the Ohio uronic acid, propylene glycol and carboxymethylcellulose. Those are three of the most popular. Another ingredient are oils we talked about. There was an oily layer to the tear film.

Speaker 2:

And so adding an oil like mineral oil or flaxseed oil. That can help restore the lipid layer, if that's an issue, and it can help prevent tear evaporation. One thing I do want to mention that's in them is preservatives. Now, the most common preservative is benzalkonium chloride, and the conundrum here is you need them in multi-dose bottles to decrease contamination, and yes, but they actually contribute to corneal damage and can precipitate dry eye disease and disrupt the tear film. So one thing that's new that I want to mention is these disappearing preservatives, and that's sodium chloride and sodium perboate. These don't have the same effect on the tear film, so there's a lot of interest in products that contain these preservatives instead.

Speaker 2:

That said, preservative-free is the best thing to do.

Speaker 1:

Sure, sure, but again, remembering that preservative-free usually means that it's going to be like a one-time use kind of thing, which is probably going to make it more expensive because it's not a multi-dose vial. Yeah right, so yeah. So again, just remembering and weighing those options. But I think it's important to understand the impact of the preservatives and, you know, if you're explaining that correctly to the patients, maybe they're willing to pay a little bit more so that they're not adding something more dangerous to their eyes. So, yeah, yeah.

Speaker 2:

Another thing is, wherever you practice and depending on your location, keeping your eye out for sales. You know if there's a preservative free and you know you have patients that are struggling dry eye disease and letting them know that that can be something that will be helpful for them.

Speaker 1:

Yeah, that's great. That's great. So, basically, what you're suggesting, advocating for, is to fully understand the active ingredients and and and make your choices based on that, as opposed to just like I have a favorite product, it's in the red box or whatever. So it's more about like also understanding too. As you mentioned, some of those things treat the different aspects of it. So is it a, is it a lipid issue, or is it a, you know, whatever? So understanding which ones to add that add, that's super helpful, yeah.

Speaker 2:

I think it would be important for pharmacists to look at the products available at their location and pick three or four that they know have the carboxymethylcellulose or hyaluronic acid or propylene glycol and one of those newer, disappearing preservatives or preservative-free, and just have those as their go-tos.

Speaker 1:

Then they're not out there wondering.

Speaker 2:

You know what I mean. It takes a little bit of homework, but in the long run. If you've got those three or four products, then you'll feel like you've got something in your armamentarium that you can actually do and not take as much time.

Speaker 1:

Well, and let's be honest, I mean, if you go out there with a plan, your patient is probably going to trust you more because you're going to know exactly what you're talking about, as opposed to being like, oh I don't know, let's see, let's turn this around and see what's in this one and let's touch this one Right, that's not a good look.

Speaker 2:

Hang on, yeah, it doesn't yeah.

Speaker 1:

Let me just double check and then I can talk to you about it. You know, I think you're right. I think it would make our conversation more impactful with a patient. I think it would really drive home the point that we know what we're talking about. So, yeah, so, like you said, do a little work on the front end, a little bit of homework, and be prepared and research, and that way you're better able to to answer the patient's questions and to recommend a product easily. Yeah, yeah.

Speaker 2:

Another thing to keep in mind is when you have that product and you're recommending it um, consistency and patience is key. Patients are going to use this and think like tomorrow their eyes are going to feel better and really that's, that's not an expectation, that it's good to um. What do I say? Get rid of that expectation or make the expectation clear.

Speaker 2:

Yeah, I have to use this for three or four times a day for almost a month to see if it's going to work or not, and unfortunately the first product you pick might not be the right one. You know, say you start with a hyaluronic acid one and it's got a preservative in it and it's not working. Maybe you progress to a product that has two. You know there are combination products that might have the.

Speaker 2:

C and C, the carboxymethylcellulose and the hyaluronic acid. That might work. So unfortunately there is a little bit of trial and error with it, but having a direction to point the patient in can be a lot better, because one of the biggest problems from I would hear from patients and what what they have is trying 100 different products, spending all this money, having all these bottles on their shelves and nothing's working.

Speaker 1:

Yeah, well, and I think it's. It's good to point out that you know it's not. I do not like putting drops in my eyes, so I would be that person that's like oh yeah, I did it once and I hated it, you know. So I feel like it would. It's really important to set the stage and to say you know, this is it's going to have to be X number of times a day, it's going to have to be for a month, you're going to have to make sure, or whatever. But, like you mentioned too, patients are all different. So it makes sense that some of the products are not going to work for some patients because they're you know, some of them may need the lipid replenishment and some of them may not, and some of them may not need, you know, the, the one that glazes over, the carboxymethasalose and whatever. So, so yeah, it's. It's going to unfortunately be a little bit of trial and error for patients. I think that expectation is important to set up as well.

Speaker 2:

Yes, and they may need the ones that I said that coat your eye more. That's something you could actually recommend for someone at nighttime. So put it on close your eyes, go to bed. Then by the morning you can kind of rinse your eyes off and hopefully you've retained the moisture from sleeping with the gel on your eyes.

Speaker 1:

Oh yeah, that's a great idea. That's great. One thing just really quick when we're talking about treatments, there are some prescription treatments. I don't want to spend a ton of time on them because I felt like the majority of our time needed to be on the OTCs, but just so that we're aware what are some of those prescription meds that would treat your eye.

Speaker 2:

There's several eye drops out there that I'm sure people are used to filling. Cyclosporine eye drops have been around for a couple of decades. The hard part is is cyclosporine is not easy to get into solution so and it causes a lot of the same symptoms you're trying to get rid of. So it causes burning in your eyes, redness. About 50 percent of patients don't continue with it because of that if you can 10%.

Speaker 2:

here the side effects do get a little better and people find improvement. They are working on new formulations, a nano emulsion, so that kind of increases the time and decreases the side effects. So, that'll be coming. Laphitigras is another one that's been around for a few years. It's another. You know, all these products affect the inflammatory cycle kind of from different avenues so the fit of grass.

Speaker 2:

So if something doesn't work for a patient, they could try another one. So cyclosporine is working. They progress past artificial tears. Cyclosporine didn't work. Lefitographs could be an option too, because it has a slightly different mechanism of action and it actually has fewer side effects than cyclosporine.

Speaker 1:

Okay.

Speaker 2:

A newer one is and hopefully I say this right perfluorohexyl octane. This was approved about two years ago and it decreases tear evaporation from the ocular surface. They don't know exactly how, but it has great success with some patients with dry eye disease. That's another eye drop.

Speaker 1:

Okay, yeah, and so I think it's really also. I'm going to reiterate what you stated it's really important to note that if patients do try the OTC formulas and they don't get relief, that there are prescriptions, options to try and there are also a couple of different ones. It's not like, oh well, you've tried this one, so you're out of luck, there's nothing else. So it's important to note that there are some steps and there are some ways to kind of get relief, even if they don't see it with a certain product. So one of the things we talked a little bit about, some of the challenges, so differentiating it from other ocular conditions. So you mentioned how it kind of mimics allergies as well. So if you want to talk a little bit more about how you know making sure that you're framing the questions correctly, because it could be that you know a patient, if you're using something to treat allergies, it could be causing dry eyes, right, Right, right. That's a good segue.

Speaker 2:

Actually I did want to mention medications. Be causing dry eyes, right? So Right, right.

Speaker 1:

That's a good segue into actually.

Speaker 2:

I did want to mention medications. You know here we are. You know we fill prescriptions all day, every day, and there are a lot of medications that can contribute to dry eye disease. So if you have someone that's complaining about it. It could be something they're taking, like allergy medications there's also, but some antidepressants will cause it. The triceplex and the SSRIs will cause. You know, can cause dry eye disease.

Speaker 2:

Beta blockers cause dry eye disease as a side effect. Diuretics, of course that brings back the whole hydration and a diuretic is decreasing your water load. So proton pump inhibitors a lot of people out there are on, you know, omeprazole or pantoprazole and and have problems with reflux. Um and then another thing that kind of touches upon the the female side of it is hormone therapy. Oh, sure, so you know, when women are taking estrogen, that can affect the um your eyes and the lubrication in your eyes.

Speaker 1:

Okay, yeah, no, that's, that's great information. The TCAs make sense as well, because they're you know what they do in general and they dry up everything in general, so that makes sense. So, yeah, that's. It's great to kind of point those out, because they may not necessarily be something that's just on the forefront of your mind, is a prescription medication may actually be causing it. So, yeah, right, right, that's great. So then, touching on a little bit too, with the fact that, as you mentioned, treating allergies within histamines can also precipitate dry disease as well, right, so Right.

Speaker 2:

Because hay fever causes running eyes. It's like a double-edged sword. You got to decide which. You know it's going to make your mouth dry and your eyes dry, but now your eyes aren't running.

Speaker 1:

Yeah, yeah. So now it's a. It's a again. It boils down to asking the right questions, getting to the root cause of what the patient is experiencing, so that we know the best treatment option for them.

Speaker 2:

Right, when do they work? Where do their yeah? What's their environment?

Speaker 1:

Exactly. Lifestyle, yeah, exactly. Where do they work, where do their? Yeah, what's their environment? Exactly lifestyle, yeah, exactly.

Speaker 2:

so one of the things too um, because I can't believe, but we're already running out of time.

Speaker 1:

I literally say it every episode. I'm like where does you know when you're waiting for your water to boil for dinner or whatever, and it you know, those five minutes take forever, and then, all of a sudden, these 30 and they're just gone. So, yeah, yeah, it always blows my mind. So I just want to reiterate too what are some of those things we can talk about and educate patients on. From the environmental side Obviously decreased screen time, wearing glasses instead of contact lenses, like what are some of the other things.

Speaker 2:

I'll just interject on that decreased screen time. I did want to mention the 20-20-20 rule. Have you heard of that? No, please share Every 20 minutes of screen time.

Speaker 1:

You should look away from your screen for 20 seconds and focus on something.

Speaker 2:

20 feet away. Wow, okay, and that's that helps you. You know cause you're staring at a screen. You you have an incomplete blink rate, so you're not. You know the when you blink, you're lubricating your eye, so if you're staring at a screen, you blink less and you blink incompletely. So this 20 minute, 20, 20, 20, you know, if you want to advise patients, just to try that 20, 20, 20 rule, and I have to do it myself. I'm on a screen all the time.

Speaker 1:

Yeah, so again it was. If you're staring at a screen for 20 minutes, look away every 20 minutes for seconds and focus on something 20 feet away.

Speaker 2:

Yes.

Speaker 1:

Okay, interesting, I like that. I mean, I'm definitely going to do that and I'm going to turn to my left and look out of my window and I'm going to find something in the snow.

Speaker 2:

Yeah, okay, don't do it every 20 minutes, try to do it regularly. I mean 20 minutes sounds like. Three times in an hour Sounds like a lot.

Speaker 1:

It's a lot, I know. I know it seems a little daunting, but I'm definitely going to do it, at least ever so often when I think of it.

Speaker 2:

Right right. You know you have to get up and walk every hour. You know when your watch buzzes you to get up and walk every hour. This is true. This is true they're doing something different.

Speaker 2:

Yep, that's a great that's a great time to do it. Yeah, that we wanted to talk about? I don't think so. I think, you know, having that stable of three or four products giving them lifestyle. You know, quick lifestyle stuff like that Twenty twenty, twenty wearing sunglasses, humidifier and and coaching perseverance and patience in the treatment and letting them know I think those are the biggest things.

Speaker 1:

Take homes. Yeah, that's great, that's great. Well, I think that kind of segues into my typical wrapping it back up and asking the guests what the game changer is. So if you could summarize, you know what's the game changer that we talked about today? What would you say it is?

Speaker 2:

I think the game changer is having a plan. It's hard because no one has any time, but having that plan that I just talked about, those couple of products, you go to training your staff, the rest of your team, to be aware of all this. I think that helps us and I think we can really help patients through education and treatment.

Speaker 1:

Yeah, yeah, and I think I love the idea also of sharing you know, like other things, like where your contact lens is less, do the 20-20-20, like other things that they can modify, as opposed to just, you know, squirt this in your eyes four times a day and you know whatever. So I love the idea of making it a complete package and really kind of as a pharmacist I'm a less is better in terms of absolutely I really like these different.

Speaker 2:

You know hacks, lifestyle they're not big ones, it's not a big change. You know exactly to give up meat, or you know, or?

Speaker 1:

go lose 20 pounds and then come back later and tell me you know, yeah, every day, exactly, exactly, yeah, no, this is great, so good. Well, jen, thank you so much. This was very informational, very informative, it was just, it was great. So I really appreciate your time today, thank you.

Speaker 2:

Thank you, I appreciate it.

Speaker 1:

Yeah, thank you. If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at ceimpactcom. And, as always, have a great week and keep learning. I can't wait to dig into another game-changing topic with you all next week.