Dr. Art Epstein on Meibomian Gland Dysfunction, and why "Dry Eye" is an Antiquated Term!

[AdminWolf]

In this InSight Studio interview, we speak with Dr. Art Epstein on Meibomian Gland Dysfunction, and why "Dry Eye" is an Antiquated term. He hits on some of the big issues in ocular surface disease today, including:

* Will meibography become a standard of care?
* The current crop of OSD treatments
* Whether meibomian gland clearance is necessary to treat the underlying condition

 

[Ken Elder]

I guess becoming a “dry eye center of excellence” was a waste.

 

[AdminWolf]

I guess becoming a “dry eye center of excellence” was a waste.

lol, good point -- though I think for consumers "dry eye" is certainly more palatable than "meibomian gland dysfunction", or even "Ocular Surface Disease"

 

[Jeff Kiener]

I like the way Art is willing to take a creative, new look at things.

 

[AdminWolf]

I like the way Art is willing to take a creative, new look at things.

Art has managed to reinvent himself to a degree which most people can't imagine!

Consider that he started his practice over from scratch in his ... late 50s? Pretty remarkable.

 

[Richard Pagan]

I did not watch the video but I agree the term "dry eye" is a pretty vague catchall used to describe a host of conditions.

 

[Diane Robbins-Luce]

One of the inspirational clinicians of our time.

Adam, you looked a little distracted when Art was talking about the roof of the the tear film, what on earth can be more important or interesting than that? Funny, I feel many of my patients look at me like that as I explain their condition.

I was once working with a young ski racer and as I was explaining the interaction of the ski edge on the snow through the arc of a turn she looked very engaged, so I went on. Wow, I think she is really getting this, so I went into more biomechanics. When I paused to check for understanding she looked at me and said these words that gave me a clear picture as to what our audience may be thinking.

Coach, your goggles sure are shinny.

You see, she was not listening or even looking at me, she was looking at herself in the mirror.

Anyway, thanks for sharing, love me some Art Epstein lectures.

 

[Jay Desai]

Dr. Art Epstein, a legend. First in specialty contact lens, now in tear film instability management.

 

[Jay Desai]

Does Dr. Art Epstein give CE in tear film instability management? I would love to attend.

 

[William R. Hall]

roof of the the tear film

Are you referring to lid wiper epitheliopathy?

 

[Diane Robbins-Luce]

No, I was referring to Dr. Epstien's supposition that the meibum oil is to the tear film what a roof is to a building. He briefly mentioned it and his CEwire lecture goes into that analogy in more detail.

Are you referring to lid wiper epitheliopathy?[/QUOTE

 

[AdminWolf]

One of the inspirational clinicians of our time.

Adam, you looked a little distracted when Art was talking about the roof of the the tear film, what on earth can be more important or interesting than that? Funny, I feel many of my patients look at me like that as I explain their condition.

LOL, it wasn't Art's explanation -- he was on target as usual.

Even though these segments are like 3 minutes a pop, the reality is when we record them I sit for 3-4 hours at a time, interviewing people back-to-back-to-back.

The InSight studio is in the J&J Booth, and it faces toward the interior of the exhibit hall, so there are people milling around, talking, waving etc... so it is tough to concentrate. By the end of the day I'm totally spent....

 

[Laurence Craig Thomas]

Where is my interview from SECO?

 

[Jay Desai]

Where is my interview from SECO?

I want to see this. Which topic did you discuss?

 

[Joe DiGiorgio O.D.]

The InSight studio is in the J&J Booth, and it faces toward the interior of the exhibit hall, so there are people milling around, talking, waving etc... so it is tough to concentrate. By the end of the day I'm totally spent....

Ah hah. And keep in mind that nowadays the optometry classes are 75% female.

 

[AdminWolf]

Where is my interview from SECO?

Never got it back from J&J -- i'll see what happened, but if I can't get it, you and I will jump on the phone and re-create the magic. IIRC it was all about practicing to the scope of your license!

 

[AdminWolf]

Ah hah. And keep in mind that nowadays the optometry classes are 75% female.

I think the reason they make the Studio face the interior of the booth is b/c it is quite a spectacle for passersby, and definitely draws people into their booth.

But for the interviewers (and interviewees) it can be a handful to deal with!

 

[Joe DiGiorgio O.D.]

I think the reason they make the Studio face the interior of the booth is b/c it is quite a spectacle for passersby, and definitely draws people into their booth.

But for the interviewers (and interviewees) it can be a handful to deal with!

No doubt it is probably highly distracting. Probably tons of people walking by, many of whom you know that want to say hello.

 

[AdminWolf]

No doubt it is probably highly distracting. Probably tons of people walking by, many of whom you know that want to say hello.

Distracting, but fun nonetheless!

I'm glad I've been given the opportunity by J&J to use the booth and talk to everyone.

BTW one of the things I love most about Art is that he can talk about anything off the top of his head -- we didn't really prepare anything for this interview, he's just always ready to go.

 

[Dr. Stanley Hallock]

What we represent as the lower case letter e but turned upside down is, if I'm getting this right, in and of itself a word in the Greek language...…..as in: keratitis e sicca.

And that term used long ago.....and will still be taught to students next year at least in some Colleges.

Then some genius about 35 years ago decided to call it....dry eye syndrome......because when one says to a Patient, "Mrs. Jones, you have keratitis e sicca," Mrs. Jones immediately asks....what's that? ….and so we dumbed it down for her and said 'dry eye syndrome'


Well that's not good enough.....probably someone.....just so they could go on the lecture circuit and get a free hotel room overnight on a weekend at some God-forsaken-conference.....oh and a free pen too!.....that someone decided instead to call it >>> "surface disease" !!!! ….and the Heavens opened. Y'all remember surface disease right around the year 2000 don't you?

Well I guess because Surface Disease Center of Excellence didn't sound so great, someone else decided it was no longer a syndrome but rather a disease......so now at least for a while until some other genius comes up with their pet term.....we've got Dry Eye Disease.

You can tell I haven't bothered to listen to Art.....and I don't need to......because I'll still call it keratitis e sicca....and when Mrs. Jones asks what's that?......I'll say just like certain parts of your body can get dry and therefore become bothersome, that's the scientific term for your eyes getting dry and then maybe watering in response and/or becoming red and or/ becoming inflamed with symptoms like burning or scratchy or sandy or whatever term is more like the background your vocabulary was developed from ……

.and she'll get it because she has a vagina but I won't use that word in polite Patient conversation but I can type vagina here because we're Doctors.

If you read this far and care to comment - please use the word vagina in your response so I know you didn't have your attention span challenged by the length of this post

 

[Paul Farkas]

and she'll get it because she has a vagina but I won't use that word in polite Patient conversation but I can type vagina here because we're Doctors.

Since we're all "Doctors" what is the proper term for a "Dry Vagina"?

 

[Michael I. Davis]

Postmenopausal atrophic vaginitis. N95.2 is a billable/specific ICD-10-CM code that can be used

 

[Joe DiGiorgio O.D.]

Postmenopausal atrophic vaginitis. N95.2 is a billable/specific ICD-10-CM code that can be used

Is that a reimbursable code in optometric practice?

 

[Joe DiGiorgio O.D.]

I've got to admit Art is a smart guy. He retires to Arizona then gets bored and decides to get back into a practice.

He looks around and sees that the average person is a white hair on Medicare and they are living in a place with like 6% humidity. Wow, what a wonderful place for a Dry Eye Center of Excellence.

Awesome move.

 

[Michael I. Davis]

I guess if you can chart that you met the exam criteria.

No, no, no...and we wonder why there is not more female participation here?

That aside; Dr. Hallock, I often espouse adapt or die. This applies to communication with the patient as much as evolving the practice with technology.

 

[Joe DiGiorgio O.D.]

I guess if you can chart that you met the exam criteria.

No, no, no...and we wonder why there is not more female participation here?

That aside; Dr. Hallock, I often espouse adapt or die. This applies to communication with the patient as much as evolving the practice with technology.

Hmmm, it is sort of like expanding your case history for the disc at risk and inquiring about erectile dysfunction and the little blue pill.