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Your dry eye columnist: Who am I, what am I doing and why
A funny thing happened to me the other day: I got an email about a column I wrote. In itself, this is not really all that unusual. Heck, my friend Prof. Dave Howard of NYU emails me every month with comments on my drivel. As an aside, Dave, you really need to chat with Dr. Digre about the trigeminal nerve stuff; she is so much smarter than I am. Anyway, the difference is that the person who sent me this email is neither an eye doctor nor a dry eye disease patient. They had no idea who I am, what I am doing with this column or why. As I conclude my fifth year writing this — 5 years! — it seems reasonable to spend a column on all of that.
I was born the son of a poor — wait, no, different story. Like so many of you who read Ocular Surgery News, I am an anterior segment surgeon who specializes surgically in advanced IOL technology for cataract surgery and laser vision correction. After my own LASIK, I realized that the DED from which I have suffered for pretty much my entire life was also a factor in the success rates of all of my surgeries. This prompted me to do a deep dive into the state of DED knowledge and research ca. 2000. What I discovered is that there really was not all that much to either. Outside of Michael Lemp, MD, and a couple of other lonely souls such as Hank Perry, MD, and Ken Kenyon, MD, examining the DED world was not much more complex than finding Visine commercials to watch. Or at least that is how it felt.
My earliest involvement in DED was an extremely selfish endeavor. For one, I finally knew why my eyes always looked so red and burned so much at the end of the day. I self-diagnosed my own gas permeable contact lens-driven dry eye. Trust me, it did not come as a shock to me around 2000-01 that LASIK increased dry eye in those who already suffered from the problem and could actually cause DED symptoms in patients without a history of the disease. This is where the second selfish part came in: I was doing what I felt to be outstanding LASIK technically, and a significant percentage of my patients were getting mediocre results because of DED. To get the results I wanted for my patients, I would have to become a DED expert.
In a nutshell, that is who I am. I am neither an investigative journalist nor a paid PR operative. I am just like you, an eye doctor who goes to work and takes care of my patients.
There are several things that I am trying to do with a column that is primarily concerned with the diagnosis and treatment of dry eye. Obviously, the first thing is to make more people aware of DED as an entity and to hopefully convince them that DED is worthy of their best efforts as an eye doctor. With “The Dry Eye,” I have attempted to teach the most basic concepts of diagnosing and treating DED, looking at both from the place where I spend the majority of my professional time: the exam room. When I first started writing the column, there were not too many other places to get even the basics of DED care. While that is no longer the case (see Dry Eye Bootcamp, Dry Eye Access, Dry Eye Coach, etc), a continuous effort to “introduce” DED and DED care is a fundamental part of this column.
Because I have been involved in so many aspects of DED over the last 20 years, I have become privy to many of the groundbreaking developments in the field a bit earlier than many other eye doctors. With this type of early access, I have tried to help all of you stay on the cutting edge of at least some of the newest research, medications and devices in the field. While I certainly see confidential information about all manner of things DED, everything you read here, even the newest things that you may see here first, comes from publicly available information. Some things are just silly, no matter where they come from. This column is also dedicated to letting you know what works and what does not.
Speaking of silly, it has always been a bit of a mystery to me as to why so few of our colleagues pay attention to what is happening in the industry part of our eye care world. Over the past 5 years, I have tried to alert you to developments on the business side of the ledger, to fill you in on comings, goings and happenings at pharma and device companies as they relate to caring for DED. In addition, as it becomes more and more difficult for our patients to pay for their DED medicines, I have attempted to pull back Oz’s curtain and explain the Byzantine processes foisted upon us by insurance companies and pharmacy benefit managers. Explaining the business of DED is a core purpose of “The Dry Eye.”
Why do it? Why write a column each month on DED? (I do write every word myself.) Well, it is not the money; I do not get paid to write either this column or the blog that runs on Healio.com/OSN (I am paid a small honorarium for the podcast). Obviously, the first and foremost reason is that I really do believe that DED is an important part of caring for our patients. I may be having trouble leaving my identity as the “red-haired stepchild” of eye doctors behind, but there is still a sense out there that DED is little more than a lifestyle inconvenience. Changing that perception is the most important answer to “why?”
Another unexpected email helps to understand “why?” a bit better. Shortly before the American Academy of Ophthalmology meeting in October, I received a note from a young medical student from Germany. Like me, Timon is a dry eye sufferer, although with a much better story. Timon’s eyes hurt so much when he read he taught himself an abbreviated form of Braille so that he could study with his eyes closed. In all honesty, I thought he was punking me with that! Similar to my story, his own journey as a patient drove him to do a deep dive into the state of DED art and somehow he found “The Dry Eye.” We met in Chicago where Timon alternated between quoting my column and showing me his treasure trove of international DED treatments. Writing this gives me an opportunity to have moments like that.
So Happy New Year to all of you out there in dry eye world. As I begin year 6, I resolve to continue to catch by name as many of you doing cool stuff as I can. I resolve to be kind when it becomes necessary to point out the silly stuff. Do keep those emails coming. Yes, even you PR person, especially now that you know a bit more about who I am, what I am doing and why.
And Happy New Year to you, Timon. See you in April.
- For more information:
- Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: dwhite@healio.com.
Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.