The Dry Eye Remedy

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REBECCA’S REVIEW

Overall assessment

"The Dry Eye Remedy" came along at a time when it was badly needed. There is a real problem in eyecare with the lack of good solid information about chronic dry eye. Many people are suffering far too much for far too long when better diagnosis, treatment and management can be achieved.

Strong points of the book:

• Dr. Latkany provides a sound framework for understanding the nature and common causes of chronic dry eye, and what to do about it, without any danger of talking over the head of the average reader or putting them to sleep.
• He covers some of the most vital overlooked and undertreated problems - like meibomian gland dysfunction (poor oil layer) and lagophthalmos (incomplete eyelid closure) - without wandering into lunatic fringe territory.
• He is practical in his approach; he doesn't suggest things that for whatever reason are likely to be inaccessible to the majority of the readers.
• He manages to present an awful lot of what could be termed natural treatments (as opposed to the usual medical fare of drugs and surgery - which, for us dry eye patients, seem to usually be the causes rather than the solutions) without coming across as overly "alternative".

On balance, "The Dry Eye Remedy" has its shortcomings. But it is engaging; readable; balanced; educational; and contains a great deal of the most important types of information that new dry eye patients need to know sooner rather than later.

Is it user-friendly?

Yes.

First of all, The Dry Eye Remedy is a very easy read. It's chatty, and is interspersed with anecdotes from Dr. Latkany's practice. The writing itself leaves something to be desired but I did not really find that that detracted materially from the effectiveness of the book. The feeling I get reading the book is of sitting in an armchair having a comfortable non-technical chat with the doctor. So it's not Shakespeare, but it works, and that's what matters.

Second, it's brimming with practical, accessible advice and ideas you can put into practice right now. It's not pushing some pet highly technical diagnosis that you can only get by flying halfway across the country, or some promising scientific development that won't hit the shelves for another six years if ever, or some product that isn't readily accessible - or, worse, products available only from the author, as is so often the case!

Instead, it captures and explains a great deal of what has long been gospel to the dry eye veterans in our online community DryEyeTalk, but which we had to learn the hard way. Humidification, moisture chambers (Tranquileyes, Panoptx), detailed directions for lid hygiene and meibomian gland care, what medicines to avoid, sensible pain management advice and much more. In fact, I was very gratified to feel that our experience as a community and a lot of the things we advocate on this site were vindicated by this book.

CONTENTS

Here's a rough overview of what's in the book:

Part I: Understanding dry eye disorders: Chapters 1-3 are an introduction to what the tear film is all about and what goes wrong with it and why; and descriptions of the exam process and basic diagnostic tests. Chapter 4 covers the use of over-the-counter lubricants.

Part II: Restoring your eye health at home: Here's the real meat. Chapters 5-7 help you review your environment, activities, lifestyle and nutrition and identify a great many ways you can better care for your eyes ranging from humidification and eyewear to nutritional supplements and a lot in between. Chapter 8 (the "Home Eye Spa") basically amounts to detailed instructions for babying your meibomian glands on a daily basis with lid hygiene, heat treatment and so on. If you've ever wondered what the heck a "lid scrub" is really meant to be and whether you're doing it right, you'll be carrying the book into the bathroom to look at the diagrams while you get the Q-tips out.

Part III: Beyond the home eye spa: Chapters 9-12 cover drugs (Restasis in detail; then walks through all the main categories of drugs with dry eye as a side effect); hormone therapy; punctal plugs and cautery; and some surgeries.

Part IV: Finding the dry eye therapy that works for you: Chapter 13 basically sorts and labels all us dry eye patients into 6 different categories ("first-time", "stymied", "just-fix-me", etc.). I have to say it's a pretty astute description of what we're like, and most of us will easily recognize our box! Anyway, then it presents a practical treatment approach geared for each group, drawing on a variety of medical and/or natural treatments depending on the needs, preferences and tolerances of each group. Chapter 14 starts with a discussion of the need for, and signs of, increasing public awareness, and ends with a brief overview of new drugs in the pipeline and other ongoing scientific developments.

Resources: The resources section lists a number of websites, organizations, and companies useful for further research.

What not to expect

You'll be disappointed if you read this book expecting either of these:

Shortcuts. No free lunch, as it were. Caring for your eyes will be work, period, unless your symptoms are quite mild. And you'll still need to find a good intelligent doctor willing to really engage with your dry eye.

Scientific depth. The book is broad rather than deep in its coverage. If you have been there and done that and already read The Dry Eye Zone and been a member of DryEyeTalk for awhile, don't expect to be wowed or to discover new medical secrets here. However, you may still find it helpful. Sometimes it's helpful to back up and reconsider treatments that you've brushed off as ineffective but did not give a fair chance to.

Gaps, unanswered questions, etc.

• Restasis (p. 128): A very suggestive paragraph in this section: "[Restasis'] effectiveness in the case of "quieter" pictures of dry eye is limited; it simply wasn't made for these less excited-looking, if equally uncomfortable, disorders." I would have loved to see this elaborated on. Among other things, if it's true, quite a lot of people currently on Restasis cannot hope to benefit from it.
• Bandage contact lenses: I didn't see anything, positive or negative, about the therapeutic use of soft lenses in dry eye flareups, abrasions etc.
• Photophobia (light sensitivity): This isn't covered at all. That was surprising to me as I have always considered photophobia as a common symptom of dry eye. It's one of the reasons so many of us benefit from wraparound eyewear.
• Over-the-counter lubricants (pp. 41-62): In a book with fewer merits, I'd probably take up this issue at length, but frankly, I'm so very pleased with the book overall that I just don't have the heart to pick this chapter to bits. So I'll just mention a couple of points: 1) Fans of research on surface wetting, oncotic pressure or osmolarity will not be impressed with the conventional but not therefore correct wisdom of "viscous = longer lasting"; and 2) the many people I know who find their symptoms worsen with too frequent use of artificial tears or with use of petrolatum/mineral oil ointments will not be impressed with the overall advice on using lubricants.
• Heat treatment for MGD (p. 114): I know it probably isn't feasible to mention anything other than commercially available products, but as an avid Rice Baggy fan I still wish some alternative sources of heat treatment were mentioned.
• Boston Scleral Lens (p. 155) As a user of this prosthetic device myself, I'm very keen on it and I would have liked to see more coverage given to this topic, rather than having a couple of paragraphs tucked away in the plugs chapter. This is an end-of-the-line treatment with high success rates and people who have exhausted their options need to know about it. However, I appreciate that the book is written for a broad audience rather than the most severe cases, and I'm glad the BSL was at least mentioned.

And by the way…

You can find most of the consumer products Dr. Latkany recommends in his book right here at The Dry Eye Shop.

WHO AM I?

My name is Rebecca Petris and I have had chronic dry eye since undergoing LASIK in July 2001. I founded The Dry Eye Company as a result of my experiences, hoping to make useful information and effective products more accessible to others with dry eye.