Dr Jennifer Rayner (optometrist) talks dry eye with TFOS

It's time to be more active in keeping up to date with the latest in dry eye. Our resident dry eye practitioner was interviewed for a blog for the Tear Film and Ocular Surface Society - a collaboration of international scientists, clinicians and industry professionals seeking the action needed to help the world see better. Here is her take on how she approaches dry eye along with an evidence-based approach.

The original post can be found here: http://www.tfosblog.org/?p=3292

Looking at the Full Picture: Dr. Jennifer Rayner

By admin • 16 December 2016 • Contact lens, Contact Lens Discomfort, contact lenses, DEWS II, Diagnoses, dry eye, Dry Eye Disease, eye, eyecare, eyehealth, Health, holistic, innovation, makeup, natural, ophthalmology, tear film, tfos, TFOS DEWS II Report, Treatment

The sign of an intelligent people is their ability to control their emotions by the application of reason. Marya Mannes

But the sign of an intelligent people is also their ability to know when emotion can serve as a valuable tool. In fact, author Susan David suggests that “emotionally agile people are dynamic, and demonstrate flexibility in dealing with our fast-changing, complex world. They are able to tolerate high levels of stress and to endure setbacks, while remaining engaged, open, and receptive.”

Dr. Jennifer Rayner’s intelligence coupling with emotional agility is compelling. To start, she defines those who walk through her clinic doors as people rather than as patients, greatly distinguishing her from many peers who insist on emotional detachment. Dr. Rayner however, claims her role is to not only examine people using evidence-based protocols linked to medicine so that she can minimize symptoms, but also to look beyond the parameters in order to construct a full picture of ones emotional and physical health. With a full picture, she can more readily understand the cause of the symptoms.

Before becoming an optometrist (BAppSc(Optom), GradCertOcTher), Dr. Rayner practiced as a nurse for 16 years and perhaps this duality has granted her an insight or a sensitivity that clinicians may not profess to have. She shares “I think my nursing background most definitely gives me an great insight to people and makes me a better practitioner for it. You learn the subtleties of what people don’t say. I have patience for those who are flustered, anxious, or unable to verbalize adequately what their concerns are. I was told when I started nursing that ‘it will take you anywhere’. I had no idea then but I understand it now – I can help take the fear out of a diagnosis, and I am always aware of the inequity of power that exists between a patient and their health practitioner.”

Based in Adelaide, Australia, she is Co-owner with Dr. Rene Malingre and is the principal optometrist at Alleve Eye Clinic that, at this point, is the only known stand-alone clinic in Australia exclusively treating dry eye patients. She hopes that establishing Alleve as a stand-alone clinic ensures that other optometrists “don’t feel threatened” to refer their clients, knowing that Dr. Rayner will refer them back for non-dry eye needs. At this point, the clinic is dedicated to dry eye twice a week but her objective is to transition it to a full-time dedicated clinic.

And there is certainly the need for such a clinic.

Dr. Rayner hopes the clinic will address two points: the increasing number of patients who seek dry eye diagnosis and treatment, coupled with information isolation in Australia. While we know that the incidence of dry eye is on the rise globally, mainly because of an explosive increase in screen devices that reduce blinking, Australia is especially vulnerable because of its natural climate. Its’ hot weather or alternatively, cool dry days, lead to increased tear evaporation, and some patients find that pollution causes their dry eye to worsen. More specifically, Dr. Rayner’s clinic is in South Australia, the driest state and the allergy capital of Australia. Data from 2014** calculates that one in five people in Australia – or 4,000,000 people – live with dry eye and 800,000 have severe dry eye. Despite Australia being physically isolated from the rest of the world, and in addition, its massive size rendering it difficult to exchange ideas and research in real time with other health professionals even within the continent, it is hoped that a dedicated center will inspire a more collaborative spirit between the excellent network of health and dry eye practitioners already established in Dr. Rayner’s home town and those interstate.

Dr. Rayner is a compassionate and empathetic person, and seeing patients suffer from ocular or systemic symptoms without respite is not an option for this doctor. She is frustrated by the fact that many dry eye sufferers don’t feel heard and, after repeatedly hearing that nothing can be done, many relinquish their fight. Dr. Rayner says “they feel isolated and alone in their symptoms and even think it’s in their head! They are often so relieved to hear they are not the only ones, and that there may be other options for them to explore.”

Keen to find a solution or at least a definite diagnosis, patients are usually very compliant and forthcoming with their full medical history, regardless of how minimal or embarrassing some points may seem to them. Dr. Rayner works to find – what she terms – a management solution to their suffering. In order to do this, she finds the key is finding the trigger point and while each individual needs her clinical expertise, they are to be looked at as people and not cases. She is proud “the center also takes a holistic approach because dry eye is so multi-factorial and the causes in each person are so individual. ‘It’s not just an isolated inflammatory condition. Factors can include dietary, autoimmune disease such as lupus or arthritis, systemic conditions can contribute or dry eye might be a systemic reaction.

Treatment might involve co-management with a GP, dietitian, endocrinologist, rheumatologist or ophthalmologist.” Without investigating the general health of a patient it is difficult for her to determine their prognosis and develop a management plan. As such, she considers listening to the patient is half the battle.

Until recently the majority of her demographic was composed of older females, but this is changing. She also finds that many of her patients are more devastated by their symptoms rather than the diagnosis itself. For example, two of her recent patients were young women who suffered terribly. The first discovered that her work colleagues considered her to be a surreptitious alcoholic because her eyes were chronically red and inflamed. The second, was a woman whose body rejected her Botox and filler treatments. Now, was she predisposed or was the treatments the trigger? In this case, it was impossible to determine but the challenge was determined how to deal with her symptoms: as a person who greatly valued her physical appearance, she was devastated by the fact that she could no longer wear makeup. Her lost confidence affected her psychologically and she even struggled at work. In this case, shame overshadowed her pain.

For Dr. Rayner, the fact that this woman didn’t have the option to wear makeup, that she was denied a choice in how she defined her beauty was unacceptable. Interestingly, Dr. Rayner opted for more natural treatment options, ones that are not necessarily mainstream but mainstream isn’t necessarily a good word. In fact, she was surprised to hear that Australia is often considered a benchmark for Americans in terms of more natural food, makeup and food products. Some of the products she is using with proven success include manuka honey and tea tree oil – and Dr. Rayner eagerly notes that, in both cases, better management of their symptoms was found with the former being able to work with better vision and whiter eyes, and the latter finally being able to wear make up again”!

Part of her empathy is due to the fact that she herself suffers from mild dry eye. This is recent and was an ironic incidental in her life rather than the reason for which she developed a dry eye expertise.

Fascinated by the fact that we are on the cusp of fully understanding dry eye, Dr. Rayner looks forward to the day when her clinic is able to focus on administering treatment to patients, allowing them to live their lives without shame, pain, or isolation. And she continues holding true to the holistic belief system, in which illness and injury are often the result of disharmony in the mind-body-spirit, and a dysfunction in one area affects the whole person and not just that one area of the body.

Dominica Drazal Director, TFOS Global Ambassador Program

** http://www.mivision.com.au/experts-demand-new-dry-eye-approach

Australiaautoimmunededdry eyedry eye diseaseeye healthholisticinflammatory markermanuka honeyophthalmologysciencetrigger point

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