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  • Writer's pictureJantz Chappel

Why does my vision change day to day (Dry Eye)

Updated: Nov 7, 2023

Disclaimer any treatment discussed, discuss with your doctor if it is appropriate for you.

I get this complaint a lot about how my vision one day changes from one day to another. Where it seems like they could see really well one day and then terribly the next day. The major player in that is dry eye. When your eyes get dry multiple micro scratches forms on your eye called SPK (Superficial punctate keratitis). These micro scratches blur up vision and cause decreased vision. Then the question is why are your eyes dry? This is actually very important. When people say I use drops (artificial tears) sometimes that is the best option but only treating symptoms, not the cause. Sometimes the cause can't be treated and sadly there is no cure, for anyone claiming to curing dry eye I would love to see a peer-reviewed scientific study because if it was true they would be a billionaire. FYI Bausch and Lomb just bought Xiidra (dry eye drop) for 2.5 billion recently so I'm not even exaggerating. Back on the subject, there are 3 major layers of your tear film aqueous, oil, and mucin. Another contributing factor can be how you blink if you don't have a complete blink your eye isn't getting refreshed for tears and that can dry out your eyes or if you sleep and your eyes aren't closed. Specialty contacts lens (scleral contact lens), sleep masks, ointments, and gels can help with it. Going back to the layers majority of the aqueous layer of your eye is made by the lacrimal gland. The only way for sure to increase the natural aqueous layer of your tears right now is called Travya (medical nasal spray). There is supposedly a supplement that may help but I have hard time believing it and the study was very small. This aqueous deficit dry eye is the one that artificial tears help the most with but this is far from the most common type of dry eye (13%). The next is the mucin layer of the tears and this is made on the cornea in the goblet cells and attaches the aqueous layer on the back surface that touches the cornea. Some studies on restaisis/xiidra as shown it may help but this is the least studied area of dry eye. It only affects at most 1% of all dry eye. The last is the most common type of dry eye by a large margin (86%) and that is the oil/lipid layer which it made mostly by the meibandian glands. These glands can be easily visualized by an instrument called meibography which we have at our office and use on everyone above the age of 18 years old. You can easily see atrophied/dead glands. When the glands aren't working properly it causes what we call evaporate dry eye which means the oil layer doesn't work, it cause the tears that you do produce on your eye to immediately disappear from your eye causing dry eye. We can measure this by TBUT test or tear break-up time anything under 10 seconds is severe dry eye. For some people that blink all the time. It can be due to extreme dry eye blinking every second to try to keep their natural tears on their eyes. The thing is you can bring meibomian glands back to life/keeping them from dying. There are two methods at home one is omega 3 (which is slightly controversial some studies says it doesn't work and other says it works but the results I have seen and from other optometrist is enough to make me a believer, It also helps with a lot of other things in the body), the other is a heat mask which helps melt the oils in the glands and make them express, and the last one which we can do at the office which is IPL (optilight). I'm going to briefly discuss two other machines. There are two other machines that have some study's Low-level light therapy which is normally combined with IPL (intense pulsed light) the effectiveness combined/by itself is less conclusive then IPL by itself and the other is radiofrequency but the only study I could find on it with MGD was done on 8 rabbits. It just seems like a fancy way to help melt the oils in the glands. Some of you may have heard of lipiflow or an instrument similar to it. The reason why I don't like it is the simple answer is it doesn't treat the underlying cause of dry eye. The underlying cause of dry is inflammation. Why dry eye happens we aren't 100% sure but what we do know is once it occurs more inflammation occurs and then dry eyes get worse. This causes a cycle where the dry eye causes inflammation then the inflammation causes dry eye which in turn makes more inflammation which causes more dry eye. It can cause this by atrophy/killing glands normally meibomian glands. This brings us back to Lumenis IPL (optilight) which gives us the option to remove inflammation from the eye. Studies have shown removing over double the amount of inflammatory mediators over the control. Even doubling the tear break-up time in the FDA-approved study. This is the best way right now to help rejuvenate those glands and help you get back to life hopeful without needy any drops. Have your vision stay the same day in and day out.

If you are talking about near vision then most likely this is due to presbyopia or loss of near vision. May also have a dry eye comment mentioned above. What causes this in simplest terms is the lens in your eye has to change shape to get stronger for you to see up close. The problem is the lens in your eye continues to bigger throughout your life making it harder for the lens to change shape. When the lens can't change shape you can't see things up close. The thing is when you are tired this causes muscles in the eyes not to be able to work as hard to change the shape and that is what can cause up-close vision to get worse day to day.

IPL Optilight Lumenis

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