New treatments for dry eye, light sensitivity, rosacea and eye mites with Dawn Wattenhofer, OD

This week, I’m joined by optometrist Dr. Dawn Wattenhofer for a conversation about dry eye, light sensitivity, and the surprising ways our modern lifestyle impacts eye health. We talk about how screen use, inflammation, and environmental stressors affect the eyes, why dry eye is becoming increasingly common, and what newer therapies are changing the way practitioners approach treatment. Dr. Dawn also shares how her perspective on sunlight and eye care has evolved over the years and why supporting long-term eye function requires a more whole-body approach.

KEY TAKEAWAYS:
• Your eyes need healthy blinking habits 
• Modern life is hard on eye health 
• Sunlight isn’t always the enemy 
• New therapies are changing dry eye care 
• The eyes reflect what’s happening in the body

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ABOUT GUEST:
Dr. Dawn Wattenhofer is co-owner of Vision Source Specialists in Rapid City and has practiced optometry since 1998. She specializes in dry eye testing and treatment through the clinic’s Ocular Surface Disease Clinic and has completed extensive post-doctoral training focused on overall health, wellness, and their impact on the eyes. Dr. Wattenhofer has also completed specialized dry eye training through the Dry Eye Institute and Dry Eye University. 

WHERE TO FIND GUEST:
Website: https://www.visionsourcespecialists.com/

SPONSOR:
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❤️ Do your best and leave the rest

WHERE TO FIND CHRISTA:
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Protocols: https://www.christabiegler.com/protocolshop

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TRANSCRIPT:

[00:00:00] Dawn Wattenhofer, OD: a lot of times if people don't have that oily layer, their eyes over-water, so they're like, "Oh, no, I don't have dry eye. I have the opposite problem." And it's we're just calling it the wrong thing.

It's a tear film dysfunction

[00:00:11] Christa Biegler, RD: I'm your host, Christa Biegler, and I'm going to guess we have at least one thing in common, that we're both in pursuit of a less stressed life. On this show, I'll be interviewing experts and sharing clinical pearls from my years of practice to support high-performing, health-savvy women in pursuit of abundance and a less stressed life.

One of my beliefs is that we always have options for getting the results we want, so let's see what's out there together

All right. Today on The Less Stressed Life, I have back Dr. Dawn Wottenhofer. Dr. Dawn has been an optometrist since 1998, and she has a specialty in dry eye. In her clinic, she treats dry eye, myopia, they do vision therapy. Think maybe you have a concussion or something. I think a lot of people don't know what vision therapy is, so you have a concussion or something that happens, and I'll let you tell us what vision therapy is, but that's what they do that, and they do sports vision training, and they also...

she's also uses these special lenses for headaches, et cetera. So Dr. Dawn is a very close friend and family member of mine, so we nerd out and spend a lot of time together. I was just talking to her offline about the last time she was here. It was in 2018, which was eight years ago, and That was episode 28, and we talked about nearsightedness increasing worldwide, especially in East Asia, where rates jump from 15 to 90%.

We talked about three things that can slow myopia progression in children, hard contact lenses worn overnight, eye drops, soft bifocal contact lenses. All work by changing how the light hits the peripheral retina. We talked about blue light. Weren't we progressive eight years ago?

Blue light from screens damaging retinal pigment cells, the same layer affected in macular degeneration. We talked about lutein, zeaxanthin, and related pigments acting as protective nutrients by building up in the retina as a buffer, and we talked about the 20/20/20 rule to help reduce digital eye strain.

Every 20 minutes, look at something 20 feet away for 20 seconds to relax the eyes' focusing muscles. Then we also talked about UV protection for all ages. Now, we're back eight years later, and we're all evolving and growing, and Dr. Dawn does a lot of continuing ed, and I know she has become really... I don't know if obsessed is the right word, but very highly interested in light, and there's so much about light that affects what's happening in our eyes.

Essentially, our eye is like a set of prisms, right? So I'll let her talk about all this, but I'm so thrilled to have her back to talk about new treatments related to light for dry eye. So welcome back, Dr. Dawn. 

[00:03:05] Dawn Wattenhofer, OD: Thanks for having me. 

[00:03:07] Christa Biegler, RD: Yeah. Okay, what about this last bullet point from 2018? UV protection matters for all ages.

For kids, it prevents deeper UV penetration of the eye, while for adults it reduces the risk of cataracts pinguecula, growths of the white in the eye, and eyelid cancers. Quality sunglasses with 100% UVA/UVB blocking are recommended. We're eight years later, and I know You literally go to conferences about light.

So is that bullet point still 100% where you stand, or has that shifted at all over the years? 

[00:03:38] Dawn Wattenhofer, OD: Yeah, I would definitely say that's shifted. In our modern world we get an imbalance of light but UV light isn't bad. I would recommend having UV protection when you're on a boat all day or if the glare driving makes you more at a higher risk or something like that.

But, Not 100%. Wearing sunglasses, getting a lot of natural light in your eyes, especially early morning and, late evening when the UV is lower. But not 100% of the time. I wouldn't recommend that anymore, and I would say most of the eyecare world would not say that.

Mantras stick, right? They stick really good. And so if you're not living in this space and learning about the different things that light does in your body we're gonna stick with that villification of the UV light.

[00:04:32] Christa Biegler, RD: Yeah. When do you think that started to shift for you? And we can talk about it from a perspective of how you shifted your own life, your own lifestyle.

Like, when do you remember... You probably always wore sunglasses for a long time, and, like how many years ago did you change- Yeah ... and how did you shift it? 

[00:04:46] Dawn Wattenhofer, OD: Yeah. I remember walking out onto the deck and walking right back in, just realizing that I didn't have my sunglass, and it was... sunglasses, and it was so uncomfortable.

And now I really try to go without them, and there's still times that I wanna put them on. And these things are always a slow morphing, right? So I know it's at least probably been a handful of years that I've been- 

[00:05:06] Christa Biegler, RD: Was that pre-COVID or post-COVID, essentially, right? Oh, 

[00:05:08] Dawn Wattenhofer, OD: yeah. Yeah. 

[00:05:09] Christa Biegler, RD: That's how we do...

That's how we, that's how we remember time frames. 

[00:05:12] Dawn Wattenhofer, OD: Yeah. 

[00:05:12] Christa Biegler, RD: So do you think it was pre-2020 or post-2020? I think 

[00:05:15] Dawn Wattenhofer, OD: I think it was post, yeah. And of course in that time frame we had time to study and learn a lot more, too,

[00:05:20] Christa Biegler, RD: yeah. 

[00:05:21] Dawn Wattenhofer, OD: Yeah. I'm sure I was learning about things at that time, but when your nutrition changes and those pigments that you mentioned, and when you're getting those things in your body and decreasing inflammation, you're just not gonna have as much light sensitivity.

But, Clinically that's a difficult thing in my field, not so much in yours because that's what people are working on. But in my field, they, Sometimes it's a brand-new story that they've never heard before, and they're inundated by all of the messages that are telling them to, wear the UV protection and stuff like that.

So I definitely try to introduce some of those other options to them just to say, "Hey, the, these things will be beneficial for your eye health and you'll probably have less light sensitivity, too." 

[00:06:01] Christa Biegler, RD: I never really thought about it from that perspective, right? We live in our own sort of world. So to me, this is analogous to, in my world, we talk about this a lot, but it's I'm not all about- elimination diets all of the time, right? I look at that as before 2010, depending on the context and the client and whatnot. And you're describing that sunglasses are the antidote to light sensitivities,

But that's like the pre-2010 optometry world, and now that we know more, now that we know the importance, like light changes throughout the day and it impacts your hormone production, would be probably one of the short things to say. Maybe there you wanna say a lot more about it, I don't know.

You've, you're going to conferences about light. But I didn't even think about, oh, part of the conversation is because people say, "I have light sensitivity." And having light sensitivity is related to not having some of these antioxidants, you're saying. Now, what's interesting about this is you started testing for nutrients in these last eight years.

When did you get that one machine that looks at, What does it look for again? I forgot. 

[00:07:00] Dawn Wattenhofer, OD: Yeah. It's called a skin carotenoid scan, and- Carotenoids. 

[00:07:02] Christa Biegler, RD: Carotenoids ... 

[00:07:03] Dawn Wattenhofer, OD: when we did that first retreat... carotenoids, yeah. So- 

[00:07:07] Christa Biegler, RD: Yeah ... 

[00:07:07] Dawn Wattenhofer, OD: yeah, you can test that with a, one-minute scan on the skin.

And when that's low, it's easy to show people, like we talk about all the time, people love numbers. Helps us understand and put ourselves on a scale and stuff like that. Yeah, we could test that, and there's a few other things. There, there's several things that can be involved in light sensitivity, but there's a few clinical things that I can try to help people with.

So being able to test that is useful. 

[00:07:36] Christa Biegler, RD: Yeah. Okay. That would be, you mentioned this quickly as an aside. We had a little retreat at the cabin, like sometime. It would've been late 2021, I would imagine. I feel like there was snow. I feel like we had to move snow. I think it was like fall of 2021.

So at that point, you had this little machine that you can scan your finger and it will show you carotenoid status overall, and you started using that- Yeah ... in clinic probably right before or after that or something like that, 'cause I think it was new. There was lots of new things that you were having at that point.

Can you talk a little bit about some of those? Just because I don't wanna leave someone hanging. If someone is dealing with light sensitivity, what are some of the clinical things and what are some of the things that you see now where that can be shifted?

[00:08:18] Dawn Wattenhofer, OD: So the carotenoids, the best sources of the ones that build up in the retina, they actually build up in the retina and act like an internal sunglass. So you can imagine if you're low on those and you're missing your internal sunglass, then, yeah, that's a setup for light sensitivity. So the green leafy vegetables and yellow-orange foods like sweet potatoes and then egg yolks.

Egg yolks aren't really high in lutein, but it's very absorbable because it's in there with that fat source, and they're a fat-soluble nutrient. So just eating those kinds of foods. We do recommend lutein and zeaxanthin supplements quite a bit- ... for eye health, and that's still another way that people can work on getting that number up and probably a little bit more quickly.

So those are something. We do dry eye testing, so the surface of the eye is really sensitive to light. And so if it's dry and irritated and light hits that cornea, you're gonna have a lot of pain and glare, dry eye testing and treatment. And then we've learned through Neurolens eyeglasses that the trigeminal nerve irritation, so that ophthalmic branch of that nerve, if it's irritated and light hits the eye, that nerve will fire in a bad way, like in an uncomfortable way, and cause light sensitivity.

Low vitamin A status is another one. 

And then there's some other things. You have to rule out, like if somebody's had really severe head trauma and their brain is inflamed, they could have light sensitivity. So that's- That would- ... that's a little bit less of just the clinical stuff.

[00:09:48] Christa Biegler, RD: Yeah, 

[00:09:49] Dawn Wattenhofer, OD: that would irritate the- Yeah, that would go over to the other side. 

[00:09:50] Christa Biegler, RD: That would in- irritate the trigeminal nerve automatically if you had- Could ... 

[00:09:54] Dawn Wattenhofer, OD: head 

[00:09:54] Christa Biegler, RD: trauma? 

[00:09:54] Dawn Wattenhofer, OD: Yes. Yeah. Yep. And just other brain tissues that- 

... 

[00:09:57] Dawn Wattenhofer, OD: Where you could get light sensitive for sure, yes. 

[00:10:00] Christa Biegler, RD: Okay, so we have this carotenoid status, but some of these other nutrients are a little bit hard to test for lutein and zeaxanthin.

And I think you know somewhat my position on testing. Some stuff is just, like we can't just easily test it. So do you just support do you just sometimes supplement? Is there any negative to just supplementing and seeing how someone does, or is that how you handle that in clinic and practice?

[00:10:21] Dawn Wattenhofer, OD: Yeah. I definitely let people know they can just supplement or we can test it. So the skin scanner tests all of your carotenoids, but it's actually, there's some research validation showing that what they measure in the skin correlates with that lutein and zeaxanthin in the retina. I'm sure it's not perfect correlation, but there's a correlation there so that if we do the testing, it it's just...

it's not out in right field. It matches. And sometimes I just tell people they can supplement or we can do this test and we as humans sometimes like the test. It's $20, non-invasive. Yeah. So it's... Yeah, so sometimes- What is that- ... people like to do that.

[00:10:58] Christa Biegler, RD: What is the machine called that you use for that?

[00:11:01] Dawn Wattenhofer, OD: It's called PharmaNex Skin Carotenoid Scanner. There's another one that's made specifically for optometry, so there's only a couple of them out there that I'm aware of right now. But that's the one that I had started using before the other one came out, and I've just stuck with it. 

[00:11:16] Christa Biegler, RD: Yeah, and you're setting the price on this, right? Where it's $20, so it might be $20 at your practice, but it might be a different price- Yes ... somewhere else. And- 

[00:11:23] Dawn Wattenhofer, OD: Yeah ... 

[00:11:23] Christa Biegler, RD: I would say it's probably far and few between that someone's optometrist would even have this. What do you think about that? Do you think you're the only clinic in your city with this scanner, or do you think anyone else has one?

[00:11:35] Dawn Wattenhofer, OD: Maybe the other one, and I can't remember the name of it, but it was built by an optometry supplement supplier. 

And uses the same technology ideas. But because it came out in the optometry world, and it's been offered at optometry conferences and stuff like that, there could be a few more that have that particular one. 

[00:11:57] Christa Biegler, RD: Cool. All right. So I've watched you go through this process of adding things to practice. Just light, from a bird's-eye view, adding things to practice- Yeah ... being excited about different things, and one of the things that you tested, I don't know if this was pre or post-COVID, but you tested

You had a small group of clients go through, and you had them do, you're really incredible at data collection, and you really wanted... where this came from is a real desire to help people, right? The best kind of clinician. And so I know you had a number of clients do like you did a tiny study of microbiome impact.

You basically had them do this three-phase, it was like prebiotic, probiotic, I think immunoglobulins or something. And it was like a kit, and you had them do it for 30, 60 or 90 days. I wanna say it was maybe 90 days. And you, like- Yep ... tested things. And I remember you were like, "Oh, the results weren't that good," and then you actually looked at the data and they were actually a lot better type thing.

It was like- Yeah. ... it was the total thing. So tell me, I don't know when that... if you can remember when that was. Was it before COVID- ... or after COVID? I don't, it doesn't really matter when it was, but just like- 

[00:12:57] Dawn Wattenhofer, OD: Oh, you know when? 

[00:12:58] Christa Biegler, RD: Yeah. 

[00:12:59] Dawn Wattenhofer, OD: When was it? It was right before COVID, because I remember I had more patients lined up to do it, and then we just stopped- Oh

having clinic. And so I ended up, being a smaller less of a study and more of a observation a thing. Because of course I was the clinician gathering all of the data. I knew that the patients were taking the gut supplements. And the reason I wanted to test that is because some research suggests that the gut microbiome is the master microbiome of the body, and this is skin, and you get overpopulation of staph bacteria on the eyelashes, and that causes dry eye.

It just causes a lot of problems on the surface of the eye, and so that's a skin dysbiosis of the microbiome in, around the lashes and stuff. And so I thought if the gut is the master microbiome and we alter that, would it alter the blepharitis?" And so I just had them take this three-step program, and it took about 90 days.

Some of the steps you have to build up slowly, so it was, probably a little bit longer than that. And I had the patients come in once a month during the process, and I just tested several things that were about the ocular surface and the glands in the eyes and the tear film and looked at the blepharitis.

And I never looked back at their other charts, I didn't care what the outcomes were, I just wanted to know the outcome. So hopefully I wasn't biased in just looking at the eyelashes and grading and looking at the surface of the eye and grading what I thought I saw. But I remember that the process didn't clear up their blepharitis, and blepharitis was the main thing that I was looking at, and that's the staph bacteria.

And it didn't clear it up and that's at some point where I was Like, darn, that didn't work. And then before I took all of the data and set it aside, I'd be like, I need to just organize this, 'cause I went through all the work and put it on a spreadsheet and I was like, wow four out of five of those patients had 50% reduction in symptoms, including, full body symptoms, 'cause we used the MSQ survey.

They had about 50% reduction in blepharitis and improvement in their tear film. So I'm a perfectionist, so since everything just didn't go away, I had kinda- ... in my mind, of course, this is all hindsight, because at that point I was, still doing clinic and going through and looking at the patients and being like, that didn't go away, and moving on, a thing.

And the other thing too is that I didn't have any of those... I asked those patients specifically to not do any other additional blepharitis treatments, 'cause you can find all types of them looking them up or your eye doctor tells you, and I had probably told them before, and I said, "Let's just do nothing but this."

And so it did- that didn't muddy the water with what was going on too. 

[00:15:36] Christa Biegler, RD: Yeah. Okay, I wanna highlight a couple of things. And I was curious about this, but you acknowledged it. Something I say sometimes on the podcast or when I'm guesting on other podcasts is, you've gotta really do a full intake of symptoms, and we've got these validated tools on the internet, they're called MSQs, that's the word you just used.

It's called a multiple symptom questionnaire. So you can Google a multiple symptom questionnaire. But the problem is, sometimes we're only focused on our most severe symptom, or maybe what they're coming to you for, right? I've got this inflammation of the eyelids. I think that's blepharitis inflammation of the eyelids.

Is that- ... technically what it is? 

[00:16:06] Dawn Wattenhofer, OD: Yes. 

[00:16:06] Christa Biegler, RD: and that might look like X, Y, Z. We'll talk about it in a second. But they might come in for that, and then you wanna do a thing, and just like you, you're like, "Oh, but it didn't fix that." And so often we need to know the total symptoms, because we're gonna see other less severe things or other things improve sometimes before we see this really severe thing improve overall.

Or the thing we had the longest sometimes will take the most time. And so I share that because it makes sense, but our brain struggles with things that actually make sense until we actually lay it out. And so it's really- Yeah ... important for us to do that total symptom improvement because that gives us like, oh, there actually was improvement, right?

And what a sad thing to discard all of the improvement that was actually done- ... in the name of perfection, because perfection isn't actually... I think it's not really real even though we think it's real, right? And so it's like- Yeah ... and it's a l- there's some subjectivity overall.

And so MSQ is one word for it. I've started calling it inflammation score. I think it like just for fun. Yeah. And so I have a little form for it. I'm putting it in my notes. I'll put it in the show notes. I bet by the time this comes out, I've got a great tech guy, I bet he can digitize it and make it like, so it'll auto add.

But I just want people to do that because it's very helpful for them to see the total possibility, because I look at it as a whatever this number is, it's very easy to get to 50% improvement. And when I say it's very easy, it's like you can do interventions that get to 50% improvement, so that's actually pretty cool.

Did you share those results with those clients at any point, or those patients? 

[00:17:29] Dawn Wattenhofer, OD: I shared the MSQ is easy 'cause it's a number. Yeah. So I definitely let them know about that. And then if I remember correctly, it was quite a while ago, but I just was like you need to start these traditional treatments now."

[00:17:42] Christa Biegler, RD: Yeah. It's 

[00:17:42] Dawn Wattenhofer, OD: not gone. Totally. You need to start. 

[00:17:43] Christa Biegler, RD: Totally. Totally.

[00:17:44] Dawn Wattenhofer, OD: I would've had numbers in there and, doing a normal clinic day I would've let them know this improved, that didn't very much. I would've thrown some of those things out there. I just remember, that's probably one of the things that I've done in my life that helped me.

I'm healing from perfectionism, right? So that kinda helped me realize that yeah, we're not gonna get there, and so let that go. 

[00:18:04] Christa Biegler, RD: Yeah. The interview right before this that I recorded today, we talked about perfectionism and autoimmunity and needing control and all of these things. I'm like, yeah, this is for all of us- Yeah

all the time, right? We all have this. So I only acknowledge that because it's so human to remind ourselves of that. Okay. You said that there's an overgrowth of staph in dry eye, but then you were talking about blepharitis. Is that correct? There is an overgrowth of staph in dry eye. Is that correct?

Or did you mean blepharitis? 

[00:18:31] Dawn Wattenhofer, OD: So dry eye, let me explain it like this. It's an umbrella term.

And it might be because the watery layer is low, the glands are clogged or inflamed, those oil glands in the eyelids. That's the most common reason people get dry eye disease. But it, but blepharitis can be a piece of it.

Poor blinking, the eyelids not closing during sleep, allergies, all of those things can be underneath this umbrella. So we have to separate out time and do a special exam a lot of different tests to define what is going on under that umbrella.

[00:19:04] Christa Biegler, RD: Cool. Okay, so dry eyes, that's the umbrella term. You said something before, eye glands inflamed, clogged. What was the one right before? Do you remember? 'Cause I was writing it all down.

[00:19:15] Dawn Wattenhofer, OD: oh the watery layer of the tears. So- The 

[00:19:17] Christa Biegler, RD: watery layer. Okay ... 

[00:19:18] Dawn Wattenhofer, OD: the oily layer is on top, and it keeps the watery layer from evaporating, and then you have a mucin layer that attaches all that to the surface of the eye. So you can have deficiencies and problems in any one of those layers, and it's usually two or more, but it's usually, 86% of the time the meibomian oil glands are part of the problem at least.

All of the problem- That makes- ... are part of the problem. 

[00:19:40] Christa Biegler, RD: That makes sense to me as you describe this, right? 'Cause we have this mucin layer in the gut. We probably have a mucin layer all over, right? And so it makes sense- ... that as you started to learn about the gut microbiome, you're like, "Wait a second, we have this in the eyeball, too."

Yeah. It's just another mucus membrane, right? And it makes sense that there would be imbalance or issues related to oil glands if things were inflamed because- Yeah ... inflammation messes with fatty acid status- Yeah ... and cell membrane status, so that makes tons of sense. And I know we've talked about this a lot in different ways over the years, but it's oh, duh, this one little thing in the body is actually connected to the rest of the body, obviously.

So thanks for giving us that list. That's what I tell 

[00:20:15] Dawn Wattenhofer, OD: people. Yeah. "Oh the eye forgot that it was a, an island out there on its own," because it's not. Yeah. And a couple other things that really struck home during that whole period of learning was in, gut inflammation and microbiome research, they would talk about the treatments decreasing the levels of interleukin 6, and thanks to COVID- a lot of people know what that is now. Interleukin 6 is one of the things that researchers... We don't measure it clinically, but researchers will be measuring that in the tear film as part of the whole dry eye thing. And then the other part of it is the conjunctiva which lines the eyelids and the white of the eye.

It has goblet cells and so does the gut, so it's A couple other things that led me to that initial thing of wondering, would that change things on the eye, too?

[00:20:58] Christa Biegler, RD: Yeah, that's cool. And yet I still feel like you're a pioneer around this. I know there's other people that are making...

understanding this, but getting... This is not mainstream, what we're talking about, in your profession- No ... at what- whatsoever. Yeah you've really sought out- ... a lot of specialty work, and in that you sought out some specialty things around light therapies. So when did you start... I know I don't remember when your first light therapy conference was, but essentially we were talking not very long ago, and you were very passionate about, "Oh yeah, we have this really cool treatment for dry eye, and it costs extra money, and I want people to do it, and I just wish they would do this thing that would really help them," right?

'Cause we have this cool new thing. And I'm curious when that came out, when you learned about it, et cetera, because we've been talking about, we've been talking about dry eye for the last decade, the last eight years at minimum together, right? And I remember when you were talking about this, I just had a revelation one day.

I was like Wait a second, I don't know what she's talking about. I know what are the previous treatments were for dry eye, or I know that loosening up the oil glands- Oh, yeah ... the blinking, et cetera. I know what your old handout said about dry eye, but then one day you're talking about this IPL treatment.

I'm like, "Wait a second. When did that happen? When did this treatment come out? And tell us more about it." So what is... You have new options for dry eye. And to be clear, dry eye is one of the most common things- Yeah ... in practice. It's like it could be your entire practice pretty much, right?

It's like the specialty. It's like a lot- It could 

[00:22:24] Dawn Wattenhofer, OD: be, yeah ... 

[00:22:24] Christa Biegler, RD: it's a lot of your clients. 

[00:22:25] Dawn Wattenhofer, OD: Yeah. 

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It's a lot of your clients. So tell me- Yeah ... how you learned about this new treatment that you have for dry eye and when you started using it, and what's going on? 

[00:23:43] Dawn Wattenhofer, OD: All right. IPL stands for intense pulse light, and it's light treatments that are done to the skin, and it's been done for decades in dermatology.

And somebody started to realize that their dermatology patients were getting improvement in the dry eye- ... mostly with rosacea, and you can get rosacea in your eyelids as well. So the treatments target the red blood cells and make them collapse, and then the abnormal inflammatory blood vessels collapse after that.

They follow. And no normal blood vessels collapse, but these, you know what rosacea looks like with the red telangiectasia vessels. And those will be up in the eyelid. So the glands are inflamed, and the vessels are bringing inflammatory chemicals to the surface of the eye. So when you do treatments that collapse those you just get a very quick reduction in inflammation.

But it also delivers that, light energy to the glands. It makes the glands... we have cool electron microscope pictures of the glands, and they're all floppy and spread out, and after IPL treatments, they're like, "Oh, I'm a gland." And they start producing more oil. Yeah, you know what?

I don't think it's enough heat to melt the oils in the glands. They've actually researched that, and we thought that's what it was in the beginning, but I don't think it is that anymore. But the gland, it just basically stands up, and it's able to start working and do better. So you can improve the glands in that sense, but you can also lose a gland.

You can lose 25% of it 50% of it. You can lose all of the gland. It can die, and we can't get those back even with the light treatments. And that's why I say things like, "Oh, I wish people would do this," because it's gonna save the glands that they have. And the more glands you have, the better tear film you're gonna have for the rest of your life.

If we wait for more glands to die, then our treatments are less effective, and you have to do more of them and you can lose the glands without symptoms. It can be a silent thing there too where those glands are just atrophying away. But the ones that are there can be helped.

They can be made to work better, and insurances aren't recognizing these treatments and so that's where you get, you know about this, but I'm in a, like a traditional clinic 

[00:25:53] Christa Biegler, RD: and- Oh, I'm a- I'm gonna ask about it,

[00:25:54] Dawn Wattenhofer, OD: yeah. I'm in a traditional clinic where insurance is, very much the most of my patients are using some type of insurance when they come in.

And a lot of people will say, "If my insurance won't pay for it, I won't do it." And even I think I feel like when people ask or when we talk about it they understand that the insurances aren't, they're not picking up new treatments. They're, trying to reduce what they're doing for people.

And especially when it's in the health and wellness space which is funny because the patient will pay for the treatment and save the insurance money on down the road for things that they would pay for when we get to end stage and have to prescribe expensive medications that don't help the tissue.

They might help the symptoms, they really don't do much for allowing the tissue to work better and maintain. So yeah, and there's more to it. There's a lot to it. Oh, 

[00:26:39] Christa Biegler, RD: I wanna actually break it up just a little bit. So I was gonna ask you why don't people do the treatment?

And is the answer insurance, right? They, it's just cost, 

[00:26:48] Dawn Wattenhofer, OD: right? It's almost always cost, yeah. 

[00:26:50] Christa Biegler, RD: Okay. So how much does it cost for someone to do this IPL how many times do they need to do it?

[00:26:57] Dawn Wattenhofer, OD: The cookie cutter. So humans we can't put them into cookie cutters, but we definitely have a baseline that we try to go through. 

And the first time we do it, we have to do the light treatment several times to get enough energy and change into that tissue to jumpstart it, I call it. So we do four treatments in a row, and they're two weeks apart, and that whole package is $1,400.

And in my clinic I use OptiLight, the brand name IPL. And I, Also do meibomian gland expression after the third and fourth treatment. I've read the research and I've looked at that clinically, and I think it's really important or it just really helps jumpstart things again if I squeeze clogs out of those glands after those treatments and say, "There you go, gland.

It's all clear now. Start working." So that's 1,400. And then, again, the cookie cutter is that every six months you need one treatment not the whole series of four again, but you need one treatment 'cause we're supporting that tissue and the way that it works, we're pushing it up there, and it will go back down.

So we gotta just kinda keep propping it up and holding it up there. And it's along that same thought process, it doesn't cure the condition. And there's reasons why that, doesn't happen, but it does allow a lot of healing in the tissue, and it allows the tissue to work in a more normal fashion.

And that's just gonna give you better long-term outcomes. When we do the maintenance treatments I believe they're $375. 

[00:28:23] Christa Biegler, RD: Okay. So I want to know when did you get this and how much was it? 'Cause this stuff is really expensive for clinics. 

[00:28:32] Dawn Wattenhofer, OD: Yeah. I got it about three years ago. I can't remember the exact year, but what happened is I have an optometry license in South Dakota, and every state is different on their scope of practice.

And it was a gray zone. It wasn't listed as an absolute yes, and it certainly wasn't on our law books as a no. But when I was watching all of that research and I was building a dry eye specialty practice, I was looking at IPL and thinking, "This is a game changer. If I want to treat my patients and give them the best outcomes, I need to do IPL."

So I wrote a letter to my board and asked permission, and they said no. And a couple years later, the FDA approved OptiLight the brand OptiLight they approved it for dry eye treatment. And any kind of eye treatments are within my scope of practice eye and annexa, anything to do with that.

So at that point with it being FDA approved and stuff like that, it, opened the flood gate. So we could do IPL in this state, and some- sometimes optometrists were doing it already in other states. But we could add it here, so that was a few years ago that I started doing the treatment.

Before that- I had to send the patient somewhere else. We had one other doctor in town that was doing it and so I would tell the patient, "This is your best option. This is where you can go."

[00:29:53] Christa Biegler, RD: And it was because they had an esthetician on staff who was licensed to use a light.

Is that what 

[00:29:57] Dawn Wattenhofer, OD: The optometrist was working in a group practice, so he could do it because he had medical doctors in his practice that he could technically be working under.

I believe the OptiLight was about oh they're probably a little over $100,000, but I'm not exactly sure the number.

[00:30:16] Christa Biegler, RD: Yeah, and that's my question is like a ballpark. 20... I think sometimes- Yeah ... we don't really understand. And so often anytime I'm getting, okay, I'll use the word correctly, anytime I'm getting a laser treatment or a light treatment or something, and I don't know the difference between all of them, I've had conversations with whoever's giving it to me about how expensive this device is.

I didn't know how much this was but I assumed it was. So essentially, for the cost of 350 to $400 per treatment, someone can really improve their quality of life around dry eye. I'm wondering since you started using it, for the people who are using it, what happens for them?

What do you see? Are they like, "Wow, this is game changing"? Tell me what... For the people that actually do elect it 

[00:30:57] Dawn Wattenhofer, OD: Yeah. Significant changes in how many of the glands in the eyelids are working. If I just put a little gentle pressure on the glands you see they can measure significant decreases in inflammation on the surface of the eye.

I don't do that. I just look at the inflammation on the surface and gauge it that way. You can see when you get more oils in the tears, after a blink, the tears last longer on the surface of the eye. We call it tear breakup time, and it's a measurement of how long the tears last before they start to evaporate.

And you can see less cell damage on the surface of the eye. So this is a mucus membrane, and it needs to be wet, so when it dries out, you get damage to epithelial cells. Now, those cells are constantly replacing themselves, so it's not necessarily a permanent damage, but if you have a chronic dry eye, you end up with epithelial cell damage every day, and that feels like sand in the eye, and that's a sign of inflammation.

It feels like grit in the eye. It makes the eyes red. And here's why I had to explain the dry eye umbrella is because a lot of times if people don't have that oily layer, their eyes over-water, so they're like, "Oh, no, I don't have dry eye. I have the opposite problem." And it's we're just calling it the wrong thing.

a tear film dysfunction But, you have to say the word dry eye or else people, they're, not on board. They're not ready to listen. They don't really know what you're talking about, but so yeah, multiple things that we measure in dry eye. It also kills mites.

So there's mites that live in the eyelashes, and they wreak havoc on the ocular surface as well, and so it decreases mite load for people as well, the light treatment. 

[00:32:33] Christa Biegler, RD: And with microbiome dysfunction, there's a lot more mites, isn't that correct? 

[00:32:38] Dawn Wattenhofer, OD: I think so. I, just making the connection, I have to use a triangle, but a lot of the dry eye patients have rosacea and mites, and a lot of rosacea patients have more mites than a regular human, 'cause they're not abnormal either, but they're- 

Overpopulated. And then if you look in the research, rosacea is associated with higher correlation with H. pylori overgrowth and SIBO, small intestinal bacterial overgrowth. So I'm like, oh, wow, there's something going on here that, you know and again, it just goes back to that eye.

It's not out there on an island by itself. 

[00:33:13] Christa Biegler, RD: Yeah. I thought it was in the research that with the overgrowth of mites was I just thought it was... I guess we made that extrapolation. It was just like, oh, in rosacea you have more mites there's more microbiome dysfunction. But I guess we came up with that conjecture instead of it coming in the research for us.

I think, 

[00:33:29] Dawn Wattenhofer, OD: yeah, I think I made that connect the dot thing. 

[00:33:32] Christa Biegler, RD: Isn't this like parasites of the eye? They're not abnormal, but they're there. Is that correct to say? 

[00:33:37] Dawn Wattenhofer, OD: Yeah, so if you look at mites in the research they might not be able to find them on kids, after you get into the middle and upper decades they're there.

They're there on just about everybody. What are they eating? What do they eat? Oh they eat the oils in the glands. So I know a lot about the two types of mites that live on the surface of the eye. If they're in a hair follicle, they're probably eating the oils that the hair follicles make and stuff too.

And then so on the eye, this is a fun conversation they crawl down into the eyelash, and they have little claws if you look them up. And so when they're crawling down in there, this is their home. They're going home during the day, and so as they're scratching your epithelial cells up, your epithelial cells will build like this collar around the eyelash base.

So if this is an eyelash, there'll be this little sleeve or collar around the base of it. So I can see a mite if I pull a lash and find one and turn the magnification up really high, but you don't typically see them when you're just looking at the eyelashes. So you see the evidence of them.

So then at night, they come out of the eyelash, and they go into the meibomian glands and, whatever they do and they wreak a whole bunch of inflammation. But this is another really interesting thing I learned about mites, was that once their population is at a certain level, they put off chemicals that keep your immune system off of them, so they're able to protect themselves from you.

And

So sometimes we have to do treatments even medications that knock that population down, and then try to, do other maintenance things that are gonna keep your body in control versus them. What kind 

[00:35:10] Christa Biegler, RD: of treatments do you do? 

[00:35:14] Dawn Wattenhofer, OD: We do tea trail, tea tree oil scrubs- ... on the lashes.

And that's pretty much all we ever had. But then recently a neurotoxin for mites came out in an eye drop that's called Xdemvy. So we can do Xdemvy drops for two, two times a day for six weeks, and that works incredibly. I've just clinically, it's been amazing. I wonder what 

[00:35:36] Christa Biegler, RD: it's made out of.

How do you spell 

[00:35:38] Dawn Wattenhofer, OD: that? X-D-E-M-V-Y. And I think it's Lotilaner, L-O-T-I-L-A-N-E-R. I might be misspelling it 'cause I always call it Xdemvy. B- but yeah, it's a neurotoxin for mites and they have a different nervous system than us. And so it's not a neurotoxin to us. But this is what we said about glyphosate too, right?

Originally, like it just kills or just uses the shikimate. pathway

[00:36:02] Christa Biegler, RD: Turns out we have it too, right?

[00:36:04] Dawn Wattenhofer, OD: We're more bacteria cells than we are human cells, so- 

... 

[00:36:07] Dawn Wattenhofer, OD: They use it, therefore we need it. And so anyway, same thing. So I'm curious to see, but there's no known, side effects of it, and I've seen it work clinically excellently and I know that we're helping that ocular surface and protecting those glands with it.

[00:36:21] Christa Biegler, RD: ' Cause you're seeing- 

[00:36:22] Dawn Wattenhofer, OD: So I'll use that sometimes, yeah ... 

[00:36:22] Christa Biegler, RD: reduction of inflammation, right? Because you see more inflammation with more mites essentially, right? 

[00:36:27] Dawn Wattenhofer, OD: You can see reduction of inflammation, you can see improvement in how the glands work, and less of the collarettes that I talked about, the sleeves that develop around the lashes.

And in the research they'll pluck an eyelash and they'll say this has 10 mites," and then after treatment they'll pluck a few and then count the mites and it'll be significantly reduced, usually not to zero. And I try to tell the patients that we're not trying to eradicate these because I'm in the camp, and there's different camps, but I'm definitely in the camp that these are normal on your body and, not meant to be eradicated.

We'll probably find out in 10 more years of research that they cause something to happen in our body that's- 

... 

[00:37:03] Dawn Wattenhofer, OD: Good for us. 

[00:37:03] Christa Biegler, RD: Commensal, 

[00:37:04] Dawn Wattenhofer, OD: commensal 

[00:37:04] Christa Biegler, RD: parasites. Commensal, 

[00:37:05] Dawn Wattenhofer, OD: yes. 

[00:37:05] Christa Biegler, RD: For sure. Commensal parasites. 

[00:37:06] Dawn Wattenhofer, OD: Yeah, I 

[00:37:07] Christa Biegler, RD: think so.

As you describe this, I can't help but This is how I think in general is oh yeah, remember since the eye's not an island, I think we can take the things that we've learned about that non-island that's connected to the rest of our body, more of the peninsula of the eye, right?

And realize that we can apply that to other things. And so I think it's really interesting that these commensal parasites put out chemicals that keep your immune system off of them. It's like this self-protective thing in general. 

[00:37:30] Dawn Wattenhofer, OD: Yeah. 

[00:37:30] Christa Biegler, RD: But it's very common for us to get overgrowth of things- In general in the microbiome for- 

[00:37:36] Dawn Wattenhofer, OD: Yeah

[00:37:36] Christa Biegler, RD: X, Y, Z reason. I think that the list is long. I think it's- 

[00:37:39] Dawn Wattenhofer, OD: Yeah ... 

[00:37:39] Christa Biegler, RD: possibly part of our environment. I think it's possibly part of stress to- I just think there's lots of possibilities there. This is still the stuff that ke- that's interesting to me in my life where I'm like, "Oh, this is interesting.

Why do we have so much of this?" Yeah. "Why does this work so well?" Yeah. "Why do we need to clear out the overgrowth of this?" And if I look at nature, it's very similar, right? It's like- 

[00:37:57] Dawn Wattenhofer, OD: Yeah ...

[00:37:58] Christa Biegler, RD: weeds happen, and they come back, and why do they come back? And what's all happening? Yeah. And maybe it's not the end of the world.

Maybe it's a skill that we learn to balance, right? Maybe it's a skill- Yes ... of learning how to make more grass than weeds, right? And what needs to happen- ... in the terrain, et cetera. So- 

[00:38:13] Dawn Wattenhofer, OD: Yes. For sure ... 

[00:38:13] Christa Biegler, RD: very interesting. Very interesting. Okay, so fun. as normal, there's so much good stuff here.

I think this episode will be very helpful to lots of people, so I'm so thankful for it for you sharing you don't even realize this is part of your normal stuff, but my goal here on this show is to help bring forth things that people didn't even know were there that are options for them.

It's like- Yeah ... by the way, you have options. 

[00:38:36] Dawn Wattenhofer, OD: Yeah. 

[00:38:36] Christa Biegler, RD: And I'd like to lay out what these options are for you, and I'd like you to realize here is the cost of this to your provider. They are trying to help you have a better life. And side note about the glands, you can tell how much they are degraded to an extent, right?

You can rate them, so you can see that, like you said, hey, there is a point where it's kinda too far gone, but you can see maybe it's 75% degraded or 50% degraded or whatever, 25% is

[00:38:58] Dawn Wattenhofer, OD: You know what? If I have a patient that has three glands, I'm gonna recommend every treatment I can do, and they're not gonna get the greatest outcomes, but things are gonna get worse.

This is one thing that we have learned, being able to take pictures of the glands. We use a- ... a camera called meibography. And we know it's gonna get worse. And so if they've already lost a significant... And anywhere they are on the thing. And so there's three things about the glands.

There's the structure. Just are they there? Are they gone? What are they looking like? Are they inflamed? And are they clogged? And then a fourth thing would be do you blink? Because the only time you use your glands is when those lids come together. And I have a handout I could send you, we could put in your show notes too, that are just the basics about the glands.

You need to do blink exercises because when you stare at a screen, you blink 70% less than normal. So just some more basic things that everybody should know and everybody should be doing and tell your kids and all this stuff. So I would recommend more aggressive treatments when somebody h- has a couple of glands.

[00:39:54] Christa Biegler, RD: Cool. Yeah, we could talk about specifically, like, why eyesight really degrades looking at screens, but you just described one of the reasons, right? Is we're not lubricating the eyelid, and so then what happens when- yeah ... or if you don't even have dry eye, but if you're not lubricating enough, you're not blinking enough, why would your eyesight be more blurry at the end of the day, or why would your eyesight start to degrade from that?

[00:40:16] Dawn Wattenhofer, OD: Because the cornea on the front of the eye it's a lens. It's like a windshield. You don't really see it. It's out in front of the colored part of your eye, and it has about 44 diopters of power. Most people's prescriptions are three diopters, so you can imagine this 44-diopter lens is very strong, and the first thing covering it is the tear film.

So if you have a distorted, irregular tear film magnified by 44 diopters, you are going to get distorted, irregular vision. That changes with blinks and stuff like that. Again, to that cell damage we talked about, if you have cell damage on, in front of your pupil on the cornea, it doesn't feel good but it affects your quality of vision, too.

So it's very rare, I'd like to say this real quick, and I know we gotta go, but, It's very rare for dry eye to cause blindness. It can, especially in people with autoimmune diseases usually. It can cause such bad damage on the surface of the eye, people can get corneal scarring, and if that cleared windshield turns opaque, then you're not gonna see well through it.

But it's more a quality of life and quality of vision thing than it is a vision loss thing. 

[00:41:23] Christa Biegler, RD: Yeah. Cool. Okay, so we've covered a lot about dry eye. We talked about changes to what you would say now about light exposure in general and when to use sunglasses. We talked about light sensitivity and those nutrients that really help.

We as an aside almost, talked about rosacea 'cause we talked about rosacea of the eye and these treatments and eye mites, et cetera. The one thing we didn't talk about, which could be saved for another episode if you want, if you feel like it would give the full service, is something else that you're excited about, which is the neural lens for headaches.

Do you feel like- ... that's a whole different thing or do you wanna talk about it a little bit, like that there's an option and how you kinda came into that? 

[00:42:00] Dawn Wattenhofer, OD: Yeah. We could talk about that separately because I don't do vision therapy. My business partner does, but it overlaps with that a bit so we could talk about those options that patients have and another that we didn't touch on, so there's a lot.

[00:42:15] Christa Biegler, RD: Yeah. Perfect. I love it so much. I think, what a gift for people to know that they have options for dry eye. What a gift for people to know that their microbiome is connected to their eye and that this eye is not an island. And I know that this was hard on you being such a good practitioner and being such a good clinician, that it was like, "Oh, I can't..."

It's "Oh, now I see everything that's possible for these people. I just wish they could see what was possible for them." Yeah. I know that's been on your heart and your mind for the last practically decade. We talk about it all the time. We talk about these things all the time, so it's really beautiful and, it was almost like an aside.

Yeah, for 

[00:42:52] Dawn Wattenhofer, OD: sure. 

[00:42:52] Christa Biegler, RD: sometimes we don't always get to talk all the time, and so when I heard you talking about these IPL treatments and just like you're like, "Man, I wish people would do this because it would just help them so much," I'm like Oh, wait a second, I didn't realize that there was a new

I guess I didn't really realize there was this whole new treatment for dry eye. So I was having some clients ask about dry eye recently, and I said, I think I have just the person that needs to come back to the show." So it's working out really beautifully, 'cause we're getting to talk about this span of out how things have grown, how things have changed, what a decade can do.

And so thank you so much for coming on today to talk about, dry eye, light sensitivity, eye mites, and for the next time we talk about headaches and nerve lens and vision therapy. Dawn, is there anything you'd wanna leave someone with? And then also, is there any place people can find you online or your practice or anything like that?

[00:43:39] Dawn Wattenhofer, OD: Our website is visionsourcespecialists.com. And I think I say this all day long, but it's one of those pieces that's on a handout that I think everyone should know is that yeah, with the screens and less blinking you gotta make sure you keep using your glands so that you keep your glands.

And they only work when the lids touch, and so closing the lids and squeezing that blink muscle a couple of times and taking a couple of real blinks just keeps those glands awake, and it's a good thing to figure out a way to keep that in your day for long-term eye comfort, whiteness, being able to wear your contacts, good vision.

[00:44:13] Christa Biegler, RD: Yeah. A soundbite, use it or lose it with those eye glands. So- It is ... I love it. It is. 

[00:44:18] Dawn Wattenhofer, OD: Yeah. Yeah. 

[00:44:19] Christa Biegler, RD: I really learned so much, as I often do when I hang out with you. So thank you so much for coming on today, and I look forward to the next one. 

[00:44:26] Dawn Wattenhofer, OD: Thank you.