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The 1000 Hours Outside Podcast
1KHO 684: Everything You Need to Know About the Blink Crisis and Dry Eye Disease, Dr. Pam Theriot
00:55:18
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- [00:01]
A
This episode is brought to you by Peloton Break through the busiest time of year with the brand new Peloton Cross Training Tread plus, powered by Peloton iq. With real time guidance and endless ways to move, you can personalize your workouts and train with confidence, helping you reach your goals in less time. Let yourself run, lift, sculpt, push and go. Explore the new peloton cross training Tread plus@onepelaton.com Welcome to the 1000 Hours Outside podcast.
- [00:28]
B
My name is Jenny Erton, the founder of 1000 Hours Outside. And today's episode is incredibly important and really goes right along with what we're doing. Getting kids outside, it is incredibly beneficial for their eyesight and we've got this overload of screen time and screens that are really close. And so optometrist Dr. Pam Terrio is here. TEDx speaker.
- [00:49]
C
That's right.
- [00:50]
B
Yes, yes, yes. And you have so many things that you offer. Online courses, consultations, different guides. We're going to be diving into kids and adults and our eyesight. Pam, thank you for being here.
- [01:02]
D
Thanks so much for having me.
- [01:04]
B
What is your background? And I love that you are really working with, you know, people go to the eye doctor, you know, for their own appointments, but you are actually going further than that and putting information out into the world about dry eye and about, I mean I tried some of the tests where you like close your eyes and then open and see how long before you blink and you're putting out all this really extra information. You have a blog with over 240 posts for people. Is it just because screens have become so present that people just need more?
- [01:34]
D
Well, I believe that our eyesight is our most precious gift and if we knew better, we would do better. So most people. Another podcast host told me she was an eye neglector and I was like, yes, people just neglect their eyes, right? We brush our teeth twice a day every day. Wouldn't dream of going to work without brushing our teeth before, before we got there. And yet if all of our teeth fell out tomorrow, we could just get new ones. And when was the last time that you actually put in effort to take care of your eyes? You know, some of us go to the eye doctor once a year, but for the most part it's, it's like a second, it's like, oh, I'm not seeing as well out of my glasses. I should, I should schedule an appointment and you know, kind of puts put to the bottom of the barrel which, what would we do without our eyes?
- [02:26]
B
Isn't that Interesting because yeah, you go to the dentist twice a year. It's like sort of this built in maintenance, but nothing with your eyes. In fact, I've never been.
- [02:34]
D
Oh wow.
- [02:35]
B
Never like. Yeah, I don't know. So I did your test. You have this free downloadable guide seen clearly in a screen filled world. And you have a lot of things you offer. I'll make sure, I'll put them in the show notes. A lot of things for parents and things for gamers. But I tried the thing where you like close your eyes and then you open them and you see long. You can open your eyes without blinking and then it's like a little test, you know, if it's more than four seconds or less than four seconds. Have you seen as an optometrist, have you seen there be more issues in relation to increased screen use?
- [03:08]
D
Absolutely. So the problem with screen use is twofold in kids. Number one, kids hold the screens way too close and our bodies are lazy, I hate to hate to put it that way, but our bodies don't want to make efforts. So in order for us to focus our eyes up close, we actually have to make an effort within our eyes to, to do that focusing. So kids become more nearsighted the closer they hold things to them. The eye just grows more nearsighted, which is a lengthening of the eye. And it happens over time. And some of us are nearsighted because our parents are nearsighted, but some of us are nearsighted just because we spent too many hours with something right in front of our faces, which is not how we were created. We were created to be hunters and gang gatherers and be outdoors and look far away and not constantly looking at something in front of us. So that's problem number one. And mostly it's for kids because in the developmental years our eyes are able to grow. Once we're in our mid-20s, our eyes aren't, aren't really growing like our bodies, you know, our bodies aren't growing as much, our eyes aren't growing as much. And so you're not going to become quite so near sighted. But so for kids that's super important. But for all of us, any of us using screens, no matter our age, when we stare at a screen, our blink rate decreases. So we should blink about 21 times a minute. But when we are staring at a screen that drops to one third of that, so about seven times a minute look at your face, you're shocked, right? And it's just the matter of like that we're paying Attention. It happens a little bit when you're reading a book, an actual book, that your blink rate will decrease. But screens have this special ability that really trap our attention, and we blink so much less. What does that mean? Okay, you're blinking less. Are your eyes really drying out when your eyes are open? Part of it is, yes, that the blinking is refreshing our tear film. It's keeping the mucous membrane of our eye lubricated. But what happens is that when we're on our screens hours and hours a day, day after day after day, for decades. Right. This is just something that happened yesterday, but it's because we're doing it every single day. For as a lifestyle, the little muscles in our eyelids that control the oil glands aren't squeezing those oil glands and getting the oil to come out. When we blink. The lid should come together, a little bit of oil should come out of those glands, and then it should spread right across the front surface of our eyes. And when you're not blinking as much, the oil in the oil gland starts to solidify. So it hardens. It's no longer like olive oil. It becomes more of a butter. And then it becomes like a Crisco. And using that analogy, we all know that olive oil is healthier than Crisco. So when that oil solidifies, it doesn't come out when we blink. We could, you know, even squeezing our eyes closed doesn't make the Crisco come out of our eyes. So then we don't have that oily layer of our tear film, and our tears just evaporate even more quickly.
- [06:10]
B
Wow. No one is talking about this, like, don't solidify your eye oil. There should be billboards about this, billboards.
- [06:21]
D
All over the place so people can know. Yes. So that knowledge is fairly new. We didn't have the capability to image those oil glands in our lids until within the last 10 years, but maybe within even the last five years. And most eye doctors just didn't have that equipment in their office to image these glands. The knowledge to know how to treat these glands, it's all very new in the healthcare realm. So now we know how to fix the problem, how to image the problem so that we can identify it and then treat it. There's still tons of research being done to know the best ways to treat it, how to even prevent damage in these oil glands to begin with.
- [07:07]
B
Yeah, that prevention is key, especially if you've got kids and you're dealing with screens. I remember when I was a kid, my grandpa would come over, we would Be watching, like shows after school, and he would come over and he would grab us by the arm and be like, you're too close. So even he knew, which is always remarkable to me, like in these older generations, that they somehow had a sense like, you shouldn't be that close to that screen. You should move back. Well, now we've got iPads and phones and it's all right in our face. So, okay, I did the test. I got to six seconds, which actually was not great. So I was like, not in the severe category, but I wasn't in the mild. Is interesting. You know, I did worse than I expected to. I've only read about this one other time, and it was recently Dr. Pam. I read about it in, I can't remember what book it was, but they were talking about how when the oil glands finally crap out and quit, like, you're done. There's no coming back at that point. And so then they said people have to like, artificially lubricate their eyes for the rest of their life. And you know, it was like a wow. Like, this is a bigger deal than I realized and something to pay attention to. So can you talk about this self assessment that you have people do? Because if they're in there.
- [08:17]
C
Well, not if they're in their car.
- [08:18]
B
Because you're driving, but like, if you're sitting around or your kids are sitting in the car, everyone can try it. Can you talk about the self assessment that you have people do?
- [08:27]
D
Absolutely. So what we're talking about is the inter blink rate. So how long can you hold your eyes in between blinks? And average is 10 seconds. So your tear film should stay full and healthy on the front surface of your eye for at least 10 seconds. So what I have people do, super simple, is that you're just going to blink your eyes a couple times to kind of prepare. And then when I start counting, you're going to hold your eyes open. So you're going to blink, blink, blink, and open. 2, 3, 4, 5, 6, 7, 8, 9, 10.
- [09:02]
B
Okay, I did it.
- [09:03]
C
All right.
- [09:03]
B
I feel better.
- [09:04]
D
Okay. So for my eyes, I. Around six seconds, I started feeling like a little stinging. Yeah, I wanted to blink, but I held it. So those are the kinds of things to think about. So if that your eyes are starting to sting and burn, your tear film is evaporating. And, and that's, that's how you're feeling that. So you should have a full layer of tears over the front surface of your eye. And as that evaporates and your eyeball Feels the environment. And that stinging sensation is an indicator that things are drying out.
- [09:37]
B
So is that how it would feel because it feels uncomfortable and you just want to blink? Is that how it would feel or start to feel if the ducts, if the glands start to solidify?
- [09:47]
D
Absolutely, yeah. As the, as there's less oil in your tear film, that the tears just evaporate very quickly. And so, yes, people who have the, this meibomian gland dysfunction or clogged up oil glands, their tears evaporate very quickly and that stinging and burning becomes almost constant. And they're lubricating all day. And just putting in artificial tears isn't always an equivalent to what your own natural tear film would be.
- [10:14]
B
Okay, this is a big deal. This is a big deal. So everyone needs to know about it. Can you talk to us about. And people would think, what in the world? Can you talk to us about blinking exercises?
- [10:25]
D
Yes. So because eye doctors came up with this, we decided to make it cute. We're going to call it the 202020 rule. So every 20 minutes while you're working on your digital device, you should take 20 seconds. And the first rule was to refocus your eyes feet away. So every 20 minutes, take 20 seconds to refocus far away. And this is really great for kids because as I was saying earlier, focusing up close is an effort. And so if we focus far away, we actually relax the eyes. So have them focus their eyes across the room on a clock. Make sure they can see the numbers on the clock or on the microwave. They can see what time it is all the way across the room and just do that for 20 seconds. But then when we got into the digital device area, we decided to add blinking. And so after you look away, then take some intentional blinks. So with blinking, you're going to squeeze your eyes closed and then open and just kind of like three or four really intentional blinks where you're really squeezing. That's going to really work those muscles. Squeeze the oils in our oil glands get the lids really closed and you'll, you'll feel the difference. You'll feel a lubrication of the front of your, your eyes with those squeezes. But just taking 20 every 20 minutes, just kind of to blink your eyes purposefully can help.
- [11:50]
B
Okay. I mean, this is the first time hearing of this, and it's really important you talk then about ways to set up. You've got this incredible. I'm going to put a bunch of links in the show notes, but this seen clearly in a screen filled World. It's this free downloadable guide. And you talk about how to set up your workstation. So this is for adults and kids. You talk about while you're working. Try these micro. Micro blank. Right. Micro blinks. Micro breaks. Micro breaks for your blinks. And. And you really have to be aware of that. But one of the things you talk about is you say this is extra credit. I've never even heard of this. A desktop humidifier.
- [12:29]
D
Yes. So if we just keep more moisture around us while we're working, especially in the wintertime here in Louisiana, it doesn't get that cold. But this week it dropped into the 30s for two days. I know, you're more northern. Right. So we turned on our heaters and because we can't stand it if it's less than 60 here in Louisiana. So we turn our heaters on and now the air is dry. So it's very dry. And to counterbalance, you know, even in the summertime, you've got the air conditioner blowing on you. You want to be cognizant of. Is there a fan blowing directly on your face? Is there a vent blowing down on. That's just extra airflow drying out your eyes. So that desktop humidifier, actually have one on my desk at home. But now I'm at work this minute. But just like it's a little bitty guy that you, you put some distilled water in, you sit it next to you. It's making some mist into the air. And just keeping the, the air surrounding your desk more moisturized can really help.
- [13:31]
B
Yeah, just these small things, these things.
- [13:33]
C
That you can do.
- [13:34]
B
I talked to this woman named Katie Bowman, and this was, this was like a phrase like when you talked about. What did the lady say? She said she's an eye neglector. Katie Bowman used this phrase about long distance looking. And it was one of the benefits of going outdoors. Like she said, when you're indoors, there's.
- [13:51]
C
It's a short.
- [13:51]
B
Even if you're in a room that's rather large, you know, it's this short distance looking. She talked about the muscle around the eye relaxing when you go outside. It's this long distance looking. So can you just, you know, it's, it's tricky to get kids outside in this day and age. From the standpoint of eyesight, can you give parents or kids or grandparents or single adults who are listening just a little encouragement that getting outside is good for their eyes?
- [14:18]
D
Absolutely. So that, that long distance looking is the opposite of what I was telling you. When you're when you have a screen in front of you, our eyes have to focus. And that's utilizing the eyes. The muscles around the lens inside the eye has to change the shape of the lens so that we can see clearly. And it happens naturally. You don't think about it, you don't feel it. But when we look in the long distance, that completely relaxes. Our eyes are the most relaxed when we're looking in the long distance. And it can feel good.
- [14:48]
B
Right?
- [14:48]
D
You can be completely relaxed. You can go outdoors, you can get that vitamin D on your skin and it can energize you. So I was just thinking that we go outdoors and we get the vitamin D, which is going to stimulate our circadian rhythms. Having the blue light on us from the sun stimulates our circadian rhythms and helps us to wake up in the morning and then shut down at the end of the day. Which is another problem that we have with all of our screen times and the blue light that's being emitted from them. So kind of jumping topics there. But as I was talking about being outside in that long distance viewing, just having the sunlight on us is beneficial.
- [15:31]
B
Well, interesting, because all of this goes through the eye. I mean, most of it, I think some light goes through the skin, but for the most part, your eye is your gateway. And so I had read a book that talked about how we look at the eyes and we think they're primarily for seeing, but they're also for light. Like, so that your body knows what time of the day it is and what part of the year it is. Like animals, their fur thickens and you know, they have all these processes that happen in part because light goes through the eyes and somehow tells the brain what the body needs to do. And so it is interesting that the, the eye, it's really the regulator for so much or it's the beginning of the regulator for so many things. So getting outside helps with that long distance looking, but also with seeing what kind of light is coming in, what color is the light. I mean, that color changes throughout the day.
- [16:23]
D
Mm. And that tells our bodies that it's time to wake up or it's time to shut down. And talking about sleep disruption. And all of us when we're staring at our screens and the blue light being emitted from our screens is disrupting our sleep when we're doing that when the sun is down, because it's, it's giving a false signal to the brain that, oh, I need more serotonin because it's time to be awake. And then we're getting into bed. A lot of people, last thing they do is check their phone one last time before they get into bed. Or they're reading something on the phone, they're watching something on the phone and then they get into bed and can't fall asleep. And it's not really because that what they were watching was so stimulating. It's the light that is stimulating.
- [17:05]
B
Yeah.
- [17:06]
D
Not even the content.
- [17:07]
B
Yeah. So all of this goes back to the eyes.
- [17:11]
C
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B
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- [20:49]
B
Gaming is a big deal. I mean, kids are spending a lot of time on games and the games are really they're really lifelike. They have all these video components. Like these video segments from one section to the next are very different than the games look like when I was young. Can you talk about the gaming and The I say to sim or similar things happening where the blink rate is going down. And then talk about how people can transport from their game into a thing that you created that helps them to remember to blink.
- [21:19]
D
Absolutely. What we're talking about here is that I'm developing a dry eye center in the Metaverse through the Fortnite game. You can transport from gaming within Fortnite into my dry eye center in the Metaverse, which is awesome. Once you get into the dry eye center, we really talk about gaming and the eyes and not only blinking, but we want to prepare our eyes to for the tasks that we're trying to do. So if, let's say we were going to run a marathon, right, we would carb load the night before, we would hydrate, we would train, we wouldn't go out and run 26 miles. We would start with 1 and then 3 and then 5. You would build up to this and prepare our bodies for the task at hand. Unfortunately, all of us, not just kids who are gamers, but those of us who sit at a desk at work and expect our eyes to focus on the computer in front of us all day long, we're doing this without giving our eyes any support for the job ahead. So what I propose is that if we gave our eyes the support that they needed throughout the day, that our eyes would help us to see clearly throughout our workday. So for kiddos, we built this gamer kit which contains a couple of things. There's three items and they're super safe for kids to use. So the first item is a lid and lash cleanser. So this is the lid and lash cleanser box. It comes in these little pre moistened wipes. So before they start gaming or after they're done gaming, they can pull this wipe out and just cleanse their lids and lashes. We all have bacteria that live on our lids and lashes and dirt, dust, debris, pollen can get trapped in our lashes. That gives that bacteria a home to create, to replicate in. And then we get an overgrowth of this bacteria. The bacteria, as I said, is supposed to be on our lids and lashes. It's normal to be there, but when it gets overgrown, it can cause inflammation on the front of the eyes. It can make your eyes more red. So if you wake up first thing in the morning and your eyes are bright red, it's probably that you have an overgrowth of this bacteria on your eyes. The bacteria also puts out toxins into your tear film and then those toxins will help to solidify the oils and the oil glands. So it's a vicious cycle of having too much bacteria and those oil glands getting clogged up. So cleansing lids and lashes once or twice a day. Super easy for kids to do. It's just like a wet wipe that is created for the eyes and then you rinse that off. The second is a warm compress. These are air activated warm compress masks. So it's not going to be too hot. Now being from Michigan, this was created from, from an eye doctor who's from Michigan. So it's called eye dration. He took the hot hands idea and made it into an eye mask. So once you pull the mask out from the packaging, it starts to heat up. And the little pads here get hot about 108 degrees, which is the temperature to melt the oil in the glands. And then there's a little loop. So you just loop it over your ears easily. It stays hot for 10 to 12 minutes, which is exactly enough time that you need to melt those oils in the oil glands. But what I like about this mask for kids in general is that it's not going to ever get too hot. We have other masks available over the counter, even by that same company. See if I had one. But you pop them in the microwave and then you put the microwaved mask over your eyes. So it's, they're, they're all made by Bruder, the Brooder worm compress that you microwave. If you microwave it too long, you could pop it all over the microwave or there's beets everywhere, or it could get too hot and then it would burn your eyes. So I love these air activated masks for kids because they're not, they're never going to burn themselves. It, it doesn't get hot enough in the air to burn. Okay. And then the third product that we have in this gamer kit is the dry eye drink. So there's three little tubes of the dry eye drink. This is a hydration drink, no sugar added. So there's not a bunch of sugar that's going to now hype your kid up. It's made with stevia and then it has the minerals that support your tear film. So you drink this down, it increases your hydration. You just add it to a bottle of water, shake it up. It comes in mixed berry, strawberry, lemonade and orange and shake it up with a bottle of water. And then the kiddos can drink this, give them that hydration, give them some vitamins and minerals to help them make a healthy tear film. And this purple one over here, this is actually the, the PM Version that has a little bit of melatonin in it as well, to help kids get to sleep after all their gaming.
- [26:30]
B
Okay, so, so you have that right on your shop and I'll make sure, I'll put a link in the show notes on your website. You have a shop and there's a lot of things there. People can take online courses or if they, they can come in for consultations, these free guides. But, well, what would happen? So if they're gaming, you're saying something could pop up and they could transport in the metaverse to this dry eye center. They would transport. You know, I would imagine that when a kid is in the thick of a game, you know, it might be difficult to get them to transport, but maybe that's just part of your routine. Maybe part of your routine is that you do the wipes or when you're done, you do the mask or, you know, you have this routine around gaming because you know that you got to make sure you're taking care of your eyes during the process. So they would pop out of their game and would it just kind of guide them through a quick thing of taking care of their eyes?
- [27:18]
D
Right. So that pops them into the, the dry eye center that I've built in the metaverse, and then from there there's a couple of places they could go. But it's the same thing. It's like a guide of how to do these three steps or the shop where you could purchase this stuff and have it delivered to your doorstep or download. Download the, the guide in PDF form.
- [27:40]
C
Okay. Okay.
- [27:42]
B
So the kids are gaming. They're gaming quite a bit. Or just if kids are on their phones or, or different things like that. Can you talk about how young this is showing up? Is it showing up pretty young? What are you seeing in with your patients?
- [27:55]
D
So what happens with those oil glands that are solidifying is that the downstream effect is something called dry eye disease. Typically, even 10 years ago, dry eye disease was something that happened to women after the age of 40. There's a big hormonal shift that we have after the age of 40. We create less moisture in our bodies, and then women's eyes got dry. But today, the prevalence of dry eye in people who are under the age of 30 is equivalent male to female. So that is caused by the increase that we have in screen use. So men and women under the age of 30 are developing dry eye disease at the same rate, which was pretty unheard of even 10 years ago. 30 year olds did not get dry eye. But now, because of that decrease in the oil production. As these oils solidify in our lids, we're seeing more and more patients with dry eye younger. The other scary thing is that more doctors are routinely imaging those oil glands on the inside of the eyelids so we can see the atrophy. Funny enough, about five years ago we got an imager in my office and so me, myself and my lead technician were setting it up and training on how, how to take the images. So she's the one who takes the images most regularly. So I was the guinea pig. She took a picture of my oil glands and voila. I have perfect oil glands. I take really good care of my eyes. I clean them every day. I use my warm compresses. So I had great looking oil glands. Now my technician, who is 20, 20 years younger than me, roughly her oil glands looked like crap, was crazy because I didn't get a cell phone until I was in my 20s, right? And so I didn't, I didn't go to college with the Internet. I, we went to the library and got books and, you know, so I don't, don't have as much screen time in my youth. I didn't have any screen time in my youth and just don't in general spend as much time on my phone as, as a younger person would. So the problem is we're now giving our 2 year olds tablets and phones and they are looking at them for hours and hours and hours. And like I said, it isn't because you were on your computer yesterday that your eyes hurt today. It's because we've been doing this for 20 years or longer with your phone in your face for long periods of time. So now that we have this ability to image these oil glands, we can, we can now identify and treat. There's new technologies that are coming through that have shown us that we can unsolidify the oils, okay. And we can help to heal the oil glands.
- [30:50]
B
That is one of the things that I was wondering. Okay, is there a point of no return though?
- [30:56]
D
Some patients have nubs. Nubs, that's all they have left to these oil glands. They should be fairly long. They should go the whole length of your eyelid and sometimes so, you know, from the lashes to the bone, upper and lower, you have about 30 oil glands on the upper and the lower lids, these oil glands, and they're in the upper lid, they're very long. But with the atrophy of these glands as the gland, as the oil inside the gland solidifies, then when you blink, it doesn't come out and the oil gland goes, you know, you didn't make the oil I made for you yesterday. So I'm just going to start to shrivel up and die. It just atrophies over time and the glands get smaller and smaller and smaller. So there are some treatments, number one, that we can heat up the oil and express it out. So just like Crisco can become butter, can become oil. If we, if we put it in a frying pan, you can watch it liquefy. That's what the, the idea of heating is doing. That's why I'm encouraging you to use a warm compress mask because you're going to melt that solidified oil and help it to come out of the glands. So there are in office procedures that you can do as well to really heat it up and squeeze it out. At home, there's no real way to squeeze it out ideally or easily. So just heating it up and blinking can get some of that clogged oil out. But in the, in the doctor's office, there are methods that we can use to express the oil out of the glands. So that's number one, we can evacuate all out, all of the clogged oil. But now we even have some energy based devices that can energize the oil glands themselves and help them to heal with light based technologies. Right.
- [32:47]
B
It's always interesting to be exposed to a whole field that you're like, I had no idea. And yet I use my eyes every day, all the time. And yet obviously there are people that are looking into this because there are the imagers. I mean, the, the fact that someone was like, let's create this technology where we can create images of the glands and the oil glands and see if they're atrophying or see how healthy they are. There's definitely a group of people that are aware of this to the point where they're making these machines. What do the images look like?
- [33:21]
D
Oh, so everyone always says they look so ugly. But it's basically a black and white image where the white, there are white lines. The white lines indicate our oil glands. Like I said, we just, we flip the lid down. And then I even have a handheld one. Now it attaches to my cell phone. And so it's a little camera on the back of my cell phone that will, when you flip the lid down, you can aim it into the inside of your lower lid and then see the image of the gland. What?
- [33:52]
B
Wow. So if they haven't completely become nubs, can they regenerate so there is evidence.
- [34:01]
D
That with the energy based technologies that we have, we can stimulate them to heal. There's been some studies to show there's growth by using something called intense pulsed light or IPL treatment. Dermatology has been using IPL treatments to treat rosacea in the face. It shrinks blood vessels. But that same energy is used around the eyes to put energy into the oil glands and stimulate them to heal. Since we have a lot of moms listening to this podcast, maybe they've seen these red light masks that you put on your face that reduce inflammation. They treat acne. So it's similar to these LED masks that we're thinking about putting energy into the skin to allow the skin to heal, which is awesome.
- [34:49]
B
Okay. But it's a hefty undertaking. And so what it seems is that the best thing is prevention.
- [34:56]
D
Right.
- [34:57]
B
And this is starting young. I mean, I really can't imagine being in your 30s and then having to deal with issues with your oil glands. You've never even heard of it. You're like, what's. People come in probably because they're just uncomfortable. They make an appointment, right. What are some of the things that they may be feeling?
- [35:14]
D
So generally it's, it's stinging and burning, feeling like they need to rub their eyes. Sometimes it's foreign body sensation. Oh, it just feels like there's something in there. Other times it may be I can't wear my eye makeup anymore or I can't wear my contact lenses. My eyes are just so uncomfortable. They become red and irritated when I wear my contact lenses. And you know, towards the afternoon they become so, so dried out and irritated. I have to take them out. Or my eye makeup is so irritating that my eyes become. It waters a lot. That's another kind of funny side effect of dry eye, is that the eyes are so dry that they water. The body is trying to flush out that sensation. And so sometimes they over water or they become super sensitive to smells, which is strange. But you put something that smells around your eyes and your eyes water. You can think of an onion or someone's perfume and the, the scent is so strong your eyes are watering. Similar, you become so sensitive to smoke. Let's say you go, go somewhere where someone is smoking or go to a campfire and now your eyes are pouring water to try and flush that out.
- [36:29]
C
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- [37:47]
B
When you tell people that are, let's say in their 30s that this is dry eye and the oil glands are struggling, are they just shocked? Surprised? Have most never heard of it?
- [38:00]
D
Right, Exactly. Then they're wondering, you know, how did this happen? And then they'll blame something that they did last week. Oh, you know, I had a big project at work and I was on my computer for 12 hours. It's like, yeah, that didn't help. But it's because you've been doing this for 20 years. It's not because last week something, something big happened. But generally it's like the straw that breaks the camel's back. Right. These things have been happening slowly. Right. We give our two year olds the cell phone to entertain them so that they don't scream their heads off while we're at trying to have lunch. And then they're using cell phones every day from the age that we're two on up. And that's, that's what's causing it. Not, not that we're overdoing it on a particular day.
- [38:41]
B
Yeah. And anyone who uses a screen, you just naturally, your body stops blinking as much so. That's so interesting. And the age to read, actually, I know they really push kids to read earlier now, but our kids didn't learn to read till they were seven. Some kids, naturally, if people allowed their kids to learn to read when they were ready to read, they might not learn to read until they're 9 or 10 or even 12 is considered normal. Like the, the reading age is like 3 to 12. Anywhere in that range used to be considered normal. That's when you learn to read. And with more leaning toward, I think, you know, 6, 7 and above. So there would have been a time period for most of history where no one was doing near work for the most part until they were 6, 7, 8. Where the eyes are starting to already be pretty formed.
- [39:33]
D
Yeah.
- [39:33]
B
So what a difference.
- [39:35]
D
Yes, yes, exactly. And even though kids aren't necessarily reading on these screens. Right. They're being entertained, they're watching things, they're having all of this near stimulus and fast paced stimulus at such a young age.
- [39:54]
C
Right.
- [39:55]
B
Which was not a thing at some point. I've only heard about it in terms of myopia.
- [40:00]
D
Right.
- [40:00]
B
And which also causes issues and can be a problem. But you know, it can come from different things. I know you talk about it can be genetics, but also it can be, it can also be caused by a lot of this near work or at least can be a factor to it. But the, the dry eye thing is just a whole other piece. Dry eye disease to be aware of. I guess in, in really thinking about that, that there was a time in life where young kids up until elementary age would not have hardly been exposed to near work at all. And so their, their eye health would have been better. What would you recommend? I guess here's what I think. It's hard to combat the screen age. And to your point, it's like you're trying to get something done or you're trying to hop in the shower. I actually talked to this man who said that he had a, he's like a pediatrician, so that, you know, is dealing with all these moms. And then one of the moms said to him, how do people used to change diapers without a screen? And she said, you know, my kid is so squirrely. I just give him my phone and he watches SpongeBob SquarePants. Well, I change his diaper. And the pediatrician was like shocked. He was like, you know, an older guy. He's like, well, people would like talk to their kids and interact and I know it's difficult, but it's A short period of time. So I mean that's a one year old, probably, you know, an 18 month old that it's holding this screen every single time they get their diaper changed. And watching this really near screen, I know it's hard, but I think having more reasons to say no is helpful. So this is another reason to say no. It is for the dry eye disease. You don't want your kid to be 30 years old and have dry eye disease. Give us some recommendations. And I, and I like strong recommendations like hey, there should be very minimal screens until, I mean there used to be minimal near work until 6 or 7.
- [41:50]
D
Right, right, yes. So I am not a pediatric optometrist, but speaking from the dry eye side of things, I would say the best thing that any parent could do for their kids eyes is clean them, which is ironic because we tend not to clean our eyes. So you wash your face and you squeeze your eyes shut as hard as you can. And that line where your, your eyes come together, the lid margins never get cleaned. So getting a product from the, you go to the pharmacy and you walk down the aisle of artificial tears and they will have these lid wipes. That's what I would recommend. That every night they brush their teeth, they wipe their, their lids and lashes, rinse off the, the soapiness from the lid wipe and you know, hop into bed. So having that habit to me even more important than brushing your teeth because you can always get new teeth. But just cleansing dirt, dust, debris, pollen from around the eyes, keeping that bacterial load down could really make a big difference. And these wipes are built for the eyes so they're not going to sting and burn. They're super simple to use. I do not Recommend Baby shampoo. 10 years ago that was a thing. Oh, get, get something very gentle for, for the eyes. Baby shampoo is no more tears. And so that should be great. But research has, has gotten into, you know, what actually is healthy to have around the eyes. And that's why these, these wipes in the eye care aisle have been developed. So get something specifically made for the eye from the eye care aisle at the pharmacy and cleanse your lids and lashes. I think just one simple step that we could start you, you stand your kids up on the stool in front of the sink at the age of two and they're brushing their four teeth. You're taking them to the dentist by age one with. My baby had two teeth in her mouth when she turned one. And there we were at the dentist's office. I'm like, what am I doing right? Have they had an eye exam? At that point they should. There are initiatives to have kids get eye exams before age of one. Catching eye cancer, catching eye turns. Things that could affect their long term vision. You know, you're taking your kids to the dentist, take them to the eye doctor as well.
- [44:23]
C
Okay.
- [44:23]
B
So we do the wipes, which I same thing, hadn't heard of them. I also really like the name hydration. I think that's very clever.
- [44:31]
D
The hydration basket. He's from Michigan. Yes. An optometrist from Michigan.
- [44:37]
B
People are so clever. You're like, did that idea come to them in the shower? They're like, we could call it hydration. I love that. Okay. But also being aware of near, near work for young kids.
- [44:49]
D
Yes. And having them just push their screen at arm's length away as, as far as their arms can go. The screen should go that far away and keep on them because tendency is they're going to pull it in, they're going to pull it in. They're going to pull it in and just push it back. I have children myself. My 10 year old will sit that screen right in front of her face and I just push it all the way back to her knees. Mom, stop. And I'm like, I don't care. I will be that annoying.
- [45:20]
B
Yeah, that's what my grandpa was doing back in the, you know, 90s. I mean, he would come and just pull people away from the, from the television. He said, you're too close, it's not good for your eyes. So at some point there was like this innate wisdom that people knew this wasn't good for you. And then the screens have just gotten closer and closer and closer for the adults that are listening that have desk work, which is a lot. That is another big change, Pam, isn't it? You know, I read a statistic and I don't remember the exact numbers, but you know, at some point in time at the turn of like the 1900s, there was a large percentage of people that worked outdoors and certainly did. Andy Crouch calls it three plain people where they moved in three planes, you know, up and down and side to side for their job. So if you're a plumber, you're a construction worker, you're moving in all different ways. I would imagine even if you're a doctor, you know, you're working with people and you're moving your body and like you're not sitting in front of a computer, you have patience. So there's certain types of jobs that you're not sitting at a desk. And then there are now a whole lot of jobs where you are. And I don't know if that will swing back with AI. Like, is AI going to take a bunch of of the jobs that people just sat staring at their screens and now we're gonna have to go out into the world again and do other things. But can you give some advice? I know this is in one of your downloadables, but on how to set up your workstation. So for the person who's listening, like me, who's not heard of a lot of these things and hasn't really considered how does this workspace affect my eyes? Can you talk about, you know, like, set it up? How far should the computer be away? You talk about font size, you talk about colors, you talk about lighting.
- [46:54]
C
There's a lot of things someone could think about.
- [46:57]
D
Absolutely. So first thing would be the distance of your screen. So you should, you should be further than your arm's length or just at your arm's length. So as far away as you can get your screen. Again, that's just going to help your focusing. The further away it is, the easier it is for your eyes to see it. So some people need to be able to touch their screen throughout the day. But if you can put it at that, that arm's length distance versus closer the better. It should also be in a downward gaze. Now, if you're over the age of 40 and you wear a bifocal, then you know that the reading portion of your glasses is at the bottom of them. So having your workstation set up so that you're looking down into it versus up at it, that's bad for your neck. It's also bad for your eyes because as we're looking up, the, the upper lid doesn't cover as much as the eye as it is. It should. And another fun fact is that your eyelids are there to protect your eyes. So they have a function and should be in a certain position. When we are looking up, we're exposing more of our eye and it can dry out faster. So in a downward gaze, your lid is actually going to come down a little bit more, focusing at your desk and making it easier for you to look. The third thing would be lighting.
- [48:18]
B
Comment?
- [48:18]
D
No lighting.
- [48:20]
B
Oh, I know. It just. It's so. I guess the whole thing is so interesting to me, Pam. Like, I've never heard any of it, you know?
- [48:26]
D
Right. You just go to work. It's like, there's your computer. Okay, get, get to it.
- [48:31]
B
And for kids, you Know, like, ed tech is such a huge thing. And so, you know, we started using computers like in, I think in the fourth grade. It was like an Apple Computer and we would play what's the game. It's like, it's like a pioneer game where you try not to die of. I can't remember what it's called. People are probably like, oh, yeah, Oregon. Oregon Trail. You know, so, like this. And you learned how to type. And so I just think about how many decades of life I've lived where no one's been. Like, have it. Have your eyes gazed down. That's like an easy thing to do, right?
- [49:02]
D
Yeah. Just pull your chair up enough so that you're looking down at the, at the computer screen, which is, which is huge. The next would be lighting. So where, where are you getting the light from? You want to have adequate lighting, but you don't want to be having it come straight at you. So behind or above is better. You can also think about glare. If you're, if you're fighting the glare from your screen constantly, it's giving you eye strain and irritating. And then within the screen, setting up your colors, you want as much contrast. Black letters on a white background, white letters on a black background. But if you think of something that's not as contrast sensitive, like yellow and blue, that, that is going to create more difficulty for your eye to distinguish the letters. So pick something that has good contrast. Font size should be 11 or larger. And the, the font that you're using, if you're using something that's, that's curly and cursive Y, where you're having to really focus on is, is that a G or is it a Q? I can't tell which way the, the tail goes. Just being aware of using a font that's easy to read can, can help your eyes make things easier.
- [50:24]
B
I talked to these people that created a product called Daylight. So it's. They have a computer and they also have a tablet. And I mean, it's fairly boring. Everything is in grayscale. It's meant to not be addictive and it's meant to be good on the eyes and it's meant to not emit a lot of EMFs. It's no blue light. It works really well outdoors with the sun. So you could take your work outdoors, which, that's such a great idea because you just automatically, like, you hear the bird, so you're gonna look away. Like there's these natural. You know, you don't have to set a timer. You're Gonna naturally kind of look up and see what's happening. But one of the things that they talked about was flicker. And I know that's one of the things that you talk about as well. The screen looks like it is one continuous image, but really it's flickering really fast. And that's what's making it look like it's one continuous image. Can you talk about how the newer. Is it better to have a lot of flicker? Less flicker?
- [51:22]
D
Yeah, so the higher flicker rate is, is actually better so that it does look seamless, more. More like a television to calm. Calm your, your system. And I think that kind of goes back to, to what your grandpa was doing pulling you away from the screen. So it used to. I don't know if there's any truth to it because this is before my time even, but people thought that those big box televisions emitted something, some rays from the television that were harmful. And so like my parents would also tell me to, you know, say it further away from the screen. That's no longer true, that there's waves coming out of our televisions or our computers that are harmful to us, except that they're emitting blue light. And so in that idea, it is true blue light. It comes from the sun. That blue light's purpose is to stimulate our serotonin and to tell us to wake up and at the end of the day we should have less blue light so that our bodies know that it's nighttime and we can calm down and our melatonin can up, uptake again. So, you know, even though there isn't some cancerous wave coming out of your computer, you are getting that blue light. And I think that's probably what the makers of that, that gray device you were talking about is that it's not emitting blue light and stimulating that.
- [52:45]
B
Right, right. And the thing, there's no flicker. I don't quite. I might be Ms. Misremembering, but they have a lot of things that just make it way healthier for adults and kids. And they have a tablet and it's pretty cool. You know, you can draw on it, you can take notes.
- [52:57]
D
It's.
- [52:57]
B
It's a fantastic alternative, I think, to what's happening. I think people can get it with like their, like their school money if they homeschool. Sometimes in your state you get school money so you can get it with that. So that's called daylight. Let me ask one last thing because, you know, we focus a lot on screens, but I really like to read. And I think that reading is a great alternative to screen time. It.
- [53:20]
C
It.
- [53:20]
B
You know, your child can build their imagination and you can really bond together. But obviously there are some similar things, like you said before, about the blinking. Are the rules or the suggestions somewhat similar? Like the 20, 20, 20. Obviously, when you're reading a book, you tend to be. You tend to be looking down, not up. You got the book in your lap or something like that. Can you give any advice for kids who really love to read?
- [53:44]
D
Oh, I love kids who love to read. So of course. So reading a book, you're going to blink a little bit more than you do on a screen. So it is better in that regard. A book is even better than a Kindle. Try to get the paper white background instead of it being backlit. Try to get the paper background. But okay, let's say you're reading a book. So same thing. You want to push the book as far away as possible to cut down on becoming more nearsighted. You do want to take breaks so that you can refocus your eyes and look away. The good thing about a book is that it has pages. So there is an endpoint. You could say every time, every four times I turn the page, I take a break. Every time I get to a chapter or get to a break in the reading, it's time for me to just look away, blink a couple of times and come back to it. Reading outdoors is easy because there's no glare off of your book. So go outside and when you hear the birds chirping, use that distraction to look away, refocus your eyes, try to find the bird in the sky and get outdoors. Right? Yeah. Take a lap around the tree.
- [54:56]
B
There we go. There we go. There we go. Okay. Clinical director of the Dry Eye center.
- [55:02]
C
At Lusk Eye Specialists.
- [55:03]
B
I'll put the link to your website, which is Pam Terrio, but it's spelled T H, which.
- [55:08]
D
Wow. It is the riot.
- [55:11]
B
Wow. Well, it's spelled the riot, but the fact that it's pronounced tear is so perfect because that's what we're working on. Right. That is incredible. Okay, so people can watch your TED Talk. Is that correct?
- [55:26]
D
Yeah, it's a TED Talk. All about screen time.
- [55:28]
C
Yeah.
- [55:29]
B
So they can watch your TED Talk. And then really there is so much there, all these blog posts. And I'll make sure, like I said, I'll put the link there so people can find it. But if they need consultation, they can get a hold of you. And if they want to find these different products that you talked about, like hydration which is so clever. Clever. They can find that and then a bunch of online courses. A lot of things there. And I'm so thankful, I'm so thankful that you have helped to expose all of us to something that we may not have known about. I didn't know about it. I knew about the long distance looking, I knew about myopia. But I, and I just read recently about the, the losing the oil glands and then having to use like artificial tears for the rest of your life. But I didn't, didn't really understand how pervasive it was, how it's going younger. Like I didn't know that the, all.
- [56:12]
C
The details to it.
- [56:13]
B
So I'm so grateful that you came on and talked and I know people will get so much out of it. We always end our show with the same question. The question is, what's a favorite memory.
- [56:21]
C
From your childhood that was outside?
- [56:23]
D
Oh, I loved riding my bike. So me and my girlfriend who lived a block away, I would ride my bike to her house and then we would tear through the neighborhood neighborhoods just street by street for hours and hours. We built ramps or we would hop our bike, you know, a foot up off of the ground and we get all the neighborhood kids and just ride our bikes around for. Until. Until the street lights came on. Right. That's how you knew that it was time to go home.
- [56:52]
B
Isn't it interesting like even that you know that you got the wind in your face so you're probably blinking a lot. Like all the sort of natural parts of childhood in the way that we grow up would they. They would help make a more robust eye health.
- [57:06]
C
And so we add in all these.
- [57:07]
B
Artificial things and they affect it and so you just have to be more aware. But I so appreciate what you're doing because I, I mean I've been studying this stuff for a long time and I didn't know. So it's a brand new thing for me to learn about and to be aware about. To be aware of. Everybody can go get the free downloadable guide seen clearly in a screen filled world and try with your kids the self assessment, the quick exercise to evaluate the impact of screen use and people can see how they're doing. Send us a message. I'd Love to know. Dr. Thierio, thank you so much for being here.
- [57:35]
D
Thanks for having me, Jenny. It was fun.
- [57:39]
E
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F
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