Screens And Burning Eyes

SPEAKER_01 0:00

Most of us stare at our screens all day and never connect that habit to the burning, tired eyes we feel by the evening. And Dr. Pamterio wants to change that. She's an optometrist and dry eye specialist trained at UC Berkeley. She has practiced across six states and carried her message to the TED stage with a talk on protecting your vision in a screen-filled world. In this episode, she explains why our blink rate collapses the moment we look at screens, how the tiny oil glands in our eyelids quietly atrophy, and why she now finds that damage happening in patients barely out of their 20s. She also makes a case for prevention. She talks about the consequences for productivity, children, and long-term eye health.

Meet Dr Pam Terriel

SPEAKER_01 0:47

So tell me in the audience a little bit more about yourself.

SPEAKER_00 0:52

Awesome. Thanks for having me, Jim. I'm Dr. Pam Terriel. I'm an optometrist and dry eye specialist, and I practice in Shreeport, Louisiana. I got my start in optometry back around 2001. I graduated from the University of California Berkeley School of Optometry. And from there did a residency and then married a man in the military. And I proceeded to practice in six different states over the past 20 years, went from state to state. And now we live in Louisiana, where my this is my husband's home state. And along the way, living in a lot of diverse climates, I moved from New Mexico, the high desert to Tucson, the full desert to Syracuse, New York, which you would think would not be dry. But in the dead of winter with all those heaters going on and below freezing temperatures, it's very dry. So I developed a love of dry eye disease and treating patients who had dry eye disease and really took a deep dive because of my own journey with the problem myself into how I could help my patients the most, choosing lifestyle-based methodology where they could change some of their habits at home that were maybe increasing their dry eye or creating their dry eye by slipping in their contact lenses for days and days, or wearing the wrong kind of eye makeup, or placing it improperly around the eye. And really, I tried to build a methodology of how I would look at my patient's eyes and treat them so that they'd have a full comprehensive plan to feel better.

TEDx Vision Tips And Eye Exams

SPEAKER_01 2:31

What was the TED Talk about and what motivated you to do it?

SPEAKER_00 2:34

So my TED Talk was living in a screen-filled world, three tips to preserve your vision. And my motivation was to bring the world of optometry to a global stage so that patients understood that the symptoms that they were having while they're sitting in front of their computers all day long, working on their phone or their computer and going back and forth, that the first step to taking care of their eyes is to have an eye exam. With every TED talk, you may know that there's always a call to action. And so my call to action was to schedule an eye exam. And I gave them three tips on things that they could do to lessen the digital eye strain that they're having. But one big thing that you may not know about TED Talks is that you cannot doctor people from the TED stage. So you cannot give medical advice from the TED stage. So I gave very typical screen placement, decrease your settings of near brightness, you know, kind of adjust the screen or the points that I gave in my TED talk. But the call to action was to see an eye care provider because that's where you're going to get your best individualized care.

Dry Eye Risk By Age And Hormones

SPEAKER_01 3:40

Is the ability to moisturize your eye also something that aging hurts?

SPEAKER_00 3:45

There's some age-related decline in year-tier production, but more so in women than in men because of our hormonal changes through menopause for sure. So dry is much more common in women over the age of 40 than in men over the age of 40. However, if you look at a population that's under the age of 30, it's equivalent men to women because of the rise of the digital devices in our lifestyles. So people who are in their early 30s right now were born with that proverbial self-ovision's hand, right? They're the generation who's had it the longest. And we can see changes in the eyes of the this patient population equally between men and women under the age of 30 because of the digital devices.

The Blink Rate Collapse On Screens

SPEAKER_00 4:31

So for that, we're really looking at the oil glands that live inside of our eyelids. And when we sit in front of a screen, our we try we tend not to blink as often as we would if you and I were sitting across the table and having a conversation. So because we're on screens, our blink rate is decreased by one-third what it should be. So 21 times a minute right now. 21 times a minute if we were in conversation, but only seven times a minute when you're staring at a screen.

SPEAKER_01 5:01

Now, is that true when I'm reading a book?

SPEAKER_00 5:04

It is decreased when you're reading a book as well, but it's not quite as profound. It might be down to like 10 to 14 times a minute when you're reading a book, but not as bad as on the screen.

SPEAKER_01 5:15

That's fascinating. So is it the blue light that's doing it, or is it just the nature of the screen fluctuating?

SPEAKER_00 5:22

I think so the flicker rate is causing us not to blink as regularly. And it could also depend on what you're doing on the screen. Like you and I are just in conversation, so we might be blinking a little bit more than that. But let's say we were playing a video game, right? And definitely not blinking as much as you would if you were, let's say, just reading something on a screen. If we were just going through a document or reading email, we would blink more than you would if you were playing a video game. So there's all these minor modifications as well to that blink rate. But in general, the screen just plummets our blink rate. People will put it off or not notice it. You know, they'll just be like, oh, you know, I used the computer yesterday. And so today my eyes are tired. I had that paper that I had to get done. You know, they'll just blow it off blaming something that just happened. But it's really a problem that's ongoing because of the number of hours that we spend on our screens every day.

Meibography And Modern Dry Eye Treatments

SPEAKER_01 6:21

So, what can we do about it?

SPEAKER_00 6:23

So there are actually newer technologies that we didn't have eager in 10 years ago. We have ways to image those mybromian glands that I was just talking about inside the lids. So we you go to your eye care provider, they can image those glands, we can see how much atrophy there is to those glands. And now we have ways that we can reach rejuvenate those glands. Sometimes we can't get back the atrophied amount, but we can keep the part that is still viable. We can keep it healthy and have healthy oil come out of those glands. What's that test called? It's mybography. Yeah. Mybography.

SPEAKER_01 7:04

So you see the oil glands and you see that they've atrophied. What's the resolution? What works it to come back?

SPEAKER_00 7:10

So there's there's lots of different methods from well, a warm compress and then an expression. That would be your basic level. You can send patients home with warm compresses to start loosening that oil, some omega-3 fatty acid supplements to help them have the building blocks of healthy tears in their system so they can build those oils. And then you can do heat and express. There's some something called lipoplow or a tear care procedure that could heat up those glands really high, melt that mybum is the oils, and completely melt it so it can be expressed. And then there's much more sophisticated devices called intense pulse light or IPL that we use light on the eyelids themselves to send those in the light into the mitochondria of the cells inside those oil glands to help rejuvenate them. And so we've got a whole gambit of different treatment options for these patients now.

Dry Eye Scale And Kids On Devices]

SPEAKER_01 8:08

What percentage of people, and maybe this is an age-related question in terms of the percentages, but what percent of people have dry eyes that are changing their day-to-day?

SPEAKER_00 8:18

Right. So we estimate there's 30 million Americans who have dry eye disease. You know, it's like less than 1% of them is on a prescription medication for the for their dry eye. So it's a huge market, it's a huge problem that most patients don't realize that what they're doing on a daily basis is having an impact on their eyes. And I think really the problem is our children, because now we're a lot of schoolwork is done on digital devices, whereas you and I didn't start working on computers until we were already adults. So these kids are just being brought up in front of these screens. And it's really affecting their blink rate, number one, but the health of their eyes. I had a 20, I don't remember, he was maybe 22. He was graduating from college and getting ready to go to law school. And I did this my biography image of his eyes and his glands were halfway atrophied in his 20s, right? And that kid, you can imagine he's about to start a career in law. How many more hours is he going to spend on his computer? So it's something that really we need to take more emphasis in getting the word out that it can cause such crushing problems in the future. If you don't have any oil in your tear film, your tears just immediately dry out into the atmosphere. And the the answer is to lubricate with drops that have oils in them, but then you're lubricating constantly throughout the day. Once you lose those glands, there's so little hope at this point when your glands are completely gone, like to get a patient comfortable. It's a significant uphill battle to get these patients to be comfortable

Outdoors Time Myopia And Healthier Blinking

SPEAKER_00 10:00

again.

SPEAKER_01 10:00

What would you advise people to do with their young children?

SPEAKER_00 10:03

Yeah, get them to go outside because what you're describing is myopia or nearsightedness. So the more time kids spend indoors and on their devices, the more nearsighted their eyes are and it causes it to grow longer. But if we get outside, which is the way our bodies were originally meant to be hunters and gatherers and be outdoors looking far away where our eyes are most at rest when we're looking far away, then it's easier on our visual system to for our eyes to function. So getting kids outdoors, getting them off of their devices for long periods of time, you know, the recommendations I don't do pediatric optometry, but I when I hear lectures of pediatric optometrists, they think two hours a day of outdoor activity, you know, getting them outside, getting them going, getting them in a different environment than being in the classroom or in the house is best for their eyes and getting that vitamin D on their skin, getting sunlight in their eyes.

SPEAKER_01 11:02

What does that do to the oil glands, though? How does that being outside or just being away from right?

SPEAKER_00 11:08

And your blink rate is going to go back to normal.

SPEAKER_01 11:11

Okay.

SPEAKER_00 11:11

So you'd be outdoors, the your eyes would be, you know, functioning more properly, rough like normal.

Blue Light And Sleep Timing

SPEAKER_00 11:19

And you'd get your circadian rhythms. That's the other problem with our digital devices, is that blue light that's coming off of our screens, it simulates the blue light that's coming from the sun. And we need that blue light in the beginning of our day to tell us that it's time to wake up, get our circadian rhythm in check, and get us to get ready for the day. But when the sun goes down at night, we don't need any blue light so that our melatonin can come in and tell our bodies that it's time to sleep or time to rest. And so when we have too much blue light at the wrong time of the day, it can be significantly affecting our sleep schedules and cause bigger problems down the

How Blinking Pumps Oil Glands

SPEAKER_00 11:57

road.

SPEAKER_01 11:57

Is it the blinking of the eye is what keeps is that the pump?

SPEAKER_00 12:02

Right. So that when we blink, we squeeze our eyes closed. Even just that the pressing of the lids together, it pulls some of the oils out of those oil glands as they touch and it spreads those oils across the front surface of our eye. So when we don't blink for long periods of time, or you know, long periods of time we're stirring at the computer and our blink rate is down for decades of this happening, then the oils that are in the oil glands start to harden so that they don't come out when they blink. And so the methodology right now is to liquefy the hardened oil and then get the clogged oil out so that the body can produce clear oil again and have it flow more easily. So though those are the treatment methods that we have right now is to get rid of the clogged stuff.

Blink Breaks Warm Compress Basics

SPEAKER_01 12:53

At the end of the day, should I be downstairs blinking for 10 minutes or so it would be blink breaks throughout the day.

SPEAKER_00 12:59

Okay. Some good hard blinks, kind of squeezing them, close and open them, you know, a couple of times throughout the day, just do three to five blinks. And also doing some warm compresses can help loosen that clogged oil in the lids. And then, of course, seeing your eye care practitioner is seeing if you can get a mybography to image those glands and see if there's damage to your oil glands or are they.

Productivity Costs And Systemic Conditions

SPEAKER_01 13:25

What are the consequences and the expense to the healthcare system or to someone's personal ability to work when they let this go too far?

SPEAKER_00 13:33

It's immense. So the patients that I have that have severe dry eye disease, number one, their vision fluctuates throughout the day because their tear film is unstable, it's constantly drying out. So they're either taking breaks from the computer to instill drops or just walk away from the computer because their vision is fluctuating so much. And that cuts down on productivity and also creativity because they're distracted constantly by their eyes. And if that continues without proper care to the patient's eyes, it can just get worse, right? So instead of just having to close their eyes when they go home or not look at any more screens for the rest of the day, then it starts creeping back into the day. So the longer that patients go without recognizing that they have a problem or getting support for their problem, then the harder it is to cure the dry eye disease. We have multiple treatments, but getting them to the eye to heal the front surface and then get the tear film healthy again can be challenging in some of these patients, especially if they also have systemic diseases like diabetes, autoimmune disease, Shogrin's disease where they're not producing enough tears to begin with, which patients can be very challenging.

Climate Differences And Contact Lens Risks

SPEAKER_01 14:50

So you've lived in six places, and now I know you're living in a more humid place versus Arizona and the other places you're darn remote. Is that a different consideration for you clinically? Is the dry eye instance more or less, or is it a different type of issue being in that more humid environment?

SPEAKER_00 15:07

It's probably less of a problem for patients than the patients I was seeing in Tucson, Arizona, where it's constantly dry when the humidity is 5% in the summertime, right? So there's less dry eye here. But I think that my patients that do have dry eye here in Louisiana can also suffer severely because there's so much diabetes in the state. There's so much autoimmune disease. So they have more of a systemic risk factor than just an environmental one. The other caveat to having it being moist here or humid in Louisiana is that people are more likely to sleep in their contact lenses. In Arizona, you don't catch anyone sleeping in their contact lenses because it's too dry and they just can't do it. Here in Louisiana, people love to sleep in their contact lenses for days and days. It doesn't bother them as much. So and it's just such a disgusting habit. It can really cause huge problems. We see tons of fungal ulcers in the summertime in Louisiana. And fungal ulcer is the worst thing to try to take care of. Whether or not you should keep reing continuously wearing them, all the proteins and the particulates that just cling to the front surface of these contact lenses. It's mind-boggling that anyone would leave

New Meds And Staying Current

SPEAKER_00 16:25

them in.

SPEAKER_01 16:25

So how do you keep current on the changes in this marketplace?

SPEAKER_00 16:29

My goodness, dry eye is exploding right now. There's so many things going on. So just constantly reading journals and listening to podcasts. One of our journals, the modern optometry, does a podcast version. So every time the journal comes out, they highlight three articles in a podcast. And so I can listen to somebody telling me about the articles and then I can go back and read them. But they we've had a ton of new pharmaceuticals in dry eye, specifically in the past three years. We've had several new launches of medications, even new classes of medications where we're getting neuromodulators. So things that tell the eye to tell the brain to make more tears. I mean, it's pretty incredible. We can really help our patients in new ways that have just come out in

The Big Threat Awareness And Prevention

SPEAKER_00 17:16

the past three years.

SPEAKER_01 17:16

So do you also have a podcast on this topic?

SPEAKER_00 17:19

I don't have a podcast myself yet.

SPEAKER_01 17:22

Maybe one of the shorts.

SPEAKER_00 17:26

Yes, where I'm posting all the podcasts that I've been on. I want to raise awareness about dry eye disease. I want patients to know that there's there is hope for their dry eye disease, but also that there are things that they can do within their lifestyle, their daily habit that they can modify to make their dry eye disease better. And getting on different podcasts, I was on a podiatry podcast, I was on a headache doctor podcast. And really, there's so much overlap between our eyes and many other things in our body that could just overlap and knowing that they are related. You know, podiatrist and I spent 45 minutes talking about diabetes and how the changes in the eye are similar to what's going on in people's feet.

SPEAKER_01 18:08

What's the biggest opportunity for this kind of communication of the biggest threat to this topic, as you see in the next few years?

SPEAKER_00 18:15

I think the biggest threat is not paying attention to it. Continue to stare at their phones and be on their digital devices constantly without bringing any awareness to them of the damage that they're doing to their mybamine glands. We have school screenings where we test children's vision. There are handheld mybographers. We could do a mybography screening at the same time as these school screenings and get in there and help prevent these things from getting worse. Also, having a home device that people could do, just like brushing their teeth. They could do something at home to take care of their eyes that would help to loosen up the nibum, that clogging in their eyelids. There's a couple of devices on the market that can do that and really pushing awareness that there are things that you could do every single day, like you brush your teeth. You could take care of your eyes in the same manner and really prevent things from getting

Where To Find Dr Terriel

SPEAKER_00 19:10

worse.

SPEAKER_01 19:10

Thank you so much. What else would you like to share with the audience?

SPEAKER_00 19:13

I'd love it if anyone would like to reach out to me. They can do so on my website, which is my name, pamtereo.com. Pam.riot.com is how it's spelled. I'm available on so all social media platforms at some combination of pamtereo, pam.tareo. And I also, if you want to watch my TEDx talk, I have a downloadable PDF that kind of walks you through how to get your computer set up after you've listened to the talk. And that's available on my website at pamtereo.com forward slash TEDx. And that might help you relieve some of your digital eye strain while you're working. Thank you.