Empower Yourself: 9th Annual Sjogren's Society of Canada Conference. Dr Rookaya Mather

The second presentation at the Conference was from Dr. Rookaya Mather. She is Associate Professor of Ophthalmology at the Ivey Eye Institute at the University of Western Ontario, specializing in Cornea and External Eye Disease, and a long time member of the Medical Advisory Board of the Sjogren's Society of Canada. 

She spoke about Understanding and Managing Dry Eye Disease, and how it affects those who live with it every day. Dry Eye Disease (DED) is the most common reason for people over the age of 40 to visit an eye care professional and may be associated with morbidity and reduced quality of life.  It is generally underdiagnosed and undertreated.

It is also a clinical challenge for the eye care professional since it is time-consuming to diagnose and manage, it is usually not curable so the patient is frustrated, there are numerous causes and exacerbating factors and the patient reported symptoms do not always correspond to the clinical signs.

Here are the symptoms of dry eye:
Burning
Foreign body sensation
Itching
Redness
Soreness
Dryness
Gritty or sandy sensation
Light sensitivity
Sticky or crusted lashes
Fluctuating or transient blurred vision

Dr Mather laid out the steps we need to take to be more comfortable, despite having dry eyes:

1. Tear Supplementation

2. Control of Inflammation using topical corticosteroids or systemic          immunosuppressants

3. Reduce loss of moisture through evaporation by modifying environment and   behaviour

4. Support meibomian gland function

5. Nutritional support

6. Enhance tear production: Salagen, Restasis

Dr Mather gave us advice on how to accomplish these goals, and also sympathized about the costs of the products we need. If a product has no DIN (drug identification number issued by Health Canada) it is not covered by any type of insurance. 

She cautioned us to think about blinking: Remind yourself to blink more often and try blinking up to 3 times in a row. Also, read differently. Use artificial tears before you sit down to read or use your computer.

Try to stay ahead of the dryness to make your quality of life better. You need to intervene before your eyes are in jeopardy - it's possible not to feel the effects of dryness. With uncontrolled inflammation you can develop corneal perforation.

One piece of advice for people with meibomian gland dysfunction was to use hot soaks and then wash the eye area with Spectrogel or Cetaphil.

People over 65 are more likely to report having dry eye. Since this is an inflammatory disease there is no easy cure. Anything in front of the eyes is going to help to reduce airflow across the eye surface so try to avoid airflow, especially when it is hot and dry. 

You can find a wide variety of eye protection from moisture chamber glasses to Panoptx which is wraparound eyewear  and other alternatives. Fortunately regular drugstore wraparound sunglasses which fit over my prescription glasses are enough for me so far.

Moisture chamber glasses to reduce evaporation

Sometimes you need to work on your problems related to Sjogren's Syndrome a few steps at a time. Dr Mather suggested we take our top 3 problems to the doctor each time we have a visit and work on gradually improving our situation, step by step.

You need to own your condition, so that you know how to help yourself. With a chronic disease like Sjogren's, education is particularly important to empower yourself and protect your eyes. That is one of the reasons I love to attend conferences - to learn more from experts and also from other patients I meet there.

Empower Yourself at the 9th Annual Sjogren's Conference!!

It's spring almost everywhere and time for the National Conference held by the Sjogren's Society of Canada.  "Empower Yourself" is the name of the conference. We'll be exploring current findings along with the "elephants in the room" to help you manage better. Presentations on new topics of Fatigue and Intimacy and Sexuality in Sjogren's will be discussed. 

Our Spring Crocuses are not up yet.

There is a great deal of evidence that suggests that patient knowledge, skill and confidence with managing chronic disease is a good indicator of better outcomes.

Lately I've seen Sjogren's Syndrome spelled many different ways: Sourjons, Soujgrens,Sjorgen's and Sojourns, all by different people who suspected this was a diagnosis that they would be adding to their other autoimmune disease(s). You can only imagine how difficult their searches for accurate information are going to be.

The upcoming National Sjogren's Conference will be a great way for both patients and health care professionals to learn more reliable facts. All you need to do to attend is register and come to the Delta London Armouries Hotel in London, Ontario on May 2. Health care professionals who attend are eligible for continuing education credits.



I am planning to take notes and post what I learn as I have in the past. Our conference has a distinctive special feature. For one hour the speakers and other volunteer heath professionals from Sjogren's related fields will host round table talks where attendees have a chance to ask personally relevant questions.  It's great to have that opportunity and also interesting to hear about the problems others face. Sometimes they match your problems.

Here's a quick overview of the speakers and their topics.

Dr. Arthur Bookman, the co-ordinator of the Multidisciplinary Sjogren's Clinic at Toronto Western Hospital and co-chair of the Sjogren's Canada Medical Advisory Board will start the program with "An Overview of Sjogren's Syndrome." He will tell us how it is diagnosed, the major manifestations and the impact it has on a patient's quality of life.

The next presentation is from Dr. Rookya Mather. She is the Associate Professor of Ophthalmology at the Ivey Eye Institute at Western University. Her topic is Understanding and Managing Dry Eye Disease and she'll be helping us to understand Dry Eye and how this affects those who live with it and have to manage it every day. Many of her patients have complex ocular surface problems.

We are excited to see Dr. Ava Wu at our conference for the first time ever. She is a Professor and researcher in the Department of Orofacial Services and has seen thousands of patients at the Sjogren's Clinic at the University of California, San Francisco where she is the Director.   Lately, she is also the co-author (with Dr. Troy E. Daniels, DDS, MS) of Chapter 16, "The Dry Mouth" in the newest "The Sjogren's Book" - Fourth Edition.  She sees patients as part of the International Sjogren's Syndrome Registry (International Collaborative Clinical Alliance (SICCA))

This year Dr. Arthur Bookman has added a new topic - "Fatigue and Sjogren's Syndrome"  This is one of the most disabling features of Sjogren's Syndrome" He will explore the possible causes, ways to minimize fatigue and promising new medications.

In comments made over the years members have indicated a wish to hear more about one of those topics that is usually kept in the closet. I have brought it up a few times but most Doctors seem to be uncomfortable with it and do not offer much advice. Since intimacy and all it implies is so crucial to maintaining relationships we will be happy to hear Iris Zink, a Rheumatology Nurse Practitioner and President Elect of the of the Rheumatology Nurses Society speak on the topic of "Intimacy, Sexuality and Sjogrens's Syndrome."

"What's New In Dry Eye Products?" This talk by C. Lisa Prokopich, OD, MSc, Optometrist and Head of the Ocular Health Clinic at the University of Waterloo School of Optometry and Vision Science will inform the audience of recent advances in pharmaceuticals and products to treat dry eye.

Glad to say my eye is never this red

After we hear from Dr. Prokopich the round table discussions occur. 

Our next speaker is Dr. Rami Abo-Shasha. His topic is "Corneal Neuralgia in Sjogren's Syndrome, A Brief Overview." I think we will all learn something new from Dr. Abo-Shasha. This is a problem that I was not previously aware of despite years with Sjogren's. It was also daunting to learn that this is not easily recognized by many doctors, so patients can spend a lot of time looking for a diagnosis.

Dryness of the mucous membranes is a hallmark of Sjogren's Syndrome

The final speaker of the day is Dr. Leslie Laing, "Saying "Treats" and Other Mouth-Watering Suggestions" who will discuss research findings on the oral aspects of Sjogren's including these areas: oroofacial altered sensation; the effects of the disorder on the quality of life; the outcome of usage of various oral moisturizers and non traditional products such as green tea, licorice root, xylitol,and virgin coconut oil. 

This is the 9th Annual Conference and is for patients and for health care professionals.  You can register at the Sjogren's Society of Canada website

Physician Accredited Conference

The Sjogren’s Society of Canada is pleased to announce that the 2015 National Conference is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification program of The Royal College of Physicians and Surgeons of Canada.  This activity was approved by the Canadian Rheumatology Association.      7 M.O.C credits.

 THIS CONFERENCE IS INTENDED FOR INTERNISTS, PHYSICIANS, RHEUMATOLOGISTS, DENTISTS,  OPHTHALMOLOGISTS, OTOLARYNGOLOGISTS, OPTOMETRISTS, HYGIENISTS AND PATIENTS

The conference is a CE for dentists, hygienists and healthcare professionals – PACE accredited, 7 CE credits.

Taking Control Part 4 - Sjogren's Conference - Dr. Rookaya Mather: Dry Eye

Dr Rookaya Mather is Associate Professor of Opthalmology at the Ivey Eye Institute at the University of Western Ontario and Department of Opthalmology and a researcher specializing in Cornea and External Eye Disease in London Ontario.

She chose Sjogren's Syndrome and Tear Film Dysfunction as her topic. Dr. Mather defined dry eye as a multifactorial disease of the tears and ocular surface that results in discomfort, visual disturbance and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface. This is the definition of dry eye from the International Dry Eye Workshop (DEWS)

This can be very disruptive to your life. It has an effect on your quality of life that is similar to moderate angina. It's possible for dry eye to be caused by drugs or a serious lack of Omega-3 as well as by Sjogren's Syndrome.

Nitro for angina

In Sjogren's patients with severe dry eye researchers have seen on biopsy that 50% of the glandular cells are still present. This emphasizes the importance of immune factors in inducing glandular dysfunction. 

Another contributing cause for dry eye can be Meibomian Gland Dysfunction (MGD). With Sjogren's there is a decrease in expressibility that leaves the lipid layer deficient and lets tear evaporation increase. When this happens your tears become very concentrated. This promotes inflammation. For some people warm compresses and eyelid massage help with MGD.

You may also see redness on the eyelid margin. This is a sign of Ocular Rosacea. The inflammation on the ocular surface is thought to be mediated primarily by CD4 cells.

You need tear film on your cornea at all times for protection or your corneas may break down. When you use eye drops you should avoid drops containing preservatives.  BAK is the worst one and it is also found in glaucoma drops. Autologous serum tears are the closest to natural tears.

She's got Botticelli eyes

As your eyes become more dry, ocular findings worsen. There are some types of eye wear that help reduce the flow of air over the eye that preserve the tear film.  These include wraparound glasses and cycling shields, Panoptx, plano glasses or the scleral contact lens. You need to be especially careful to moisturize at night since tear production drops then.

Dr Mather ended with more good advice. Number one was "Be proactive, not reactive." Sticking to a daily care routine is essential. When you read close your eyes after each page for a few seconds more than a blink.

This is the comprehensive strategy to manage dry eye in 5 points:
1. Tear supplementation
2. Control of inflammation
3. Reduce evaporative loss
4. Support meibomian gland function
5. Prevent disease progression

Omega-3 capsules with fish pictures

Lifestyle factors can help. She suggested 2000mg of fish oil daily, use of lubricating eye drops, lid hygiene, warm compresses, possibly punctal plugs. Also consider flaxseed oil . Another idea that was new to me involved rolling a small bottle (like a pill bottle) full of warm water over the eye for a warm massage.

You can find more information about dry eye here at Dr R. Fox's site and more info on compresses for dry eye at this site which I found through dry.org. It also mentions eyelid massage.