Global Trends in Eye Care

with Dr. Maria Pribis

Insights from Experts

Together We See is launching a new program, Insights from Experts, in which we interview experts in ophthalmology and public health in order to make health information more accessible to the public. In each segment of this program, we hope to cover unique public health topics, including eye health, visual impairments, and public health disparities. As Together We See is an organization founded by youth, getting advice from professionals helps us to refine and improve our approach. Thank you so much to Dr. Reddy sharing your insights with us!

About Dr. Pribis

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Maria Pribis, OD, FAAO, Diplomate of the American Board of optometry graduated Magna Cum Laude from the University of Pittsburgh with a BS in Psychology.  She graduated with high honors from Pennsylvania College of Optometry at Salus University. While in optometry school she was president of SOSH. Dr. Pribis was inducted into BSK honor society. She completed an ocular disease residency at the Baltimore VA Hospital. During this time she rotated through Johns Hopkins cornea and specialty contact lens clinics.  She’s a partner in private practice in Stamford, CT where she specializes in ocular surface disease and contact lenses.  Dr. Pribis lectures extensively with the optometry education company, KMK. Dr. Pribis was awarded Connecticut’s young optometrist of the year award in early 2015. She is the founder of OcularPrime, which is a website that encourages you to “Live in Your OcularPrime,” which is a short phrase designed to support a commitment to consistency across the entire health spectrum for those who want to become the best version of themselves.

Key Takeaways

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Dr. Pribis shared insights with Soham on global trends in eye care. Here are some key takeaways from what they discussed:

  • In America, we need to increase our awareness about the importance of visual health and proactively take measures in many areas of our lives to maintain our visual health: nutritional habits, ideal light conditions, and screen time. In these troubling times of Covid-19, we need to remain vigilant of the possible dangers of the “movement to virtualization.”

  • On the international level, there exist many health disparities between the developing and developed world. Some of the barriers contributing to this are the lack of awareness about medical options, the availability of nearby professional care, and the income/resource barrier. In countries with diverse populations, there can be a cultural barrier between doctors and patient.

  • When working internationally, Together We See should focus on working with local communities and organizations when providing service. Not only does doing this allow TWS to better take the needs of the community into account, but helping small businesses can circulate money through the local economy, in a spillover effect.

Listen to the Interview

Transcript

SOHAM: Hi. My name is Soham Govande, and I’m the host of this interview with Dr. Maria Pribis. Dr. Pribis is a renowned optometrist, and she has a private practice in Connecticut and travels all over the country to teach and spread awareness about eye care. She also runs a blog called OcularPrime to help make information about eye care more accessible to people. Today, she’s going to give us some deeper insights from her experience, and Dr. Pribis, I’m really excited to hear your viewpoints. 

DR. PRIBIS: Thank you so much for having me, Soham. I’m so glad to be here and talk about eye care.

SOHAM: Thanks for coming on. Can you please tell us a little about yourself and what inspired you to study in this field?

DR. PRIBIS: Yes, so, I have been in eye care the last 10+ years. I became very interested during my childhood because I needed glasses, so I spent a lot of time around my eye doctor, learning a lot about the field. They always stressed how much they loved taking care of patients, and as I got into college, I knew that’s what I wanted to do. I started my focus on ocular surface diseases in optometry school when I completed my residency. This area is sometimes overlooked, and patients can be extremely symptomatic. Ocular surface disease encompasses many things, but the most common type of ocular surface disorder is dry eye. Dry eye can have a range of symptoms, such as the sandy feeling of graininess in the eyes and itching. This is something that makes patients frustrated. My goal with all my patients is to help them get their best look, do their work, travel, and live their lives to the fullest without the devastating symptoms of these disorders.

SOHAM: Yeah, dry eye is definitely an irritating condition to have. From your perspective, what’s the most interesting part of your work and interacting with patients?

DR. PRIBIS: I would have to say the most interesting part of my field is my practice. No patients are the same, and every patient brings a unique health background. Many patients have underlying conditions, such as diabetes, high blood pressure, and high cholesterol, which can all contribute to ocular diseases. Those are all things I like to talk with patients about. Dry eye is so common because of all of the different environmental factors that play a role: increased screen time (time on your computer/iPad), sunlight, and other factors which affect the fragility of the eyeball. Thanks to our knowledge of the history of the eye, we’re able to make advanced medications to make our eyes more comforted. Also, sleep is very important to protect against dry eyes, and we also need to keep in mind the time we spend on our digital devices.

SOHAM: Yeah, so as you’re describing, there is a network of several genetic, environmental, and societal factors that are contributing to dry eye disease. Are patients always aware of these?

DR. PRIBIS: Most of the time, patients are not aware of all the things they’re doing that can make their dry eye worse. Sometimes, their dry eye can worsen depending on some medications they are taking. Many people nowadays are taking anti-allergy medications, like Claritin, which has a side effect of dry eyes. I tell them that they should try to only take these medications when they need them. Another option for them is increasing their water intake or trying artificial tears. I think that a lot of people have no idea that what they’re doing in their day-to-day lives can make dry eye worse. 

SOHAM: Yeah, definitely. Kind of going off of the “lack of awareness” aspect, something I’ve noticed is that as Americans, we’re a very health-conscious society, when it comes to things like exercise, nutrition, and mental health. However, I feel that eye care isn’t always as prioritized as these other forms of healthcare. Why should we focus on prioritizing this more?

DR. PRIBIS: I totally agree with you. I can’t tell you how many times I’ve seen a patient with new glasses or contact lenses and their eye exam shows that they have perfect vision. A lot of people don’t realize that there’s so much to the eye... A lot of times, maybe if you’re not seeing an eye doctor, you may not be seeing a primary care physician either. We need to do a better job from a public health standpoint in emphasizing the importance of eye care to our quality of life. Another dimension to this is that blindness is very expensive. Many of our patients come in with treatable diseases, like glaucoma. However, they come in after they’ve already lost a significant amount of vision, and you can’t reverse that. The key is early detection in order to protect their vision. I think that there needs to be a movement that as a society, we need to do better, whether on social media or telling my own patients to spread the word, but I definitely think we need to do a better job.

SOHAM: Yeah, and it’s interesting because right now, especially as Covid-19 is progressing, I feel like many of us are spending a lot of time on our screens, like personally, I’m spending several additional hours on my laptop every day, and I’m sure you may be experiencing this as well. Because of this movement towards virtualization, do you feel that we Americans could be affected by increased eye strain, going forward?

DR. PRIBIS: Oh, definitely. The number one complaint I’m seeing since Covid-19 came into our lives has been increased eye strain. There’s a lot that can be done for those who are doing significantly more work online. Meetings have become virtual. I know that I still see a lot of my patients online, but some people are doing telemedicine with them. Our educational meetings with them are being done on Zoom. So, across all industries, there’s definitely a significant increase in screen time. In terms of what can be done, there are glasses that can be purchased that are non-prescription, which have something called blue-blockers. In terms of eye health, we’re still not 100% sure about what light emitted from screens can do to our eyes, in addition to eye strain. There are various reports that it may prematurely age the eyes, resulting in cataracts or age-related macular degeneration. Another thing we need to keep in mind is that the extra light can really disrupt our sleep cycles. This can be very devastating to our brains functioning normally. You can use free applications—on my website, OcularPrime.com, I have an article on these different options. On iPhones, you can turn on a setting tab, under display, which can reduce blue light on your screen from midnight to the morning. In terms of computers, I have a PC, so I’ve downloaded a free program that reduces blue light. Another thing that can be useful is making sure that your eyes are slightly above your computer screen and you’re looking downwards at it. You should also take frequent breaks. Every hour of screen time should be balanced with 10 minutes off of your computer or phone. Getting outside is really important (of course, wear your sunglasses), but outdoor time is really important to give your eyes a break.

SOHAM: Yeah, definitely. I feel that there are lot of proactive steps that we can take in preventing these diseases, such as dry eye, going forward. So, these conditions are very prevalent in our society. When we consider these, do you feel that certain groups of people are more affected by others or are disproportionately affected?

DR. PRIBIS: In terms of eye care, there are some different diseases which are more prevalent by ethnicity. We know that our African American population is more susceptible to glaucoma. We know that our caucasian and Asian populations are a little bit more susceptible to age-related macular degeneration, but dry eye affects everybody. It doesn’t seem to have a bias towards these factors. One thing that I have found is that people who use computers more and people who take a lot of medications (e.g. antidepressants, anti-anxiety medications, etc.) have more common dry eye. This is also an age-related issue. Many of our patients who have acquired cataract surgery are 55 years of age and older. There are some exceptions of patients who have systemic, or oral, steroids. People who use eye drops and skin creams that are steroids have a tendency to develop cataracts at a younger age. In the U.S., if a patient has glaucoma, cataracts, or age-related macular degeneration, most cases can fortunately be treated. However, there is an accessibility issue in terms of economics, when we consider patients who don’t have insurance. A lot of my old patients are calling me and telling me that they lost their jobs due to Covid-19 and don’t have any insurance, so we’re doing everything we can to get them in during these times. But definitely, age is the number one issue when it comes to eye health problems.

SOHAM: Like you’re saying, there’s a genetic, social, and environmental network of factors (the social determinants of health) that are influencing people’s susceptibility to developing eye conditions and accessibility to care. In some cases, there can be a language-culture barrier between the patient and the doctor, some cultures have a cultural stigma of developing visual impairments, and like you mentioned, there can be an income barrier. Sometimes, there’s a distance barrier, if people are living in rural or remote regions distant from professional clinics. So, if we broaden our focus to the international level, the World Health Organization recently reported that there were 2.2 billion cases of visual impairments around the world, and over 90% of these occurred in developing countries. From your experience in Guatemala, you’ve been able to work with many of these communities firsthand. What was that like?

DR. PRIBIS: It was an incredibly rewarding experience. We traveled to Guatemala and worked at an eye center with local surgeons to perform cataract surgery. Cataract is one of those conditions that can be treated very easily, but if it isn’t, it can significantly deteriorate your vision. We were able to work with surgeons from many different areas to get so many surgeries done. And then, once surgery is done, it’s one of those things that lasts a lifetime. Another big issue we saw there was glaucoma. Treatments are often inaccessible to many patients in need, so this lack of accessibility can result in permanent visual damage and scarring—it’s so unfortunate, this is one of the leading causes of blindness in developing countries. 

SOHAM: Together We See aims to mitigate some of these disparities in hopes of more equitable eye care. Similar to the eye camp that you organized in Guatemala, we’re hoping to organize eye screenings in school settings in rural communities abroad. We’re aiming to do a lot of vision screening for refractive errors for myopia/nearsightedness and other impairments. I was wondering, from your experience, how do you think we should approach this issue, and what are some strategies we should keep in mind?

DR. PRIBIS: This is a really important topic. I’ve learned a lot on this in the last 10 years. We spent a lot of time in Guatemala donating glasses to people, and we took hundreds of them from the U.S. One thing you should keep in mind is that, in these developing countries, people get a lot more outdoor time and they don’t have the same type of schooling, so they don’t tend to be as myopic or nearsighted. In their 40s, all of them require glasses to assist them. So, I think a very useful tool for Together We See, as an organization, is to have the ability to take glasses down there. In these countries, especially Southern ones, patients are experiencing significantly higher UV radiation, which can cause UV damage to their eyes. Ideally, when you would go, you would use an autorefractor so that you can get a good idea of what the person’s prescription really is. Then, you can see if you can somehow team up with a lab to make glasses specific to each patient. We actually did a study, and we found that people much prefer to wear a pair of glasses that are perfectly suited for their eyes. If you work with a lab to provide these glasses right on site, it’ll be significantly better. We actually found that when patients were dissatisfied, they weren’t using the glasses when we checked up on them 1 year later. Also, trying to train local healthcare providers on how to do a vision screening can be immensely beneficial for the community and communicate with them (even if you’re in the United States), for example, about patients’ prescriptions. This might work better in the longer term, for not only to have the right prescriptions, but for the patients to like them and want to use them. 

SOHAM: Yeah, I think the idea of partnering up with local organizations and local doctors there is really important because we want to make sure that the glasses we give the community are being used and they’re actually helpful for the community members. One of your suggestions I really liked was sunglasses because as Americans, we often have a lot of sunglasses lying around in our homes, so it’s easy—or at least, comparatively easier—to collect sunglasses donations. We’re planning on a mission trip to a South American country, maybe Peru, so I think that would be a great opportunity to travel there to donate sunglasses and partner up with local organizations to better provide a form of eye care.

DR. PRIBIS: Right, and I think that even if they have locally-available glasses where you’re going, you could find the prescription that they need for them and purchase it from the local business. At the end of the day, you would be able to not only help the local needs, but also contribute to local businesses, versus the other way—you would feel great, but it wouldn’t have the same impact as being able to have a longer-term impact on a local community.

SOHAM: Yeah, definitely. And also, stimulating local business growth also spills over to other areas as well, so we may see a ripple effect down the line. 

DR. PRIBIS: Absolutely.

SOHAM: Just to wrap it up, do you have any take-home messages for kids and parents who are looking to maintain their visual health at home?

DR. PRIBIS: Yes, I have a ton! The things we talked about on computers are really important—another thing is to make sure that the computer isn’t the only bright light in the room. Make sure you have other lights around you, or your computer will definitely contribute to increased eye strain. If you have access to a pediatrician, definitely ask them if your child can get an eye exam. I know a mom who has a 3-year-old daughter, and she’s already had 3 eye exams. I think that early in childhood and in teens, it can play a vital role. Also, in terms of nutrition, the best foods to eat are leafy greens (spinach, kale, etc.), brussel sprouts, carrots, potatoes, butternut, and squash. Also, increasing your intake of omega-3 foods, such as fish, salmon, and walnuts can help. Remember to drink a healthy amount of water and limit your caffeine intake to at most 1 caffeinated beverage per day.

SOHAM: There’s different ways that we can use to optimize our lighting, nutrition, and minimizing our digital eye strain. And, I’m glad you mentioned the importance of taking regular eye examinations, and I wanted to ask you about that. In some low-income communities and those who are uninsured, the cost of eye exams can deter people from seeking help, which was one of the reasons I founded OcularCheck, to give people a means of doing this at home for free. 

DR. PRIBIS: There are definitely great apps available to do an actual vision check. But at the same time, so much of our visual health isn’t vision-related. For example, glaucoma is completely silent, and the person wouldn’t even know they had it. There’s no tool to detect it, without being assessed. Same with macular degeneration and dry eye—a lot of these conditions are currently hard to self-diagnose. However, that being said, starting out with regularly checking your vision is a great idea because if it changes, you’ll know you need to see your eye doctor right away, hopefully at least yearly. It can be problematic for low-income families, but thankfully, there are programs that are starting to prioritize it and provide wellness checks just for the eyes, just like those you would get from your pediatrician. I do think that slowly but surely, things are improving. But things that I always tell patients that they should come and see me right away if they’re having blurry vision, a red eye, eye pain, or a sudden, complete loss of vision. It’s really important that they get their eyes checked.

SOHAM: Wow, it’s great that despite these challenges, we’re moving forward in a positive direction. Thank you so much for coming here today, and as an organization, there’s only so much we can do as teenagers, and we’re really hoping to be able to gain insights from experts in creating effective strategies for change, so I really appreciate your advice and your help in doing this.

DR. PRIBIS: It’s my pleasure. Thank you so much for inviting me on. It’s great that you’re getting involved at a young age and bringing others in from a young demographic—the future doctors and leaders. I look forward to helping along the way, in any way, shape, or form. Thank you so much, and I hope you do well. We’ll talk soon.

SOHAM: Thank you!