When Dr Rolando Toyos started his own ophthalmology and aesthetics practice in the United States 25 years ago, he had big dreams. He still does. Having started out with two employees, Toyos Clinic now operates in six locations across America, and Dr Toyos has invested in the emerging Australian business, Dry Eye Solution.
His commitment to research and innovation has led to the global use of intense pulsed light (IPL) to treat dry eye disease (DED) and he recently released a book, focussed on diet and lifestyle modifications, to help patients manage this relentless condition that can significantly impact quality of life. In this article, Dr Toyos describes his journey as an eye care professional who is committed to advancing our knowledge on DED.
patients should be put on a strict diet filled with foods that are pre-biotic and pro-biotic and the results measured
When I created my first general ophthalmology and aesthetics clinic, aesthetics was a new specialty. Interest in the use of Botox to reduce the appearance of wrinkles was on the rise, and my clinic immediately gained a growing base of patients willing to be at the forefront of emerging rejuvenation technologies.
It was in my aesthetics clinic that I discovered that intense pulse light (IPL) could be used to treat both skin and dry eye. It was a long, hard road to gain the medical community’s acceptance of this concept, but eventually IPL was adopted internationally.
Systemic Inflammation
Back in 2004, DED was not considered an inflammatory disease. I first had to educate people on the importance of controlling inflammation before I could discuss treatment. To do this, I turned to social media, using Youtube, Facebook, and even MySpace.
When you realise that dry eye is an inflammatory disease of the skin, glands, and tears, you begin to consider that controlling overall systemic inflammation can help control DED. Often doctors immediately think of pharmaceuticals to alleviate systemic inflammation. I believe we should first consider diet and lifestyle changes to improve general health. This is something I have been interested in for many years – even at an early age, when I was involved in competitive sports, I considered the potential for diet to improve performance.
we have simply been too vague in our discussions with patients in terms of health and wellness
Doctors have underestimated their power to effect substantial change in their patient’s overall health patterns. Yet, a simple discussion with our patients about an anti-inflammatory diet can lead to changes in their eating patterns. For example, once we explain the benefits of taking an Omega-3 supplement, we often find our patients are more likely to incorporate it into their routines.
And, when we point out why staring into a computer all day without proper breaks can lead to worsening of the disease, our patients will usually make an effort to change their behaviour.
These simple fixes can make a big difference, but time and energy constraints mean that few doctors are discussing basic health and wellness.
And so, for the past 25 years I have been instructing my patients on medical treatments as well as improving their overall health through diet, supplements, and lifestyle changes.
Impact of Lifestyle and Diet
We have reached an incredible time in medicine, with the ability to map the human genome and use that knowledge to determine how food, supplements, and lifestyle changes can influence disease. People have coined the term ‘bio-hacking’ to define the way in which we are now able to manipulate our genes by implementing small changes to our bodies, diet, and lifestyle to control disease and improve health.
We also have the capacity to study the healthiest among us to determine what daily choices they make to live disease-free lives, although this information has not been readily available to doctors and the general population.
To change this situation, I spent several years looking at all the lifestyle research that would help my DED patients.
I then started using that knowledge to guide my own choices and to advise my patients on theirs. I was amazed by the positive effects. I realised that by giving patients very specific guidelines, with the studies to back them up, they quickly adopted them and improved their DED. I put all this information into my latest book, Toyos Dry Eye Diet, along with a two-month starter diet backed by scientific studies.
Although I wrote the book specifically for DED patients, anyone can benefit from the research presented. For example, most of the population is suffering from an abnormal gut due to bad dietary choices.
A gut filled with abnormal bacteria leads to overall body inflammation, so how do you populate your gastrointestinal system with good bacteria? The answer is not with expensive pro-biotic supplements. Instead, patients should be put on a strict diet filled with foods that are pre-biotic and pro-biotic and the results measured. By doing exactly this, I have demonstrated that we can change an acidic gut to one that is filled with bacteria that will improve overall health.
Sprinkling some flaxseed on your food, for example, will increase the small chain fatty acids, SCFA, that feed your gut with good bacteria. And an apple, which contains the sirtuin activating compound, STAC, will stimulate the genes to improve overall health and longevity. However, there is no sense in increasing your intake of apples to clean your gut if you are also going to follow it with a fast-food cheeseburger!
A lack of nutrients in our current food intake can also be a serious problem and one that requires supplementation. For example, B12 added to our system will help for the following reasons:
1. A lack of B12 in the food supply,
2. Decreased absorption as we get older,
3. Inappropriate supplementation, i.e., pills do not sufficiently increase levels, especially in the older population. To overcome this, I recommend B12 injections that bypass the gut.
Supplementation isn’t only about the vitamins and minerals you frequently hear about on television – like vitamin C. It includes the ones that are discussed in the anti-aging peer-reviewed published papers.
For many years, I have spoken about how IPL stimulates mitochondria, through the process of photobiomodulation, to improve functioning of the cells of the meibomian gland. But did you know that some foods and supplements will also target the mitochondria, helping it to work better?
Mushrooms, which are recommended in my starter diet for improving the gut, are a great example. As it turns out, when mushrooms are combined with IPL, you have an ideal approach to treat a DED patient with dormant meibomian glands.
Give and Take
When I first talk to patients about the idea of making lifestyle changes, they often worry about what they will need to cut out of their life.
I have learnt to listen carefully to what is important to them and, if I am going to take something away from them, I am sure to give them an alternative. One patient was crushed when I told her that she would have to lose the long false eyelashes that were disrupting her tear film and exacerbating her blepharitis.
Eyelash length wasn’t important to me, but it was incredibly important to her. I told her that if we could improve her meibomian glands, we would be able to mimic the effect of her false eyelashes by “bringing her lashes back” with some hair growth supplements and the application of topical drops that contain castor oil. If I hadn’t provided her with an alternative, she would never have trusted me enough to follow the path that I laid out for her.
Growing Our Knowledge
There is no question that our lifestyles have had an incredible impact on the broadening DED demographic. We now have patients, young and old, suffering from this disease.
However, we cannot hold back progress. We can’t expect people to give up certain things, like using digital devices, just because they are causing decreased blinking, which is creating fewer natural tears and resulting in ocular surface damage.
So, should we be looking for more realistic ways to change behaviour and manage the symptoms?
Over the years I have had the great fortune of travelling the world and having open discussions with my dry eye colleagues on how they handle certain problems. I bring back their hot takes to my clinic and try them out. Some work and some don’t.
I also continue to read and assess the research.
In writing Toyos Dry Eye Diet, it was difficult to find a publish date because of this constant exposure to new experiences and new research papers that I wanted to include in the book.
I released the e-edition of the book a few months ago, and it has been met with wonderful reviews. Patients, dieticians, and doctors, have all said that having specific dietary and lifestyle recommendations has exponentially increased compliance, confirming my view that we have simply been too vague in our discussions with patients in terms of health and wellness.
I am currently finishing the soft cover edition of my book but I know that it will be a living document with new research added over time.
I would like to conclude with some ancient wisdom from one of the first doctors, Hippocrates: “Let food be thy medicine and medicine be thy food.”
Dr Rolando Toyos is a United States ophthalmologist specialising in cataract surgery, LASIK, glaucoma, and dry eye. He is the inventor of the procedure intense pulse light (IPL) for dry eye disease. He has trained hundreds of surgeons both in the US and internationally on surgical techniques, medications, and new technologies.
He has authored several papers and books. Toyos Clinic has been recognised as one the fastest growing companies in the United States.
