Interview Transcription
Flora B.L.: What is your profession? Are you an optometrist?
Dr. Christopher Wolfe: Yeah, I’m an optometrist and I practice in Omaha, Nebraska
F: Okay, how many years have you been in practice?
Dr. W: I’ve been in practice since 2008
F: Okay so that’s?
Dr. W: 14 years
F: And what is your specialization or area of interest in the field?
Dr. W: Well, primarily, I would consider myself a comprehensive optometrist. But my area of emphasis would be anterior segment disease, dry eye, irregular corneas, are the things that I spend most of my time doing
F: So, what made you first get involved with Peeq?
Dr. W: Well, about four years ago, Cheryl Chapman and I were having a conversation about better ways to care for patients, and better ways to intervene with patients who have a common condition called anterior blepharitis and posterior blepharitis. That’s the number one reason that patients will develop dry eye over time. And so what we did was we wanted to figure out a way to intervene earlier, so patients weren’t seeing as many downstream effects of those problems, which include grittiness, blurring of their vision and kind of chronic redness, irritation to their eyes, symptoms that are usually associated with dry eye most of the time stem from problems in their eyelids. And so that’s really what we wanted to develop was to try to fix the problem way earlier that we were seeing in our clinics.
F: So you were one of the founders?
Dr. W: Yes
F: Awesome. Okay, so what is the benefit of Peeq Pro to your patients?
Dr. W: Well, really the number – the main reason that we get patients that have overgrowth of microorganisms along their eyelids is from both staph microorganisms, bacteria as well as Demodex. And so Peeq can cover – can kind of debulk both of those. Studies show that it debulks both of those microorganisms. So we don’t get the biofilms, or aren’t as likely to get the subsequent biofilms that live along those eyelids and lashes that migrate over the orifices of their meibomian glands. And so the whole goal is to try and remove those microorganisms for our patients so that they don’t wind up with additional secondary problems. One of the things that we see that’s a challenge for a lot of my patients, especially my female patients, is that they don’t do a very good job of getting their makeup off, specifically their eye makeup. It’s not because they don’t intend to, in most cases, it’s because they don’t have good mechanisms to do it. So they don’t have a good way to physically abrade it off, or a lid hygiene that completely eliminates that debris, and because of that they wind up with sort of these places for microorganisms to kind of hold on to and they just don’t wash off or go away.
F: Would you be able to briefly explain what a biofilm is, in simple terms, and maybe how that differs from what your eyes should actually look like ideally?
Dr. W: Yeah, so when we think about biofilms, oftentimes they’re very, very small, even beyond like when we think of microscopic levels. I mean, they are microscopic. But when we do an evaluation of the eyelids and lashes on a normal exam, sometimes it’d be really challenging to see unless you’re looking specifically for them. So imagine like plaque on your teeth. When you’re looking in the mirror, when you’re looking at a high powered mirror, sometimes it’s hard for you to see it. So you have to look at it in different ways. So you might find your dentist staining that putting a little, especially for kids like they might have washed with a mouthwash that kind of highlights those areas purple. Well, we can use the same types of things to see those biofilms. So what they are, is, it’s a protective mechanism that microorganisms have developed so that your body can’t eradicate them, so that they’re not exposed to the same sort of things that would normally kill them without a protective film. And so they sort of build up this film. And that’s so that they can colonize the area more. And then what winds up happening is we’ll see signs of that over time of redness of the eyelids, redness of the eyeballs like the white part of the eye. And patients will get kind of these recurrent red eyes, acute red eyes, they don’t know why they happen. So they’ll get an antibiotic, it goes away and then it comes back again. Reason comes back again, it’s because those microorganisms aren’t completely eradicated because they’re protected by that biofilm. And so unless you actually get in there and remove that biofilm or prevent it from developing by just having a standard hygiene practice, then you’re going to wind up with some of those other downstream effects.
F: The microorganisms are present on the eye and they produce the biofilm?
Dr. W: Correct, yes correct.
F: With some sort of secretions, something like that?
Dr. W: Exactly. Yeah, think about it. Like, think about the easy way to think is that there’s, there’s no bacteria that live you know, all over our body. And specifically, normal soap burns our eyes and so we don’t usually wash that area really aggressively. And so those microorganisms are susceptible to our body’s own defense. So our body’s defense system will recognize it as being foreign and say, “Hey, this isn’t supposed to be here.” So it’ll send out messengers to kind of clean up that area. And most of the time, those microorganisms don’t cause infection, they just sort of live on our bodies and don’t wind up with any other infection per se. But what happens is they will build in order to protect themselves from the body’s defenses against them, they’ll secrete basically proteins and lipids that will kind of coat their colony so that our body can’t get to them as easily and eradicate them. Well, our bodies still tries to, it’ll still send out inflammatory mediators and those inflammatory mediators over time will accumulate on the active surface and create other damage. Remember, what they’re trying to do is kill stuff. And so if they’re, if they’re there just creating havoc, and it’s just sitting on a thing that they can’t kill, because they can’t kind of crack that nutshell, that is the biofilm, then it leads to those other downstream effects that we talked about.
F: Wow. The more you know!
Dr. W: Yeah
F: How do you think Peeq Pro fits into the world of Optometry?
Dr. W: Well, I think from an optometric standpoint, really, we think about eyelid hygiene, usually when patients are presenting it to us symptomatically. So I think there’s absolutely this realm of keeping patients under control, once they’ve developed symptoms. So now the patients have identified that, you know, wake up in the morning and a lot of crusting or crusting of their eyelids, or their eyes are kind of irritated and gritty. And so usually what the optometrists will do is they’ll start them on some sort of lit hygiene, again, we believe Peeq Pro is great for a number of reasons. One is because it contains tea tree oil, or terpinen-4-ol, which is the active ingredient in tea tree oil. And the other thing that we really liked about it is that most tea tree oil options are, they wind up with a really distinct smell. And so while you can smell kind of this faint tea tree smell, there’s a lot of other things within Peeq that are natural, that can help make the scent more pleasing. So that makes it easier for patients to use more reinforcing to that kind of habit that you’re trying to form. And so I think from a kind of a standard, okay, patients come into the practice and have specific problems that you’re seeing along their eyelids and lashes, and you need to clean that up. It’s a great workhorse there. I think also as doctors sort of transition to the thought process of we need better options to be able to take care of our patients and their eyelid hygiene in general before their problems. It’s a great workhorse there for makeup removal, and just basic cleanliness before those patients are developing problems.
F: What do you like most about working with Peeq?
Dr. W: I think that the idea of making things simple for patients and reinforcing what we’re trying to do in our practices, and having other tools and sort of a team approach where I can sort of offload some of the additional kind of ongoing things that I would might have to normally do in terms of checking in with patients and providing opportunities for that patient to customize their experience differently. In my practice, there’s some things that I may not have a need for on an everyday basis within eyecare. So different products that patients are interested in using that are related to their eyes, but they don’t really know exactly what to use, that’s going to be good for their eyes. And it may not be something that I’m going to use on an every single day basis or may not even think about that my patients are thinking about. So things like toner around their eyes. So Peeq offers an opportunity for me to not only provide that kind of wheelhouse service when I’m taking care of eye diseases, but also an expansion of services. So when patients asked me “Hey, Dr. Wolf, what do I do to kind of help with some of these wrinkles around my eyes?” There’s solutions for that. “How do I, are there other makeups, or other products that are going to be okay for my eyes?” Well, that’s another area that Peeq can be helpful with.
F: What is the benefit of Peeq Pro to your practice, specifically?
Dr. W: Well, I think, in general, what I like the most about having things in my practice, to be able to offer to patients is I know they’re getting specifically what I’ve recommended. And one of the challenges when I just say an eyelid scrub, that is not a common term that patients are familiar with yet, and so they don’t really know what you’re talking about. So you can say when you make that handoff and say and I’m going to have Sarah show you what that looks like or I’m going to have Kelly show you what that looks like. And then that transition, you know the patient already gets it. Plus, once that patient runs out, we’ll get patients often in our practice that will run out of something and then it goes two, three, four months before they come back in for their next visit. And they say, and you ask them, have you been doing X, right? In this case, it would be “Have you been cleaning your eyelids?” “Oh, I was, I was so good about it, but I ran out of it. But I need some more now.” So the idea of Peeq is you don’t have that gap between when that patient was supposed to see you or is seeing you. And when they run out of something that they’re supposed to be doing on an ongoing basis, and Peeq can bridge that gap.
F: So I know you’d kind of talked about the biofilm. But how does Peeq work specifically to treat dry eye and other ocular conditions, like, it’s hard for me to connect what is the biofilm’s impact with dry eyes?
Dr. W: Sure, I’m gonna get a little detailed then.
F: Ok
Dr. W: So if you can imagine that there are these oil glands in our eyelids that look like fingers. And those oil glands, they’re in our upper and lower eyelids. And every time we blink, those little glands need to squeeze. So that upper eyelid comes down and touches the lower eyelid. And it causes this squeezing mechanism, there’s a muscle called the muscle of reel-in that squeezes those oil glands. Well, if those biofilms migrate over the orifice of those oil glands, then what happens is that oily layer doesn’t push out very well. And so even if you’re making a complete blink, those oils aren’t coming to the surface. Now if you can imagine, if you put a pot of water out in the sun, and then a pot of water with oil over the top of it out in the sun, over the course of a day, the one with oil on top of it isn’t going to evaporate, but the one without oil will evaporate. So what happens is it leads to tear film instability, because those oil glands are pushing oils out into the front surface of the eye because the biofilm is preventing those oils from pushing it out even when the muscle squeezes right. And then when that happens, we have this hyperosmolar state, and then you get this salt to water ratio of the tears that is too high. And that kind of begins this cascade. So the very basic level is our tear film isn’t stable when our oil glands aren’t working well. And that leads to a dry situation. One of the common things when you’re young enough to produce good watery tears, and you don’t have chronic damage to the other cells that produce like the watery component of your tears, or the mucousy component of your tears. But you just have a problem with your oily layer is that you can produce a watery layer on demand. So what a lot of patients, one of the first symptoms that they’ll complain of is blurry vision, because remember the tear film, if it’s not stable, it breaks apart. And that’s the very first surface that light strikes when light enters your eyes, it strikes that surface. And so the complaint of blurry vision, and the other thing they’ll complain of, and it fluctuates. So blurry vision, especially after they’ve been on a computer all day long or been reading all day long. Or if they’re in arid environments. The other thing that patients will notice is that their eyes water and that’s a real challenge for patients to wrap their minds around because they’re hearing the doctor say “You’ve got dry eye.” But then they’ll say well, “Doctor, my eyes water, they’re too wet.” But the reason their eyes water is because you can produce a reflex tear, almost like a crying tear that doesn’t stick to your eye, but you can do it on demand. So if you can imagine those oily tears are not keeping the normal what we call basal tears, or the kind of the normal watery and mucousy tears that are on the surface of the eye. And then they produce kind of a crying tear as a reflex when that surface, that oily layer isn’t sufficient. And then it again, it leads to a huge cascade of other problems over time. That’s how you think of biofilms clogging the oil glands, and then the oil glands not pushing the oils out on the surface, and then the tear film becoming unstable.
F: The last question is, are your patients satisfied with Peeq Pro products?
Dr. W: Absolutely, no question. Patients love it. They have tried other products because we’ve kind of embraced this idea for a long time in our practice. And so they’ve tried other products with tea tree oil, without tea tree oil, and patients really like it from a standpoint of a kind of a refreshing sensation. They like the smell of it. And they like the way it makes your eyes feel. They feel like they’re more rejuvenated and really cleaner throughout the day. Again, it’s sort of our baseline, a component of our baseline treatment for patients who have kind of, well have any sort of dry eye and it’s related to eyelid problems.
F: Alright. Well, thank you so much for your time
Dr. W: You’re welcome