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A broad vision for healing


Dry eye had been a 20-year problem for Betty Ferrell, RN, PhD. But three years ago, discomfort became agonizing pain. Long days of reading and writing ended with ice packs on her eyes and head. She had been to many doctors and various clinics, none of whom could help solve this growing problem.

“As a researcher, I spend a lot of time on the computer writing,” she says. “I also travel quite a bit and I’m frequently in dry areas like airplanes. It was becoming worse and worse.”

She experienced a heightened sensitivity to light. She constantly used eye drops and took ibuprofen around the clock to dull the pain.

“My grandkids were ready to play but I had ice packs on my eyes and head,” she remembers. “It was miserable. It was a part of my everyday life, the pain, light sensitivity and exhaustion.”

Her condition became dangerous when she had to pull off the road while commuting to work because the morning light was too intense for her to see properly, even though she wore two pairs of sunglasses. She worried about how she would continue her work in cancer research at City of Hope and, more importantly, if she would be able to play with her grandchildren. Her daughter, who witnessed her suffering, was increasingly concerned.


Her optometrist referred Dr. Ferrell to Justin Kwan, OD, FAAO, assistant professor at the Southern California College of Optometry at Marshall B. Ketchum University and chief of the Stein Family Center for Cornea and Contact Lens at Ketchum Health in Anaheim Hills, California.

Well respected in his field, Dr. Kwan had first come to SCCO as a research fellow in 2009 and, shortly thereafter joined the faculty to teach and see patients at the dry eye institute of the University Eye Center at Ketchum Health.

“Dr. Ferrell was calm and composed but as we started talking, I could tell that she was desperate for help,” he remembers. “The medication she was previously prescribed made it feel like there were razor blades in her eyes.”


As a faculty member and dry eye focused clinician, Dr. Kwan appreciates the opportunity to practice in a world-class, comprehensive teaching facility that provides the latest research, high-tech facilities and advanced tools at his fingertips. Dr. Kwan and his students have the knowledge, network and tools to respond in a coordinated manner that prioritizes quality of life and the overall health and well-being of the patient.

“We’re looking at different approaches to customize care for each patient that fits the reality they personally live in,” he says.

Additionally, Ketchum Health provides advanced instrumentation such as the OCULUS Keratograph® 5M, allowing Dr. Kwan to show patients the surface of their eyes, which makes a decided impact on education around diagnosis and care.

“If a patient can see their own eyelashes and oil glands and the surface of their eyes, they can understand the degree of severity that their eyes are affected and really get to buy into their treatment plan,” he says. “We can educate them so they can take ownership of their condition and treatment.”

With more than 50 percent of optometry practices independently owned it can be difficult for every practice to invest in this level of advanced instrumentation, leaving patients like Dr. Ferrel feeling frustrated when, in her case, treatments fail to bring relief and symptoms worsen. But collaboration and patient referral with teaching facilities like Ketchum Health levels the playing field and allows every independent optometrist access to the same diagnostic tools and evaluations as even the largest clinics and academic institutions. This results in more comprehensive evaluation, better training for future optometrists and improved patient care.

“In all the 20-plus years prior to Ketchum, it had always been, ‘You have dry eyes, here are some eyedrops,’” Dr. Ferrell remembers. “Since coming to Ketchum, it is remarkable the extent of diagnostic evaluation. I feel like Dr. Kwan never gave up. He kept doing more tests and through his evaluation, found new information.”


After a comprehensive examination and series of tests, Dr. Kwan discovered that Dr. Ferrell suffered from Meibomian Gland Disease (MGD), an oil gland dysfunction that is leading cause of dry eye for more than 86 percent of patients. MGD occurs when the meibomian glands, located in the eyelids, no longer produce and release the oils needed to maintain healthy tears. The watery layer in the tear film begins to evaporate causing discomfort and in some cases, extreme pain. Patients like Dr. Ferrell would wash out their eyes to restore moisture, but Dr. Kwan notes this can actually add to the problem as the good components of the tears are flushed away. When Dr. Kwan prescribed an oil-based eye drop, Dr. Ferrell’s relief was immediate.

“I just can’t begin to tell you,” continues Dr. Ferrell, “it was a night and day difference on the quality of my life.”

Quality of life was not just important to Dr. Ferrell. It is her life’s work. Dr. Ferrell’s research specifically focuses on quality of life for patients and families facing cancer. She is a pioneer in palliative care and pain management and in 2000, launched the End-of-Life Nursing Education Consortium project that has trained hundreds of thousands of nurses in palliative care. She is now developing a new palliative care curriculum for all nursing schools in the nation.

“Having an untreated eye problem takes over your life,” she says. “My daughter is a physician and unbeknownst to me, she wrote a letter to Dr. Kwan thanking him for his care. It was quite a statement in that she saw such a remarkable difference in me and my ability to be a mother, grandmother and a happy person.”


For his students, Dr. Kwan can’t imagine a better training environment than Ketchum Health. As students from the School of PA Studies and the College of Pharmacy begin their clinical training, and the medical clinic and pharmacy build out are completed, optometrists will be training collaboratively with other health care professionals.

“Dry eye is often linked to the rest of the health of the body,” Dr. Kwan says. “Autoimmune disorders can affect the water gland of the eye. Disorders such as Sjögren’s and lupus can be managed collaboratively with other health professionals so we can care for the eyes and the rest of the body.”

The collaboration of all three disciplines working toward a precise diagnosis and targeted treatment plan, versus an uncoordinated trial and error methodology, can only benefit the patient. This patient-centric, forward-thinking culture will prepare the next generation of optometrists, PAs and pharmacists for the new health care landscape that streamlines care and looks at the whole patient.

“We’re detectives that put pieces of puzzles together,” Dr. Kwan says. “We do a powerful thing here at Ketchum in terms of our patient care.”


With her experience of 39 years in researching cancer and palliative care, Dr. Ferrell has seen the power of interprofessional training and practice for the benefit of patients and families.

“Ketchum’s commitment to quality of life is the same as ours,” she says. “When we care for the human being and the family, bringing together the PAs, pharmacists and optometrists, it is a different kind of health care and it is the future.”