Milton Hom, O.D., F.A.A.O.: We have been diagnosing a lot of demodex this year. I think it’s due to my lack of awareness in past years, as opposed to a greater prevalence. I used to think it was a rare occurrence, but that was before I learned to look for it. Now, it seems everyone has it.

Ben Gaddie, O.D., F.A.A.O.: Just like the nirvana of awareness that settled on me 10 years ago with MGD and blepharitis, this infestation phenomenon has me simply amazed. I tried to ignore my colleague’s enthusiasm for identifying and treating this microorganism akin to lice. Thanks to the excellent work of Milton and Katherine Mastrota, O.D., we have an easy and novel way to clinically diagnose these critters.¹ The technique of using a cylindrical cuff to circularly “grind” the eyelash follicle makes it easy to find demodex and demonstrate it to patients. I’ve been amazed at how many MGD/blepharitis patients, who have been recalcitrant to treatment with steroids and antibiotics, actually have demodex infestation.

M.H.: Here is my story. It all started on a bike ride. By chance, I saw Scott Schachter, O.D., from Pismo Beach, Calif., on the ride. He told me all about demodex (it’s a long ride). When he told me he saw at least one case a day, I almost fell off my bike. Prior to this, I thought demodex was rare and like lice — was I ever wrong. With Scott’s mentoring, I got a microscope and epilated. I went through angst, because I realized I had been misdiagnosing ocular surface disease all these years. At times, I would bury my head in my hands wishing I never learned about the mite. But, it changed the way I practice and unlocked many mysteries for me, and my patients have surely benefited. Its like a veil has been lifted from my eyes. I’ll never go back to how I practiced before.

In addition, I enjoyed sending video of live, moving mites to my friends and colleagues in the early days. Just ask Kirk Smick, O.D., and Leonard Bielory, M.D., how many nightmares I caused them.

M.H.: I liken the whole event to a scene out of The Matrix. Morpheus tells Neo to take either the blue pill or the red pill. The blue pill returns Neo back to the fabricated reality in which he now lives (or, a life without mites.) The red pill opens your eyes to the real truth. Ben, you have taken the red pill. OM