Restasis and post-lasik

Hi,
I know many people say Restasis isn't for post-lasik dry eyes, but my
case is a little different.
I had mildly dry eyes before my Lasik 1 1/2 years ago. My Dr. put
some lower punctal plugs in.
My eyes have been fine during the day - my problem is at night.
Every night for the past year and a half, I've woken up at least once
because of the gritty, tight feeling in my eyes. I put some Refresh
Plus drops in and go back to sleep. And usually, I put some drops in
first thing in the morning, and I'm good for the rest of the day.

My lasik Dr. kept telling me that the dry eyes would go away. Well,
they didn't, so on my last visit 4 days ago, he prescribed Restasis
for me.

I started using the drops - once in the morning, and once at night.
Last night, I had some pretty bad burning in my eyes - to the point
that it kept me up for a little while. And my normal Refresh Plus
drops didn't seem to do the trick.

I was a little scared so I hit the internet and did some researching.
I found out several things.
-Restasis just came out in April, 2003
- burning is a common side effect
- it can take weeks / months to notice any difference
- it has no effect for those with punctal plugs
- One site even said that the plugs are bad because they prevent the
medicine from flushing the t-cells (or whatever) out of your eyes.

Since I have plugs, I was concerned and called the Dr. I informed him
of what I read, and he said that the burning is normal and that its
okay to have the plugs in.

So, finally, my questions are:
Why would I only be having problems at night?
and
Why would my Dr. say its okay to have the plugs in when the drug
literature specifically says:
"Increased tear production was not seen in patients currently taking
topical anti-inflammatory drugs or using punctal plugs"

I can't find the 'reason' why this is, so I can't really tell the
doctor that he's wrong.

-Marc

 

Maybe you are sleeping with your eyes slightly open. Do you have a
humidifier in your bedroom? I've been using one the past week and it
has made an enormous difference in the mornings (not feeling dry in
general eyes, nose, throat, sinuses).

Perhaps your Doc doesn't have any other suggestions and hopes that it
will work for you despite what the literature says. Or your doc has had
another patient like you for whom it has worked.

I find many doctors prescribe drugs for their patients because in
general patients feel better if they go to the doctor and come away with
a prescription in their hands rather than nothing. Also, it helps
protect the doctor who can say--well, we tried everything!

If I really feel that it won't help my case, then I don't fill the
precription and then get a second opinion. You don't have to do what
your doctor says. It's a good thing you are asking around. Good luck!

 

It seems obvious that you open your eyes slightly during sleep. Two
suggestions would be to use a moisturizing gel like GenTeal before
going to bed. RT has already suggested a humidifier in your bedroom.
We have a detailed article on dry eye treatment at
http://www.complicatedeyes.org/dry_eye_treatment.htm.

LASIK induced dry eye normally is resolved within the six-month
healing period, but not always. You had pre-existing dry eye and it
will be difficult to know how much was caused by LASIK and how much
was natural. The only reason this would be valuable to know is
because the LASIK induced dry eye will probably eventually be resolved
with long-term healing. The natural dry eye is a different story.
Also, LASIK induced dry eye is normally caused by disrupting the
nerves in the cornea, so the treatment would be different than with
naturally occurring dry eye, which is often caused by gland disorder
or inflammation.

Restasis is a cyclosporine ophthalmic emulsion that works as an
anti-inflammatory for people with naturally occurring dry eye. The
idea is that due to inflammation, the glands and channels that secret
the mucin, aqueous, and lipids for the tear film are restricted.

One must use Restasis for at least three months to gain any effect,
and six months is what the manufacturer recommends. So you will be
putting in burning eye drops for months before you will know if they
are actually working.

It is okay to leave the plugs in, but the manufacturer recommends the
plugs be removed. Of course, that is a Catch 22. You need the plugs
to retain the tear film, but you need them removed to get the full
effect of the medication.

I suggest that you have the plugs removed and see how bad your dry eye
is without them. If it is intolerable, insert plugs in the top
eyelids first and see how that does. If you still have problems,
insert plugs in the bottom lids and remove the top plugs.

IMO, the reason increased tear production was not seen in patients
using plugs is because the plugs had already increased the amount of
tears on the eyes by reducing or eliminating outward flow, not because
of a biochemical incomparability.

The doctor is not necessarily "wrong", but is not necessarily "right"
either. The only way to know what is going to work best for you is to
remove the plugs and determine how problematic you dry eye is until
the Restasis takes effect. Considering that it takes three to six
months for the drug to work, that puts you in a bit of a quandary.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www.USAeyes.org
http://www.ComplicatedEyes.org
glenn dot hagele at usaeyes dot org

I am not a doctor.

 

Dear friend, you have been cheated in the first place, now you regret.

You deserve to suffer because if you were more intelligent you could
have avoided the lasik and all that nonsense.

--
Please visit
http://www.stores.ebay.it/juppiterconsultingrishi
and you can buy a replica of the Original Dr. Bates book
"Perfect Sight Without Glasses"
and if you are interested, join the group
http://health.groups.yahoo.com/group/PerfectSight/

 

Good suggestion, but a sound body won't need any external device to stay
well.

"Despite what the literature says" is an interesting statements the
scientific people may comment about here.

Wow! Nice! It seems you grasped it!!!

Good luck!!!

--
Please visit
http://www.stores.ebay.it/juppiterconsultingrishi
and you can buy a replica of the Original Dr. Bates book
"Perfect Sight Without Glasses"
and if you are interested, join the group
http://health.groups.yahoo.com/group/PerfectSight/

 

No one deserves to suffer. The patient had preexisting dry eye
problems. LASIK may have exacerabated the problem, but it was there
before the elective surgery.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www.USAeyes.org
http://www.ComplicatedEyes.org
glenn dot hagele at usaeyes dot org

I am not a doctor.

 

Now what to do?

 

I posted some ideas directly to the patient in this thread.

Glenn Hagele
Executive Director
Council for Refractive Surgery Quality Assurance
http://www.USAeyes.org
http://www.ComplicatedEyes.org
glenn dot hagele at usaeyes dot org

I am not a doctor.

 

I wish you had better distinguised between the temporary dryness - dry
eyes following LASIK and the serious condition known as "dry eye"
which can benefit from Restasis. Dry eyes and "dry eye" are totally
different. Lasik does not induce dry eye.

Here's a new idea... for people who live in arid climates, how about a
room humidifier? I used to have one when I raised parrots. I had
millet grass growing in my carpeting.

 

Some doctors over-use plugs. Perhaps the corneal specialist was one of
those who never saw an eye he couldn't plug. There are so many kinds of
dry eye, and yet only a few effective treatments.

DrG
The reason Restasis shows no effect on patients with punctal plugs is
because the plugs themselves are a treatment for dry eye, and their
presence simply confounds or masks the effect of the Restasis during the
trial. It also may be the case some patients who are still very dry after
plugs may also be resistant to any other treatment. It is also the case
that plugs keep the medication in the eye longer, thus increasing the
effects, including side effects.

DrG

 

Dear Mr. Hagele,
recently in Italy they broadcasted a program about lasik etcetera with
several doen of patient very very angry at the outcome of their own
operations with the dirty machine.

At the end of the program, one very very angry man finally told how he
could find some relief.

He went to an optician who built a contact lense, but all BLACK, opaque,
with a small hole at the center.

Just a stenopeic hole.

The man now can get well with his post-surgery problems with lasik.

No doctor was able to make this great breakthrough.

We wonder why.

 

Wow... I deserve to suffer. Hatred really becomes you. Can I be your friend?

To everyone else with something useful to say, thanks for the tips.
You are correct, I believe my eyes are slightly open at night.
The nighttime ointments make my eyes feel 'strained' when I wake up.
I will try the humidifier and the flax seed oil.

 

Yes, you should understand to the very core what was your stupidity.

Only if you touch the very bottom can start, or at least hope to start,
to go up again.

Why the docs did not tell you this before?


--
Please visit
http://www.stores.ebay.it/juppiterconsultingrishi
and you can buy a replica of the Original Dr. Bates book
"Perfect Sight Without Glasses"
and if you are interested, join the group
http://health.groups.yahoo.com/group/PerfectSight/

 

Marc,

I've got pretty severe dry eyes (among other eye issues). All four of
my puncta are plugged. I've been on Restasis for about six months. I
periodically sleep in those (oh, so stylish) moisture goggles. I use
Systane periodically throughout the day (with some apparent benefit),
and I take the flax seed oil regularly.

In addition, I use the GenTeal eye _gel_ at night (which seems to
help). I also started using this product two weeks ago:

ttp://www.naturestears.com/nt_new.html

I have absolutely no economic interest in this company, but their
product is a small aerosol-type spray can with "tissue-culture grade
medical water" in it. You spray it at your face with open eyes. It
offers pretty good short-term relief at a fairly moderate price.

When I talked with my ophthalmologist about Allergan's disclaimer,
"Increased tear production was not seen in patients currently taking
topical anti-inflammatory drugs or using punctal plugs," his
assumption was that Allergan may not have performed any testing with
people who have punctal plugs; therefore, they might have been
obligated to state that the efficacy of its product had _not_ been
proven in their case. Sounded plausible to me.

(Forgive me here) The other thing that I began to see in literature
was the Eastern philosophy that subtle liver issues can exacerbate dry
eyes or other ocular symptoms. The 'remedies' to these conditions
made inherent sense to me: eliminate unnecessary prescription drugs,
cut down on caffeine, alcohol, fried or fatty foods, and drink plenty
of water and decaffeinated herbal tea. What I can say is, in my case,
my eyes feel a great deal better when I stay pretty closely to these
dietary recommendations.

Best of luck in your pursuit,

Neil

 

What i find strange in this message, referring to Eastern thought, is
that you Americans had the great luck of having given birth to Dr. Bates
who had a knack of that sort of Eastern thought and was able to
translate it in scientifical terms and help millions to cure their
eyes... And you simply discarded him!

 

I wasn't aware that Bates helped anybody in a significant manner. He
may have been a brilliant man, but his ideas and techniques are VERY
obsolete. He would be considered a quack today. He did the best he
could for his time. I believe he was the first person to try and
gather a meaningful database of the visual acuity of the general
population. Why don't you get with it and advance 200 years with the
rest of the world?

And as for eastern thought. Just what has eastern thought contributed
to the modern world? Not much I'm afraid.

 

You sound like you are doing a good job dealing with your dry eyes. I
assume that since you are on Restasis that you never had refractive
surgery. Restasis does nothing for the temporary dryness which often
follows LASIK.

Also, plugging the upper puncta is a waste of time. Stick with
plugging the bottom puncta.

 

You aren't aware of many things, first of all that your beliefs stick
still now to 400 hundred years ago!

What is the modern world?
It is composed of the same old idiots, I understand.
You may have a big SUV, but in the end you are very much an idiot,
waring glasses and all the rest of idiotic things you are well
accustomed to!!!

--
Please visit
http://www.stores.ebay.it/juppiterconsultingrishi
and you can buy a replica of the Original Dr. Bates book
"Perfect Sight Without Glasses"
and if you are interested, join the group
http://health.groups.yahoo.com/group/PerfectSight/

 

I don't thing the anti-lasik nuts would even recommend the very old
and obsolete and ineffective Bates method.

I have no need to wear glasses nor contacts after my LASIK surgery -
which is the subject of this newgroup.

 

What is really astonishing is that you BELIEVE that a LASIK operation
has solved your problem!!!

--
Please visit
http://www.stores.ebay.it/juppiterconsultingrishi
and you can buy a replica of the Original Dr. Bates book
"Perfect Sight Without Glasses"
and if you are interested, join the group
http://health.groups.yahoo.com/group/PerfectSight/