Comparative Toxicity of Preservatives in Ophthalmic Solutions

[clairvoyant]

All steroids reduce healing (just like antibiotics) increasing BAK nocivity. Did you mean inflammation? vascularisation?

Anyway, potent steroids have side-effect too so If you use potent steroid to control BAK side-effects that's not going to be very effective. Single use vials would be better serve you

But of course, what do you think BAK does? It would cause inflammation. Steroids would more than negate the BAK, even the dilute lotemax. Steroids do not reduce healing though lol they are the best medicine for inflammatory problems most of the time but like you said they carry side effects so doctors tend to use them spariningly. Sometimes stuff can come back stronger after steroids but this can happen with ANY medicine. So if you have chronic inflammation you will need some type of suppression. And if you would rather your site regress to a worse prescription caused by the dry eye then go right ahead.

On the same accord the side effects from steroids very from person to person and are probably not as bad as people make them out to be. You gotta think a lot of people with these different diseases are required to take high amounts of oral steroids for life.

I will look for that article per your post.

Have you ever had a conversation with a dry eye expert about this?

[stella]

We have to ask why the large "watch dogs" of the ophthalmic /medical world ,like the BMA in GB and AMA in USA have not banned BAK ?

There must not be enough evidence of damage for them to have let it remain on the market

They have been known to take harmful drugs off the market -- for example some NSAIDS such as Vioxx have been boycotted 'cos of harm to the heart i believe

Is there any watchdog in Europe or the USA that have concerns about BAK and if not why not ?

[Toril]

Hello, everyone!

Just wanted to share my experience with BAK. I have very dry eyes due to autoimmune disease, and I've also got allergies to pollen, dust, etc. When I started my treatment with a dry eye specialist, he started me on 1 drop a day with Vexol (steroid with BAK....the doctor would have prescribed me Vexol without preservatives if it was available, as he's agaist the use of preservatives).

He wanted me to try steroids to see if my eye inflammation got reduced by it, and yes, it did. The first 2 days my eyes felt better than in a long time. Then gradually...after 2 weeks or so, my eyes got more and more irritated, they were again as inflamed as before, and in addition to it, they got so sensitive I was hardly able to keep them open.

After 1 month I had no choice but quit the Vexol, and and after 1 week or so, my eyes were back to "normal bad." The healing effect that I experienced the first days were "beaten" by the effects of BAK. BAK affects the lipids in the tearfilm, and for me, as I have a very low TBUT, it made my eyes more sensitive and painful than before I started the treatment.

So...how you react to BAK, and how fast you react, well, that's very individual.


Toril

[Z351]

Truthfully I do not know as much as an expert in the subject would but I do know it is not as bad as people on this site are makeing it out be.

What that means is that I am not sure if the more you use it, the more you will become sensitive to it. That is the only part I am not sure about.

As far as proof well I could search pub med for hours and find that article but I already looked for like 30 mins and could not find it. I do know though that I have read an article that said as long you use less than 4 drops a day you are ok. They might have gave a concentration too but I don't remember that, I just remember coming away from that article knowing not to go over 4 drops a day.

The other proof I have, that I can't prove, is that I have been to a number of good doctors, including leading authorities on dry eye and 2 of them seem to feel BAK in these situations are OK.

At the same time they have also said preservitive free stuff is better. So I think it is a matter of if you can get the drop perservitive free than that is probably preffered but if you can't it probably doesn't matter in the grand scheme of things. And if a knowledgable doctor gives you such a drop he probably has you on other things to negate the damage. Now an unknowledgable doctor is a different story..

Hope that helps

Many impressions. Nothing supported.
Even the DEWS report recognizes this as a major problem...
Even Allergan and Alcon have recognised the problem...check their letters
Make your own opinion by reading relevant research on this matter:
http://preservative.free.fr/

If you find such an independent study indicating 3 drops a day is fine, please let us know

[Z351]

Think about it, if you use BAK in a potent steroid you don't think that steroid will more than heal the damage caused by the BAK?

All steroids reduce healing (just like antibiotics) increasing BAK nocivity. Did you mean inflammation? vascularisation?

Anyway, potent steroids have side-effect too so If you use potent steroid to control BAK side-effects that's not going to be very effective. Single use vials would be better serve you

[clairvoyant]

MGD:

Could you please cite your references or cite a link to a professional study or opinion to support this? I don't mean to be picky here, but I am concerned that someone could interpret this as medical advice.

Scout

No, not at all. I completely understand. There are so many abstracts and things on this site that say BAK is a no no.

Truthfully I do not know as much as an expert in the subject would but I do know it is not as bad as people on this site are makeing it out be.

What that means is that I am not sure if the more you use it, the more you will become sensitive to it. That is the only part I am not sure about.

As far as proof well I could search pub med for hours and find that article but I already looked for like 30 mins and could not find it. I do know though that I have read an article that said as long you use less than 4 drops a day you are ok. They might have gave a concentration too but I don't remember that, I just remember coming away from that article knowing not to go over 4 drops a day.

The other proof I have, that I can't prove, is that I have been to a number of good doctors, including leading authorities on dry eye and 2 of them seem to feel BAK in these situations are OK.

At the same time they have also said preservitive free stuff is better. So I think it is a matter of if you can get the drop perservitive free than that is probably preffered but if you can't it probably doesn't matter in the grand scheme of things. And if a knowledgable doctor gives you such a drop he probably has you on other things to negate the damage. Now an unknowledgable doctor is a different story..

Hope that helps

[clairvoyant]

Think about it, if you use BAK in a potent steroid you don't think that steroid will more than heal the damage caused by the BAK?

[stella]

Well said Mary ---

Dr Holly's drops are my lifeline and as you rightly say it comes down to a matter of trust.
The fact is that there are quite a lot of us on this site who have found Dr Holly's drops to be the only ones which make a significant difference and i suppose the last thing we want to hear is that the preservatives he uses will harm our eyes
Dr Holly obviously thinks otherwise ---
So you either believe him or not

[mary kenny badami]

I'm adding some comments especially for Stella -- as well as other users of "Dr. Holly's drops":

Yes, I did sign the anti-preservatives petition, as well as making several posts here urging others to consider doing likewise.
Well, I subsequently received private correspondence from someone following these matters who supports the petition initiative,
but wonders why I continue to acknowledge that I use Dakrina and NutraTear daily. Below I reproduce an edited version of my replies.

============================
As for my opinion on preservatives: 
simply as a non-doc, as a layperson/ patient, I am convinced that preservatives are trouble for healthy eyes, and potential poison for damaged eyes.

BIG EXCEPTION: I exclude the materials in "Dr. Holly's Drops" from that statement. 
Dr. Holly is, was, and I expect always will be my hero.

To answer your question about why I make exceptions for "Dr. Holly's drops":
for me, as a non-scientist, I struggle through the scientific and medical citations, 
but at some point I'm simply going on faith in Dr. Holly, as well as my own trial-and-error.
Dakrina and NutraTear were the only, only, drops ever to bring relief to my post-Lasik (also post-menopausal, and having been previously diagnosed) dry eyes. 
And believe me, I was one of the most skeptical of skeptics when he started posting over on SurgicalEyes.
It was only after my trusted online buddy Tron/Ethel posted regularly in her "Dwelle Diary" about the relief she'd getting, that I reluctantly gave them a try.

============================
Let me add that I think that "indrep's" comment earlier on this thread is brilliant:

A presentation at ARVO stated similar findings. The excuse docs give for not being more forceful with patients is: "patient wants the cheapest eye drop." I think patients deserve to know what's bad for their eyes. then if they choose they can continue to use a product that doesn't help. But the doctor should inform the patient.

Amen to that, indrep, amen! . . . In which case, I CHOOSE "Dr. Holly's Drops." < insert smiley-face here >

[Scout]

I use to think bak was bad too.

I was just as paranoid as you but truthfully it is not that bad as advertised. Those other preservatives are bad too but as long as you limit your use to say 3 a day you should be fine.

MGD:

Could you please cite your references or cite a link to a professional study or opinion to support this? I don't mean to be picky here, but I am concerned that someone could interpret this as medical advice.

Scout

[stella]

I accept your explanation and reasoning

I have already signed the petition to get rid of preservatives in eye drops and do hope it will put pressure on the drug companies concerned
Keep up the good work
Stella

[Z351]

Z 351
As a dedicated member of Keratos , i appreciate that your prime concern is a campaign to get rid of ALL preservatives in eye drops -- and that would help us all on this site , however i do think you should be careful not to alarm those of us who are very vulnerable 'cos of our DES over issues we do not properly understand because we are not scientists in this field
After all it is not as though we have any choice in many instances -----
In my case if Dr Holly's drops were to come on the market unpreserved - of course i would rather use those - until that happens i have no choice but to use the preserved drops, and hope and pray they will do no damage

MGD: you don't know how someone else's cornea really is... so how can you be sure it'll be fine using BAK 3 times a day?

Stella: My ONLY purpose is to inform everyone and find a way to have non-preserved options for all of us. I have nothing to gain from alarming for the sake of alarming but there's a thin line between sharing what worries you because of what you read about it and possibly alarming people as a side-effect; Besides, Is not knowing something so reassuring?

Consider my posts as general considerations on this issue and avoid reading them if need be, but I feel these opinions have the right to be expressed in such a forum, don't they?
I never told anyone to change his treatment, nor indicated anyone what do to (use this, this is fine and this isn't).

[stella]

Z 351
As a dedicated member of Keratos , i appreciate that your prime concern is a campaign to get rid of ALL preservatives in eye drops -- and that would help us all on this site , however i do think you should be careful not to alarm those of us who are very vulnerable 'cos of our DES over issues we do not properly understand because we are not scientists in this field
After all it is not as though we have any choice in many instances -----
In my case if Dr Holly's drops were to come on the market unpreserved - of course i would rather use those - until that happens i have no choice but to use the preserved drops, and hope and pray they will do no damage

[clairvoyant]

I use to think bak was bad too.

I was just as paranoid as you but truthfully it is not as bad as advertised. Those other preservatives are bad too but as long as you limit your use to say 3 a day you should be fine.

[Z351]

Additional info

Hi Stella if you want to perfect your knowledge on preservative synomyms, here's a page for you, but Cindy's right:

http://preservative.free.fr/English/...n-eyedrops.htm

I asked the guy who knows more about this within Keratos, and he told me that:
- regarding the 4 daily dose even the industry "sends conflicting messages, have a look at the comparative study done by Allergan after seven days of use: http://preservative.free.fr/Images/N...comparison.jpg. Obviously damage is proportionnal to dosage, frequency and individual factors but it starts with the first drop.".

I you want to look for yourself, there are also listed studies on EDTA on the same site but there are "no studies on polexitonium to support innocuity or eventual danger".

On EDTA, a researcher, Dr Dhouailly, that support Keratos and the ban has sent us "a letter regarding her experience with EDTA but the English letter was not uploaded yet. I'll keep you posted."

As a friend of mine usually says: "with dry eyes, either you become your own expert or miraculasly get better... or you're *******".

My advice is then become the expert