any RN's here

[DrG]

I was merely suggesting an exchange of services, nothing more. Dr. G, do you have some sort of reputation or something?!

You mean in return for letting untkicker observe, he gets to administer a kick to me, or I get to administer a kick to him??!!

[dianat]

Hey, doc, whatever does it for you...

[dryeyes2]

one more question about contacts for Dr. G

I wonder about why RGP were more comfortable too. What I am wondering about is how do people with dry eye actually tolerate these lenses even if they are just for bandage purposes? If I already have contact lens intolerance a few years ago (the RGP) and my eyes are worse now, it seems like I would never be able to tolerate any kind ever again. Are any of these patients on Restasis too?

[DrG]

I wonder about why RGP were more comfortable too. What I am wondering about is how do people with dry eye actually tolerate these lenses even if they are just for bandage purposes? If I already have contact lens intolerance a few years ago (the RGP) and my eyes are worse now, it seems like I would never be able to tolerate any kind ever again. Are any of these patients on Restasis too?

These patients do not respond to Restasis nor plugs. They describe their discomfort as intolerable. They have been through acute myelogenous leukemia, a marrow transplant, and the subsequent widespread effects of severe autoimmune disease that leaves their corneas severely damaged. They frequently have ulcers.

The first GVH patient I ever treated came in wearing tight fitting swim goggles. Upon removal, he was dosing himself with eyedrops every 5 minutes. The effects of the bandage lenses were immediate, and to him quite miraculous. At 6 months, he was wearing the lenses 24/7, and his eyedrop usage is only several times/day.

I guess you have to compare your situation to that.

[dryeyes2]

Toric Lenses

That is amazing that the lenses helped him. My situation is not to the extreme as the patient you described, however, it is very severe and I am concerned that if the Restasis doesn't help, I am not sure what I am going to do.

I looked up those lenses online and they would not work for me because I have an astigmatism and my rx is -13.50 in my right eye for glasses, so I would have to use toric lenses. Would those be able to serve the same purpose or is the material completely different?

Do you know why more opthamologists don't use this approach to helping with dry eye? My optometrist didn't mention it either.

I really appreciate your help.

[DrG]

Dryeyes, whether you would need a toric lens depends on the amount of astigmatism, which you did not state. Generally, for one diopter or less, a spherical lens will work as well. Although Focus N&D does not go high enough in the power range for you, the Acuvue Oasys and Advance do (-12). Those are all silicone-hydrogel lenses, although with higher water content.

Even though you regard your eyes as being very dry, if there is not visible damage to the cornea, I doubt that bandage lenses will do very much for you. However, given that trial lenses cost absolutely nothing, it couldn't hurt to try.

As others have mentioned, treating dry eye is anything but a simple straightforward formula. Ophthalmologists as a rule do not receive much training in contact lenses, and typically relegate that kind of work to an optometrist, optician, or technician. The professions are inclined to think of medical therapies, and tend to go first for the plugs and the Restasis. However, when I see exposure ulcers and surface damage, I go first for the bandage contact lens. Naturally, if there is any infection present, contact lenses are contraindicated.

[dryeyes2]

Corneal abrasions

When I first went to see my opthamologist about this I did have corneal abrasions. I do feel that I get them if I am not very careful. I have been wearing non-prescription wrap-around sunglasses (without my glasses) when I go for a walk with my husband because they block more air than fitovers. However, last night even after dosing myself with gel before walking out the door, my right eye in particular feels like I might have an abrasion. This morning it is still bothering me. I also had a detached retina many years ago and they put a scleral buckle on that eye. It tends to be more sensitive to pain. Lately, I have been wearing safety goggles around the house with bits of wet cotton inside them to provide moisture because air conditioning is really difficult to deal with.

I am not sure which measurement shows astigmatism, but my right eye is cyl -.50 and Axis 102. My left eye is -10.00, cyl -1.25 and Axis 155.

Can a patient use Restasis at the same time as using bandage lenses?

Thanks again!

[DrG]

The astigmatism(cylinder) is insignificant for one eye, and low in the other. With two eyes, you probably won't notice it.

You can't use Restasis with the contacts, but you can instill the Restasis at night. You would probably have to skip the morning dose.

[dryeyes2]

Thank you

Dr. G,

I truly appreciate your help. It gives me another avenue to pursue.

dryeyes2

[DrG]

I truly appreciate your help.

One never gets tired of hearing that. This fall it will be 8 years since I started doing this internet stuff.