2 days with Dakrina/Dwelle/NutraTear

[dryeyeguy]

Just a two day update since iuhave been trying these. Dakrina intial sting going away, but still for a second or two, hard to tell if it is working better than systane or refresh I was using. I notice after the stinging more red eyes that subsudes quickly and then they seem to maybe be a bit clearer than usual, hard to say.

Dwelle stings more and is not getting me through the night, I still find my refresh liquigel the best but I am hopeful.

The red nutra tear I like a lot. They are mild and seem to provide nice quick relief.

[Rebecca Petris]

Thanks for the update... keep us posted. - For some people the sting from Dwelle/Dakrina subsides after a few days of use, for others there is often a bring sting on instillation. It has a lot to do with the surface condition. One tip that others here have mention, and which I've found useful myself - especially in the morning when my eyes are at their 'rawest' - is to do a bit of an eye rinse with Unisol (or similar) about 15 minutes before putting the drops in.

Dwelle & Dakrina technically are the best of the three for severe dry eye but not infrequently somebody with bad chronic dry eye prefers NutraTear. That's definitely my favorite for daytime use too. Feels good and lasts longer than other 'thin' drops.

[dryeyeguy]

Rebecca,

What is the theory as to why these drope may be "better" than others. Is it a less harsh preservative or some other aspect?

[Rebecca Petris]

Well, I'm hopelessly un-technical but I'll try....

It's basically a question of wetting* and high oncotic pressure (unique to all of Dr. Holly's drops including FreshKote which is essentially Dwelle plus a special patented lipid-containing ingredient.) The 3-polymer blend adheres fully to the epithelial surface. The high oncotic pressure helps compact the layers of the epithelium to promote healing.

* About wetting: Years ago Cindy came up with a simple way to visualize what this means. We took a plastic plate and put on it, spaced about 1/2" apart, a drop of Dwelle, a drop of Dakrina, and a drop of other leading drops (TheraTears, Refresh, Refresh Liquigel, Systane, etc.). Then we tipped up the plate. As they each ran down, as you might expect some moved faster and others moved slower depending on their viscosity. However, all the 'other' drops sooner or later broke up into 'beads' - very round little droplets whose edges were practically perpendicular to the surface - and some practically disappeared once they had run off. Dwelle and Dakrina, despite not being viscous, left a solid trail behind them that did not break up. Even if I moved my finger back and forth through them (i.e. mimicking the action of the eyelids over the eye surface) they hung on for dear life. - Anyway, the 'visual' helped me understand why these drops, adhering the way they do even to the dry spots, can be somewhat uncomfortable initially but ultimately are more helpful at least to many of us.

About the preservative - I honestly don't know. I would like it to be studied but don't have the ability to get that done myself right now. As a minimum though I'd say that having an unusually 'kind' preservative definitely helps because then you don't get the effect of preservative side effects out-shouting lubricant effectiveness. - Separately, I've been told that the preserved version of these drops is thought to actually be more effective than the same drop without any preservative but, absent data to prove this, I just can't say.

[dryeyeguy]

Very interesting, thanks.

[neil0502]

Separately, I've been told that the preserved version of these drops is thought to actually be more effective than the same drop without any preservative but, absent data to prove this, I just can't say.

The only explanation that I've ever seen that seems to support this theory is the fact that most preservatives tend to increase the permeability of the cornea. In other words, they make it easier for substances to pass through. This is something akin to poking millions of tiny holes in the corneal surface and--in itself--is a known characteristic of dry eye syndrome.

While increased corneal permeability can be construed as a relatively helpful side effect if the drug in question is an antibiotic, anti-viral, or antifungal drop prescribed to treat an infection and used only for short term, I've never seen this issue (increased corneal permeability) described as a net positive ... in any way ... for improving the state of ocular surface disease.

In other words: increased corneal permeability is actually a feature of dry eyes (they become more porous ... like a sponge). In itself, this tends to worsen the condition.

TIME FOR MY DISCLOSURE: I have refrained ... since my initial participation on the DEZ ... from making any comments about Rebecca's drops out of the deepest respect for what she is doing here, but ... after much consideration, I can no longer--in good conscience--"give them a pass."

We're all trying to get better here. We can do that through good information, or--absent that good information--we can do that through discussions of what science tells us, coupled with individual decisions that we all must make (in conjunction with our eye docs).

I have never seen any evidence that any preservative is "harmless" to the eye. The analogy I use is this: I have a spoonful of Drano. Would you eat it? No? If I put it in 8 ounces of water, would you drink it? No? If I put it in 128 ounces of water, would you drink it? No? What about if I put it in a 55 gallon drum of water, and chilled that drum in the refrigerator first. Would you drink it then??

If not, then consider that this is how I (and some others) view preservatives. They may be diluted. They may have soothing emollients alongside of them. But the underlying preservative that fights off contamination seems to always hurt the surface of our eye to some degree. If you're risk-averse this way (like I am), then you probably want to avoid any preserved lubricating drop, especially if you have any kind of corneal defects, if you're plugged or cauterized, or if you are using the products at night (increased time on the eye)

Just my $0.02. Your mileage may vary. Not stated as fact, etc., etc., etc.


Best,
Neil

[Rebecca Petris]

Dear DryEyeGuy:

I am sorry that your post about the drops had to be diverted to a chapter of a local dispute of sort.

Dear Neil:

I have the greatest sympathy for what you have gone through, and for the reasons why you are campaigning against all preservatives based on your experience with BAK and your research on certain other preservatives. At the very time you were posting your message above, I was on the phone with a woman in Florida who is suffering debilitating symptoms in one eye which from all the evidence seems to date from when she started using topical medications containing BAK. She described telling her doctor she was sure that that was what caused it because she never had dry eye before going on the BAK-preserved steroids and he never accepted it as a possible explanation.

Clearly, we badly need to raise awareness, about BAK and about a great many more issues related to dry eye, and people with passion are the best ones at doing that. So knowing what you're going through and why you're doing what you're doing, it makes me very sorry to have to publicly oppose you. But you and Kakinda have taken things to an extreme and in a manner that I'm sure you know leaves me little choice. (I've poured a huge amount of time, effort, money and risk into keeping Dr. Holly's drops on the market because of all the people who have manifestly benefitted greatly from them over the years and who would otherwise be left high and dry. I have nothing to hide about the drops, and I would never, ever recommend them to anyone against their doctor’s advice. Every day I get emotional testimonials from people over the phone about how much they have been helped. I’m not going to be intimidated into dropping something that I know has done so many people so much good. I have never, ever made any unreasonable claims about their benefits, or about how many people are likely to benefit from them; I've been accused of failing to make enough people aware of them - but never of over-promoting them; nor has anyone, anywhere ever had reason to suggest the specific preservative in them is harmful. So you cannot reasonably expect me to sit idly by while a campaign is launched against them on my own bulletin board.) I had invited both of you to speak with me so that we can get our views out on the table and try and find more common ground, and I am disappointed that neither of you has been willing to do so. I think real talk is the only thing that could restore trust here. I sure know email won't do it.

So here's the bottom line:

This bulletin board is, first and foremost, an online support group.

It is NOT to be used as a platform for a campaign, yours or anyone else's, of any kind, no matter how ardently you believe in the campaign, and no matter whether I personally support or oppose part or all of the campaign. It's just not the purpose of the board and I will not accept seeing it used as such.

Bulletin boards are skittish things. Comfort and trust in the community are deeply important to me. Many of us have seen, or experienced, boards where one confident, authoritative voice - even if essentially well-meaning - can break that down, by making people afraid to speak up with their real opinions if there is always someone there to talk them down, or real questions if they’re afraid they’ll effectively get ‘scolded’ for what they’re doing. I even have to watch myself on that count, trying hard to make sure I'm not becoming such a 'broken record' on some topics. So I have a keen nose for dominant voices and the effect they’re having.

It has always been a basic principle with me to keep board moderation matters confidential wherever possible. However, sometimes transparency is more important. Therefore, I will state the following: Contrary to various private allegations, I in no way restricted Neil's or Kakinda's access to the bulletin board after their recent "departure" notices. More recently, however, I suspended Kakinda due to complaints from members about unsolicited, inappropriate emails. I am also as of today, with deep regret, suspending Neil, until and unless we can come to an understanding about appropriate use of this board. You have done so much good here that this goes sorely against the grain with me. I would sincerely like to work things out in such a way that DEZ or some part of it can collaborate with you on preservative awareness. But that will only happen with real dialogue, as opposed to electronic communications.

I wish you both the very best in your efforts and on my end, I will continue warning people about BAK and cautioning them about the use of preservatives in general. I hope we can continue respecting each others’ work even if we have to do so from a distance for now.

[calli66]

About wetting: ....We took a plastic plate and put on it, spaced about 1/2" apart, a drop of Dwelle, a drop of Dakrina, and a drop of other leading drops (TheraTears, Refresh, Refresh Liquigel, Systane, etc.).

Just wanted to comment that I appreciated your description and "tests" of the drops. I have always kept my original "samples" of Dwelle and Dakrina, and your test made me want to try them again--it gave me a better understanding of their qualities.

I find that I CAN use Nutratear now, when I really couldn't at first (over a year ago). I put it in after removing my contacts and it seems to "last" 4-5 hours. I just tried Dakrina again, and it burned a bit--and I still couldn't get past that feeling in my eye that it sort of "clumps up" --feels like a foreign body--uncomfortable. But it happened with only one eye; the other felt OK.

Haven't tried Dwelle again---maybe 6 months from now!

C66