Alternating artificial tears, for bicarb, zinc, matrix, and hypotonicity

[Rojzen]

Was wondering whether anyone has tried a regimen that alternates different artificial tear products over the course of the day in order to ensure the application of a particular set of ingredients not present in any single product. . .

For example:

Bion Tears and Thera Tears PF appear to be the only PF drops that include sodium bicarbonate, which has been associated with corneal healing. . .

Systane PF and Bion Tears appear to be the only PF drops that include zinc chloride, also associated with corneal healing. . .

Systane has the guar gum that is touted for its ability to hold corneal tissue together in a matrix, to promote healing. . .(Dr. Holly's drops have a similar property, I think, but are not yet available in PF.)

Thera Tears appears to be the only hypotonic product that can be gotten in preservative-free vials. . .(Dr. Holly's drops and HypoTears are also hypotonic, but not or no longer available in PF.)

I've seen some writing about using the right combo. of these, spacing applications of different brand drops by about 5 minutes, for each combo. dose. . .

It looks like Systane PF and Thera Tears PF would be the least common dominator, in this analysis. . .and I'm thinking that since the Liquid Gel version of Thera Tears is touted as holding the "tear replication" ingredients of that product on the eye, one could get away with using a little less of the Liquid Gel version than of the original Thera Tears (which is supposed to be used with saturation dosing), and still achieve the intended chemistry. . .

Anyway, even if bicarb, zinc, the matrix effect, and hypotonicity are not the elements one should look for, (with other components and properties being more important), I'm interested in whether anyone has ever tried combining drops methodically, this way, and whether results were good. . .

[liz56]

Hi, Rojzen!

I like how you think, but I don't think that I can keep up with you. You must be the most studied eye-drop user this side of the Rockies!

I use the osmotic drops through the day and stay away from hypotonic drops (at least ones that are not osmotic, like Theratears). I really like Rebecca's suggestion of Dwelle as an osmotic and NutraTears for a nice in-between wetting drop. Sometimes, NutraTears makes my eyes feel, like, squeaky. It's like there is too much of something there. However, I really like how Tears Naturale II feels and use that 15 minutes after Restasis, from Eli's suggestion.

I'd be interested to hear what other people do. I cannot believe how much eye drops have helped my problem.

[Rojzen]

ah. . .remembering previous posts on this now

Thank you, liz56, but to prove that I am far from studied, or even coherent, I've already forgotten how osmotic differs from hypotonic, and must now revisit this issue. . .

Thank you so much for sharing your regimen here. . .It sounds very smart. . .and very studied! (:^). . .Your reply also reminds me of Eli's proposals on alternating drops. . .I'm going straight back to Archives now to find those. . .

Something that prompted me to wonder about all this is that after months of some interesting, positive benefits from FreshKote (with a little Dwelle at night), I'm having loads of irritation and drying. . .This once happened with Systane multi-dose. . .and so finally I'm realizing that my problem may be with the preservatives in the multi-dose bottles. . .Having to consider PF again, I'm prompted to wonder how I can use the OTC PF products to maximum benefit. . .You are helping me greatly to figure all this out. . .

More soon...

[Rojzen]

apologies: back to the drawing board

Apologies to any who have read my earlier post tonight implicitly assuming benefits from bicarbonate, zinc, and hypotonicity. . .I've reread some of Dr. Holly's articles since that post, and want to be sure, from this point on, not to endorse hypotonicity. . .

For the moment, what grabs me about Dr. Holly's guidelines, is the importance of using a high-oncotic pressure drop that contains Vitamin A (i.e. Dakrina) for low TBUT that may be accompanied by mucin deficiency. . .

[liz56]

[snip]
Something that prompted me to wonder about all this is that after months of some interesting, positive benefits from FreshKote (with a little Dwelle at night), I'm having loads of irritation and drying. . .This once happened with Systane multi-dose. . .and so finally I'm realizing that my problem may be with the preservatives in the multi-dose bottles. . .Having to consider PF again, I'm prompted to wonder how I can use the OTC PF products to maximum benefit. . .You are helping me greatly to figure all this out. . .

More soon...

I get a clearer picture of what you are looking for now, Rojzen. Thanks for the explanation. It might be good advice to take a break from all preservatives from time to time. I'd have some trouble giving up Dwelle and NutraTears at the moment, however.

Maybe OT: Do you use Tranquileyes? I've used them every single night since I got them on 12/14/07, and I have been so happy with them. When my eyes act up, I also try and wake myself up a couple times night. For me, losing sleep every now and again makes my eyes feel better. Go figure.

[Rojzen]

same experience with sleep loss!

Thank you, liz56, yet again! Funny, but I, too, always have a better eye day if I've slept poorly, interruptedly, too little, or not at all. . .That has been true for me from day 1 of DES. . .Perhaps adhesion of the ocular surface to the lid, which, possibly, increases with deep sleep, is an issue for us. . .

I do not yet use Tranquileyes, even though I know these would help greatly. . .The advent of clear lenses in these could convince me, but I've avoided them largely because my fibromyalgia and some newer spinal problems make it unbearably painful for me to lie on my back for long stretches. . .I'm also such a severe insomniac that I generally cannot sleep at all if I have to worry about any sort of appendage. . .These are not great reasons, though, and so I should definitely start moving to the Tranquileyes, to protect my corneal health. . .

May I ask what it is about Dwelle and NutraTears that you love? Dr. Holly's slides on treating post-LASIK DES indicate that if low TBUT is associated with mucin abnormality, Dakrina is the best bet. . .Do you have low TBUT? (Please forgive if you've disclosed that elsewhere and I've missed it. . .)

[liz56]

[snip]

I do not yet use Tranquileyes, even though I know these would help greatly. . .The advent of clear lenses in these could convince me, but I've avoided them largely because my fibromyalgia and some newer spinal problems make it unbearably painful for me to lie on my back for long stretches. . .I'm also such a severe insomniac that I generally cannot sleep at all if I have to worry about any sort of appendage. . .These are not great reasons, though, and so I should definitely start moving to the Tranquileyes, to protect my corneal health. . .

Hi, Rojzen!

I was so fearful of Tranquileyes, because of my weakened cornea, but they have helped me so much. I understand your concerns, so you may want to check out eye eco's site, where it discusses how a 20-40 minute session with the goggles can be a good treatment, too. That way, you won't have to commit for eight hours just to get the benefits. That's just a thought.

May I ask what it is about Dwelle and NutraTears that you love? Dr. Holly's slides on treating post-LASIK DES indicate that if low TBUT is associated with mucin abnormality, Dakrina is the best bet. . .Do you have low TBUT? (Please forgive if you've disclosed that elsewhere and I've missed it. . .)

Dwelle is the most important for me. The high oncotic pressure keeps my abmd in check. I can feel it dry out my eyes (in a good way). Dr. Holly's explanation of how the drop will dehydrate the basement membrane, which is prone to become "waterlogged," and, yet, lubricate the outer surface of the epithelium made lots of sense. The drop does double duty, which is really hard to imagine when one thinks of the very thin (but extremely crucial) membrane of the first layer of the cornea. And, it is especially amazing to think of how it helps both of my conditions (abmd and dry eye syndrome).

May I ask, "Where did you find the slides?"

I don't know my tbut, though I know that my specialist is keeping track, because when I saw him last and he was looking through the slit lamp, he kept saying, "Blink. Blink," at intervals. I did not bother to ask, because, like weight, such quantification attempts may cause me to get hung up on numbers as signs of improvement, resulting in frustration if the numbers improve but my experience does not. Rather than step on a scale each day, I'd prefer to think of making the choice to eat more vegetables, take a walk, etc.

I'd really love to try FreshKote, but things as they are are working at present, so I will keep going on my current routine.

I hope that you get back to the improved way you were feeling back in September!

--liz

[Rojzen]

Dr. Holly's post-LASIK care slides; symptom links

Here, liz, is the URL to the pdf document that contains Dr. Holly's slides on post-LASIK care. . .I hope this works. . .It is a humongously long URL. . .

http://visionsurgeryrehab.evecommuni...slides_alt.pdf

I can now see why the Dr. Holly product line is so essential to your care. . .Please forgive that I had forgotten about your abmd. . .It is INDEED amazing how the Dr. Holly concept addresses both the anchoring membrane's need for dessication, and the surface layer's need for real wetting. . .

I will also now look more at the Tranquileyes approach, thanks to you. .

Your not getting hung up on TBUT and other numbers is RIGHT ON! Possibly the reason I focus on my zero TBUT is because I can actually feel the tears evaporating from my eyes, and associate this directly with my subjective symptoms (burning, blurring, rawness). . .Yet, I have no scientific basis on which to conclude that it is, in fact, my astronomically low TBUT that accounts for my worst symptoms. . .

If only we could find doctors who would attempt to link symptoms to diagnostic observations, we might have an easier time of choosing our optimal remedies. . .I don't even imagine the time, yet, when doctors will care enough to do the latter for us, even when they know exactly what is wrong (:^). . .

Your wishes for my restored comfort are so appreciated! and I will be cheering you on, too, every step of the way. . .

[liz56]

Thank you for that fantastic information, Rojzen!

I believe that I also can feel the tears evaporate, but I cannot worry about that, because I have to work to heal my epithelium as much as possible-- eyes on the prize, and, eye-ronically, the eyes are the prize.

On the matter of doctors, I feel lucky, because after five, I found a good one. And, there's also the highly sympathetic and deeply understanding Dr. Holly. The thought that he put into helping us to find a conservative treatment has really pushed the whole study of tears leaps and bounds and has saved me a good deal of chronic misery.

Thanks, too, for the good wishes.

[brd888]

I just want to comment on the PDF file in the 2nd above reply.
This has a few gems regarding drops i.e. lipid ointments are undesirable, oily and/or viscous drops are undesirable and non-wetting rather than drying is the problem.
I recommend the file is read by all.

Ta
Bruce

[Judy]

Thanks for the link! Very very interesting material by Dr. Holly!

[Stanza]

interesting idea about using different drops throughout the day...

[Rojzen]

eyes open wider, now (figuratively)

Indeed, those Dr. Holly slides on post-LASIK dry eye are pure gold, brd888!. . .They prompted me to re-read some of his other writings, and I am finally, and for the first time, beginning to grasp important distinctions, such as drying v. wetting. . .

Liz's input adds bona fide scholarship to this line of inquiry. . .Not to mention that a major light bulb lit up, in my brain, when Liz referenced the experience of benefiting from Muro at the basement membrane level, all the while experiencing excessive drying, due to its particular hypertonic formula, closer to the ocular surface and on the lids. . .BINGO. . .

I think that this phenomenon (i.e., different reactions inside cornea and on the surface) may explain why I maxed out on FreshKote, one of the Dr. Holly drops that features the high oncotic pressure that has become known for aiding healing of erosions and anchoring basement membrane). . .I have historically had erosions and basement membrane issues diagnosed, and can therefore CLEARLY benefit from continuing with some form of the Dr. Holly drops. . .BUT, at 4 doses a day of FreshKote, I was getting too dry and red on the lids. . .(with burning). ..

Hence, my eureka moment in all this, thanks to Liz, is that in some cases, it may be possible to optimize benefits from the Dr. Holly products by taking less, rather than more. . .Moreover, to fill in the dropped doses, I'm thinking that it may be useful to add a dose or two of Systane (for guar and zinc) and of a hyaluronic acid-containing "rewetting" drop (with a safer preservative), throughout the day. . .To cover for bicarbonate, though, either Bion Tears or Thera Tears would have to be added to the regimen, possibly with a tilt towards Bion Tears, since Thera Tears are hypotonic and, possibly, inconsistent with Dr. Holly drops. . .(though who is to say that taking both hypotonic AND high oncotic pressure drops is necessarily a bad thing? . . .If it is, btw, I will welcome a correction to my all-over-the-place line of thinking. . .

[liz56]

Rojzen,

Thanks so much for your kind words and for thinking through the drop thing with me. I really appreciate the resource you shared, especially after reading through it a second time.

(Welcome to the Rojzen-Liz lovefest, everybody!)

Seriously, I have been helped a lot as we talk through these issues. I, too, get to points when it feels like the drops are not helping as much as they were for months and months. My ophthalmologist is telling me to start cutting back. On the one hand, I am glad, but, then, I am also afraid of getting myself back into an erosion cycle. The real trick, once we gain some control over this problem, seems to be finding the right balance.

I really agree with you about TheraTears. I find them to be quite bad for me. They make my eyes feel like I just cried, which is when my eyes feel the second worst (first would be in an erosion). A drop that is hypotonic and not osmotic is a terrible combination for me, and the slide show you posted, Rojzen, taught me that. (My eyes just taught me that they did not like the drops!) I do have some TT left over, so I keep them by the bed for when my eyes stick. They are good for that, because they are so watery.

At some point, I'd like to see if Muro 128 will help again to sharpen my vision. I used it for a month in my bad eye, but my "good eye," which has ebmd, too, and does not act up, never had any in it. Now, my vision is sharper in my bad eye than the good one. What a confounding eye disease!

Thanks, again, Rojzen. I always enjoy reading your posts. You give me lots to think about.

--Liz