7 months on Dr. Holly drops: the numbers are in

[Rojzen]

In case it hasn't been obnoxiously obvious , I admit here and now that I have been touting the Dr. Holly drops in recent weeks, and simply can't get over how they have changed the course of my disease. Today, I saw my eye doc, and finally got some numbers to report, after a trial of FreshKote and Dwelle over a period of about 7 months.

For about 10 years, my tear break-up time was consistently measured, by many different doctors, to be from 0-1 seconds. Throughout that period, I had to wear moisture chamber glasses 24/7, even in indoor environments with completely still air, due to menthol/windy sensation that made it hard to keep eyes open without protective eyewear. . .I have LOVED my moisture chamber glasses, because they have essentially made living possible, for these years. . .

After about 6 months on Dr. Holly drops (excluding NutraTears, which I have yet to try for a sustained period, though not by itself), I accidentally put on regular glasses for a day, sans moisture chambers. I found that I could go for many hours, this way. . .At 7 months, I am rarely wearing the moisture chambers, though I expect always to need them at some times. . .

Today my doctor measured a tear break-up time that he described as significantly greater than 1 second, and almost "normal-looking". . .I still have dry spots, after a few seconds. . .But the break-up no longer starts instantly after a blink.

Interestingly, my Schirmer scores are very high, now, too. . .but I don't trust Schirmers for good information on tear production, and I have never been severely deficient lacrimally. . .

Anyway. . .Having tried literally DOZENS of different therapies over the years, I never believed change was possible. . .Now I see that it is. . .

The only downer today was that while I raved and raved about the high oncotic pressure Dr. Holly drops, and even handed my doctor literature about them, this kindly, but oblivious, doctor still asked me to try Soothe and Systane. (I tried these years ago, and was, in fact, involved in the Soothe clinical trials, where I was pronounced a bad candidate for the product. . .Soothe was awful for me, even though I have MGD. Systane was nice, but not therapeutic.) I also found the literature that I'd given the doc inside my patient file, as I left the office. . .evidence that he will not be reading it. . .

Crazily, the doctor said to me "You know more about the composition and physiological effects of artificial tears than do most cornea specialists." He then proceeded not to care at all what kind of drop he tells patients to put in to their eyes. . .I'll stick with this doctor, because he is well meaning and a brilliant surgeon and ocular surface expert, but I'm on my own with treatment. . .

The whole experience makes me worry that there seems to be little motivation, in ophthalmologists and optometrists, to see whether eyedrops can be THERAPEUTIC, and not just soothing. . .I want to do something to change this, but I'm not sure how. . .

[liz56]

Yea!

I am so glad to hear that your numbers correlate with your subjective feelings, Rojzen.

Your posts have been quite helpful on this matter.

Perhaps over time your doctor will be able to think to recommend Dr. Holly's drops to other patients. It's hard to describe how much they help, but you are right, Rojzen, it takes a lot of time for real differences to be noticeable. I know that the recommendations on the drops' pages in the Store suggest giving them one or two weeks, but there is something that happens over a month, at least, I am convinced that it took that long for me to think that these are more than just good eye drops but that they are stunningly healing.

[Lucy]

A doctor who lets the patient "in" on their care! Rojzen, I think you made your point and the doc thinks if they help, who's he to say no!

I brought Dr. Holly's drops to my doc's attention when we first became aware of them in 2001. I've used them since. I also use TheraTears at times. No particular time, but I usually have a box in the house in case I feel I need a change of drops. I hope the continue to be of great help to you.

Lucy

[Rebecca Petris]

This is one of those posts that I want to frame and put on my wall for inspiration. Measurable TBUT... after all these years... I'd hardly dared even to hope!

Crazily, the doctor said to me "You know more about the composition and physiological effects of artificial tears than do most cornea specialists."

Not surprising to me at all. I can imagine you hardly know what sensation is foremost: gratification, or disillusionment.

The whole experience makes me worry that there seems to be little motivation, in ophthalmologists and optometrists, to see whether eyedrops can be THERAPEUTIC, and not just soothing.

For all the lip service that is paid to the composition of the tear film these days, few take any serious interest in what's going on on the ocular surface and why.

Dr. Holly has often asserted that dry eye care and research regressed in the 80's and 90's. I think that this is correct and that it simply coincides with the advent of laser refractive surgeries, because that is where the attention of the cornea community has been squarely focused for nearly 20 years now.

[Rory]

Rojzen,

Did the Dr say what your TBUT time is now?

Also, you have MGD, rather than aqueous deficiency. I was under the impression that Nutratear would be the most suitable of Dr Holly's drops in that case? Can you explain how you have used Dr Holly's drops?

I received Dr Holly's drops for the first time this week, and have been trying Nutratear and Dwelle at night. Its only been a couple of days, but my lids are very inflamed. Did you experience anything like this?

Also with regards to removing protective glasses.. i wore protective glasses for a number of years and stopped wearing them for a while...and my eyes were also much more comfortable ..but i wasnt taking any treatment at the time...could it be that the glasses themselves gave you the improved symptoms?

Anyway, I hope that whatever it is that is helping you, continues to work.

Rory

[Rojzen]

will answer

Rory - - I will come back and answer your terrific questions later today. . .and then also ask you for your best guidance on pacing/alternating the Dr. Holly drops. . Several of us here are trying to pin down regimens that are optimal, for these. . .

Thank you, all, for following my news so closely and caringly. . .And Rebecca: I knew I could count on you to grasp and fully process the magnitude of what has happened to my TBUT. . .I'm intensively pondering today how to turn around the adverse side of my exam experience. . .Thinking tentatively of reaching out to some other local eye docs who have seen my eyes, over the years, and who, with that backdrop, may have a better appreciation of what's happening. . .

More soon. . .and thank you, dearest friends. . .

[Stanza]

This is wonderful

[Maenad1]

Congrats on your increased TBUT, Rozjen! That's wonderful. I look forward to hearing more about the specifics.

*runs off to put in some Dakrina*

[Rojzen]

more info. on exam after Dwelle/FreshKote use

Rory - - Thanks for your patience, and for posing such good questions. . .

First, I am indeed convinced that wearing moisture chambers has helped to stabilize the condition of my ocular surface tissue for all the years I've worn them. They have slowed my tear break-up time significantly, while I wear them. This was once demonstrated by an ophthalmologist who took an interest in how well I felt while wearing the glasses. He found that after I wore the glasses for a few hours, my break-up time would be greater than 5 seconds, even after I took the glasses off. . .Five or ten minutes later, though, my break-up time would revert to about zero seconds. In other words, it could be assumed that while the glasses are on, they slow the break-up time significantly. I believe, because I have suffered only negligible erosions during the years I've worn the chambers, that slowing break-up time has protected my corneas and conjunctiva, to some degree.

On the other hand, it is noteworthy that I have never regained normal break-up time JUST by wearing the moisture chambers. . .

RE: the best Dr. Holly drop for MGD-related unstable tear film: I actually don't know the answer to this, except to say that I believe Dr. Holly has, in some places, suggested that Vitamin A is indicated when break-up time (TBUT) is severely reduced from normal. I have therefore deduced that Dakrina might work best for me, as an MGD sufferer with a horrible TBUT; BUT, clinically, results are not in, for me. It seems to be well accepted that Vitamin A can help goblet cells to produce more/better mucin, and that may be why highly unstable tear films, which require normal mucin (among other things), call for Vitamin A (and Dakrina). On the other hand, based on Dr. Holly's writings, I am beginning to understand that tear film instability is probably never due to only one cause, like meibum deficiency; and the fact that my meibomians are still very sluggish at best, but my TBUT has improved nonetheless, tells me that the Dr. Holly drops' action on my corneas is, by itself, capable of affecting tear film stability for the better.

About the TBUT number: The doctor yesterday would not give me a number on my TBUT, for some reason, even when I pressed him for this. But he said that it took a while for the tear film to begin to break up, and my subjective sense was that this time amounted to at least 5 seconds. I was never able to hold my eyes open, in the past, for more than a second, during TBUT measurement, but yesterday, I had no trouble, even prior to administration of anesthetic.

Now 5 seconds is not a good TBUT, but for those who live with a tear film so unstable as to produce a zero-second TBUT, those 5 seconds can feel tremendously new and better. Those 5 seconds have, so far, been enough to buy me long stretches without protective eyewear. Will this last? Who knows. . .But the subjective improvement is dramatic, and I am optimistic that this spells real health improvements for my corneal tissue. . .

If, in fact, NutraTears can beneficially affect the meibomian glands, as Rory suggests, this may complete the picture for patients like me. . .I am aware that B12, which NutraTears contains, has often been used to accelerate corneal healing, but perhaps even eyelid tissues/organs respond to it in some way, too. . .

I, and others, are hopeful that Dr. Holly will help us to arrive at some paradigm for combining the 3 available drops that he created, based on our diagnoses and symptoms. .

Right now, I am sensing that for reasons unclear, Dwelle is the best all-purpose drop for me. . .but I'm starting to bring Dakrina in to the picture, and will see what happens...

Importantly, I've realized something additional in the last 24 hours alone. In other threads, this week, we have been discussing the adverse affects of fluorescein and other drops that the eye docs use during exams. Count me in on that concern, because even with my Dwelle in all day, I'm having lots of menthol wind today, after being subjected to flourescein, Lissamine, and anesthetic yesterday. I believe this means that Dwelle/Dakrina are probably not curing me, in the sense that will some day be healthy and need no eyedrops at all. At the same time, I feel very confident that by tomorrow or the next day, as I continue with Dwelle, I'll be back to where I was earlier in the week. . .In any case, I no longer aspire to "cure," and will be ecstatic if the best I can do is to live comfortably and safely just by using the Dr. Holly drops (:^). . .That would still be way beyond what I ever believed possible. . .I know that others share this outlook. . .

[Terri]

Let me second Rojzen's joy. I've written elsewhere about my love affair with Dwelle (especially), Dakrina and NutraTear. I can't emphasize too strongly what a HUGE difference these drops have made for me. I faithfully use one drop of Dwelle at night before bed, and I might (or might not) need an additional drop of Dakrina or NutraTear during the day.

That, to me, is amazing. As someone who used to use drugstore drops every 10 minutes (and thought I had made great progress when I got that down to once every two hours), using only one or two drops every 24 hours is remarkable.

But what is even more remarkable is the condition of my eye. Drugstore drops did nothing to heal my damaged eye; in fact, now I think they greatly contributed to my dry eye problems (even the PF ones I used to swear by). Dwelle has made it impossible for me to tell the difference between my normal and dry eye because they look and feel the same.

Like Rojzen, I don't think Doc Holly's drops will cure me, but I'll settle for this great feeling of being normal again.

PS: Thanks to Rebecca for going to extremes to bring these drops back on the market. I cannot imagine going back to life without them.

[Rory]

I have 2 more questions about Dr Holly's drops.

1. How long are they "fresh" after opening the bottle?

2. The flakiness of Dwelle, could this contribute to MGD, gland blockages, general irritation? I have yet to open Dakrina, does this have a similar flakiness.. I have not noticed any flakiness with Nutratear.

Rojzen,

You clearly have much worse sypmtoms than me, much more severe TBUTs. In normal conditions, my TBUT can be normal... but in drying conditions my TBUT decreases dramatically. I can also not tolerate contact lenses for more than an hour or so. It is also only ever my eyelids that are irritated, never my eyes. Therefore I wonder if Dr Holly's drops are suitable for all of us?

Have i misunderstood, is it your belief that the mucin production or adhesion of the tear has improved with the drops, rather than the lipid component? As this does not seem to be my problem, i wonder if they would have any use to me at all.

[Rojzen]

Terri! So wonderful to have you encapsulate this Dwelle experience so crisply and clearly. . .You've made points that I failed to emphasize sufficiently in this thread. . .

Like you, I have found that using just two doses daily, with bedtime a must, seems to bring about the finest result. And the contrast you draw with drugstore drops is so key!

At onset, back in 1998, I happened on TheraTears. . .I used these about every 10 minutes, because I believed that if I just stuck with an artificial tear, my eyes would somehow catch up and normalize, so that I could later cut back on drops and be comfortable. . .That never happened. . .and, in the particular case of TheraTears, the recommended regimen actually involves applying many drops over a period of 5 minutes, each and every time one treats. . .In any case, since that product, and the endless others I tried, were not composed right for me, and necessitated so much trauma to the eye, through frequent dropping (Dr. Holly has been clear about the adverse affects of frequent dropping), I never improved. . .

Exactly as Terri describes, with Dwelle, and possibly Dakrina and FreshKote, for some of us (and I suspect many), life is not just about keeping up with the constant demand for moisture, but, rather, about gradually improving to the point of feeling amazingly free of a whole slew of bad symptoms. . .

Rory's questions and needs may be different from those of us who have had to work on restoring corneal health. . .but I can't see how the Dr. Holly drops could hurt anyone with any variety of DES symptoms. . .To answer: I don't believe that accumulation of flakes, from Dwelle/Dakrina, need hamper meibomian function, if one simply washes the flakes away regularly with a nice cleanser. . .I do not, however, Rory, know whether I am getting better because of improved meibum/lipid production or because of improving mucin function, both, or something completely different. . .I suspect that my lipid production has not changed, but that the layers of my cornea have consolidated and strengthened, possibly with some concomitant improvement in goblet cell operation/mucin production. I deduce this because I haven't done anything new mechanically (no more expression or heat) with the MG, and stopped doxycycline years ago, when I was overprescribed it, for periods of years at a time.

Hope that helps. . .

And Terri. . .Your analyses here have been fascinating and eloquent, not to mention that the joy of your healing is infectious, and a huge source of cheer to me and others. . .

[dianat]

This thread may have been Rebecca's favorite birthday present!

[Rory]

I am still confused as to whether I should give Dr Holly's drops a real go.

I have to say that I am very put off by the excessive flaking of Dwelle and Dakrina (really irritates the inside eyelids...and not always possible to hygienically clear). I am also unclear as to the science behind the drops. What exactly is it that they are aiming to achieve? Are they more than mere lubricants?

I have reasonable TBUTs and very low schirmers (despite apparently having no serious aqueous deficiency..work that one out?)..but only really have bad symptoms in aircon and central heating.

My favourite current drops are basic.. Refresh soothe and protect...and Refresh contacts (with contacts).

I dont like to use eyedrops at all if possible...and I believe the more that you use the more problems you will have.

Any wise advice? Which of Dr Holly's drops would suit my symptoms?

[Terri]

Rory: It might be good to ask Doc Holly if one of the three drops would work better for you than the others. I am fortunate in that I don't have a problem with the flaking you and some others have described. I only use one drop of Dwelle at night before putting on my Tranquileyes, though, and I imagine if I used more than one drop that flaking or crusting might occur.

Dwelle healed the rough, abraded surface of my dry eye. I can't describe exactly how it did that, but I think it eliminated the edema in my epithelial cells, allowing them to compress into a normal layer with normal functioning. It also provided a smooth, continuous surface over my eye. Within two weeks of starting to use Dwelle, my husband said, "Hey! What happened to your eye? It looks normal!" It was no longer red with areas that looked like they had been roughed up with sandpaper.

The other great benefit of Dwelle is that it lasts forever. I posted earlier that one drop at night is all I need on most days. I agree with your comment below that using fewer drops is better.