DHEA Eye Drops

[JPiven]

I have been reading this website for about a week and think it is terrific. I appreciate all the comments that have been posted. Thanks to all of you who have shared your experiences.

I am a 51 year old male, physician (child psychiatrist) and medical researcher (causes and brain mechanisms in autism). I had mild dry eye symptoms in my 30’s (problems wearing contacts). I developed very severe dry eye symptoms almost overnight at 42 (at the same time I had a severe viral syndrome, pleural effusion). I have always wondered if they were related.

About 4 years ago I tried cyclosporine (pre-restasis availability) with mild improvement. Three years ago, after following the literature (mainly from David Sullivan’s work at Harvard) on the role of androgens in dry eye, I started treatment with DHEA (dihydroepiandrosterone) eye drops. I have been very surprised to see that there has been no mention of this treatment on this website. I had a fairly dramatic improvement in my symptoms (going from being substantially impaired in my function – marked difficulty reading, traveling, working etc. to having my symptoms be generally very manageable, although I do use tears VERY regularly). I wanted to share this experience and encourage others to consider it.

I obtained DHEA eye drops from Leiter Pharmacy, a compounding pharmacy specializing in eye medications in San Jose California. You need a doctor’s prescription (and should be followed by an opthalmologist if you do this). I started 1 drop per eye four times per day for a few days, then titrated down over a few weeks to 2 times daily (this was basically my own regimen). I began to show improvement after the first week and continued with improved symptoms thru the first 2 years. I have been doing this for about 3 years. I am followed by a general ophthalmologist and have had no discernible adverse effects. DHEA drops in the eyes have no systemic effects (i.e., just local eye effects).

Again, I highly recommend trying this treatment. Leiter Pharmacy is easy to find on the internet. Chuck Leiter is well versed in this approach to dry eye treatment. I have sent a number of people to them. Some have not had any benefit. Others have had substantial benefit like I have. I would be happy to discuss this further if anyone is interested.

Again, thanks to all of you for sharing your experiences. I am sure many of us could relate to todays post by Jessica about having one of those desperate days and finding nothing else to do but search the internet for solutions. Here is one that I hope may help some of you.

Joe Piven
Chapel Hill, N.C.

[Philipp_from_Germany]

DHEA Drops

Dear Joe-
Thank you very much for sharing your positive results with us!

Allow me two questions:

1.: Have you ever done a test or been tested as androgen/testosterone deficient?
2.: Do you have you any objective data to back up your improved well-being, like a more stable tear film visible for the ophtalmologist?

I am happy that you have found relief!

[DrG]

DHEA and other androgens

Thank you for calling attention to DHEA eyedrops. There have been a number of posts on this subject on the D'Eyelogues BB since March 2005. If you do a search using the terms "DHEA," or "androgen(s)" they will come up.

I first heard of Dr. Sullivan's work with androgen eyedrops in January 2003, when Dwight Cavanagh gave a talk on the subject at the Dry Eye Symposium of the annual CLES meeting. Dr. Holly, who invited me to fill a last minute opening in the program, was the honored keynote speaker. DHEA is a precursor to both androgens and estrogens. It is widely available in health food stores (thankfully). As well, I have had female patients come into my office who were either taking DHEA orally, or had used a testosterone patch for the treatment of dry eye.

[sazy123]

Jpiven: are DHEA drops the same as androgen eye drops? or do they have a simular effect but different? what type of dryeye do you have?

Phillip: do you know if we have confonding pharmacies in europe that can make these kind of things up? Or would you have to go to the states? I dont know if there are any in the UK.

http://www.dryeyepain.com/CustomEyedrops.htm

[20/20_Hindsight]

I posted about this several months ago. I brought literature to my eye doctor, who refused to write a prescription stating this was a steroid drop. He said that the use of it could induce early cataracts. Since I suffer from autoimmune disorder, and Sjogrens (androgen deficiency being part of Sjogrens), I had particular interest in this treatment, but the door was slammed shut before I could get started. He said I have enough problems without adding long-term steroid drops and cataracts to the mix.

[JPiven]

cataracts and DHEA

RE: Cataracts

I think you should get a second opinion on the issue of cataracts. I have not heard this from the doctors I have spoken to. Allergan is currently doing a trial of DHEA drops and I don't think this is a major concern.

Either way it is doubtful they would cause catarcts in the short term. My suggestion is to try them and if they don't work, then it isn't an issue. If they do work, then you make the decision. You would need to then get more information about the issue of cataracts to make an informed decision about whether to continue a treatment that works or not to continue it, for fear of the side effects. It seems to me that it is premature to make that decision before having all the information about whether they work at all for you.

jp

[Rebecca Petris]

Allergan is currently doing a trial of DHEA drops

I've heard quite a bit of positive feedback about this from patients and doctors - mixed with some frustration at the delays. I wish the process didn't have to take so long but I guess having so many things in the pipeline at this point is a blessing compared to just a few years ago.

[Philipp_from_Germany]

@sazy123

Dear fellow european Brit :

As I recall, any major pharmacy should be able to compound you those drops.
That is with a prescription, of course! My father is a pharmacist and he also prepared testosterone cream for my eyes once...

What is even more important is the fact that you have to get your hormone levels checked before you engage in such an endeaour. Especially your sex hormones. If you do not have an uncharacteristcally low testosterone level (for a female) those drops won't do you any good.

Also, while doing this pick up the package of your contraceptive and find out whether it is androgenic.

Take care!

[JPiven]

Dhea

Dear Phillipe

I think it is premature to conclude that the DHEA drops will not do you any good unless your androgen levels are low. We have no data on this to know. also, it isn't always clear what normal hormone levels are. There is a lot of individual variation. The main issue is change over time (even if you are within the normal range) and most people don't have longitudinal data on their own levels. Certainly what you say is a reasonable hypothesis but in my discussions with researchers involved in this work the local hormone levels (e.g., in the eyes) may not always be as closely linked to systemic levels as one might guess. My worry is that such comments (you have to have a low level for this to help) may dissuade some people from trying this and are not based on existing data.

So, while baseline hormone levels may be interesting to measure, I don't think we have any reason to think that they have to be done or should necessarily guide ones decisions on whether to do this largely empirical trial.

jp

[markL]

...

I have read that 'the pill' (contraceptive) lowers levels of testosterone in women.

[kaypeeoh]

Androgens and eyes

For a few years now I've looked for methods to make RGP lenses more tolerable. I've been told my problem is a poor tear break up time. But nobody can tell me why. Reading every abstract I can find on medline suggests a poor TBUT can be due to a lack of lipid in the tear film, causing too much evaporation. So why a deficiency of lipid? Other abstracts suggest a hormonal connection. Some have tried testosterone eyedrops with mixed success.

I had my testosterone level checked and found it was within normal limits. So I ruled hormonal problems out. But now I'm reading a book on testosterone. I don't have it handy to cite but if anyone wants better info I can get to it tomorrow. What is most interesting is that even with normal testosterone levels there can be health problems because of too much estrogen. There has to be a healthy ratio of testosterone:estrogen. An unhealthy ratio leads to problems. Although the book doesn't talk about tear film, hormonal problems can't be ruled out. There are non-medical ways to lower estrogen, thereby improving the t:e ratio.

I'm going in for a checkup soon and will see about getting a prescription for dhea drops. If it works for me, I'll let you know.

BTW, I tried cyclosporin in oil long before Restasis was available. It raised my TBUT from 2 second to 10 seconds, not enough to be theraputic.

[DrG]

BTW, I tried cyclosporin in oil long before Restasis was available. It raised my TBUT from 2 second to 10 seconds, not enough to be theraputic.

That seems like a HUGE increase to me. You really ought to try some Macrolenses. They feel just like soft lenses.

DrG

[Rebecca Petris]

You really ought to try some Macrolenses. They feel just like soft lenses.

Noisy second from over here. I never did manage to wear corneal lenses with any kind of regularity, but I have done well with Macros.

[kaypeeoh]

That seems like a HUGE increase to me. You really ought to try some Macrolenses. They feel just like soft lenses.

DrG

I was also told by an OD that a TBUT of at least 20 seconds in necessary for RGP wear. Would macros work with a poor TBUT?

[Rebecca Petris]

I have no idea what my TBUT is but I sure don't think it's 20 seconds.

I'm not saying that the lenses are a slam dunk, I have to take care of my eyes and keep the lenses lubricated and moving and all that, but I am usually able to wear them all day.