DHEA Eye Drops

[Miles]

DHEA eye drops

This is my first entry to this site and I would like to add my dry eye experiences to the many other stories I have read.

I am a 58 year old male who began having dry eye symptoms 4 years ago. They began with the usual gritty sensation of having sand in my eyes, especially at night. This evolved into pain that kept me awake and, eventually, sleep deprived. I tried GenTeal Liquid Tears throughout the day and GenTeal Severe Gel at night. These helped only slightly and the Gel often seemed to cement my eyelids together, worsening the problem.

Soon I had a corneal abrasion which caused extraordinary pain. I saw my ophthalmologist who measured a positive Schirmers test and installed a contact lens "bandage". After taking out the contact she prescribed Restasis which, over the next month or so, had no effect. My eye sensitivity during the day was to the point that I could not tolerate even the slightest movement of air across them and my pain at night became so severe that I would wear Speedo swim goggles to bed with the lenses filled with water-soaked gauze. Can you imagine… what an absurd image! I have a very supportive wife!

After another corneal abrasion ("tear" seems more appropriate given the level of pain) and another lens bandage the ophthalmologist suggested either punctual plugs or cauterizing the tear ducts. Opting for the plugs, I was only able to wear them for 24 hours when I asked to have them removed. They were just too painful.

She then gave a scientific article published in the periodical "Cornea" suggesting that, in a rat model, meibomian gland function is influenced by androgens. After extensive dry eye research on the Web I found significant work done by Dr. David Sullivan at Harvard. Desperate, I asked him about research on androgens and dry eyes, and any possible solutions he could put forward. David put me in touch with Dr. Joe Piven who very kindly shared with me his wonderful experience using compounded DHEA eye drops. My ophthalmologist was very intetested in Joe's experience and supportive of his approach, so she gave me a prescription for a 1% DHEA compounded solution.

My results have been nothing short of miraculous. For the past 9 months I have been virtually pain free. I open my eyes to the wind and, most importantly, I am able to sleep at night. No more goggles! I am still aware of slight dryness at times but it is negligible, and I occasionally supplement with liquid tears. However, after much pain and research, I am now a believer in DHEA eye drops. I am not saying it will work for everyone, but I do suggest that it is definitely worth a try. Joe Piven is my new best friend.

Philipp's comments regarding sex hormones are not to be ignored. There are data indicating these hormones are one link to dry eye syndrome. However, I must side with Joe in that current data are also inconclusive to rule out all other possible causes of dry eyes and that to deny patients access to such things DHEA drops without evidence of "abnormal" sex hormone levels (whatever those are) would, sadly, deny them a possible pathway from intractable eye pain. My ophthalmologist told me that 75 - 80% of patients come to her complaining of dry eyes. Is it likely that they would all have low hormone levels?

To "20-20 Hindsight" I would say keep looking for an ophthalmologist who will try DHEA drops, even if it takes a 2nd, 3rd, or 4th opinion. My sincere best regards to you all.

Miles

[20/20_Hindsight]

Miles,
This is wonderful! I appreciate you coming on this post and telling us your experience. I must pursue this further. I have extreme dry eyes after Lasik and have corneal erosions/abrasions sometimes on a weekly basis. I need help bad. I've tried everything for dry eye known to mankind EXCEPT dhea. I use DHEA cream on my eyelids and it helps tremendously for the one day a week I can tolerate it. However, the cream causes bad irritation to the lids and they swell and get red, but the relief temporarily from dry eye is nice once in a great while. I used to save it for the one day I had to go to the office building I worked in. I am going to try and find another ophthalmologist who might prescribe these for me. I am flat broke due to job loss, so I am wondering how to go about this? I cannot afford to go to one doctor after the next. I need to hit the jackpot first time around.

[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?

Hah! I wish all of my patients who wear RGP's had a 20 second TBUT. After all, a "normal" TBUT is less than 20 seconds.

My comments stem from the fact that you seem to be able to tolerate RGP's IF you wear a soft lens over them. Without knowing any more details, this made me wonder if you might not be able to better tolerate an RGP that was designed to fit like a soft lens.

[DrG]

DHEA and androgens

The link between androgens, dry eyes, and females is expressed in the title and content of Dr. Sullivan's 2002 paper: Androgen Deficiency, Meibomian Gland Dysfunction, and Evaporative Dry Eye, in which the role of androgens in the treatment of meibomian gland insufficiency in women with Sjorgren's disease was explored. Without citing studies, it is generally accepted that women are more prone to dry eye than men, thereby lending more support to the androgen pathway and the role of androgen insufficiency in dry eye.

However, DHEA, while converted into testosterone (and estrogen), may have its own receptors at the cellular level. A study at the Southern College of Optometry compared the efficacy of eyedrops containing DHEA, testosterone, and a placebo. The DHEA-containing eyedrops were more effective than either the testosterone or the placebo. DHEA is also a substance that cannot be licensed, and hence is unattractive to pharmaceutical companies. It is already available OTC. A quick Google search will turn up hundreds of references for oral and topical routes of administration.

[sazy123]

dhea drops

Miles:

Im 20 so im assuming that im not hormone defficient. As your male you wouldnt be androgen defficent? but the DHEA drops still worked for you. So they could work for me being younger?

thanks

[Rebecca Petris]

Miles, welcome to Dry Eye Talk. Thank you very much for sharing all this information with us and your experience. There is a real need for stories with hope in general, as well as of course patients' reports of their experience with less common dry eye treatments.

For those coming to our conference next month, there will be one or two doctors speaking who have been involved with the androgen drops clinical trials, so we'll certain be having some discussions about it there.

Happy Monday all.

[kaypeeoh]

The book I alluded to is The Testosterone Syndrome by Eugen Shippen, MD. His point is even with normal testosterone levels in the blood there can be health problems because of too much estrogen. All males produce estrogen as well as testosterone. The book does not address tear film problems. But to suppress estrogen production there are ways to tie up the enzyme aromatase, which converts testosterone to estrogen. The author recommends zinc, soy and cruciferous vegetables.

[Philipp_from_Germany]

Hormone Therapy

Hey folks

Just a very general statement:

I think that there is far too much speculation going on in this particular thread...

We should focus on using scientifically proven facts only when discussing such things like new eyedrops with active molecules (hormones are steroids btw.).

The only thing the pros. have managed to prove is the fact that there is an interconnection between a lack of androgen and meibomian gland dysfunction. You can check with Dr. Sullivan's work for that. Furthermore, there are statistically NOT significant case studies about the use of testosterone cream (Dr. O'Conner of the Southern College of Optometry). I also came across one study that demonstrated the effect of this cream in a man. BUT: He was androgen deficient. Not very highly but because of this age he was a little off balance. I have been in conatct with both Drs. Sullivan and O'Conner and they have told me the hormone factor is generally a thing for women and just for men with off balanced sex hormone levels.
I had my levels checked (OK) and tried the O'Conner cream for 12 weeks without any effect whatsoever.

I am very sceptical because both of the two promoters here are older than 50 years. It is usual even for males that sex hormone levels begin to fall at that kind of age. That is a "normal" process and therapies adresses at this patient population will not work for a real pathologic dry eye!!

I am sure there is quite interesting literature about hormones and their impact on various body functions. But unless there is scientific proof, we shoul refrain from putting too much emphasis on this!

Maybe the doctors on the DEZ conference in february can shed some light on this...

[Philipp_from_Germany]

Tbut

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?

I think the general consent in the literature is that a healthy tear film breaks up after more than 15 secs. The "pain threshold" is 10 and when you have got 5 or less you do have a mojor problem (severe dry eye).

As I have barely 3 secs I think I would kill for ten. When I had ten seconds I used to wear soft contacts for 18 hours a day without the slightest signs of dryness. Are you sure you have ten? In you first thread e.g. it was only 8:
http://www.dryeyezone.com/talk/showthread.php?t=576

Of course it is hard to create some kind of objective scale on which to measure pain but with 10 seconds I would throw a party in an a/c airport lounge and smoke and drink allnight..

[kaypeeoh]

It's been so long, I honestly can't remember what I was told by one doctor or the next. I think it was 5 years ago that the opthalmologist said the TBUT was 2 or 3 seconds and prescribed Restasis. I remember the insurance wouldn't cover the cost so I used a veterinary version which is much stronger than Restasis. After months on the stuff another doctor examined me and said the TBUT was 5-6 seconds. Later, somewhere someone told me 10 seconds and someone else somewhere else told me 20 seconds. But I don't remember who or which clinic this happened. For me the point is nothing has improved RGP wear time, regardless of TBUT. I have used piggybacking and was able to wear lenses for 8 or more hours. But only if I wear the soft lenses atop the RGPs. Normally piggybacking is the opposite: soft lenses against the cornea and RGPs atop.

I was able to order DHEA eyedrops and should get them by the end of the week.

[jcorbett]

Are there any known side effects of DHEA drops? Are they safe for long term use? I hear 'steroids' and I panic.
I wonder if there is any difference between the over the counter DHEA drops and prescription drops?
I'm sorry if this is such an obvious question....but is DHEA the same as testosterone? I have been using the t. cream with good results.

[JPiven]

JCorbett

It is true that DHEA is a steroid but all steroids are not the same. So estrogen and testosterone are stereoids but don't have the same adverse effects as cortisone or prendisone -- the steroids that cause diabetes, and weight gain and cataracts etc. But estrogen and testosterone have other adverse effects.

I have not seen any data to suggest that DHEA eye drops (that don't go to your entire body and -- just stay around the eye region) have any significant side effects. but then again we don't have a lot of data except perhaps from unpublished Allergan trials and perhaps animal studies.

Joe Piven

[kaypeeoh]

DHEA and testosterone differ only because of two extra hydrogen ions on DHEA. Theoretically DHEA will attach to testosterone sites in the meibomian glands, stimulating lipid secretion. But in tablet form DHEA does not have an affect on the production of testosterone. That is, it's different enough that the body does not assume it is testosterone and does not curtail testosterone production. In comparison, anabolic steroids are close enough to testosterone that it causes a negative feedback, suppressing natural testosterone production. A medline search of DHEA shows no reports of negative consequences from it.

[sazy123]

restasis useage

kaypeeo:

Is it ok to get 10 weeks out of one tray of restasis if you leave it in the fridge? Did your doc say it was ok? how many viles do you get in one tray? 15 or 30?

[kaypeeoh]

kaypeeo:

Is it ok to get 10 weeks out of one tray of restasis if you leave it in the fridge? Did your doc say it was ok? how many viles do you get in one tray? 15 or 30?

I first used the veterinary version: Optimmune 0.2% cyclosporine. Eventually I broke down and paid the $100 for Restasis. It comes in a plastic tray with 30 ampules I think. I didn't refrigerate. Putting a drop in each eye twice daily meant one ampule would last 4 or 5 days. So I got nearly 12 weeks of treatment out of one tray, making it cheaper even than the veterinary version. Keeping the tray in the refrigerator is probably a good idea. The MD who prescribed it used it also. He kept the opened ampule in a clean jar with a snap lid and was careful not to touch the top of the ampule.