Restasis: Worse Before Better?

[Aaron77]

Just talked to my opthamologist, he says that it stings in about 15% of patients and that if its not unbearable I should persist as the stinging often subsides. Guess I just have to patiently wait... its darn hard though.

[dave25]

What I do to help the burning is put it in about 10 or 15 minutes before I take a shower and then when I am done with my shower my eyes feel good again. Then for the second application I put in right before I go to bed. Then I can just close my eyes and the burning goes away quickly.

[msienkiewicz]

When I first started using restasis, I would put it in right before bedtime and then use my freezer eye mask straight from the freezer.

Best wishes,
Melissa

[Guest]

If I recall correctly, in his book, Dr. Latkany says that he often gives patients who are starting Restasis a course of Lotemax for the first month... apparently it helps with the burning/stinging in that first month... after that, things should be much better... Might be worth asking your opthamologist about that...

[Aaron77]

If I recall correctly, in his book, Dr. Latkany says that he often gives patients who are starting Restasis a course of Lotemax for the first month... apparently it helps with the burning/stinging in that first month... after that, things should be much better... Might be worth asking your opthamologist about that...

I will ask my opthamologist when I see him first week of November about Lotemax. The steroid I had tried before seemed to dry my eyes out though, I think it was Predforte. Might have to get myself back on Doxy as well, the lids are super inflamed in the mornings. Eyes still stinging really bad on the computer, wish I could completely eliminate computer use from my work life.

[howdryiam]

hello

I hated restasis - but I did find if you refrigerate them - it reduces the stinging

[Aaron77]

I hated restasis - but I did find if you refrigerate them - it reduces the stinging

My problem is that so far my eyes sting for the entire day while on Restasis not just when I put them in. Its much worse when I'm on the computer though, they may actually be wetter I'll get some measurements from my opthamologist next week.

[dave25]

My problem is that so far my eyes sting for the entire day while on Restasis not just when I put them in. Its much worse when I'm on the computer though, they may actually be wetter I'll get some measurements from my opthamologist next week.

Yeah if they burn all day that's not a good sign.

[nycdryeyegirl]

My problem is that so far my eyes sting for the entire day while on Restasis not just when I put them in. Its much worse when I'm on the computer though, they may actually be wetter I'll get some measurements from my opthamologist next week.

Hi,

Have you tried using preservative-free lubricant eyedrops fifteen minutes before and after using the Restasis drops? Perhaps you might want to try this method.

Pam

[RobLIC]

Aaron, are you doing lid margin scrubs, too? Adding Restasis to thickened meibum (with amino acids) can create a somewhat toxic reaction, IMHO. If you scrub first then apply, it might go easier. My 2 cents. Rob

[Aaron77]

Aaron, are you doing lid margin scrubs, too? Adding Restasis to thickened meibum (with amino acids) can create a somewhat toxic reaction, IMHO. If you scrub first then apply, it might go easier. My 2 cents. Rob

I probably need to scrub or rinse the lids a little better before application, I think I will start applying it along with lid scrubs before and warm compresses before and after. During the day my lids don't seem to have much of a visible build up of anything though, I generally only get crusting and swelling in the mornings when waking but I believe this to be more a result of the lubricant I use before going to bed. The lids do look like crap if I've been on the computer for a long time - red and extra oily. I wonder to what extent blepharitis is my problem if it is at all.

[Aaron77]

I had to leave work early today, the eyes were bothering me way too much to make it through to 4:30... the right eye was getting the brown mucus like strands stuck on the cornea and it hurt like hell. Once I'm away from work and off the computer I feel so much better, not normal but much better... its always such a relief to get off work and away from the computer.

[ringo]

update

I was prescribed Restasis together with Akular and FML weak steroid (took care of any stinging/pain and enhanced the antiinflammatory action of all the drugs).

Regarding Optimmune-- i think it is the only thing that actually treats dry eye. Because of the higher cyclosporine concentration and the fact that as an ointment it stays long on the eye (especially at night) since I started it over a month ago I gradually stopped all else, including the artificial tears. I do not use any more artificial tears. I was using nearly a box of preservative free every couple of days.hard to believe!

cyclopsorine not only has immunosuppressive properties, it actually stimulates the nerves in the eyes to produce tears...however all these effects are only possible with certain concentrations.

Its like having pain and taking 1/4 of the pain killer tablet. Is it going to produce relief? may be just very little...

seems like nothing below 0.2% cyclosporine improves dry eye. I think the lesser concentrations just slow down the deterioration. Not even stop it actually.

wonder how does that relate to economic profit from dry eye products!

i think it is actually very mean that 0.2% is not provided for human use. safety profile is excellent....the pharmaceutical company simply stated after the trials that the effect on dry eye of the 0.05, 0.1% and 0.2% was identical. which is absolutely not true, from my own experience, and from the papers published on the animal clinical trials where nothing below 0.2% produced any improvement whatsoever.

And other substances that cure dry eye even better and faster than cyclosporine have been stopped in phase 2 and phase 3 of clinical trials for some hard to understand reasons-- all related to long term safety....well i must say that when i read the possible adverse effects of most medications, they are much more serious and real than the "potential" ones from the minimal doses in the eye drops mentioned as reasons to stop the products from manufacturing. Is it safer to use steroids and NSAIDs? No, much less safe.
Now these products are only available for animals. May be coz animals do not have the option of choosing to spend thousands each month on dry eye products and doctors for a lifetime.

[Rebecca Petris]

I
i think it is actually very mean that 0.2% is not provided for human use. safety profile is excellent....the pharmaceutical company simply stated after the trials that the effect on dry eye of the 0.05, 0.1% and 0.2% was identical. which is absolutely not true, from my own experience, and from the papers published on the animal clinical trials where nothing below 0.2% produced any improvement whatsoever.

And other substances that cure dry eye even better and faster than cyclosporine have been stopped in phase 2 and phase 3 of clinical trials for some hard to understand reasons-- all related to long term safety....well i must say that when i read the possible adverse effects of most medications, they are much more serious and real than the "potential" ones from the minimal doses in the eye drops mentioned as reasons to stop the products from manufacturing. Is it safer to use steroids and NSAIDs? No, much less safe.

Ringo,

Efficacy is a difficult issue with dry eye drug approval because the disease is so variable in individuals. It's a recognized issue and will continue to be. But SAFETY? When there is a safety issue with a dry eye drug I for one do NOT want it on the market, period. Look at Restasis - from the moment it was approved, it started being doled out indiscriminately to anybody with any complaint resembling dry eye. A dry eye drug with serious safety issues going into widespread distribution is a recipe for disaster. We've got enough problems without side effects particularly systemic ones which are potential issues with some.

What dry eye drug has been stopped in Phase III for safety reasons?

[ringo]

Dear Rebecca,

I absolutely agree that safety of a drug is always an issue and that Restasis is prescribed quite indiscriminately for many kinds of dry eye. The logic being that is suppression of inflammation and stimulation of tears by cyclosporine would help most of the patients.

When my doctor was researching treatment options, he managed to obtain the FDA reports on a few products that were "delayed" for approval for reasons explained in a very "legalistic" obscure way, pertaining to very long term safety and potential adverse effects of accumulating the drug systemically in the body through the eye drop. However during or after the clinical trials none of the patients treated developed any adverse effects, and the dry eye symptoms and clinical signs were completely resolved.

One example is pimecrolimus-- i am sure you have loads of information about it as well--the reason for delaying its approval were stated very obscurely and not convincing to my doctor, and according to him there are eye drugs widely in use with real adverse effects,which have much less efficacy on dry eye or other eye conditions they are supposed to treat. Despite that, they have been approved and are widely prescribed to patients, who sometimes also end up treated for the adverse effects as well.

For example, it is clinically proven (not just speculated as in the case of highly efficient drugs like pimecrolimus) that steroids do accumulate in the eye, and might show adverse effects even years after stopping use. Yet, steroids are prescribed for dry eye inflammation. Unlike pimecrolimus, their effect is short-lived and not really targeting the dryness-type inflammation cascade. The benefits of using them hardly outweigh the risks.

In the case of drugs like pimecrolimus, the benefits highly outweigh the risks, which are stated as remotely probable, "potential", and a ton of other vague statements, risks that have never materialzed in anyone treated with the eye drug. There have been some again "potential" adverse effects suspected with a skin pimecrolimus ointment, but again there the concentration is much much higher.

The oral immunosuppressants used for autoimmune conditions involving dry eye and a host of other problems-- their safety profile and adverse effects is awful and their efficacy weak in many cases; but they are still approved and very much in use.

Safety is always a concern, but my point is that this concern should not be overrated or used to deny people a cure for the sake of profiting from existing inefficient drugs. If the people in charge of approving treatments and medications were so overconcerned with safety, 90 percent of the medications on the market should be banned, including the LASIK procedure.

Very Expensive Drugs for rheumatoid arthritis and similar conditions caused tuberculosis, lymphomas and SJS in clinical trials and post-marketing experience but nevertheless are widely prescribed. I do not think that this shows a very high concern for drug safety. The explanation being that in many patients the benefits outweigh the risks. Why does this logic never apply to dry eye treatments?