Punctal plugs and Restasis

[Brula]

Hello!
I have punctal plugs. Is it now smart to start treatment with Restasis ?

[kitty]

Latest research

Timely question! I just got back from my eye doctor. During the appointment, he showed me an article published last December I think, showing that in a small study (30 people), those who used Restasis plus punctal plugs not only did better than the groups who used one or the other, but there seemed to be some additional benefit over what was expected. I got plugged about 2 months ago, and started Restasis once daily one month ago. Time will tell as far as whether or not my response matches those in the study. Sorry I did not get the reference for the article.

[indrep]

There have now been in couple of studies that show Plugs enhance the benefit of Restasis. Keep in mind that Restasis still does not work on everyone and that if you are going to see benefit it should happen by 16 weeks.
Good Luck.

[kitty]

For Indrep....

Have you come across any information or studies about the concurrent use of Restasis and Patanol? Can the drying effects of the BAC preservative in Patanol negate any tear producing effects from Restasis?

[neil0502]

Have you come across any information or studies about the concurrent use of Restasis and Patanol? Can the drying effects of the BAC preservative in Patanol negate any tear producing effects from Restasis?

I've got anecdotal for you, Kitty: when I told two dry eye gurus that my last trial of Restasis was--as it turns out during the same time frame in which I was using the (BAC-containing) cycloplegic drops--both basically said, "Well, each probably just canceled out the effect of the other."

That was just an educated opinion on their part, AFAIK, but ... it sure makes some sense to me.

If I come across anything like that, though, I'll surely loft it onto the forum.

EDIT: while I'm thinking about it ... one of the things that BAC is KNOWN to do is to increase the permeability of the corneal epithelium ... sort of opening the flood gates. For something like an ophthalmic antibiotic, this is a good thing.

For Restasis, though? I have no idea.

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

[indrep]

Kitty

Restasis is an antiinflammatory. So it doesn't technically increase tear film. What their scientist say is "It reduces inflammation along the lids, hopefully allowing more tear out and more lipids."

To answer your question though, no I have not seen any studies of the effects of combining the two.

[neil0502]

Based on its (not entirely understood?) mechanism of action, do you have any opinion as to whether increasing the permeability via BAC would be a GOOD or a BAD thing with Restasis??

[SusieD]

There have now been in couple of studies that show Plugs enhance the benefit of Restasis. Keep in mind that Restasis still does not work on everyone and that if you are going to see benefit it should happen by 16 weeks.
Good Luck.

Its always made sense to me that it would work better with plugs in place anyway - as the drop will be in contact with your eye longer than it would without them, so you get more out of it, so to speak. Without plugs, half of it probably just drains away before it has chance to be absorbed.

[kitty]

Goblet cells

I ran across a study that found that the active ingredient in Patanol reduces goblet cell density. Patanol and goblet cell density

Restasis, or so I have read, is thought to help increase goblet cell density. So, why would a doc prescribe both Patanol and Restasis? I sure as heck don't need to lose any more goblet cells. Interesting development too. While my eye doc says I am not allergic to Restasis, the Patanol seems to relieve the side effects I experience from it. My next conversation with my eye doc will be interesting no doubt.

[indrep]

Kitty,
Reducing Goblet Cell density is a bad thing. Studies have shown that dcreased goblet cell density is directly proportional to severity of Dry Eye disease.

Susie you are correct in the assumption that punctal occluded eyes do better with topical meds because they stay on the eye longer. This has also been shown with glaucoma patients and their meds.

Neil,
For what ever benefit might be attained from permeability would be lost from goblet cell loss. I am not a big believer in Restasis anyway. I have also seen the Patanol have a negative impact on my wife's eyes so I am not a proponent of that either.

I have to say that I look at DES as a progressive chronic illness, like RA, Lupus, glaucoma, diabetes, etc. but with different causes. One can be environmental, literally where you live o r the job you have, or caused by a medication you might be on temporarily(birth control pills) or it can be systemic in nature. If it is environmental for you, you have to decide between the DES and the factors you can change. If it is systemic in nature then you have to learn to make the situation be as much as you can in your favor.
BUT, and this a pretty big but, DES has only recently had a lot of attention paid to it. Dr. Holly and Dr. Gilbard were early pioneers to look at things like osmolarity and oncotic pressure. Now even with all the research going on it seems to more times than not come back to these two things. Also don't be so harsh on docs because the truth is nobody is really out there with a consensus on what to do. DES becomes very complicated once it has progressed to the depleted goblet cells and electrolyte imbalance stage. So it is important start treatment early.

Having said all of this if you have blepharitis don't ignore it. Clean those lids. If you have poor tear volume look at ways to keep the tear on your eye longer and the sooner the better. But also clean your lids. Like any progressive disease, the longer you wait to start treatment the longer it takes to stabilize it. Always look for ways to make your eyes more comfortable. Dwelle and TheraTears are probably the best drops you can use. (I have no financial interst in either of these by the way.) The goggles or the other "air circulation" blockers are helpful.

While one thing may help some people it make take many to help others. Some get relief from just drops or plugs others may need clean lids, drops, plugs, goggles, etc. to get relief.

Above all else continue to make your voice heard to your doc and keep up the good fight..

[Rebecca Petris]

K
Having said all of this if you have blepharitis don't ignore it. Clean those lids.

Dr. Gilbard's got a new product coming out for this, incidentally, called Sterilid, an antibacterial lid foam, which sounds very promising. They've been promoting it at the trade shows. I got a cute ad in the mail for it the other day. On one side a picture of a baby shampoo bottle with "Great for washing hair". On the other, a picture of their lid cleanser with "Great for prepping lids".

[Delilah]

Restasis not helping?

HI Everyone, I wanted to know why Restasis seems it's not helping me? I've been on it for about 2 months now, also the Castor Oil eye drops, seems like my eyes are going back to the way they were? The mucus strings are back worse and the dry eye is horrible, I don't know what to do? Im getting more Restasis today from the student health center, its cheaper, Im on the graduated plan, the Restasis will cost around 90 bucks, compared to Wal*Greens and it's 114 there I just don't know what to think or do anymore, I've done everything I can for my eyes, Im still taking the Flax Seed and Fish oil and Vitamin E supplements. I drink like a gallon or more of water per day, Im on a diet now, I have been smoke free since March I feel better about that but its just these damn stupid eye mucus strings that bug me to death, I wish I knew how to get rid of them? Hope all ya'll are doing okay. Have a good Memorial Day weekend. Ciao D

[indrep]

Delilah,
The weather could have something to do with a regression of your symptoms. My wife has had the mucus strings going on 10 years now. It just sorta comes with the territory. Warm washcloths and patience along with copious amounts of artificial tears.

[kitty]

Delilah, it can take as long as 6 months to see benefit from Restasis. The benefit may not be tear production as much as a reduction in the burning (the anti-inflammatory effect). I have been on Restasis with once daily dosing for about 6 weeks and believe there has been some reduction in the burning, but no increase in tear prodcution. My photosensitivity is better, which indicates that there is less inflammation in my eyes.

[Delilah]

Thanks Everyone

It's been raining cats and dogs so there is humidity? I have a humidifier, I also think that a lot of it has to do with me messing with my eyes even more than they need to be messed with. I find sometimes if I am busy doing something and not focusing on them they will be okay for awhile. Anywho it's a lazy Sunday and Im going to read the newspaper, boring Idaho lol, a few days ago the big headlines was a baby moose came down from the mountain and was walking in Old Town, they scared him back to the woods. WOW lol, I wish I could take a trip to Vegas and get crazy and wild and maybe I'd forget about my eyes for a bit? Have a good weekend everyone. Ciao D