Does Restatis work with 4 punctal plugs?

[GeorgeT]

Hi,
I am posting this thread to get knowledge if Restatis works with 4 plugs.
I have 4 plugs in and watery eyes most of the time due to MGD(maybe ocular rosacea-no acne rosacea detected) and I want to start Restatis to eliminate(hope so) the rest of the discomfort and the fluctuations in vision that I have and difficulty to focus and light sensitivity.
I've read contradictory data about Restatis with/out 4 plugs.
Thank you so much for your help.

Best of All!!

George

[Eli]

George-
My understanding of the clinical trials with Restasis was that the drug was never evaluated with patients using punctal plugs, possibly for cost/time reasons. In any case, using punctal plugs does not prevent the Restasis from performing its function as an anti-inflammatory. So yes, it could still work for you even if you are plugged. I myself am plugged and am on restasis as well. On another note, I wonder if your blurry vision is due to having too high of a tear volume in your eyes. Perhaps dropping down to lower plugs only, or lower flow controller plugs with solid upper ones might help.

[GeorgeT]

Thank you so much Eli.
I forgot to mention that I have 4 flow controllers. I was told that only a small amount of tears flow through.

Regards,

George

[IanJ]

Hi,

I wonder if there is another issue here.

If Restatis is an immuno-suppressant (sp?) and one had four solid plugs fitted would this not leave the eye extremely open to infection etc.
My theory being that with 4 plugs there is no wash through going on with the tears so germs etc will hang about longer......and then to turn on an immuno-suppressant on top of that would be more harmful.

I'm a beginner here so shoot me down if I'm wrong.

I have four solid plugs (smart) and bathe/scrub my eye's with Sterilid.

Ian.

[kitty]

My eye doctor showed me an article/study that shows plugs plus Restasis give greater benefit than either plugs or Restasis alone. I think the article came out last year.

[indrep]

I heard recently that Allergan is recommending the following protocol based on reponses from the docs. Lotemax and Restasis for two weeks, stop Lotemax, at the end of the fourth week insert punctal plugs.

The theory is reduce or eliminate the inflammation and then insert plugs for patient comfort and reducing osmolarity. But most imporatant keep Restasis sales high.

I'm not a big believer in Restasis so couldn't help the last sarcastic remark.

[Rebecca Petris]

I thought that the point of the cyclosporine was to control inflammation and that the previous pitch was that plugs should not be used when there is uncontrolled inflammation. If the steroids and a coupla weeks of cyclosporine get the inflammation under control to the point where plugs are OK, why continue cyclosporine? If the inflammation is not under control, why are plugs now OK? Cesspool theory undergoing some convenient modifications?

I am a believer in Restasis - for a SMALL, CAREFULLY SELECTED group of patients. (Remembering that cyclosporine always was useful to some dry eye patients long before Restasis.) I don't think personally that there are any simple cookie cutter answers to whether combining it with plugs or not is a good idea - each case is so different and responds differently.

Like indrep I can't help but be highly skeptical of these new regimens whose chief object seems to be to widen the field of people to whom Restasis can be prescribed. We have already seen in the past two years on this board innumerable reports of "Well I think the Restasis is helping but I don't know because it's been so long and so many other things have changed. At any rate I'm afraid to stop because it MIGHT be helping and I don't want to make things worse." It's a great recipe for empty pockets and happy shareholders. I try not to begrudge Allergan their success with it since it does seem to be helping some people, but I personally feel that Restasis is too often being used as a shortcut to avoid truly sorting out each individual dry eye case and developing an individual treatment plan.

[IanJ]

Rebecca,

I'm trying to work out what dry eye condition Restasis is aimed at, or is helpful for. If I fit then I'll give it a proper try......I'm reading on these forums that you have to give it minimum 6 months.

I'm aqueous deficient in my right eye, It seems that my lacrimal gland is simply not producing enough tears. This is the eye I get 'pain'.

My left eye tears a lot more, is always wet enough.....but dry all the same (you know what I mean!).

I also have bleph and am quad occluded (all plugged up). My right eye almost never tears by itself, my left eye does weep a bit but not to the point of running down my face.

PS. If I do give Restasis a good go, will using other eye drops alongside Restasis be counter productive?

Ian.

[Rebecca Petris]

Rebecca,

I'm trying to work out what dry eye condition Restasis is aimed at, or is helpful for. If I fit then I'll give it a proper try......I'm reading on these forums that you have to give it minimum 6 months.

It's aimed at lacrimal insufficiency. However, I don't think it would be an exaggeration to say that many doctors prescribing it don't necessarily make a diagnostic distinction between lacrimal insufficiency and meibomian gland disorders, or if they are, they're prescribing it for people with MGD anyway. And there are doctors out there who believe it is helping some people with MGD.

Worth a try anyway. I don't personally buy the 6 month minimum. It may apply to some people though.

PS. If I do give Restasis a good go, will using other eye drops alongside Restasis be counter productive?

I don't believe so - in fact probably most people in Restasis are also using artificial tears. However, I would strongly recommend making no changes to your treatment regimen including type and frequency of artificial tears while you are on Restasis so that you can better judge the effects of the Restasis.

[GeorgeT]

Hi,

I was prescribed Restatis for MGD/rosacea with Schirmer of zero and TBUT normal. Seems kinda of strange to have MGD and TBUT normal. Up to date I haven't seen any improvment due to Restatis (a month only) but I can use it only once at night.
So, probably I will see some results in much more than 6 months.

Thanks,

George