Contact Lenses and Dry Eye on You Tube

[Blinks]

Hi,

On my journey for better vision and improved CL comfort, I found an enlightening lecture presented by Deborah Jacobs, MD of Boston Foundation for Sight back in November of 2011. It's about 30 min. and her audience is fellow physicians. The first few minutes of QA includes lively discussion around Restasis.

I learned a great deal from this lecture (why my piggy backs don't work, why Restasis won't work for me, why PROSE may be an alternative worthy of further investigation, and why my cataract surgeon failed me). Quite a take away!

From the YouTube description: "Eyespot medicine contact lenses and life by Deborah Jacobs, MD (about 30 min)
Reknown corneal specialist Dr. Deborah Jacobs from Boston Foundation for Sight, Massachusetts Eye and Ear Infirmary and Harvard Medical School discusses “What Every Physician Needs to Know about Contact Lenses”

http://www.youtube.com/watch?v=hQyAyb0Fo0Q
(This is the first time I've tried to post a link so I apologize in advance if this doesn't work.)

Blinks

[zuzu70]

Very informative, Blinks! Thank you for sharing.

[littlemermaid]

Essential viewing on contact lenses with dry eye and allergy.

She says if allergy is eyes and nose why not use eg cromolyn topical to the eye, trickling through to the nose down the tear ducts, or spray up the nose - rather than oral meds. (Some people's eye problems are prompted by steroids up the nose, though, presumably because they affect the immune system.)

Also, she saw someone 10y without realising the patient was atopic and using tacrolimus in patches for the skin. Only then started to treat the eyes for that. This is what we are finding. Many eye docs switch off or blank us or are openly dismissive when we try to talk about skin and systemic disorders, and don't even ask what other meds we're on and what allergies we have. So we need eye docs who recognise systemic disorders from eye problems and refer.

I am finding when the acne rosacea skin is well controlled with topicals the eyes are great. And that anything we use on the face, anywhere, has affected the eyes, even eg topical retinoids. The skin is an absorbent organ and the immune system around the eye has heightened responses to invaders.

Great doctor, great informative video.

[unicorn]

Thank you for posting this! Very interesting viewing.

I guess what I was looking for was some info about whether the use of soft contact lenses can in fact cause dry eye, and I didn't really come away with any further understanding about this. She seemed to be quite in favour of keeping people in their lenses as long as possible - am I right in thinking this? In fact I think she mentioned very briefly that some dry eye patients feel more comfortable in their lenses (this is sometimes true in my case).

Still rather confused about the allergy aspect though, esp the use of topical steroids to the nose - I am sure there is a member here who was advised to stop the use of nasal steroids as they may have contributed to her glaucoma.

Littlemermaid, do you find that the rosacea skin is always in flare up when the eyes are worst? I have actually not had any bad flushes or papules recently, my skin is reasonably good, other that persistent slight redness. But my eyes have become very inflamed in the last few months. I suppose I've still to get an official 'diagnosis' of ocular rosacea from the ophthalmologist, so perhaps allergies are more of an issue?

[Blinks]

Hi,

Glad this video contained some help. I have tried to find a way to get a transcript as the presentation is packed with information and I'm not familiar with all the terminology. After listening to the Restasis section (minute 26:32) several times, this is my best attempt at capturing Dr. Jacob's words. (I'm not so great with capturing on the fly so this may not be 100% accurate.)

Question: “What’s your experience with Restatis?
Answer: Dr. Jacobs: I think Restasis works great for immune-based dry eye. Question is which of your dry eye patients have immune based dry eye. Allergan sought FDA approval for all dry eye and it took longer for them to get approved because they wanted that broader indication. But for dry eye particularly associated with ordinary contact lens intolerance, patients in their 30s, 40s, 50s, Restasis is useless and they benefit from plugs. But for someone with Atopic (?) eczema, underlying rheumatoid arthritis, ulcerative colitis, it’s a game changer, You know how you know? They stay on it. It stings, it’s expensive, and it’s inconvenient. For contact lens intolerance, choose plugs and lubrication. I choose Restasis depending on the underlying systemic picture. I believe in it but not for the market it was marketed for. I’m a fan of plugs, I’m a fan of dissolving plugs, dissolving plugs, Duraplugs, there are different brands, silicone plugs or cautery. “ (some omissions here)

Blinks

[unicorn]

Very useful transcript, Blinks. I also found some of it hard to catch.
I don't remember if roscacea was mentioned. Would that come under the category of 'immune-based dry eye' I wonder? ie would it be helped by Restasis?

Not that we can get it in the UK, yet

[Blinks]

Hello Unicorn,

Yes, the information on lenses for dry eyes was quite interesting. In Dr. Jacobs's discussion around dry eye and different types of contact lenses she included mention of lenses with a "rigid modulus" as being better for dry eye. Maybe there are readers who have experience with the Focus Night and Day lens, or who can share which soft lenses have helped.

I've failed a trial with AcuVue Moist high water content lenses for the reasons given by Dr. Jacobs.

Here's my best attempt to capture the words of Dr. Jacobs (errors, if any, are all mine):

Dr. Jacobs: "Dry eye often feels better with a lens. A higher water content lens is not the answer (for dry eye) because the lens acts as a sponge drying the surface. Lenses with more rigid modulus, physical stiffness of curvature of soft lens. Stiffer modulus holds more fluid against the cornea like RGP lens. (Ciba?) Focus Night and Day is great therapeutic lens but patients report lens is edgy when they blink. Trial lenses help patients decide what makes them happy. Not a case of doctor knows best. Just like fitting shoes. The patient must decide."

Blinks

[littlemermaid]

Unicorn, The eyes are worst when the skin is flared - triggers also include virus so it must be the immune system. But the meibomian glands were not cleared until we stopped eyedrops with preservatives and chemicals. Some people get sensitive to contact lens materials and solutions. Karjade improved on stopping nasal steroids for allergy, also Tiff was using it paediatric for her 3yo son's allergies and stopped. There's a risk with steroids and immunomodulators interfering with the immune system, I guess.

PS Restasis is not available UK but there are other ciclosporin formulations like Optimmune easily available NHS (and some more as specials from Moorfields Pharmaceuticals).

Thank you, Blinks

[unicorn]

In my case I was wearing Acuvue Oasys lenses. I've stopped these as of about 4 weeks ago due to possible allergy to the solutions, but previous to this they definitely helped against the feeling of burning and stinging, although I would find my eyes a little dry (as in slightly gritty, irritated) towards the end of the day.

They are a silicone hydrogel lens which has a low water content - like the Focus Night & Day, as far as I know. I also seem to remember reading that the silicone hydrogel lenses are a little 'stiffer' than normal hydrogel lenses which is perhaps what Dr Jacobs is referring to?

The only daily disposable silicone hydrogel lens on the market at the moment is Acuvue TruEye, although I haven't tried it yet (it was recommended to me by an optometrist I saw recently about my dry eyes).

[No tears in ATL]

Chemia, this interesting. My tear breakup time is within good range (about 14-15 seconds) but my tear volume is not so great. With plugs in, the tear volume is just...ok.

My eyes get super red after computer use (sometimes as little as an hour) and in cold offices. This makes work suck pretty bad.

I was wearing the Acuvue Oasis lenses for some time, and my dry eye first became a problem then. Had to quit contacts. I just assumed that the Oasis were actually GOOD for dry eye, and if I couldn't wear THOSE, then contacts were not an option.

So can you wear these all day? 8 hours or so? How are they for doing computer work?

[Lacrima]

The only daily disposable silicone hydrogel lens on the market at the moment is Acuvue TruEye, although I haven't tried it yet (it was recommended to me by an optometrist I saw recently about my dry eyes).

There is another brand of silicone hydrogel daily disposables called clariti 1 day: http://www.sauflon.co.uk/eye-care-pr...s/clariti-1day

[littlemermaid]

http://www.ncbi.nlm.nih.gov/pubmed/18065213
Eur J Pharm Sci. 2008 Feb 5;33(2):138-45. Epub 2007 Nov 6. Cytotoxicity of contact lens multipurpose solutions: role of oxidative stress, mitochondrial activity and P2X7 cell death receptor activation. Dutot M, Warnet JM, Baudouin C, Rat P. Laboratoire de Toxicologie, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris 75006, France.

OBJECTIVE: To investigate the cytotoxicity of multipurpose solutions used for contact lens disinfection.

METHODS: Four multipurpose solutions (Optifree containing quaternary ammonium as preservative, Renu, Solocare and Complete containing polyhexamethylene biguanide as preservative) were incubated on a conjunctival cell line to evaluate their capacity to induce necrosis (neutral red test), intracellular redox status alteration (Alamar Blue test), reactive oxygen species overproduction (DCFH-DA and dihydroethidium tests), mitochondrial alterations (NonylAcridine Orange and JC-1 tests) and to activate P2X7 cell death receptor (YO-PRO-1 test). Tests were performed using cytofluorometry and inverted fluorescence microscopy.

RESULTS: Our results showed that multipurpose solutions induced necrosis, in addition to oxidative stress. Optifree induced oxidative stress with increased mitochondrial mass, Renu, Solocare and Complete induced whether a decrease in reactive oxygen species production with mitochondrial alterations, or an increase in reactive oxygen species production, but each solution stimulated P2X7 cell death receptor activation. Early stimulation of P2X7 cell death receptor, prior to any superoxide production, demonstrated the possible involvement of this receptor in the oxidative stress process.

CONCLUSION: These new findings suggest that most of multipurpose solutions are toxic with oxidative stress and apoptosis induction.

[Blinks]

http://www.ncbi.nlm.nih.gov/pubmed/18065213
Eur J Pharm Sci. 2008 Feb 5;33(2):138-45. Epub 2007 Nov 6. Cytotoxicity of contact lens multipurpose solutions: role of oxidative stress, mitochondrial activity and P2X7 cell death receptor activation. Dutot M, Warnet JM, Baudouin C, Rat P. Laboratoire de Toxicologie, Faculté des Sciences Pharmaceutiques et Biologiques, Université Paris Descartes, Paris 75006, France.

OBJECTIVE: To investigate the cytotoxicity of multipurpose solutions used for contact lens disinfection.
(snip)

CONCLUSION: These new findings suggest that most of multipurpose solutions are toxic with oxidative stress and apoptosis induction.

Littlemermaid,

This study on multi-purpose solutions was quite timely and helped me a great deal. Thank you for posting it. Recently I had a bad episode with a multi-purpose solution, which may have occurred due my very compromised and unhealthy corneas. I've been reading about the various preservatives, anti-microbials, disinfectants, etc so I can try to avoid over the counter drops or solutions with similar ingredients. It's truly buyer beware. This forum has provided so much information and the insights of many. Truly a huge benefit. It helps those of us who are feeling at sea with our respective dry eye issues and suffering from the fractured medical system. Thank you so much for your kindness.

Blinks