I-Brite Eye Whitening with Dr. Boxer Wachler

[dutcheye]

I'm still considering to get the surgery, however, since I am a member of this forum and followed up some advice, my eyes are much better.
I stopped using Visine, which (together with other vasoconstrictors) I have been using for 15 years on a daily basis. I was convinced I couldn't live without my drops. E.g when going out and than discovering I forgot my drops, made me go home again to get them. First thing I did in the morning was putting these drops in my eyes to get my eyes clear. Since I stopped, I found out I was actually only treating the rebound effects all the time. Now, I still have a bit red eyes with some prominent vessels, but way way less than it used to be! Those vessels I would like to get rid of some day.

At the same time I did an allergy test and found out that I'm allergic to mite ?? (not sure if this is correct in english) So, vacuum more often and wash my sheets every second day. Also I started eating a spoon of locally produced honey every day. This also helps to fight allergic reactions you might have against certain plant particles.
My last advice is to eat red fruits, like berries every day.

I have found so much improvement, mostly I guess from stopping Visine.

Hope this will help people in their quest.

[robster]

The fact that they use MMC in this procedure should be enough to put people off if they goggle the effects MMC can have on your health. MMC is mainly used for LASEK in eye surgery circles but very few places use MMC these days due to serious concerns regarding the drug being used on the eyes.

[google me]

Like many of you I had serious concerns about the I-Brite procedure and I kept looking for reviews outside of the I-Brite website. You can read the forum but keep in mind these comments are just opinions. I wanted to hear from people who actually had the procedure and like many of you I was wondering why we did not hear from more people on forums like this? The procedure is life changing and you would think that posts would be pouring in...I would recommend having your own consultation with Dr Boxer Wachler, watch the video testimonials (I-Brite Website) and make your own informed decision.

Dr. Boxer Wachler uses MMC following the procedure but note this is less than 10% concentration and only used for a couple of days then you use a combination of other drops to help the healing process. I-Brite is a last resort in my opinion. I tried everything from changing my diet, flax seed oil, discontinuing get the red out drops, using ointment, staying hydrated, etc. None of these worked for me and I have been searching the web for years and my confidence self esteem was low. Many of you know what I am talking about it's depressing.

[Removed by moderator]

Read my other post regarding the I-Brite procedure. Research, Research, Research and if you decide to have the procedure done please come back and share with everyone your experiences.

[dutcheye]

Googleme, could you do us a favor and post before and after pictures here?

How long did recovery take you?

[google me]

Hi, you can see dozens of before and after shots on the I-brite website some of those are days, weeks and even months after the procedure.

[Removed remainder of post]

[Rebecca Petris]

I am sorry but at this point I have to interfere.

Google Me, much as I do not want to offend you as I am sure you mean well, I have removed most of your post and I'm going to suggest that you find another website(s) to share your good results. Not here. If people want to learn about I-Brite they can do it somewhere else.

There is overwhelming reason to believe that this procedure is not a medically acceptable solution for people with a primary diagnosis of dry eye, which is all our readership. This procedure is for other conditions - not dry eye - and I do not want any of my readers construing this thread into support for the idea that it could be right for them.

[calcan]

Hi everyone,
I have seen a few archived threads about this procedure but I wanted to see if anyone had anything to add. Here is an overview of the procedure: http://www.boxerwachler.com/whiteeyes/ It consists of the doctor, um, peeling off your sclera (clear membrane over eyes). Supposedly a "crystal clear memberane without red blood vessels, yellow or brown spots grows back in its place."

I asked my opthamologist about this procedure. He had never heard of it and said it sounded dangerous. What concerns me is that there is no peer-reviewed study on this procedure and I am having a hard time finding some unbiased feedback on personal experiences. I sent in my pictures, and I was told I would be a "great candidate." The cynical side of me thinks that they say that to everyone who sends in pictures. Anyway, I was told it would cost me $4,650 PER eye for the procedure. I live in the midwest so it would be a big commitment to fly all the way out there for a consultation.

Has ANYONE here had this surgery? What was your experience like? How long did recovery take? Are your eyes better than before, or about the same (or worse)? If you could do it again, would you?

Here's some background on me and why I am considering taking such drastic measures:

I am 26 years old, and my eyes have always been sensitive--they would get red after I wore my contacts all day. But once I moved across the country, they got even worse and now they are red all the time, even though I completely stopped wearing my contacts (and eye makeup) about 5 months ago. I use preservative-free eye drops regularly, and I have seen 3 different opthamologists who have given me varying diagnoses from "you have rosacea-associated blepharitis, that's why your eyes are red" to "you wore your contacts too long, so now you have these veins and the blepharitis is continuing to irritate them." The one constant feature is that there is nothing I can do except try to keep my lids clean and take fish oil.

My doctors have said things like "it's not THAT bad" and "oh nobody's eyes are perfectly white, what they do in the movies is all faked." That may be true, but I do know that when I see other people's eyes, they look much healthier than mine. And when I look at old pictures of me (even from just a year ago, before my move) my eyes are so, so much healthier-looking.

I want to get back to "normal" and not feel trapped in my own body behind these "dirty" eyes, but I also realize that this is a serious surgery that hasn't been proven safe (or even effective), and it will cost me $9,300, plus a round-trip plane ticket and hotel (and I'd have to take at least 3 days off from work). So I REALLY would appreciate ANY feedback, good or bad, about your thoughts and/or experiences with this procedure.

Thank you and take care.

When I was your age and dealing with this issue, I wishfully dreamed of the day that surgery or some other cure could fix this. However, even though that time has finally come, I have decided that surgery is not worth the risk. Too few doctors are performing this surgery, and like others have posted, there are not enough studies on the safety of this surgery; by the looks of things, it could actually make our eyes worse. I will continue to fight the redness with every natural cure known to man, and of course, never use vaso constrictors continuously as I did before ( I still use them a few times a year for special occasions).

[StephenP99]

Unfortunately, this is the only peer reviewed article on the subject so this is the best information we have. I downloaded the actual article and it mentioned that the way this surgery was carried out (with extended mitomycin C usage, no graft leaving the sclera bare), the complications were much more frequent than standard pterygium surgery where only a portion of the conjunctiva is removed and a graft (autograft or amniotic membrane) is used. So in my opinion, if I were to ever do a surgery like this, I would not opt for something like the I-Brite. To date, Dr Boxer Wachler has never published any studies on his I-Brite surgery in a peer-reviewed journal.

I'd love for there to be more of these studies since we don't know the history of those they tested. They only did 48 patients and I'd be happier if they tracked 1000 or so to really get a better idea of the stats for this surgery. Since I do know of quite a few people who did get the surgery and were happy with their results over a year later, so the 90% complications rate is high for me. Once again, more independent studies would be great since the doctors normally don't keep track of their patients afterwards, and it'd probably require another full time team to really be able to do that effectively.

I'm going to try the no dairy/less meat diet and see if that could possibly help some; it's really the only thing I haven't tried besides this procedure. Then maybe I'll try one eye and pray to God none of these bad side effects happens to me. That'll probably be another year or so down the line though since in the beginning there were a ton of great stories, and now a few bad stories have come out as well, so trying to weigh the potential good vs the bad, both of which would be dramatically life changing, will take time.

[hankm9]

Last week, the prestigious American Society of Cataract and Refractive Surgery (ASCRS) warned that an elective eye-whitening procedure for the cosmetic treatment of chronic, red eyes is a dumb idea.

The ASCRS explained in its Clinical Alert that this dubious practice originated in South Korea, where it was banned by the Korean Ministry of Health and Welfare in 2011. [Click here for a copy/link to the ASCRS I-BRITE Clinical Alert]. That did not stop one enterprising Beverly Hills ophthalmologist, identified in the ASCRS alert as Dr. Brian Boxer Wachler, from offering the unsafe procedure, under the trade name I-BRITE. ASCRS cites two large studies revealing complication rates ranging from 83% to 92%, with 56% considered “serious.” The stated purpose of the ASCRS Alerts is “to draw attention to the risk for severe complications that can arise from this elective procedure…”

Based on the high rates of complications from the operation in East Asia, the Korean Ministry of Health and Welfare banned the procedure in 2011, citing among its reasons the number of lawsuits arising from patients who claim they were injured or suffered damages from the operation. Among the issues cited by researchers examining the procedure were complications from the operation’s large incision, the questionable practice of removing so much conjunctiva for cosmetic purposes, and the use of MMC, which has been associated with serious vision-threatening complications that may develop many years after surgery.

Seems just a tad different to the I-BRITE website claims :

[DamagedEye]

I am sorry but at this point I have to interfere.

Google Me, much as I do not want to offend you as I am sure you mean well, I have removed most of your post and I'm going to suggest that you find another website(s) to share your good results. Not here. If people want to learn about I-Brite they can do it somewhere else.

There is overwhelming reason to believe that this procedure is not a medically acceptable solution for people with a primary diagnosis of dry eye, which is all our readership. This procedure is for other conditions - not dry eye - and I do not want any of my readers construing this thread into support for the idea that it could be right for them.

I agree. I had a similar procedure done on my left eye, and aside from other terrible side effects of the surgery (atrophied iris, peripheral vision loss, etc.), my eye is so dry that I cannot see clearly except for a few minutes in the morning. (And by the way, I do have punctal plugs, use preservative free drops, take fish oil, vitamins, and am now trying taurine too!)

[littlemermaid]

Hankm kindly posted the ASCRS (American Society for Cataract & Refractive Surgery) Clinical Alert warning April 2014 for the I-Brite procedure, but people are still posting here speculating about whether it's a good idea especially with dry eyes or pre-existing chronic inflammation.

Rebecca tells us ophthalmologists are contacting her asking patients not to consider it.

A specialist in Oz contacted me on Twitter to warn us yet again of the nightmare results they are seeing (which I have to say is very cool of him) but I'm having trouble linking to the ASCRS Warning. Here's the best I can do from an Eyeworld 2014 cache -

'EW NEWS & OPINION 18 Considering the relatively young population that has elected to undergo this procedure from pre- vious studies (i.e., mean age of 35.93 years with range of 26–52 years 9 and mean age of 39.2 years with range of 22–77 years 4 ), the concern for addi- tional and long-term complications exists as well. We hope the informa- tion presented in this alert will help clinicians better understand the risks of performing this procedure and educate their patients about those risks and other safer, more conservative treatment options that are available. EW References 1. Kim B-H. Regional conjunctivectomy with postoperative mitomycin C to treat chronic hyperemic conjunctiva. Cornea 2012; 31:236–244. 2. Boxer Wachler B. I-BRITE Eye Whitening. Boxer Wachler Vision Institute and MedNet Technologies Inc., 2014. Available at: www.boxerwachler.com/whiteeyes. Accessed March 19, 2014. 3. Caceres V. An eye-opening look at eye brightening procedures. EyeWorld October 2013, pages 60–61. Available at: digital.eyeworld.org/i/194331/62. Accessed March 19, 2014. 4. Lee S, Go J, Rhiu S, Stulting RD, Lee M, Jang S, Lee S, Kim HJ, Chung ES, Kim S, Seo KY. Cosmetic regional conjunctivectomy with postoperative mitomycin C application with or without bevacizumab injection. Am J Ophthalmol 2013; 156:616–622.e3. 5. Hayasaka S, Iwasa Y, Nagaki Y, Kandoi C, Matsumoto M, Hayasaka Y. Late complications after pterygium excision with high dose mito- mycin C instillation [letter]. Br J Ophthalmol 2000; 84:1081–1082. Available at: www.ncbi.nlm.nih.gov/pmc/articles/PMC1723 650/pdf/v084p01075h.pdf. Accessed March 19, 2014. 6. Dunn JP, Seamone CD, Ostler HB, Nickel BL, Beallo A. Development of scleral ulceration and calcification after pterygium excision and mitomycin therapy [letter]. Am J Ophthalmol 1991; 112:343–344. 7. Saifuddin S, el Zawawi A. Scleral changes due to mitomycin C after pterygium excision: a report of two cases. Indian J Ophthalmol 1995; 43:75–76. Available at: www.ijo.in/text. asp?1995/43/2/75/25262. Accessed March 19, 2014. 8. Fujitani A, Hayasaka S, Shibuya Y, Noda S. Corneoscleral ulceration and corneal perfora- tion after pterygium excision and topical mito- mycin C therapy. Ophthalmologica 1993; 207:162–164. 9. Rhiu S, Shim J, Kim EK, Chung SK, Lee JS, Lee JB, Seo KY. Complications of cosmetic wide conjunctivectomy combined with post- surgical mitomycin C application. Cornea 2012; 31:245–252. 10. Kim B-H. Surgical treatment of necrotic scleral calcification using combined conjuncti- val autografting and an amniotic membrane inlay filling technique. Eye 2011; 25:1484– 1490. Available at: www.ncbi.nlm.nih.gov/ pmc/articles/PMC3213665/pdf/eye2011209a. pdf. Accessed March 19, 2014. 11. Kwon HJ, Nam SM, Lee SY, Ahn JM, Seo KY. Conjunctival flap surgery for calcified scle- romalacia after cosmetic conjunctivectomy. Cornea 2013; 32:821–825. 12. Leung TG, Dunn JP Jr, Akpek EK, Thorne JE. Necrotizing scleritis as a complication of cosmetic eye whitening procedure. J Oph- thalmic Inflamm Infect 2013; 3:39. Available at: www.ncbi.nlm.nih.gov/pmc/articles/ PMC3605078/pdf/1869-5760-3-39.pdf. Accessed March 19, 2014. Editors' note: This ASCRS clinical alert is provided for informational and educational purposes only. It is not intended to mandate or establish a specific standard of care or dictate the treatment of any particular patients. ASCRS members must make independ- ent judgments about the treatment of their patients based on all the facts and circumstances relating to each patient's condition. Contact information Cindy Sebrell: csebrell@ascrs.org April 2014 '

One problem seems to be it's not like a debridement in that the conjunctiva is changed when it re-epithelialises, and the mitomycin-C changes DNA synthesis including at the limbus where new cells form (sorry, not remotely medical). Necrotic means dead.

Unfortunately when they've bought expensive kit, want to become famous for a 'groundbreaking' procedure, or have practice management and cashflow problems, patient safety and harm is hidden. This is why tracking data and stats will become so essential and useful.

[littlemermaid]

ASCRS Clinical Alert - Eye Whitening Procedure

'Eye Whitening Procedure: Regional Conjunctivectomy with Mitomycin-C Application

An elective eye-whitening surgical procedure for the cosmetic treatment of chronic, red eyes has been introduced and practiced in East Asia and has also been offered in the United States. This procedure, known as regional conjunctivectomy with mitomycin-C (MMC) application or eye whitening, involves the excision of the medial and/or lateral conjunctiva with or without excision of Tenon capsule combined with the application of topical MMC intra- and/or postoperatively.(1)

The procedure originally gained popularity in East Asia, with one clinic in South Korea performing more than 1800 procedures as of 2013. (1) A very similar procedure has also been offered in the U.S. and goes by the name I-BRITE. (2,3) Although both procedures have gained attention for their attractive claim of treating conjunctival hyperermia, they have also drawn scrutiny and criticism for their potentially serious and sight-threatening complications.

Based on the high rates of complications from the operation in East Asia, the Korean Ministry of Health and Welfare banned the procedure in 2011, citing among its reasons the number of lawsuits arising from patients who claim they were injured or suffered damages from the operation.(4) Among the issues cited by researchers examining the procedure were complications from the operation’s large incision, the questionable practice of removing so much conjunctiva for cosmetic purposes, and the use of MMC, which has been associated with serious vision-threatening complications that may develop many years after surgery.(5-8)

Reports in the peer-reviewed literature have pointed to the extremely high rate of complications, some of them very severe, associated with this procedure. The first retrospective study published in Cornea reviewed the medical records of 48 consecutive patients who underwent cosmetic wide conjunctivectomy with topical MMC application and presented between January 2009 and January 2011 to the authors with various complications.(9) This study revealed that roughly 92% of patients who had the procedure presented with complications that ranged from less severe (i.e., fibrovascular conjunctival adhesions, chronic dysfunctional tear syndrome, abnormal vessel growth, and lymphangiectasis) to more severe (i.e., chronic conjunctival epithelial defects, scleral thinning with or without calcified plaques, adhesions of Tenon capsule to the conjunctiva at the extraocular muscle insertion site, extraocular muscle fiber exposure, diplopia) in nature.

Another large cross-sectional cohort study from the American Journal of Ophthalmology reviewed the medical records of 1713 consecutive subjects who received cosmetic wide conjunctivectomy plus postoperative topical MMC by a single surgeon at a single center with or without bevacizumab injection from November 2007 to May 2010.(4) Of the 557 subjects who could be contacted and agreed to participate in the study, the authors discovered a complication rate of 83%, with 56% of those considered serious in nature, including fibrovascular conjunctival tissue proliferation, scleral thinning with calcified plaques, and intraocular pressure elevation.

In addition to these two large studies, smaller case series and case reports, including one from the U.S., have described the various medical and surgical treatments for these complications, which range from aggressive lubrication to conjunctival flap surgery, conjunctival and amniotic membrane grafting, and strabismus surgery.(10-12) These treatments highlight the severity of the complications that can arise from this eye whitening procedure.

The purpose of this ASCRS Alert is to draw attention to the risk for severe complications that can arise from this elective cosmetic procedure that is available both within and outside the U.S.

Considering the relatively young population that have elected to undergo this procedure from previous studies (i.e., mean age of 35.93 years with range of 26–52 years,(9) and mean age of 39.2 years with range of 22-77 years(4)), the concern for additional and long-term complications exists as well. We hope the information presented in this alert will help clinicians better understand the risks of performing this procedure and educate their patients about those risks and other safer, more conservative treatment options that are available.

ASCRS Cornea Clinical Committee
This ASCRS Alert is provided for informational and educational purposes only. It is not intended to mandate or establish a specific standard of care or dictate the treatment of any particular patients. ASCRS members must make independent judgments about the treatment of their patients based on all the facts and circumstances relating to each patient’s condition.

References:

1. Kim B-H. Regional conjunctivectomy with postoperative mitomycin C to treat chronic hyperemic conjunctiva. Cornea 2012; 31:236–244

2. Boxer Wachler B. I-BRITE® Eye Whitening. Boxer Wachler Vision Institute and MedNet Technologies, Inc., 2014. Available at: http://www.boxerwachler.com/whiteeyes. Accessed March 19, 2014.

3. Caceres V, “An Eye-Opening Look at Eye Brightening Procedures,” EyeWorld October 2013, pages 60–61. Available at: http://digital.eyeworld.org/i/194331/62. Accessed March 19, 2014

4. Lee S, Go J, Rhiu S, Stulting RD, Lee M, Jang S, Lee S, Kim HJ, Chung ES, Kim S, Seo KY. Cosmetic regional conjunctivectomy with postoperative mitomycin C application with or without bevacizumab injection. Am J Ophthalmol 2013; 156:616–622.e3

5. Hayasaka S, Iwasa Y, Nagaki Y, Kandoi C, Matsumoto M, Hayasaka Y. Late complications after pterygium excision with high dose mitomycin C instillation [letter]. Br J Ophthalmol 2000; 84:1081–1082. Available at: http://www.ncbi.nlm.nih.gov/pmc/arti...084p01075h.pdf. Accessed March 19, 2014

6. Dunn JP, Seamone CD, Ostler HB, Nickel BL, Beallo A. Development of scleral ulceration and calcification after pterygium excision and mitomycin therapy [letter]. Am J Ophthalmol 1991; 112:343–344

7. Saifuddin S, el Zawawi A. Scleral changes due to mitomycin C after pterygium excision: a report of two cases. Indian J Ophthalmol 1995; 43:75–76. Available at: http://www.ijo.in/text.asp?1995/43/2/75/25262. Accessed March 19, 2014

8. Fujitani A, Hayasaka S, Shibuya Y, Noda S. Corneoscleral ulceration and corneal perforation after pterygium excision and topical mitomycin C therapy. Ophthalmologica 1993; 207:162–164

9. Rhiu S, Shim J, Kim EK, Chung SK, Lee JS, Lee JB, Seo KY. Complications of cosmetic wide conjunctivectomy combined with postsurgical mitomycin C application. Cornea 2012; 31:245–252

10. Kim B-H. Surgical treatment of necrotic scleral calcification using combined conjunctival autografting and an amniotic membrane inlay filling technique. Eye 2011; 25:1484–1490. Available at: http://www.ncbi.nlm.nih.gov/pmc/arti...ye2011209a.pdf. Accessed March 19, 2014

11. Kwon HJ, Nam SM, Lee SY, Ahn JM, Seo KY. Conjunctival flap surgery for calcified scleromalacia after cosmetic conjunctivectomy. Cornea 2013; 32:821–825

12. Leung TG, Dunn JP Jr, Akpek EK, Thorne JE. Necrotizing scleritis as a complication of cosmetic eye whitening procedure. J Ophthalmic Inflamm Infect 2013; 3:39. Available at: http://www.ncbi.nlm.nih.gov/pmc/arti...-5760-3-39.pdf. Accessed March 19, 2014

ASCRS| 4000 Legato Road, Suite 700| Fairfax|VA /22033| (703) 591.2220

[text copied entire and unedited from the original forwarded to us by @ASCRStweets]

[littlemermaid]

http://www.boxerwachler.com/i-brite-..._page=2#videos 'Patients with mental illness or psychiatric disorders may not be good candidates for I-Brite® because of 1) unrealistic expectations 2) difficulty accepting less than perfect results, and 3) continuous fixation on cosmetic variances due to individual differences in the body’s healing response.' Best consider expectations and mental health.

[Rebecca Petris]

Adding to the plethora of medical documentation of reasons NOT TO GET IBRITE, the latest, sent in by PegD:

Complications Related to a Cosmetic Eye-Whitening Procedure

Purpose
To report sight-threatening complications following extensive bulbar conjunctival resection and postoperative mitomycin C therapy for cosmetic eye-whitening in the United States.

Design
Retrospective noncomparative case series.

Methods
Multicenter report of 9 patients referred for evaluation and management of complications following bilateral cosmetic eye whitening.

Results
Seventeen eyes of 9 patients underwent cosmetic eye-whitening performed between 2 and 48 months prior to referral to one of the centers. Sixteen of the 17 eyes had persistent conjunctival epithelial defects, with 10 eyes requiring amniotic membrane grafting to facilitate re-epithelialization. Four eyes of 2 patients developed limbal stem cell compromise confirmed with in vivo confocal laser scanning microscopy. One patient developed infectious scleritis and diplopia resulting from Tenon capsule scarring. Another patient developed scleral necrosis, secondary infectious scleritis, and infectious endophthalmitis. This patient subsequently developed noninfectious scleritis that required 3-drug-regimen immunosuppression.

Conclusion
Severe adverse effects can occur after extensive cosmetic conjunctival resection followed by topical mitomycin C application. Patients and physicians should be aware of the potential sight-threatening complications associated with this eye-whitening procedure.

[jads]

Dr Boxer Wachler was featured on the show The Doctors some time back discussing this procedure with the panel and one of his patients. The young guy discusses how his eyes have ALWAYS been bloodshot but the reasons for this aren't all that clear outside of the Dr suggesting that the redness in the sclera is due to a UV damage over time.

Not certain how accurate the diagnosis of UV damage is as a cause. If anyone has any reference for this it would be interesting to read.