Little Disappointed - Followup subsequent checkup

[nitrodrops]

Was a little disappointed with my 2nd subsequent followup checkup yesterday with my opthamologist which i have been seeing for the last 7 mths. Seems like i am much more knowledgable than him now after finishing reading "Reversing Dry Eye Syndrome" book and lurking in the forum for the last 3 months.

1st Consultation
Was rather impressed because he seems to be more knowledgeable than my previous Opthamologist. He did all the necessary dry eye tests TBUT and Schrimer. He diagnosed me having Punctal Epitheliopathy, and my DES is due to the nerves cut during the lasik.


After this 1st consultation i started reading this forum actively. (Thanks Rebecca for this great forum!)


2nd Consultation
Proposed Inserting 2 plugs for me, and proposed a new Systane Ultra for me to try. Improved slightly for my dryness.


After the 2nd consultation, i went to purchase "Reversing Dry Eye syndrome" book.


3rd Consultation
I started to ask him all the Dry Eye questions.

1.) Only realised i have MGD after i asked him if i have any eye disorders such as MGC, Blepharitis & Sydrogen. Sigh, why didnt he tell me during the 1st consultation? Luckily i have been doing warm compresses every night after i found this forum.

2.) Ask him if my nerves are re-generating, he said Stilt lamp cannot examine the fine nerves

3.) Ask him how is my tears breaking up now? he said better but didnt elaborate.

4.) Ask him if i should insert 2 more upper plugs? he said he doesnt seem a need.

5.) Ask him if i should try other eye drops? Unfortunately, the Eye Centre only carries a little type of OTC drops, and patient can only try on their own and gave him feedbacks

6.) Ask how long more should i try Restasis with Plugs, he said give it some more time, even though i have already tried for 4months.

7.) Ask if i should switch from Theratears to Biotears (supplements), he told me he has never heard of Biotears

Not looking very optimistic now being his patient. Cannot rely on his limited knowledge.


Moving forward, i plan to try the follows

1.) Switch from 'Systane Ultra & Restasis' combination to 'BioTears & Restasis' combination.

● Bicarbonate containing artificial tears have also been shown to promote healing in severe dry eyes. Available bicarbonate containing tears include: Bion Tears, Murine Tears.

2.) Switch from Theratears to BioTears

Thera Tears Nutritionals does not include Omega 6 fatty acid, gamma-linolenic-acid (GLA), which is required to produce tear specific PGE1. BioTears includes the best quality available Omega 6 and Omega 3 fatty acids to address the inflammatory process frequently associated with all three layers of the tear film.


Going to continue with warm compress, drinking plenty of water & green tea, Restasis and Lower plugs. Will continue to log on the progress.


Next course of action is trying TCM and acupucture.


In this forum, i have come across many more people whose DES is much worse than me, but overcome them. This forum has given me strength to fight DES, thanks Rebecca for this forum.

[MaryVa61]

My experience with changing ophthalmologists was very similar to yours, and it's continued to get worse with each visit. So I wonder about changing again but not sure there's any point so holding off on that decision.

Does Restasis seem to help you? It did not help me. And I was curious because of what their website says. I was on anti-inflammatory drops both times I tried it and also had plugs the second time, but neither ophthalmologist seemed to know about this info Restasis puts out (restasis.com) below.

Indication:

RESTASIS® Ophthalmic Emulsion helps increase your eyes’ natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS® did not increase tear production in patients using anti-inflammatory eye drops or tear duct plugs.

Somewhere else on the site it gives the percentage of people Restasis helps, according to research, and it was an amazingly small percentage. So if it's working for you, that may mean something important about your eyes.

Mary

[nitrodrops]

My experience with changing ophthalmologists was very similar to yours, and it's continued to get worse with each visit. So I wonder about changing again but not sure there's any point so holding off on that decision.

Does Restasis seem to help you? It did not help me. And I was curious because of what their website says. I was on anti-inflammatory drops both times I tried it and also had plugs the second time, but neither ophthalmologist seemed to know about this info Restasis puts out (restasis.com) below.

Indication:

RESTASIS® Ophthalmic Emulsion helps increase your eyes’ natural ability to produce tears, which may be reduced by inflammation due to Chronic Dry Eye. RESTASIS® did not increase tear production in patients using anti-inflammatory eye drops or tear duct plugs.

Somewhere else on the site it gives the percentage of people Restasis helps, according to research, and it was an amazingly small percentage. So if it's working for you, that may mean something important about your eyes.

Mary

Hi Mary,

I did ask my opthamologist this question too, if Restasis works with Plugs.

He explained because of the plugs, some chemicals might be retained in the eyes. And Restasis plays the part of preventing inflammation.

I will say plugs help with 'slight' improvement only, wanted to go for 2 more upper plugs, but was told unncessary.

Cheers

[Mawsky]

[QUOTE=nitrodrops;66284]Hi Mary,

I did ask my opthamologist this question too, if Restasis works with Plugs.

He explained because of the plugs, some chemicals might be retained in the eyes. And Restasis plays the part of preventing inflammation.

I will say plugs help with 'slight' improvement only, wanted to go for 2 more upper plugs, but was told unncessary.

Cheers[/QUOT

Hi, Just wanted to add that the opth/surgeon I saw said that the upper plugs do very little, that only a small percentage of tears are drained out of the upper punctums (my lower punctums are enlarged from prior surgery for (if you can believe this) punctal occlusion. My Opthamologist inserted plugs in my uppers, because those were the only ones he could, my lowers are too large to hold a plug, so my only recourse now would be another procedure to close them. So it was more than likely that he is right about the uppers. Hope you see more improvement with the new drops

[Storm]

Puntal Plugs in Upper

I had lower puntal plugs put in about 6 months ago. It helped my left eye so that it was relatively pain fee; but it did not help my right eye, so my Optometrist put a plug in the upper right eye. This worked well for both eyes (ie mostly pain free) for the rest of the summer. I still use drops at least every hour. When the cold weather returned so did burning and stinging in my right eye. I will continue to use the plugs as it is the only thing that has helped significantly. I do have an appoint next week for Lipiflow so I am hoping for more relief.

[nitrodrops]

Hi, Just wanted to add that the opth/surgeon I saw said that the upper plugs do very little, that only a small percentage of tears are drained out of the upper punctums (my lower punctums are enlarged from prior surgery for (if you can believe this) punctal occlusion. My Opthamologist inserted plugs in my uppers, because those were the only ones he could, my lowers are too large to hold a plug, so my only recourse now would be another procedure to close them. So it was more than likely that he is right about the uppers. Hope you see more improvement with the new drops

Read somewhere it is 50/50 for both upper and lower ducts, hence dont mind giving 2 x upper plugs a try.

Read somewhere it is 50/50 for both upper and lower ducts, thus dont mind giving it a try for 2 x upper plugs/

[Majorglory]

hi nitrodrops, i thought to chime in about your intention to switch from theratears to biotears.. while im not familiar with the theratears product i couldnt be more enthusiastic about biotears, it really made such a big difference for me.

even though the company says you will see the effects in a matter of a couple weeks i think it may actually need some months to really kick in- i can tell you in my case i noticed a slow but consistent improvement in my syptoms over the course of years.

since some months i upped the dose beyond the label indication and guess what im noticing even less inflammation, so you may want to consider that with your doctor (by the way im a pretty big guy so probably 4 tablets a day was too low of a dosage to benefit me the most possible).

good luck!

EDIT: if it was possible to add to my post a title hinting at biotears id be grateful because i noticed just now my post sounds very random in the thread.. thanks!

[nitrodrops]

hi nitrodrops, i thought to chime in about your intention to switch from theratears to biotears.. while im not familiar with the theratears product i couldnt be more enthusiastic about biotears, it really made such a big difference for me.

even though the company says you will see the effects in a matter of a couple weeks i think it may actually need some months to really kick in- i can tell you in my case i noticed a slow but consistent improvement in my syptoms over the course of years.

since some months i upped the dose beyond the label indication and guess what im noticing even less inflammation, so you may want to consider that with your doctor (by the way im a pretty big guy so probably 4 tablets a day was too low of a dosage to benefit me the most possible).

good luck!

EDIT: if it was possible to add to my post a title hinting at biotears id be grateful because i noticed just now my post sounds very random in the thread.. thanks!

Hi Major,

Agreed. have been consuming BioTears for 5months now, i noticed better improvements on my eyes now compared to TheraTears.

[Hopeful2]

Apparently biotears includes lactoferrin, which is supposed to increase the mucin layer. I think I will take it more consistently now.

[msny]

After many years of suffering I can only say what has worked
for me thru trial and error. My eye doctor has given me several
OTC drops to try over time.

Here is what I'm using now.
Restasis - 2x a day for last 4 years
Systane Balance - about 4x during day - last few months
Oasis Tears Plus - 1x before bed - last few months
I use the heating gel pads/rice baggy bought here about 2x to 3x for last 3 years
Punctal plugs, both eyes.

The heat and Restasis take time to work, it's not a couple of weeks
and give up treatment. I'd say about 3 to 4 months to see results.

It's not perfect. Recently we have had bad weather swings with low humidity
from cold to very hot, then back again.

This drives my eyes nuts, and i find I need more drops. The sun is a killer
for me too, and I can dry out very fast. Sun light hurts my eyes, I'm
light sensitive, even on cloudy glarey days I wear sunglasses.

I'd say if your eye doctor seems causal about your treatment, time to find
a new eye doctor who takes an interest.