What kind of artificial tears/goop do you use?

[Steve]

Update on my goop

Tears Naturale and Refresh Tears are both water-based tear substitutes, and I don't know any reason one should be "better" than the other except whatever you've found.

I have an update on my tears regime and with thanks to all of you for getting me off the BAK (and Cetrimide) preservatives, I can now say:

1. Systane is wonderful and is now soothing, rather than irritating. This may have to do with having dropped the constant irritation and cell damage from the BAK. I use Systane drops about 4 times daily now.

2. Restasis apparently helps with my Blepharitis. I'm using it as directed, BID, and I've seen substantial improvement in eyelid redness and eye dryness over the last 6 weeks.

So that's the current routine. Any comments?

[TWB]

First of all, I hope you all don't mind me posting here, but I'm doing some contract research at the moment on Visine branding, and some of the posts here caught my attention!

Clearly they have a problem in that they aren't well regarded among professionals and well read sufferers like yourselves, which prompts a couple of questions.

Are you aware of the Visine Professional products for severe dry eye? It's relatively new and doesn't contain BAK, but I've seen very little info around.

Would you consider Visine products at all, or is the company's reputation such that you'd steer clear regardless?

Any comments would be appreciated, and again apologies for this kind of post if it's deemed inappropriate.

[Steve]

Interesting question

I personally didn't have anything against Visine the company up until just now, when you mentioned the new "Professional" line.

Any company that realizes they're selling eye products that damage eyes (with BAK) and keeps selling them, and then comes out with a new "Professional" line without the poisonous ingredient, leaving the "amateurs" to continue getting worse, is doing far more damage to its reputation than if they just remained apparently ignorant.

Visine should, if concerned about their reputation, read through the preponderance of evidence and IMMEDIATELY change the preservative on all their eye products to something safer (not Cetrimide; it has the same problems).

It's not like there's a lack of evidence against BAK as a killer of epithelial cells, even in concentrations FAR LESS than that used in Visine. A quick google search turns up these peer-reviewed studies (google benzalkonium chloride cell damage):

* http://cat.inist.fr/?aModele=afficheN&cpsidt=14876897
* http://www.blackwell-synergy.com/lin...1.2004.00782.x
* http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
* http://bjo.bmj.com/cgi/content/full/86/3/299

[TWB]

Appreciate the response Steve. You're certainly right about the amount of evidence against the usage of those preservatives. Hopefully we'll see them rapidly phased out, but unfortunately not all users are as informed as you guys seem to be.

[Steve]

Don't understand.

Appreciate your response, TWB -- but I don't get it.

Why would the state of knowledge of the users matter? The less-informed users are trusting Visine to help with their eye problems, and to do the necessary research.

It's entirely Visine's (or Allergan's , or whoever) responsibility to change formula to keep their users safe. I can't see how the state of knowledge or ignorance of the users (or even ophthamologists) should make any difference.

I think Visine, as part of their branding, is in a position of trust by saying they're selling products that will help, not damage, dry eyes. In my view, by knowing that they're doing damage and continuing, they're just abusing that trust.

[kakinda]

I couldn't agree more with what you said Steve just add Alcon and PFIZER to your lab list selling preserved drops to uninformed patients.
Basically it's: for those informed about our wrong doing you may find this other option that will preserve your eyes, but for those who are not aware... then too bad for them, we'll keep selling.

For crying out loud, TWB, we are talking about people's sight, lives!
These people trust labs with their eyes... and it's not so easy, when you're hurting and desperate to find solutions to find the appropriate info on BAK. People are looking for solutions not additional problems.

and surely even a mild dry eye sufferer (a state I overpassed since 94) deserves some respect and proper care.
PFIZER is not doing its job if it's not informing everyone that they should be using unpreserved drops for chronic treatment... therefore you should be recalling all your dangerous BAK-containing products and just leave the professional line of the Visine brand.
Don't you agree with me? if not please point out where my logic fails me...

[TWB]

Couldn't agree more actually. I suppose my reference to user knowledge was that if these issues were more widely publicised, companies would have more consumer pressure to change their products.

But of course the responsibility exists regardless, and is not being dealt with appropriately.

[kakinda]

Couldn't agree more actually. ....
But of course the responsibility exists regardless, and is not being dealt with appropriately.

Well actually you can agree more... meaning your could inform you pfizer bosses to consider this issue, their responsibility and deal with it appropriately (that is to go preservative-free! PF).
Anyway, the PF revolution has started (through consumer information) regardless of pharma's behaviours... so i guess Pfizer and others may as well use it to sell their new PF lines (and stop producing Preservative versions). If not being truly responsible (by doing their pharmacovigilance job by themselves) at least trying to look like it doing so...
Sorry if this seems rather disrespectful for your line of work but it has ruined my left eye so it's difficult for me to understand that some eyes are still in danger due to frequent preservative use, pharmas irresponsible behaviour, medical ignorance... in 2007. As I said, BAK consequences were first reported in 1941. In 2007, there is overwhelming evidence... and yet you're still selling.
No, I don't get it... someone once told me that only a trial against pharmas would change things, maybe he's right! I may consider getting Keratos association into that.
Since common sense is never enough!

[Rebecca Petris]

First of all, I hope you all don't mind me posting here, but I'm doing some contract research at the moment on Visine branding, and some of the posts here caught my attention!
...Any comments would be appreciated, and again apologies for this kind of post if it's deemed inappropriate.

Dear TWB,

Welcome! I'm glad you happened across our site.

I've got no problem with posts like this - in fact I really welcome any opportunity for the dry eye community to get its concerns out to manufacturers. You may need some thick skin - we have a truly wonderful community of people here, but things like BAK will bring out strong feelings. Even mine. I think of myself as relatively even tempered but every time I hear "There's a Visine for that" it really gets my spleen up.

Would you consider Visine products at all, or is the company's reputation such that you'd steer clear regardless?

I'd like to share my own thoughts with you about Visine's branding and formulation issues. See also our page on Visine products here.

Re BRANDING:

Visine has long been the king of consumer OTC eyecare branding but in my opinion Pfizer has done an enormous disservice to the public by extending the Visine brand to include dry eye care products. I am pleased to see that the increase in consumer marketing by companies like Allergan has improved public awareness of dry eye and has stepped up the pressure on other companies to more carefully consider the messages they are sending.

Here on DEZ you see an unusual and sophisticated consumer group. The average undiagnosed dry eye consumer browsing the shelves at Walmart does not have the knowledge to differentiate between vasoconstrictors and 'pure' lubricants much less the knowledge to differentiate between the various preservatives.

Exploiting the branding power of Visine to sell OTC lubricants and hybrid products comes at an unknown and I would expect enormous cost of consumer confusion resulting in increased misuse of both vasoconstrictors and BAK-preserved products. If Pfizer wants to make any friends in the professional community or the community of educated dry eye veterans, they MUST re-brand and keep ANY AND ALL dry eye related products under a completely different brand.

Re FORMULATION:

In my opinion, it is understandable (not to be confused with 'acceptable') that BAK has historically been used in many prescription medications for eye conditions such as glaucoma. I am pleased to see that pressure from professionals and to some extent the public is moving things in another direction albeit too slowly.

What is neither understandable nor acceptable, in my opinion, is the use of BAK in ANY OTC dry eye products. It is well known to cause harm to the ocular surface; it is absolutely unnecessary; and it places consumers at great risk of unwittingly exacerbating an already serious problem.

Anyway, those are my thoughts in a nutshell. I wish you well in your research and I earnestly hope Pfizer decides to take a different track with their dry eye product line.

[TWB]

Thanks Rebecca, you've provided some really helpful insights, as have the other posters here, which will be part of the research I present to the company.

I'd like to clarify that i do not work for Pfizer or Visine, I work for a comms company recently contracted to them.

I would also add, hopefully on a more positive note, that Visine has been sold by Pfizer, and will now be run by J&J, who (at least from our dealings so far) intend to focus on the more medically credible variants of the product.

Thanks again and best of luck all.

[neil0502]

What is neither understandable nor acceptable, in my opinion, is the use of BAK in ANY OTC dry eye products. It is well known to cause harm to the ocular surface; it is absolutely unnecessary; and it places consumers at great risk of unwittingly exacerbating an already serious problem.

While I'd like to shout a gigantic "HOORAY!" for the totality of your post, Rebecca (and Steve's, and Kakinda's, and ....), there is one thing above with which I take issue:

It is ENTIRELY understandable that MANY of these companies would use BAK in ANY of their ophthalmic products.

It's just loathsome and contemptible.

Read about Jeffrey Wigand. Big Tobacco spiking nicotine levels to ensure the consumers were addicted to cigarettes.

It's no different with BAK and eye drops. Assume, arguendo, that BigPharma has--in this situation--been either stupid or evil. They aren't stupid. The BAK damage has been well documented since before WWII.

Somebody, somewhere, at some time ... and on an ONGOING basis--either tacitly or actively--made, and makes, a business decision (it's not the chemists; it's the Mahogany Row Execs (that's my background, Folks) who determined whether or not to continue using BAK in their products.

It MAKES a market. People get worse. They use more drops. They STILL get worse. They try ANOTHER drop--quite often from the same manufacturer's lineup.

This may sound like nothing more than bitter cynicism, but I've been at the big table when analogous decisions were made ... on countless occasions.

Never doubt it.

The upside? The same pressures that influenced the Execs' decisions in the first place are the ONLY thing that will influence the RIGHT decision now: the power of the pocketbook.

All of the BENEFITS of moving toward PRESERVATIVE-FREE formulations has to substantially outweigh the total of all of its COSTS. That can come from lawsuits, grass-roots (letter writing campaigns, 20/20 and 60 Minutes style investigative journalism), or from consumers leaving their products and their brand.

But it must come.

TWB: I'm, perhaps, the poster child for damage due to BAK for the DEZ. I will make this offer--and believe that, perhaps, Kakinda would do the same: if you will be the vehicle, I would be ready, willing, and able to draft letters, bear witness, corral experts, and give plaintive testimony before the relevant folks at BOTH Pfizer AND J&J (and others).

I'm still trying to save myself at the moment, but ... I'll make myself available to do what I can in this matter. Lives are at stake. Nothing less.

Please feel free to contact me ... and please do.

Regards,
Neil
neil0502@yahoo.com

[kakinda]

TWB: whether you work directly or indirectly for them it doesn't matter to me (but i guess it's better for you and clearly could help you to point out that they not going in the right direction with BAK products), what I mean is that if you're analysing the market potential and branding for DE products then... you should warn them about the change that will come one way (sheer confrontation) or the other (a true exchange of interests which could be benificial for all).
So it's really not a personal attack against you nor the pharmas...
Actually, I don't consider pharmas as ennenies per se at all, they're in fact allies when they are doing the propper things (for instance two French pharmas here, Théa and Horus-pharma who committed themselves not to produce preservative products anymore for DE and have always a PF version available for other frequent use; their products contain inserts calling upon banning the use of BAK and warning patients about potential risks).
So, I guess i can speak for Neil and myself, it's not the branding we're after but the behaviour behind it.
I am very much willing to help you to get some sense into this BAK issue, through testimonials, reports and articles, whatever... to help Pfizer decide on which side of the barrier they want to be (I guess that considering their stock value and the prescription (juridical, meaning ending) of several patents, they're not in position to make that many commercial mistakes...).

Anyway, Neil and I will be working on a BAK banning website so we'll keep you posted on any progress.

[AccutaneJay]

I use TheraTears drops in the vials and bottle. I've been using the gel, but it seems to be irritating to my eyelid skin when it dries and become crusty. I wake up and the corners of my eyes (skin) is irritated and it is sort of a mild burning/irritated feeling. I'm switching back to just using the regular tears throughout the night.

[Rojzen]

Optive: levocarnitine - why?

I've had good experience with Optive, too. . .and it appealed to me because it contained some ostensibly bio-active components I've never seen elsewhere, like levocarnitine. . .coupled with Allergan's claim that the product is actually therapeutic (and not just a symptom treatment). . .Many notes to Allergan, though, about what is special about Optive have been unanswered. . .I wish I knew what the thinking was behind this interesting product. .Does anyone know? There's a second ingredient that intrigues me. . .Can't recall it now. ..alas. . .

[Mika]

tears naturale fort v/s tears naturale 2 ?

well guys i usually use T.N fort but recently i tried the T.N 2 as it contain less preservative... the T.N.F contain approx 11 preservative or inactive while the T.N 2 contain approx 6 preservative or inactive.....

the T.N. forte contain the 5preservative/inactive of T.N 2 but the latter has sodium borate exclusively.

in using this tear naturale 2, i've noticed it is a bit irritating to my eye....dats strange as it contain less preservative/inactive!! mayB its the sodium borate? and the tears naturale forte is more comfortable....
but still i wonder if i must stick to the tears naturale 2 bcoz of it containing less inactive, altho it is a bit irritating sometimes....