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So I'm a little shocked by this doc's response. Found this on an online message board

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  • So I'm a little shocked by this doc's response. Found this on an online message board

    I was looking up some info on autologous serum and found a response from an opthamologist who apparently thinks that serum drops are junk science. This is old (2009) but seriously, I hope this is not the norm still.

    Thread question:

    "Curious as to opinions of opthamologists about the efficacy and safety of autologous serum eyes drops to treat chronic dry eye.
    Along the same lines, any opinions on the surgical stenosising of the lacrimal puncta in an effort to avoid constantly having to replace plugs that fall out."

    Response:

    "Autologous serum drops are a hideously expensive and a complicated way to wet the eye. The cases where I have seen these used were with patients whose doctors had exhausted every available commercial drop and were at the end of their rope, due to patient dislike or intolerance for anything else. In these cases, the patients did not need autologous serum drops either, what they needed was a psychiatric consultation.

    The drops have to be compounded at a hospital pharmacy, have only a very limited shelf life and require scrupulous preservation by refrigeration. They are expensive.

    I have yet to see anyone in more than a decade who really needed this. Maybe severe autoimmune conjunctivopathies with extreme dry eye or post-burn or Stevens-Johnson Syndrome patients merit their use, but those are not common. Unpreserved eye drops with or without methylcellulose thickeners in single-use dropettes are sufficient for most people who have sensitivities to preserved eye drops.

    Punctal stenosis is a way to retard evacuation of tears from the eyelids. It also retards evacuation of bacteria and mucus and debris. ("It's awfully dry in this room, I think I'll go down the hall and plug up the toilet.") It works to keep applied drops available to the eye surface a little longer. Of course, if the primary problem is tear-film deficiency, it does nothing to address that problem.

    I rarely need to do this procedure. I also almost never put plugs in anymore either. Most people with tear-film deficiency benefit more from treating their root cause of the deficiency, whether it be age-related decrease in basal secretion, blepharitis, rosacea, Demodex, chronic inflammation or whatever else ails them, and augmenting low aqueous secretion with wetting drops.

    My $0.02. I know I could make more money doing differently, though."

    http://forums.studentdoctor.net/arch.../t-607345.html

    Seems like he got chewed out later down in the post but I mean, wow....people with dry eye need "psychiatric evaluation?" Oh, and serum is "hideously expensive?" I think not, when you consider Restasis at $90 a brick and whatever excessive amounts of over-the-counter product plus steroid drops that most of us would be using if we weren't on serum. Does this doc just put his patients on steroid drops for life or something? He doesn't even like plugs.

    Not to rile anyone up but I am so glad this doc is not mine and can only hope that there aren't others out there like this gem.

  • #2
    Rebecca I just read your post on "conflicts with docs." This post is not meant to "doc bash" (the post was anonymous) but to show how GRATEFUL I am for my doc!

    Comment


    • #3
      Wow. Yes, there is a lot to dislike in that post isn't there. It just shows how much more education the ophthalmology community need. Funny, the psychiatric eval comment may actually be true but NOT in the way that it was intended. Depression is part and parcel of chronic pain. An over-anxious patient might be nuts. (Some patients really ARE difficult, after all.) But more likely, they're just not getting effective treatment, respect, communication and support.

      Re: doc bashing, I am sure you understood what I mean but just in case anyone took it differently... I don't mean in any way to inhibit people airing grievances about their doctors - it's so important for us all to have a safe place to vent!! I just don't want to have potential defamation issues (real or perceived). As far as I'm concerned, you can say what you want, just don't give us their name
      Rebecca Petris
      The Dry Eye Foundation
      dryeyefoundation.org
      800-484-0244

      Comment


      • #4
        I have changed my insurance provider because of the eye care I was or was not receiving. The doctor was very polite, but never offered up more than Restasis, compresses, plugs and OTC eye drops. I found myself paying out of pocket and visiting more innovative doctors who were not covered by my insurance. Even if this disease is not curable, one must have some sense of hope to make it from one day to the next, and if the doctor shows no hope, then you have nothing. I am looking for an eye doctor who is on top of the latest developments and is willing to run the gamut. I do not dislike my current eye doctor, but she gives me no promise of hope, ever. Living with chronic pain is very difficult. I am willing to try anything, and in that thought alone, there is hope. Any new studies looking for a volunteer? I'm waving my hand over here!

        Comment


        • #5
          If all it took was psychological evaluation and treatment to cure the majority of dry eye, I'm guessing an awful lot of us would sign up immediately. I do agree with the statement, "Most people with tear-film deficiency benefit more from treating their root cause of the deficiency, whether it be age-related decrease in basal secretion, blepharitis, rosacea, Demodex, chronic inflammation or whatever else ails them,"
          Unfortunately, finding the CAUSE of some of the problems listed, in order to treat them, isn't quite so easy, and I'm guessing that the doctor in question, doesn't have those answers either because if she/he did, as with the rest of the medical community, most of us would be a lot healthier and happier.

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          • #6
            La Diva, I have been there. I have had a couple of really nice, patient docs, who offered up all the things you suggested, but it's obvious that they were not dry eye specialists. They had busy practices and a lot on their plates, so I understand not devoting much time for dry eye. Heck, even some "dry eye specialists" really aren't up on the latest research and literature. Good luck finding a doc that's on top of it!


            Originally posted by LaDiva View Post
            I have changed my insurance provider because of the eye care I was or was not receiving. The doctor was very polite, but never offered up more than Restasis, compresses, plugs and OTC eye drops. I found myself paying out of pocket and visiting more innovative doctors who were not covered by my insurance. Even if this disease is not curable, one must have some sense of hope to make it from one day to the next, and if the doctor shows no hope, then you have nothing. I am looking for an eye doctor who is on top of the latest developments and is willing to run the gamut. I do not dislike my current eye doctor, but she gives me no promise of hope, ever. Living with chronic pain is very difficult. I am willing to try anything, and in that thought alone, there is hope. Any new studies looking for a volunteer? I'm waving my hand over here!

            Comment

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