Restasis + Plugs observation...

[patientpatrick]

So I've been using Restasis twice a day. One drop in the morning when i wake up and one in the even just before bed.

I usually put a drop in my eyes and keep them closed until the drop is gone.

I've noticed that before I had plugs, the drop would remain in my eyes for about half a min to a min and a half if I'm lucky.

Now that I have plugs I notice that the Restasis hangs out in my eyes for much longer... as long as 10 min at times.

So here's my question. Would the fact that Restasis would drain down my ducts before plugs make it rather ineffective?
It would seem that a 0.05% cyclosporine solution that goes away after a min wouldn't do too much. But if it hung out in my eye for 10X longer could make a huge difference.

I also wonder if using 1 drop a day with plugs would be more effective than some who use it 4X a day w/o plugs.

Just an observation... any thoughts would be appreciated.

P

[DCRdryeye]

I only have my right lower plugged at the moment. I close my eyes for one minute after application of Restatis, then open them and wipe up the excess. Sometimes, it makes my eyes red and causes my lower lids to burn. So I wouldn't want it to hang around for 10 minutes. In any case, in my opinion, Restasis is over rated and it hasn't done anything for me at all. Clearly, they have got to develop something better than "Restasis".

[bunnyrabbit123]

"Clearly, they have got to develop something better than restasis" Amen to that!!! For me, it's been almost 2 years using this and still supplementing thru the day with otc stuff.

[indrep]

Restasis was not approved until its 4th or 5th run through the FDA. It was approved after results from patients with punctal occlusion were admitted to the study group. Several studies since the approval have indicated that results are better in patients with punctal occlusion. Keep in mind that the end point for "better" is improved schirmer strip score.

[bunnyrabbit123]

This is probably a stupid question, but wouldn't improved schirmer strip score be better in patients with punctal occlusion anyway?

[indrep]

Bunnyrabbit,
Yes.
Most practices, in my experience, now realize Restasis might be good for those in early stages(less than a year) of ocular surface dryness due to aqueous production from inflammation of the lacrimal gland. Usually there is another issue involved that Restasis does nothing to help.

[patientpatrick]

Hi inderp what is that other "issue" you are referring to?

I got put on restasis 11 months post lasik. And after 2 months my schrimer scores were 5 and 7. Pre-lasik I was 18 and 19,

I'm wondering if I got put on restasis too late and if this means its pointless to continue.

Plus I've read studies about restasis retarding nerve regeneration... So I'm not sure what to believe

[indrep]

patrick,
There are many other issues; systemic disease, prescribed medications, menopause, pregnancy, birth control pills, environment (wind, humidity, etc.), contact lens wear, age, eye surgical procedures, blepharitis. There are two basic causes of ocular surface disease to start: lack water (aqueous) or too rapid evaporation; both caused from one or more of the above issues. Both of these conditions lead to hyperosmolarity (too much salt in the tears) which starts the inflammatory response in the eye.

So to treat the issue becomes a journey to find the recipe, of many therapies available, that helps the individuals situation. The condition generally, except surgery induced, takes years to develop. It can take months to find the right recipe of therapies that bring relief and a healing environment for the eyes.

[patientpatrick]

I have both an aqueous deficiency and an evaporative one. My dry eye started after I had lasik 15 months ago and has not resolved since.

I had a tear osmolarity test and scored a 322 I believe which would mean DED and hyperomolarity. And that's what's probably what is causing the burning in my eyes since one would assume there's too much salt in my tears, and ultimately leading to inflammation.

-

I'm still hung up on studies demonstrating that cyclosporine retards nerve regeneration after refractive surgery, yet I've read a lot about MDs starting patients on Restasis pre-op and continuing treatment several months post-op. It would seem that would slow down healing if that were the case.

But if inflammation creates a cascading of effects that make healing difficult wouldn't controlling the inflammation be key in fixing the dry eye and problem?

Seeing how I'm 15 months post lasik, one of my docs said my nerves have completed their regeneration process (which I hope they haven't and wish they can still regrow). It would seem then using a higher dose cyclosporine drop wouldn't affect my nerves. But in the event that my nerves are still regrowing, wouldn't it be more effective to stop use of Restasis? I'm continuing the twice a day recommended dosage, but feel that I'm in a weird position where I should either take the conservative approach of continuing the same dosage for another 3 months and see if there's more improvement, or taking a more aggressive approach of either increasing the dosage or stopping it all together.

[indrep]

Patrick
Inflammation is secondary to hyperosmolarity of the tear film. So if more water could be held on the ocular surface then the inflammatory cycle could be broken. So plugs, a tear that holds water and a therapy that increases lipid secretion can go a long way toward creating an environment that allows healing. This of course takes time and patience.