Advice using Ikervis (Restasis)

[quattroboy]

Just looking for some tips.

I've recently been prescribed Ikervis (Restasis but 0.1%). Unlike Restasis you only use it once before bed.

The instructions are very clear that it should be the last thing used in your eye before bed. Allowing 15 minutes if others drops are used.

Prior to Ikervis I was using Castor oil drops at night to keep my eyes lubricated. Now when I wake my eyes are very dry. How do others handle this?

[hannsho]

Hi Quattroboy

I haven’t used Ikervis, but I have used Restais for 8 months. When I first started to use Restais, my ophthalmologist also prescribed a very thick pomade, called ‘Terra-Cortril’, to apply to the interior of my eyelids just before going to sleep at night. I applied the Restasis drops about 15 minutes before using the pomade. I can’t see why you shouldn’t be able to do the same with Castor oil drops if they help you, particularly since it can take quite a long time before Restais/kervis produces any noticeable effect.

In the past when I had such doubts, I sent an email directly to the manufacturer to ask them, and usually I got a prompt answer to my queries. So if you are particularly worried about using Castor oil with Ikervis, that’s what I would recommend. If you do write to the manufacturer, it would be interesting to hear what they have to say.

[Meibum Ian]

Just looking for some tips.

I've recently been prescribed Ikervis (Restasis but 0.1%). Unlike Restasis you only use it once before bed.

The instructions are very clear that it should be the last thing used in your eye before bed. Allowing 15 minutes if others drops are used.

Prior to Ikervis I was using Castor oil drops at night to keep my eyes lubricated. Now when I wake my eyes are very dry. How do others handle this?

Hi,

I'm interested that you have instructions to use Ikervis last. I started Ikervis a few weeks ago (following with Thealoz Duo gel after 20+ minutes) and have not seen this. It does not seem to be stated explicitly in the patient information leaflet I've linked to.

Could you share what your instructions say please?

[quattroboy]

Hi Meibum Ian the instructions were from my consultant. I think the theory being it allows the Ciclosporin to be properly absorbed into the eye. I, therefore, interpreted the line "IKERVIS eye drops should be used at least 15 minutes after any other eye drops are used." to mean the last treatment to be used.

I have an appointment with the consultant on the 17th of July, I will check the details and make sure I've not misunderstood.

[Guest]

Hi Meibum Ian the instructions were from my consultant. I think the theory being it allows the Ciclosporin to be properly absorbed into the eye. I, therefore, interpreted the line "IKERVIS eye drops should be used at least 15 minutes after any other eye drops are used." to mean the last treatment to be used.

I have an appointment with the consultant on the 17th of July, I will check the details and make sure I've not misunderstood.

I'd say these directions are accurate. I was putting in other drops after my restasis and it didn't work as well. Now, I use restasis last and allow it to sit on my eyes for at least 45 minutes before I add any gels or anything for the night. I always use restasis last regardless of time of day.

[Meibum Ian]

Hi Meibum Ian the instructions were from my consultant. I think the theory being it allows the Ciclosporin to be properly absorbed into the eye. I, therefore, interpreted the line "IKERVIS eye drops should be used at least 15 minutes after any other eye drops are used." to mean the last treatment to be used.

I have an appointment with the consultant on the 17th of July, I will check the details and make sure I've not misunderstood.

Hi again,

I found this leaflet on Ikervis, targeted at GPs. It includes the advice you've had to use last thing at night: https://www.gwh.nhs.uk/media/229014/...d-gp-guide.pdf

What helps for me at night is to close my eyes, and repeatedly pulse / squeeze them together, without ever opening them. Eventually some thick oils usually get released, helping to seal the eyelids together a little.

[MGD1701]

Curious to know WHY your doctors prescribe you Restasis, based on Osmolarity test? Could you please share it. Thanks!

Just found my note that Prof. Marguerite McDonald, mentioned (pretty sure in 2018?) if osmolarity 296 or higher she prescribes Restasis. My level is about the same (after LipiFlow), yet none of 15 doctors prescribed me - they all said I had no inflammation yet pure HOCL spray helps me just in a few days.

[Meibum Ian]

Curious to know WHY your doctors prescribe you Restasis, based on Osmolarity test? Could you please share it. Thanks!

Just found my note that Prof. Marguerite McDonald, mentioned (pretty sure in 2018?) if osmolarity 296 or higher she prescribes Restasis. My level is about the same, yet none of 15 doctors prescribed me.

In my case:

MGD, Schirmer 0-1mm, Corneal staining & signs of inflammation. Osmolarity was previously 305/325. There was not enough moisture to collect a sample for the test on the last try!

Having to pay privately, as NHS was useless in my case(& didn't do an osmolarity test).

[quattroboy]

He took one look and released how dry my eyes where. Plus signs of inflammation.

Seemed to be onto something. My eyes feel better nearly two weeks using the steroids. Hoping the Ikervis will start making a difference in a few months.

[Meibum Ian]

He took one look and released how dry my eyes where. Plus signs of inflammation.

Seemed to be onto something. My eyes feel better nearly two weeks using the steroids. Hoping the Ikervis will start making a difference in a few months.

The fact you are responding well to steroids would suggest that you should see improvement if you can find a way to control inflammation long term.

[MGD1701]

Thanks for sharing. Seems your doctors treat you in the right direction. I have just realized most opinion leaders also prescribe at least Restasis at early stage (to stop progession).

My eyes have been pretty fit - only need 1-2 drops day, not sure if I still need it. Wont hurt to ask - but I dont like medication.

[quattroboy]

I hope so, of course, there are no guarantees. Two months on the steroids, then I assume I'll begin tapering off. The idea being the Ikervis picks up where the steroids left off.

Finding I don't need to use my OTC drops anywhere near as much during the day.

As side-note, I'm picking up a pair of glasses with gaskets tomorrow for my computer work. I'm hoping they will help when at the office and keep me comfortable when working with the screen.

Not really what I signed up for when I did LASIK but needs be!

[MGD1701]

............

[Matt0029]

The fact you are responding well to steroids would suggest that you should see improvement if you can find a way to control inflammation long term.

Is there any way of controlling inflammation long term. As strongly as steroids do? I was on a course of steroids for about 2-3 months and by eyes were a lot better and tear production greatly improved. Ikervis just doesn't seem strong enough to have this effect.

[deep_dry_eye]

Is there any way of controlling inflammation long term. As strongly as steroids do? I was on a course of steroids for about 2-3 months and by eyes were a lot better and tear production greatly improved. Ikervis just doesn't seem strong enough to have this effect.

Between Xiidra and Restasis, I find Xiidra to be much better than Restasis. IPL is another very good option as well, since you are UK based , Azyter is a rapid option as well (but probably can't be used long term since its an antiobiotic).