ikervis and lower plugs still struggling

[Matt0029]

does the amt lens stay in long term? I will look in to it.

[deep_dry_eye]

does the amt lens stay in long term? I will look in to it.

AMT (Prokera) is amniotic tissue that your eye absorbs. Insertion takes like 5mins, and over a few days (3-10 days) your eye will absorb the tissue. The theory is that it will help heal the cornea and nerves. Traditionally AMT has been used for severe eye damage (think chemical burns) with great success; now its being used as a treatment for dry eyes (i.e., heal cornea and nerves).

[quattroboy]

does the amt lens stay in long term? I will look in to it.

Loads of stuff on the web on this, I found this very useful:

https://www.youtube.com/watch?v=u1EpS79Cc4Y

If fact its the one that has mean't I'd really like to give it a go.

[deep_dry_eye]

thanks I would like to try Xdra but I don't think it's available in the uk yet. I see an NHS consultant but privately, I get my prescriptions Ikervis and Hylo forte prescribed through my GP. I don't have any damage on the surface of my cornea any more but my eyes have started to feel sore and painful again and vision getting worse, my tbut was 5 seconds right eye 4 seconds left eye last time saw my doc 1 month ago. My oil producing glands are pretty good so I have been told. I may go back soon as things seem to be getting worse. But I think my only options are cautery or upper plugs. Upper plugs have never been mentioned though I think some surgeons are against having no drainage in the eye? As said steroids and Ikervis sorted my eyes out. Ikervis on its own doesn't seem strong enough. I put it in at night as the last drop at night with no drops before hand for a good 30 minutes at least.. I press near my nose to block both ducts and close my eyes for 2mintutes.

If your corneas are clear, you should try AMT (Prokera) to heal the nerves; also add in autologous to heal the nerves (although I personally found autologous to not be too helpful; like you my corneas are clear). Your TBUT is very very borderline, it still suggests some form of MGD. Continue the Cyclosporin and try 2 weeks of topical Azithroymicn (Azyter). Canada is opposite, we have Xiidra but no Azyter

[quattroboy]

Hi Matt0029 Just Salivary gland autotransplantation is listed on the NHS site as a treatment option.

Be interesting to see what your consultant says that idea.

If you mention it could you let us know how you get on? Not sure it's actually used.

http://www.dailymail.co.uk/health/ar...-dry-eyes.html

[Matt0029]

Thanks I only saw him a month ago but my eyes seem to have got progressively worse since. I am private so may book an appointment to see what else can be done. My tbut was 8 seconds while on the steroids my eyes felt a lot better then.

[quattroboy]

Thanks I only saw him a month ago but my eyes seem to have got progressively worse since. I am private so may book an appointment to see what else can be done. My tbut was 8 seconds while on the steroids my eyes felt a lot better then.

Let us know how you get on?

I'd be interested in knowing your consultants thoughts on plugging all four and maybe cauterisation.

My cornea is also clear but I have a lot of staining on the inner corners of my eyes. I'd like to try the AMT to see if it can help heal my nerves and stabilise my tear film.

I think our circumstances seem very similar.

Post LASIK, low tear production, I've got low TBUT too. I know that's to do with missing glands on the inside of eyes due to partial blinking.

So far treatment has been Ikervis, steroids, lower plugs, OTC drops as required, eye bag and eye lid hygiene.

Happy to keep sharing my experiences.

[Matt0029]

Thank you. How often do you see your consultant quattroboy?

[quattroboy]

Thank you. How often do you see your consultant quattroboy?

I've seen in twice so far, the first was the 19th June and then the 17th July.

I'm seeing him again in around 5 to 6 weeks, just waiting for my appointment to come through.

By then I would have expected to see some results from the Ikervis, he reckons around 6 to 8 weeks, but that seems quick compared to restasis, which we know is at least 3 months.

I've been on steroids since the 19th June. Not sure whether I've noticed any change in my dryness, I wake with very dry sore eyes, but I'm only putting in Ikervis at night, last thing, at least 15 minutes after my OTC drops.

Properly already mentioned he was dead against Pilocarpine and annemonic membrane.

As a side note I've agreed to go back to my LASIK provider (Optical Express) on the 10th August for a surgical review. I left a damning review on Trustpilot and they contacted me. I'll see what they are prepared to do to compliment my NHS treatment. I don't have high hopes!

[Matt0029]

Thanks. Do you see yours through the NHS? I saw my consultant about 5 weeks ago at the time my eyes were just starting to maybe go bad again, ikervis seemed to be doing its job but not as good as the steroids. But these last 5 weeks bar one period of a few days they have been pretty bad. I was told follow up in 9 months but come back sooner if have problems. So may need to go back soon not sure what else they'll think can/will help.

[quattroboy]

Thanks. Do you see yours through the NHS? I saw my consultant about 5 weeks ago at the time my eyes were just starting to maybe go bad again, ikervis seemed to be doing its job but not as good as the steroids. But these last 5 weeks bar one period of a few days they have been pretty bad. I was told follow up in 9 months but come back sooner if have problems. So may need to go back soon not sure what else they'll think can/will help.

Yes NHS treatment, he's been very good. When I asked about AMT and Pilocarpine he really didn't like the idea, but suggested the next step would be serum drops if the Ikervis didn't do it's job.

He didn't seem keen to plug all four ducts either, but I generally believe that would help, certainly in my left eye, which is the worse.

In our first meeting he did say give him 12 months and was sure he can help. This does suggest is prepared to do more if the Ikervis doesn't work.

My GP has agreed to do a testosterone blood test, just to eliminate that.

On the 10th I'm going back to OE with a list of treatments, let see what they say. But they are not replacing my NHS treatments.

Out of interest is it just tear production you're struggling with or have got MGD/Blepharitis, as well?

[Matt0029]

Thanks what would a testosterone blood test show? If your levels are low this could be causing the dry eye? Mine is low tear production which was causing the inflammation I think. Did your dry eye start immediately after lasik? Mine started to show about 3 years after lasek. Was about 4 years after till figured all my problem with my eyes is caused by dryness. I have had a couple of moments when I have thought I had been cured. After lower plugs had a lot more tears for about 3 days then think my eyes adjusted to the plugs and produced less. And then towards the end of my steroid treatment took my tbut to 10-8 seconds. Back down to 4-5 seconds now.

[MGD1701]

Hi Matt
Are you sure you are pure water deficiency as that is rare. Most people have a combination of MGD and water issues or MGD alone.

When one has water issue, sooner or later will have MGD issue too, according to the dry eye expert, Prof. Christopher Starr, MD, USA. Good to check/monitor your gland/secretion status to stop progression - as often they are overlooked.

[quattroboy]

Thanks what would a testosterone blood test show? If your levels are low this could be causing the dry eye? .

There is a strong link with hormones and dry eye https://healthiertalk.com/testosterone-dry-eye-syndrome.../

I got a home kit from https://www.forthwithlife.co.uk/ the results are very interesting. My free androgen index, free testosterone and oestradiol levels are low. My Prolactin levels are high!

I getting an NHS blood test Thursday. I'll have to wait till I get back from family holiday to get the results.

[Matt0029]

I would suggest adding upper plugs. For instance,
farmgirl mentioned in her comments it made a difference for her whereas just the lower plugs did not do the trick. I would also recommend serum drops because they have healing properties and various nutrients similar to our tears. They do not’ increase tear production usually but they are good for improving TBUT and reducing ocular staining as well as promoting healthy nerve growth. If you have corneal neuropathy (abnormal nerve growth due to mechanical damage/inflammation/LASIK) then you could have “pain without stain” (symptoms worse than signs).

In addition, I know someone who benefited from TrueTear device. However, I have not seen many discussions about it here. This device is pretty new and expensive.

Even if you have normal TBUT, it would be good to get rid of blockage in the meibomian glands because the oils are important for lubrication, too.

Finally, do you know why do you have aqueous deficiency?

Thank you yes I am sure my symptoms are worse then my signs.