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**NYer** · 06-Feb-2008, 12:05

Looking at your arsenal, I can comment on one item...I absolutely hated "Soothe" drops. I found that they made my eyes feel substantially worse than they did before I put them in. So, although everyone is different, if I were you, I'd remove them from your regimen. What I do like is Systane Preservative Free drops (in the individual vials) and also "Tears Naturale Free" preservative free drops also in the vials. Systane is a bit more viscous, and therefore longer lasting, than the "Tears" and I find that the "Tears" leaves a little crust on my lashes in the morning, so I have to clean them off. But they both are helpful.

**Rebecca Petris** · 06-Feb-2008, 12:36

Maenad,

This kind of post makes me really grit my teeth. On the one hand I want to scream No no no, you really need to be out of contacts before things get worse. I want to encourage you, but I don't know how to give you hope that you are doing something other than fighting a losing battle.

On the other, as a former very high myope, I understand! With a vengeance!

I have three different possible suggestions for you. Big disclaimer, I'm not a doc etc etc.

1) Stop soft contacts altogether for a set period, during which you max out MGD and dry eye treatments... possibly including visiting other eye doctors. Re-try contacts ONLY after your clinical signs are a lot better than they are now.

2) Pursue a more specialized contact lens solution: Large gas perms, like a corneal-scleral or intralimbal or even mini-scleral lens. This will involve a special kind of optometrist and may require travel. This could actually be a decent long-term solution, as opposed to simply slathering your eyes with stuff to mask dry eye symptoms in order to tolerate soft lenses longer. Most people think of gas perms as uncomfortable but believe me - the larger they are, if they are well fitted, (big if), they can be awesome.

3) If you must pursue the 'patch-and-go' approach in the short term, then if it were me, I'd start Dr. Latkany's home eye spa regimen in the evenings; cover your eyes at night; if possible take a contact lens break in the middle of the day; try Blink or Aquify as a lens wetter if you want something FDA approved or if you don't care then try NutraTear; (and by the way Soothe and most of these other tears are not approved for contacts either) try a drop of Dwelle each morning about 15 min. before putting the lenses in - I know a lot of people who get extended weartime this way. Maybe plugs but only if you've got good strong confirmation there is no lid margin disease going on (active blepharitis/MGD).

I really don't care if my eyes are a little red by the end of the day, so long as they're sufficiently better by the next morning so I can put the contacts back in.

Forgive me for scolding but JIMMINY CRICKETS these are your eyes we're talking about - you really should care, because you don't want to end up like some of the rest of us.

I want to stress that based on your examination results, you have more clinical signs of dry eye than many people in this forum who have more severe symptoms (pain/discomfort). Don't go by your sensation alone. Clinical signs are important and IMHO that exam result is telling you you've really got a problem here that needs addressing.

If it were me personally, then with all the benefit of hindsight etc, what I would do is follow steps 1 AND 2, in order to maximize my chances of staying in contacts long-term.

What you DON'T want to do in this situation is take a piecemeal approach that will put you in such a bad state that your chances for ANY contacts are history.

My (long) $0.02.

**brd888** · 06-Feb-2008, 13:27

Originally posted by Maenad1 View Post

I am willing to try any type of drop

Drop the contacts! Your eyes are giving you plenty of warning that they are not coping with them. Remedy the situation while you still have time - please!

Regards,
Bruce

**Stanza** · 06-Feb-2008, 13:59

I've had to drop contacts, and I hardly wore them because they were never great for my eyes, but they aren't why I got DES.

I'm almost 99% sure I'm a higher prescription than you. It sucks. It sucks really bad but you just have to realize they will make you worse and worse.

I'm down to wearing them for special occassions right now - but I figure I need to know the state my eyes are in without them so I can control them for the times I do wear lenses.

You just can't wear them all day - it's the way it goes.

**Maenad1** · 06-Feb-2008, 16:16

Thanks....

I appreciate the comments, even if (some of it) wasn't what I wanted to hear! I guess it's better to know what's going on than to live in denial.

Maybe my doctor just isn't taking my case very seriously, because I specifically asked him, "Am I doing damage to my eyes by wearing contacts, if I have moderate to severe dry eye?" and his response was, "No." He discouraged me from moisture goggles because he said I don't have lagopthalamos. He said eyelid scrubs would be a waste of time. That totally conflicts with what I'm reading here. Should I see another doctor to get another opinion?

See, I already took a break from contacts -- about 1.5 months. During that time, I wore glasses. And I was miserable. I'm a -13.75. Even in the tiniest frames, with the "thinnest" lenses, my lenses are coke-bottle thick, full of distortions, everything looks much tinier than it is, I have no peripheral vision -- it's just horrible. Wearing them makes me really depressed. I'm also starting to get presbyopic (I'm 40) and I don't know how it's going to be possible to fit me into a bifocal -- assuming I am going to be wearing nothing but glasses -- when I have to wear such small frames.

Even when I don't wear contacts, my eyes are dry, and that side of my left eye gets red when my eyes are tired or strained. So I'm not sure if all my problems are from the contacts. The doctor said the "white" of my eye is worse than the cornea, that the contact seems to be keeping some of the moisture on the cornea.

I tried RGP lenses once, years ago, and hated them. Even though they re-made the lenses for me twice, with a bigger diameter each time, I kept seeing circles. I had never considered sclerals, didn't even know they existed till I found this forum. I will investigate this possibility.

Rebecca, I really value your opinion because you are clearly so knowledgeable...which of my clinical signs do you think need(s) to be better in order to successfully wear soft contacts? And what type of "confirmation" do I need to rule out lid margin disease? The O.D. was very dismissive when I asked about it. He said it's usually only "older" people who get MGD.

BTW, I live in the Chicago area, if anyone knows of a specialized dry eye doc here. Thanks again.

**Rebecca Petris** · 06-Feb-2008, 16:37

Like I said I'd normally be saying ditch the contacts pleeez, but there are two circumstances where I really understand the motivation to keep in them: extremely high myopes & astigmats, and those with very uneven prescriptions. Basically, people who can't see well in glasses. My oldest sister is in a similar situation. She has terrible trouble even getting contacts she can see OK with let alone glasses, and she's starting to get drier eyes. She recently tried a hybrid contact called Synergeyes but without success and is looking at other options.

Originally posted by Maenad1 View Post

Maybe my doctor just isn't taking my case very seriously

I wouldn't say that. I think that he's hearing your desperation to stay in contacts and he's trying to help. Also, in general the level of training out there in dry eye matters is terribly inadequate - note that many people here have been to multiple corneal specialist ophthalmologists and still not had good advice. So, it's kind of status quo. There are also a wide range of attitudes amongst optometrists, from those who are really focused on corneal health and will be quick to get you out of contacts when something's wrong to the other end of the spectrum.

He discouraged me from moisture goggles because he said I don't have lagopthalamos.

Fair enough - the best known use of moisture goggles is for lagophthalmos - but it's not the only use. Many people with dry eyes and good lid closure benefit.

He said eyelid scrubs would be a waste of time. That totally conflicts with what I'm reading here.

Well, he's looking at your eyes and we're not. HOWEVER, note also that large numbers of people here had conflicting opinions from doctors about the state of their eyelids and saw several doctors before poor MG health was diagnosed. I think what I, & others here, would react to is... your staining and your doc's conclusion that you've got a poor oil layer. Oil comes from the MGs, therefore....

I'm a -13.75. Even in the tiniest frames, with the "thinnest" lenses, my lenses are coke-bottle thick, full of distortions, everything looks much tinier than it is, I have no peripheral vision -- it's just horrible. Wearing them makes me really depressed.

I used to be -12.00 plus some astigmatism. Grew up in the days when everyone wore large glasses too, ugh. I'm surprised about coke bottles though. Back in the 90's I had some that I really liked, in a small frame, that weren't very thick at all. Granted, you don't get peripheral vision, but you can at least protect your eye health better. And believe me the most expensive pair of glasses I ever bought was still less than most people here spend on their Restasis co-pays and artificial tears in any given 6-month period.

So I'm not sure if all my problems are from the contacts. The doctor said the "white" of my eye is worse than the cornea, that the contact seems to be keeping some of the moisture on the cornea.

Quite right the problems aren't from the contacts but the contacts will make it worse in your state. And at the same time though the contacts can act like a bandage so you don't feel the discomfort from the dryness. Sounds counterintuitive but that's how it works.

He said it's usually only "older" people who get MGD.

Heh, heh. We've got an awful lot of 20-somethings around here who would like to have a word with your doctor. I won't argue with "usually" but we aren't all usual.

**Stanza** · 07-Feb-2008, 00:46

I'm surprised about coke bottles though. Back in the 90's I had some that I really liked,

the problem every 0.25 at this level of 'minus' really adds to the thickness, I don't know why. So Maenad's will be pretty thick.

Last time I had my prescription changed the thickness was added, again, even though the changes was 0.25 - it's terrible - it can add a millimetre again.

So yeah even with the right frames, they are still coke-bottles and after a certain 'minus' you can't go too small as the distortion is really bad on the edges of the lenses.

The worst thing is when people tell me ''you can get thin lenses you know'' and you have to smile and if you say, I already have the thinest you can get, they give you a pity smile and say you should get laser surgery. And then you say, I can't and it would probably make my eyes more problematic, and they look at you like you don't have a clue.

Even low to moderate myopes say this to me periodically. It's extremely depressing. The hardest thing is wondering how you're going to do in the old people's home when you're glasses are thicker still...

Potentially some high-myopes might end up pushed to lens implants, as otherwise they really can't see anymore with glasses and if contacts aren't working....

Sorry, sounds a bit down but I can see where Maenad is coming from. We have the pressure of needing to get the eyes levelled so we can at least wear lenses a little.

I'm hoping scerals might become more commonplace in time, as they sound like they could be good for us high myopes.

**Rebecca Petris** · 07-Feb-2008, 08:07

Stanza,

I used to be -12.00. I really do understand... I didn't mean "thin" lenses, I just meant "a lot thinner than the coke bottles I wore the decade before". I shouldn't have said I liked my last glasses - that's not altogether true - I guess I was trying to say just that in retrospect, I sure wish I could get them back. With the knowledge I now have of how much worse things can get, I would have handled my situation differently.

Originally posted by Stanza View Post

We have the pressure of needing to get the eyes levelled so we can at least wear lenses a little.

I got mine "leveled" 7 years ago. Sigh.

EDIT: re-reading this I can see I was reading everyone's posts too quickly and responding before I understood what they were saying. Point taken about the 0.25 Stanza - yikes, 1mm?? ouch.

**calli66** · 07-Feb-2008, 12:05

As a moderate myope (-8.50) who just gave up on soft contacts about 4 months ago, I'd have to say it was the healthiest thing I've ever done for my eyes. It took more than a month for the lid inflammation to subside, and the tear layer to become stable. I have to stick with the decision, because my eyes feel SO MUCH BETTER!

After reading some of Dr. Holly's posts about how the tear layer spreads out over the eye surface during blinks, I now understand how contact lenses interfere with that process. So that reinforces my decision about quitting contacts. I still may get some dailies to wear for special occasions.

The difference (while wearing contacts with dry eyes):

My vision was poor because of fluctuating tear quantities

More mucous was produced, which collected on both inner and outer surfaces of the lenses, causing irritation and cloudy vision

More debris (inflammatory substances) was deposited on the inside of the lenses, causing cloudiness---had to remove lenses frequently to rub it off.

All the irritation and eye stress caused my eyes to look terribly fatigued---plus I couldn't use eye make-up. My eyes made me look pale, old, and tired.

Glasses: yes, there are all the drawbacks, as everybody has mentioned. I am doing OK with mine---I got Physio 360 high index lenses in a progressive (plus astigmatism correction). The lenses are designed by computer and they give VERY good acuity---much better than cheaper options. I used to choose the smallest frames, too, in the past---but the vision through them is poor and there's no room for a progressive. The "short corridor" progressives they sell to fit the skinny (vertical dimension) frames don't work very well. I was able to find some smallish frames that are slightly "taller" and the vision through them is a big improvement over tiny frames.

Calli

**Maenad1** · 07-Feb-2008, 12:16

Dry eyes with Lasik...

Rebecca, from what you've experienced and heard, are dry eyes caused by Lasik significantly worse than dry "virgin" eyes?

I'm feeling a little better today about my eyes. I went to Wal-Mart last night and bought Systane, Aquify, Gental gel and TheraTears. Wait, don't yell at me yet! I'm planning to slowly work my way through them and test each one out to see what works best -- I'm not going to dump them all in my eyes at once. My short-term plan is to find a product that works well for CL rewetting, a heavy-duty gel or ointment for when the contacts are out, and combine those two with limited CL wear to see if I can make a go of it.

I took my contacts out after eight hours and babied my eyes the rest of the night. I put in Refresh Celluvisc several times and that felt GREAT! Cool and moist, just delightful. I made sure to blink a lot. My left eye was a little red but not too bad. Before bed, I put in my Restasis, then some more Celluvisc, and went to sleep. This morning, both eyes were in reasonably good shape so I put in Restasis, then Dwelle, before inserting my contacts (which I pre-moistened with TheraTears). Three hours later, I feel fine and my eyes aren't red. I'm going to keep up with the TheraTears for the rest of the day and see if that does a better job than Refresh Tears had been doing; seemed like Refresh Tears was evaporating too quickly.

With regard to eyeglass lens thickness, my glasses seem a lot thicker now than they used to, mainly because my myopia has progressed over the years and I've now got 1.5 diopters of cylinder in the left eye. Twelve years ago I was still just a -10, no cylinder, and those lenses were a lot thinner than what I have now. When I was in high school, I was about a -9. But I was wearing contacts then; hardly ever wore glasses. I have to laugh when I think of the old-fashioned contacts I wore back then -- B&L U3 daily wear, and I would disinfect them in a little heating unit every night. I wonder if they even make those anymore??

**Rebecca Petris** · 07-Feb-2008, 12:27

Originally posted by Maenad1 View Post

Rebecca, from what you've experienced and heard, are dry eyes caused by Lasik significantly worse than dry "virgin" eyes?

It's always hard to make comparisons and there are so many kinds of dry eye with such a huge spectrum of symptoms. Check out Diana's story for an example of severe post LASIK dry eye. Doesn't sound like it could get much worse than that. Nonetheless, I get phone calls from patients in as bad or worse shape without LASIK on pretty much a daily basis.

But I was wearing contacts then; hardly ever wore glasses. I have to laugh when I think of the old-fashioned contacts I wore back then -- B&L U3 daily wear, and I would disinfect them in a little heating unit every night. I wonder if they even make those anymore??

LOL! Wave of nostalgia. That's me back in the early to mid 80's.

**Rory** · 07-Feb-2008, 13:00

Maenad,

You said that your Dr told you that you have lipid deficiency but not MGD?

I just wonder how that could be possible? Surely lipid deficiency...evaportative problems are a sign that the meibomiam glands are not working effectively...and therefore MGD..

I see that you have asked this to Dr Latkany..so I will let him answer that one!

**Maenad1** · 14-Feb-2008, 12:05

Update...

Well, it's been a week, and so far, I'm hanging in there. I'm just taking this one day at a time.

The contact lenses are working out, in a manner of speaking. Here's what I do. When I wake up in the morning, my eyes are somewhat red. Not terrible, but not what I'd like to see. I put in Refresh Tears, followed by Restasis. Restasis seems to calm down the redness. After Restasis comes Dwelle. At this point my eyes look fairly good, almost "normal." I wait 15 min. then I put in the contacts, with each one containing a good dollop of TheraTears in the middle before insertion.

Throughout the day I rewet the lenses every two hours with Systane, NutraTear or Aquify, depending on how my eyes feel (the drops affect me differently -- Aquify is great for helping me feel "wet," whereas NutraTear is good for keeping me moist for a longer stretch). After 10 hours of wear, I take the lenses out (about 8 p.m.). My eyes generally aren't too red at this point, but I put in either Systane or some goop (liquigel, celluvisc) and leave them alone until bedtime, when I put in my nightly dose of Restasis (wait 15 min.) and Genteal Gel right before I turn out the light.

Then I get up the next morning and start all over again.

So my eyes don't seem to be getting better, per se, but they're not really worse either. And on the days I wear glasses and don't put in my contacts at all, my eyes have the same degree of redness and dryness that they do with the contacts. My eyes are better on the days I don't work on the computer, but there's no way I can avoid the computer every day, because I am an editor and that's what my job consists of ...reading and editing copy on a computer screen. I *am* trying to remember to blink more, but I find if I sit there and consciously think about blinking, I think about my dry eyes too much and they *feel* drier because I'm focusing on them, if you know what I mean.

I do find it odd that my eyes are redder and drier in the morning than they are in the evening after I take out my contacts. Sometimes in the evenings I can feel myself making some of my own tears. But during the daytime I don't feel it as much. I feel fortunate that I don't have any pain whatsoever, any discharge or crust, or any itchiness. Just a dry feeling at times.

I'm thinking of adding warm compresses to my routine. I wonder if that would help. I've also scheduled an appointment in March with an ophthalmologist who is a dry eye specialist, so I can get another opinion about my treatment. The O.D. I've been seeing seems competent but he is so young, and in that practice they always make me see the O.D., not the ophthalmologist, who does a lot of surgeries.

**Justin** · 14-Feb-2008, 17:32

Message Re-Sent As a PM

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Saw dr. today; feeling a little discouraged. Advice?

Saw dr. today; feeling a little discouraged. Advice?

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