Restasis for MGD?

[odydnas]

Hi Dr. Bazan,

I have been diagnosed w/ MGD and no tear production deficiency (my schirmer's test was normal). I have been on azithromycin for a month, tobradex for 1 week, and continually on warm compresses 3x a day, lid scrubs, nutritional supplements, and I use tranquileyes at night. I have some improvement, but not enough where I can be comfortable outside of my humid bedroom.

My new optometrist now wants to start me on Restasis 2x a day for one month. Does this make sense to you? Correct me if I'm wrong, but I thought Restasis didn't do anything for people with MGD, and that it takes about 3 months to even feel improvement.

Thanks for your opinion and time!!!

[Justin]

Hi Dr. Bazan,

I have been diagnosed w/ MGD and no tear production deficiency (my schirmer's test was normal). I have been on azithromycin for a month, tobradex for 1 week, and continually on warm compresses 3x a day, lid scrubs, nutritional supplements, and I use tranquileyes at night. I have some improvement, but not enough where I can be comfortable outside of my humid bedroom.

Awesome. Keep it up. All those things are going to make a difference. Remember it takes time and "some improvement" is a very positive sign.

My new optometrist now wants to start me on Restasis 2x a day for one month. Does this make sense to you? Correct me if I'm wrong, but I thought Restasis didn't do anything for people with MGD, and that it takes about 3 months to even feel improvement. Thanks for your opinion and time!!!

Restasis is also thought to reduce inflammation on the ocular surface. Because of its anti-inflammatory properties it is possible to speculate that it may also help with an inflammatory component of your MGD. If you have shown some improvement with topical drops that posses anti-inflammatory properties (azasite, tobradex), you may find long term relief with restasis. It has the potential to be very beneficial. Due to the slow onset of relief, many doctors are now considering a short concurrent treatment with a faster acting eye drop such as lotemax. I think limiting the trial to only a month may be a point to discuss with your eye doc again. Also, what artificial tear are you using throughout the day?

[odydnas]

Thanks for the reply, Dr. Bazan.

When you say it takes time, how much time do you mean? I've been doing that routine for about 5 months and i feel the improvement has plateaued. Maybe I am not patient enough?

I usually use Optive and preservative-free Systane. Why do you ask? Is there something else you recommend?

Also, my doctor that prescribed me Restasis did not perform a TBUT or Schirmer's on me, but she did look at my meibomian glands. I thought that was strange....but do doctors not do that anymore?

Again, thank you SO much for your time and blog =)

[Justin]

Thanks for the reply, Dr. Bazan.

When you say it takes time, how much time do you mean? I've been doing that routine for about 5 months and i feel the improvement has plateaued. Maybe I am not patient enough?

Your welcome. Thanks for taking a look at the blog. To speculate on time is a tricky thing with out knowing all of the facts. Many people don't feel the full relief from restasis until they have been using for 6 months.

I usually use Optive and preservative-free Systane. Why do you ask? Is there something else you recommend?

I always prescribe artificial tears based on what I want them to accomplish and keep in mind what they claim to do. I just wanted to be sure your doctor keeps a similar mindset.

Also, my doctor that prescribed me Restasis did not perform a TBUT or Schirmer's on me, but she did look at my meibomian glands. I thought that was strange....but do doctors not do that anymore?

It is not strange. MGD can be diagnosed based on other tests, including just observing the glands and meibum. Tear film can be assessed without a TBUT. Simple observation of the tear film can provide details about stability and quality.

Many eye docs only perform shirmer's if its required by insurance companies to ensure they get paid. Most will get an idea of tear quantity by looking at the tear meniscus.

Sometimes a doctor maybe a great diagnostician, but fail to communicate the "what and why" part. Its unfortunate, because patients are getting great care, but they feel otherwise.

You seem like the type of patient who would benefit from a doctor who talks you through the procedures and explains everything. I personally am very vocal in an exam. I find my self constantly telling my patients why I am doing a test, explaining what I am observing as I do it, what the findings are, what they mean, and what we are going to do with those findings.

Here is some food for thought...how many of you out there have seen improvements in your condition after finding a doctor "you like"? How many out there have seen improvements in your condition from a doctor you "don't like"?

[Justin]

"In addition to aqueous-deficient dry eye, Restasis also effectively treats meibomian gland dysfunction (See Figure 2).7 In a prospective study, 33 patients with meibomian gland dysfunction were randomized to receive either Restasis or placebo twice daily for three months. They were evaluated at baseline and at the end of each month for subjective symptoms and objective signs, including meibomian gland inclusions, lid margin vascular injection, tarsal telangiectasis, fluorescein staining, tear breakup time, and Schirmer scores.
The study found that, at the three-month visit, several objective examination findings were statistically significantly improved in the Restasis group compared to placebo. These differences included lid margin vascular injection, tarsal telangiectasis, and fluorescein staining. The most significant finding was the greater decrease in the number of meibomian gland inclusions in the Restasis group, Dr. Donnenfeld says."



SOURCE: http://www.revophth.com/index.asp?page=1_829.htm

[odydnas]

Dr. Bazan,

I cannot thank you enough for not only answering my question, but also following up with some study results. We need more doctors like you who are constantly thinking about their patients!

I've decided to trust my new doc and give the Restasis a try.

You do make a point about improving after seeing a doctor you like vs. one that you do not like. I have to say that my new doctor seems to really care about how my eyes are doing and the pain that i am going through. She spent over half an hour talking to me and even reminded me a few times to send her a email every 2 weeks to let her know how I'm doing. I do not know how much more knowledgeable she is about dry eye than the other docs I've seen, but the fact that she seemed to care, rather than rush me out of her office, made my eyes feel better after the appointment. I think that sometimes it is hard to deal with this dry issue because it's so hard to find a doctor that is willing to work with me to find something that works.

Anyway, both you and Dr. Latkany make me wish I lived in the NYC area!

[Justin]

Great! You're very welcome. I always say everyone should live in NYC for 1 year. It is an amazing place to live.But I do think we are in the top 25 worst places to live in the US for dry eye sufferers.