Restasis Doesn’t Work… and other dry eye facts and myths

so Restasis doesn’t work dry eye
syndrome facts and myths is what we’re going to go over today in The Dry Eye Show
I’m Dr. Travis Zigler and I’m Dr. Jenna Zigler we’re going to jump right into that first
myth of Restasis not working and so we hear this all the time Restasis didn’t
work for me I tried Restasis for a couple weeks and it didn’t work for me I
tried Restasis for three months and it didn’t work for me and so Restasis is
an immunomodulator and immunomodulator is just something that modulates the
immune system or changes the immune system so what it does for us
specifically for dry eyes is it decreases the inflammation it targets
activated t-cells the key word being there activated t-cells it doesn’t just
target t-cells it targets activated t-cells and tries to deactivate them and
so when these t-cells are activated they usually last about 3 to 6 months on your
eye and so when you’re deactivating them it
can take up to six months for this drop to fully work the problem with
Restasis is that it does take six months to fully work and that leads to a
problem with compliance with patients and so it’s very hard for a patient to
stay on something that takes six months to work we get a lot of feedback on just
our Heyedrate Lid and Lash Cleanser that it didn’t work and we ask the patient how
long they used it for they say two days and so that again isn’t going
to work overnight it works for some people makes them feel really refreshed
but it takes up to two weeks to fully feel that healing process and so make
sure with Restasis if you’re going to commit to it
commit to it for at least three months and I say six months I’d
say six months what I actually do with my patients in my practice is I usually
prescribe at least a three-month supply and that usually lasts them about six
months or so I’m not going to say how they do that because I can’t do that on
the air but it will last them six months and so they have to do it because they
already have that and so you’re going to notice the difference in signs and
symptoms after that six months and that’s usually when you start to avoid
the harsh side effects like blurry vision and burning of your eyes so if
you don’t notice an improvement after six months at all then I would recommend
trying Xiidra next and Xiidra would be anywhere from two weeks up to two months
I’d try Xiidra for about two months so Restasis six months Xiidra at least
two months so the myth debunked Restasis doesn’t work it does work and
multiple studies have shown that yes you know and we’re not spokesman for Xiidra
or Restasis as you guys know and we just know that it works but there are
better ways to fix inflammation which we’ve always talked about which is diet
and hydration so let’s jump in to myth number two so myth number two is
artificial tears are not a viable dry eye therapy now this is probably the
number one absolute favorite treatment for doctors for patients you know
everybody with dry eyes pretty much is on some type of artificial tear but are
they you know are artificial tears actually treating anything or they just
masking the symptoms that you have you know of course they’re going to make you
feel better in the moment you put eyedrops in and oh you feel refreshed
but is it actually doing anything to heal your eyes so you know first of all
these drops come in multiple different forms we always recommend that you use a
preservative free drop no matter what you choose
you know preservatives can be very irritating to the eyes so number one
definitely use a preservative free drop but actually studies have shown that
artificial tears can be very beneficial and those with level 1 dry eye so level
1 is basically defined by the dry eye workshop as the mildest form of dry eye
so this is characterized by you know sporadic blurred vision and discomfort
you know there might be a little bit of redness in your eyes maybe a little bit
of inflammation every once in a while but you’re not feeling the symptoms all of
the time you know artificial tears are actually going to help heal your cornea
in that case if you’ve got any dryness on your cornea the artificial tears can
kind of cover that area and help that area to heal because the cornea can
actually you know heal pretty quickly so in this case it’s not just going to mask
the symptoms of the dry eye disease it’s actually going to help to treat the
problem in level one now with that being said does artificial tears not help if
you’ve got worse dry eye you know level 2 level 3 level 4
if you’ve got more severe dry eye that doesn’t mean that artificial tears
aren’t going to help you of course they’re going to help with symptoms but they are
going to help to some extent heal your cornea but if you’ve got super severe
dry eye there are just better medications out there they’re going to help
your cornea heal much more quickly things like autologous serum and
amniotic membranes and things like that Restasis Xiidra all of those are going to help you a
lot more than what an artificial tear is but if you’ve got a mild form of dry eye
then absolutely those artificial tears are going to help you treat that and side
note the person that did the study actually graduated with Jenna yeah
pretty cool so that was pretty cool so myth number three is dry eye has no
visual complications which can’t be further from the truth as most dry eye
sufferers know blurry vision sucks from dry eye and the number one cause of dry
eye is meibomian gland dysfunction meibomian glands are the glands that run
along your eyelids they run up and down and you have about thirty one on top
thirty one on bottom they have a little opening if you pull down your eyelid you
might see that little opening if you do see that opening or you see a little
yellow bump in that opening that’s a bad sign that usually means you have meibomian gland dysfunction but with that being said meibomian glands are
responsible for the third layer of tears that third layer of tears actually keeps
your tears intact so every time you blink what happens is the tears come
together and they stay together depending on how good your oil is an oil
how good your oil is depends on your warm compresses how clean your eyelids
are your diet your hydration how unhealthy you are or healthy you are so
when you blink it brings the tears together and depending on how fast those
tears break up depends on how well you see and so when you hear the term tear
break up time which I hear a lot of you guys talking about that on the dry eye
syndrome support community and in The Dry Eye Show to your breakup time is simply we
have you blink blink blink so that brings the tears together and then they
stay together and then we watch how long they stay together and so we count one
Mississippi two Mississippi while holding your eyes open yep you hold your
eyes open and as soon as we start to see that break up that’s the tear break up
time and so when I’ve heard people say you know I have a one second I have
a five second I have a ten second we look for about ten seconds the longer
the better ofcourse but when you blink it gets that oil
released it tears as your tears brings them together and it holds the tears in
place which makes your vision stable the number one refractive surface of your
eye is the tears and so without stable tears you’re not going to have a good
refraction which means you’re not going to have good vision
so myth number four myth number four is punctal plugs will
make dry eyes worse now I know you have asked about this a lot in the community
and we’ve said that we’re a little leery about punctal plugs and there is a lot
of debate about this topic so basically punctal plugs work by plugging up the
little puncta or the little drainage holes that are in your eyelids you have
four of them one on the upper one on the lower of each eye and these drainage
holes basically when you plug them up it’s supposed to help keep the tears on
your eyes so when you plug them up though
are you also keeping all of that inflammation in your eyes that’s kind of
the debate basically but first of all all dry eye is not caused by
inflammation and there’s not inflammation in all dry eyes so there
are some people out there who really don’t need to worry about this and you
know studies have shown that punctal plugs can help improve both signs and
symptoms especially in people who don’t necessarily have inflammation but
they suffer more from things like aqueous deficient dry eye caused by
Sjogren’s syndrome or you know dry eye due to systemic medications that they
can’t go off of or you know people that have had LASIK sometimes punctal plugs can
be wonderful for that sometimes contact lens induced dry eye people with
abnormalities in the way that their eyelids close you know corneal issues
that affect the tear film those type of things those are the people that are
going to benefit from punctal plugs now if you’ve got raging meibomian gland
dysfunction and blepharitis and you can’t keep it under control and
you know you’ve just got a poor tear film and it’s just awful punctal plugs
are not for you because they’re just going to stop up the
inflammation that’s already in your eye and they’re going to make your eyes more
inflamed so it is a myth punctal plugs are actually helpful they do treat the
signs and symptoms of dry eye but it’s specific types of dry eye that they’re
most beneficial for correct all right so myth number five contact
lenses cannot be worn by those people that have dry eye and so this is false
and true at the same time and so if you were to talk to me about ten years ago
or maybe not like 15 years ago about wearing contact lenses with dry
eye I would have said absolutely not the materials were just weren’t there
the lubricating agents weren’t there the solutions just weren’t there and they
just worn it as comfortable as they are now and so the two that we
choose to go with when a patient has dry eye first get the dry under control
before we ever put a contact lens on them going back to what I was talking
about with the tear film if you don’t have a good tear film you’re not going to
have good success with contact lenses and so when I discussed contact lenses
with a patient with dry eye we get the dry eye under control first I then have
them back for a contact lens evaluation which they usually don’t like but you
know what that’s under that have you’d be more successful than hate your
contact lenses and so we usually fit Acuvue Oasys 1-Day or a Dailies
Total 1 which is a daily lens so a daily lens is a fresh new lens it’s a
brand new material you put it on your eye every day and you throw it away when
you’re done sounds wasteful but it’s the healthiest way to wear a lens and it’s
the best way to wear lens if you have dry eye now if you can’t afford
Dailies because they can be a little cost prohibitive if you’re wearing like
a monthly or two-week lens we always recommend using a Clear Care Solution or
a hydrogen peroxide solution like Clear Care be very careful though because it
is hydrogen peroxide and if you put it in your eye you will notice it and it
will not feel good now if you can’t tolerate contact lenses at all and
you’ve tried all the soft contact lenses even the Dailies Dailies Total1 and Acuvue
Oasys 1-Day a scleral lens might be your next option a scleral lens is a
hard lens it’s really big and what you do is you fill it with solution before
you put it in and then you put it in after you put it in you have that
bathe that solution bathing your eye at all times and so it’s going to be a
little more comfortable for you it’s going to be a lot nicer for you and so
that’s always a good way to wear contact lenses if you
want to wear contact lenses and you have dry eye
we also fit scleral lenses if you have dry eye and want to be more comfortable to
so now going on to myth number six which number six and seven go together kind of
and I believe that these two are probably my favorite ones because I mean
we have a child and everybody would do anything for their children or
grandchildren and so this is something that you really need to think about
talking to your children about and if your children have grandchildren talking
to them about this so with that being said myth number six and that is
staring at a computer screen will not hurt my child’s eyes and this is
actually one of the scariest things that we learned at our Academy meeting this
is a separate lecture from Dr. Kabat’s lecture and basically you know we
already know that there are so many reasons to get your children outside to
play but one of those is that computer screens can actually be incredibly
harmful for your child’s eyes so we already talked about today how the
evaporation of your tears can cause dry eyes and issues like that and you know
contact lens wearing computer screens and all of that can really exacerbate
that tear evaporation issue but a study in 2014 actually showed that chronic
exposure to stressors such as a computer screen can deplete the myocyte stem
cells and therefore cause meibomian gland atrophy this is in your children and they studied children you know of course
it happens in adults too but we’re more concerned about kids because they looked
at kids that were you know under the age of 18 and they found that these kids are
spending eight point six hours on average in front of a screen every
single day and I believe they found that like 80% of them had some
type of meibomian gland atrophy already which is just insane I mean can you
imagine I mean you know hardly any of us here in this group are 18 years old but
can you imagine having meibomian gland dysfunction and dry eye
and all of those symptoms when you’re younger than 18 can you imagine what its going to be like when you’re 50
you know like for these kids you really need to encourage that your kids or
grandkids get away from the computer screen go outside and play you know take
breaks from the computer screen you know all of this just contribute so much to
meibomian gland dysfunction and dry eyes and we want to do everything that
we can to protect our kids eyes because you know they’re our future and if
something you know if they can’t handle it what are we going to do you know so you
know the next myth kind of goes along with this so I’ll let you go over that
one so the last myth of tonight is treating children for dry eyes is a
waste of money which again going back to the last time in something you forgot to
mention in the study is that the average kid’s screen time today this is studying
over 12 countries is nine hours nine hours a day looking on screens either
a laptop a phone or a tablet and so treating their dry eyes is nowhere near
a waste of money especially with the accessibility that we’ve made for things
like Heyedrate Lid and Lash Cleanser and so I’m going to go over four ways that you
can treat dry eyes and to make sure that meibomian gland dysfunction doesn’t
happen that you keep your eyelids clean and we’re going to talk about other ways
that we need to be doing and teaching our children so number one is blinking
exercises you have a great video on this and go to youtube and put in dry eye
blinking exercises I think we’ll also put it in the comments below that you
can check it out there and that’s just ensuring that you’re closing your eyes
or your kids are closing their eyes fully when they blink even just a hard blink
you know an intentional blink is so important because so many people just
don’t fully close their eyes when they blink when you’re on a screen nine hours a day
and you’re not blinking as much which is an causing an evaporative dry
eye which is then causing meibomian gland atrophy so blinking exercises
helps tremendously reducing that computer tablet and phone
use going back to the nine hours of screen time and it not only causes meibomian gland atrophy but it also causes nearsightedness and so being on the
screen reading more and not being outside causes more
nearsightedness so prevent glasses by sending your kids outside and give them
an old book and come out of the house and so eyelid hygiene we talked about that
using our Heyedrate Lid and Lash Cleanser this used to be extremely expensive when we
had to do prescription medications like Avenova or Ocusan but if you use our
Heyedrate Lid and Lash Cleanser you can get your first bottle free at
and then after that it’s just a usually $18 a month after that but if you buy a
four-month supply it’s even less than that so and then for a child or
just for anybody that doesn’t have dry eyes yet weekly warm compresses you can
do this simply by using the mask that we talk about all the time is you know 20
seconds in the microwave close your eyes 10 minutes on your eyes 10 to 20
minutes and then just do that light massage a very simple way to teach your
kids how to do it in the shower so a warm shower let that warm water just hit
their eyelids make sure it’s not too hot and just massage gently that’s just
going to heat up those oil glands and just let them flow again can’t see right now
our microwaves been broken lately just sidenote and I’ve been really missing my
warm compresses because I can’t heat my mask in our microwave cause it catches on fire do the traveling warm compresses in the shower I know I’m missing it our microwave is catching on fire it was exciting times so those were the 7 myths of dry eye all debunked so the first
myth was Restasis doesn’t work which is completely false it does work it’s
been studied for over 15 years probably even longer than that actually it’s been
out for 15 years and it works incredibly well you just have to be patient you’re
dry eye didn’t come overnight Restasis isn’t going to help overnight helping in 6
months or even 2 weeks is pretty tremendous when you talk about Restasis
building up over time so artificial tears are a good option if you have very
mild dry eye or for symptom relief in later stages of dry eye make sure you’re
using a non preserved artificial tear we usually recommend Retain MGD and so
actually I’m going to switch my recommendation tonight just because the
newer ones come out of the market in the last probably a year and Restasis
Mega-3 is that newer one and that one seems to work pretty well Refresh Mega-3 that’s what I meant to say Refresh Mega-3 not Restasis Refresh Mega-3 over the counter
it’s it’s a little newer and it has flaxseed oil in it so it tends to help
as well and I like that one so yeah try that one out
dry eye does have those visual complications and so it does cause
blurry vision causes halos at night punctal plugs do not make dry eye worse
they can help certain situations but make sure you don’t have inflammatory
dry eye when you get it make sure you have something like Sjogren’s or more of
a aqueous deficiency dry eye which is Sjogren’s lasik things like that
contact lenses contact lenses can make dry eyes worse but you can find ways
around it to fix that staring at a computer screen will hurt your child’s
eyes and it will cause meibomian gland atrophy so make sure you start them on a
regimen of eyelid hygiene blinking exercises reduced tablet use and weekly
warm compresses yes so thank you for watching
now we’re going to jump over to the live questions so let’s jump over there and
see what’s going on alright so Darla says she’s been using Restasis for two
years not sure how much it does help I used restaurant is don’t know what
that means Rstasis does I don’t know what
that is either alright so Linda says been using
Restasis for over three years hasn’t helped me at all and no coupons for
Medicare people so I ask you why do you take it why do you take Restasis or
Xiidra I saw you try Xiidra too on the next comment why do you take it at
all if you don’t feel like it helps I would recommend trying things that help
more because at that point if you really truly have not seen a difference
in your doctor hasn’t seen a difference then you’re just spending a lot of money
it’s like a really really expensive artificial tear when you could just buy
artificial tears that are going to give you the symptom relief that you’re looking for so if you’re using it for symptom relief yeah yeah try Refresh Mega-3 Maida says
using Xiidra is helping so that’s good Linda also says I do have a
little bump and been using your Lid and Lash Cleanser for six months and it helps somewhat however I always look like I’m crying so pretty common have
artificial tears that is more of a meibomian gland dysfunction
pretty common to have a lot of tearing and that’s usually meibomian gland
dysfunction it could be also that your lid is not completely adhered
to your eyes that’s really important to mention that to your doctor tight
against your eyelids or against your eye not adhered all right Sue says I have an
autoimmune problem with dry eye and dry mouth I have been on Restasis for ten
months I was wondering if it is working so quit for 5 days and symptoms worse
I quick got back on the drops I’m also taking omega-3 change in diet eye plugs
and using over-the-counter eye drops Xiidra not in my Medicare insurance problem not
gone but I can manage so Sue if you haven’t got to
and you’ll see everything that we recommend for diet it sounds like you
have a type of Sjogren’s did she say she’s on punctal plugs I don’t know because that might be an option I did not see it but yeah just figuring
out if you have allergies because an autoimmune condition is something
that you’re doing that’s causing your body to attack itself and so usually
that’s diet related sometimes not but sometimes it is and it sounds like
you might have like a Sjogren’s type syndrome and so that might be something
to explore all right Linda says I believe my three teenage grandkids need
glasses already because of their computer use I believe we recommend kids
get eye exams at nine months in every other year after that until six
and then after age six they should have one every year kids don’t know what
they don’t know exactly so if they don’t know they can’t see they don’t really
know that and so that’s the problem we see so many kids that you know they come
in and their parents are shocked at their prescription like I can’t believe
he needs glasses he never told me that he can’t see kids don’t know that they
can’t see they just think that that’s normal and that everybody sees like they
do so it’s very important to get their eyes looked at and if they’re on the
computer all the time they should be wearing some blue light blocking glasses
truthfully because that’s really going to cut down on a lot of that glare and a
lot of that eye strain that they can get from that Linda’s going to try blinking
exercises and her doctor suggested a few stitches in the eyelid so that leads me
to believe that you do have a very lax eyelid that’s probably causing you’re a
pupillar or your eyelid or your eye tearing the reason that is because you
have puncta and you’re puncta right here and they’re actually pointing
against your eye so every time you blink you actually blink from the outside in
so it’s kind of like a wave pattern you don’t notice that but it pushes the tears
to the puncta and if your eyelids are lax the puncta are going to be
pulled off the eye so when you blink it’s not going to have anywhere to go so
it’s going to drain off your on your face and so you might have little red
streaks and that’s because your tears have a lot of enzymes and
they’re just making that skin raw so let’s answer Jenifer’s question I
developed GPC in July and now I have aqueous tear deficiency I never had dry
eyes did I develop it from GPC I now wear Dailies Total-1 can we take that one now so he probably developed your aqueous tear deficiency not from GPC but
yeah GPC stands for Giant Papillary Conjunctivitis which is just
inflammation of the inner eyelid and it’s usually caused from silicone in a
contact lens me personally if I saw you I would not put you in Dailies Total-1
because it has silicone in the lens I would actually put you in the older
contact lenses that I talked about earlier in the show even like a
1-Day Acuvue Moist which is an older daily lens you should be in a daily disposable lens it’s an older lens
it’s thinner and it doesn’t have that silicone so that’s what I would prefer
you be in and I think you would be more comfortable in those too maybe they’re comfortable lens but Dailies Total-1 tend to be the mecca
of comfort but they have that silicone in there and if you have GPC
problems that’s an allergy to that silicone so I would have you on an
allergy drop and then a daily like Acuvue 1-Day Moist and the
allergy drop would be something like a Zaditor or an Alaway something over-the-counter that you can get all right answer Karen’s questions hi I ate a little
bit of sushi successfully last Friday I didn’t have a reaction so I had a lot of
sushi on Sunday a week ago since Monday morning I’ve had a flare-up in my eye
that has more aqueous deficiency than MGD I found out that the sushi rice has quote
lots of sugar sugar is on my medium list of food sensitivities could it really be
that I’ve had a flare-up for a week due to sugar or should I just try to figure out
another reason yes sugar is the poison of our generation it could be the
sugar and you’re right that sushi rice does have a lot of sugar because it uses
rice vinegar to make it you know to make it sticky and so it
does and that very well could be it you know I know what the holidays to sugar
is just everywhere so it could be tough but definitely that could be what’s
causing it I love this Terri said that we’re right that kids don’t know what
they don’t know and they can’t see she was in fourth grade when she got her
first glasses and she was nearsighted and nobody knew it she didn’t know it
and then she got her glasses and it changed her life so that’s why we always
recommend after the age of six every year because they never really know
trying Xiidra two month a little improvement wondering if i should switch
to Restasis i have Hashimoto’s and MGD explore diet more than medications yes
so go to to get our diet recommendations and I
would probably stay on Xiidra if you have seen a little improvement I would
stay on it all right let me jump over here to that’s our live one we
asked the question if you’ve used Restasis or not and so use Restasis for six
weeks my eyes stay red and stung most the day nighttime dose was the worst
though it really stung my eyelids also became swollen I’ve been using Restasis for years I’ve also tried Xiidra for a short while neither one is a
miracle for me and that’s true for a lot of people alright and
anything else over here Restasis doesn’t work really you read the rest of
the title that says debunking myths it’s a myth Sara says Restasis helps me
Zack says I use it very little when I use it a lot it cause deep eye socket pain
so yeah you were getting a side effect unfortunately and I’ve
used Restasis for years I can’t say it is really effective stop taking it consult
your doctor about that I use Restasis for several years it works some
switched to Xiidra and thought it was better neither drops have truly given
relief I’m frustrated that’s when you need to explore diet more so go to get your diet recommendations get your
green smoothie recommendations you’ll notice a big difference with those
green smoothies for breakfast have been I think
the number one thing that our patients and customers have done that really
really helped them yeah well I totally agree don’t know where I don’t know where you
are but you can X out of it too Restasis worked for me for ten years I’ve
been prescribed Restasis for 12 years that means it’s working pretty well yeah
Restasis worked for me I noticed if I skip a day I really depend on
Restasis for help so those are usually people that have been on it for a long time so
yeah all right let’s go back over here Linda says thank you
Linda says since having cataract surgery in May and getting corrective
lenses I was hoping that tearing would be better without needing contacts but
not the case I guess I will look into getting my lids stitched like you suggested
yeah and so the reason that is is because your tears just aren’t staying
on your eye because of that problem and so your visions not going to be better
as a result and once you get that fixed that’s when your vision will start to
stabilize again and hopefully you won’t even need contact lenses because your
tears are the number one refractive surface and so bad tears equal bad
vision glasses aren’t going to help contact lenses
aren’t going to help until you get the tearing fixed it can be frustrating though yeah
all right Karen says I’ve been avoiding all holiday sweets which is very tough what
we do is if we want something we usually split it
we usually actually split what’s on the what’s usually the serving size well
split it and then we’ll split it between us so you think I’m crazy I do that all
the time I know you do it like I’m the person that leaves like the half
cookie in the box but I always go back and
eat part of it later is the problem so why don’t I just eat it all at once I don’t
know so side note we went to a Christmas party last night on Jenna’s side and I had a
lot of gluten which is like my inflammatory food and we went for a walk
today I couldn’t walk the first half mile like my knee was killing me because
when I eat gluten I inflamed I get my wrist hurt I can’t do push-ups I can’t
do anything with my wrists they’re very hurt I can’t open jars my knee hurts and
so gluten is my sensitivity but it’s very hard to stay away from it and so I
know when I’m getting into when I eat it but sometimes I just need a good
cheesy potato and comfort food yeah I mean you’re an example of you know you
don’t have celiac disease or anything like that you just have a you know you
have an allergic reaction to it so it can happen all right so we went over dry eye
myths today we’ll post the replay in the comments it’s also in the description
above we are also doing a giveaway for five dry eye relief kits for the end of the
year and also because we’re celebrating two years of dry eye syndrome support
community so thank you all for being a part of it and if you’re not a part of
it go join it dry eye syndrome support community on Facebook it’s free to join
and then we’re also celebrating 6,000 members in that community which is
pretty awesome stay awesome and we can’t thank you guys enough so we’re giving
away five dry eye relief kits which comes with our Heyedrate Lid and Lash
Cleanser our Heyedrate Omega-3 our Warm Compress and our Tea Tree Oil Soap so
make sure you enter that because we’re giving away five of them so we are
excited about that yeah click the link in the description Acuvue 1-Day Moist is not made of silicone and Acuvue Oasys is so
make sure it’s the old one the Acuvue 1-Day Moist they’re still all made
of plastic yes but this one doesn’t have silicone they’re actually made a Hema
yeah all right well happy holidays everybody and
we’ll see you next week


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