Blog Comments

Thanks for posting this. For anyone affected by Thyroid Eye Disease associated with Graves' Disease, and RAI treatment, suggest some searches on selenium. There are many advocates of the "block and replace" therapy as alternative to RAI to avoid the downside of RAI long term. European countries have long avoided RAI therapy.

For those of us who had one or more RAI treatments, there are many studies and articles on the value of selenium supplements in improving quality of life, aiding dry eye (RAI is known to damage lacrimal glands) and improving assimilation of thyroid replacement medications. As with all supplements, moderation is needed, due to possible toxicity.

http://www.ncbi.nlm.nih.gov/pubmed/21591944

http://www.hindawi.com/journals/jtr/2012/736161/

http://jcem.endojournals.org/content/87/4/1687.abstract

http://www.tshservices.com/autologou...eye_drops.html

Oooh dear. Thank goodness that's resolved itself. Let's hope s/he didn't end up with a dry eye from the cornea damage.

I've always thought there might be reduced sensation on the eye surface for children who've got surface changes from eyedrops eg with BAK. I think this because despite dry eyes, my daughter can outstare anyone by a long way and we've always had the problem that after blitzing with random prescribed meds for 1y from age 11 when the ophth didn't know what it was, she didn't feel discomfort very much despite the damage so didn't drop enough. Now much better at age 15 she feels dry eye more like an adult.

The paed ophth say it's because children don't complain about pain like adults because they don't know what's normal and just go along with it, ie they don't necessarily say 'there's something wrong with my eyes'. Eg they might remove a bandage contact lens after surgery and there is infection and inflammation, whereas an adult would have known immediately there was a problem.

But a small degree of neurotrophic keratitis from chemicals in eyedrops sounds like our experience. This is also about formulating eyedrops for children's eyes, smaller area and more sensitive and absorbent, I guess, like their skin. And the age-old problem of working out how adult meds affect children, which is sometimes very differently.

Does anyone know if it is possible to get PRP eye drops? I live in NYC and I can only find serum eye drops. they are not the same ...

Thanks for this study.....Unfortunately there are still doctors, mine included, who are prescribing BAK preserved prescription medications to their cataract patients who have active corneal disease.

It took more than five months for my eye to recover from the inflammation caused by the NSAID drug Nevanac (Nepafenac) preserved with BAK, prescribed pre- and post-operatively.

Yes, there is a preservative-free NSAID drug available for cataract surgery: Acular PF

At one year post-op, my eyes are still exquisitely sensitive to many common chemicals, including flourescein, and components in over the counter drops and solutions. I can only conclude this ongoing sensitivity is due to the damage caused by BAK since it began after the cataract operation.

Thanks to this forum, I know about BAK, and only too well understand the damage from this preservative in my surgeon's prescription. This surgeon was highly recommended, and is affiliated with one of the top eye hospitals in the US, the recipient of many awards, and is still in practice.

As long as there are practicing physicians who fail to keep up with current research, keep those BAK studies coming. We patients need to be informed!

For me, this experience has raised many concerns: Why aren't eye docs required to attend sessions on BAK as part of their continuing education? Why doesn't the FDA put black box warnings on BAK medications so patients might have a shot at avoiding this stuff? Why are BAK preserved drugs still on the market when there are safer substitutes? Why aren't pharmacists consulting with patients who come in with prescriptions for BAK-preserved medications? Baby boomers are just one demographic likely to have cataract surgery or other eye diseases like glaucoma; why aren't consumer oriented magazines like AARP writing about this issue so readers can be more informed?

This stuff is dangerous and I'm sorry to be "singing to the choir" here, but yes, keep those studies coming. Maybe there's someone of your readers in this forum who may be able to avoid similar damage after reading these studies by challenging their doctors who are after all under oath to "first do no harm".

Let's hope they crack on with this a bit faster, at last. Plenty to do. Good people involved - Serge Doan is listed. Thanks, Rebecca x

Totally selfish of me, I know, but I would LOVE there to be a definitive test for rosacea (facial or ocular, I don't care).

In the meantime, however, perhaps they could work on some good treatments and/or cures!

Glad to see this research out there. Hope that cornea docs, or neuro-ophthalmologists will finally gain a more in-depth understanding of corneal pain.

I looked at the abstract again and it's a "prospective RCT". So what the authors are saying is that they denied people surgery.

The question is if they are pickier than all the other Lasik/PRK places.

Whether it's preoperative or postoperative exclusion criteria, when you see a study that has a *bunch* of inclusion/exclusion criteria, buzzers should go off that the authors may have "created" an artificial sample of "cleaned/sanitized" participants that may not represent the population of people getting Lasik/PRK.

When you've cherry-picked your participants, you can get to the point where the results are NOT generalizable to the population.

My impression is that the authors report their inclusion/exclusion criteria because these are the "normal/standard" criteria for anyone getting Lasik/PRK in the real world. That's the only way these results can be applied to the real world... if the Lasik/PRK places use the same stringent criteria when choosing who to operate on. Do they???

I have Lasik KCS (dry eye) and I have noticed that the decreased corneal sensitivity is at the root of my disease.

How did I deduce this? Well, the sclera of my eyes hurt, a lot. My corneas, not at all except for around the edges?!? Hmm.... My Ophthalmologist triggered this when she said something like "if you have corneal de-sensitivity you should not feel any pain." This made me more cognisent of my pain and where it actual ... resides?

Well, I can tell you that the center of my corneas feel nothing. My scleras feel like they're burning and raw. My eyelid margins feel irritated and my eyelids feel chapped.

Not sure this was relevant or helped anyone ...

spmcc thanks. I assume those were preoperative exclusion criteria?? I mean we know they were excluded from the STUDY on this basis (which I see includes things like MGD) but we don't necessarily know they were excluded from having the surgery?

You know, this kind of thing really pisses me off. I have been working my way up through a month or two of studies & newsclips I hadn't gone through, so it was not until AFTER I posted on the blog about the study that I saw all the publicity they got for it ("Gee, look, you're really no more likely to get dry eye with LASIK than PRK after all! Guess we were wrong all those years!") They're always just so flagrant with this stuff.

You know what's important to me... the EXCLUSION criteria. In other words, researchers "hand pick" the best candidates.

See their exclusion criteria -

We excluded patients in whom both eyes did not meet all inclusion criteria and either eye met any exclusion criteria; combination of baseline corneal thickness and planned LASIK parameters resulting in <250 mm of remaining posterior corneal thickness; baseline standard manifest refraction >0.75 D; more minus in sphere power or a difference of >0.50 D in cylinder power; a different type of astigmatism (i.e., with the rule, against the rule, or oblique) when the cylinder was >0.50 D compared with the baseline standard cycloplegic refraction; patients desiring spherical undercorrection in 1 eye; hard or rigid gas-permeable contact lens use; preoperative assessment of the ocular topography and/or aberrations; severe dry-eye syndrome; severe blepharitis; anterior segment pathology (cataract, corneal scarring, neovascularization within 1.0 mm of intended ablation zone); residual, recurrent, or active ocular or eyelid disease, including any corneal abnormality (recurrent corneal erosion, severe basement membrane disease); progressive or unstable myopia or keratoconus; unstable (distorted/not clear) corneal mires; previous intraocular or corneal surgery of any kind; history of herpes zoster or herpes simplex keratitis; chronic systemic corticosteroid or other immunosuppressive therapy use; immunocompromised or significant atopic disease, connective tissue disease, or diabetes; history of steroid-responsive rise in intraocular pressure, glaucoma, or preoperative intraocular pressure >21 mmHg; macular pathology; pregnancy, lactation, or planning to become pregnant during the course of the study; known sensitivity to planned study concomitant medications; and participation in any other ophthalmic drug or device clinical trial during the time of this clinical investigation. All intraoperative and postoperative complications were assessed at each scheduled and unscheduled study visit. These data were entered into case report forms in the chart and the institutional review board was notified of any adverse events within 72 hours.

Perhaps in the "normal" world, LASIK and/or PRK centers aren't as picky!!!

Byers Eye Institute @ Stanford University School of Medicine performs lasik so its no surprise that their study "found" the results they wanted:

http://eyelaser.stanford.edu/

http://www.nice.org.uk/CG85 National Institute of Clinical Excellence - Diagnosis and management of chronic open angle glaucoma and ocular hypertension
`Consider offering people with COAG who are intolerant to a prescribed medication: alternative pharmacological treatment (a prostaglandin analogue, beta-blocker, carbonic anhydrase inhibitor or sympathomimetic) or a preservative-free preparation if there is evidence that the person is allergic to the preservative.'

NB ocular hypertenson is extended here to include chronic inflammation, and that anyone with a risk of raised eye pressure through chronic inflammation or use of steroid eyedrops is entitled to frequent eye pressure checks, NHS. When the eye pressure is raised, an optometrist must refer to an ophthalmologist and the ophthalmologist must provide a management plan. The optometrist must be qualified to identify clinical changes and must refer them (College of Optometrist guidelines). Clinical changes for which they must refer include intraocular pressure above 21mmHg, signs on optic nerve heads and fundus.

A list of qualified optometrists providing co-care services in the 'community' is provided by the Primary Care Trust or Clinical Commissioning Group.

or, I should have said, lack of effectiveness. Judy

Thanks for posting this update on the effectiveness of TearLab in diagnosing dry eye, Rebecca. Judy

Thanks for that. Applies to me for sure.

Ha! My Lasik Surgeon in NYC charged > $1000 every time he plugged my ducts!!!

I am really glad that a study is being done to look at the effect of a 'food like' substance on the eyes.
I had thought the negative effect of alcohol on dry eye was due to chronic consumption. It is interesting that alcohol shows up in the tears. It makes me wonder what else shows up in the tears. Given that alcohol is a sugar, it makes me wonder if it is the sugar component of the alcohol that is contributing to the corneal staining and shortened TBUT.

Interesting that the research has a Korean connection. A poster on d'eyealogues stated that in Korea, the Lasik doctors tell patients not to consume any alcohol for four weeks following lasik surgery. Looks like this study might be confirming some suspicions about alcohol and its effect on the ocular surface.