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Thread: DHEA Eye Drops

  1. #1

    DHEA Eye Drops

    I have been reading this website for about a week and think it is terrific. I appreciate all the comments that have been posted. Thanks to all of you who have shared your experiences.

    I am a 51 year old male, physician (child psychiatrist) and medical researcher (causes and brain mechanisms in autism). I had mild dry eye symptoms in my 30’s (problems wearing contacts). I developed very severe dry eye symptoms almost overnight at 42 (at the same time I had a severe viral syndrome, pleural effusion). I have always wondered if they were related.

    About 4 years ago I tried cyclosporine (pre-restasis availability) with mild improvement. Three years ago, after following the literature (mainly from David Sullivan’s work at Harvard) on the role of androgens in dry eye, I started treatment with DHEA (dihydroepiandrosterone) eye drops. I have been very surprised to see that there has been no mention of this treatment on this website. I had a fairly dramatic improvement in my symptoms (going from being substantially impaired in my function – marked difficulty reading, traveling, working etc. to having my symptoms be generally very manageable, although I do use tears VERY regularly). I wanted to share this experience and encourage others to consider it.

    I obtained DHEA eye drops from Leiter Pharmacy, a compounding pharmacy specializing in eye medications in San Jose California. You need a doctor’s prescription (and should be followed by an opthalmologist if you do this). I started 1 drop per eye four times per day for a few days, then titrated down over a few weeks to 2 times daily (this was basically my own regimen). I began to show improvement after the first week and continued with improved symptoms thru the first 2 years. I have been doing this for about 3 years. I am followed by a general ophthalmologist and have had no discernible adverse effects. DHEA drops in the eyes have no systemic effects (i.e., just local eye effects).

    Again, I highly recommend trying this treatment. Leiter Pharmacy is easy to find on the internet. Chuck Leiter is well versed in this approach to dry eye treatment. I have sent a number of people to them. Some have not had any benefit. Others have had substantial benefit like I have. I would be happy to discuss this further if anyone is interested.

    Again, thanks to all of you for sharing your experiences. I am sure many of us could relate to todays post by Jessica about having one of those desperate days and finding nothing else to do but search the internet for solutions. Here is one that I hope may help some of you.

    Joe Piven
    Chapel Hill, N.C.

  2. #2
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    DHEA Drops

    Dear Joe-
    Thank you very much for sharing your positive results with us!

    Allow me two questions:

    1.: Have you ever done a test or been tested as androgen/testosterone deficient?
    2.: Do you have you any objective data to back up your improved well-being, like a more stable tear film visible for the ophtalmologist?

    I am happy that you have found relief!

  3. #3
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    DHEA and other androgens

    Thank you for calling attention to DHEA eyedrops. There have been a number of posts on this subject on the D'Eyelogues BB since March 2005. If you do a search using the terms "DHEA," or "androgen(s)" they will come up.

    I first heard of Dr. Sullivan's work with androgen eyedrops in January 2003, when Dwight Cavanagh gave a talk on the subject at the Dry Eye Symposium of the annual CLES meeting. Dr. Holly, who invited me to fill a last minute opening in the program, was the honored keynote speaker. DHEA is a precursor to both androgens and estrogens. It is widely available in health food stores (thankfully). As well, I have had female patients come into my office who were either taking DHEA orally, or had used a testosterone patch for the treatment of dry eye.
    Last edited by DrG; 05-Jan-2006 at 13:31. Reason: broken link

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    Jpiven: are DHEA drops the same as androgen eye drops? or do they have a simular effect but different? what type of dryeye do you have?

    Phillip: do you know if we have confonding pharmacies in europe that can make these kind of things up? Or would you have to go to the states? I dont know if there are any in the UK.

    http://www.dryeyepain.com/CustomEyedrops.htm

  5. #5
    I posted about this several months ago. I brought literature to my eye doctor, who refused to write a prescription stating this was a steroid drop. He said that the use of it could induce early cataracts. Since I suffer from autoimmune disorder, and Sjogrens (androgen deficiency being part of Sjogrens), I had particular interest in this treatment, but the door was slammed shut before I could get started. He said I have enough problems without adding long-term steroid drops and cataracts to the mix.

  6. #6

    cataracts and DHEA

    RE: Cataracts

    I think you should get a second opinion on the issue of cataracts. I have not heard this from the doctors I have spoken to. Allergan is currently doing a trial of DHEA drops and I don't think this is a major concern.

    Either way it is doubtful they would cause catarcts in the short term. My suggestion is to try them and if they don't work, then it isn't an issue. If they do work, then you make the decision. You would need to then get more information about the issue of cataracts to make an informed decision about whether to continue a treatment that works or not to continue it, for fear of the side effects. It seems to me that it is premature to make that decision before having all the information about whether they work at all for you.

    jp

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    Quote Originally Posted by JPiven
    Allergan is currently doing a trial of DHEA drops
    I've heard quite a bit of positive feedback about this from patients and doctors - mixed with some frustration at the delays. I wish the process didn't have to take so long but I guess having so many things in the pipeline at this point is a blessing compared to just a few years ago.
    Rebecca Petris
    The Dry Eye Zone

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    @sazy123

    Dear fellow european Brit :

    As I recall, any major pharmacy should be able to compound you those drops.
    That is with a prescription, of course! My father is a pharmacist and he also prepared testosterone cream for my eyes once...

    What is even more important is the fact that you have to get your hormone levels checked before you engage in such an endeaour. Especially your sex hormones. If you do not have an uncharacteristcally low testosterone level (for a female) those drops won't do you any good.

    Also, while doing this pick up the package of your contraceptive and find out whether it is androgenic.

    Take care!

  9. #9

    Dhea

    Dear Phillipe

    I think it is premature to conclude that the DHEA drops will not do you any good unless your androgen levels are low. We have no data on this to know. also, it isn't always clear what normal hormone levels are. There is a lot of individual variation. The main issue is change over time (even if you are within the normal range) and most people don't have longitudinal data on their own levels. Certainly what you say is a reasonable hypothesis but in my discussions with researchers involved in this work the local hormone levels (e.g., in the eyes) may not always be as closely linked to systemic levels as one might guess. My worry is that such comments (you have to have a low level for this to help) may dissuade some people from trying this and are not based on existing data.

    So, while baseline hormone levels may be interesting to measure, I don't think we have any reason to think that they have to be done or should necessarily guide ones decisions on whether to do this largely empirical trial.

    jp

  10. #10

    ...

    I have read that 'the pill' (contraceptive) lowers levels of testosterone in women.

  11. #11

    Androgens and eyes

    For a few years now I've looked for methods to make RGP lenses more tolerable. I've been told my problem is a poor tear break up time. But nobody can tell me why. Reading every abstract I can find on medline suggests a poor TBUT can be due to a lack of lipid in the tear film, causing too much evaporation. So why a deficiency of lipid? Other abstracts suggest a hormonal connection. Some have tried testosterone eyedrops with mixed success.

    I had my testosterone level checked and found it was within normal limits. So I ruled hormonal problems out. But now I'm reading a book on testosterone. I don't have it handy to cite but if anyone wants better info I can get to it tomorrow. What is most interesting is that even with normal testosterone levels there can be health problems because of too much estrogen. There has to be a healthy ratio of testosterone:estrogen. An unhealthy ratio leads to problems. Although the book doesn't talk about tear film, hormonal problems can't be ruled out. There are non-medical ways to lower estrogen, thereby improving the t:e ratio.

    I'm going in for a checkup soon and will see about getting a prescription for dhea drops. If it works for me, I'll let you know.

    BTW, I tried cyclosporin in oil long before Restasis was available. It raised my TBUT from 2 second to 10 seconds, not enough to be theraputic.

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    Quote Originally Posted by kaypeeoh

    BTW, I tried cyclosporin in oil long before Restasis was available. It raised my TBUT from 2 second to 10 seconds, not enough to be theraputic.
    That seems like a HUGE increase to me. You really ought to try some Macrolenses. They feel just like soft lenses.

    DrG

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    Quote Originally Posted by DrG
    You really ought to try some Macrolenses. They feel just like soft lenses.
    Noisy second from over here. I never did manage to wear corneal lenses with any kind of regularity, but I have done well with Macros.
    Rebecca Petris
    The Dry Eye Zone

  14. #14
    Quote Originally Posted by DrG
    That seems like a HUGE increase to me. You really ought to try some Macrolenses. They feel just like soft lenses.

    DrG
    I was also told by an OD that a TBUT of at least 20 seconds in necessary for RGP wear. Would macros work with a poor TBUT?

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    I have no idea what my TBUT is but I sure don't think it's 20 seconds.

    I'm not saying that the lenses are a slam dunk, I have to take care of my eyes and keep the lenses lubricated and moving and all that, but I am usually able to wear them all day.
    Rebecca Petris
    The Dry Eye Zone

  16. #16

    DHEA eye drops

    This is my first entry to this site and I would like to add my dry eye experiences to the many other stories I have read.

    I am a 58 year old male who began having dry eye symptoms 4 years ago. They began with the usual gritty sensation of having sand in my eyes, especially at night. This evolved into pain that kept me awake and, eventually, sleep deprived. I tried GenTeal Liquid Tears throughout the day and GenTeal Severe Gel at night. These helped only slightly and the Gel often seemed to cement my eyelids together, worsening the problem.

    Soon I had a corneal abrasion which caused extraordinary pain. I saw my ophthalmologist who measured a positive Schirmers test and installed a contact lens "bandage". After taking out the contact she prescribed Restasis which, over the next month or so, had no effect. My eye sensitivity during the day was to the point that I could not tolerate even the slightest movement of air across them and my pain at night became so severe that I would wear Speedo swim goggles to bed with the lenses filled with water-soaked gauze. Can you imagine… what an absurd image! I have a very supportive wife!

    After another corneal abrasion ("tear" seems more appropriate given the level of pain) and another lens bandage the ophthalmologist suggested either punctual plugs or cauterizing the tear ducts. Opting for the plugs, I was only able to wear them for 24 hours when I asked to have them removed. They were just too painful.

    She then gave a scientific article published in the periodical "Cornea" suggesting that, in a rat model, meibomian gland function is influenced by androgens. After extensive dry eye research on the Web I found significant work done by Dr. David Sullivan at Harvard. Desperate, I asked him about research on androgens and dry eyes, and any possible solutions he could put forward. David put me in touch with Dr. Joe Piven who very kindly shared with me his wonderful experience using compounded DHEA eye drops. My ophthalmologist was very intetested in Joe's experience and supportive of his approach, so she gave me a prescription for a 1% DHEA compounded solution.

    My results have been nothing short of miraculous. For the past 9 months I have been virtually pain free. I open my eyes to the wind and, most importantly, I am able to sleep at night. No more goggles! I am still aware of slight dryness at times but it is negligible, and I occasionally supplement with liquid tears. However, after much pain and research, I am now a believer in DHEA eye drops. I am not saying it will work for everyone, but I do suggest that it is definitely worth a try. Joe Piven is my new best friend.

    Philipp's comments regarding sex hormones are not to be ignored. There are data indicating these hormones are one link to dry eye syndrome. However, I must side with Joe in that current data are also inconclusive to rule out all other possible causes of dry eyes and that to deny patients access to such things DHEA drops without evidence of "abnormal" sex hormone levels (whatever those are) would, sadly, deny them a possible pathway from intractable eye pain. My ophthalmologist told me that 75 - 80% of patients come to her complaining of dry eyes. Is it likely that they would all have low hormone levels?

    To "20-20 Hindsight" I would say keep looking for an ophthalmologist who will try DHEA drops, even if it takes a 2nd, 3rd, or 4th opinion. My sincere best regards to you all.

    Miles

  17. #17
    Miles,
    This is wonderful! I appreciate you coming on this post and telling us your experience. I must pursue this further. I have extreme dry eyes after Lasik and have corneal erosions/abrasions sometimes on a weekly basis. I need help bad. I've tried everything for dry eye known to mankind EXCEPT dhea. I use DHEA cream on my eyelids and it helps tremendously for the one day a week I can tolerate it. However, the cream causes bad irritation to the lids and they swell and get red, but the relief temporarily from dry eye is nice once in a great while. I used to save it for the one day I had to go to the office building I worked in. I am going to try and find another ophthalmologist who might prescribe these for me. I am flat broke due to job loss, so I am wondering how to go about this? I cannot afford to go to one doctor after the next. I need to hit the jackpot first time around.

  18. #18
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    Quote Originally Posted by kaypeeoh
    I was also told by an OD that a TBUT of at least 20 seconds in necessary for RGP wear. Would macros work with a poor TBUT?
    Hah! I wish all of my patients who wear RGP's had a 20 second TBUT. After all, a "normal" TBUT is less than 20 seconds.

    My comments stem from the fact that you seem to be able to tolerate RGP's IF you wear a soft lens over them. Without knowing any more details, this made me wonder if you might not be able to better tolerate an RGP that was designed to fit like a soft lens.

  19. #19
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    DHEA and androgens

    The link between androgens, dry eyes, and females is expressed in the title and content of Dr. Sullivan's 2002 paper: Androgen Deficiency, Meibomian Gland Dysfunction, and Evaporative Dry Eye, in which the role of androgens in the treatment of meibomian gland insufficiency in women with Sjorgren's disease was explored. Without citing studies, it is generally accepted that women are more prone to dry eye than men, thereby lending more support to the androgen pathway and the role of androgen insufficiency in dry eye.

    However, DHEA, while converted into testosterone (and estrogen), may have its own receptors at the cellular level. A study at the Southern College of Optometry compared the efficacy of eyedrops containing DHEA, testosterone, and a placebo. The DHEA-containing eyedrops were more effective than either the testosterone or the placebo. DHEA is also a substance that cannot be licensed, and hence is unattractive to pharmaceutical companies. It is already available OTC. A quick Google search will turn up hundreds of references for oral and topical routes of administration.

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    dhea drops

    Miles:

    Im 20 so im assuming that im not hormone defficient. As your male you wouldnt be androgen defficent? but the DHEA drops still worked for you. So they could work for me being younger?

    thanks

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    Miles, welcome to Dry Eye Talk. Thank you very much for sharing all this information with us and your experience. There is a real need for stories with hope in general, as well as of course patients' reports of their experience with less common dry eye treatments.

    For those coming to our conference next month, there will be one or two doctors speaking who have been involved with the androgen drops clinical trials, so we'll certain be having some discussions about it there.

    Happy Monday all.
    Rebecca Petris
    The Dry Eye Zone

  22. #22
    The book I alluded to is The Testosterone Syndrome by Eugen Shippen, MD. His point is even with normal testosterone levels in the blood there can be health problems because of too much estrogen. All males produce estrogen as well as testosterone. The book does not address tear film problems. But to suppress estrogen production there are ways to tie up the enzyme aromatase, which converts testosterone to estrogen. The author recommends zinc, soy and cruciferous vegetables.

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    Exclamation Hormone Therapy

    Hey folks

    Just a very general statement:

    I think that there is far too much speculation going on in this particular thread...

    We should focus on using scientifically proven facts only when discussing such things like new eyedrops with active molecules (hormones are steroids btw.).

    The only thing the pros. have managed to prove is the fact that there is an interconnection between a lack of androgen and meibomian gland dysfunction. You can check with Dr. Sullivan's work for that. Furthermore, there are statistically NOT significant case studies about the use of testosterone cream (Dr. O'Conner of the Southern College of Optometry). I also came across one study that demonstrated the effect of this cream in a man. BUT: He was androgen deficient. Not very highly but because of this age he was a little off balance. I have been in conatct with both Drs. Sullivan and O'Conner and they have told me the hormone factor is generally a thing for women and just for men with off balanced sex hormone levels.
    I had my levels checked (OK) and tried the O'Conner cream for 12 weeks without any effect whatsoever.

    I am very sceptical because both of the two promoters here are older than 50 years. It is usual even for males that sex hormone levels begin to fall at that kind of age. That is a "normal" process and therapies adresses at this patient population will not work for a real pathologic dry eye!!

    I am sure there is quite interesting literature about hormones and their impact on various body functions. But unless there is scientific proof, we shoul refrain from putting too much emphasis on this!

    Maybe the doctors on the DEZ conference in february can shed some light on this...
    Last edited by Philipp_from_Germany; 09-Jan-2006 at 15:18.

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    Tbut

    Quote Originally Posted by kaypeeoh
    I was also told by an OD that a TBUT of at least 20 seconds in necessary for RGP wear. Would macros work with a poor TBUT?
    I think the general consent in the literature is that a healthy tear film breaks up after more than 15 secs. The "pain threshold" is 10 and when you have got 5 or less you do have a mojor problem (severe dry eye).

    As I have barely 3 secs I think I would kill for ten. When I had ten seconds I used to wear soft contacts for 18 hours a day without the slightest signs of dryness. Are you sure you have ten? In you first thread e.g. it was only 8:
    http://www.dryeyezone.com/talk/showthread.php?t=576

    Of course it is hard to create some kind of objective scale on which to measure pain but with 10 seconds I would throw a party in an a/c airport lounge and smoke and drink allnight..

  25. #25
    It's been so long, I honestly can't remember what I was told by one doctor or the next. I think it was 5 years ago that the opthalmologist said the TBUT was 2 or 3 seconds and prescribed Restasis. I remember the insurance wouldn't cover the cost so I used a veterinary version which is much stronger than Restasis. After months on the stuff another doctor examined me and said the TBUT was 5-6 seconds. Later, somewhere someone told me 10 seconds and someone else somewhere else told me 20 seconds. But I don't remember who or which clinic this happened. For me the point is nothing has improved RGP wear time, regardless of TBUT. I have used piggybacking and was able to wear lenses for 8 or more hours. But only if I wear the soft lenses atop the RGPs. Normally piggybacking is the opposite: soft lenses against the cornea and RGPs atop.

    I was able to order DHEA eyedrops and should get them by the end of the week.

  26. #26
    Are there any known side effects of DHEA drops? Are they safe for long term use? I hear 'steroids' and I panic.
    I wonder if there is any difference between the over the counter DHEA drops and prescription drops?
    I'm sorry if this is such an obvious question....but is DHEA the same as testosterone? I have been using the t. cream with good results.

  27. #27
    JCorbett

    It is true that DHEA is a steroid but all steroids are not the same. So estrogen and testosterone are stereoids but don't have the same adverse effects as cortisone or prendisone -- the steroids that cause diabetes, and weight gain and cataracts etc. But estrogen and testosterone have other adverse effects.

    I have not seen any data to suggest that DHEA eye drops (that don't go to your entire body and -- just stay around the eye region) have any significant side effects. but then again we don't have a lot of data except perhaps from unpublished Allergan trials and perhaps animal studies.

    Joe Piven

  28. #28
    DHEA and testosterone differ only because of two extra hydrogen ions on DHEA. Theoretically DHEA will attach to testosterone sites in the meibomian glands, stimulating lipid secretion. But in tablet form DHEA does not have an affect on the production of testosterone. That is, it's different enough that the body does not assume it is testosterone and does not curtail testosterone production. In comparison, anabolic steroids are close enough to testosterone that it causes a negative feedback, suppressing natural testosterone production. A medline search of DHEA shows no reports of negative consequences from it.

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    restasis useage

    kaypeeo:

    Is it ok to get 10 weeks out of one tray of restasis if you leave it in the fridge? Did your doc say it was ok? how many viles do you get in one tray? 15 or 30?

  30. #30
    Quote Originally Posted by sazy123
    kaypeeo:

    Is it ok to get 10 weeks out of one tray of restasis if you leave it in the fridge? Did your doc say it was ok? how many viles do you get in one tray? 15 or 30?
    I first used the veterinary version: Optimmune 0.2% cyclosporine. Eventually I broke down and paid the $100 for Restasis. It comes in a plastic tray with 30 ampules I think. I didn't refrigerate. Putting a drop in each eye twice daily meant one ampule would last 4 or 5 days. So I got nearly 12 weeks of treatment out of one tray, making it cheaper even than the veterinary version. Keeping the tray in the refrigerator is probably a good idea. The MD who prescribed it used it also. He kept the opened ampule in a clean jar with a snap lid and was careful not to touch the top of the ampule.

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