Category: Blog Posts

🔊 Listen
Last year Susie Brockman shared with all of us her remarkable Story of Hope. Today she follows up with what she calls “the most important piece of advice I can give anyone with Dry Eye.”

As Dry Eye sufferers we’re desperate to find relief from pain. We sign up for support groups, purchase every new over-the-counter drop we can find, join any number of online forums, and seek out other Dry Eye sufferers. We modify our lives to accommodate our disease.

But all too often, nothing seems to work.

That’s because Dry Eye is extremely complex. Many different things can cause Dry Eye and there are lots of variations of it. So treating the disease takes a lot of finesse. Or, in other words, one size doesn’t fit all.

Each Dry Eye Case is Unique

Each Dry Eye case is unique and there are many causes. For example, various diseases can contribute to, or cause Dry Eye, e.g.: diabetes, collagen vascular diseases, autoimmune diseases like Sjogrens syndrome, rheumatoid arthritis, scleroderma, lupus, or Hashimoto’s thyroiditis.

Many medications can cause Dry Eye or make it worse, e.g.: antihistamines, pain pills, blood pressure meds, birth control pills, antidepressants, or hormones, to name a few. Other causes of Dry Eye include aging, radiation treatment, Lasik surgery, inflammation, and allergies. The list goes on. In many cases, a patient has a combination of these problems which makes diagnosing complex.

The Most Important Piece of Advice

Nevertheless, an accurate diagnosis is the first step in finding relief for anyone with Dry Eye, and especially anyone with an advanced case. That’s why the most important piece of advice I can give is to find an ophthalmologist. Preferably the doctor will specialize in cornea and external disease and sub-specialize in Dry Eye, because all ophthalmologists aren’t alike. There are different sub-specialists and even sub-sub-specialists. So, even if an ophthalmologist specializes in cornea and external disease, he may not be a Dry Eye specialist.

A general ophthalmologist will typically prescribe over-the-counter eye drops, prescription eye drops, warm compresses, some type of lid wipe, and maybe eventually punctal plugs. Unfortunately, if these treatments don’t work, they don’t prescribe other treatments. It’s only those who specialize in Dry Eye, and have experience with the complexities of the disease, that will figure out what’s really going on and give you hope.

It All Begins with Finding the Right Doctor

Once you find a Dry Eye specialist, he’ll examine your eyes carefully and put you through a series of tests – Schirmer tests, meibography, tear break-up, and so on. Afterwards you’ll get a diagnosis and treatment plan. You’ll finally find out what’s causing your symptoms. It might not be what you expected, and it might be something you’ve never even heard of. But at least then you’ll start treating the conditions you have and the diseases that are causing you pain. Doing that will restore your hope.

If you’re one of those who’s tried different treatments, but none of them helped, this is especially important for you to understand. It’s not that the treatments are bad (although some might be questionable), it’s that the treatments aren’t working on your specific set of conditions. There might be systemic or environmental causes. You might have meibomian gland disease or something entirely different. Just because someone else has success with a treatment plan, doesn’t mean you’ll require the same regimen to solve your Dry Eye issues and relieve your pain.

Remember, it all begins with finding a doctor, then getting tested properly, getting a comprehensive and accurate diagnosis, and following your Dry Eye specialist’s plan of action. That’s how I found hope, and you will too.

Susie Brockman, Chronic Dry Eye Patient

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🔊 Listen

I’d like to thank everyone for their questions. It’s important to remember that my routine – the things I do every day, my treatment plan – is specific to me and my set of conditions. They won’t necessarily work for everyone. Even so, learning what I do may help you develop a routine that keeps your eyes comfortable and works for you.

Question 1:

It sounds like you do a lot each day to stay comfortable. How much time does all of that take?

Answer:
In the morning my routine takes maybe 10 minutes including a shower. Lid wiping takes 30 seconds. Irrigating takes something like 20 seconds. Drops are just seconds.

Steaming takes three minutes while I brush my teeth. Plus steaming is good for my skin.

Sleeping with moisture chamber goggles is a non-issue and washing them takes maybe a minute.

It’s not the length of time, it’s the discipline of doing it that matters. We’re all supposed to brush our teeth two times a day. So I wash my eye lids two times a day too.

Question 2:

What do you mean by steaming? What do you actually do?

Answer: I use a facial steamer. I fill the steamer with two cups of water (using the measuring cup that comes with the steamer) and turn it on. The water gets hot in about three minutes. I put my face close to the steamer, a couple of feet away, and close my eye for three minutes. Since I use the steamer while brushing my teeth, it doesn’t really add much time to my daily routine.

Question 3:

How much better are your meibomian glands?

Answer: I had probing just a few days ago, on January 30, and had more glands open than ever before. There were 37 open glands in the left upper lid, 31 in the right upper. (My lids have a double fold. With 60 glands in the upper lids I’m a virtual oil factory). I tend to develop fibrosis in the glands, and probing pierces through that tissue.

I still had some aqueous deficiency in the right eye, so during my appointment the doctor partially cauterized the lower tear duct in that eye.

Question 4:

Do your eyes feel better in Seattle or in Florida?

Answer: My eyes definitely feel better in Florida. It could be the heat, the humidity, maybe allergies, or all of the above, or who knows what.

Question 5:

Do you work? Are your eyes comfortable enough to hold down a job?

Answer: Yes, I work full time. But without my daily routine and my annual appointments, I think it would be uncomfortable and difficult to hold down a job. There’s nothing like really bad eye discomfort. I’ll never forget it!

I’d like to add that no one should ever lose hope. In the beginning, until you find the care you need, it might seem daunting, especially when your eyes feel bad. It can be hard to search for anything – or do anything at all – when your eyes are uncomfortable. But these days, there are many effective treatments for many of the conditions that can happen under the Dry Eye ‘umbrella’ – like conjunctivochalasis or MGD. It’s a question of getting a really good diagnosis first, so you know what you have, and then treating what you have accordingly.

An Event That Will Stir Your Heart

(Please note: as of September 5, 2018, this event has been cancelled. We apologize for any inconvenience.)

Finally, I’d like to remind everyone about our first ever Dry Eye Retreat for patients, their families, and friends, in Williston, Florida, November 9-11, 2018.

We’ve created an event that will stir your heart. You’ll have a chance to connect with Dry Eye sufferers just like you, participate in face-to-face support groups, and make a difference. Register early to reserve your spot.

Note  – the event fee does not include accommodations, but there are plenty of hotels, B&B’s, and rentals in the area. Just book early because our event is during college football season. And if the Gators are having a home game that weekend, it might be hard to find a room.

I hope to see many of you there.

Diana Adelman
Executive Director, Not A Dry Eye Foundation

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🔊 Listen
I shared my Story of Hope back in May 2016, and am happy to report that today my eyes are still comfortable. Since then, I’ve learned to avoid the triggers that make my eyes feel worse. I now know what to do each day to keep my eyes comfortable and moist. And I also had another meibomian gland probing.

At home my daily regimen includes cleaning my eye lids, anti-inflammatory and allergy drops, steam, and moisture chamber goggles.

My Daily Regimen

This is regimen I follow daily.

In the morning when I get up I use a solution containing hypochlorous acid — Avenova lid cleanser prescribed by a local ophthalmologist, or Heyedrate — on both eyes. I squirt the solution two or three times on a cotton pad, wipe it on my eye lids, and leave it on.

Then I irrigate my eyes with sterile saline, squirting half a tube in each eye. After irrigating I take a shower and make sure my lids are really clean.

Next, I use a drop of Restasis in each eye, capping the tiny tube for the next use until it’s empty. Ten minutes later I put a Pataday drop in each eye. At noon I use Restasis again.

In the evening I repeat the steps, and add steaming with a facial steamer for three minutes.

After steaming, I clean my lids with the hypochlorous solution, irrigate with sterile saline, and apply Restasis. Plus, I take another shower.

The day ends with moisture chamber goggles. I sleep in them, then wash and dry them carefully each morning.

It may sound like a lot of steps, but it’s completely worth it to me, because my eyes feel just fine practically all the time.

Doctors and Life Style Changes

I’ve changed my diet, avoiding coffee and sugar while eating more fish, vegetables, and organics when possible. Lots of doctors recommend these changes to their patients. To me, it just makes sense to eat healthier.

I see a local eye doctor at least once a year for general eye health. And at least once I year I see the specialist in Florida who first diagnosed and treated all of my Dry Eye conditions.

At my annual visits the specialist administers a variety of tests: Schirmer tests, meibomian gland exams, tear break-up time, eye pressure, and sometimes a meibography to see if my meibomian glands are changing. Then, depending on what he finds, he may adjust my treatment plan.

About once a year I have meibomian gland probing, which keeps the glands open and functioning. By the time the one year period rolls around my eyes are usually a little less comfortable than usual. They might be getting a bit gritty or sometimes have foreign body sensations. After probing these symptoms go away and my eyes feel great. After each probing my glands have stayed open longer and produced more oil. Meibographies have even shown that my glands are getting longer, which I think is remarkable.

To some it may seem like a long way to travel just to see a doctor (I live in Seattle and he’s in Florida), but I feel it’s an important step to make sure my eyes stay comfortable. In time, these visits may become even less frequent, but for now I’m sticking with once a year. Each time I go, my hope and my faith in the process of healing is renewed.

I hope sharing the steps I take to make my eyes comfortable inspires you to learn how to take care of your eyes. And I also hope to see you at the Dry Eye retreat this November 9-11, in Williston, Florida. Registration will be opening soon, but space will be limited so please register early. See you in November!

Diana Adelman
Executive Director, Not A Dry Eye Foundation

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Send your questions and comments to blogger@notadryeye.org.

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🔊 Listen
Remember when you were first diagnosed with blepharitis or MGD and heard about meibomian glands? Who knew secreting oil into your eyes was so important. Who knew the glands that did it could become so sick?

Remember when you tried to say the word meibomian the first time? It probably didn’t come out quite right. Miyoban. Miboan. Mayobeen.

Hint: It’s My, as in my house. Bow, as in bow tie. Me, as in me and you. An, as in an apple. My-Bow-Me-An, with an emphasis on Bow.

Eventually you tried different treatments, from warm compresses to lid wipes to any number of in-office procedures. If you were lucky you learned about meibomian gland probing and had it done by someone trained to do it right. Finally, your meibomian glands were working and meibum, the oil they secrete, was lubricating your eyes.

You may have had to undergo surgeries — like AMT — or continue other treatments – like lubricating drops and warm compresses — and may have wondered, was probing worth it? If you still had to do all of those other things, why would you have to have your glands probed too?

Meibomian Glands After Probing

We could take time explaining it, but a picture is worth a thousand words. This month, the picture is on the cover of the British Journal of Ophthalmology and shows a series of meibomian glands before and after probing.

Meibomian glands before and after probing

The pictures show that after probing meibomian glands were longer. Longer means they produce more oil. More oil means more lubrication and a longer tear breakup time. In other words, longer means more comfort and more relief.

Most people report feeling better after probing, but without visible proof of its effectiveness it might be hard to understand exactly how probing helps. These photos show just one of the surprising ways probing improves eye comfort.

You probably didn’t know about meibomian glands until you got Dry Eye, but at least now you know about the simple procedure that can make them regrow.

And remember, it’s My-Bow-Me-An.

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Send your questions and comments to blogger@notadryeye.org.

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🔊 Listen
As 2017 comes to a close, we’re taking a moment to recall one of its saddest moments, remember some of its highlights, and share what’s already in the works for 2018.

We Mourned

We mourned the tragic death of the young woman in India who simply couldn’t find help soon enough for the pain in her eyes. There is no way to express our grief adequately and nothing that will ever make what happened ok. Simply put, we mourned, deeply.

If you’re contemplating suicide, please contact your local suicide prevention hotline immediately. Reach out. There is help out there for each and every one of us.

New Board Member

This year Susan Howell volunteered more blogs and personal tips for coping with Dry Eye. We were impressed by Susan’s openness, willingness to contribute, and her boundless energy. She stands as a beacon of hope for many of us, having suffered through the pain of Dry Eye coupled with depression.

Despite these seemingly insurmountable conditions, Susan remained steadfast in her pursuit of relief. We were delighted when Susan agreed to join the board. She will be instrumental in organizing the 2018 Dry Eye Retreat.

270K Page Views

Our website had over 270,000 page views this year, averaging around 750 a day. That volume of traffic indicates that thousands and thousands of people are searching for information on Dry Eye. We hope the information on our website helps them find the relief they’re seeking.

Planning the 2018 Dry Eye Retreat

This summer we started planning our first Dry Eye Retreat and are now finalizing its details. We hope you’ll join us for what promises to be a heartfelt and deeply moving event.

If you subscribe to our blog you’ll be notified when online registration opens. Space is limited. So if you plan to attend, please register — and book your hotel room — early.

(Please note, as of September 5, 2018, this event has been cancelled. We apologize for any inconvenience).

Thank You Bloggers

Thank you to all of our bloggers who contributed 19 different stories, opinions, updates, and various musings this year.

If you have Dry Eye and would like to share your personal Story of Hope with our readers, send an email to blogger@notadryeye.org. We’d love to hear from you, as would our readers.

Giving Patients a Voice

When DEWS II released its voluminous publication on the state of Dry Eye, we decided to resend the “manifesto” sent in 2016 to all of the DEWS II Committee members. Thank you Kristen for making Constant Contact work for us. Dry Eye patients everywhere deserve to be heard!

Here’s what’s on deck for 2018     

Dry Eye Retreat

The Dry Eye Retreat will be held in Williston, FL, November 9-11, 2018. You will need to arrange your own transportation and accommodations, so please plan to book hotel rooms early. Williston isn’t too far from Gainesville, Fl., the home of the University of Florida Gators. If there’s a home game that weekend, hotel rooms will book up early. And we’d hate it if you missed the event just because you can’t find a place to stay.

(Please note, as of September 5, 2018, this event has been cancelled. We apologize for any inconvenience).

Seeking Volunteers

If you’d like to volunteer, we’d love your help. We’re looking for people who have experience or interest in social media, traditional and on-line marketing, SEO, event management, print media, fundraising, leading patient support groups, writing/blogging, public speaking, and more. To volunteer, just send an email to contact@notadryeye.org and let us know how you’d like to help.

Patient Reported Outcomes

We’re looking into ways to facilitate gathering information from Dry Eye patients who undergo treatments and the outcomes of those treatments. Are they effective? Do they cause side effects? How effective are they? And how bad are the side effects? This initiative started over a decade ago at the FDA and may one day benefit Dry Eye patients, especially those who try treatment after treatment after treatment but find no relief.

We’ll share more about this exciting development that could have a tremendous impact on each of us, though by no means is this something that will happen overnight. This as a long-term project that could have long-term effects. So stay tuned.

That’s all for 2017. We’ll be in touch again in 2018.

Happy New Year everyone!

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SAVE the DATE: Dry Eye Retreat, November 9-11, 2018, Williston, Florida

Send your questions and comments to blogger@notadryeye.org.

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🔊 Listen
We heard from many of you after the last blog when we compared Dry Eye to having a 125-foot orange in your mouth. We guessed that nobody would tell you a sip of water would help wash it down.

That got us thinking. Could there be other things you’d never hear again if you had a 125-foot orange in your mouth?

Absolutely!

In fact, it took literally no time to come up with more – 10 things you’d never hear again from your families, your friends, and your doctors if you had a 125-foot orange in your mouth.

Here they are, in no particular order.

1. At least you don’t have cancer

The word “cancer” really gets everyone going. Yes, in lots of cases it’s a horrible disease that can be fatal. But there are lots of different kinds of cancer, and some are very treatable. Regardless, can you imagine anyone saying “at least you don’t have cancer” if they saw you walking down the street with a 125-foot orange in your mouth? We couldn’t either.

2. You’ll learn to live with it

We can’t joke around about this when we know people who have committed suicide because of the pain in the eyes. Others become disabled, unable to work, unable to perform simple daily tasks. So no, some of us will never “learn to live with it.” And like some cancers, Dry Eye can cause death.

But that orange, no one is ever going to say you’ll learn to live with something that big in your mouth. Heck, the Charlie Brown balloon in the Macy’s Thanksgiving Day Parade is just 53 feet long, 31 feet wide, and 46 feet tall.

Your orange is way bigger than that.

3. It’s all in your head

No-o-o-o-o-o-o, it’s not all in our heads. It’s all in our eyes.

And in the case of the 125-foot orange, it’s all in our mouths. Enough said!

4. But your face looks good

As if the only time your eyes might feel bad is when they’re red or swollen or something other than clear and bright. Macular degeneration anyone? But with a 125-foot orange in your mouth we’re pretty sure there’s going to be some distortion to your face and nobody’s going to think your face looks good. Nobody.

5. You can’t possibly have a 125-pound orange in your mouth

The worst thing is when nobody believes what you’re feeling in your eyes.

But the orange – there it is – all 125 juicy feet. Now, doc, please DO SOMETHING!

6. I don’t know what it is so I’ll call it neuropathy

Neuropathy seems to be the new catchall “disease” diagnosed by a variety of specialists these days. Ocular neuropathy is extremely rare, yet there’s a trend these days to attribute chronic Dry Eye symptoms to neuropathy. But is it neuropathy or is it, in fact, a case of inadequate diagnosis or misdiagnosis? Because in the eyes – with that high concentration of nerves – something exceedingly small that can’t be easily detected – can still feel significant.

But, if you had a 125-foot orange in your mouth, chances are the doctor wouldn’t call it neuropathy. Instead, he’d say something useful like, “Your problem is that you have a 125-foot orange in your mouth.”

7. I don’t see anything in there

The next word out of the doctor’s mouth will be “neuropathy.” (See number 6 above). But there really is an underlying issue here.

Let’s first take a short quiz.

Question: What are the three most important things in real estate?

Answer: Location, location, location, in that order.

Question: What are the three most important things in engineering?

Answer: Drainage, drainage, drainage, in that order.

Question: What are the three most important things in medicine?

Answer: Diagnosis, diagnosis, diagnosis, in that order.

Unsurprisingly, that 125-foot orange makes diagnosis real easy.

8. Your tests results are all negative

See number 7 above.

Signs (exam and test results) and symptoms (what you feel) often don’t coincide for Dry Eye patients.

But that 125-foot orange probably wouldn’t even warrant any medical tests. It’s just that obvious.

9. You might have symptoms, but there are no signs of disease

Really doctor? Maybe you need to sharpen your diagnostic skills, because Dry Eye patients can feel extreme pain and discomfort, even when there are no signs of disease.

But who could miss a 125-foot orange in anyone’s mouth. That’s unmistakable, although it would be pretty shocking.

10. Don’t they have drops for that?

No, they don’t have drops for what many of us have. And they don’t have drops, or prescribe drinks of water, to get 125-foot oranges out of people’s mouths either.

So next time someone says something to you about how good your eyes look, or that what you’re feeling is all in your head, or that you’re lucky you don’t have cancer, or whatever other nonsense you here all the time, you might try telling them about the 125-foot orange. Maybe it will change their mind.

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🔊 Listen
Are you a patient Dry Eye Patient? In two words, probably not. In fact, you’re probably impatient and frustrated.

You’re sick of well-meaning people saying “just use some eye drops.” You’re tired of thinking about your eyes. You can’t believe how much money you’ve spent on them. You’re confused about the conflicting advice you get from doctors. When you let yourself look back at the life you once led, you wonder if you’ll ever get any of it back.

Take heart, you will.

If you’re patient, chances are – with the help of your doctor(s) – you will eventually figure out what’s going on and what needs to be done about it.

But it takes perseverance and patience. And that’s just not something most Dry Eye patients have. Who would when it feels like there’s a knife, or a log, or a boulder lodged in their eye?

The 125-Foot Orange

Remember the first time you woke up in the morning feeling like there was a knife in your eye? Did you panic? Did you want something done about it NOW!?!?!?

Sure you did. Here’s why. The eye has 300 – 600 times more nerves than any other part of the body. So something that’s small, like an eyelash, can feel 600 times bigger.

Let’s put that in perspective.

An average orange is about 2.5 inches in diameter. If it were 600 times bigger it would be 125 feet in diameter. That’s an enormous difference. You’d notice if you had a 125-foot orange in your mouth! And you’d probably want somebody to take it out RIGHT AWAY!

All of your friends would notice too, and nobody would suggest sipping a little water to make it go down easier. They’d be right there by your side, calling 911, pulling out their juicers, and FREAKING OUT!

The Impatient Dry Eye Patient

When panic sets in we become irrational. Our thinking becomes clouded. We lose patience and get angry, lashing out at our doctors, at our friends, our families, and even at other Dry Eye patients. We thrash around as if we’re drowning. But the thrashing just makes things worse.

We don’t believe our doctors. How can we when they tell us different things? We wonder if we’ve been diagnosed properly. Will the treatment be effective? Will we ever, ever get on with life?

It’s an ongoing battle. Actually, it’s more like a war.

On Your Way to Healing

Like with any war, you need to know your enemy and its allies (all of the co-morbidities that complicate things), inside and out. How they behave. How they respond. What they’re going to do next.

Then there’s treatment. Remember that patience and steadfastness are on your side, even when it feels like there’s a log in your eye.

That’s when it’s especially helpful to stop, breathe, reflect, and remember that you’re on your way to healing. And healing, like all good things, takes time.

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🔊 Listen

It may have started with some dryness or or feeling like there’s something in your eye. You’d seen countless commercials for eye drops that promised to help. When you got to the drug store you were overwhelmed. Who knew there were so many different drops? And the price, especially for the preservative-free versions, probably gave you sticker shock. So you opted for drops that didn’t seem too expensive, even if the bottle turned out to be ant-sized.

At first maybe your eyes felt better. But then, after a while, they felt worse. Pain. Burning. Redness. More pain. More burning. Feeling like someone plunged a knife in your eye, or worse. There can be worse?!?!?!?

What the heck was going on? You tried researching online, but reading was becoming more and more painful.

Finally, you saw a doctor, maybe an optometrist. Maybe an ophthalmologist. Maybe even more than one.

Treating Dry Eye is Like Baking a Cake

What did they prescribe?

Lubricating eye drops. Warm compresses. Lid wipes. And, talk about sticker shock, Restasis. Maybe you started taking Omega 3’s.

Come back in 6 or 8 weeks, they said.

Maybe after a while you felt better. If you did, you were lucky. The treatments worked. You could get on with life.

But maybe you didn’t feel better. Why? Because treating Dry Eye is a lot like baking a cake. Here are four reasons why.

REASON #1 – Lots of Recipes

They all have some kind of flour and some kind of sugar, but there are literally countless recipes for cake. Chocolate. Vanilla. Strawberry shortcake. Angel food. Devil’s food. Cupcakes anyone? Boston creme pie. It’s not really pie, is it? What about frosting or drizzle? Is one tier ever really enough? Bundt. Pound. Pineapple upside down cake. Pineapple upside down CUPcake. Now we’re talking! What about a flourless chocolate cake?

There’s literally the same endless variety with Dry Eye. Each and every one of us is pretty much the same. We’re all human. We all have DNA. But at the same time we’re all completely and utterly unique. So if your doctor is treating you as if you were a statistic, or exactly like the patient who came before you, you might not feel better. It’s one of the most frustrating things about Dry Eye. But don’t despair. Just like with baking a cake, eventually you’ll figure out which recipe for treatment is right for you.

REASON #2 – You Really Do Need a Recipe

You could try throwing some flour and sugar into a bowl, adding some butter, maybe some eggs. Mix them up. Pour into a cake pan and put it in the oven. But at what temperature and for how long? If you take this approach – without a recipe – chances are your cake will turn out yucky. On the other hand – start with a recipe – and you’ll improve your chances of ending up with something luscious that might even be beautiful.

Why is this like Dry Eye? Because before you start throwing treatments at your eyes, you first need to know exactly what you’re treating. Do you have meibomian gland dysfunction? Restasis probably won’t help much. Do you have aqueous deficiency? Lid wipes, not so much. Demodex mites? Skip the serum tears. Foreign body sensation? It’s anybody’s guess.

One of the things Dry Eye sufferers sometimes try is the shot gun approach. They throw any and every treatment at their eyes in the hopes that something will work. Maybe some will. Others won’t. The danger with this is approach is that some conditions could go undiagnosed and untreated. And if something helps, it’s anyone’s guess what does and what doesn’t. So you won’t know which treatment to stop or which one to keep doing.

Maybe you do need lubricating drops, warm compresses, lip wipes and Restasis. But maybe you need more. With a good and comprehensive diagnosis, just like with a good cake recipe, you’ll find out what specific conditions you have. Your treatments will target them and you’ll have a much better chance of a good outcome.

REASON #3 – The Better the Ingredients the Better the Results

Even if you have a good recipe your cake will only be as good as the ingredients its made of. If you use rancid butter or rotten eggs your cake will be horrible. But baked with good quality butter, fresh eggs, and other quality ingredients, your cake stands a good chance of being scrumptious.

It’s the same with Dry Eye. If you’re using lubricating drops regularly, avoid the ones with preservatives. If you apply warm compresses, only let the cleanest materials touch your eyes. And wash your hands. Don’t touch your eyes for any reason unless you’ve just washed your hands. Rest your eyes often and get a good night’s sleep. In other words, do everything you can to give your eyes a chance to feel better.

And then don’t stop doing it!

REASON #4 – The Better the Baker, The Better the Cake

Yes, just about anyone can make a cake from a mix that’s moist and delicious. But if you want something truly spectacular you’ll turn to an experienced baker who really knows her craft.

It’s the same with doctors. Most can treat mild forms of Dry Eye. But if your symptoms just aren’t going away, you may need to look for a Dry Eye specialist, typically an ophthalmologist who specializes in Cornea and External Diseases. These doctors will usually have the most training and the largest set of tools (just like professional bakers in professional kitchens), to treat all of the various co-morbidities contributing to your symptoms.

Whatever you do, whichever recipe you choose, don’t give up. There are lots and lots of cake recipes out there and lots and lots of treatments for your condition. That means there’s always hope!

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Send your questions and comments to blogger@notadryeye.org.

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🔊 Listen
If you’re a Restasis user, you’ll want to watch the Allergan and Imprimis battle.

Before we look into that, you’ll be happy to learn Imprimis announced it will soon offer a lower-cost alternative.

Allergan released a multi-dose version of Restasis a few months ago. But it charged the same high price as the single-dose vial version.

Patients have been storing what was left in the vials for later use. By squeezing out a few more drops from those single-use vials they could save some money. But a multi-dose version could end that practice, improving Restasis sales.

But what’s good for Allergan’s bottom line still left patients with hundreds of dollars a month in out-of-pocket expenses.

Allergan and Imprimis Battle

Enter Imprimis, a California-based compounding pharmacy.

Imprimis announced on October 19, 2017 that it will fill initial prescriptions of a generic version of Restasis (cyclosporine) for just 99 cents. Refills will start at $79 a month. Cyclosporine, an immunosuppressant, is the active ingredient in Restasis.

Imprimis’ is even working on a spin-off. Surface Pharmaceuticals will seek FDA approval for drugs for Dry Eye, blepharitis and other ocular surface diseases.

But the announcement prompted Allergan to file a lawsuit against Imprimis citing patent protection.

Congress Takes Notice

The patent protection saga is in itself noteworthy. Allergan transferred the Restasis patent to the Saint Regis Mohawk tribe, a Native American tribe in upstate New York. This move would quash any patent challenges filed by competing drugmakers. By default, that would extend patent protection.

According to Bloomberg.com:

The pact, which will entitle the upstate New York tribe to a one-time $13.75 million payment and $15 million a year in royalties, could open up a new way for drugmakers to head off challenges to patents backing billions of dollars a year in sales.

Technology companies have used similar moves in the past.

Getting the Congressional Attention

However, Allergan’s move didn’t go unnoticed. This one even got the attention of Congress. On October 3, 2017 members of the House Committee on Oversight and Government Reform sent a letter to Allergan’s CEO Brent Saunders. The letter reads:

The sovereign status of Native American tribes adds time and complexity to contesting the status of the patents in question, because tribes may be immune from the legal claims generic drug makers use to challenge patents and bring less costly drugs to market more quickly.

The implications of Allergan’s patent transfer raise questions for Congress as the exchange may impair competition across the pharmaceutical industry and ultimately dissuade companies from pursuing less-costly generic alternatives to brand drugs.

The letter goes on to ask Allergan for detailed documentation regarding the transfer of the patent. The deadline for submitting the information was October 17.

Allergan’s battles with Congress started a day earlier. On October 2, Sen. Clair McCaskill (D-Missouri) wrote to the Pharmaceutical Research and Manufacturers of America, asking the group to investigate if Allergan’s action with the tribe was “consistent with the mission” of the trade organization.

I ask that PhRMA review whether actions to block patent challenges through claims of tribal sovereign immunity align with PhRMA efforts to promote innovation and discourage predatory pricing practices and anticompetitive conduct.

A few days later she introduce legislation to do away with the sovereign immunity defense when challenges are made to the validity of U.S. patents before the U.S. Patent and Trademark Office.

But Does It Work?

The widely-advertised treatment for Dry Eye has had issues from the start. For example, in clinical trials it was only effective in about 10-15% of patients. According to the product information sheet distributed with each prescription:

RESTASIS demonstrated statistically significant increases in Schirmer wetting of 10 mm versus vehicle at six months in patients whose tear production was presumed to be suppressed due to ocular inflammation. This effect was seen in approximately 15% of RESTASIS ophthalmic emulsion-treated patients versus approximately 5% of vehicle-treated patients.

So if you do the math, Restasis helped about 10-15% of trial participants. Even so, it reached the FDA efficacy threshold of 10%.

Since it’s prescribed to lots of Dry Eye patients, it’s no wonder Allergan is protecting its patent. Who wouldn’t if they stood to lose some $1.5 billion in revenue, the amount Restasis brought in last year.

References

Congress probes Allergan’s patent deal with Native American tribe
Helio Ocular Surgery News
October 6, 2017
View the full report

Imprimis to offer low-cost alternative to Restasis
October 19, 2017
Helio Ocular Surgery News
View the full report

Letter to Brenton L. Saunders
Committee on Oversight and Government Reform, United Stated House of Representatives
October 3, 2017
View the full report

A Native American tribe, a drugmaker and an unusual patent plan
C Koons, S. Decker
Bloomberg.com
September 8, 2017
View the full report

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Send your questions and comments to blogger@notadryeye.org.

Subscribe to our blog to keep up with Not A Dry Eye.

Support Not A Dry Eye Foundation. When you shop at smile.amazon.com, Amazon donates 0.5% of your purchase.