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Xiidra and Restasis

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Restasis versus Xiidra – 3 big differences

For 13 years, Restasis was the only topical eyedrop approved by the FDA to treat patients with dry eye.  What was thought to be a small problem turned out to be huge. At least 30 million Americans suffer from dry eye  a prescription for Restasis was written every 15 seconds. 

With Restasis, we learned a lot about the causes and potential treatments for dry eye.  What we thought was a disease related to not enough tears turned out to be a disease  of chronic pain that affects primarily women but that men suffer, too. We learned that it is an inflammatory condition like rheumatoid arthritis and that like inflammatory diseases, if left untreated (or treated only with artificial tears), people with dry eye disease were doomed to have their disease  worsen slowly over time.

This is important because now we understand why artificial tears, punctual plugs and warm compresses don’t help people who suffer from dry eye.

As of July 11, 2017, doctors and patients have another option: Xiidra.  Dr. Austin has patient experience with both medications.  There are 3 important differences:

1. Xiidra is approved by the FDA to treat both the signs and symptoms of dry eye. . Why is this important? The reason it’s been 13 years since any drop was approved for dry eye is because dry eye notoriously complex to study.  The signs don’t always match the symptoms and showing improvements in both was basically a statistical nightmare. Restasis could not show improvement in both, but Xiidra did after conducting one of the largest studies of its kind, looking at over 2500 eyes.
2. Xiidra works faster than Restasis. A lot of doctors and patients were frustrated with Restasis because it took up to 16 weeks to see a difference. Xiidra was able to show improvements within 6 to 12 weeks of treatment and in many cases within 2 weeks. Several of my toughest dry eye patients have already commented that they feel a difference within 2-3 days of starting the medicine. It works earlier on T-cells in the inflammatory cycle than Restasis, so it makes sense to me that patients would respond sooner.
3. Less stinging.  Many patients started Restasis only to stop it due to terrible eye pain after instilling the drop.  Usually this went away after a few weeks but some patients  had to use an additional medicine, often Lotemax, for a few weeks in order to tolerate the Restasis. For some patients,  the burning from Restasis never got better. In the studies, Xiidra caused less stinging and burning and does not require additional medications for tolerability.

Another thing that is the same for Xiidra and Restasis is the price. These medications will be equally priced the same for cash paying patients and coupons and discounts will also be available.  The best way to determine if this medication is right for you is to schedule an appointment at The Dry Eye Treatment Center of Orange County where we will complete a full dry eye exam. If it is, you may be eligible for a free month’s supply.

 

Punctal Plugs

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A punctal plug is a very tiny, bio-compatible device that is inserted into the tear ducts to block drainage.  Once inserted into the tear ducts, punctal plugs increase the eye’s tear film and surface moisture to relieve dry eyes.

No larger than a grain of rice, punctal plugs are also known as; punctum plugs, occluders, and lacrimal plugs.

There are two types of punctal plugs:  semi-permanent and dissolvable.  Semi-permanent punctal plugs are typically made of long-lasting materials such as silicone; whereas dissolvable plugs are made of materials that eventually absorb such as collagen, and usually last from a few days to several months. Dissolvable plugs are typically used to prevent dry eyes following LASIK surgery or are used to determine whether a patient can benefit from punctal plugs.

Dr. Austin will measure the size of your tear duct openings to determine the proper size of the punctal plug needed to keep it in place and block drainage within the channel – sometimes only a lighted, close-up examination is needed to determine the size and type of plug you need.

Inserters that resemble forceps, syringe-style inserters, actual forceps, or other instruments may be used by Dr. Austin to place the punctal plug into your eye’s tear duct.

Initially, there may be slight discomfort.  However, once your punctual plug is inserted and in place, you should not feel it, and should be able to drive yourself home and resume normal activities.

 

 

Scleral Lenses

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Scleral lenses are a relatively new type of treatment for ocular dryness. A scleral lens is a large-diameter contact lens that vaults across the entire corneal surface and rests on the white part of the eye, known as the sclera. Liquid fills the space between your eye and the back surface of the scleral lens. This liquid bandage protects the cornea from the ongoing mechanical shearing effect of the eyelids that occurs when you blink. It also continuously bathes your sensitive corneal tissue.

If you have dry eye and also require vision correction, the scleral lens is additionally helpful because other contact lens options may be limited by the compromised state of your ocular surface. As a result, you will most likely be unable to tolerate conventional soft lenses or small diameter corneal gas permeable lenses. Fortunately, scleral lens designs can overcome the challenges associated with the other contact lens types – these lenses work especially well for vision correction because the fluid layer helps smooth out defects caused by dry eyes, providing a more uniform refractive surface.

Autologous Serum Drops

Your Blood, Your Tears… No Sweat!

Your tears are complex in nature and crucial to eye health. Unfortunately, patients with severe dry may just not produce enough tears to remain comfortable, and supplementing natural tear production with artificial tears or lubricants is often inadequate. Many people have underlying medical issues which cause or worsen dry eye, including diabetes, rheumatoid arthritis and thyroid disease. Others take medications which diminish tear production. In many cases, there may not be a “quick fix” for the problem. At the Dry Eye Treatment Center of Orange County, we work to find relief for patients with dry eye and to prevent long term damage to the ocular surface resulting from a lack of tear production.

What are Autologous Serum Eye Drops? Autologous means that the donor and the recipient are the same person. The eye drops in this case are made from your own blood. Red blood cells and clotting factors are removed, leaving behind blood serum. This is diluted with a sterile, preservative-free solution to produce a tear substitute that is unique to the patient, and contains many important growth factors and nutrients normally found in healthy tears. Since blood and tears have an almost identical salinity and pH, there is no issue of burning or stinging upon instillation. Because they are non-preserved, the drops are stored in the freezer until you need them.

How do you make them? The Dry Eye Treatment Center of Orange County has contracted with a local laboratory to easily and efficiently draw your blood and process it into usable eye drops in the same day. .

How much do they cost? The cost for autologous serum eye drops varies by the amount of blood drawn and the number of bottles produced from the sample. In general, the laboratory charges $250 for a four to six-month supply of the drops.
Will my insurance cover the cost? Insurance will probably not pay for serum eye drops any more than they pay for artificial tears. However, we will happily submit a letter of medical necessity on your behalf if you wish to challenge the claim.

When will I know if they’re working? Everyone is different, but for those patients who experience relief using autologous serum eye drops it is usually seen within the first few weeks.  

NeuroLenses®

Neurolenses® are a new treatment option for patients that suffer from dry eye symptoms secondary to trigeminal dysphoria (click the link for more information regarding how this condition may cause dry eye symptoms)

https://www.reviewofoptometry.com/article/the-dry-eye-misalignment

In order to better care for our patients, Dr. Austin has added an exciting, new technology that has been proven to alleviate some symptoms of dry eyes.

Neurolens®  is a company that is currently working with a small, select group of optometrists throughout the country and on February 22nd, 2017 we became the 12th clinic in the United States to implement eyeBrain's SightSync and neuroLens® technology to our clinic so that we can better help patients like you!

If you find yourself experiencing any of the symptoms above please call us at (714) 634-0033 to be one of our first patients to experience this exciting technology firsthand.

To learn more about neurolens® technology, visit https://www.neurolenses.com or watch the video below.