Exposing the LASIK Scam

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 Post subject: Dry eye question
PostPosted: Mon Sep 24, 2007 10:47 pm 
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My lasik surgeon blames my fluctuating vision on dry eye. Even though my optometrist who is GREAT and HATES Lasik and warned me about it before I got it, tells me that I am +.50 in my non dominant left eye and -.50 in my dominant right eye.

Anyway, my surgeon put me on Restasis last November. I haven't noticed any improvement. I do get scratchy eyes on occasion (I have allergies). My surgeon insists I have Meibomian Gland Dysfunction. Does Restasis treat this? I do lid scrubs and the hot compresses and I haven't noticed any difference in my vision. Shouldn't he have tried plugs first before Restasis? I'm confused. I'm just sick of paying for this prescription if it's not doing any good. Can my optometrist insert plugs?


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PostPosted: Wed Sep 26, 2007 5:58 am 
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Well... the piece of paper that comes with Restasis says that Restasis does not work with plugs.

I don't know why. I don't know how Restasis works.

I've seen a lot of doctors myself, and some of them also claim that dry eye is the cause of my visual issues. I think they're full of shit.

But the more important question is, do your eyes feel better with dry eye treatment? For me, the pain is unbearable unless I do the whole dry eye regiment. Biotears, plugs, Restasis, doxycycline, yadda yadda. So whether or not it affects vision is not really relevant.

Anyway, I believe the normal order is tears -> Restasis -> plugs -> jump off a bridge. Why jam stuff in your ducts if drugs'll work?

In addition to the fact that it's probably bad for you because stagnant bacteria builds up, I met a woman whose 4 plugs scarred shut all 4 of her punctal ducts. She was pissed and was in the process of seeing a plastic surgeon to get them reopened.


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 Post subject:
PostPosted: Wed Sep 26, 2007 10:44 pm 
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For supplements that can be helpful, check out the link I posted previously ... http://www.lasikflap.com/forum/viewtopic.php?t=1642

Restasis supposedly can be just as effective (and possible even more) effective with plugs. However, the clinical studies performed using Restasis did not include any patients with plugs. That's why sometimes you hear about Restasis not working with plugs. This is not necessarily true.

Having said this, I used Restasis for one year and it did little to help me. It may have reduced my eyelid inflammation a little in the early days, but 100 mg/day of doxycycline was a lot more effective than Restasis in reducing inflammation.

I don't think Restasis is very helpful for most people with LASIK induced dry eye since LASIK dry eye is typically due to nerve damage and Restasis does little, if anything, to fix nerve damage problems. IMHO, Restasis is given to LASIK patients to pacify them with a prescription.

I have both meibomian gland dysfunction (MGD) and aqueous tear deficiency. I'll put the stuff that has worked best for me first ...

- Doxycycline for MGD
- Moisture chamber (MC) sunglasses and plano MC glasses
- Warm compresses
- Supplements including Carlson's liquid fish oil
- Quality sleep

The stuff that helped me very little if at all includes...

- Plugs
- Restasis
- Artificial tears (just because they are such a temporary fix and can mess up your already compromised natural tear production)

I recommend using MC goggles over using frequent artificial tears. How far post-LASIK are you?

_________________
Let the FDA know about your poor LASIK outcome by reporting it through the FDA MedWatch program ... http://www.lasik-flap.com/forum/viewtopic.php?t=1620


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 Post subject: dry eye
PostPosted: Fri Sep 28, 2007 9:36 pm 
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I'm a little over 3 years post lasik. I started having eye problems last November when I was a little over 2 years. Since then I have took the doxycycline, I take Thera tears nutrition dry eye capsules, do warm compresses every day and eye lid scrubs every night after I take my makeup off. I even tried going months without eye makeup. I don't feel my eyes really feel dry except when my allergies are acting up. My vision hasn't really improved since last year. I still have the problem with my right eye. I don't think the Restasis has really helped at all. So i'm not sure if i'm going to continue buying it. I really can't afford it.

My lasik surgeon insists the reason my right eye is blurry is because of dry eye. However, one other opthalmologist and my optometrist both told me I don't have dry eye and I have an astigmatism and am undercorrected in that eye. So I wish he would just fess up it's not the dry eye causing my vision to be blurry in that eye.


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 Post subject: LASIK surgeons lying about your prescription
PostPosted: Fri Sep 28, 2007 10:47 pm 
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It isn't all that uncommon for LASIK surgeons to lie to patients about their post-LASIK refraction. Broken Eyes wasn't told that surgically induced astigmatism (the regular kind that can be fixed with glasses) was causing her blurry vision. Her surgeon's office let her panic and then find out on her own. Nice, huh?

Every patient who has had LASIK should go to an Optometrist NOT affiliated with their surgeon, or better yet with ANY LASIK surgeon... and have a good refraction. If you have significant refractive error that is correctable with glasses, get some glasses. Then you will know where you stand. What's left is higher order aberrations, and/or blurry vision from dry eye.

I don't happen to think Restasis works very well for patients who have dry eye from excimer laser surgery.

The active ingredient in Restasis is a drug called cyclosporin, which inhibits the migration of inflammatory cells. Typically you don't have a huge infiltration of inflammatory cells to inhibit unless you have DLK. Epithelial cells themselves, when damaged by dry eye, can produce plenty of pro-inflammatory mediators... so you don't need to recruit inflammatory cells the site at all to have a lot going on with ocular surface disease... but Restasis only prevents inflammatory cell migration. That's it. If the root cause of your problem is nerve damage, it's not going to really help.

The nerve damage causes a cascade of other problems. Your tear production is insufficient, your blink rate too slow... and your tears break up over the flattented bumpy post-surgical surface. With out a good protective tear film, ocular surface disease (dry spots of dead/dying cells) can appear. Your lids may also become inflamed, and the meibomian gland ducts which release comforting oils to your ocular surface to stabilize tear film may be blocked.

Lid scrubs, hot compresses, rice baggies heated in the microwave... these treatments all address the meibomian oil production issue - as does fish oil supplementation.

The vehicle that is used for restasis has mineral oil in it... that's why it's cloudy. Again, many patients have meibomian gland dysfunction secondary to LASIK because their ducts become inflamed and close up. The mineral oil in restasis probably feels great to these patients, and the fact that Restasis is so expensive probably increases compliance to use it twice a day.

My guess is that a controlled experiment using a placebo (just the vehicle) on post-excimer laser surgical patients would show no difference between Restasis and vehicle alone.

In my mind Restasis is another scam.

And I do feel that plugs can help... if you do better with plugs and your eyes are not likely to become any wetter... consider lower punctal cautery.

Plugs can become colonized with bacteria and tend to loosen and leak over time.

I was miserable until I got plugs. They were the thing that helped my dry eye the most, aside from lower punctal cautery which I absolutely love.

_________________
We can easily forgive a child who is afraid of the dark. The real tragedy of life is when men are afraid of the light. -Plato


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 Post subject: vote for doxy
PostPosted: Sat Sep 29, 2007 7:53 pm 
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Based on my experience in the last 6 mos., doxycycline has helped to control the worst of my MGD, and I plan to stay on 50mg/day for at least a year, if not indefinitely...

I haven't done intense research, but I haven't been informed of any serious risks and have personally tolderated it well. I know there are conditions for which people stay on Doxy forever (e.g. past malaria)...


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