On my quest for relief from LASIK induced dry eye I've tried about everything! Well there is more to try apparently...an amniotic membrane.
I'm currently in the middle of this treatment (Prokera). I'll update this post as I progress through the treatment.
Recently, a visitor to my site said that steamy showers really helps his dry eye. I thought, what if there was a steamer device I could use for my eyes. Watch the video to learn more!
The winter season is a nightmare for my LASIK dry eye. Nearly two years ago, I opted for LASIK to correct my nearsightedness and have regretted it ever since. A common complication of LASIK surgery is dry eye (50% of patients get it temporarily or permanently). I'm now in the 2nd winter season since developing Dry Eye Syndrom as a result of the surgery.
The air is dryer in the winter and everyone is running the HVAC, drying out the air even more. I've found some relief from the winter blues by using a humidifier and alternate heat sources that don't dry out my eyes. Watch the video for some harmonica and a review of the products below.
Any tips to share?
Products reviewed in this video:
Why Take Fish Oil?
Here’s an excerpt from a recent NY Times blog article:
"The omega-3s in fish oil are believed to reduce inflammation. So if the dry eye is aggravated by inflammation of the eyelids or surfaces of the eye, it makes sense that a supplement would help, said Dr. Stephanie Marioneaux, an ophthalmologist in private practice in Chesapeake, Va., and a spokeswoman for the American Academy of Ophthalmology:
Dry eye is pretty complex, and there is no cure,” she said. “Treating the inflammation, however, can improve some of the symptoms."
A study published in the International Journal of Ophthamology reported:
"A prospective, interventional, placebo controlled, double blind randomized trial was done at two referral eye centers. Two hundred and sixty-four eyes of patients with dry eye were randomized to receive one capsule (500mg) two times a day containing 325mg EPA and 175mg DHA for 3 months (omega-3 group).
Sixty-five percent of patients in the omega-3 group and 33% of patients in placebo group had significant improvement in symptoms at 3 months (P=0.005). There was a significant change in both Schirmer's test value and TBUT values in the omega-3 group (P<0.001), both comparisons. Read the study HERE."
So it seems that Fish Oil can help dry eye. It’s worth trying right? I’ve been using it for close to two years since my LASIK induced Dry Eye started ruling my life. I’ve discovered all fish oil products are not created equal. It took asking a lot of doctors and fellow dry eye sufferers to get the real scoop. I’ll try to demystify with this blog article.
After asking 5 doctors about this, I finally got the amount:
You need to ingest 2-3 grams of DHA per day. GRAMS not milligrams. The high potency fish oil capsules typically contain 200-500mg of DHA per serving. That’s not much. Here’s an example using Nordic Natural’s DHA Eye brand:
2 Capsules contain 788 mg of DHA. To get about 3 grams you would need to take 3 servings of this fish oil per day (or six capsules). That is pretty expensive! One bottle costs about $50 (contains 60 capsules).
Can’t I just take the Fish Oil you get at the drug store or COSTCO?
I took these for a time. I did not find them helpful. They do not typically contain enough DHA to make a difference. Also, one doctor talked to me about fish oil being esterified. What does this mean? Apparently, (I’m not a doctor) fish oil converted to ethyl esters can aid in better DHA absorption. The process is more costly (to esterify) and so the cheap fish oil manufacturers bypass this process. In a nutshell: cheap fish oil won’t absorb as well, limiting the positive effect for your dry eye. Read more about esterification of fish oil HERE
WARNING: to calorie counters! Four tsp of this oil is about 140 calories a day.
You can purchase Carlson’s online or in most vitamin shops. Keep it refrigerated after opening.
Does it help?
I’m not 100% sure honestly. I have noticed improvement in my condition since starting this regimen and less inflammation. However, I have made some other changes to my regimen. It costs me about $30 a month to do this. My current doctor recommends it. I will continue until told otherwise.
What about Flax seed oil?
I’ve used the pill form in the past. I’m not sure about the effectiveness of this product. I have discussed concerns with other dry eye sufferers about potential Mercury content in fish oil. One dry eye sufferer I work with takes flax seed oil for that reason. I have been grinding flax seed in my protein shakes.
Please feel free to pipe in with your comments or questions! I’m not an expert. I’m learning just like you.
Preservative free eye drops for treating dry eye are very expensive. Similasan and Hyco San offer an alternative. Watch this video to see my review.
How was the visit?
It was a really positive experience (2 hours) and he gave me some very good suggestions for managing my condition. He clearly cares for the patients and shared about his own personal struggles with Dry Eye. Dr. Jensen and I talked a great deal about my extensive regimen. His comment was (I’m paraphrasing):
“I see a lot of patients that are using a laundry list of medications and remedies. When I ask them what the diagnosis is, they say, ‘dry eye.’
But then I ask again, ‘what is the actual diagnosis? What is causing those symptoms?’
They can’t answer because the real underlying cause has not been identified. In many cases, they were prescribed medicines or therapies without receiving a diagnosis at all. Often times, things they may perceive to be helping (drops/medicines/regimens) may not be. They may just appear to work on a given day because their dry eye symptoms wax and wane. This is why I try to avoid prescribing or recommending a course of action until the condition can be diagnosed. Diagnose then treat. Not the other way around.”
What does this mean for us?
We may be taking more things than we need. When my dry eye gets really bad. I get desperate. I throw money at it. Anything that might help I pile it on to the list. In some cases, we may be doing things to make it worse. Personally, I’ve been able to reduce my reliance on OTC eye drops and medications since having Lipiflow and using the following strategies:
I’ve been updating my regimen reduction on the website as I’m able to eliminate things.
What does he recommend?
One interesting strategy Dr. Jensen recommended was to isolate certain treatments to one eye to make sure it is working. Example: Using Systane on one eye consistently and Simulasan on the other.
Was he able to diagnose my symptoms?
Unfortunately, no. Dr. Jensen said he would need to reverse engineer or “back into the diagnosis” by working with me over a few weeks. But he gave me some good suggestions which will be in my next blogs.
About Dr. Jensen
Dr. Paul Jensen has over 25 years of experience in treating difficult cases. He is a published author, researcher, and frequently lectures across the US to train doctors in advanced dry eye disease care. A Seattle native, Dr. Jensen is a graduate of the University of Washington and the University of California, Berkeley, School of Optometry. Visit his website at https://nwdryeyecenter.wordpress.com
Last month I had a great visit with Dr. Jensen in Renton, WA. What a class act! He spent two hours with me and gave me lots of great information on my LASIK dry eye symptoms. I'm planning to use some the items to create blogs, but first had to share this new one on a curious subject...
Dr. Jensen said he has seen a correlation between men with beards and blepharitis (seborrheic)! Apparently, having a beard can cause an over production of oil everywhere, not just in the beard area. He didn't tell me to shave it, but he didn't tell me not to either.
He also recommended using Selsun Blue all over my head for a week after. I had some fun with this and made a video with my usual harmonica and shaving my beard off.
Ready to shave?
Dr Jensen https://nwdryeyecenter.wordpress.com
Last month, I blogged about moving to another climate to get relief from my LASIK dry eye symptoms. You can read it here. If you suffer with Dry Eye Syndrome (DES), you may have asked yourself: "Can I move some place wet with lots of moisture?"
How about the rainforest?
According to my research, Seattle-Tacoma is the 'Dry Eye Mecca.' It has low allergens, lots of rain and precipitation, and fairly mild winters. This month, I took a visit to see for myself and to visit my good friend, Skip. As a bonus, I was also able to get an appointment with Dry Eye Rock Star Dr. Jensen. Look for a blog later on my visit with him. Let's get to the Seattle Report.
Is it really rainy and wet?
YES. I arrived Friday night and the ground was very wet. The next day, it rained all day into the evening. The weather was in the 60's.
Did your eyes bother you?
Not as much as when I'm at home. Saturday I had to put drops in about 8 times, but when they felt dry I just walked outside into the constant drizzle of rain and I felt better! It's like walking around in a constant humidifier.
Day 3 and 4 were sunny and very nice. I used my eye drops 5 times on each day. Note: Day 3 and 4 were without serum drops (I ran out). So I only used Systane Ultra and Simulasan. That is a very big change.
Don't people get depressed because of the weather?
I've heard that, but honestly I was already depressed because my eyes hurt all the time. Depression be damned! I would love to walk around the city without messing with my eyes. Washington has some amazing outdoors things to do including mountains, lots of hiking, water sports, AND gorgeous waterfalls (Snoqualmie pictured above). Plus, Seattle rules. What an awesome town. I even got to play at a blues jam. It reminds me a little of Boston.
What about the medical community?
Dr. Jensen has his dry eye practice here! Guy is a stone cold dry eye genius (I will blog later about this). So a very big bonus for living here!
I saw a noticeable difference with the wetter climate. My eyes felt best on the sunny days because the moist air and wind coming off the water. I would attribute the Saturday dryness to recovering from a 5 hour flight (airplanes have the driest air second only to the Sahara desert). When can I move? I'm ready.
Do you live in a Dry Eye friendly climate?
In reading my LASIK story, you’ll note that I’ve mentioned tear diagnostic tests multiple times. From what I’ve learned (as my own patient advocate), eye doctors and specialists use these tests to measure tear health and production.
LASIK doctors SHOULD use them to determine if you are a good candidate for the procedure (If they don't run!) To review, they are:
Why is it important for your LASIK surgeon to use these tests?
They need to pre-screen you to see if you are at risk for developing dry eye after LASIK surgery. AND they are going to administer your post-surgical care! If you develop LASIK induced dry eye, your surgeon needs to use the proper diagnostic tools to assess your tear production and health.
In my case, my LASIK surgeon DID NOT USE ANY tear diagnostic tests to pre-screen me. Prior to LASIK, I had no eye health issues or dry eye. However, post-LASIK it has been a miserable experience dealing with the chronic dry eye. My research has shown that 50% of LASIK patients encounter dry eye symptoms post-surgery. For some, it is a temporary nuisance. For others, it can last a lifetime, severely degrading that person’s quality of life.
When I started seeing my new Doctor (20 months post-surgery). He did all three tests mentioned above. This was the first time someone had used these diagnostic tools to assess my dry eye. I saw at least five doctors prior to my current physician. My LASIK surgeon treated me for 20 months and never used these tests. He did put yellow colored numbing drops in my eyes to see visible dry spots (areas on the eye that are not getting lubricated). They also refer to this as ‘Staining.’
In the gruesome picture shown above, I had a Schirmer tear saturation test performed (September 2016). My number was a "6." The doctor places a solution in your eyes and then paper strips on the eye (for about 5 minutes). The strips collect moisture from your eye and the resulting number gives an indication of your tear production. Apparently, the lowest (very very dry) is a “5.”
The Tear Break Up test determines how quickly your tears evaporate. They put a solution in your eye and then touch it with another paper indicator. In my case, tear production was healthy, but my tears were evaporating very quickly. This is a symptom of MGD - your glands aren't producing enough oil to prevent the tears from evaporating.
The LipiView (see picture above) takes film of your Meibomian Glands. Mine were very dysfunctional (see a large spot where they atrophied on my right eye lid). This test also films you blinking. Another issue identified in my case showed that I don't always close my eyes completely. This can lead to dry eye as well. See my earlier blog about this concept HERE.
Course of Treatment with Tear Diagnostic Results:
The doctor advised me to stay on my current regimen and he added the following:
I returned to see my doctor last month, seeing a major improvement in symptoms. My Schirmer test was a 12’!!!! Thank God. His prognosis: see him in six months unless things get worse. Stop taking Alrex and the Azasite. My symptoms have improved greatly, although I still deal with dryness on a daily basis. Frequency of using drops is every 1-2 hours vs. every 15 minutes.
Since having Lipiflow, I have had several periods (4-6 hours) when I did not notice my eyes. I didn’t think about them. Folks, when I get a glimpse of what it used be like pre-LASIK. I get a lot of hope.
If you are considering LASIK surgery….RECONSIDER. If you must, make sure your surgeon discusses all options (PRK, EpiLASIK) and performs the proper screening to measure tear health. There are no guarantees of course, but these tests can give you an indication of potential dry eye complications post-LASIK.
What's your number?
Bluesifyin' LASIK Dry Eye sufferer. Read my blog to get tips, struggles, blues, reviews, whatever on this journey through hell.