Plugs or no plugs

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Plugs or no plugs

Postby Betty39 » Sat Jan 06, 2007 1:00 am

My 3 month check up is on Tuesday and they are planning to put in new plugs as the old ones probably have melted. My eyes are still a bit dry but way improved from a few months ago. I put in my liquid gel drops at 6 in the morning, then at 12 noon, then around 3 or 4 p.m. and again maybe 2 times in the evening. Also, when I awake in the night I put drops in because this is when they feel most dry. This is way better than a few times an hour which it used to be. I definitely feel I am improving.
So should I go ahead and get the plugs put back in? I had them put in in November originally. The doctor is now going to charge me 50 dollars for them which is a big savings but still I'm a little put out that I paid 5000 bucks for this and he can't spot me another pair of the plugs.
What should I do?
Betty39
 
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Postby LasikExpert » Sat Jan 06, 2007 9:03 am

Punctal plugs are great at keeping tears in the eyes longer, but tears draining down the punctum may not be the reason for your dry eye. Read details about the causes of dry eye and jump down to the paragraph that starts with "To properly maintain or resolve refractive surgery induced dry eye problems, it must first be determined exactly what is contributing to the dry eye."
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Postby Betty39 » Tue Jan 09, 2007 5:36 am

So if the doctor suggests the plugs again should I insist he do the tear tests?
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Postby LasikExpert » Tue Jan 09, 2007 6:21 am

You will be an informed patient when you arrive - you have been reading here! 8^) Ask what the actual tear deficiency is. If it is aqueous deficiency and a low Shirmer's test, then plugs may be appropriate. If it is fast tear breakup time, then plugs may not be appropriate. Ask what alternatives to plugs may be appropriate, including Restasis or supplements like flax seed oil. Once you start the conversation you will know if there is a good understanding of your tear problems.
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now I'm really confused!

Postby Betty39 » Wed Jan 10, 2007 4:58 am

I went to my 3 month check up and I told the dr. that while slowly resolving, my eyes still have dry eye issues. Then I asked him if he could do some tear testing. He said he didn't need to because whatever they would show him he would do the same thing, put in the plugs. That goes against what I've read here. Then he wasn't even going to examine my eyes but I asked him to so he did. Then he goes, "hmm...did they test your eye pressure?" And I said no that assistant said they didn't test pressure for a year after lasik. Then he asked me which eye bothers me the most and I told him the right slightly more. He said that one looks a little more dry. I think he saw some redness there and wondered if they irritated it testing the pressure? I don't know why he asked me that. He told me to use the flarex drops again. I had to ask him for how long. He said once in the morning for 2 weeks. What are those drops exactly? Steroids? He then said in his 18 years of surgery I am the patient who has "complained" most about dry eyes. He said that he has seen eyes dryer eyes than mine but I must be more sensitive to the feeling than anyone he's met before. That made me feel like I'm a whiner or something. I don't see how anyone could have eyes that felt like mine especially in the first 2 months and NOT complain! I have had 3 natural childbirths and a hysterectomy (TMI, sorry) so I'm no newby to pain.
Anyway, they put plugs in the bottom holes and sent me on my way. I go back in 3 months. I do feel my eyes are improving with time. But I'm wondering why his practices seem different than what I have read should be done. I also have a hard time believing that I am the first patient they have ever had that has had dry eye this severe before. Should I stay with this dr? I am improving slowly but surely. Or should I be looking for a second opinion?
Betty39
 
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Postby LasikExpert » Wed Jan 10, 2007 8:29 pm

Flarex is a fluorometholone, which is in a class of drugs called corticosteroids and is often used to control inflammation. The use of steroids can increase the intraocular pressure (IOP) inside the eye. That is probably why the doctor asked if your IOP had been measured. In my opinion the doctor should not have asked, but should have taken a measurement before prescribing steroids. You probably should also be checked after starting the Flarex to see if IOP is elevated. Also, normally you should not stop taking steroids suddenly. You need to taper off.

I think you would be well served by a second opinion.
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Postby Betty39 » Thu Jan 11, 2007 12:35 am

So should my second opinion come from another refractive surgeon or from a regular opthamologist? Also, using 1 drop a day for two weeks do you think I would still need to taper off? I have never had elevated pressure in my eyes but that is scary. Also I have a hard time believing in 18 years of practice I am the only "complainer" about dry eyes after surgery. That doesn't sound resonable to me.
And he said come back in 3 months for more plugs. I got the idea he thinks that if this hasn't resolved in 3 months that it will be a chronic problem. In your opinion does the fact that it's been 3 months and isn't totally gone indicate it will be chronic long term (past the 6 month healing period)? I do feel I have improved a lot in the last month or so.
Thanks for all your advice Glenn. I sure feel I would have been left in the dark if not for this site.
Betty39
 
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Postby LasikExpert » Thu Jan 11, 2007 12:48 am

I didn't catch that the steroids were only one drop per day. You could not really taper off of that.

If in three months you still have dry eye problems the doctor will probably want to insert punctal plugs in the upper punctum as well as those in the lower punctum.

A dry eye specialist may be in order. I usually recommend contacting the ophthalmology department at the nearest university affiliated teaching hospital for a second opinion.

Perhaps you are not the only Lasik dry eye complainer the doctor has encountered, just the best!
:)
Glenn Hagele
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Postby Betty39 » Thu Jan 11, 2007 8:50 pm

Glenn's got jokes! :P That was funny. I think I am going to give this another 3 months, making that the 6 month mark, and if my eyes aren't totally over the dryness then I will see a dry eye specialist. I am about 60% better now at 3 months so I'm hoping by 6 months it will be 100%.
I am taking 2 tablespoons daily of the cold pressed flax seed oil. I think it has helped a lot. Plus, I haven't gotten sick yet this season and everyone around me has been sick a couple of times already. I read flax oil boosts the immune system. I'm thinking it's maybe true.
Betty39
 
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