Patient asks about the use of Restasis
Daniel G. writes :
Dear Dr. Chynn,
I used Restasis for 3 days then I stopped, as it had some side effects — and when I read the package insert it also emerged that it may not have any efficacy in my case.
Two days into using it I started to have some conjunctival hyperemia, foreign body sensation, and visual disturbance. The latter was particularly unusual — it occurred as an episode of transient retinal hypoperfusion might express itself, happened after for example sitting up from a chair or completing a strenuous set of weight lifts, lasting 10-30 seconds, and occurring ONLY in the right eye.
Furthermore, the Restasis website and the PI repeatedly make this statement re. efficacy, based on observations in 4 clinical trials that enrolled some 1200 patients:
“Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs.”
Dr. Chynn replies :
The Hyperemia happens in most if not all patients. We instruct our patients to ignore this as it goes away after a few days. The visual thing sounds just like and orthostatic hypotension and was unrelated to the situation.
Also, we get patients asking about this on a monthly basis. It was a design flaw, that is to say, in percentage terms it is harder to statistically prove an increase in patients who were plugged or on steroids, as these things already increase tears. This does not mean Restasis works any differently or less in such patients. Please understand that in 99% of cases of Restasis use post-refractive surgery; a patient will be on one of these two things and the majority of the use now is post-refractive. So, in conclusion, PLEASE DO NOT TAKE THE WRONG CONCLUSION FROM THE PACKAGE INSERT !!!
Emil William Chynn, MD FACS MBA
