Doctors,

What can you tell me about .83% Phentolamine (I think I spelled it right). I have heard that this is a much better way to treat GASH than pilo. It lasts longer, does not induce mild myopia, among other side effects that pilo has. Is it used for this purpose? It sounded very promising in the info I read about it. Also, anything else on the horizon to treat / cure GASH? Thanks

In my discussions with patients., Alphagan has been reported as being able to help reduce or eliminate night time problems such as glare and halos. Alphagan appears to work by preventing the pupil to enlarge as much at night time, although it does not appear to do much to pupil size during the day time. Alphagan is a completely different type of medication than pilocarpine, although it is used for glaucoma (like pilo).
I would also mention that many patients find that ony 1/8th percent or 1/4 percent pilo is all that is needed to control night time visual problems. The lowest concentration of pilo commercially available is 1/2%, so these other formulas have to be specially made. But this helps limit the side effects of pilo.
As for this last medication, I have no experience with it and do not know its side effects.

I hope this is helpful

Bill Trattler, MD
Miami, FL

Thanks!

>Thanks!

Dave,

Have you tried the Alphagan? Was it successful for you? I had my surgery almost 2 years ago and my starburst are worse now than ever. Any other ideas for reducing starburst? Dave or the Doctors can help.

Thanks, JCB

JCB,

I just recently tried Alphagan. The first few days it worked great. I though it was a Godsend. Now, it doesn't work nearly as well, or last as long. It didn't realize that the eyes could get used to it so fast. I have some questions for my doctor, since I've only been on it about 10 days. If any doctors have answers, please reply.
- Can it be taken more often than every 8 hours to help with the decreased effect it is having now?
- Is this normal after 10 days that it doesn't work nearly as well, and is there a possibility that it will become more effective?
- Any other versions of this drug that I might ask my doctor about?

Thanks

Your story is very interesting. Everyone reacts to medications like alphagan differently, and it is dissapointing that the medication is not working as well.
First - most people only use alphagan for its effects at night time - so you might talk with your doctor about using it late in the afternoon rather than 3 times a day.
I hope this helps

Bill Trattler, MD
Miami, FL

I've been using Alphagan on and off, I live in Norway so you get a lot of darkness and I really need to use Alphagan.

At first it worked really well and as you know, the effects weren't as good as time went by. I only use it when I need to so the effects are strong when I need to drive at night etc.

I've also noticed that my eyes are really bad at times and blurry, glasses wearers know the difference between a -1,75 prescription without glasses and I know that I should see better without my glasses than I do. I've also tried using diamox, but that really screws up my guts and doesn't seem to work any more.

Timolo in conjuntion with Alphagan seems to work as well.

I'm using occutears to help as I have really dry eyes and my doc had noticed dry patches on my cornea, I used a little Canesten and the next time I went to him the dry patches where gone. I also found that I had a strange feeling in my eyes, which I can't describe apart from it feeling funny, since using canesten, the feeling has disappeared.

I've just starting trying out eye baths with saline, 5 minutes per eye per day, omega oils and vitamin a. I'll let you know how this goes.

Without Alphagan I have problems with low level light and I get very glared vision. It was amazing to finally see without starbursts after all 2 years.

After the surgery, it took about a year and a half for the starbursts to appear.

None of the doctors seem to know what the hell is going on and can't offer any solutions.

So, let's see what can happen.

I look forward to your suggestions, questions and advice.

J

It looks to me like you are self-medicating. Why would Diamox work for a large pupil(it is a carbonic anhydrase inhibitor), and why would Canesten work for dry eye(it is an antifungal)? It is probably the case that the vehicle in the Canesten is acting as the active ingredient.

Another approach that works well in my practice is to fit patients with large rigid contact lenses with large optical zones. The lenses act to extend the ablation, or correction, out to or beyond the edges of the pupil. Sometimes the effect persists for awhile after the lens is removed. I have actually published about this effect.

DrG

Greg Gemoules, O.D.
Coppell, Texas