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Undergone PRK eye surgery. Prescribed Lotemax. Suggest the right dosage for Lotemax

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Ophthalmologist
Practicing since : 1977
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I already asked this question and I got a good answer from Dr. XXXXXXX Shah, but I was not specific enough in my question. I was instructed to use Lotemax 4 times a day for 4 weeks after PRK eye surgery. I understand it might be okay to use Lotemax for this long, but I have seen information about how other people with the same procedure have had the dosage tapered off with each consecutive week and my doctor did not instruct this. So is it okay to take lotemax 4 times a day in each eye for 30 days without tapering off? Or should I ask my doctor if I should use less and less as each week passes. Thank you.
Posted Wed, 24 Apr 2013 in TMJ
 
 
Answered by Dr. N. K. Misra 1 hour later
Dear XXXXXX,
Thanks for sending your query to us.
Lotemax is a corticosteroid eye drop.This group of drops are to be used for a prescribed period of time only.
After the time period when we do not need the anti inflammatory effect the drug should be tapered off at a time gap of 5 to 7 days.
In your case use the drop for 4weeks then taper it off at 5 days interval.3 times a day for 5 days then twice a day for 5 days and then one drop a day for another 5 days.
Abrupt stoppage can at times lead to rebound phenomenon,which we avoid by tapering.
Very prolonged use of steroids may lead to certain complications which are best avoided.
Please do get back to me in case of any further query in this regard.
Above answer was peer-reviewed by
 
Follow-up: Undergone PRK eye surgery. Prescribed Lotemax. Suggest the right dosage for Lotemax 8 hours later
Hello and thank you. I had my PRK procedure on thursday 03/21/2013 (about 12 days ago). I began using the lotemax last Thursday (6 days ago). My doctor said to use the lotemax 4 times a day for 4 weeks. I am wondering if I should start tapering after week one (tomorrow) or after week 4. I have a follow up visit with him in 2 weeks (april 18th). He never mentioned anything about tapering off, but I don't think it would make sense for me to start tapering after week 4 since I am only supposed to use the drops for 4 weeks total, sorry for the confusion. I think I will call the office to confirm the amount I should be using. After tomorrow I am not sure if I should continue using 4 times a day, or if I should reduce to 3 times a day. I suppose the only way to confirm is to call and ask, so I will try that. I just don't want to continue at 4 times a day after the first week if I am not supposed to, I would prefer to reduce to the 3 times a day and so forth, but I don't know. He was not very specific when he gave me the instructions. Anyway thank you, I will try to find out more information.
 
 
Answered by Dr. N. K. Misra 1 hour later
My Dear ,
Thanks for getting back to us.
Do not be in too much of hurry to stop the drug .
These drops have a specific purpose and they should be used for a while.
Use it till your next appointment.These are anti infllamatory and have to be used for a while to take care of the surgical injury to the eye.
Ger back to me in case of any further query in this regard.
Above answer was peer-reviewed by
 
Follow-up: Undergone PRK eye surgery. Prescribed Lotemax. Suggest the right dosage for Lotemax 9 hours later
Hello and thank you again.
I understand the drops are important and I will use them until my next appointment. In your opinion, which of the following two scenarios makes more sense after a PRK surgery. #1: Use Lotemax 4 times a day without tapering off after week 1 or
#2. Use Lotemax 4 times a day for the first week and then reduce to 3 times a day for the second week, and 2 times a day for the third week etc....
The actual amount of medicine I am using is more concerning to me than the length of time I use it for. I am okay with using it for 3 or 4 weeks, but is it alright to use it 4 times a day constantly for 3 or 4 weeks...
If it is okay to use this medicine 4 times a day for 3 weeks then I will do that, but I would like to know.
Sorry for being persistent with the same question, and thank you again.
 
 
Answered by Dr. N. K. Misra 3 hours later
Dear XXXXXX.
Thanks for getting back to me.
First of all please do not feel sorry for persisting with a question.It is good to clear off a doubt and be at peace.
I would like to go with scenario 2.It is the initial period that you need the medication most.So that is when you use it more. I feel if there is no infllamation then the drug can be reduced after 2 weeks.
We have had patients where we had to use the medication 10 to 15 times a day.
So the frequency is related to severity of problem.
For you ,if there is no other problem the drug can be safely reduced after 2 weeks.
If any doubt persists ,do get back to me.
Above answer was peer-reviewed by
 
Follow-up: Undergone PRK eye surgery. Prescribed Lotemax. Suggest the right dosage for Lotemax 10 hours later
Thank you very much, I appreciate it.
I would like to get your opinion on a few things before my next follow up visit in 2 weeks.
I had my PRK surgery on Thursday 3/21/13 and my eyes feel good and I am healing well. Unfortunately my vision is not very good and I am worried that I still may need further correction or glasses.
Before the surgery I was told my prescription was -7.50 and I have astigmatism and I was nearsighted, and I wore glasses.
I had a follow up visit the day after the procedure and I was told everything looks good.
I had another follow up visit one week after the procedure to take out the temporary bandage contact lenses and was told my vision was around 20/50 at that time, and that I could pass a driving test, that does not say much for the vision portion of the driving test.
The doctor told me it would be one month from the procedure date before he could have an accurate measurement of my vision. (That is when my next follow up visit is approximately)
It has been two weeks since the surgery and my vision feels like it has stabilized. When I had my glasses on before the surgery I saw very well (probably 20/20), and now I am not seeing nearly as well as I did with my glasses.
My biggest trouble is seeing the computer screen at work, I have to get within 8 to 12 inches of the monitor for things to appear clearly, so I am still nearsighted but not as bad as before. I feel like I am straining my eyes a lot to focus on the screen at work and this is worrying me. I can't see the screen clearly when I am sitting upright in my chair, about 2 feet away.
My distance vision is not great either, when I am driving I cannot read many signs clearly, and overall my vision still feels blurry, near and far. I can tell it is nowhere near 20/20. My biggest concern is whether or not this can be corrected or if this is permanent, I don't know.
I know that I need some correction whether it be enhancement with the laser, or just a pair of glasses, I don't know, but I am concerned and I want to be able to ask my doctor the right questions on my next visit.
I just want to be able to see clearly, even if I have to still wear glasses that is okay. I know that my vision without glasses before the surgery was very poor, and it is better now, but I can't continue to do my job straining my eyes and getting very close to the monitor to see clearly, it is hurting my eyes and giving me a headache.
Does this seem like an over correction or an under correction of some sort? I wouldn't know, so please give me your opinion. I can get by for now with work and driving, but I don't think it is safe for me to drive with my vision like this. My next follow up visit is in two weeks.
I am taking Lotemax, and Restasis. I was told I had dry eyes a month or so prior to the surgery so I have been on Restasis for about two months.
Anyway, I just want to be able to see clearly again, I hope that my vision is not going to be like this forever, that would be unfortunate. I just hope it can be corrected with glasses, or another procedure if necessary (I hope not).
Thank you for your time Doctor.
 
 
Answered by Dr. N. K. Misra 19 minutes later
Dear XXXXXX,
Thanks for getting back to us.
Other than the problems of over correction and under correction ,which are very rare these days with the type of advance technology we are using these days,what you may be having is corneal haze.
This haze is due to infllamation of cornea and that is the the reason you should not reduce steroids.
If there is a residual power then easy way out is to lift up the flap which has not healed as yet and redo the correction and the problem is over.
You have to ask the doctor the reason for for non improvement.under or over correction or infllamation.
Answer to this will decide the future line of action.
We as a routine ask our patients to use lubricants for 6 months.
Please do get back to me for further query.
Above answer was peer-reviewed by
 
Follow-up: Undergone PRK eye surgery. Prescribed Lotemax. Suggest the right dosage for Lotemax 21 minutes later
Okay thank you, I will ask the doctor, maybe it is the haze. I thought in PRK (LASEK) there is no flap, maybe I'm wrong, sorry. I am using the rewetting drops regularly also. Thanks again.
 
 
Answered by Dr. N. K. Misra 52 minutes later
You are welcome
Above answer was peer-reviewed by
 
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