Pilocarpine .5% safe???

I've been using Pilocarpine .5% for almost a year after getting a ReZoom lens inplant and having problems with Halos. My New doctor is concerned about the side effects and had me get a 1/8% ($40)  solution made up at a compounding pharmacy and it didn't work at all. He's given me a 1/4% perscription, but as the .5% doesn't always work, I'm afraid it will just be throwing good money after bad. Are the side effects, especially the retina detachment, really such a concern on a .5% (1/2%) solution??  I see patients on these boards getting 1% and 2% solutions.
Thanx!!!  JP

[Ray T Oyakawa, MD]

Just get the 1% pilocarpine.   Pilocarpine has been used as a glaucoma medication at 4% for many years.   I have never seen a retinal detachment problem from its use.  A similar drug has been used for many years at the end of cataract surgery to constrict the pupil.

The Rezoom less is probably the least used of the multifocal/accommodating IOLs.  Even with perfect surgery 5 to 10% of the patients never neuroadapt to the halos.

Dr. O.

[Sandy Feldman, MD, MS]

Dear Johnnypro,

Your doctor is trying to ameliorate your symptoms with the least amount of risk to you.  I commend him for trying all of this.  No one knows the exact risk of using these drops, especially at the lower doses, but we suspect, lower is better.

Another possibility is to use alphagan rather than pilocarpine.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[johnnypro]

We tried Alphagan .1% and it didn't work at all. I agree that lower dose is better, but since the Pilo 1/2% is working "Most but not all" of the time, I figure the 1/4% isn't going to work either. Just trying to get your opinion on the safety of Pilo 1/2%. Thank You for weighing in. I REALLY appreciate it. :-)  JP

[johnnypro]

My original doctor and I had talked about nothing but the Chrystalens. After my surgery I had the normal next day and next week appointments, and then found out I needed open heart surgery. 4 Months after the eye surgery, after I had already contacted Bauch and Lomb (sp?) about my glare and halo problems, my doctor told me that he had substituted a ReZoom for the Christalens during the surgery because of "the size of my pupil". He wanted to yank out the Rezoom but I was hesitant. I found another surgeon, who checked out the eye in every way he could and found that the Rezoom was in there properly. Both doctors had seen scarring behind the capsule, the new doctor did a Yag Laser treatment hoping to make the glare go away, but It got worse instead.

Going with a Toric lens for my other eye surgery in a few weeks. Wish me luck!!!  :-)  JP