“Everything should be made as simple as possible, but not simpler.”

– Albert Einstein

At CT Glaucoma, we believe expensive and complicated is often worse than inexpensive and simple.

Many glaucoma patients with chronically red, uncomfortable eyes are told to add more products to their eyes: allergy drops, lubricating drops, anti-inflammatory drops. However, the effective approach is less, not more: use the fewest drops possible and prescribe only preservative-free medication — plus hot compresses at least a few times a week to keep the oil glands flowing.

Most styes are blocked, not infected, glands. So the right treatment is hot compresses to melt the oil plugs, not antibiotics trying to treat an infection that is not there.

Most dry eye is due to inadequate oil flow through the oil glands. Hot compresses melt the oil plugs, and improve the flow of oil, which protects the cornea and slows evaporation of the tears. Unfortunately, expensive patented dry eye medications — Restasis and Xiidra are so marginally effective that they were never approved in Europe — are commonly prescribed without even trying hot compresses, which are usually more effective.

Cataract patients often pay hundreds for postoperative drops: a non-steroidal anti-inflammatory, a steroid, and an antibiotic — but this expense and complexity is of uncertain value. The non-steroidal drop is very important, but there is no evidence that the expensive new products are better than the older generic ones. The expensive steroid drop can be easily replaced with an inexpensive injection at surgery — or an expensive steroid implant that has not been shown to be better than injection. And there is growing evidence that antibiotics injected into the eye at surgery are critical, while antibiotic drops do not seem to be helpful. (Dr. Libre, with technician/student Sean Matthews, published a study of injectable antibiotic effectiveness: “Endophthalmitis prophylaxis by intracameral antibiotics: in vitro model comparing vancomycin, cefuroxime, and moxifloxacin” (Journal of Cataract and Refractive Surgery, 2017).