2 minute read
BEBRF 2021 Symposium 2nd Q&A Session
DR. JURIJ BILYK, DR. ALISON WATSON, DR. ADITYA KANESA-THASAN, DR. ANN MURCHISON REPORTED BY BARBARA KIMMEL
Q: Who mixes the botox?
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A: Dr . Bilyk stressed the importance of having a welltrained technician mix the botulinum toxin since things can go wrong with each of the many steps.
If his office’s one dedicated technician is away, Dr.
Bilyk mixes it himself. Steps/variables include what preservative is mixed in, drawing out the correct amount, and using a fresh needle (he doesn’t inject with the needle used to draw the botulinum toxin because this original needle will be dulled and a sharp needle will hurt less).
Q: What type and dose of Omega 3 is recommended?
A: Dr . Kanesa-Thasan said the data on supplements is mixed. He doesn’t recommend specific supplements to his patients since he hasn’t seen much success with Omega 3 (or other supplements including flaxseed) among his patients. He leaves it up to patients to see what supplements work for them. If a patient decides to take Omega 3, he often suggests PRN Pharmaceuticals which is specifically targeted for dry eye (he couldn’t recall the dosing off hand). He recommends a healthy diet including fatty fish.
Q: What’s the difference between blepharoplasty and myectomy?
A: “Gigantic . ” Myectomy is a long, meticulous, risky procedure involving removing the entire orbicularis, stripping all muscles from the brow to the lower lid. Blepharoplasty removes only a small strip of orbicularis – and in some blepharoplasty, no muscle is removed. Blepharoplasty doesn’t give the functional effect of myectomy. (Note: Dr. Bilyk has seen multiple new patients who misthought they had a myectomy but had had blepharoplasty.)
In her two years at Wills Eye, Dr. Watson said she
has been able to talk all of her patients who were considering myectomy out of it. Dr. Bilyk: “You know somebody’s done a lot of myectomies when they try to talk patients out of it. It’s not a bad procedure, but you must be careful to pick the right patient. If you do, the success rate is better.”
Q: Why is photophobia such a big problem for blepharospasm patients?
A: It’s not known why. It could have something to do with your central nervous system or a feedback loop from the brain. Treating the dry eye component sometimes helps with the photophobia. Also, blocking some spectrums may help.
Q: Does the body produce enzymes that detoxify botox? Can that contribute to decreased efficacy over time?
A: They are not aware of enzymes that break down the botulinum toxin protein. Decreased efficacy is more likely an antibody issue. Dr. Bilyk said decreased efficacy could be from botulinum toxin being given too frequently.
