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  • IPL at Univ of MI - Ann Arbor Kellogg Eye Center

    Here is some info about IPL at the Univ of MI. I began Wednesday August 29th.

    Univ of MI eye care requires a doctor, I believe a corneal specialist, to ok a patient to allow them to get IPL through their office. This I found very frustrating because its a 4 hours drive there and I had already seen a corneal specialist, but this is U of M policy. I waited for 3.5 hours to see the doctor, had a 16 minute consult where I spoke most of the time. He did not look at my glands. He pressed on my eyelid and said some of the glands are giving off oil, but he did not do a manual expression. He said OK and then I paid $195 because they are out of network and my insurance said I had already seen a corneal specialist and that IPL is a experimental treatment. I was very angry for the run around and lack of care.

    I made an appointment to get IPL but was never seen any information about how to prepare for the treatment, IE, should I stop taking doxcycline or any other information.

    One piece of info: The doctor only does IPL wednesdays afternoons, but she is completely booked up. I saw her schedule as I left.I dont understand why the doctor doesnt add another afternoon or morning. The scheduler had remarked that people are very upset dealing with the wait times to see the doctor. As a severe dry eye sufferer hoping for treatment I understand the patients emotions.

    The treatment is $400 for each visit. The first visit is longer with talking and meibography. Later visits I imagine will be quite short. I wish it was in my city, would be wonderful.

    I made the trip there and the doctor who does the IPL was very professional and helpful. Most people getting IPL apparently dont know much about it so she was surprised about my knowledge of dry eye and the academic literature available.

    She took pictures of my glands and which I have attached and said it looked like they are mostly intact, though the picture of the bottom glands isnt very clear. I have been told my lower lids are quite tight and hard to pull out for photos. I told her that the previous doctor should have taken pics of the glands to rule out people who dont have any glands left, because she said some people do the first consult, then come to the second consult only to be told their gland loss is too severe, seems like could be managed better.

    The IPL treatment was very fast. Less than 5 minutes. We looked at my skin type and according to skin darkness she can turn the machine up higher the lighter the skin. I have extremely fair, lightly ruddy skin from my English grandmother. So she turned the machine up to its highest level she uses. There was some slight sting at some points on my face but overall it was relatively painless. I did not experience any side effects such as blistering or pigment change.

    After the IPL treatment she did an extremely thorough manual expression. Each lid was gone over 3-4 times using a lot of pressure. She did a numbing drop, then did a lid. Then waited a moment. DId another numbing drop, then another lid.

    On my right eye which is less painful she said the oil was slightly thick. On my left eye which is usually painful she said it was much more like toothpaste.

    When she finished each gland was very clear in the mirror. I went to the bathroom and looked, and it was very beautiful to see such perfect, uncapped glands looking at me. But my eyes were a bit raw.

    Next time I will bring a small cooler with a couple wash clothes, ice and also my Hypocholoric acid spray and some cotton pads to really clean the eye after the expression. I used a lot of drops and blinked my eyes.

    Results: That evening my eyes were wonderful. I pressed on my eyes when I got home after dinner with family in a city along the way and the 4 hours drive I got home at 10 pm. Oil was pouring out of the glands. All of them. Even some of the outside edge of my eye that my Lipiflow dry eye doctor had said looked a bit faint on the meibography he took, they were also expressing oil.

    The next few days my eyes went 90-100%. I mean a revelation. I didnt need drops and my eyes were producing tons of oil. The oil was clear and came easily from the glands.

    The next day I started getting blockage and now today more blockage. Goggles back on. When I do a warm compress I can a lot of oil to come out but it seems to thicken up after that. Though some of the glands stay open, which is still better than before.

    SO thats where I am now.

    I am in talks with a local doctor to start doing these very thorough manual expressions because of the results it gave me. Hopefully he will agree and then I can do the IPL every 3-4 weeks and in between get another thorough expression.
    Last edited by edmunder; 03-Sep-2018, 18:09.

  • #2
    I guess I should add that many people don't get any benefit from the first treatment but I felt great. The doctor had mentioned if I see improvement to be happy because that usually means after 4-5 treatments there can be some real progress with the thinning of the oil. I am praying that will be the case. But as you can see Im also looking into manual expression other times to try and express the bad oil as much as possible.

    Comment


    • #3
      I have a lot of hope for you, seems like your glands are capable of producing good quality meibum. But for some unknown reason, they're unable to do it consistently and get blocked easily. But the good news is, your glands are still there and can produce oil!

      I would go at least 6 rounds of IPL treatment in your case, I hope you will get improvement with each round.

      Another treatment for consideration is Prokera (AMT), I suspect cases like you, there is definitely a nerve factor to it. My theory is that you are experiencing extreme symptoms due to your nerves misfiring, and your nerves control your glands. Dry eyes -> nerves gone wild -> more dry eyes -> more nerves gone wild.

      Let us try and reduce the inflammation of the nerves by doing AMT.

      Comment


      • #4
        Yes its very frustrating and psychologically very challenging. When i had lipiflow it got better then back to blocked. IPL same thing.

        Part of me wants to stop doxycycline and try very high levels of probiotics plus probiotic foods such as sauerkraut, kimchi, resistant starch etc to increase bacterial health of the body.

        I also want to try water fasting for 4-5 days to kill all the bad white blood cells and regenerate the immune system in my body.

        I just feel like im doing the same e thing again and again. Its not working. Hard to be patient thats for sure.

        Comment


        • #5
          Originally posted by edmunder View Post
          Yes its very frustrating and psychologically very challenging. When i had lipiflow it got better then back to blocked. IPL same thing.

          Part of me wants to stop doxycycline and try very high levels of probiotics plus probiotic foods such as sauerkraut, kimchi, resistant starch etc to increase bacterial health of the body.

          I also want to try water fasting for 4-5 days to kill all the bad white blood cells and regenerate the immune system in my body.

          I just feel like im doing the same e thing again and again. Its not working. Hard to be patient thats for sure.
          Personally, I think probiotics is just a marketing scam (although many of the foods that supposedly contain probiotics are naturally healthy and good for your regardless).

          Doxy is good, it should help thin your oil long term, azithromycin is better. Next time you do IPL, ask for AzaSite or oral azithromycin z-pack. You can also ask for Prokera (AMT), it costs around 1.5k CAD per eye in Toronto. I definitely have a lot of improvement in the eye I did Prokera. I have my followup on that in a few days time, I'll update on what the dr says as well.

          I have like multiple doctors lol, 1 for IPL, 1 for LipiFlow, 1 for Prokear

          Comment


          • #6
            Hey edmunder itís great to hear IPL really helped you, at least temporarily. It shows thereís still hope and that if your glands are still capable of producing good quality oils then at some point the effect can be continuous. I have no real feedback since I havenít done IPL myself but I notice the challenge with all of these treatments (lipiflow, IPL, probing) is that the results tend to be positive initially but it can revert back to old levels. I agree itís prudent to look into dietary changes, I know you already have a great diet but some kind of GLA (omega 3) supplementation makes sense. Iím also looking into 5 day fast mimicking diets (currently on public library waitlist for The Longevity Diet by Dr. Valter Longo who advocates these sorts of fasting). Hopefully with repeat treatment there can be a longterm effect.

            Comment


            • #7
              Thanks for the update. Youíve had more success than the average person, albeit temporary, with initial LipiFlow, IPL, and gland expression treatments, so thatís definitely promising future treatments can help even more.

              I really believe finding the right diet can be key for your glands to continue to produce healthy oil on their own long term. I canít remember if youíve had extensive blood tests on autoimmune disease, hormone levels, vitamin deficiencies, etc., but it can be helpful to see a naturopath to help with diet, supplements, and other testing regular doctors donít order. I had one who also was an M.D., so that was helpful in ordering his own tests and reviewing all my other medical records. I learned a lot from my naturopath, and seeing him was key in my belief and success finding diet was a big part of the long term solution for me.

              Comment


              • #8
                Thanks edmunder, seems the oil qualityis the issue. Omega 3/GLA helps but normally takes 2-3 months.
                Blood test, I would include heavy metals and iron.
                What are your results for MMP-9 & osmolarity??
                Last edited by MGD1701; 04-Sep-2018, 05:36.

                Comment


                • #9
                  Iím sorry it was a pain in the ass bit happy you got in and felt better even for a short time. When I called, they said they would have to review my medical records before they would accept my case. Iím assuming thatís just their thing, they have to screen patients. I hope you find your root cause so you can end this mess.

                  Comment


                  • #10
                    Originally posted by MGD1701 View Post
                    Thanks edmunder, seems the oil qualityis the issue. Omega 3/GLA helps but normally takes 2-3 months.
                    Blood test, I would include heavy metals and iron.
                    What are your results for MMP-9 & osmolarity??
                    Ive been taking Hydroeyes for about 2 months which has GLA but not enough so Ive ordered just a GLA supplement. Ive been taking PRN fish oil for 5 weeks but other lesser fish oils before.

                    Ive had a lot of blood tests but not for heavy metals. My primary care doctor isnt great. She mostly sees me as a problem she cant help.

                    Osmolarity i cant remember clearly.

                    Left eye - bad eye - 315?
                    Right eye - 295

                    Havent done MM9.

                    Comment


                    • #11
                      So week later results.

                      Some very positive things. I didnt have goggles most of the day. But at night my left eye felt pretty sore from it.

                      More oil cones out from warm compress but still not enough.

                      I do the warm compress, 15-20 minutes, then lightly roll my fingers up on the lids. Then i get some drops from the fridge and drop on my eyes, the hot to cold colors the oils that came out of the glands. A bit cloudy. So i can see what came out. Then i get a q-tip with occusoft foam and clean the lids. Then hypocholoric acid. So far there has been obvious progress. Just not a whole lot.

                      In a week i will get a manual expression from local doctor. He bought a newer eyelid heating

                      http://www.heatedeyepad.com/

                      Its hard to have a good day and then at night realize it was partly a mirage, the dry cornea at night, goggles back on. I only use blood serum drops, drops like retaine make my eyes feel awful.

                      Comment


                      • #12
                        Originally posted by edmunder View Post
                        So week later results.

                        Some very positive things. I didnt have goggles most of the day. But at night my left eye felt pretty sore from it.

                        More oil cones out from warm compress but still not enough.

                        I do the warm compress, 15-20 minutes, then lightly roll my fingers up on the lids. Then i get some drops from the fridge and drop on my eyes, the hot to cold colors the oils that came out of the glands. A bit cloudy. So i can see what came out. Then i get a q-tip with occusoft foam and clean the lids. Then hypocholoric acid. So far there has been obvious progress. Just not a whole lot.

                        In a week i will get a manual expression from local doctor. He bought a newer eyelid heating

                        http://www.heatedeyepad.com/

                        Its hard to have a good day and then at night realize it was partly a mirage, the dry cornea at night, goggles back on. I only use blood serum drops, drops like retaine make my eyes feel awful.
                        Your IPL, did they use corneal shields or stickers? i.e., did they do your uppers?

                        I just chatted w a doctor who just started doing IPL, he claims that doing the uppers is important (he started only doing the lowers) and he noticed a difference in his patients. I am switching to this doctor to my IPL now, i.e., to do uppers and lowers, and use corneal shields .

                        Comment


                        • #13
                          Just lowers - cheeks, nose and lower lids.

                          i brought it up with the doctor. I may send her the video ftom that dryeyemaster Doctor and her protocol.

                          I only have one choice. Its already 4 hours.

                          I will ask if she will consider trying the corneal shields and this new protocol on me though.

                          Comment


                          • #14
                            Originally posted by edmunder View Post
                            Just lowers - cheeks, nose and lower lids.

                            i brought it up with the doctor. I may send her the video ftom that dryeyemaster Doctor and her protocol.

                            I only have one choice. Its already 4 hours.

                            I will ask if she will consider trying the corneal shields and this new protocol on me though.
                            I wish you further success man, glad this solutions seems to be helping.

                            Comment


                            • #15
                              Hi edmunder
                              that drymaster, Dr Periman, ''measures both osmolarity and Mmp9 at each DryEye visit'', for your info.
                              I know many doctors apply them to make their treatment plan and monitor if it works. - makes sense, right?

                              secretion
                              I can only see (big & small) oil drops from upper lids with 20-zoom mirror. Can you see from bottom? How?
                              Last edited by MGD1701; 06-Sep-2018, 03:46.

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