Dry eye light impulse therapy (DELIT)

[mansfield61]

On a show called The Doctors, Dry eye light impulse therapy (DELIT) was discussed for those suffering from blepharitis. This from their website:

Stacie, 36, suffers from severe dry eyes, which become red and irritated and burn. She applies eye drops more than 10 times every day to alleviate the symptoms but can't find a permanent fix. "If I don't have my eye drops, I can't function because I can't concentrate," she says. "It's a constant source of distraction."

Ophthalmologist Dr. Kerry Assil, from the Assil Eye Institute in Los Angeles, California, explains what causes the condition. "Tears are made of oil and water, [and] when there's not enough oil on the surface, the water evaporates 10- to 20-times faster, leaving the surface of the eye chapped and dry," he says. "That dryness can translate into inflammation, which can even cause infection over time."

Dr. Assil performs Dry Eye Light Impulse Therapy (DELIT), a five- to 10-minute treatment, on Stacie. The Intense Pulse Light applied to the lower eyelids unclogs inflamed and dormant glands that produce the oil part of tears. Dr. Assil explains that as the natural oil is produced by the treatment, it seeps from the oil glands in the eyelids into the tear film, so the tears don't dry up and evaporate as quickly. "People notice that the redness starts to go away, and their dependency on eye drops starts to go away," he says.


"The problem with using eye drops for dry eyes is [that] it's kind of like licking a chapped lip," he adds. "It only has a very temporary effect, because it's not going after the source of the problem. The source of the problem in this case is insufficient oil in the tear film. So if you use the artificial tears too often, whether it's stuff designed to get the redness out, or the dry sensation, it can actually make the condition worse."

This from youtube: http://www.youtube.com/watch?v=xl0NhsJ8Sd0

Has anyone had any experience with this treatment?

[RobLIC]

Search the threads here for "IPL" - Intense Pulsed Light. That's what they're talking about and you'll find many comments and additional information about it.

[diggylove]

having IPL treatments now

I, too, saw the segment on "The Doctors" & am currently going to Dr. Assil for IPL treatments for meibomian gland disorder (MGD). I have so far had 2 in the series of 4 treatments he proposes. The demo on the show was pretty accurate, except it did not show how pressure is applied to the lids afterwards to try to express oil. There is some pain from the heat but it's brief. The biggest pain is the cost...it is not yet covered by insurance & is $700 for each treatment, although other doctors may be less. However, not many doctors are trained to do it. After the 4th IPL treatment, patients generally have follow-ups at 6 month or yearly intervals, depending on their ability to maintain a good moisture level. No one is ever cured of this disorder, but I gather a successful patient would need to use less drops from then on.
Anyway, my eyes had been dry for 5+ years, getting worse over time. They were brutally dry before I started, with a TBUT that was practically nil. I had tried many different therapies & had one puctum cauterized shut. Still in misery, IPL was certainly worth a try. I have to say...after 2 treatments, I have seen no difference. I am going for #3 this week &, if I see no improvement in the weeks that follow, I will unlikely want to go thru with #4, but, of course, I would discuss that first with Dr. Assil. I have read you are considered a "non-responder" if you're unsuccessful after #3, but I have also read that most patients derive at least some relief. Perhaps I am not typical. Yes, I am discouraged, but still hoping.
Anyway, Dr. Rolando Toyos in Nashville, the pioneer of the procedure, writes a lot about IPL on his website. Check it out. Overall, I have seen no increase in wetness or had any help with my burning eyes, & I'd be most interested to read comments from others, preferably who have gone to Dr. Assil, or any other doctors. If you like, you can email me personally at diggylove@aol.com.
Best of luck to us all!
Susan in So. California

[spmcc]

RE: IPL for dry eye

I've had two treatments of IPL for dry eye with Dr. Friedman in Palo Alto.

During my past visit, he told me that they (I assume he meant Toyos, Assil, Yee, Coads, and himself) expect/hope to find an increase of 1-2 seconds in TBUT for every IPL treatment.

I went up only 1 second from my first to second treatment (from 5 to 6). However, I may be "IPL resistant" due to the fact that I've already had tons of laser/IPL/PDL to my face over the last 15 years.

[RobLIC]

Hey Chemia. Can you please explain the microwaved potato comment?

My barber, who was very happy with his LASIK, keeps telling me to grate a potato, put the shavings in a paper towel, and rest with it for 10 minutes. I'm somewhat opposed to taking medical advice from my barber, so I haven't done this. Yet.

Rob

[RobLIC]

Thanks. My barber insists there's some sort of bad-stuff abosrbing quality in the potato. Kinda fun. This sounds more like the same idea as a rice bag for heat or cold application. I'm staying out of the produce section.

[mansfield61]

I've had two treatments of IPL for dry eye with Dr. Friedman in Palo Alto.

During my past visit, he told me that they (I assume he meant Toyos, Assil, Yee, Coads, and himself) expect/hope to find an increase of 1-2 seconds in TBUT for every IPL treatment.

I went up only 1 second from my first to second treatment (from 5 to 6). However, I may be "IPL resistant" due to the fact that I've already had tons of laser/IPL/PDL to my face over the last 15 years.

I was reading the website of Dr.Totos with regard to IPL for dry eye.

http://www.toyosclinic.com/media/doc...e-syndrome.pdf

I live just outside of Toronto, Canada and cannot seem to locate a opth. who offers this treatment option. The closest I could find was a Derm. in Toronto.

http://www.gidonaesthetics.com/acne.htm

SPMCC I see you are fro Canada but are seeing Dr.Friedman in Palo Alto,Calif.
Is this because you couldn't find anyone in Canada to do this procedure?

I have a feeling that Dr.Gidon in Toronto won't know the first thing about Dr.Toyos' protocals.

[spmcc]

Re: IPL for dry eye, IPL in Canada, laser/IPL resistant

I've had tons of IPL/PDL/laser in Canada (and some in Washington State). I use it for *facial* rosacea... to reduce permanent redness and flushing. It also helps with chronic inflammation and pain associated with having blood vessels that are always swollen.

I believe that this is the basic theory behind doing IPL for dry eyes too... constant inflammation caused by irritated blood vessels is blocking oil from exiting the MGs... attack/destroy the blood vessels and the inflammation (the root of the problem) ceases and oil flows.

Laser resistance can happen when, after multiple laser treatments, the blood vessels that you are trying to destroy actually become stronger (e.g., thicker walled). When that happens, further treatments just don't do anything (picture a bullet bouncing off Superman's chest!)

After all my *facial* treatments in the past, I wanted to see what the ophthalmologists were doing that was so different. I decided to go to Dr. Friedman out of curiousity.

There is a difference... he goes up much higher under the eyes (on the lower eye lids) than any "normal" laser place I've tried.

MANSFIELD61 - No, I have not found a laser place in my area that would go up this high on my lower lids. And I couldn't find anyone who knew about Dr. Toyos' protocol (I took in printed info to show them).

[diggylove]

price for IPL is not accurately stated

Hello...I have had 3 IPL treatments by an MD in the Los Angeles area...I have been advised not to use a doctor's name in a deregatory light. Three treatments later, I am no better & have conceled my 4th. That alone disappoints me, but I am hugely distressed at this point to find out that the $700 cost per session...not covered by insurance at all...is only part of the patient's cost. It turns out that there is an additional per-treatment charge for the post-IPL "expression of the lids" (done by the optomotrist)...this part is billed to insurance & altogether brings the cost to up to over $800. I do not think they are clear about the price when a patient phones the first time. I am saddened to think that this is going on in what is considered a reputable medical office.

[JoeInLA]

Not to worry

diggylove, as long as what you post is the truth (i.e., facts that you can prove), you have nothing to worry about as far as the doctor claiming you are defaming him. I read your post and there is nothing defamatory in the information you posted. I'm sorry the treatments did not work for you. I know the doctor you are talking about -- Kerry Assil in Beverly Hills. He performed my LASIK treatment some years back which I was very happy with, even though the residual halo effect I still have (which is worse when my eyes are dry) would probably make some patients very unhappy. Compared with the coke-bottle bottom glasses I had worn since the age of 5, though, putting up with the halo effect still seems like a small price to pay. That said, I called Dr. Assil's office about eight weeks ago to inquire about the cost of the IPL dry eye treatment and was appalled to hear that he is now charging $750 per treatment (which, since he recommends 4 to 5 treatments, means I would wind up paying between $3,000 to $3,750 for the IPL treatment alone -- out of my own pocket, not covered by insurance). The receptionist never said anything to me about any additional charges, but I am not surprised to hear that they tack on an additional $50 per session. The whole thing sounds like sheer greed to me. I think I read elsewhere on this board that Dr. Toyos (who trained Dr. Assil and for a while was flying to Los Angeles once a month to treat patients in Dr. Assil's office) charges in the neighborhood of $300 per treatment. I was told by another eyecare professional that Dr. Toyos and Dr. Assil had a falling out which is why Dr. Toyos no longer travels to Los Angeles, and when I heard the amount Dr. Assil is now charging per treatment I wondered if that was at least part of the reason they are no longer working together. My dermatologist already has the IPL equipment, but since he probably won't be comfortable working as close to the eye as Dr. Toyos recommends, I have been talking to my opthalmologist here in Los Angeles about her acquiring the IPL equipment and learning the procedure, or perhaps entering an agreement with my dermatologist to use his equipment. She was initially very interested, but during our last conversation she mentioned that she didn't think she had enough dry eye patients to warrant leasing the equipment. I told her that if she was able to charge patients what Dr. Toyos charges for the treatment (which is less than half what Dr. Assil charges) I was sure she would start getting calls from dry eye sufferers all over Southern California once word got out. I'm going to keep trying to convince my opthamologist to start using the IPL and will keep readers posted.

Hello...I have had 3 IPL treatments by an MD in the Los Angeles area...I have been advised not to use a doctor's name in a deregatory light. Three treatments later, I am no better & have conceled my 4th. That alone disappoints me, but I am hugely distressed at this point to find out that the $700 cost per session...not covered by insurance at all...is only part of the patient's cost. It turns out that there is an additional per-treatment charge for the post-IPL "expression of the lids" (done by the optomotrist)...this part is billed to insurance & altogether brings the cost to up to over $800. I do not think they are clear about the price when a patient phones the first time. I am saddened to think that this is going on in what is considered a reputable medical office.

[spmcc]

Re: IPL for dry eye

I heard/read here (?) that the IPL laser machine, Dermamed Quadra Q4, used by Toyos, Assil, Friedman, etc. costs approx $50,000 USD. Keep in mind that the life of lasers/IPL machines is relatively short - 3-4 years - and then the "latest and greatest" model appears and one "must" upgrade to stay in the game.

If you can, you could fly to San Francisco and see Dr. Neil Friedman at Stanford University (also trained by Toyos). He charges $400 per treatment and he expresses the glands himself (wow, I guess!?!). I told Dr. Friedman (after I saw the video of Dr. Assil's IPL treatment on The Doctors) that he should get himself a "gel guy" and up his prices to Assil's level. That's why I believe Assil charges more... he has a gel guy put the conducting gel on the wand for him... he doesn't do it himself (heehee).

Anyway, Friedman's an option if you want to stay on the west coast.

FYI I had 4 IPL treatments for dry eye but saw no improvement in TBUT (that's what they use to measure). My eyes are the same as they were before I started. However, I do think this is helping some people so I don't discourage anyone from trying if they can spare the $$$.

[Dinobear]

Question

I have inflammatory MGD without Rosacea. Can I still benefit from IPL?

[diggylove]

bills for IPL...

To update on my 3 IPL treatments in B.H. between April-June '10...the 4th one being canceled due to no progress being seen for severe MGD...I must say I have received no further bills (yet), aside from the initial consult fee (billed to my insurance but I had to meet my deductible...I was advised upfront that I would have to pay this) & the $700 per treatment ($750 for the first). The reason I feared more "extra" bills would arrive for services done (expression of the lids) by the doctor's assistant was that my EOB indicated I would. So, without having received a bill, I phoned the doctor's office, to be told...yes, there were charges for the "expression" on visits 2 & 3...as well as for a "surgery" (?)...which turned out was removal by the doctor of one lash that had grown inside the lower lid. Well, whether it was my annoyed phone call that did it or not, I do not know...as far as I can tell, my insurance was billed these "extra" amounts (total about $250) but I was never billed by the office for my portion. You figure it out...
I, too, would not discourage anyone from trying IPL if they can afford it & if the procedure intrigues them. My regular eye doctor insists he's had patients who were successful & he has no "ties" with the BH doctor. I wish I had been able to see Toyos or the doctor in No. Cal. but, for now, I'll let it be...no more IPL for me. In a way, it seemed "too easy" to be true...it's done so fast for the cost involved, but I know the technology is pretty high-tech. Just remember...if you see improvement after 4-5X, you still need to return at least 1X a year, probably more. It's not a cure. Good luck everyone!

[JoeInLA]

Thanks, smpcc. I'm still going to try to convince my eye doctor to get the machine and start treating dry eye/occular rosacea patients here in Los Angeles, but just the other day I was checking round-trip fares to Memphis (Dr. Toyos' office), and Palo Alto is much closer and cheaper than Memphis, so Dr. Friedman has now moved into second place, ahead of Dr. Toyos on my list. BTW, as long as the IPL treatment is not covered by insurance companies, I think it's a smart move on the part of doctors who do the procedure to keep their prices as low as possible as they will get more patient volume that way. Look at the booming sales of the most recent version of the Kindle as a perfect example. Most people could not afford to pay $400 for the original model (or, like me, just thought it was too damned expensive at that price), but now that they have dropped the price to $140, they can't keep them on the shelf. In fact, it's now on my Christmas wish list, even if I have to buy it myself!.

Joe

I heard/read here (?) that the IPL laser machine, Dermamed Quadra Q4, used by Toyos, Assil, Friedman, etc. costs approx $50,000 USD. Keep in mind that the life of lasers/IPL machines is relatively short - 3-4 years - and then the "latest and greatest" model appears and one "must" upgrade to stay in the game.

If you can, you could fly to San Francisco and see Dr. Neil Friedman at Stanford University (also trained by Toyos). He charges $400 per treatment and he expresses the glands himself (wow, I guess!?!). I told Dr. Friedman (after I saw the video of Dr. Assil's IPL treatment on The Doctors) that he should get himself a "gel guy" and up his prices to Assil's level. That's why I believe Assil charges more... he has a gel guy put the conducting gel on the wand for him... he doesn't do it himself (heehee).

Anyway, Friedman's an option if you want to stay on the west coast.

FYI I had 4 IPL treatments for dry eye but saw no improvement in TBUT (that's what they use to measure). My eyes are the same as they were before I started. However, I do think this is helping some people so I don't discourage anyone from trying if they can spare the $$$.

[diggylove]

various costs of IPL

For now, I think I'm "spent out" on bills to Dr. Assil, totaling in full over $2,200 for 3 treatments, plus the initial consult. While I like the sound of Dr. Friedman, I lack my zest to start the process anew, even within CA. I do realize Dr. Assil's costs are ridiculous when you compare them to those of other respected MDs doing IPL...no doubt his prices are motivated by his glitzy office & rent. Would I have made multiple trips to No. Cal. in the first place? I doubt it...perhaps I haven't been desperate enough. And yet, I continue to suffer with pretty bad MGD, & have mildly looked into the very pricey Boston scleral lenses, now being fitting at Doheny Eye/USC. They are covered by most insurances, but are still costly. Interestingly, there is a higher cost per lens if your insurance pays a chunk...it's a bit disconcerting to realize Doheny "gets more" if your insurance pays some than if it's totally self-pay. But, back to the IPL...in that I've seen no change in how I feel after 3 treatments, I've moved on. Good luck with getting your Kindle, Joe...it sounds like more fun.
Susan in Glendale, CA