LipiFlow device - what the????

[akmpt]

I had three treatments with the Mibo Thermoflow back around november and i haven't had problems with my eyes since. Maybe this could work for you.

http://painpointmedical.com/miboflo.html
https://twitter.com/MiBoThermoflo
https://www.facebook.com/MiBoThermoflo

[littlemermaid]

The Review of Optometry always makes interesting reading for doctor-shopping http://www.revoptom.com/content/d/pr...i/2856/c/48319. Some Optometrists sound very disorganised, dishonest and exploitative. And some sound professional. I wonder why they don't explain things clearly to patients and maybe do a leaflet about expectations and what medical records to bring to include in the appointment confirmation letter.

[DocwithDryEye]

Sorry, I don't know how to select specific condensed quotes so I included the whole long post.

The Pre/Post Lipiflow Procedure you mention are basically exactly what we've ALREADY have been doing.

The only "new" POST LIPIFLOW I read was the use of of Lotemax after the treatment. I asked my opthamologist about Lotemax use Post-Lipiflow and he had not used it or knows of any colleagues using that after treatment. Why do the patients at your practice treated with Lotemax after Lipiflow?

So, I don't understand why your Lipiflow works so well. I recall you saying something about 100 patients, happy, no complaints. Sorry if the number is incorrect. If one reads the Lipiflow CONTRAINDICATIONS, how many people out of the 100 treated has your practice have to turn away?

I can certainly understand if the 100 or so patients with great results have none of the Lipiflow Info Site list of contraindications.

Too many people with the listed contraindications are still having the Lipiflow treatment done per recommendations of their doctors...I think that's unethical
practice.

I had TWO separate evaluations, the whole pre-test stuff KNOWING of the contraindications yet BOTH Independent Practices tried to schedule me to have Lipiflow performed the SAME DAY.

Lastly, I went to a large teaching hospital in Durham, North Carolina, where the physician is involved with Lipiflow research, and even has a FINANCIAL INTEREST in the Lipiflow, he said I WAS NOT a candidate and so he wouldn't perform the procedure.

P.S. DocwithDryEye, PLEASE private message me with a way that my opthalmologist in Durham, North Carolina, ( He's a Clinical Professor at the university teaching hospital) so that you both can discuss this treatment plan so that he'll be able to treat more patients with greater success. Thank you.

Almondiz,

Once again, I firmly believe that some doctors are not taking the time to educate the patient on expectations and treatment plans. I have seen a handful of patients who have already had the procedure once, that informed me MOST of what I said, they were hearing for the first time. When I had the treatment done myself for the first time, the ophthalmologist simply thanked me for having the procedure, and there was ZERO discussion of expectations and post op treatment. How many patients have had a negative experience with LipiFlow, because they were not good candidates in the first place?

Please private message me the name of your opthalmologist and I may be able to look into it.

Thanks

DWDE

[cathy8889]

Thank you for mentioning the anaesthetic, I will remember this next time I see a specialist.

I will ask about Vita Pos next time I visit my gp thanks, I've just been presribed vismed so going to give that a go. Up to now I've found my eyes can only come with Thera Tears and systane preservative free viles (going through them likes theres no tomorrow though!)

I have the tranquileyes mask and the onyix. I mainly use the tranquileyes but im waking up with it on my forehead and I whenever I put it on I get a pin like feeling in my upper lids, I think I might use the Onyix more thanks, I didnt think that the pressure could be irritating my lids, im so dosy sometimes!

Thanks for understanding, I hope I get an appointment with this dry eye specialist.

Catherine

I just ask about the anaesthetic because this can produce a different result with the Schirmer's test. Theoretically a Schirmer's test with anaesthetic evaluates baseline secretion whereas a Schirmer's test without anaesthetic evaluates baseline secretion plus reflex tears so it is important to have the same one every time to be able to compare. That is how it has been explained to me anyway.

Couldn't stand Viscotears, have never used Sno Tears. Vita Pos which you can get through a GP in the UK and Systane Gel are good for me at night. I am sensitive to just about everything. I have MGD and aqueous deficiency and use Systane Ultra UD preservative vials in the day time. Do you use an eye mask at night or do you not like the pressure? The Onyix has been the best for me but a lot of people like Tranquileyes. I don't like pressure on my eyes as I have sensitive eyelids. I have a TBUT of around 3 secs and a barely non-existent Schirmer's 1 result so I understand this is painful!

I don't have a good understanding of pinguecula I'm afraid so I hope someone else chimes in. I went through numerous Ophthalmologists until I found a good one to work with. A hell of a lot of it is trial and error which you are probably finding out. If it is MGD normally you would be prescribed Doxycycline or another tetracycline derivative depending on the severity of the condition.

[Almondiyz]

LIPIFLOW/MGD/Pre-Post Procedure

This post is the second part of two parts describing how our Dry Eye Clinic uses the LipiFlow system to manage evaporative dry eye. Thanks again for taking the time to read


Post LipiFlow Treatment

1. Steroid use. We use Lotemax gel three times daily for two weeks. This mild steroid has long been used to lower ocular inflammation. It is quite mild, and rarely causes any increased intraocular pressure.

2. Fish oil - There has been recent research indicating that fish oil, specifically omega 3's, and the increased risk of prostate cancer. If the patient has prostate issues, we may not recommend Omega 3 treatment, but for everyone else, it's a no brainer. From lowering stress hormones, to improving good cholesterol to lowering bad cholesterol, Omega 3 is a great supplement to be on. I always say that since MGD is a oil issue, it makes sense to supplement with a healthy oil to promote a more regular meibum production in the body.

It is important to note that not all fish oils are created equal. First, you want a product that is Omega 3 and DHA, EPA only. You do NOT want Omega 6 or 9, which have been shown to INCREASE inflammation.

Also, there are two main ways fish oil is processed. There is the ethyl ester form, and the natural triglyceride form. The ethyl ester form is a more processed, less bio-available form that the body has a harder time absorbing, and actually degrades in the system to some nasty chemicals. Unfortunately, this is the form that most fish oils from Target, Walmart, Kroger, Costco, etc chain stores use. It's cheaper for them this way, and that's why you can buy 600 capsules for 10 dollars. You want to see the word "Triglyceride" on your bottle of fish oil. Many health food stores have this product. Two good examples are FortifEye and Nordic Naturals.

A simple way to test your fish oil is to use a stick pin to pop a hole in the capsule, and squeeze it in a Styrofoam cup. Leave it in the cup for ten minutes, and then take a look at the cup. If after ten minutes the cup has started to dissolve or be eaten away by the oil, you know you have a ethyl ester fish oil, or a lower quality fish oil. If it eats through Styrofoam, imaging what it's doing to your insides!

We recommend two capsules daily, with food, one in the morning and one in the evening. The goal is close to 3000mg of omega 3.

3. Warm compress - Once again, before the LipiFlow system, this was what we recommended most. The idea is to liquefy the oil in the glands to promote better oil release. However, this method has limited clinical effectively on its own. The glands themselves are deep within the lid in a structure called the tarsal plate, a thick collagen like tissue that protects the glands. In front of this tarsal plate are blood vessels that whisk away heat to protect the eye. Think of when you sweat. Your body recognizes that the body is hot, and to help regulate itself, it releases sweat to cool you down. Simple homeostasis. The eyelid is no different. Heat is recognized by the eye, and the blood vessels pump heat away from the lid. The method of warm compress is nowhere near the amount and placement of direct heat that is needed to tag thick clogged glands, and liquefy the oil. However, we have found that AFTER the LipiFlow procedure, when heat is directed to the BACK of the eyelid (right where the glands are), and that the glands have been purged of thick pasty oil, the use of the warm compress is much more beneficial at MAINTAINING a liquefied meibum. I continue to use the warm compress each morning, and my eyes feel GREAT after using it. We use the Bruder Mask, which contains little beads that heat up in the microwave and remain warm for 2-5 minutes, rather then a washcloth that stays warm for 10 seconds. The Bruder Mask is machine washable (cold water), and has worked very well for us. I know other people on the forum have used other masks, all of which I have heard good things.

4. Blinking exercises - When I first heard about blink exercises, I dismissed it. I thought it sounded ridiculous. The steroid, fish oil, and warm compress made sense, but I didn't think I wanted to discuss blinking with my patients. I didn't think it was going to be something the patient wanted to hear. "You need to blink more often". Of course, this is the quick answer, and leaves the patient wanting more. At least I wanted to hear more then just "blink more".

However, as time went on, and I started doing blinking exercises myself, and heard back from other patients following a good blinking regiment, I have come to believe that this is the most important part of having a good success with the LipiFlow system, ESPECIALLY IF YOU ARE A PARTIAL BLINKER.

A quick repeat from an earlier post about evaporative dry eye:

Our eyes feel dry because of decreased tears on our eyes, and the inflammation that results. There are decreased tears because these tears have evaporated. Tears have evaporated because there is a decreased lipid/oil component to the tears. There is a decreased oil component because the meibomian gland is not excreting oil. These glands are not working because the oil has solidified and become stuck under a fibrotic/collagen like tissue that grows over the orifice of these clogged glands. And what we are finding is the cause of this growth, rather then clean open glands in lid hygiene issues, are impartial blinks.

Full blinks cause a release of this oil. If you have the LipiFlow performed, but do not make a conscious change to improve your blinking habits, you may feel a little better from the procedure for a short while, but will then be right back where you started. I'm wondering if this is where many people have failed. Patients have the procedure, and make no changes. I think it boils down to we want immediate results, without doing anything different. It would be amazing if dry eye was simply cured by taking a tablet three times a day for a week, and living life the same way we had been. THIS IS NOT THE CASE WITH EVAPORATIVE DRY EYE.

What is a "blink exercise?" It's simply taking the time to stop and consciously think about your blinking. It takes 1.5 seconds to do it. Here is what I tell the patient:

"Take a second to stop whatever you are doing and think 'I'm going to close my eyes, and close them completely. I'm going to think about my eyelids shutting all the way and making contact. Stay this way for half a second, and then simply squeeze down for another half of a second, and open. That's one repetition. It's like lifting weights. Multiple reps."

"Now you need to find something that you do multiple times throughout the day, and link blinking exercises to these activities. Everytime you take a sip of water, or send an email, or walk from one room to the next, or turn the page of a book, and so on and so forth, you do a blinking exercise".

I've found that after doing them myself, my eye feels more moist, and I can often feel the tears on my eyes.

I had one patient back recently who said "Things have been going GREAT since the procedure!" While I've noted that almost all of my patients have returned 3 months post procedure doing better, this woman seemed very excited. So of course, I said "I'm glad that you are are doing better, and that you are so excited! Tell me, what have you been doing that you're so excited about the outcome?!?"

The patient reminded me that she works for Fed Ex. She drives a truck all day around town delivering mail and packages. We had talked about blinking exercises, as she was a partial blinker, and she had started doing three blinking exercises every time she came to red light while driving around town. Naturally, shes at a stop light many times throughout the day, and always does the blinking exercises.

NOTE: SHE HAS LINKED THE BLINKING EXERCISES TO SOMETHING SHE DOES MULTIPLE TIMES THROUGHOUT THE DAY. It made me realize even more how important this behavioral modification is to our schedules. If we don't think about improving our blinks, we are not going to be feel better. Our glands our going to clog again, and we are going to be right back where we started.

So, steroid use for two weeks, fish oil, warm compress, and blinking exercises are what I call the Big Four.

One last thing that we recently began recommending:

5. Manual lid debridement. Use one hand to pull the lid down and press in slightly so the lid margin becomes easily accessible. Looking in a mirror, take a Q-Tip, wet it slightly, and run it up and down along the lower lid, along the lid margin that makes contact with the eye. Do not use a cheap generic brand of Q-Tip. I know of some patients who have seen the professional grade cotton swabs we use in the office and purchase these online, as the cotton is of higher quality and doesn't dissolve on contact like some cheap brands. We have patients doing this once a week.

We now recommend these 5 things to all patients post operative LipiFlow. We have patients return in 3 months for a first follow up, and then again another 3 months for a second follow up.

A few extra things:

Some patients with ocular rosecia or other inflammed lid margin issues may already be on Doxy, or need to start a Doxy regiment, Azasite regiment, or something similar to address the inflammed glands.

As noted in an earlier post. It is thought that close to 30% of patients with evaporative dry eye also have an aqueous component. We often look at the patient 6 months post op LipiFlow to see if Restasis may be beneficial. Some patients are very happy, and we don't pursue Restasis at that point. Others who may not have tried Restasis in the past may be a better candidate now that the evaporative component has been addressed. The old battery of tested used for checking for aqueous deficiency are so variable that it's best to treat the MGD component if there is one, as it is so much easier to see and diagnose. I'll put in here that if the patient has the dry eye workup, and everything looks good from a evaporative dry eye component (no partial blinks, good gland structure, healthy oil secretion), we will most likely start with Restasis if the patient has not tried this option before doing the LipiFlow.

Noctural Lagophthalmus - I found about a year ago that I have this issue myself. My wife noticed on the few occasions that I fell asleep before her that my eyelids stay open a little when I'm asleep. I can be completely asleep, and she can see the whites of my eyes, and even the very bottom of my blue iris while asleep. This is obviously an issue, as all night long air is blowing across my eye if we have the overhead fan on, or the heater on, or the window open. I always recommend that if the patient lives with someone, and they don't mind being watched in their sleep, that they have someone check if this is going on. Chances are very high if you wake up with dry cracked eyes.

Alright, after reading all that, take the time to do some blinking exercises. Your eyes are probably pretty dry from looking at the screen so long! Take a break. I know I need one!!

TAKE HOME MESSAGE:

1. DRY EYE IS A CHRONIC ISSUE. Most people are on this forum because they are miserable, and they have been for a long time. We want an easy out. We want to take something for a week, and then be done with dry eye. IF THE BEHAVIOR MODIFICATION (linked blinking to daily tasks) DOES NOT OCCUR IN EVAPORATIVE DRY EYE, NO SIGNIFICANT CHANGE IS EXPECTED. I preach this to patients all day long, and I forget to do blinking exercises myself occasionally. In writing this tomb of a post, I've worked intently for over an hour, and hardly blinked. But as soon as I look away from the computer, I do my exercises. ALSO: It's important to note that if you only do your blinking exercises when your eyes are dry, you are always playing "catch-up". The evaporation has already occurred, and you're not making a change. The best thing to be doing is blinking exercises when your eyes are NOT dry (which for some of us is never, I realize).

Thanks for your time.

DocwithDryEye

Sorry, I don't know how to select specific condensed quotes so I included the whole long post.

The Pre/Post Lipiflow Procedure you mention are basically exactly what we've ALREADY have been doing.

The only "new" POST LIPIFLOW I read was the use of of Lotemax after the treatment. I asked my opthamologist about Lotemax use Post-Lipiflow and he had not used it or knows of any colleagues using that after treatment. Why do the patients at your practice treated with Lotemax after Lipiflow?

So, I don't understand why your Lipiflow works so well. I recall you saying something about 100 patients, happy, no complaints. Sorry if the number is incorrect. If one reads the Lipiflow CONTRAINDICATIONS, how many people out of the 100 treated has your practice have to turn away?

I can certainly understand if the 100 or so patients with great results have none of the Lipiflow Info Site list of contraindications.

Too many people with the listed contraindications are still having the Lipiflow treatment done per recommendations of their doctors...I think that's unethical
practice.

I had TWO separate evaluations, the whole pre-test stuff KNOWING of the contraindications yet BOTH Independent Practices tried to schedule me to have Lipiflow performed the SAME DAY.

Lastly, I went to a large teaching hospital in Durham, North Carolina, where the physician is involved with Lipiflow research, and even has a FINANCIAL INTEREST in the Lipiflow, he said I WAS NOT a candidate and so he wouldn't perform the procedure.

P.S. DocwithDryEye, PLEASE private message me with a way that my opthalmologist in Durham, North Carolina, ( He's a Clinical Professor at the university teaching hospital) so that you both can discuss this treatment plan so that he'll be able to treat more patients with greater success. Thank you.

[Santaklauzz]

Hi, Max

The product is called Indocollyre 0.1%. Its active ingredient is indomethacin.
(And the anti-allergic drop is N-acetyl-aspartyl)

[Max52]

Quick update:

For the first time in more than two years, I have the feeling that my eyes are improving a bit instead of getting worse.
The difference is only minimal, but still. When I'm studying at home, I can have hours on end that my eyes don't bother me now.
I also used to have very bad eyes in the morning. Like they were glued together. But that has improved as well.
But the most striking thing happened this morning: Most days I have to go to class by bike (if I can go to class at all) and for the past years, that has meant hell.
But the discomfort I had today was almost nothing compared to what it used to be. I almost enjoyed it!
The sun on my face, the wind in my hair, the smell of spring... I pictured all the things that I'll be able to enjoy again if this mess ever heals.
I can't describe how great it feels to have hope again. To remember how it was to be normal.

It's very well possible that this 'good' period is just a fluctuation. Maybe my eyes are worse again next week.
But I don't think this is a coincidence. My MG's are open and working thanks to doxy and MG probing.
And now that I'm on Restasis + non-steroidal anti-inflammatory drops + anti-allergic drops, my eyes might be going back to normal slowly.
I will certainly keep you guys updated. Hopefully, more positive news will follow...

Hi...can you tell me what the non-steroidal anti-inflammatory drop is you're using?

[cathy8889]

That's great news

[Santaklauzz]

Quick update:

For the first time in more than two years, I have the feeling that my eyes are improving a bit instead of getting worse.
The difference is only minimal, but still. When I'm studying at home, I can have hours on end that my eyes don't bother me now.
I also used to have very bad eyes in the morning. Like they were glued together. But that has improved as well.
But the most striking thing happened this morning: Most days I have to go to class by bike (if I can go to class at all) and for the past years, that has meant hell.
But the discomfort I had today was almost nothing compared to what it used to be. I almost enjoyed it!
The sun on my face, the wind in my hair, the smell of spring... I pictured all the things that I'll be able to enjoy again if this mess ever heals.
I can't describe how great it feels to have hope again. To remember how it was to be normal.

It's very well possible that this 'good' period is just a fluctuation. Maybe my eyes are worse again next week.
But I don't think this is a coincidence. My MG's are open and working thanks to doxy and MG probing.
And now that I'm on Restasis + non-steroidal anti-inflammatory drops + anti-allergic drops, my eyes might be going back to normal slowly.
I will certainly keep you guys updated. Hopefully, more positive news will follow...

[lizlou29]

Hi Liz
He didnt really give me a treatment pland. He prescribed me Sno Tears for day use and Viscotears gel for night time use. Both of which irritate my eyes terribly. I felt like it was a waste of money seeing him, I have some kind of diagnosis now which is only thing that came out of it.

He didn't use any anaesthetic, would they usually use this under a thorough examination?

My pinguecula are constantly inflamed because of the dryness and they make me so depressed, I feel like I dont have the tools to make dry eye better, I went through 6 systane vials yesterday.

Thanks for your message

Catherine

I just ask about the anaesthetic because this can produce a different result with the Schirmer's test. Theoretically a Schirmer's test with anaesthetic evaluates baseline secretion whereas a Schirmer's test without anaesthetic evaluates baseline secretion plus reflex tears so it is important to have the same one every time to be able to compare. That is how it has been explained to me anyway.

Couldn't stand Viscotears, have never used Sno Tears. Vita Pos which you can get through a GP in the UK and Systane Gel are good for me at night. I am sensitive to just about everything. I have MGD and aqueous deficiency and use Systane Ultra UD preservative vials in the day time. Do you use an eye mask at night or do you not like the pressure? The Onyix has been the best for me but a lot of people like Tranquileyes. I don't like pressure on my eyes as I have sensitive eyelids. I have a TBUT of around 3 secs and a barely non-existent Schirmer's 1 result so I understand this is painful!

I don't have a good understanding of pinguecula I'm afraid so I hope someone else chimes in. I went through numerous Ophthalmologists until I found a good one to work with. A hell of a lot of it is trial and error which you are probably finding out. If it is MGD normally you would be prescribed Doxycycline or another tetracycline derivative depending on the severity of the condition.

[cathy8889]

Hi Liz
He didnt really give me a treatment pland. He prescribed me Sno Tears for day use and Viscotears gel for night time use. Both of which irritate my eyes terribly. I felt like it was a waste of money seeing him, I have some kind of diagnosis now which is only thing that came out of it.

He didn't use any anaesthetic, would they usually use this under a thorough examination?

My pinguecula are constantly inflamed because of the dryness and they make me so depressed, I feel like I dont have the tools to make dry eye better, I went through 6 systane vials yesterday.

Thanks for your message

Catherine

[lizlou29]

Thanks for this post doc with dry eye, it's been really useful especially the bit regarding evaporative dry eye. I was just wondering if you or anyone could help me please. I'm hoping for an appointment with a dry eye ophalmologist as I would like a second opinion. I saw an olphalmologist a month ago and he told me that I have aqueous tear deficiency and seborrhoeic blepharitis but I do not have MGD. I don't think my problems are just down to aqueous tear deficieny though. My tbut time is 4 seconds in left eye and 3 seconds in right, from what I have read this can indicate that MGD could be present, I don't feel like the olphalmologist examined my glands at all, he pulled my bottoms eyelid down only for a second and definitely did not try and secrete any oil. Do you think an olphalmologist can rule out MGD just from looking at my glands for a second? Can evaporative dry eye be purely due to aqueous tear deficiency? My schirmer created about half the normal punt in each eye, I was never told the exact mm measurement. Any help or advice would be appreciated, trying to convince my gp to send me to see an olphalmologist via the nhs as there budgets are so rubbish is not easy.

Kindest regards

Catherine

Obviously not an expert here but the schirmer's test isn't the best diagnostic tool. Was it with or without anaesthetic? I believe that all good Opthalmologists will examine the MG's by pushing just below/ above them to see the quantity and quality of the oil. What treatment plan did he give you?

[cathy8889]

Thanks for this post doc with dry eye, it's been really useful especially the bit regarding evaporative dry eye. I was just wondering if you or anyone could help me please. I'm hoping for an appointment with a dry eye ophalmologist as I would like a second opinion. I saw an olphalmologist a month ago and he told me that I have aqueous tear deficiency and seborrhoeic blepharitis but I do not have MGD. I don't think my problems are just down to aqueous tear deficieny though. My tbut time is 4 seconds in left eye and 3 seconds in right, from what I have read this can indicate that MGD could be present, I don't feel like the olphalmologist examined my glands at all, he pulled my bottoms eyelid down only for a second and definitely did not try and secrete any oil. Do you think an olphalmologist can rule out MGD just from looking at my glands for a second? Can evaporative dry eye be purely due to aqueous tear deficiency? My schirmer created about half the normal punt in each eye, I was never told the exact mm measurement. Any help or advice would be appreciated, trying to convince my gp to send me to see an olphalmologist via the nhs as there budgets are so rubbish is not easy.

Kindest regards

Catherine

[unicorn]

Thank you for replying, DWDE. Yes, it's a high dose of Azithromycin, isn't it - hence my question about switching to Efracea/Oracea. (I didnt expect to be told 'it doesn't exist', though!)

Addressing the route cause is key, as you say, and for me I think this is largely stress and anxiety. I'm starting to think blepharospasm may also be involved.

Another problem I face is that any sort of pressure on my lids to express the glands seems to cause a lot of inflammation which makes things worse (I have rosacea). Hence being very sceptical about Lipiflow.

I am doing what I can to keep the oil clear by using a gentle warm compress once a day and taking fish oil, flax oil, and have recently added Sea buckthorn oil. I am going to stop taking the Azithromycin (I don't have any heart problems, by the way, but thanks for the warning!) and see how things go.

[DocwithDryEye]

Just venting a little. I had lipiflow about 3 weeks ago and although I've read thru this thread that it could take 3 months or longer, I thought I'd feel SOMETHING. Some kind of change, even minor, but so far nada, so doubt as to whether this will work for me is creeping in.

Sorry to hear that Max52.

I would recommend our usual regiment of triglyceride fish oil twice daily, warm compress, and blinking exercises, as well as good water intake. Hope you start to feel relief at some point.

DWDE