LipiFlow device - what the????

[Sammy B.]

I love the pic of the eye that obviously shows zero signs of dry eye issues, BTW.

http://www.medcitynews.com/2012/02/h...edical-devices

[icenet]

Hi All,
Just returned from my Lipiflow evaluation at Dorris Stein(UCLA). I was surprised how badly I scored given that my DES is mostly tolerable compared to others. Here is what I learned:
1.) My blinks don't close all the way. I was given a blinking exercise to do one hour per day, every ten minutes Can this really help?
2.) My Lipiflow score was 35 in the right eye and 41 in the left. The Doc said you should score 70 and above to be normal. 50-70 you start to see problems.
3.) I was tested for active meibomian glands. Not good. Right lower eye lid had 4, the left had 2. I was told they like to see at least 5 working for best results from the treatment. By the way, he used very light pressure for the test.

No surprise the doc said Lipiflow would help my DES. He put it at 9 months. For $1500, that's a large sum for a condition I can manage. What I don't know is if the treatment is preventive down the road for worsening symptoms. What should I do? Thanks!!!!

[Hopeful2]

HI icenet,
Thanks for sharing your Lipiview experience with everyone. This is such a new procedure, done on a pretty small segment of the population, that there isn't a whole lot of unbiased information available. It is really important for people to use this site to post about there experience. This probably is the only way that we can obtain unbiased testimonials.

I had Lipiview done and chose not to undergo the Lipiflow. My numbers were a little lower than your's, however, I can tell that all or almost all of my lower ducts are open. They may not be making a lot of high quality lipid, but they are working. When I run my finger along my lower lids, I can feel moisture on my eye. I suspect the uppers work as well, as the same thing happens. I just can't see the pools of oil when I press on the glands.

I wasn't satisfied with the answers I was given when I asked how the procedure would improve the quality of my lipids. I also was not given any info as to how Lipiflow improved the aqueous and mucin layer of the tear film. They are really all interconnected, and dry eye is seldom just a problem with one layer.

To address you questions;
1) I do think blinking exercises can help. I notice that I blink more when I do not use as many drops. . . maybe this improves the lacrimal system. If your blinks don't close all the way there may be a possibility that your eyes don't close all the way when you sleep. This can be very common and can exacerbate dry eye symptoms. Have someone check on you a few times when you are sleeping.

2) My scores where about 30 and 34. I had come in from a windy walk to the centre and my eyes did feel dry. I asked if maybe we could wait and let my eyes reestablish their baseline setting. The technician waved off this idea and suggested we start the Lipiview right away.

3) I understand that for some people not all glands are secreting at the same time. Light pressure could make a difference in terms of the number that are secreting. What do you see with a 10X mirror? What do you feel when you rub under your lashes on your lower lids?

The Lipiflow procedure is not without some risk. I would read over all of the risks before proceeding and be sure that the benefits outweigh any of the risks. There is a poster here who believes that the procedure actually made her eyes feel worse off.

In any case, keep us posted. Even though dry eye is different for all of us, we can still learn from each other's experience.

[icenet]

Thanks Hopeful2. I'd be happy to help all those on this site as much as possible.

Interesting. How can all your glands be open yet your scores were lower than mine? My issue with the pressure was that when I saw Dr. Latkany, he showed me how to use a Q-tip to open the glands. He "pushed" into lid while pulling. Dr. Hamilton used what felt like a tiny brush with very light pressure. I'll have to get a stronger mirror to inspect my lids. Can't see much as is. They do feel dry.

[icenet]

Chemia, thanks for clearing that up for me. Makes sense that the pressure should be equal to an eye blink and not a q-tip. They did offer me the option of doing Lipiflow on one eye only. Unfortunately, both my eyes are about the same as for symptoms.

[Rebecca Petris]

...on February 1st. Yikes, I'm behinder than I thought I was. Sorry about that.

[Rebecca Petris]

Interesting article from last month mentions a few practical items that interested dry eye patients might want to know...

How TearScience’s dry eye treatment sparked a new FDA 510(k) strategy
MedCity, 7th Feb 2012

One piece of the commercialization puzzle that TearScience has yet to solve is reimbursement. Insurers do not yet pay for LipiFlow treatment and though the company has applied to instate reimbursement, Willis estimates the entire process can take anywhere from three to 10 years. For now, patients pay between $1,400 and $1,900 out of pocket for a treatment on both eyes that lasts nine to 18 months. Willis said that considering that some people with moderate to severe dry eye are already spending up to $4,000 annually on other remedies, patients are willing to pay. For a physician’s practice, the entire TearScience diagnostic and treatment system costs about $100,0000.

[Rebecca Petris]

A Single LipiFlow(®) Thermal Pulsation System Treatment Improves Meibomian Gland Function and Reduces Dry Eye Symptoms for 9 Months.

Purpose: To evaluate the effect of a single treatment with the LipiFlow(®) Thermal Pulsation System on signs of meibomian gland dysfunction (MGD) and dry eye symptoms over a 9-month period. Methods: Patients (n = 42 eyes, 21 subjects) diagnosed with MGD and dry eye symptoms were recruited for a non-significant risk, prospective, open-label, 1-month clinical trial. Patients received a single 12-minute treatment using the LipiFlow(®) Thermal Pulsation System on each eye. The LipiFlow(®) device applies heat to the conjunctival surfaces of the upper and lower inner eyelids while simultaneously applying pulsatile pressure to the outer eyelid surfaces to express the meibomian glands. Patient symptoms were evaluated using the Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation for Eye Dryness (SPEED) dry eye questionnaires; tear break-up time was measured with the dry eye test (DET™); and meibomian gland function was evaluated using a standardized diagnostic expression technique. Data are presented for patient's pre-treatment (baseline) and at 1-month and 9-month post-treatment. Results: Meibomian gland secretion scores improved significantly from baseline (4.4 ± 4.0) to 1-month post-treatment (11.3 ± 6.2; p < 0.0001) and this improvement was maintained with no significant regression at 9 months (11.7 ± 5.9). Similarly, baseline tear break-up time (4.8 ± 3.2) was significantly increased at 1 month (9.6 ± 7.6; p < 0.001) and this increase was maintained with no significant regression at 9 months (7.1 ± 5.6). Symptom scores on both OSDI and SPEED questionnaires improved significantly at 1 month (p < 0.0001) and this improvement was maintained at 9 months. Conclusion: With such prolonged improvement in signs and symptoms of dry eye disease, the LipiFlow(®) Thermal Pulsation System offers a technological advancement for the treatment of dry eye disease secondary to meibomian gland dysfunction. A single 12-minute LipiFlow(®) treatment results in up to 9 months of sustained improvement of meibomian gland function, tear break-up time and dry eye symptoms that are unparalleled with current dry eye treatments.

Curr Eye Res. 2012 Feb 10. [Epub ahead of print]
Greiner JV.
Source
Schepens Eye Research Institute and the Department of Ophthalmology , Harvard Medical School, Boston, MA , USA.

[Rebecca Petris]

I guess it's nice to have some hopeful reports like this to round out some of the less impressive results I've been hearing from some of the patients. What we'll all think of it 3 years down the road is anyone's guess at this point.

Case Report: A Successful LipiFlow Treatment of a Single Case of Meibomian Gland Dysfunction and Dropout.

OBJECTIVE:
The aim of this study was to investigate whether a single case of meibomian gland dysfunction (MGD), with significant MG dropout resulting in evaporative dry eye, could be effectively treated with the LipiFlow (a new Food and Drug Administration-approved thermodynamic pulsatile treatment).

MATERIALS AND METHODS:
A 39-year-old white woman experienced severe dry eye symptoms because of MGD with considerable MG dropout resulting in evaporative dry eye. Standardized diagnostic MG expression and meibography led to the tentative diagnosis of nonobvious MGD (only 1 functional MG on each lower lid) and MG dropout (∼50% of the lower lid MGs were missing with the remaining MGs being severely truncated). The patient underwent a single 12-min LipiFlow treatment per eye and returned for follow-up at 1 and 7 months posttreatment.

RESULTS:
The LipiFlow treatment increased the number of functional lower lid MGs from 1 to 5 glands OD and 1 to 7 glands OS at 1 month with slight regression at 7 months (4 OD and 4 OS); increased fluorescein break-up time from 4 to 7 sec OD and 4 to 9 sec OS at both 1 and 7 months; and decreased symptom scores by approximately 50% at 1 month and approximately 75% at 7 months.

CONCLUSIONS:
These results demonstrate the effectiveness of the LipiFlow in restoring MG function and improving ocular comfort even in this particular case of significant MG dropout and MG truncation.

Eye Contact Lens. 2012 Mar 12. [Epub ahead of print]
Korb DR, Blackie CA.
Source
Korb Associates (D.R.K., C.A.B.), Boston, MA; and TearScience Inc. (D.R.K., C.A.B.), Morrisville, NC.

[Sammy B.]

Finally! Finally.

http://palmharbor.wtsp.com/news/news...ease-treatment

[Hopeful2]

Hi Rose

Congratulations!!! I loved being pregnant . . . I hope that you sail through it. It is truly such a miraculous experience.

Your lipiview scores are better than mine. I was about -33 in both eyes. Did they give you any blinking exercises for the partial blinking?

I really hope the Lipiflow brings lasting relief!

[tornado]

Hello everyone, I'm an Italian patient in venice, here we are not talking about these issues, I would like to know if among you there are people who are positive Schirmer test. I am completely without tears and aqsciutto, I use the drops, and my eyes are fine, I noticed that at intervals of 1 month my Western are full of sand, and I also see how if I had a white veil in front, I do inpacchi of fresh water for relief, sometimes I take off my eyeballs so I ended up suffering, many of you were subjected to the treatment of lipoflow? and if it works in cases like me, I hope to dear friends, thank you all
mooris

[cricketburglar]

I had Lipiflow done in MN. I had only 5 functioning glands per lid and only after the surface was scraped with a scalple and squeeze. Anyway, I saw NO improvement from Lipiflow. My follow-up visit showed no improvement...still only 5 working glands and only after scraping and pressure.

Was a big waste of hope and money for me.

Stacy

[tornado]

Hello everyone, I'm an Italian patient in venice, here we are not talking about these issues, I would like to know if among you there are people who are positive Schirmer test. I am completely without tears and aqsciutto, I use the drops, and my eyes are fine, I noticed that at intervals of 1 month my Western are full of sand, and I also see how if I had a white veil in front, I do inpacchi of fresh water for relief, sometimes I take off my eyeballs so I ended up suffering, many of you were subjected to the treatment of lipoflow? and if it works in cases like me, I hope to dear friends, thank you all
mooris

[Tankie]

Hi everyone,

I just had LipiFlow done yesterday (June 13, 2012) and I just wanted to share my results with everyone. I've decided that I don't want to say anything with regards how I feel right now because it's too early to tell. I'll make another post in about 30 days with regards how I am feeling.

(LipiView from November 17, 2011)
(LipiView from June 13, 2012)
(LipiFlow from June 13, 2012)
(Blinking exercises from June 13, 2012)

[spmcc]

@spmcc:

You're going to kill me, but I never did a LipiView this time around. Sorry! Maybe I'll do one when I go back in September.. it all comes down to if I have the money.

I'm not going to kill you (grrr). FYI My follow-up LipiView (when I returned to the place that did my LipiFlow) was free. Check with them. It should be freeeeeeeeee!

[grant555]

this seems to be the trend with lipiflow. positive lab results but no one ever seems to actually feel better. only way to treat mgd is to treat the cause of it. if i remember your diagnosis tankie, you have lagapthalmos (like me). the only way our glands are going to start working is if we get our blinks to fully close and express the glands every blink. until then, relief is doubtful unfortunately.

[Tankie]

@spmcc:
I was told that I would have to pay for a follow-up LipiView. I'll definitely ask the doctor the next time I'm there just in case I was mislead and done out of a free LipiView.

@grant555:
I hear what you're saying. Having said that, I've had several surgeries and my lagophthalmos is a lot less problematic than it used to be. I'm counting on the doctors telling me the truth at my last appointment, and that my glands really are producing a ton more oil. If this is the case, I would say there's a very good chance I could see some relief in the near future. I'll keep you posted either way.

[caroline929]

Hi there,

I suffer from MGD for almost 8 years. Maybe caused by Accutane when I was younger? I don't know. I don't wear contacts and I never did the Lasik surgery.
As many of you, I have tried tons of things to get better: Asazite, lotemax, restasis, punctual plugs, acupuncture, Omega3 all over the place etc... you name it, I did it!
Warm compresses and eyelid cleaning foam have helped, everything else has not.

I haven't tried the probing or the laser yet.

I made an appointment at UCLA with Dr Rex Hamilton for an evaluation and maybe a session of Lipiflow if I'm a good candidate.

I'll probably do only one eye to start. I would love to get more feedbacks on this new procedure. According to what I read so far on this forum, the results don't seem outstanding. I'm desperate and I really feel the need to do something about it (something that I can afford). The laser and the probing are much more expensive than the lipiflow and the feedbacks on these 2 procedures don't seem better than the ones on the lipiflow.

I would love to hear from anyone who got a successful result with any of these new procedures.

Thank you all

Caroline

[spmcc]

I'm so happy for you, Rose! Your Home Depot story was wonderful (really!!).

All the best,
Sheila

[Emerald]

Rose,
your experience is encouraging, so glad you have gotten relief!! Still no change here..haven't tried doxy yet, but suppose that is the next option.

[gichamp]

LipiFlow

I had LipiFlow done a couple of weeks ago and feel I have had some improvement, but it has not yet been a miracle. I had the treatment in Charlotte, NC and I will say I did appreciate the very thorough eye exam and testing that preceeded the Lipiflow - more than I have received with my eye doctor over the last 5 years. The doctor also examined my eyes after the procedure to make sure my lower plugs were unaffected by the Lipiflow and he said to me at that time that I definately had more glands working than prior to the procedure, but as he said, the trick is for them to keep working. I have a follow-up appointment in 10 weeks to see how the glands are working.

I am encouraged by some of the posters who have stated that it takes time to see the full effect because the information provided on Lipiflow is really not very clear whether results will be known immediately or over time. I would appreciate dialogue with anyone who has had the procedure.

[Sammy B.]

All,

I had Lipiflow around June 4th and I figured I would supply everyone with an update.

I have more comfort most definitely. There is no more scratchiness or pain throughout the day. Only late at night just before bed do I experience problems.

I also have switched from Genteal Gel at night to Soothe XP ointment with a saline flush every morning.

Perhaps it's the new combination or just the Lipiflow or something in my water supply... But things have definitely improved and I'll take it!

Rose

[robster]

When you went for your Lipiflow were they able to tell you how many of your glands were blocked beforehand and will they tell you how many of your glands are blocked at your follow-up appointment?

[Sammy B.]

Rob,

When I went in initially, they said I had about 2-3 glands open on each lower lid (they did not test the uppers).

I have yet to go back for my second visit.

Rose