Storm - MGD

[Storm]

I've struggled with MGD (Meibomian Gland Dysfunction) for over 2 years and I hate it as we all do.

Today I am using drops, heat packs, ointments, gels and punctal plugs. My punctal plugs have almost dissolved and its time to get new ones. So far for me punctal plugs gave me the most relief.

Today I went to Herzig Eye Institute (in Toronto) for an assessment and will be going for the new treatment called Lipiflow December 9. Doctor said 1) my eyes were very dry and I may never be able to get by without drops 2) I do not close my eyes completely when I blink, so I have exercises to do 3) treatment sometimes takes 4-6 weeks to provide relief 4) don't use eye drops with preservatives more than 4 times a day. He recommended Refresh Plus, I have been using Systane Ultra 5) prescribed Tobradex ointment to prepare for the procedure. This procedure cost $750 each eye.

I'm hoping for a great Christmas present from Herzig this year.

Love this web site. I have gotten some important information from this site.

[tearless2]

Keep us updated after your December 9th appointment. Waiting 4-6 weeks for relief after the procedure probably doesn't sound that bad compared with the last 2 years of struggling with MGD.

Why did he prescribe Tobradex to prepare for the procedure? Is that typical?

I hope it works for you!

[Storm]

Tobradex was prescribed because it was and anti-inflammatory ointment

[Hopeful2]

Hi Storm,

I am happy to hear your enthusiasm. I am going down for an assessment at Herzig on December 16th. I am looking forward to hear what Dr. Patel has to say. I know I am improving with the supplements and exercises I am using. It would be good to know about status of lipid layer and blink closure. I'm not sure I blink the same way after lasik : (

Do you know if the Tobradex has a preservative?

Looking forward to hearing how it goes. Sounds like a patient, multi faceted approach will work best.
Hopeful2

[spmcc]

Today I went to Herzig Eye Institute (in Toronto) for an assessment and will be going for the new treatment called Lipiflow December 9.

I had my third LipiView this past week. Here is my progression:

• July 9 - - OD= 38nm ±3 - - - OS= 43nm ±4 - - - had LipiFlow in Toronto ON
• Aug 25- - OD= 40nm ±10 - - OS= 46nm ±12
• Nov 23- - OD= 45nm ±3 - - - OS= 57nm ±4 - - - had LipiFlow in Richmond BC

I was told that <50nm is severe. Normal is >70-75nm.

If anyone is going for LipiView, please follow their instructions:

Do not use any natural tears 4 hours prior to your visit, no ointments 24 hours prior to your visit, refrain from restasis for 24 hours prior to your visit and no makeup.

This way you'll get the most accurate readings of your lipid layer thicknesses.

[jenny2008]

So are you feeling a lot better? You have had 3 treatments ? I cannot imagine going without drops that long.. wow.. i use them every few minutes in my left eye.. wow.

[spmcc]

You have had 3 treatments?

No, I've had three assessments (aka LipiView).

I've had 'only' two treatments (aka LipiFlow). I will mention that to-date the research has NOT shown that two treatments are better than one. But I went for it because I didn't think it could hurt.

I cannot imagine going without drops that long.. wow.. i use them every few minutes in my left eye.. wow .

I used PF saline for 24 hours prior and stopped everything 4 hours prior. It wasn't bad because I ALWAYS have my eyes covered 24/7.

So are you feeling a lot better?

Yes, I'm feeling better... but I am cautiously optimistic (as everyone is who has suffered from this for years and had many failures).

I also need to qualify my remarks by explaining that I've been on a blitz the last 1+ year. I've had 4 IPL treatments specifically for dry eyes, two probing with ******, all puncta sealed (3 cauterized and 1 sutured), and now two LipiFlow treatments. I also wear Wileys ALL day and seal my eyes at night.

But right now I'm using only PF saline at night (altho I keep Lotemax, Azasite, Vigamox, Restasis, and Systane Balance nearby). But this is an improvement.

In my general opinion, however, I would say that LipiFlow has been the best treatment for me so far (along with having all puncta sealed and wearing Wileys). I would rank it above IPL and certainly above probing for MGD treatment.

BTW my diagnosis is ocular rosacea since 1995.

[tearless2]

I am so excited for you. I have aqueous deficiency not MGD, but if I did, I would be driving to Richmond BC to get this done...and then I would go out for dim sum there

Do the doctors think that you may be able to get to 75? What is the most improvement someone has gotten from this?

[spmcc]

Do the doctors think that you may be able to get to 75?

No one has promised anything (unfortunately).

What is the most improvement someone has gotten from this?

I haven't seen any study results showing data (let alone huge jumps in numbers). Hopefully, those studies are to come. The only abstracts I've seen are these:


http://www.ncbi.nlm.nih.gov/pubmed/21281063 (2011 - Korb - LipiFlow - but no LipiView)

http://www.ncbi.nlm.nih.gov/pubmed/20531168 (2010 - Korb - LipiFlow - but no LipiView)

http://www.ncbi.nlm.nih.gov/pubmed/19574906 (2009 - Korb - gives measurements in nm)

http://www.nature.com/eye/journal/v1.../6700224a.html (2003 - Korb - lipid layer thickness)

http://www.ncbi.nlm.nih.gov/pubmed?t...0Cornea%201994 (1994- Korb - lipid layer thickness and blinking)

http://www.ncbi.nlm.nih.gov/pubmed/15590483 (2004 - a review - don't know if it gives measurements)



If someone knows of any abstracts that I've missed, please let me know.

[Storm]

Well I had my LipiFlow treatment Friday and so far my right eye hurts as much as ever (Its only been 3 days). I know I have to wait 2-6 weeks for possible improvement. Dr Patel never gave me any numeric readings; but I'm going to ask him next time i see him Jan 5.

I used Tobradex just up to the LipiFlow procedure to prepare for the procedure.

I've switched to Thera Tears eye drops which are preservative free although it took about 3 days to get used to.

[Storm]

Follow-Up

Its been 2 weeks now since my LipiFlow. There is no significant improvement yet; but they may not be untill 4-6 weeks.

The one thing I noticed after heating my eyes for 5-10 minutes is that there is usually an abundance of fluid in the eyes. Its seems like it might be oily substance because it feels quite comfortable. It lasts about 15 minutes.

I did find out that my LipiView readings for Lipid layer before LipiFlow were:
Right Eye - 31
Left Eye - 37
This is considered Severe Dry Eyes.

I'm hoping for the best.

[ScottishDave]

The one thing I noticed after heating my eyes for 5-10 minutes is that there is usually an abundance of fluid in the eyes. Its seems like it might be oily substance because it feels quite comfortable. It lasts about 15 minutes.

I get that every morning after heating/massaging. I agree that it does feel quite comfortable.

[Hopeful2]

Hi Storm,

I had my lipiview last week, with 34 in drier eye and 30 for other eye.

I was told my glands are open and secreting meibum, but that the quality of the meibum is not good due to blockages in the glands. Did they explain to you how the lipiflow would improve your glands and secretions?

After compresses I now notice that my eyes feel moist, but not cloudy. Several months ago when I did compresses my eyes would just feel dry. I also notice that the secretions appear almost pinkish when pooled inside behind my eye lids. Yesterday, after expressing my glands I noticed there was a shimmering along lid line (like oil slick). Have you noticed this effect?

Do you also wake up in the morning with some grittiness in your lashes? I use Refresh PM at night and wonder if this is residue of the lubricant.

The lipiflow docs do say it could take 4-6 weeks to notice improvement. I would not give up hope

Let us know how it goes. I may go back for the actual treatment in January.

[Storm]

To Hopeful2
I've never noticed any cloudiness or pinkish fluid in my eyes. My eyes seem clear. Before Lipiflow I did get tiny grains of sand on my eyelashes and some debris or crusting; but not a log. I've recently switched to Thera Tears eye drops and Refresh Celluvisc which are both preservative free. This seems to have reduced the debris on my eyelashes.

Here is my daily regiment:

Heat eyes twice a day. I try to express the lids afterwards with a Q-tip; but I don't know if I'm doing it correctly or if it is doing anything.
Clean the margins after the above, with Lid-Care Towelettes (The towelettes have baby shampoo in them)
Use Thera Tears or Refresh PM every 20-60 minutes
Use Refresh Celluvisc if my one eye hurts too much. It makes eyesight blurry; but it feels good.
At night I use Refresh Celluvisc and tape my eyes closed.
Drink 8-10 cups of fluids a day. (This has helped my dry lips)
4000 mg of Fish Oil. (I think the idea behind this is to improve the quality of the oil produced by the eyes)
Doing the blinking exercise for 20 seconds every 20 minutes. (Definitely helps)

Other unrelated:
Walk 30 minutes each day
Daily vitamins
Take HRT (Hormone Replacement) and synthroid (thyroid hormone)

Wishing you the best Hopeful2. Do you go to Toronto?

[Storm]

To spmcc

In the readings that you gave, are they after Lipiflow or at the time Lipiflow was given.

For OD measurement: You show an improvement of only +2 (38-40) in one eye after a month and then +5 (40-45) in November. This doesn't seem like much for 2 treatments? Maybe I have mis-interpreted your numbers.