IPL Update

[jimi51]

Hi,
I had originally posted in a section just for IPL but the thread seemed to die after I posted last. At the request of Sammy B., here is my latest update. I am a post LASIK mess and I am 22 months in to it. I saw Dr. Assil in Beverly Hills , Ca four times now for the IPL treatments. While they say I am a good candidate for the procedure and my oils are still like "toothpaste," I can't honestly say if I have benefited from the treatments much. And to re-cap, I was told by all other doctors that I had no signs of MGD but all the staff I have seen at the Assil Eye Institute have said otherwise! I still have miserable days and most evenings I can't even stand the pain. I really like going to their office, the staff is incredibly nice and I always walk away with a sense of hope. My last visit (#4) was a month ago, Dr. Assil removed my lower silicon plugs before the treatment and offered me temps to see how it was going. Four days later I was back at my regular Docs for new silicons. I am scheduled to return on the 5th of November, I'll let you know as this is definetly my last treatment as I am broke!

On another note, I have been in contact with the BFS, one of the Drs. here in Southern California. I spoke with the doctor yesterday and she was explaining to me that the lens they offer may help me but was concerned that I might have something more than dry eye but also nerve damage from the surgery that they are beginning to see more of from LASIK even up to four years later. I am making plans for a visit to see her at the Doheny eye Center in LA. and will see what they can do.

I am feeling a bit hopeless myself, I can't lie, but I am holding on to the chance that things can still get better, I know one thing for sure, I can not afford this anymore! The IPL's are very expensive and I can't even imagine what the lenses will cost me if that is even an option. Anyway, thanks and God Bless

Brad

[Sammy B.]

Brad,

Thanks for posting this - it definitely keeps everyone in the loop.

I saw your other post about plugs helping your symptoms. It has been my understanding that if plugs work, what you may be experiencing is more aqueous-deficient dry eye than lipid-deficient. So perhaps that is why the IPL did not "work"?

I think anyone who has had any sort of eye surgery has nerve damage, LASIK just goes a little deeper than most surgeries. It is very scary to think about. I have everything crossed for you that you find the holy grail in the scleral lenses. If you fail at BFS, try Dr. G. in Texas. I've heard rave reviews about his lenses as well.

The important thing to remember is that you are not out of options!!

Rose

[Guest]

I'd ask your doctors about trying something like Pilocarpine. A lot of people don't tolerate it very well, but if you are lucky, maybe you'll be ok on it. Assuming you don't have any contraindications to its use, it's worth a try... you could just get a small number of tablets to try it out... that way, if worst case you don't tolerate it, you aren't out that much money.

I just started pilocarpine recently... I didn't really think it would help me because it seems like most of the small number of people I've seen here who have tried it have had no luck with it... but so far, I can definitely feel a noticeable increase in tears after I take it... needless to say, I'm thrilled!

[jimi51]

Thanks for the uplift Rose, I'll take that as my daily word of inspiration which I try to find each day. SAAG, could you please give me a bit more info about Pilocarpine? I must admit I have never heard of it before. I have very responsive drs. when I ask for certain things so maybe it's worth a try. I have decided that I will go for the 5th (and final) treatment with Dr. Assil as they seem convinced it should be working.

With the plugs issue, I find that I have tear "overflow" from the am until about 7-8 PM and then it quickly deteriates to the need for Genteal Gel which I use every night as to not have any more erosions. When they removed the lowers at Dr. Assils, the optometrist installed two temps that must of fallen through immedialty because I had no relief until my regular Dr. put the silicon ones back in. But I have to say, the upper plugs hurt as they rub on my sclera..Thanks again for the reply guys

Brad

[tearless2]

plugs rubbing on sclera

I do not think your plugs should be rubbing on your sclera. You should consider going back to the eye dr and having them put them in better.

When my optometrist first put mine in I said they rubbed just a little bit but I was so hopeful to end the pain of dry eye that I didn't mind a little irritatation from the rubbing. My Dr said I should not feel any sensation and proceeded to adjust them more deeply into the puncta. I do not feel them at all now.


Saag, that's good news on the pilocarpine as I think that might be the next treatment for me.Thanks for the update.

[jimi51]

Hi,I have the silicon plugs with the little flat head on them. My Dr. says that because one eye lid in particular, my left one, rotates inward causing the rub. I don't feel it all the time but it's there if I look back and to my right like backing out of the driveway I really feel it. I am afraid to go to the "inside" type or the "Smart" plug as I have been warned that they could be impossible to remove and may become infected more easily. So, I will live with these. Thanks
Brad

[Guest]

http://www.tearfilm.org/dewsreport/p...DEWS-noAds.pdf
The following was taken from the DEWS report, the chapter on Management and Treatment of Dry Eye:

Table 4. Treatment recommendations by severity level
Level 1:
Education and environmental/dietary modifications
Elimination of offending systemic medications
Artificial tear substitutes, gels/ointments
Eye lid therapy
Level 2:
If Level 1 treatments are inadequate, add:
Anti-inflammatories
Tetracyclines (for meibomianitis, rosacea)
Punctal plugs
Secretogogues
Moisture chamber spectacles
Level 3:
If Level 2 treatments are inadequate, add:
Serum
Contact lenses
Permanent punctal occlusion
Level 4:
If Level 3 treatments are inadequate, add:
Systemic anti-inflammatory agents
Surgery (lid surgery, tarsorrhaphy; mucus
membrane, salivary gland, amniotic
membrane transplantation)
Modified from: International Task Force Guidelines for Dry Eye185

You'll see that secretagogues are listed under level 2 treatment strategies. Pilocarpine (brand name Salagen) is considered a secretagogue. A product called Exovac is also available (in the U.S., not in Canada)

Also, you can read more about secretagogues starting at the bottom right corner of page 168 (see page number on the actual document.. if you go based on the page number in your browser, it will be different, so don't so that).

Hope this helps.

I haven't tried yet, but if you google Salagen, you may be able to find a full monograph on the drug itself so you can read more about side effects, who should not take it etc.

[tearless2]

I am glad to hear the rubbing of the plugs doesn't happen all the time. I actually don't know what type of plugs I have other than permanent (non-dissolvable).

You mentioned that you have tear overflow with the plugs, I read on this site something about plug flow controllers which help with tear overflow. Here's a link to the product:
http://dryeye.org/flow.htm

I hope your eyes get better or that BFS can help.

[Sammy B.]

Brad,

I think that it is a good idea that you are going in for the fifth IPL treatment with Assil. I was doing some (incessant) Googling yesterday and while they are merely anecdotal, people have reported progress after the fifth or sixth treatment.

Keep your chin up.

Rose

[jimi51]

Thanks! I will certainly keep you posted!

Brad

[odydnas]

I just had my 4th IPL treatment with Dr. Toyos last week. So far, I have not had any symptomatic improvement. Dr. T also told me that I am responding VERY VERY slowly, and so he does not expect me to feel any different yet. Maybe after the 5th or 6th treatment I will feel some improvement.

I am not Lasik patient, my symptoms just became extremely bad out of nowhere 3 years ago. I am also a BFS patient, but the lens did not help at all, and I am now one of Dr. Rosenthal's "pain patients".

Btw, Dr. Toyos and Dr. Rosenthal both completely disagree on the reason for my eye symptoms. But since my BFS treatments did not help, I decided to give IPL a try.

[Michael2]

i will add my two cents...i responded randomly one day about a week after my 3rd treatment, and ive been doing IPL for another 9 months and have been progressing for sure...but very very slowly. i have not reached comfortable eyes yet, unfortunately, but Dr T tells me my glands are at 100% open and 50% butter

right now my eyes are definitely lacking in meibum. i can tell that for sure. when i take pain meds, they sort of numb my eyes...but somehow my eyes still feel kinda 'empty' and lacking of that glue.

if you do respond to IPL, I find that there are two things which have helped accelerate the progress, because sometimes I stall in between a treatment. I would suggest using Dwelle every four hours, and i would also suggest warm compresses twice a day once you respond. I can feel the oil come out now, whereas before IPL there was nothing

good luck!