Intense Regulated Pulse Light ?

[buiduyt]

Hello!

I am looking into treatment in Singapore and one clinic offers Intense Regulated Pulse Light treatment. Is there anyone here familiar with this treatment? Any thought?
http://ophthalmologytimes.modernmedi...e-pulsed-light

[Jahcpa]

I've had 6 treatments. It helps most people. Unfortunately I was one of the rare ones it did not help.

[pythonidler]

I first had IPL done 3 times in 2015. It didn't work for me initially because I had scar tissue covering my meibomian glands. In late 2016, I had meibomian gland probing to clear the scar tissue. Recently, I've had 4 IPL treatments, and I can say that they've definitely helped me.

[MGD1701]

Hi pythonidler
How can I know if I have scar tissues? and what cause them? There are inside the glands NOT on lid margins, right??
Do you have rosacea, if I may ask? IPL seems effective for people with MGD + rosacea, I have read. I dont have it though.

I asked one doctor if probing/BlephEx would help me. Yes, he said.
But the one who performs probing/BlephEx said I dont need them as all my pores (glands) are open (after LipiFlow)

Thanks!

[buiduyt]

Hello all!

Silly me, only after my post did I realize that Intense regulated pulse light is indeed IPL (that's why my search result came out none!) Anyhow, what test will let you (your doctor) know that you have MGD? in other words how does a doctor determines that you need treatment as IPL or probing or BlephEx? The cost for IPL where I am going is very high,and I have to fly there to get treatment. So I really don't want to be tricked into a commercialized clinic!

Thanks,

Mai

[pythonidler]

Hi pythonidler
How can I know if I have scar tissues? and what cause them? There are inside the glands NOT on lid margins, right??

When I saw my doctor in Boston, he took images of my lids and was able to see that there was scar tissue. I think the tech used the same machine that they used to look at my corneal nerves (a confocal microscope), but don't quote me on that.

As for what causes scar tissue, I didn't ask my doctor about that. My guess is the immune system in your eye is somehow doing that. And I thought the scar tissue was actually on the lids, not inside the glands. But again, don't quote me on that.

The bottom line is that probing helps clear out the scar tissue and makes it so that IPL will work.

Do you have rosacea, if I may ask? IPL seems effective for people with MGD + rosacea, I have read. I dont have it though.

I haven't been diagnosed with rosacea. But one of the ophthalmologists I saw said she thinks of meibomian gland dysfunction as a type of ocular rosacea.

I asked one doctor if probing/BlephEx would help me. Yes, he said.
But the one who performs probing/BlephEx said I dont need them as all my pores (glands) are open (after LipiFlow)

To be honest, probably not everyone with MGD needs probing. But if you've had imaging done and your doctor can definitely say "you have scar tissue and your glands are mostly closed off", then you should probably have it done.

I would probably try less invasive things before probing - like IPL, if you haven't already.

[pythonidler]

Hello all!

Silly me, only after my post did I realize that Intense regulated pulse light is indeed IPL (that's why my search result came out none!) Anyhow, what test will let you (your doctor) know that you have MGD? in other words how does a doctor determines that you need treatment as IPL or probing or BlephEx? The cost for IPL where I am going is very high,and I have to fly there to get treatment. So I really don't want to be tricked into a commercialized clinic!

Thanks,

Mai

To determine if you have MGD, your doctor will probably do a variety of tests on you (or he should, anyway).

Such tests include, but are not limited to:
1. Using a special tool (looks like a USB stick) to press against your lids and observe the amount of oil flowing from your glands
2. Measuring the osmolarity of your tears
3. Using a device called LipiView to record your blink rate, blink "quality" (whether you are a partial blinker or not), oiliness of your tear film, and thickness of your tear film.

And in my opinion, a decent doctor should be able to get at least one image of your eye. One of these images should be something called "meibography", which is an image of your meibomian glands. Do a quick Google search to see what it should look like.

As for how a doctor determines what treatment you should get - sometimes (ok, maybe most times) doctors just recommend the procedure that their office does. For example, the first time I was diagnosed with MGD, the doctor recommended LipiFlow, because that's what he used to treat MGD. He either didn't know I had scar tissue (which I probably did at the time), or knew he couldn't do anything about it anyway so he didn't bother checking for it.

But assuming you can find a doctor who has the ability to detect scar tissue (see my above post about how my doctor determined that I had it), then the doctor will recommend either probing if you have it, or probably either Lipiflow or IPL if you don't.

The bottom line is - it's probably going to be tough to find a doctor who is truly knowledgeable enough about MGD to diagnose you properly. It will probably be a lot of trial and error to find what works and what doesn't. Personally, I tried both LipiFlow and IPL before I had probing done.

[MGD1701]

Thanks pythonidler.
None of 2-3 doctors who did images ever mentioned about scar tissue.

BlephEx:
Have you done this? This removes debris and damaged (scar??) tissue.

IPL: Why you did 4 times? Do you plan to do it on a regular basis so you dont need to do compress, massage daily?
Did dr express glands afterwards? Seems some doctors express while some do NOT.

Some doctors say if one has no time for daily compress, massage at home,
he/she can do LipiFlow annually or every 2-3 years to maintain gland function. How nice to be wealthy!

Confocal microscopy - never done it but it is on my list for the next visit in an hospital.
It can detect more on glands so as demodex issues.

Lastly, happy for your success and thanks for sharing as always.

[pythonidler]

Thanks pythonidler.
None of 2-3 doctors who did images ever mentioned about scar tissue.

That was the case for the first few doctors I saw as well - and yet I'm pretty sure I had it when I saw them. They either didn't know about it, or they didn't have the right machine to look for it. FYI, I believe scar tissue is also known as keratinization.

BlephEx:
Have you done this? This removes debris and damaged (scar??) tissue.

No, and I've only heard of this procedure from this forum, not from any of my doctors. I doubt it could remove scar tissue, though. The probing I had done was very invasive, and the doctor had to use quite a bit of force in order to break up the scar tissue. In contrast, it doesn't look like BlephEx uses enough force to do that. I'm sure it could remove loose debris and tissue, but I really don't think it will break up any scar tissue.

IPL: Why you did 4 times? Do you plan to do it on a regular basis so you dont need to do compress, massage daily?
Did dr express glands afterwards? Seems some doctors express while some do NOT.

Dr. Toyos, the ophthalmologist who pioneered IPL for dry eye (it was originally used as a skin treatment), recommends doing IPL once a month for the first 4 months. After that initial treatment, you need additional treatments every few months. Exactly how often you get them depends on the individual (my doctor says every three months). If your doctor is doing IPL correctly, he should definitely express the glands afterwards. I also prefer manual expression to be done with forceps, not a q-tip as some doctors do.

Also, I try to do a hot compress every day. This will help your MGD and make IPL more effective when you get it done.

Some doctors say if one has no time for daily compress, massage at home,
he/she can do LipiFlow annually or every 2-3 years to maintain gland function. How nice to be wealthy!

I would definitely recommend a hot compress over a massage. The heat is very important to get the oils flowing. I would also probably recommend IPL over Lipiflow. It's definitely cheaper than Lipiflow, and might be more effective as well.

Confocal microscopy - never done it but it is on my list for the next visit in an hospital.
It can detect more on glands so as demodex issues.

I know for sure a confocal microscope should be able to look at your corneal nerves, just not sure about if it can also detect scar tissue. The article I attached to this post says that keratinization was detected in rabbits using meibography, not a confocal microscope.

[MGD1701]

Thanks a lot for the details.

Massage: most doctors recommend it and research/studies also support it. I recently found out why - to get ride of OLD oil and hopefully NEW oil will be regenerated.
I use Blephasteam/42.5C which proved to be effective/safe for its constant heat and the moisture/steam (can remove dirts, bacteria etc effectively).
I often wonder if it could acheve better results if I forcefully blink when doing it, maybe just 5 min toward the end, (as it is similiar to LipiFlow). But not sure if any risks?

BlephEx: maybe you could consult dr about this as it proved to be effective - and inexpensive.
Many doctors recommend it prior to LipiFlow. Dr Korb does the debridement manually every 6 months, according to one of his (old) viedos.