[IPL] Is my doctor lying to me?

[romeodakins]

I had a LipiView scan and test and got about 33 LLT for each eye but it seems like I have no dropout of glands. Lower lid glands are pretty truncated though but the upper lids look good, they're all very long. I then started getting IPLs via the Toyo's protocol with a different doctor that offered it.

After each treatment they tell me I'm getting more oils and they're getting smoother and smoother. After the 3rd and 4th one especially, she said I'm getting output out of all glands and they're all butter smooth (compared to being toothpaste in the beginning and only getting output out of some of them). So far I've felt pretty much the same throughout, but after the 4th one I think I might've felt a little better but not enough that I'm certain that I'm getting better.

Today I got another LipiView test with the first doctor and I'm getting around 38 LLT for each eye. And my doctor manually expressed my glands and it still seems like only some are producing and not much is coming out. So my LLTs are pretty much the same after 4 IPLs, how could it be that my IPL doctor is telling me the oils are getting so much better but my LLTs are still this bad? Is she lying to me? I'm going to keep doing the IPLs as that seems like the only hope left. Is there gonna be a drastic night and day improvement after a certain number of treatments? Or does improvement come incrementally as I continue treatments? It's pretty demoralizing having the same LLT even after 4 treatments, and my IPL doctor keeps getting my hopes up after each treatment

[anteloper]

I have had the LipiView LLT test done multiple times, and from my experience, it's very unreliable.

YMMV but I found that both the LipiView LLT test and the doctor manually expressing my glands were not strongly related to my symptoms. Since my symptoms and oil quality varied a lot from day-to-day, those measurements would mostly pick up the random variation on that individual day.

I have talked to multiple doctors about this and there still really isn't a single good, quantitative test for measuring dry eye severity (but I do think osmolarity is better than LLT). The most important question is: what are your subjective symptoms like?

From my experience, I think it's highly unlikely your doc is lying to you. I have had multiple dry eye doctors give me incomplete or incorrect information, but except in extremely rare cases, this is definitely not intentional. Unfortunately the reality is that the medical system isn't perfect, doctors are (flawed) humans too, and no doctor has a complete picture of the disease. Most doctors try hard to be helpful based on the limited info and understanding they have, and sometimes that includes trying to encourage the patient. This is not your fault. Most patients don't respond well to a doctor that simply reports the facts with complete objectivity. I wouldn't assume your doc is lying, but if you feel like the actual symptoms you're experiencing don't match up with what the doctor says, that's worth bringing up.

There are definitely reasons why your oil quality could appear to be improving immediately after an IPL treatment without you noticing a symptomatic improvement, or an improvement in the LLT test. Dry eye is a complex disease so I can't list out all the factors here, but I talk about this in some of my other posts.

Is there gonna be a drastic night and day improvement after a certain number of treatments? Or does improvement come incrementally as I continue treatments?

IPL is definitely an incremental thing.

I don't know your eyes, so I can only guess at what else could be going on, but personally I find IPL very helpful for my ocular rosacea and not very helpful for my MGD. I still need Lipiflow for my MGD. Blink quality and diet matter a lot too. But I think for a lot of patients, the amount of improvement they see from IPL is directly related to how bad their ocular rosacea is/was. If you have done 4 IPL treatments and your subjective symptoms haven't improved, then it's definitely time to look into trying other treatments. Personally, I unfortunately need Lipiflow, but there are a lot of folks on here who have said Lipiflow didn't do anything for them.

If you have bad ocular rosacea on your eyelids and your IPL has not been treating your eyelids directly, that may be worth looking into. Or maybe your ocular rosacea wasn't that bad to begin with, and your dry eye / MGD is caused by something else.

[bcn90]

I believe dry eye is a big scam. In the sense that no doctor knows why we have this condition and seems like all this pharmaceutical companies don't want to find any cure as is huge and profitable business. I was thinking, why they cannot just produce a meibum-like gel that we can use many times a day? Is it really so hard to synthetize this chemical compounds and oils? Why is nobody researching this? Ipl, lipiflow, and so on, just lots of marketing and playing with our hopes and charging us fortunes to take advantage of our suffering. Am I the only one thinking this? Just common sense. Hopefully i am wrong.

[Rebecca Petris]

If you are tempted to think "nobody" is researching dry eye... all you have to do is go to clinicaltrials.gov and type dry eye into the search terms. You'll be amazed at how much research is going on.

"Is it really so hard to synthetize this chemical compounds and oils?" This is not a simple disease, nor is it a single disease, and yes, it really is that hard.

Yes, there is lots of marketing going on. But I don't think it makes sense to paint everyone with the same brush here. There really is a lot of good work going on

[anteloper]

why they cannot just produce a meibum-like gel that we can use many times a day?

The chemical components of any biological, glandular secretion like meibum are very complex and difficult to synthesize. And even if you could create synthetic meibum, it isn't easy to turn it into a commercial product, you have to scale the process up, then figure out how to preserve it (without adding preservatives), plus distribution, getting it cleared by the FDA, etc... it is really that hard. The eye drops already on the market are essentially the industry's current best attempt at creating synthetic meibum.

Even if you had this meibum-like gel it could not cure MGD, ocular rosacea, etc., so IPL and Lipiflow, and so on, would still be needed.

I believe dry eye is a big scam. In the sense that no doctor knows why we have this condition and seems like all this pharmaceutical companies don't want to find any cure as is huge and profitable business... Ipl, lipiflow, and so on, just lots of marketing and playing with our hopes and charging us fortunes to take advantage of our suffering. Am I the only one thinking this? Just common sense. Hopefully i am wrong.

There will be no "cure" for dry eye because dry eye is caused by so many different things. It's typically a chronic inflammatory disease, it's not like a bacterial infection where you pop some antibiotics and it usually goes away.

It is true that the medical industry in most places is profit-driven. This is a complex social and political phenomenon and it cannot be explained simply by malice. There is a lot of marketing because humans are vulnerable to marketing, and most voters aren't interested in advocating for better regulation of medical marketing.

I can tell you that most doctors hate the system too. Residency in the USA means working 80 hour weeks for years while being paid less than minimum wage, and a lot of doctors graduate medical school with hundreds of thousands of dollars in debt. Because of their debt, they are often forced to participate in this system that puts profit before patients.

Dry eye is a real disease, not a scam, and no one is forcing you to buy these treatments. If you want someone to get angry at, I suggest looking at the politicians, the industry lobbyists, and even fellow voters... there are reasons why preventative care for dry eye is mostly nonexistent.

[jack1988]

The chemical components of any biological, glandular secretion like meibum are very complex and difficult to synthesize. And even if you could create synthetic meibum, it isn't easy to turn it into a commercial product, you have to scale the process up, then figure out how to preserve it (without adding preservatives), plus distribution, getting it cleared by the FDA, etc... it is really that hard. The eye drops already on the market are essentially the industry's current best attempt at creating synthetic meibum.

Even if you had this meibum-like gel it could not cure MGD, ocular rosacea, etc., so IPL and Lipiflow, and so on, would still be needed.




There will be no "cure" for dry eye because dry eye is caused by so many different things. It's typically a chronic inflammatory disease, it's not like a bacterial infection where you pop some antibiotics and it usually goes away.

It is true that the medical industry in most places is profit-driven. This is a complex social and political phenomenon and it cannot be explained simply by malice. There is a lot of marketing because humans are vulnerable to marketing, and most voters aren't interested in advocating for better regulation of medical marketing.

I can tell you that most doctors hate the system too. Residency in the USA means working 80 hour weeks for years while being paid less than minimum wage, and a lot of doctors graduate medical school with hundreds of thousands of dollars in debt. Because of their debt, they are often forced to participate in this system that puts profit before patients.

Dry eye is a real disease, not a scam, and no one is forcing you to buy these treatments. If you want someone to get angry at, I suggest looking at the politicians, the industry lobbyists, and even fellow voters... there are reasons why preventative care for dry eye is mostly nonexistent.

Is that what MGD is then, an inflammatory disease? I don't seem to have inflammation anywhere else is why i question that.

My lids are pretty clean and not red really, so it's annoying that MGD causes me so many problems

[anteloper]

Is that what MGD is then, an inflammatory disease? I don't seem to have inflammation anywhere else is why i question that.

My lids are pretty clean and not red really, so it's annoying that MGD causes me so many problems

Of the 7 different dry eye doctors I've seen, the most helpful one did say she thinks dry eye is most commonly an inflammatory disease. However, that doesn't mean inflammation plays the main role for every dry eye patient, and it's entirely possible that inflammation isn't the main issue for you. For example, post-LASIK and hormonal dry eye have non-inflammatory root causes (though they may themselves induce inflammation). Everyone's dry eye is at least little different, so it's hard for me to guess at what's going on for you.

For MGD specifically it is important to get inflammation under control, but if you don't have a lot of inflammation already, it may be worth working with your doctor to investigate more esoteric possible causes for your symptoms. Like a lot of complex, multifactorial diseases, dealing with dry eye is like using process-of-elimination to work down a checklist of possible causes, starting with the most common (i.e. inflammation).