So what's what's the deal with IPL?

[Ariel]

I heard from Dr. Toyos office that only a handful of doctors have been trained by him to use this technique, all of which are in the US. If you watch the clips shown in youtube it appears that a lot of training would not be required to use it for DE treatment.

http://www.youtube.com/watch?v=xl0Nh...eature=related
http://www.youtube.com/watch?v=G_9zFX5d6So

There's IPL being used for cosmetic purposes all over the place, virtually in every country and yet nobody is using it to address the obstruction of meibomian glands. Perhaps IPL for DE treatment requires a different device. That may be the case but if it isn't, it doesn't make sense that not a single DE doctor is using it outside the US. If it works as well as it is claimed and there's money to be made with it you'd think there would be people doing it everywhere.

[hirentherock]

has any1 tried it?
There r very less reviews available on net also.

[odydnas]

I think the "tricky" aspect of IPL is choosing the correct settings to use because it differs for each patient. If the doctor isn't able to use the right settings, then the IPL would not be effective or less effectvie.

i am currently a patient of Dr. Toyos and I've done 2 IPLs so far, with no progress in my symptoms, altho he says its too soon to tell. I got the above information from Dr. Toyos.

[hirentherock]

Nice to get some reviews!
I would say make a new thread where posts wil be solely by the ppl who took IPL treatment.So that other people may get to know the in depth report of IPL treatment.
Thank you for ur review.

[Ariel]

Odynas--- It's great to be able to discuss this topic with someone who's actually getting it done with Dr. Toyos. What you mentioned is very interesting so if you don't mind I have some things I'd like to ask you:

What exactly does Dr. Toyos do to find the right setting?
Does something tell him he has found it or is it a hit or miss kind of thing?
Do the eyelids look any different under the slit lamp when you're using this technique correctly?

Thanks for your input and sorry about asking so many questions.

[suebuie@hotmail.com]

Ipl

I am going to throw out a word of caution re: IPL. There are not double-blind studies that I can see and it seems like it is really heavy into the marketing aspect- yes I bought the $30 Dr. Toyos video and upon second thought feel it is totally inappropriate to "charge" for a video and not answer basic questions on the phone -- just a thought.

[Lucy]

Sue, usually when a medical procedure or product is "advertising via a video, they do not charge for this service. Also $30 is a nice hunk of change just for info you may or may no use. Lucy

[Ariel]

Sue--- I didn't know about the $30 video. Thanks for letting us know. I totally agree with Lucy, and other things are also worth looking into. For what I understand IPL is only an easier, more convenient way of doing in-office expression, so why charge such ridiculous prices?

[odydnas]

Odynas--- It's great to be able to discuss this topic with someone who's actually getting it done with Dr. Toyos. What you mentioned is very interesting so if you don't mind I have some things I'd like to ask you:

What exactly does Dr. Toyos do to find the right setting?
Does something tell him he has found it or is it a hit or miss kind of thing?
Do the eyelids look any different under the slit lamp when you're using this technique correctly?

Thanks for your input and sorry about asking so many questions.

Hi Ariel! I have no idea what Dr. Toyos does to find the right setting of what tells him he has found it. I have heard of another situation where a patient was seeing a doctor that was trained by Dr. Toyos, but that particular doctor was doing the wrong setting on that patient, and it was not very effective, and the patient had to go see Dr. Toyos to essentially get it done right and was able to get some improvement that way.

As for the eyelids, Dr. Toyos records your eyelids under a slit lamp so that you can see what your glands look like during the expression after IPL. According to most docs I've been to, apparently no oil at all comes out of my glands because they are so clogged, even with docs try to express them for me. Dr. Toyos confirmed that for me. AFter the IPL, he did my expression, and I could see on the video, all this disgusting toothpaste-like gunk coming out of my meibomian glands. I have no idea if a simple warm compress would give the same effect as IPL would though...

I think that $30 is ridiculous to pay for an informational video. Information should be free! Even tho I am doing IPL, I do not have my hopes up, as I have already been to BFS and am a patient of Dr. Rosenthal, and I am still at zero improvement because nothing has worked for me. I am also not completely convinced that IPL is "the cure." I just feel at the end of the line, so I am cautiously hoping that the IPL will get my glands working enough that maybe I can wear my BFS sclerals since a lack of a tear film makes wearing any type of lens uncomfortable.

[spmcc]

Re: Ipl

The laser that Toyos, Friedman, Assil, and the others trained by Toyos use is called Dermamed Quadra Q4. It has pre-programmed settings that control, for instance, the wavelength and duration of pulse. The doctors can, however, change the joules for each setting.

So, for instance, the two pre-programmed settings that Friedman used on me were "Acne" and "Vascular". He told me this is what Toyos does too.

I had:
1st Treatment:
1st pass: Acne 12 (12 is the maximum joules for "Acne" setting)
2nd pass: Vascular 14

2nd Treatment:
1st pass: Vascular 15 (15 is the maximum joules for the "Vascular" setting)
2nd pass: Acne 12

3rd Treatment:
1st pass: Vascular 15
2nd pass: Acne 12

4th treatment:
1st pass: Vascular 15
2nd pass: Vascular 15

The pre-programmed settings take any guesswork out of what the doctors do. The downside is that the doctors can't make adjustments if they want/need to.

Cheers,
Sheila

[odydnas]

Thanks for the info Sheila! This makes me wonder if Dr. Toyos takes more liberties than other docs when it comes to adjusting the settings, esp since Dr. toyos sees a lot of patients with higher Fitz scores like myself and needs to adjust according. This is one reason why I am flying to see Dr. Toyos, because I do not want the pigment of my skin to be affected.

How are you feeling after 4 treatments?

[spmcc]

Re: Ipl

IPL for dry eyes has not helped my eyes... my TBUTs (how they (Toyos, Assil, Friedman, etc) measure "success" with their IPL treatments) did not change at all before or after each treatment.

That does not mean that I discourage others from trying this. I have had tons of IPL/PDL/RFL/laser to my face already. I have facial rosacea and have been having laser since 1994. My case does not mean that everyone will react the same.

The gist of what I was trying to explain about the Dermamed Quadra Q4 is that the doctors cannot do much tweaking at all to the settings... only the joules can be changed. There are no liberties that can be taken... those pre-programmed settings are it. Dr. Friedman told me he consulted with Dr. Toyos and they do the same thing (they go up to the maximum joule).

For those with facial rosacea who are very keen on lasers, you should read this post from a rosacea forum: http://www.rosaceaknowledgeforum.com...r-rosacea.html.

Cheers,
Sheila

[Ariel]

Thank you Sheila-- The information you shared with us is very useful. Best wishes!

[odydnas]

Sheila, just to clarify, your TBUT didn't change at all...does that mean your MGs look exactly the same as they did prior to treatment? Are your MGs clogged and not excreting clear oil?

Dr. Toyos never measured my TBUT. I know because he did not put the dye in my eye and ask me to blink and I saw my file while I was waiting for him. Instead, he measured improvement by estimating the percentage of my glands that were excreting oil.

I personally do not trust the TBUT as it changes very often....mine changes from a 1 to a 10 and everything in between.

Thanks!

[spmcc]

RE: IPL for dry eye

The information that I gathered from every trip to see Dr. Friedman included

* TBUTs (before and after)
* percentage of open glands (before and after)
* IPL settings
* consistency of oil

My TBUTs did not change.

The percentage of open glands started around 50% and ended up around 80% (this is only the lower lids).

The IPL settings are posted above.

The consistency of oil is not like toothpaste but still cloudier than preferred.

But mostly, I don't feel any relief (which is what I really wanted!)