'Dry Eye Centre' in London?

[unicorn]

http://dryeyecentre.co.uk/

Anyone here been to this place? I was searching for somewhere to get meibography done. They also offer LipiView.

Or if anyone knows anywhere else that offers meibography, I'd be interested to hear.

Also ... those who have had meibography: is it useful? I know it's a diagnostic test, not a treatment. This would be a 900-mile round trip for me, so I'd need to be sure it was worthwhile.

[Santaklauzz]

Ah that's great. A clinic that's dedicated to dry eye and so nearby. I've seen that they offer MG expression.
That's something I've wanted to try for a long time.

Unicorn, I had a meibography done in Germany. I was afraid my glands would be truncated, but they turned out fine. It was a big relief.
It can be a useful extra tool to evaluate the condition of your glands.
In my case, it was helpful because now I know my glands are intact, but just not functioning correctly.
It does leave you with the question what to do next of course... But I guess that's always on the mind of a dry eye patient desperate for relief.
At least I can now narrow it down to getting my glands to work again and I don't have to bother myself with nightmares of my glands disappearing.
It's also good information for future appointments.

[unicorn]

At least I can now narrow it down to getting my glands to work again and I don't have to bother myself with nightmares of my glands disappearing.
It's also good information for future appointments.

I think that's precisely what I'd be worried about finding out... not sure I could cope if it turns out I just haven't got enough functioning glands any more. I wore contacts for 19 years and only just found out this can cause MG atrophy. Scary stuff.

I've emailed the centre asking how much meibography might cost but they haven't got back to me yet.

[littlemermaid]

I wonder how they assess and treat 'severe dry' without medical prescriptions or doctors. They must miss a lot of co-morbidities. Recognising medical conditions is just not in the College of Optometrists' training. There are some prescribing ODs in some US states, I understand, but many states are resistant for that reason.

Sometimes on Harley Street people buy equipment to service the independent 'clinics' then their job is to attract payments from all sources.

I think Lizlou got seen by a qualified Ophthalmologist at Centre for Sight, plus follow-up for problems, but she can tell you more about that. Maybe one of the questions is - would they go ahead if the procedure they offer was contraindicated? and would they know it was contraindicated? I think their 'questionnaire' will be based on risk rather than medical assessment.

Would they care if it made you worse?

'Harley Street' has a fascinating and mixed reputation, doesn't it

[unicorn]

Just got this reply from them:

"The initial dry eye assessment costs £225, it lasts for usually an hour and a half. It includes the LipiView - which analyses the thickness of the lipid layer of the tears, and meibography to assess the viability of the glands. In addition we will assess your blinking rate and whether your eye lids close completely. We will also use some of the other standard measures of dry eye.

At the end of the assessment if we find that the meibomium glands are blocked, we heat your lids to the temperature that melts the oil in the glands and then we squeeze the glands gently to try and get the oil flowing again.

We then give you a treatment plan for what we want you to do at home to keep things going. Our aim is to get you to a point where your dry eye is manageable and your quality of life returns to normal."

It's really the meibography I'm interested in. I doubt they would be able to offer me much in the way of treatments - and I'm not interested in trying LipiFlow.

I know there are a lot of people out there offering various tests, treatments, etc and yes, you need to be wary. I suppose - see my other post just now - I'm grasping at straws here, to feel better. Or at least get a better idea of how my eyes are doing, objectively.

[littlemermaid]

.......................

[unicorn]

Also found this place in Bristol offering meibography:

http://www.johnsonandfurze.co.uk/specialisttests.html

Seems like there's more 'dry eye optometrists' around these days. Their dry eye clinic charges £75.

[DryLondoner]

Unicorn - did you go for this?

Any feedback?

[unicorn]

Funnily enough I was there on Friday. I'll be putting up a post about it this weekend, so look put for that. But yes, it was very useful and I would absolutely recommend it.

[DryLondoner]

That's so good to hear!

Look forward to reading your post.

[spmcc]

Funny that you'd ask this today because there is a new study by Korb on meibography. Here's info:

Meibomian Gland Function Cannot Be Predicted By Meibography In Patients Symptomatic For Dry Eye.

David Murakami (1,2), Caroline A Blackie (1,2), Heiko Pult (3,4) and Donald R Korb (1,2)
1 TearScience, Morrisville, NC
2 Korb Associates, Boston, MA
3 Optometry and Vision Research, Weinheim, Germany
4 School of Optometry and Vision Science, Cardiff University, Cardiff, United Kingdom

Commercial Relationships: David Murakami, TearScience (E), TearScience (I); Caroline Blackie, TearScience (E), TearScience (I); Heiko Pult, None; Donald Korb, TearScience (F), TearScience (I)

Abstract

Purpose:The purpose of this study was to determine if meibography could predict meibomian gland (MG) function with regard to number of functional MGs and/or estimation of functional MG volume in patients symptomatic for dry eye.

Methods:Patients (n=23) symptomatic for dry eye who met the inclusion criteria for the study were fully consented and enrolled. Inclusion criteria: willingness to participate in the study, over the age of 18, no lid abnormalities, no current ocular inflammation/disease, no ocular surgery within the last 6 months, no history of lid surgery. Symptoms were scored using the SPEED questionnaire. MG function and estimation of functional MG volume were performed with the Korb meibomian gland evaluator. Meibography was performed using the Modi Topographer and analyzed using the Phoenix software provided. Lower lids were examined in three equal sections: nasal (N), central (C) and temporal (T) for the number of functional MGs and their functional volume (volume was as 1 for minimal, 2 for moderate and 3 for copious), and for MG dropout. MG dropout was categorized according to the Pult Meiboscale.

Results:Only data for right eyes are presented. The mean age and symptom score of the patients was 48.0±12.1 years (5 males; 18 females) and 8.9±5.0 respectively. The average number of functional glands per lid section was: N=2.7±1.7, C=2.2±2.0, T=0.2±0.5. The estimated functional gland volume per lid section was: N=5.0±3.9, C=3.2±3.2, T=0.3±1.1. The N and C lid sections had significantly more functional MGs and higher functional gland volume relative to the T section (p < 0.005). Conversely the amount of gland loss as determined by gland atrophy was significantly highest in the nasal section of the lid (p<0.0001) and drop out showed no apparent correlation with MG function or functional volume.

Conclusions:There appears to be no relationship between the level of apparent drop out and the number of functional MGs and/or functional MG volume. These counterintuitive results strongly indicate that standard noncontact infrared meibography cannot be used to predict MG function in terms of number of functional glands and/or functional gland volume except in the case of total gland dropout, when the glands are completely absent.

Link http://abstracts.iovs.org/cgi/content/abstract/55/5/27

[unicorn]

That's very interesting, spmcc. For me, meibography was about determining if I had significant gland atrophy/dropout following 19 years of CL wear, and I'm glad to say this isn't the case, which was a relief. Glands on my right eye look pretty intact and there is minor gland loss on the left eye, <25% on lower lid only. Interestingly enough it is usually my right eye that is more symptomatic so this makes sense given the study you quote.

[DryLondoner]

This is a post for any Londoners out there.

Unicorn - thanks so much for posting your experience at the Dry Eye Centre on here.

I decided to give it a go. I spoke to Caroline on the phone a couple of weeks ago, and we had a chat and she was very honest and said there wasn't much she could do for me, and to continue following the advice of my surgeon.

I decided to see her anyway, as I want to cover all bases. And I am glad I did. The appointment lasted about an hour.

Turns out my glands are good (yay!!) however the LipiView showed that I am not blinking properly so my lipid layer is significantly reduced (r:45 and l:60, when it should be closer to 100). She captured my blinks and I could see I was only half closing my eyes (good to actually see the video evidence rather than someone just telling you). I've been seen by two other opths., an optometrists and my surgeon and she was the first person to point this out. She checked all the glands thoroughly my pressing on them, much more thoroughly than anyone else. It is expensive (esp, as I didn't need my glands to be expressed), but for me I just needed someone to listen and give me another opinion, so worth it.

She made suggestions for drops and some other stuff (I decided not to purchase from them) and will email me a plan (which is actually similar to what my surgeon has suggested). A lot of the people I have been seen by so far didn't really seem interested in my problem. She is the first person who really listened and was sympathetic.

Thought I would post my experience as I know when I joined this forum I found it useful to read what others experiences were. Feel free to PM me if you have any questions. I hope this doesn't read too much like an advert!

[unicorn]

Very glad you had a good experience there, it's important to remember there won't be much they can offer you in the way of treatment but it's good to have the tests done and maybe now you're aware of you partial blink that will help you. Maybe try blinking exercises?

[DryLondoner]

Think blinking exercises could be very beneficial. Apparently, my muscles could be weakened due to not having blinked properly for such a long time.

Thank you for posting your experience, I would never have stumbled across them otherwise.