Good Dry eye Clinics in India

[Nevil]

Hello Everyone,

I am from India and having dry eyes for about 4-5 years now. I have tried various eye drops, Restasis and now my doctor is suggesting to go For LipiFlow, which is pretty expensive. But unfortunately, I don't have much options, so I am thinking about it.

I am currently visiting Narayana Netralaya in Bangalore.

I wanted to check on feedback regarding which dry eye clinics have folks in india visited , so that i can try them next because I am not making much progress at my current clinic. And i really want to.

Thanks!
Nevil

[Hokucat]

Neerav1989 is a member in the forum from India who I believe went to several top clinics in your country. He/she has issues related to LASIK, but may be able to recommend which are the better clinics in India. Perhaps send Neerav a private message.

What is your diagnosis...do you have MGD, aqueous deficiency, etc.? Do you know the probable cause of your dry eyes, such as excessive use of electronic devices, autoimmune disease, LASIK, allergies, etc.? There are many other treatment options still available, and knowing the diagnosis and the probable cause are helpful in determining which options to pursue next. Many of these options you can learn about from those in this forum and past posts, versus relying on hearing about them from doctors.

There are two clinics in India that specialize in scleral lenses to help manage the symptoms. One in Sankara Nethralaya and another in Mumbai. I wear scleral lenses to help with the dryness, and it is one of the key components of my regimen to give me comfort. Not everyone can wear the lenses, but if you can, it can provide some relief. Neerav is also familiar with sclerals and went for a consult, however the lenses did not help his/her particular situation. Here's a good general description of how the lenses work, and two locations that fit them:

http://www.bostonsight.org/PROSE/PRO...y-Eye-Syndrome

http://www.bostonsight.org/PROSE/PRO...thralaya-India

http://www.bostonsight.org/PROSE/PRO...ialities-India

[Nevil]

Thanks for the response Hokucat ! I will definitely reach out to Neerav to get his suggestions.
As per my doctor, I have MGD and most likely the reason is excessive use of screens. I am a software engineer and have spent past 5-6 years on the screens everyday. Planning to go for Lipiflow as per his suggestion.

I believe scleral lenses are majorly for aqueous deficiency. I will perhaps investigate that after going through LipiFlow.

Regarding the clinics, I have been to Sankara Nethralaya and the doctors there didn't even diagnose my kind of dry eye and just gave me eye drops. But that was very early and maybe i did not have a severe condition back then. In any case, I think Narayana nethralaya in bangalore is definitely much better.

[Hokucat]

You're welcome, Nevil. The LipiView evaluation prior to the LipiFlow should also provide you good info on your blink rate, tear film, possibly if your glands are capped with scar tissue if they can see that, etc.

Some people in this forum have found several treatments of Intense Pulsed Light (IPL) helpful for MGD, but it is not widely available like LipiFlow is. If your glands have scar tissue like mines did, neither Lipiflow or IPL will help. I had to have probing to get my glands unblocked.

i know your career centers around using the computer, and continuing to look at screens several hours a day means you will continue to blink less, so MGD will continue and can get worse. Try to take more breaks to give eyes a rest, and would recommend blinking exercises:

http://www.skyvisioncenters.com/blog...exercises-app/

Yes, if you cannot find relief with other treatments, it's worth a try to go for a scleral consult to try on the lenses to see if you can tolerate them, and if it makes your eyes feel better, even though you heard it's mainly for aqueous deficiency. I have both MGD and AD, and it helps me.

[Nevil]

Regarding Lipiview : I am hoping to see all the details like tear film oil content, blink rate etc. during this test.
Thanks for sharing the blinking exercises , I am trying to develop a habit of doing that consciously.

Will see how LipiView goes and If its not successful, will think about Scleral lenses. Will update my post about the progress.

[Neerav1989]

Hi Nevil,

I am so sorry about your situation. I can completely sympathize with you. I have visited Shroff Eye Center New Delhi (Dr Ranjan Dutta and Dr Dipender Chauhan (cornea specialist)). I have also consulted one of the leading cornea specialists in Mumbai (Dr. Vinay Agarwal). Have consulted dozens of other doctors in Surat, Vadodara and Mumbai.

You should probably visit Dr. Vinay Agarwal. I personally found him the most knowledgeable and he is aware of the latest happenings in Opthalmology. He has also read papers published by Dr Perry Rosenthal which is actually very rare for an opthalmologist in India. But because he is one of the leading doctors in mumbai, he wont give you a lot personal attention and time. So I prefer consulting Dr Kunjal Sejpal in Mumbai. I have not been consulting them for almost a year now. because no doctor in India can do much about corneal neuralgia.

Our issues are completely different actually. Mine is post lasik corneal neuralgia and very little MGD. Yours seems to be MGD induced dry eye. based on my experience, my advice to you would be:

1) warm compresses twice a day
2) eat flax seed
3) Get your vitamin D3 and B12 levels checked and start medication/injection for the same
4) Dont use gentel gel or eye drops containing preservatives because they will only aggravate your MGD. I read some research in American Academy of Opthalmology that refresh liquigel & gentel gel only aggravate MGD in long term
5) Try Autologous Serum Tears. not sure it will be of help to you. But it has indeed helped me. I was completely suicidal for almost 3 years but it has made life a little better for me. I am not sure how much you are aware of Post Lasik Corneal Neuraliga but it is a suicidal disease. The pain/burning is absolutely relentless. anyways you can try serum as there is no harm and it is from your own blood.

Please let me know if I can be of any help to you.

All the best.

[Nevil]

Hi Neerav1989 ,

Thanks for taking the time and sharing this information!

I will definitely plan to visit these doctors in Mumbai if my Lipiflow treatment isn't very successful.
Regarding the advice you shared:

#1 ) I have been trying this by dipping a towel in hot water, not sure if that's very effective. I will create another thread to get suggestions on whether i should get a readymade, reusable one. I don't have a microwave so not sure. Any thoughts on this?

#2)Got them recently

#3) Regarding Vitamins D3, B12 - You are absolutely right. They are low for me and my doctor had caught this in the 1st visit and I have been taking medication for these since last 2 years and they are in check.

#4) I use Systane. Unfortunately , I can't survive my day without them. Will look into this though.

#5)Where did you get Serum tears made from your blood? Is this technique common in india?


Also, I hope you are getting better at handling this situation of yours.
Wish you all the best too

[Neerav1989]

Hi Nevil,

Sorry for the delayed response.

Dipping a towel in hot water was effective for me. I did it twice a day for a year and got rid off MGD. you need to continue doing that for a longer period. However I do feel that microwave activated moist heat compress is more effective. I would get one if I were in your place considering the severity of MGD in your case. Hokucat should be able to give more insight on the same i guess.

Serum tears is not particularly common in India. there are very few doctors in Mumbai who actually prescribe it. But I keep telling my doctors that they should try them in every patient who is suffering from dry eye. It has given people remarkably good results. I get them made in a laboratory.

Since I dont check this forum often. Please message me on https://www.facebook.com/Neerav.KA?ref=bookmarks if you have any queries regarding Serum tears. I will guide you. alternatively you can also mail nealmat@cox.net for any information on serum tears. Neal has done a lot of research on the same.

Thanks and Take care.

[Hokucat]

Yes, the reusable microwave activated moist heat compress stays warm longer, is more convenient, and works well. These are usually the masks that contain the heat activated beads. I used to use ThermalOn Dry Eye Moist Heat Compress when I had severe dry eyes, it’’s only $10-$15 USD:

https://www.amazon.com/gp/aw/d/B0043...70L&ref=plSrch

[Nevil]

Thanks for the responses Neerav1989 , Hokucat . I have started using a towel for this two times a day. Its messy yes, but I dont have a microwave right now. Will plan to get one and get such a compress.

[Nevil]

Regarding serum tears, I am planning to give lipiflow sometime and then evaluate scleral lenses or serum tears. Will definitely get in touch once I plan for that

[Milo007]

Hello folks,
I am from India too. I have recently visited narayana nethralaya in rajajinagar, Bangalore. I am suffering from evaporative dry eye (MGD) for the past 3 years now. I had been poorly treated in the past with only artificial tears and steroid drops until I had a consultation with doctor Rishi gupta of sankara nethralaya, Kolkata on May 1st this year, who put me on systane ultra eye drops, azithromycin eye ointment for a month and doxycycline tablets for a month. It made a difference and I felt much better.But after doing some research on meibomian gland dysfunction I decided to get some more specialized investigation done so I had a consultation with Dr. Sharon D'Souza in narayana nethralaya (campus 1) on 10th July this year.She did some basic tests (TBUT measurement, schirmer's test and tear film thickness measurement ) followed by a meibography on both my eyes. My TBUT came out to be 3 seconds on both eyes and schirmer's results were good. Meibography showed that I have 24% gland loss on each of my lower eyelids, 44% gland loss on my upper eyelid left eye and 23% gland loss on my upper eyelid right eye. She said my lipid layer is very unstable.She put me on systane ultra eye drops as before, a chloramphenicol and polymyxin B eye ointment nightly for a month and UV Lube Unims Eye Drops and adviced me to do hot fomentation with lid massage twice a day. She will be reviewing me after 3 months. I would be visiting again in December.Even though I feel better than before I have episodes of eye dryness variably. I am very serious with my condition and seeking to learn as much as possible to stop progression of the disease.

I would like to ask Nevil about the cost of lipiflow in narayana nethralaya if you are aware of it.Also my doctor didn't advice me for a lipiview or a lipiscan.Are these instruments available in narayana nethralaya?

Even though I don't have extreme gland loss I still have occasional episodes of eye dryness
variably. Is it because my glands even though they are there have atrophied and not producing enough oil?

Nevil whom have you consulted in narayana nethralaya for your condition?

Have you got your lipiview or lipiscan done?

[MGD1701]

Hi Milo
There is an international (dry eye?) meeting in India
OSKON2018
maybe you could find dr list, such as Doctor Srinivasan, Iyer, and Chodosh (not sure if these are all Indian??)??
or just visit LipiFlow website - search for doctors

Good luck!

[Nevil]

Hi Milo007 ,

Looks like your consultation at Narayana netralaya was very informative based on the details you shared. Its good to know the most about dry eye.


I have been consulting with Dr.Rohit Shetty there, he definitely is knowledgeable regarding dry eye.

Regarding Lipiflow, it is available at Narayana netralaya and I got it done sometime back.It was a pleasant experience but unfortunately I think it hasn't helped me much, I am yet to visit their again.I have shared you other details on a private message. I think its the only place in India where they do Lipiflow.

I am currently trying to do pretty much everything described by Neerav in one of the post in this thread like having flax seeds etc. Would advise you to tackle it as aggressively as you can.
You can definitely talk to your consulting doctor about LipiFlow, maybe she thinks your condition isn't so severe or it does not fit Lipiflow. There can be varied reasons.
Let me know if I can help you in any other way. Glad this forum could connect us. All the best!



MGD1701 : I have checked the Lipflow website and could only find Narayana Netralaya in India where lIpiflow is done.
Thanks for sharing the note about OSKON 2018, will definitely check it out!

[Milo007]

Thanks Nevil for sharing your valuable experience and information.

I am quite impressed that you were able to consult Dr. Rohit Shetty as I was told that Dr. Shetty doesn't attend dry eye patients directly anymore and dry eye patients are redirected to Dr. D'Souza for basic evaluation followed by a Delphi with Dr. Shetty if required.Initially I was interested in booking an appointment with Dr. Rohit Shetty but I was denied and instead referred to Dr. D'Souza.

Anyways from your quote in your private message I see that lipiflow is quite expensive indeed provided the certainty of benefits it might bring about. You are right my doctor didn't suggest me a lipiflow session perhaps because it's one of the last options they preserve for more severe cases I guess.But that's what I think is a misconception since lipiflow won't provide any remarkable benefits to patients who have professed to advanced stages meibomian gland dysfunction and lost most of their glands. It's much more beneficial to patients who have begun to lose their glands due to obstructive MGD.

I would like to mention that increasing intake of omega 3 fatty acids won't have any significant effects on MGD or the quality of meibum production as is popularly believed.It's as good as placebo as some of the the recent studies have found. Despite of this fact you may try and see for yourself as clinical studies are often contradictory.

Another very important thing I would like to mention from my personal experience is that I believe that MGD is the direct effect of excessive blue light exposure to the eyes and not ONLY the decrease in blink rate due to focused work. I have noticed that while staring at a digital screen for an hour would make my eyes feel symptomatic even though I consciously blink at least 20 times a minute doing so. Whereas this doesn't happen when I am reading for extended hours which also requires focus and a decrease in blink rate. I believe that the blue light damages the tiny blood vessels supporting the meibomian glands which eventually leads to gland atrophy and drop out. Since non obstructive MGD is poorly understood this could be an explanation for the same. I came to know about this from one of the articles in Dr. Sandra Lora Cremers's blog.If a decrease in blink rate was solely responsible for MGD then people who were avid readers back in the days when computers and smartphones were not there would have developed MGD as commonly as these days which was not the case. MGD is a new issue in this digital age and it has to do a lot with digital screens trust me. So my advice would be to reduce screen time exposure to the minimum possible.

There is one more place in India which offers lipiflow - The Grewal Eye Institute

I find Dr. Sandra Lora Cremers to be the most proactive person in the field of dry eye treatment with her new experimental treatments that provides hope to regenerate atrophied and dropped out glands which are not scarred with intra-ductal PRP and stem cell injections. She has been successful in doing so with PRP injections. I hope such treatments become available in India in the coming years after widespread adoption.


Feel free to share anything you would like to. I would stick to warm-compresses two times a day for at least a year before expecting results.And I would continue chloroquine phosphate eye drops with effects similar to cyclosporine drops to see if my glands revert back partially or fully.