I've been offered free MIBOFLOW by my Dr, has anyone here had it done?

[Phillips55]

Apparently the clinic where my primary eye Doctor is located is offering free testing for patients of something called MIBOFLO which I have never heard of. I was just wondering if anyone here on the forums has had it done, and if so is it safe and how did it go?

[Rebecca Petris]

Never heard of it. Interesting. Like all in-office treatments make sure they provide you with informed consent. Love to hear what it's like and how it goes if you end up doing it.

[Phillips55]

Thanks Rebecca, I've found some threads here but I couldn't glean much info about it. It looks like it applies 100 degree heat to the eyelids over ultrasound gel which is supposed to work like lipiflow. I don't mind offering myself up as a test subject because my Doctor's helped me a lot and who knows maybe it might help. I just hope it's safe...
Heres a video on it https://www.youtube.com/watch?v=j49SYwJI57g
And the website http://painpointmedical.com/miboflo.html

[MGD666]

Interesting, do let us know how it goes Phillips!

[Peppermint]

Please post your experience with this, Phillips. My dr is offering this as well and I have been apprehensive to try it.
Thanks!

[Phillips55]

Hi, just got done with my first Miboflo. The procedure went smoothly, a technician coats your eyelids with ultrasound gel and massages them with a heated metal plate for 12 minutes each. It basically felt like a warm lid massage and was pretty pleasant. The important thing is that is seems totally safe. I've heard horror stories of peoples retinas being torched from IPL so I was concerned a bit before I did Miboflo because there really isn't much info on it. I am scheduled for 3 sessions 2 weeks apart and it's free for me because I volunteered to be a lab rat. I guess the cost per session ranges from $100-200 and that does include both eyes.
The metal plate thing is heated to 108 degrees so just taking that into account it isn't much different from a heated rice bag. The wildcard may be in the ultrasound gel, which is supposed to let the heat permeate deeper into the eyelids. I can't say I notice a huge difference after the first session, but I certainly will report how things progress. Having had Lipiflow done I would say the experience is similar. I personally think Lipiflow is a rip off because even if it works, it's prohibitively expensive and I think that treatments like Lipiflow and Miboflo need to be repeated on a semi regular basis to be effective. Anyway Ill keep you posted!

[eyes78]

I went to the Miboflo website and saw their animated illustration that says "without ultrasound gel the heat is dissipated and the skin will not allow the heat to penetrate the meibomian glands" - basically saying that regular (non-ultrasound) warm compresses don't work - because the heat never gets to the gland.

Is this true?? Aren't there lots of people who feel that they benefit from regular warm compresses? Is it really possible that the heat can't get through about 3 mm of tissue to the glands?

This just worries me but I suppose it could be just the company's marketing ploy. I'm not saying their product doesn't work, just that I hope their statement that implies regular warm compresses are useless is not true.

[MGD30]

The metal tool with the ultrasound will dissipate heat at a higher rate than a regular dry compress. A wet compress will have higher thermal conductivity than the dry compress.I would assume the metal with the gel has a higher thermal conductivity than the wet compress. But how effective is it if you only do it a few times compared to doing the compress every day?

[Spoon]

"Without ultrasound gel the heat is dissipated and the skin will not allow the heat to penetrate the meibomian glands".

Yes ultrasound gel is better than no ultrasound gel but what this statement implies is not at all valid.

"Without ultrasound gel the heat is dissipated…" – Actually with ultrasound gel the heat is dissipated too and only to a slightly lesser extent when considering all the ways heat is dissipated between the heat source and the actual meibomian glands . Using ultrasound gel will improve the heat transfer rate to the skin surface because it effectively increases the contact area between the hot surface (in this case the metal plate) and the cooler surface (the eyelid skin). The skin is microscopically rough and therefore without the gel the metal plate will be just touching the ‘ridges’ of the skins surface without significant compression. The only medium transferring heat from the metal plate to the areas of skin that aren't in direct contact with the plate is air. Air is poor at transferring heat, both gel and water are significantly better. Therefore the overall heat transfer rate is improved with gel or water because they can fill in the microscopic ‘valleys’ in the skins surface with a medium that transfers heat much better than air.

However as eyes78 points out their statement implies that regular compresses are worthless which is not true at all.

• With or without ultrasound gel or water, heat is still dissipated. In their case a lot because there are proportionately high edge losses due to the small size of the hot plate. However they maintain constant temperature with a peltier/thermoelectric element.

• The statement implies that using ultrasound gel solves the only barrier the skin has against heating the meibomian glands. Blood vessels in the lids act as a mini heat exchanger that is effective is pumping heat away from the lids to maintain normal tissue temperature. Then there is the tarsal plate etc.

• The fact that their device is flat and not curved is a drawback for the heat transfer rate as more gel will be required to fill the gap between the curved lid and the flat plate.

• Ultrasound gel does not appear to have a higher thermal conductivity than water but it may work better as it will not run off the lids and therefore might provide more intimate contact between the lids and the heat source. If you want to try ultrasound gel with your warm compresses it is very cheap to buy (a few pounds on eBay).

Maybe the investors in this device will make money as there are so many patients that will just try it as a lot of us tend to try everything that might help. The fact that they use the ultrasound gel as a draw card just shows the weakness of this devices proposition in my view. They must wish they could place the hot plate on the inner eyelid which would make the device worth looking at but Tear Science owns this function (until 2028 I think).

[eyes78]

Thanks for the explanation, Spoon. That is reassuring to know that my warm compresses are doing something. I think after reading your post, though, I'll stick with the wet compresses over dry.

[Phillips55]

Hey folks, going in for my second treatment of miboflo tomorrow, I do notice some improvement the oil flow which seems to be a bit more consistent, especially over the course of the day. With a good lid expression after it, this might be a good cheaper alternative for lipiflow if your have thick oil problems, which I don't really have. So if it has helped me a little it might help some folks out there a lot. Anyway I'll keep you a updated!

[neilw]

Phillips
I know this is a little off topic, but I was wondering how your eye that had the Prokera treatment was going. Am I right that you had only one eye done ? I thought you were also thinking about getting the other eye treated. I am guessing that as you are now trying MIBOFLOW that the benefits of Prokera did not last.
Thanks
Neil

[Phillips55]

neilw,
Hi yeah Prokera's been a miracle for me and I'm getting the other eye done before the end of the year. I'm surprised more Doctor's aren't using AMT treatments like Prokera to treat dry eye.

[indrep]

My experience with about 30 patients that had MiBo Flow is without a maintenance therapy such as Tranquileyes the effects are short term, 3-10 days.

As to amniotic membranes. They do an excellent job of healing the epithelial cells of the cornea and reducing inflammation. However, the cause of the dry eye must be addressed with maintenance therapies. If the osmolarity of the tear film is not addressed then the inflammatory cycle will continue.

[spmcc]

If the osmolarity of the tear film is not addressed then the inflammatory cycle will continue.

I just read this article called "Diagnosis of dry eye disease and emerging technologies" (abstract: http://www.ncbi.nlm.nih.gov/pubmed/24672224 Full text: http://www.dovepress.com/getfile.php?fileID=19369).

In the section on tear osmolarity, it says

... osmolarity measurements with the TearLab showed no ability to distinguish between healthy individuals and patients with dry eye

The reference for that statement is Szalai E et al. Evaluation of tear osmolarity in non-Sjogren and Sjogren syndrome dry eye patients with the TearLab system. Cornea. 2012;31(8):867–871.