Significant Improvement -- Sharing My Treatment Protocol

[Milo007]

Yes you’re probably right with the fats. I have about 30-40%. Atrophy. In regards to dropout you mean atrophy ? Not dropout of 40% of glands right?

I think the term "atrophy" and "drop out" are vaguely used interchangeably even by doctors. Rarely do they differentiate between atrophy and drop out. Almost all ophthalmologists I have been will say you have no "atrophy". Some will say you have no "drop out".

I have also noticed that they don't even use terms like "duct dilation" or "peri glandular fibrosis" or "gland tortuosity" when interpreting the meibography images. All they seem to care about is if there are traces of glandular tissue visible or not. If you have visible glands (in whatever condition they might be) then everything is supposed to be fine.

[deep_dry_eye]

I’m doing many of the things that you are doing...started in January it’s slow improvement. Did you ever consider scleral lenses? If not, why not?

I’m getting fitted for scleral now as I hope they will help get me back to work. I still plan on continuing all treatments as I want to maintain the MGs I have left...I have moderate to severe MGD.

Thanks!

Yes -- I considered getting it, however I decided not to do it mainly for for teh reasons of partial blinks. I suspect (but without proof or trying it out myself), that getting sclerals would make full blinks harder, since its such a big lens. Additionally, sclerals while can help ur symptoms, does not fundamentally improve the underlying disease, psychologically it was like giving up to me which i was not ready to do.

[deep_dry_eye]

I think the term "atrophy" and "drop out" are vaguely used interchangeably even by doctors. Rarely do they differentiate between atrophy and drop out. Almost all ophthalmologists I have been will say you have no "atrophy". Some will say you have no "drop out".

I have also noticed that they don't even use terms like "duct dilation" or "peri glandular fibrosis" or "gland tortuosity" when interpreting the meibography images. All they seem to care about is if there are traces of glandular tissue visible or not. If you have visible glands (in whatever condition they might be) then everything is supposed to be fine.

My dr uses terms like the ones u described above, i.e., not just looking at the black out ('dropout' / 'atrophy') part of the image. My glands have improved in the ducts and the dilation of the glands. I suspect that if I continue my treatment course and control the inflammation, I can get tissue growth again and regrow my glands. At least thats the hope...

[Dryinvancity]

Yes -- I considered getting it, however I decided not to do it mainly for for teh reasons of partial blinks. I suspect (but without proof or trying it out myself), that getting sclerals would make full blinks harder, since its such a big lens. Additionally, sclerals while can help ur symptoms, does not fundamentally improve the underlying disease, psychologically it was like giving up to me which i was not ready to do.

I tried them yesterday and was surprised by how small they actually are. I have a test pair for the next few days and agree with your point about the partial blinking...I’ll be looking out for this.

I hope the sclerals are an option for me as I need to get back to work to pay for ongoing treatment!! I don’t plan on giving up on my MGs as my preference is that I wear my glasses and who knows if sclerals will work long term.

I have my 4th IPL on Friday and then plan on starting a series of RF in April.

Thanks for all your information...it’s encouraging I wish you ongoing success.

[deep_dry_eye]

I tried them yesterday and was surprised by how small they actually are. I have a test pair for the next few days and agree with your point about the partial blinking...I’ll be looking out for this.

I hope the sclerals are an option for me as I need to get back to work to pay for ongoing treatment!! I don’t plan on giving up on my MGs as my preference is that I wear my glasses and who knows if sclerals will work long term.

I have my 4th IPL on Friday and then plan on starting a series of RF in April.

Thanks for all your information...it’s encouraging I wish you ongoing success.

Which dr are u getting your IPL from? I maintain a website: http://dryeyetoronto.com and would like to add your dr to the list.

Does your dr to both upper and lower ids? Do you know the energy levels of your IPL?

I would suggest to do more than 4 IPL, another member in the forum farmgirl found she needed 6+ IPLs to get results (if I rmb correctly). I also needed multiple rounds, I now firmly believe in IPL and I do it on a monthly basis.

[Milo007]

My dr uses terms like the ones u described above, i.e., not just looking at the black out ('dropout' / 'atrophy') part of the image. My glands have improved in the ducts and the dilation of the glands. I suspect that if I continue my treatment course and control the inflammation, I can get tissue growth again and regrow my glands. At least thats the hope...

If you have access to your meibography images - the ones when your eyes were the worst and the ones after you have recovered, please share them in the forum. I am always looking for images that demarcate structural improvements in terms of duct and acinar dialation. Never found one. I believe my acini look dialated in my meibography images. They don't look like "slender" piano key like structures as normal meibomian glands.

[farmgirl]

That is correct deep_dry_eye 4 was helpful but 6 was even better. Of note I had no improvement at all until after the 3rd so be prepared to do the full meal deal of at least 4 if you are going to try the treatment at all.

[romeodakins]

Do you still think Azithromycin is worth a shot if I don't have skin issues? I've tried doxy for like 1.5 months and I didn't really notice anything. I'm currently in the middle of IPLs so I don't wanna stop that. Also by which IPL treatment did you start noticing noticeable improvements? I'm hoping to do what you did and do IPLs every 3 weeks for as long as it takes to get better haha.

Also you mentioned Azithromycin was good a flushing out glands, by that do you mean clearing out glands? Would IPLs be just as effective (maybe more) at doing that? The doctors always mention that a week after treatment my eyes will feel drier bc all my oils are cleared out and I really do get a lot drier the first week after each treatment (I tried lipiflow once and did not get this dry feeling which makes me believe lipiflow is not as good at clearing out glands).

I've also tried Erythromycin Ophthalmic Oinment once per night (only for a week though, didnt really feel much), I think this is similar to Azithromycin? Should I try getting back on this and is it safe to use while on IPL?

Also how did you figure out that the Toyos protocol wasn't as effective? Did you start your series of IPL with toyos and then switch over and notice more improvements, or did you do the Periman protocol, switch to Toyos and felt it was less effective, and then switched back to Periman? My local doctor does the Toyos protocol (she says the shots on the temples and your nose does target the upper lids apparently) and I'm wondering if I should drive out a few hours to get a doctor that does the upper and lowers.

I apologize if the above has already been answered in previous posts, I can't use the computer much bc of my eyes so I can't read the previous posts