going to a private clinic, what to ask for?

[orange86]

Hi, im a 33 year old male. I live in West Yorkshire, England.

I am suffering from dry eyes. They are red, sore and burn. The sensation of burning is the overriding factor.

I have a desk based job, im looking at a laptop screen all day with overhead lighting. I believe i'm now photo sensitive. It's really hard to concentrate at work with the burning pain and discomfort.

I've tried HycoSan Extra, Systane, Carbomer Eye Gel, they all provide very short term relief (say under 30 minutes).I have a microwaveable eye mask, the heat helps but it's just short term relief.

I recently saw a NHS ophthalmologist, she wasn't much help. Said my eyes look ok besides some red blood vessels visible and told me continue with the ointments and gels plus the eye mask !!
I asked her to book me in to get the eye plugs (3 month wait !!!)

I took Hyabak Caps for a month and didnt notice a difference. I've switched to Thera Tears eye nutrition 2 days ago. I'm also taking Centrum multi vitamin 1 a day tablet. I also take probiotic 1 a day.

I was taking Mirabegron 25mg a day and Finasteride 1mg per day. I've stopped both, concerned the finasteride (anti androgen) is impacting my eye glands due to the androgen receptors in there.

I suffer from overactive bladder and IBS, i may also have a leaky gut.

I've booked into a Dry Eyes Clinic (Optimax) in Leeds for an initial appointment. There promote the MiBO Thermoflo treatment but dont know if that is what i need.
Can anyone let me know what i should be asking the ophthalmologist so i have an accurate diagnosis of what type of eye dysfunction i have?

I'm at my wits end here as i'm in discomfort all day and it can get painful.

[Alix]

I’ve discussed Mibo Thermoflow with NHS consultants as well as private ophthalmologists - the consensus is that it is an expensive waste of time and just a way for Optimax to make money. It has the same effect as hot eye compress. If you read up about it on the internet I don’t think you’ll find many doctors advocating this.

If you don’t know already I would ask whether your dry eyes are due to lack of tear production ie aqueous deficiency, or if it’s due to MGD ie evaporative dry eye.

Depending on what the root cause of it is, the treatments will differ.

Good luck.

[deep_dry_eye]

MiBO Thermoflo is a scam and waste of money -- microwave warm compress is much more effective.

You would rather pay for the full LipiFlow (which costs quite a bit more), but imo, much more effective (with the expression to flush out the glands).

You should ask for Ikervis and a course of Azyter. You should find out who in UK has IPL and go for that as well.

Ikervis should be used long term to control inflammation. Azyter is an antibiotic (Azithromycin), but somehow has the effect of very quickly reducing inflammation and getting the glands to express. You should go on ~2wk trial of Azyter. IPL should be done ~6 sessions, with possible maintenance to further control and reduce the inflammation.

Good luck!

[orange86]

So either LipiFlow or IPL?
They are both expensive, which one is the better?

Also, Optimax offer 'Oral tetracyclines', does Ikervis fall under this? is Doxyclinine same as Azyter?

http://www.dryeyeclinics.co.uk/dry-e...ory-treatment/

I've got a free consultation here in a couple days so nothing to lose, just need help before i go back to work on the 2nd jan as the pain of air con and stairing at computer will cause my eyes agony.

[deep_dry_eye]

LipiFlow and IPL can be complementary, I've done and will continue to do both to keep my glands functional and inflammation down.

Tetracyclines (of which Doxy is one, but not Azyter), is another class of antibiotic drugs that somehow can thin out the oil. I personally find Azyter to be more effective, but you can give them a try as well. Antibiotics are perhaps one of the cheapest and most effective meds, however, they cannot be used long term due to antibiotic resistance risks.

Ikervis/Restasis is Ciclosporin.

[orange86]

thanks for the info. i just had a look at the prices of LipiFLow and its eye watering (no pun intended).

£1,200 for LipiFlow for both eyes: https://www.dryeyesclinic.co.uk/pricing/
I wouldnt be able to fund these this type of treatment continually.

Can't see any IPL providers around Leeds so might have to look further afield.

With my limited knowledge, the LipiFlow / IPL is useful only if i have MGD?

[Alix]

Hi I would recommend you go to the Dry Eye Clinic in Manchester if you are in Leeds. The problem with Optimax is that they will try and sell you expensive treatments which don’t work, like lipiflow. Not a single doctor or optometrist has had anything positive to say about lipiflow and I’ve seen about 15 different ones here in London in the past 2 years, all really good ones.

In the first instance I would go to an ophthalmologist who specialises in dry eye and find out the root cause this is the key.

Depending on what the cause is then you can start targeting your eyes with the right medication. For example Azyter is for evaporative dry eye whereas Ikervis is for aqueous deficiency. No amount of doxycycline is going to work if you have lack of tears it’s for blocked glands. Same for IPL it’s for MGD / blocked glands not aqueous deficiency.

[deep_dry_eye]

Hi I would recommend you go to the Dry Eye Clinic in Manchester if you are in Leeds. The problem with Optimax is that they will try and sell you expensive treatments which don’t work, like lipiflow. Not a single doctor or optometrist has had anything positive to say about lipiflow and I’ve seen about 15 different ones here in London in the past 2 years, all really good ones.

In the first instance I would go to an ophthalmologist who specialises in dry eye and find out the root cause this is the key.

Depending on what the cause is then you can start targeting your eyes with the right medication. For example Azyter is for evaporative dry eye whereas Ikervis is for aqueous deficiency. No amount of doxycycline is going to work if you have lack of tears it’s for blocked glands. Same for IPL it’s for MGD / blocked glands not aqueous deficiency.

I respectfully disagree with some of these comments.

Azyter can help MG glands, however Ikervis can help MGD as well. The theory behind Ikervis (Cyclosporine) is that its an immunosuppressant drugs and MGD is somehow caused by inflammation, with exact cause unknown. I have MGD and I find Restasis to be beneficial.

I do find LipiFlow to be beneficial as well, the theory is that there might be internal blockages inside the glands, the theory of LipiFlow is that it can flush out the blockages and help keep the glands functional. Most patients do LipiFlow on a 1-2 yr basis, where as IPL is usually done w/ 4-6 sessions (every 3 wks) and 1 session every 4-6 months for maintenance. Of course this depends on the patient, I am on regular IPL because I find it beneficial in keeping the inflammation down and my glands producing less thick oils.

[Alix]

My point is, there is no point going to see an eye doctor or an optometrist and asking for this and that, without knowing what the root cause of your problem is.

Also, they dont give out Ikervis here on the NHS for MGD so if you have MGD and you want to try it you would have to buy it on a private prescription which is expensive. You are looking at 110 pounds per month and you need to take it for 6 months for it to start working. So you really need a proper diagnosis first otherwise you are going to waste time and money.

Lipiflow is beneficial in the short term like warm eye compress but the effects dont last very long. Thats why only very few places offer it here in the UK, like Optimax who dont have a very good reputation.

[Matt0029]

Hi I'm from near Leeds and have been to optimax. I'd recommend paying to see a private opthalmologist though. Optimax you just see an optician. I started then then paid to see an NHS consultant privately.

[orange86]

Hi I'm from near Leeds and have been to optimax. I'd recommend paying to see a private opthalmologist though. Optimax you just see an optician. I started then then paid to see an NHS consultant privately.

Hi Matt, i've sent you a private message.

[quattroboy]

Please don't waste your time for optimax.

Find a good dry eye specialist.

Dry eye clinic in Manchester is a specialist in bleph and MGD. Does Lippiflow and probing but expensive. Will prescribe medication if required.

TKS in Northampton is good. Offers all the tests including lippiview to image glands. Offers IPL and LED mask at reasonable prices. Also able to prescribe if required. They also do mmp9 and osmolality testing.

Dr Hamada cones very highly regarded but I think he's only London based. Seen a report of his for another suffer, very comprehensive.

in the short term try Manuka honey gel on your lids three times a day and drops twice a day. You can purchase optimal products from Amazon.

[orange86]

Hi Quattro boy, i've provisionally booked an appointment at: http://www.bbroptometry.co.uk/eyecare/tear-clinic.aspx
Just waiting on them to confirm if they can prescribe meds for my aqueous deficiency.

I went back to work today and my eyes were red and in agony.. Even my boss said they have got worse!!

[quattroboy]

BBR are good I know someone who goes and they can prescribe.

[orange86]

in terms of meds to treat my sore red inflamed eyes and also help kick start lacrimal glands for producing tears:

I could ask for doxycycline to for anti-inflammatory effect and Ciclosporin (ikervis) eye drops for immune suppressing effects?
Can ikervis kick start the lacrimal glands?