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[IPL] Is my doctor lying to me?

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  • [IPL] Is my doctor lying to me?

    I had a LipiView scan and test and got about 33 LLT for each eye but it seems like I have no dropout of glands. Lower lid glands are pretty truncated though but the upper lids look good, they're all very long. I then started getting IPLs via the Toyo's protocol with a different doctor that offered it.

    After each treatment they tell me I'm getting more oils and they're getting smoother and smoother. After the 3rd and 4th one especially, she said I'm getting output out of all glands and they're all butter smooth (compared to being toothpaste in the beginning and only getting output out of some of them). So far I've felt pretty much the same throughout, but after the 4th one I think I might've felt a little better but not enough that I'm certain that I'm getting better.

    Today I got another LipiView test with the first doctor and I'm getting around 38 LLT for each eye. And my doctor manually expressed my glands and it still seems like only some are producing and not much is coming out. So my LLTs are pretty much the same after 4 IPLs, how could it be that my IPL doctor is telling me the oils are getting so much better but my LLTs are still this bad? Is she lying to me? I'm going to keep doing the IPLs as that seems like the only hope left. Is there gonna be a drastic night and day improvement after a certain number of treatments? Or does improvement come incrementally as I continue treatments? It's pretty demoralizing having the same LLT even after 4 treatments, and my IPL doctor keeps getting my hopes up after each treatment

  • #2
    I have had the LipiView LLT test done multiple times, and from my experience, it's very unreliable.

    YMMV but I found that both the LipiView LLT test and the doctor manually expressing my glands were not strongly related to my symptoms. Since my symptoms and oil quality varied a lot from day-to-day, those measurements would mostly pick up the random variation on that individual day.

    I have talked to multiple doctors about this and there still really isn't a single good, quantitative test for measuring dry eye severity (but I do think osmolarity is better than LLT). The most important question is: what are your subjective symptoms like?

    From my experience, I think it's highly unlikely your doc is lying to you. I have had multiple dry eye doctors give me incomplete or incorrect information, but except in extremely rare cases, this is definitely not intentional. Unfortunately the reality is that the medical system isn't perfect, doctors are (flawed) humans too, and no doctor has a complete picture of the disease. Most doctors try hard to be helpful based on the limited info and understanding they have, and sometimes that includes trying to encourage the patient. This is not your fault. Most patients don't respond well to a doctor that simply reports the facts with complete objectivity. I wouldn't assume your doc is lying, but if you feel like the actual symptoms you're experiencing don't match up with what the doctor says, that's worth bringing up.

    There are definitely reasons why your oil quality could appear to be improving immediately after an IPL treatment without you noticing a symptomatic improvement, or an improvement in the LLT test. Dry eye is a complex disease so I can't list out all the factors here, but I talk about this in some of my other posts.

    Is there gonna be a drastic night and day improvement after a certain number of treatments? Or does improvement come incrementally as I continue treatments?
    IPL is definitely an incremental thing.

    I don't know your eyes, so I can only guess at what else could be going on, but personally I find IPL very helpful for my ocular rosacea and not very helpful for my MGD. I still need Lipiflow for my MGD. Blink quality and diet matter a lot too. But I think for a lot of patients, the amount of improvement they see from IPL is directly related to how bad their ocular rosacea is/was. If you have done 4 IPL treatments and your subjective symptoms haven't improved, then it's definitely time to look into trying other treatments. Personally, I unfortunately need Lipiflow, but there are a lot of folks on here who have said Lipiflow didn't do anything for them.

    If you have bad ocular rosacea on your eyelids and your IPL has not been treating your eyelids directly, that may be worth looking into. Or maybe your ocular rosacea wasn't that bad to begin with, and your dry eye / MGD is caused by something else.


    • #3
      I believe dry eye is a big scam. In the sense that no doctor knows why we have this condition and seems like all this pharmaceutical companies don't want to find any cure as is huge and profitable business. I was thinking, why they cannot just produce a meibum-like gel that we can use many times a day? Is it really so hard to synthetize this chemical compounds and oils? Why is nobody researching this? Ipl, lipiflow, and so on, just lots of marketing and playing with our hopes and charging us fortunes to take advantage of our suffering. Am I the only one thinking this? Just common sense. Hopefully i am wrong.


      • #4
        If you are tempted to think "nobody" is researching dry eye... all you have to do is go to and type dry eye into the search terms. You'll be amazed at how much research is going on.

        "Is it really so hard to synthetize this chemical compounds and oils?" This is not a simple disease, nor is it a single disease, and yes, it really is that hard.

        Yes, there is lots of marketing going on. But I don't think it makes sense to paint everyone with the same brush here. There really is a lot of good work going on
        Rebecca Petris
        The Dry Eye Foundation