MG probing by Dr ******

[RobLIC]

Hi Amy. Thank you for that, because I just learned something. ... We didn't specifically discuss whether probing can help atrophied glands - but I'm sure it's his position that it would. He's very approachable. Why don't you ask him? His Web site's dr******.com.

I don't know what I'll do about follow up treatments. There's always the idea I could do IPL next. Or rip my eyes out. Just not sure. He said some of his patients benefit from retreatment 4-6 mos after probing; others haven't needed it. Personally, I plan to "maintain" with forcible expression, readily availabe in NYC, and see how it goes.

Rob

Thanks Rob. My understanding of atrophy is that it can present in 3 ways: 1) the gland is totally missing, 2) the gland starts at the lid margin but is shorter than a full gland, or 3) the gland is shortened, and does not start at the lid margin. In this case, there is tissue between the opening of the gland at the margin and the beginning of the gland itself. I was wondering if probing can address that 3rd kind, where the probe penetrates through the non-gland tissue and creates an opening to the gland. You said he noted atrophied, yet probed each gland. He must have felt that probing can help even the atrophied glands--did he say anything regarding how it may affect atrophied glands?

Also, what did he suggest for follow up with him or further treatments?

Thanks,
Amy

[indrep]

Roblic
I am not a surgeon nor an expert on reimbursement codes and my understanding of blepharatomy is that the procedure is an incisional procedure. In other words an incision would be made to drain an abscess in the eyelid. What you are describing is a probing procedure. This would compare, I'm guessing, to probing the canaliculus for an obstruction vs a DCR where incisions are used to remove an obstruction. Did the doctor's office suggest that code and say that is the code they are using?

As for what changes the make up of the secretions from your meibomian glands, the published literature leans heavily on diet. More fish (Omega #s, etc.) help change the secretions to a more fluid state. Inflammation closes the duct and reduces or eliminates the ability of the secretions to flow.

[amyk]

Thanks Rob. My understanding of atrophy is that it can present in 3 ways: 1) the gland is totally missing, 2) the gland starts at the lid margin but is shorter than a full gland, or 3) the gland is shortened, and does not start at the lid margin. In this case, there is tissue between the opening of the gland at the margin and the beginning of the gland itself. I was wondering if probing can address that 3rd kind, where the probe penetrates through the non-gland tissue and creates an opening to the gland. You said he noted atrophied, yet probed each gland. He must have felt that probing can help even the atrophied glands--did he say anything regarding how it may affect atrophied glands?

Also, what did he suggest for follow up with him or further treatments?

Thanks,
Amy

[RobLIC]

Hi indrep ... The procedure does have a CPT code. It's 67700, for blepharatomy. I submitted that with a diagnosis code - the one for MGD with inflammation, whatever it was, 359 something. I'll report back once I hear from United/Oxford with or without a check

Afraid I don't know what a k-reading is or how to answer your other questions. Here's what I can tell you: I did all four lids. I'm aware only of a nice pocket of oil in my lower right conjunctival sac. This is reflective of me - and I hope no one reading this will draw conclusions from it.

Your last question is interesting because others have asked, and until I get some slit-lamp photography done I can't answer for sure. But I would seriously doubt that the act of putting a probe into an orifice - clogged or not - would change the consistency of the secretions. That seems more a hormonal/medicinal/nutritional thing to me. My "toothpaste" began after my LASIK and never went back to normal. The theory is that the inflammation in the glands is what changes the consistency from oily to milky. OK, but that theory really bugs me, because there's not a lot of common sense to it ... anyone want to convince me I'm wrong? Please?

roblic
My understanding is this procedure does not have a specific billing code for reimbursement. Typically insurance comapnies want a diagnosis code and CPT code describing the procedure performed. I hope you get some reimbursement.

By the way what are your k-readings? When Dr. ****** was taking your TBUT were your lower centrally? If not which quadrant was lowest? Does the probing help make excretions more fluid?

[indrep]

roblic
My understanding is this procedure does not have a specific billing code for reimbursement. Typically insurance comapnies want a diagnosis code and CPT code describing the procedure performed. I hope you get some reimbursement.

By the way what are your k-readings? When Dr. ****** was taking your TBUT were your lower centrally? If not which quadrant was lowest? Does the probing help make excretions more fluid?

[RobLIC]

Philipp: We did a lot of TBUT testing. My doctors in NY usually put me at a 5; Dr. ****** was describing my TBUTs differently at different regions in the same eye, so no number I quote you will have any relevance. All I can tell you is that in one eye, now, I am aware of some more oil. I would not call it a dramatic difference.

Amy, yes, he used the transillumination tool, but not to guide how far to proceed. In my case, he used only the 2 mm probe. I wish I'd pushed him to use the deeper probe, but he felt that my "clogs" were closer to the surface

All my eye docs note gland atrophy, as did he. Not sure what you mean "address that" with the probing. He probed each gland - some made pops, some produced hemes.

He did not instruct me to use drops to aid in healing. No negative side effects to report - but understand tenderness in my lids was before and remains a significant aspect of my life.

Rob,
That is great that you had this done and feel some relief so far. Just a few questions... In his poster regarding the technique, Dr. ****** mentions that he examines the margins using transillumination. Did he use the transillumination tool/light to guide how far to probe? Did he notice any atrophy/drop out during his examination, and if so, was he able to address that with the probing? Did he direct you to do anything in particular, or prescribe any drops, after the procedure to help with healing? Lastly, did you have any negative side effects like swelling, tenderness, etc?

Thanks for your help!
Amy

[amyk]

Rob,
That is great that you had this done and feel some relief so far. Just a few questions... In his poster regarding the technique, Dr. ****** mentions that he examines the margins using transillumination. Did he use the transillumination tool/light to guide how far to probe? Did he notice any atrophy/drop out during his examination, and if so, was he able to address that with the probing? Did he direct you to do anything in particular, or prescribe any drops, after the procedure to help with healing? Lastly, did you have any negative side effects like swelling, tenderness, etc?

Thanks for your help!
Amy

[Philipp_from_Germany]

Hi Rob!

One question: Did ****** assess your tear film stability (TBUT) pre and post probing?

[RobLIC]

I went to Tampa this week for MG probing. Five days out, I'm aware of better oil flow in my right eye - let's assume this is more a function of my own physiology, since my left eye is more damaged from surgeries and not prone to a good "coating" anyway.

The probing isn't painful, but it can be startling. As the probe penetrates the gland, you may hear a "pop." Try to imagine poking the edge of a paper clip through a piece of newspaper or Saran wrap. Theoretically, the doctor explains, this is the probe poking through bands of fibrotic nerve tissue; in other cases, it may be poking through keratinized cells of some sort.

I applied for an "in network exception" to my health insurance company, which was approved, and am hoping for significant reimbursal - we'll see, since I've just mailed the forms in. The staff at Dr. ******'s office is really sharp at helping navigate that paperwork.

Rob in Queens

[djb]

A step in the right direction for Europe !

Don't you think it's odd that it is we patients who have to draw attention to these developments?

No matter. Keep us posted.

I've introduced probing and IPL to my local doc via email with success. I started by looking up the practice online to see if they had an email address. I sent the info to three practices and only one doctor responded. He is now my eye doctor. I would encourage everyone to use email to keep doctors informed. I guess they have a life outside of the office and the last thing most of them want to do is more work/research after a long day of seeing patients.

[irish eyes]

A step in the right direction for Europe !

Don't you think it's odd that it is we patients who have to draw attention to these developments?

No matter. Keep us posted.

[Philipp_from_Germany]

I have contacted an (dry eye specialised) Optometrist in my vicinity. He was thrilled by the invention and has ordered the device from Dr. ******. I will undergo this procedure in a few weeks and post an update...

Here is an interesting quote from his response:

"The technique is easy and less and less invasive than unblocking an occluded tear duct, which I do routinely.At last - tools for manually unblocking them. Fed up of expressing them."

I ll keep u guys posted

[djb]

My local doctor probed 90% of my upper left lid today with the smallest probe available. Took about an hour. He couldn't probe the lower due to epithelial growth over the lower lid MG orifices. He said he would have to scrape the growth off in order to see the openings to continue probing. Prescribed Azasite, Doxy 20mg pills, Fluorometholone, hot compresses in order to try and keep the probed orifices open. He'll continue the process in four weeks. No improvement with vision yet, but my eye seems more comfortable. I can't tell you if the comfort is from the procedure or all the meds, drops, and gel that have been put into my eyes today. I would equate the procedure to a dentist cleaning the base of your teeth with that scraping tool. There's slight pain, but its tolerable. Hopefully, it will help when he is finished.

Since the inner lining of my eyelid has overgrown the MG orifices, it would seem to me that IPL would not help me unless the doctor removes that growth first. What do you all think???

[Sabrina]

Proceed with caution is good advice.

However, I am happy that there are Docs. out there that seem to know more about this than the average opthamologist and are continually looking for ways to find out how to give their patients relief vs throwing a box of Restasis at you and sending you on your way.

We can all continue to follow the progress of these procedures. Everything is new at some point. Who knows. Maybe one of these procedures will end up being the breakthrough we are all looking for.

Can you tell I'm having a postive thinking day??

[Rebecca Petris]

About testimonials

I'm sorry this thread is getting diverted further away from its initial subject again but... I think I need to state where I'm coming from on the subject of testimonials, and if others would like to share any thoughts about how they would like this sort of thing to be handled, please feel free. I totally understand where Lucy's coming from, we've both seen a lot of disheartening stuff over the years, but I still feel a little differently.

I don't actually have any objection to doctors occasionally sending patients here to describe their experiences with a new or infrequently used treatment, even if it's invasive and even if I in my opinionated-ness about invasive surgeries don't happen to be crazy about it. In fact I've occasionally encouraged doctors I'm acquainted with to send a few this way. (Note: Testimonials about products are a different matter. Anybody newly registered who plugs a product and walks away is usually going to find their post removed as spam.)

Often these treatment testimonials are NOT helpful to us as a community (getting people excited over nothing, raising false hopes etc) and at least as frequently, they're not pleasant for the one posting because if they were not already a member, registering just to post a testimonial raises all kinds of red flags and so they may not be well received. And usually when a testimonial is posted, it's somebody in the first throes of excitement over how they feel shortly after the surgery. If as is all too often the case they never come back and update us, we don't have any idea whether it was ultimately successful. In my "ideal world" somebody posting a testimonial about any treatment would be at least a few months into it without any substantial changes to their treatment regimen in the interim, and in the case of an invasive procedure maybe a longer waiting period.

NOTWITHSTANDING all that, there are some treatment areas where any information better than no information to the one who ultimately needs it (probably a tiny percentage of actual readers).

On that basis, I'm willing to take the risks involved in letting people post their experiences freely. They just need to understand they're going to get a lot of questions and the less they share, the less respect they're going to get.

There are many 'niche' problems and 'niche' solutions. What is one person's waste of $10k is another person's changed life. Time and time again I've heard myself say "Really???" on the phone to someone whose condition was finally brought under control by some means I never would have guessed could be helpful. So... information needs to flow, and if it gets a little messy in the process, well, so be it.