MG probing by Dr ******

[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

[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

[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]

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?

[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

[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.

[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

[djb]

I had 2mm probing done by my local doctor four weeks ago. Today, was a followup visit. He was able to express some oil out of my left upper lid today. That was encouraging since I had no oil prior to probing. I go back for a long session of probing on Oct 16th. He'll try the 4mm/6mm then. I think he's going to leave my lower glands alone because he can't see them and doesn't feel comfortable probing blindly. I can appreciate that!

He told me he's traveling to a doctors conference in San Francisco soon. He's going to bring up probing and IPL as discussion topics. We'll have to wait and see if anything comes from that event.

[djb]

Feeling bummed out today...local doc probed yesterday with the 4mm probes and I don't see any change in my condition. I guess my mgs aren't functioning even though they are open now. I hope that others get better results.

[kdc66]

MG Probing

I just had the MG probing by the same doctor that DJB saw in Maryland. I had the 2mm probes done on both the upper and lower lids 3 weeks ago and last week had the 4-6 mm probes used.

Dr. Spagnola was able to open about 80% of the glands for both the upper and lowers. The remaining ones he couldn't penetrate through using the probes. According to Dr. ****** you don't need to get all of them open but maybe 1/2 to 2/3 to see improvement

I have to say so far my left eye(which is the one that bothers me) feels alot better. I'm reluctant to say that since I have tried various drops, plugs, etc. where I would have a good weeks but than revert back to being in pain. So I will say I think it has helped but will need a month or 2 of feeling good to truly say the procedure has worked.

I do believe this or the IPL can work for folks who have blepharitis/lid issues. I think the MG probing needs more clinical research as well as people trying it and reporting success before you try it. However, if you are desperate for relief I would seriously consider having a Dr. perform it.

DJB, hang in there hopefully something will work.

[Brooke]

Kdc66,
It's good to hear that you've had some initial improvement from the probing. I agree that many treatments seem to have a short initial effect, but hopefully it will continue. You said you had the 2mm probes 3 weeks ago, and now the larger probes. Did your improvement start right after the 2mm probing? Did it last until the time of your 4mm probing session? Did the larger probing session give further relief than the initial?

I've mentioned this to a few doctors who immediately give me a disapproving look. They don't even want to talk about it, not sure why. I really hope we can get more feedback from patients who try it so that other doctors will be more open-minded. At least you and djb have a doctor that is willing to listen. Please keep us posted!

[kdc66]

MG probing

I did feel a little relief after the 1st probing with the the 2 mm probes. so far with the 4-6 mm probes the left eye feels really good one-week after the procedure. on the 2nd visit, Dr. Spagnola was able to probe more glands because he had more time than on the 1st visit.

Like I said, I am optimistically reserved here. I think that if I feel really good after a month than I can claim success. The other concern here is that once they have been probed; the glands may be open for a while but could eventually revert back to being closed over time due to the long-term inflamation. I am hoping that now that they are open that with omega 3s, heat and massage that they will stay open. The other possibility is using the IPL laser treatments.

Does anyone know from Dr. ****** that once people were probed that they were able to maintain open glands for a long time?

[wetEyes]

In one of the two articles below, Dr. ****** states that the effect lasts for about 4 to 6 months:

http://www.ophmanagement.com/article...article=103161
http://www.modernmedicine.com/modern.../detail/610890

[judge515]

Does anyone have a list of Doctors that already do the MG probing procedure? (besides Dr ****** and Lange). I want to do it very badly, but really do not want to fly down to Florida.


Also, for those of you that have had it done. I know it costs about $650 per half of your eye, does this cover the visits after to do the 4mm and 6mm probing?

[kdc66]

MG probing

DJB and I have had the probing by Dr. Spagnola in the Baltimore Area-which is not to far from PA. This was all covered by my insurance so I'm not sure what he charges.