VERY interesting article about IPL for dry eye!

[sazy123]

Sorry i did post this in the thread about ipl for dry eye here http://www.dryeyezone.com/talk/showthread.php?p=40416#post40416

But i thought more people would see it here and some of the info is to interesting to be avoided.

Article by Dr toyos

http://www.bmctoday.net/crstoday/pdfs/CRST0409_14.pdf

i found these bits V interesting:


The light acts as a warm compress that liquifies the meibomian gland’s
secretions and ultimately unplugs them.

This is interesting to me, because ive suspected vascular involvement in my DE for a while:

One reason
why intense, pulsed light may work is that the closed
blood vessels can no longer send inflammatory mediators
to the gland. These mediators may cause the gland’s dysfunction


The first thing we noticed in patients treated with intense,
pulsed light is that their telangiectasias disappeared, as did
the erythema and swelling in the gland. Consequently, the
eyelids themselves appeared cleaner. One month after treatment,
meibomian glands that had not functioned at all
began to operate. Instead of resembling toothpaste, the
secretion we observed was thinner and more normal.



When the light reaches the lower eyelid, we
have patients look up and then apply treatment right
below the eyelash margin. The upper meibomian glands
are not treated directly, but we have seen an improvement
in the upper glands from indirect therapy.



All patients report a subjective improvement in
their dry eye symptoms (no steroids were prescribed after
treatment). On examination, we find that patients with
telangiectasia at the lid margin will have less after only one
treatment. Glands will show more fluid secretions when
pressed.
We also find less capping of the meibomian glands.
The lid margins are less erythematous and clearer

Sounds promising for all MGD suffers As you dont need to have facial rosacea for the treatment to work.
Maybe its too good to be true, but it gives me hope :)

[LasikRelatedDES]

During the last year, fewer than 1% of our treated patients
have been nonresponders.


Some of our patients come in every 3 months,
whereas others will not return for 1 year. Most of our patients
no longer need eye drops after they have finished
their initial course of treatment. They usually return for a
maintenance treatment when they feel that their symptoms
are coming back.

Oh my heck. Sign me up.

[vman]

That is very interesting..it's nice to see something totally new sometimes!

It's too bad that it's restricted to fitzgerald skin types 1 and 2...that excludes all non-caucasians, who are all 4 and higher. hopefully there will be a reliable approach to using light therapy in darker skin tones in the not too distant future...it looks like something that's of broad interest to the dermatology field, not just us dry eye types...so I'm fairly optimistic.

[sazy123]

That is very interesting..it's nice to see something totally new sometimes!

It's too bad that it's restricted to fitzgerald skin types 1 and 2...that excludes all non-caucasians, who are all 4 and higher. hopefully there will be a reliable approach to using light therapy in darker skin tones in the not too distant future...it looks like something that's of broad interest to the dermatology field, not just us dry eye types...so I'm fairly optimistic.

Mmm yeah thats a shame. I think though the majority of mgd patients would be type 1,2,3, because of rosacea and that mgd is very common in fair skinned people. They do say they will consider type 3 and that patch testing will be done.

You can see what type you are here:
http://www.spa-medical.com/fitzpatrick_skin_typing_test.htm

im between 1-2.

[stella]

Great find Sazy !
are you going to go for it ?
Your signature is- " i want a cure" - well maybe this is IT for you
Do hope so
All the best
Stella
PS I've always thought of you as a trail-blazer ! This may prove it

[lboogie]

I wonder how someone would be able to try this? Aside from flying to Tenessee. My opth always seems pretty open to things, but I am part of Kaiser, and they pretty much never cover the cost of anything that is not super, super proven and tested. I would be willing to pay out of pocket though to give it a try.

[sazy123]

I wonder how someone would be able to try this? Aside from flying to Tenessee. My opth always seems pretty open to things, but I am part of Kaiser, and they pretty much never cover the cost of anything that is not super, super proven and tested. I would be willing to pay out of pocket though to give it a try.

You would have to fly to LA 4 times (he does it in LA), and it would cost $1500 for the whole treatment, insurance doesnt cover it, (mite do eventually?) it is fairly new. Im from the UK so it will be costly but i have to try anyway, i have saved some money. Im wondering whether i could get two treatments 3 weeks apart and stay for 3 weeks- but that might not be cheaper. I may just hire a car and sleep in that when im out there or take a tent, might be cheaper.. desperate lengths!

[lboogie]

I just visited his clinic site....lots of lasik..........grrrrrrrr. Well if he makes dry eye, at least he's helping to figure out how to fix it.

Please keep us posted if anyone can ever try this!

[autumnn]

I am schd to see Dr. Toyos a week from tomorrow. I'd like to compile questions from this forum so that I can be as much help as possible to everyone who is interested in this treatment. Lets try to put together a master list of what we would like to know before I go and hope that this is an answer- or at least some help- for many of us.

[Lucy]

Hi AUTUMNN,
I wish you luck in your visit(s) with Dr. Toyos. I thought about one question you could ask him. He may not have an answer, but I'm wondering if this will work for those with bad dry eye who have Sjogrens. Sjogrens usually gets worse as time goes by and I think the eyes dry up accordingly. (I also have Lasik damaged eyes prior to dx of Sjogrens.) Lucy

[stephgurl1986]

wow, this sounds VERY intersting. I would love to try this therapy...and to be honest I think it would work for me.

I'm skin type 2 I believe (but a lot closer to 3 than to 1)...So I think I would have to go there during winter.

1500$ seems okay to me - why do I have to live a 12hours flight away?

I'm interested in what Sazy said about having the treatments within a shorter time and make a holiday out of it, because obviously I couldn't fly to L.A. once a month (imagine the horror for your eyes to fly 12h once a month, aside from the costs).

So he says he has treated so many patients - where are they? Nobody from dryeyezone? It seems like these patients only had a mild form of dry eye...

[Philipp_from_Germany]

Thanks for sharing this essay Sarah.

I have been observing Mr. Toyos' endeavours for a few years now. This might become standard treatment for the "regular" dry eye patient one day. (Which is a medium scale MGD patient btw. "Hello, long time contact lens users...")

It does sound a bit too optimistic though. Raises one biiiiig question:

"To my knowledge, no one besides myself is using this technique."

WHY?????????? Pure ignorance? I can tell that exists being a scleral lens user.The german medical community just blindly ignores this fine instrument as treatment for dry eyes (did save my life though..). So I strongly believe in "mechanical" approaches lie this (as opposed to drugs) to resolve our "condition".

Good luck autumn - keep us posted!

[sazy123]

Thanks for sharing this essay Sarah.

I have been observing Mr. Toyos' endeavours for a few years now. This might become standard treatment for the "regular" dry eye patient one day. (Which is a medium scale MGD patient btw. "Hello, long time contact lens users...")

It does sound a bit too optimistic though. Raises one biiiiig question:

"To my knowledge, no one besides myself is using this technique."

WHY?????????? Pure ignorance? I can tell that exists being a scleral lens user.The german medical community just blindly ignores this fine instrument as treatment for dry eyes (did save my life though..). So I strongly believe in "mechanical" approaches lie this (as opposed to drugs) to resolve our "condition".

Good luck autumn - keep us posted!

In an email to me he said that he was in the process of rolling out training of othmalogisits. I am still sceptical but if it actually does what he says for MGD i can see this becoming a standard treatment for MGD, for one thing there is money in it which will make othphs much more interested in treating dry eye and wanting to diagnose MGD. Currently treating dry eye takes up time and there isnt much money in diagnosing and treating MGD.

[sanna]

Atummn,

I have a few questions. Why is he the only one useing this ipl? Like Phillip in Germany said. (I do not think that the German Doctors just ignors this, or the Swedish, there must be a reason. But I wish thats why i did not know about this) That is what you are going to visit Dr Toyos for right?
What about your vision?, I mean when they do this ipl thing, and can the the white part of your eye melt? Maybe I am just beeing stupid.

I hope that the ipl thing works, I really do. Maybe it will come to europe one day, or maybe I will do this prygium surgery instead for my ugly veins...

[autumnn]

OKAY all I am going today at 2:30...please post any questions ASAP and I will try to get the scoop for us!
Autumnn

[lboogie]

Ask about this with lasik dryness! And/or why the m. glands get so much worse after lasik, and can this help?

[LasikRelatedDES]

OKAY all I am going today at 2:30...please post any questions ASAP and I will try to get the scoop for us!
Autumnn

Please ask if this can help people with glands that do not not show clear signs of being clogged but are instead just not producing oil or at least not enough oil.

[sazy123]

Im probably off the mark, but one thing i have thought about regarding why the M glands are effected in lasik is this: If you have a vulnerability or already have a mild MGD but nothing that significant, the application of holding the eyelids apart with that scary looking instrument may cause vascular disruption in the eyelids which leads in inflammation and MGD, and resulting bacteria etc.... just a thought.

[sazy123]

Please ask if this can help people with glands that do not not show clear signs of being clogged but are instead just not producing oil or at least not enough oil.

I would really like to know this as this is the case for me.

One of the ways he mentioned in the article was that it helps other than unblocking was by reducing vascular signals that cause inflammation.

[autumnn]

Hi All- :( I am so disappointed, I was just turning on the freeway to head to Dr. Toyos (armed with everyone's questions from this thread and from the other thread) when I got a call from the office saying that they needed to reschedule my appointment. I was having such a painful eye day and was looking forward to hearing some hope. I was so disappointed that I actually started crying. My poor boyfriend had to pull the car over to console me. Anyway, I am rescheduled for the 23rd. I will keep you all posted.

[sanna]

Atummn.

you are just like me. I do not know how many times I have cried over my eyes. My doctor told me I was crazy, but I just want my white eyes back.
Good luck on the 23 rd.

[odydnas]

Hi Autumn,
I'm sorry to hear your appt got rescheduled.

I had another question...can you ask Dr. Toyos, if in the near future, he can use IPL therapy for people of skin types 3 or 4 with a different type of laser or something? I mean, is he developing ways to use this type of treatment for people with darker skin, and if so, is he close?

Thanks!

[autumnn]

yes, I will add all these questions on, for sure.....I'd also like to be in touch with some of his patients and hear about this treatment from them. I asked the office if they consider you a "candidate" do they do the first treatment on the day of the consultation and they said "yes". So, who knows, Thursday I could have the procedure and some news to report back.....not sure how many treatments you need to see results but we shall see....

[sazy123]

Good luck today Autumn I hope it goes well for you and the doc is nice and forth coming with information!
Sorry to hear that you couldn't go last monday.

I think in the article it said 3 treatments- if there is no improvement after 3 that you prob wont get improvement. But you can see improvement after the first treatment according to the article.

[advocate]

For those of you who can't travel to get pulsed light, have you considered natural sunlight?

Years from now, I'll bet that they will find that the pulsed light killed the natural mold and fungi that inhabits the eyelids and that was causing an allergic reaction in people who are allergic to mold. Natural sunlight might well do the same thing, although you'd probably need more of it.

P.S. I'm on a mission to persuade you all that your symptoms just might be allergy.... :) I've just posted a very long explanation why...

[ALK-O'd]

I'm an MGD sufferer too (induced by ALK refractive surgery) and would love to see some sort of direct, proven gland treatment come about. But I have to say I'm very skeptical about this treatment. I think one thing that everyone is missing here is the fact that this particular treatment only directly treats the lower lid region - which unfortunately is where ONLY ONE THIRD of your mebomian glands are located. The other two thirds are in your UPPER LIDS. The article does state that:


The upper meibomian glands are not treated directly, but we have seen an improvement in the upper glands from indirect therapy.

..."indirect therapy"??? Errrrr...ummm... Like I said, I WANT to believe, but come on. I don't by that one. Perhaps it might help the glands in the lower lid some - but again, at best you may only be getting some short term improvement to a small portion of your glands - and who knows what the long term effects of zapping anything might be?

For me, I'll be sticking with hot compresses and lid massages for the time being.

[advocate]

I understand your concerns. I suspect that the natural flora/fungi that lives in all of us is causing an allergic response in those of us who have MGD. The IPL undoubtedly wipes out that natural flora and fungi, but like all microscopic life, it will eventually come back....

If my theory is correct, the lower eyelid is all that matters. That's the one where the allergens collect, and that's the one where the MG's malfunction the most. By curing the bottom lid, you cure the majority of the problem, and thus alleviate the symptoms.

Note that IPL is not a "cure," because patients have to come back for touch up treatments in the future.


I'm an MGD sufferer too (induced by ALK refractive surgery) and would love to see some sort of direct, proven gland treatment come about. But I have to say I'm very skeptical about this treatment. I think one thing that everyone is missing here is the fact that this particular treatment only directly treats the lower lid region - which unfortunately is where ONLY ONE THIRD of your mebomian glands are located. The other two thirds are in your UPPER LIDS. The article does state that:



..."indirect therapy"??? Errrrr...ummm... Like I said, I WANT to believe, but come on. I don't by that one. Perhaps it might help the glands in the lower lid some - but again, at best you may only be getting some short term improvement to a small portion of your glands - and who knows what the long term effects of zapping anything might be?

For me, I'll be sticking with hot compresses and lid massages for the time being.

[buntbean]

I had IPL for rosacea and THEN developed all my problems. My doctors and I have always wondered if there was a connection. Apparently, I'm not alone:
http://www.dryeyezone.com/talk/showthread.php?13970-Dry-eye-problem-after-IPL-hair-removal-with-cosmetic-surgery.