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    Thread: My experience with Lipiflow in Toronto

    1. #1
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      My experience with Lipiflow in Toronto

      I just returned from my Lipiflow treatment in Toronto Canada at the Herzig Eye Institute, so here is the report from that trip:

      Just a tip: Toronto has a pretty good public trasportation system and you can get anywhere for $2.50. So instead of the $65 cab rib to downtown, just take the subway, rail car, bus system.

      Herzig Eye is located on Bloor Street West just between the University of Toronto and the Yorkville area. It is across the street from the Chanel store, in the same building as Mont Blanc, a block away from the Hugo Boss store ... you get the idea. It is in a VERY nice part of town and on the way in, I got the impression that the fee I was going to pay was in part to pay the expensive rent of the area.

      When I was checking in, they asked me to pay the full fee upfront (this is unusual in US medicine and I was a little put off by it). They charge you a small fee for the initial Lipiview consultation and a much larger fee for the Lipiflow treatment. They charge on a per eye basis. Each eye is more than a single IPL session. So it added up to what I thought was a moderate to large fee. PM me for exact details.

      Dr. Ritesh Patel OD is the optometrist doing the Lipiflow. He is a really nice guy actually and spent maybe an hour and a half with me examining me, doing the Lipiview, the Lipiflow and then answering all of my many questions. He also told me places to visit, eat, etc. while I was in Toronto and was otherwise very helpful overall.

      Lipiview:

      So lipiview is an interferometer that watches you blink and then measures the lipid film in your tears. the scales goes from 0-240 I think and "lipid deficiency" is <70. I measured 45 or 50 in both eyes, so I am lipid deficient.

      Also, he showed me a few examples of his previous patients and their followup results. One guy started at Lipiview score of 35 (very low) and improved to 115 after 5 weeks from his Lipiflow treatment. He said he had several other examples like that.

      Slit lamp:

      Then he did a slit lamp examination on me and looked for open glands in the lower lid. I had 4 open on the left and 6 open on the right.

      So, this is what I am starting with. Then I am supposed to return in a month and Dr. Patel will check for progress in these 2 things.

      Lipiflow:

      So, then the treatment. Dr. Patel put this device on me that has a rubber contact that fits over most of the front of the sclera. Then they slip your eyelids in the outer part of the device, the part that compresses your eyelids.

      Lipiflow does one eye at a time. It took 12 minutes per eye. First, you only feel the heating from the inside of your eyelids. It gets up to 43 degrees C according to Dr. Patel. It did get pretty warm. In all my days of warm compresses, I'm not sure I ever got my inner eyelids this warm, so I think it does an effective job of this.

      Then after a few minutes, it starts the compression part of the treatment. The compression is very gentle at first. Then towards the end of the treatment, it was a little more rigorous, but still pretty gentle, I thought.

      Actually, to be honest I was a little disappointed with how gentle the compression part was. I think I have a lot of gunk in my glands and I really wanted it all to get squeezed out.

      Also, depending upon the shape of your eye, the compression part may or may not be very effective. The contact didn't exactly fit my eye very well, so I felt the compression mostly on my upper eyelids and not very much on my lowers. I told him about it and he tried to reposition the contact and he tried to press down harder to make the compression better. I have no idea if that helped, but I left thinking my lower lids were not going to be as good as my upper lids.

      Well, so that was it. Dr. Patel had some other recommendations for me regarding dry eye - most of which I have heard before because I have seen so many eye doctors in the last year.

    2. #2
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      A couple things I forgot:

      After the Lipiflow treatment, Dr. Patel examined my lids again to tell me which ones are open. He said several more seemed to be open, but that he couldn't tell for sure which are open and the glands need a while to rejuvinate because they have been dormant and inactive for so long. He will be able to tell on the follow up visit.

      My overall impression of Lipiflow is that it is a warm compress with eyelid massage times 10 (or maybe more). In my experience with the warm compress, they are mostly useless, even when I get it very hot, do it for a very long time, and then express the glands really hard. But if Lipiflow is as effective as they say it is - it is just because it is a very effective warm compress with massage.

      Actually, now that I have had 2 IPL session, I can tell that eventually, the IPL will get as hot (or maybe almost as hot) as the lipiflow gets and it will melt some secretions that Dr. Toyos can express to get them out. I am sure this is how ALL successful Meibomian gland treatment is accomplished now - lots of heating of the glands with a good expression afterwards.

      Something interesting that happened while I was there - 2 TearScience employees showed up at the Eye Institute and I specifically asked about the FDA approval process. Of course, they don't know and they wanted to complain about the FDA, but I got a specific answer - "sometime between June 2011 and June 2012". So for those of you who don't want to travel outside the States, it sounds like you might be able to get it in the next 12 months or so somewhere in the States. My guess is Boston will be the first place.

      No improvement yet that I can tell, but I am on Tobradex for a few days which always dries out my eyes and stings, so I really don't know what might have happened from the treatment. I'll keep everyone posted.

    3. #3
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      Well, I am now 2 days from the Lipiflow treatment and I wanted to give a little update:

      First, I don't know if I have any improvement in symptoms. It is definitely too soon to tell. According to Dr. Patel, after the glands are opened and cleared of secretions, it takes weeks for them to "upregulate", meaning they haven't worked in so long that they need to realize that they can start making oil. So, even though I have heard of people making progress this early, I know it is too soon for most.

      Second, I have noticed a couple things. I have quite a bit of mucus discharge from both eyes. Also, I have a few internal hordolea. They look just like this:

      Dr. Patel says that both of these are due to the expression of all the material that was in my glands that probably had a ton of bacteria in them. So, now I just have to take the Tobradex (antibiotic and steroid) and that stuff will clear.

      Actually, I was a little worried that I had so much bacteria at first, but it seems like Lipiflow must have done something very good if there was bacteria hiding in my glands and it is out of there now. And if I take the tobradex, it can get in the glands that are now open and kill all of them.

      I am really hopeful, but I have been disappointed before so I am not getting my hopes up too much...

    4. #4
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      Hi

      Could you just remind me - were you able to express your glands at all before this treatment?

      Thanks

    5. #5
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      Dr. Patel says he could express 4 glands on the left and 6 on the right (in the lower lid).

      A week ago, Dr. Kamat (my IPL doctor) says he could express about 25% in both lower lids (about 6 in both).

      A few days before the procedure, I was able to express maybe 8 on the left and maybe 6 or 7 on the right (the lowers).

      So, I won't know how many "opened up" until I go for my follow up in 4 weeks. But I *should* have some symptomatic improvement by then... Dr. Patel seemed pretty sure that I would.

    6. #6
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      A little update 3 days after the Lipiflow procedure:

      Left lower lid 15 glands expressing normal oil
      Right lower lid 10 glands expressing normal oil
      Can't say I feel any different, but I'm not supposed to just yet

      I can't express my upper glands very well for some reason. Quite a few of the uppers were open after probing 3 weeks ago, but now I can only express 5 or 6 of them in each lid and they don't put out very much oil. The weird thing is that Lipiflow worked MOSTLY on my upper glands and I thought they would all be open for sure after lipiflow....

      Anyone have any thoughts about the uppers?

      Also, a big crowd of people got the treatment yesterday. It would nice to hear from some of them...

    7. #7
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      Thanks for your helpful updates on Lipiflow.

      It's interesting that there were a crowd of people there to get the treatment! I'm unsure that it's the case at the London Clinic - yet.

      I discussed this method with my consultant this morning and he said that other companies were developing similar treatments. This is being talked about at conferences more and more. Let us all hope!!

    8. #8
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      Hey man,
      I really appreciate u letting us know about your experience with these procedures.Im sure they help many others aswell.
      thanks

      P.s. does anyone know how many meibomian glands there are in the upper and lower lids?

      Quote Originally Posted by NeedMyEyes View Post
      A little update 3 days after the Lipiflow procedure:

      Left lower lid 15 glands expressing normal oil
      Right lower lid 10 glands expressing normal oil
      Can't say I feel any different, but I'm not supposed to just yet

      I can't express my upper glands very well for some reason. Quite a few of the uppers were open after probing 3 weeks ago, but now I can only express 5 or 6 of them in each lid and they don't put out very much oil. The weird thing is that Lipiflow worked MOSTLY on my upper glands and I thought they would all be open for sure after lipiflow....

      Anyone have any thoughts about the uppers?

      Also, a big crowd of people got the treatment yesterday. It would nice to hear from some of them...

    9. #9
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      5 days after Lipiflow update:

      Right lower lid: between 15 and 20 glands expressing normal oil (even most of the lateral glands which don't work in some normal people!)
      Left lower lid: 13 glands expressing normal oil

      However, some of these glands are making very little oil - which makes sense because they haven't been working for 10 months...

      Upper lid glands seem to be making *some* I really can't say how many because they are harder to evaluate, but I would guess 50%, which is unchanged since before Lipiflow, so I'm not sure about the uppers.

      However, I still don't really feel better... :-(

      And Anthony, there are around 100 total meibomian glands - 4 lids each with around 25. However the lowers are more like 20-25 and the uppers are more like 25-30.

    10. #10
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      Thanks for the thread - very interested in Lipiflow and appreciate you taking the time to share your experience!
      The magic gloop IS out there somewhere - right?

    11. #11
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      7 day post Lipiflow update:

      Right lower lid: I counted 20 open and producing normal, crystal clear, virgin olive oil...

      Left lower lid: I counter 15 open making normal oil, including those that were the worst a few weeks ago, filled with inspisated secretions...

      Upper lids - not sure since they are hard for me to see/express but I estimate atleast half are open.

      Keep in mind, only a few of these are making a ton of oil. The rest are just putting out little pools... I guess because they have been closed so long.

      Am I feeling better? Meh...

    12. #12
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      How do you express the glands and how are you able to view the oil? What kind of magnification are you using? Thanks

    13. #13
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      Honestly, it isn't easy to see the glands in the mirror and even harder to see the expression. I had this condition and tried to express my glands in the mirror for 6 months before I really figured out where they were.

      Here's what I do: I have a little makeup mirror that I bought at Walmart - it is 10x maybe or 4 x, I'm not sure. So I look in this mirror and I have several overhead lights on nearby.

      I look in the mirror at my lower lid and let the light reflect off my lower lid so I can see the little orifices. I can only see a few at a time. Then I press just below my lower lid and again let the light reflect off the orifices. Then I will see little pools of what looks like water around the orifice of the glands making oil or I will nothing around those that are clogged.

      That's about it. It isn't easy to do and it takes practice. If you know some of your glands are working, try those first.

      Good luck!

      NME

    14. #14
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      Just a follow up to the above posting on how to see your MGs. This what it looks like when I do an expression now:


      Except, all I see is little pools of oil like you see on the above image. It's really hard to see the orifice AND the oil at the same time in the mirror. It's really easy to see little pools of clear oil though.

      Also, looking at the above picture, I can see maybe only 4 orifices and maybe 7 little pools of oil. So this makes me wonder - am I counting little pools of oil and calling that the number of glands? I think I am. So maybe when I count 25 in the right lower lid, maybe it is 25 little pools of oil and maybe only 15 or 17 orifices, but I really have no idea.

      Anyone else have this issue?
      Last edited by NeedMyEyes; 20-May-2011 at 17:10. Reason: picture didn't show up

    15. #15
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      Thanks for the explanation. I actually use a X20 mirror. It is quite amazing what you can see. I find that when I express my bottom glands with a q-tip (cotton removed) I can see clear oil coming out. However, I find that I have to press just right to see the secretions. My issue are the uppers. I have a difficult time determining if any oil is coming out.

    16. #16
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      Well, so I just had an appointment with a dry eye expert ophtho and he told me all my upper glands are "plugged".... what the? So they must have all been plugged before Lipiflow and the Lipiflow couldn't unplug them?

      So, I have looked at these glands in the mirror several times and it looks like some are indeed plugged, but not with meibum. No, I think they are plugged with keratin. Meibum is yellow and this is sort of clear skin over the glands.

      Anyway, after my compress tonight, I looked at my right eye uppers and there are definitely at least 10 open glands making (only a little) normal looking oil. So, I'm really not sure what the expert was looking at...

    17. #17
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      2 weeks, 2 days post Lipiflow update:

      It looks like the gland count has stabilized to around 15 open in each lower lid. Also, some of these glands are really starting to put out a lot of oil, so it isn't just quantity, its quality.

      Just to make sure everyone knows, in addition to Lipiflow, I had 2 IPL treatmens just before Lipiflow and the probing procedure. I have also had 2 tea tree oil scrubs. Also, I had temporary plugs done a few days ago. So I can't say I have a done a scientific trial on just Lipiflow - but yes, I am pretty sure it helped and I am pretty sure it opened up at least 6 or 7 glands that are pumping good oil in each lower lid and maybe more than that in the upper lids.

      Am I feeling more comfortable - well it is only 2 weeks out and they say you have to wait 4 weeks for real results. And I have had some rough days in a new working environment in the last few days... So, I'll have to let you know in a couple weeks.

    18. #18
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      You should get permanent plugs. I read studies that showed they significantly improve the even spreading of the oil you do have and therefore decrease dryness.
      Regarding Lipiflow, I am a little concerned at all the responses to your questions this doctor gave you. Does he have study data to back it up ? How does he know your glands are "dormant" or "inactive" and that this treatment will rejuvenate them ? How does he know you had bacteria in there, and now that you cleared the glands they will magically (without drugs) start functioning again. I hate to sound like a party pooper , but I am more of a science guy and this doctor sounds a little snake- oilish to me. He seems to have an ambiguous answer for all your valid questions. I apparently have "milky oil" which is dysfunctional and yet no doctor can tell me why I have this. Just like they can't tell you why your glands are blocked and your friends' glands are not.
      I would loooove to have normal eyes that don't hurt all day but so far I see the medical industry going in the wrong direction. I looked at the drugs that are on trial and none of them seem to address dysfunctional oil production and blocked glands, which I think is key to curing this. They look like they are bandaid fixes for the inflammation and don't work on the true causes. The NSAID drops look promising. If I'm screwed for life with this disease I might as well have numb eyes !

    19. #19
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      Thanks so much for taking the time to share your experience. Dr Patel is very nice I agree, most persoanable Dr I had there (I got my LASIK done there a year ago today!). I had the assessment but declined the treatment as I didn't want to sign any more consent forms that said I was taking the risk that it could make things worse, I didn't want to take the risk.

    20. #20
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      @ LilyFair: I totally understand what you mean - they want you to sign something else that says they can screw your life up and you can't blame anyone for it. I definitely understand. However, I would reconsider if I were you. First, LipiFlow seems absolutely harmless to me. It was warm and relaxing. The massage was extremely gentle.

      I don't know why they need you to sign a consent form because it is really hard for me to imagine anything bad happening. In the US, you have to sign a consent form for anything and everything so this didn't cause a problem for me.

      Also, if Lipiflow were being offered at another eye institute then you would probably sign the form and get the treatment. Really, I think you should reconsider because the sooner you get the Lipiflow, the sooner you will get the improvement which takes a few weeks.

      @ FunDryEyes: I am set for permanent plugs in a week or 2 and yes I think they will help. I always hear about this "inflammation on my ocular surface" and that I shouldn't get plugs, but they definitely feel better with some of my own tears on them. We'll see I guess...

      I don't get the impression that Dr. Patel is a "snake oil" eye doc at all. He gets all of his information from the inventor of Lipiflow, Dr. Korb, who is one of the most prominent eye doctors dealing with Dry Eye and Meibomian Gland Dysfunction. It sounds like this upregulation of glands may be a hypothesis of Dr. Korb's. To be honest with you, I am of the opinion that if Dr. Korb thinks so, it is probably right.

      Actually, you could look up some of Dr. Korb's papers in pubmed and I think you'd be convinced with his abilities as a scientist and with the science behind Lipiflow.

    21. #21
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      3 weeks after Lipiflow

      I just went to an ophthalmologist and he checked my glands. The final report is:

      Right lower - 80% open (up from 20% 2 months ago)
      Left lower - 60% open (up from 20% 2 months ago)

      Right upper - > 5 glands capped and obstructed and a few hordolea
      Left upper - only 1 hordolea, more open than the right

      So, that's it. This has to be my last update since I am going for IPl tomorrow. If I have any improvement after this I won't know if it is IPL or Lipiflow.

      I guess I do feel a little better, but keep in mind I just got temporary plugs...

    22. #22
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      Does one eye feel any better than the other?

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      hi nme,

      good to see you're doing bit better by now.
      actually the amount of working glands isn't very bad at all i think.
      i guess there are people out there the with the same percentage of functional glands who are completely a symptomatic.
      3 weeks is not very long,so maybe all this just needs a little more time for you to notice a significant improvement in symptoms. after all the occular surface has a lot of healing to do.
      probably the most important thing to do now is to keep the reopened glands open and functional. (easier said than done,i admit that).
      the glands have gone bad for some reason. do you know the root cause for your glands to clog up like this?
      has your opthalmologist given you an advise to maintain the health of your glands?
      to prevent them from clogging up again maybe going on azasite or low dose doxy long term is a way to shift over to a more or less maintaining modus.

      keep us posted!
      i'm very keen to hear about your experiences.
      mgd wise we're somewhat on the same boat here...

      patrick..

    24. #24
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      Mgd

      @Margaret:

      Well, it's complicated.

      The simple answer is the left. It feels about 75% normal during the day and if I tape it shut at night and put a little saline in, it feels normal when I wake up.

      But keep in mind I have a temporary plug in the left and the one in the right is probably dissolved by now (different plugs - it's a lond story).

      The right eye has Grade 2 or Grade 3 lid wiper epitheliopathy and I think that's the main problem with the right. I think the MGs are "okay" in that eye. If I can fix the LWE in the right eye, I think I may have a very livable situation with both eyes.

      @patrick: yes, I think I have found my quick fix for MGs - if they clog again, I am definitely headed for a Lipiflow treatment. You know, I *may* be back to where they were before all this happened. Now I just have to deal with the after effects of the dry eye - the lid wiper's, the allergies from drops / baby shampoo / Occusoft pads / etc. etc.

    25. #25
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      I, may sound like I'm playing the devil's advocate - but after the disastrous "almost 100% safe" neurosurgery I had which resulted in, amongst other awful complications, severe DES, RCEs, and then suddenly I also found out I had EBMD and MGD which are unrelated to the neurosurgery...I do not believe any procedure is without risk. I did not think that before my surgery, but believed I had no choice but to take the risk. (The recent neurosurgery had nothing to do w/eyes, was due to a botched emergency neurosurgery 23 yrs ago for something totally nonrelated). Taking or applying any drug, herbal supplement, etc. has risks. I will wait a considerable time until I see at least several years of trials, research, before I trust the vision I have left to a new technique. I'm not negative, just much more cautious at this point.

      Maria
      Last edited by mgshutterbug; 04-Jun-2011 at 21:45. Reason: to add additional information. I am very happy for you that this seems to be working nme. Just wanted to add my viewpoint.

    26. #26
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      Quote Originally Posted by NeedMyEyes View Post
      @ LilyFair: I totally understand what you mean - they want you to sign something else that says they can screw your life up and you can't blame anyone for it. I definitely understand. However, I would reconsider if I were you. First, LipiFlow seems absolutely harmless to me. It was warm and relaxing. The massage was extremely gentle.

      I don't know why they need you to sign a consent form because it is really hard for me to imagine anything bad happening. In the US, you have to sign a consent form for anything and everything so this didn't cause a problem for me.

      Also, if Lipiflow were being offered at another eye institute then you would probably sign the form and get the treatment. Really, I think you should reconsider because the sooner you get the Lipiflow, the sooner you will get the improvement which takes a few weeks.
      Thanks for your input/opinion.

      I made my decision in January, it was offered to me as a treatment free of charge as I had my surgery done there. It just didn't feel right in my gut, and I did not want to take the risk of this making the dry eye worse (which the consent form says could happen even though the odds are low). Dr Patel was great though, best Dr. I've seen there for listening and being personable. (Apart from the guy who's long gone who ok'd me for the surgery, saying Dry Eye was a side effect sometimes but no big deal!). It's hard to trust after that.

      I do hope you have continued success and your symptoms get better.

    27. #27
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      @mgshutterbug:

      yeah, I definitely understand - EVERY medical intervention can possibly cause side effects - aspirin causes bleeding, penicillin can give you C.Diff colitis, etc,

      However, I have to say neurosurgery is WAAAY more invasive than Lipiflow - which is an in-office warm compress. Yeah, there could be side effects, but again, I just want to say my impression was it was very non-invasive.

      But I have to say there is wisdom is waiting until all the side effects are known.

    28. #28
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      Lipiflow in the news (Youtube video)



      Well, so Herzig Eye is in the news with Lipiflow. These are the same rooms I was in getting my treatment about a month ago.

      I just called to make a follow up appointment and they are booked solid for the next month or two.

    29. #29
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      If I heard correctly, the treatment is 12 minutes long? You know what freaks me out a bit? My eyelids would get stuck to my eyeballs just from a 5 minutes warm compress (hence the reason I use steam now instead)... sooooo, I worry that if I tried the Lipiflow, the device would get stuck to my eyeball... sorry... I know that's totally gross... but it seriously scares me. Any thoughts?
      Yet another post-Lasik (2005)...
      Anyone have a time machine so I can go back and undo this mess?

    30. #30
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      No problem for you I think

      Hi, SAAG,

      I think it won't be any problem at all. After those 12 minutes, you will wish the Lipiflow took longer...

      Dr. Patel will put a few drops in your eyes before the treatment for various things so they will be moist already.

      I'm sure he can put in a little unpreserved saline to keep things moist if you tell him about your dilemma. A little moisture would not have hurt anything as far as I can tell. If you call Dr. Patel or email him, I'm sure he'll answer your questions. He was pretty easy to get in touch with.

      Good luck and let me know how it goes!

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