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Thread: LipiFlow Information

  1. #1
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    LipiFlow Information

    Hi,
    I just thought I would pass this along, I recieve in the mail today a flyer from the Jules Stein Eye Institute at UCLA where I had been seen in the past for my post LASIK mess. They are now offering the "LipiView Ocular Surface Imaging System" and "LipiFlow Thermal Pulsation" for dry eye sufferers by Dr. Rex Hamilton at the UCLA Laser Refractive Center. The cost is $150.00 for the analysis and $750.00 per eye for the treatment. I have never had it, I have had 6 IPL treatments so I figure it probably won't help me anyway but I am thinking this is pretty expensive, also they are claiming to be the first in the western US to offer this treatment. I thought some of the people on this board have tried it and if so, what was the outcome and how much did it cost? Take care.

    Brad

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    I got LipiView done in Richmond BC Canada. Here's their website: http://www.central-eye.com/dryeye.html.

    As far as I recall it cost either $110 or $120 + tax. It was one or the other I'm pretty sure.

    For the LipiFlow I think it was $900 for one eye and $1500 for both (although I never got this done since I couldn't afford it).

  3. #3
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    Brad, I'll try and respond to your inquiry regarding Lipiflow afer IPL. So far I have completed 4 IPL treatments in Charlotte, NC by a doctor trained by Dr. Toyos. I also had the Lipiflow performed at Duke Medical eye center a few days ago. The treatment is $1500.00 for both eyes and includes the Lipiview.

    Upon completing the IPL treatments, the doctor informed me that the glands were performing a whole lot better and the oil secretions were clear and liquid. Great news, right! Sypmtoms have not improved at all though. I should also mention that the treatments were very intense and lots of squeezing going on. The heat generated is also intense and following each IPL treatment I had lot of oil secretions form around my eyelashes in the morning and mucous film throught the day. After the 4th treatment, less mucous formed and the oils became clearer. To me that is good news when oils form around eyelashes in the morning. Short lived though.

    Now Lipiflow. The doctor (corneal specialist and involved in lipiflow research) said my glands were still blocked and my lipiview numbers were really low (average 40-45). He pressed gently on my glands with a tool that exerts the same pressure as a natural blink and found that I had less than 6 glands excreting. That was done on the lowers and not the uppers. Did not do anything to the uppers. Of course, I continued with the Lipflow.

    The procedure lasts 12 minutes and it is a flickering motion with mild heat. Not uncomfortable at all. However, in my opinion, the heat generated and the massaging effect is so mild I did not expect it was doing a whole lot. Again in my opinion, the squeezing performed by the IPL doctor is far more intense than anthing lipiflow will ever accomplish and the heat generated from IPL is far more intense. Also while the doctor expresses your glands, he/she is doing it under the slit lamp and basically sees what is going on and pushes against the glands until clear oils are coming out. With the lipiflow, you just have to believe the junk and thick secretions are being pushed out but you really never know.

    After the procedure, I felt nothing and went home after 2 hour drive. I woke up next morning and no mucous or oil forming around my eyelashes. In fact, my eyes did not feel different at all. I know I was told to wait a few weeks for the full benefit, but I am skeptical I will feel the improvement later.

    I am to return 3 months later for the lipview evaluation and from there decide the frequency of the treatments.

    Here is my opinion and only my opinion:
    I basically wasted $1500.00 on lipiview and possibly 4 IPL treatments @ $375.00 each. I discussed my thoughts with the lipiflow doctor and he agreed with everything I said concerning meibomian gland disease. Here is what I think:
    If your oils are thick and glands get clogged, then any treatment you perform such as IPL, probing, lipiflow is very temporary. It may improve your symtoms for a short while but in the end your oil secretions will revert back to how they were since it is genetically controlled and possibly under hormonal influence.

    So before you spend lots of money on the above, have a doctor who knows what he/she is doing express you glands after heat application. Check if you feel any improvement and for how long. Chances are that will give you somwewhat an indication whether it is worth it to undergo the "fancy" treatments.

    In the end, all the treatments are similar since their purpose it to squeeze out the junk in the oil glands and really how it is accomplished I believe makes no difference.

    Of course, I know several of you may disagree but I have put a lot of thought into this.

  4. #4
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    Chemia,
    It's so good of you to take the time to share your experiences and I completly understand your going ahead with the lipiflow treatment despite reservations- All we all want is relief from this plague. It's infuriating that one doctor will tell you your glands are open and functioning and the next says they're not- I've been thru this just going from one opth to another and it's like WTH? Are they or aren't they? I'm disappointed to read that you haven't had a real change in your condition with the lipiflow though, as I was hoping that would be the "magic gloop" that could really help us. I've never even been able to get a doctor to express my glands for me- I get the usual instruction about warm compress and massage, which really seem to make me worse and I begin to think that maybe I just don't produce enough oil. I do hope you'll post again after some time has gone by and perhaps things will have improved.

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    Brad,

    From what I understand, Lipiflow reaches the upper glands too, not just the lowers. Did your IPL treatments ever reach the uppers? Mine did not and that always left me kinda skeptical.

    I guess what I am getting at is that Lipiflow might be worth looking into because the uppers could be 50% of the problem. I will be researching it furiously until it arrives in Florida.

    Sorry to Chemia about the lack of relief after spending all of that money though... I agree that with IPL you get to see the gunk. Seeing it was, for me, a validation of sorts that I did have a reason to feel this way.

    FYI to all though - I asked a local dry eye guy who I've been seeing how long it will take for Lipiflow to be covered by insurance and he said since it already has FDA approval, it might only take a couple of years. Woooooot!

    Rose

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    Lipiflow does reach the uppers but I can tell you for a fact that the heat and massaging action is too mild in my opinion to make a difference. The lowers by the way hardly feel anything and was confirmed by the doctor since I made the remark that I feel the action only on the uppers.
    When I had the IPL done, I felt more heat on my uppers merely from the IPL wand being directed around the face especially around my temples and nose area. My doctor dids also express my uppers manually.

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    Chemia,
    I'm wondering if, once the mebomian glands are open, if going on doxy for a while would help keep things flowing?

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    I specifically asked the Dr. about that and he told me he discourages long term use of doxycycline due to potential long term side effects and mentioned to me how his colleague got admitted to ICU from doxycycline. He suggested azasite one month on and 2 months off for a while.
    I should also mention I have tried doxy twice and could not handle the heartburn, loss of apetite and other issues I developed.
    My dermatologist is the one who actually requested I stop the doxycycline when I mentioned my heart burn situation and gave me quite a scare when I was told continued heartburn and ulcers from antibiotics could eventually lead to esopgageal cancer.
    To be honest, I never benefited from doxycycline and so really it was doing more harm than good.
    I may start azasite but I know I tried it in the past and had no luck.

  9. #9
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    Here's a little chart of my LipiView scores.

    Attachment 367

    I have another appointment for LipiView in January.
    Last edited by spmcc; 15-Dec-2011 at 18:10. Reason: added more detail to the chart

  10. #10
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    Hi All,
    Thank you for the replies. I tend to agree Chemia, the IPL along with the aggressive gland expression seems more beneficial. I however never felt any better even after 6 IPL treatments one month apart. I just received word to day that a resident I have been seeing has finally gotten approval through the college for autologous (sp) serum, I will be starting that in January and I will be involved in study as well.

    On another note, the college is the Southern California School of Optometry, I initially went there for sclera lens fitting, and the total cost would have been under $1000.00 which is a fraction of BFS. In fact I had tried earlier in the year for a fitting at the Doheney Eye Institute at USC and the Dr. was a resident at the same college! In fact, the Dr I now see took her place and they dispense all of the same brands and style of sclera lenses. They tell me they treat many post-LASIK dry eye and ectasia patients.

  11. #11
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    I also wanted to ask, spmcc, are you feeling any better? Are you a post LASIK? And I could not wear the sclera lens, way too much pain and I forgot to mention that cost me $600.00 for the fitting and would have cost nearly $10,000 if I had gotten the lenses, in contrast, the SCSO was $75.00 for the fitting! Sadly I failed both attemps

  12. #12
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    Quote Originally Posted by jimi51 View Post
    I also wanted to ask, spmcc, are you feeling any better? Are you a post LASIK? And I could not wear the sclera lens, way too much pain and I forgot to mention that cost me $600.00 for the fitting and would have cost nearly $10,000 if I had gotten the lenses, in contrast, the SCSO was $75.00 for the fitting! Sadly I failed both attemps
    Yes, I'm feeling better... but I am cautiously optimistic (as everyone is who has suffered from this for years and had many failures).

    I should explain that I've been on a blitz the last ~2 years. I had 4 IPL treatments specifically for dry eyes, two probing with Maskin, all puncta sealed (3 cauterized and 1 sutured), and now two LipiFlow treatments. I also wear Wileys ALL day and seal my eyes at night.

    I also tried sclerals in 2009. They weren't for me.

    IMHO, LipiFlow has been the best treatment for me so far (along with having all puncta sealed and wearing Wileys). I would rank it above IPL and certainly above probing for MGD treatment.

    BTW I have never had Lasik or any other refractive surgery. My diagnosis is ocular rosacea since 1995.

  13. #13
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    Quote Originally Posted by spmcc View Post
    Here's a little chart of my LipiView scores.

    Attachment 367

    I have another appointment for LipiView in January.
    Thanks for sharing the graph. Very useful information. Are the July readings pre-treatment? When I look at the readings I see minimal change from July to November with a decent change in the left eye from 46 to 57 but could also be due to the high SD (standard deviation of the test) more than the actual improvement. Just a thought. I was told that in order for the test to be considered a success, the lipid thickness should be double what is was originally.

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    Quote Originally Posted by Chemia View Post
    Thanks for sharing the graph. Very useful information. Are the July readings pre-treatment? When I look at the readings I see minimal change from July to November with a decent change in the left eye from 46 to 57 but could also be due to the high SD (standard deviation of the test) more than the actual improvement. Just a thought. I was told that in order for the test to be considered a success, the lipid thickness should be double what is was originally.
    Yes, the readings are pre-treatment. They wouldn't take readings right after treatment because they don't expect a huge jump right after or even a few weeks later.

    I didn't include any info on the standard deviations. If you want them, July 9 OD was 3, OS 4; Aug 25 OD was 10, OS 12; Nov 23 OD was 3, OS 4.

    I've never heard about any promise of doubling lipid layer thicknesses. Sounds suspect!

    I think patience is key.

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    Sheila,

    As always you are a wealth of information. Could you answer a question for me by chance - if someone wanted to go get Lipiflow once a week, would they allow you to do it? Say, cost was no issue and you just wanted to empty those glands?

    Rose

  16. #16
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    Quote Originally Posted by Sammy B. View Post
    if someone wanted to go get Lipiflow once a week, would they allow you to do it? Say, cost was no issue and you just wanted to empty those glands?
    You'd need to ask TearScience (makers of LipiView/LipiFlow) that question. As far as I know, there's no published research on repeating treatments.

    As for my situation, I was 4.5 months out from my first treatment in July, and Central Eye in Richmond BC told me No to a second treatment in Nov. I had to convince them that I knew that LipiFlow didn't hurt, that I didn't think I'd have any reaction, blah blah. They tried to reach TearScience in NC, but we're 3 hours behind and TearScience had closed. Finally, their local (west coast?) rep said it probably wouldn't hurt, but could kick up inflammation so I should use Lotemax for 2-3 days after.

    Anyway, it's kind of a strange treatment... you'd think that after you have it you'd be instantly fixed/better. But it doesn't seem to work that way. It's a slow process. I don't know why... and actually, I don't even care... as long as it works in the end.

    So, I'll update DEZ when I get more info. As long as there is a trend of increasing lipid layer thicknesses, I'm happy. I'll post another chart in January after my 4th LipiView.
    Last edited by spmcc; 17-Dec-2011 at 18:14.

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    Quote Originally Posted by Chemia View Post
    I was told that in order for the test to be considered a success, the lipid thickness should be double what is was originally.
    Hi Chemia,

    Can I ask you who said the scores should double to be considered a success? And, perhaps even more importantly, did they tell you WHEN you could expect to see a doubling of your scores?

    As you can see from my little chart, I started out at 38 and 43. And, yes, my plan is to be "normal" which is considered >70-75nm. That's pretty much double. So, maybe it's true what you heard?!?!

    Thanks!
    Sheila

  18. #18
    The following are some questions I ask in regards to treatment:
    How does this treatment reduce the inflammation that may be reducing secretion of lipids?
    How does this treatment improve the quality of lipid secretions?
    How does this treatment work in reducing the environment that starts the inflammatory cycle?
    How is this treatment different than 20 minutes of warm moist head and lid cleansing with an agent that reduces bacteria?
    If this treatment expresses all of the lipids currently in the glands how long do the eyes go without lipids to regulate evaporation?
    How does this treatment impact the lack of aqueous?
    If there is no therapy to address the lack of aqueous isn't the inflammatory cycle going to continue?
    How does this device stimulate more lipid production by the meibomian glands?
    Can excess lipid be toxic to the eye?
    What pretreatment regime is prescribed to improve lipid quality?
    What ongoing tests are performed to evaluate the improvement or lack there of of the epithelium cells and goblet cell density?

    These are just a few questions a doctor should be prepared to answer before taking $1500.

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    Sheila,

    I have a loosely formed theory on why stuff doesn't "work" right away. If we have pretty dry eyeballs, there are probably dry spots here and there. Even after a treatment like IPL or Lipiflow, it takes a while for the dry spots to heal, hence the delayed relief.

    Alternatively, one could probably postulate that our glands or systems just aren't right, so even though the glands have been emptied, the cycle of inflammation has been there so long that the glands have forgotten how to act.

    Oh I could go on!

    Rose

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    Sheila, I should first mention that Dr Carlson performed my lipiflow. I actually asked him what I can expect to see 3 months after this treatment and he indicated doubling of my lipid thickness was a possibility. He of course cannot guarantee that but possibly from what he saw he made an educated guess. He did continue to say that more important, it is improvement in symptoms that counts more than anything else.
    Now if you have low oil production then perhaps it may be a challenge to reach scores between 70-75 nm.
    As you can tell from my posts, I am not impressed with lipiflow and find it difficult to see how different it is from regular warm compresses. The $1500.00 I spent on this is not sitting well with me.

  21. #21
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    Indrep, great questions. You definetly should ask Dr. Carlson with Duke the above questions. He is on facebook, he has blogs, and you'll find he is heavily marketing lipiflow. You should email him your questions.
    Also look at the data presented on the tear science web site ( they have modified it recently and included a lot of information) comparing warm compresses versus lipiflow and you will find that the difference is not significant. Also the research performed on lipiflow is very weak in my opinion.

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    Indrep, excellent questions. I recently had lipiview, although not before I saw your questions. I did happen to ask some of those same questions. I have to admit that I am not altogether pleased with the preciseness of the answers I received.

    When asked how the system works to improve quality and quantity, I was told something to the effect that ' by unclogging the glands they are better able to produce more quality lipids' . . . I am still left wondering how the gland function is improved.

    When asked about perhaps needing to correct an aqueous deficiency as part of the dry eye treatment, I was told that 'irregardless of my aqueous status, my lipid layer needed to be improved'. . . My scores were pretty low, lower than I had expected. It appears that even though I am now able to express some meibum after a compress, which is clear and runny, I do not produce much with the pressure that is exerted by a normal blink.

    I am still wondering about how lipiflow treatment would work for someone who does not have 'toothpaste' like blockages of their glands. If the secretions are already fluid like, how would lipiflow be helpful?

    I am post lasik and up until month six, I was producing next to no meibum that I could see or feel after warm compress. I actually ended up stopping my compresses because my eyes felt drier afterwards. Now at seven months I can see and feel my meibum being released with moderate pressure.

    Like any test, the lipiview is a snapshot of your gland function at a particular point in time. How many of you notice that your TBUT seems better in the morning and deteriorates as the day goes on? How many of you notice that your eyes feel more dry when you are anxious or dehydrated? I think these are all factors to consider when you look at the results of the lipiview.

    IMHO, I think the meibomian glands are ultimately influenced by our internal hormonal system, which is in turn influenced by our diet and emotions. Lasting change may need to come from within

  23. #23
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    Quote Originally Posted by Chemia View Post
    Sheila, I should first mention that Dr Carlson performed my lipiflow. I actually asked him what I can expect to see 3 months after this treatment and he indicated doubling of my lipid thickness was a possibility. He of course cannot guarantee that but possibly from what he saw he made an educated guess. He did continue to say that more important, it is improvement in symptoms that counts more than anything else.

    Now if you have low oil production then perhaps it may be a challenge to reach scores between 70-75 nm.

    As you can tell from my posts, I am not impressed with lipiflow and find it difficult to see how different it is from regular warm compresses. The $1500.00 I spent on this is not sitting well with me.
    Ah, I remember Dr. Carlson from the LipiFlow video from this past thread. He's a big wig. That's good.

    In the video, they show the results of some research comparing LipiFlow to warm compresses. They use OSDI (not lipid layer thickness) as their outcome measure. I haven't seen the results published however.

    For me, I don't/wouldn't use warm compresses because I have rosacea and it just kicks up the inflammation that is causing my dry eyes!

    As for the list of questions to ask before having it done... I guess you could say that you should ask those questions prior to doing anything including OTC drops, prescription drops, oral meds, autologous serum, sclerals, IPL, probing, and on and on.

    TearScience may have some answers: TearScience LipiView and LipiFlow info

    Maybe it's the cost of the treatment that makes people believe the mechanism of action should be explained. I don't know. But, for me, I don't really care how or why it works. I just want it to work and NOT hurt short-term or long-term.

    So, I hope it does work... for you, Chemia, and for me too! I believe I'll get over the pain to my wallet if the pain in my eyes disappears (and I'll save tons of money on all the other cr*p I use! I spend the same amount on Restasis every year.)
    Last edited by spmcc; 17-Dec-2011 at 21:05. Reason: added TearScience link

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    Thank you all for the good information, I guess the thing that concerns me most and probably always will, since I was normal before LASIK and now three years later I am still suffering from the same thing. While all these therapies attempts to address the glands etc., The real thing is there has been a mechanical disruption (nerve damage)from the procedure and they can not fix that, therefore these therapies are not always effective on some, me particularly. This is why when I see another $1500.00 I am now shying away until there is more evidence that there is a benefit to LASIK sufferers. But as always, I remain hopeful something will come along but the more time out from the surgery with no improvement I guess the less likely it will ever improve.

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    Quote Originally Posted by jimi51 View Post
    the more time out from the surgery with no improvement I guess the less likely it will ever improve.

    I am 16 years and counting with ocular rosacea (and I have menopause to look forward to ).

    But I'm not giving up. So, you don't give up either!

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    I had Lipiflow at [removed] in Oct, 2011; during that time they were just setting up the device. Lipiview was not working at that time. During the procedure did not notice anything significantly going wrong. After the procedure, I experienced pain within 48 hrs of the procedure was diagnosed with a 40% deep corneal scarring in left eye.

    After this, was out of office on disability with that scarring for a month as I could not keep my left eye open, only keeping it shut helped with the acute pain; so, during that time I was keeping my left eye shut with ointment as much possible thru out the day. Now usually my left eye keeps having pain from that scarring but these days docs don't see any reason why that pain is coming. A combination of Serum drops and Scleral lenses helping me manage the left eye pain somewhat and help me to get thru the long hours computer job. I think I have not healed yet from this scarring although the left eye pain intensity has reduced. Keeping that eye shut takes away the the pain significantly.


    Before LipiFlow & this scarring, I had 2 corneal abrasions & 1 corneal pitting which healed quickly. Another cornea doctor - who did not perform the LipiFlow - think that the type of corneal scarring I had can only happen from a trauma, it can not happen happen from usual breakdown of the corneal surface. The fact that (a) I got it in 48 hr span after the procedure, (b) LipiFlow device sits so close to the cornea, (c) never had a scarring before and (d) am not aware of any trauma with the eye during that time, I suspect that (i) I may have gotten it from that procedure or (ii) may be the procedure was not safe enough for me or (iii) may be it was not administered on me correctly. But I am not certain that my theory is correct. As usual, the doctor who did the procedure does not think that the scarring can be from the procedure.

    The docs who performed the procedure think that it has helped but other docs do not think anything has improved with the glands. I have not experienced any betterment of my symptoms. These days I find it hard to believe these doctors, otherwise how can on the same patient seen on the same week their opinions differ are so. They do not miss any opportunity to praise and take credit that their treatment is working even though there is no improvemnt of symptoms.

    Before LipiFlow, I had 2 IPLs with [/quote] and same experience there.

    I am on Doxy - 100mg x 2 times/day for more than a year now to help these glands. But have not found any relief. Contemplating whether to discontinue as I am worried about long term side effects.

    Eyelid skins are sore after doing warm compress for a year now that I can not tolerate it anymore! To add to that I got another rosacea flare up on face which am unable to tame with medications for last 1 month.

  27. #27
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    I am so sorry to hear about your difficult experience with lipiflow. It sounds like the procedure may have traumatized your eye. It is exceptionally frustrating to have a procedure that is intended to be helpful, actually harm you. I am surprised that they performed the Lipiflow without actually doing a Lipiview. I had the Lipiview done and they recommended that I have the Lipiflow. . . I decided to wait and see how much my eyes are able to recover from the lasik with more time.

    I am glad that you are experiencing some help from the scleral lenses. I think that the eyes can take some time to heal. . . especially when one is older.

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    Thanks Hopeful2! Eye is healing really slowly - am trying serum drops to expedite it but it is still slow. Lipiview was giving erroneous reading that day. Since the clinic knew my case as a very severe dry eye case, they went ahead with LipiFlow. During the procedure(LipiFlow), they use numbing drops, so, even if something get messed up, one can not figure that until after wards!

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    I just came across this LipiFlow safety information - another member of this board kindly pointed out to me:

    http://www.tearscience.com/physician...ng-and-safety/

    This says that this procedure is not safe with following conditions - lagophthalmos, recurrent corneal erosion, corneal epithelial defect, Grade 3 corneal fluorescein staining etc. and may cause injury.

    I have lagophthalmos condition and prior to the LipiFlow treatment have had (a) corneal pitting (b) couple of corneal abrasions AND the reputed university doctors who performed this procedure on me were well aware of my conditions.

    This certainly shows how careless and callous attitude these so called Dry Eye experts have towards their patient.

    I want to spread the word on this so that prospective Lipiflow candidates checks these safety issues & matches with their conditions before choosing it.

    It is hard to trust the doctors to do this basic check on your behalf!

    IT IS EVIDENT THAT I SHOULD NOT HAVE HAD LIPIFLOW IF THEY FOLLOWED THESE BASIC SAFETY RULES!!

    DO NOT want another single patient to suffer like me from this procedure!!
    Last edited by shanku; 22-Jan-2012 at 12:39.

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    That is awful Shanku. I never liked the theory and hefty price of the LipiFlow treatment. Why pay $1400 for both eyes for a very temporary treatment? All it does is basically "melt" the meibum from the inside of the eyelid. But it will soon harden again and then back to square one. What a waste of money. I mentioned earlier it's just a system to cash in on the dry eye market.

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