Patients with severe dry eye can often feel miserable. Imagine feeling a painful sandy sensation grate over the front of your eye every time you blinked. Any innovation that helps is priceless to these patients and their doctors who yearn for better treatments for this frustrated patients.
I came across this article today about Lipiflow in Europe. It has some interesting points. The key concern I have with Lipiflow is the cost for the treatment. It costs about $1700-$2200 in the Washington DC area. In the last few years I’ve noted of those patients who have had Lipiflow (either before they first saw me or after I referred them to a Lipiflow center–of which I have no stock or financial interest in), about 50% of patients love it but 50% said it did nothing to help their symptoms.
We try to warn patients that there is no 100% money-back guarantee with Lipiflow (we do not own the machine and refer to a center if a patient wants Lipiflow) or any of the innovative dry eye treatments which is frustrating for everyone. Still, though, in cases of desperation, patients are willing to try anything to provide relief.
I have been following over the years patient’s suggestions on dry eye care at Dry Eye Zone.
An easy paper presentation for a med student would be to review Dry Eye Zone and other online sites to see what is the average perception of all the different dry eye treatments. If anyone out there feels compelled to do this research or write the code to extract this information from such sites, please let me know.
I have started a database of my dry eye patients to see what are our successes thus far.
In my 19 year career I have noted the following:
1. I have only 2 patients out of at least 250 who said Autologous Serum did not help at all. The vast majority have had a significant improvement to the point that many have called it their “miracle drop.”Additionally, I used to think that Autologous Serum should only be reserved for severe Sjogrens or Rheumatoid Arthritis patients but I have found it works really well for those patients who do not have autoimmune disorders as the cause of their dry eye. The downside is the need to have a blood draw every 3-4 months and the cost. Currently we charge about $275-$350 depending on amount, & type created.
2. I have been pleasantly surprised by the effectiveness of Intraductal Gland Probing. I was not expecting such a dramatic improvement in some of my patients. 1 out of over 50 patients has said it did not help at all. This was likely due to the extensive scarring present in this patient’s glands that allowed us to show the patient that there is almost no oil production from this patient’s meibomian glands. One of the best things about Intraductal Gland Probing is being able to videotape the procedure to show the patient their meibomian glands, count how many are open or closed, and show the patient the quality of their oil production as it is expressed from the glands.
The biggest downside of IGP is the discomfort involved: I have had to inject lidocaine into the lid in 2 out of the 50 patients due to significant discomfort. The other downside is the cost: range about $250-300 per EYELID. Each eyelid can take between 15-20 minutes and a specialized cannula is used to enter each gland if possible. Again there is no guarantee it will work but it definitely gives the surgeon and patient the most information about the status of the patency and oil production of each gland: this information in my mind is priceless as it gives the patients more information about their long term prognosis.
3. I have not been impressed by Lipiflow and hope more innovations are coming soon.
4. I have been impressed with Testosterone cream & drops (Leiters Pharmacy). Thus far 4 patients out of 4 have felt an improvement.
5. Restasis: again it depends on when patients use it. If patients have truly followed the first 3 steps on my step ladder, particularly the warm/hot compresses & the cleaning with Tea Tree Oil, then the use of Restasis helps in about 70% of my patients. If they have not done the cleaning and steps 1-2, the effectiveness of Restasis is closer to 30% and these patients are much more likely to give up on Restasis before the 3 month mark, which is often truly needed for Restasis to start to have a positive effect on a patient’s symptoms.
So these are some thoughts on some of the treatments we use daily for our dry eye patients.
Lipiflow is definitely on to a great idea.
The best dry eye machine would the likely following:
1. Heat the eyelids even warmer for 10-15 minutes then
2. Use microscopic probes as we use for Intraductal Gland Probing and enter each gland with laser precision and possibly inject a little steroid in those glands that are scarred or were scarred prior to being popped open.
3. Then massage the eyelid with a milking-type apparatus
Still though, we live in the best time in history to have dry eyes!
Sandra Lora Cremers, MD, FACS