Dry Eye syndrome, and its treatment has always been a challenge. Finally we know why!
Dry Eyes comes in two basic forms:
- Aqueous (water) deficiency
- Lipid (oil) deficency
A recent paper written by Lemp et al. Cornea 2012 has discovered that 86% of dry eye suffers have at least some lipid deficiency – also known as meibomian gland dysfunction. Historically all we have been treating was aqueous deficiency. In theory 86% of dry eye patients therefore have not had adequate treatment! This was all we were doing is trying to replace the evaporating water with a plethora of water-based eye drops that, once instilled in the eyes, would either just drain away immediately or evaporate again quite quickly. All the dry eye irritations would just come flooding back.
On Tuesday this week we installed the first meibomian gland dysfunction treatment device called LipiFlow. What was amazing was the first three patients that had booked in, had found us off the internet. They all had been desperately seeking a solution to their constant discomfort.
One patient was from New Zealand, one from Melbourne and one from Sydney. This certainly surprised us – why would people travel so far to have an innovative procedure done, so early in the release of this new procedure?
Obviously because they perceived that their symptoms warranted more help.
Assessment for suitability for the LipiFlow procedure involves a significant process. This maximises the potential of choosing successful candidates. All three patients that were assessed this week suffered from meibomian gland dysfunction and therefore were all suitable for the procedure.
Now we wait. Most people that have been interviewed from overseas seem to suggest that significant improvement in symptoms occur after a week or two. This is also a little confusing. The problem is immediately fixed and this can be seen immediately after the procedure is done. The meibomian glands definitely start to secrete more meibomian oil. Then why does it take a few weeks to perceive less irritation?
We assume that the corneal surface as well as the eyelids are still inflamed and tender. With the extra oil bathing the eyes, they are no longer being irritated hence will take time to settle down from their extra sensitive state. Whether this is true is purely hypothetical at this stage.
Next week we are performing another four procedures. Believe it or not three from Melbourne and one from the Central Coast! There definitely seems to be more people from Melbourne inquiring about LipiFlow at this stage. Is it the environment? Your guess is as good as ours, but what has been interesting are the constant enquirers that keep calling and emailing us.
As we start to see more and more people seeking LipiFlow treatment for their dry eyes we will keep you up to date on what are the obvious and not so obvious trends. What is for sure is that this is a fascinating topic, especially now that we finally have a treatment for what has been a most frustrating problem for patient and practitioner alike.