Answered Questions


Thank you for reading Answered Questions on DryEyeNews.com. Below is a number of frequently asked questions. To submit your own question, please fill out the form located on the right. Your question may be answered in a future column. Please note that due to the volume of questions we receive, Dr. Toyos is not able to answer every question or respond to each inquiry. If you are in need of immediate health care services, please contact your physician.



Is IPL treatment effective for post Lasic dry eye for which no other treatment works: drops, gels, specialty fitted lens covers etc?

Answer:


We have found that LASIK itself does not cause dry eye. Whenever this happens there usually is a form of sub clinical or asymptomatic dry eye and LASIK is just the straw that breaks the camel's back. IPL will certainly help if the cause of the symptoms is found to be MGD, meibomian gland disfunction. If this is the case, the majority of topical treatments address the symptoms, rather than the cause. I would recommend seeing a Doctor in your area that does the IPL for dry eye procedure for an evaluation to determine if IPL is the right option for you.




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Is LipiFlow the same as IPL Treatment?

Answer:


Lipiflow is similar to IPL in that heat is used to express the glands. But IPL is much more. Think of dry eye as a skin gland problem that effects the natural tears and then the eyes. IPL improves the skin and the gland getting to the root of the problem. Expression alone will only give temporary relief.




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Who are the best candidates for IPL treatment?

Answer:


The best candidates for The Toyos Optimum Dry Eye Treatment are patients with moderate to severe Dry Eye, or patients suffering from Meibomian Gland Dysfunction (MGD).




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What results can I expect?

Answer:


After the initial treatment, most patients report some improvement in their symptoms. Studies have shown an objective increase in tear function after each treatment, with the maximum improvement happening after the fourth treatment. Depending on the severity of the dysfunction, some patients may need fewer treatments while others may need more. All patients need maintenance therapy at least once a year.




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Is this treatment covered by insurance?

Answer:


This is an out of pocket procedure although some insurance plans do cover it.




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Is it okay to receive treatment while on medication? Are there any contraindications?

Answer:


Certain medications cause photosensitivity. Always inform your ophthalmologist of any medications you are on, or changes in medications.




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I wear punctal plugs, can I still receive a treatment?

Answer:


Yes you simply remove the plug prior to treatment.




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I have a pacemaker. Can I receive a treatment?

Answer:


Yes you can. IPL emits less frequency than your cell phone.




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Will I need someone to drive me home?

Answer:


IPL is a non-invasive procedure and has no down time other than limiting sun exposure post treatment and wearing a physical sunscreen.




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I have visible blood vessels on my upper eye lids. Does the IPL treatment also target that area? When will you be bringing this treatment to Alberta, Canada?

Answer:


The upper eyelid vessels do improve since we close off feeder vessels and also because the treatment reduces inflammation. I would find an ophthalmologist in your region that would be interested in the Quadra Q4 Dry Eye Treatment. They can call Cheryl, the education coordinator at DermaMed Solutions, at 610-358-4447 to start the discussion. I personally train every physician on how to best utilize the system. If you can not find a doctor then I suggest flying to the Toyos Clinic in Nashville or Memphis. For a free consultation at the Toyos Clinic call Nikki at 901-683-7255.




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I am an African American woman in my 40’s with dry eye. Will this work for me?

Answer:


IPL is an excellent option for very light to medium color skin such as light Hispanic. IPLworks by targeting the pigment and vasculatures in the skin. It is not suited for darker skin types. Your doctor will have other options to assist you with treating your dry eye problems.




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Will I still need drops when I am done?

Answer:


Many patients will be free from drops upon completion of the series of treatments.




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I have rosacea really bad, will this cause me to burn?

Answer:


IPL is FDA approved for rosacea. You will find, as many patients do, that their skin improves dramatically as a result of the procedure.




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I am going on vacation, can I get a treatment when I get back?

Answer:


It is recommended that you limit sun exposure and wear a good physical sunscreen. If you are tan we recommend you wait for a treatment until your skin tone returns closer to your normal color. Remember IPL targets vascular and pigment so it will recognize your tan as pigment and would make the procedure uncomfortable and potentially hypo-pigment the skin. Also, we do not recommend treating skin that has been spray tanned due to the pigment in the tanning solution.




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My doctor informed me I need cataract surgery. Can I still treat my dry eye with this procedure?

Answer:


Before cataract or laser vision correction surgery, treatment of any tear deficiency problem is now considered critical to a good outcome, since dry eye can predispose to infections and unsatisfactory vision.




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What are IPL treatments like?

Answer:


First, the area around the eye is cleansed, and external stick-on IPL shields are applied to the eye area. Then a thin layer of cooling gel is applied to the treatment area. IPL treatments are accomplished through a hand piece attached to the IPL system. When the pulse of light is administered, there is a momentary sensation that is easily tolerated.




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How many treatments will I need?

Answer:


Treatments are repeated once a month over the course of 4 months.




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How many patients do you treat per month? I am trying to determine whether the IPL machine would be of financial and medical benefit to a practice with 3 corneal specialists. Is this a first line treatment for you?

Answer:


At the Toyos Clinic we easily do 100 patients a month. It is not first line unless the patient has come in from somewhere else and has tried other things, or if they have moderate to severe dry eye. If they have mild dry eye I still do traditional treatments. Doctors that I have trained rave about the medical benefits and are happy with the financial reimbursements.




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If my initial LipiFlow procedure didn’t work is there any reason to try again?

Answer:


LipiFlow acts like the ultimate warm compress, it massages the glands while at the same time it softens the secretions. However, it does nothing for the Talangiectasias or blood vessels that are causing inflammation on the eyelid margin, and therefore the MGD or Meibomian Gland Dysfunction that has been found to be the root of Dry Eye in most cases does not get properly treated with LipiFlow.




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My son has had chronic dry eye for about 2 years now. He has seen an eye surgeon, had plugs inserted, used Restasis all to no avail. He was told his condition was caused by the LASIK surgery. Is there anything available to help him other than what he has already tried?

Answer:


Lasik patients who complain of dry eye usually have dry eye before the surgery. The symptoms can be masked by the contact lenses or the glasses, then they have Lasik and now without the glasses or contact lenses they feel the symptoms. So we need to get to the root cause of your sons dry eye. 90 percent of people have a tear film problem due to poor functioning glands. Perhaps this is what your son is dealing with now. If this is the case then he can be treated with IPL. We have treated several patients with this problem post Lasik with great success.




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I am in desperate need of help. I live in New Zealand and have seen 3 eye specialists, none have been able to help my condition. I have been diagnosed with Meibomiam gland dysfunction, blepharitis, and Hashimotos. I have been through all the treatments they can offer, which are the omega 3 supplements, hot compresses, doxycycline, restasis, moisturising drops, punctal plugs etc, nothing is helping. Throughout the day my eyes go through periods of feeling like they have grit in them to feeling normal then feeling like there is acid being poured on them as I get a burning sensation from whatever comes out of the ducts. I have had to stop driving and I find it extremely hard to work on my computer. I am so totally desperate I would do almost anything to feel normal and have my life back again. Is there any advice you can give me?

Answer:


We have had patients fly from Australia to see me in the past. Book a trip to see me and we can evaluate you and treat you. Once we have a treatment plan I can have someone in Los Angeles continue the treatment protocol at my direction if that saves you money. I hope this helps. See you soon. Dr. Toyos




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