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We just had a great interview with Dr. Christopher Wolfe on how Lipiflow can help your blepharitis, dry eyes, and meibomian gland dysfunction. I will put some of the great talking points below, but tune in to the whole video for tons of great info on the treatment of blepharitis, MGD, and dry eye!
In general, it’s important to screen patients before they’re symptomatic. So many people will have symptoms that they would never attribute to these conditions, and it’s important to look under the hood. Screening for functioning of the meibomian glands and looking for the health of the oils coming from those glands gives us the sense of how severe the meibomian gland condition is. In his practice, warm compresses and eyelid scrubs are started on day one with most patients, unless there are no signs. After one month on this regimen, Dr. Wolfe begins looking deeper into the issue.
Eyelid hygiene is started early on because biofilm that builds up over time can begin to migrate back and affect the meibomian glands. Biofilm can be properly managed with a good eyelid hygiene regimen, and many people will find relief from this. Just like brushing and flossing your teeth, it’s an important daily step to preventing greater issues.
If the warm compresses haven’t done enough to clear the glands, we need to determine whether or not the issue is more of an oil issue (evaporative dry eye) or watery issue (aqueous deficient dry eye). InflammaDry is performed as well as tear film osmolarity and staining procedures to search for inflammation. If these things are positive, the underlying inflammation may be chronic or acute, and it’s up to doctors to figure out which it is.
When inflammation is present, it’s important to use anti-inflammatory medications such as omega-3 supplements, Restasis, Xiidra, Cequa, or low dose steroid eye drops in an attempt to bring the eyes back to their pre-inflammatory state. Most of the time, there is inflammation as well as an issue with the meibomian glands, but if there is inflammation only, then we know we’re dealing with a chronic inflammatory cycle.
LipiFlow is always considered if the patient has meibomian gland dysfunction as well as inflammation, or if their MGD has not improved with warm compresses alone. LipiFlow is a nonsurgical procedure that applies heat and pressure to the eyelids in order to soften and release the oils of the meibomian glands. It is important to note that this procedure is part of an entire dry eye protocol - LipiFlow will always do what it’s said to do, but it may not always work perfectly for everyone.
How do we know if LipiFlow will be successful? First, we have to look at the number of functioning glands. If there are less than 10 functioning glands in the lower eyelids and they have decent structure, LipiFlow will usually be effective based on gland function (the number of functioning glands was shown to improve in FDA studies on patients such as this). In addition to this, a dry eye questionnaire (SPEED) is important. These measure the patient’s symptoms as they see it, and are helpful to see how much improvement they’ve actually noticed after a procedure. Remember, your inflammation was not built in a day. It took years to overflow, so it’s going to take time to get this inflammation down.
Truthfully, it can be 100% if the correct patient is chosen. As already discussed, there are specific people who will truly benefit from this procedure.
Historically, the cost was much greater. The applicators which attach to the eyelids are a single-use device, meaning they must be replaced with every single patient. In addition, it takes a lot of time for a practice to become experts in LipiFlow, and this takes a lot of manpower as well. If you’re looking at the cost of LipiFlow vs. the cost for chronic anti-inflammatory medication, it may be easier to justify the cost because it could be more cost effective than these prescription medications (depending on how much your prescription costs).
At this time, insurance isn’t covering LipiFlow and it may never be covered due to the way insurance companies work.
Although it’s rare, it is possible that the front surface of the eye could be irritated after the procedure. However, most people will never experience this and LipiFlow is a very safe procedure.
LipiFlow is FDA approved for the treatment of obstructive meibomian gland dysfunction. As MGD builds, the glands become obstructed by keratin-like plugs that need to be cleared out. Thus far, there aren’t any major studies that show that the glands elongate after LipiFlow (reversing atrophy). However, 51% of patients didn’t have to be retreated after four years of treatment with LipiFlow. Keeping inflammation down is key!
34:50 - Joy Marie - Ask for alternatives since the procedure is too expensive for most of us.
35:20 - Kon Bar - How effective is iLux compared to that?
35:50 - Karen Davis Mathews - Why does it take much longer to feel results vs MIBO? Lipiflow can take weeks/months where MIBO is days/weeks. Why does it cost so much more than MIBO?
37:05 - Traci Dudzic McCabe - Is it truly better than the regular lid expression treatment?
37:55 - Ali Ali - Is it better to get blephex before lipiflow or a debridement with a metal tool? Is it the same or is one better?
39:01 - Adam Richards - Would a treatment like Regener-Eyes be recommended before Lipiflow because it targets and reduces inflammation? Would that potentially create a better end result?
39:33 - Anu Chiarelli - Is there a benefit of choosing Lipiflow over IPL? If so, what is the benefit?
40:09 - Louise Budowski Cook - If it doesn’t work the first time should you keep trying? Can it eventually work even if no change after one time?
41:25 - Ellen Rocco - I had lipiflow about 5 years ago. Has the processes or prognosis improved?
41:53 - Sabrina Segarra - Will getting it done stretch out your lids?
42:15 - Tom Zachar - I have floppy lid syndrome. Am I a candidate for this? Will the procedure loosen my lids more?
43:19 - Marilyn Parver - Should it be used with a shield on the upper lid or is it safe to use on the upper lid?
43:57 - Joy Marie - Why do some of us develop blepharitis after Lipiflow?
45:01 - Adriana Iozzi Gonzalez - What are the lipiflow outcomes or experiences of patients with ocular rosacea and/or rosacea?
45:51 - Wanda Cation - I have shunt implants and tube shunts in both eyes, as well as lens replacement in both eyes. Would that disqualify me for lipiflow?
46:47 - Tracy Tulloh Galloway - Can progress be seen on the Lipiview machine?
47:49 - Tracy - What defines success for a patient who has undergone Lipiflow. What is the definition of a positive outcome?
He is a graduate of Oklahoma College of Optometry and, after completion of his training, won the Golden Retinoscope Award, the College of Optometry’s highest distinction for clinical excellence. In 2013 and 2015 he was awarded Young Optometrist of the Year for the Nebraska Optometric Association, and in 2016 he was awarded Optometrist of the Year for the Nebraska Optometric Association and the Young Optometrist of the Year for the American Optometric Association.
Dr. Wolfe has a passion for education. He is a co-founder of KMK Board Certification Review Services, a company specializing in preparing Doctors of Optometry to take the American Board of Optometry examination. He is also the founder of EyeCode Education, a company specializing in clinical and billing education. He is the co-author of the book: KMK Optometry Board Certification Review Manual and KMK Update and EyeCode: Billing and Coding. Dr. Wolfe is a fellow in the American Academy of Optometry and a Diplomate of the American Board of Optometry. He also has special interests in therapeutic scleral contact lenses to correct visual distortions in patients with corneal diseases. Dr. Wolfe is an avid runner and most of all, he enjoys spending time with his wife Jaime, daughters Ryan, Paityn, Camryn, Logan, Maisyn and sons Lincoln, Deacon and Benton.
Dr. Wolfe got into dry eye disease because of an interaction with a patient. At the time, he notes that we were trained that blepharitis would be obvious. But that’s not always the case! We have to be vigilant and look for those patients who don’t exhibit the outward signs, yet may have excruciating symptoms.
