… and drying their eye.
Because if you live in Arizona you would be a lot worse than by living here because it’s the environment has a significant factor on how dry your eyes are. If you go out to Walmart to go look for something, they run the air conditioner there at that place high, full-blown, 24 hours a day and the air in there is extremely dry and then you’re staring to look at something and not blinking. So then, people are saying “As soon as I go in there, then I have trouble seeing, I can’t see. My eyes are dried out.”
So this is the same thing about dry eye management.
This is the new hot topic about dry eyes. This is the LipiFlow and LipiView machine. There’s only a few and they still get it in the United States and we’re fortunate enough to have one of the first 20 machines that were ever built or made. We have people fly as far away as Seattle in the country to get treated. The great thing about this equipment even though it is expensive very expensive is that we can now diagnose exactly what’s wrong with your dry eyes. Before it was just a guess. “Try this, see you later. Try this, see you later.” It was always just shooting in the dark and hoping for something that works.
Now we don’t have to do this. Now I can measure how salty your eye is so I know how much liquid layer you have. This machine measures the outer oily layer of your tear film and the microns sublevel. So by scanning that, this takes a scan of your eye, so move, so we actually see how well you blink, and while it’s doing it, it’s now measuring how thick is the oily layer on the surface of your eye. So now when we get that we know exactly what kind of dry eyes you have and how we’re gonna treat it.
This one side is about 90 microns in thickness. That’s pretty close to normal. About a hundred and a hundred and ten is normal. On the other eye is 55 so they’re half abnormal in this person. Unfortunately, I have people who come in with 20s, who have almost no oil to their tear film at all. So they have severe dry eye problems.
So now we know ahead of time what’s wrong with your tear film, that your Meibomian glands are not producing any oil and this is basically what happens. So you saw that fixed up. So as your inflammation over years of time, those glands started producing a little worse, a little turbid stuff then they got thicker, then it got to a point it plugs up. So now those glands are plugged they can’t secrete oil any more. And after a while, those glands will atrophy and die, never to be healthy again. So the longer this goes, your chance of recovery gets less, less and less because you’re gonna slowly, over years of time, lose another gland, lose another gland, lose another gland. So that’s what happens.
So someone who has a reading of 30 or 40, they’re 3 times below normal. So they have very minimal glands that are working. Something are, or streaming just a little, some are plugged, still alive but plugged and some are dead and gone.
This LipiFlow machine is the first and only FDA approved treatment for Meibomian gland disease or dry eyes, due to this. So ahead of time we’ll know if you’re gonna be a great candidate for the procedure because we measure what was there before. We’re not guessing and hoping that it works. It works 90 something percent of the time.
So this is the apparatus, so this part here goes inside your lid. Your lid goes in between these, and there’s a little balloon here that goes on outside to the upper and lower lid. This heats up to a 106 degrees. Just like if you put bar in a pan, when you heat it up, you get more liquid. So it heats up to a 106 degrees, and this balloon then pumps and squeezes and cleans your glands out after it’s heated enough. And so I showed you where the glands are located inside your lid so that’s where the heat is applied directly to where the glands are.
This is what it looks like. It’s not painful. When we bought the machine in my office, I had a little bit of a dry eye problem. I said okay, we’ll find out what it’s all about. So I sat down and I was the first person who’ve been treated by my machine. And I almost fell asleep in the process just like going to the spa. It just generally heats your lids up to a hundred and six degrees and it generally pumps and squeezes the glands and cleans them out. So the glands there are recoverable. We can now get you back to where it was working.
And this is what it looks like. So we have this part inside, and then there’s where the gland is, so it keeps the gland directly, and then this pumps and squeezes and cleans those glands up. It’s a 12-minute treatment. It takes 12 minutes to do the whole process.
So this is just some studies that where done. When you have to do a study with the FDA, you can only do that treatment and nothing else. That is, these people weren’t allowed to do many of the other things we’re going to talk about how to treat dry eyes. After a year or so, ‘cause people ask me, “How long is this gonna last.?” I don’t know. Just to be honest but I don’t know.
I know that after a year the study was done, that a few or small percentage of people started having symptoms coming back, but they were allowed to do nothing other than just the treatment. So the same disease that caused it to happen is still gonna be smothering on, and actually you’re gonna go right back to where you were before. So we have to do things as a maintenance so we keep you healthy longer. The machine’s only been around about a year here since June, so we don’t know by doing what I’m doing now how long it’s gonna last, but I think it’s gonna last a lot longer.
So this is the study that show its effect. There’s been really no damage that has been done; there’s no significant pressure. It’s all insulated. The the heat isn’t there. So basically, the LipiFlow is the only approved procedure to treat dry eyes. There’s nothing else that’s been FDA-approved that says it’s safe and effective. But this is only part of what we do. But this is the newest, latest thing.
So now we’re gonna go over a little bit about what we do.
You come in, you have dry eyes. What do we check? I look. See how dry your eyes look. See if the glands are inflamed; you have blepharitis along with it. So we do the whole exam of how your eyes look. We take a sample of your tear to measure how salted they are. Then we put you on the LipiView machine and measure your oily layer. So then I sit down with you I have all these data. So then I can tell you “this is why your eyes are dry. This is why they bother you.”
The symptoms from dry eyes can be very dramatic. We’ve got people who don’t have a lot of symptoms, to people who have severe symptoms. They can no longer work, drive a car, read a book, do anything because they’re putting tears in their eyes every ten minutes and they’re in horrible pain. And by looking in your eye, I can’t tell you because you have people who have fairly looking, pretty bad dry look or looks who don’t complain too much and other people who are just at the beginning of it and complaining a lot.
And there’s two or three reasons for that. One reason is, the first time, if you ever put on a hard contact lens on someone’s eye, back in the old days when hard lenses were common, they’re crying and going crazy and nuts. They have to build up the wearing time because they can’t tolerate those things in their eyes. And then three months later, they don’t know they’re in. Because your nerve endings have been desensitized by having the hard lens rubbing up and down your eyelid. It’s not that you get callused but your nerve endings just get numbed.
Same thing, as that salt level goes up. Just like there’s no fish that live in the dead sea because it’s too salty. As the salt level goes up, it burns your nerve endings where you’d no longer feel what’s going on. So your symptoms can vary off the board from mild to horrible. The most common thing is “Doctor, my eyes are burning and watering.” And I look they’re dry. “It can’t be dry, they’re watering all day long.” Well they’re watering because you’ve irritated your eyes so bad that you’re crying, pouring out water. So you’re just running the loop. They dry up and then your eye says we’re hurting here, we need some help. Then it waters. It dries up and it waters. So you’re just on a loop. Just like if you’ve got something in your eye or you scratched your eye, your eye waters. So in any inflammation or irritation gets to a certain point, your eye’s gonna water. That’s all I can do; I can do nothing else.
So the symptoms gonna be red, itching, burning, scratchy, itchy, foreign body sensation. “I wake up in the night my eyes are stuck together.” There can be all kinds of variety of symptoms about dry eyes. So I want you to find out what’s wrong then we design a customized treatment based on what’s wrong with your particular tear film. If you don’t produce enough liquid, then we have to treat what you’re not doing it. Common thing is you’d might be, in that case, would be to put you on Restasis which is a medicine that advertises on TV all the time. And for certain people that works really well. Other people, if you have bad Meibomian gland disease, it’s gonna do zero for you. So if you have Meibomian gland disease I’m not putting you on Restasis because it’s probably not gonna work there.
So you can plug up your tear ducts; so you have ducts to drain the tears from your eye into your nose. That’s the reason why when you cry your nose runs. Just like if you have a river without enough water in it, you would dam it up so you can have more water. So you can put tiny little microscopic plugs in those openings and block the drainage from your eye, so that now you have more moisture because it has nowhere to drain to.
And the first time we do that, we do it with temporary plugs that dissolve in a week. So that way, you get to say “okay, that made them feel a lot better.” Then you would put a permanent kind in that’s not gonna go away. But then you’re gonna try; you’re not stuck. “Put them in and I hope it works.” And if it doesn’t work, I did all these and then…” but you get the trial first.
So those things would be something if you weren’t producing enough liquid. Plus, then you’re gonna use tears to help supplement your tears. We have different kinds of tears. There’s over 50 something types and brands of tear drops on the market. There’s thick ones, there’s thin ones, there’s all kinds of different ones. Even the big companies like Allergan and Alcon, they have three or four different kinds of their own kind of tear drops.
That’s where we can help. Because before, when I was in the same boat, before I knew what was wrong with your tear film, I just say, “Here’s a sample go try it, if it doesn’t work, try another.
We now tell people, “Okay if you don’t have the liquid part, then you need to get one that’s basically designed to be the liquid portion. This one is a preservative-free tear. If you have the big bottle of tear drops, there’s preservative there. If you’re using it a lot, you may wanna not use that kind because you’re putting chemicals in there all the time and those chemicals can irritate your eye. You should never use Murine, or Visine or Clear Eyes that says “It takes the red out.” That chemical that squeezes those blood vessels is very irritating to your eye. It makes them white and bright and shiny for a while but if long term it’s not good for you.
We have tear drops on our shelves. We actually sell this. This is a really good, plain regular, nothing-special tear with no preservatives. Then, if it turns out and another thing that we do now especially if you have the Meibomian gland disease and that kind, is we now put people on HydroEye. HydroEye is Omega 6 fatty acid from black currant seed oil. Some people are saying they’re taking fish oil; not the same. It’s great if you’re taking fish oil and I’m not saying you shouldn’t do that, just continue doing it. Like I said earlier, there are some studies with large amounts of fish oil that have made people’s dry eyes better. But this one does a unique thing.
Omega 6 fatty acids from salmon or from fish is actually probably inflammatory. That is, Omega 6 probably causes inflammation. Omega 3 is anti-inflammatory. So when you get a fish oil, you gotta make sure you there’s a lot more 3 than there is 6 because if not, you’re not gonna get the benefit out of it. So Omega 6 fatty acids from animal source can actually cause inflammation. This, as from a plant, has been shown, it has scientifically been shown, that what this does is you have different chemicals in your body. This is your body produces in a reaction to different things, like when you get sunburn, your skin produces prostaglandin, I forgot which one it is. And that makes sure my skin turn red and burn, that’s your prostaglandin.
There’s also prostaglandins that calm down inflammation and that’s called prostaglandin 1. This is the strongest stimulus of the production of prostaglandin 1, anti-inflammatory prostaglandin in your body that they found so far. So this calms your eye down. It takes a while to work; maybe a couple of months to kick in. But it’s been working so well for since like July or so that I started taking the stuff a month ago myself. There’s just too many people starting to come back…
Lady 1: What is it called again?
Dr. Croley: It’s called HydroEye.
Gentleman: Is it effective in children?
Dr. Croley: Yes, because it’s anti-inflammatory. In children, it’s an autoimmune disease, where you’re attacking your own cells, so this is an anti-inflammatory, so it should work, as well.
Lady: Where can we buy it? Through a drugstore?
Dr. Croley: You can only get it through a doctor’s office.
Lady: “Like you.”
Dr. Croley: Like me or some other doctor who cares…
(See Part 3 for Continuation…)