(Part 3 of 4 Parts)
Dr. Croley: …directly from the company. They don’t sell other drugs. This isn’t a cure but it helps and it works.
So for people who have, so we went over the distilled water part.
So now we have the most common type. That is, your oily layer is not very good. Then we gotta do things to clear up and make your oily layer better. So one, if you have all that stuff on your eyelashes or blepharitis, we have to treat that. So that means scrubs, cleaning your lashes off every morning, and then we have a foam that has an antiseptic stuff on the foam you can put on, rub on your eyelashes at bedtime, and then hot compresses.
So with blepharitis, we treat with hot compresses and with Meibomian gland disease, those are glands in your lid, we treat that with hot compresses too.
So we have two options on eye compresses. You can take a washcloth, put in hot water, keep going back and forth, and keep it hot. You can try and putting a wet towel in the microwave but you gotta really be careful not to burn yourself. Or this is some goggles we found. This company makes these goggles with jelly beans inside of it. You drop ‘em in a cup of water, microwave for 45 seconds, put on back in put the goggles off for 10 or 15 minutes and you’re done. So this is an option or you can do the hot compresses with the washcloth, it really doesn’t matter as long as you’re doing it.
Then we have another drop. Actually this drop, we’re out of it at the moment. This drop has become so popular, this is the same company but not the same drug. This is the only oil containing, lipid-containing tear drop, preservative-free on the market.
Lady from the Audience: What’s the name?
Dr. Croley: It’s called Retaine MGD?
Same thing, you’re not gonna get it at the drugstore. This company is fairly small. They only sell it through specialists who’ve been treating dry eye like I am. They sell it only through a doctor’s office. It has been working, that means helping people tremendously. It has the oil in it; it has no preservatives; and it works really well.
We can treat a lot of Meibomian gland disease. If you have the blepharitis, we treat that, and then if you don’t have that then we put you on the pills, hot compresses and this special drop that has got back order from the next two or three weeks. They sold enough, they can’t keep it in stock. Those three things will make almost everybody better.
If it turns out that you’re just really severe and you’re unhappy and you really need relief, and your lipid layers are really bad, then there’s nothing that’s gonna make you get a lot better until you clean those glands and have them working again. And the only thing we have is the LipiFlow. I don’t push people to do LipiFlow. I even a lot of times, tell these three things. And I tell people, “We’ll give you a couple of months. If you improve a whole lot and you’re happy and you wanna sit tight, you can. You can just stay the way you are. But, you have to know that every so often, you’re gonna close off a gland which is not gonna come back.
We don’t do a lot of treatments; we probably do two or three a week. Not a lot because the thing is, a lot of people were asking earlier, the LipiFlow is not covered by insurance. That’s the beat? If it was covered by insurance then there’d be a machine in every doctor’s office in the United States. It’s a hundred thousand dollar piece of equipment. I thought long and hard for a long time before I bought it because there are enough people who have severe dry eyes disease who’s gonna pay me $1600 to treat their eyes with this machine which is not covered by insurance. It turns out, there’s enough that I’m paying for my payments and we’re making a tiny amount of profit.
But we’re have people from… I have eye doctors drive from Tampa to me to get treated because they have dry eyes and not the machine. They know it works; they’re just not spending a hundred thousand dollars on the machine in their own office. So it’s a big decision and it’s probably never, unfortunately, gonna be covered by insurance even though it’s FDA-approved.
The company, I can’t tell you if it’s true or not true, but the company has told me, that the apparatuses you saw that goes in your eye, they charge at $1600, $800 goes back to the company, plus they gotta pay for the machine. They’re telling me that that little apparatus is hand-made, expensive to make and so they were scared to death that they went to Medicare and said, “We’re now FDA-approved, we want a procedure code for this treatment and we want you to pay for it.” Which Medicare will have to do because it’s now an approved procedure that they will have to come back to Medicare and say, “Okay, the doctor fee for this, including the cost of the apparatuses, that’s $349.” They’re being charged $800, to begin with. So they’re scared to death that the price will be so low for Medicare insurances that they’ll have no company. They’ll have no way they can do business so they’re never gonna ask them to cover anytime in the foreseeable future.
Man from Audience: So is it just a one-time treatment?
Dr. Croley: Hopefully, it’s a one-time treatment is gonna last for a pretty good while. I think with the treatment and the maintenance of doing the hot compresses, taking those pills and doing that special oil-containing drop, which you’ll gonna have last for a long time. So far, since June no one has come back and said my eyes are getting worse.
But in the study, there were a few who did, but in the study, they were not allowed to do any of the things I’m telling you to do. They were not allowed to treat their blepharitis, they were not allowed to do anything because when the government study something they want just the machine involved in the process and nothing else.
So, there are all kinds of ways of treating dry eyes now. We have a whole two pages of things that we offer people. I even have put a lady on testosterone drops and cream to their eyes because there are two or three studies that show that in post-menopausal women, which is the biggest group of dry eye patients, that there are testosterone and estrogen receptors on your eye and that controls how your eyes produce tears and function. There are a few doctors who are treating dry eyes with testosterone cream. So I hope we do that, some of the rare case we do.
Lady from the Audience: Can you sort of get a handle on whether a person has a certain type of dry eye just because it’s only one one eye, or is that more common to have in one eye or more common to have it on both eyes.
Dr. Croley: It’s usually worse on one eye than the other. Not any equal. Just like the one I showed you on the LipiView. It was 90 on one side and 55 on the other. So you’re gonna have different symptoms on two eyes.
Lady from the Audience: Have you ever done studies if a patient reduces the amount of sodium intake, would that have any effect?
Dr. Croley: They have no effect. Because like I said, if you took a tablespoon of salt today you’re gonna swell up like a balloon but your body is gonna… if you did a blood test, your salt level is still normal. It wouldn’t have any effect. The reason you have high salt level in your eye is your tears have evaporated off and minerals and all the other particles can’t fly up in the air. They get left behind. So your eye becomes hyper-osmotic from the tears evaporating away or from low production.
Gentleman from the Audience: Do allergies and red tide have an effect on the glands?
Dr. Croley: The red tide might just because it might cause inflammation. Allergies can too a little bit. The company that makes, does the salt level is working and maybe the company has a test for allergies too. Because you can measure… I have an old machine that will measure the IGE levels in your tear film. If we can measure that then we could know exactly how much of your irritation is from allergies cause your IGE levels will be elevated. If they’re not elevated then that’s all dry eyes. Eventually we get to the point where you could measure which one is which.
Now typically with allergies, it’s seasonal, that is, “my eyes starting to watering in the spring, in the fall or whenever it is and dries all the time. It’s a little worse in the winter because the air’s drier and there’s wind in the winter here. But those symptoms are usually worse when you’re outdoors because the wind’s blowing.
So I get people saying, “I take my morning walk and my eyes are watering all the time as I am walking down the street.” I said, ‘Your eyes are drying out and then you’re crying as you’re walking down the street.” Now people who have Sjogren’s syndrome sometimes do this much of the watering because their lacrimal gland is infected, as well. So they don’t cry as much as someone with regular dry eyes because not only the regular glands, other glands are not working. Their lacrimal gland is not working.
Lady from the Audience: Does sinus have anything to do with it?
Dr. Croley: Sinus trouble just can cause general inflammation around your eyes but there’s been no no study to show it.
Gentleman from the Audience: Is Restasis effective?
Dr. Croley: Yes for the right people. I have some people who just said that statement. That it worked fantastic. So we have a lot of people on Restasis. We have a large armamentarium to treat dry eyes with. So that’s one of them. The pills, the drops, specific type of drops, hot compresses. There’s a list of things we can do now to make people feel better. In the back…
Lady from the Audience: Have you ever heard of the laser treatment…
Dr. Croley: The laser treatment which is called IPL, Pulse Light treatment, has never been shown in a study to be effective. There’s some doctors using it and promoting it but has not passed FDA scrutiny as of yet, and that it works. It’s more painful because you’re doing a laser skin treatment that is burning your skin and at the same time hoping that heat penetrates down at the glands and it has not passed FDA approval.
Gentleman from the Audience: Would drinking more water or fluid help reduce salt concentration?
Dr. Croley: Not the salt but it may help you produce a little more liquid. So you recommend to people to drink a lot of water. I can’t tell you that it does a lot, but there’s harm in doing it.
Lady from the Audience: I take it there’s no danger to your visionary thing…
Dr. Croley: No, it’s all protected…
Lady from the Audience: If you go to your ophthalmologist every two years, do they check for dry eyes syndrome?
Dr. Croley: They look…. Probably you could look…
(to be continued in Dry Eyes Part 4)