Intense Pulsed Light for Dry Eye (IPL) - Lumenis M22
The Lumenis M22 with OPT is a medical grade Intense Pulsed Light technology and is the specific IPL that Dr. Toyos utilizes. Doctors all over the country that are certified Toyos Centers of Excellence have acquired this technology in order to offer their patients the same treatment that Dr. Toyos offers. The Lumenis M22 has the parameters set by Dr. Toyos after several years of research supported by a grant from the American Society of Cataract and Refractive Surgery.
We have a new light technology that patients can utilize at home called, The Q, short for the Quantum. The Q compliments the in office IPL treatments. The Q offers low energy light at a safe wavelength to stimulate the glands that produce our tears. Dr. Toyos has patented this technology that is only available at selected doctors office. Recently results from treatment research was presented at the Ocular Surgery News International meeting in Italy. The prospective study showed increase in tear production and over a 90% satisfaction rate by patients.
Autologous Serum and PRP
Autologous Serum drops is the term we use when a patient's blood is spun in a centrifuge to filter out the Red Blood Cells so that you are left with a clear serum. What will you get from autologous serum? Nerve Growth Factor, NGF, is a vital component in the regeneration of damaged nerves and normal maintenance. In injury to the cornea whether from dry eye, inflammation, trauma, or Lasik requires NGF to repair itself. NGF may have some antimicrobial properties as well to prevent infection after injury. Vascular Endothelial Growth Factor, VEGF, also has neuroprotective capability. There is an alphabet soup of mediators that work for the normal function of the eye but NGF and VEGF have been studied the most. Autologous blood serum contains many factors including NGF and VEGF. Most physicians will centrifuge the patient’s blood and then dilute the drop in various ratios and different vehicles (artificial tears, balanced salt solution, and straight without any additives). We have tried all different combinations presented in the literature. We have been impressed with the response but we have started a new form of blood treatment called Platelet Rich Plasma, PRP.
PRP may be the best way to concentrate active factors while removing useless components of the blood. In the standard serum procedure the red blood cells are spun down to the bottom and you are left with the rest. The serum contains valuable products but also contains elements that you do not need like white blood cells. In PRP we are able to extract the platelets that have Platelet Derived Growth Factor (PDGF), TGF-B, VEGF, Sema7A, and NGF in the form of Brain Derived Neurotrophic Factor (BDNF) all in a concentrated form.
We are currently using a new advanced system where blood is collected and anticoagulated, followed by centrifugation to separate the PRP. The red blood cells and platelet poor plasma is removed to render a highly concentrated form of PRP. We are achieving levels 14 times greater than if we were conduct simple blood autologous serum drop collection without the PRP system. We mix the PRP with a vehicle and have the patient utilize the drop twice a day. We have been able to produce on average 5 bottles of PRP that last a month each. We have tested several vehicles and will be submitting our results. We found that some vehicles coagulate the PRP. Other vehicles are not well tolerated by patients. We advocate using a vehicle that will make the drops safe to store and to use. The concern with not utilizing a vehicle is that you may run into problems with bacteria growth which could lead to infection. Some autologous serum specialists have even used antibiotics solution as a vehicle. We have found quicker wound healing utilizing PRP for corneal injury. DED patients report increase comfort in PRP as opposed to autologous serum drops. PRP has become the preferred autologous blood product in other specialties such as Neurosurgery, Orthopedics, and Plastic Surgery and I believe it will be the preferred modality in Ophthalmology. You have probably heard of famous athletes having their joints injected to heal injuries. Or what has been made popular by the Kardashian TV show is the Blood Facial where PRP is placed on the skin after a laser rejuvenation treatment for better results. There is no question that we are finding new and better ways to provide relief to our dry eye patients. Intense Pulse Light is still the gold standard to treat patients with Meibomian Gland Dysfunction and we feel that PRP drops could some day be the gold standard in treating dry eye disease pain. The procedure can be completed in 20 minutes and patients have told us that it is much easier and faster than autologous serum. If you are interested in PRP drops for your dry eye call our office for a consultation.
Dry Eye Measuring Devices
Toyos Clinic has tried several technologies to objectively measure dry eye disease severity. The problem with the currently marketed technologies is that they fall short in precision and accuracy. That is why Dr. Toyos is currently working with two international companies to produce two new measuring devices. One device specifically looks at the layers of the tear film and determines any abnormalities. Another technology measures a specific inflammatory mediator that researchers at the National Institutes of Health in Amsterdam have determined is the most specific for dry eye disease. Toyos Clinic is the only clinic in the United States with these technologies.
Dr. Toyos has written a book, Dry Eye Disease Treatment in the Year 2020, that discusses all the new and future technologies that they are using to improve the signs and symptoms of the disease. The book is written specifically for the patient but we are already finding it out it is a favorite of specialists internationally. The book opened number two in best sellers on Amazon.com. You can purchase the book here.