IPL vs LipiFlow, An Unbiased Comparison | EyeLoveCares
IPL vs Lipiflow: discover the differences between Intense Pulsed Light (IPL) Treatment and LipiFlow treatment, including a including a comparison of side effects, costs, patient studies, and more. We cover it all in this informative article.
People who suffer from dry eye typically go through over-the-counter or prescription medications. Often these medications are supplemented by eye drops, eye ointments, or even omega 3 or steroids. Chronic dry eye is a serious condition. If it is not treated, it can cause impaired vision or eye scarring. Dry eye disease (DED) is estimated to affect between 14% and 33% of the population worldwide. It is estimated that DED affects more than 7 million Americans older than 40 years of age, and approximately 1 million to 4 million Americans between 65 to 84 years of age. Read More here. Dry eye can be caused by age, certain medications, environment (especially dry climates), or lifestyle (such as spending long hours looking at a computer screen). In this article, we are going to look at two advanced treatments for dry eye, IPL vs LipiFlow®.
Slowed Blink Rate
According to Optometry Times, a normal blink rate is once every three to four seconds. When reading or using a device with a digital screen, blinking naturally slows down to about once every 13.5 seconds.
If a patient has a decreased blink rate for long periods of time, it can affect eyelid mobility and contribute to dry eye. If the patient also has scarring or dryness of the eye from other sources (climate, age, medications, etc.), this combination can increase their risk for developing meibomian gland disease (MGD).
With the rise of digital devices, more children are being monitored for dry eye symptoms. If a slowed blink rate is caught early, an eye doctor may prescribe blinking exercises. However, many doctors question if blinking exercises are enough. Females are more at risk for meibomian gland dysfunction and may require extra treatment. Optometry Times suggests 10 good blinks—meaning eyes fully closed for two seconds, then squeezed for another two seconds—for every hour of digital device use. To help increase blinking back to a normal rate, you can also download a blinking app or set blinking reminders on a mobile phone or laptop.
When an eye doctor prescribes blinking exercises, they usually suggest a follow up appointment in four weeks to see if the patient has any improvement in dry eye and eye pain management. The doctor can also determine if the patient is willing to do the exercises, and if not, they can prescribe additional treatments such as heated eye masks.
Early detection of dry eye is important to take advantage of therapies for advanced dry eye disease. The earlier the disease is diagnosed, the less likely the therapies will cause pain and affect vision.
Meibomian Gland Dysfunction (MGD)
Meibomian gland dysfunction (MGD) is the most common cause of dry eye disease in regards to evaporative dry eye and aqueous-deficient dry eye. There are several treatments for MGD. There is expression of the glands, which gets rid of debris that blocks natural tears, using warm compresses to liquefy solidified gland contents. You can also treat MGD with eyelid scrubs and medications that target inflammation in and around the eye. However, these baseline treatments rarely offer long term relief since there is not a cure for dry eye disease. Patients who experience dry eye often live with vision issues and eye pain.
We will be comparing two procedures for chronic dry eye: Intense Pulsed Light (IPL) vs LipiFlow®. These two procedures both target subsets of dry eye syndrome. Each treatment has its benefits and potential side effects. If you are looking for relief from dry eye, it is a good idea to research both of these treatments as one may be more catered to your situation than the other. Like with any procedure, it is recommended that you speak with your eye doctor and discuss any concerns or medication you are taking that might interfere with the treatment. Your doctor can provide a dry eye assessment and recommend a plan of action to help you get relief from chronic dry eye.
What is Intense Pulsed Light (IPL) Treatment?
Intense Pulsed Light (IPL) is an outpatient procedure that provides relief for dry eye. The therapy has also been used to combat rosacea, acne, and sun damage, which make sense since IPL targets those with evaporative dry eye. This type of dry eye is caused by ocular rosacea or eyelid inflammation. Inflammation causes the meibomian glands to not work to capacity allowing tears to evaporate too quickly. The lack of natural oil to work with natural tears in turn causes dry eye. People who experience dry eye often complain of blurry vision, redness, and a burning feeling. IPL is only used when the patient has run out of options and has tried medication, eye drops, and supplements.
How Does IPL Work?
The Intense Pulsed Light procedure involves using pulses of light in areas around the eye. The light pulses reduce inflammation and provide a similar sensation to a warm compress. This warming effect can free debris that obstructs the glands that make tears. The glands are expressed, and any secretions are removed creating an immediate relief. Once the procedure is complete, patients are given eye drops that further reduce inflammation. Depending on the severity of dryness, the patient might be required to use the eye drops every day until the next IPL treatment.
IPL is known for increasing natural tear production and has its best success after the fourth treatment. However, some people will feel relief after the first treatment. After the condition has normalized, the patient only needs a maintenance treatment once or twice a year. Maintenance is determined when symptoms come back or the expressible meibomian gland count decreases. Younger patients need less maintenance.
Intense Pulsed Light (IPL) starts by cleansing the eye area. Eye shields are used to protect the area while the treatment is performed, and cooling gel is placed in the treatment area. The eye doctor then uses the IPL wand to place short bursts of light around the eye area. When the IPL wand is working, you will feel a slight heat sensation. This feeling is the device working to decrease inflammation and clear out glands that may be blocked, preventing normal, natural tear production.
Who Qualifies for Intense Pulsed Light (IPL) Treatment?
Patients who qualify for this procedure have chronic dry eye, meibomian gland dysfunction (MGD), or blepharitis. The treatment is only done on lighter skin tones. Darker skin tones may be lightened by the pulsed light, so IPL is not recommended. During the procedure, patients wear safety glasses, eye shields, and keep their eyes closed to prevent damage to the eyes. It should also be noted that IPL can cause some pain and may be hard for those with low pain tolerances to bear. This procedure is generally not covered by insurance, so you will need to get a cost estimate before beginning treatment.
Side Effects of IPL vs LipiFlow
The side effects of IPL often include redness and tender skin where the light was pulsed. This can cause the skin to look like a sun burn. You will need to use an r SPF moisturizer on the skin for 1-2 weeks after the treatment has been completed. After the initial redness has gone away, the redness should be decreased due to the reduction in blood vessel inflammation. As a bonus, some patients notice a decrease in surface wrinkles and sunspots in the treatment area. IPL was used in dermatology before it was used to treat dry eye, so enjoy the added benefits!
How Much Does IPL Cost?
IPL is currently not covered by insurance. Unfortunately, dry eye disease is not seen as life or vision threatening. However, insurance coverage changes frequently. Always contact your insurance company before starting a new procedure. Insurance representatives will be able to let you know if a procedure like IPL is currently covered under your plan.
Costs vary across the country greatly for IPL procedures. Typical East Coast costs range from $300-$1,000 and average $475 (published in 2017). Cost is determined based on the specific surgeon, where the procedure takes place, and how severe the patient’s individual needs are.
IPL Patient Study
A significant number of studies have been completed regarding IPL, including a study in 2016 by Joanne F. Shen, M.D. and a team of researchers. The study was conducted with thirty-five patients, all of which were treated with IPL. The study accounted for several factors of each patient including eye health history, demographics, Standard Patient Evaluation of Eye Dryness 2 (known as SPEED2) symptoms, slit-lamp examinations, and meibomian gland evaluations before the start of the study and before each IPL treatment. All patients had a minimum of six months of follow-up after the first treatment and typically received one to four treatments spaced four to six weeks apart.
After the four initial treatments, there was a significant decrease in SPEED2 scores. The scores were as follows: 8 patients (23 percent) had a ≥50 percent decrease in SPEED2 scores, 23 patients (66 percent) had a 1 to 49 percent decrease in SPEED2, 1 patient (3 percent) had no change in SPEED2, 3 patients (9 percent) had an increase in SPEED2.
Over three-fourths of the patients in the study had improvement in at least one eye. These findings prove that IPL is an effective treatment for patients with dry eye disease that have not seen improvement with any other treatment. While some patients seen improvement after one IPL treatment, most needed four treatments to have sustained improvement.
According to this study, over sixty percent of the IPL study patients had previously not seen any improvement after completing LipiFlow® treatment. It should be noted that both treatments, IPL and LipiFlow®, are not a cure. Regression will and does occur. When regression is seen in patients, it is recommended that they undergo another IPL treatment as often as four times annually.
After IPL treatments, other medications for dry eye are not usually necessary. However, omega-3 supplements are often prescribed after treatments to help restore the eye surface and tear film. Omega-3 supplements help treat the cause and rebalance the body instead of being prescribed drops or steroids that only mask the problem.
What is LipiFlow® Treatment?
LipiFlow® is a treatment that combats the effects of meibomian gland dysfunction (MGD). It was developed with over 25 years of research by TearScience. LipiFlow works with the surface of the eye to measure oil tear film thickness. Treatment of LipiFlow is the first electronic device currently approved by the FDA for the treatment of MGD. LipiFlow treatments must be conducted by a doctor that has been trained in this dry eye procedure.
How Does LipiFlow® Work?
First, a disposable eye shield is placed over the eye. Both eyes can be treated at the same time. LipiFlow applies a patented algorithm of intense heat using Vectored Thermal Pulsation technology, and the heat is applied to the inner and outer eyelids with the intent of massaging the meibomian glands to remove blockages. The massaging heat expresses the meibomian glands and emptied of any debris. After treatment, patients should see an improvement in the natural oil flow to the tear film on the eye’s surface.
After a topical anesthetic is applied, the treatment lasts about twelve minutes and feels like a gentle massage on the eyelids. The LipiFlow activators focus on the area over and under the eyelids. The activators do not come in contact with the eye surface, which reduces risk of complications and eye discomfort. The heat and gentle pressure during the procedure is called Vectored Thermal Pulse (VTP). To remove any gland obstructions, the VTP uses heat and gentle pressure. While the procedure itself takes about twelve minutes, the final results are not typically seen until six to eight weeks after the treatment. However, it is reported that a single 12-minute session is at least as effective as twice daily lid warming and massage over 3 months.
LipiFlow treats the most common cause of dry eye due to MGD. Once the meibomian glands have been cleared of any blockages, the glands can release oil to protect the tear layer of your eyes. The oil on the surface of your eye is known as lipids. If you have suffered or been diagnosed with dry eye, it is very likely that you have mMGD as well. Only a trained eye care professional can properly diagnose your dry eye. It is essential that you treat dry eye early before it is painful or irreversible.
Who Qualifies for LipiFlow®?
LipiFlow is comfortable for even patients with anxiety of medical procedures. To qualify, a patient must have their blocked meibomian glands evaluated and suffer from a mild form of dry eye. If you experience continuous eye dryness, sensitivity to light, blurry vision, issues wearing contact lenses for an extended period of time, excessive eye fatigue, or uncomfortable irritation, you might be a fit for LipiFlow vs. IPL.
LipiFlow should be avoided if you previously had or currently have the following conditions: ocular surgery (within the last three months), ocular injury (within the last three months), ocular herpes of the eye or eyelid (within the last three months), active ocular infection, active ocular inflammation or history of chronic, recurrent ocular inflammation (within last three months), eyelid abnormalities, or ocular surface abnormalities.
You may also not qualify for LipiFlow if your eyes are too small for the eye shields, you have moderate to severe conjunctivitis, severe eyelid inflammation, systemic disease conditions that cause dry eye (such as vitamin A deficiency, rheumatoid arthritis or leukemia, among others), currently taking medications known to cause dryness, or using punctal plugs that have been previously inserted (LipiFlow procedure may loosen these plugs).
Side Effects of LipiFlow®
According to Dry Eye & MGD, LipiFlow is considered a safe procedure but side effects can occur. Side effects may include eyelid/eye pain, eyelid irritation or inflammation, eye surface irritation or inflammation, eye symptoms such as tearing, itching, stinging, burning, visual disturbance, foreign body sensation, sensitivity to light, and discharge.
How Much Does LipiFlow® Cost?
LipiFlow is currently not covered by insurance. Unfortunately, dry eye disease is not seen as life or vision threatening. However, insurance coverage changes frequently. Always consult your insurance company before beginning a new procedure, so you can find out if LipiFlow is covered under your plan.
The current cost of LipiFlow is $450-$500 per eye. While this may be an investment for some people, it is important to go ahead with the procedure if your physician thinks you can benefit from it. Ignoring dry eye will only compound your eye issues in the future. Reduced vision can wreak havoc on work productivity and put a damper on your quality of life. If you have exhausted less expensive treatments, you should consider LipiFlow as a next step in improving your eye health.
LipiFlow® Patient Study
A study was completed in 2011 regarding the effect of a single LipiFlow treatment in 21 patients over a 9-month period. To qualify, patients had signs of meibomian gland dysfunction (MGD) and dry eye.
Patients in the study received a single LipiFlow® treatment on both eyes that lasted twelve minutes. Patient symptoms were evaluated using the Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation for Eye Dryness (SPEED) dry eye questionnaires, tear break-up time was measured with the dry eye test (DET™), and meibomian gland function was evaluated using a standardized diagnostic expression technique. Read More Here. Information was collected multiple times: before the study began, at the one month mark, and the nine-month mark for all patients. All scores including meibomian gland secretion, baseline tear break-up time, OSDI, and SPEED questionnaires documented improvements at one month with no regression at nine months.
Patients with mild dry eye symptoms that did not see improvement with traditional dry eye medications saw improvement with LipiFlow®. This study was a validation that dry eye disease can see sustained improvement with a one-time 12-minute in-office treatment.
IPL vs LipiFlow
IPL vs LipiFlow… the two are similar in the fact that they treat dry eye symptoms and are both approved by the FDA, but the procedures differ in many aspects including cost, length, and degree of aid in relieving symptoms. If you think you may qualify for one of these procedures, talk with your eye doctor about the pros and cons of each treatment.
Cost Differences –
Since the cost can vary depending on the severity of your dry eye, having a thorough eye exam is the only way to get an accurate cost estimate. Since IPL and LipiFlow are not covered by any insurance plans, knowing how much you will pay out of pocket for the selected procedure can help put your mind at ease. IPL most likely will require multiple procedures and these costs can add up fast, especially since the procedures are done close together to help you feel relief as soon as possible.
LipiFlow is regarded as a one-time procedure. However, you may still be required to use over-the-counter medications or supplements to feel long-lasting relief as dry eye disease does not have a cure. It is important not to put off doing one of these procedures if you are suffering from dry eye. Although the costs can be daunting, the longer you prolong these procedures, the worse your dry eye disease will be. Similarly, the longer you ignore the symptoms, the more costly improving your eye health could become.’
Length of Procedure –
It is also important to consider the length of these procedures. While IPL can take four procedures to see any lasting results, mild dry eye sufferers may only need one treatment of LipiFlow. IPL procedures are done at certified IPL centers. IPL can be painful for those with a low pain tolerance or can be stressful for those with medical procedure anxiety. There are more side effects with IPL such as skin redness, swelling, bruising, blisters, or burns. IPL requires more time off work and possibly more down-time.
LipiFlow is a one time, 12-minute procedure that is done in a standard doctor’s office. There is minor pain associated with expressing the glands, but the dry eye pain is often alleviated immediately since expressing the glands allows natural tears to flow again.
However, LipiFlow is only for people with mild dry eye syndrome, so the majority of people who have suffered too long from dry eye may not qualify. LipiFlow has been known to be ineffective in people who have severe dry eye. LipiFlow often requires the use of over-the-counter medication, eye drops, or supplements but the procedure itself does not have to be repeated frequently. On the other hand, IPL is repeated up to four times a year (after the initial four treatments). The positive is that IPL qualifiers often do not need additional medication once they hit the maintenance treatment.
When To Consider IPL or Lipiflow –
Keep in mind that LipiFlow and IPL treatments are only considered after other less invasive treatments such as eye drops, prescription medications, and natural products have been exhausted. The severity of your dry eye disease is the deciding factor when your physician recommends either LipiFlow or IPL. It is up to you to research these procedures so that you are aware of the side effects and treatment details.
Although each procedure has risks, it will be up to your eye doctor to determine which procedure is right for you. Unfortunately, dry eye does not get better on its own. You should take action quickly or deal with additional pain. Whether you have dry eye disease from aging, medications, your environment (especially dry climates), or lifestyle (such as spending long hours looking at a computer screen), each one of these factors can make your dry eye disease unique in its source and severity.
It is important to note that although IPL vs LipiFlow are different procedures for different cases of dry eye, each procedure has had promising clinical trials. As more people are diagnosed with dry eye, these procedures will become more common and may even be covered as a preventative procedure by insurance companies in the future.
Conclusion: IPL vs LipiFlow
If you suffer from dry eye, you are not alone. Dealing with any kind of eye discomfort can cause you to be less productive at work. It can decrease the amount of time you spend outside or in natural sunlight affecting your quality of life. It can also cause physical pain that can be unbearable, sometimes leading you to change where you live or your profession.
Luckily, there are advanced medical treatments that can provide relief from your physical symptoms of dry eye. When you first notice dry eye, you might begin with over-the-counter eye drops. If your dry eye has progressed further, you probably know that eye drops are not enough to deal with the pain. Going to the eye doctor is your next step. Your doctor can provide you with a comprehensive eye exam that evaluates your level of dry eye.
Your doctor will most likely start with prescription medication. These eye drops are more intense than over-the-counter and can only be used twice a day. If your condition does not improve after using these eye drops, you will need to notify your doctor of your progressing condition. Your doctor will evaluate your dry eye and talk about the treatments you have been using. If your dry eye has progressed, LipiFlow vs IPL are both viable options.
When is Lipiflow Used –
LipiFlow is used for milder cases of dry eye. It is used when the primary issue is tear duct clogging. Once the clog is removed during the single 12-minute procedure, it is common for your eyes to function properly on their own and only need a little aid of traditional eye drops to keep the eye from clogging again. However, since there is no cure from dry eye, once diagnosed, it is a disease that you will have to battle for the rest of your life.
If you do not qualify for LipiFlow, or if LipiFlow has not worked for you, you may be guided in the direction of IPL. IPL is a more intense procedure that leads to more side effects. It requires more treatments for it to work. The up side is that once IPL is in maintenance mode, you often do not need additional daily eye drops to keep the eyes moist. Since IPL attacks the inflammation around the eye, it reduces inflamed veins and allows your eyes to function without pain.
Typical Candidates –
If you are a good candidate for LipiFlow or IPL, it would be wise to talk with friends or family who has had the procedure. This will help answer any questions that you may have that are beyond what eye doctor can convey. Friends and family can also help recommend a qualified surgeon and walk you through the recovery process. They can even give you a good estimate of what you will have to pay for each procedure.
As with any procedure, you will need to think about the time it will take to complete the procedure, recover from the procedure, and the costs associated with it. Your eye health should be a top priority. There is no benefit to delaying treatment because dry eye only increases as you get older, especially in women. Do not be afraid to talk to your doctor regarding a dry eye exam and the pros and cons of IPL vs LipiFlow. Your eyes will thank you.