Clinicians Combine IPL, Heat Pulsation in Dry Eye Treatment Plan


Source:

McGee S, Devries D. Aesthetics in Optometry – A Therapeutic Approach. Presented at: Vision Expo East; Orlando Florida; 2-5 June 2021.

Disclosures: Devries and McGee claim to be Lumenis consultants.



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ORLANDO – Two practitioners pleaded for a therapy package for diseases of the ocular surface comprising four sessions with intense pulsed light and one with thermal pulsation in the office.

Selina R. McGee, DO, FAAO, and Douglas K. Devries, OD, stated that this treatment regimen is appropriate for patients with moderate to severe dry eye, meibomian gland dysfunction (MGD) or blepharitis.

McGee performs a number of dry eye diagnostic tests at her clinic. She said she was starting with the Standardized Dry Eye Patient Assessment Questionnaire (SPEED).

“If they answer positively to two of the SPEED questions, we proceed with the tests,” she said, which includes tear osmolarity, InflammaDry (Quidel), lissamine green stain and fluorescein, time to tear rupture, tear meniscus height and meibomian gland assessment and imaging.

“There should be a catch rate of around 30%,” she said.

“Press down on the meibomian gland,” Devries said. “If it looks like baby oil or olive oil, it’s okay. Otherwise, it is not. If I don’t take care of it, it will improve.

One in 10 people are affected by rosacea, he said.

“If they have rosacea, they probably have MGD,” Devries said.

McGee noted that ocular rosacea often presents before skin rosacea.

“Sometimes we’re the first-line diagnosis,” she said.

Devries said it’s important to tell patients that you understand why they are having their symptoms because they often think it’s right on their mind.

“Some of them suffer for years before they seek help,” McGee added. “These patients are loyal, no matter how confident they are.”

Intense Pulsed Light (IPL) was used to treat dry eye and meibomian gland dysfunction for several years until the recent FDA de novo approval in late April for the device from Lumenis, now marketed as ‘OptiLight.

Devries and McGee both have a Lumenis M22, which is used by dermatologists for vascular and pigmented lesions and hair removal. Dermatologists began to see improvements in their dry eye patients, which led to the initial off-label use in eye care.

The Fitzpatrick skin type scale should be used to determine the correct IPL setting, they said.

Contraindications to IPL include: infections, dysplastic nevi, concomitant skin conditions, active cold sores, open lacerations or abrasions, chronic or skin disease, recent sun exposure and tattoos , said McGee.

McGee and Devries recommended treating patients with IPL at 3 week intervals and then doing thermal pulses on the fourth IPL visit.

In preparation for IPL treatment, paper eye shields are placed over the patient’s eyes and isopropyl alcohol is used to remove makeup and oils from the face. Ultrasound coupling gel is applied to the face and the clinician and everyone else in the room should wear safety glasses.

Devries said he applied pulses from tragus to tragus and then the rest of the face and forehead for a more even treatment appearance.

“Stay at least 2mm away from any tattoo on the eyebrows or eyeliner,” McGee said, and also treat around a mustache or beard.

Then clean the treatment area and advise patients to avoid sun exposure and use sunscreen.

Devries said the head of the device will need to be replaced every 100,000 or so pulses, but that there are no click charges.

McGee noted that ODs are prohibited from performing this procedure in only three states.


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