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SkyVision enters age of LipiFlow
A shift in the TearScience business model may change the landscape of MGD diagnostics and treatment.
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Nothing makes me crankier than seeing a promising medical technology or treatment held hostage by a bad business plan. As an aside, nothing I write produces more agita in my editors than when I propose to vent my spleen on topics such as this. I find it even more distressing when cool stuff is marketed primarily on the financial benefits a test or treatment will bring to the practice that adopts the new technology. This is especially depressing when the technology is not only cool in its own right, but also brings a clear and concrete benefit to our patients.
That is why it is important to raise the flag when a company pivots and starts to move in a direction that will likely increase access to its technology. This is the case with TearScience and its Lipi-View and LipiFlow technologies. As I mentioned in a recent Healio.com/OSN blog post, dry eye disease (DES) associated with meibomian gland dysfunction (MGD) can be treated quite well without the use of LipiFlow, but it is impossible to ignore the near-evangelical zeal with which early LipiFlow adopters talk about their patient results. After being surrounded by “believers” on a panel as the designated “LipiFlow-denier,” I visited with TearScience to re-evaluate the SkyVision position on treating MGD with regard to both LipiView and LipiFlow.
History and a confession
First, a little history and a confession. Until recently, TearScience was selling an expensive diagnostic device coupled with an equally expensive treatment device. To make matters worse, your practice was charged a user fee each time you used the diagnostic test. In order to pay the costs of using the equipment, it was necessary to prequalify DES patients as candidates for treatment by charging them for an advanced DES diagnostic evaluation: barrier No. 1. Capitalizing the investment in the diagnostic and treatment equipment, as well as the cost of the disposables used in the treatment and your overhead costs, necessitated a rather high procedure fee: barrier No. 2.
Confession: I was so put off by the original business model that I gave the technology, and the elegant physician interaction with the technology, only the most cursory of evaluations. No shrinking violet, I made no small effort to share my thoughts. Judging by feedback I received from rank-and-file DES doctors and sales figures of the technology, I was not alone. Now I am happy to report that all of the stuff that TearScience got right before has gotten better and that it is working hard to remove the barriers placed between its products and the patients and doctors who wish to use them. SkyVision is in.
What is the same and different
Let me start with the part of the technology and business model that is still mostly the same: treatment. When used in the appropriate setting, the elegant application of heat and massage in LipiFlow appears to be a highly effective treatment for MGD and, by extension, the symptoms of evaporative DES. You can certainly treat MGD successfully with a more traditional approach, as I described in an earlier column. Indeed, DES doctors with extensive experience using LipiFlow on their patients find enhanced results if they continue to use pre-LipiFlow therapies such as high-dose fish oil and even AzaSite (1% azithromycin, InSite). LipiFlow works.
It is the changes on the diagnostic side of the ledger that will drive growth in our use of this technology. TearScience has pulled off the classic tech maneuver of making a better product for a lower cost that is easier to use. Kismet! LipiView is in many ways the gatekeeper to LipiFlow, and version 2.0 now costs roughly half of what version 1.0 did. The new unit still measures the lipid layer in the tear film and provides a video analysis of your patient’s blinking. What is new clinically is the addition of a three-part photo documentation of the physical characteristics of the meibomian glands themselves, which allows us to more accurately determine a patient’s candidacy for LipiFlow.
The business side
This part of the LipiView diagnostic is typically covered by health insurance, and TearScience has also done away with the per-use “click fee” for LipiView. Full credit here to the company for making a business decision that will cause an initial decrease in its revenue. There is no longer an imperative to charge our patients when we want to include this basket of tests in our DES evaluations, and this should dramatically increase the use of LipiView. Indeed, this is a case of useful technology that should be a part of our core evaluation, now made dramatically more accessible to both doctor and patient.
Returning to my confession, I likely would not have taken the time to look at the efficacy of LipiView without this change in the business model. Admit it: Evaluating MGD in the office setting has been almost all art, little science. We look at the lid margins, push on the meibomian glands with a finger, Q-tip or probe, maybe try to transilluminate with a muscle light to get a sense of what the glands look like. The LipiView process now allows us to calibrate several aspects of this examination. The lowest tech part of the process, the meibomian gland analyzer, might be the coolest: We now have a standardized pressure applied to the lid margin in order to assess meibomian secretion. Even when LipiView does not lead to a LipiFlow treatment, we are finding it to be an extremely valuable teaching tool when trying to get our patients to adhere to chronic MGD treatment.
This is real progress, and we should all be handing out back pats to those inside TearScience who spearheaded the change. Kudos to those hardy early adopter DES doctors, too. Is this a happy ending, all unicorns and rainbows? Am I now a full-fledged acolyte traveling the ophthalmic highways and byways dispensing Kool-Aid? Not yet. The science is good and clearly looks like it is going to get better. Fewer barriers to testing will likely result in not only better understanding of MGD but, yes, more LipiFlow treatments. What we need to charge for those treatments in order to cover the disposable and office costs is still likely to be a barrier to the kind of volume necessary for us to determine just how valuable LipiFlow may actually turn out to be.
Fair warning: I am still a bit cranky about that.
For more information:
Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: dwhite@healio.com.Disclosure: White is a consultant for Bausch + Lomb, Allergan, Nicox, Shire and Eyemaginations. He is on the speakers board for Bausch + Lomb and Allergan.