Clinicians combine IPL, thermal pulsation in dry eye treatment plan
ORLANDO – Two practitioners advocated for an ocular surface disease therapy package including four sessions with intense pulsed light and one with in-office thermal pulsation.
Selina R. McGee, OD, FAAO, and Douglas K. Devries, OD, said 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 in her clinic. She said she starts off with the Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire.
“If they answer positively to two of the SPEED questions, we proceed with testing,” she said, which includes tear osmolarity, InflammaDry (Quidel), lissamine green staining and fluorescein, tear break-up time, tear meniscus height, and meibomian gland evaluation and imaging.
“There should be about a 30% capture rate,” she said.
“Press on the meibomian gland,” Devries said. “If it looks like baby oil or olive oil, it’s normal. Otherwise, it’s not. If I don’t take care of it, it’s going to progress.”
One in 10 people is affected with 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 is important to tell patients you understand why they have their symptoms, because they often think it is just in their mind.
“Some of them suffer for years before they come for help,” McGee added. “These patients are loyal, regardless of insurance.”
Intense pulsed light (IPL) has been used to treat dry eye and meibomian gland dysfunction for several years off label until the recent de novo FDA approval in late April for the device from Lumenis, now being marketed as OptiLight.
Devries and McGee both have an M22 from Lumenis, which is used by dermatologists for vascular and pigmented lesions and hair removal. Dermatologists began seeing improvements in their dry eye patients, which led to the initial off-label use in eye care.
The Fitzpatrick skin type scale must be used to determine the proper IPL setting, they said.
Contraindications to IPL include: infections, dysplastic nevi, concurrent skin conditions, active cold sores, open lacerations or abrasions, chronic or cutaneous diseases, recent sun exposure and tattoos, McGee said.
McGee and Devries recommended treating patients with IPL 3 weeks apart and then doing thermal pulsation on the fourth IPL visit.
In preparation for the IPL treatment, paper eye shields are placed over the patient’s eyes, and isopropyl alcohol is used to remove make-up and oils from the face. Ultrasound coupling gel is applied to the face, and the clinician and anyone else in the room should wear safety glasses.
Devries said he applies pulses from tragus to tragus and then the rest of the face and forehead for a more uniform treatment appearance.
“Stay at least 2 mm away from any eyebrow tattoos or eye liner,” McGee said, and also treat around a mustache or beard.
Afterwards, clean the treatment area and advise patients to avoid sun exposure and use sunscreen.
Devries said the device’s head will need to be replaced about every 100,000 pulses, but there are no click fees.
McGee noted that ODs are prohibited from performing this procedure in only three states.
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McGee S, Devries D. Aesthetics in optometry – A therapeutic approach. Presented at: Vision Expo East; Orlando, Florida; June 2-5, 2021.