Published in Ocular Surface

Discover the Difference: A Compelling Testing and Treatment OSD Solution with Long-Term Benefits

This post is sponsored by E-SWIN USA
17 min read

In this session from Eyes On Dry Eye 2023, host Damon Dierker, OD, FAAO is joined by Sarah Darbandi, MD as they discuss how E-SWIN USA’s diagnostic and treatment solutions for ocular surface disease (OSD) help to improve patient care and enhance workflow efficiency.

Who is E-SWIN USA?

E-SWIN offers solutions to improve visual comfort and help patients enjoy better quality of life. The company designs and develops pioneering technologies with the aim to create new standards for smart screening and long-lasting treatment. Providing fast, mobile, efficient, and easy-to-use equipment, E-SWIN and its eye care division, ESW vision, is a trusted supplier and a reliable partner for eyecare practitioners in more than 50 countries worldwide.
tearcheck® for smart screening offers nine different dry eye exams, which can be performed in less than ten minutes. E-Eye® provides a short and efficient treatment protocol that can provide long-lasting benefits.
The combination of both technologies provides eyecare professionals with a full-service solution and a quick and proven ROI.

Why should tearcheck be on your radar for dry eye analysis?

tearcheck is designed to create a new standard for dry eye analysis. The testing device provides a quick start with everything completely installed, is easy to use, and the complete exam only takes a few minutes. It includes the following nine exams:

OSIE®—Ocular Surface Inflammatory Evaluation

  • Shows increased risk of inflammation
  • Provides exact dimension and score of the dryness

TFSE® / NIBUT—Tear Film Stability Evaluation / Non-Invasive Breakup Time

  • Share the same imaging sequence
  • Shows the micro-movements of the tear film
  • Provides quick evaluation in ten seconds
  • Gives the user an exact score of dryness

Abortive Blinking

  • Shows all blinks identified over the acquisition time (expected one minute)
  • Determines the structure of the identified blinks: complete or incomplete blinks

Eye Redness

  • Assesses hyperemia caused by dry eye-induced inflammatory processes
  • Can reassess the patient as treatment progresses


  • Captures the base of the eyelashes with enlarged images
  • Provides ability to trace and visualize signs of demodex presence

Meibography IR

  • Provides visualization of the meibomian glands
  • Shows rate of gland loss (in %)
  • Shows morphology of glands present

Tear Meniscus

  • Shows height of the tear meniscus
  • Calculates two values: measurement below the iris center and the thickest measurement

Eye Fitness Test

  • Provides an overview of the patient’s eye fitness in everyday life

How does E-Eye treat dry eye syndrome?

E-Eye provides long-lasting and efficient treatment. As a medical device, it is FDA cleared under 510(k) K200616 as a prescription device intended for the treatment of rosacea. International distribution of the device began in 2016, and it is now available in over 50 countries around the world.  Internationally, since 2015, E-Eye was specifically certified and sold to treat MGD, creating a pioneering position on the market.
E-Eye’s treatment design is based on the use of innovative IRPL® (Intense Regulated Pulsed Light) technology, patented by E-SWIN. It generates IRPL by producing perfectly calibrated and homogeneously sequenced light pulses. The sculpted pulses are delivered under the shape of a train of pulses. The energy, spectrum, and time period are precisely set to provide the best possible result.

Discovering the difference for ocular surface disease

Dr. Darbandi is an ophthalmologist and cornea specialist at Bowden Eye & Associates in Jacksonville, Florida and is also part of their Dry Eye University.
“So, for the last 10 years, ocular surface disease management has been such a priority in both caring for our patients and teaching other doctors to do the same,” she said. “We're really excited to have E-SWIN as part of that world as well.”
Additionally, she said her practice includes aesthetics—which includes using intense pulsed light for skin treatments.
“So, I have some additional experience in that realm and we're so excited to have this technology now for our dry eye patients,” Darbandi explained.
Clinical literature shows that 80% of rosacea patients suffer from meibomian gland dysfunction.1,2

How tearcheck optimizes efficiency and improves patient care

For Dr. Darbandi, E-SWIN’s diagnostic solution—the tearcheck dry eye analyzer—“really takes care of a lot of problems in the office.”
“Not only is the diagnostic testing they offer very complete, but it's very efficient,” she explained, noting how the range of dry eye metrics they’re able to assess has grown.
“The tearcheck dry eye analyzer has had a positive impact on workflow and improved efficiency,” Darbandi said. “The technician can run multiple tests on the patient without needing to leave the room. It's all on one machine.”
She also noted that all of the diagnostic data is then provided on a one-page report with the ability to show change over time, a major differentiator from other technologies.
“The technology really excels in that it's user-friendly, and the device itself is very compact and doesn't take up a lot of space,” she explained. “For a lot of practices that can be very important.”
Darbandi described how they use the various tests available and how they impact patient care—such as assessing the blink rate.
“This is so important not just for our adult patients, but for pediatric patients, because many people and children are partial blinkers,” she said. “That incomplete blink can drive imbalance of the tear film and be the beginnings of exposure. Being able to identify and show patients that can be a strong piece of data to demonstrate the start of dry eyes.”
In addition to assessing the blink rate, Darbandi said tearcheck offers a number of other tests.
“It also will measure eye redness and takes really high magnification photos of the lashes to look for collarettes,” she said. “So it can help with your search for demodex and provide images.”
Tear film stability can also be evaluated and meibography images provided. In addition to providing quality meibography images, Darbandi said tearcheck also calculates the percentage of gland loss, which can help to remove the “guesswork” and inform the treatment plan, supporting a more standardized approach to care.
She said tearcheck also performs an ocular surface inflammatory evaluation, calculates the height of the tear meniscus, and provides the eye fitness test—similar to the SPEED questionnaire—to help identify the patient's symptoms and comfort level.
“That’s also an important metric to share with patients to compare how they’re feeling from visit to visit,” Darbandi said. “It helps to be able to show them they're getting better—or alternatively—if they're having a flare up and maybe need more treatments. So the diagnostic testing is remarkable and very complete.”

How tearcheck metrics increase patient retention

When asked about workflow, she said once the technician completes the testing, the results are provided in a one-sheet PDF, which can then be wirelessly transferred to the electronic medical record and shared with the patient.
“So it makes it very simple to store and review this data at any time,” she said.
Dr. Dierker underscored how valuable it is to have easy access to images and data to track progress with the patient by sharing information about their diagnosis, treatment, and progress to help them feel more empowered throughout their healing journey.
“Patients are much more engaged when they are involved, and I think this is a fantastic solution,” he said, adding that this type of service is key for patient retention because they are offered a new level of involvement they haven’t experienced before.
Darbandi agreed, saying that some patients now ask about their metrics compared to the previous visit.
“’What were my gland counts? What were my percentages?’ They've become very engaged,” she said, adding that the convenience of tearcheck is a big plus.
“When they see how nice and compact the technology is and that it's not a big burden on their time, I feel like they're more agreeable about having it done at the next visit,” she explained. “So E-SWIN's really made it a lot simpler for the patients and the doctors.”

Should you be treating OSD with IRPL?

When asked about E-SWIN USA’s treatment solution for OSD, Darbandi described the company’s IRPL offering, E-Eye.
“This technology has been really amazing,” she said. “It utilizes all the basics we’re familiar with about intense pulsed light, but in a way that allows the treatment to be more effective.”
She said the “big thing” she’s noticed is that it's more comfortable for the patient.
“The intense pulsed light that's regulated in a homogenous eight pulses with reset time between provides treatment to the skin without the big blast of heat energy found in other offerings,” she said. “That’s not only painful for the patient, but can create increased redness and skin issues you may not have anticipated.”
“If you're a provider who’s new to intense pulsed light treatment, E-SWIN makes it very easy to provide safe and consistent treatment across the board,” she added.
When asked if E-SWIN’s IRPL technology makes it more efficient to deliver light therapy compared to other technologies she’s used, Darbandi said it does.
“It makes it more efficient because you're basically treating a larger area of the skin in a way that allows you to effectively treat rosacea, but at the same time, you're not causing the patient to jump,” she explained. “I actually had a patient today I was treating with E-SWIN’s IRPL unit. Since she’d had the other before, she was somewhat bracing herself for that more intense treatment. But because it wasn’t painful at all, I was able to treat from tragus to tragus in the infraorbital area for dry eyes, as well as her full face for some aesthetic concerns. I was able to complete it more efficiently because the patient tolerated it better and it went along much more quickly and easily. She was so happy with it. It was great.”

What is the E-Swin workflow?

As far as workflow, Darbandi said that in her practice, the process starts in the exam room.
“Usually, in the exam room, I discuss the treatment,” she said. “If it’s a new dry eye patient, they'll have their testing done and then talk to the dry eye counselor to outline some of the different options. Then I meet with them again and make recommendations. They typically go back to the dry eye counselor—which is when we’ll usually get them scheduled for what they need.”
If the patient opts for treatment the same day, she said the technician helps the patient with prepping—such as makeup removal— and applies the IPL gel. Afterward, Darbandi said she applies the goggles and starts the treatment.

How does IRPL help patients with dry eye?

When asked how IRPL helps patients with dry eye, meibomian gland dysfunction (MGD), and rosacea, Darbandi said “it's doing a few things.”
“Intense pulsed light uses light energy to travel into the skin,” she explained. “With the IRPL, it's actually going about four to five millimeters into the skin. Our goal with intense pulsed light is to transfer that light energy to heat over anything that's pigmented.”
“So when patients have small blood vessels, capillaries that are dilated and inflamed, those capillaries are drawing in inflammatory cells and mediators to the lid,” she added. “So by treating around that area, the light is basically causing some venous thrombosis because it's targeting that pigmented hemoglobin molecule, and then that heat will help to close those little blood vessels. So in that way, it really helps to prevent further inflammation that comes downstream.”
Darbandi said with its ability to stimulate certain cells, IRPL can also “up-regulate the kind of anti-inflammatory cells we need and help to down-regulate the inflammatory cytokines, things of that nature.”
As far as the treatment regimen, Darbandi said for most patients, treatments will be three to four weeks.  For optimum results, perform treatments on Day 1, Day 15, Day 45 and Day 75.
“There are some patients who can have it a little further out,” she said. “For example, if I have somebody who has really significant rosacea, I might give them a little bit more time between treatments. And because this is a chronic condition, many patients understand that even after their three to four weeks of sessions, they may need some maintenance treatments. ”
She said with living in Florida, many patients are very receptive because they understand the effects of sun exposure—and that there can be flare-ups, allergies, and other factors that can cause this to recur.
“So it’s important to manage those expectations,” she added. “I love for patients to maintain their effects with IPL sessions throughout the year.”

Combining IRPL with other dry eye treatments

When asked whether she ever combines IRPL with other dry eye treatments, such as manual expression of meibomian glands or thermal pulsation, Darbandi said she does.
We offer the patient different options,” she explained. “So if I see a new patient and they need some cleanup, I might start by doing an eyelid cleaning procedure. And then if I need to reopen the glands, I might do meibomian gland probing, and then some type of thermal pulsation can be done after that to help evacuate the glands. And then lastly, I would do a session of the intense pulsed light just to treat the skin and help with that inflammation and the prevention of other issues. And then we just continue with the IPL sessions every three to four weeks.”
Alternatively, she said if patients have had those types of procedures done and are interested in intense pulsed light, they perform that treatment and then an expression of the lids afterwards.
“So basically, I'm manually expressing the lids right after the first session of the IPL,” she said. “But I don't necessarily do the expression every treatment.”

Working with E-SWIN USA

When asked what it’s like to work with E-SWIN USA, Darbandi was generous with her praise.
“You want a company that's reliable and is going to be there when you need them,” she said. “With E-SWIN, if I ever have a question, I've got my representative right there.”
Darbandi added that it’s a big plus to have everything included—instead of being required to pay extra for service calls, which can be frustrating and expensive.
“E-SWIN bundles all that together so you have a safety net,” she said. “If you need support, anything with the machine, they're right there in real-time.”
“The way E-SWIN has packaged it makes my day so much easier,” Darbandi added. “I can do more add-on treatments the same day. Patients are more receptive to it. The technology is so easy to use. If I knew nothing about intense pulsed light, I would immediately feel comfortable using this because E-SWIN also makes an effort to come out and physically train both the doctors and the staff. It's really incredible and it's different from other companies we've worked with. So there are a lot of reasons to partner with E-SWIN USA.”
1. Viso E, Clemente Millan A, Rodriguez-Ares T. Rosacea-associated Meibomian Gland Dysfunction—An Epidemiological Perspective. Touch Ophthalmology. - (Accessed April 3, 2023)
2. Machalińska A, Zakrzewska A, Markowska A, et al. Morphological and Functional Evaluation of Meibomian Gland Dysfunction in Rosacea Patients. Curr Eye Res. 2016;41(8):1029-1034.

Sarah Darbandi, MD
About Sarah Darbandi, MD

Dr. Sarah Darbandi joined the Bowden Eye team in August 2012. She was born and raised in Baltimore, Maryland. She obtained a Bachelor of Science degree in Biology from the University of Maryland, Baltimore County. Following this, Dr. Darbandi attended Medical School at West Virginia University, then went on to a residency in Ophthalmology at the West Virginia University Eye Institute.

With her interest in corneal transplantation and refractive surgery, she then completed a fellowship in Albany, New York, in Cornea and Refractive Surgery. In 2015, she signed on as Dr. Frank W. Bowden, III’s, first partner, making her Vice President of Bowden Eye & Associates.  She provides general ophthalmic care, as well as custom cataract surgery, corneal transplantation, ocular surface reconstruction, and refractive surgery.

Dr. Darbandi also provides aesthetic care including Botox, fillers, brow lifts, upper and lower lid blepharoplasties, laser skin resurfacing, and even permanent makeup.  In her free time, Dr. Darbandi enjoys spending time at the beach, stand-up paddleboarding, pilates, and scuba diving. She also enjoys learning the newest makeup/beauty trends and spending time with her dogs.

Sarah Darbandi, MD