In this session from Interventional Mindset, Marjan Farid, MD, the Director of Cornea, Cataract, and Refractive Surgery at Gavin Herbert Eye Institute, UC Irvine, discusses how to incorporate LipiFlow treatments into your clinical practice.
Interventional Mindset is an educational series that gives eye physicians the needed knowledge, edge, and confidence in mastering new technology to grow their practices and provide the highest level of patient care. Our focus is to reduce frustrations associated with adopting new technology by building confidence in your skills to drive transformation.
Browse through our videos on a variety of topics within cataract and refractive surgery, glaucoma, and ocular surface disease to learn practical insights into adopting a variety of new surgical techniques and technology.
Taking an interventional approach to dry eye disease
The first step to adopting any new technology is to embrace the patients who need that specific procedure. In the case of LipiFlow, this means treating patients with ocular surface disease, specifically meibomian gland dysfunction (MGD), and taking a proactive approach to diagnosing and treating these conditions. It’s also important to educate patients on the treatment expectations and alternative offerings available.
We are in a time with a wide range of both pharmaceutical and procedural interventions available for dry eye disease (DED). By combining different treatments, eyecare practitioners can formulate a treatment recipe tailored specifically to the needs of the patient.
How to diagnose meibomian gland dysfunction
To incorporate LipiFlow, it’s important that eyecare practitioners (ECPs) diagnose dry eye disease and, more specifically, meibomian gland disease first. Meibography imaging is very helpful in the diagnostic process because it shows you the structural changes occurring in the meibomian glands. Another way to diagnose dysfunctional meibomian glands is to push on the glands at the slit lamp and assess the quality and viscosity of the secretions.
Clinicians can then use this information to educate patients on the state of their meibomian glands and connect it to their dry eye symptoms. It’s best to outline what causes MGD first and then explain the important role of the meibomian glands in dry eye disease. When talking to patients, you can connect these by explaining that blockages in the meibomian glands cause a dysfunctional tear lipid layer that, in turn, may be causing the patient’s dry eye symptoms.
Further, it’s important to invest time and energy in the educational process so patients thoroughly understand the condition coupled with how treatments like LipiFlow can improve their symptoms.
How to discuss LipiFlow with patients
While LipiFlow is still a treatment that requires out-of-pocket costs, by making time to thoroughly explain the root cause of MGD and how LipiFlow will provide symptom relief, patients will see how the treatment is an investment in their health.
When discussing how LipiFlow works, clinicians should start by outlining that the procedure only takes 12 minutes, has a favorable safety profile, and is a soothing treatment for many patients because it gently heats the lids. After describing the benefits of the procedure, Dr. Farid then shifts the conversation to the cost of the procedure and highlights that it is a cash procedure that has limited insurance coverage.
Initially, when Dr. Farid first started performing LipiFlow procedures 10 years ago, bringing up the financial burden of the procedure with patients was more difficult, so she limited herself to offering the procedure to patients with severe MGD. However, with time she realized that the patients who tend to respond well symptomatically to LipiFlow are younger patients and those who have mild to moderate meibomian gland disease. Oftentimes, these patients come back to repeat the LipiFlow procedure after 12 to 18 months.
Further patient communication pearls for LipiFlow treatments
When communicating with patients about LipiFlow, Dr. Farid compares the treatment to going to the dentist’s office once a year to get a thorough cleaning. While the annual cleaning is helpful for resetting the system, similar to the importance of daily brushing for dental health, patients need to do at-home maintenance in the form of warm compresses to maintain the benefits of LipiFlow for as long as possible.
Additionally, as the cost of the applicators has gone down, so has the financial burden of the treatment, making it more accessible. Once patients can appreciate the impact that the treatment has on their quality of vision, they will likely be more receptive to the out-of-pocket costs. For pre-surgical patients who have a significant lipid layer deficiency, LipiFlow can be offered to optimize the tear film before their cataract surgery or laser vision correction.
Lastly, it’s important to keep in mind that as you stack successful treatments, you complete on top of increasingly positive feedback you receive from patients, the more confident you will be to proactively recommend these treatment interventions to other patients.
Conclusion
If you are a refractive surgeon, LipiFlow is an effective tool to have in your office as you are likely to come across patients with DED who need to have their ocular surface treated prior to the procedure. Now is the time to embrace treating dry eye, considering the increasing impact of screen time on daily life, even in younger patients, who are seeing a rise in meibomian gland dysfunction.
Technological adoption by clinicians is imperative. With improved patient access to these treatments, you can provide significant symptom relief with minimal side effects.
