After refractive error, dry eye disease (DED) is the most common ocular disease condition that optometrists and ophthalmologists are seeing in their practices today.1 This isn’t surprising given that an estimated 49 million Americans experience symptoms associated with DED, while only half have been diagnosed.1,2
Unlike other common ocular diseases with proven diagnostic and treatment protocols, dry eye is a multifactorial condition characterized by a persistently unstable and/or deficient tear film causing discomfort and/or visual impairment, accompanied by variable degrees of ocular surface epitheliopathy, inflammation and neurosensory abnormalities.3
Currently, dry eye disease can be categorized into aqueous-deficient dry eye (associated with reduced lacrimal gland function) and evaporative dry eye (largely correlated with meibomian gland dysfunction and commonly abbreviated as MGD).4 Evaporative dry eye is far more common than aqueous-deficient dry eye, and many patients have both forms concurrently.5 Adding to the complexity, dry eye disease has many risk factors, ranging from contact lens intolerance and prolonged screen time to aging, illness, immune disorders, surgery, MGD, and Demodex infestation, to name a few.
Treating dry eye is equally confounding and can often be managed on a patient-by-patient basis in order to treat the underlying conditions causing decreased tear production or eyelid and/or ocular surface inflammation. While prescription drops and ointments as well as warm compresses, omega-3 supplements, and eyelid cleaners all play a role in mitigating signs and symptoms to varying degrees, intense pulsed light therapy (IPL) has emerged as a viable treatment for meibomian gland dysfunction.
What differentiates OptiLight from other IPL treatment modalities, is the patented Optimal Pulse Technology (OPT™), which works by delivering no-spike square pulses, enabling a consistent high energy delivery to ensure effectiveness through a safe and comfortable procedure. The broad spectrum of light addresses the underlying inflammation of dry eye disease6 and may alleviate abnormal telangiectasia7 (with subsequent decrease in pro-inflammatory markers8) and reduce proliferation of bacteria and Demodex loads at the eyelid margin.9,10 It has also been shown to reestablish the secretion of meibum by liquefaction of the solidified material,11 raise the symptom score of patients and associated ocular-surface indexes, improve meibomian gland function, restore meibomian gland microstructure, decrease meibomian gland inflammation,12 and potentially reduce the severity of rosacea.13
To learn more about this technology, check out The Ultimate Guide to OptiLight!
Four leading dry eye specialists weigh in about how Lumenis’ first and only IPL, FDA-approved light therapy for dry eye management has improved their practice workflow. Read on to learn more from Jaclyn Garlich, OD, FAAO; Cory Lappin, OD, MS, FAAO; Inna Lazar, OD; and Kambiz Silani, OD.
How to know if OptiLight is right for your dry eye workflow
Many optometrists* have been drawn to Lumenis’ light therapy as it’s the first IPL to be FDA-approved to manage the signs of dry eye disease due to meibomian gland dysfunction. In healthy individuals, meibum is produced by the meibomian glands. This substance is then amalgamated into the oily layer, combining with water and mucus to form the essentials of tear film composition. If the glands become clogged over time, due to a myriad of intrinsic and extrinsic factors, less meibum reaches the ocular surface, causing dry eye symptoms. Some contributors that may influence the severity of MGD could be age, ethnicity, high cholesterol, allergies, bacterial loading, and autoimmune diseases like Sjögren’s syndrome, rosacea, lupus, and rheumatoid arthritis.
Dr. Lazar, who owns and practices at Greenwich Eyecare in Connecticut, chose OptiLight because of her dismay that while prescription drops helped some of her patients at first, they tended to plateau after time and experienced a return of uncomfortable symptoms.
“I felt that as an ocular surface disease specialist, I clearly wasn’t providing the best for my patients,” she said. “After researching how the OptiLight technology was shown to reduce inflammatory mediators,14 improve tear breakup time, and improve meibomian gland morphology and functionality, I wanted to see if it could help my patients.”
Dr. Garlich, who owns Envision Optometry, an advanced dry eye center in Boston, wanted to provide her patients with the latest technology in order to provide the highest quality of patient care.
“I was struggling with how to treat the inflammation that lives in the eyelid,” she said. “How could I get rid of that and help that patient? I spoke to a lot of colleagues who treat dry eye and the overwhelming response from a lot of them was to use OptiLight, so adding it to our practice was the natural next step.”
"We developed a strong relationship with Lumenis over the years," said Dr. Silani, who is the chief clinical director of Beverly Hills Optometry. "In 2021, we proudly introduced the OptiLight device into our practice along with an appreciation for the FDA designation, the dozens of clinical studies, and the treatment outcomes."
When is the right time to introduce OptiLight to dry eye patients?
“The most important thing to remember about ocular surface disease is that it’s multifactorial, chronic, and progressive,” said Dr. Silani. “If left untreated or treated incorrectly, dry eye symptoms will continue and may worsen.”
Adding to that, many dry eye specialists see patients on a referral basis who have already tried several other treatments and are still struggling to find relief.
“Many of our patients have already seen several different doctors before coming to me so they’ve already tried a lot of things,” said Dr. Lappin, who has seen patients from as far away as the Middle East and South America at the Dry Eye Center of Arizona. “It used to be that OptiLight was offered when other treatments failed. But I now often offer it even at a patient’s initial dry eye exam if I believe they are a good candidate. The biggest reason for this is my direct experience with successful patient outcomes following their respective OptiLight sessions.”
Dr. Lappin stresses the importance of utilizing complementary treatments, including omega-3 supplementation and proper lid hygiene, while appreciating that Lumenis light therapy may be able to address multiple factors that contribute to dry eye disease as a foundational treatment modality.
“In my professional opinion from direct clinical experience, OptiLight, along with the aid of meibomian gland expression, can address MGD, eyelid telangiectasia associated with ocular rosacea along with periocular Demodex and bacterial infestation,” he added. “And that’s huge, because you don’t really get ALL of these benefits in other treatments. The other nice thing about this treatment is that they come into the office, and we perform the procedure. It’s not a drop a patient has to use every day, whether it’s artificial tears or a prescription immunomodulator.”
“In my professional opinion from direct clinical experience, OptiLight, along with the aid of meibomian gland expression, can address MGD, eyelid telangiectasia associated with ocular rosacea along with periocular Demodex and bacterial infestation,” he added. “And that’s huge, because you don’t really get ALL of these benefits in other treatments. The other nice thing about this treatment is that they come into the office, and we perform the procedure. It’s not a drop a patient has to use every day, whether it’s artificial tears or a prescription immunomodulator.”
Other doctors agree with Dr. Lappin that IPL treatment doesn’t present certain barriers such as patient compliance that other dry eye treatments do.
Dr. Silani, who offers OptiLight earlier in the treatment cycle, has a slightly different approach.
“Depending on the duration of the condition as well as the severity and frequency of signs and symptoms, we share treatment options with patients including a stepwise plan,” he said. “Many dry eye patients, especially moderate to severe, opt for a proactive approach which combines at-home and office-based therapies, including my professional recommendation of OptiLight.”
While some patients may experience significant discomfort due to their dry eye symptoms, other patients may have signs but no symptoms, complicating the “which treatments to introduce when” dilemma even more. Many have already tried almost every pharmaceutical treatment available, but others may simply be coming in for an annual exam or contact lens fitting and will display the signs—if not the symptoms—of dry eye, including telangiectasia on the eyelids, ocular rosacea, keratitis, or other allergic symptoms indicating inflammation.
“It’s important to remember that while rosacea shows up on the cheeks and nose, those vessels can lead to the eyelids and cause havoc,” said Dr. Silani.
The complexity of dry eye disease adds additional nuance because treating dry eye is never a one-size-fits-all approach. Just as a patient might see their primary care doctor and be diagnosed with thyroid disease, high blood pressure, and high cholesterol, patients with dry eye symptoms may have many contributing factors, including meibomian gland dysfunction, inflammation, and high levels of bacteria near the ocular surface.
“It's rare to have just one treatment that fixes everything when it comes to dry eye,” said Dr. Garlich. “Taking it one step further, the disease itself is multifactorial, your treatment should be as well.”
All the experts recommend thorough examination and proper diagnostic analysis prior to the introduction of any dry eye treatment including:
- Meibography imaging studies
- Checking tear breakup time using vital dye stains or non-invasively with corneal topography or slit lamp photography
- Measuring tear meniscus height and estimating tear volume
- Checking for collarettes/cylindrical dandruff of the lashes
- Assessing whether a patient has ductal fibrosis or clogged meibomian glands
- Analyzing lipid-layer thickness with interferometry
- Measuring bacterial load on and in the lashes and the tear film (i.e. saponification with the appearance of foamy tears)
- Staining with fluorescein and lissamine green to detect desiccated and devitalized areas of the cornea and on the conjunctiva, respectively
Educating patients about OptiLight for optimal results
“In my experience, not one of my patients has ever heard of a meibomian gland,” said Dr. Lazar. “In fact, I think most patients don’t realize that eyelids do a lot more than blink and spread the tear film.”
In many cases, patient education is most effective when a patient is allowed to view the images and see their own test results.
“I take a lot of anterior segment photos and share the images with the patients,” Dr. Lazar added. “Once we are done with the exam, that’s when education starts. I show them images of meibomian glands, so they see an oil gland and then they see a gap—and I explain why that isn’t OK. I’ve found that the more I share, the more receptive the patients are and the more compliant they tend to be if they are invested in their own care.”
Dr. Silani also helps patients understand how 21st century living can contribute to dry eyes, from staring at screens and wearing masks to stress, poor diet, and inadequate makeup removal. Additionally, certain surgeries like LASIK can alter the ocular surface and trigger dry eye symptoms.
“Although we encourage patients to stick with the game plan, it’s kind of a tug of war where life is pulling them in one direction so we need the ideal treatment plan to head in a better direction,” he said. "I’ve found that one of the most important aspects of being a dry eye specialist is truly listening to our patients and evolving their protocol based on our deep interactions.”
Dr. Silani, like Dr. Lazar, takes baseline measurements and shares them with the patients.
“Creating a treatment plan after gathering baseline and comparative data both objectively and subjectively has a positive impact on my patients,” he said. “For instance, with our diagnostic imaging devices, we can demonstrate that their vital dye staining improved, their tear stability improved, and their oil function improved. Equally or more importantly, they also feel better, see better and look better over time.”
What are the biggest benefits optometrists* have seen from OptiLight?
#1 Patient Satisfaction
Unlike drops and heating devices, OptiLight addresses the signs and key contributors to inflammation underlying dry eye symptoms due to MGD. Patients can see a difference in just four sessions, and many see results sooner than that.
“I think of dry eye patients using OptiLight the way a glaucoma patient might choose SLT rather than using a drop,” said Dr. Lappin. “I even have patients who want to use OptiLight the same day I tell them about it because it’s such a benefit to come into the clinic four times rather than remember to take drops a few times a day.”
#2 Time Efficiency
From a practice efficiency standpoint, each OptiLight session typically takes about 10-15 minutes. Gland expression is an additional component which is usually a part of the procedure.
Dr. Lappin recommends performing treatments in a single day, back to back, which he calls a “procedure day” to optimize patient workflow for scheduling purposes.
“It keeps things flowing really well, and because the treatments are short, I can add in a patient who wasn’t previously scheduled,” he said. “My patients really appreciate that flexibility.”
#3 Increased Revenue
The saying, “what’s good for your patients is good for your practice,” has never been more true than for doctors who incorporate OptiLight into their practices. While it can be challenging to know what to invest in during unpredictable times, the number of patients suffering from dry eye may be validation enough.
“Since I started using OptiLight, it’s grown my practice so much,” said Dr. Lazar. “I’m opening up a second office and just purchased another OptiLight because so many patients are suffering from dry eye. But like I tell my colleagues, I think we’re only at the beginning. While I don't treat children with OptiLight, I see many children for myopia and as I scan their lids, I see meibomian gland loss. If you have a nine-year-old with four meibomian glands left on a lower lid, what’s going to happen when she is 35?”
“Since I started using OptiLight, it’s grown my practice so much,” said Dr. Lazar. “I’m opening up a second office and just purchased another OptiLight because so many patients are suffering from dry eye. But like I tell my colleagues, I think we’re only at the beginning. While I don't treat children with OptiLight, I see many children for myopia and as I scan their lids, I see meibomian gland loss. If you have a nine-year-old with four meibomian glands left on a lower lid, what’s going to happen when she is 35?”
#4 Improved patient relationships
“As optometrists,* we’re big on developing long-term, lasting, and positive relationships with patients who trust us,” said Dr. Silani. “Typically, we see a patient come in once a year for an annual exam unless they get an infection or they’re glaucoma suspects. What’s nice about OptiLight is we see dry eye patients for four sessions about a month apart. And more often than not, they feel and see better after each visit. On top of that, they are also getting compliments on how their skin is glowing.”
Dr. Silani also emphasizes how important positive patient relationships are to his practice.
“We really enjoy building long-lasting relationships with our dry eye patients, as we guide them through their journey to restore clear, comfortable vision at all distances.”
For doctors who run dry eye centers, having cutting-edge equipment is important for building patient trust—which can lead to loyalty, referrals, and increased revenue.
Dr. Garlich, who runs a dry eye center, believes that offering a solution like OptiLight reassures her patients that she is committed to the highest standards of patient care. She believes OptiLight has helped her practice stand out from the others. For example, OptiLight has brought in patients who searched for an effective, light-based technology and discovered her practice through their internet searches.
“I’m just so excited,” said Dr. Lazar. “The benefits of OptiLight enable me to treat almost every patient with moderate to severe signs of dry eye disease. We have the ability to reduce inflammation, reduce the Demodex population, reduce telangiectasia, and rehabilitate the meibomian glands. I mean, what else is there? My patients want to walk in, get their treatments done, and look good, and you know what—I’m here to give it to them.”
*OptiLight is intended for use by licensed practitioners per local regulations.
