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HomemiequipmentOptima Intense Pulsed Light for Dry Eye

Optima Intense Pulsed Light for Dry Eye

When the United States Food and Drug Administration approved the Optima Intense Pulsed Light technology for medical treatments back in the ’90s, little did we know it would become a powerful treatment for the underlying causes of dry eye disease.

Intense Pulsed Light (IPL) uses broad wavelengths of light ranging from 515nm to 1200nm to target specific chromophores on the skin. This is used to treat various conditions including abnormal vascular and pigmented lesions, aging, and hair removal. IPL produces pulsed energy levels ranging from 10Joules/cm2 to 30Joules/cm2.

In 2001, I discovered that IPL applied to the skin helped some patients with dry eye disease (DED). This revelation led to our clinic (the Toyos Clinic) completing several research studies to define parameters and protocols to bring a reliable treatment to market.

Lumenis had the first Food and Drug Administration approved IPL system in the late ’90s. Several companies followed suit and developed IPL systems. We were fortunate to use all of these different systems when we were studying its use for dry eye. Over the years, Lumenis has improved on its original design and technology, enabling doctors to deliver a treatment that is efficacious and safe.

Several peer-reviewed studies, including our own, have shown that IPL improves the signs and symptoms of DED

The Lumenis Optima M22 has Optimal Pulse Technology that controls the pulse shape, providing more consistent reproducible results. IPL systems are arc lamps that use Xenon to produce coherent light. The more you use the arc lamp, the more that most of these systems lose their overall energy output. For example, if you program 14J/cm2 into an ordinary IPL system, with frequent use programming the system will output less than 14 J/cm2. Some IPL systems attempt to correct this problem by having replacement bulbs, however this requires the doctor to continuously purchase disposables and does not ensure consistency of the bulb with use. The output that you program into the Optima will be the energy that is produced. This feature is important because our research has shown that specific energies for certain Fitzpatrick skin types work best. The Optima allows the doctor to control the energy, cut off filters, and the number and duration of pulses. The Optima also contains continuous contact cooling on the handpiece. This means the heat generated by the IPL will not burn the epidermis during treatment and so patients will feel more comfortable.

We found the best protocol is to apply therapy from tragus to tragus, including the eyelids. The procedure is not a ‘one and done’ treatment. Most patients require multiple treatments to improve meibomian gland dysfunction (MGD) dry eye disease. Once the patient achieves a normal tear film then patients will undergo maintenance treatments to preserve normal gland and tear production.

How Does IPL Work?

The number one question from doctors is, “What is the mechanism of action of IPL for DED?”. Our understanding of the multiple mechanisms through which IPL benefits DED patients has evolved as knowledge of the disease and technology has advanced. One important characteristic of IPL is its ability to kill microorganisms. An IPL robot called the Xenex is now being used to disinfect operating theatres and hospitals and was a critical part of controlling the Ebola outbreak.1,2

Overgrowth of bacteria and Demodex is a hallmark of MGD, and studies show that IPL improves the signs of blepharitis. Also, IPL warms the dermis to temperatures up to 43º C, thus melting the thick secretions produced by patients suffering from MGD and allowing me to manually express the glands easily. I find that heat-assisted gland expression helps to relieve some of the signs and symptoms of DED but does not change the overall function of the glands.

Certain wavelengths of light at specific fluences can stimulate cells and glands to function normally. This process is called photomodulation. Importantly, several articles have demonstrated that IPL stimulates fibroblasts in skin to produce more collagen.3,4 I believe the cells of meibomian glands are also stimulated by IPL. Over time, researchers and practitioners will learn more about all of the morphological changes that occur to the skin and glands of patients undergoing the procedure.

Expanding Scope

The Optima M22 has the ability to add different treatment modes to the system besides IPL, allowing surgeons to branch out into aesthetic procedures and DED:

These include:

  1. Fractional non-ablative skin resurfacing with the ResurFx
  2. Multi Spot Nd:YAG for the treatment of larger vascular lesions
  3. Q switched Nd: YAG for skin toning and dark tattoo removal.

Several peer-reviewed studies, including our own, have shown that IPL improves the signs and symptoms of DED. The Lumenis Optima system brings many advances that can be used by the doctor to customise the treatment for each patient. The ability to control all the parameters and continuous cooling decreases adverse events and increases patient comfort. We have learned that several types of DED are skin gland diseases that affect the eyes. The Optima is an evolved technology that doctors can use to treat the underlying disease causing the signs and symptoms of dry eye disease.

Rolando Toyos, MD is the medical director and founder of Toyos Clinic, which has locations in Franklin, Memphis, Nashville, and Southaven, Tennessee. He received his medical degree at the University of Illinois, graduating with James Scholar Academic Honors and received a community service award for helping Chicago City Public Schools develop a pre-med program for students interested in medicine. Dr. Toyos completed his internship in Internal Medicine at Illinois Masonic Hospital in Chicago and his ophthalmology residency at Northwestern University and Chicago Children’s Hospital. Dr. Toyos spent one year performing LASIK at the Assil Eye Institute in Beverly Hills. Dr/ Toyos consults to Lucentis.

References
1. Nagaraja A, Visintainer P, Haas JP, et al. Clostridium difficile infections before and during use of ultraviolet disinfection [published online ahead of print July 6, 2015]. Am J Infect Control. doi:10.1016/j.ajic.2015.05.003.
2. Martinez M, Vercammen P, Hannah J. Germ-zapping robot Gigi sets its sights on Ebola. CNN website. http://cnn.it/295d6VB. Updated October 18, 2014. Accessed June 30, 2016.
3. McDaniel DH, Weiss RA, Geronemus RG, et al. Varying ratios of wavelengths in dual wavelength LED photomodulation alters gene expression profiles in human skin fibroblasts. Laser Surg Med. 2010;42(6):540-545.
4. Wong WR, Shyu WL, Tsai JW, et al. Intense pulsed light effects on the expression of extracellular matrix proteins and transforming growth factor beta-1 in skin dermal fibroblasts cultured within contracted collagen lattices. Dermatol Surg. 2009;35(5):816-825.
5. Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg. 2015;33(1):41-46.
6. Vegunta S, Patel D, Shen JF. Combination therapy of intense pulsed light therapy and meibomian gland expression (IPL/MGX) can improve dry eye symptoms and meibomian gland function in patients with refractory dry eye: a retrospective analysis. Cornea. 2016;35(3):318-322.