With an estimated 4.3 million Australians estimated to be living with dry eye, the decision to expand your treatment options to include this disease could be a profitable one.
It is a familiar scenario – spending hours in air-conditioned offices in front of computers, picking up the phone to scroll through social media on the public transport commute home, then perhaps doing a little online shopping after dinner.
A significant proportion of people don’t recognise that they do have dry eye and when you bring it up, they are responsive to it
Not surprising then, that the number of people suffering from dry eye is increasing.
Many people put up with the debilitating symptoms of dry eye: the dry, gritty burning sensation, the redness, the watery or teary eyes, or the blurry eyes – often without recognising that there is treatment available.
Intense Regulated Pulsed Light
Dry eye has traditionally been treated with drops, lid massage, warm compresses, and manual expression. More recently, Intense Pulsed Light (IPL) has emerged as the gold standard treatment for both the condition and symptoms of dry eye.
The E-Eye IRPL (Intense Regulated Pulsed Light), made in France by ESW-Vision, was the first IPL to be approved, in 2014, by the Therapeutic Goods Administration (TGA) for the treatment of dry eyes, meibomian gland dysfunction (MGD), inflammation, blepharitis, rosacea, etc.
Now distributed in over 55 countries globally, the new generation of the E-Eye IPL, called the Tearstim from Eyetek, uses the same patented technology. Eyetek said the E-Eye/Tearstim produces a “perfectly calibrated and homogeneously sequenced light pulse spectrum” with the “time period set precisely to stimulate the meibomian glands” to return them to their normal function.
IRPL, the company said, provides “long-lasting, genuine treatment” for dry eyes.
Additionally, Eyetek said it improves surgical outcomes when used to treat the tear film of patients before and after refractive and cataract surgery.
The Tearstim offers the same technology, outcomes, and treatment benefit as the previous generation (E-Eye) IPL device but, with a condensed footprint and an improved design. Eyetek also describes the Tearstim as “more user-friendly”.
Dry eye treatment with IRPL takes only a few minutes. The patient’s eyes are covered by protective eyecups. Hydrogel is applied to the lower eyelid before a series of light pulses are performed.
As a result, the meibomian glands’ actions are restored, allowing them to produce a higher quality and quantity of lipids, which naturally lubricates the cornea, reduces the evaporation of the aqueous layer and prevents the eye from drying out. In addition, the quality of the glandular secretions is improved, and the tear film’s lipid layer is stabilised.1
The technology has been backed by many studies and more than 10 years’ of research and development demonstrating “significant improvements in dry eye symptomology, tear film lipid layer thickness, and meibomian gland capping in MGD patients”.2
“Serial intense pulsed light therapy combined with meibomian gland expression significantly improved dry eye symptoms and clinical signs from the first session, including meibomian gland secretion quality and expressibility and ocular surface inflammation. Treatment effects were cumulative and sustained for at least six weeks after the final treatment.”3
Building A Dry Eye Clinic
Optometrist Lisa Armistead from Hope Island Optical invested in IPL about five or six years ago, while searching for a point of difference for her Gold Coast practice.
“You come across dry eye all the time. It’s so much more prevalent than you think. It’s in everyday people all the time. People just don’t know about it.”
She said she works with general practitioners and ophthalmologists – as well as receiving many referrals through word of mouth – to help manage dry eye.
Optometry-wise, I think it is great to use it to increase your scope of work. You can use it for so many more people than you think.”
She said she starts screening for dry eye when people come in for a routine eye examination.
“A significant proportion of people don’t recognise that they do have dry eye and when you bring it up, they are responsive to it. Many come in because of dry eye symptoms and about 85% of people are successfully treated.
Using the E-Eye system from Eyetek, Ms Armistead said she will treat patients with an intensive course over several sessions. Regular ‘top ups’ are required when symptoms return. This is usually every six to 12 months, although some people only require additional treatment every two years. IPL is quick to incorporate into someone’s routine eye testing.
She said while some people “won’t notice the difference”, they will recognise they aren’t using eye drops as much. “Unbeknown to them, they are so much better once you do the measurements.
“Those that have MGD or blepharitis are the ones that really benefit.”
Pre- And Post-Surgery
Gold Coast ophthalmologist Dr Frank Howes agreed that dry eye and dry eye management are not insignificant problems.
“You need a lot of arrows in the quiver, as it were, to manage dry eyes.
“Dry eye is a very common frustration for so many people with causes varying across the spectrum from primary (idiopathic/ageing) to secondary (auto-immune/ocular surface disease/MGD etc.) dry eye. So many of these people also need or want ocular surgery and this group indeed, needs careful dry eye management both pre-operatively and postoperatively.
He said the E-Eye IRPL system forms “one of those important arms to manage the disease”.
“Dry eyes are managed in various tiers, according to the severity of the problem. IPL functions well at the higher tiers of management in conjunction with other management strategies. I would not like to be without this additional arm of management in a disease that is often likely to be lifelong.
“Remember that when patients are happy and comfortable, you tend not to hear that much from them… I wouldn’t say it cures but it can certainly reduce the demand for supplementary medications and help them forget the degree of dry eye that they have,” Dr Howes said.
Education And Training
Ms Armistead said the machine is very easy to use, and other practice staff can be trained to use it.
“Eyetek provides training and education. It is really nice and simple. If you need support, they are there to help. They will pop out and train anyone for you, or give you resources you need to market it.”
Eyetek Managing Direct Jeremy Rebion said more than 150 practices were now using the company’s IRPL devices in Australia.
He said the relatively new Tearstim device was “very agile and very easy to operate” and less intimidating for eye care professionals.
“The technology has been condensed into a smaller footprint device, which fits really well in any optometry practice or ophthalmology clinic, it also has a dedicated travel suitcase, allowing practitioners to travel between clinics, practices or hospitals if required.
“Anyone in the practice can operate the device after training, based on the fact that we have a very specific interface allowing everyone to use it easily without having to change filters and power settings – everything is calibrated to deliver optimal results while being comfortable for patients,” Mr Rebion said.
References
1. eyetek.com.au/product/ipl-dry-eye-e-eye.html [accessed 27 April 2023].
2. Xue A.L., Wang M.T.M., Ormonde S.E., Craig J.P., Randomised double-masked placebo-controlled trial of the cumulative treatment efficacy profile of intense pulsed light therapy for meibomian gland dysfunction. Ocul Surf. 2020 Apr;18(2):286-297. doi: 10.1016/j.jtos.2020.01.003. Epub 2020 Jan 30. PMID: 32007523.
3. Albietz, J.M., Schmid, K.L., (2018) Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction, Clinical and Experimental Optometry, 101:1, 23-33, DOI:10.1111/cxo.12541.
