InMode recently hosted an evening showcasing the Envision device, an innovative treatment that combines radiofrequency and intense pulsed light (IPL) to effectively manage dry eye symptoms.
About 50 optometrists gathered in person in Sydney, while over five hundred joined the livestream to hear the latest development in dry eye management. Dr Gina Chapman-Davies, a lecturer at the University of New South Wales (UNSW) School of Optometry and Vision Science and staff practitioner at the UNSW Dry Eye clinic, discussed case studies and demonstrated the Envision device, giving useful clinical pearls for improving outcomes in dry eye management.
The Burden of Dry Eye
Dry eye disease affects up to 15% of Australians and can significantly impact quality of life. Dr Chapman-Davies spoke on the impact that dry eye has on a sufferer, noting that in a meta-analysis, the prevalence of anxiety in dry eye patients was 39% and depression was 40%. It is not, she stated, a “frivolous complaint”. It can also be associated with a reduced quality of life, reduced productivity, and social withdrawal.
Diagnosing Dry Eye
The DEWS II algorithm remains the gold standard in diagnosing dry eye. Dr Chapman-Davies stressed the importance of a systematic workup, starting with triaging questions, risk factor analysis, and symptom questionnaires like the Ocular Surface Disease Index (OSDI) and Dry Eye5 Questionnaire (DE5-Q) before moving onto the ocular findings.
Physical examination of the lid margin and lashes can reveal signs of demodex or rosacea, which can be underlying factors. Lissamine green can be particularly helpful in the absence of positive fluorescein staining. Meibography remains a crucial tool in the early detection of meibomian gland dysfunction (MGD) – a contributing factor in over 80% of patients.
The main advantage of RF over IPL is that it delivers sustained heat at 42°.
Advanced Treatments
Intense pulse light (IPL) has been used to treat dry eye since the early to mid 2000s. It reduces inflammation through photocoagulation and photomodulation, and it is bactericidal and eradicates demodex.
Dr Chapman-Davies recommended a series of about four treatments, spaced out over every two to four weeks; more severe cases will potentially need more treatments. While adverse effects are rare, they can include pain, blistering, reactivation of herpes simplex, lash and brow loss and, if improper eye protection is used, uveitis and iris atrophy are possible. Additional caution is also needed for patients with Fitzpatrick skin types five and six, and the use of medications that increase photosensitivity is contraindicated.
Radiofrequency (RF) however, generates an electric current within an electromagnetic field. When this radiofrequency current meets tissue, the energy is converted to heat, which can be applied to the meibomian glands directly.
The main advantage of RF over IPL is that it delivers sustained heat at 42°. An eye shield is not required, which allows a more targeted treatment over the periorbital area. There is no limitation to the skin type and photosensitising drugs are not contraindicated. There are some adverse effects, but almost all of them relate to overheating. Finally, RF can be delivered more frequently than IPL.
Integrating Envision at UNSW
An InMode Envision device was installed in a dedicated treatment room at the School of Optometry at the UNSW in January last year. This, Dr Chapman-Davies noted, has “transformed” the clinic.
Three case studies were discussed, each case having a different degree of chronic dry eye symptoms. All three showed significant improvement in their quality of life and symptom scores.
Dr Chapman-Davies described the synergistic effect of combining IPL with RF: the IPL targets the telangiectatic blood vessels and inflammation, while RF heats the meibum at a sustained temperature. Used together, she said they enhance the overall therapeutic effect.
Live Demonstration
The evening concluded with a live demonstration of the IPL and RF treatment, followed by meibomian gland expression. Dr Chapman-Davies recommended going twice along each eyelid margin and showed the audience her preferred tool of expression – a small, flat tweezer-like instrument.
For optometry practitioners in the audience, Dr Chapman-Davies’ account of the successful integration of IPL and RF at UNSW indicated the potential of Envision in clinical practice.
Learn more about Dr Chapman-Davies’ experience with IPL and RF treatment in the video below.
