Tech solutions for dry eye offer optometrists yet another way to participate in the evolution of optometry towards the eye-health model of practice. Optometrists are moving steadily beyond drops and sprays for dry eye solutions and are turning to technology. The results have been good for the patients and good for business sustainability.
Dr Nicholas Young
The Dry Eye Centre
The Quadra 4 is an intense pulse light (IPL) device that is currently unavailable in Australia. We were impressed by its effectiveness and it had a solid track record of performance for dry eye, so we registered it with the TGA and brought it into the country ourselves.
The Quadra 4 represents a departure from the ‘decongestive technologies’. The other technologies and drugs that we use all target the meibomian glands, to free them so the oil flows better. IPL and especially a vascular treatment IPL is intended to photocoagulate red blood cells. Basically, it fuses the blood vessels so they won’t leak.
In essence, what IPL does is progressively remove the body’s capacity to produce an inflammatory response. IPL use is strictly limited to patients with obvious signs of inflammation or telangiectasia.
In our practice, the Quadra 4 works like any other IPL device. We put the patches over patients’ eyes to protect them from the intensity of the light source, and we use an ultrasound gel, which disperses the heat from the unit.
We proceed with a number of flashes, beneath the eye. The flash doesn’t go on the eye’s surface; it goes just below on the lower edge of the eyelid. The procedure takes about five minutes. It has to be repeated and treatments are one month apart. Over a period of four treatments with the Quadra 4, the symptoms of dry eye become less each time.
It’s an excellent device and we’ve never had a treatment failure with it.
20/20 Sight & Style Behavioural Optometrists
Lipiflow Thermal Pulsation System
Lipiflow is a thermal pulsation system that treats evaporative dry eye caused by meibomian gland dysfunction by opening and clearing blocked glands, allowing the body to resume the natural production of lipids needed for the tear film.
Lipiflow reactivates the eye’s lipid-secreting glands through the simultaneous application of heat and compression, which reduces dry eye symptoms.
Lipiflow aims to directly target evaporative dry eye by restoring the correct balance of lipids into the tear film. In practice, the contact lens-like applicator is inserted onto the eye. Over a 12.5 minute treatment period, the instrument allows us to precisely and directly heat meibomian glands to melt thickened meibum and apply pulsed pressure to unclog those glands. Patients find the procedure surprisingly comfortable.
Lipiflow allows us to offer patients with dry eye a full complement of targeted treatment interventions, including IPL, Blephex and therapeutics.
Oculus Keratograph 5M Topographer
Designs For Vision
The K5 is a corneal topographer for Placido ring keratometry, with a built-in colour camera for imaging. The magic is in the built-in LEDs.
Since meibomian gland dysfunction (MGD) is rapidly becoming known as the leading cause of dry eye disease, I use the Oculus K5 to screen all my patients for MGD. I also use it to screen for irregular or unusual corneal conditions like keratoconus, pellucid marginal degeneration and astigmatism. It also assists me in evaluating the cornea before contact lens fitting, during fitting and at all after-care visits.
The LEDs give us great illumination, and the blue diodes allow for assessment of contact lens fittings or surface disorders during a fluorescein examination. The K5 has infrared diodes for photography and examination of the meibomian glands (meibography). It also has white diodes for measuring tear film volume, rate of evaporation and redness of the eyes.
In our practice, we are known for our speciality contact lens fittings and we run a full-scope dry eye clinic. We use the K5 to evaluate our contact lens fittings as I find the images better than the standard slitlamp camera.
As a patient consultation tool, the K5 is extremely valuable as it allows us to give our patients a mini-presentation about their ocular condition. Our patients tell us that they find the presentations highly educational and they are a motivator for compliance with treatment.
Just like the OCT or the fundus camera, I cannot imagine life without the K5.
Eyecare Plus Optometrist Springvale
Designs For Vision
Blephasteam is an eyelid warming device to relieve symptoms of patients suffering meibomian gland dysfunction and associated diseases. It provides moisture and heat therapy, and this dual action melts meibomian gland secretions. Manual meibomian gland expression then helps clear the obstructions.
We have used Blephasteam as an in-office treatment for MGD for several years and I have treated many patients ranging from teenagers to patients in their 80s. We find it simple to use and effective.
First, to ensure patient comfort, I always use topical anaesthetic before treatment and then a drop of Chlorsig and prednisolone after each treatment. The goggle is preheated and then placed on the patient. It reaches the optimal temperature of 42 degrees Celsius and maintains it for 10 minutes, melting the meibum that is blocked in the meibomian glands.
When the goggles are removed, I follow with expression of the glands on the upper and lower lids of both eyes. This is a crucial step in the treatment. Each treatment session usually takes 30 minutes and patients are given repeated treatments, from two to four weeks apart, until the meibum consistency is soft and clear.
Patients with mild MGD may need only one or two Blephasteam treatments. For moderate to severe MGD patients, I prefer Intense Pulse Light therapy for faster, more effective and better long-term results. For severe MGD patients, I sometimes use a combination of Blephasteam and IPL, always followed by expression.
Patients usually report less dry eye symptoms after each treatment, and the effect lasts longer with each treatment. Post-treatment, many patients don’t require lubricants daily. Once I am happy that the patient has good functioning glands, I review them, usually after six to 12 months, depending on the severity of their condition. This is important to ensure that when there is sufficient blockage detected, you are there to perform top-up treatments.
Dr Jim Kokkinakis
the eye practice
BlephEx is an in-practice procedure that allows optometrists to take an active role in treating blepharitis. A handpiece spins a medical-grade micro-sponge along the edge of eyelids and lashes, reducing scurf and bacterial debris, the main causes of inflammatory lid disease, and exfoliating eyelids.
BlephEx is probably best for anterior blepharitis. This is commonly associated with dry and red eyes. It is one of the most common reasons that patients seek our services.
Anterior blepharitis accounts for about 30 per cent of our comprehensive dry eye assessments. BlephEx is our ‘go to’ in-office treatment.
It is a very simple dry eye treatment, similar to a professional dental clean. A disposable sponged tip is attached to a handpiece similar to an Alger brush, which spins and frictionally removes the typical inflammatory debris that is found in blepharitis. The sponged tip needs to be dipped in one of the common lid cleaning solutions such as Blephedex foam.
Even though this treatment is invaluable, it is only as good as the maintenance at home that must be prescribed. Repeat treatments, depending on severity, are required every three to 12 months.
These before and after images (below) convey the efficacy of Blephex.
Before and after Blephex