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Dry Eye

The Unequivocal Benefits of Incorporating OptiLIGHT Into Your Dry Eye Practice

August 8, 2023

Kelsi Greider-Sideris
Kelsi Greider-Sideris, MD

Dr. Kelsi Greider-Sideris is a comprehensive ophthalmologist at Greider Eye Associates, San Diego County, California

I believe there really is no replacement for incorporating Lumenis’ OptiLIGHT light-based therapy into the management of patients with dry eye disease (DED).
Many patients have a very large evaporative component to their DED. These patients have often struggled for years with artificial tears, punctal plugs, and prescription medications, which may help with addressing symptoms associated with tear deficiency but fall short in providing a solution for patients with meibomian gland dysfunction. These patients may find some relief with daily hot compresses and lid hygiene, but compliance might be an issue. Even with perfect compliance though, it rarely leads to a marked increase in tear film stability seen by improved tear breakup time (TBUT).

Incorporating OptiLIGHT into my practice has made a real difference in patients with meibomian gland dysfunction (MGD) and evaporative dry eye. Lumenis light therapy is the first and only that is FDA-approved for DED, and that is a strong affirmation of safety and efficacy for doctors who are considering implementing OptiLIGHT in their practice as well.
I have seen significant increases in the TBUT for each of the patients I’ve treated, going from a 0- to 1-second TBUT, to an average of 14 to 15 seconds in patients who have completed all four treatments.

I have never seen patients improve this much with conventional treatment methods, and this demonstrates that we can address the evaporative component in a way we just couldn’t before.

Addressing the Underlying Cause Is the Best Practice

I find it essential to address the root cause of meibomian gland dysfunction in my evaporative dry eye patients with OptiLIGHT. In addition to OptiLIGHT, I strongly recommend a good lid hygiene regimen to reduce any overload of bacteria, and Demodex, which contribute to lid and ocular surface inflammation. Additionally, I have them do hot compresses, and use high-quality preservative-free artificial tears while awaiting their OptiLIGHT treatments to keep signs under control.
Once a patient has completed four sessions of their OptiLIGHT treatments, daily hot compresses are not really necessary, but I do recommend that they continue lid hygiene and artificial tears to optimize their ocular surface health.

OptiLIGHT Easily Integrates Into Your Practice Workflow

OptiLIGHT is the first treatment modality we’ve worked with that enables us to address the underlying MGD inflammatory component of DED. Prior in-office therapies targeted to DED due to MGD could improve symptoms, but did not work towards offering a multi- factorial, effective solution to DED. These patients struggle with their dry eye condition for years and are often frustrated by conventional treatments that are burdensome time-wise and provide limited results. Being able to offer OptiLIGHT to these patients at my practice has been one of the most rewarding opportunities of my medical career.
When I first started offering OptiLIGHT, I discussed it as an alternative to conventional treatment. After seeing such consistent positive results, my approach has shifted. If I determine that a new patient would benefit from OptiLIGHT, I go ahead and introduce the treatment at the first visit. Many patients will go forward with that treatment plan from the start, knowing that they’re going to get a real solution to their longtime condition.

Demodex Count Can Be Reduced With OptiLIGHT Treatment

Lately, everyone is talking about Demodex. Personally, I think that the impact of Demodex overgrowth on dry eye and blepharitis has been overlooked, and I am thrilled that dry eye specialists are focusing more on how to reduce Demodex counts. I have observed that patients with underlying MGD and DED are more likely to have signs of Demodex blepharitis on exam, similar to the known correlation of patients with rosacea and Demodex infestation1.
It is unclear whether the underlying immune dysregulation in rosacea promotes the overgrowth of Demodex or if Demodex overgrowth causes the immune dysregulation itself. Either way, Demodex overgrowth contributes to the inflammatory cycle in rosacea and blepharitis patients. We know that the OptiLIGHT technology, can decrease the amount of Demodex present in oil glands of the face and eyelids, and is therefore a good approach for management of Demodex- associated blepharitis2. In addition to directly killing Demodex mites, I suspect OptiLIGHT can help prevent regrowth in the future by restoring healthy immune balance to the lids and periocular area.

OptiLIGHT May Help to Positively Impact Overall Ocular Health

Dry eye management can vary greatly in its impact on a patient’s ocular health. Some patients have a little bit of dry eye with an impact on ocular health that is minimally bothersome. They may have some blepharitis, or MGD, but they’re not too concerned by it.
Then there are patients at the other extreme. In addition to having severe DED that might really impact quality of life, patients with severe meibomian gland dysfunction/blepharitis or ocular rosacea can end up with corneal scarring that threatens vision. So, on this end of the spectrum, DED can have a very large impact on a patient’s overall ocular health.
We also have patients that come in and have “20/20 unhappy vision,” where they may be able to read the eye chart well but notice blurred vision in most settings due to tear film instability. If your tear film evaporates after 1 to 2 seconds you will never get crisp, quality images. One situation where I see this frequently is in patients who have had cataract surgery with multifocal lenses and coexistent dry eye and are unhappy with their visual outcome. Evaporative dry eye can impact their quality of vision significantly, and these patients may benefit from OptiLIGHT. I also like to discuss OptiLIGHT treatment with DED patients who are considering cataract surgery in the near future. It’s important to optimize the ocular surface prior to cataract surgery, to ensure accurate measurements for more successful outcomes, and to minimize the need to bring patients back to the office multiple times3.
In younger patient populations, I notice many cases with evaporative dry eye and blurred vision from increased screen time. As many workers have switched to working remotely throughout the pandemic, this has increased the portion of the day they are in front of computers. These patients are excellent OptiLIGHT candidates. By improving a patient’s DED, it may positively affect their comfort and quality of vision while working from home.

OptiLIGHT Enhances Practices At Any Experience Level

I’ve only been out of training for three and a half years. I became very passionate about incorporating this procedure into my practice early on, because I had seen so many patients who suffered from meibomian gland dysfunction that could benefit from it.
I personally suffered from ocular rosacea, and was antsy to receive the treatment myself!
Even though I was very fresh in my career, I brought in OptiLIGHT because I could see it would help elevate patient care. And this really allowed me to establish an “in” for myself within the community. I’ve developed a strong patient following; a lot of new patients come in with referrals from friends and family. I really believe wherever you are in your career, whether early or later on, adding OptiLIGHT to your practice can really help you develop a stream of patients who suffer from DED and are looking for a real solution.

Additional Revenue Stream

As a mostly medical ophthalmologist, I don’t do cataract surgery. I do minor procedures and lid surgery, but do not spend much time in the operating room. Having OptiLIGHT in my practice serves as a replacement to that cash-pay premium lens revenue source. The same can be true for any ophthalmologists that don’t want to do cataract surgery, whether it’s someone later in their career so they’ve stopped operating and they want to have something to replace this part of the business, or someone earlier on like me that has chosen to spend more time in clinic than the OR.
The cataract surgeons in my office always have me in mind if they have a patient with a troublesome ocular surface, either pre- or post-surgery, and will refer those patients to me to clean up the problem. OptiLIGHT has been a true revenue generator for me.

Incorporating OptiLIGHT Allows Practices To Expand

There are just so many patients with DED, and so many can be benefitted by this treatment modality. This segment of my practice has grown on word of mouth alone. So I’ve taken this passion project, from where I was expecting to have a few patients here and there to add into my schedule, to a point where I have a designated OptiLIGHT afternoon and two additional time slots throughout the week to try to accommodate patients. It’s a very satisfying addition to a practice. The requirements are pretty minimal in terms of space, staffing, and time. When you’re busy, you can bring the patients in and get them out quickly. You can do it out of one room in the clinic, and with minimal tech support required. I have one technician working with me who goes through paperwork, takes photographs, and measures the TBUT before I perform the treatment. The treatment itself takes around 15 minutes, even with cosmetic treatments included. Not only do OptiLIGHT days keep me busy and thus increase office cash flow, but also my patients are happy to be there, and excited for their treatments.

Final Thoughts

It’s very exciting being on the leading edge of using the OptiLIGHT system, as it becomes more of an emerging technology and more eyecare practitioners are using it. It’s very satisfying to have something to offer to patients, where they didn’t have that access before.
It’s a very powerful treatment tool and I see its benefits for eye care in general. I was one of the first clinicians in San Diego to acquire OptiLIGHT some time ago, and as we were waiting to get started there was a waitlist of people who wanted to try it, and were very excited to have access to it. They knew a real solution was finally coming available and were anxious for it. And now patients are reading about this online and seeing video on social media, so they come to me directly asking for it!
I’ve found it very satisfying to be involved with the progress and growth of this technology as it has emerged into wider use.

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    1. Chang YS, Huang YC. Role of Demodex mite infestation in rosa- cea: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Sep;77(3):441-447.e6. doi: 10.1016/j.jaad.2017.03.040.
    Epub 2017 Jul 12. PMID: 28711190. https://pubmed.ncbi.nlm.
    2. Zhang X, Song N, Gong L. Therapeutic Effect of Intense Pulsed Light on Ocular Demodicosis. Curr Eye Res. 2019 Mar;44(3):250-
    256. doi: 10.1080/02713683.2018.1536217. Epub 2018
    Oct 25. PMID: 30321061. https://pubmed.ncbi.nlm.nih. gov/30321061/
    3. Nibandhe & Donthineni (2023) Seminars in Ophthalmology, 24-30

    PB-00043680, Rev B