Dry eye has become an ever-important part of optics so who should be involved, and when should it become a specialism within practice or even a clinic in its own right?
Last month, Optician invited a collection of key opinion leaders (KOL) and three suppliers to provide information for practitioners looking to get more involved. An evening of discussion sponsored by BIB Ophthalmic Instruments, The Body Doctor and Mainline Instruments, took place last month and can be viewed here.
Growth in the understanding of dry eye disease (DED) has seen clear definitions in the types of DED and suitable management strategies emerge.
Opening the webinar was Ros Mussa, an author, presenter and clinician with over 30 years’ experience. In practice, Mussa works as a contact lens optician with a special interest in DED management and she combines that with a variety of advisory, educational and professional services roles.
She kicked off her talk by suggesting clinicians needed to understand the past before looking to the future. In the past, refraction was a measure of our understanding of the eye’s functionality, but scanning techniques and a deeper recognition of the tear film’s structure meant we could take a more nuanced approach to eye health.
Definitions of DED devised by the Tear Film & Ocular Surface Society’s Dry Eye Workshop reports had transformed understanding and created multidisciplinary management and consensus.
Mussa outlined the diagnostic pathways for dry eyes before moving on to classification of DED types and management plans. She stressed the need for intervention to avoid a spiral of inflammation, which could only lead to pain, discomfort and runny red eyes. Routes to resolution were manifold, but any treatment had to rely on an evidence base, she said.
Various treatments are available, said Mussa, especially for the more common conditions such as lid-related issues. She described the evolution that has taken place since the days of baby shampoo and bicarb before describing patient use and in-practice treatments available.
A wide suite of products is at the profession’s disposal and it was up to practitioners to understand what was available, she added.
Where dry eye differs from other areas of practice, Mussa concluded, is in its scope: ‘This is not just adding another contact lens to your portfolio, this is adding a whole new management clinic.’
The opening presentation from the sponsoring companies was delivered by The Body Doctor, which took the opportunity to introduce itself and describe some of its products.
Co-founder Sam Wymer said the Body Doctor was founded in 2012 to provide science-backed practical solutions to promote and optimise eye health. He said too many practices relied on old-fashioned and piecemeal approaches to dry eye. He said The Body Doctor wanted to offer the latest technologies in a holistic and systematic way.
Intense pulsed light therapy
The second KOL for the evening was Michelle Beach, a multi-award-winning practice owner with a range of special interests spanning sports vision, contact lenses, fashion eyewear and dry eye. She has worked as a clinical researcher, lectures and presents on a range of topics and opened Park Vision in Nottingham in 2008.
Beach took a deeper dive into one of the most exciting technologies in the dry eye area: intense pulsed light (IPL) therapy and looked at how it is changing dry eye management.
Beach revealed that she got her first IPL machine back in 2008 when she opened her dry eye clinic. At the beginning, she said the choice of machines was limited to one and, like many clinicians, she had concerns around safety.
Today the choice of machines is much greater and any fears around patient safety have been dispelled. The technology, said Beach, was far from new; it has been around since the 1960s when it was used in dermatology.
Providing a background on the technology and its action against meibomian gland dysfunction (MGD), she said IPL worked by being absorbed into the skin and creating heat.
A hand-held wand delivers a broad spectrum of light, but the ultraviolet and blue light are blocked using a filter. The remaining wavelengths work on the meibomian glands by heating and softening meibum, easing inflammation and reducing the bacterial load on the lids.
She stressed that the science base for IPL was now substantial both for MGD and skin conditions and patients could be reassured it was ‘not some new age treatment’.
She provided a few pointers on setting up a clinic and said equipment suppliers provided training and consent forms, while indemnity insurances held by optical practices covered controlled use of the equipment.
When introducing IPL, she stressed it should be used as part of a dry eye regime and was not a standalone treatment. IPL was not cheap, she added, so establishing benchmarks around the tear film was key to be able to demonstrate improvements through the patient journey.
In her presentation, Beach described some of the benchmarks she uses in practice, her chosen kit and her approach to treatment. While three treatments in the first fortnight is usual, a fourth can be given depending on results.
Holding this fourth treatment ‘in the bag’ could be crucial, explained Beach. She then ran through the basics of treatment such as eye and skin protection, gel handling and consent forms.
After a review of outcomes and follow-up, Beach shared a case study, which demonstrated a transformation in one patient’s dry eye over a three-month period. Not only was the patient delighted, but new patients were won by Park Vision as a direct result of that success.
In a neat segue from her generic talk on IPL, Beach moved on to talk about her latest IPL of choice, the Thermaeye Plus. She said selecting this BIB Ophthalmic Instruments machine was very much about trading up from an earlier model to take advantage of improved benefits and features included in modern machines. She went on to explain why BIB’s Thermaeye Plus had been her choice.
For Beach, the portability and small footprint of the device was key, as was its ability to treat different skin types, fingertip filters and the unit’s controllable cooling system, which improves patient comfort.
Looking to the future, she said the Thermaeye Plus can also perform aesthetic treatments. While she was not a cosmetic practitioner, she said she was not an audiologist either, but hearing services are offered by Park Vision. This leaves open the door to expand into new areas of patient care.
So is IPL worth consideration by a practice? Beach suggested it was by sharing the numbers around cost and potential income and the clinical satisfaction of being able to improve patients’ lives.
Word of mouth also meant those delighted patients told their friends and that worked to the practice’s benefit, she concluded.
She ended her presentation by sharing her contact details and inviting any of the webinar audience interested in offering dry eye services to get in touch with her or BIB.
Dry eye clinic
Sharon Flora was the final KOL and gave her insights into creating a dry eye spa. Flora is an award-winning dry eye optometrist with over 20 years of experience in optics. She has been the owner of a full scope optometry practice for the past 17 years and is also the founder of the Eye Retreat Medispa, which integrates holistic treatments for dry eye with cosmetic services.
In a wide ranging interview with chairman and Optician editor-in-chief, Chris Bennett, Flora said her concept was a medispa, rather than pure spa. This focuses on evidence-based treatments delivered with comfortable spa touches to enhance the patient experience. The Medispa also offers aesthetic services because of the ‘huge overlap’ between dry eye and skin, she explained.
When considering setting up a dry eye clinic, patient care had to be the overriding driver when it came to the services offered, said Flora. Her clinic started as a result of the debilitating dry eye many of her patients reported.
‘They were feeling unheard and, as eye care professionals, we are absolutely in the right place to be offering advice and treatments for our patients,’ she said.
Flora urged anyone thinking of setting up a dry eye clinic not only to speak to their patients but also interrogate their own database. Practices are always talking about getting new patients, but she said when it came to dry eye, those patients were probably already there; ‘sitting in your chair every day’.
When thinking about dry eye, she suggested looking at patients who are contact lenses wearers, those pre- and post-surgery, those suffering with auto-immune issues, glaucoma and diabetes or patients with skin conditions.
She said her initial approach was to offer home products before moving on to more sophisticated treatments. However, when it came to deciding what to offer, Flora said the ocular surface had to be top priority.
Investing in diagnostics was ‘super important’ because it meant you could educate patients properly. This could be meibography and tear film assessment or simply a slit lamp approach. In her specialist clinic, she uses all of the latest light and radio frequency technologies and the software and artificial intelligence tools that support it.
She said cost did not need to be a barrier to entry, as practices can start at any level of involvement and did not have to invest in all the latest equipment from day one. She encouraged practitioners to reach out for advice and said the supply companies and early adopters were good places to start. She shared her own contact details for those wishing to get in touch.
Practical factors such as space, training and decor were also discussed by Flora, as were professional courses run by agencies such as the British Contact Lens Association. In her experience, she said getting the wider team on board was also crucial, as they would be the biggest champions for any clinic.
Providing some personal insights, Flora said making the patient feel special, cared for and ‘heard’ was important. Make the area as comfortable as possible, she said. The genesis for her dry eye medispa venture was driven by contact with dry eye patients throughout her career who were not really satisfied with the products on offer.
She said she wanted to do more for them and her research brought her to IPL. She felt the trust with her patients grew and that led her to broaden out her services and move into more aesthetic-led treatments.
Dry eye diagnostics
Mainline Instruments took the third sponsor slot for the evening where commercial director of ophthalmic therapeutics, Jeff Landucci, guided the audience through the company’s suite of equipment for the diagnosis and treatment of dry eye.
This included instruments such as the Oculus Keratograph 5M and its supporting accessories, which, Landucci said, created a truly gold-standard analyser for contact lens fitting and dry eye assessment.
He then ran through a series of cameras and software for use with slit lamps before highlighting multifunction M-6000. Units such as this had dedicated routines for addressing DED, making it a space-saving addition to any clinic.
Moving on to treatment, Landucci outlined the Envision unit by Inmode. Inmode’s background is in aesthetic treatment, but it had developed the Envision IPL unit for the optical market. He shared the unit’s heat and light functions and its more aesthetic-led functionality and encouraged the audience to get in touch for more details.
Bennett thanked all of the speakers and closed the webinar by inviting BIB to provide more information on its Thermaeye IPL device.
