In March, Optician invited three key opinion leaders (KOL) and three suppliers to provide information for practitioners looking to expand their offering in the dry eye sector.
An interactive evening of discussion was sponsored by BIB Ophthalmic Instruments, The Body Doctor and Mainline Instruments. The full webinar can be viewed at tinyurl.com/3b7vdzud.
Viewers attending the live webinar broadcast were invited to pose questions to the speakers. Here are some of the responses offered by our KOLs and sponsor speakers.
Ros Mussa
Opening the webinar was Ros Mussa, an author, presenter and clinician with over 30 years’ experience. She gave an overview of dry eye disease (DED), its classification and some treatment options.
Are companies now removing tea tree oil from their products?
Tea tree oil (TTO) is a valuable tool in managing dry eye, particularly where demodex or blepharitis is present. However, insights and patient feedback have highlighted the importance of using TTO with caution, especially in those with chronic dry eye, or sensitive skin. There is some suggestion that TTO is harmful to the meibomian glands.
TTO is appropriate when:
- There is confirmed or suspected demodex infestations
- It is used short-term
Be cautious or avoid TTO:
- In chronic dry eye with compromised tear film or ocular surface
- When patients have sensitive skin, rosacea or a history of dermatitis
- Where patients report irritation, stinging or redness
Recommended alternatives:
- The Zocular system – at home and in practice treatment
- The Eye Doctor Eyelid Wipes to remove some of the meibum collarettes where demodex lay their eggs
How often do you see ‘toxic soup syndrome’ after fitting punctal plugs?
Toxic soup syndrome is rare but can occur, especially if punctal plugs are inserted without adequately managing underlying inflammatory dry eye. The idea is that by blocking tear drainage, you trap inflammatory mediators on the ocular surface, exacerbating symptoms. This underscores the importance of:
- Accurate patient selection
- Pre-plug anti-inflammatory treatment (eg steroids, cyclosporine)
- Monitoring post-insertion for signs of worsening inflammation
Lissamine green – how key is it?
Lissamine green is not currently licensed as a medicine in the UK, but it can still be used under a category called ‘specials’ or unlicensed medicines. This means it’s available for clinical use, but it must be sourced through appropriate channels. Clinically, it is very useful:
- Stains dead or devitalised cells and mucus (unlike fluorescein)
- Helps assess conjunctival staining, which is important for diagnosing aqueous-deficient dry eye, lid wiper epitheliopathy, and mild conjunctival damage
What is the basic distinction to determine whether the patient is evaporative or aqueous-deficient?
See table 1. Diagnostics like tear osmolarity, meibography, non-invasive tear break-up times (TBUT), and ocular surface staining help distinguish the two types – though many patients have mixed forms.
Sam Wymer
Mussa was followed by a presentation from The Body Doctor’s co-founder Sam Wymer who gave an overview of the company’s products.
What should a practice consider when investing in dry eye equipment?
Clinical factors
- Prevalence of DED in your patient base
- Accuracy and reliability of diagnostics
- Improved treatment outcomes, leading to better patient satisfaction and retention
Financial factors
- Initial cost of the equipment and potential financing options
- Reimbursement opportunities, where applicable
- Potential for new revenue streams – including bundled treatments, follow-up visits and sales
- Volume capacity: how many treatments can be done daily/weekly?
- Consumable costs (eg single-use tips)
- Training and staffing costs for using the equipment effectively
Marketing/strategic value
- Practice differentiation – offering advanced dry eye solutions can set your clinic apart
- Attracting new patients actively searching for relief from chronic symptoms
- Integration with current services – how easily it fits into your workflow and clinical protocols
How do air pollution and climate change affect the prevalence of DED, and are there specific interventions to counteract these factors?
Increased pollutants can irritate the ocular surface, leading to inflammation and tear film instability. Global warming also contributes to increased pollen counts and longer allergy seasons, exacerbating DED. Indoor environments may be overly air-conditioned or heated, causing ocular dryness. Wind, dust and lower humidity can also increase evaporative dry eye.
Specific interventions
- Environmental controls (humidifiers, air purifiers, filters)
- Protective eyewear to shield from wind and dust
- Lid hygiene and anti-inflammatory therapies to combat chronic inflammation
- Topical antioxidants and omega-3 supplementation may offer some protective effects
- Public education and early screening in high-pollution areas
How often is Zest cleaning recommended?
- Initial phase: Typically every six to eight weeks for two (maybe three) sessions if significant build up or significant inflammation is present
- Maintenance: Every three to six months, depending on severity, symptoms, and home compliance
- High-risk patients (eg contact lens wearers, allergy sufferers) may benefit from more regular treatments
- Clinical judgment, patient response and symptom severity should also guide frequency
Michelle Beach
The second KOL for the night 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. She gave an overview on intense pulsed light (IPL) therapy before talking more specifically about BIB Instruments’ Thermaeye Plus IPL device.
How do you see artificial intelligence (AI) shaping personalised treatment strategies for dry eye?
AI is certainly coming into all aspects of eye care – you only had to be at 100% Optical in March to see it being implemented in the newest tech coming out. I think it could certainly help with the diagnostics – the DED software; probably helping on the decision-making following meibography, tear interferometry and staining. Any equipment that helps explain and justify your decision-making to a patient is a good thing.
What do you use for evaluation of the tear film and meibomian glands?
I have the Idra software, which I have been using for the past six years. It’s a great piece of diagnostic kit with a clear traffic light system for demonstrating results to a patient and an app for showing them their scores.
Do you think IPL is useful for high degrees of meibomian gland atrophy?
I have been surprised at the results of IPL. I have had some patients with really poor meibography results that were very keen to go ahead despite me giving a very guarded result. Glands that can look like they have dropped out plump up and fill with meibum and tear film improves.
Does IPL damage eyelash follicles?
No, not that I have seen – eyelashes usually improve as the patient isn’t rubbing and scratching their eyes and demodex, inflammation, etc, are reduced.
Do you do IPL yourself or delegate it?
We have talked about indemnity insurance a lot – I feel IPL is a clinical procedure that should be delivered with care by a clinician. I, or one of my trained optometrists certified to use the IPL machine, deliver the treatment. It is expensive and you are monitoring patient reaction, effect on the ocular adnexa and aftercare guidelines. The patient should feel they are getting an expert delivering an expert treatment.
Does using your IPL to offer aesthetic treatments affect your insurance requirements?
You must always work within your capabilities as an optometrist. Use an aesthetic clinician or make sure you have the appropriate training if you start skin treatments. The ThermaEye has the capability of producing some amazing results. Tim Baker from BiB Ophthalmic Instruments is currently in discussions with some insurance companies to provide the covering insurance required. Outside of ocular treatments, you won’t be covered by the Association of Optometrists.
Who decides how much a patient should be charged for one session?
How much you charge is completely up to you and should be based on your patient demographics and location. If you are charging for a course, you will know how much a single session costs.
Optician would like to thank all of the KOLs and sponsor speakers for taking part in our Building the Dry Eye Clinic of the Future webinar and our audience for attending and asking such interesting questions. We tried to answer all of the questions posed, but if your question was missed the speakers are happy to be contacted for further information.
