Intense pulsed light therapy
Intense pulsed light (IPL) therapy (photorejuvenation) has been available for many years as a U.S. Food & Drug Association (FDA)-approved treatment for acne and rosacea. A handpiece emits brief, powerful bursts of light in the 500 to 800 nm range to thermally coagulate cells and produce vascular thrombosis, resulting in decreased hyperemia and reduction of problematic skin flora.
Rolando Toyos, MD, reported that in addition to reducing telangiectasia and enhancing skin appearance, many patients with dry eye syndrome (DES) reported a significant reduction in their symptoms post-IPL.6 Thus IPL is now being used to treat meibomian gland dysfunction (MGD) and DES, in addition to the aesthetic benefits it provides.7,8
Related: Understanding intense pulsed light
Additionally, as with RF, research using IPL as a therapy for MGD and DES has shown significant efficacy when treatments are applied to the eyelids because the combination of heat and massage is known to help evacuate the meibomian glands. One study found Pellevé RF therapy was equivalent to LipiFlow (Johnson & Johnson Vision) in objective and subjective measures.9
For states with broad optometric scopes of practice, aesthetic laser therapies are available, collectively known as laser skin resurfacing, which employ various fragmentation lasers.
Related: How IPL can help dry eye
Additionally, non-invasive, FDA-approved ultrasound technologies are able to eliminate wrinkles and stimulate collagen production.10
On the more invasive front, some states allow doctors of optometry to inject botulinum toxin to smooth and shape the periorbital region, treat essential blepharospasm, and employ commercially available injectable fillers to tighten skin.11
Care should especially be given to appropriately assess patient risk, follow approved protocols, and maximize safe, effective outcomes for all invasive procedures.
Many eyelid and periorbital skin concerns still require an oculoplastics referral, but patients now have more options than ever before at their disposal. More so than in any other area of eye care, dedicated staff and consistent marketing are a must to succeed in any aesthetic endeavor. Fortunately, RF, IPL, laser skin resurfacing, and ultrasound therapies can be performed by a trained technician (most manufacturers provide training and certification), freeing the doctor’s schedule to see other patients.
These therapies can allow a practice to differentiate itself while expanding services and meeting patients’ needs with these private-pay procedures. In states with a more limited scope of practice, check with the state optometry board to insure these arrangements comply with all state statutes and regulations.
As patients continue to seek solutions for these conditions, it is exciting to have these novel therapies available, so consider implementing them as they make sense within individual practices.
1. Howard D. Structural Changes Associated with Aging Skin. International Derman Institute. Available at: www.dermalinstitute.com/us/library/11_article_Structural_Changes_Associa.... Accessed 9/3/19.
2. Cleveland Clinic. Skin. Available at: https://my.clevelandclinic.org/health/articles/10978-skin. Accessed 9/3/19.
3. Fries WC. Solutions for Dark Circles and Puffy Eyes. WebMD. Available at: https://www.webmd.com/beauty/features/eyes-puffy-circles#. Accessed 9/3/19.
4. Lyerly J. Your Eye Doctor’s Guide to Reducing Dark Under Eye Circles. Eyedolatry. Available at: https://www.eyedolatryblog.com/2015/02/your-eye-doctors-guide-to-getting.... Accessed 9/3/19.
5. Weiss RA. Noninvasive radio frequency for skin tightening and body contouring. Semin Cutan Med Surg. 2013 Mar;32(1):9-17.
6. Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg. 2015 Jan 1;33(1):41-46.
7. Albietz JM, Schmid KL. Intense pulsed light treatment and meibomian gland expression for moderate to advanced meibomian gland dysfunction. Clin Exp Optom. 2018 Jan;101(1):23-33.
8. Gupta PK, Vora GK, Matossian C, Kim M, Stinnett S. Outcomes of intense pulsed light therapy for treatment of evaporative dry eye disease. Can J Ophthalmol. 2016 Aug;51(4):249-253.
9. Jaccoma EH, Litherland C, Jaccoma A, Ahmed A. A pilot study comparing the efficacy of the Pellevé System to LipiFlow for the treatment of dry eye due to meibomian gland dysfunction. J Dry Eye Ocular Surf Dis. 2018 Mar;1(1): e11-e21.
10. Cleveland Clinic. How Ultrasound Skin Tightening Can Firm, Lift Your Face.Available at: www. https://health.clevelandclinic.org/how-ultrasound-skin-tightening-can-fi.... Accessed 9/3/19.
11. Becker A. In the Eye of the Beholder: Aesthetic Procedures for the Periocular Area. Rev Optometry. Available at: https://www.reviewofoptometry.com/article/in-the-eye-of-the-beholder-aes.... Accessed 9/3/19.