Optometry Podcast: Intense Pulsed Light Therapy with Dr. Richard Adler

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With the newly published DEWS II Report still just beginning to make its’ impact on our diagnosis and treatment strategies in dry eye, the timing is perfect to begin rethinking our standard treatment protocols.  Topical anti-inflammatories, punctal plugs, heated compresses, and omega supplements are treatments we’ve been recommending for a decade with variable results.  Dr. Richard Adler, ophthalmologist and ocular surface specialist at Belcara Health outlines why Intense Pulsed Light (IPL) treatments are quickly becoming a go-to treatment for chronic ocular surface inflammation across eyecare and should be thought of as an important addition to your dry eye treatment regimen.

IPL originated as a breakthrough dermatology procedure targeting the telangiestatic vessels associated with facial rosacea.   High output flashes of light in the wavelength of 500 to 1200 nanometers are applied to skin, where the high heat energy acts to photocoagulate the small telangiestatic blood vessels and thus improving cosmetic appearance. Anecdotally, many doctors were surprised to find their patients returning after facial treatment stating their dry eye symptoms were better too. By coagulating the telangiectasia, the associated inflammation around the vessel also resolved, seemingly resulting in a quieter ocular surface.  Around 2012 pioneering ocular surface specialists adopted the technology to specifically treat ocular rosacea and associated ocular surface inflammation.

The results have been impressive. A 2014 study of 100 patients diagnosed with meibomian gland dysfunction and dry eye syndrome showed statistically significant improvement in in edema, facial telangiectasia, lid vascularity, meibomian gland severity score, and OSDI score from pre-treatment measurements to final visit. Tear break up time also showed a statistically significant improvement, as did the quality and quantity of meibomian gland oil secretion. On average patients needed 3 to 6 treatments spaced 4 to 6 weeks apart.

The exact method of action for why meibomian gland function improves is still unknown, but Dr. Adler discusses the common theory that the thermal effect of the pulsed light acts to melt and soften meibum, as well as reducing the bacteria and parasitic load on the lid margin that might be exacerbating inflammation.

Because IPL is not technically a laser treatment, state laws may allow easier adoption among optometry practices as well. Whether you choose to investigate adding this treatment to your own in office arsenal, or establish a referral network with ophthalmology in your area, the potential for IPL to improve your patient’s ocular surface inflammation is an excellent new addition that deserves to be included in our mainstay dry eye protocol.

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