therapeutic focus

Treating Dry Eye Disease

Device aids in the management of meibomian gland dysfunction

WALTER CHOATE, O.D., F.A.A.O.

With the aging population, the number of patients who present with dry eye complaints is growing significantly for most practices.

The practice of handing the patient several artificial tears for trial use continues to be the treatment of choice by many optometrists. However, in order to effectively treat the meibomian gland dysfunction form of dry eye disease (DED), a more aggressive management approach is needed.

When at-home treatment (lid hygiene, artificial tears, omega-3 supplements, cyclosporine [Restasis, Allergan] and topical steroids) is not enough, we recommend an in-office treatment called BlephEx, from Rysurg, which has helped achieve optimal results as part of a comprehensive treatment program.

The BlephEx eyelid-cleansing device, from Rysurg, was introduced in 2014.

Overview

Brought to market last year, BlephEx is an in-office device designed to provide deep eyelid cleansing, or “microblephexfoliation,” as the company has coined it.

The instrument employs treatment packs of surgical sponges that spin at about 1,000 RPM in two different directions to remove scruf, biofilm and bacterial exotoxins from the eyelids.

Training

The training process for the BlephEx device can be completed with a quick 30-minute to one-hour session.

Currently, our practice is in the process of training our technicians to perform the procedure, which will help to free up the doctor time involved in this procedure. (Disclaimer: Before delegating this task, be sure to check with your local and state governing bodies.)

Procedure

In our office, we have developed a treatment procedure that is thorough and highly effective in using the BlephEx device. We begin with 12 to 15 minutes of a moist heat compress mask, followed by meibomian gland expression of all four lids. Next, we perform microblephexfoliation with the BlephEx device, which involves two passes with a mild surfactant foaming lid cleanser followed by thorough irrigation with a balanced salt solution (BSS). We then do two passes with a hypochlorous acid-based eyelid cleanser. Afterward, we irrigate once more with BSS. This process is repeated with all four lids.

We explain to patients that the microblephexfoliation procedure must be repeated at three- to six-month intervals depending upon the severity of their disease and the effectiveness of their at-home treatment.

ROI

The income potential for this device is significant. This procedure is not covered by insurance, so it is an out-of-pocket expense of $75 to $95 per eye in most offices. However, we have had no patient unhappy with paying for the treatment.

We acquired the BlephEx device nine months ago and perform an average of two to three procedures per week. We are now considering using the procedure prior to initiating home treatment. We plan to measure patient response and clinical improvement to determine future protocols.

Practice benefits

What microblephexfoliation with the BlephEx device has done for our patients is give them a clearer understanding of the importance of regular lid hygiene. This education has made a particular impact on our older patients who recognize they have compromised immune systems and, thus, must stay on top of this critical component of DED management.

With the addition of this procedure, we are seeing frequent referrals to our practice from happy dry eye patients.

A key step

DED is chronic disease that must be regularly managed. Although not effective as a stand-alone treatment, microblephexfoliation with BlephEx has become an important part of our comprehensive treatment program. OM

DR. CHOATE IS FOUNDER OF CHOATE EYE ASSOCIATES IN GOODLETTSVILLE, TENN., AND VICE PRESIDENT OF MARKET DEVELOPMENT OF OPTOMETRIC MEDICAL SOLUTIONS. ALSO, HE IS AN ADJUNCT PROFESSOR AT SOUTHERN COLLEGE OF OPTOMETRY, THE UNIVERSITY OF MISSOURI - ST. LOUIS SCHOOL OF OPTOMETRY AND THE UNIVERSITY OF ALABAMA BIRMINGHAM SCHOOL OF OPTOMETRY. IN ADDITION, HE IS AN FDA INVESTIGATOR AND A CONSULTANT FOR CONTACT LENS-RELATED PRODUCTS AND EQUIPMENT, A FELLOW OF THE AMERICAN ACADEMY OF OPTOMETRY AND A CHARTER MEMBER OF THE AMERICAN OPTOMETRIC ASSOCIATION’S CONTACT LENS SECTION. TO COMMENT ON THIS ARTICLE, VISIT TINYURL.COM/OMCOMMENT.