Patients are not only interested in seeing their best but also looking their best. The eyes are notable aesthetic features and, as such, both men and women seek products and services to enhance the appearance of their eyes and eyelid area. This is especially true in North America, which represents the largest share of the global eye makeup and the anti-aging skincare markets that were estimated at $16.5 billion and $14.2 billion, respectively, in 2020.^1-3

As the specialists on everything in the eye and around the eyelids, optometrists are in an excellent position to offer guidance on cosmetics and provide in-demand ocular aesthetic services. Thus, optometrists have a unique opportunity to be key players in this specialty area that can bring differentiation and increase practice revenue.

Based on our experiences and research, the following is a look at how to add ocular aesthetics to a practice successfully.

ACQUIRE EDUCATION

Education is the cornerstone for success in offering ocular aesthetic services. Optometrists interested in adding these services can get a jumpstart by utilizing CE and journal articles to get up-to-speed on the common cosmetic trends and possible eye-health complications. Websites, such as YourSpark.com , offer resources and articles to help navigate facial anatomy, fillers and neurotoxins. O.D.s also can join the American Association of Aesthetic Medicine and Surgery (aaams.net ) to learn about the latest skin care and beauty trends.

Note: Before you consider offering any of the cosmetic/aesthetic technologies, products or services that follow, check with your state board of optometry to ensure you are following all appropriate state guidelines.

EVALUATE IN-OFFICE TECHNOLOGIES

Next, consider investing in the following technologies, each of which offer both minor non-surgical, anti-aging aesthetic benefits and improved outcomes for meibomian gland dysfunction:^4-8

• Radio frequency (RF): RF is an electrosurgical system that can decrease skin laxity and improve the rhytids (wrinkles) of the face, including the periocular area, by heating the dermis.⁹
• Intense pulsed light (IPL): IPL uses various wavelengths of light to coagulate telangiectatic blood vessels to alleviate redness and inflammation on the cheeks and eyelids.¹⁰
• Low-level light therapy (LLLT): LLLT uses low-level lasers or light-emitting diodes on the skin, demonstrating beneficial effects on wrinkles, scars and certain inflammatory diseases, such as psoriasis and acne.¹¹

OFFER AESTHETIC PRODUCTS AND SERVICES

In addition to RF, IPL and LLLT, there are a number of ways to enter the optometry aesthetics arena, for example, by dispensing products in-office, such as:

• Anti-aging skin products. We recommend products with ingredients, such as pycnogenol, bilberry, jojoba oil, lavender and hyaluronic acid, that have been demonstrated to naturally promote hydration and collagen production that one can retail in the office (see photo on p.45). We also educate patients that certain products, such as those high in retinol or vitamin A, have been linked to ocular surface disease.
• Blepharoptosis treatment. Non-surgical options include mechanical intervention (e.g., eyelid tape or scleral contact lenses), off-label medications (such as apraclonidine) and the FDA-approved daily prescription drop oxymetazoline hydrochloride ophthalmic solution 0.1 (Upneeq, RVL Pharmaceuticals), a direct-acting alpha-adrenergic receptor agonist, believed to selectively target Muller’s muscle to lift the upper eyelid for up to eight hours.¹²

INVEST IN SKIN CARE/COSMETIC PRODUCTS

With a myriad of makeup and makeup removers at the disposal of patients, education and providing guidance on safe products is essential. A plethora of electronic resources are available to assist patients in selecting safe skincare and cosmetic products, including apps such as Think Dirty — Shop Clean, SkinSafe, CosmEthics, CodeCheck and Detox.

• Eye makeup removers. We recommend eye makeup removers that contain ingredients that have been shown effective with little or no adverse effect, such as micellular water, tea tree oil, coconut oil or jojoba oil. We also advise patients that certain ingredients can produce adverse effects, such as dry eye disease, allergy and ocular irritation. These ingredients include sodium laurate sulfates, phenoxyethanol, tretinoin, benzalkonium chloride, formaldehyde, imidazolidinyl urea, parabens and bromo 2-nitropropane.^13-16
• Eyelash enhancement. These include false eyelashes, magnetic eyelashes (see photo on p.44) and eyelash serums. While a comprehensive summary of these products is beyond the scope of this article, it is critical to understand both the benefits and complications of each option. For example, a survey on complications associated with lash extensions demonstrates that 26.8% of the participants experienced ocular complications, ocular hyperemia, pain and itchy swollen eyelids.¹⁷

It is our duty to protect and educate our patients about these risks and offer alternative options or healthier practices, such as magnetic lashes with a low concentration of iron oxide particles to reduce complications, which can be retailed in the practice. Also, consider partnering with a licensed esthetician to offer lash services to those patients who consider false eyelashes a must-have, so that any complications can be managed by an eye care professional.

MARKET YOUR SERVICES

Optometrists can begin marketing their ocular aesthetics services internally via targeted email campaigns to current patients and custom internal signage. O.D.s can expand their marketing and advertising reach — and create a robust referral network — by sending letters to local oculoplastic surgeons, general ophthalmologists, dermatologists and estheticians, informing them of the ocular cosmetic and aesthetic services available in the practice.

Lastly, perception is reality. As a result, optometrists should curate a luxurious and relaxing perception of the practice, such as an “eye spa” on social media by partnering with a professional photographer and brand strategist (see photo on p.42).

To boost growth in our practices, we designated a staff member as an ocular aesthetics champion. This team member plays a vital role in the success of these services by researching new offerings, working closely with vendor representatives to stay abreast of new therapies and equipment available and managing patient flow and retention.

SET FAIR FEES

When providing aesthetic and cosmetic services and products, optometrists should not be afraid to charge for the value of what is being offered. O.D.s should spend time detailing fees, develop bundled packages, documenting what is included in the package and how often the patient will need to purchase it. Additionally, optometrists should consider incorporating subscription or membership services, partnering with third-party companies to offer low-interest payment options, and offering payment installments.

SHOWCASE THE BENEFITS

The value of imaging in patient education and in-office procedure conversion cannot be overstated. Images that demonstrate the harmful effects of toxic cosmetics and skincare may prevent complications. Positive treatment outcome before-and-after images can improve conversion rates for advanced treatment options and maintenance procedures. Utilizing imaging also empowers staff and patients to champion new services out in the community on our behalf. Word-of-mouth is an excellent practice driver and revenue booster.

BOOST CREDIBILITY

Writing articles and lecturing on ocular aesthetics can increase credibility. This will likely increase referrals from practitioners and patients. Once published, other practitioners may learn of your expertise through the literature. Involvement in research in ocular aesthetics will help one stay on the cutting-edge, as well as enhance credibility with patients who are study participants. To get started, read trade magazines, journals, attend state conferences with CE classes focused on aesthetics and lastly, collaborate with other optometrists who participate in research studies.

BEAUTIFY THE PRACTICE

O.D.s are in the perfect position to take ownership of the skin and tissue around the eye by opening the door to offering ocular aesthetics. With proper preparation, patients will see and safely look their best. OM

REFERENCES

1. Eye Makeup Market Data 2021: Key Manufacturers, Current Trend and Future Forecast, Industry Size, Share, Revenue, Business Growth, Regional Analysis & Forecast to 2025. PR News Wire website. https://www.prnewswire.com/ Published Dec. 15, 2020. Accessed Feb. 7, 2021.
2. Worldwide Eye Make Up Industry to 2025-Increasing Innovation in Eye Makeup Product to Spur Global Demand. PR News Wire website. https://www.globenewswire.com/news-release/2020/10/05/2103348/0/en/Worldwide-Eye-Makeup-Industry-to-2025-Increasing-Innovation-in-the-Eye-Makeup-Product-Category-to-Spur-Global-Demand.html . Accessed Feb. 7, 2021.
3. Anti-Aging Products Industry Projected to be Worth $83.2 Billion by 2027 - Key Trends, Opportunities and Players. Globalnewswire.com Published July 24, 2020. Accessed Feb. 7, 2021.
4. Jaccoma EH, Litherland C, Jaccoma A, Ahmed AH, Pellevé vs Lipiflow MGD-Related Dry Eye Treatment Study: The ThermaLid Procedure. J Dry Eye Ocu Surf Dis 1(1):e11-e21; 2018 Mar 28.
5. 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; 33:41–46.
6. Verges, C et al. Prospective evaluation of a new intense pulsed light thermaeye plus, in the treatment of dry eye disease due to meibomian gland dysfunction. J Optom. (2020), https: doi.org/10.1016/j.optom.2020.08.009 .
7. Helko P. Low Level Light Therapy in the treatment of Meibomian Gland Dysfunction. ARVO annual meeting abstract. 2020;61(7) https://iovs.arvojournals.org/article.aspx?articleid=2769219 Accessed February 7th, 2021.
8. Biesman BS, Pope K. Monopolar radiofrequency treatment of the eyelids: a safety evaluation. Dermatol Surg. 2007;33(7):794-801. doi:10.1111/j.1524-4725.2007. 33172.x
9. Taub AF, Tucker RD, Palange A, Facial Tightening With an Advanced 4-MHz Monopolar Radiofrequency Device. J Drugs Dermatol, 2012 Nov;11(11):1288-94.
10. Kassir R, Kolluru A, Kassir M (2011) Intense pulsed light for the treatment of Rosacea and Telangiectasias, Journal of Cosmetic and Laser Therapy, 13:5, 216-222, DOI: 10.3109/14764172.2011.613480.
11. Avci P, Gupta A, Sadasivam M, et al. Low-level laser (light) therapy (LLLT) in skin: stimulating, healing, restoring. Semin Cutan Med Surg. 2013;32(1):41-52.
12. Slonim CB, Foster S, Jaros M, et al. Association of Oxymetazoline Hydrochloride, 0.1%, Solution Administration with Visual Field in Acquired Ptosis: A Pooled Analysis of 2 Randomized Clinical Trials [published online ahead of print, 2020 Oct 1]. JAMA Ophthalmol. 2020;138(11):1168-1175.
13. Doll, T. Lashing Out: Dangerous Beauty Trends. Review of Optometry. 2019;156(11):52-57.
14. Wang J, Liu Y, Kam WR, Li Y, Sullivan DA. Toxicity of the cosmetic preservatives’ parabens, phenoxyethanol and chlorphenesin on human meibomian gland epithelial cells. Exp Eye Res. 2020; 196:108057.
15. Color additives and cosmetics: fact sheet. US Food & Drug. www.fda.gov/industry/color-additives-specific-products/color-additives-and-cosmetics-fact-sheet . Accessed Feb. 7, 2021.
16. Chen X, Sullivan DA, Sullivan AG, Kam WR, Liu Y. Toxicity of cosmetic preservatives on human ocular surface and adnexal cells. Exp Eye Res. 2018; 170:188-197.
17. Amano Y, Nishiwaki Y. [National survey on eyelash extensions and their related health problems]. Nihon Eiseigaku Zasshi. 2013;68(3):168-74. Japanese. doi: 10.1265/jjh.68.168.

DR. DAVISON, private practice owner of Brilliant Eyes Vision Center and Premier Dry Eye Spa & Cosmetic Eye Care, specializes in dry eye disease and optometry aesthetics.

DR. MICKLES is an associate professor and director of Nova Southeastern University’s Dry Eye Care Center. She is a fellow of the American Academy of Optometry and the Scleral Lens Education Society. Dr. Mickles lectures and publishes extensively in the areas of ocular surface disease and contact lenses.