LUMECCA-I
INTENSE PULSED LIGHT (IPL)
and
FORMA-I
RADIOFREQUENCY (RF)

What is Dysfunctional Tear Syndrome (Dry Eye Syndrome)?

 

If your eyes sting, itch /burn, water, feel gritty /sandy, are red, light sensitive, or your vision fluctuates throughout the day, you may be experiencing the common symptoms of Dysfunctional Tear Syndrome (DTS), or "Dry Eye." This means that either your eyes do not produce enough tears, or the tears that are being produced are not the correct quality and evaporate too quickly.

 

The natural tears that your eyes produce are composed of three layers. Each layer has a specific job to perform to keep your eyes lubricated. Should one layer not function correctly, all three layers will be harmed, and the tears will become dysfunctional.

 

 

 

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• The outer oily lipid layer prevents or slows the evaporation of the tear film

• The middle watery aqueous layer moisturizes and nourishes the front surface of the eye. 

• The inner mucin layer helps maintain a stable tear film.

 

What Causes Dysfunctional Tear Syndrome?
DTS can be the result of many causes, including the normal aging process, exposure to environmental conditions (like living in Southern California), certain medications (including antihistamines, oral contraceptives or anti-depressants), use of contact lenses, previous eye injuries or surgeries (even LASIK), and smoking cigarettes. General health problems or other diseases, including arthritis, thyroid dysfunction, and diabetes may also contribute to DTS.

Although Dysfunctional Tears Syndrome can be caused by the eyes not making enough tears, in roughly 86% of the cases, DTS is due to meibomian gland dysfunction. This means the oil glands next to the eyelashes become clogged, producing a thickened, toothpaste-like secretion. This contributes to an unstable lipid layer of the tear film, causing tears to evaporate more quickly and leading to the typical symptoms of Dysfunctional Tear Syndrome and dry eyes.

Will Dysfunctional Tears Syndrome harm my eyes?
If untreated, yes. Excessive DTS can damage tissue and possibly scar the cornea at the front of your eye, impairing vision. Dysfunctional tears can make contact lens wear more difficult since good tears are required to keep the contact lenses wet and lubricated. Because of these reasons, it is important to recognize DTS early and treat it accordingly.

How is Dysfunctional Tear Syndrome diagnosed?
During your yearly eye examination, you will be asked about your general health, use of medications, and work and home environments to determine factors which may be contributing to DTS. Diagnostic instruments that allow a highly magnified view of your eyes will be used to assess the quantity and quality of the tears.

 

Once DTS has been diagnosed, our optometrists will want to perform a 20-minute evaluation of your ocular surface to determine exactly what type of dry eye you have and what could possibly be causing it. This will help identify the correct treatment for your specific type of DTS.  

How is Dysfunctional Tear Syndrome treated?
DTS cannot be cured, but your eyes' sensitivity can be lessened, and measures can be taken so your eyes remain healthy. The most frequent method of treatment starts with the use of artificial tears or tear substitutes. This helps patients who have mild dry eye, mainly acting by adding more lubrication to the surface of the eyes.

 

For more severe DTS, there are prescription eye drops, nighttime ointments, or special contact lenses. In some cases, small plugs may be inserted in the inner corners of the eyelids to slow drainage and loss of tears. If a more aggressive and permanent solution is required, an in-office procedure utilizing the Envision platform should be considered. All of these options will be considered and discussed by our optometrists.  

 

 

The Envision Platform- Lumecca-I and Forma-I

 

 

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What is Lumecca-I?

Lumecca-I is an Intense Pulsed Light (IPL) designed to treat DTS and pigmented and vascular lesions. Lumecca-I uses non-invasive photothermolysis. Through a handheld device, a comfortable light treatment is delivered to the skin around the eyes. IPL has been FDA approved for more than 15 years to remove superficial skin lesions. More recently, it has been shown to be effective in treating DTS.

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How Does Lumecca-I Work?

During treatment, there will be a series of bright flashes of light and a sensation on your skin that feels like a light snap from an elastic band.

 

These pulses of light break down blockages in the meibomian glands and reduce inflammation by targeting the surrounding blood vessels. This anti-inflammatory effect allows for the production of the healthier oils which are part of the outer lipid layer of the tear film. This, in turn, helps to improve tear film stability and reduce dry eye symptoms.

 

What is Forma-I? 

Forma-I is an innovative, nonsurgical procedure that delivers bipolar radiofrequency (RF) technology to smaller, more delicate subdermal layers. RF therapy has been used for years in dermatology and cosmetic procedures to tighten the skin around the eye and reduce fine lines and wrinkles, primarily due to its ability to stimulate the growth of collagen. Recent research supports a role of RF therapy alleviating symptoms related to DTS. Unlike some other procedures, RF is safe on all skin types and has no post-procedural restrictions.

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How Does Forma-I Work? 

Forma-I uses the energy of electrical waves to gently heat the deep layers of the skin. The heat improves meibomian gland function by melting the thickened secretions within these oil glands and improving the stability of the tear film. It also stimulates the body’s own natural production of collagen and elastin fibers, helping to build new glands to aid in the formation of new tears.

 

This procedure feels like a warm massage in the eye area, improving blood circulation. The small size applicator and precision RF depth control allow for treatment in small and delicate areas. 

 

What are the Benefits of IPL and RF? 

One of the most significant benefits of the Envision treatment is decreased eye and lid inflammation and increased gland stimulation to aid in the production of good, quality tears. IPL and RF can also be used to treat ocular rosacea, meibomian gland dysfunction, blepharitis, and demodex.

 

These procedures are particularly beneficial for those who suffer from dysfunctional tear syndrome, chronic dry eye, or other severe conditions such as Sjogren's syndrome. Patients that wear contact lenses, have had, or will have refractive surgeries benefit greatly as well. With increased tear production, you can enjoy greater comfort and improved vision.

 

Other advantages include:

• It is a non-invasive treatment. There are no incisions or injections, and it is relatively painless.

• It addresses the root cause of the condition, not just the symptoms.

• It is suitable for most patients and can be combined with other dry eye treatments.

• It can aid in the removal of superficial blood vessels and smaller pigmented spots, as well as reducing fine lines and wrinkles.

• It has minimal side effects with no downtime following the procedure.

 

Is IPL or RF Better for Treating Dysfunctional Tear Syndrome?

IPL reduces ocular inflammation, while RF unclogs the glands and boosts the body’s natural healing process. In the past, choosing between the two options came down to the type of procedure that was available at an individual’s eye care provider’s office. At Visualeyes Optometry, because both options are available, if the patient is a candidate, it is best to treat DTS with all options possible. Using both IPL and RF treatments offer a significant benefit for dry eye patients over all other conventional treatments.

Both Dr. Dodge and Dr. Younany have intensively studied these technologies throughout the years and can attest that finally there is the opportunity to provide both IPL and RF treatments together here at Visualeyes Optometry to help all of our patients with their dry eyes.

 

How Safe Are These Treatments?

These treatments are very safe and are FDA approved to treat dry eyes. The treatments are recommended for patients who are seeking non-invasive procedures to address their symptoms. The small size applicators allow for treatment in small and delicate areas.

 

Am I a Good Candidate for IPL and/or RF?

Some factors to consider when determining if Envision is right for you includes:

• Severity of dry eye: Envision is most effective for mild to moderate cases of dry eye.

• Skin type: While Forma-I can be used on all skin tones, Lumecca-I works best on fair to medium skin tones.

• Medications: Certain medications like Accutane, tetracycline, St. John’s Wort, anticoagulants, and some NSAIDs can make you more sensitive to light and increase the risk of complications. Be sure to discuss any medications you are taking with your doctor.

• Pregnancy: Envision is not recommended for pregnant women.

• Previous Eye Procedures: No previous eye surgery or injury in the treatment area in the past 12 months. No Botox or eye injections in the past 6 weeks.

 

What Can I Expect?​

All treatments are performed at Visualeyes Optometry in our special treatment room. Each session takes fifteen to thirty minutes, and each patient requires four sessions on average, separated by 3-4 weeks. There is no general anesthesia, no incisions, and no lasers that are associated with other interventions. Most patients find the treatments very comfortable.

 

The Forma-I is a 15-20 minute treatment. It begins with the optometrist or optometric assistant applying ultrasound gel to the treatment area. They will then use a radiofrequency wand to gently heat your eyelids and surrounding area to 43°C. While you relax with your eyes closed, you will feel the warmth on your eyelids as the wand moves back and forth over your bottom and top eyelids. Most patients note that the experience reminds them of a warm stone massage.

 

After the radiofrequency treatment, the optometrist will begin expressing the glands with a simple tool. This is done to facilitate the removal of the blocked oils from the glands. This procedure involves no pain and takes only a minute or two.

 

After the gland expression, your optometrist or optometric assistant will apply more ultrasound gel to the eyelids and surrounding face. A corneal shield will be used to protect your eyes, either in the form of goggles or contact lenses. Once you are prepped, the optometrist will begin the IPL procedure. The IPL handpiece is brought closely to the treatment area, and a bright light is emitted. Some patients describe the light as a little zap or small elastic band snapping, but the procedure is not painful. Depending on the amount of treatment required, there can be anywhere from 20-100 quick pulses per session. The procedure takes roughly 10-15 minutes in total.

 

Individuals may resume their daily activities with no downtime. The treatment area may be slightly red upon leaving the office, but this resolves within a few hours. The patient should keep the treatment areas moisturized and avoid sun tanning for 24 hours. Individuals are instructed to continue their existing dry eye treatment regimen and follow-up with the team at Visualeyes as directed.

 

While an improvement in symptoms may be noted after just one treatment, multiple sessions spaced a month apart are often recommended for optimal results.

 

Your optometrists will discuss in detail with you the specifics of your customized treatment plan, including the number of sessions required, and how it will address your individual condition. Treatments will always be specifically tailored to obtain the optimal results.