By Matthew Ward, OD
April 7, 2021
Dry eye is becoming more prevalent, with 16 million people in the U.S. experiencing it, according to the National Eye Institute. I recently added a technology to my practice that addresses dry eye, along with some of my patients’ aesthetic concerns.
I decided to bring Intense Pulse Light technology (IPL) into the practice in January of 2019, after watching colleagues across the U.S. use this technology to treat dry eye, including Richard Toyos, MD, and Laura Periman, MD, both of whom have created many YouTube videos showing how to introduce and use the technology to help patients. I was excited to be the first OD in the state of Iowa to have this technology, adding the Optima IPL (Lumenis) to my practice.
Taking Dry Eye Treatment to the Next Level
I have had fair success treating dry eye with many of the tools available to us: warm compresses, omega 3, preservative-free artificial tears, prescription eye drops, as well as technologies that heat and express the meibomian glands. After learning more about IPL, it became obvious that this was the next step in treating the root cause of dry eye.
IPL addresses inflammation, the root cause of dry eye. By reducing facial inflammation, on the face and around the lids, we reduce inflammatory mediators, constrict vessels, decrease the temperature necessary to melt the meibum and destroy demodex. There is even research showing on confocal microscopy that IPL improves the morphology of the meibomian gland cells, resulting in better functioning glands.
Ninety Percent of Patients Notice Improvement
Of the more-than-60 patients we have treated with IPL since starting in early 2019, 90 percent have noted at least some improvement. I always ask the patient to give us a percentage in answer to the question, “How much better do you feel since we did the IPL treatments compared to before treatment?” It’s always exciting to hear most respond by saying they feel 50, 60, 70 percent better since doing the treatment. As there is no cure for dry eye, and everyone is different, we do have patients who estimate only a 10-15 percent improvement, but of those patients, all said they were happy they did IPL treatments, and that they would recommend it to others with dry eye.
One patient, a 46-year-old male working in the auto mechanic industry, noted a complete resolution of his dry eye symptoms after IPL treatment. Before treatment, he had red irritated lid margins, with anterior blephartis, and poor meibomian gland expression. Along with in-office heated treatments, hypocholorus acid, omega 3 intake and warm compresses at home, in three months he was extremely happy with the IPL treatment results. “When I blink now,” he told me after his five treatments, “it’s like water sliding across glass. No resistance, and my eyes feel great.”
Since IPL was initially created by dermatologists to treat rosacea, we have seen great improvements in skin as well. We had a 95-year-old female patient, who after undergoing treatment of IPL for dry eye, also noted that her skin looked younger and more healthy. At a holiday gathering a few months after her last treatment, friends and family asked if she was getting Botox. Her family members 20+ years younger noted how good her skin looked, and they expressed interested in the treatments for themselves.
Some of our happiest patients are those with obvious ocular rosacea and subsequent meibomian gland dysfunction and ocular surface disease symptoms. To be able to address the skin inflammation, as well as the eye inflammation, I can be confident with IPL treatments that I am addressing root causes of redness, irritation, and hopefully promoting a healthy ocular surface for future years.
Impressive Long-Term Profitability
I purchased the Optima IPL (Lumenis) for $55,000 with a loan working with a local bank, with six months no payments. My payments are now $1,180 monthly.
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If I was able to allocate 100 percent of the money I collected on the procedure, I could pay off the whole unit in one year. Factoring in other business expenses, poor months due to COVID, and being only in my third year as a business owner, my goal is to have the instrument paid off completely in the next 2-3 years.
We charge $750 for five facial treatments if doing IPL alone (something we just started doing), but $1,250 for IPL along with heated gland expression in office. Looking at metrics for the 2020 year (which, of course, was not a great year for anyone with at least two months of no business), we saw 50 patients for IPL with heated gland expression in office, resulting in a gross of $61,000, not to mention profit from the other billing related to medical visit follow-up visits, punctal plugs and other dry eye treatment additions.
Educate the Patient of the Value of IPL Treatment
IPL is not yet covered by any form of insurance, so this is a 100 percent out-of-pocket fee for the patient. I have found that patients really suffering from dry eye do not care if the procedure is covered or not, if they have tried enough other things to stop their symptoms, and have yet to find something that provides lasting relief.
When you show patients their glands using gland imaging, discuss what type of meibum their lids are expressing and provide information on the ocular surface environment (low tear prism, demodex, anterior bleph, dilated lid vessels, ulcerated lid margins, etc), and then tell them they need IPL to address this, most are willing to listen to the professional medical advice. The patient is always free to go home and think about the procedure. We provide a comprehensive packet that discusses treatments, pricing and other commonly asked questions. We keep track of the patients who elect to hold off on treatment, and call them back later to reach out and offer our services.
Create a Memorable Patient Experience
I highly recommend having a dry eye treatment room with a reclining chair or massage table. Some doctors splurge and add a reclining massage chair, so the patient can feel extra pampered while having their IPL treatment.
Generate Referrals from Other ODs with IPL Technology
I work with 8-10 MDs and ODs in my area who understand the importance of managing and treating dry eye well with IPL, and because of that understanding, refer patients to me. I may only provide the IPL portion of the patient’s treatment, while the referring doctor sees the patient for regular evaluations, and offers other services like punctal plugs, prescription eye drops and beyond.
Each referral relationship is unique, and I’m willing to help the patient however the referring doctor deems necessary. More often then not, it’s that the OD or MD has tried everything in their arsenal to address the dry eye symptoms, and have not been able to satisfy the patient, and so they refer them to our clinic.
I recommend finding a local eyecare professional who offers services that you do not, and collaborating to help patients and your practices. That way you can begin building two-way consultations. IPL treatments are one of those services that many other local practitioners in your area do not offer that you can provide help with, improving patient lives as you grow your profitability.