Embracing aesthetics in optometry


The aesthetics industry is a growing market and Derek Cunningham, OD, FAAO, and Walter Whitley, OD, MBA, FAAO, say it represents an opportunity for eyecare practitioners (ECPs) to become the leading experts in ocular aesthetics.

The aesthetics industry is a growing market, and Derek Cunningham, OD, FAAO, and Walter Whitley, OD, MBA, FAAO, say it represents an opportunity for eyecare practitioners (ECPs) to become the leading experts in ocular aesthetics.

How big of an opportunity? Dr. Cunnigham says the dry eye market is a $2 billion market-the facial aesthetics industry is a $200 billion market. He says that other specialists such as dermatologists and plastic surgeons don’t have the tools or knowledge of the ocular anatomy to properly provide these kinds of services-but ECPs do. 

Related: Sagging lids and conjunctiva are an OD's responsibility

A practice grower

Dr. Cunningham says it’s not unusual to see ODs who don’t have experience in the aesthetics realm-he didn’t either until six months ago, but now it’s a major part of his practice in Austin, TX. In his office, there is a fellowship-train oculoplastics surgeon. She also has fellowship training in facial plastics and body plastics. 

He says that in the short time his office has offered aesthetics services, it has been a huge driver for patients.

“I can’t scare a patient enough to get him to use his glaucoma drops consistently-and I can’t get him to pay $100 for those glaucoma drops,” he says. “But if I tell him that I can give him something to make his eyes look a little better or give him instant gratification by changing his appearance, he drops money instantly on it.”

Still not convinced? Aesthetics is already a part of most optometry practices. Your patients choose contact lenses-and increasingly, colored contact lenses-or put great care into choosing a frame all because they want to look good.

“We’re all intimately involved with aesthetics in some way-that’s what we do,” Dr. Cunningham says.

Both Drs. Cunningham and Whitley offer a variety of aesthetic procedures in their practices to meet the growing and changing needs of their patients. 

Next: Red eyes bother patients


Red eyes bother patients

Dr. Whitely says one of the main symptoms of ocular surface disease that will commonly bother patients the most is eye redness.

“If you walk into the drug store and see the endless shelves of artificial tears, there is one tiny bottle that outsells everything else in the country combined: Visine,” says Dr. Cunningham. “Why? Because it works. And because it’s what patients want-patients want to feel better right now and want the red gone immediately.”

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Dr. Cunningham says it would be unwise to underestimate how important clear, white eyes are to patients and this factor’s influence on patient satisfaction. 

To understand the growth of the red eye relief market, Drs. Cunningham and Whitely point to the development of an eye-whitening conjunctivoplasty procedure, performed by Brian Boxer Wachler, MD, in Beverly Hills, CA.

While both doctors said they also believe in identifying and treating the root cause of red eyes, they also believe in giving patients what they want. 

Next: Botox more common than you think


Botox more common than you think

Many people have a negative connotation of Botox (botulinum toxin, Allergan)-including Dr. Cunningham, until he got it in his practice, he says.

“From the medical side, it has many uses, but from the cosmetic side, I’m telling you, it is as ubiquitous as eye drops-and patients want it,” he says. “Instead of always telling patients what they should do, maybe we should start to listen to what they want, too.”

When used for cosmetic procedures, the injection lasts for about three months. Dr. Cunningham says that once Botox’s effects wear off, in his experience, patients don’t want to go back to looking like they did before-so, his practice capitalizes on that.

“For anyone that has LASIK or premium intraocular lenses, we give them a free Botox session,” he says. “Guess how many people take us up on it? 100 percent. Guess how many people come back and pay for it again? About 80 percent.”

Dr. Cunningham says that patients who opt to undergo procedures like LASIK have aesthetically driven needs, so they are drawn to the idea of Botox, as well.

Next: Counteract aging with fillers


Counteract aging with fillers

As we age, we lose subcutaneous fat, which leads to wrinkles. Injectable fillers help fill in the lines and wrinkles to give a patient a youthful appearance. Some fillers last about 12 months, while others last for years-but they’re all temporary and almost all are reversible (except for Radiesse [calcium hydroxylapatite, Merz]).

Dr. Cunningham says that while other minor procedures, like Botox injections, are often performed by technicians, fillers really should only be administered by a surgeon. Once they are injected, the fillers stay put, so you need an expert that has the experience to know how much and where to inject the fillers.

“We love them, and they’ve definitely grown our practice,” says Dr. Whitley, “and it’s been great for our referring practices, too, because they know that there are different opportunities for their patients to help them not just with their vision, but with their appearance as well.”


Other aesthetic procedures

Drs. Cunningham and Whitley offer a variety of other procedures to their patients, including laser skin treatments. While fillers and Botox can help with wrinkles, lasers are the most effective treatment option for improving the appearance of the skin. Dr. Cunningham says everyone could see benefits from intense pulsed light (IPL) laser treatment, but it can be dangerous. It’s possible to de-pigment skin if the lasers are used incorrectly, and the skin will never regain its color after this type of damage.

Chemical peels are another option to help treat the appearance of a patient’s skin. While lasers are a bottom-up approach, peels are a top-down approach. Dr. Cunningham says his practice often combines laser treatments and peels.

While ODs are taught that pterygiums must be encroaching on the visual field before they should be treated, Dr. Whitley says that surgery should be considered for aesthetic purposes.

“Essentially, it comes down to quality of life,” he says. “If it looks bad, feels bad, or sees bad, that is all going to be an indication that for doing a pterygium removal.”

And finally, the doctors recommend offering blepharoplasty for patients whose lids are interfering with their visual fields. Dr. Cunningham says that if you place your thumbs on a patient’s forehead and raise their eyebrows a bit and the motion alleviates a lot of the tenting, the patient needs a brow lift, not a blepharoplasty.

But if you life the eyebrows and the tenting remains, the patient is a candidate for blepharoplasty. Dr. Whitley says once you’ve identified a candidate, find out what kind of role the surgeon would like you to play both pre- and post-operatively.

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