Intense pulsed light bridges eye care and aesthetics

June 5, 2017

What is this age-defying modern technology that a young, nonmedical professional is applying to her face? It is a YAG laser combined with an intense pulse light (IPL).

For the past few months, my wife Jill has been visiting a boutique for a quick 10-minute procedure to remove debris and trapped oils from her facial skin. If you ask Jill, she will tell you that this laser procedure is “amazing” and it has made a huge difference in the appearance of scarring and the occasional acne breakout.

What is this age-defying modern technology that a young, nonmedical professional is applying to her face? It is a YAG laser combined with an intense pulse light (IPL).

Yes, the very same YAG that we use to break up the opacified capsule. The YAG is commonplace in the ophthalmic office; however, IPL may be an irregular fit in eye care. I will argue that both are right at home in the ophthalmic practice and venture to say our utilization for the skin should be normal as well.

Previously from Dr. Bloomenstein: Managing presbyopia heading into the year 2020

IPL uses

This laser light has been used in dermatology for decades to treat a variety of skin problems, including facial rosacea.1

As commonly occurs with procedures and medicines, anecdotal changes often accompany the original goal. Take the lash growth seen with the use of bimatoprost (Latisse, Lumigan; Allergan) as an example of a sequela that is fortuitous for the patient.

 

Because studies have concluded that 80 to 90 percent of patients with facial rosacea also have ocular rosacea, it should come as no surprise that patients experienced an improvement in symptoms of dry eye after IPL treatment for their facial rosacea.2 It appears that breaking up the inflammatory cycle may be utilized for both rosacea as well as dry eye.

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IPL procedures

The mechanism of action for IPL is to absorb light filtered to certain wavelengths into selective target tissues. IPL shares similarities with laser treatments in that it uses light to heat and destroy its targets-unlike lasers that use a single wavelength (color) of light which typically matches only one chromophore, and hence only one condition. IPL uses a broad spectrum which when used with filters allows it to convert light into heat. This conversion can then be used against several conditions.

IPL therapy is considered a non-ablative resurfacing technique, meaning it targets the lower layers of skin (dermis) without affecting the top layers of skin (epidermis). The results are not as dramatic as ablative resurfacing in which both the dermis and epidermis are injured to produce a more noticeable overall outcome.

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In the treatment of inflammation, the laser targets oxyhemoglobin, which is present in the walls of telangiectactic blood vessels, to induce thrombosis. These superficial leaky blood vessels release inflammatory mediators that are often the impetus for inflammatory-related conditions, including dry eye.

Dermatologists tend to target the oxyhemoglobin of the skin by starving the glands of the inflammatory mediators that are needed to perpetuate the inflammatory cascade. Targeting the eyelids and lid margins for thrombosis of these vessels may decrease the symptoms of inflammatory dry eye.

 

By addressing the telangiectactic vessels that feed the meibomian glands, IPL may provide these glands with an opportunity to return to homeostasis. This may not always be accomplished in atrophied glands, and often a series of treatments is needed to provide relief.

The multifactorial nature of dry eye disease makes a single treatment or diagnostic test nearly impossible. ODs must manage this condition with multiple resources, utilizing non-invasive and practical treatments.

Patients who have symptoms of dry eye disease and have signs of meibomian gland dysfunction, telangiectactic vessels around the lid, or have failed on other therapies may benefit from the use of this novel treatment idea. When patients are preparing for surgery that will impact their vision, whether it is refractive or cataract refractive surgery, the YAG laser may be enough to balance the tear film for a more stable recovery.

Related: New correction option for presbyopes

The future of IPL treatment

As the population seems to have peaked with the baby boomers, ODs are seeing an increase in the percentage of millennials with this condition. We must find ways to prevent these conditions from exacerbating.

As we see this bridge between aesthetic services and ophthalmic treatments, IPL seems poised to provide that opportunity. When I am treating patients, my goal is to provide treatments that go beyond a single treatment paradigm. Light may target pigment in the exoskeleton of Demodex, reducing its number and the possible negative effects related to rosacea.3  

Our role as ODs creates a profound opportunity for us to participate in treatments that can add benefit to our patients. IPL is one such non-invasive opportunity to add an aesthetic and practical resolution of eye-related problems-more importantly, my wife is happy.

Related: Managing the non-surgical aspect of comanagement

References

1. 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 Jan 1;33(1):41-46.

2. Viso E, Clemente Millán A, Rodríguez-Ares MT. Rosacea-associated meibomian gland dysfunction-an epidemiological perspective. European Ophthalmic Review. 2014;8(1):13-16.

3. Prieto VG, Sadick NS, Lloreta J, Nicholson J, Shea CR. Effects of intense pulsed light on sun-damaged human skin, routine, and ultrastructural analysis. Lasers Surg Med. 2002;30(2):82-85.

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