Sometimes, one plus one equals more than two. Such could be said for combining intense pulsed light (IPL) technology with dual-frequency radiofrequency (RF) in the treatment of dry eye. In November 2023, Lumenis Vision announced OptiPLUS, a dual-frequency RF device that delivers heat across various tissue layers, increasing blood circulation.

OptiPLUS is generally intended to be used in combination with OptiLIGHT, which received FDA approval in April 2021. Although OptiLIGHT treats the root cause of dry eye, which is often inflammation, OptiPLUS improves the functionality of the meibomian glands, notes Itay Mayer, vice president and managing director, Lumenis Vision. The OptiPLUS RF technology enables energy penetration to different skin depths, heating the superficial layer to promote collagen formation and stimulate periorbital skin rejuvenation while also reaching into the deeper tissue to target the meibomian glands, according to Lumenis.

OptiPLUS offers 1-MHz and 4-MHz wavelengths. The 1-MHz wavelength penetrates deeper into the tissue while the 4 MHz is more superficial, “so we are targeting basically two layers of the skin to achieve maximum results,” explains Mr. Mayer. The 4-MHz wavelength improves collagen production, improving the elasticity and health of the skin, while the 1-MHz penetrates deeper into the skin, targeting the meibomian glands and improving their productivity, he notes.

Working Together 

When you use IPL, “you're going to take out the very surface blood vessels sequentially with these treatments,” says Edward H. Jaccoma, MD, Excellent Vision, Portsmouth N.H. and Bay State Excellent Vision, Stoneham, Mass. “That's the beauty of IPL. It’s tuned on purpose to not be that heavy hammer but to more selectively target these blood vessels.” These blood vessels then regress and are absorbed into the skin, he explains.

Immediately using the RF technology in OptiPLUS after the OptiLIGHT treatment allows the blood vessels to dilate for a short time, during which a physician can express the meibomian glands. After the RF treatment ends, the injured blood vessels have the chance to go through their natural repair cycle, according to Dr. Jaccoma.

Physicians may use OptiLIGHT and then OptiPLUS during the same session or they may do a number of treatments with OptiLIGHT and then move to OptiPLUS, notes Mr. Mayer. Either way, a patient will typically need four treatments with each device, he says. OptiPLUS will alternate between the 1-MHz and 4-MHz wavelengths automatically. Typically, the OptiPLUS protocol calls for 8 minutes per eye. Of note, the treatment itself is comfortable, feeling like a massage, according to Mr. Mayer.

“The perfect scenario for the average patient is to do the light treatment followed immediately by the heat treatment,” says Dr. Jaccoma. This allows you to “get the full benefit of what both technologies will do and not interfere one with the other by otherwise staggering them too far apart.”

“There is actually a synergy because the OptiLIGHT treatment heats the tissue to some degree, and so it gets you into your treatment zone faster on the OptiPLUS,” explains James Chelnis, MD, FACS, oculoplastic surgeon, Manhattan Face and Eye. OptiPLUS, he notes, is a type of “smart RF” in that it counts the time the device is actually at the treatment temperature.

Dr. Jaccoma says that the average patient requires four treatments, using both the OptiLIGHT and OptiPLUS at each treatment. The patient might then need one or two treatments a year as maintenance.

Getting to the Root 

As opposed to drops for dry eye, the combination of OptiLIGHT and OptiPLUS addresses the root cause of dry eye, Dr. Chelnis suggests. “When you're using drops, you're not really treating the underlying cause of the problem,” he says. “How can we break the cycle? How can we bring a patient to a position where we've actually treated upstream of just the symptom itself? That's really the biggest difference with what OptiLIGHT and OptiPLUS can do from previous methodologies for treating dry eye.” 

What’s more, the combination of technologies eases the burden of patients having to instill drops. “Now we have tools that are powerful enough that in the office, you can really make a change in a person's life and do the heavy lifting for them,” says Dr. Chelnis.

In a 2023 clinical study in which Dr. Chelnis was lead investigator, researchers found pairing IPL with multifrequency RF significantly improved the number of expressible meibomian glands (more than 150% on average), meibum clarity (more than 70%) and symptoms (more than 60%).¹  

“The impressive thing is that we had core qualities of the eyelid and the meibum that we were measuring, and every single one of them improved,” notes Dr. Chelnis of the findings, which were published in Clinical Ophthalmology.

In some of his patients, Dr. Chelnis finds “a really quite remarkable change in terms of the productivity of individual glands when we combine IPL and RF.”

Another benefit of pairing IPL and RF involves regrowing meibomian glands, which, until recently, was not thought possible. That's an “incredible sea change versus perhaps a decade ago in terms of our understanding of what was possible with meibomian gland regrowth and injury,” says Dr. Chelnis.

Pristine Quality

Also of value are the aesthetic benefits, which include enhanced blood circulation and collagen production for periorbital skin rejuvenation. With the two technologies combined, “this was kind of a win-win, that you would help to restore oil function at the same time that you were helping people look a few years younger and helping them with their aesthetic concerns,” says
Dr. Jaccoma.

Today’s technologies, such as femtosecond lasers, notes Dr. Chelnis, can provide amazing optics for patients. Still, he says, some patients can’t see optimally because of a poor ocular surface. In treating that surface with OptiLIGHT and OptiPLUS, “it really checks almost the last box in terms of the optical system and our ability to produce pristine quality for patients.”  OM

Disclosures: Dr. Chelnis does consulting work for Lumenis. Dr. Jaccoma reports financial relationships with Cynosure, eyeThera, InMode, Jett Plasma Medical, Lumenis, Okra LLC, and ThermiRF/Celling Biosciences.

References

1. Chelnis J, Garcia CN, Hamza H. Multi-Frequency RF Combined with Intense Pulsed Light Improves Signs and Symptoms of Dry Eye Disease Due to Meibomian Gland Dysfunction. Clin Ophthalmol. 2023;17:3089-3102.  doi:10.2147/OPTH.S426564