The past couple of years have been incredible for the advancement of Dry Eye therapies. We’ve seen treatments like IPL, Gland Expression, and Radiofrequency become more mainstream. But many of these newer Dry Eye treatments are expensive or not covered by insurance or both.
So how do you decide which expensive treatments are actually worth it so you don’t break the bank in treating your dry eye?
Welcome back to the Eye school blog, with me Dr. D, where I teach you about products and treatments related to dry eye syndrome and eye beauty so you can have healthy, beautiful, comfortable eyes.
Before we get into specific therapies, remember that there are basically TWO goals to consider in dry eye treatment. So ask yourself what you’re trying to accomplish with any given therapy before spending a ton of money on it. The two goals are REDUCE inflammation and CLEAR obstruction. If the treatment isn’t going to solve an issue you have, it’s never worth the money.
These Dry Eye Treatments Are Worth The Money$$!!
Autologous Serum - Autologous serum drops made from your own blood are able to mimic the biochemical properties of your natural basal tears since they are made from your own blood. To get autologous serum, you first give whole blood, typically a good number of vials (6-10 depending on concentration), then the blood is separated by centrifuge. After which, it is diluted to the concentration specified by your doctor with sterile saline. The drops are then frozen, which is how they have to be stored by you as well until use.
Autologous serum contains proteins, growth factors, vitamins A and C, antioxidants, and electrolytes. The components actually are almost identical to those of basal tears but are typically in an increased concentration.
They’re typically much more expensive than artificial tears, but they’re also much more useful! Due to the growth factors and anti-inflammatories, these tears work to heal your corneas.
Amniotic Membranes - Whether you’re using cryopreserved or dehydrated amniotic membranes, these little pieces of tissue pack a serious healing punch when it comes to dry eye and corneal problems. Here are some of the things these powerful tissues are capable of:
Facilitates neutrophil apoptosis, polarized M2 macrophages, and suppresses Th1 and Th17 lymphocyte activation to reduce inflammation
Prevents myofibroblast differentiation to prevent scarring
Maintains stem cell quiescence to promote regenerative healing.
All in all, the things that promote growth in a fetus you can imagine would also promote growth and healing in the human cornea, and that;s essentially what we do with the amniotic membrane - harness the healing power of the amnion. Amniotic membranes ARE able to be billed to your insurance so this isn’t usually an out of pocket expense, unless you have a high deductible plan. But if it is indicated in your care for severe dry eye or filamentary keratitis or even Recurrent Corneal Erosion (RCE)…it's definitely worth the healing power it brings.
More Groundbreaking Dry Eye Treatments We Think Are Worth Your Investment
Intense Pulsed Light - Lumenis received FDA clearance for their Optilight device earlier this year in 2021. Intense pulsed light has been used for over 20 years with over 50 studies demonstrating its efficacy in dry eye disease. IPL targets pigment, so it is very effective in patients with rosacea at decreasing the amount of telangiectasias present on the skin.
We know that the presence of ocular surface inflammation increases with increased telangiectasias on the face. By treating the face for these abnormal blood vessels, ocular surface inflammation decreases.
In addition, IPL changes the secretion of the meibomian glands and even rejuvenates glands that have begun to atrophy. It decreases the population of demodex mites, and I’ll link my favorite youtube video of all time above that shows IPL killing a demodex mite. After IPL, tear breakup has been shown to increase, and symptoms scores also improve.
I made a video about what to expect with IPL treatment. If you have the opportunity to try IPL for your dry eye I would highly recommend it. This treatment is NOT covered by insurance and will run you $1500-$2000 for four sessions.
Gland Expression - Unclogging the Meibomian glands and reducing the obstruction that occurs with Meibomian Gland Dysfunction is very important to your long term care if you have dry eye syndrome caused by meibomian gland dysfunction. Unclogging the glands in my clinical experience helps with the signs AND the symptoms of dry eye disease.
Common procedures are Tearcare, iLux, Miboflo, and Lipiflow. TearCare is a blink-assisted warming device that delivers heat to the meibomian glands. Within three minutes after the heating session, meibum clearance is performed manually with a clearance tool, allowing the clinician to spend as much time as is necessary to evacuate the meibomian glands. Each of the four eyelids are compressed individually, one section at a time.
When compared with at-home warm compresses twice a day for four weeks, TearCare was superior in improving tear break up time one month after the procedure.
Another out of pocket procedure, this has become a mainstay in my practice just because there is no other way to clear obstruction. Warm compresses have not been shown to be as effective in studies and so in my opinion if there is obstruction present you MUST work to clear the glands.
Don’t Chase Pointless Dry Eye Treatments
Immunomodulators - Prescription drops are another important player in reducing ocular surface inflammation, but they too can be expensive and not always covered by insurance. Restasis, Cequa, and Xiidra however make a serious impact on turning the course of progression around in dry eye disease and should be considered.
Treating dry eye disease can feel complicated and very expensive. It is true that some of the most effective treatments are out-of-pocket costs and can add up very quickly. I hope this list has helped you to determine which of the treatments might be more necessary for you to spend your hard earned money on. Remember at the end of the day the treatments that you choose should be addressing your information and obstruction of the glands.
Spending money and chasing down treatments that don’t accomplish those two goals are pointless. However, the treatments above all have proven track records of helping with those two key components of Dry Eye treatment.
Spending money and chasing down treatments that don’t accomplish those two goals are pointless. However, the treatments above all have proven track records of helping with those two “key components of Dry Eye treatment. Make sure to let me know in the comments below which of these more expensive dry treatments you’ve tried or are hoping to try in the near future.
In-Office Thermal Expression https://www.sciencedirect.com/science/article/pii/S0039625722000376