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Current developments in ocular surface and the power of biophotomodulation
Main Themes and Key Findings:
Dry Eye: The Revolution in IPL Treatment, Lifestyle, and Technology
The dry eye is no longer an unsolvable mystery. In the last decade, understanding and ocular surface treatment have evolved drastically. Dr. Serna reveals how the intense pulsed light (IPL) therapy, the photobiomodulation and a comprehensive approach in the lifestyle are transforming the management of this complex condition. Discover the future for your eyes!
Dry Eye: From the Unknown to Robust Science
Just 10 years ago, the dry eye It was a field limited to rheumatic conditions such as Sjögren's Syndrome, leaving many patients without a clear diagnosis. Today, thanks to a more robust definition and a deep understanding of the vicious circles of disease, we can offer more precise and effective solutions.
Pillars of Modern Dry Eye Treatment
According to Dr. Serna, the current approach to dry eye is based on two fundamental pillars:
- Lifestyle: We recognize the crucial impact of factors such as diet, exercise, use of electronic devices, and cosmetics on ocular surface health.
- Advanced Technology: The intense pulsed light (IPL) therapy and the photobiomodulation (LED red light therapy) are key tools to address the root cause of problems.
The Power of Lifestyle on Eye Health
In the last five years, the lifestyle has gained unprecedented importance in the treatment of dry eye, supported by growing scientific evidence. There is a direct connection between lifestyle and metabolic/oxidative stress at the cellular and mitochondrial level.
- Nutrition: A pro-inflammatory diet Rich in ultra-processed foods affects the intestinal microbiota, nutrient absorption and lipid metabolism (essential for Meibomian glands), contributing to a significant inflammatory component in dry eye.
- Digital Screens: Prolonged use of electronic devices alters the blinking pattern, exacerbating symptoms.
- Cosmetics: The cosmetic industry, although popular, can negatively impact the ocular surface.
Dr. Serna integrates lifestyle into initial consultations, focusing on the digital impact, he metabolic control and one anti-inflammatory diet. It also highlights the importance of the probiotics and the need for a diet rich in omega-3 (cold water fish), suggesting supplementation in patients with symptoms. A multidisciplinary approach with nutritionists and rheumatologists is crucial.
IPL and Photobiomodulation: Cutting-Edge Technology for Your Eyes
The Intense Pulsed Light Therapy (IPL) and the Biophotomodulation (LED red light therapy) are positioned in the Stage two of dry eye treatment According to the DEWS (Compendium of Scientific Evidence on Dry Eye) report, this is after using drops, lifestyle modifications, and supplementation.
Mechanisms of Action of IPL:
- Photobiomodulation: It stimulates cellular (mitochondrial) metabolism in the Meibomian glands and skin, improving their function.
- Therapeutic Heat: Light generates heat that liquefies the meibum (fat of the glands) and improves glandular metabolism.
- Nerve Stimulation: Activates the nerve endings of the meibomian and tear glands.
- Acción Antimicrobiana: Attacks parasites such as Demodex and bacteria that cause blepharitis, since they are sensitive to pulsed light.
IPL Protocol and Results:
A typical IPL treatment consists of 3-4 sessions spaced 15 days apart, extending over a month. Light bursts are applied to the periocular area, followed by a manual expression of the meibomian glandsThis combination is more effective, facilitated by the heat of the IPL.
IPL is very safe when applied correctly. Unlike external heat therapies, which are insufficient and only temporarily relieve symptoms, IPL addresses multiple mechanisms of action. Patients notice objective and symptomatic improvement after one to two months, with an increase in tear breakup time and a decrease in telangiectasias.
Who Are Ideal Candidates for IPL?
- Patients with ocular rosacea.
- Those with Meibomian gland dysfunction (DGM), especially with pasty meibum.
- People with recurrent styes or chalazia.
IPL can also be used in patients with autoimmune diseases such as Sjögren's syndrome, helping to address the evaporative component of dry eye, although expectations should always be managed and systemic treatments continued.
Contraindications for IPL:
- Background of herpetic ocular inflammations.
- Very active acute inflammatory processes (e.g. Steven Johnson, Pemphigoid).
- Use of isotretinoin, which increases skin sensitivity.
Beyond the IPL: Future Advances in Dry Eye
Dr. Serna sees a promising future with new technologies and approaches:
- Aesthetic Benefits: An aesthetic improvement of the skin in the periocular area has been observed.
- Myopia Control: Interest in red light therapy for the control of myopia in children and adolescents.
- Improved Visual Acuity: Although possible due to the improvement of the ocular surface, it is difficult to attribute directly to IPL.
Upcoming Technologies:
- Nasal spray (Tirbaya): Stimulates natural tear production (available in the US).
- New formulation of cyclosporine cyclosporine
- Better technologies for the Platelet-Rich Plasma (PRP) on the ocular surface.
- Research in 3D models, tear gland transplant and stem cell injection to stimulate natural tear production.
The Future: Individualization and Comprehensive Approach
Influence the lifestyle of patients is a growing challenge in the modern environment. Therefore, the individualization of treatment, combining a lifestyle approach with advanced technologies, is key. These technologies not only alleviate symptoms but also address the pathophysiological mechanisms of the disease. Despite limitations such as cost and time, the potential of IPL and other innovations offer a promising future for patients with ocular surface diseases
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