Rolando Toyos, MD is the founder and CEO of Toyos Clinic. He talks about how he created a product to combat dry eye for his patients.
Interview conducted by Ivanhoe Broadcast News in December 2021.
What exactly is “OptiLight”?
DR TOYOS: About 20 years ago, I started using intense pulsed light in our clinic for aesthetic causes and for things like rosacea, and then, I would have some rosacea patients that also had dry eye. I would do intense pulsed light on these patients, and then some of them said that their dry eye was improved. From there, I started to see a correlation that intense pulsed light could be used to help patients with dry eye. It took seven years of research to finally figure out the right protocol and parameters to use for these dry eye patients when I used intense pulsed light, and then, over the years, I started teaming up with Lumenis, which is the inventor of intense pulsed light, and discussing ways to improve the technology so that we could specifically use it for dry eye. We did various research studies and we had patients that were involved in various research studies to show that, with some modifications to the intense pulsed light system, we could get great results for our dry eye patients. We, then, embarked on an FDA study to get FDA approval specifically for intense pulsed light for dry eye with the Lumenis system. All those things came together to develop the OptiLight system. So, it’s maximized for patients with dry eye to improve their dry eye. What we showed in the FDA study is that we could improve the signs and symptoms of dry eye in these patients.
How is it different than all the other treatments that we have now for dry eye?
DR TOYOS: Let’s take a step back and define dry eye. We produce a tear to keeps our eye well lubricated and to optimize our vision. Patients with dry eye are not producing a natural tear. There are three parts to our tear – a protein layer, a water layer and a fatty layer. Most patients with dry eye have a problem with their fatty layer. You’ve got about 20 to 30 of those right on the lid margin and usually, they make a nice olive oil-like secretion. Most patients with dry eyes, instead of those glands making an olive oil-like secretion, they’re making more of a toothpaste-like secretion. So, those glands get plugged. When those glands get plugged, you don’t have that normal oil in your tear, that tear evaporates very quickly and you have inflammation, irritation, decreased vision and all the different symptoms that patients complain about. Some of those complaints can range from irritated eyes or tired eyes to their vision being cloudy, or they feel like they have to blink all the time. Even itching and burning of the eyes, which is usually equated with allergy, can sometimes be dry eye, and more people are getting dry eye just because of the way our lifestyle has changed. Some of the things in our lifestyle, like our diet, has really changed over the last 40 years. We’re eating more processed foods and getting away from vegetables and fruits and eating more meat. We also live in a digital society, now. We’re constantly looking at the phone. When looking at the phone or TV screen or computer monitor, you’re blinking about half the time that you normally would be blinking. So, usually, in a minute, you’re going to blink anywhere from 15 to 30 times. When you’re on a digital device or looking at a TV, you’re blinking about half that time so your eyes and that tear film will dry out quickly. If you don’t have a normal tear film to start with, that just aggravates the problem and now we’re even getting 10-year-olds come in that are having dry eye disease just because of the way our lifestyle has changed. Now, we know that COVID can contribute to dry eye disease. Having to wear masks all the time during COVID also exacerbates dry eye because you’re breathing all that air, and it’s leaking out and drying out the eye even more. With a combination of all things that are going on, we used to only see about 10% of our patients with dry eye, but a recent study said that 38% of the patients that are walking into an eye clinic have dry eye disease. That’s a big percentage of people. There is an estimated 10 to 20% of the population suffering from dry eye now. This is a big problem. In the beginning, people thought that this was just a nuisance, saying, “Oh, you have dry eye. Don’t worry about it, we’ll give you some artificial tears.” But this can really affect people’s daily activities. Some patients’ eyes are so dry that they have had to drop out of school, or have stopped working, or they become depressed. This is an inflammatory disease, and if you don’t decrease that inflammation or get those glands working better, there will be a downward spiral with the disease, and it can get worse. The new way that we think is based on decreasing inflammation. We know that there’s inflammation in those glands that are causing them to make more of a toothpaste-like secretion. How do we do that? There are a bunch of FDA-approved medicines, like anti-inflammatories drops that decrease the inflammation in the eye, but those drops won’t make the meibomian glands work any better. The intense pulsed light and OptiLight come and direct energy to those glands so that they begin to work better. It usually takes about four treatments to get those glands to work effectively. We think of dry eye as a skin gland condition that’s affecting the tears, and it’s manifesting in a bad tear. This treatment is treating the root of the problem, not just treating the end result of the problem, which is inflammation. Lumenis has worked with our team and have made modifications and developed ways to make this a better treatment for dry eye, so you don’t have to experience adverse events that can occur with other treatment parameters or systems. The OptilLight is the first major change with a little pencil tip so that you can get to areas of the face quickly and easily to direct this energy to those meibomian glands. The other thing it has is a little chiller plate. There’s heat generated when you’re doing these light treatments and with a little chiller that’s cool to the skin touch, there are fewer patient complaints. We also have different skin types and different skin colors. In the beginning, you could only do intense pulsed light on somebody who had pale skin with no pigment. Because they’re absorbing so much energy – the pigment in skin will absorb this light energy and cause so much heat that people with darker skin couldn’t take all that energy. With OptiLight, we have the ability to change the pulses of light so that we can pulse this light and they’re not getting all of that energy all at once. That helps us bring this treatment to patients with darker skin tones. With the OptiLight, you can treat all ranges of skin without a problem. All of these modifications have made this one of the most effective treatments for dry eye disease and, one of the only treatments that actually treats the root cause of the problem.
Are there any side effects to the treatment?
DR TOYOS: Yes, you have to be trained to do this procedure. I have 21 years of experience treating dry eye disease with intense pulsed light, so my parameters and my protocol are built into the OptiLight technology, and then somebody comes and trains you how to use it so that there’s no adverse event. The only time you would get into problems is if you use the technology wrong. For example, I tell people that if you drive a car at 100 miles an hour and don’t use the blinkers, you can get into an accident. But if you drive it safely, it can get you from point A to point B. The same thing goes for the OptiLight technology. Once you get trained, the parameters and protocols are there. One that we said before is that the light is picked up by pigment. We have pigment in our eye. If you were to do IPL and not have the patient close their eye, that energy could be absorbed in the eye by the iris. That’s why it’s very important to get the training and have the parameters and protocols built into the system. It’s an out of the box system, and the doctor should feel very comfortable doing the treatment without any problems.
Besides any user error, are there any known side effects or any patients that this would not be good for?
DR TOYOS: The risk of adverse events is very small. I’ve been working with the FDA for seven to eight years presenting my data, presenting that there’s no adverse events, and that it’s very effective in treating patients. This is a treatment that’s used worldwide – in Asia and Europe, South America, everywhere. It’s a very effective treatment, and the adverse events are very small.
After a person has their four sessions of this treatment, how soon can they see relief?
DR TOYOS: All the studies have shown that patients will feel a bit of relief after each treatment, and, usually, they get treatment and come back two weeks to get another light treatment. We’re giving the light treatment and treating them from ear to ear. We also express those glands in the treatment. Those glands that are compacted with a toothpaste-like substance, we express those glands after the OptiLight treatment. Those secretions are much thinner. The glands are open, and you can get all that toothpaste-like material out of their glands so they can work better. When you get into the third and fourth treatment, that’s when they get the biggest amount of relief, and then, they’re going to come in for maintenance treatments. Somebody who’s older with more severe dry eye may come back sooner, like every four months. Somebody that has mild dry eye may come back once a year for just a maintenance treatment to keep those glands working. This light energy is stimulating the cells of the glands to work better so, you want to give it a bit of energy to continue to work better.
What is entailed in those maintenance treatments?
DR TOYOS: The same thing that the regular treatment is consisted of happens in the maintenance treatments. You would use this OptiLight from ear to ear, on the skin, close to the glands, and then you would express those glands. A maintenance treatment is a one-time treatment. The normal treatment protocol for a first-time visit is a four-treatment protocol.
Are there four treatments in eight weeks?
DR TOYOS: Yes, I recommend that they come in every two to four weeks. This light energy is stimulating the cells of the gland to work better, so you want to continue boosting them with energy intermittently to continue to maintain results.
For someone who’s been dealing with dry eye for a good portion of their life, what can this treatment mean for their quality of life?
DR TOYOS: We’ve seen what a difference this can make to patient’s ability to function in their lives and in their quality of life. I’ve had patients who would sit at home and wouldn’t go out because their dry eye was so severe, and when they got OptiLight, they could resume their normal lives. I’ve also had patients who dropped out of college because their eyes were so dry, and then, used OptiLight and went back to college, got their degree, and got a job. We’ve seen a little bit of everything in terms of how much this impacts a patient’s life.
How recently was this FDA approved?
DR TOYOS: The beginning of 2021.
Can you go into detail on the connection of diet and dry eyes?
DR TOYOS: When a dry eye patient comes into our clinic, I take a holistic approach because I want to know what they are doing, like, what job they are doing, if they’re in school, if they use their phone a lot, and things like that. I also want to know what their diet is and what their normal exercise regimen is because all those things play a role. I’ve written books on dry eye disease and there is definitely a correlation between a bad inflammatory diet and worsening of the dry eye. Things that are inflammatory are dairy, meat, and eggs. You should have more of a Mediterranean diet because fishes provide omega three, which helps the glands work better. Some things that are high in omega three are salmon, sardines, and mackerel. Many studies show that ultra-processed foods are worse for the body and create more inflammation in the body than more natural foods. Instead of having potato chips, have a potato because it would be better for you. There are several documentaries and books that cover this. I refer to “How Not to Die” a lot and look at their studies. So, the first thing we do is try to get them on a healthier diet. One of the future things that you’re going to see in dry eye is the relationship between genetics and health. So, I recommend my patients do 23 and Me where they submit to kind of genetic testing. It tells them traits and things about them that will affect their health like, if they allergic or gluten allergic and if that’s the case, that’s going to cause inflammation. We want to eliminate gluten from their diet. So, I think that’s what you’re going to see in the future of medicine and in the future of dry eye, we’re going to make links into genetics to figure out ways to work with their genetics to get them in a better state.
Are there any restrictions after treatment?
DR TOYOS: After treatment, I tell patients that they should avoid sun exposure and use a sunblock. Their epidermis is going to have dead skin cells on the outer layer of your skin that slough off. They usually take 24 to 48 hours and then you’re rejuvenating your skin cells. When you do IPL, it’s almost like a microdermabrasion and you’re going to be sloughing off some of that dead skin cell layer of your epidermis, which makes you more susceptible to the sun and burning. But dry eye patients should be avoiding the sun, anyway. A lot of patients have rosacea or sensitive skin, and when they take too much sun, it causes more inflammation on the skin, which causes more inflammation on the glands and eventually, causes more inflammation and dry eye.
After treatment, how long should they avoid the sun?
DR TOYOS: I always tell my patients do a lot of sun avoidance, anyway, but I would advise them to use a sunblock for the first 72 hours. As they’re going through their four-treatment protocol, we usually tell them to use sunblock and avoid the sun by wearing a hat, and then, the sunblock that they use can become important, too. We believe in a zinc-based sunblock instead of a chemical-based sunblock, because there are all sorts of reports that say the chemical-based sun blocks may be bad for you.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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