ANTIAGING EYE CARE AND AESTHETICS

Going beyond the traditional scope of primary eye care.
BY BRIDGITTE SHEN LEE, OD
The scope of primary eye care has grown
beyond the typical vision and eye health
examination. Older people today have active
lifestyles, and more patients are asking about
antiaging products and procedures during
their annual eye examinations. By 2030, more
than 20% of US residents will be age 65 years
and older,1 and already today there are more
than 100 million adults in the United States older than 50.1
On a daily basis, my patients ask about options to help
them see and look their best. Because in many cases I have
been taking care of their eyes for almost two decades, these
patients trust me to recommend the latest innovations in
antiaging eye care and to discuss aesthetic procedures. And
as a busy working mom who is raising two children, running two businesses, and keeping up with my own emerging presbyopic body changes, I have been on the quest
myself for effective antiaging products and nonsurgical
procedures.
One of my favorite quotes is from the well-known and
respected aesthetic dermatologist Doris Day, MD: “Growing
old is a privilege, aging is optional! I help you look your best
at every age.” This is a great sentiment describing what many
of us do daily: helping patients to see and look their best.
How do we incorporate conversations on antiaging and
aesthetics topics into our already busy schedules? The key is
to build the antiaging eye care dream team: optometrist +
refractive surgery ophthalmologist + aesthetic dermatologist + plastic surgeon. At my practice, Vision Optique, we
have developed a simple three-tiered approach to antiaging
eye care: (1) clear, comfortable vision; (2) healthy eyes; and
(3) ocular and facial aesthetics. The educational information
available to patients starts online on our website and various
social media platforms, and the conversations continue in
the examination rooms.
CLEAR, COMFORTABLE VISION
Our first job is to help patients see their best. Presbyopia
affects approximately 120 million Americans today.2 Offering
bifocals and reading glasses no longer suffices, as today’s
presbyopic individuals lead busy lives, are tech-savvy, active
in social media postings, and care about their appearance.
Common complaints and frustrating annoyances include
having to put on readers to see their smartphones and needing a flashlight to read a menu.
Presbyopic adults today want solutions that do not make
them feel and look old. In addition, our patients want eye
care solutions that help them to keep up with their demanding lives. People stare at various digital devices all day to connect with the world; it is estimated that 90% of Americans
use multiple digital devices for more than 2 hours a day, and
65% experience digital eye strain (DES). DES is characterized
by dry, irritated, and red eyes; blurred vision; headache; and
neck, shoulder and back pain.3 More and more people are
experiencing the effects of high-energy visible (HEV) blue
light from digital devices and general lighting.
Fortunately, the optical industry has innovative solutions.
There are no old eyes with the availability of digital nanoophthalmic progressive lenses. There is no need for readers
with the emergence of daily disposable multifocal contact
lenses. There will be no tired and red eyes with the use of
tear-infused silicone hydrogel daily disposable contact lenses.
There is no need for glasses with refractive surgeries. And
there is no DES when antifatigue digital lenses are combined
with HEV blue light protection. The visual demands of living
in the digital world are helping to drive a fast-growing vision
care market. The total US vision care market generated
about $34.5 billion in 2012.4 By 2022, that number is projected to reach $165 billion.5
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ANTIAGING EYE CARE
AND AESTHETICS
HEALTHY EYES
Our second job is to make sure patients’ eyes are healthy
and stay healthy. One of the most common complaints
among the aging population is dry and red eyes. Dry eye
disease (DED) is a multifactorial inflammatory disease of
the tears and ocular surface that affects the eye’s ability to
refract correctly and that, left untreated, can have a serious
impact on functional vision, eye comfort and appearance,
and patient quality of life.6 The three biggest risk factors for
DED are age, diabetes, and digital device use.
In the United States, there are an estimated 30 million
individuals with DED, and the number is growing. The
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$2 billion market for DED treatment is expected to
grow to $2.5 billion by 2020, according to Market
Scope.
DED is one of the main causes of ocular surface
disease; comprehensive diagnosis and treatment of all
causes are necessary to manage ocular surface disease.
A better understanding of the roots of DED (evaporative and/or aqueous deficiency, medical, and environmental), innovative diagnostics, and more treatment
options are allowing us to provide better quality of
life to patients with DED. Those treatment options
now include LipiFlow Thermal Pulsation System
(TearScience), Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan), Retaine MGD ophthalmic emulsion (OcuSoft), and Prevencia (HEV blue light protection coating, Essilor).
OCULAR AND FACIAL AESTHETICS
Older patients want to know what they can do to get
rid of wrinkles, spots, bags, and sags. Once the conversation starts and patients realize that you are knowledgeable about aesthetics, then other topics, such as bulges
and cellulite, are broached. It is helpful for optometrists
to have a general knowledge of effective cosmetic procedures and to develop co-referral relationships with
experienced board-certified cosmetic dermatologists
and plastic surgeons who will help patients decide
what’s best for them.
The growing global obsession with physical appearance is driving the aesthetics market. The global market
for plastic surgery products is expected to exceed $15 billion
by 2020, including $8 billion in the United States alone.7 In
2015, almost 10 million procedures were performed in this
country. More than 3 million of these were medically necessary skin cancer treatments, and more than 6 million were
aesthetic procedures all over the body, including 2.62 million
laser or energy-based procedures, 1.79 million wrinkle-relaxing injections, 1.36 million soft-tissue fillers, 600,000 chemical
peels, and 230,000 body sculpting procedures.8
The number of nonphysicians operating lasers is increasing, particularly outside of a traditional medical system.
Patients should be aware that laser treatments are medical procedures and should verify the training, certification,
and experience of the person performing the procedure.9
Increases in harmful complications resulting from the nonphysician practice of dermatologic and cosmetic procedures
have been reported nationally.10 Optometrists can help to
reduce these serious complications by referring patients to
experienced dermatologic and plastic surgeons.
M. Christine Lee, MD, is a dermatologic surgeon and
director of The Skin and Laser Treatment Institute in
Walnut Creek, California. Paul Friedman, MD, is the director
of Dermatology & Laser Surgery Center in Houston, Texas,
36 ADVANCED OCULAR CARE | JULY/AUGUST 2016
who also practices at the Laser & Skin Surgery Center of New
York. They have advised on the next section which describes
top minimally invasive laser procedures.
No Short Eyelashes: Latisse and Zoria. Latisse (bimatoprost ophthalmic solution 0.03%; Allergan) is a prescription
prostaglandin analogue indicated to treat hypotrichosis of
the eyelashes by increasing their growth. It has the same
active ingredient as the glaucoma drug Lumigan (Allergan).
Latisse helps to lengthen and thicken eyelashes, although it
carries the risk of potential (but reversible) side effects such
as increased iris and periorbital pigmentation.
Zoria Boost Lash-Intensifying Serum (OcuSoft) utilizes patented polypeptide technology to naturally enhance and support the eyelash growth cycle for longer and darker eyelashes. It is a drug-free formula without the potential side effects
of Latisse. Latisse and Zoria work well for the right patients,
and optometrists can prescribe Latisse and sell Zoria.
No Wrinkles, Bags, Aging Spots: Botox, Fraxel, KTP and
Nd:YAG. Botox (onabotulinumtoxinA; Allergan) is a neuromuscular blocking agent with multiple indications, in and
outside of eye care. For aesthetic purposes, this neurotoxin
can be used to temporarily improve the look of moderate to
severe crow’s feet and frown lines between the eyebrows by
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ANTIAGING EYE CARE &
AESTHETICS
Antiaging Eye Care
1. No Old Eyes: Essilor S Series, Zeiss Progressive Lens
Individual 2, Hoyalux Id Mystyle
2. No Digital Eye Strain: Essilor Eyezen, Hoya Sync,
Zeiss Digital
3. No Tired Eyes: Acuvue Oasys 1-Day With Hydraluxe™,
Dailies Total1, Myday
4. No Readers: Biotrue Oneday For Presbyopia, 1-Day
Acuvue Moist Multifocal, Clariti 1 Day Multifocal, Dailies®
Aquacomfort Plus Multifocal
5. No Dry Eyes: Lipiflow, Restasis®, Retaine Mgd
Antiaging Ocular Aesthetics
1. No Short Eyelashes: Latisse & Zoria
2. No Wrinkles, Bags, And Aging Spots: Botox, Pellevé, Ipl
3. No Sagging: Ultherapy, Thermismooth
Antiaging Body Aesthetics
1. No Bulges: Coolsculpting & Coolmini
2. No Dimples & Cellulite: Cellfina
3. No Sweating: Miradry Thermidry*
4. No Double Chin: Coolmini And Kybella
5. No Thin Lips: Juvéderm Volbella, Restylane Silk
6. No Hollow Cheeks: Juvéderm Voluma Xc, Restylane Lyft
Source: The American Society for Dermatologic Surgery
paralyzing the muscles in the face and around the eyes.
Fraxel utilizes non-invasive laser technology to stimulate
collagen and resurface the top skin layer. It helps reverse the
visible effects of aging, such as fine lines and wrinkles, surface
scarring from acne, hyperpigmentation, sun damage, and
actinic keratosis.
The gold standard for treating vascular and pigmented
lesions, according to Dr. Lee, is a combination KTP and
Nd:YAG laser which she helped to develop. Lasers are more
effective for targeting individual lesions because they penetrate deeper and are more specific for the chromophore
(light absorbing molecule) in the individual lesion. Having a
smaller spot size also allows for precise concentration of the
laser energy on the targeted lesion.11
No Sagging: Ultherapy, ThermiSmooth, Thermage.
Ultherapy (Ulthera) is a noninvasive ultrasound treatment
that stimulates collagen production at the level of the dermis.
ThermiSmooth Face (Thermi) uses temperature controlled
radiofrequency energy to stimulate collagen remodeling.
Thermage is a non-invasive radiofrequency therapy that helps
to improve the appearance of sagging or loose skin. These
38 ADVANCED OCULAR CARE | JULY/AUGUST 2016
technologies help the skin on the face to tighten and tone,
thereby improving the appearance of lines and wrinkles.
No Double Chin: Kybella, CoolMini. Kybella (deoxycholic acid injection 10 mg/mL, Allergan), injected into the fat
located in the chin, begins breaking down the fat. The active
ingredient is a naturally occurring molecule in the body that
aids in the breakdown and absorption of dietary fat.
CoolMini (Zeltiq) is an applicator for a procedure called
Coolsculpting, a nonsurgical technique that freezes fat cells
with the application of a controlled cooling system. Once
the fat cells become crystallized, they die. Over time the
body eliminates the dead fat cells, creating a more sculpted
appearance in the treated area.
No Thin Lips: Juvéderm Volbella, Restylane Silk,
Belotero. Juvéderm Volbella injectable gel (Allergan) uses
the patented Vycross technology (Allergan) that incorporates short and long chain hyaluronic acid crosslinking. It
helps restore fullness and shape to the lips. Volbella is the
newest addition which will be available in October 2016.
Restylane Silk injectable gel (Galderma Laboratories) helps
to smooth out the wrinkles around the mouth and enhance
the size and shape of the lips. This product uses a clear gel
formulation of hyaluronic acid that acts similarly to the
body’s naturally produced hyaluronic acid to plump and
shape the lips.
Belotero is another favorite filler to use around the eyes
and lips. Dr. Lee says “it has unique crosslinking that creates
a lower viscosity gel that goes in smoother and softer than
other hyaluronic acids, making it ideal for thinner skin areas
like the eyes and lips.”
No Hollow Cheeks: Juvéderm Voluma, Restylane Lyft.
Juvéderm Voluma XC injectable gel (Allergan) is another
member of the Juvéderm family of fillers; it is used to add
volume beneath the skin’s surface to lift and contour
the cheek area. Restylane Lyft injectable gel (Galderma
Laboratories) is another hyaluronic acid gel indicated to help
correct volume loss and treat wrinkles in the face.
AESTHETIC BODY CARE
Beyond their eyes, patients also want insights into aesthetic body procedures in general.
No Bulges: CoolSculpting & Vanquish (BTL) combined
with Exilis (BTL) or TightSculpt (Fotona). CoolSculpting is
a procedure that targets fat areas by vacuuming and freezing
fat cells through the application of a controlled cooling system, creating a more sculpted treated body area.
Vanquish is a multipolar radiofrequency device that
melts fat that can be used all over the body and has a special applicator that can be used specifically on the arms
and legs. Exilis is a monopolar radiofrequency device that
tightens the skin and does body contouring. TightSculpt is
the latest skin tightening and body contouring device from
Fotona which is an attachment to the SP Dynamis Pro.
OPPORTUNITIES
Beauty begins with the eyes! It’s an exciting time for
optometrists to be a part of the integrated aesthetic medicine team that encompasses eye care, skin care, and cosmetic and plastic surgery procedures! When the antiaging
aesthetic dream team (optometrist, ophthalmologist, aesthetic dermatologist, plastic surgeon) collaborate together
to educate patients, the result is happy patients and healthy
practices! n
1. Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States. U.S. Census Bureau. May
2014. http://www.census.gov/prod/2014pubs/p25-1140.pdf. Accessed June 24, 2016.
2. The Vision Council. Digital Eye Strain Report 2016. http://www.thevisioncouncil.org/digital-eye-strain-report-2016.
Accessed June 24, 2016.
3. Statistics and facts on the eyewear industry in the U.S. Statista. http://www.statista.com/topics/1470/eyewear-in-theus/. Accessed June 24, 2016.
4. Global Market Insights. Eyewear Market Size forecast to reach USD 165 Billion by 2022. Nasdaq GlobeNewswire. March
28, 2016. https://globenewswire.com/news-release/2016/03/28/823217/0/en/Eyewear-Market-Size-forecast-to-reachUSD-165-Billion-by-2022-Global-Market-Insights-Inc.html. Accessed June 24, 2016.
5. AARP. Getting to know Americans age 50+. . 2014. http://www.aarp.org/content/dam/aarp/research/surveys_statistics/general/2014/Getting-to-Know-Americans-Age-50-Plus-Demographics-AARP-res-gen.pdf. Accessed June 24, 2016.
6. [no authors listed] The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007;5(2):75-92.
7. AestheticsWire. Global plastic surgery market set to boom. April 22, 2016. http://modernaesthetics.com/wire/view.
asp?20160422-global_plastic_surgery_market_set_to_boom. Accessed June 24, 2016.
8. American Society for Dermatologic Surgery. ASDS survey: Nearly 10 million treatments performed in 2015. May 5, 2016.
https://www.asds.net/_Media.aspx?id=9449&terms=survey. Accessed June 24, 2016.
9. Friedman PM, Jih MH, Burns A, et al. Nonphysician practice of dermatologic surgery: the Texas perspective. Dermatol
Surg. June 2004. https://www.dermlasersurgery.com/wp-content/uploads/pdf/Nonphysician_practice.pdf
10. University of California, Los Angeles (UCLA), Health Sciences. “Lawsuits increasing over skin-related laser
surgery performed by non-physicians.” ScienceDaily. ScienceDaily, 17 October 2013. www.sciencedaily.com/releases/2013/10/131017093507.htm.
11. Lee MC. Combination 532-nm and 1064-nm lasers for noninvasive skin rejuvenation and toning. Arch Dermatol.
2003;139(10):1265-1276.
Bridgitte Shen Lee, OD
ofounder and CEO, Vision Optique, Houston, Texas
C
Founder and consultant, iTravelCE
n 832-390-1393; drbshenlee@iTravelCE.com
n Financial disclosure: consultant to Essilor, Johnson & Johnson
Vision Care, Bausch + Lomb, OCuSoft, Guardion Health Sciences
n
n
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No Dimples and Cellulite: Cellfina. The Cellfina System
(Ulthera) relies on a minimally invasive needle-sized device
to treat the primary structural cause of cellulite. Tight connective bands woven throughout fat in the thighs and
buttocks pull down on the skin, creating puckering on the
surface of the skin. During treatment, these tight bands are
broken, causing the treated skin to smooth out.
No Sweating: miraDry, THERMIdry. With the miraDry
System (Miramar Labs), microwave radiation is applied to
the underarm to treat axillary hyperhidrosis (excessive armpit sweating), creating a focal energy zone of heat to obliterate the sweat glands. ThermiDry (Thermi) applies controlled
heat to the sweat glands using radiofrequency energy under
local anesthesia to disable the glands from functioning.