New, Targeted Technology for Treating the Root Cause of Dry Eye Disease (DED)
MiBo ThermoFlo (PainPoint Medical Systems) is new technology targeted at treating the root cause of lipid-deficient dry eye disease (DED): a poor lipid layer resulting from an insufficient amount of meibum secreted onto the ocular surface. MiBoFlo uses thermoelectric heat via a handheld probe that has a double eye pad attached with ultrasound gel applied to the end to facilitate the heat transfer through the lid to the meibomian glands.
Heat at a temperature of 108° is emitted from the probe. A technician can easily massage the lids with the probe alternating between a circular and back and forth motion.
In my colleagues and my DED clinic, we have developed a specific protocol for treatment, which works very effectively. We perform three consecutive treatments. The first is 12 minutes per lid, the second is performed 1 week later and lasts 10 minutes per lid, and the third is performed 2 weeks later and lasts 8 to 10 minutes per lid.
We charge $450 for all three treatments, and it is an out-of-pocket expense for the patient. There are no disposable eye pieces or activators necessary, allowing the cost to patients to be minimum. In our experience, patients are very receptive to the treatment and the cost is not prohibitive.
Additionally, we strongly recommend that patients also begin a regimen of the triglyceride form of omega-3 supplements, such as Dry Eye Omega Benefits from Physicians Recommended Neutriceuticals, at a 2,300-mg dose. The healthier meibum combined with the heat treatment and better meibum flow lends to excellent results in our experience. We make these treatments available in a spa-like environment with music and a special pillow, which makes it a great experience for the patient.
We have preliminary data from a 51-patient study which they underwent three treatments as per our protocol. We evaluated Schirmer tests, tear breakup time (TBUT), osmolarity, and both Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation of Eye Dryness (SPEED) scores at baseline, 1 month, 2 month and 4 months after treatment. At the 4-month, visit TBUT, osmolarity, OSDI and SPEED scores all showed statistically significant improvement.
Our clinic utilizes both the LipiFlow (TearScience) and MiBoFlo technology. We have found that the latter gives patients an almost immediate improvement in their symptoms after their first treatment, where in our experience, LipiFlow may take 6 weeks. Many patiens appreciate the cost benefit of not having to pay for the disposable activators.
We offer MiBoFlo as a first-line treatment for our lipid-deficient DED patients, combined with the triglyceride form of omega-3s and lipid-based artificial tears. We have had success in patients with meibomian gland dysfunction, meibotitis, and posterior blepharitis. We have also treated pre- and post-LASIK patients, those becoming contact lens intolerant, and patients with acute hordeolum.
While practices struggle to find alternate revenue streams, we have found that aggressively treating DED and incorporating MiBoFlo in a successful practice builder.