TearCare for MGD, Blepharitis, and Dry Eye with Dr. Derek Cunningham
While leading the country in refractive lens exchange procedures, Dr. Cunningham found that the number one limiting factor for patients' success was dry eye disease. The same was true for LASIK surgery. After making this discovery, they set out to treat dry eye disease proactively in their patients, whether they’re having refractive surgery or not. Their office now has every piece of equipment available for dry eye, and they’ve dedicated much of their days to treating those with this devastating condition.
What is TearCare?
The more science moves and the more quickly we develop technology, we want to improve on what we have. This is true for the TearCare system. TearCare is unique because it only heats the glands of the eyelids, instead of heating the entire eyelid. This device uses small electrodes to uniquely heat the meibomian glands in the eyelids but nothing else. On the device, there are temperature gauges present for the entire length of the eyelid to ensure the correct temperature is being used. After the 15 minute treatment time, gland expression is performed to evacuate the glands of any stagnant oil.
The oil from the meibomian glands is so important because it acts as the third layer of the tear film. This oily layer protects the eyes and prevents the tears from evaporating. Without functioning meibomian glands and healthy oil, the tears will evaporate too quickly and you’ll be left with uncomfortable eyes and even blurry vision.
How to Use TearCare | What to Expect
Before having the TearCare treatment, your doctor will confirm that you are a great candidate for the procedure. First, your doctor or a technician will have you remove your contact lenses (if you wear them). They will then clean your eyelids of any debris, oil, and makeup to ensure that the electrodes will stick firmly to your eyelids. Your skin should be dry before the device is applied.
The doctor or technician will then carefully remove the SmartLid device from its tray and peel off the flexible elements that come in contact with your eyelids. They will have you first look down and apply the SmartLid temporarily and then nasally on your top eyelid, avoiding your eyelashes. For the lower eyelids, they’ll have you look up and the same procedure will be used. They’ll then have you look straight ahead as they apply the temple housing unit. The same procedure will then be completed for the other eye.
The disposable pieces will be attached to the main TearCare device behind your back, so as not to disrupt the cords. Once the device is turned on, you will immediately feel a warming sensation on your upper and lower eyelids. During the procedure, you should blink naturally. The TearCare procedure will last for 15 minutes, and the heat will automatically be shut off. The devices attached to your eyelids will be gently removed and discarded.
If you experience any discomfort during the procedure, tell your doctor. They can adjust the temperature or even terminate the procedure early. Immediately following the TearCare procedure, your doctor will manually express the oil from your meibomian glands.
Who is Suitable for TearCare?
TearCare can be beneficial for those with dry eye disease due to meibomian gland dysfunction. If a patient does not have MGD, there is no need to use the TearCare system. In addition to this, the distinction needs to be made between LipiFlow and TearCare so the correct procedure can be chosen.
LipiFlow is a compression device which heats and compresses the lid all at once. The biggest problem with this is that it also compresses the fine blood vessels on the lid margin. Many dry eye patients have this telangiectasia, or tiny abnormal blood vessels on the eyelid margins. Heat and compression on the eyelid margins themselves can be pro-inflammatory for these patients.
Instead, TearCare directs the heat right on the glands themselves and leaves the lid margins alone. For this reason, patients who have any telangiectasia will be directed to TearCare over LipiFlow. Dr. Cunningham uses about 80% TearCare and 20% LipiFlow in his office.
What is the Success Rate for TearCare?
Severity of disease can vary widely, and so does the success of these treatments for patients. It’s important to note that none of these in-office procedures are stand-alone treatments. You still need to use adjunctive and preventative therapy alongside any in-office treatment.TearCare allows the glands to be heated up so that the doctor can express the glands, and this jumpstarts the system. But there still needs to be daily maintenance involved (with eyelid hygiene, nutrition, and supplementation) or you’ll end up right back where you were.
Dr. Cunningham treats all dry eye disease as an autoimmune condition. Just like you don’t get rid of arthritis easily and after one treatment, you won’t get rid of dry eye after one treatment either. However, with proper pretreatment and post care, he sees a 90-95% success rate in patients feeling better after treatment.
The Cost of TearCare
The cost of TearCare varies based on location. It is usually competitively priced close to that of LipiFlow. If you’d like to find a doctor near you who offers TearCare, visit TearCare®.com.
Insurance Coverage for TearCare
Insurance coverage is a lengthy, typically 3-5 year process for device coverage. TearCare® does have a temporary code that providers can file, 0563T, although there is currently no insurance coverage that we know of. TearCare is currently working to assure coverage for the system in the future, as they recognize the patient burden and want to assure the best chance for patient satisfaction and procedural success.
Contraindications to TearCare
If the patient does not have viable glands after imaging is done, no gland expression therapy will be performed because the glands need to have some ability to return to functioning. Intense Pulsed Light (IPL) will be used in these cases. Other situations which are contraindicated for the use of TearCare include:
Recent (i.e. within the last 90 days) intraocular or periocular surgery
Recent ocular injury
Recent history of Ocular Herpes Simplex or Herpes Zoster
Active ocular or periocular infection or inflammation
Diminished or abnormal facial, periocular, ocular, or corneal sensation
Ocular surface ulcers
Patients under 22 years old
Is TearCare FDA Approved for the Eyes?
TearCare has been in the market less than 2 years; the longest studies performed are 1 year duration. Recently, TearCare was compared to LipiFlow and both were found to work well in this non-inferiority study. 76% of female patients receiving TearCare improved their OSDI score while only 56% of those using LipiFlow did. Studies on this system are ongoing.
The TearCare® System is indicated for the application of localized heat when the current medical community recommends the application of a warm compress to the eyelids. Such applications for TearCare would include MGD, Dry Eye, or Blepharitis. Note that the TearCare System is a tool, not a treatment, and it is not specifically indicated to treat the signs and symptoms of dry eye disease.
Dr. Cunningham practices at Dell Laser Consultantsin Austin, TX. You can call his office at 512-347-0255 to schedule an appointment. At their office, there are lots of opportunities to get involved in research and different studies being conducted on dry eye disease.
About Dr. Cunningham
Dr.Cunningham’s research covers a wide spectrum of eye care and neuroscience including; dry eye treatments, glaucoma medications and surgeries, retinal diseases, cataract surgery and LASIK surgery, cosmetic treatments and products, vision enhancement and sports vision. His innovative research has been presented at major national meetings including the American Retinal Society, the American Academy of Ophthalmology, the American Academy of Optometry, and the American College of Sports Medicine. His research has been featured in many medical journals and showcased in publications such as Sports Illustrated and Forbes Magazine.
In addition to having been an associate professor at Texas Tech School of Medicine, Dr. Cunningham also held adjunct professor status at the Inter American University of Puerto Rico, University of Waterloo, University of Houston, and University of Incarnate Word.
Dr. Cunningham is an internationally recognized educator, having provided continuing education lectures to eye doctors throughout the world. He is also a Fellow of the American Academy of Optometry and was one of the first optometrists to be Board Certified by the American Board of Optometry. He is also the founding Chair of the Integrated Ophthalmic Task Force for the American Society of Cataract and Refractive Surgery.
Dr. Cunningham is the director of the Dell Eye Institute for Dry Eye Research at Dell Laser Consultants in Austin, Texas and is well published in the areas of advanced dry eye treatments. Many of Dr. Cunningham’s dry eye protocols are used by academic institutions around the country.
Dry Eye Milestones
Dr. Cunningham was one of the lead authors for the only peer reviewed published optometric dry eye guidelines in North America.
Dr. Cunningham was a co-host and Chair of The Dry Eye Summit. A meeting of the top 50 leading dry eye optometry experts in North America.
As Director of Optometry and Research at Dell Laser Consultants, Dr. Cunningham specializes in the evaluation and management of vision correction surgery patients and coordinates clinical research studies. He also oversees the Dell Eye Institute for Dry Eye Research at Dell Laser Consultants, offering advanced dry eye treatments.