Sydney ophthalmologist DR NISHA SACHDEV dissects low light level therapy, a new tool generating what she describes as remarkable, non-invasive results in patients with dry eye, ocular surface and eyelid issues.
One of the most cutting-edge developments in ophthalmic device technology of late is photobiomodulation therapy (PBMT), more commonly referred to as low light level therapy (LLLT). This has been recently adapted for ophthalmological use, having been applied in other fields such as dermatology and pain management thanks to its versatility, non-invasive nature and impressive results.
LLLT is gaining widespread recognition as a powerful tool for addressing various ocular surface diseases. This therapy works by harnessing the power of specific light wavelengths to promote cellular repair and regeneration.
The foundation of LLLT lies in photobiomodulation – a process where light photons are absorbed by cellular components, primarily cytochrome c oxidase within the mitochondria. It boosts the production of adenosine triphosphate (ATP), the cell’s primary energy source. ATP plays a critical role in cellular repair and regeneration, revitalising damaged tissue, enhancing metabolic activity, and improving overall cellular function.
The beauty of LLLT is that it works in a non-invasive, atraumatic and painless manner. Unlike other treatments that may involve surgery, discomfort or downtime, PBMT is completely non-destructive. It delivers energy to cells in a controlled way, triggering beneficial biological responses without causing thermal damage or injury to the tissues.
LLLT has proven extremely effective for various ocular surface diseases. Some of its primary uses include dry eye disease (DED), allergic eye disease, anterior and posterior blepharitis, meibomian gland dysfunction (MGD), meibomian cysts, pre- and post-cataract and refractive surgery, and lower eyelid oedema.
A key advantage is addressing these conditions without the need for surgical intervention. For instance, meibomian cysts or chalazia can now be treated effectively using LLLT, providing a new non-invasive option. Additionally, certain wavelengths in LLLT can reduce scar formation and minimise tissue oedema, particularly removing bags under the eyelids. This is valuable in reducing post-operative oedema and scar tissue formation following eyelid surgery.
The effectiveness lies in its targeted mechanisms of action. Depending on the wavelength used, PBMT can trigger various beneficial effects within the eye. Here are the three main types adopted in ophthalmology:
1. Red light therapy: Red light can penetrate the skin of the eyelids and reach the subcutaneous fat layers, where it targets the meibomian glands. By increasing ATP production in these cells, red light helps to reduce inflammation, liquefy meibum and improve blood circulation within the glands. This makes red light therapy particularly effective in DED, MGD, posterior blepharitis and chalazia.
2. Blue light therapy: This, on the other hand, penetrates more superficially, targeting the epidermal-dermal junction. It is particularly effective for anterior blepharitis and bacterial infections like Demodex. Blue light is absorbed by porphyrins within bacteria, ultimately leading to the destruction of the bacterial cell wall, hence a bacteriostatic effect.
3. Yellow light therapy: Yellow light penetrates the dermis, where it increases ATP production and promotes the release of nitric oxide, which plays a crucial role in tissue repair and neurotransmission. Additionally, this helps to reduce inflammation and erythema while increasing skin elasticity and reducing oedema through the lymphatic system.
Clinical results and real-world applications
The clinical outcomes of LLLT are impressive. I now have more than 12 months’ experience with 322 treatments to 97 patients. The outcomes have been outstanding for several systemic and ocular conditions, in particular ocular surface diseases, eyelid cysts and autoimmune disorders.
Case 1: A 58-year-old woman with chronic DED from Sjögren’s syndrome and scleroderma using multiple combinations of topical steroids, cyclosporin and lubricants over the years. After three sessions of red light LLLT, her symptoms improved dramatically, inflammation subsided, and tear film quality improved. She enjoyed lasting relief with quality-of-life improvement and no drops.
Case 2: A 33-year-old man with multiple cysts on his eyelids and severe eyelid erythema with known eczema and an autoimmune disease (figure 1). After three sessions of red LLLT five days apart, followed by three sessions of blue LLLT, he experienced complete resolution of all eyelid cysts. They disappeared without the need for surgical correction.
Case 3: A 9-year-old girl with a chalazion. Three sessions of red LLLT resulted in complete resolution of her cyst, without surgical intervention.
As shown, LLLT is helping to reshape how we approach ocular surface diseases. This form of photobiomodulation therapy is not only safe, non-invasive, and painless, but offers patients an office-based treatment option that can deliver long-lasting results without the risks or downtime associated with more invasive procedures.
Whether used as a primary treatment or as an adjunct with IPL, LLLT is opening new possibilities in the management of various eye conditions like DED, blepharitis, and meibomian cysts, and providing new hope for patients.
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