Equipment is becoming increasingly popular in the treatment and management of dry eye disease. Practitioners tell Insight why they made that investment and how it has worked in their clinics.
When Shaina Zheng first began advocating for more sophisticated technologies to manage dry eye disease, she expected curiosity – even debate. What she didn’t expect was the degree of scepticism.
“In the early days, I definitely felt undermined,” Zheng recalls. “Not intentionally, but I could sense that people thought dry eye was just a symptom you soothed with eye drops.
“When I tried to talk about inflammation, gland obstruction, about long-term progression, people would look at me like I was overthinking it.”
The irony isn’t lost on her: she was managing her own dry eye condition at the time. In those moments, Zheng says she leaned heavily on research, curiosity, and persistence.
“Even as someone who suffered from dry eye, I didn’t initially grasp how complex it is,” she says.
“It took years before I understood the underlying disease mechanisms. So when others didn’t understand it, I couldn’t really blame them, but it did feel like swimming against the tide.
“I knew there had to be more we could do than ‘here’s a bottle of drops, off you go’. And once I realised how progressive this condition can be, I couldn’t ignore it.”
Today, the sceptics are fewer, the demand is greater, and her practice is home to one of the most comprehensive suites of dry eye technologies in the country.
At Eyecare Plus Mermaid Beach, Zheng and her husband, Jackson Yip, have spent a decade building a practice known for full-scope optometry with a strong dry eye focus.
Intense pulsed light (IPL) and low-level light therapy (LLLT) spearhead a suite of at least six device-based dry eye interventions in her practice.
Most patients are over 50, and dry eye presentations – ranging from mild discomfort to advanced meibomian gland dysfunction (MGD) – are a daily occurrence.
The clinical team includes three optometrists and a group of trained dispensers and assistants.
“We’re not a niche dry eye clinic,” Zheng says. “We still do general optometry, refractions, ocular health checks. But because so many patients have dry eye, it’s naturally become a significant part of what we do.”
That significant commitment is reflected in another role, as vice president of the Dry Eye Society, and in the launch of a venture, Dry Eye Impact, aimed at elevating dry eye care across all optometry settings.
“Dry eye shouldn’t be considered niche when it affects one in three Australians over 50,” she says. “It should be core competency.”
“Once you really understand dry eye as a long-term inflammatory disorder, you stop thinking in terms of quick fixes. The conversation becomes: What’s the underlying cause? What’s the patient already tried? What needs to be treated first?”
As a result, Zheng takes a structured and deliberate approach to her dry eye work.
First-line care includes eyelid hygiene, warm compresses, dietary supplementation, patient education about chronicity, and over-the-counter lubricants (already familiar to most patients).
Only when these steps fail or when the clinical signs indicate blockage, inflammation or gland dysfunction does she escalate to pharmacological or device-based interventions.
“If someone comes in asking for IPL, and they don’t have MGD or blepharitis, it’s not necessarily going to help them,” Zheng says.
“Technology is incredibly powerful, but only when it’s matched to the underlying mechanism. That’s something we emphasise with patients and staff.”
Technology – the evidence
The growing interest in in-practice technologies for dry eye – particularly IPL and LLLT – has been underpinned by growing evidence.
A 2023 study published in Ophthalmology and Therapy – Effectiveness and Safety of Intense Pulsed Light Therapy for Dry Eye Symptoms Due to Meibomian Gland Dysfunction, provided one of the strongest endorsements to date.
It found significant improvement in tear break-up time, symptom scores, and meibomian gland function following a controlled IPL treatment protocol, with a strong safety profile reported across participants.
Similarly, a review published in Clinical Ophthalmology examined the mechanism of IPL in MGD: the thermal and anti-inflammatory effects appeared to reduce abnormal telangiectasia, liquefy meibum, and improve gland expressibility.
The review concluded IPL was “a promising adjunct therapy for patients with moderate-to-severe MGD who fail conventional care”.
Another study, from Photobiomodulation, Photomedicine, and Laser Surgery (2022), explored LLLT. The paper reported that photobiomodulation helped reduce inflammation in periocular tissues and improved tear film stability, suggesting LLRL may provide an additional pathway for patients who do not fully respond to IPL.
And a 2022 multicentre trial in Cornea further backed IPL’s safety profile, reporting no serious adverse events and high patient-reported satisfaction.
Importantly, the authors emphasised the need for appropriate patient selection – something Zheng and others echo strongly in their clinical workflow.
Taken together, the literature increasingly positions IPL and LLLT not as fringe tools but as validated options for treating MGD-related dry eye when first-line management is insufficient.
It’s the reason why many independents have been investing in the technology, alongside the rollout in some of the country’s biggest corporate networks.
Zheng’s practice now uses a large range of dry eye treatment devices, including IPL and radiofrequency (RF) technology, as well as Rexon-Eye, LLLT, BlephEX, and Blephasteam eyelid warming goggles.
They weren’t purchased all at once.
“It’s been a gradual investment over many years,” she says. “We started with Blephasteam, and as the research expanded, we added Rexon-Eye, then upgraded our IPL systems, and brought in radiofrequency and red-light options.”
Many practitioners ask her how she justifies the sheer number of devices.
“To be honest, the business case alone doesn’t make sense for everyone,” she admits.
“These are expensive machines. If you’re looking for a strict return-on-investment calculation, you probably wouldn’t buy all of them.”
So why did she?
“Because I’m purpose-driven,” she says.
“I want every patient who walks through the door to have an option that genuinely helps them. Dry eye varies and one device can’t treat everyone. I never want a patient to feel like we didn’t have the right tool for them.”
One of the biggest barriers for both practitioners and patients remains funding.
“Medicare doesn’t cover any dry eye treatments or IPL at this stage,” Zheng explains. “I’ve heard whispers that a Medicare item number is being explored, but nothing concrete.
“But right now, nobody offering these services can do it without private fees – it just wouldn’t be financially viable.”
She acknowledges this creates challenges for some patients and practices. “I wish Medicare or private health funds contributed. Dry eye impacts quality of life just as much as cataracts or refractive error.”
Her team is transparent from the outset about costs and options, ensuring no patient feels pressured or confused.
Initial hesitancy – both internally and externally – is something Zheng recognises as a key implementation barrier.
“The hardest part of new technology isn’t learning the device,” she says. “It’s integrating it into the practice, getting the team comfortable, and addressing patient questions like ‘Why wasn’t this recommended before?’.”
But over time, outcomes have shifted perceptions.
“Our staff really see the difference now. They see patients come back for reviews with improved glands, less redness, less irritation, which helps build confidence in our approach.”
“We get a lot of appreciation [from patients]. For many people, it’s the first time anyone has explained why they have dry eye and treated the root cause. Even when people don’t get a full resolution, they feel heard and supported.”
Asked what guidance she would give other optometrists exploring IPL, LLLT or other technologies, Zheng pauses for a moment.
“First, understand the disease,” she says. “If you don’t understand dry eye properly, no machine will make you a better clinician.”
Second: start small.
“You don’t need every device. Start with one that aligns with the patients you typically see. Build your protocols and your confidence.”
Then be prepared for change, including educating the practice’s team and its patients, and then integrating technology into the daily workflow.
Finally, she says, don’t underestimate the emotional side.
“For years, I felt like I was pushing uphill. But now the demand is there. Patients are more educated, colleagues are more open-minded, and the research is incredibly strong. It’s worth the journey.
“If one in three of our ageing population has this condition, then having technology on hand isn’t a bonus, instead it’s becoming a necessity.”
She sees a clear future for the profession where every optometrist understands dry eye deeply, and where tools like IPL, LLLT and RF are integrated thoughtfully rather than hesitantly.
“I genuinely believe we’re moving towards that future,” she says. “And the more we embrace the technology and the research, the better care we can offer.”
Technology for everyone
Optometrist Varny Ganesalingam certainly ‘gets it’ and she too is moving her practice into that future.
She’s the manager of the cornea and dry eye team at the Australian College of Optometry (ACO).
“The manager title gave me a bit more admin time to make sure we’re progressing, that we’re up to date with guidelines, and that staff coming into our specialist clinics are properly trained.”
Ganesalingam has long been central to the ACO’s dry eye service, which operates within its broader network of general and specialist clinics.
Her focus is on providing thorough diagnostics, evidence-based management and access to treatments that, in private practice, can be commercially out of reach for many patients.
The ACO recently rebranded its clinical arm as ACO Eye Health, however Ganesalingam says the underlying model hasn’t changed: it is still a public health service built around community access.
“We’ve always had a strong focus on ensuring all parts of our community – including people from disadvantaged backgrounds – have the same access to care,” she says. “That hasn’t changed at all.”
Because of this public-facing role, the patient cohort in ACO’s dry eye clinic differs from those typically seen in private practice. Many face socioeconomic barriers, have complex health needs or are managing multiple comorbidities.
Dry eye itself is handled within a specialist clinic, separate from ACO’s general and disease-specific services.
This means patients who aren’t progressing with standard first-line approaches – often because those clinics are already focused on glaucoma, retina or paediatrics – can be referred for more in-depth assessment.
“We want to make sure patients who need proper dry eye diagnostics and management are given the opportunity to have that addressed properly,” Ganesalingam says.
The ACO recently added LLLT through the Eye-Light system, which also supports IPL via a separate module that the ACO currently does not possess.
Ganesalingam advocated strongly for the LLLT component as ACO’s first step into light-based treatments.
“We went for the low-level light therapy initially because we didn’t want patients we couldn’t treat, purely based on skin type,” she explains.
“IPL is restricted to the first four categories of the Fitzpatrick scale (very fair to light brown/olive skin). We’re a public service – we get everyone under the sun. We needed an option for all skin types.”
LLLT also better suits the ACO’s diverse patient population in terms of comfort and tolerability.
“Low-level light therapy is mask-based and essentially painless,” she says. “IPL still has that little burst of energy on your skin. Dry eye patients tend to include a large subset with mental health concerns, so we wanted something we could wholeheartedly say was gentle.”
She admits she’s still “on a crusade” to eventually purchase the IPL module as well. “Some patients – like those with ocular rosacea – do very well with IPL. It would be great to have the full gamut.”
It’s not for everyone
She says the treatment has slotted into the clinic’s workflow more easily than some expected.
A standard LLLT session runs around 15 minutes, during which patients sit with the mask in place before undergoing meibomian gland expression.
“Our model is a 50-minute consultation whether it’s diagnostics, review or light therapy,” Ganesalingam says.
“But we’ve made it easier by allocating a dedicated procedures day. Wednesday mornings are back-to-back LLLT. It’s much simpler for clinicians, and it means we can book a full four-week protocol in advance.”
Although LLLT is proving popular – and notably more accessible from a cost and comfort perspective – Ganesalingam stresses that not every patient is ideal for the technology.
Patients with severe ocular rosacea, significant inflammatory drivers or complex comorbidities may require different interventions, including therapeutics such as cyclosporine or, when available, IPL.
Ultimately, she says, the goal is to lay out the full range of options clearly.
“People fall into different categories – financially, medically, in terms of how they want to treat their bodies,” she says. “Our job is to help them make an informed decision that’s right for them.”
