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Speaker 2 00:00:53 In today's episode, we have the pleasure of speaking with Carly rose OD of iCare on the square in Cincinnati, Ohio, to talk all about blepharitis. Welcome Dr. Rose. Thank you so much. Thank you guys. And thank you for having me. I'm super honored. So I'm a big fan of everything that you do on social media, all your Instagramming or YouTube being. Um, but why don't you tell us a little bit more about your practice and then we'll get into more of those new, exciting things that you're doing a little bit later. So as you mentioned, I have a practice here in Cincinnati called iCare on the square, and it is, you know, it's a, it's a primary care office. So we see all ages. We have full optical, the routine glaucoma workups, but from day one, I basically launched an internal dry eye clinic, which proved to be very challenging right from the get go because my primary location is only 750 square feet.
Speaker 2 00:01:51 So we ran out of room very, very quickly. And that led me to this second business. So I just opened the second location that is exclusively, a dry eye med spa. So how did you develop this OD specialty, um, practice, this separate one? Is this that always been a passion of yours to kind of cross over into the aesthetics realm? No, actually the aesthetics totally took me by surprise. I always knew I wanted to do dry eye. Um, so during residency, I figured out that I liked dry eye a lot more than our colleagues, because we would have whole dry eye days. And my co-residents were basically cursing me all day. And I was like, what? You guys don't think this is the best day ever. So that is actually when I figured out that I had a little thing for it. Um, and so I think I told art Epstein once that I have a crush on dry eye and I just do all things dry eye all the way.
Speaker 2 00:02:48 So what happened is my luminous M 22. I, I, that was not the first piece of equipment I purchased, but it was the first aesthetic combo piece. And when the sales reps were talking to me about the aesthetic benefits, I was just like, yeah, yeah, yeah. Tell me about the dry eye. I don't care about that. And then what happened is I realized there's so much overlap and the eyelids are the skin. So I have to know about the skin. I have to know about cosmetics and products and procedures. And I realized that patients that were also getting the aesthetic benefits were happy patients. And I was very pleasantly surprised to deal with all of these happy patients now. And you just really can't separate them in my opinion, the way I practice. And so it was just a natural progression. And here we are, a dry eye med spa was developed.
Speaker 3 00:03:46 So Carly, you mentioned you chose, you got the M 22 how'd you decide on that for your procedure. And then my next questions gonna be, you mentioned what's the first thing you bought. So when it comes to a dry eye, how, what is the first thing you bought when it came to your dry eye clinic?
Speaker 2 00:04:00 Uh, the first thing I bought was the Lippa scan Lipa flow combo. And that was I, I purchased my practice and about three months later, I purchased the lip scan, Lipa flow. So I, I was not pausing to dive right in. And then the let's see, I think I'm gonna go and order here of purchase. I bought the Lippo scan, Lippa flow, um, InflammaDry new, um, Oculus five M new lids, then the M 22 and then radio frequency. And then I look then firely Venter lab. I think I got them all in order
Speaker 3 00:04:41 Have so many different, uh, treatments in our arm momentum. And that you have all those in your practice. That's awesome. Both with the diagnostic and the treatment component. So today we wanna, we wanna focus mostly on blepharitis because we know when it comes to dry eye. I mean, how many of us got burned? Like a, patient's been on SPO for months and you're like, they're like, why am I so symptomatic? And it's because many times we've been overlooking the lids mm-hmm <affirmative>. So how important is it to differentiate between the various forms of blepharitis? Because we have to take a step back, look at those lids, but can you talk to that?
Speaker 2 00:05:14 Yeah. You know, I don't think I, I, I really do look at it more holistically as basically a, this global ocular surface disease in general. And I feel like it all progressively leads to each other anyway. So I actually treat it very aggressively, right. From the beginning, I jump to procedures very quickly, kind of like dues too, you know, it's, it's that, it's that level two. So I, I really do jump to it right away if they are asymptomatic and very mild, I just talk home therapies and I still mention procedures if and when, so I'm having these pretty deep conversations right from the beginning. Mm-hmm <affirmative> I often tell my patients, I, I do things a little bit differently. I, I know a lot of people will treat in a stepwise approach and, you know, tap, tap one thing on the patient. See if it works, come back a couple months later, try another thing, add another thing. And I do it. I throw everything on them at once that I believe that they need. And then we'll slowly pull things away once I get them comfortable.
Speaker 4 00:06:20 Yeah. So what, what are your go-to treatments for a blepharitis? So if you're seeing that, you know, that crusting either at the base of the eyelash a little further down, what do you, what are you doing in your office that
Speaker 2 00:06:30 I am always having the conversation with hot compress, blink exercise, lid, wash omegas, always every patient, honestly, if they don't have any symptoms at all, I'm having these conversations with them, with the amount of screen time and, uh, medications. We're just having this conversation with everyone. At this point, I tell patients it's like the dental model. This is brushing. And flosing then if you have a problem with this, with these things, then you come back and we do the procedures. And when I'm jumping to procedures, I usually package four IPLS and some type of thermal pulsation type, some type of my Boan gland evacuation if they need it. So I really do throw everything on them. I also will do in office debridement. That's very rare because oftentimes my home therapies and IPL will take care of it, but I have a handful of patients that we still do in office debridement.
Speaker 4 00:07:22 And what, what products are you using for your at Holi hygiene?
Speaker 2 00:07:26 We love eyes oil and foam as flow me away. As long as there's no tea tree oil sensitivity, if there is a tea tree, oil sensitivity, or just, you know, a lot of these patients are so inflamed and can't handle anything, I will do either the story, makeup wipes.
Speaker 4 00:07:43 Okay.
Speaker 3 00:07:45 So, so, so can you tell me more about, we love eyes? I mean, I've heard great things about that product, but I don't have any experience with it. So it does have, uh, teach re oil in it. You mentioned.
Speaker 2 00:07:54 Yeah, it's very diluted. Okay. It is even lower than most of the other commercially available products. Mm-hmm <affirmative> and it's a two step process. So this is how I present it to patients. It's an oil in a foam combo. I usually will have the patient put, wash their hands, put a dropper to of oil on their finger, close their eyes and rub along the lash line in circular motions and then foam, same thing, rub RINs
Speaker 4 00:08:19 Mm-hmm
Speaker 2 00:08:19 <affirmative>, and it's really clean products. And what I also tell patients, great cosmetic remover, there's again, the overlap with the aesthetics and the lid hygiene. It's a great cosmetic remover. And I have found anecdotally that most of my patients come back saying that their lashes are longer and healthier. And so that's another problem. A lot of my patients are talking to me about is this lash growth. They want longer lashes, but almost all of the lash serums available will cause this inflammatory surface disease. So it's a great alternative mm-hmm
Speaker 4 00:08:52 <affirmative> well, when you get that normal load under control, there's nothing, that's keeping the lashes in, in that inflammatory cycle. So yeah, you clean that up and lashes do grow longer. You're
Speaker 2 00:09:01 Right. That's wonderful.
Speaker 3 00:09:03 So what about demodex? Are you using that for demodex or do you have a different protocol for symptomatic demodex patients?
Speaker 2 00:09:09 That is what I'm using for demodex. And then I will also layer on the I P
Speaker 3 00:09:14 OK. Okay. That's so
Speaker 4 00:09:16 What, so what is your protocol for I P I mean, that makes a difference. I think you're gonna ask the same question. <laugh>
Speaker 3 00:09:21 Mm-hmm <affirmative> yeah.
Speaker 4 00:09:23 <laugh>
Speaker 2 00:09:24 Yeah. So I, I kind of mostly follow the pyramid protocol. I do the Toyos Trius to Trius double pass. I do the blend up and down. I do double passes on the upper and lower eyelids, and I will usually put in some vascular cheek pulses.
Speaker 4 00:09:40 Okay.
Speaker 3 00:09:43 So I know you've had patients that came in on baby shampoo. What are your thoughts on baby shampoo and what do you tell the patient and what do you, what do you recommend to our colleagues about that?
Speaker 2 00:09:54 I re I recommend to everyone that will listen to stop using baby shampoo right away. It has fragrances and dies in there that are just not friendly, just because it doesn't burn doesn't mean it's, it's good. Right? We have such better formulations that actually work a lot more effectively. And, um, you know, I really do try all, all of us. Don't like to step on the toes of other providers. I tell patients we're all like chefs that cook steak differently. We all do dry eye differently, but baby shampoo is one that I will never get behind. That is one I will call you out every time there's no excuses for baby shampoo.
Speaker 4 00:10:33 <laugh> the issue, baby shampoo is it's really not any different than any other cleanser that's out there. There's nothing in it. In particular, when you dilute it to the level that you are, that's actually going to kill anything,
Speaker 2 00:10:46 Not effective.
Speaker 4 00:10:47 It's just sodium. Benze, that's, there's nothing that's specifically targeted to the populations that you're trying to get under control. So if you, I tell my patients, you'd probably be any really any soap you'd put on your eye would do the same thing.
Speaker 2 00:11:01 Exactly. And we can do better. We can do better.
Speaker 3 00:11:04 Do you have experience with the okra based pot products?
Speaker 2 00:11:07 I do. I have a handful of patients on those myself. They burned me. They were a lot more aggressive on my skin than the wheel of eyes. And so just, uh, personally I prefer the wheel of eyes. Almost all of my patients are obsessed with it, but I do have a handful of patients. So I do carry the okra based in office. It's just not my top seller. I also have. OK. Yousoft I have a few thi I have some opt taste products. I have quite a few different lid cleansers, but hands down wheel of eyes is the biggie for me.
Speaker 3 00:11:38 So, you know, I, it's funny, I did a lecture, not too long ago. I was talking about the evolution of the treatment of BLE. Um, you know, what are your comments? Cause over the years it's changed before it used to be cleaning up, maybe shampoo, maybe use an antibiotic, maybe a combination, drop it. Now we have so many options that are available to help our patients.
Speaker 2 00:11:58 We do. And I think it's kind of evolving with the whole skincare idea. I think it's a lot slower to evolve than skincare, but it is evolving just like skincare. The more we know, the more we can change. And now we're doing things like two step cleansers and, you know, mutually beneficial ingredients, ingredients that cleanse and nourish and take care of multi, multiple things. So you can put, I like to simplify my patient's lives as much as possible. So if we can get a makeup cleanser and a lash growth and a BLE blepharitis treatment, all in one, that's what I'm gonna do all day long.
Speaker 4 00:12:35 Great. And you can get patients off of their makeup removers that aren't doing them any favors.
Speaker 2 00:12:40 Those exactly. A lot of alcohol. Yes. A lot of alcohol based cleansers that are, were pulling away. Yeah.
Speaker 4 00:12:50 So,
Speaker 3 00:12:50 Um, all right. So, so, so being a guy and I'm gonna speak for a lot of our colleagues that are male is, you know, we hear a lot of, uh, lot of talk about, you know, stay away from this, stay away from that. Most of us are not gonna look up to say, what are the different ingredients? So can you just give us a few that we should, that we could recommend to our patients that are not seeing endorse anything in particular? So name like 12 or three
Speaker 2 00:13:14 Of like, of, of, of products of products. Yeah. Okay. So basically what are some buzzwords you men could use to talk to the, your patients that do these
Speaker 3 00:13:23 Cosmetic? That's what I,
Speaker 2 00:13:24 Okay. Got it. Got it. Okay. So you are definitely gonna want to do we love eyes and they know that there are fragile men out there. And so they actually have, we love eyes that are branded for men. It's the exact same product, but they're branded for men. So you can talk about that. But if you're talking to your female patients, you're going to want to avoid waterproof mascara, um, lash, extensions, you are gonna want to avoid, um, gliters in the eye shadows. If, if you have a dry eye patient, a cream based eye shadow is gonna be better than a powder eye shadow. Um, retinols can migrate. So stay quite far away from the eye. What else? No liner tattoos, no liner on the waterline. These are some biggies. I'm trying to think. Tracy, do you have any others? I know I'm gonna,
Speaker 3 00:14:14 I know she
Speaker 4 00:14:15 Does from a, yeah. From a, from a standpoint when I'm talking to men and, uh, they do care about their appearance. Just, it just takes a little bit of chatting with them. Um, I had a gentleman last week who was actually, he asked me point blank about his eyelash growth. He said, will my eyelashes grow back? Because everyone used to tell me that I had amazing eyelashes <laugh> I
Speaker 2 00:14:36 Didn't, oh, that's amazing.
Speaker 4 00:14:37 Every everybody cares. And this is not a personality. And we were talking like, this is a, this is your sports guy. I mean, like, while you, you would hang out with this guy, um,
Speaker 2 00:14:45 You know, it, you know, go
Speaker 4 00:14:46 About his eyelashes
Speaker 2 00:14:48 In that same vein. A lot of my male patients are very concerned with the cosmesis. They don't want the redness. And with this new, with this new med spa, I'm creating, I'm going to a lot of aesthetic conferences. And the men in the aesthetic world are about to tenfold. So it is no longer a woman's industry.
Speaker 4 00:15:08 So particularly for, for patients when I have my male patients and I tell them to avoid, and they do have very male specific, um, facial products. So the retinol is a big one. There are a lot products targeted towards men that have eye creams that have retinol in them. So I tell them to, you know, avoid those. Um, I have a line of sports sunscreens that I will tend to recommend. Um, and it's was that one that I liked I'll think of it in a, it was called SIS, actually, Dr. Lord Perryman turned me onto that. It's a spray, it's a good sports one. So that's one, that's nice. That's cleaner. Um, and they do love the okra based products that I, that, that I have in office. Um, especially foams, cleansers are really great. Anything they can use in the shower is really helpful. But in terms of things to stay away from the retinol creams are probably the biggest one that I noticed that men will have, um, in, and when I tell them to bring in whatever they're using, a lot of them will have it and not even realize it mm-hmm
Speaker 3 00:16:03 <affirmative>. Yeah.
Speaker 4 00:16:05 Does that help you answer your question? Well,
Speaker 3 00:16:07 That does help. So I thank you both. Cause I found, we just started talking like, this is the best time to ask you
Speaker 2 00:16:12 Both <laugh>
Speaker 4 00:16:13 No, they, they do care if you ask, they will absolutely tell you <laugh>.
Speaker 2 00:16:17 Yeah. I can't tell you how many. I actually chose a very masculine aesthetic in my med spa for this exact same reason. And I cannot tell you how many of my male reps have come in and stopped and said, I think I'm gonna have to come see you soon. I think I'm ready for a little it's called bro talk. I think I'm ready for a little bro. Talk. It's it's it's a thing it's here. It's here to stay.
Speaker 3 00:16:39 Yeah. Yeah, exactly. So, uh, Carly, you mentioned new lids and that's something that you've utilized for the, at home, uh, micro, micro bluffer, exfoliation, how's that been going for you and your practice? I mean, we've discussed in previous podcast, the results of those, but what are your thoughts on that? And how's it working for your patients?
Speaker 2 00:16:57 You know, it, it's kind of hot and cold. It's only right. For certain patients. A lot of patients are a little bit uncomfortable with the idea of it for whatever reason and that's fair and I don't actually push it. And like I said, most of the time, these procedures, the at home therapies and the in-office procedures take care of it, but for the patients that want it, it's a great option. So I like, I, you know, I've just listed everything I have. I like to have everything available if the patient wants it. I don't push it on anyone though. It's a little bit outside of some patient's comfort zones.
Speaker 3 00:17:28 Mm-hmm <affirmative> Tracy, do you have anything to add on that?
Speaker 4 00:17:32 Um, as far as
Speaker 3 00:17:34 At home treatments, cause I'm just gonna complete compliance issues, but go ahead.
Speaker 4 00:17:39 Um, <affirmative> um, so part of my education to my patients about at home therapies is that if you would like to see me less, and I know I'm fun, but if you would like <laugh>, if you, and if you would like to maximize your pocketbook, then you probably ought to be doing the at home therapies because not only does it help you feel better, it actually can extend the time in between the in office treatments that we're gonna have to repeat. So if you do at home, the less I have to do here, it's again, we go back to the dental mall. It's like flossing your teeth.
Speaker 2 00:18:13 Yeah. You know, my, my one liner for that is protect your investment. And that's actually the same in skincare. You know, if you get all of these procedures, you've gotta be wearing your sunscreen and you've gotta be drinking water and getting eight hours of sleep, like protect your investment. This is, this is the root cause of all of it.
Speaker 3 00:18:32 Did you say eight hours of sleep? I've never heard of symptom.
Speaker 2 00:18:35 <laugh> do what I say and not what I do. Right.
Speaker 4 00:18:38 <laugh>,
Speaker 3 00:18:40 You know, for me, you know, getting to the blepharitis and the treatments, you know, you mentioned if they're symptomatic, you know, you're gonna say, Hey, these are the procedures that we do. And you know, those are, I, I definitely agree on that, but you know, the, the presentation, the amount, if patients have two plus, you know, pleuritis or scarf or whatever you wanna call it, you can prescribe that lid scrubs. But when they come back for a follow up in two and three weeks, it looks exactly the same. And so typically if I see, you know, the two plus or more, I'm going straight to it in office procedure, because that's the only way to effectively get rid of that.
Speaker 2 00:19:13 Exactly
Speaker 4 00:19:15 True. Um, unless you show them a picture of the might, in which case that'll <laugh>
Speaker 3 00:19:21 Or the video of the moving might into the fall.
Speaker 4 00:19:24 I also tell them that if they put the time in ahead of time that this will make their procedure much more effective. So you get anybody to do anything for a month. It's a habit. So,
Speaker 3 00:19:34 Yeah. So, so Carly, what are some of the future treatments for bluff rise? What do you, what have you heard? What have you seen in the horizon here?
Speaker 2 00:19:41 You know, I think one thing we're gonna really go hard into is at home light therapies like tos Q and different L E D therapies at home mm-hmm <affirmative>. Um, I also think as the years go on and I know some of our colleagues are Al already digging pretty deep into this, but I think we're gonna look at the gut microbiome a lot more. And I think if we understand the gut and nutrition and you autoimmune conditions and food sensitivities, I think that that's truly gonna root cause it even further, and we're gonna know a whole heck of a lot more
Speaker 4 00:20:17 Targeting the root cause. Sounds important. Um, any hands on the new drop that's in the pipeline, the TPO three by Tarsis
Speaker 2 00:20:25 I am watching very curiously.
Speaker 4 00:20:32 What about you all? What are you gonna do? <laugh>
Speaker 3 00:20:35 About that? Oh, I'm excited. I'm excited, you know, you know, financial disclosure I've been working with them for, for a while. So I've spent a lot of, lot of the early data on there. And so, you know, if we can eradicate it with, you know, seeing a patients using it twice a day, you know, for six weeks and you know, some data was at four weeks, but utilizing that, that, uh, that drop, there was no lid scrubs involved, but it occurred and eradicated, uh, the mights. And so it's is, it's something that, you know, likely their patient's gonna need co to use couple times a year. Uh, but that's what from the, the early data that, that, uh, that I've seen, it'll be exciting.
Speaker 2 00:21:12 Very, it's an exciting field.
Speaker 4 00:21:15 It won't your makeup though, so that's always gonna still have a place and right. Well, thank you, Carly so much for your insight and everything that you know about blepharitis and talking to us about your aesthetics practice and congratulations on that again. Um, anything else to add Walt before we close out?
Speaker 2 00:21:37 You know, I just think it's a really exciting field. I'm, I'm so honored to be in the dry eye world because it is so rapidly changing and we're constantly having new technologies and medications and, and honestly the diagnostic piece, knowing where it's all coming from is insane. Trying to keep up with it all. So I, I know that I like staying fresh on and I'm being challenged every day. Right. So it's a, it's a cool field to be in.
Speaker 3 00:22:03 Well, Hey, thank you so much again, Carly for your time. And look forward to speaking with you again soon.
Speaker 2 00:22:08 Ye no, thanks guys. Thanks for having me. This was awesome.
Speaker 4 00:22:11 Thanks for listening. Join us for our next episode. Soon
Speaker 5 00:22:14 For over 18 years, ICO has been an industry leader of natural effective at home dry eye management. We support you and your patients with scientifically proven products for mild, moderate, and severe dry eye. Join us
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