SECO 2025: Insightful discussions on light therapy, ptosis, and the view from behind the slit lamp

Enhancing paraoptometric training: A view behind the slit lamp

Mile Brujic, OD, FAAO, recently delivered a series of courses at SECO, which took place February 26 through March 2, 2025 in Atlanta, Georgia. One of these was focused on paraoptometric education. The goal was to provide support staff with a deeper understanding of what optometrists observe behind the slit lamp—something that is fundamental to patient care but often unseen by assistants.

By offering this behind-the-scenes perspective, the course aimed to improve paraoptometrics' ability to recognize both normal and abnormal ocular conditions. Through extensive video demonstrations, participants were exposed to a wide range of cases, enhancing their ability to distinguish between different pathologies. The session also provided insight into the clinical decision-making process, allowing support staff to understand why certain treatments are chosen. The feedback from attendees was overwhelmingly positive, with many expressing appreciation for the opportunity to expand their knowledge.

Advancements in light therapy for ocular conditions

Brujic also discussed the evolution of light therapy in optometric care. While UV protection has long been a key focus, modern optometry has leveraged light for therapeutic purposes, particularly in treating dry eye and meibomian gland dysfunction. Two primary treatments—low-level light therapy (LLLT) and intense pulsed light (IPL)—are making significant strides in improving patient outcomes.

• Low-Level Light Therapy (LLLT): Patients undergo six 15-minute sessions, spaced one week apart, to improve meibomian gland function and ocular surface health.
• Intense Pulsed Light (IPL) Therapy: This involves four sessions, spaced two weeks apart, and is particularly effective for conditions like ocular rosacea and dry eye syndrome.

While these treatments are proving effective, they come with the challenge of being out-of-pocket expenses for patients. This presents a unique conversation for optometrists, as they must help patients navigate treatment options when insurance coverage is unavailable.

Understanding and managing ptosis

Another key topic Brujic covered was ptosis, a condition characterized by drooping of the upper eyelid. He emphasized the importance of differential diagnosis, as ptosis can sometimes be mistaken for conditions like thyroid eye disease, which can create an illusion of lid asymmetry.

Brujic categorizes ptosis into three levels:

1. Mild: The eyelid is above the midpoint of the iris but below the upper limbus.
2. Moderate: The eyelid covers more than half of the iris but does not encroach upon the pupil.
3. Severe: The eyelid droops to the point of covering part of the pupil, significantly affecting vision.

Beyond cosmetic concerns, ptosis can have functional implications. Patients often compensate by tilting their heads backward, which can lead to postural issues and an increased risk of falls due to a restricted lower visual field.

Treatment options for ptosis

Brujic outlined three main approaches for managing ptosis:

1. Observation: Patients can choose to do nothing if the condition does not interfere with daily life.
2. Pharmacological Treatment: The FDA-approved 0.1% oxymetazoline drop can be used once daily to stimulate Müller’s muscle, lifting the eyelid to a more natural position. However, this treatment is not covered by insurance, requiring patients to pay out-of-pocket.
3. Surgical Intervention: For those seeking a permanent solution, surgery remains a viable option, particularly for more severe cases.

Conclusion

Brujic’s presentation highlighted the importance of ongoing education for both optometrists and paraoptometric staff. By enhancing the knowledge base of support teams, improving access to innovative therapies, and refining patient education strategies, optometrists can continue to elevate the standard of care. The discussions on light therapy and ptosis management underscored the need for tailored treatment approaches, particularly in cases where financial constraints may impact patient decisions.