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Best Practices | Oct 2016

Cosmetometry: You Already Know a Lot More Than You Think You Know

There are many parallels in aesthetics to the core services optometrist already provide to patients.

Injections, fillers, cosmetics, cosmeceuticals, products, ointments, creams, etc.­—there is a seemingly endless list of aesthetic products and services on the market, so much so that it would be easy to be overwhelmed by information overload. How does the optometrist interested in expanding into aesthetic services even start to understand the volume of offerings, especially if he has no personal experience with beauty products? On the one hand, analysis paralysis could lead to never introducing new services, and what a shame that would be, given that there is tremendous opportunity to grow the practice and serve patients by offering beauty and wellness products and preocedures to complement one’s eye care practice.

After a pause to think about the aesthetics market, it becomes apparent that much of the training that optometrists have prepares them to extend into this area. Who better to educate patients about the skin around their eyes, their eyelids, and the ocular anatomy than eye care practitioners who have spent years studying it? Optometry has spent the past decade in a state of transition into the medical model, wherein the field is looked upon as the primary providers of eye care. Thus, we can and should think about what kinds of services are appropriate for our field to offer to patients so that we are delivering optimal care reflecting the breadth of our training.

The aesthetics market is not as intimidating as it seems at first blush. Much of what leads to success with these services parallels much of what we do on a daily basis—educating patients, listening to their concerns, offering solutions, and generally making them happy.


The size of the health and beauty market is unmistakable. That it is growing by leaps and bounds is obvious. The volume of products in this space, however, should not deter providers interested in offering aesthetics to their patients.

Quite simply, once an optometrist gains market awareness, he or she can use his or her training and expertise to judge the quality of those products and determine how to relate them to patients. I believe it is a matter of confidence more than anything. We know that medical-grade products that have been thoroughly tested and held to a high standard provide the best assurance of quality outcomes; it is a principle we are familiar with in comparing branded and generic topical medications. Once we know that companies like Allergan, Teoxane, and OcuSoft, are producing high-quality cosmetics that have been thoroughly vetted, it becomes easier to talk about their benefits or even to sell them in the practice. Providing products or talking about best practices for caring for the skin around the eyes is not a foreign concept for optometrists if such education is offered under the premise of overall ocular health.

Other aspects of optometric services like lid hygiene lend themselves naturally to discussions about beauty, health, and wellness. Talking to patients about the importance of washing their lids and removing their makeup, as well as how to do it properly and which products to use is a conversation many optometrists already have almost daily. We already know how these practices affect the potential for dry eye disease (DED) and other ocular surface diseases, so it is not a stretch to add information about why good eyelid hygiene and makeup removal can have aesthetic benefits as well.

Speaking with patients about lid hygiene may lead to a conversation about the options for boosting the appearance of the lashes. One option is permanent eyelid tattoos. At least one study showed that patients who get eyelid tattoos may have a much shorter tear breakup time (4.3 seconds versus 11 seconds).1 Granted, this was a small study of 10 patients, but we have some data at the ready with which to educate patients. We can let them know about products like Boost Lash (OcuSoft), which is an over-the-counter but well-tested intensifying serum designed to amplify the appearance of the lashes. Certainly bimatoprost (Latisse; Allergan) offers another approach, albeit one that requires a prescription.

DED is another category where there are natural parallels to our skill set. Many patients attempt to self-medicate for ocular irritation with vasoconstrictors that may work in the short term but that can have dire consequences if used inappropriately. If patients are experiencing red eyes that they perceive as a cosmetic issue, I would argue that we have a duty to evaluate that eye to determine if there is a valid medical cause—DED, ocular allergy, or otherwise—that requires pharmacotherapy or other interventions.


To my thinking, the question about optometry’s potential role in the aesthetics market is not so much a matter of fit but of personal preference. Beyond the educational aspects of informing patients about good ocular health, there is a world of products and procedures that optometrists can discuss with their patients.

Within the integrated care model, many optometrists already spend a great deal of time discussing the cataract, refractive, and surgical glaucoma services that their ophthalmology colleagues can provide. Is it really so different to discuss the work of oculoplastic and cosmetic surgeons in one’s network or to share information about the cosmetic surgeries that ophthalmic surgeons may provide?

Such conversations do not have to be exclusively about elective surgeries. For example, pterygium surgery may be covered by insurance in some cases if the growth is interrupting the visual axis. Similarly, blepharoplasties are excellent for restoring a youthful appearance to the eyelids, but they may be medically indicated if droopy eyelids or other correctable lid issues are having a negative impact on vision.

A similar paradigm exists for some causes of DED. There is a known association between ocular rosacea and meibomian gland dysfunction,2-4 and each is treatable with intense pulsed light therapy. The skin manifestation is easily identifiable in patients being examined at the slit lamp for DED and fluctuating vision, and there may be a treatment benefit for DED if intense pulse light therapy is used for ocular rosacea.5


Beyond the financial motivation for optometrists to offer aesthetic services is the opportunity to be important connectors of patients to valuable information about products and services that help to enhance beauty and that promote wellness. Our field has positioned itself to provide care to patients on a more holistic level, inclusive of topics such as the role of nutrition for ocular health and how patients with diabetes need to be cognizant of their A1C levels. In other words, we are already more comprehensive in the services and education we provide by thinking beyond the eye to benefit eye health. In some ways, cosmetic and aesthetic services are another extension of this principle.

Not every optometrist will be interested in the aesthetics market, and this is perfectly fine. After all, not all optometrists offer contact lenses in their practice. Each and every optometrist has the opportunity to provide health and wellness services and education if we so desire, however, we should not let the seemingly overwhelming volume of products in this market intimidate us when there are so many parallels to the core services many optometrists already provide.

1. Lee YB, Kim JJ, Hyon JY, et al. Eyelid tattooing induces meibomian gland loss and tear film instability. Cornea. 2015;34(7):750-755.

2. Alvarenga LS, Mannis MJ. Ocular rosacea. Ocul Surf. 2005;3:41-58.

3. Vieira AC, Höfling-Lima AL, Mannis MJ. Ocular rosacea­—a review. Arq Bras Oftalmol. 2012;75:363-369.

4. Steinhoff M, Buddenkotte J, Aubert J, et al. Clinical, cellular and molecular aspects in the pathophysiology of rosacea. J Investing Dermatol Symp Proc. 2011;15:2-11.

5. Toyos R, McGill W, Briscoe D. Intense pulsed light treatment for dry eye disease due to meibomian gland dysfunction; a 3-year retrospective study. Photomed Laser Surg. 2015;33(1):41-46.

Walter O. Whitley, OD, MBA, FAAO
Walter O. Whitley, OD, MBA, FAAO
  • director of optometric services, Virginia Eye Consultants, Norfolk, Virginia
  • chief medical editor of AOC
  • (757) 961-2944; wwhitley@vec2020.com
  • financial disclosure: consultant to Allergan and OcuSoft
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