Category: Marco Blog

Blepharitis: With So Many In-Office Procedures, How Do I Determine Which is Best?

By Dr. Paul Karpecki

Blepharitis, including meibomian gland dysfunction (MGD), affects over 35 million people and that number underestimates the true population who suffer from this condition.  While most patients are treated with artificial tears and eyelid hygiene, I’ve found that in-office procedures can be more effective in moderate to severe cases.  With a plethora of options from microblepharoexfoliation to thermal pulsation to photobiomodulation, what’s the best choice to bring the most relief to patients?

Anterior Blepharitis

The decision of how to treat anterior blepharitis patients depends a lot on what you see clinically.  There are three types of blepharitis one can diagnose and different treatment options for each: demuxed blepharitis, staphylococcal blepharitis, and seborrheic forms.  While microblepharoexfoliation (MBE) or Blephex might work in all three cases, they are most effective in seborrheic and bacterial forms like staphylococcal blepharitis.  Additionally, LLLT treatment with the blue-light mask can positively affect bacterial blepharitis.  In my experience, the most effective options for demodex blepharitis are blue-light Low Level Light Therapy (LLLT) and Intense Pulsed Light (IPL).   Blue LLLT alone will work but there is an enhanced effect when combining it with IPL.  This can even be followed by microblepharoexfoliation (MBE) to de-bulk the collarettes.  In my experience, MBE does not kill demodex like blue light LLLT with IPL, but it helps remove the remaining collarettes and debris.  If you do not have access to MBE, you can use lid scrubs – preferably one with Manuka extract – after the LLLT procedure.

Posterior Blepharitis/MGD

The more difficult decision may come from the multitude of treatments for posterior blepharitis that range from thermal pulsation to IPL and LLLT.  Fortunately, that decision can be made based on the pathology.  For example, a patient with easy meibomian gland expression, but paste-like or turbid meibum, can do well with thermal pulsation or red-light LLLT.  A patient with ocular rosacea, often identified via telangiectatic vessels on the lid margin, will do better with IPL.  Likewise, patients with no visible meibomian gland expression diagnostically seem to do better with IPL followed by red-light LLLT.


I haven’t had a lot of success with using IPL for chalazion in my practice, but I have had positive outcomes with red-light LLLT.  Likewise, hordeola responds very well to LLLT treatments with the red-light mask.

With so many options for in-office treatment of blepharitis, it helps to look closely at the specific pathology and then customize the treatment.  For the majority of conditions LLLT is most versatile, but combining IPL with LLLT can be extremely effective as can MGE with an LLLT for anterior blepharitis.

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The Right Exam Lane Technology Can Make The Day Easier – And More Fun – An Article From Women in Optometry

Original Article Published in Women in Optometry

Karen Wrigley, OD, with two practices, Wrigley Eye Associates and Visual Eyes, in the Philadelphia, Pennsylvania, area, has always tried to keep her practices updated with the latest technology. Yet when she brought in new exam lane equipment from Marco recently, she was impressed by not only how it sped up the refraction and exam process but also by how much patients are enjoying the experience.

Dr. Wrigley originally added an OPD-Scan III, and a Marco TRS automated refraction system to one of her two exam lanes in each office. She added a second TRS and a new slit lamp with the ION camera in June of this year. In the pretest area, technicians can capture wavefront aberrometry, topography and keratometry, among other features, with the OPD-Scan III. This data provides the doctors with more information about the surface of the patient’s eye before they are even in the exam room, which is particularly helpful with specialty lens fittings. Now, those patients with complex fitting needs can receive even more customized contact lens prescription, helping them see and feel better. The updated slit lamp has also allowed for a more precise patient examination.


Dr. Wrigley’s office serves as an internship site, and she says that while the manual phoropter provided interns a good learning experience, it was outdated and more difficult. It’s ergonomically stressful for the user, and the process can be stressful for the patients.

“If we’re going to update our technology, let’s wow our patients,” Dr. Wrigley says. The new slit lamps have updated camera software so that Dr. Wrigley and her team can show patients their images right there in the exam room. Plus, the new TRS technology lets doctors use a tabletop console to sit a distance back from the patient, supporting social distancing, which puts both parties more at ease.

The TRS and OPD systems in her two offices have created more efficiency while allowing the doctors to provide even better care to their patients. Dr. Wrigley has been able to minimize downtime in exam lanes, thanks to the updated technology in her offices. She or her technicians can complete the refraction faster, and she gains the measurements she needs accurately.

Leveraging her Vision Source member benefits, Marco brings doctors the “best bang for their buck” on upfront costs, lease programs and technical support, she says. Marco’s support is stellar; technician assistants will fix equipment on-site or remotely, which has also helped save the practice time and avoid downtime as, in many cases, they no longer have to ship equipment out for repairs or updates. She also appreciates that her representative is just a phone call away for pricing, advice, support and tech questions.

Dr. Wrigley has seen a positive return on investment and the intangible benefit of happier customers with the Marco systems. “Our vision statement at the practice is helping patients see well and look great. The new technology has helped us achieve this,” Dr. Wrigley says. “My goal is to always keep up and push forward.” She says her patients have even noticed the office updates. Those who have jumped to another practice for their eye care often come back to her because “they know we keep up with the latest and greatest in the industry,” she says. “It is so nice that they see what I’m trying to provide for them.”

Dr. Wrigley has been able to prioritize the best care for her patients without it burdening her team or herself; in fact, it actually makes her days easier.

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Blepharitis, Dermatitis and Modern-Day Management

By Dr. Paul Karpecki

Blepharitis is one of the most common conditions eye care practitioners (ECPs) diagnose and yet it is one of the most under-diagnosed conditions! The reason is that blepharitis isn’t usually diagnosed until it is severe, which involves loss of meibomian glands, thinned lashes, advanced erythema, lid edema, and dry eye disease. The fact is that blepharitis, inflammation of the eyelids, begins years or decades prior and only subtle signs exist. Recent research has shown significant bacteria to be present within the follicles of lashes (where you can’t observe) or surrounding the base or in the meibomian glands or lash follicle orifices. Clinicians must look for blepharitis sooner, such as for debris at the base of the lashes; as the lashes grow out, they may include discharge to collarettes. I suggest that ECPs have their patient look down at the slit lamp and scan the upper lash margin for collarettes. Early diagnosis is key to preventing future chronic issues and permanent tissue loss.

While commercial lid scrubs and hydrating compresses are helpful and recommended, additional treatments are necessary. Think of the dental model: the dentist (or more likely the dental hygienist) performs in-office cleaning and various procedural options, but you still brush and floss your teeth at home. Likewise you should see your ECP for in-office procedures and use lid scrubs and hydrating compresses at home.

In office treatments include micro-blepharoexfoliation (MBE) and photobiomodulation such as intense pulsed light (IPL) and low level light therapies (LLLT). We typically combine these treatments. The photobiomodulation kills the microorganism and the mechanical treatment removes debris, residual bio-film, and in the case of demodex, mites and eggs. Advantages of LLLT/IPL include killing the organ-isms as opposed to simply removing them (like MBE). Some disadvantages of tea tree include potential toxicity and damage to meibomian glands, as well as patient discomfort in higher concentrations. Lower concentrations work on milder presentations but may not affect a severe blepharitis presentation. Anti-biotic drops or ointments as well as surfactant-based cleaners will work for bacterial blepharitis but not demodex.

LLLT is a particularly helpful technology for blepharitis. In my experience, we’ve seen dramatic improvement in all forms of blepharitis including bacterial and demodex – especially when combined with IPL. In infectious cases we use the blue LLLT mask, which has particularly good anti-microbial effects, followed by the red LLLT.

Blepharitis is common and needs to be diagnosed early and treated aggressively the moment the first signs of disease are present. Combining at home treatment with in-office procedures appears to best address infection and dermatological forms of blepharitis

1. Nattis A, Perry HD, Rosenberg ED et al. Influence of bacterial burden on meibomian gland dysfunc-tion and ocular surface disease. Clin Ophthalmol. 2019 Jul 12;13:1225-1234.

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[Webinar Recording] Qualifying Your Patients For Premium IOLs – Not Everyone Is A Candidate

Not every patient is an ideal candidate for premium IOLs. During this webinar, expert Mayah Bowen discusses the information needed to qualify your patients for these lenses as well as how the OPD-Scan III can be used to verify each patient, helping to improve outcomes and reduce post-op complaints.

Topics include:

  • The importance of Angle Alpha
  • The limits of corneal coma
  • Does pupil size matter?
  • Post-op complaints (tilted and decentered IOLs)
  • And More!

Watch the entire webinar below:

Request more information about the OPD-Scan III from Marco →

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Advancing Eyecare Announces Acquisition of Santinelli International

Jacksonville, Florida, January 5, 2022 – Advancing Eyecare, North America’s leading provider of ophthalmic instruments and portfolio company of Atlantic Street Capital (ASC), announced today the acquisition of Santinelli International, a respected leader and award-winning provider of optical finishing equipment.

Advancing Eyecare is currently comprised of Lombart Instrument, Marco Ophthalmic, INNOVA Medical, S4Optik, Santinelli International and other leading brands. Founded in 1973, Santinelli International is the leading provider of lens edging equipment in the United States. The combined scope of Advancing Eyecare offers the broadest product portfolio, the most knowledgeable people, and the most reliable service in the industry.

Brad Staley, Chief Executive Officer of Advancing Eyecare, said, “As we continually anticipate ways to help ophthalmic practices thrive, the addition of Santinelli International is a natural fit. Santinelli International is a respected leader and well-recognized provider of optical finishing equipment in the U.S. In fact, they have won 13 consecutive Vision Monday EyeVote Readers’ Choice awards as favorites in the in‐office lab equipment, finishing equipment, and overall optical equipment categories. Santinelli International’s strong reputation for top-quality products and their commitment to after-sale service and customer satisfaction have contributed to their dominant market share in this space. We recognize the expertise this brings to Advancing Eyecare, and it introduces a new line of prestigious products and services to be made available to our customers.”

Gerard Santinelli, CEO of Santinelli International, commented, “This represents a tremendous opportunity for our customers, our valuable employees, and the Santinelli International brand. It is a testament to our proud heritage as we join this group of best-in-class solutions providers. Santinelli International has served the market for nearly 50 years and is a cultural and professional fit to Advancing Eyecare. We are thrilled to add our edgers, blockers, tracers, consumables and accessories to the Advancing Eyecare portfolio of products.”
Visit for more information.

About Advancing Eyecare

Advancing Eyecare™ is the leading provider in the eyecare instrumentation marketplace established to offer the best products and service solutions in the ophthalmic equipment industry. Currently comprised of Lombart Instrument, Marco Ophthalmic, INNOVA Medical, S4Optik, Santinelli International, and other leading brands, the combined scope of the organization has the broadest product portfolio, the most knowledgeable people, and the most reliable service in the industry.

About Santinelli International

Founded in 1973, Santinelli International is a leading distributor of optical finishing equipment in the United States. The company also provides thousands of supplies to eyecare practitioners through Sios Optical, their optical supply and accessories division. Santinelli International is headquartered in Hauppauge, New York. For more information, go to and

About Atlantic Street Capital

ASC is a private equity firm that invests in lower middle market companies poised for the next level of growth. The firm targets entrepreneurial management partners and fundamentally sound companies between $4 million and $25 million of EBITDA that will benefit from capital investment and ASC’s value-added strategic and operational support. As a result, ASC works closely with management to unlock their business’ underlying value and help them succeed. For more information


Media Contact:
Chris Tofalli
Chris Tofalli Public Relations, LLC

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Post-Pandemic Safety Concerns Prompted Purchases That Have Yielded Far More Benefits – An Article From Women in Optometry

Original Article Published in Women in Optometry

Like every doctor who purchased a practice in mid-2019, Nyssa d’Hedouville, OD, could not have anticipated that just seven months in the future, the COVID-19 pandemic would force her to close Mashpee Vision Care, the Mashpee, Massachusetts practice she acquired, for two-and-a-half months. But she sees some positive developments that came out of that time. “I updated every area of the practice while we were closed to routine patient care,” she says.

While the practice did have a visual field analyzer and older optical coherence tomography equipment, she wanted a higher-tech experience for her patients.

She added Marco diagnostic and lane equipment, include the TRS 6100 automated refraction system, the OPD-Scan III and iON imaging system. The advanced technology has been a benefit in a number of ways.

First, it has sped up the time it takes to get an accurate refraction. “The technician measures the patient’s current eyewear in the lensmeter and performs an OPD scan. That is all uploaded into the TRS when I come into the exam room,” she says. Patients love not being asked the old “1 or 2” question, and she sees an immense benefit to being able to toggle back and forth between their previous prescription and the new one. “Patients are much more likely to purchase new eyeglasses if they understand what the difference in their vision is going to be. It’s much faster than dialing the prescriptions in and going back and forth,” she says.

The simulator that generates a depiction of the patient’s visual acuity is great for patients – and parents of young patients. “I had a young man who came in with his father. The patient had been diagnosed with keratoconus and could not achieve clear vision with eyewear. I was able to use the simulator to show his father how higher order aberrations made his son’s vision so poor. Suddenly, the father understood why getting the son fit with specialty contact lenses became imperative. Because I had those measurements ahead of time, I could save time, instead of repeating what had happened so often before when doctors were unable to get him seeing clearly with eyeglasses.” Similarly, that strategy works well for parents of young children, too.

Best of all, she can conduct her exam with just as much personal attention – but at a great distance with the TRS and iON. “I’m able to sit further away than I could during earlier slit lamp examinations. Plus, it’s great for patient education,” she says. She can share the images with the patient and explain what she’s looking at, whether that’s blepharitis, dry eye, nevi or lid lesions. “It’s so much easier for the patient to understand what we can see when they look at the image. It helps show the value of what we do, especially when we can use the first day’s measures as a baseline and then show them the effectiveness of the treatment.”

Just as important as the physical distance – the feature that most attracted her when she was able to start welcoming patients back into the office – is the patient education aspect. The result is increased face time, where she’s talking directly to the patient about a refractive or ocular health issue.

The diagnostic instruments also provide her with a better idea of what she’s facing. For example, the patient may have said nothing about dry eye symptoms, but the OPD-Scan III data indicates that the patient might have dry eye. “So often, when I tease out whether the patients have symptoms, they tell me that they do, but they did not think it was significant or that I could do anything about it.”

Finally, the data from the TRS is uploaded directly into her electronic medical record, which means she doesn’t have to worry about transposition errors.

As these benefits revealed themselves, they reinforced the value of bringing this equipment it. “As business owners, we’re always worried about our return on investments. But rather than ask whether it’s something you can afford, take a look at how it can affect your practice. For me, this technology has halved the amount of time I need to do a refractive exam. My technician has already gathered good data, and I can finish that portion of the exam more quickly. The patient can see whether the new eyewear would help, so it has resulted in more sales and a higher capture rate,” she says.

“I got it because I was worried that I wasn’t going to be able to open without having this technology. But now I enjoy it for all the other benefits it brings.”

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Understanding Photobiomodulation Therapy

Original Article Published on Modern Optometry

A new energy-based treatment for inflammatory eyelid disease is available.

Like many modern optometrists, I do not subscribe to the traditional classification of blepharitis (ie, anterior vs posterior blepharitis). In fact, I prefer to use the term inflammatory eyelid disease because I think it describes the condition more accurately.

More important than how we choose to classify or describe blepharitis is how we treat it. Optometrists now have two types of biostimulation devices to choose from when delivering photobiomodulation therapy (PBMT) to patients with inflammatory eyelid disease: intense pulsed light (IPL) and low-level light therapy (LLLT).

IPL is an energy-based technology that has been used for several years, especially in dermatology, and has recently been shown to be safe and effective for treating patients with meibomian gland dysfunction and reducing symptoms of dry eye disease.1 LLLT, on the other hand, despite having been around for more than 50 years, has only recently become available as an office-based device. Because IPL therapy has been covered in numerous articles and videos, the remainder of this article focuses solely on LLLT, a form of PBMT.

Read the full article by Craig Thomas, OD here.

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Two Equipment Additions Provide OD With Efficiencies, More Data And Patient Wow Factor

Original Article Published in Women in Optometry

After being shut down for two months at the start of the COVID-19 pandemic, Melissa Richard, OD, wanted to make some changes at Spectrum Vision Care in Chalfont, Pennsylvania, the practice she opened in March 2016.

Her first step was to furnish a second exam lane, which would allow her to bring on a second contact lens specialist one afternoon a week to help accommodate the growing patient load. She had her eyes on the Marco TRS automated refraction system, and the built-in social distancing features made it an obvious fit.

She moved her manual phoropter to her new second lane, but the Marco lane is by far her preferred exam room. “I use that second room more for medical services and consults,” she says. She wanted Marco anyway because that was the system she used in her previous setting and was already “sold” on its quality and benefits, “and it’ made a lot of sense coming back after COVID-19,” she says. “It’s faster, and I can hit one button that allows patients to compare what today’s prescription looks like compared to what their current prescription is. It’s been really great for sales of eyeglasses,” she says. Without having to dial in the changes and have patients try to compare those, “this feature provides an instant ‘oh wow’ from my patients,” she says.

However, the added benefit of being able to conduct this refraction process from a distance made her and her patients feel much more comfortable. “I can operate the TRS from six feet away, and patients love that.”


At the same time that she was making these changes in the summer of 2021, she also added the Phoenix Meibography Station from Marco. The unit has a topography workstation, and she wanted a topographer to help provide additional clinical data to her contact lens specialist. But she quickly realized that the Phoenix would help her with the dry eye patient management, too. “I remember thinking that the Phoenix dry eye module would be great once I could start my dry eye patients back,” she says.

The Phoenix provides her with a dynamic view of non-invasive tear film break-up time with tear meniscus height imaging and measurement. She can image the tear film dynamics as a video, too.

Dr. Richard began to realize how much more prevalent dry eye signs and symptoms were once she started screening all of her patients with the neurolens lifestyle questionnaire. “There’s a question on dry eye in there, and if dry eye is a patient’s primary issue, we will bring that patient back in for dry eye testing,” she says.

“Patients don’t always tell me about their dry eye symptoms unless we specifically ask,” she says. The lifestyle questionnaire has them grade their dry eye signs on a scale of 1 to 5. “If it’s a 3, 4 or 5, I’d call that significant,” she says.

As a result, she’s seeing about a three-fold increase in Meibomian gland dysfunction and blepharitis, much of it due to increased screen time and mask-wearing, as well as more chalazion and stye. “We’re able to do infrared meibography and start addressing tear volume,” she says.

She shares the report from the Phoenix, which “validates for the patient what they’re feeling and helps monitor improvement,” she says. It also helps improve compliance and patients’ willingness to return when they can see objective improvement that coincides with how much better they’re feeling.


Dr. Richard says that her Marco technology has added efficiency to her practice. The Phoenix Meibography Station with a topography workstation is in the pretesting area while the TRS is in the exam lane. Because the TRS is linked to her practice management system, there are fewer transcription errors and fast transmission of the results to whomever needs them. “Patients are impressed with the technology. I’d say that the TRS 6100 is the patient favorite,” she says.

That could be because nearly every patient interacts with it, unlike advanced equipment used to detect and monitor ocular diseases. Plus, patients love that they can skip the “1 or 2” questions that adds stress for so many.

Dr. Richard became a Vision Source® member when she opened, noting that the buying power helped her stretch her opening budget.

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Marco Ophthalmic and HOYA Vision Care Announce Collaborative Program to Provide Greater Benefits to ECPs

Jacksonville, Florida, October 4, 2021 – Marco Ophthalmic, a leading ophthalmic technology company, is collaborating with HOYA Vision Care, a global leader in lens technology. The two companies will work together to provide customized offers that are tailored to the needs of each independent eye care practitioner.  

For over 50 years, Marco has specialized in practice management, patient throughput, and productivity by leveraging their full suite of automated refractive and diagnostic devices, classical lane equipment and dry eye solutions.

HOYA Vision Care is a global leader in lens technology with a presence in over 50 countries. They provide proven expertise in lens designs and freeform surfacing technology combined with leading high performance, quality AR coatings. HOYA also offers best-in-class programs to meet the specific needs of the independent eye care practitioner, including the Visionary Alliance™ loyalty program, the HOYA Hub, and the HOYA Learning Center.

Through this program, eye care practitioners will receive complete complimentary consultations in both the technology and lens spaces, program discounts, and unparalleled support from both Marco and HOYA Vision Care. Jocelyn Hamilton, Head of Sales and Vice President/General Manager for Marco Ophthalmic, commented, “After observing the evolution of the rapidly-changing eyecare industry, we wanted to offer independent eye care practitioners a ‘total solutions’ option. By partnering with HOYA, we are able to create customized, tailored offers and loyalty programs at specialty pricing, further inspiring growth for our customers.”

Patrick McCarthy, HOYA Vice President of Sales for Independent Eye Care commented, “We are very happy to work with key partner Marco Ophthalmic to bring unique solutions designed to support our customers’ needs. Their expertise and strength in equipment and solutions to drive the patient exam is the perfect match for our lens solutions for the best possible vision for the patient.”

To contact Marco to learn more about what this unique program can bring to your practice, click here.

To find out more about HOYA Vision Care, click here.


About Marco 
As the Leader in Vision Diagnostics®, Marco continues to revolutionize the ophthalmic industry with a full suite of automated refractive and diagnostic devices as well as a broad range of high-end classic exam lane equipment. Marco is a member of the Advancing Eyecare Alliance. Visit for more information.

About HOYA
Founded in 1941 in Tokyo, Japan, HOYA is a global technology and med-tech company, and a leading supplier of innovative high-tech and medical products. HOYA is active in the fields of healthcare and information technology, providing eyeglasses, medical endoscopes, intraocular lenses, optical lenses, as well as key components for semiconductor devices, LCD panels and HDDs. With over 150 offices and subsidiaries worldwide, HOYA currently employs a multinational workforce of 37,000 people. For more information, please visit

About HOYA Vision Care
For over 60 years, HOYA Vision Care has been a global leader in the eyeglass lens business. With a presence in over 50 countries, HOYA Vision Care has a proven expertise in lens designs and freeform surfacing technology combined with a leading position in high performance, quality AR coating. HOYA Vision Care’s solid market portfolio includes VISION EASE, SEIKO and PENTAX optical lenses, as well as innovative products such as Yuniku, the world’s first vision-centric, 3D tailored eyewear. The company employs over 16,000 employees worldwide with mass production facilities in Asia & Europe and over 40 local Rx laboratories globally. For more information, please visit

Contact HOYA:  Mike Hanbridge | HOYA Vision Care, North America |

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