A New Energy option - Plasma Pens and Dry Eye Disease!

What is Jett Plasma therapy, and would it help dry eyes?

Jett Plasma Medical (or JPM) is a direct current-mediated medical device that uses the “4th state of matter” to provide highly targeted treatment of skin and mucous membranes. Developed in Europe and now used by some practices around the world, I am excited to announce being chosen as the first practitioner in the USA to acquire this novel device.  While I’ve had it “under my wing” since May of 2024, it has taken approximately 5 months for me to feel comfortable with the device and its uses as they apply to a number of my dry eye patients. Currently, treating dry eye disease is recognized as an “off label” use as it has not been evaluated for this purpose by the FDA yet in this country.

 Plasma is recognized as the 4th state of matter, since there are solids, liquids, gases and then plasma. Using Radio Frequency energy, it is possible to create a plasma (in simple terms, an electrically charged ion cloud) from the gases in our atmosphere. These “ion clouds” contain electrons, which can flow into and out of the ion cloud, with predictable precision. I should note that there have been many machines marketed as plasma energy devices in the USA, which have been available for some years (and largely used in the aesthetic side of medicine). Combining certain gases and alternating currents can provide much higher levels of plasma energy, but in my research, the Jett Plasma Pen with its direct current technology is uniquely suited to treatment around delicate eye and eyelid areas with its unidirectional energy flow.

In several of my posts, I’ve detailed how “ion channels” are gateways into and out of cells responsible for making tears (among every other cellular function in our bodies). Electrons from the plasma can spin off and create more of these ion channels in an event called “electroporation.” These tiny “pores” are then gateways allowing passage of the ion “tokens” to activate various cellular functions. In low power delivery, this can have the ability to “recharge” the cells, reinvigorating them. Laboratories have used this technology for years to alter the states of cell cultures to tweak them into revealing cellular secrets and to change them in ways that can benefit humanity. When the power is intensified, it can reliably take out weak and dead cells or be used in a more surgical way to penetrate, cut, cauterize and behave like a precision scalpel. Medications like steroids may be in a better position to enter tissues when applied during a treatment. Activating the mucin-producing goblet cells, plasma helps them deliver their mucous during a treatment!

 Add to the repertoire of this plasma energy, the electrical stimulation of muscles and nerves. Electricity is the common activator throughout our bodies and this plasma application can equally stimulate them. Patients report a feeling like a “TENS” unit (an electrical device used to stimulate nerves and muscles to reduce pain). This can also create a “tingling” sensation around dental fillings and metal implants. Like other RF devices, we don’t apply this energy to patients with pacemakers or other implanted electrical devices that cannot be safely turned off during a treatment. A benefit of activating muscles in the lid is that this can facilitate the emptying of the Meibomian Glands – as well as encouraging and strengthening those muscles.  In a common aesthetic application, this muscle strengthening adds some natural “filling” of the tissues, which can add “air into the balloon” that is our face. Stimulating the skin, while strengthening (and “bulking up”) the underlying muscles - can result in smoother, younger-looking skin and facial features.

 In my clinical practice, this has augmented the abilities I have to treat my dry eye patients. Specifically, some lid margins develop “capping” over the openings to the oil producing Meibomian Glands, and this technology has helped me to sequentially “scour” this capped material (waxes, skin cells, keratin, bacteria and the like). By removing this biologic “varnish” from the surface, it allows freer access to these oil glands and their oily products (meibum). Secondly, by applying this energy over the conjunctival membrane overlying these glands, I’ve witnessed the plasma’s capacity to breakdown and breakup the heavier “concrete-like” products inside those that have more advanced clogging of this type. My tools have so far been limited to using mechanical cleaning and scrubbing devices (ZEST and BlephEx), heat (RF, Lipiflow and the like), light (IPL) and probes (of Dr. Maskin’s design). I’ve had to “scrape” the lid margins to reduce the “varnish” and apply substantial pressure to move some of these “concrete-like” products from the glands.

 In a series of prior posts, I detailed the apparent source of the more “pasty” meibum as coming from the interaction of germs with the normal human oils within these glands. These “germs” can include the decaying bodies of Demodex (the tiny mites that frequent our lids – more of my posts deal with that ugly issue) – who may feed on even smaller bacteria (as well as dead skin cells and our oils). In researching Dr. Maskin’s work (and others), scar tissue can also contribute to clogging, as well as the tiny “keratin granules” that can also form in our oil glands. Keratin is the stuff of hair and nails, so it is no surprise that such material can also be a significant source of an oil gland’s clogging. Remarkably, the plasma appears to break this all down into a more liquid form and allows me the clinical ability to move this stuff out of these highly clogged glands when nothing else appears to do the trick.

 So, is Plasma the “Holy Grail” of dry eye (and perhaps all of medicine)? I wish it was that simple. I find that each of my tools has their own clinical (and often unique) usefulness. Much as the Plasma can be used to kill germs and “clean” lids, I still find a ZEST-modified BlephEx to be a quicker, simpler and in some cases, likely more efficacious tool for general lid cleaning. In some cases, I would recommend using that as a “starting tool” and then add the Plasma treatment on top of that, since it can then sequentially scour more persistent “varnish-like” capping material when needed. Plasma (in this iteration) doesn’t significantly raise the temperature of the tissue the way we can with other modalities (like my off-label use of the many Radio Frequency tools available today). Once oils turn to wax, any reliable heating device can offer a general purging of the waxy oils in a quick, noninvasive, in-office procedure. IPL, while poor at heating clogging waxy oils, is great at closing off abnormal, inflammation-carrying blood vessels – something that appears unique to this light therapy. IPL and some Low Level Light Therapies, also have been heralded for uniquely activating the cells that make tears (a term called “photo-biomodulation”). This appears to activate the cellular furnaces (called mitochondria) which can add energy to the cellular function. Plasma can also affect cells in a “electro-ionic-biomodulatory” way, thanks to the ion channel effects – so I would postulate that the two forms of therapy may be “synergistic,” where each can augment cell functions in their own unique and additive way.

 Where RF and Plasma overlap, is in their abilities to perform delicate surgical tasks. Plasma Pens have been recognized for plicating conjunctivochalasis – abbreviated CCH (typically with tiny “spot weld-like” cauterization points). Each point will heal with tiny scars, binding the “CCH” or loose membrane, back to the white (sclera) of the eye wall. Another overlap is in the ability to turn wayward lids in the direction that better suites normal lid function (see my posts on the eyelid innie and outtie). Some doctors in Europe have been using Plasma for a less invasive form of blepharoplasty (again using the small point-like cautery function to tighten the skin without actually cutting it). Having a new tool is exciting and exploring the range of what it can do is still a work in progress – made easier and safer thanks to colleagues in Canada (Drs. Friedman and Salsberg in Toronto), as well as many in the EU and the COMPEX team that developed and are now marketing this tool in the Czech Republic). For more information, see this link: https://www.ophthalmologytimes.com/view/nonablative-treatment-offers-safety-efficacy-and-multiple-applications-for-the-cornea

To schedule an appointment with Dr. Jaccoma, call Excellent Vision at either of these two dry eye offices:

(1) 155 Griffin Rd, Portsmouth, NH 03801 (603) 574-2020

(2) 3 Woodland Rd, STE 112 Stoneham, MA 02180 (near Boston) (781) 321-6463

Also note that past topics I’ve posted on can be easily found by using the “Search Bar” in the blue gauze “mask” on the woman at the top of the Blog Page.