to-the-point
To The Point
Episode 3

It Might Be Mites

You've definitely encountered Demodex in practice, but how good are you at recognizing these microscopic mites that live in hair follicles? In this episode, Jackie and Leslie discuss how to differentiate between blepharitis and Demodex blepharitis.

Leslie O'Dell (00:06):

Ocular surface disease. It's complex, chronic, and progressive, but rife with opportunity for the enterprising optometrist.

Jackie Garlich (00:14):

The mission of this podcast is to make this condition more understandable and accessible to those interested in specializing in it, so let's get To the Point.

Jackie Garlich (00:26):

Hello. Welcome back to another episode of our podcast, To the Point. This podcast is really for doctors that are looking to start and to grow their dry eye practice. And, so, we cover topics like how to find your patients and how to start the conversation with your patients, like we talked about in Episode 1, to more complex topics. This episode, we're gonna be talking about Demodex, which is ...Frightening.

Leslie O'Dell (00:52):

Gross. (laughs)

Jackie Garlich (00:53):

Right. My name is Jackie Garlich. I'm an optometrist practicing in Boston, and I am joined by my cohost…

Leslie O'Dell (01:00):

Leslie O'Dell, in private practice in York, Pennsylvania.

Jackie Garlich (01:04):

So we're gonna just dive right into Demodex, and I want to get your opinion. How do you diagnose someone with Demodex? I just read this paper. It was published, I don't know, a couple of weeks ago in, I think it was ... I think it was Ophthalmology or Cornea ... You know what? I might just be naming a bunch of publications at this point.

Leslie O'Dell (01:26):

(laughs)

Jackie Garlich (01:26):

But, anyway, it was published somewhere a couple of weeks ago, about how you can look for Demodex with just things that are in your exam room, so your slit lamp, and using a 90 diopter lens to sort of view, in place of an actual microscope if you don't have that. But I'm curious what your regiment is when you're suspecting ... What makes you suspect Demodex, and how do you confirm?

Leslie O'Dell (01:47):

Okay. So, first of all, blepharitis is a huge problem for the patients we’re treating. They're estimating 20 million Americans have blepharitis, and as high as 45% of those are Demodex blepharitis, so a much bigger problem than you might realize. So, you are encountering it, it's just, are you seeing it, right? The biggest thing is looking for this cylindrical dandruff. It's pretty pathognomonic of Demodex, without anything more needing to be done, and that is different from your typical anterior blepharitis you might ... You know, in a typical anterior blepharitis, that might be staph related. It, you see kind of flaking, more looks like dandruff on the, like flaky dandruff and sometimes like in a seborrheic one, you'll see like an oily coating to the base of the eyelash. This cylindrical dandruff or debris is very different. It's almost like a little waxy plug that is surrounding the base of every eyelash. Have you seen that?

Jackie Garlich (02:49):

Okay. Yeah. Like a sleeve.

Leslie O'Dell (02:50):

Yeah. Yeah.

Jackie Garlich (02:51):

Yes. Yep.

Leslie O'Dell (02:51):

So that's all you really need, actually. You know, I take some other steps, but it's really just to prove to myself and sometimes educate the patients. But, if I would see that, I would initiate therapy, you know, just right there with that cylindrical dandruff.

Jackie Garlich (03:06):

Okay. And then ... But you use a microscope, or you have something?

Leslie O'Dell (03:10):

Yeah.

Jackie Garlich (03:10):

What is the thing called?

Leslie O'Dell (03:10):

Yeah. So I do use an LED microscope that, you know, I bought on Amazon for super cheap, like maybe $199 or something.

Jackie Garlich (03:18):

Oh.

Leslie O'Dell (03:18):

And it is very nice, you know, kinda getting back to our biology days. It was kinda fun at first to be plating and looking for things, you know? Took me back to my science class in biology.

Jackie Garlich (03:29):

(laughs) [crosstalk 00:03:30]

Leslie O'Dell (03:29):

But, so if you're going to epilate lashes, you do want to have good language for patients.

Jackie Garlich (03:35):

Mm-hmm (affirmative).

Leslie O'Dell (03:35):

You don't wanna cause psychoses because there are these things that you can do that you're gonna create a lot of anxiety for patients-

Jackie Garlich (03:42):

Yeah.

Leslie O'Dell (03:42):

... maybe create, that they are like itching their skin all the time, you know? So you have to really (laughs)

Jackie Garlich (03:48):

Oh, wow. Yeah.

Leslie O'Dell (03:48):

... have a nice conversation before you show it to the patient. Now, you could epilate and look for yourself. And then, like I said, we'll kinda dig into the whole patient psyche of Demodex 'cause it definitely is a delicate matter.

Jackie Garlich (04:01):

Yeah. So, okay, but if you're not telling the patient, and you're just like, "Hey, I'm gonna epilate a lash."

Leslie O'Dell (04:06):

Well, I learned that you should definitely tell the patient. (laughing) Oh, so first of all, I'm always gonna tell them when I'm gonna pull out their eyelash. Yeah, yeah, yeah.

Jackie Garlich (04:11):

Okay. I was like, "What are you doing?" (laughs)

Leslie O'Dell (04:13):

So that part I'm telling. I say, what I usually say, my language kind of is, "You have this debris on your eyelashes. It doesn't belong there. It's much like plaque on your teeth. I wanna figure out what's gonna be the best way to cleanse it for you. And in order to do that, I'm gonna take a lash or two out of your, you know, out of the eyelid and look at it under a microscope."

Jackie Garlich (04:31):

Okay.

Leslie O'Dell (04:31):

And then people are usually like, "Oh, okay."

Jackie Garlich (04:32):

That sounds normal.

Leslie O'Dell (04:33):

Yeah.

Jackie Garlich (04:33):

Yeah, yeah.

Leslie O'Dell (04:33):

And, so, but you don't just yank it out. So, then there's a technique to how you wanna get that eyelash out before you do put it on the plate to look at it underneath your microscope. And that is, using your forceps, you would do like this big circle motion. I think Kathy Mastrota actually developed this technique. And if you're doing that at your slit lamp, you'll actually see the mites come out of the lash as you're rotating the lash, and they'll look like smaller than a rice, like an uncooked rice, but they're like translucent to white. And once you start to see them, you'll be able to see them with your naked eye.

Jackie Garlich (05:12):

Oh.

Leslie O'Dell (05:12):

So, yeah, it kind of is-

Jackie Garlich (05:14):

[inaudible 00:05:14] (laughs)

Leslie O'Dell (05:14):

Yeah, yeah. So as you're rotating, a- you, you know, I kinda now know if I have a good sample or not. But in the beginning, you just wanna take these big, circular motions of rotating the lash, and then eventually, the hair follicle and the root of the lash will release. So it's usually not a tug.

Jackie Garlich (05:30):

Oh, so you're not, like, epilate ... Oh.

Leslie O'Dell (05:30):

Yeah. It's usually not a tug.

Jackie Garlich (05:30):

[crosstalk 00:05:30] okay.

Leslie O'Dell (05:32):

So, I usually even tell the patient that, like, "I'm not gonna just yank this out."

Jackie Garlich (05:35):

Hmm.

Leslie O'Dell (05:36):

"It, it's a little bit of a special technique, so it takes me a little longer."

Jackie Garlich (05:39):

Yeah.

Leslie O'Dell (05:39):

Just so they don't wonder why it's taking so long. (laughs) Okay. So different ... Um, I've, I've seen different techniques, so personally, I actually use a lipid-based tear because they're use ... They're eating the sebaceous gland, you know, the oils from the skin. And, so, I'll use whatever I have, you know-

Jackie Garlich (05:58):

Mm-hmm (affirmative).

Leslie O'Dell (05:59):

... in the office. I normally don't use one that is super cloudy looking...

Jackie Garlich (06:03):

Okay, yeah

Leslie O'Dell (06:03):

But if it's like a clear lipid base tear, that works the best for me. And actually it really makes them active. I've also, you know, done fluoresce, but I have better results actually using a lipid based tear.

Jackie Garlich (06:17):

So this is like you putting it on a microscope slide?

Leslie O'Dell (06:20):

So what I do is I just put a drop of the lipid tear onto the slide, and I have my slide cover sitting the side, and as I get a lash I just put it down and it kind of goes into the, you know, the moisture of the, the drop that's on the slide.

Jackie Garlich (06:34):

Okay.

Leslie O'Dell (06:34):

And then you put your slide cover on. But I would always take two lashes, because you don't want to...

Jackie Garlich (06:38):

Mm-hmm (affirmative)

Leslie O'Dell (06:38):

I usually say "I'm taking two, because I don't want to have to come back and do this again."

Jackie Garlich (06:42):

Oh.

Leslie O'Dell (06:42):

So I take two because my first sample might not have anything and then I'm not sure, you know, well.

Jackie Garlich (06:47):

Mm-hmm (affirmative)

Leslie O'Dell (06:48):

Even though I'm seeing that cylindrical dandruff, am I really? I kind of started doing it just to convince myself, I think.

Jackie Garlich (06:54):

Yeah.

Leslie O'Dell (06:55):

But you really, you wouldn't need to take that step.

Jackie Garlich (06:57):

Are you taking two in the forceps when you're doing that...

Leslie O'Dell (07:00):

One at a time.

Jackie Garlich (07:00):

One at a time, okay.

Leslie O'Dell (07:01):

One at a time. So and like I said, if you, and like I sometimes will back up, look at my forceps underneath the slit lamp and I can see, like I said, you'll start to actually, you know if you have a good sample, you see something hanging off of the eyelash. It is pretty obvious.

Jackie Garlich (07:16):

So gross as you're talking about it. (laughs)

Leslie O'Dell (07:18):

I know, it is like a frighteningly fun thing. (laughs)

Jackie Garlich (07:22):

All right, so then, okay. So you plate it and then you're seeing this under the microscope.

Leslie O'Dell (07:25):

Yeah.

Jackie Garlich (07:25):

Do you show this to the patient?

Leslie O'Dell (07:27):

So, then I'm looking at it, and you know, I usually have this other conversation

Jackie Garlich (07:31):

Mm-hmm (affirmative)

Leslie O'Dell (07:31):

That goes something like…

Jackie Garlich (07:32):

Mm-hmm (affirmative)

Leslie O'Dell (07:33):

"I'm gonna show you something, if you want to see it" (laughs) and so I kind of get a feel for the patient's body language then. And then a lot of times they do want to see or they'll have like a family member and they'll be like get your phone out, take a video of that.

Jackie Garlich (07:46):

Oh really, oh wow.

Leslie O'Dell (07:47):

They do seem to, but again, it's a fine line to know the patient that you're dealing with. Because there is such a thing of causing a little bit of psychoses (laughs) for them

Jackie Garlich (07:56):

Oh really?

Leslie O'Dell (07:56):

As you can imagine.

Jackie Garlich (07:57):

Yeah, yeah totally.

Leslie O'Dell (07:57):

Usually after we have the conversation, inadvertently one of us starts to scratch our scalp.

Jackie Garlich (08:02):

(laughs) yeah.

Leslie O'Dell (08:02):

But then the conversation goes more like, this isn't like lice, so it's not gonna jump from you to me, you know, and then we start to have that conversation.

Jackie Garlich (08:10):

Yeah, okay. All right so, tell me about what your treatment options are for Demodex. Because I was out to dinner with my friend, who is an ophthalmologist in Boston, and we were talking about Demodex, as one does (laughs)

Leslie O'Dell (08:26):

(laughs)

Jackie Garlich (08:26):

...at dinner time, anyway.

Leslie O'Dell (08:27):

Great dinner conversation.

Jackie Garlich (08:27):

I know, I know. And she was like what do you use? Like how do you treat that? And I think there's like not a clear, because what I then did, is after sort of talking to her, I surveyed other people. And I said, like I asked you, I texted you, what do you use to treat Demodex? I text someone else what do you use, because I know the studies will say you need 50% of tea tree oil to really actually kill the Demodex mites. But that is not always well tolerated with patients and then so the compliance of that maybe drops and then you're really not doing anything?

Jackie Garlich (09:01):

So, um, the 1%, 2% that you'll find in other products, is that sufficient? And my thinking and my sort of research on this is that it will kill any mites that are outside, like on, sitting on the lash. But the ones that are burrowed in and like inside the lash follicle, it doesn't really get to those. But, is it true, we all have maybe a little Demodex anyway? And like a little is fine, it's the overgrowth or the proliferation of those that are really the problem in these cases.

Leslie O'Dell (09:33):

Yeah so, I've seen some reports that say we all have about 2,000 that are living on us, and remember it's not just your eyelashes, it's your eyebrows, it's like the glabellar region, your nose, your cheek, the inner part of your ear. So, they can actually do, sometimes if a person has Rosacea, they can just put a piece of tape onto their face and they can get mites that way. Just from like skin contact.

Jackie Garlich (09:55):

Mm

Leslie O'Dell (09:55):

So that..

Jackie Garlich (09:56):

Okay (laughs)

Leslie O'Dell (09:56):

...might be more of like a contagious thing than the eyelashes themselves.

Jackie Garlich (10:00):

Mm-hmm (affirmative)

Leslie O'Dell (10:01):

Some of the research that I actually have helped do, looked at confocal imaging, so instead of having to remove the lash and plate it, it was actually taking photos- images through the lash of the person that had the Demodex infestation. And the mites are so, very tightly burrowed around the base of the lash.

Jackie Garlich (10:21):

Mm-hmm (affirmative)

Leslie O'Dell (10:21):

So there may be some that are living on the outside of the skin, but most of them are actually...

Leslie O'Dell (10:26):

Right at the root of the hair follicle. So some of the, and I'm not really 100% sure, but some of the things I've heard over the time, like they come out at night to breed. I'm not really convinced that is the case.

Jackie Garlich (10:38):

Mm-hmm (affirmative)

Leslie O'Dell (10:39):

Based on the confocal imaging I saw. That they're, they have no, they don't need to move to make more of themselves. They're all jammed together, you know? The scarier part though is that we don't have the, none of our treatments are effective at killing the entire life cycle of a Demodex mite.

Jackie Garlich (10:54):

Mm-hmm (affirmative)

Leslie O'Dell (10:54):

And that means that it's an egg, and then it goes into this larva into the Demodex folliculorum usually or the brevis. But they, none of our treatments, this research showed that the eggs never were touched. So.

Jackie Garlich (11:10):

Oh. Mm-hmm (affirmative)

Leslie O'Dell (11:10):

That's interesting. Which means that you think about the life cycle of the mite, which is about 2 weeks and then whatever your treatment is, it's not a once and done thing. You have to like pauce it. So, you might do something in office, which we'll talk about here, but then you have to see them back like within a 2-week period to either do that again. Or if you're gonna start them on some kind of tea tree oil-based cleanser at home, you want to see them like in 2 weeks to see okay is that doing enough? But your treatment endgame would be no visible cylindrical dandruff?

Jackie Garlich (11:41):

Okay.

Leslie O'Dell (11:41):

That's what you're looking for.

Jackie Garlich (11:41):

Okay.

Leslie O'Dell (11:42):

So yes, we all do have some. You want to get rid of the visible evidence.

Jackie Garlich (11:45):

Okay.

Leslie O'Dell (11:45):

Do we, you know, they could have some good. They're eating bacteria. If you completely eradicated it, could that be changing the balance of something else? You know, so my goal is just to remove the sign of it on the outside of the lash.

Jackie Garlich (11:59):

Okay. So what are your treatments? What do you recommend?

Leslie O'Dell (12:03):

So, I usually will start with an in-office treatment with a 50-50 concentration of tea tree oil. And like you said, it is abrasive. I know some of the studies show macadamia nut oil is something they dilute that tea tree oil down with, I use jojoba oil, or I don't know how you say that word. (laughs) I might say that wrong. Then I've found that that's really tolerable to patients when I put that on after a topical anesthetic they don't complain about tingling in the office.

Jackie Garlich (12:32):

Hm.

Leslie O'Dell (12:33):

So how that looks is I still am very conservative, I put a bandage contact lens on the patient when I'm doing that concentrated, concentration, just to be you know...

Jackie Garlich (12:41):

Oh.

Leslie O'Dell (12:41):

...100% proactive and protective of the cornea. I don't know if it's necessary. But what I do is I have the patient sit with their eyes closed and then I take a, first I take an eye dropper and I'll 10 drops say of my concentrated tea tree oil.

Jackie Garlich (12:57):

Which where do you get that by the way?

Leslie O'Dell (12:59):

So I, you know, there's lots of debate about essential oils right? And who's got the purest one. And honestly, I'm kind of lucky that I have an organic grocery store nearby.

Jackie Garlich (13:09):

Oh, okay.

Leslie O'Dell (13:09):

And even, she's the one that told me about this carrier oil, which would be less irritating to the skin versus maybe the macadamia nut oil. But -

Jackie Garlich (13:15):

Okay.

Leslie O'Dell (13:16):

Maybe even looking for, whatever it is, you want it to be 100% pure tea tree oil. So, I'd get an eye drop bot- eye dropper, take some out, count 10 drops, do the same with the oil. That's how I kind of mix it up.

Jackie Garlich (13:29):

In what? What do you mix it in?

Leslie O'Dell (13:30):

I use a contact lens case. Yeah.

Jackie Garlich (13:32):

Oh. All right.

Leslie O'Dell (13:32):

So I use a contact lens case for a lot of different things like that in the office. If I'm soaking something like for the micro-exfoliation, you know if I'm gonna soften up those sponges I'll use the contact lens case to do that too.

Jackie Garlich (13:44):

Okay.

Leslie O'Dell (13:44):

So, then I just take a cotton bud, patient has their eyes closed, they have the bandage contact lens with Proparacaine is what I do. Proparacaine drop into their eye and then also on the skin around their eye.

Jackie Garlich (13:54):

Hm.

Leslie O'Dell (13:55):

And then I just paint it at the base of their eyelashes, like five times across.

Jackie Garlich (14:00):

Mm-hmm (affirmative)

Leslie O'Dell (14:01):

Let it sit for 5 minutes, do it again, let it sit for 5 minutes and then I do it one more time. And that's, I didn't make that up, that's out of the papers. (laughs) You know that came from Dr. Scheffer Tseng.

Jackie Garlich (14:11):

Hm. Okay.

Leslie O'Dell (14:11):

Yeah. And then I send them home with an at-home cleanser. I mean I do use a lot of Cliradex -

Jackie Garlich (14:21):

Okay.

Leslie O'Dell (14:21):

But Cliradex is a little bit intolerable for some patients. You know they have a lot of stinging and burning. The big thing is, you just told them they have mites, what's the natural reaction? Scrub your eyes as hard as you can, right?

Jackie Garlich (14:32):

Yeah.

Leslie O'Dell (14:32):

So I say, if you're gonna use this, in particular, you want to be painting it on. You want to let it air dry before you open your eyes. Because I don't want to get the calls back that it was burning and they couldn't use it, right?

Jackie Garlich (14:42):

Yeah. Okay.

Leslie O'Dell (14:43):

And so, the more that they're just educated to just do more of a gentle, swipe of that solution…

Jackie Garlich (14:49):

Yeah.

Leslie O'Dell (14:50):

Is gonna be better.

Jackie Garlich (14:50):

Okay.

Leslie O'Dell (14:51):

And then, like you said these 1% and 2% tea tree oils, I think the verdict's out. I mean, it might work, it just might take longer. Right?

Jackie Garlich (14:58):

Yeah.

Leslie O'Dell (14:59):

And so, it's hard to,

Jackie Garlich (14:59):

It’s like it’s a balance. Because if like the patient's uncomfortable, or stinging…

Leslie O'Dell (15:05):

And that's where maybe thinking about the in-office treatment...

Jackie Garlich (15:07):

Yeah.

Leslie O'Dell (15:08):

...is something. We have a fee for service for that. I mean,

Jackie Garlich (15:11):

You do?

Leslie O'Dell (15:11):

...a lot of patients elect treatment the same day because I just showed them that with the microscope and they...

Jackie Garlich (15:16):

Okay.

Leslie O'Dell (15:17):

They want to be as effective. And um, when you're doing the concentrated tea tree oil, you have a kill rate in like the first 4 minutes. When you're doing an at-home cleanser, those cleansers take about 40 minutes to penetrate in to do the same work.

Jackie Garlich (15:30):

Okay.

Leslie O'Dell (15:30):

But you can't do just the in-office and not send them home with something.

Jackie Garlich (15:34):

Yeah. Right. So, when you're in-office, you have this like kill rate of 4 minutes or whatever you said and, but that's not killing the eggs. Which is why you have them back in 2 weeks?

Leslie O'Dell (15:42):

Yup.

Jackie Garlich (15:42):

And then repeat it?

Leslie O'Dell (15:43):

Mm-hmm (affirmative)

Jackie Garlich (15:44):

And then back in another two?

Leslie O'Dell (15:45):

Yup.

Jackie Garlich (15:45):

And repeat it again.

Leslie O'Dell (15:46):

Depends on what you see, right?

Jackie Garlich (15:48):

Okay.

Leslie O'Dell (15:48):

So if you're, if you keep seeing at the slit lamp the cylindrical dandruff, you're gonna continue some kind of therapy.

Jackie Garlich (15:54):

Okay.

Leslie O'Dell (15:54):

Until you don't see that.

Jackie Garlich (15:56):

Okay, all right.

Leslie O'Dell (15:56):

So then it's the patient conversation. You definitely, I mean, in my mind you wanna have the conversation. I have had a patient that actually found out from a website of a cleanser that we issued, and, I don't even think it actually was me, I think another doctor actually gave them that cleanser with no explanation.

Jackie Garlich (16:15):

I see.

Leslie O'Dell (16:16):

They went to the website, now when we saw them back they knew a lot about Demodex and no one had told them.

Jackie Garlich (16:22):

I see.

Leslie O'Dell (16:22):

So I think it's, you know there is, I think you should have the conversation.

Jackie Garlich (16:27):

Yeah.

Leslie O'Dell (16:27):

I do think a lot of the research comes out of dermatology and I'm not really sure what that conversation looks like with Rosacea and Demodex.

Jackie Garlich (16:34):

Right. Yeah.

Leslie O'Dell (16:35):

I've had some patients go to their dermatologist after me seeing them and then the dermatologist, you know, kind of makes me feel like I'm the crazy one, but… (laughs)

Jackie Garlich (16:44):

Oh really?

Leslie O'Dell (16:44):

Because they don't really have that conversation I don't think as much.

Jackie Garlich (16:47):

Yeah.

Leslie O'Dell (16:47):

With their patients. But, I usually tell people, you know I like to be honest with them.

Jackie Garlich (16:53):

Yeah.

Leslie O'Dell (16:53):

So I'm, I explain to them, it's like Staph bacteria, we all have it, you just have an overgrowth right now and we're gonna work to kind of get it back in balance.

Jackie Garlich (17:01):

I think that is not so unreasonable to, or I could see how this would happen, where a patient finds out (laughs). Like they're prescribed Cliradex or something and then they're like oh, this actually says for Demodex, I didn't know I had this. 'Cause I think it's kind of an awkward conversation, I think it's hard. I think this conversation you and I are having is a good one because it's a little, could be a little uncomfortable having that conversation with a patient, you're not sure how they'll kind of react with that. But I think the way you just said it makes total sense. And like, it's a, super alarming I think to the patient, you know what I mean? (laughs).

Leslie O'Dell (17:30):

It is, and, but like I said, sometimes they're a little bit more open to the idea and they'll take a picture so they can show somebody.

Jackie Garlich (17:38):

Yeah.

Leslie O'Dell (17:38):

And then other times people are like, I don't wanna see, you know, I don't wanna see. And so, you have to tread lightly, because you don't want to create bigger problems for them.

Jackie Garlich (17:46):

Yeah. I think that, you know, actually showing the patient probably has some value too. Because I feel like, you know if someone told you, you had this mite, you would have maybe some level of doubt about that unless you actually saw...

Leslie O'Dell (17:58):

Mm-hmm (affirmative)

Jackie Garlich (17:58):

...this mite? So there's probably some value in doing that also.

Leslie O'Dell (18:00):

Yeah, so I mean it doesn't cost a lot to bring in a microscope.

Jackie Garlich (18:03):

Yeah.

Leslie O'Dell (18:03):

I have seen that paper that you're talking about...

Jackie Garlich (18:06):

Yeah.

Leslie O'Dell (18:06):

...with the 90 diopter lens, and I've tried to do it.

Jackie Garlich (18:08):

Yeah what did you think?

Leslie O'Dell (18:10):

I still need to develop my technique (laughs).

Jackie Garlich (18:12):

Yeah right. I mean the way that it was done was there was the microscope, it was the same thing as if you're gonna plate it under the, on your microscope.

Leslie O'Dell (18:17):

Oh! Okay.

Jackie Garlich (18:18):

So you put it on a microscope slide.

Leslie O'Dell (18:19):

Yes.

Jackie Garlich (18:20):

You put a drop of fluorescein.

Leslie O'Dell (18:21):

Oh okay, I was doing it wrong.

Jackie Garlich (18:22):

You put the lash on there.

Leslie O'Dell (18:23):

Mm-hmm (affirmative)

Jackie Garlich (18:23):

You put the slide um...

Leslie O'Dell (18:24):

Cover?

Jackie Garlich (18:25):

The cover on and then you put it in the slit lamp and then you take your 90 diopter lens...

Leslie O'Dell (18:29):

Oh!

Jackie Garlich (18:29):

And then, it's like you're creating a microscope.

Leslie O'Dell (18:31):

Yeah, yes.

Jackie Garlich (18:32):

But it's all the same technique up until the microscope. So, I guess it's like if you didn't want to actually purchase one is how the other one was.

Leslie O'Dell (18:36):

Yeah.

Leslie O'Dell (18:37):

But then you can't show the patient and so I think the value...

Jackie Garlich (18:40):

Totally.

Leslie O'Dell (18:40):

...lies in being able to take the picture or say...

Jackie Garlich (18:43):

Mm-hmm (affirmative)

Leslie O'Dell (18:44):

...Come look at this. And the one with like the visible LED screen is...

Jackie Garlich (18:46):

Yeah.[crosstalk 00:18:47]

Leslie O'Dell (18:47):

...worth the money.

Jackie Garlich (18:47):

What's the name of that one?

Leslie O'Dell (18:49):

I think it's Celestron or something. C-e-l-e-s-t-r-o-n.

Jackie Garlich (18:53):

Okay.

Leslie O'Dell (18:53):

Yeah.

Jackie Garlich (18:53):

All right.

Jackie Garlich (19:01):

Well this was a good talk on Demodex as they all are (laughs).

Leslie O'Dell (19:04):

[crosstalk 00:19:04] And you know what it is another great way to grow your practice is pitch the story to the local news, because they really, you know we did it kind of around Halloween, like what's hiding in your eyelashes?

Jackie Garlich (19:13):

Oh really?

Leslie O'Dell (19:13):

Yeah, so yeah, it was, I mean, same kind of reaction, but…

Jackie Garlich (19:18):

Yeah.

Leslie O'Dell (19:19):

It's a good way to educate your population of patients that you're serving.

5/6/2020 | 20:41