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What does Dr. Steinsapir think about I-Brite?

Published on October 22, 2013

I-BriteTM is a surgery that is designed to remove the sun-damaged tissue that makes the eyes look red. This is one of several types of surgeries that are offered out there with an aim to directly treat the tissues that cover of the eye but become discolored. The discoloration can be caused by pigmentation and redness on the eye–for example pterygium, pinguecula (a yellow or brownish color), pigmented areas that look like freckles, and excessive blood vessels that cause eye redness. I-Brite involves both the surgical removal of abnormal, sun-damaged conjunctiva, the normally white covering over the eye and the use of a powerful alkylating agent called Mitomycin C. Mitomycin C may be used at the time of surgery and applied as a dilute drop after surgery to prevent the abnormal blood vessels from returning. I-Brite is the method developed by Beverly Hills Ophthalmologist Brian Boxer Wachler. There are other procedures performed elsewhere using similar methods that are designed to accomplish a similar goal. One example is Cosmetic Eye WhiteningTM, performed commercially in South Korea.

Given that brief overview of how the procedure technically works, what can be said for the safety and effectiveness of I-Brite and related surgeries being marketed today? Unfortunately, it’s difficult to say conclusively whether these treatments are promising, because not enough is known about the safety of this surgery. These procedures appear to rely on mitomycin C, which is a very potent drug that can cause damage to the eye-wall with possible loss of vision. Although off-label use of medications and treatments are at times advisable, the key to safe off-label use is in ensuring that the off-label use has been reliably demonstrated to carry minimal risk, and that the benefits clearly outweigh any potential dangers. Treatments to save someone’s life or preserve vision are good examples of when there may be reason to accept a certain level of risk or uncertainty with a procedure. In the case of a new cosmetic surgery performed directly on the eye itself, it’s important to not prematurely assume a new treatment is safe in the absence of peer reviewed clinical evidence and general acceptance by the medical community.

The tissue on the eye that is removed with this procedure is the very layer that is needed for glaucoma surgery, so it cannot be understood as inconsequential. Later in life, if you need glaucoma surgery, will the history of having eye whitening surgery prevent you from getting vision preserving glaucoma surgery? It is too soon to say conclusively. Additionally this layer of tissue carries part of the blood supply for the front of the eye. Removing this tissue may effect the circulation to the front of the eye. While there may be advancements with eye whitening surgery research over time, it is important to note that the research literature today does not yet demonstrate the safety of this surgery. Significant questions remain about the inherent and long term safety of the procedure.

Furthermore, recent reports have been emerging regarding a very serious and potentially vision threatening complication of eye whitening surgery. These concern necrotizing scleritis, which represents a melting of the eye wall. This type of complication has the potential to cause loss of vision. Presently it is unclear how commonly this type of complication occurs with eye whitening procedures including I-Brite.

You already know how important your eyes are if you are considering this surgery–both functionally and aesthetically. The appearance of our eyes and the surrounding anatomy can make a huge difference in how others perceive us and in how we feel about ourselves. Our vision is also incredibly valuable to us. This is why any treatment to the eyes, eyelids, or surrounding tissue needs to take into account the importance of both appearance and function. There are certainly safe cosmetic options available for improving the appearance of your eyes that have been thoroughly researched and shown to be safe and effective. There is no evidence that eye whitening procedures including I-Brite are safe and effective.

Until the emergence of recent reports regarding necrotizing scleritis, procedures like I-Brite and other eye whitening procedures seemed promising. However these complications change the entire safety profile. Dr. Steinsapir now strongly advises against having these procedures. The benefit of removing redness can never balance the risk of visual loss. Perhaps one day the safety of this type of procedure will improve, until that time, please protect your eyes and your vision. In Dr. Steinsapir’s opinion, these procedures, including I-Brite are not recommended.

About Dr. Steinsapir

Dr. Steinsapir is a board certified eye surgeon and fellowship-trained in oculoplastic surgery and cosmetic surgery in Los Angeles where he specializes in balanced facial cosmetic surgery for natural results, with an emphasis on minimally invasive techniques, fast recovery time, and leadership in medical technology. Dr. Steinsapir has a private practice and also serves as an Associate Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, at the David Geffen School of Medicine at UCLA. Contact us today to learn how Dr. Steinsapir’s experience and training make him an expert in cosmetic surgery, which can be a vital part of your evidence-based treatment plan.

Services described may be “off-label” and lack FDA approval. This article is informational and does not constitute an advertisement for off-label treatment. No services should be provided without a good faith examination by a licensed physician or surgeon and an informed consent with a discussion of risks, benefits, alternatives, and the likelihood of treatment success. Only you and your treating physician or surgeon can determine if a treatment is right for you.