Innovations in eye care are changing how we treat dry eyes and enhance facial aesthetics. Dr. Harbir Sian explores these advances with Dr. Vicente Rodriguez, Global Medical Director of Jett Plasma, who explains how this revolutionary technology uses low-intensity electrical stimulation to target the conjunctiva, eyelid margin, accessory glands, and orbicularis muscles. He shares the evolution of Jett Plasma from non-invasive facial rejuvenation to advanced ocular applications, detailing techniques for treating blepharitis, Meibomian gland dysfunction, and lid wiper epitheliopathy, while also highlighting emerging possibilities for retinal stimulation and veterinary applications. This conversation offers a rare, in-depth look at how precise electrical stimulation is improving patient outcomes and expanding the frontiers of ophthalmology and optometry.
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Jett Plasma: A New Frontier In Dry Eye And Aesthetics – Dr. Vicente Rodriguez, Global Medical Director Of Jett Plasma
Jett Plasma, Dry Eye, And Why This Technology Matters Now
Welcome back to another episode of the show, Canada’s number one optometry show. Thank you, as always, guys, for taking the time to join me here to learn and to grow. I have an amazing episode for you here with a wonderful guest who is going to teach us a lot about some emerging technologies in the eye care space.
I have Dr. Vicente Rodriguez, who is an ophthalmologist based in the Gran Canaria Islands. He is a corneal and refractive surgeon, a world-renowned surgeon, and a multiple-time recipient of the gold medal of ophthalmological societies around the world. He lectures around the world on various topics, in particular these days about the Jett Plasma technology, which is something I am sure many of us have heard of.
Dr. Rodriguez is the Global Medical Director for Jett Plasma. I am very excited to dive into this topic and help us all learn more about this exciting new technology. Before we jump in, as always, I have one big requesta which is if you get some value, and based on what I just told you, I know you’re going to get a lot of value, please share it, send a link to a friend, send a text message, or put something up on Instagram. Let us know that you are listening, and let us know what you learned.
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Here we are, Dr. Rodriguez. Thank you so much for joining me all the way from Gran Canaria. Tell me, if you do not mind, please tell us a little bit about yourself before we jump into the Jett Plasma conversation.
Thank you, Dr. Sian. It is a great pleasure to be with you. It is a further pleasure to have the possibility to introduce the Jett to the optometrist community in Canada. I know that the optometrists love, in general, the patients suffering from dry eye. With the Jett, we will have the possibility to optimize the ocular surface in patients suffering from dry eye and blepharitis. I am Dr. Vicente Rodriguez from the Canary Islands, Spain.
Unfortunately for me, I am a little old, with more than 30 years of experience in corneal refractive surgery and in keratoconus surgery. I love keratoconus surgery because in the Canaries, with the sun and the allergies, we have a lot of patients suffering from keratoconus. To have the possibility to introduce new treatments for that, the intracorneal ring segment, the different cross-linking, the epi-on and epi-off, the accelerated cross-linking, and the combining of intracorneal ring segment and cross-linking, is a big opportunity for our people suffering from keratoconus.
As a refractive surgeon, I have the possibility to see every time more dry eye in the youngest population. Fifty percent of our patients in our day-to-day cataract surgery suffer from mild or even moderate dry eye symptomatology. We need to consider this before cataract surgery, before presbyopia correction, before myopia correction, or even because of the symptomatology. We need to treat and pay attention to this growing group of patients in our day-to-day work.
Why Ocular Surface Optimization Is Reshaping Eye Care
That is becoming more and more present. We’re hearing refractive surgeons talking more and more about the importance of treating the ocular surface and optimising the ocular surface to optimise the results afterwards. That makes sense. I wanted to ask you the question, how did you come about diving into the world of dry eye as deeply as you have? That makes sense because you want to help your patients have better results. Let us talk about the plasma pen technology. We will speak specifically about this brand, Jett Plasma, but the technology more broadly. When did you come in contact with this and learn more about that?
My first contact with the Jett, I remember, was in 2018 at the World Ophthalmology Congress in Barcelona. In this moment, my interest in the Jett was not for the ocular surface. It was about non-invasive oculoplastic procedures and facial rejuvenation. I love the field of ophthalmology in general. In some cases, I love to do blepharoplasty or crow’s feet treatment. This was an option in 2018 because this device was developed initially for aesthetic medicine.
When I decided to begin with this technology, I was working with IPL and with LipiFlow in my clinic. Arrive the Jett, and we were using the Jett only for oculoplastic procedures and facial rejuvenation. When I understood the correct mechanism of action, I said, “This is amazing,” because the Jett is not a laser. The Jett is not a radiofrequency. The Jett is not a thermal pulse technology. The Jett is only, but enough, an electrical device. My father was an electrical engineer. We talked many times about the effect of electrical stimulation on the body.
When I understood the mechanism of action well, I said, “I consider that we can use electrical stimulation for treating dry eye or blepharitis.” In 2019, the company only used the device as an ablative procedure with the golden tip or the golden applicator. Later, we will speak about the different applications that we use. In 2019, the company in 2019 used the golden application to treat severe cases of dry eye with hyperkeratinization on the eyelid margin.
In these cases, it is not a good idea to use intense pulsed light, for example, because with hyperkeratinization, you cannot drain the meibomian gland. Even with LipiFlow or thermal expression, it is impossible to drain the meibum because the hyperkeratinization in the eyelid margin prevents this liquefaction. I decided to use the Jett with the plasma discharge to break, in some cases, the hyperkeratinization in the eyelid margin.
Immediately, when you break this hyperkeratinization, you can see the orifices of the meibomian glands again. This is really amazing. I consider that the treatment is aggressive, it is very aggressive because it is painful, and we need to use local anaesthesia on the eyelid for treating with the plasma discharge. We need to modify the situation and use the direct current flow for treating mild and moderate cases of dry eye.
Now that I understand this mechanism of action, the low-intensity direct current flow in contact with the conjunctiva, in contact with the skin, and in contact with the eyelid margin, I think, “This is a revolution.” I am working at the same time with IPL and with LipiFlow. My good results with intense pulsed light are in approximately 50% of the patients. Why? It’s because the IPL was designed with an anti-inflammatory effect for treating rosacea, specifically facial rosacea.
When you treat facial rosacea, you can see that the patients are better regarding dry eye. This is the reason we use IPL for treatment. Dr. Toyos did an amazing investigation for that. We are treating rosacea, and the patient is better regarding dry eye disease or even blepharitis. I decided, “In the patients where I am not happy with intense pulsed light, how can I introduce the Jett?” Immediately, I considered that with conjunctiva stimulation, we can stimulate another parameter, another actor involved in the pathogenesis of the dry eye.
Treating facial rosacea can improve patients’ dry eye symptoms.
For example, goblet cells. Regarding goblet cells, every person assumes the relationship in dry eye is meibomian gland dysfunction. It is not only meibomian gland dysfunction. In many cases of dry eye, we can have goblet cells involved in the pathogenesis. In addition, we can have the orbicularis muscle, the Riolan muscle, or even the accessory glands like the Manz gland involved. We need to address all these points.
How Jett Plasma Works: Direct Current Stimulation And Ocular Physiology
That is incredible. That is a lot of very important information. I want to try to go through a few of those things step-by-step here. First, I love hearing about the backstory of how something came to fruition. The fact that your father was an electrical engineer and you paired that knowledge with your ophthalmology experience is great. You are one of the few people who would uniquely understand the mechanism of action and how it applies to the eyeball and the structures in the eye. Somebody could just tell me it is direct current, and I would say, “Great, that’s nice to know.”
You actually understand what direct current means versus alternating current and how that is applicable to the surface of the eye. That is really amazing. One thing I want those who are tuning in and watching, if you haven’t seen the Jett Plasma, please go search it. It is a relatively small device that looks like a large pen. You can apply it right to the palpebral conjunctiva and then the lid margin, as Dr. Rodrigues is saying, which most of the devices we’re using right now are always on the outside of the eyelid. We can be careful.
Even in the fornix, because from time to time, we can have the aqueous component involved in the dry eye too. The accessory lacrimal glands produce the basal aqueous component in the tear film. We can modify this basal component if we stimulate the fornix directly on the conjunctiva. Every time, we personalise with the Jet. With the Jett, we can stimulate all the other parameters. With LipiFlow or with intense pulsed light, we can stimulate some specific parameters in dry eye.
With the direct current flow, we can stimulate the orbicularis muscle and the Riolan muscle because it is very low intensity. If you have a problem in the back, the physiotherapist decides to use electrical current for the stimulation of the muscle. This is the reason we can stimulate the muscle even in the eyelid and the orbicularis oculi. Every time, people blink less. Fifty years ago, the population in general blinked more than 50 times per minute.
Fifty times per minute?
Yes. 100 years ago, when we did not have TV, smartphones, or computers, the health of the ocular surface was better than now. Currently, we do not blink enough, and we need to blink more often. Every day, I explain to my patients in my day-to-day work, “Please, you need to blink more often,” because I see the faces of the patients. They do not blink while they speak and speak.
Please, blink, blink. No. You say, “How many blinks does this patient have?” Maybe 8 or 9 blinks per minute. This leads absolutely directly to dry eye. People blinking less than ten times per minute will finish with dry eye. In the near future, unfortunately, we will have more children with dry eyes because of computers and the smartphone.
It is very easy to tell the population to blink more, but if we stimulate the orbicularis muscle directly, the patients need to blink spontaneously. When we are working with the Jett, using the silver applicator, we are very near the orbicularis muscle. We can stimulate the superior and the inferior portions, and even near the eyelid margin, we can stimulate the Riolan muscle. The Riolan muscle is around the meibomian glands. When we stimulate the Riolan muscle, we help express it.
If we can think back to anatomy, we would all remember the Riolan muscle right along the lid margin. That is important for expressing the meibomian glands to release more moisture for the eyes. The physiotherapy analogy makes a lot of sense. We usually get that intramuscular stimulation to help the muscle rebound and strengthen. I just did not know the Jett did that. That is very interesting.
The standard protocol initially was a little different. We were working only on the conjunctiva or in the eyelid margin. Every time, we know more about the pathogenesis of dry eye. It is very easy to contact the Wolfring and the Krause accessory lacrimal glands in the fornix. Now we are developing a new applicator, a longer applicator. If you have the applicator working in the conjunctiva to stimulate the fornix, we need to have a longer applicator.
At this time, we can stimulate the conjunctiva and the fornix at the same time. We can stimulate the goblet cells and the Krause and Wolfring accessory lacrimal glands. In one minute, in a very easy way, we separate only the conjunctiva from the cornea. It is very comfortable for the patient and for the doctor.
Clinical Protocols For Dry Eye, Blepharitis, And Demodex
It is very easy to stimulate all the conjunctivae and definitely the Wolfring and Krause accessory lacrimal glands in the fornix. This is very interesting. For example, every time in your meetings and mine, I am sure, we speak about the blepharitis secondary to Demodex. For example, Demodex is every time more frequent in our meetings and our conferences.
With the Jett, we have the possibility to destroy the capsule of the Demodex with electrical stimulation. For that, we need to modify the standard protocol. Normally, the protocol for the treatment of dry eye is two minutes working on the conjunctiva in this position or in this position. Regarding the applicator, we can work in this position or in this position. For the conjunctiva, we normally need to stimulate.
Dr. Rodriguez, before you continue, for those who are tuning in, I want to try to clarify what you said with “this position or this position.”
Mainly for the audio.
For the people tuning in.
I understand now.
For those who are watching, of course, they can see the motion that you are making. I just thought when you were saying the applicator would be parallel to the conjunctival surface instead of being perpendicular?
Not perpendicular. You need it parallel. Parallel is more comfortable for a beginner. For a beginner, it is more comfortable because the surface of the applicator is longer than the tip. You use the tip in this position in contact with the conjunctiva. The longer surface provides a bigger space for stimulation than the tip of the applicator does. The standard protocol, we can speak one more time about the standard protocol, two minutes on the conjunctiva, 30 seconds on the eyelid margin, and one minute on the skin.
This is the standard protocol for meibomian gland dysfunction. If you have blepharitis secondary to Demodex, we need to modify it a little because the problem is not in the Krause and Wolfring glands or the meibomian glands. The problem is in the eyelid margin. We need to work for a long time on the eyelid margin to destroy them. The direct current flow with low energy destroys the Demodex without an ablative procedure.
It is only with contact and the application of direct current flow, not the plasma. If we apply it for only 30 seconds. Thirty seconds is not enough. This is the reason that in dry eye, we need to understand the diagnosis to know exactly what the main area is that we need to stimulate. Depending on the diagnosis, if you have blepharitis secondary to Demodex, the problem is in the eyelid margin. We need to use the stimulation for approximately one and a half hours with very slow movements on the eyelid margin.
For dry eyes, it’s important to understand the diagnosis to identify the main area that needs stimulation.
This would be the tip perpendicular to the eyelid margin.
In this case, perpendicularly.
I never knew there was an application for Demodex.
Thirty seconds is the standard protocol. In this case, if you are convinced that the etiology is Demodex, you need to work for maybe one minute or even more. You can check in the slit lamp if the situation in the follicle has changed.
This is incredible. I am learning a lot myself here. From the little that I knew about Jett so far, I was looking at it from meibomian gland dysfunction. There is obviously an application there, but you’re saying accessory lacrimal glands, goblet cells, and even Demodex. There are various applications for this one device. In all of these cases, is it just the direct current at this point in time?
Yes, it is only direct current. In dry eye or blepharitis, we only use the plasma if the patient has a hyperkeratinized membrane on the eyelid margin. In this situation, you need to break this membrane. Without breaking the membrane, it is impossible to have better results with our treatment. You can use the Jett in the same position, two minutes on the conjunctiva, one minute on the skin. No. The result will be no good. This is the reason that in many cases with IPL, LipiFlow, or Rexon-Eye, we need to break the hyperkeratinization and open the orifices again. If we do not open the orifices, we cannot resolve the meibomian gland dysfunction.
Ablative Applications And Lid-Based Treatments With Jett Plasma
Makes sense. I wonder if we can jump a little bit more into some of that. I know this will not be directly applicable to everybody, but I think it’s really exciting to learn. This was the initial application for the device, which was the ablative stuff. You discovered with your knowledge of electrical engineering that direct current could be very valuable for dry eye. Can we jump back to the ablative side? Can you tell me what the term plasma means?
Plasma is an amazing technology because you can ionize a gas. If you have a gas and you apply an electrical flow, the plasma discharge begins. With the Jett plasma pen, the gas is air. We ionize the air. If you ionize the air with electrical stimulation, the result is plasma discharge. You can see the discharge. It is very beautiful because the color is symmetric and parallel, and it has only a 100-micron diameter.
You can see it if you are working approximately between 2 and 3 millimeters from the conjunctiva. In some cases, for example, in ectropion or in entropion, we use the plasma discharge to resolve this pathology. I love treating entropion with the Jett because it is a very easy way. The standard surgery is very complicated for many doctors without long experience in oculoplastic procedures. With a non-invasive technology like plasma, it takes only a few minutes to finish the procedure.
You need to do one triangle in the diameter of the entropion on the skin and apply the plasma discharge dot by dot on this surface. For example, if you have an entropion in the center of the eyelid with a one-centimeter diameter, you need to do the triangle with one centimeter on the three sides. Inside, apply the plasma discharge dot by dot, separated by approximately one millimeter.
You can see the result immediately at the end of the procedure because the position of the eyelid moves to the right position after you finish. If the problem is not entropion but ectropion, we need to apply the dot-by-dot plasma discharge directly on the conjunctiva. In the lower nasal eyelid, you consider a 0.9-centimeter area. You mentally see a triangle on the conjunctiva finishing in the fornix, with the base parallel to the lid.
Is the point in the fornix?
Exactly. You can discharge the plasma dot by dot directly on the conjunctiva. Unfortunately, all procedures with plasma discharge are painful. We need to use topical anesthesia. Depending on the sensitivity of every patient, we use Ophtesic. It is a product specifically designed for ophthalmology. Many surgeons use it even for cataract surgery, so they do not have to use lidocaine intracameral inside the anterior chamber. They use the lidocaine 2% gel on the cornea five minutes before the surgery.
In many cases, you can do a topical cataract surgery only with this little guy. We use the same gel for many procedures, for example, conjunctivochalasis. Every time, we can diagnose more conjunctivochalasis as being involved in the etiology of dry eye. In these cases, we cannot do the conventional treatment with the direct current flow. We need to do an ablative procedure with the plasma discharge directly on the area involved in the conjunctivochalasis without any damage to the sclera.
Treating Conjunctivochalasis And Ocular Surface Lesions With Plasma
I wanted to ask you about CCH, actually. I have heard about that, and I find it a little scary. We’re going to do this plasma treatment right on the ocular surface. How deep is it going? Is the sclera or any deeper structures affected? You’re telling me it is just the conjunctiva that is absorbing the energy, and it is not going any deeper than that?
Yes. I have treated approximately 20 to 25 cases of conjunctivochalasis directly in my clinic. Every time I visit different hospitals around the world, and a patient suffers from conjunctivochalasis, they say, “Vicente, you can do the first case.” I have more experience now, personally, more than twenty patients treated with Jett. The first cases were with a lot of control using the fundus camera and analyzing the retina with indirect ophthalmoscopy. Now I can check even the retina after the procedure because I consider that the procedure is very safe.
That is actually really good to know. In the case in the world of ophthalmology, these are actual applications, but in the world of optometry, there are potential applications in the future as our scope expands over time. I do not know if we will be able to do conjunctivochalasis treatments anytime soon, but regarding other ablative work on the eyelid, I know that in some jurisdictions, removing skin tags is easier.
You can treat a chalazion because the treatment for a chalazion is only with the direct current flow. You do not need to use the plasma. The treatment is exactly the same as for dry eye, but concentrated in the area around the chalazion. When the meibum arrives on the ocular surface of the conjunctiva. You can introduce the tip inside the capsule of the chalazion to finish and remove the material inside. You can consider that the meibum is liquefied, and finally, you finish the treatment inside the capsule of the chalazion.
When you say inside the capsule, what does that mean?
Every time in the chat, a user and even optometrists present different cases of chalazion treated with the Jett.
That is one area where I think it is immediately applicable in optometry as well. When you say inside the capsule, what does that mean exactly?
The chalazion has a capsule, and we need to break this capsule to resolve the case. If you do not open the capsule that involves the chalazion, the problem continues. We need to break the capsule. Until the capsule is closed, you need to work around the chalazion. On the chalazion and around the chalazion, one minute, two minutes, three minutes. Using the right energy in most of the cases, two and a half is enough for opening the capsule. You can see the meibum on the surface and finish the problem. In my case, I prefer applying direct current stimulation on the skin in the same area as the conjunctiva and even directly on the orifice involved in the chalazion.
Practical In-Clinic Use: Safety, Comfort, And Scope Of Application
I know there was a note here about lid wiper epitheliopathy because I think that is quite common. What is the application for Jett for lid wiper epitheliopathy?
This is an inflammatory condition. Unfortunately, in many cases, the first etiology is contact lens wear. It is every time more frequent because the patients use them for longer than the correct time. This is the reason that every time more patients consider scleral contact lenses the best option, because they protect the cornea with scleral contact lenses. Lid wiper epitheliopathy is very frequent in the large group of patients using contact lenses.
The treatment is very easy because we need to stimulate mainly the tarsal conjunctiva. The problem is very near the eyelid margin. The wiper area is approximately 2 millimeters wide and separated from the eyelid margin by less than 1 millimeter. It is in the distal area, very near the eyelid margin. I recommend stimulating all the conjunctivae because the second etiology of lid wiper epitheliopathy is meibomian gland dysfunction.
These are the two big etiologies, contact lens wear and meibomian gland dysfunction. We see it even in patients without contact lenses. In these cases, we need to stimulate the affected area and the other area of the tarsal conjunctiva. We can have the meibomian glands involved in this diagnosis, too. In this case, we do not need to use the skin only working on the conjunctiva and working on the eyelid margin can be enough to treat lid wiper. It is very important to mention in all the interviews.
In all cases, working with direct current stimulation, we need to use a gel. We need to work on the gel, not only on the conjunctiva, but on the skin and the eyelid margin too. It is very common in your center or your clinic to use hyaluronic acid gel or another gel for the treatment. We need to have a conducting gel because it is an electrical stimulation procedure. For all electrical stimulation procedures, you need a conducting gel. This is very important. I am sorry because I did not mention it before.
Treatment should target the tear film, not just the conjunctiva or the skin on the eyelid margins.
That is okay. I do not expect anybody to be using it.
It is not a dry treatment. I know some doctors in France recommend doing the treatment without a gel, but I consider that the effect is greater if we use the correct conducting gel during the procedure.
What’s Next For Jett Plasma In Eye Care
Good to know. We’re going to wrap up. I wanted to ask you one last thing, a combined question. Is there anything we wanted to talk about that we missed, and what are some future applications or indications for Jett Plasma that you are excited about?
For me, I am on another wave. In this moment, the current indications for the Jett are not enough for me to be excited. I need to think about what the next step is. In my opinion, the next step can be the optic nerve. For me, the next step can be the retinal surface. Every time, we have more evidence that electrical stimulation can regenerate, maybe regenerate is too strong a word, but near to regenerating the structures in the retina.
Maybe in the future, we can have the parameters and the applicator adequate for treating the optic nerve or even the retina with stimulation. Another question for the near future, and I have a lot of experience, but only in pets, for example, facial paralysis. I collaborate with veterinary ophthalmologists, and at the next European meeting of the European Society of Veterinary Ophthalmology, I know that some teams are presenting different cases of facial paralysis in animals. We treated them with the brother of the Jett in the veterinary field.
It is the same technology, but applied in veterinary medicine.
I do not have experience with humans at the moment, but it can be a door that we can open.
There could be some relationship. That is very interesting. I have learned a lot in this conversation, Dr. Rodriguez. I really appreciate that. This is certainly exciting technology that has applications in the aesthetic space, dry eye, and beyond in these ablative procedures around the ocular surface. I look forward to seeing more of this and how it is going to help move the profession forward, both ophthalmology and optometry as well. Thank you, Dr. Rodriguez, for taking the time to be here. I know you’re a very busy man.
Thank you. It was a pleasure. I will repeat it for you and for the optometrists involved in dry eye in Canada in the future if necessary.
Thank you so much. Thank you to everybody who is tuning in and watching the show. We’ll see you guys in the next episode.
Important Links
- Dr. Vicente Rodriguez on LinkedIn
- Jett Plasma
- Dr. Harbir Sian on Instagram
- Dr. Harbir Sian on LinkedIn
- Dr. Harbir Sian on YouTube
About Dr. Vicente Rodriguez
Dr. Vicente Rodriguez is a world-renowned ophthalmologist, corneal and refractive surgeon, and internationally recognized expert in ocular surface disease. Based in the Canary Islands, Spain, he brings more than 30 years of clinical and surgical experience in corneal refractive surgery, keratoconus management, and advanced dry eye care.
Dr. Rodriguez has been awarded multiple gold medals from ophthalmological societies around the world in recognition of his contributions to eye care and innovation. He is a frequent international lecturer and educator, known for his deep understanding of ocular surface physiology and his ability to translate complex mechanisms into practical, patient-centred solutions.
He currently serves as the Global Medical Director for Jett Plasma, where he plays a key role in advancing the clinical applications of plasma and direct-current electrical stimulation technology in eye care. His work has helped expand the use of Jet Plasma beyond aesthetics into areas such as dry eye disease, blepharitis, meibomian gland dysfunction, Demodex management, lid wiper epitheliopathy, and ocular surface optimization.
With a unique background influenced by electrical engineering principles and decades of surgical experience, Dr. Rodriguez is at the forefront of rethinking how clinicians approach dry eye — moving beyond single-target treatments toward a more comprehensive, mechanism-driven model of care.
