There are two major processes in Optimize Indexes, the SQL validation process and the index search process.
In the validation process, a database connection is created to validate (by retrieving the execution plan) the SQL statements one by one from the Profiler file.
Once the validation process completed, the index search process can begin by clicking the 'Start' button.
In the index search process, another database connection will be created to perform the index search process, Optimize Indexes will then create session base virtual indexes and retrieve the execution plan to see if the validated SQL statement affected.
During the whole Optimize Indexes searching process, there are only two database connections created and mainly retrieving execution plan.
It is believed that Optimize Indexes impact on production server would be minimal.