New Dry Eye Technology
Three systems will help elevate your dry eye disease work up.
KELLY K. NICHOLS, O.D., M.P.H., PH.D.
There are many reasons to add ocular surface technology to your practice, whether you want to start a dry eye disease (DED) clinic or supplement what you already have. In our clinic, we have a lot of new technology for the diagnosis and management of DED. The reasons: We are a teaching institution, and we want our students to use the newest and the best, and technology helps me be a better doctor.
Here, I discuss the technology options.
The TearLab Osmolarity System (TearLab Corporation, San Diego, Calif.) has been adopted in clinics throughout the world (visit www.tearlab.com).
Interestingly, TearLab studies have shown that many asymptomatic patients have higher than normal tear osmolarity. We found this is true in our Family Practice Service, indicating a need for DED assessment and referral to our Dry Eye Center.
Meibomian gland structure
The Oculus Keratograph 5M topographer (Oculus USA, Arlington, Wash.) has a suite of dry eye tests that includes the viewing of the meibomian glands using infrared technology. The image is captured and automatically enhanced for optimal contrast (visit www.oculus.de/us/products/topography/keratograph-5m).
In addition, non-invasive tear break-up time can be measured, and the device provides information about the speed of break-up across the cornea by region. Tear meniscus height is measured following image capture, and the instrument takes excellent color fluorescein images.
The LipiFlow Ocular Surface Interferometer and the LipiFlow Thermal Pulsation System (TearScience, Inc., Morrisville, N.C.) has made me think about the lid margin and glands more than I ever did before (visit www.tearscience.com). While I have been expressing meibomian glands for almost 10 years, I have not routinely scraped the lid margin, which now we do before every LipiFlow procedure.
Just removing lid margin debris and the top bit of a blocked gland seems to make a difference clinically. Think of it as teeth cleaning for the lids. Why have we not been doing this for years? It makes sense.
Wrapping it up
We can now look at so many more elements of DED than we could without the technology described here.
Our Dry Eye Center patients experience a battery of tests before I ever see them behind the slit lamp. What a wealth of information, which has taken no more of my time in the clinic, yet enhances my ability to tailor a management plan. Technology adds something to a DED work up that is different from what a patient experiences in a routine examination: It elevates the DED work up, the perception of the doctor, as well as treatment compliance. OM
DR. NICHOLS IS A FOUNDATION FOR EDUCATION AND RESEARCH IN VISION (FERV) PROFESSOR AT THE UNIVERSITY OF HOUSTON COLLEGE OF OPTOMETRY. SHE LECTURES AND WRITES EXTENSIVELY ON OCULAR SURFACE DISEASE AND HAS INDUSTRY AND NIH FUNDING TO STUDY DRY EYE. SHE IS ON THE GOVERNING BOARDS OF THE TEAR FILM AND OCULAR SURFACE SOCIETY OF OPTOMETRY AND IS A PAID CONSULTANT TO ALCON, ALLERGAN, INSPIRE AND PFIZER. E-MAIL HER AT KNICHOLS@OPTOMETRY.UH.EDU, OR SEND COMMENTS TO OPTOMETRICMANAGEMENT@GMAIL.COM.