Dry Eye Diagnostics

Top reasons to consider an investment in advanced DED technology

When I began my career in optometry more than 20 years ago, dry eye disease (DED), in my opinion, was regarded by the profession as the underappreciated “step-child” of eye care, and the lack of related diagnostic technology at the time reinforced this perception. Fast forward to 2020, and diagnostic technology in DED abounds. Yet, regardless of these advancements, some optometrists don’t see their need, saying, for example, “I have a slit lamp and a thumb for meibomian gland expression, so I have all I need to diagnose and treat dry eye disease.”

Here, I discuss why these O.D.s should consider advanced DED diagnostic technology.


While basic technology can be used to care for these patients, I would argue that employing such technology places optometrists at risk for losing DED patients. Why? Patients desire high-tech, equating it with stellar care. So, if the patient undergoing basic technology hears from a friend or family member about a local optometrist who uses a meibographer, for example, that patient may seek that O.D. instead for her DED management.


Advanced DED technology improves efficiency. In this day and age of managed care requirements, efficiency is needed more than ever to both sustain a practice and maintain that one-on-one doctor-patient time that creates patient loyalty. So, yes, it’s true that a slit lamp and thumb can enable optometrists to diagnose and treat DED, but let’s consider this statement: “I have two feet, so I can get around town.” Also, true, but most of us prefer cars for their efficiency.


Devices that aid in determining ocular surface structure analysis, tear quality measurements and tear quantity measurements provide insights into DED that a slit lamp and thumb simply cannot.

For example, a meibographer creates images of the gland architecture hidden within the eyelids. Ultimately, the images provide the doctor with three items:

  1. immediate direction for patient care,
  2. a curated record for monitoring progression and
  3. a tool for patient education.

Regarding the third item, I have found advanced DED diagnostic devices aid in increasing the likelihood of patient compliance to prescribed treatments because patients can actually see the disease.

Another example: Devices that measure tear quality, such as osmolarity systems, enable O.D.s to pinpoint whether a patient’s decrease in VA is due to DED vs. a normal slight change in refraction. A Snellen chart, alone — a basic technology for evaluating VA — speaks to the quantity of letters one can interpret, not their quality.


Many doctors lean on the capital investment (cost) as the reason not to bring in advanced DED technology. I would argue that the purchase of such technology is an excellent investment because of the prevalence of DED. In fact, according to a recent study in the American Journal of Ophthalmology, the prevalence in the United States is 5.28% of the population.

A DED questionnaire alone can elicit several suspects for the chronic condition, warranting the use of such technology. Additionally, once treatment is prescribed, these devices are used repeatedly to assess pathology. Therefore, advanced DED technology is worth fitting into clinical care. OM