Article

CLINICAL: Dry Eye

DED Diagnostic Testing

Diagnostic devices can provide clinical insights and patient education

When I was 11 years old, I fell off my bicycle trying to avoid a puddle and landed squarely on the concrete with my arm pinned beneath me.

I pulled myself up and made my way home, feebly pushing my 10-speed. My arm hurt when I moved it. As a result, my mother tried ice and OTC pain relievers before relenting to my whining and taking me to an urgent care center. (She didn’t buy my story, but took action in spite of herself.)

An X-ray revealed I had chipped my elbow. Specifically, the doctor at the urgent care center pointed out tiny fragments of bone that appeared to be floating around the major bones in the image. Thanks to that X-ray and the doctor’s knowledge, my mother understood the reason for my whining, and we both understood the importance of complying with what needed to be done to heal my arm: a cast for the next few weeks.

Just as my mother questioned the necessity of taking me to urgent care for an X-ray, some optometrists question the necessity of dry eye disease (DED) diagnostic testing.

Here, I make the case for DED diagnostic devices, and I use one such DED diagnostic test to illustrate this.

A MISPERCEPTION

Blink rate testing, corneal topography, diagnostic equipment that contains slit biomicroscopy algorithms, meibography, meibomian gland expression devices, MMP-9 and tear osmolarity testing provide two crucial points of value to optometrists: clinical insight and patient education. The former aids in a definitive diagnosis, while the latter often helps optometrists to secure patient compliance to the one or more DED treatments we prescribe based on the definitive diagnosis.

AN EXAMPLE

Take meibography as an example. The image created shows us what meibomian glands lie below the surface of the lid margin.

If the doctor who examined me after my bicycle accident had merely conducted a physical examination of my arm, he wouldn’t have seen that small break, which was the root of my pain. The X-ray and his interpretation of it showed my bone was palpably broken in two, but it wasn’t protruding through the skin. It was subtle. Subtle, but painful.

Let’s remember that, often times, DED can manifest similarly. And, as was the case with the X-ray, DED diagnostic tests aid us in validating and linking patients’ reported symptoms with their signs, providing clinical insight.

Additionally, showing patients an image provides them with greater understanding of meibomian gland dysfunction and the need for intervention.

While my mother believed my arm hurt, she needed to see the X-ray to truly embrace the complaint and, inevitably, the solution.

MY ELBOW

Within a few weeks, the cast was removed from my arm. The clinical outcome was a success, thanks to appropriate diagnostic testing, coupled with a knowledgeable doctor. For years, I gave my mother a hard time for not believing the severity of my injury. When my son was in the seventh grade, he too fell while riding his bicycle, but he broke his wrist. I tried the ice and OTC medications route before taking him to an orthopedist. Like mother, like daughter. OM