Dry eye is the most common chief complaint among eye care patients. It is estimated that 80% off Americans suffer from some degree of clinical dry eye. This number may seem high but if you look how the typical Americans lifestyle has changed then the mystery clears up and it becomes easy to see how the problem will increase in prevalence. Twenty years ago people had vastly different daily activities and put very different demands on their eyes. The population wasn’t transfixed on a small screens and LCD monitors like today. Contact lens wearers were fewer, refractive surgery was in its infancy, and computer use was much less.
Dry eye and CVS (Computer Vision Syndrome), or more technically aesthenopia, is a major problem for people. It can cause blurred vision, headaches, eye-pain, and even double vision. The diagnosis is difficult as the problems are non-specific and can be intermittent. Dry eye is a component of asthenopia and can further complicate the problem by mimicking allergies. For many years the dry eye patient was moved to the side of treatment due to the lack of quality tools for understanding the facets of the disease and treatments. The ubiquitous: “Use lubricating drops as needed.”, or “Use a warm compress like a microwaved bag of rice or a potato and place it on your lids for a few minutes.”, never seemed to help dry eye sufferers and these people felt as if they weren’t being listened to.
The issue wasn’t that doctors weren’t listening but that doctors didn’t have effective tools at their disposal. Until now, todays doctors have a handful of very effective tools that can address this huge population of patients. Many doctors are only beginning to understand the new tech but the ones that are progressive in their learning and technology purchases are reaping big benefits.
The three most influential technologies to create a “dry eye” clinic are the Keratograph 5M by Oculus, LipiFlow by TearScience, and TearLab’s Osmolarity Test. Oculus’s Keratograph 5M is the one tool every practice should employ due to its many functions and far reaching benefit to so many patient types. The Keratograph is a dry eye work-up station featuring five types of scans. The first is a non-contact tear break-up time scan and should be used on everyone walking through the door to assess tear film quality regardless of chief complaint.
Any patient considering refractive surgery, contact lens wear, or that are having non-specific ocular issues should be screened this way. The second type of scan is tear meniscus height. It will give clues to whether the tear film is deficient in lipid or aqueous volume. Thirdly, the Keratograph 5M has a lipid layer scan. Again, this will provide the practitioner information about the thickness or thinness of the lipid layer.
The fourth type of scan is a tear film dynamics. Similar to an objective assessment via a slit lamp this records the viscosity of the tear film and can be used to observe partial or complete blinks. The last Keratograph 5M scan is the Meibography. This powerful scan images and allows for detailed measuring of the Meibomiam glands. A healthy patient will have long tightly packed glands running from the eye lid margin and be straight in appearance. Unhealthy eyes can easily be detected by observation of wavey, or tortuous, paths for the glands and be truncated. The most severe dry eye patients will have drop-out zones where glands no longer exist. The power of the Keratograph 5M is obvious to a doctor but because the system displays all the information on a large screen for the patient to see, it strikes home deeper and enforces treatment compliance.
The LipiFLow device is a very effective tools for a dry-eye practice to include. LipiFlow® is a new procedure designed to treat the root cause of Evaporative Dry Eye, blocked Meibomian glands. Opening and clearing these blocked glands can allow them to resume natural production of lipids (oils) needed for a healthy tear film.
LipiFlow uses a single-use eyepiece to relieve blockage of the meibomian glands during a treatment. Controlled warmth and gentle massaging allow blocked glands to open. The body can then resume its natural production of lipids needed for your tear film. No longer do patients have to microwave rice bags or potatoes and hope that their blocked glands clear up.
The last piece of a dry eye clinic is Tear Lab’s Tear Osmolarity test. This is a unique addition to a dry eye work-up because it is 100% billable for practitioners. The test works by using a non-invasive test card to obtain a tiny sample of tear fluid. It provides a quick and simple method for determining tear osmolarity, the salt content, of tear fluid directly from the eyelid margin. The TearLab Osmolarity Test utilizes a temperature-corrected impedance measurement to provide an indirect assessment of osmolarity. A lot of science is behind the system but osmolarity has been found to be very specific in patients with different levels of dry eye disease.
Clearly, there has been a lot of advancement in testing tools and treatment tools for the dry eye patient. Using the right tools and understanding how use them correctly can provide many new diagnostic and treatment opportunities for practitioner. Many practices have found great success and many happy patients using the tools mentioned above and supplementing them with take home controlled-heat compress masks and dietary nutriceuticals. Some of the best products for patients to take home are TranquilEyes masks by Eye Eco and dry eye dietary supplements by PRN Omega Health. These have clinically proven results and are a great treatment option for patients.
Before Eco Eye (Keratograph 5M Tear Break Up Scan, orange/red = poor tear quality) After Eco Eye 20min wear (Keratograph 5M Tear Break Up Scan, green = healthy tear film)
Bringing back patients for follow-up visits and running a dry eye work-up will give the doctor an opportunity to demonstrate the effectiveness of the treatment plan and make for a very satisfied patient. By smartly using the correct diagnostics and recommending effective treatments it is easy become a recognized dry eye clinic of excellence.
Keratograph 5M by Oculus www.oculususa.com
LipiFlow by TearScience www.tearscience.com
Tear Osmolarity by TearLab www.tearlab.com
Controlled Heat Compress Masks www.eyeeco.com
Dry Eye Nutriceuticals www.prnomegahealth.com
Guest post by Erich Mack, Oculus USA Rep for AZ & Southern California. I am a licensed optician as well and ABO-Advanced, and NCLE certified. My optical experience spans over 8 years and includes positions such as working in a lens lab, office management, and consultative selling. In my spare time I write ABO and NCLE continuing education courses