Over the past few years, dry eye syndrome has become a widespread issue. According to the American Academy of Ophthalmology, approximately 3.2 million women and 1.86 million men over the age of 50 suffer from dry eye syndrome. And with increased talk about what dry eye is and its symptoms, eye care practitioners are now finding themselves with an influx of patients searching for relief.
In order to serve these patients, both ophthalmologists and optometrists need to invest in the latest dry eye technologies to ensure they are providing patients with the best management of their condition. One company offering such technologies is Topcon Medical Systems, Inc., which offers three products for dry eye diagnosis and management.
The Slit Lamp
First off is Topcon's SL-D701 Slit Lamp, which can be quickly upgraded to a fully-featured digital photographic slit lamp with the addition of the 5-megapixel DC-4 Digital Camera that allows for the capture of still images, video and multiple capture sequences.
Another option for the SL-D701 is the BG-5 Background Illuminator that allows for color anterior segment image capture. Additionally, when the DC-4 and BG-5 are used in combination, doctors can view and photograph the Meibomian glands via near infrared technology.
For Dr. Laura M. Periman, ophthalmologist at the Redmond Eye Clinic in Redmond, Wash., having the capability to take high-resolution images and videos in real time has enhanced her dry eye referral practice as it allows her to efficiently take an image of a patient's Meibomian glands without needing to move the patient to another room.
"There’s a time efficiency aspect that without a slit lamp mounted camera you miss," she explained. "When you see something, you can say I’m going to take a picture and show you what I'm seeing. Bam — capture it, show the patient on the screen. Your education time, the clinic flow, the confidence in your care is enhanced."
And being able to easily show patients a microscopic structure in real time aids in the clarity of communication. "Having that real-time assessment keeps the conversation fluid, relevant and impactful when you’re educating a patient on the nature of their dry eye disease," Periman added.
The Wavefront Analyzer
In conjunction with the SL-D701 Slit Lamp, Periman also uses Topcon's KR-1W Wavefront Analyzer that she refers to as an all-around workhorse as it offers the combined technologies of wavefront aberration, corneal topography, auto-refraction, keratometry, and pupillometry all in one system.
For Periman, whose particular interest lies in ocular surface disease, being able to show a patient the impact of their tear instability has been powerful. And for patients having dry eye complications post-surgery, she said it has been a great tool in teaching patients the problems they are experiencing are not the fault of their surgeon. "They then stop blaming (the surgeon), buckle down and get to work to rehabilitate their tear film," she added.
To use the non-invasive, no-contact device, patients are asked to blink and then hold their blink, during which Periman said the KR-1W captures data points from the eye over time and measures higher order aberrations. Additionally, higher order aberrations can be tested under both photopic and mesopic lighting conditions. HOAs degrade over time in dry eye disease.
"That’s especially helpful for the dry eye sufferer who says I don’t see well at night," Periman said. "It’s a nice objective point to measure over time as you work toward ocular surface rehabilitation and restoration."
And Periman said the KR-1W also offers an optotype analysis interpretation that approximates what the visual experience is for dry eye patients that are not seeing normally. This allows patients to "understand the nature of their blurred vision, why another pair of glasses is not the answer and why they have to pay attention to the ocular surface to improve their visual performance."
The Corneal Analyzer
The third product in Topcon's dry eye product line is the CA-800 Corneal Analyzer — a comprehensive corneal topography solution for the complete evaluation of the anterior corneal surface.
According to Dr. Richard A. Adler, director of ophthalmology at Belcara Health and assistant professor of ophthalmology at the Wilmer Eye Institute, the CA-800 is an ergonomically compact device that consolidates a number of different modalities doctors might normally have separate instruments for, including Meibomian gland imaging, corneal staining and corneal topography.
While all three of those modalities are important when diagnosing and managing dry eye, Adler said he was drawn to the CA-800 for its meibography capability. "It is an under-appreciated diagnostic tool in dry eye," he explained. "it’s so relevant in so many ophthalmic conditions, not just dry eye, but lid disease, contact lens intolerance, reactions to chronic glaucoma medication use, allergic disease. It’s a modality that is so useful, I thought incorporating this into my practice would be a value."
And Adler has found the CA-800 to be an excellent education tool for patients, especially with a condition like dry eye that can be somewhat ambiguous. "For folks who are suffering from dry eye disease, it’s very meaningful, very helpful, to be able to objectify their disease in a meaningful way," he said. "Even if they are worse, it gives them an explanation for why they’re worse. Here’s something that makes intuitive sense to folks — it explains why we’re treating them, why they’re suffering, why they’re better. And it's easily accessible on the screen sitting right next to them in the exam room."
Creating a Center of Excellence
For ophthalmology or optometric practices looking to build a dry eye center, Adler says these instruments provide practitioners with the tests they need to clinically grow that part of their business.
If a practice is newer, Adler recommends investing in the CA-800 because of all it offers. However, if a practice is mainly interested in adding meibography to their services, he suggests looking at the SL-D701 and the BG-5 attachment. "The emphasis here is on this under-valued, under-appreciated, under-performed diagnostic modality called meibography," he explained. "Of all the diagnostics available for dry eye, I would say it is potentially the most useful."
And for Periman, having objective metrics of visual performance has allowed her to better pinpoint where the problem is coming from to ultimately deliver a better end result to her patients.
"What has helped me the most is the ability to objectively demonstrate and corroborate the reported problem is and meaningfully connect with the patient on what they’re reporting to me with fluctuations in vision," Periman concluded. "To be able to collect and demonstrate objective measures calms the patient, and you take the conversation away from a theoretical, subjective thing to a tangible, objective thing. It becomes a powerful diagnostic and analytic tool for detailing the underappreciated impact of the ocular surface on the eyes' visual performance. The therapeutic relationship is enhanced."