The pros and cons of the latest dry eye technology

New Orleans-Over the last few years, there have been several advancements in ocular surface disease diagnostic and treatment technology. Not sure which ones are right for your practice? Milton Hom, OD, FAAO, and Ben Gaddie, OD, FAAO, shared their advice on the latest and greatest dry eye tools at the American Academy of Optometry 2015 meeting in New Orleans.

Related: Diagnosing and treating dry eye with technology

Dr. Hom says that industry meetings give ODs the opportunity to discuss their experiences with the latest technologies and treatments.

“There seems to be a gap of when to use these technologies, how to use these technologies-should we use these technologies on every patient? The thing is that we don’t know the answer,” says Dr. Hom. “My hope is that we can help narrow that gap and shine some light on how to proceed.”

Keratograph 5m

The Keratograph 5M from Oculus is a corneal topographer that can conduct a variety of dry eye tests, including non-invasive tear break-up time.

“It gives you a nice map of what’s happening in terms of break-up-how long it breaks up, the average break-up time, and everything like that,” says Dr. Hom. “And for a patient, showing him these things is very, very impressive.”

He says also credits the device with bringing meibography to the masses.

“This is really important because patients don’t really understand why they need meibomian glands or what the purpose of them is-it really is a turning point for them to understand why they’re having symptoms,” says Dr. Gaddie.

One problem is that the patient has to keep his eye open for a long time, which may be a struggle for someone suffering from dry eye.

Pros:

• Unlimited uses

• Run by techs

• Costs about $20,000

• Non-invasive

Cons:

• Evolving norms

• Time consuming (“You could spend an hour doing all the tests, if you wanted to,” says Dr. Hom.)

• Not covered by insurance

Next: LipiFlow

LipiFlow

LipiFlow from TearScience is a bladder that goes over and under the eyelid that heats and massages the lids to treat meibomian gland disease.

Related: Using warm compresses to treat MGD

Pros:

• 79% effective

• Developed by Donald Korb, OD, FAAO (“What can you say about Don Korb? He is the genius God of optometry,” says Dr. Hom.)

• Does not cause corneal distortion common with lid therapy

• Moderately invasive

Cons:

• Not a cure, repeat treatments needed (“They’re talking about the dental model-every six months or so,” says Dr. Hom.)

• Expensive initial and disposable costs

• Not covered by insurance

• Other treatments are available

• Demodex?

Dr. Gaddie says that TearScience lowered the price of the device and no longer requires that you also purchase the LipiView diagnostic device. He says that TearScience is also working on lowering the price of the disposable parts of the device.

“That’s why I really think it’s going to be a game changer and why we implemented it in our practice,” says Dr. Gaddie.

He says that current clinical trials show that a single LipiFlow treatment can offer relief for up to 18 months.

Next: MiBoFlo

MiBoFlo

Dr. Hom describes MiBoFlo as half of a LipiFlow that applies 108-degree heat to the outer lid, but not the inner lid. He recently conducted research that found that MiBoFlo improved meibomian secretions over the control eye but there was no symptomatic improvement.

“It’s probably little less expensive than LipiFlow-but it’s not that much less expensive,” says Dr. Gaddie. “But it’s not getting the back side of the eyelid and that’s why you’re not getting any symptomatic relief.”

Pros:

• Lower cost than LipiFlow

• Does not cause corneal distortion common with lid therapy

• Moderately invasive

Cons:

• No data

• Not covered by insurance

Next: Inflammadry

InflammaDry

InflammaDry is a point-of-care diagnostic device from RPS that takes a tear sample and test for inflammation.

“You wait about 10 minutes and you look-I hate using this analogy, but it’s essentially like a pregnancy test-it has a control line if you have an accurate sample, and it will give you a pink line if the inflammation is over a certain threshold,” says Dr. Gaddie.

Pros:

• Covered by insurance

• Run by techs

• Minimally invasive

Related: Treating dry eye with lipid-based eye drops

Cons:

• Low profit margin

• One-time use

• Difficult to read

• No algorithm

“I personally don’t find a lot of value in it to diagnose dry eye,” says Dr. Hom. “In my practice, it’s more like you establish the patient has dry eye, and then you can use it to identify the subtype.”

Next: Sjö

Sjö

“Is Sjögren’s syndrome the new dry eye?” asks Dr. Hom.

Sjö is a diagnostic test that requires a small blood sample to identify patients with Sjögren’s.

The vast majority of the patients suffer from both dry eye and dry mouth, so Dr. Home recommends screening patients by asking how often the experience dry mouth or other parts of the body, fatigue, and joint pain.

Related: Identify Sjögren’s patients with Sjö test

Dr. Hom says that the test’s results may surprise you-he has even identified male patients in their 30s who are diagnosed with the disease.

Pros:

• Covered by insurance

• Run by techs

Cons:

• Highly invasive

• No profit margin

• Expensive for the patient

Next: TearLab Osmolarity

TearLab Osmolarity

Both doctors say they were early adopters of the TearLab Osmolarity system.

“Osmolarity is not an easy concept for everyone to understand what the hallmark features are,” says Dr. Gaddie. He says TearLab has done a lot to educate practitioners on how to use the device and integrate it into their practices.

Dr. Gaddie says his practice tries to integrate both InflammaDry and the Osmolarity test.

Pros:

• Covered by insurance

• Run by techs

• Minimally invasive

• Lots of supporting data

Cons:

• Reliability of the results

• Disposables required-one-time use

• Low profit margin