• Dry eye. Schirmer testing and tear break-up time served optometry well for decades, but it’s time to recognize that newer technology adds valuable data these old standbys cannot. Point-of-care diagnostics—e.g., testing for osmolarity (TearLab) and MMP-9 (Rapid Pathogen Screening)—has greatly enhanced the accuracy of dry eye diagnosis, allowing patients to begin therapy earlier and avoid ineffective treatment based on symptoms alone. In 2017, we’ll see further developments in biomarker capability. In time, we’ll be able to use these advances to hone our diagnoses and gauge the likely patient response to targeted therapies.
Meibography will also become vital. Imaging with the Keratograph M5 (Oculus) with multiple dry eye tests, including non-invasive tear break-up time and meibography, and the CA-800 (Topcon) are greatly assisting with DED diagnostics. TelScreen meibography and video imaging will advance in 2017, and high-res dynamic meibography imaging is now available with LipiScan and LipiView (TearScience).
• Glaucoma. Wearable tech continues to be a multi-billion dollar industry and will have numerous health applications. The Sensimed Triggerfish contact lens provides non-invasive 24-hour monitoring of changes to the cornea’s curvature—a measurement that coorelates with changes in IOP.1
Corneal hysteresis, measured by the Ocular Response Analyzer from Reichert, has been shown to be sensitive at predicting visual field progression in glaucoma patients.2 Recent upgrades to the Icare tonometer added LED indicators for proper alignment, series testing for six rapid test measurements and better alignment and design features.
• Retina. More than two-thirds of a retina specialist’s income comes from medical care, not injections and surgery. This is an area optometry will participate in to a greater extent. Diagnostic advances such as dark adaptometers (AdaptDx, Maculogix) can provide valuable clues three or more years prior to seeing macular drusen and will allow a clinician to begin managing age-related macular degeneration earlier through dietary supplements and lifestyle changes.
OCT angiography, recently introduced by several companies, allows imaging of microvascular changes early in the course of diabetic retinopathy. Optometrists can easily incorporate this new tool into practice without the need for fluorescein angiography.
• Refraction/vision testing. According to the most recent Review of Optometry technology survey, the second most likely device to be purchased in the next 12 months after tear osmolarity was an automated phoropter.3 It’s not a surprise—these technologies continue to advance and streamline efficiency. Current options including systems from Zeiss, Marco and Topcon, and new additions from Reichert and Visionix will provide even greater options. Point-spread-function phoropters (VMax) can measure to 0.10D and even 0.05D and design free-form glasses with that correction.
Two other devices to watch for: the HD Analyzer (Visiometrics), which measures scatter from refracting surfaces to help the clinician choose the best intervention (ocular surface vs. corneal vs. lenticular), and a new technology called NeuroLens (eyeBrain) that can measure eye alignment and provide progressive prism to treat binocular misalignment, computer vision syndrome, frequent headaches and even symptoms of dry eye in patients without DED.
I wish I’d had many of these when starting out! But—better late than never—we’re steadily gaining ground on ocular disease diagnosis.
Relevant financial disclosures for Dr. Karpecki: eyeBrain, Icare USA, Maculologix, Oculus, Reichert, TearLab, TearScience, TelScreen, Topcon, Vmax, Visionmetrics.
|1. Mansouri K, Medeiros FA, Tafreshi A, Weinreb RN. Continuous 24-hour monitoring of intraocular pressure patterns with a contact lens sensor: safety, tolerability, and reproducibility in patients with glaucoma. Arch Ophthalmol. 2012;30:1534-9.|
2. Anand A, De Moraes CG, Teng CC, et al. Corneal hysteresis and visual field asymmetry in open angle glaucoma. Invest Ophthalmol Vis Sci. 2010 December;51:6514-8.
3. Hepp R. Out with the old, in with the new. Rev Optom. 2016;153(9):32-9.