The old adage holds true for clinical practice—an accurate diagnosis is key to a successful outcome. The latest innovative diagnostic technologies are becoming mainstream either because they replace testing that patients don’t look forward to, replace those that are difficult to perform or simply provide critical clinical insights you can’t get elsewhere. Let’s review them.
Let’s admit it—there are tests patients complain about, from manual refraction and binocular vision assessments to visual field testing.
Phoria testing is one such example, as most find it impossible to determine the misalignment endpoint. One might argue that this test belongs in the “difficult for the doctor to perform” category as well. The Neurolens Measurement Device, Gen 2, makes the task simple with an objective, repeatable test that takes less than two minutes. It acquires 10,000 data points and all misalignments are determined to an accuracy of 0.01µm. Contoured prism is prescribed, which has had a dramatic effect on my patient population in relieving asthenopia, headaches, neck stiffness, dizziness and/or dry eye sensation.
Another task patients (and techs) loathe is visual field testing. Patients get tired and frustrated with the button-pushing and insecurity of correct answers with standard automated perimeters (SAP). Because of this, it’s not uncommon for patients to fail to return to the office for follow-up testing. If you are looking for a VR headset, make sure it has active tracking—meaning the testing automatically halts if the patient loses fixation-—and options such as neighborhood cluster testing to ensure a quick test that typically is less than three minutes (M&S Technologies is one example).
ObjectiveField (Konan Medical), or the OFA, is a binocular, objective field analyzer that uses neurological pupil response to precisely map the visual field, with no button to push. Further setting OFA apart from SAP, both eyes are tested at once and novel diagnostic information such as mapped hyper-sensitivities and latencies, fellow-eye asymmetries and their respective progression analysis are captured.
Difficult to Perform Tests
There are assessments that we know are important but difficult for doctors or staff to perform consistently well, or lack the sensitivity to provide useful information. For example, many patients with early glaucoma have a subtle relative afferent pupillary defect (RAPD), but I doubt many of us could pick up that level of asymmetry with the swinging flashlight test. Pupil testing with EyeKinetix (Konan Medical) provides a detailed neurological pupil testing assessment in about 90 seconds accurately and objectively. Early glaucoma is a common cause of these subtle RAPDs.
Ultrasound and other biometry measurements are difficult to obtain but helpful for myopia management. New devices such as Lenstar Myopia (Haag-Streit) or Myopia Master (Oculus) make testing more accurate and provide easy to follow patient reports with long-term tracking data.
Uncovering Clinical Insights
Diagnostics that provide insights beyond standard testing can add a level of sensitivity that increases our accuracy and prevents us from treating a patient who may not require it. One example is measuring hysteresis with the Ocular Response Analyzer (Reichert). While IOP gives us an idea of risk, hysteresis provides a more accurate IOP, and it alone is the most accurate marker for determining who is likely to have a progression to glaucoma and risk of visual field loss.
Osmolarity is a key differentiator of DED. Far too many conditions such as eye misalignment, exposure keratitis, epithelial basement membrane dystrophy and blepharitis have symptoms similiar to dry eye. Putting such patients on dry eye treatments fails, is costly and is frustrating for doctors and patients. Osmolarity above 308mOsmol/L in either eye confirms a diagnosis. The new ScoutPro (Trukera Medical) is a single, portable handheld system that provides a precise tear osmolarity measurement in seconds.
Good diagnostics are the key to success in clinical practice. Consider new innovations that uncover essential clinical data or replace difficult tests—that’s essentially what innovation is meant to achieve.
Dr. Karpecki is medical director for Keplr Vision and the Dry Eye Institutes of Kentucky and Indiana. He is the Chief Clinical Editor for Review of Optometry and chair of the New Technologies & Treatments conferences. A fixture in optometric clinical education, he consults for a wide array of ophthalmic clients, including ones discussed in this article. Dr. Karpecki's full list of disclosures can be found here.