Last month, I observed a significant peripheral malignant melanoma in a patient who presented without complaints and 20/20 vision. No online testing or online optical using dated prescriptions would have caught that—and the consequences could have been life-threatening. But what did help me catch that was the technology I have at my fingertips these days. While we are all leery of innovations such as online refraction and dispensing services, some advances do more good than harm when used properly. Here is a look at the technological advances transforming your office.
Technology is getting smaller and more portable. One of the more extreme examples is the recently introduced handheld full-field flash ERG + VEP (RETeval), which fits in the palm of your hand and holds its charge for at least 70 patient exams, according to the company. In the near future, the Eyekinetix (Konan Medical) may help you measure a relative afferent pupillary defect in less than 30 seconds with accuracy far beyond what’s possible with a swinging penlight.
Automated systems are beginning to stack up. I recently conducted a study evaluating the Perfectus (VMax) refracting system, which uses point spread function (PSF). Preliminary results suggest the device is as accurate as a doctor’s refraction in 97% of cases—and even more with difficult refractions such as in patients with keratoconus. These technologies have changed how patients view the optometric refraction by providing increased efficiency, accuracy, EHR compatibility and innovations such as wavefront and PSF.
We all know the sooner a diagnosis is made, the better the prognosis. We can now detect diseases much earlier than ever before with the help of newer technology.
Age-related macular degeneration (AMD). Dark adaptation has over 90% sensitivity and specificity for AMD. It’s not merely a predictor; if you fail this six-minute test, you have AMD. In addition, the Pharmanex Biophotonic scanner (NuSkin) is designed to help you accurately measure the level of carotenoids or antioxidants in patients’ soft tissue, such as the palm of their hand.
Glaucoma. New technologies are modernizing your glaucoma examination, including OCT, progression analysis and corneal hysteresis measurements. Longitudinal studies show that patients with a corneal hysteresis number less than 10 have three to five times greater progression of visual field loss.1 For me, it is often the deciding factor for my initiation of treatment in patients with early or inconclusive signs of glaucoma.
Diabetic macular edema (DME). In diagnosing DME—a disease complication we know can result in irreversible damage to the macula and permanent loss of vision without proper treatment—OCT can help distinguish a subtle epiretinal membrane to pinpoint why a patient’s vision is compromised.2
Dry eye disease (DED). Research shows that a clinician who used symptoms alone to determine DED would be wrong more than 40% of the time.3 Point-of-care testing is essential in helping to determine who does or does not have DED. For example, an osmolarity reading between 280mOsmol/L and 295mOsmol/L and within 5mOsmol/L between eyes in a patient that has not applied eye drops in the last two hours has a 3% chance or less of having DED.4
Optometry is embracing smaller, more specific and point-of-care testing to help improve our diagnostics. Let’s use our innovations to distinguish our profession from online and in-pharmacy efforts, increase our efficiency and accuracy of diagnosis and ensure patients understand their ocular, and often systemic, health depends on us.
|1. Medeiros FA, Meira-Freitas D, Lisboa R, et al. Corneal hysteresis as a risk factor for glaucoma progression: a prospective longitudinal study. Ophthalmology. 2013;120(8):1533-40. |
2. Pershing S, Enns EA, Matesic B, et al. Cost-effectiveness of treatment of diabetic macular edema. Ann Intern Med. 2014;160(1):18-29.
3. Bron AJ, Tomlinson A, Foulks GN, et al. Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf. 2014;12(2 Suppl):S1-31.
4. Nolfi J, Caffery B. Randomized comparison of in vivo performance of two point-of-care tear film osmometers. Ophthalmol. 2017 May 22;11:945-50.