TearLab is an interesting new technology but how do I use the results from the test to improve my patients symptoms? Has it really been validated? Does it really make a difference?
At Vision Expo the most common discussions I heard from colleagues; I buy into the science that osmolarity is the best bio-marker for determining DED (dry eye disease). That TearLab is highly accurate and it gives me an objective outcome. Finally we have an indicator that is sensitive to help manage ocular surface disease. Although is it really going to change way I practice? Can I pay for the device through patient visits and procedural codes? What does the number actual determine?
Dry Eye Disease (DED) is a complex syndrome with many factors cascading to result in discomfort, reduced visual abilities and secondary infections. Its onset may be triggered by many factors including exposure to systemic drugs, contact lens wear, ocular surgery and adverse environmental and work conditions. Tear osmolarity defines how much solids are in solution. If all the solids are dissolved the tear osmolarity is low. As the tear film thins solids precipitates out of solution and the tear osmolarity increases. Tear hyperosmolarity is central to the dry eye disease process, it serves as a measurement of disease severity and a means to monitor treatment efficacy. Tear osmolarity is an indicator not a symptom or cause. The results tell me that the tear film has reduced liquid in relation to the solids. The most important parameter of tear osmolarity is the change from pre-treatment to post-treatment.
I can think of three reasons why a practitioner wants to incorporate the TearLab device into their practice.
- As an innovator practitioner, develop dry eye therapies to problem solve patients complaints
- Growing your practice and marketing for new patients
- Building a Dry Eye Practice
The number one complaint patients express in our practice besides vision is ocular surface disease related symptoms. These are serious issues that do not go away. The result of this syndrome; affects comfort, vision and secondary infections. Ocular surface disease creates visual problems with spectacles, contact lenses and reduces quality of life. This disease has most doctors think that DED patients are difficult to control. That’s because they think there is nothing they can do for them and don’t feel that they can appropriately find a systematic approach to solve their discomfort. Every time an ocular surface problem patient comes into the practice a therapeutic approach of dry eye drops, steroids, antibiotics, vitamins/supplements and procedures such as punctual plugs are thrown at them hoping that something will improve their discomfort. In my experience, DED patients are willing to pay anything for a doctor who can solve their problem. It’s not just an inconvenience to the patient; it’s a major lifestyle issue and they will do anything for relief. They don’t want to be told to just go and try a bunch of drops. They want someone to deal with their disease in a logical systematic approach. They want the complaint to be monitored and they want to be able to measure success and progress. Most importantly they are happy to pay for a resolution and happy to refer all of their friends who share both their discomfort and frustration with their doctors who solves their symptoms.
For me it’s helping to build the practice in a significant way. I am also providing a higher standard of care and feel that I can separate a therapy that is working verse blindly picking a therapy. Not only am I treating patients with complaints in a way that is making a difference in their lives but now have the tools to monitor one of the most frustrating diseases on a regular basis. One third of all patient encounters complain of DED symptoms and TearLab can confirm if it is truly Dry Eye or direct me to think about another cause. The most common side effect of Laser Vision correction is dry eye and the reason why most of my patients drop out of contact lenses is dryness.
It is a great tool to help me counsel patients prior to laser surgery correction. It will never stop patients from having surgery but the results from the Tear Lab device aid in the discussion of post-surgical complications and appropriately add therapies for a successful outcome. The Tear Lab device has reduced the post-surgical disappointment of adverse reactions and created a friendly partnership to solve complications.
My contact lens patients now understand the differences in polymer selection and TearLab can help me determine the best bio-compatible lens for them. Patient who complains about dryness especially later in the day can scientifically find a polymer that will reduce evaporation and bind with the tear film to improve tear osmolarity. Patients experience the systematic approach of lens selection rather than the trial and error approach that induces frustration and the reason why contact lens patients leave our practice.
I can go on but I think you get the point. Do you have to incorporate TearLab into your practice today? No. I think you can go on doing things the way you have always done them. But the TearLab measurement provides another data point that helps me in diagnosing and assessing the quality of my therapeutic approach. Could it take your practice and your expertise to a different level? Absolutely!
