LAS VEGAS – Jason Miller, OD, MBA, said he uses technology to better treat ocular surface disease in his practice and create an experience for the patient.
Miller spoke here at the Global Contact Lens Forum, held during Vision Expo West.
A multitude of traditional diagnostic tools are available, including staining and questionnaires, he said. Miller uses the TearScience Meibomian Gland Evaluator. He explained that a predetermined pressure is applied on the lid and held 10 to 15 seconds.
“Do it nasally, centrally and temporally – on both the upper and lower lids – and grade the quality and quantity of the meibum,” he said.
Clear liquid oil is grade 3, and if nothing comes out, it is 0.
“It takes about a minute to do all glands,” Miller said. “I do this on patients having dry eye symptoms.”
A common at-home recommendation is the use of warm compresses, but they have limited efficacy, he said.
“The heat doesn’t penetrate to the meibum from a warm washcloth,” Miller said. “You need something more. We use Lipiflow [TearScience]. It’s soothing; most patients enjoy it. We play music while it’s running for about 12 minutes. You can tell the difference in tear quality and tear film afterwards.”
Patients are then given a dry eye pack that includes a warming mask and fish oil to take home.
Miller also discussed TearCare (Sight Sciences) for in-office meibomian gland expression.
“This is a little more manual, but when you do the manual expression, you can see the meibum,” he said.
He recommended instilling an anesthetic drop and expressing both the lower and upper lids.
“Another option is iLux [MGD Treatment System, Alcon],” Miller said. “You hold it in place and do manual expression immediately afterwards.”
While he is currently performing this procedure himself, he agreed that it could be delegated to a well-trained technician.
These technologies are associated with different levels of costs; “find out what works for you in your practice,” he said. “Lipiflow is more convenient, but if you like to see the expression happening, do TearCare or iLux.
“If we’re not doing something to treat ocular surface disease, we need to re-analyze how we treat these patients,” he added. – by Nancy Hemphill, ELS, FAAO
Quinn T, et al. Effective and efficient use of technology in practice. Presented at: Vision Expo West; Las Vegas; September 18-21, 2019.
Disclosure: Miller reports no relevant financial disclosures.