The first recorded mention of our need for tears, and the concept of dry eye, dates back to 1550 BC from an ancient Egyptian medical document called the Ebers Papyrus. In it, they referred to tears as “the water within.”
Speaking of Egypt, let’s imagine a desert oasis. There’s dry air all around, but one obvious factor can relieve that: an oasis with water. In the desert, a quick glance at the surroundings makes it clear why it’s arid and where to go next. But with dry eye, the solution isn’t as simple — and discerning the topography of the eye requires a more detailed look.
Diagnosing Dry Eye
Dry eye is a multifactorial disease characterized by unstable tear film. This causes a variety of symptoms and/or visual impairments, and is potentially accompanied by ocular surface damage. There is a key word here: multifactorial.
The numerous conditions associated with dry eye can make it difficult to pinpoint the underlying cause. Indeed, sometimes a patient’s dry eye isn’t noticeable during regular exams until they experience vision impairment. Unfortunately, many patients also experience dry eye as a result of other conditions involving other organs in the body (like autoimmune diseases) and, in frustration, are doomed to hop from practitioner to practitioner seeking relief.*
The Keratograph 5M (OCULUS Optikgeräte GmbH, Wetzlar, Germany) provides such an oasis in the desert of dry eye. This advanced corneal topographer, with a built-in keratometer and color camera optimized for imaging, offers a comprehensive eye examination complete with an easy-to-understand report that doctors can use to advise patients.
Dr. Pragnya Rao, works as a consultant ophthalmologist specializing in cornea and ocular surface diseases at the LV Prasad Eye Institute (LVPEI) in Hyderabad, India, which has launched a dedicated dry eye clinic for comprehensive care of these patients. Before implementing the OCULUS Keratograph 5M, the clinic was already equipped with LipiView (Johnson & Johnson Vision, Florida, USA) and IDRA (Clarion Medical Technologies, Ontario, Canada) for tear film analysis and utilizing LipiFlow (Johnson & Johnson Vision) for therapeutic interventions. The team catering to care of dry eye patients also includes a panel of physicians who do detailed workups for autoimmune diseases that are associated with dry eye disease. In other words, all patients undergo a complete, systematic evaluation once they visit the dry eye clinic.
“They work to understand what type of dry eye does the patient has, what is the underlying cause, and if there are any other issues in the body, like a generalized systemic issue, that is causing it,” Dr. Rao explained. “It’s a very holistic approach to treating a patient with dry eye disease. We look at the extent of involvement of the eyes and other organs, and at the same time try to treat both together.”
Almost two years ago, the LVPEI’s dry eye clinic added the OCULUS Keratograph 5M. Dr. Rao asserts that it’s been a great addition to the capacities of their practice. The most appreciated element of the machine for the clinic is the amount and variety of information it measures. “We are able to image the oil glands that are present in the eyelids,” she expounded. “At the same time we’re able to get a more objective measurement of the dynamics of the tear film on how fast it’s breaking up, with non-invasive tear break-up time assessment.”
The JENVIS Pro Dry Eye Report in the Keratograph 5M offers metrics for tear film, lipid layer, tear meniscus height, meibography of the upper and lower eyelids, and a conjunctival redness scan (R-Scan).
Topographical measurements include keratometric data and surface analysis, including Fourier and Zernike analysis, keratoconus screening and curvature, and other analyses for daily practice — even outside of dry eye needs.
“If you have a practice where you do a lot of refractive surgery and contact lenses — and you want to start off with having dry eye assessment — I think this is a very good machine,” she added.
This Keratograph 5M is also designed for fitting contact lenses. The device’s multi-purpose topographer is very useful for evaluating the tear surface before performing refractive surgery on patients; it may also be of interest to optometrists because it helps in contact lens fittings, especially in multifocal contact lenses, said Dr. Rao. It additionally simulates the transmissibility of oxygen through soft lenses — which is of key importance when evaluating dry eye symptoms among lens wearers — via its Oxi-Map® function.
…and Patients Alike
Dr. Rao and others at LVPEI appreciate that the machine’s testing includes a user-friendly report. The summary is color-coded and graphically represented, which helps the patients to understand their condition; this also helps the clinic to follow-up with them post-therapy. These reports help patients understand their status, their individualized recommendation therapy, and can be a helpful tool to remind them of their treatment in a multifactorial approach.
“The reports have been very useful in counseling my patients,” said Dr. Rao. “I can tell them, ‘these areas are the healthy zones … but you’re slightly at the borderline … or you’re falling into that zone where the tear film is not looking really good,’ so that they understand.” The tool is especially helpful in explaining to dry eye patients how much improvement to expect with treatment, as they need to understand that the condition cannot always be drastically improved or cured altogether based on its underlying cause.
For ease of study, imaging and color-coded topographical charts are available and can be compared side-to-side within the program.
Quench Dry Eyes — and a Variety of Testing Needs!
Perhaps the main advantage of implementing the OCULUS Keratograph 5M is its versatility. “It definitely gives a very good and comprehensive evaluation of dry-eye,” concluded Dr. Rao, adding that for the price, the machine delivers a lot of data. “If you want to do a basic evaluation and you don’t want to have too many machines in the clinic, then this is the instrument that you would want to have.”