to-the-point
To The Point
Episode 10

The Dry Eye Diagnostic Armamentarium: A Look at the Options

Unsure of which tools you should get for your dry eye practice? Hosts Leslie and Jackie give a rundown of the different diagnostic tools you can purchase for your growing dry eye clinic, from low-end to high-end and everything in between, sharing their personal challenges and successes with each.

Leslie O'Dell (00:06):

Ocular surface disease, it's complex, chronic and progressive, but rife with opportunity for the enterprising optometrist.

Jackie Garlich (00:14):

The mission of this podcast is to make this condition more understandable and accessible to those interested in specializing in it. So, let's get To the Point.

Jackie Garlich (00:26):

Welcome to another episode of the To the Point podcast. My name is Jackie Garlich and I am joined by my cohost, Leslie O'Dell. Hi Leslie.

Leslie O'Dell (00:35):

Hi, how's it going?

Jackie Garlich (00:37):

It's going good. Today we are going to be giving a rundown on the diagnostic tools that you can purchase for your growing dry eye clinic. And we're going to kinda give a rundown on low-end and then go up to more high-end options for our diagnostic testing. So, I think what we're gonna start with is some of the lower end options that you should have or can have in your practice. So, Leslie, what should we start with here? What do wanna talk about?

Leslie O'Dell (01:11):

Well, I mean, I will say that with dry eye being such, you know, at the top of minds of, of companies and also doctors, and we're always trying to seek better ways to make an easy diagnosis because it's still a very underdiagnosed and undertreated disease state. We are not at a loss of things to talk about. (laughs)

Jackie Garlich (01:31):

(laughs)

Leslie O'Dell (01:31):

I feel like there is a lot of technology, every time I feel like I turned around, I'm seeing something new and exciting coming out, and it's easy to want, you know, to be able to have it all when you're building out your practice, but sometimes you have to really be able to, you know, graduate into different levels of diagnostics. So, I think if you start at the basics, some of things that we talked about early on would just be the vital dye stains. If you look at what you would use as your foundation for treating dry eye, TFOS DEWS II for example, the diagnosis of dry eye disease is made based on symptoms, and then vital dye testing. So, fluorescein and lissamine green are easy to find and not that expensive to add. And I think that's definitely one of the first things that I would want to have to do a good dry eye evaluation.

Jackie Garlich (02:27):

Yeah. Agreed. I have also, I think right next to that should be your Schirmer testing strips. It's standup box looks just like the others. (laughs)

Leslie O'Dell (02:39):

Yeah.

Jackie Garlich (02:40):

Just add that to your shelf. (laughing)

Leslie O'Dell (02:42):

Yeah. So Schirmer strips, you know, can be the, what we're used to seeing with, you know, hinged over the, bottom eyelid and kind of the measuring stick. You can also look to things like the phenol red thread. I know some doctors really love that it gives the results in a lot quicker of a time, maybe five seconds, I think. And then also it's a string that you put in and it kinda highlights-

Jackie Garlich (03:07):

Yeah.

Leslie O'Dell (03:08):

... and then you measure when the string has changed color. The other one that's-

Jackie Garlich (03:14):

I've never used that.

Leslie O'Dell (03:14):

Yeah. You know, I honestly don't use it a lot either, but I know when I'm lecturing with other doctors that are doing a lot of dry eye management, they really, you know, speak highly of that phenol red thread. One that I'm starting to use is made by Quidel and it's called the SM Tube, and it looks like a, it looks like a ruler on two sides. And one side is for the right eye, one side is for the left eye, and you're using the tear meniscus to kinda, with a pipette type, you know, action, acquire some of the tears and it quickly measures what their Schirmer is. And that's another very fast test that's done within seconds versus the traditional one or five minutes, you know, depending on if you're doing the prepare cane or no prepare cane with the traditional Schirmer. So, I know that, you know, I feel sometimes doctors think, oh, Schirmer's so antiquated, but it's still a big part of, you know, FDA trials. It's still a big part of some of what the medications labeling is. So, you know, depending on what medications you're starting, it also is very helpful for me for when I'm trying to uncover more of a systemic disease. So, I do like Schirmer testing, but it is nice to kinda have some options that are not the traditional, you know, piece of paper.

Jackie Garlich (04:38):

Yeah. Yeah. Yeah, good point. The other thing that I have found useful is the MGE, the Meibomian Gland Evaluator. Is that what it's actually called? I always call it MGE.

Leslie O'Dell (04:51):

Yeah.

Jackie Garlich (04:51):

And that, that is, that was developed by Dr. Korb.

Leslie O'Dell (04:55):

Correct.

Jackie Garlich (04:55):

I believe. Right?

Leslie O'Dell (04:56):

Mm-hmm (affirmative).

Jackie Garlich (04:56):

Okay. So then, I actually got that through my J&J rep, Steve. Shout out to Steve.

Leslie O'Dell (05:04):

(laughs)

Jackie Garlich (05:04):

And his colleague, (laughing) I forgot who was with him. Yeah, but that, that's another useful tool and a nicer way to sort of standardize when you're looking at the meibomian glands and judging the function of those. So that's a nice way to, I think, standardize that. I mean, I think it's an easy thing to push on the glands and say, yeah, these look turbid, or like no expression, but like to have a better sort of standardized way to do that, the MGD, MGE, excuse me, is a nice tool for that-

Leslie O'Dell (05:34):

Yeah. And, you know, it’s nice and a very low cost. And the best way to get that is to touch base with your J&J rep. Maybe even like the contact lens, it might be a good place to start, but it is part of their ocular surface section. And just like you said, Dr. Korb developed that to be standardized pressure. So it's three pounds per square inch, which is what your, or 0.3 pounds per square inch, which is what your pressure of your blink is. And so when I'm pressing against it with my thumb versus you're pressing against it with your thumb or somebody else, we know we're all pushing with different pressures. And so it is a good way to kind of have a standardized measurement, and sometimes shocking to see the difference between if you are using your finger to kind of manually evaluate the glands, and then you do MGE, you're gonna usually get kind of a worse result, which makes sense because the blink isn't as forceful as we are kind of manipulating the lids when we're pushing with our thumb. So, I do agree, MGE is a great tool for figuring out the function of the glands, for sure.

Jackie Garlich (06:40):

The other thing that we could mention are two different instruments. So, like the Karpecki Debrider versus the Mastrota paddle are two other options that are relatively inexpensive and, you know, in-office instruments that you could use.

Leslie O'Dell (06:58):

Yeah. I, so I think that Mastrota paddle was developed more with the intent, I think for maybe being able to evaluate gland.

Jackie Garlich (07:08):

Treat.

Leslie O'Dell (07:08):

Yeah, but I think also like to help with expression-

Jackie Garlich (07:11):

Yeah.

Leslie O'Dell (07:12):

You know, she, but I think it was also first intended to be a diagnostic, you know, you'd put it in and use a cotton tip to kind of push out the meibum. Now the Karpecki Debrider, I like a lot, it has a nice smooth edge. And so, what I found actually with- I was using a foreign body spud for a long time to kind of clean off the meibomian glands before I did assess them. Or if there was the meibomian gland kind of like cyst looking at the edge that I wanted to kind of uncap. And it is pretty sharp. I felt, you know-

Jackie Garlich (07:47):

(laughing)

Leslie O'Dell (07:47):

... with the sharper edges the foreign body spud, but it makes sense, you're trying to dig out a foreign body, you know, from the cornea is what it's intended for. So, I do really like the Karpecki Debrider for that reason that it's just not a sharp edge, it's a little bit dulled down and does a really good job for that debridement of the lids. Which I think is important before you actually do your MGE. So, it's sort of you clean off the lid to then evaluate what's coming out. I think that those tools kinda can go hand in hand.

Jackie Garlich (08:19):

You know what we've been using to basically debride is the Clearance Assistant from TearCare. I'll use that, which I feel like works pretty well.

Leslie O'Dell (08:32):

Yeah. Kind of a very similar edge, which, you know, that expressor, that TearCare pairs with their treatment unit is very good. Also, I've used a bunch of different ones over the years and I can't even remember them all, but, it's good just to kind of experiment with them and get comfortable with one. The one I use most commonly in addition to that TearCare expressor is a catina. And basically, it looks much like the TearCare expressor, it's just a little bit smaller of a plate. And so, it may be targeting one to two glands versus three glands. And it, but I will say that because this area is smaller, it's a little bit more painful for the patient. So, the one that TearCare did, or Sight Science had paired with their TearCare system, I like because it is a lot less uncomfortable to the patient.

Jackie Garlich (09:26):

Mm-hmm (affirmative). Yeah. Okay. What else can we talk about in the low-cost price point here?

Leslie O'Dell (09:32):

Well, you know, we talked about this a lot in another episode, but the biggest low cost you already own and, it's your transilluminator. So, I feel like two things your transilluminator, you know, is helping for that inadequate nighttime lid seal by again, shining it on the tap lid in the dark room. And then it also could be the poor man's meibography.

Jackie Garlich (09:55):

Meibographer, yeah. (laughs)

Leslie O'Dell (09:55):

Yes.

Jackie Garlich (09:55):

(laughs)

Leslie O'Dell (09:57):

So the transilluminator is one, and then the other one is your finger. So just being able to assess the lid laxity by doing the snap test, pulling down on that bottom lid and seeing how quickly it bounces back. And then also same thing, lifting up the top lid to look, to see how loose that might be if you're thinking about like a floppy lid syndrome or something like that, you know. So those are two things that are already in your office and don't cost us anything. So, but you know, when you look at TFOS DEWS II especially, and again, you know that questionnaire. You know, questionnaire is something that we all need to be doing and it is another low-cost diagnostic. So, whether it's the speed or the OSDI or the DEQ-5 you know, finding one you're comfortable with and implementing that, aside from the vital dye, the next diagnostic is the tear breakup time. So, you have the fluorescein again, but there's a lot of cool science coming into that space with noninvasive tear break-up time, you know, measurements and how that might interfere with vision in such that breaking up reading rates and things like that.

Leslie O'Dell (11:09):

Which kind of lends into what we were gonna talk about with one of the diagnostic tools that's been really coming to the forefront. I would say, of giving us a pretty concise idea of what's going on with the patient with the oculus, the 5M. You know, that piece of equipment is really impressive. It can do noninvasive tear breakup time. It can do meibography. It's doing this customized tear report, the crystal report, I think crystal tear report. So, it's giving you a lot of diagnostics before you even have the patient in the exam chair.

Jackie Garlich (11:51):

One thing I just remembered we forgot is point-of-care testing, which I know we have covered in a, you know, I'm talking about the oculus is sort of more of a more expensive purchase, but-

Leslie O'Dell (12:01):

Okay.

Jackie Garlich (12:02):

... point-of-care testing, we talked about that previously in a different podcast, but that's another lower cost option. Inflammadry, TearLab, two good options for that.

Leslie O'Dell (12:15):

Yep. And again, when I think about, you know, just how I lay out my dry eye exam, I put TearLab first, because osmolarity is another diagnostic that's defining dry eye. So to TearLab is giving us our osmolarity readings, and that, you know, is expected to be changing and adding some other diagnostics that are more inflammatory in origin with interleukin and MMP-9 in their discovery unit that should be available sometime in our country, it’s available in Europe right now. But then MMP-9 kinda goes into the, you know, when you're trying to subtype and get to your treatment plan, MMP-9 is very helpful at uncovering, or I'm sorry, Inflammadry is very helpful at uncovering MMP-9 levels, which, you know, tell us that there is inflammation present. So definitely point-of-care testing is, and I will say on the lower side of an acquisition cost. Now with the TearLab system, you do have disposables. So, you do have to pay for the machine and then you have to pay to keep that machine working.

Jackie Garlich (13:29):

So mid-range maybe, not really high end, but like, yeah.

Leslie O'Dell (13:33):

Yeah. Yeah. I would say mid-range. But-

Jackie Garlich (13:34):

Mid-range.

Leslie O'Dell (13:34):

... something that, I think, if you have the ability to do point-of-care testing it's something you should be considering early in, because it's telling you a lot about the patient and the disease and even how treatments are going.

Jackie Garlich (13:48):

So, you sort of started to segue us into like the more expensive higher cost diagnostic equipment that you can purchase for your practice. One of them, when you and I have been talking about this previously, but the Oculus, the K5M, which is, you know, and as you said, a device that does a lot of interesting things and gives you a lot of information. That's also coupled with the topographer as well. So you have meibography, topography, and there are many, I feel, like bells and whistles to the K5M. But there are others, certainly other meibographers. And we can just list out a couple of those, LipiView, LipiScan, which I haven't, I've seen LipiView before, but I have no experience with LipiScan.

Leslie O'Dell (14:39):

Okay.

Leslie O'Dell (14:40):

So, both of them I think are great meibographers. LipiView, yeah, it's actually LipiView II because the LipiView system that first came with LipiFlow did not have meibography. So, it was a scan that was measuring lipid layer thickness and blink rates. And it did not have meibography. And so LipiView II came a few years after the introduction of LipiFlow and it incorporated their meibography, which is really impressive. The way that it uses the infrared light and gives different scans to really be able to visualize the glands. It's really easy for a tech to use both of their pieces of equipment. The difference between the two is that LipiView II, also is giving us the blink rate, which is important because you see a lot of the partial blink. So if you, you know, you're treating that computer user that has a lot of dry eye disease, and you wanna show them what's happening at the screen, or you have a contact lens patient that's really suffering with dry eye, and, you know, you already know they're blinking less, but if you can show them that they're having eight out of 10 partial blinks, that speaks to them, to the patients. And they really understand that they get that.

Leslie O'Dell (15:57):

It also gives you this lipid layer thickness, which can be really impressive when you do like a pre-imposed treatment analysis when you're releasing meibum, you can really see that layer bulk up, which you would expect. LipiScan is nice because it is a smaller footprint, and again, very easy to train technicians to run that machine. It's only doing the meibography report, you know, or imaging rather, with that. But, I've been very impressed with the images that come from their systems.

Jackie Garlich (16:29):

I was just gonna say that. I have had my images taken with a couple of different pieces of equipment and it was actually, I misspoke, I had it taken on the LipiScan, not the LipiView. But the quality of that image was so much better than some other meibographers that I've actually tried. So, it, I didn't really realize there was such a difference in like the quality of those images. I kinda felt they were all probably similar in some way, but I did, I do feel like that quality is amazing,

Leslie O'Dell (17:02):

You know, and in that case, 'cause you shared some of those pictures and it looked like you went from having glands to not having glands-

Jackie Garlich (17:08):

Exactly. (laughs)

Leslie O'Dell (17:08):

... I guess, you know, when you commit to something, you would only have usually one imaging system so you're gonna be looking at the patient with the same thing. So, but if it's showing less glands, you're gonna be far more aggressive in your treatment than maybe you would need to be. It's definitely interesting how different some of those imaging systems can be. So, the other one, well, so Oculus does a very good job with their K5M. Their meibography I've used that again, you know, from other doctors when we're doing different research projects and it seems pretty tech-easy, they get really great images of the superior glands, the inferior glands. So, what, you know, I do really like that. And then the newer one, a couple of newer ones, one is Meibox, which I have some experience with. I like it because it's small, it has the smallest footprint of any of these. It fits into the Ruby lens of your slit lamp. And then, you know, just saves the images on your computer desktop.

Leslie O'Dell (18:09):

It can do superior, inferior, and you could train a tech to do it, but I usually ended up taking those photos because it's done at the slit lamp. And for me, if I wanted superior glands, it was far easier to invert lids using that technology than to evert the lid, you know, behind a big machine and I'm leaning over the machine and also trying to evert the lid on the lighting source. So, I do really like the Meibox for that reason. And I think that, you know, that's an Optometry found company with Dr. Trinh. And I think that he, you know, he's even capturing some video in his second version. So, it definitely is something to be on the lookout for. And that's called Box Medical Solutions, I think is his company.

Jackie Garlich (18:58):

Yeah. The other nice thing is that that is portable. Like you can move that from room to room, which is great if you have, you know, multiple exam rooms that you know you're gonna be wanting to get images from.

Leslie O'Dell (19:12):

Yeah. And as far as that goes, it's a nice lower costs meibographer.

Jackie Garlich (19:18):

Right.

Leslie O'Dell (19:19):

And like you said, you can move it from one room to the next, which makes it really, really convenient.

Jackie Garlich (19:24):

There's also the Antares, which is from Lumenis the company that has one of the IPLs. They also have a meibographer as well that does, I think it actually does blink rates and tear breakup-time.

Leslie O'Dell (19:41):

Yeah. I think they do noninvasive tear breakup-time with that instrument as well. I think really when you're looking to maybe bring something in, at least from where I am now, you know, I'm building out a medically focused practice where dry eye will still be a big part of that. But I'm trying as much as I can to get instruments that do more than one thing and also take up less space in an office. So I'm really looking hard at what can do noninvasive tear breakup-time, because I think that's really important moving forward if I'm gonna be doing patient care, but definitely if I'm gonna be doing any kind of research, I know that that's a big part of where research is heading. They want to see that noninvasive tear breakup-time.

Jackie Garlich (20:26):

Yeah, it's a good point. The other thing that we should maybe mention is a like an anterior segment camera. So, if you are wanting to, I find this actually to be more helpful, not as much from a billing perspective, but from a patient education standpoint. It's so much nicer when I can show a patient, like this is what's on your lashes, or this is what your meibum gland looks like. You know, like, I find that to be really useful and there's certainly higher end, you know, cameras that adapt right to your slit lamp, but then you can also do a very low end iPhone, with an iPhone adapter and achieve similar results. And I've seen a lot of people actually use their iPhone. And actually, before I was at the practice now, I would hold my iPhone up to an ocular and get like really good images with just doing it that way. So that can be actually a low expense item as well, but, very, very useful from a patient education perspective.

Leslie O'Dell (21:30):

Yeah, I think that photography is so powerful when you're trying to educate somebody, you know, from something like blepharitis. There are things I've seen, one camera called a LashCam, it was paired with, you know, I forget who was, I forget who even was selling that right now. I feel like it was either paired with a cleanser or paired with a microexfoliator, but it's called LashCam and it was like a microscope that would attach to your phone and take a zoomed in picture of the eyelashes so you could easily just show the patient right there, their blepharitis. I, it might've been, you know, with BlephEx, you know, that would make sense, but don't hold me to that.

Jackie Garlich (22:15):

Mm-hmm. (affirmative)

Leslie O'Dell (22:15):

But then I've definitely used my iPhone. I had an iPad that would connect to the oculars, but the one thing that I am looking forward to is having a slit lamp camera that is a little bit more, you know, maybe it was just user failure on my part with my iPhone, but I'm really looking forward to a little bit better quality than what I was capturing.

Jackie Garlich (22:36):

(laughs)

Leslie O'Dell (22:36):

But I have seen some really amazing pictures just from the slit lamp, you know, from photos from the iPhones and the phones. But so, I've been looking at TelScreen. They have a good system that connects to a slit lamp. You know, Zeiss actually has some imaging for the slit lamp that I've been looking at. And also, Firefly. Firefly can do meibography as well, and I've used that at some of the trade shows when I've been working, you know, with some of the companies just to show doctors how to do certain things. And I've been impressed with all of theirs. But they all do have, it's almost like a luxury car, I feel like buying an anterior segment camera. It's like, you know, you really want it-

Jackie Garlich (23:16):

(laughs)

Leslie O'Dell (23:17):

... but you may never really pay for it. I don't know, you know, like, you know, you really want it, but it's never gonna... I don't know.

Jackie Garlich (23:23):

Really pay for it so, maybe but, yeah.

Leslie O'Dell (23:25):

Right. But, you know, I think it does. 'Cause I do really think having the patient understand what's going on and it's so abstract to just kind of talk them through it, to be able to show it to them I think is really powerful.

Jackie Garlich (23:35):

Yeah, I agree. I mean, certainly from when I'm doing a thermal, like if I'm doing a TearCare procedure and I show them what's happening and what's coming out of their glands, I'll take a video with my anterior segment camera and they'll just be like-

Leslie O'Dell (23:50):

Oh yeah, that's very efficient for life after you show them that.

Jackie Garlich (23:54):

(laughing)

Leslie O'Dell (23:54):

You know, same with, you know, same with blepharitis and demodex, you know, being able to show them that, I mean, even a patient just to see their eyelashes magnified, it's already, they're already bought into whatever you're gonna tell them. 'Cause they've never seen their eyelashes so magnified.

Jackie Garlich (24:09):

Yeah. Yeah.

Leslie O'Dell (24:09):

Yeah. So, I think that, I think it's definitely something that you should grow to acquire, you know, as your practice grows. Oh, one thing I just saw that I wanted to tell you about, which is really, quite a cool science is by Advanced Ophthalmic Solutions is that, AOS. And so-

Jackie Garlich (24:32):

Yeah, I think so. Yeah.

Leslie O'Dell (24:32):

... they have, they don't take the image, but you can upload an image to their software, and it can do a lot of really cool things. Like you can put a grid on it, on the cornea. So, say you have your fluorescein picture, you can put a grid on it that shows central, temporal, nasal, inferior, superior, and it will count every punctate keratitis in all those-

Jackie Garlich (24:56):

(laughs)

Leslie O'Dell (24:56):

... zones and tell you. Like-

Jackie Garlich (24:59):

Yeah.

Leslie O'Dell (24:59):

... that's amazing.

Jackie Garlich (24:59):

I know. I saw this technology, this is crazy.

Leslie O'Dell (25:01):

Or it will tell you what the conjunctival redness is.

Jackie Garlich (25:05):

I was just gonna say that like the level of injection, it is kind of crazy. I do think this is the way of eye care, like this is the future of like, it's almost like AI, you know, figuring out (laughs) how bad your dry eye patient is or how bad that redness is. But yeah, I did see that as pretty interesting.

Leslie O'Dell (25:23):

Yeah. And I'm, I can only imagine that they'll eventually do the same with meibography. I didn't see that in their platform, but I was really impressed with that. I'm thinking here I am like counting these things and this machine is just doing it for you, you know, the software is doing it for you in a second. It's pretty impressive.

Jackie Garlich (25:40):

Yeah. It is pretty impressive. Yep. All right. Well, I think we covered hopefully all of the options from a diagnostic standpoint when we're talking about dry eye. Do you wanna just review a few of the treatment options?

Leslie O'Dell (25:54):

Yeah, I think that the treatment, you know, the treatments are also growing, which is really exciting to see. We still have topical therapeutics which are so important, you know, you wanna create the foundation to help with inflammation, but then you have to be thinking about meibomian gland expression. And now we have lots of tools that help us to do that, and they are ranging from, you know, something that does have a small footprint, like the TearCare system from Sight Science. You know, it's the size of a hockey puck. You can carry that easily from one exam room to the next, you know, to even iLux is relatively low footprint. It just docks.

Jackie Garlich (26:33):

Mm-hmm (affirmative). Yeah.

Leslie O'Dell (26:34):

So, these two are some of the new, you know, new to the game of meibomian gland expression tools that we could acquire when we're thinking about treatment. Of course, we have, you know, the first, which was LipiFlow Thermal Pulsation, and that still is a very important part of a dry eye practice and very important part of meibomian gland expression. And then, you know, IPL with the intense pulse light that is helping so much with inflammation and meibomian gland expression, rosacea, and maybe even things like demodex. You know, I've seen some papers saying that it's helping in that area too, so it can get very expensive very quickly. And I'm speaking from the point of being, you know, in a dry eye center of excellence in the recent past, you know, I have had access to actually try all of them. I wasn't able to acquire all of them because of just, you know, the cost to do so. So, you have to kinda be selective. It's good to see if you can get some hands-on, you know, whether that's in your own office or, you know, if there's any way to meet up with the companies but being able to kind of understand and get comfortable.

Leslie O'Dell (27:50):

So, for me, for example, I have a lot of comfort with LipiFlow. I've been doing it since 2012. We were the first center in Pennsylvania to have access to that. So, I feel very confident about when I'm gonna refer a patient for LipiFlow, you know, I know it works. I have, I feel very confident about that. It took me a little bit more time to get comfortable with the iLux, mostly, just because of, it's in my hand the whole treatment and, you know, treating the superior glands takes a little bit more practice for me, you know, but it doesn't mean that it's not something that I would use routinely, it just that it was just a little bit more cumbersome for me personally.

Leslie O'Dell (28:33):

And then the TearCare system, you know, just adheres to the eyelid with the smart lid technology. The patient's in the chair with their eyes open, blinking on their phone, you know, for the 15 minutes while the heating. And then, you know, quite frankly, it's kind of fun to do the meibomian gland expression after that. The videos you're showing your patients to scare them at night, but, -

Jackie Garlich (28:53):

(laughs)

Leslie O'Dell (28:55):

... (laughs) you know, I feel like it's very powerful. They can see what's coming out of there, and now they have a much better understanding, you know, and then IPL, yeah IPL again, very exciting in technology and lots of research kind of mounting on how that is so crucial. And a lot of doctors, you know, pair these treatments together. They'll do-

Jackie Garlich (29:17):

Mm-hmm (affirmative). Right.

Leslie O'Dell (29:17):

... some kind of expression and then they'll do IPL. You know, at sometimes they'll alternate it, or they'll do three or four IPLs and then move on to something like an expression treatment. So it is, there is room to have more than one of those. It's just figuring out when that works best for your practice.

Jackie Garlich (29:35):

All right, great. This is good Leslie. Anything else you wanna cover?

Leslie O'Dell (29:38):

I think that about wraps it up, but I mean, there could definitely be some new, exciting technology on the horizon that we just don't know about, and so we feel bad leaving anything out, but certainly, you know, share with us anything we might've missed, right? We are always excited to try something new.

Leslie O'Dell (30:01):

And now for the To the Point wrap up. Dry eye disease continues to expand in both the research around treatments and in our diagnostic technologies. It can be overwhelming for anyone getting into dry eye disease, but it doesn't have to be. Remember, start small, build your patient base by using things like questionnaires and your vital dye staining, and then explore options that allow for better diagnostic, whether it be noninvasive tear breakup-time, point-of-care testing, meibography. Look for machinery and technology that can allow for more than one diagnostic test whenever possible to save money to your practice and also save space within your practice. But most importantly, embrace the technology and have fun on this journey.

10/22/2020 | 31:03