Two Queensland optometrists have an older client base and a fair bit of dry eye on their plate.
To help with diagnosis and management, there’s one instrument they depend on.
“For anyone wanting to be involved in the dry eye space, if they’re not using objective parameters to measure or perform an initial assessment, and they’re not quantifying metrics, they’re just guessing.”
Those are fighting words from Queensland optometrists Dr Hugh Bradshaw and Dr Adam Barron.
And they are just as forthright about the vital piece of equipment they take into that battle with dry eye. The device they trust to diagnose the disease and confirm they are on track with its management is their Idra tear film analyser, from Italian manufacturer SBM Sistemi.
Dry eye is an important focus in their Toowoomba practice, Heron Eyecare.
Dr Bradshaw joined the business in 2009 and then took over a little later on when founders Henry and Miriam Heron left. Dr Barron joined in 2017 and is now a partner.
Many of their patients are older, and Toowoomba is known as the ‘Garden City’, meaning plants, pollen and plenty of allergies to exacerbate any eye issues, making dry eye a key focus.
Because of that, Dr Bradshaw is on the board of the Dry Eye Society and joint chair of its Education Committee.
The disease has become a strong pillar of growth in his practice, clinically and commercially.
“Patients that are struggling with dry eye are often referred to us because we have got either the equipment or the expertise to manage it better,” he says.
“We have improved our retention, but also our referrals, both from ophthalmology and from local optometry as well.”
That equipment includes intense pulsed light (IPL) technology and the Rexon-Eye, which uses high-frequency electric fields to regenerate cells.
But devices to aid treatment and management are nothing without other equipment to first diagnose what is wrong and then objectively track treatment and management.
And for that, Dr Bradshaw and Dr Barron swear by their Idra device.
The machine, distributed in Australia by BOC Instruments, enables a quick but detailed structural assessment of tear composition, an important part of diagnosing dry eye and its severity.
“The tear film has got three layers – oil, water, gel. If you’ve got the right amount and the right ratios, you’ve got good tear film,” says Dr Barron.
“Idra analyses meibomian glands and tear film content,” he says.
“Using interferometry it can analyse the stability of your tears, your blink rate. It analyses the oil layer, so you know the amounts and strength of that layer. It quantifies the aqueous tear layer by the tear meniscus height, which is an indirect barometer for the aqueous layer across the ocular surface. And it also measures the stability of the tear film and blinking efficiency.
“So we get a quantitative metric for all of those parameters, and from there that helps us with advice, management and progression analysis in terms of actually how someone feels at any given point in time.”
That gives the practice, and the patient, a definitive, objective analysis of not only the severity of their dry eye but also the efficacy of its treatment and management.
Dr Bradshaw says other machines can provide part of that picture, but the SBM Sistemi Idra distributed by BOC Instruments “gives you all of this data in a very short space of time, in a quick snapshot, and then collates the data concisely so that we can measure it against what’s considered normal and what’s not”.
The device can also help some patients stay the course on treatment, when they appear frustrated by a lack of perceived progress.
“It’s an unequivocal diagnostic tool,” Dr Barron says.
“Often through the course of treatment there’s a disconnect between physiological and symptomatic improvement, which can be a source of frustration and concern for patients,” he says.
“When patients can see objective quantitative data showing an improvement to physiological signs, their fear and frustration turns to confidence and we all know we’re heading in the right direction and all we need to do is be more patient.”
The machine is also invaluable for helping professionals understand when treatment is not working.
“Based on our professional judgment we can implement a management plan, but when that doesn’t work, for whatever reason, you then need to be able to reassess why, and this is where it can help.”
Both agree the Idra is an essential part of the toolkit for any professional looking to focus on dry eye in their practice.
“If you want to be definitive, if you want to show your patients that you know what you’re doing and that you’re on the right track – or not, then this is the piece of kit you need.”
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