Innovation is the lifeblood of our profession, and some practices have differentiated themselves and grown on new technology alone, such as with OCT. More than a decade ago, lecturers said you didn’t need an OCT to effectively manage glaucoma. While that’s still technically true today, the technology has proven indispensable, and I, for one, wouldn’t be confident in my glaucoma management without it. Here are a few other tools and treatments that are making waves.
In With the New
Speaking of glaucoma, corneal hysteresis (CH) is starting to replace pachymetry. Studies show that pachymetry does not accurately correlate with IOP, and it can’t be adjusted based on a linear scale of adding or subtracting mm Hg.1 CH, unlike pachymetry, correlates with visual field loss progression and is a tipping point in the diagnosis for many early cases.2
The newest Icare ic100 tonometer increases accuracy compared with Goldman tonometry and allows for easier and more efficient measurements. The Icare Home now allows patients to measure their IOP daily.
Novel post-surgical treatments are starting to replace drops with the recent approvals of Dexycu (EyePoint) and Dextenza (Ocular Therapeutix). Dexycu is a time-released dexamethasone ‘pellet’ inserted into the anterior chamber, while Dextenza is a dexamethasone-eluting punctal plug. Both have indications for inflammation and pain following ocular surgery. These advances may increase compliance and effectiveness, particularly for those who struggle with drops. Another good option is new injectable solutions such as Dex-Moxi-Ketor (Imprimis).
Enhance, Not Replace
Autorefractors haven’t replaced a subjective refraction, and many new tools will follow a similar path. For example, I use ultra widefield fundus imaging (UWFI), but it’s not a replacement for a dilated exam. With UWFI, I can better identify suspicious areas that need a closer look with dilation; I’ve caught retinal tears I would have likely missed without it. But there are times when UWFI may not accurately isolate pathology, which is why it’s a complement to, not a replacement for, a dilated exam, especially in cases of flashes and floaters.
Innovation on the Horizon
Several advances aren’t here yet, but may make it to your office soon:
The swinging flashlight test, which provides relative afferent pupillary defect (RAPD) measurements, may meet its match this fall. A new technology called EyeKinetix (Konan) measures pupil disparity and provides an accurate reading of an RAPD, including early or subtle levels—in about 30 to 40 seconds.
ObjectiveField (Konan) is an objective visual field test that appears to show similar accuracy (and perhaps greater accuracy in first-time users) than subjective visual field testing. This will likely debut in 2020, potentially replacing subjective visual field testing.
We will likely see adjustable IOLs (RxSight) in late 2019 or early 2020, which allow for adjustment up to 30 days post surgery. Say a patient wishes they had chosen monovision, and you use a contact lens fit on the non-dominant eye to determine that -1.50D is the ideal correction—a UV light laser can adjust that on the IOL.
Also, an implantable artificial capsule (Omega Ophthalmics) will one day allow for an IOL exchange or addition, should a patient require further visual correction.
As tear-based point-of-care testing becomes more sophisticated in measuring inflammation, allergy markers and, eventually, systemic conditions such as diabetes and Alzheimer’s, it will replace traditional measures of diagnosis.
Technologies that replace previous diagnostics and treatments are essential to the growth of our profession and the improvement of our patients’ vision. It’s imperative that we explore these technologies and determine which ones will enhance our practice and patients’ lives. Those are worth the investment.
Note: Dr. Karpecki consults for companies with products and services relevant to this topic.
1. Zareei A, Razeghinejad MR, Salouti R. Corneal biomechanical properties and thickness in primary congenital glaucoma and normal eyes: a comparative study. Med Hypothesis Discov Innov Ophthalmol. 2018;7(2):68-72.
2. Susanna BN, Ogata NG, Daga FB. Association between rates of visual field progression and intraocular pressure measurements. obtained by different tonometers. Ophthalmology. 2019;126(1):49-54.