Imaging for Evaporative DED
The pathology revealed by my diagnostic technology helped me make a definitive diagnosis.
KEY TAKEAWAYS
- Advancements in imaging have significantly aided in both the identification and management of dry eye disease.
- Such devices capture telling pathology, enabling us to move farther away from trial-and-error care and more toward targeted, mechanism-based treatment.
- Diagnostic devices that provide imaging offer objective metrics to monitor treatment response.
- Imaging can be used to educate patients on the mechanism of their dry eye disease and help them understand why certain treatments are recommended.
Advancements in imaging have significantly aided in both the identification and management of dry eye disease (DED). Specifically, such devices capture telling pathology, enabling us to move farther away from trial-and-error care and more toward targeted, mechanism-based treatment.
What’s more, diagnostic devices that provide imaging offer objective metrics to monitor treatment response, which can be particularly helpful for patient education and adherence to treatment(s), as measurable improvements often precede subjective symptom relief.
Here, I provide some recent images (Figures 1-6) that helped me make definitive diagnoses when paired with my clinical examination findings (see Prepare for These Common Scenarios).
PREPARE FOR THESE COMMON SCENARIOS
- Reduced lipid layer thickness (LLT) and intact but obstructed glands. This presentation strongly supports the diagnosis of DED secondary to an evaporative etiology.
- Normal LLT and relatively healthy meibography in a highly symptomatic patient. This suggests evaporation may not be the primary mechanism behind the patient’s DED, prompting the use of additional diagnostics to evaluate for inflammatory, aqueous-deficient, or neurotrophic etiologies of DED.
- Advanced meibomian gland dropout observed on meibography. This is a sign of chronic DED. As such, the patient should be educated on long-term maintenance therapy, and realistic expectations should be set for any in-office treatments. These patients often require multiple therapies to achieve symptomatic relief.
- Reduced tear breakup time (TBUT) with a normal tear meniscus height. This is suggestive of evaporative DED.
- Normal TBUT with a low tear meniscus height. This suggests an aqueous-deficient etiology of DED and may prompt consideration of tear conservation strategies.
Some caveats: While the findings I have illustrated in these cases likely indicate the diagnosis, nothing is definitive until the clinical examination. Also, much of DED is a continuum of meibomian gland dysfunction (MGD), tear insufficiency, and inflammation and is not mutually exclusive. In other words, just because MGD isn’t the main cause of a patient’s dryness doesn’t mean they don’t have MGD.
FORWARD-THINKING OUTLOOK
"The future of DED imaging is closely linked to the integration of AI. Automated segmentation and grading systems, particularly in meibography and noninvasive TBUT analysis, are expected to reduce observer bias and significantly decrease the time required for data interpretation,” according to a recent study in Diagnostics. The study’s researchers add that the creation of multifunctional devices will “likely improve patient workflow and diagnostic throughput.”
THE VALUE LIES IN THE APPLICATION
The true value of modern diagnostic platforms lies in how they are applied in clinical practice. Considering objective findings across platforms helps reshape how eyecare providers evaluate DED. Recognizing DED as a spectrum and using diagnostics to provide a comprehensive picture of each patient’s underlying disease mechanism enables more precise, confident, and effective management for long-term success.
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