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Home / Articles

Article

The Utility of Normal Tear Osmolarity Results

February 16, 2023 by Lisa Dockray

By: Christopher E. Starr, MD

Hyperosmolarity is a well-established fundamental characteristic of dry eye disease (DED).1

When patients have dry eye symptoms, osmolarity testing is a logical step to confirm the diagnosis, but what does it mean when the tear osmolarity test is normal in a patient with symptoms suggesting DED?

In the early days of point-of-care tear osmolarity testing, many practitioners faced with this diagnostic dilemma assumed the test was inaccurate because it went against their clinical judgment. When osmolarity testing disagreed, our early reaction was often that the machine must be wrong. We now know otherwise.

Just as tear osmolarity can help us diagnose DED, it can also help us know when to pause and look for an alternative diagnosis. My colleagues and I conducted a study exploring how osmolarity testing can help make alternate diagnoses in symptomatic patients.

Take-home message

Patient symptoms are not an effective method to diagnose dry eye as they often overlap with other pathologies. Tear osmolarity results provide clues for alternative diagnoses.

(Ophthalmology Times, March 15, 2017)

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Filed Under: Articles

Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning

February 15, 2023 by Lisa Dockray

Alice T. Epitropoulos, MD, Cynthia Matossian, MD, Gregg J. Berdy, MD,
Ranjan P. Malhotra, MD, Richard Potvin, OD

● PURPOSE: To evaluate the effects of tear osmolarity on the repeatability of keratometry (K) measurements in patients presenting for cataract surgery.

● SETTING: Three clinical practices.

● DESIGN: Observational prospective nonrandomized study.

● METHODS: Subjects were prospectively recruited based on tear osmolarity (Tearlab Osmolarity System); that is, osmolarity more than 316 mOsm/L in at least 1 eye (hyperosmolar) and osmolarity less than 308 mOsm/L in both eyes (normal). The baseline K value was measured, and a second measurement was taken on the same instrument (IOLMaster) within 3 weeks of the first. Variability in average K, calculated corneal astigmatism using vector analysis, and intraocular lens (IOL) sphere power calculations were compared between groups.

● RESULTS: The hyperosmolar group (50 subjects) had a statistically significantly higher variability in the average K reading (PZ.05) than the normal group (25 subjects) and a statistically significantly higher percentage of eyes with a 1.0 diopter (D) or greater difference in the measured corneal astigmatism (PZ.02). A statistically significantly higher percentage of eyes in the hyperosmolar group had an IOL power difference of more than 0.5 D (P Z .02). No statistically significant differences were present when the subjects were grouped by self-reported dry eye.

● CONCLUSIONS: Significantly more variability in average K and anterior corneal astigmatism was observed in the hyperosmolar group, with significant resultant differences in IOL power calculations. Variability was not significantly different when subjects were grouped by self-reported dry eye. Measurement of tear osmolarity at the time of cataract surgery planning can effectively identify patients with a higher likelihood of high unexpected refractive error resulting from inaccurate keratometry.

(J Cataract Refract Surg 2015; 41:1672–1677 © 2015 ASCRS and ESCRS)

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Filed Under: Articles

Cornea and Sclera

February 15, 2023 by Lisa Dockray

Duane’s Foundations of Clinical Ophthalmology – Volume 2
Physiology of the Eye and Visual System
Daniel G. Dawson, Mitchell A. Watsky, Dayle H. Geroski, Henry F. Edelhauser



Please click below to view Chapter 4 detailing the cornea and sclera of the vast reference that is Duane’s Foundations of Clinical Ophthalmology.

Click here to view chapter


Filed Under: Articles

A Game-Changing Approach to Help Overcome Contact Lens Dropout

February 15, 2023 by Lisa Dockray

By: Paul Karpecki, OD, Ian Benjamin Gaddie, OD, David Geffen, OD and John Rumpakis, OD, MBA

Contact lens dropout rates have not changed appreciably in nearly two decades. Although new materials and preservative-free products have helped, neither was the tipping point we hoped for in contact lens practice. What’s more, as clinicians, we now face even greater challenges than we once did. The explosion in digital device use has placed an unprecedented burden on the ocular surface, erecting yet another hurdle to comfort. If there is one thing we have learned about contact lens dropout, it is this: We are less likely than ever to overcome it using traditional strategies. It’s time to start thinking outside the box.

In our clinical experience, and in that of many of our forward-thinking colleagues, the most effective way out of what is otherwise sure to be a downward spiral is to catch as many patients as we can as they come in for their annual exams. In other words, we need to identify which patients are at risk of dropping out prior to first fittings and before refits.

In this three-part series, we will explore how osmolarity testing can be the catalyst for change that the contact lens industry has long sought. This surprisingly simple approach is both practical and profitable.

(Review of Optometry, May 15 2016)

Click here to view the full three-part series

● Part One: A GAME-CHANGING APPROACH TO HELP OVERCOME CONTACT LENS DROPOUT – By: Ian Benjamin Gaddie, OD and Paul Karpecki, OD
● Part Two: FITTING WITH CONFIDENCE – By: David Geffen, OD and Paul Karpecki, OD
● Part Three: THE VALUE PROPOSITION: CLINICAL LAB TESTING IN OPTOMETRIC PRACTICE – By: John Rumpakis, OD, MBA and Paul Karpecki, OD

 

Filed Under: Articles

Alternative Revenue Sources Webinar
Dr Wes McCann: Q&A

May 19, 2020 by Lisa Dockray

During the webinar titled ‘Alternative Revenue Sources: Starting Up and Operating a Thriving Dry Eye Sub-speciality Post COVID-19’, Dr Wes McCann shared his views on the importance of developing a Dry Eye clinical specialty in the new Covid19 practice environment.  He provided an overview of how he has set up and continues to grow his Dry Eye practice at Central Optometry in London, Ontario, using a structured, operational approach.  Below please find the Q&A’s from the webinar with Dr McCann’s responses.

1. Would love to hear more about how Kyklos fits into an office flow outside of EHR
a. In our practice, Kyklos fits into your office and runs in parallel with your EHR. Patients are booked in your EHR and in Kyklos (to ensure you don’t have double booking in your EHR) and billing is done in your EHR (to maintain reporting for paying yourself and associates) but that is the extent of what is done in your EHR. The rest is done in Kyklos for dry eye appointments. I can see from my EHR when a patient was in for a dry eye visit, then I either refer to Kyklos for the clinical data, or I can print off a summary page from Kyklos and input that into a scans folder in the patients EHR file.

2. What is the redness scan?
a. It is a scan that is part of the Keratograph from Oculus. It grades the “redness” of the patient’s bulbar conj and a computer algorithm will give you a score. You can also, as the clinician, override that score.

3. Does your staff do all that testing listing or do you perform bottom half? I.e. lissamine and nafl and expression
a. My Staff perform: Osmolarity, InflammaDry, Redness scan (Keratograph), Vital Dyes (and photograph with the keratograph), NIKBUT, Meibography, and Lids & Lashes photography (Keratograph).

4. What do you charge for a dry eye consult?
a. We charge $268. You will have to consider what your overhead costs are and factor all that into your fees. (Consumables can run you upwards of $76 during the assessment for Osmolarity & Inflammadry. You need to consider your Chair Time Cost which can run anywhere from $70-125 for 30 min depending on where you are located [That is even before the OD is paid]). If you pay yourself or your associate OD a % of gross between 21-30% that could add between $56-$80 to your cost. So in total the COST of doing a dry eye assessment could be between $202-$281 on both extremes.

5. What test do you use to measure osmolarity
a. iPen, but I am considering switching to Tearlab when they come out with the combo MMP9/Osmolarity Device.

6. When do you use Restasis vs. Xidra
a. Restasis is my go to for chronic inflammation. + on MMP9 and depending on the level of dry eye I will Rx Lotemax Gel QID x 10 days and if a strong + on Inflammadry I will add Restasis. If the primary cause of the MGD is controlled with in office treatments we can consider removing the Restasis down the road and re-evaluate if it is still needed.

7. What is the difference between iLux/ Lipiflow?
a. Check out the manufacturer’s websites to see the differences. iLux is about ⅓ the investment of Lipiflow.

8. What dosage and frequency do you prescribe doxycycline for mild, moderate and severe cases?
a. I don’t prescribe Doxy as much anymore since I purchased my IPL. I’d rather refrain from disrupting the gut flora when possible.

9. What is the cost of the initial assessment?
a. We charge $268. You will have to consider what your overhead costs are and factor all that into your fees. (Consumables can run you upwards of $76 during the assessment for Osmolarity & Inflammadry. You need to consider your Chair Time Cost which can run anywhere from $70-125 for 30 min depending on where you are located [That is even before the OD is paid]). If you pay yourself or your associate OD a % of gross between 21-30% that could add between $56-$80 to your cost. So in total the COST of doing a dry eye assessment could be between $202-$281 on both extremes.

10. The iLux is not as soothing as the LipiFlow, what about RF and IPL.
a. IPL is painless (unless you have significant rosacea, then it feels like a small pin prick). RF feels like a warm stone massage. Both you can pretty much go back to work after. Little to no downtime.

11. what IPL brand did you purchase
a. M22 from Clarion

12. What are the platforms you can sign on that allow you to send forms to patients?
a. Kyklos will allow you to communicate with your patients for your dye eye assessments
b. For Primary Care check out Intake Q or Cognito Forms

13. What’s your treatment protocol for RF?
a. 3-4 Treatments 2-4 weeks apart.

14. what RF machine do you have as well
a. Cynosure

15. What lifestyle questionnaire do you use? Could you share it?
a. It is embedded into Kyklos. Comes with the program

16. Do you do gland expression after iLux and is it a staff member doing expression or OD
a. Part of the iLux protocol involves expression during the treatment so my staff do it. I will always check the glands after the treatment to see if more expression or further treatment is required.

17. Any views on the difference between The IPL devices E Eye and E Light?
a. Not familiar with E Eye or E Light, however, there are MANY differences in IPLs. My thoughts when purchasing a new device such as IPL, is this is a whole new field for Optometry. I want to purchase a device that has LOTS of clinical data behind it and is more or less the gold standard for treating dry eye. You can run the risk of burning a patient if you get the wrong device, and I wasn’t willing to take that risk on an unknown device or a device that has not been extensively tested in dry eye from a professional liability perspective.

18. How do you structure your fees? Charge as you go, diagnostic and follow up separate fees and extra for treatments. Or one large package.
a. Dry Eye Assessment includes one follow up as do treatments. Treatments are, however, sold in packages.

19. Does Kyklos “speak” to any specific EMRs so that the data can be pulled in? Or do you have to entire this info twice?
a. In our practice, Kyklos fits into your office and runs in parallel with your EHR. Patients are booked in your EHR and in Kyklos (to ensure you don’t have double booking in your EHR) and billing is done in your EHR (to maintain reporting for paying yourself and associates) but that is the extent of what is done in your EHR. The rest is done in Kyklos for dry eye appointments. I can see from my EHR when a patient was in for a dry eye visit, then I either refer to Kyklos for the clinical data, or I can print off a summary page from Kyklos and input that into a scans folder in the patients EHR file.

20. Is Kyklos a subscription based program?
a. Yes

21. Is Kyklos program available for French speaking patients?
a. Yes

22. Which in office treatment is most effective in your opinion for Meibomian gland obstruction?
a. This depends on how obstructive the disease is. IPL is becoming more my first line treatment, however, if the patient has moderate obstructive MGD, they will likely benefit from both IPL first then iLux or Lipiflow. Maintenance could then be likely done with IPL.

23. When did you start Kyklos? Right from the start or later?
a. 6 Months ago. We adopted it about 6 months after we got our feet wet in dry eye, but it was really needed from a comprehensive patient management part.

24. How do we do all these treatments With COVID? Are you concerned about safety and touching patient and possible risks?
a. Our staff and ODs, when that close to the patient, are gloved, masked, in scrubs and have a face shield. IPL especially has MINIMAL manipulation of the eye except expression afterwards, however, risk with expression of the meibomian glands would be no greater than flipping the lids or evaluating the lids during anterior slit lamp exam.

25. What did you to get other docs to refer to you? ODs? GPs?
a. Talk to them, educate them and be prepared to answer questions.

26. Where to look for such a staff who has some experience and then we can build on. My biggest barrier to dry eye practice is to find a staff to sustain the specialty.
a. Don’t necessarily look for someone with the experience you need. Find the ideal PERSON and PERSONALITY and drive you want and train them from the ground up. If a qualified person falls in your lap then that’s amazing, but Millennials and Gen Xers are looking for jobs with opportunity for growth, advancement and training. If you can provide that opportunity in your practice you will get some great dedicated people.

27. Do you charge for diagnostic follow ups? If so, do you price it the same as initial testing?
a. No charge for 1st follow up (included in fees). If there are additional follow-ups after that we charge for the partial and any additional tests we are doing to cover the consumables.

28. What’s your technique for screening meibomian gland expression?
a. Cotton tip pressure on the lid against the globe or finger pressure expression against the lid against the globe. I do that on lower lids medially, centrally, and laterally. Then grade that expression.

29. How do we find out suppliers for IPL and RF?
a. IPL – Clarion
b. RF – Cynosure

30. Do you bundle treatments? Like ilux and IPL?
a. Yes

31. What fish oil do you recommend? What if they are allergic to fish?
a. PRN – they have an excellent published study to support its efficacy
b. There are some Vegan options available. Nutrasea has one, however, the dosage isn’t as high as PRN.

32. Is RF as effective as Lipiflow?
a. Clinical studies are still underway as to the efficacy of RF, however, anecdotally, I have found it to be effective.

33. Why would you use Kyklos if you have the Crystal report from Oculus
a. The metrics Kyklos provides, Patient videos, and ongoing patient engagement from home. That was something that I asked myself prior to adding Kyklos before, however, getting your patients to ‘buy in’ and stay engaged in their treatment protocol is the most difficult part. Kyklos helps with that, however, you need to use the program to its full extent.

34. Will patient’s insurance cover some of these treatments?
a. Usually have them try a health care spending account. But create a form template letter that you can give them. The more insurance companies are exposed to this the more likely they are to create an envelope of $ to dedicate to other eye care expenses such as Dry eye, VT, advanced diagnostics etc.

35. How would you structure fees of diagnostics and treatments in Ontario? Would you be able to provide examples?
a. Diagnostics – we created a dry eye assessment which encompasses most of our diagnostics. Some are included in our in office TX and follow-ups.
b. Treatments are stand-alone costs that include their one follow-up in our office.

36. Do you enter these patients DE info in your general EMR also?
a. No, if they have a dry eye exam or in office treatment or follow-up it is all in Kyklos. Everything else and billing is in our EMR

Filed Under: Webinars, Articles

Innovative Digital Solutions to Support Your Clinic

May 15, 2020 by Lisa Dockray

As you are aware, the response protocols to the Covid-19 pandemic, and timelines for opening back up are evolving quickly. How you work safely, serve your patients optimally, and sustain your practice financially are questions that are top-of-mind for our team. We are here to support you, your practice, your staff, and your patients.

In this “new normal”, innovative solutions to help support the re-opening of your practice are more important than ever. Our company values long-term vision and innovation and has a history of bringing innovation to practice.

Digital solutions are key to assist your practice in managing patients, training staff, and driving sustained revenue growth as you transition to the new environment. At Labtician Théa, we have developed innovative tools to help you continue to provide quality care and best-in-class products to your patients, while minimizing in-person contact.

As the leader in preservative-free medications, we continue to provide our products only through Eye Care Professionals to their patients, and want to ensure you have the best platforms available to allow your patients to access much needed treatments without having to visit your office in person.

We invite you to reach out to our team to let us know what needs, opportunities, or challenges you are experiencing in this unprecedented time, and discuss how we can provide you with innovative solutions.

Our family businesses does business with heart, and enhancing visual health while supporting our communities is our top priority. We are deeply grateful for all of the healthcare professionals and first-responders around the world who are working tirelessly and courageously to care for all of us and help slow the spread of Covid-19.

Together we can flatten the curve of this pandemic and enhance the visual health of patients global-ly.

Stay well.

Yours,

Polydor Strouthos                                                                                   Fiona McCloskey

President, Labtician Ophthalmics Inc.                                               General Manager, LabticianThéa

#EnhancingVisionSupportingCommunities

Filed Under: Articles, News

LABTICIAN OPHTHALMICS and LABTICIAN THÉA ARE HERE TO SUPPORT YOU

March 27, 2020 by Lisa Dockray

As a family business, we do business with heart. Supporting our “family” of employees, customers, patients, and communities is our top priority.  We want to thank all of the healthcare professionals and first-responders who are working tirelessly and courageously to care for all of us and help slow the spread of the Coronavirus.

We aim to be proactive and find innovative solutions to support you during this unprecedented time.

As a designated essential business during COVID-19, we remain open to serve you and your patients. As we recognize that these are challenging times for all, we want to let all of our partners know that we are offering flexibility in payment terms to support you. The details of this payment flexibility will be managed on a case-by-case basis to ensure we are supporting your individual needs.

We also want to assure you that our inventory levels are sustainable and our supply chain is uninterrupted. Our Surgical Specialists, Territory Managers and Dry Eye Practice Consultants are accessible by email or phone, and our Customer Service desk is also available to take your calls at 1-(855) 651-4934

As many clinics are being required to close their doors, or serving emergency patients only to limit exposure and help slow the spread of COVID-19, we at Labtician Théa want to do everything we can to support patient access to needed treatments.

To help patients who cannot otherwise access their treatments during this time, we are temporarily lowering our prices for on-line ordering. Product can be ordered directly at https://labticianorderonline.com/storefinder/

Stay well.

Yours,

Polydor Strouthos                                                                                   Fiona McCloskey

President, Labtician Ophthalmics Inc.                                               General Manager, LabticianThéa

Filed Under: Articles, News

Coronavirus Disease (COVID-19)

March 17, 2020 by Lisa Dockray

To all Labtician and LabticianThéa Customers

As you know the response protocols to the COVID-19 virus are evolving quickly.

The safety of your team, your patients, our team and the broader community is the top priority. Therefore out of an abundance of caution to stay safe, protect the vulnerable and help flatten the curve of the pandemic, we are suspending any visits by our team to hospitals or clinics until March 30, 2020.

We will reassess “in-person” visits at that time based on advice from Public Health Authority and our commitment to doing all that we can to protect you, our customers, your patients, our team and our community.

In the interim, your local representative and our internal team are available to you by phone or via conference video call  to address any questions that you may have.

During this time Customer Service continues to be available if you wish to place an order.

We can be reached at:

Tel: 1-855-651-4934 or email: orders@labtician.com

Please note that we do not expect any supply disruptions as a result of current measures.

We all have a role to play in stopping the spread of this pandemic.  Thank you for your understanding.

If you have any questions or concerns please let us know.

Stay well

Yours,

Polydor Strouthos                                                                                   Fiona McCloskey

President, Labtician Ophthalmics Inc.                                               General Manager, LabticianThéa

Filed Under: Articles, News

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