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A new compact, portable device for rapid, high-definition meibomian gland imaging (LipiScan, TearScience) is an efficient screening tool for patients with complaints of dry eye and/or candidates for surgical procedures in which pre-existing dry eye could affect outcomes.
Reviewed by Preeya K. Gupta, MD
Morrisville, NC-A recently introduced high-definition imaging device for evaluation of meibomian glands (LipiScan, TearScience) measures lipid layer thickness and evaluates blink dynamics with an efficient, easy to use device for clinical practices, said Preeya K. Gupta, MD, assistant professor of ophthalmology, Duke University.
“Despite being smaller and easier to accommodate in a clinic, it still takes very high resolution meibomian gland images,” she said. “I use it as a screening tool in my office to help identify patients who might have meibomian gland dysfunction (MGD) or who may have been misdiagnosed or underdiagnosed in the past.”
She also uses it to screen both refractive surgery and cataract surgery candidates to identify coexisting MGD that can lead to dry eye.
Before the development of imaging devices specifically for evaluation of the meibomian glands, it was difficult to determine if a patient had gland atrophy and other signs of gland dysfunction such as dilation or tortuosity, Dr. Gupta said. “Now you can identify anatomically whether or not there is gland dysfunction or atrophy. As a clinician it has provided a lot of information about the meibomian glands that we really didn’t have access to in the past.”
It is not only helpful for making a diagnosis but for framing treatment expectations in discussions with patients, she added. For example, if the images showed very severe gland atrophy, she could explain that the treatment goal is to preserve the few remaining glands, and that it could be an uphill battle. But if the patient had relatively minor gland atrophy accompanied by symptomatic dry eye or MGD, she could outline the specific treatment steps likely to produce improvement.
Compared to traditional procedure
The device uses a patented technique that takes high-definition images of the glands using a transilluminator and near-infrared technology, said Joseph Boorady, OD, president and chief executive officer of Tear Science.
The device and its predecessor (LipiView, TearScience) have a transilluminator, which everts the eyelid and uses a proprietary infrared light source to image the lid, he said. “The infrared light allows the camera on the lid to take very high quality, high definition images of the glands.”
“In order to accurately diagnose MGD, which still today is vastly misunderstood and underdiagnosed, you need to look at two things: structure and function. Look at the structure of the meibomian glands and [whether they are] secreting lipid or not,” Dr. Boorady said.
Historically, doctors would transilluminate the eyelid and use a slit-lamp to evaluate the meibomian glands when they wanted to look at the structure. However, the patented imaging technology developed by the company provides a high-resolution view of the glands in under 10 seconds per lid, Dr. Boorady said. Function can then be assessed using the slit-lamp along with the company’s handheld meibomian gland evaluator or by manual expression.
Until relatively recently, tools for evaluating the meibomian gland had largely been found in research settings and tended to be more sophisticated and complex than was necessary for the typical clinical practice, Dr. Boorady said. The new product was developed in response to demand for a dedicated, smaller, and less expensive device that produced high quality images.
Integrating into clinical practice
"It’s been an easy instrument to integrate into clinical practice because it’s not invasive and it’s easy for technicians to use and become familiar with,” Dr. Gupta said. “As a clinician, what I’m focused on is whether a device going to give me good images, and also [whether] it easy for my staff to use. I would say this device definitely captures excellent images…but it’s much more portable and compact and easier to integrate, especially into higher volume practices and busy clinics.”
Dr. Gupta noted that the device is less expensive than one of the company’s previous developments (LipiView II), and clinicians could purchase multiple devices for different office locations or more than one in a large clinic. The device’s small footprint also makes it unlikely to disrupt patient flow, regardless of the practice size and number of devices on site.
Filling the niche
Introduced at the 2016 American Society of Cataract and Refractive Surgery (ASCRS) symposium, the device has had better than expected sales so far, Dr. Boorady said.
“I believe [physicians] are looking for an easy and cost effective way to get images so that they can screen a lot more patients in their offices,” he said. “We believe we’ve filled that niche. More screening and more identification of MGD will lead to more treatment, which is why we want to help doctors identify this dysfunction.”
Preeya K. Gupta, MD
Dr. Gupta is a consultant to TearScience.