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Is it the dry eye or the cataract that is making the patient unhappy?
The Ocular Scatter Index on the HD Analyzer provides a method to assess quality of vision.
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Let’s face it: Old patients get cataracts, and old patients get dry eye. This is especially true of women, patients with diabetes and those on multiple systemic medications.
Sometimes it is difficult to sort out why the patient is complaining — cataracts vs. dry eye and the relative contributions of each. It is also important to determine if the non-complainers have a healthy enough ocular surface to withstand the challenge of a presbyopia-correcting IOL or LASIK. One tool that is especially suited to these tasks is the HD Analyzer from Visiometrics.
The HD Analyzer provides the Ocular Scatter Index (OSI), which is a method to assess the quality of vision. It can identify early but visually significant cataracts before they are visible at the slit lamp (an issue with older patients who request LASIK) and ensure that premium cataract patients are set up for positive postoperative outcomes.
In 2016, an article in the Journal of Refractive Surgery stated that the OSI was “the most sensitive and most specific test for the detection of cataract, even at an early stage.” Using a rapid and noninvasive double-pass technique, this device detects refractive aberration and ocular scatter. An article in the journal Investigative Ophthalmology & Visual Science stated, “The [double-pass] technique produces a more accurate description of the optical quality, better correlated with the quality of vision.”
For instance, if a patient has a stable tear film (within the “green zone” on the color-coded tear film analysis) but an elevated OSI score indicting a clinically significant cataract and normal topography and macular OCT, they are likely a good candidate for a premium IOL. If a patient has a poor tear film that is not within the green zone, we pretreat the ocular surface disease for 2 to 4 weeks and repeat the tear film analysis. If the patient is now in the green zone, we feel much more comfortable offering a premium IOL.
Source: Visiometrics
If we encounter a 52-year-old patient who wants LASIK and has a normal tear film analysis (in the green zone) but an elevated OSI in the yellow or red zone, we steer the patient away from LASIK and toward lens removal, with a discussion regarding premium vs. monofocal IOLs.
Besides its routine use in our offices to assess the severity of dry eye and cataracts and their impact on vision, the HD Analyzer is now used by scientists in clinical trials to assess multifocal IOL optical performance, to compare visual function post-ICL with and without a central hole, to make an objective optical assessment of tear film in dry eye disease patients and to assess the effect of eye drops on vision quality in dry eye patients. I predict that, soon, many FDA trials will utilize the HD Analyzer for an objective measurement of the impact of topical medications on vision, as well as an objective assessment of quality of vision with new premium IOLs.
- References:
- Díaz-Doutón F, et al. Invest Ophthalmol Vis Sci. 2006;doi:10.1167/iovs.05-1049.
- Galliot F, et al. J Refract Surg. 2016;doi:10.3928/1081597X-20151222-02.
- For more information:
- Marguerite B. McDonald, MD, FACS, can be reached at Ophthalmic Consultants of Long Island, 360 Merrick Road, Lynbrook, NY 11563; email: margueritemcdmd@aol.com.
Disclosures: McDonald reports she has no financial interest in Visiometrics and the HD Analyzer. Fumuso reports no relevant financial disclosures.