Upper Lid Care: A Vital Aspect of Patient Health
- Despite a decade of growing attention to dry eye disease, millions of patients remain undiagnosed - whether symptomatic or asymptomatic - highlighting an opportunity to enhance thorough care,...
- One persistent gap in comprehensive exams is the frequent omission of a simple diagnostic step: evaluating the upper eyelids.
- Historically, the upper eyelid has been more difficult to evert adequately for imaging, leading to a higher percentage of missing or poorly everted images (Daniel et al.; Wolffsohn...
Key takeaways:
Table of Contents
- Upper lid assessment can help identify disease earlier than lower lid meibography.
- Innovative instruments make everting the upper eyelid easier and more consistent.
Despite a decade of growing attention to dry eye disease, millions of patients remain undiagnosed – whether symptomatic or asymptomatic – highlighting an opportunity to enhance thorough care, provide relief and support practise growth.
One persistent gap in comprehensive exams is the frequent omission of a simple diagnostic step: evaluating the upper eyelids. Historically, lower lid meibography was considered sufficient, and the practical challenges of upper lid eversion led many clinicians to forgo upper lid imaging altogether.
Historically, the upper eyelid has been more difficult to evert adequately for imaging, leading to a higher percentage of missing or poorly everted images (Daniel et al.; Wolffsohn et al.). Less efficient lid eversion techniques can increase chair time and patient discomfort (Wolffsohn et al.). Gupta and colleagues underlined the importance of effective eversion for meibography: “notably, proper eyelid eversion is crucial for ensuring image quality and accurate assessment, especially for long-term monitoring.”
Meibography sets practices apart in their ability to identify and treat MGD effectively. Upper lid imaging uncovers more patients with gland loss, and sharing these images helps patients understand the need for intervention. This facilitates in-office therapies such as intense pulsed light (eg, OptiLight from Lumenis) and thermal pulsation (eg, lipiflow from Johnson & Johnson or iLux from Alcon), which are typically paid out of pocket and recommended periodically, providing both improved patient outcomes and additional revenue opportunities.
The implementation of specialized instruments (eg, Meivertor from Meivertor, LidVue eyelid everter from VisuScience or LidStick from Oculus) reduces chair time, streamlines procedures and simplifies lid eversion while supporting efficient workflows, maintaining patient comfort and offering a superior option to cotton applicators or finger-only eversion.
The Meivertor is a multiuse stainless steel instrument for upper and lower lid eversion with disposable silicone tips to improve hygiene, provide secure eyelash handling and enhance patient comfort. Its single-handed design leaves the clinician’s other hand free to operate the imaging camera or perform other tasks.
LidVue assists with lower lid eversion for meibomian gland imaging, featuring smooth, rounded edges for easy handling and patient comfort.
For clinicians who prefer single-use tools, the LidStick is a disposable, multiuse instrument made of medical-grade silicone and plastic, providing a convenient and hygienic option for routine exams.
These innovations enhance efficiency,support patient flow and optimize revenue per patient,making comprehensive meibography sustainable. Whether lid eversion is performed by a clinician or a technician, these tools simplify the process and help ensure that clinical time is directed toward image interpretation and patient management.
By combining efficient lid eversion tools with comprehensive upper lid imaging, practices can streamline workflows, enhance patient care and unlock new opportunities for revenue, making meibography a practical and impactful.
New Technologies Offer Hope for Earlier Detection of Keratoconus
Researchers are developing and refining technologies to detect keratoconus, a progressive eye disease, at earlier stages, potentially slowing its progression and preserving vision. These advancements focus on analyzing the cornea’s structure and identifying subtle changes often missed by customary methods.
Understanding Keratoconus and the Need for Early Detection
Keratoconus causes the cornea, the clear front part of the eye, to thin and gradually bulge outward into a cone shape. This distortion leads to blurred vision and increased sensitivity to light. Early detection is crucial as interventions like corneal crosslinking can halt or slow the disease’s progression when initiated in its initial phases.
Advances in Corneal Mapping and Analysis
Several technologies are showing promise in improving early diagnosis:
- Scheimpflug Imaging: This technique creates a detailed map of the cornea’s anterior and posterior surfaces, providing measurements of corneal thickness, curvature, and elevation. Research by Viso et al. published in Invest Ophthalmol Vis Sci in 2012 demonstrated the utility of Scheimpflug imaging in characterizing corneal topography. (https://iovs.arvojournals.org/article.aspx?articleid=2127290)
- Optical Coherence Tomography (OCT): OCT provides cross-sectional images of the cornea, allowing for detailed analysis of its layers. Studies by Pucker et al. in Cont Lens Anterior Eye (2019) explored the use of OCT to assess corneal parameters. (https://www.contactlensjournal.com/article/S1367-0484(18)30880-4/abstract)
- Artificial Intelligence (AI) and Automated Segmentation: Researchers are developing AI algorithms to automatically analyze corneal images and identify subtle signs of keratoconus. Vunnava et al., writing in the Indian Journal of Ophthalmology in 2023, detailed an automated system for segmenting and quantifying corneal features. (https://journals.lww.com/ijo/fulltext/2023/04000/automatic_segmentation_and_quantified_analysis_of.48.aspx)
- Corneal Topographic Aberrometry: This combines corneal topography with wavefront aberrometry to provide a comprehensive assessment of corneal irregularities and their impact on vision. Wolffsohn et al. published research on this in Cont Lens Anterior Eye in 2019. (https://www.contactlensjournal.com/article/S1367-0484(19)30047-5/abstract)
Challenges and Future Directions
While these technologies are promising, challenges remain. Standardization of image acquisition and analysis protocols is needed to ensure consistent and reliable results. Further research is also focused on identifying biomarkers that can predict the progression of keratoconus. Zang et al., in Eye (2018), highlighted the importance of understanding the genetic and environmental factors contributing to the disease.(https://www.nature.com/articles/s41433-018-0149-5)
Pucker et al. also noted in