Hello, and welcome to Case of the Day! I’m Doctor Croley and today we are shifting gears a little bit again. And that we are not gonna be discussing a specific case or patient, but what we’re gonna discuss [is] a new instrument in our office called the Cartograph 5 that we use mostly to diagnose dry eye patients. It does have a lot of the capabilities that are used for measuring the curvature of the Cornea. It has a lot of the contact lens fitting parameters where you can look at the contact lens on the eye make sure it fits well especially the bifocal contacts, where you can see the segment height which you can line it up with the system, and it also has pupil size that will measure. Sometimes we use that measurement prior to LASIK Surgery.
But what we are going to discuss today is mostly about dry eyes. So, we have lots of people who come in with dry eyes and we actually have a LipiFlow and a LipiView machine, that we’ve sort of gone over in the past but maybe we are going into more depth in the future. But we use this machine because it measures several different attributes of your tear film. And so, we are going over to show what that is.
Your tear film is actually made up of three layers, there’s the bottom mucus layer, then a water layer and an oily layer. So we try to find out what part of your tear film is not correct so, then we can treat the underlying problem or cause of your dry eyes, because if all you’re doing is putting tears in your eyes, which is a good thing to do, you’re not really getting down to the reason why you have dry eyes. You are not treating the cause of your dry eyes, which in the long term you need to. Because if you don’t do something, your dry eyes will slowly overtime, months and years get worse and worse.
We actually have young kids coming in with dry eyes, because they’re sitting on their gaming all day long and they’re stare what they’re looking at and they stop blinking and their eyes dry out and this starts the inflammation, it starts this whole dry eye problem. So we now actually have young people coming in.
The first thing we gonna do is go over the test, that this allows us to do. So, the first thing that I’m gonna show you is, this is a cartograph or topography and it measures exactly the curvature of your cornea. We use these measurements typically for cataract surgery. We use this for fitting contact lenses, and this shows us exactly the shape of your eye, the contour of your eye, so this is a typical cartograph or topography of someone’s eye.
So, we’re gonna go to the next test, which this is measuring the lipid layer of your tear film. So, now we’re looking at the amount of colors around the ring so when there shines the light on to the surface of your eye, then were looking at how colorful is that pattern. If it’s just dull gray, all these little rings are dull gray, then you don’t have any lipid layer to your tear film. If it has a lot of color to it, then you have a lot of lipid layer in there then the lipoview machine actually measures that layer down to microns and details. So, this tells us that this person has moderate amount of oil or lipid layer because there is some color but not as much as we want to normally like to see.
So, now we would go to the next test. And this is actually a movie, I don’t think the movies gonna show very well. But this takes the movie and you can watch the tear film move around on the surface of the eye as the person blinks. And so if your tear film is very thick because there is not enough liquid layer, then the motion is very limited. Whereas there are lots of tears then the motion is a lot. And so this is another parameter that we use to evaluate your dry eyes.
Then the next thing we’re gonna go in is the tear meniscus height, so, this will measure tiny detail of how much tear film is present from here up to where the edge, so this tear film lake, we can measure down to tiny little parts of a millimeter. So, this is .26 millimeters in height and that sort of limit of lower-lower limit of normal, anything below that is dry anything above that is pretty normal. So, we can measure exactly how dry somebody’s eye is and how much tear meniscus they have.
So, we will go to the tear break up time. So, the tear break up time calculates, how many seconds, we have someone blink a couple of times and then we have them not blink and then we count, the machine counts, how long it takes before the tear breaks apart. And so it calculates how long that is and this was 8.6 seconds which also is at the lower limit of normal and it tells us exactly what part of the tear film, where it was located and where the tear started to break apart, watching these layers, these rings and where it starts to fall apart, that’s when it stops the timer and tells us when it happens, what part of the cornea.
So, the next one is a redness test. So it calculates how red are the eyes and so it gives us a reading, it gives 1.1 and again as the bulva or the renosone or the white part of the eye. The level redness is 0.7 and 1.0 on the left, and so, that tells us how red someone’s eye is. And also it tells us how inflamed their eye is from dry eyes.
And then the next test which is most important test, is actually we can measure and take a 3D image of their meibomian glands and so what this shows if you can see this, we will try to zoom in. You can see these glands up here and these glands empty up with tiny opening on lid. These glands secrete the oil or lipid to you tear film, so you can see these glands here have died, and these glands are a little short, these glands a little short, and these glands are a pretty normal over here and so this person here has mild to moderate dry eyes due to the meibomian glands not secreting the proper amount of oil to the tear film and we can actually photograph the quality of their glands.
And so, the last thing is just a photo, there is a lid lesion here someone has skin cancer or something like that and then we can take a picture of that so we could track the lesion and what it’s doing. So this is a little bit of different things that this would do, and so it allows us to diagnose the type of dry eyes someone has, and then we come up with a treatment protocol based on what type of dry eye, this person has some meibomian gland disease, therefore we treat the meibomian glands to make their dry eye better.
If someone has a normal meibomian gland but their liquid layer was thin, we would treat them because that portion of their tear film is abnormal, with different things and so, now is it’s just not going to a doctor’s office and saying my eyes are dry, and we find out and examine you and tell you, that your eyes are dry and just use some tears, but now we can get specific about the treatment.
So, if you have any questions about how we examine someone for dry eyes and the different types of treatment, you can always contact us through the website, if not may God bless you with healthy eyes and great vision.