Back in pre-pandemic times, I had the opportunity to try out the IDRA system (figure 1), an adapted camera system that is mounted on a slit-lamp base and allows easy, accurate and repeatable analysis of the tears and ocular surface. Tests such as meibography (figure 2), non-invasive tear break-up time (figure 3), tear volume prism height measurement (figure 4) and blink rate and patency analysis (figure 4), and interferometry of the lipid layer (figure 5) were all easy to perform. Best of all, the results could then be combined (figure 6) and presented as part of a management plan to address a patient’s dry eye disease. See Optician 21.12.18 for my review.
Figure 1, 2 & 3 (clockwise): The IDRA in clinic in 2019; Meibography; Non-invasive tear break-up time display
In August 2020, sole UK distribution of the IDRA was taken over by Essilor Instruments. This added to their ‘dry eye portfolio’ as already they had sole rights to distribute the TearStim, which first launched at 100% Optical earlier that year. TearStim is a novel treatment for meibomian gland dysfunction (MGD) that employs intense regulated pulsed light (IRPL) technology to stimulate gland function.
In April of this year, Essilor Instruments announced the launch of the Activa Home Eye Mask (from SBM Sistemi, who also produce the IDRA), which uses heated automatic massage technology and can be rented to patients and offered as an in-practice treatment. At the launch, Paul Cumber (Essilor Instruments director) said: ‘The effectiveness of IRPL treatments such as TearStim can be enhanced by using the Eye Mask to help unblock the meibomian glands and give quicker, short-term relief, and IRPL can then be used to provide longer lasting benefits.’ When combined with the use of IDRA for diagnosis and monitoring, Essilor can now supply a complete ‘dry eye package’ to clinics. I was keen to learn more about TearStim and Activa, but first wanted to know if IDRA had any new functionality.
Figure 4, 5, 6, & 8: 4) Inferior tear meniscus height measurement; 5) Interferometry of the lipid layer; 6) Summary of results from the IDRA system; 8) The SBM app allows remote secure data transfer
IDRA
I was pleased to see that all the functionality of the IDRA remains. I find particularly helpful the range of reports that can be generated as required for each individual patient when designing a management strategy and protocol for monitoring and follow-up (figure 7). With dry eye disease, this is especially important. Not only is good compliance by the patient with any strategy essential, but management plans need to be modified over time as, hopefully, the condition is being treated. Being able to generate a follow-up report is really helpful.
Having mentioned compliance, a nice feature new to me is the SBM app. This allows you the patient to view their ocular surface status on their smart device and also can be used to send information taken remotely, such as a Dry Eye Questionnaire 5 (DEQ-5) back to clinic (figure 8).
Figure 7: Report options possible with IDRA
TearStim
The TearStim system (figure 9) allows intense pulsed light treatment to be applied to the eye lids and is an essential part of any management plan, especially for chronic blepharitis and for patients with evidence of telangiectasis. The patient wears eye protecting goggles (figure 10) and then the intense light pulses are applied using a hand unit (figure 11) directly to the malar region around the eye where the nerves supplying the meibomian glands are located. The benefit of this treatment is long term resolution of the lid problem and so less reliance upon repeated use of topical agents.
Figure 9, 10, 11: The TearStim system; Patient wearing protective goggles
Activa Home Eye Mask
The Activa Home Eye Mask (figure 12) offers a fully automated procedure that heats and massages the eye lids, generating heat of approximately 42 degrees for 15 minutes while applying a micro-vibration-based massage. The mask is controlled via a touchscreen and powered and regulated via an attached control base unit. The system can be rented to patients for home use (figure 13) and offered as an in-practice treatment.
Figure 12 & 13: Components of the Activa Home Eye Mask system; Activa in use at home
- Look out for a full review of the Essilor Instruments dry eye management system in the coming weeks.
