EyeWorld India March 2015 Issue

50 EWAP CORNEA March 2015 by Jonathan Solomon, MD Embracing the future of diagnostic technology Several new testing modalities could help in clinical practice I n this Google age, patients no longer take their doctor’s opinion as unquestionable gospel. They want answers, and the internet has generated a need for instant gratification and rapid transfer of knowledge. If we are able to give patients a reasonable diagnostic timeframe and reproducible data using advanced technologies, they might feel more confident in our ability as physicians. Here are a few technologies that we have had success with in our practice and will continue to use moving forward. Ocular allergy testing Because there is crossover between systemic and ocular allergic findings from a seasonal and a perennial standpoint, our Doctor’s Allergy Formula (Jacksonville, Fla.) test allows for a broader scope of diagnostic testing in office. We don’t have to subject our patients to multiple subspecialty allergy assessments. Instead, we can better refine their care beyond the ocular surface. The point-of-care test is specific to ocular allergies in our region and allows for the rapid assessment of potential allergens. It is a reimbursable test that is covered by private insurance as well as Medicare and Medicaid. Ocular allergy testing allows us to communicate with the allergist or the primary care doctor intelligently if we need a more generalized scope of treatment. Other testing methods Additionally, we utilize the RPS InflammaDry Detector (Rapid Pathogen Screening, Sarasota, Fla.), an in-office test that detects MMP-9, an inflammatory marker that is consistently elevated in the tear film of patients with dry eye diseases. We take tear samples from the inferior fornix, and results are available within 10 minutes. In essence, the test recognizes chronicity, whether it is ocular rosacea, meibomian gland dysfunction, or even corneal erosion. It allows us to identify patients who have underlying concomitant diseases and rapidly institute care. The discovery of three novel and gland-specific biomarkers that detect Sjögren’s syndrome earlier in the disease process and with higher sensitivity and specificity than traditional biomarkers has led to the development of Sjö (Nicox, Sophia Antipolis, France). Sjö is an advanced diagnostic panel for the early detection of Sjögren’s syndrome for patients with dry eye. The test can be used to help us identify a potential systemic cause of a patient’s dry eye disease. Additionally, new evidence is pointing to the fact that the prevalence of Sjögren’s syndrome among the general dry eye population is much greater than previously thought. As many as 1 in 10 patients with dry eye might in fact have Sjögren’s as an underlying cause. 1 To use the Sjö test, we collect a blood sample using an in-office finger prick and send the sample via prepaid envelope to the laboratory to run the proprietary diagnostic panel. The lab returns a report to our office within a week or so that is easily interpreted and either confirms or rules out Sjögren’s syndrome based on the findings from testing the novel biomarkers and traditional biomarkers. That information can be passed on to the patient and facilitates collaboration with a rheumatologist and/or primary care doctor, if needed. Prior to implementing this technology, we would send only those highly suspected patients to Jonathan Solomon, MD continued on page 52