Image-Guided Evaluation and Monitoring of Treatment Response in Patients with Ocular Surface Disease

Abstract

Cutting-edge image capture and analysis promises to be a new frontier for both diagnosing disease and monitoring treatment response in patients with ocular surface disease. IVCM and AS-OCT both provide important data that allow clinicians to make a pinpoint diagnosis and to prescribe a patient-specific treatment. Through the use of IVCM, it is possible to distinguish a patient with dry eye from one with corneal neuropathy, to know the degree of inflammation present in each condition, to watch nerve regeneration over time, and to note the efficacy of the treatment prescribed at the cellular level. IVCM also provides objective parameters for evaluating and monitoring meibomian gland dysfunction. This instrument is able to detect the density of meibomian gland distribution, gland morphology, the size of their ducts, and the amount of associated inflammation. Along the same lines as IVCM, AS-OCT is a new technology that can be very useful in assessing DED patients, especially those with possible meibomian gland disease. AS-OCT images of glands can assist a clinician by easily visualizing gland engorgement, morphology, prevalence, and length (along with the weight of the tear meniscus). Other dedicated meibomian gland imaging systems such as LipiView™ or Keratograph 5M™ can provide similar information about glands that are of higher quality compared to current AS-OCT images; however, many practices already have AS-OCT and may not have yet invested in a dedicated imaging system for meibomian glands. Together, these pieces of equipment can influence the decision on what form of therapy will be most effective.

Despite the clear benefits they provide, IVCM and AS-OCT use is not yet widespread for ocular surface disease. While IVCM is well acknowledged, its application is limited by the fact that few practicing ophthalmologists are able to interpret and apply the data. Furthermore, while utilization of AS-OCT in addressing ocular surface disease is extremely promising, it is still not validated. Clinical trials using in vivo imaging tools are needed to thoroughly evaluate their application as objective in vivo tissue biomarkers of disease. These types of studies will serve to expand the use of this technology and to incorporate these tests as critical parts of any ocular surface disease assessment.