Disclosure: Dr. Denton sits on the Bausch + Lomb speakers bureau; consults with Alcon, Optase, and Visus; and earns affiliate income from Èyes Are The Story
Brooke Beery is Assistant Editor of Optometry Times®.
Hey, Dr. Denton Dombrowski here. I am a private practice optometrist. I own my own practice. I started cold about 4 and a half years ago. This video is for Optometry Times®, but I actually have my own YouTube channel where I post educational videos about eye health and vision related products. You can subscribe to that, we will make sure to leave a link down below to the page for Salisbury Eyecare and Eyewear.
Today, we are talking about meibography and anterior segment imaging. And we will be covering the Meibox (Box Medical Solutions). I am going to talk to you about the usability of the device, some pros and cons when it comes to using it, as well as patient care, what my experience has been, and what I have been able to see in images since I have had it the last 5 days.
Let me give you a little bit of background. I am a doctor of optometry as you probably are, if you are watching this. I have my own private practice that I started cold 4 and a half years ago, and I have always been very proactive about treating dry eye. It is not like I am inventing this from absolute square 1. But as a new practitioner and starting a practice cold, of course, I didn't have the money to get every single diagnostic and treatment device.
Starting out, I treated dry eye by using a combination of questionnaires, really good patient histories, great slit lamp exams, fluorescein, all the basic things. My practice has elevated a little bit from the baseline by just offering a lot of dry eye products. We offer tears at my practice, Bruder masks, and all the lid scrubs.
We also started using InflammaDry (Quidel) a couple of years ago, and that certainly enhanced the experience. However, I am looking to really elevate the experience further. At this point, if you are going from a baseline level, like me, of treating some dry eye, offering products, and trying to elevate your dry eye center, you might be going through some of the things I am, which includes figuring out the right diagnostic equipment, the right treatment equipment to offer, and how to package those up. You might also be taking a look at the operations of your practice. In the course of finding the right diagnostic equipment, I have been looking at anterior segment imaging, and one of the devices that was suggested to me was the Meibox. So, today's video is all about the Meibox.
What is Meibox?
All right, so what is it? Meibox is an anterior segment camera. It is really nice because it can be used independently from the slit lamp or with the slit lamp. It is very mobile—you can move it from room to room if you so choose. And you could certainly use it for patients who are unable to get up into the slit lamp, maybe even on some of your kiddos because you can get so close to the eye.
I think it is really a great option for examining the anterior segment when you can't help a patient with the traditional slit lamp. In terms of usability, it is going to fit on most slit lamps. I actually have what some would call an "ancient" Haag-Streit slit lamp in one of my exam rooms. I acquired it when I bought another practice for their equipment, and the Meibox doesn't fit on that.
If you have any newer generation slit lamps, certainly anything you have bought in the last 10 or 20 years, you are going to be fine, most likely. But if you have really ancient slit lamps in any of your rooms, just keep in mind you might have to go completely slit-lamp free and use your hands for imaging in that room.
In terms of usability, there is a little bit of skill required to use the Meibox. Of course, if it is mounted on the slit lamp, you are going to have to be able to use a slit lamp. So, having your team do this right away might not be 100 percent feasible. My team unboxed the Meibox and started playing with it and using it on each other without a slit lamp. So, they got pretty good at doing it without the slit lamp. But again, there is a learning curve to it. To image the upper glands, you are going to have to flip the lids. That is something my team members had to become comfortable with.
Let's talk about the software. The software is easily downloaded; it doesn't take up too much space on your computer or affect the speed of your computer at all. Everything is great with that. There is one login code you can use to log in to every computer within the office, which I think is a really nice feature. If you are imaging in one of your exam rooms, or potentially a pretest area, you will be able to access those images no matter what room you move into.
Pros and cons
All right, so let's get into some pros and cons of the Meibox. One pro that I really like is the price. For what it does, it is priced very competitively—a lot lower than some of the other options on the market. I like that it is mobile. Mobile is really key because being able to take it off the slit lamp and get imaging as you go wherever you are is kind of neat. And it is also more comfortable for the patient to not have to be in the slit lamp. My team has gotten pretty good at imaging without the slit lamp and that is one thing they liked: being able to talk to the patient throughout the exam. There is no barrier with the slit lamp.
One con of the device is that it doesn’t conduct a live exam. Some of the competitors for this product are going to offer you a live exam option. For instance, a slit-lamp camera is going to offer more of that live exam experience, and this is not that. It does have some capability with not only the meibomian glands but imaging the tear film and some anterior segment stuff. To be fair, I haven't gotten too used to every single function, yet. We have mostly used it for meibography at this point.
It doesn't have all the functionality of a slit-lamp camera, to my understanding. So, it is going to be a little bit more limited. But again, the price point is really nice if you are looking for something to just up your diagnostics game. You can show your patients what is going on and maybe have better compliance with treatment.
There is a mobility issue here. I know we talked about that as a pro. It is a mobile device, you can use it without the slit lamp. But to me, that also gives you a little bit of a con. We have described it as yoga. There is a certain amount of yoga you have to be able to do in order to successfully use the device and image the gland.
Right. Those are some logistical things about the hardware, the software, and using the device. The second piece of it, if you are a doctor wondering about the device, is: "What is it like for patient care?" "Can I see the glands?" "Will I be able to know how many of my patients are going to have meibomian gland concerns, and what does that look like?”
When I got this device, we didn't decide to use it on every single patient because it is a little bit time intensive. What I did was, I had all patients who I had seen in the last week, with known dryness or meibomian gland dysfunction, actually go through the images. I have also elected to do it on a range of patients including young patients, old patients, and patients of different racial demographics because I wanted to get a sense of how well I would be able to see the glands, regardless of skin tone.
In some respects, the results are surprising. I imaged my own team, and I am going to put some of their images here, as well as my own. Most of us looked pretty good, but it was interesting that some of the images had early alterations in the glands that are starting to get kind of wiggly or squiggly. There are glands that are a little bit thicker than average.
At least one of my team members had a lot of gland dropout, which was completely unbeknownst to her. Her only symptom is not being able to wear contact lenses, so that was really enlightening.
Now I am going to show you some of the patients I took pictures of. Here is a patient that has a recurring stye. I actually have 2 patients that came in with recurrent styes. I will put them both right there. And both of these patients had exactly what I would expect: a lot of gland dropout, maybe even some styes present, a lot of thickening of glands, and a lot of irregularity. This was great to be able to show them exactly what I have been telling them for months and years.
I am going to show you another one. This one is of a patient who is in her 20s, who works on computer a lot. She has been working on her computer even more than usual lately because she’s been working from home and having a lot of discomfort, dryness, and eye strain. This case is really not too bad. There is no gland dropout but a little bit of early alteration of the glands. So, we are able to talk to her about what we saw and reassure her that there is no gland dropout. Then we can get her on a proper course of treatment to prevent gland dropout from ever happening.
All right, so to wrap it all up, I think that the Meibox is a great option. I love that the company lets you do a trial if you are really interested. That is something to consider, if you are looking at this—definitely contact the company and see if they will let you trial it. I don't know if they have that availability everywhere, in every region, but it is something to consider.
I have enjoyed having it. It has taught me a lot.
I didn't realize how much gland dysfunction could be out there, even in mildly symptomatic patients. It will definitely affect the protocol of my practice going forward particularly who we will test and who we won't, who will image and who will not. I hope that you enjoyed this video and learned something.
If you have further questions about dry or starting a dry eye center, please make sure to leave them in the comments below. I am in the process of starting a dry eye center right now and would love to hear from you and share best practices because it is a lot of fun. And there is a lot to learn. Thank you for tuning in.
I'll see you next time.