ScoutPro handheld device offers time-saving portability.

With refractive and cataract surgery patient expectations skyrocketing, you do all you can to ensure the best possible outcomes. Now, an improved osmolarity testing system from Trukera Medical can help ensure that a patient’s tear film doesn’t harm what could be an otherwise excellent procedure — all without getting in the way of practice efficiency.

Launched in September 2022, the ScoutPro Osmolarity System combines specimen collection and lab analysis into one handheld system. Trukera says it is the first and only portable osmometer in the United States, bringing together nanoliter volume sample collection and analysis into a portable device.

As a refractive surgeon, “tear film osmolarity is critically important to me,” says Robert F. Melendez, MD, MBA, founder/CEO of Juliette Eye Institute, Albuquerque, N.M. Tear film osmolarity is “a gauge for me as a surgeon that I use to help me on my decision tree.”

MULTIPLE ADVANCES

Darrell E. White, MD, cataract and refractive specialist and founder of Skyvision Centers in Westlake, Ohio, has been using an osmolarity testing unit from Trukera (formerly TearLab) for well over 10 years. This is one of the foundational tests that he performs at his dry eye referral practice.

While the previous osmolarity testing unit from Trukera was accurate, the ScoutPro offers notable advances. First, this latest device offers portability. No longer does a technician have to return to a base unit with the handheld device to obtain the osmolarity value, as the earlier device required. Instead, the ScoutPro integrates the specimen collection and analysis all within the handheld device, and the osmolarity value displays on the handheld unit.

“One no longer has to travel,” says Dr. White. “The instrument is with the technician who’s doing the test.” In addition, the device is so compact it can fit in a technician’s pocket, he notes.

Another advantage: Although the actual tear collection and analysis still takes only 7 seconds per eye, the total collection process, including patient flow is much more efficient, Dr. White says. “Previously it was more like a 3-to-5-minute test, depending on where the patient was located in the office,” he says.

For a technician who works up 15 to 20 patients per day, “that’s an additional 45 to 70 minutes that a technician is not available to do other things because they’re literally moving back and forth in space,” notes Dr. White.

Dr. Melendez concurs. “There’s a significant time difference comparing the old device with the new device,” he says. “It’s a significant time saving for your patient flow with the ScoutPro because you don’t have to go back to the base station to read it.” Instead, the osmolarity reading displays on the device.

What’s more, the ScoutPro offers major time savings over other techniques typically used to test for dry eye. Before the ScoutPro, according to Dr. Melendez, he was using the Schirmer’s test, which could take up to 7 minutes to perform. By comparison, he estimates that the ScoutPro can measure osmolarity in less than 1 minute for both eyes (he gives the system more time than Dr. White).

Second, the unit utilizes new Verilyte technology, which integrates specimen collection and analysis in a single device. This gives a technician the ability to combine two steps in one, thus saving valuable testing time for the practice and the patient.

Third, the unit maintains up to two prior test results in memory. This eliminates any chance of losing an osmolarity value because the technician failed to write it down, notes Dr. White. Test cards, he says, can be stored in exam rooms.

“When I first saw the system,” he says, “it was instantly apparent to me that the best way to use it, especially in a larger, busier practice, was one ScoutPro per technician doing workups. They just pop them in their pocket. It’s there all the time. If it’s appropriate to do a tear osmolarity test, they pull it out. It’s extremely efficient, and I think lends itself to people being more comfortable using tear osmolarity just because now it’s so convenient.

ENSURING AN ‘AMAZING OUTCOME’

As a refractive surgeon, Dr. Melendez performs osmolarity testing on 100% of his patients. For his corneal refractive patients, whether the patient is having LASIK or PRK or SMILE, he’ll use the ScoutPro. If he finds that a patient has a high level of osmolarity, he will start the patient on artificial tears and typically recommend SMILE. In his experience, SMILE patients tend to do much better when they have pre-existing dry eyes. He avoids LASIK in patients with significant dry eye symptoms and high osmolarity readings as this increases their risk for worsening dry eyes after their LASIK surgery.

Similarly, Dr. Melendez will use the ScoutPro for his lens-based refractive surgery patients, including his implantable collamer lens, refractive lens exchange and cataract patients.

“These are patients who want an amazing refractive outcome. As surgeons, we all know that the single most important area of the eye that’s responsible for refractive error is the tear film. When that’s abnormal, that affects the entire visual system,” says Dr. Melendez. “You might perform a perfect cataract surgery with an accurate power lens, but if that tear film is abnormal, you’re not going to get an amazing outcome.”

On the same note, Dr. White uses the ScoutPro to test tear film osmolarity for every laser refractive candidate and for all dry eye patients. And he’ll also use the device for cataract patients, especially if he is going to implant any type of upgraded IOL, such as a toric implant or presbyopia-correcting IOL, so that it can be treated preoperatively, Dr. White explains.

“All of our surgical candidates are tested with tear osmolarity preoperatively to make sure that we’re not missing it. We don’t necessarily test them postoperatively unless we’re actively treating them. But in the dry eye population, they’re getting tested pretty much every time they come in,” says Dr. White.

GOOD SCIENCE, GOOD BUSINESS

One potential objection to testing tear film osmolarity involves hindering practice efficiency. But “the physical instrument itself removes some structural procedural barriers from practices that are high volume and super efficient from adopting tear osmolarity. I think Trukera has seen the barrier and has made what looks to me to be a very wise and purposeful change in the physical characteristics of their instrument,” says Dr. White.

The osmolarity testing itself, he notes, basically works much as it did since the early 2000s.

“But the vehicle that you’re using for that test is much more efficient,” Dr. White says. “It’s much more elegant. And I think it directly addresses some of the objections that super high efficiency practices had toward osmolarity. As such, it’s not only awfully good science, but also it’s pretty good business.” OM

Disclosures: Dr. Melendez and Dr. White are consultants for Trukera.