Glare Testing Defined

Cataracts are known to cause reduced vision and disabling glare. This is particularly significant for older patients driving an automobile at night. There is no accurate screening method currently available to measure vision in the presence of glare from headlights, streetlights and other bright sources of light in an otherwise dark environment. Lack of adequate documentation of this visual impairment in patients with cataracts may result in denial for coverage of cataract surgery from Medicare and other insurance companies. It is known that failure to treat patients with visually significant cataracts who may have difficulty driving at night increases the safety risk for themselves and others on the road. 

It is well documented that cataracts patients have a lot of issues with glare specially at night. A cataract is a clouding of the normally clear lens in the eye. Many times it’s like looking through a foggy window. Patients with cataracts have difficulty reading or driving especially at night due to disabling glare and halos. The cloudy lens causes the incoming light to scatter rather than follow the usual path to retina in the back of the eye. This is particularly significant for older patients driving at night which can easily become a disability and has been a top complaint from my patients.

I felt there was a need for a device that accurately mimics, and documents real life glare conditions in cataracts patients. This was around the time that Mentor stopped making the BAT Brightness Acuity Tester.

In 2003 I came up a prototype that looked like an “ice cream scoop” to measure the glare that my patients were experiencing at night, and was awarded my first U.S. patent. The Idea and the prototype was literally placed in a drawer for a few years until I was contacted by OhioHealth Research Institute and TechColumbus in 2008 to present the idea to a technology incubator group. After presenting the idea to the incubator group, I was awarded a $50,000 TechGenesis grant to bring the idea to market. I subsequently received the TechColumbus 2008 Innovation Award of “Outstanding Woman in Technology”.

The commercialization pathway was started. After completing the marketing studies, I worked with teams of engineers and optimized the design. In the process another 3 patents were filed and awarded bringing the total patents to four.

Device validation was completed with a successful multicenter study with 89 patients (40 patients with cataracts and 49 without) and the results were published in JRS in 2015. The evaluation concluded that the EpiGlare® demonstrated the adverse effect on visual acuity due to glare in patients with cataracts and accurately simulated night driving glare issues for patients with cataracts. (https://www.ncbi.nlm.nih.gov/pubmed/25751837) PMID: 25751837 DOI: 10.3928/1081597X-20150225-03

The EpiGlare® Tester is a patented attachment for a manual refractor and can be customized for different brands, allowing for documentation of the amount of visual disability resulting from glare experienced by patients with mild to moderate cataracts. The product is particularly useful in detecting visual impairment in night time conditions. The patient would read the standard Snellen chart while a virtual image of a headlight would be illuminated through the eye piece. Glare would be tested by the line acuity of the Snellen chart - a standard operating procedure in an eye care doctors’ offices.  Up until now, there has not been any reliable methods to test for glare from oncoming headlights in patients with cataracts. Surgeons and other eye care providers may use a pen light to shine in the patient’s eye as they ask the patient to read the standard Snellen chart. This test is very subjective as the intensity and the angle of light to the eye is not constant and results vary from provider to provider.

The EpiGlare® device is designed around a patented array of LEDs that simulates nighttime headlight glare, a key complaint of cataract patients. The multi-center study using the EpiGlare® showed corrected distance visual acuity (CDVA) was reduced for patients with cataracts while minimally affecting those without cataracts. Cataract patients stated the device accurately reflected the difficulty they experienced driving at night. Nighttime glare testing technology offered by the EpiGlare® line of products will integrate into virtually any practice.

Many of my colleagues use EpiGlare in their practices and I am happy that I was able to finally bring this device to market and help measure and document the disability that cataract patients experience at nighttime.

It was a long learning process for me. Innovation in medicine often emphasizes disruption and creativity. Many physicians and caregivers are dedicated to patient care and manage high volume clinical conditions that need to be maximally leveraged.

Medical inventions and technologies are saving millions of lives around the world, preventing the spread of disease, allowing for more accurate diagnosis, and enabling better patient care. We as physicians are on the front line of patient care and often see how advances in health and medicine have touched the lives of nearly every person on the planet.

Many physicians see how technologies can be improved and some are hesitant to get involved in the innovation process because they are not unfamiliar with the process. The one point I want to stress is that there are rational, tested ways of approaching Innovation, product design and development. In fact, there are even books that can serve as a helpful starting point for interested clinicians to understand this process. Get involved - our lives will be better for it.

For more information please contact Dr Alice Epitropoulos at EyesMD33@gmail.com or John Lakey at JLakey@eyecareandcure.com of Eye Care & Cure. Thank You.