Dry eye has cemented its place in all of our practices no matter where we practice.
It’s a common yet difficult condition that many optometrists face on a daily basis. Much research has been done to produce effective treatment regimens and diagnostic tools to alleviate the symptoms that plague our patients.
This article focuses on two very easy yet effective tools that any optometrist can integrate into their daily dry eye evaluation.
The first is TearLab’s Osmolarity System which measures the individual tear osmolarity of each eye, and the second is InflammaDry which is a product of RPS that tests for an inflammatory marker in dry eye. These two products serve a vital role in the initial analysis of my patients who I suspect may be suffering from this ocular surface disease.
Here’s a 36 page guide on understanding dry eye and meibomian gland dysfunction. Learn how you can treat MGD using LipiFlow, and how to bring this technology to your practice.
Let’s first start with the medical definition of dry eye as stated by the guidelines from the 2007 International Dry Eye Workshop.
“Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.” 1
The first tool that I utilize in my clinic to objectively measure a patient’s dry eye condition is TearLab’s osmolarity system. This is a simple system that an optometrist or a technician can perform on a patient following baseline exam measurements. Both the test itself and its results are accomplished within seconds.
The system consists of a small stand and an osmolarity test pen which utilizes one-time use osmolarity test cards, and does need to be properly set up before use. Once calibrated and placed in a convenient place in your practice, the machine is easy to access and use with all your dry eye patients.
The chart below summarizes what TearLab would consider as normal, mild, moderate or severe dry eye. The use of this machine can gauge what the osmolarity of the tear film is and can direct your treatment options based on these results.
There is no single way to treat dry eye and a particular protocol may be created by your practice.
One thing to keep in mind in regards to dry eye, is that there is an inflammatory component to this ocular condition.
This becomes very important in deciding to complement baseline ocular lubricant treatments with ocular corticosteroids pulse dosing or long term cyclosporine use. The use of RPS’s InflammaDry is another simple dry eye test you can do for all your dry eye evaluations.
“InflammaDry is the first and only, rapid result, in-office test that detects elevated levels of MMP-9, an inflammatory marker that is consistently elevated in the tears of patients with dry eye disease. InflammaDry is a disposable, low cost test that requires no additional equipment to administer or interpret results. Using four simple steps, InflammaDry test results are achieved in just 10 minutes, aiding in the diagnosis of dry eye before the patient leaves the office.” 2
I find that when training support team members to use these tests in your office, it’s highly beneficial to invite a company representative to do an in-office demonstration on each other.
This encourages team members to practice on one another before patients. They further can supplement their education with the above easy to view instruction videos.
Tear Lab Osmolarity and Inflammadry have become two vital technologies I use in my clinic for my dry eye patients. They help me develop a unique and customized dry eye treatment plan for each of my patients.
Furthermore, this serves to provide optometrists objective measurements in deciding to add to baseline ocular treatment plans with prescription ocular medications, or to measure a response to a patient’s current treatment regimen.
If you are interested in incorporating these two important technologies into your practice please contact TearLab and RPS directly to put your practice in contact with one of their local representatives.