When my colleagues and I decided to expand our range of point-of-care testing and treatment for dry eye, the primary goals were to reduce dry eye discomfort after cataract and refractive surgery and to offer non-surgical patients the relief from dry eye that they have sought for years.
We developed a dry eye centre of excellence, where we routinely screen for dry eye disease according to a standard protocol, and then treat the ocular surface based on individualised plans.
To address both aqueous deficient and evaporative types of the disease, we acquired a range of tests to objectively evaluate the tear film and meibomian glands.
A test intended to measure the osmolarity of human tears (TearLab Osmolarity System, TearLab) tells us the concentration of salts in the tear film. Hyperosmolarity indicates that the film’s aqueous component is reduced, either by evaporation or decreased production, and the patient likely has dry eye.
Another test (TearScope Plus, Keeler) helps us to visualise the tear film, while an infrared camera/meibographer allows us to see and evaluate the meibomian glands.
Because inflammation is part of the dry eye disease process, we use a test (InflammaDry, Quidel) to detect the presence of the inflammatory marker MMP-9. Finally, a tear ferning test shows us whether the tears have a normal or abnormal crystallisation pattern.
These point-of-care tests give concrete, reproducible results that we can share with patients to explain their diagnoses and to monitor the results of treatment over time.
As physicians who have watched the diagnosis of dry eye disease evolve over the years from ambiguous to concrete, objective testing is a welcome addition. From the patient’s perspective, numbers always have a greater, more immediate impact than the subjective opinion of even the most experienced physician.