APR 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/119916

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40 EW FEATURE February 2011 Dry eye/ocular surface April 2013 Up-and-coming technologies may be key for management of dry eye by Ellen Stodola EyeWorld Staff Writer AT A GLANCE • MMP-9 is often elevated in patients with dry eye. • It is important to distinguish whether or not there is inflammation occurring as a symptom of dry eye because additional treatment measures may be necessary in this case. • Problems checking for dry eye often arise depending on the format of the test; some devices and methods cause reflex tearing and others make it hard for a physician to identify the accuracy of the test. Several new devices have been developed for testing various factors of dry eye sota, Fla.) to measure matrix metalloproteinase-9 (MMP-9). Although he is not currently using any of these, Dr. de Luise said he thinks the TearLab Osmolarity System is the technology that is the farthest along. He said osmolarity is an early and foundational change that occurs in many cases of dry eye. "I think that the TearLab Osmolarity System will continue to be a go-to diagnostic device." Dr. Lemp discussed why he thinks the TearLab Osmolarity System works particularly well for managing dry eye and how it is a better test for osmolarity than others before it. The progress of the osmolarity test was stalled for some time because it required a large volume of fluid, which could be hard to collect in someone with dry eye. "It was limited to being a research tool." Dr. Lemp said that osmolarity previously required a great deal of technical expertise, so it was not practical for use in a doctor's office. He said the TearLab Osmolarity System is "a way of measuring tear osmolarity that is almost volume independent." So even patients with severe dry eye will likely have enough tears to do a measurement. "The unique thing about this technology is that now we have something where we can collect tears very easily from the marginal tear strip," Dr. Lemp said. The device gives automatic readings. "The whole thing takes about 15 to 20 seconds," he said. "The collecting part of it is instantaneous." This helps to change the game because the measurements can be done in the doctor's office. Dr. Sambursky stressed the importance of the InflammaDry device from RPS to rapidly detect inflammatory dry eye. "The InflammaDry test is a single-use disposable test that can be performed by a technician or a medical assistant," he said. Since the patient does not need to leave the exam room to be tested with an external device or wait for an electronic device to be brought into the workup room, it can easily be administered before the physician comes in to see a patient. It also offers a quick turnaround for results, taking less than 30 seconds to perform and only about 10 minutes to produce results. "It's a proven technique that's easy to use to collect a small tear sample, and in a dry eye patient, it can be difficult to collect more than a small sample," Dr. Sambursky said. "Since it's looking for an inflammatory protein produced throughout A s more attention is being paid to the quality of the ocular surface, new tests and devices for measuring and treating dry eye are emerging in the United States and around the world. Vincent de Luise, MD, assistant clinical professor of ophthalmology, Yale University School of Medicine, New Haven, Conn., weighed in on testing for dry eye as a whole, while Robert Sambursky, MD, cornea specialist, LASIK and cataract surgeon, Manatee Sarasota Eye Clinic, Bradenton, Fla.; Stephen Lane, MD, adjunct professor, University of Minnesota, and medical director, Associated Eye Care, Stillwater, Minn.; and Michael Lemp, MD, clinical professor of ophthalmology, Georgetown University and George Washington University, Washington, D.C., discussed specific devices coming into play for treatment of the condition. Different devices used for dry eye "There are several technologies to measure dry eye," Dr. de Luise said. Devices include the TearLab Osmolarity System (TearLab, San Diego) to measure osmolarity, the TearScience LipiView (TearScience, Morrisville, N.C.) to measure tear film quality and interference patterns, and the InflammaDry test (Rapid Pathogen Screening, Sara- The TearLab Osmolarity System measures the osmolarity of human tears and helps diagnose dry eye disease. Source: Michael Lemp, MD

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