Eyeworld

63 EW CORNEA February 2016 implies increased evaporation," Dr. Pflugfelder said. "A low or absent tear volume and a high lactoferrin is ADDE. A high tear volume or normal tear volume in the setting of a high lactoferrin is likely to be EDE," Dr. de Luise said. The lactoferrin test is a reasonable choice if the clinician wants to add a diagnostic test to his or her armamentarium "because it has some ability to distinguish the 2 major types of dry eye, is commer- cially available, and has a reimburse- ment code," he said. Both lactoferrin and lyso- zyme are proteins produced by the lacrimal gland. "They're some of the most abundant proteins in the tears," Dr. Pflugfelder said. A lacri- mal gland disorder will adversely affect the protein level, but whether or not there's sufficient evidence to make this a go-to diagnostic is still debatable, he said. Future promises? The Dry Eye WorkShop (DEWS) committee is currently developing an update to its landmark 2007 guidelines, but until there are better Getting to the root of the issue "T here's a whole series of potential causes that have to be considered when we're thinking about dry eye. Unfortunately, clinical diagnoses are not always correct," Dr. de Luise said. Dr. Pflugfelder said the "traditional clinical tests and a good exam" may be enough, but he also performs anterior segment optical coherence tomography on all his potential dry eye patients, and "that can provide me with information that my clinical exam wouldn't." Performing any of these additional tests also means spending more time with the patient—and for busy practices, that may not be realistic for every patient who does not come in with a dry eye complaint. Dr. Pflugfelder sets aside a full day a week to dedicate to his dry eye patients. Dr. Latkany predicts the next few years will see a better algorithm developed to guide how to manage these patients, based on what the underlying cause of the dry eye is. EW tests, or one embraced as a new gold standard, it is unlikely there will be a new or better algorithm to diag- nose dry eye. For now, though, even without one single test being the ultimate determining factor, "when any of those tests are abnormal it suggests there's an issue that should be ad- dressed," Dr. Pflugfelder said. "Diagnosing dry eye is an evolv- ing field, and there will be improve- ments in our ability to quantify and qualify our patients," he said. "These patients are not going to go away, and you have to give them your attention. You can't just dismiss their complaints and pre- scribe artificial tears and schedule an appointment a year from now," Dr. Latkany said. "All these new tests are thoroughly welcomed because all of a sudden dry eye is the hottest topic. All of this exposure will lead to more research, progress with diagnostic testing, and better treatment for dry eyes." EW Editors' note: The physicians have no financial interests related to this article. Contact information de Luise: eyemusic73@gmail.com Latkany: rlatkany@gmail.com Pflugfelder: stevenp@bcm.edu

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