Eyeworld

Supported by unrestricted educational grants from Allergan, Shire Pharmaceuticals, TearLab, and TearScience It also will help ophthalmol- ogists assess new technologies as they consider which OSD testing devices to add to their armamen- tarium. The algorithm will guide cli- nicians in using tests logically and efficiently. For example, based on test results, the ophthalmologist will not waste resources by pre- scribing an antibiotic when the diagnosis is dry eye. He or she will reach an accurate diagnosis much faster and develop an appropriate treatment strategy. The algorithm will help clinicians interpret test results. For example, they will know what constitutes a negative or posi- tive result or a false-positive or false-negative result. In addition, it will help them understand the diagnostic value of conflicting results. As new technologies and treatments emerge, we look to this algorithm to help clinicians streamline the process of diagnos- ing and managing OSD. Dr. Mah is director of the cornea ser- vice and co-director of the refractive surgery service, Scripps Clinic, La Jol- la, California. He can be contacted at Mah.Francis@Scrippshealth.org. by Francis Mah, MD Potential impact of new algorithm on OSD management technologies, and it will recom- mend how to implement these devices when diagnosing and managing dry eye. However, clini- cians using the algorithm will not need to purchase all of these tests. The algorithm will help them determine how to use the tests they currently have to diagnose and manage dry eye. mimic OSD, such as bacterial or viral conjunctivitis. Many papers have been published on dry eye, but this will be a user-friendly guide that clinicians can refer to in the oph- thalmology or optometric eyecare lane for every patient. When developing this tool, the committee considered all commercially available diagnostic ASCRS to release new OSD management tool in upcoming months R esponses from the ASCRS Clinical Survey indicate that clinicians may be puzzled by the number of diagnostic technologies available to detect ocular surface disease (OSD), as well as how to use them to their greatest advantage in OSD man- agement. When asked about an algo- rithm for OSD diagnostics, 35% of members responded that such a tool would be valuable (Figure 1). After years of work, Christo- pher Starr, MD, and the ASCRS Cornea Clinical Committee will soon release and publish an algo- rithm that will guide practitioners in OSD management. The two- part tool covers OSD dry eye and other conditions that cause or Francis Mah, MD Figure 1. The 2016 ASCRS Clinical Survey asked, "Would an algorithm for ocular surface diagnostics be valuable to you?" 35% responded, "Yes, I would incorporate for all patients." Traditional fluorescein tear breakup time is highly variable and poorly reproducible, but tear breakup time is rapid, objective, and noninvasive, requiring no drops. Optical coherence tomog- raphy is noninvasive and does not disrupt the tear film or ocular surface. It is objective and quick, allowing clinicians to measure the tear meniscus height, area, and volume. Case report A 48-year-old man had a history of intermittent foreign body sensation, fluctuating vision, dry- ness, redness, and mild itchiness. Another physician diagnosed dry eye. Artificial tears did not reduce his symptoms. He had 1+ conjunctival injection, mild inferior punctate epithelial erosions, and a normal tear breakup time. Osmolarity was 295 and 293 mOsms/L, indicating it most likely was not dry eye. The patient had positive MMP-9 results, indicating inflam- mation, and allergic conjuncti- vitis was diagnosed. Tear IgE and allergen skin testing also would be useful, as well as adenovirus testing if infection was suspected. Conclusion These objective diagnostics are easy to incorporate into our practice and will help us diagnose most cases of complex OSD accu- rately and efficiently. References 1. O'Brien TP, et al. Acute conjunctivitis: truth and misconceptions. Curr Med Res Opin. 2009;25:1953–61. 2. The Clinical Laboratory Improvement Amendments (CLIA) establish quality standards for laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed. A waiver signifies that the test has been classified as a low complexity device, which allows medical office personnel of CLIA-waived offices (not only physicians) to perform it. State laws vary with regard to who may perform CLIA-waived testing. 3. Leibowitz HW, et al. Human con- junctivitis. Diagnostic evaluation. Arch Ophthamol.1976;94:1747–9. Dr. Starr is associate professor of ophthalmology, director of the refrac- tive surgery service, and director of the cornea, cataract, and refractive surgery fellowship, Weill Cornell Medicine, New York-Presbyterian Hospital, New York. He can be contacted at drstarr@gmail.com. continued from page 4 7

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