Eyeworld

24 March 2018 EW NEWS & OPINION Research highlight by Maxine Lipner EyeWorld Senior Contributing Writer plained that the tear osmolarity re- sults were stratified into three scores. "A score better than 308 mOsm/L was considered mild dry eye, about 316 mOsm/L was moderate dry eye, and more than 340 mOsm/L was serious dry eye," Dr. Sharma said. Based on this, there were two patients who fell into the severe dry eye group, but all the other migraine sufferers who were found to have dry eye were in the mild to moder- ate range, Dr. Dodd noted, adding that patients were also considered to have dry eye if the differences between the two eyes was greater than 8 milliosmoles. "Based on that criteria, 48.5% of those that we studied had a diagnosis of dry eye disease," she said. "One of the other interest- ing findings of the study was the relationship between those with aura," Dr. Dodd said. The migraine sufferers who experienced seeing an aura were more likely to have dry eyes, with this occurring in 43.8% of patients compared with 5.9% of those who did not experience aura. Likewise, the frequency of the headaches appeared to play a role. "Neither the medications they used nor the subjective severity of their migraines correlated, but we did find that those who had daily headaches were more likely to have higher tear osmolarity," Dr. Dodd said Dr. Sharma pointed out that lack of sleep, as found in another study, 2 might factor in here, since this can increase hyperosmolari- ty. "It could be that it's leading to lack of sleep," he said. "If patients are having headaches, they're not sleeping, which leads to dry eye." In Dr. Sharma's experience, he has noticed that patients who mention that they're not sleeping well tend to have more dry eye symptoms, but this is anecdotal. When it comes to the tear osmolarity test, Dr. Dodd said the simplicity of the test should not be overlooked. "We were testing these patients in a neurology office, not an ophthalmologist's office, and it was a simple and easy test to use," she said. "Some of the other tests that people use may not fit as easily into this practice model." patients at the office of co-author Paul Masiowski, MD. "Melody Wong, MD, co-author, and I looked at consecutive patients who were seeing the neurologist for migraine," Dr. Dodd said. "We started in May 2015 and ended in November 2015." Patients were given two questionnaires: one related to how severe their headaches were and the other on their subjective symptoms of dry eye, known as the OSDI score. "Then we performed tear osmolarity testing," Dr. Dodd said. Afterward they looked at the charts to see if there were objective signs of the severity of headaches or other med- ical conditions or medications that might predispose patients to dry eye. Vikas Sharma, MD, assistant professor of ophthalmology, Univer- sity of Saskatchewan, Canada, ex- sensitive and specific and easy to do in the office, had not been studied in migraine, so investigators decided to take a closer look. The connection between migraine and dry eye is not well understood, but could involve corneal surface inflammation and the trigeminal nerve pathway, which innervates the cornea, Dr. Dodd pointed out. "We thought that if we found that those who had migraines were also more likely to have an objective diagnosis of dry eye—even in the absence of subjective symp- toms—we might be able to help treat their dry eye disease and in some way be able to help treat their migraines," she said. Studying migraine patients The study centered on 34 adult Considering a connection to dry eye I nvestigators recently undertook a study to explore a possible relationship between dry eye and migraine. This study, 1 pub- lished in the Canadian Journal of Ophthalmology, showed that nearly half of those with migraine had increased tear osmolarity scores, according to Mary-Magdalene Ugo Dodd, MD, co-author. "There is a body of literature that correlates migraine and dry eye disease," Dr. Dodd said, adding that previous studies have used tests including tear breakup time, Schirm- er's test, and the Ocular Surface Disease Index (OSDI). However, the tear osmolarity test, which is very Under the migraine umbrella

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