Dry eye disease (DED) is a multi-factorial disease characterized by the loss of homeostasis of the tear film by tear film instability, hyperosmolarity, and ocular surface inflammation.1 DED is frequently encountered in every optometric practice, and today, there are a number of different diagnostic tools that can help diagnose, manage, and treat this complicated condition. Even though these diagnostic tools can provide a quicker diagnosis and treatment of DED, they are supplementary tests meant to compliment a comprehensive eye exam.
LipiScan noninvasively images the meibomian glands in 10 seconds using an infrared light. Eyecare professionals rely on Meibography as a critical tool to help diagnose, treat, and manage meibomian gland dysfunction (MGD) (Figure 1).
LipiScan can help establish a patient’s level of gland degeneration and atrophy and help clinicians determine whether conservative treatments such as lipid-based artificial tears and warm compresses will be sufficient enough for improving dry eye symptoms or if the MGD has progressed to an advanced stage where alternative treatments such as radiofrequency, Lipiflow, or IPL are likely needed.2
In Figure 1, Pult’s ‘meiboscale’ describes a five-grade scale with meibography images to further assist in the diagnosis in the MGD grading process. Upper and lower lids are assigned a grade from 0-4, with higher grades indicating higher gland atrophy and degneration.2
Meibomian Gland Evaluator™
The Meibomian Gland Evaluator is a hand-held instrument that noninvasively evaluates patients meibomian gland expressions and over all gland function. The instrument provides a quick and efficient method for applying a consistent, gentle pressure to the lower eyelid while assessing the meibomian gland expressions through a slit lamp.3
The Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire was designed to quickly and efficiently screen patients for the severity of dry eye disease over time. The questionnaire is a summed up score from 0-28 where the results are tallied from eight items that assess the frequency and severity of dry eye symptoms, this includes assessing dryness/ grittiness/scratchiness, soreness/irritation, burning/watering, and eye fatigue. The average score for mild dry eye is 5.0, moderate dry eye 6.6, and 10.0 for severe disease.4
InflammaDry is a disposable, low-cost test that can be quickly administered and interpreted. It specifically tests the tears for matrix metalloproteinase-9 (MMP-9), an enzyme involved in promoting inflammatory pathways, and accurately identifies elevated MMP-9 levels in tear samples taken from the palpebral conjunctiva in the lower lids. Elevated MMP-9 levels have been shown to significantly correlate with decreased visual acuity, decreased fluorescein tear breakup time (TBUT), corneal and conjunctival fluorescein staining, and abnormal superficial corneal epithelia.5
InflammaDry has also been shown to provide highly accurate results that gives 85% sensitivity and 94% specificity.5
In order to administer the test, a tear sample must be collected, where it is then activated with a buffer solution for 10 minutes. The test uses 40 µg/ml of MMP-9 as a cutoff point meaning results below this value will show a single blue line, indicating a negative non-inflammatory result, and results above this value will show a blue line and a red line, indicating a positive pro-inflammatory result.5
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Tear osmolarity assesses the severity of ocular surface inflammation. An increase in tear osmolarity can reduce tear film homeostasis and stability due to inflammation and cell apoptosis. The TearLab Osmolarity Test Card and the TearLab Osmolarity System provides a quick method for measuring tear osmolarity using nanoliter volumes of tear fluid collected from the eyelid margin.
The Test Card is held in place by the Osmolarity Test Pen for accurate and safe collection, then the TearLab Osmolarity System calculates the overall tear osmolarity by displaying a numerical value. A reading of >300 mOsm/L, or an inter-eye difference of >8 mOsm/L can indicate instability of the tear film and ocular surface inflammation.
The Tearlab Osmolarity System, as seen in Figure 2, has a positive predictive value of 89%.6