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"Why Do You Think You Have Dry Eyes?"

Friday, October 22, 2010

I was asked that question by a delightfully earnest young man in a Dry Eye Device booth at last weekend's Academy of Ophthalmology meeting in Chicago - after I told him that I had dry eyes. The implication was that I could not possibly know if I had dry eyes until I knew the results of his test.     

Listen up eye docs: if you want to keep a female patient in your practice, don't ask her that question.  It could be viewed as offensive as being asked, "Why do you think you have cramps?"

Trust me: women know when our eyes are dry, just like we know when we have cramps.

Dry Eye is a painful, life-changing, vision-changing chronic disease. I can speak for all women when I say none of us appreciate being told we don't have dry eyes based on the unreliable objective tests that most doctors use to diagnose dry eye disease.  These tests are more often than not wrong when they suggest that a slightly, or miserably uncomfortable patient does not have dry eyes: they are rarely wrong when they suggest a patient does have dry eyes.

Your patients' perception of dry eye is still far more reliable than the three standard dry eye tests used in clinical evaluation:  Schrimers, tear break-up time and corneal staining.  Unfortunately, poor correlation between clinical testing for dry eye and the symptoms patients experience is acknowledged at academic levels, while most practices continue to use these three tests and way too many practices still offer the same cookie cutter dry eye therapies in this order:  1) samples of any of the over-the-counter dry eye drops from their sample closet - even though some are much more effective than others,  2) a prescription for Restasis, 3) punctal plugs.

Lifestyle adjustment, including dietary intake, is still way down the treatment list in too many eye care practices though it's often one of the major players in the dry eye disease process.  The lifestyle changes can be as simple as drinking more water; cutting back on empty calorie junk foods; consuming nutrient dense diets that include cold water fish at least twice a week; remembering to blink more often; cutting back on computer time, and Dr. Jeff Anshel's 20/20/20 rule: look up from your monitor every 20 minutes and focus on an object 20 feet away for 20 seconds to rest and lubricate your eyes. And, taking carefully designed multiple nutrient supplements that address the biochemistry of all three layers of the tear film.  

At this point there is still no one test for dry eye disease that provides as much reliable information as the 12-question scientifically validated Ocular Surface Disease Index (OSDI).  It's a wonderful cost effective way for dry eye patients to document their symptoms, both for the benefit of their eye care professionals and to satisfy their own curiosity, particularly about how their dry eyes are responding to different treatment regimens.  We recommend that you download this OSDI link for individual and patient use since there is no one test, and there is no one treatment right for all forms of dry eye disease.

Addressing the inflammatory component with prescription drops is still in vogue even though ocular surface inflammation is only one of the causes of dry eye (this information may be sad news to all of the venture capital groups who invested in companies chasing new drugs to compete with Restasis, which treats the inflammatory component of dry eye).   

A dry eye quality of life (QOL) study published in the Japan Journal of Ophthalmology in July of this year concluded that it's necessary to address subjective symptoms and QOL scores in addition to clinical  findings when evaluating dry eye.

When women (and men) tell  their doctors they have dry eyes, doctors need to take their word for it, even if some of their clinical tests suggest they don't have dry eyes.  

Jobson, the ophthalmic research group, reports that misdiagnosed and untreated dry eye  is the primary reason patients change eye doctors.

Ellen Troyer, MT MA
Biosyntrx CEO / Chief Research Officer


The folks from Tear Lab  are now selling  a promising osmolarity testing device. I'm told  that the Tear Lab pipeline may also include Immunoglobulin E ( IgE) tests for the allergic dry eye, and Immunoglobulin A (IgA) testing for mucosal immunity and the inflammatory dry eye. 

Touch Scientific in Raleigh, NC has objective dry eye tests available that can be used to measure vitally important tear film proteins. 

The bottom line: Improved tests for better understanding of the multifactorial causes of dry eye disease will lead to improved therapies.   Patient compliance and healthy lifestyle choices will still be required for positive outcomes.

Crestpoint Management, LTD instrument announcement:
Daya Endostar Set DK7650


Tong L, Waduthantri S, et al. Impact of symptomatic dry eye on vision-related daily activities: The Singapore Malay eye Study. Eye, May 21, 2010 [PubMed]

Reliability and validity of the Ocular Surface Disease Index. Schiffman RM, et al. Arch Ophthalmol. 2000:118:615-621. [abstract]

Ocular surface disease index for the diagnosis of dry eye syndrome. Ozcura F, Aydin S, Helvaci MR. Ocul Immunol Inflamm. 2007 Sep-Cot, 15(5): 389-93 [abstract]

Performance of tear osmolarity compared to previous diagnostic tests for dry eye diseases. Versura P. Profazio V, Campos EC. Curr Eye Res. 2010 Jul, 35(7):553-64 [abstract]

The Tear Lab folks can be reached at this web site

Touch Scientific can be reached at 919-872-4445 (their new web site will open soon).