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Slit-lamp exam can help determine patient compliance with dry eye drugs
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Slit-lamp biomicroscopy can help determine whether patients are complying with their dry eye treatment regimens, according to a study.
Renée Solomon, MD, and colleagues used slit-lamp biomicroscopy to evaluate oil-emulsion formulations of two dry eye agents in patients being treated for the disorder. The researchers noted that no previous report “describes the physical findings in the precorneal tear film of patients under slit-lamp biomicroscopy exam.”
Their report describes how to find micellar aggregates or “oil-slick appearance” in patients using topical cyclosporine A ophthalmic emulsion or glycerin 1%-polysorbate 80 1%. Both agents are delivered in an oil-emulsion formulation.
To see the micellar aggregates, the slit-lamp beam is focused on the patient’s precorneal tear film. The researchers suggest the beam should be slightly thicker than an optical section. The eye is stained with fluorescein, and a blue cobalt filter with a light beam of maximum intensity is used under high magnification. When the slit-lamp is moved toward the examiner, the white micellar aggregates or oil layer resting on the tear-film surface should be visible.
“The microscopic micelles in the emulsion change over time and break apart as they are destabilized, which occurs when the emulsion is diluted by tears and the viscosity of the drops,” the researchers said.
The noninvasive technique for examining the tear film of dry eye patients using topical emulsions can help verify compliance, the study authors said.
“We estimate that the micellar aggregates are visible for hours,” they said.
The technique can help ophthalmologists determine whether an increase or decrease in dosing is required.
The study is published in the Journal of Cataract and Refractive Surgery.