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Symptoms alone inadequate for dry eye diagnosis, speaker says

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BOSTON — Symptoms alone are insufficient for an accurate diagnosis of dry eye disease, a speaker told colleagues at the American Society of Cataract and Refractive Surgery annual meeting here.

“Dry eye disease is present in about half the population. It’s at least as common in the refractive and cataract populations as well,” Marguerite B. McDonald, MD, said. “Dry eye symptoms are present in half the normal patients who do not have dry eye and in only half the patients with significant dry eye. Symptoms alone cannot be used to diagnose dry eye. Dry eye must be diagnosed and treated before surgery in order to assure excellent clinical outcomes.”

Marguerite B. McDonald

McDonald cited polls showing that there are an estimated 55 million Americans with dry eye disease and an estimated 39 million people with dry eye who may not have been diagnosed.

The Dry Eye WorkShop Report established tear hyperosmolarity as the central mechanism causing ocular surface inflammation, cell damage and symptoms in dry eye disease, McDonald said.

“Osmolarity is, by far, the test with the best positive predictive value, so it’s considered the gold standard test for dry eye with 45 years of peer-reviewed research behind it,” McDonald said.

In the Dry Eye Prevalence Study, 48% of subjects had osmolarity of 308 mOsm/L or greater and 52% had osmolarity of 308 mOsm/L or less. Half of hyperosmolar patients reported at least three symptoms of dry eye and almost half had no symptoms, McDonald said.

“Interestingly, of the normals, half of them had at least three symptoms that sounded like dry eye disease, but they had something else, so many asymptomatic patients are hyperosmolar,” she said.

In a 2013 ASCRS membership survey, 1,000 respondents said 21.1% of their cataract patients and 24.2% of laser vision correction patients presented with at least level 2 ocular surface disease, McDonald said.

Disclosure: McDonald is a consultant for Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, Focus Laboratories, Oculus, TearLab and TearScience.