This article is more than 5 years old. Information may no longer be current.
In Asia, clinical signs and symptoms as important as point-of-care tests
Click Here to Manage Email Alerts
Patients often present with an itchy, burning eye in an ophthalmologist’s office. There are a multitude of causes that can result in such symptomatology, and diagnosing the appropriate causes can be challenging. This is because a multitude of conditions affecting the ocular surface can result in similar or overlapping complaints, and it is well known that there is a significant disconnect between signs and symptoms in these disorders. Clinicians therefore have to evolve their approach to such patients, and an algorithmic approach may help determine the problem. Various clinical tests that can be performed in the office exist, but they often lack specificity, sensitivity and repeatability. The cover story in this issue describes various point-of-care tests that are intended to address these limitations of existing office tests, and they are a welcome addition to the armamentarium of ophthalmologists who deal with ocular surface disease.
The TearLab osmolarity test (TearLab) has been in use for some time now and offers a qualitative assessment of the increase in tear film osmolarity, which is an indicator of dry eye disease. A recent article that assessed the role of various dry eye tests to detect dry eye disease, including TearLab, concluded that the best combination was afforded by the Ocular Surface Disease Index, tear break-up time and Schirmer’s test. However, TearLab should help differentiate dry eye disease from other causes of a red eye when such patients present in the clinic. Similarly, until recently, the only clinical tool for assessing the presence of surface inflammation was redness of the ocular surface, which was not specific or quantitative. The InflammaDry test (Rapid Pathogen Screening) that detects the presence of MMP-9 as a measure of inflammation of the ocular surface is a welcome addition to the tests currently available. However, whether MMP-9 activity is elevated in all conditions that cause inflammation remains to be evaluated.
There has been an increasing interest in meibomian gland activity and its role in ocular surface disease. The LipiView ocular surface interferometer (TearScience) offers the ability to study interference patterns in the tear film and measure the lipid layer, and the Meibomian Gland Evaluator (TearScience) assesses gland obstruction. A recently described in-office method allows assessment of interference patterns, although it does not support quantitative measurements. Similarly, many devices commonly in use in the office, including the autorefractor can be used to obtain clinical photographs of the meibomian glands, and this can serve as a semi-quantitative assessment, with potential for serial follow-up of the condition.
Similarly, while the potential to diagnose conditions such as Sjögren’s syndrome, adenovirus, allergies and select corneal dystrophies in the office is an exciting development, it may be important to view these changes in the proper context. This is especially true in the Asian context, where insurance is often not available for outpatient treatment. In this scenario, while it is important to be aware of new developments, attention to clinical signs and symptoms and using existing tests appropriately may still hold the key to cost-effective diagnosis and management of ocular surface disease, at least for the present.
References:
Alves M, et al. PLoS One. 2014;doi:10.1371/journal.pone.0097921.
Hwang HS, et al. Cornea. 2014;doi:10.1097/ICO.0000000000000161.
Nichols KK, et al. Cornea. 2004;23(8):762-770.
Rao SK, et al. Compr Ophthalmol Update. 2006;7(4):157-167.
Srinivasan S, et al. Optom Vis Sci. 2012;doi:10.1097/OPX.0b013e318253de93.
For more information:
Dennis S.C. Lam, MD, FRCOphth, can be reached at State Key Laboratory in Ophthalmology, Sun Yat-Yen University, 54 South Xianlie Road, Guangzhou 510060, People’s Republic of China; +852-3997-3266; email: dennislam.gm@gmail.com.
Disclosure: Rao and Lam have no relevant financial disclosures.