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PUBLICATION EXCLUSIVE: The state of dry eye care, part 1
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Back in the Dark Ages, you know, like 1999 or so, dry eye disease was considered the crabgrass that grows on the lawn of eye care. Ophthalmology especially.
My tiny tribe of DED pilgrims were looked upon with pity, if we were looked upon at all. Perfectly good dry eye medications were ignored and/or abandoned, even if they had an on-label indication to treat an established dry eye sign or symptom — ahem, Lotemax (loteprednol etabonate, Bausch + Lomb). The near universal opinion in the eye care community was that there was nothing you could really do to treat DED. Why bother even testing for it when the state-of-the-art diagnostic test was just a gussied-up piece of coffee filter someone named Schirmer filched from the staff kitchen?
How times have changed.
You can tell when a medical disease has hit the big time when there is competition in every part of the marketplace. An especially “hot” segment will also have at least a junior varsity controversy about the accuracy and usefulness of diagnostic tests and a vigorous debate about both the effectiveness and benefit of treatment. We have an abundance of all of that right now in DED. This month, in part 1 of a series, I cover diagnostic testing for DED. Part 2 will cover what is available for treatment.
Let us keep things simple. There are three types of tests available to evaluate DED: tear osmolarity, inflammatory activity and meibomian gland imaging. You can surely come up with other measurements, even some that have an instrument you can buy that will give you some sort of result, but I am declaring that you need only these three.
Tear osmolarity
Measuring tear osmolarity (TO) is now an established part of DED best practices. Period. It is an essential part of both the initial diagnostic process and monitoring the progress of your treatment. Essentially all of the original instruments used to test osmolarity have been relegated to the junk heap of history, and TearLab now has the space to itself. The business model is simple, and anyone who owns a cell phone or uses a traditional razor to shave understands it: The base unit is “free,” and the price of your “lab on a chip” depends on how many you use. Performing the test is simple and fast (less than 30 seconds), and how many units you put in your clinic can be titrated by your flow protocols and your volume.
- Click here to read the full publication exclusive, The Dry Eye, published in Ocular Surgery News U.S. Edition, June 25, 2017.