Researcher: Dry eye diagnostic options critical to personalized treatment

Dry eye disease has no specific diagnostic approach despite its high prevalence, according to a review published in the Journal of Clinical Medicine.

“Dry eye disease [DED] affects tens of millions of people and poses a clinical challenge due to differences in patient-reported symptoms and physician-observed findings,” co-author Kevin Wu, MD, a resident at Icahn School of Medicine at Mount Sinai, told Primary Care Optometry News.

“Patients often respond differently to intervention, signifying a growing need for advances in diagnosis and treatment techniques that allow for patient-specific management,” he said. “Our review seeks to not only highlight recent advances in dry eye disease diagnosis and treatment, but also note opportunities for future research endeavors to benefit patients.”

Heidari, Wu and colleagues evaluated studies that focused on the assessment of tear volume and tear osmolarity, which cause oxidative stress at the ocular surface in patients with DED.

The tear meniscus (TM) is generally evaluated by fluorescein staining, but the Oculus Keratograph 4 is capable of measuring tear-film break-up time (TBUT) noninvasively, the authors said. A study by Raj and colleagues found no significant correlation between the TM area measured by Fourier domain OCT (FD-OCT), TBUT and the Schirmer test.

Fukuda and colleagues found a significant correlation between upper TM volume, lower TM volume and lower TM height (TMH) with the Schirmer test, but not with TBUT.

Baek and colleagues found a significant correlation between TMH measured with keratography and FD-OCT, but keratography reported lower results in TMH elevation.

Rocha and colleagues deemed the Wescor Vapro 5520 Pressure Osmometer accurate and precise for measuring tear osmolarity, and Yoon and colleagues came to the same conclusions for the TearLab Osmolarity System.

Badugua and colleagues developed a novel technique for determining individual ion concentrations in tears using silicone hydrogel.

Inomata and colleagues reported that maximum blinking interval (MBI) was significantly shorter in a DED group compared to the non-DED group. There was also a positive correlation between MBI and TBUT, with a negative correlation between MBI and corneal fluorescein staining.

“We noted the use of infrared illumination to study the meibomian gland and the use of optical methods to measure lipid layer thickness at the meibomian glands,” Wu told PCON. “Although we did not elaborate on the LipiView system for imaging the meibomian glands in our manuscript, we are aware of the potentials of this technology and similar ones from Johnson & Johnson Vision for dry eye disease management.”

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Because DED results in tear lipid instability, clinicians can use meibomian gland characterization to diagnose it. Palmar and colleagues reported using OCT to visualize significant meibomian gland loss in the lower eyelids of individuals with ocular rosacea. Finis and colleagues reported that the degree of meibomian gland atrophy in the lower and upper eyelids significantly correlated with TBUT and age.

Clinicians can also diagnose DED by measuring matrix metalloproteinase 9 (MMP-9) in tears with InflammaDry (Quidel), a point-of-care MMP-9 immunoassay device. Sambursky and colleagues reported an 85% sensitivity and 94% specificity for InflammaDry DED diagnosis.

“Impression cytology combined with mass spectrometric analysis of metabolites (including those related to signaling lipids and oxidative stress) is another method that has potential to guide diagnosis and patient-specific treatment of dry eye disease,” Wu said. “[Co-author] Dr. Mashaghi’s group has just finished a study of metabolomics analysis on a small number of cells collected from ocular pemphigoid patients; a similar analysis can be done on dry eye disease patient cells.” – by Erin T. Welsh

References:

Baek J, et al. Cornea. 2015;doi:10.1097/ICO.0000000000000575.

Badugua R, et al. Anal Biochem. 2018;doi:10.1016/j.ab.2017.11.014.

Finish D, et al. Curr Eye Res. 2015;doi:10.3109/02713683.2014.971929.

Fukuda R, et al. Am J Ophthalmol. 2013;doi:10.1016/j.ajo.2012.11.009.

Inomata T, et al. Sci Rep. 2018;doi:10.1038/s41598-018-31814-7.

Palamar M, et al. Cornea. 2015;doi:10.1097/ICO.0000000000000393.

Raj A, et al. J Clin Diagn Res. 2016;doi:10.7860/JCDR/2016/18717.7722.

Rocha G, et al. Clin Ophthalmol. 2017;doi:10.2147/OPTH.S127035.

Sambursky R, et al. JAMA Ophthalmol. 2013;doi:10.1001/jamaophthalmol.2013.561.

Yoon D, et al. Curr Eye Res. 2014;doi:10.3109/02713683.2014.906623.

Disclosures: The authors report no relevant financial disclosures.