EyeWorld Asia-Pacific June 2014 Issue

58 EWAP DEVICES June 2014 InflammaDry (RPS, Sarasota, Fla., U.S.) identifies patients with elevated levels of matrix metalloproteinase-9, an inflammatory marker for dry eye, in a binary fashion. “Dry eye doesn’t fit a yes or no picture,” Dr. Galor said. “If someone has symptoms but comes back as ‘no,’ it’s not clear how to use the information—do you now tell the patient they don’t have dry eye? Or if the number comes back as ‘yes,’ but there are no symptoms, how should you counsel the patient? It’s not clear to me how to use a yes/no test.” If clinicians are unwilling to change how they manage patients based on test results, “then how good is the test?” Dr. Galor asked. Biomarkers are an important aspect in the management of dry eye, she said, but “there’s no way at this point to measure them in a way to be as clinically selective as we need.” Dilemmas remain An issue that has confounded clinicians and industry alike is that numerous patients have severe symptoms and no clinical signs of dry eye, or vice versa—clinical signs abound, but the patient has no complaints or is asymptomatic. “I’m a tech person and I like new technology, but the biggest issue of using some of the newer tests is, can we use it on everyone?” Dr. Davidson said. “I do think for patients who have severe symptoms, it could be a way to track them.” People with obvious moderate or severe dry eye will be expected to have osmolarity numbers in the higher ranges with more fluctuation within the ranges and a likely ‘yes’ for inflammatory markers, but when a patient presents with milder symptoms and osmolarity in tighter, normal ranges, Dr. Galor questions how aggressive her treatment would be based on “just a number.” “One of our obstacles is that we have limited therapeutics to treat these patients,” she said. “When you don’t have many options, it doesn’t really matter what the results are because there’s only so much we can do for our patients.” Correlating symptoms to signs What the newer tests can provide, however, is a means to track treatment efficacy in certain patients, Dr. Davidson said. “I’m not convinced we can correlate it with symptoms. Tracking tear osmolarity in one person does not mean we will be able to predict how symptomatic the person is based on the increase or decrease in the number. Technology makes our world better and I hope in the near future some of this new technology pertaining to dry eye will make its way into mainstream practice.” Dr. Galor said the tests help to make the argument that a patient has a specific type of dry eye and that may help clinicians develop a different type of treatment regimen. “If patients come in and they’re miserable on their current treatments, then it’s clear they need to be on something else,” she said. “At this point, these tests may be more helpful when we have some other agents to ‘treat’ dry eye with a different mechanism of action than what’s currently in our armamentarium.” Dr. Davidson would also like more targeted treatments. “I’d like to see us get to the point where we have certain biomarkers that we can measure and we can then predict and prognosticate based on those biomarkers,” he said. “That way we can show patients how they’ve improved over the previous year.” Both physicians agreed that treating dry eye is still an individualized process. The newer diagnostic tools are useful in quantifying some aspects of dry eye, but how useful they will be in everyday clinical practice remains to be seen. EWAP Editors’ note: The physicians have no financial interests related to this article. Contact information Davidson: +1-720-848-2500, Richard.Davidson@ucdenver.edu Galor: +1-305-575-7000, AGalor@med.miami.edu Newer - from page 56 New OCULUS Keratograph 5M Topography and advanced external imaging for dry eye assessment OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 • Fax +852 2987 1090 www.oculus.de • info@oculus.hk • High-resolution colour camera • Imaging of the upper and lower meibomian glands • Non-invasive tear film break up time and tear meniscus height measurements • Assessment of the lipid layer and tear film particles • Grading of the bulbar redness • Image and video documentation