EyeWorld India March 2017 Issue

59 EWAP DEVICES March 2017 generation of people from getting to that moderate to severe stage by diagnosing them earlier, that’s a win for everyone.” She recommends making treatment decisions based on more than one single test, and often a combination of tests can lead to a diagnosis. For instance, if the patient has normal osmolarity but high symptoms and elevated MMP-9 levels, the patient may have an inflammatory condition—like superior limbic keratoconjunctivitis, or recurrent erosions due to map-dot fingerprint—that may masquerade as dry eye. Dr. Farid stressed clinicians must take the whole patient into consideration when developing treatment strategies. “Testing should supplement the exam,” she said, but clinicians should continue to treat the symptoms. Using older diagnostic tools Newer tests don’t necessarily mean throwing out the older ones. Staining is “still very valuable,” Dr. Starr said, as is tear break-up time (TBUT). If the patient has fluorescein staining on the ocular surface, “it’s already a late-stage finding,” Dr. Farid said. Dr. Gupta also “routinely” measures TBUT and uses corneal fluorescein staining because “patients tolerate it well and it’s inexpensive.” She’ll also use lissamine green, but only for select cases where she’s looking for specific evidence of inflammatory conditions. Schirmer’s, on the other hand, is more error-prone. “Schirmer’s doesn’t give you a whole lot of strong evidence,” Dr. Farid said. “Reflex tearing can affect the result,” as can meibomian gland dysfunction. Rose bengal is still useful in cases of herpetic eye disease, she said. With optical coherence tomography and keratography that can noninvasively measure the tear meniscus height, area, and volume, and other tests to differentiate between aqueous deficient and evaporative dry eye, Dr. Starr said tests like Schirmer’s are becoming obsolete. In those patients with suspected aqueous deficiency DED, we should have a very low threshold for ruling out Sjogren’s syndrome in both men and women, he added. “What’s more important is if I do a test, I want to see how it’s going to change my management,” Dr. Gupta said. “There are very few times that Schirmer’s changes my management.” EWAP Editors’ note: Dr. Farid has financial interests with Abbott Medical Optics (Abbott Park, Illinois), Allergan (Dublin, Ireland), Rapid Pathogen Screening, and Shire (Lexington, Massachusetts). Dr. Gupta has financial interests with Rapid Pathogen Screening, TearLab, and TearScience. Dr. Starr has financial OCULUS Keratograph 5M with JENVIS Dry Eye Report: See all relevant dry eye information at a glance! The JENVIS Dry Eye Report is a unique feature of the OCULUS Keratograph 5M that summarizes all data from your dry eye workup and offers an easy-to-grasp printout for your patient. Optimize your dry eye diagnosis: combine screening and patient education with the OCULUS JENVIS Dry Eye Report! For more information visit www.dryeyemasterpiece.de OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 • Fax +852 2987 1090 www.oculus.de • info@oculus.hk A Masterpiece of Dry Eye Diagnostics Visit OCULUS at APACRS, Hangzhou interests with Allergan, Bausch + Lomb, Rapid Pathogen Screening, Shire, Sun Pharma (Mumbai, India), and TearLab. Contact information Farid : mfarid@uci.edu Gupta : preeya.gupta@duke.edu Starr : cestarr@med.cornell.edu