PURPOSE: To evaluate the use of tear osmolarity in the diagnosis of dry eye disease. DESIGN: A prospective, observational case series to determine the clinical usefulness of tear osmolarity and commonly used objective tests to diagnose dry eye disease. METHODS: A multicenter, 10-site study consisting of 314 consecutive subjects between 18 and 82 years of age. Bilateral tear osmolarity, tear film break-up time (TBUT), corneal staining, conjunctival staining, Schirmer test, and meibomian gland grading were performed. Diagnostic performance was measured against a composite index of objective measurements that classified subjects as having normal, mild or moderate, or severe dry eye. The main outcome measures were sensitivity, specificity, area under the receiver operating characteristic curve, and intereye variability. RESULTS: Of the 6 tests, tear osmolarity was found to have superior diagnostic performance. The most sensitive threshold between normal and mild or moderate subjects was found to be 308 mOsms/L, whereas the most specific was found at 315 mOsms/L. At a cutoff of 312 mOsms/L, tear hyperosmolarity exhibited 73% sensitivity and 92% specificity. By contrast, the other common tests exhibited either poor sensitivity (corneal staining, 54%; conjunctival staining, 60%; meibomian gland grading, 61%) or poor specificity (tear film break-up time, 45%; Schirmer test, 51%). Tear osmolarity also had the highest area under the receiver operating characteristic curve (0.89). Intereye differences in osmolarity were found to correlate with increasing disease severity (r(2) = 0.32). CONCLUSIONS: Tear osmolarity is the best single metric both to diagnose and classify dry eye disease. Intereye variability is a characteristic of dry eye not seen in normal subjects.
PURPOSE: To evaluate the use of tear osmolarity in the diagnosis of dry eye disease. DESIGN: A prospective, observational case series to determine the clinical usefulness of tear osmolarity and commonly used objective tests to diagnose dry eye disease. METHODS: A multicenter, 10-site study consisting of 314 consecutive subjects between 18 and 82 years of age. Bilateral tear osmolarity, tear film break-up time (TBUT), corneal staining, conjunctival staining, Schirmer test, and meibomian gland grading were performed. Diagnostic performance was measured against a composite index of objective measurements that classified subjects as having normal, mild or moderate, or severe dry eye. The main outcome measures were sensitivity, specificity, area under the receiver operating characteristic curve, and intereye variability. RESULTS: Of the 6 tests, tear osmolarity was found to have superior diagnostic performance. The most sensitive threshold between normal and mild or moderate subjects was found to be 308 mOsms/L, whereas the most specific was found at 315 mOsms/L. At a cutoff of 312 mOsms/L, tear hyperosmolarity exhibited 73% sensitivity and 92% specificity. By contrast, the other common tests exhibited either poor sensitivity (corneal staining, 54%; conjunctival staining, 60%; meibomian gland grading, 61%) or poor specificity (tear film break-up time, 45%; Schirmer test, 51%). Tear osmolarity also had the highest area under the receiver operating characteristic curve (0.89). Intereye differences in osmolarity were found to correlate with increasing disease severity (r(2) = 0.32). CONCLUSIONS: Tear osmolarity is the best single metric both to diagnose and classify dry eye disease. Intereye variability is a characteristic of dry eye not seen in normal subjects.
Authors: Gemma Caterina Maria Rossi; Luigia Scudeller; Federica Bettio; Gian Maria Pasinetti; Paolo Emilio Bianchi Journal: Int Ophthalmol Date: 2018-06-07 Impact factor: 2.031
Authors: Corey T Ungaro; Adam J Reimel; Ryan P Nuccio; Kelly A Barnes; Matthew D Pahnke; Lindsay B Baker Journal: Eur J Appl Physiol Date: 2015-01-10 Impact factor: 3.078
Authors: Mark D P Willcox; Pablo Argüeso; Georgi A Georgiev; Juha M Holopainen; Gordon W Laurie; Tom J Millar; Eric B Papas; Jannick P Rolland; Tannin A Schmidt; Ulrike Stahl; Tatiana Suarez; Lakshman N Subbaraman; Omür Ö Uçakhan; Lyndon Jones Journal: Ocul Surf Date: 2017-07-20 Impact factor: 5.033
Authors: Mark S Milner; Kenneth A Beckman; Jodi I Luchs; Quentin B Allen; Richard M Awdeh; John Berdahl; Thomas S Boland; Carlos Buznego; Joseph P Gira; Damien F Goldberg; David Goldman; Raj K Goyal; Mitchell A Jackson; James Katz; Terry Kim; Parag A Majmudar; Ranjan P Malhotra; Marguerite B McDonald; Rajesh K Rajpal; Tal Raviv; Sheri Rowen; Neda Shamie; Jonathan D Solomon; Karl Stonecipher; Shachar Tauber; William Trattler; Keith A Walter; George O Waring; Robert J Weinstock; William F Wiley; Elizabeth Yeu Journal: Curr Opin Ophthalmol Date: 2017-01 Impact factor: 3.761
Authors: Anat Galor; William Feuer; David J Lee; Hermes Florez; Vincent D Venincasa; Victor L Perez Journal: Invest Ophthalmol Vis Sci Date: 2013-02-19 Impact factor: 4.799