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. 2014 Jan;157(1):69-77.e2.
doi: 10.1016/j.ajo.2013.07.019. Epub 2013 Sep 21.

What is the value of incorporating tear osmolarity measurement in assessing patient response to therapy in dry eye disease?

Francisco Amparo  1 , Yiping Jin  1 , Pedram Hamrah  1 , Debra A Schaumberg  2 , Reza Dana  3
Affiliations

What is the value of incorporating tear osmolarity measurement in assessing patient response to therapy in dry eye disease?

Francisco Amparo et al. Am J Ophthalmol. 2014 Jan.

Abstract

Purpose: To evaluate the correlation between changes in tear osmolarity, symptoms, and corneal fluorescein staining in patients with dry eye disease (DED).

Design: Retrospective, clinic-based cohort study.

Methods: In this single-institution study, we reviewed the charts of 186 patients with DED from whom we had data on tear osmolarity, symptoms, and corneal fluorescein staining from 2 separate visits. Main outcomes included the correlation of the changes between the 2 visits for tear osmolarity (TearLab system), symptoms (Ocular Surface Disease Index), and corneal fluorescein staining (modified Oxford scheme). For tear osmolarity and corneal fluorescein staining the scores from the eye with highest readings were analyzed. The correlations were repeated on subgroups based on proposed cutoffs for DED severity and on patients' treatment.

Results: We found a modest, though statistically significant, correlation between changes in corneal fluorescein staining and symptoms of DED (R = 0.31; P < .001). However, there was no correlation between the recorded change in tear osmolarity and symptoms (R = -0.091; P = .38) or between changes in tear osmolarity and corneal fluorescein staining (R = -0.02; P = .80). This lack of correlation was consistent in all the subgroups studied. A multivariate analysis revealed that changes in corneal fluorescein staining had predictive value on symptom changes, whereas tear osmolarity changes did not.

Conclusions: Changes in tear osmolarity do not correlate significantly with changes in patient symptoms or corneal fluorescein staining in dry eye disease.

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Conflict of interest statement

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest.

Figures

Figure 1
Figure 1. Correlations of changes in tear osmolarity, corneal fluorescein staining, and symptoms among all studied subjects with dry eye disease
Correlation between changes in symptoms and corneal fluorescein staining (Left). Correlation between changes in symptoms and tear osmolarity (Center). Correlation between changes in corneal fluorescein staining and tear osmolarity (Right). OSDI, Ocular Surface Disease Index©; CFS, corneal fluorescein staining; OSM, tear osmolarity.
Figure 2
Figure 2. Correlations of changes in tear osmolarity, corneal fluorescein staining, and symptoms in patients with dry eye disease with an Ocular Surface Disease Index score of >12 at the initial visit
Correlation between changes in symptoms and corneal fluorescein staining (Left). Correlation between changes in symptoms and tear osmolarity (Center). Correlation between changes in corneal fluorescein staining and tear osmolarity (Right). OSDI, Ocular Surface Disease Index©; CFS, corneal fluorescein staining; OSM, tear osmolarity.
Figure 3
Figure 3. Correlations of changes in tear osmolarity, corneal fluorescein staining, and symptoms in patients with dry eye disease and a tear osmolarity value of >308 mOsm/L in the eye with the higher reading at the initial visit
Correlation between changes in symptoms and corneal fluorescein staining (Left). Correlation between changes in symptoms and tear osmolarity (Center). Correlation between changes in corneal fluorescein staining and tear osmolarity (Right). OSDI, Ocular Surface Disease Index©; CFS, corneal fluorescein staining; OSM, tear osmolarity.
Figure 4
Figure 4. Dry eye disease cases distributed by corneal fluorescein staining and symptoms improvement/worsening in respect to tear osmolarity change
Top panel shows the changes of tear osmolarity in respect to changes in corneal fluorescein staining. Central panel shows the changes of tear osmolarity in respect to changes in symptoms. Bottom panel shows the changes of tear osmolarity in cases in which both symptoms and corneal fluorescein staining worsened or improved, respectively. The bars represent the percentage of cases. Light colored bars represent the cases in which there was a decrease in tear osmolarity. Dark colored bars represent the cases in which tear osmolarity increased. Stripped pattern bars represent cases with no change. OSDI, Ocular Surface Disease Index©; CFS, corneal fluorescein staining.
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References

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