Test de Osmolaridad: Seguridad y Eficacia

~ 2020 ~

Inter-eye osmolarity differences in patients with symptomatic and non-symptomatic dry eyes.

Pena-Verdeal et al.

Arquivos Brasileiros de Oftalmologia 1010; 83(2), 103-8.

A randomized study of 135 patients. The authors analyzed whether inter-eye osmolarity differences were related to dry eye symptomatology. Osmolarity values compared between the right and the left eyes and the absolute inter-ocular difference correlated with the Ocular Surface Disease Index (OSDI) score. The authors concluded that tear film inter-eye osmolarity differences are significantly higher in severe dry eye disease symptoms. This study shows that symptoms are correlated to objective signs of dry eye as osmolarity.

Correlation of non-invasive tear break-up time with tear osmolarity and other invasive tear function tests.

Ozulken et al.

Seminars in Ophthalmology 2020; 35(1):78-85.

This is a study of 170 patients which says that it is important to use a sensitive, reproducible and non-invasive method in the evaluation of tear functions. The authors think that the objective and noninvasive topographic NI-BUT measurements and the minimally invasive osmolarity measurements should be used more frequently in practice because they are correlated with the measurements obtained by invasive methods and should be widespread in clinics.

~ 2019 ~

The utility of a normal tear osmolarity test in patients presenting with dry eye disease like symptoms: a prospective analysis.

Brissette et al.

Contact Lens an Anterior Eye, 2018.

A prospective observational cohort study of 100 patients. The aim of this study was to evaluate for the presence of any alternate OSD in patients with DED-like symptoms and a normal tear osmolarity. The authors concluded that osmolarity can help to make a correct diagnosis from the first visit. The most frequent diagnoses in patients with normal tear osmolarity included blepharitis and allergic conjunctivitis. Other diagnoses were epithelial basement membrane dystrophy (EBMD), contact lens intolerance, conjunctivochalasis, neuropathic pain and computer vision syndrome.

An algorithm for the preoperative diagnosis and treatment of ocular surface disorders.

Starr et al.

J Cataract Refract Surg 2019; 45(5):669-684.

Cataract surgery in general, and the creation of corneal incisions in particular, have the potential to aggravate DED. The ASCRS Cornea Clinical Committee developed a new consensus-based practical diagnostic OSD algorithm to aid surgeons in efficiently diagnosing and treating visually significant OSD before any form of refractive surgery is performed.

Comparison between tear film osmolar concentration and other tear film function parameters in patients with diabetes mellitus.

Derakhshan et al.

Korean J Ophthalmology 2019; 33(4):326-332.

This comparative study recruited 51 patients with diabetes mellitus and other 20 control subjects. The tear film osmolarity was significantly higher in patients with poor glycemic control. TFO had a positive correlation with the duration of DM. The authors concluded that tear film osmolarity is damaged in patients with uncontrolled DM and is better correlated with glycemic control and dry eye symptoms than the TBUT and Schirmer tests.

~ 2018 ~

Dry Eye Syndrome Preferred Practice Pattern®

Robert S. Feder MD et al.

American Academy of Ophthalmology 2018.

Tear Osmolarity has been thought to be an indicator of dry eye disease, and a commercial device is available for clinicians. Several studies using this device have demonstrated tear hyperosmolarity and/or significant inter-eye osmolarity differences in patients with aqueous tear deficiency or evaporative dry eye, and it has been approved by FDA for use as a point-of-care laboratory test to diagnose dry eye.

Prevalence of ocular surface dysfunction in patients presenting for cataract surgery evaluation.

Gupta et al.

J Cataract Refract Surg 2018; 44(9):1090-1096.

A prospective case series of 120 patients which stipulates that in the setting of preoperative cataract surgery planning, dry-eye disease and meibomian gland dysfunction can impair clinical refractive measures such as keratometry values worsening surgical outcomes. In addition, ocular surface dysfunction has been reported to increase after cataract surgery.

Change of tear osmolarity after refractive surgery.

Kacerovská et al.

Czech and Slovak Ophthalmology 2018; 74 (1):18-22.

A prospective non-randomized comparative study. The author evaluated the results in two groups of patients who underwent binocular refractive surgeries: FS-LASIK & ReLEx SMILE. Osmolarity was measured in both group of patients as a point-of-care test which is described as a significant objective indicator of dry eye disease. TearLab was the chosen osmometer as the most precise in the market. The aim of this study was to compare the differences in preoperative and postoperative values of tear film osmolarity in both types of refractive surgeries.

~ 2017 ~

Prospective evaluation of intense pulsed light and meibomian gland expression efficacy on relieving signs and symptoms of dry eye disease due to meibomian gland dysfunction.

Dell et al.

Clinical Ophthalmology 2017:11 817-827.

In a prospective study in 40 patients, the authors study the efficacy of the intense pulse light therapy. Their inclusion criteria consisted of at least two of the following measures: TBUT (tear breakup time), MGS (meibomian gland score), CFS (corneal fluorescein staining), SPEED questionnaire (standard patient evaluation of Eye-Dryness, and TFO (tear film osmolarity). An abnormal osmolarity was defined as [1] if TFO was ≥310 mOsml/L, or [2] if the difference of TFO between eyes is ≥8 mOsnl/L.

Tear osmolarity and subjective dry eye symptoms in migraine sufferers.

Wong et al.

Canadian J Ophthalmol 2017; 52(5): 513-518.

A prospective cross-sectional study in 34 patients of neurology practice. The authors explore the relationship between dry eye and symptoms in patients with migraine. They did not find an association between headache severity and dry eye, but their data suggested a positive correlation between daily headache and tear osmolarity, maybe due to the role of the trigeminal pathway: the cornea contains a high density of trigeminal nerve endings and the trigeminal nerve plays an important role in migraine pathophysiology. They concluded that migraine sufferers have a higher prevalence of dry eye disease according to tear osmolarity.

DEWS II Diagnostic Methodology Report

Wolffsohn et al.

The Ocular Surface 2017; 15(1):539-574.

The report has determined, through scientific evidence and consensus, the most appropriate battery of tests to diagnose and monitor DED. The most appropriate test order and techniques to conduct these tests in a clinical setting have been identified, if the triaging questions do not identify a possible different diagnosis which needs further investigation. Critical diagnostic tests as symptoms, NIBUT, osmolarity and corneal/conjunctival/lid margin staining, have been differentiated from tests that inform subtype classification etiologies (MGD imaging/observation and expression, lipid thickness, and tear volume tests.

Correlation between tear osmolarity and other ocular surface parameters in primary Sjögren’s syndrome.

Kim et al.

Korean J Ophthalmol 2017; 31(1):25-31.

A study of 155 patients that demonstrates that tear osmolarity can reflect both symptom severity (OSDI score) and objective signs as Schirmer test and Ocular Staining Score (OSS). In clinical practice, tear osmolarity can have a central role in screening and diagnosing dry eye disease in patients with Sjögren’s Syndrome. Also in the revised international classification for Sjögren’s Syndrome (2002), the Schirmer test and corneal staining score are more important than tear film break-up time when diagnosing SS.

~ 2016 ~

The Effects of Intense Pulsed Light on Tear Osmolarity in Dry Eye Disease.

Toyos and Briscoe

Journal of Clinical & Experimental Ophthalmology 2016, 7(6):1000619

A statistically significant decrease in tear osmolarity from abnormal to normal range as well as a reduction in inter-eye difference demonstrates an improvement in tear film quality after one treatment with IPL, thus suggesting IPL’s effectiveness at treating dry eye disease. This prospective study shows that one month after a single treatment of IPL and one day of QN NSAID, patients showed a statistically significant lower tear osmolarity in both eyes from abnormal to normal. These are important finding as we are discovering how significant tear osmolarity measures are in determining the severity of patient’s dry eye.

Role of Tear Osmolarity in Dry Eye Symptoms After Cataract Surgery.

González-Mesa et al.

American Journal of Ophthalmology 2016;170:128-132

A prospective, observational cohort study in 52 patients with unilateral cataract to analyze changes in tear osmolarity in patients after cataract surgery. Examinations were performed preoperatively and 1 and 3 months postoperatively. The patients with tear osmolarity values of 312 mOsml/L or higher are more likely to have more ocular discomfort postoperatively. Ophthalmologists should consider evaluating tear osmolarity preoperatively, specially in highly demanding patients.

Ocular neuropathic pain.

Rosenthal et al.

Br J Ophthalmol 2016; 100(1): 128-134.

An overview of disorders of the corneal pain system in the context of neuropathic pain as it relates to dry eye disease (DED) and other disorders affecting the corneal sensory system characterized by otherwise inadequately explained chronic pain.

~ 2015 ~

Effect of tear osmolarity on repeatability of keratometry for cataract surgery planning.

Epitropoulos et al.

Journal Cataract Refractive Surgery 2015; 41:1672-1677.

Observational prospective non randomized study which evaluates the effects of tear osmolarity on the repeatability of keratometry measurements in patients presenting for cataract surgery. The authors concluded that hyperosmolar group showed more variability in average K and anterior corneal astigmatism, which significant resultant differences in IOL power calculation. Therefore the measurement of tear osmolarity at the time of cataract surgery planning can effectively identify patients with a higher likelihood of high unexpected refractive error resulting for inaccurate keratometry.

Tear film osmolariry and dry eye disease: a review of the literature.

Potvin et al.

Clinical Ophthalmology 2015:9, 2039-2047.

A review of all publications after the year 2000 which included the key-words ’tear osmolarity’. The objective was to evaluate the evidence regarding the use of tear osmolarity as a physiological marker to diagnose, grade severity and track the therapeutic response in DED. The literature broadly supports the use of tear film osmolarity as an objective numerical measure these 3 actions.

Clinical guidelines for management of dry eye associated with Sjögren Disease.

Foulks et al.

The Ocular Surface 2015; 13(2): 118-132.

This publication shows a consensus panel evaluation of reported treatments for dry eye disease associated with Sjögren disease. Also describe the sequence of the methods to evaluate the signs of dry eye as this sequence can influence the results of the subsequent tests. The general principle is to perform the least invasive tests before the most invasive ones: starting with slit-lamp and direct observation without any manipulation of the eyelids, tear film or ocular surface; next osmolarity, instillation of topical fluorescein and distribution of the dye with several complete blinks to measure the tear film break-up time and Schirmer.

~ 2013 ~

Impact of time between collection and collection method on human tear fluid osmolarity.

Keech et al.

Current Eye Research 2013; 38(4):1-9.

This publication shows a consensus panel evaluation of reported treatments for dry eye disease associated with Sjögren disease. Also describe the sequence of the methods to evaluate the signs of dry eye as this sequence can influence the results of the subsequent tests. The general principle is to perform the least invasive tests before the most invasive ones: starting with slit-lamp and direct observation without any manipulation of the eyelids, tear film or ocular surface; next osmolarity, instillation of topical fluorescein and distribution of the dye with several complete blinks to measure the tear film break-up time and Schirmer.

~ 2011 ~

Tear osmolarity in the diagnosis and management of dry eye disease.

Lemp et al.

Am J Ophthalmol 2011; 151(5): 792-798.

A multicenter study (10 sites) consisting 314 subject between 18 and 82 years of age. The authors conclude that tear osmolarity is the best single metric both to diagnose and classify dry eye disease. Inter-eye variability is a characteristic of dry eye not seen in healthy patients.

~ 2010 ~

Performance of tear osmolarity compared to previous diagnostic tests for dry eye diseases.

Versura et al.

Current Eye Research 2010;35(7):553-564.

A comparative study with 25 normal subjects and 105 DED patients. Several tests for diagnosis were performed. The authors conclude that tear osmolarity test showed a good performance in dry eye diagnosis, higher than the other tests considered, mainly In severe eye. The study also shows the cut off value used to determine the mild/moderate severity of DED (309 mOsm/L). All data shown in the study suggest that the tear osmolarity increases as the severity of the disease increases.