November 01, 2013
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BLOG: Tear osmolarity and choosing an artificial tear

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Read more from Darrell E. White, MD.

A part of our Dry Eye Protocol v2.0 is using tear osmolarity (TO) to assist in choosing the specific artificial tear or category of artificial tears to recommend to a patient. We always make a very specific recommendation, and we discuss it with our patients in the same manner in which we might discuss a prescription medication.

In our SkyVision experience, we’ve found that patients take the need to lubricate more seriously if we discuss it with them in this manner.

Many other dry eye syndrome (DES) experts who write about this discuss a single tear supplement: Blink by Abbott Medical Optics. We agree that Blink is a fantastic product that does pretty much exactly what you’d like an artificial tear to do, and being hypotonic, it also reduces osmolarity.

However, anyone who has treated DES patients knows all too well that a single product is not going to suffice because a sizeable percentage of my patients do not like any product, including Blink.

Our SkyVision program involves three tear groups. The tear surface stabilizers are Systane Balance (Alcon), Optive Advanced (Allergan) and Blink. We prescribe these for patients with a low TO and a low tear breakup time (TBUT). Aqueous supplements would include the TheraTears products (Advanced Vision Research). We suggest these for patients with a high TO and low tear volume. Note that Blink can be used here as well in its non-contact lens formula. For those patients who have milder DES and a correspondingly low or normal TO, we have the group that is designated the “utility” tears: Refresh (Allergan), Optive (Allergan) and Systane Ultra (Alcon).

A simple decision tree might look like this for a typical patient who comes in with slightly low tear film, slightly reduced TBUT and mild symptoms: low TO -> surface stabilizer; normal TO -> utility; high TO -> aqueous supplement. We have found that our patients tend to stick closer to our recommendations when we couple our specific tear suggestion with their personal TO measurement.

Disclosure: White is a consultant for Bausch + Lomb, Allergan, Nicox and Eyemaginations. He is on the speaker board for Bausch + Lomb, Allergan and TearLab.