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      Tear Film Osmolarity in Patients with Diabetes Mellitus

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          Abstract

          Purpose: To compare tear film osmolarity (TFO) between patients with diabetes mellitus (DM) and normal healthy individuals. Methods: In this prospective case-controlled study, the TFO in 46 normal subjects (control group) and 55 patients with DM (study group) was evaluated. TFO in milliosmole (mOsm) was measured by using an auto-osmometer. The serum levels of glycosylated hemoglobin (HbA<sub>1</sub>c) and blood glucose in all participants were also measured. Mean outcome measures were TFO and its relationship with HbA1c level and duration of DM. Results: Mean TFO was 320.40 ± 21.80 mOsm/l in the study group and 308.22 ± 18.16 mOsm/l in the control group (p < 0.001). The TFO values were significantly associated with duration of DM (r = 0.476, p < 0.001), but no significant correlation was found with HbA<sub>1</sub>c level (r = 0.225, p = 0.114). Conclusions: The study shows a significantly higher TFO in patients with DM than in the healthy controls. TFO also correlates with the duration of DM.

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          Methodologies to diagnose and monitor dry eye disease: report of the Diagnostic Methodology Subcommittee of the International Dry Eye WorkShop (2007).

          (2007)
          The role of the Diagnostic Methodology Subcommittee of the Dry Eye Workshop was 1) to identify tests used to screen, diagnose and monitor dry eye disease, 2) to establish criteria for test performance, and 3) to consider the utility of tests in a variety of clinical settings. The committee created a database of tests used to diagnose and monitor dry eye, each compiled by an expert in the field (rapporteur) and presented within a standard template. Development of the templates involved an iterative process between the Chairman of the subcommittee, the rapporteurs, and, at times, an additional group of expert reviewers. This process is ongoing. Each rapporteur was instructed on how to the complete a template, using a proforma template and an example of a completed template. Rapporteurs used the literature and other available sources as the basis for constructing their assigned template. The chairman of the subcommittee modifed the template to produce a standardized version and reviewed it with the rapporteur. The completed database will be searchable by an alphabetical list of test names, as well as by functional groupings, for instance, tests of aqueous dynamics, lipid functions, etc. The templates can be accessed on the website of the Tear Film and Ocular Surface Society (www.tearfilm.org). This report provides a general overview of the criteria applied in the development of tests for screening and diagnosis.
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            Tear osmolarity in the diagnosis and management of dry eye disease.

            Michael Lemp, Anthony Bron, Christophe Baudouin … (2011)
            To evaluate the use of tear osmolarity in the diagnosis of dry eye disease. A prospective, observational case series to determine the clinical usefulness of tear osmolarity and commonly used objective tests to diagnose dry eye disease. 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. 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). 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. Copyright © 2011 Elsevier Inc. All rights reserved.
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              An objective approach to dry eye disease severity.

              Allison Porreco, Diane Whitmer, Alan Tomlinson … (2010)
              A prospective, multisite clinical study (10 sites in the European Union and the United States) evaluated the clinical utility of commonly used tests and tear osmolarity for assessing dry eye disease severity. Three hundred fourteen consecutive subjects between the ages of 18 and 82 years were recruited from the general patient population, 299 of which qualified with complete datasets. Osmolarity testing, Schirmer test without anesthesia, tear film breakup time (TBUT), corneal staining, meibomian dysfunction assessment, and conjunctival staining were performed bilaterally. A symptom questionnaire, the Ocular Surface Disease Index (OSDI), was also administered to each patient. Distributions of clinical signs and symptoms against a continuous composite severity index were evaluated. Osmolarity was found to have the highest correlation coefficient to disease severity (r(2) = 0.55), followed by conjunctival staining (r(2) = 0.47), corneal staining (r(2) = 0.43), OSDI (r(2) = 0.41), meibomian score (r(2) = 0.37), TBUT (r(2) = 0.30), and Schirmer result (r(2) = 0.17). A comparison of standard threshold-based classification with the composite severity index revealed significant overlap between the disease severities of prospectively defined normal and dry eye groups. Fully 63% of the subjects were found to be poorly classified by combinations of clinical thresholds. Tear film osmolarity was found to be the single best marker of disease severity across normal, mild/moderate, and severe categories. Other tests were found to be informative in the more severe forms of disease; thus, clinical judgment remains an important element in the clinical assessment of dry eye severity. The results also indicate that the initiation and progression of dry eye is multifactorial and supports the rationale for redefining severity on the basis of a continuum of clinical signs. (ClinicalTrials.gov number, NCT00848198.).
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                Author and article information

                Journal
                Journal ID (publisher-id): ORE
                Journal ID (nlm-ta): Ophthalmic Res
                Journal ID (doi): 10.1159/issn.0030-3747
                Title: Ophthalmic Research
                Publisher: S. Karger AG
                ISSN (Print): 0030-3747
                ISSN (Electronic): 1423-0259
                Publication date Subscription-year: 2013
                Publication date (Print): June 2013
                Publication date (Electronic): 22 February 2013
                Volume: 50
                Issue: 1
                Pages: 1-5
                Affiliations
                aThe Eye Institute of Muş State Hospital, Mus, bDepartment of Biochemistry, Etlik Education and Research Hospital, Ankara, and cDepartment of Ophthalmology, Karaelmas University Faculty of Medicine, Zonguldak, Turkey
                Author notes
                *Mehmet Tetikoglu, Hürriyet Mah, Tuba Sokak, Gözde Koop., A blok kat 2 daire 4, TR-49000 Muş (Turkey), E-Mail drtetikoglu@yahoo.com.tr
                Article
                Publisher ID: 345770 Other ID: Ophthalmic Res 2013;50:1-5
                DOI: 10.1159/000345770
                PubMed ID: 23445780
                SO-VID: 88df80c2-b9f5-481c-9fe6-159ac4573908
                Copyright © © 2013 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 21 February 2012
                Date accepted : 02 November 2012
                Page count
                Figures: 2, Tables: 2, Pages: 5
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Vision sciences,Ophthalmology & Optometry,Pathology
                Keywords: Tear film osmolarity,Glycosylated hemoglobin,Diabetes mellitus
                Data availability:
                ScienceOpen disciplines: Vision sciences, Ophthalmology & Optometry, Pathology
                Keywords: Tear film osmolarity, Glycosylated hemoglobin, Diabetes mellitus

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