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Matthew Young, Han Zhong, Eric Peterson, Ekta Patel, Daniel Schwartz, Yablick Michael, Christopher Leffler; Clinical Evaluation of Schirmer Test Variations on the Predictability of Benefit from Artificial Tears. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2882.
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© 2017 Association for Research in Vision and Ophthalmology.
Common ocular surface disorders causing chronic symptoms include dry eyes, ocular rosacea, or staphylococcal hypersensitivity. Patients might experience ocular irritation, foreign body sensation, or blurred vision. Artificial tears are often the first line treatment recommended for these symptoms. The purpose of this study was to determine which signs and symptoms identified patients who benefit from artificial tears. Additionally, a modified version of the Schirmer test, consisting of medial Schirmer strip placement, use of an evaporative barrier over the strip, and fluorescein/benoxinate instillation, was evaluated for its ability to better predict who would benefit from artificial tears.
Participants were divided into 1 of 3 groups based on symptoms and treatment response: 1) A control group without ocular surface symptoms, 2) a "Tears Help" group with ocular surface symptoms which had responded to artificial tears, and 3) a "Tears Don't Help" group with ocular surface symptoms which had not responded to artificial tears. All participants filled out an Ocular Surface Disease Index (OSDI) form and underwent standard Schirmer testing, modified Schirmer testing, and a slit lamp exam to assess and grade punctate epithelial erosions (PEE) , Meibomian gland dysfunction (MGD), blepharitis, and tear break-up time (TBUT).
There was no significant difference in standard Schirmer testing, modified Schirmer testing, PEE, MGD, blepharitis, TBUT, or OSDI scoring between the "Tears Help" and "Tears Don't Help" groups. When comparing all symptomatic patients to controls without symptoms, there was a statistically significant difference in Schirmer testing (p=0.03), PEE (p<0.001), MGD (p=0.04), TBUT (p<0.001), and all but one item on the OSDI. Participants who were symptomatic were statistically significantly more likely to be female and older.
Standard clinical metrics such as Schirmer testing, PEE, MGD, TBUT, and the OSDI correlate with ocular surface symptoms. However, among patients with chronic symptoms, we have not yet identified clinical tests which can identify the subset who benefit from artificial tears. Given the low cost and morbidity of artificial tears, a trial of treatment is useful in most patients with chronic ocular surface symptoms. Future studies would benefit from taking the type of artificial tears used into account as well as frequency of use.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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