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K. K. Nichols, L. A. Jones; Is Osmolarity a Key Feature in Dry Eye in Postmenopausal Women?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5284.
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The recent DEWS report highlights osmolarity as a key feature in dry eye disease, in addition to symptoms of ocular irritation, visual disturbance, tear film instability, and inflammation. The underlying core mechanisms of dry eye also include osmolarity, with the end result being a significant impact on quality of life (QoL). The aim of this analysis is to explore the association between tear film parameters, such as osmolarity and the end result of QoL in postmenopausal women.
The NEI-VFQ (short form 25) was completed and a dry eye evaluation was performed in 500 postmenopausal women. Overall and sub-scale NEI-VFQ scores were calculated, and patients were queried as to previous dry eye diagnosis, if patients "think" they have dry eye, and if significant symptoms were present. Dry eye examination tests included osmolarity (Advanced Instruments Nanoliter Osmometer, Norwood, MA), fluorescein corneal staining, lissamine green conjunctival staining, tear break-up time, and the Schirmer test.
Of the sample, 32.1% had been previously diagnosed with dry eye. Of those who had a previous dry eye diagnosis, 38.6% demonstrated osmolarity values greater than 316 mOsm/kg. The average osmolarity in the dry eye group was 312.7 ± 26.6 mOsm/kg with no statistically significant differences between groups. As with previous reports, statistically significant differences were demonstrated for many of the NEI-VFQ subscales based on the symptomatic reports. As expected, the ocular pain subscale demonstrated the largest differences for all symptom classifications. Central corneal staining was associated with statistically lower general, near and distance VFQ subscale scores (p <0.05), while osmolarity >316 mOsm/kg only showed a significantly lower VFQ driving subscale score (p = 0.005). When an osmolarity of >316 mOsm/kg was combined with the European Sjögren’s criterion, no increased level of association was demonstrated over the European criterion alone, indicating that vision-specific QoL differences in dry eye are likely driven by symptoms. It is important to note that missing osmolarity data due to difficulty obtaining the sample may have influenced the osmolarity results.
These data confirm that symptoms are critical in patients’ perceptions of dry eye disease, and that increased tear film osmolarity may be found in postmenopausal women, requiring higher cutpoints for the disease state. Difficulty in obtaining the needed sample (~300 nL) and in transfer continue to be a challenge in evaluating osmolarity. The ocular pain, near, far, and driving VFQ subscales warrant further investigation in dry eye.
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