June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Modified Schirmer Tear Test to Determine Lacrimal Tear-Production Rate from Subjects with Low Wetting Lengths
Author Affiliations & Notes
  • Clayton J Radke
    Chemical and Biomolecular Engineering Department, University of California Berkeley, Berkeley, California, United States
    Herbert Wertheim School of Optometry & Vision Science, University of California Berkeley, Berkeley, California, United States
  • Young Hyun Kim
    Herbert Wertheim School of Optometry & Vision Science, University of California Berkeley, Berkeley, California, United States
    Chemical and Biomolecular Engineering Department, University of California Berkeley, Berkeley, California, United States
  • Jennifer Ding
    Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California Berkeley, Berkeley, California, United States
  • Sarah M Chang
    Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California Berkeley, Berkeley, California, United States
  • Meng C Lin
    Herbert Wertheim School of Optometry & Vision Science, University of California Berkeley, Berkeley, California, United States
    Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California Berkeley, Berkeley, California, United States
  • Footnotes
    Commercial Relationships   Clayton Radke None; Young Hyun Kim None; Jennifer Ding None; Sarah Chang None; Meng Lin None
  • Footnotes
    Support  Roberta Smith Unrestricted Research Fund
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 3966. doi:
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      Clayton J Radke, Young Hyun Kim, Jennifer Ding, Sarah M Chang, Meng C Lin; Modified Schirmer Tear Test to Determine Lacrimal Tear-Production Rate from Subjects with Low Wetting Lengths. Invest. Ophthalmol. Vis. Sci. 2023;64(8):3966.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : A recent modification to the Schirmer Tear Test (STT) quantifies basal tear-production rates of patients by collecting three wetted lengths in time (Kim et al. TVST 2019). However, existing methodology cannot determine the tear-production rates from subjects that do not wet past 5 mm of the Schirmer strip within 5 min. Unfortunately, these low strip-wetting patients are more likely to suffer from aqueous-deficient dry eye. We extend the modified Schirmer Tear Test to quantify tear-production rates from patients that do not adequately wet the Schirmer strip within 5 min of strip insertion.

Methods : The modified STT sheathes the Schirmer strip. Alongside, eyes are anesthetized to prevent reflex tearing. Details of the modified STT are provided in Li et al. (OVS 2018). To determine tear-production rates of low strip-wetting patients, Schirmer strips are pre-wetted onto the unsheathed portion of the strip out to the notch with 1.6 µL of non-preservative saline solution (PuriLens Plus, The LifeStyle Company, Inc, USA) and then immediately inserted into each eye.

Results : Figure 1 provides an image of the Schirmer strip with and without pre-wetting. Two subjects that could not wet past 5 mm in a STT were recruited for this feasibility study. Four repeated tear-production rates of both eyes for each subject were measured in four inter-day clinical visits. Table 1 tabulates the gathered raw tear-production rates.

Conclusions : Determined tear-production rates in Table 1 indicate that subjects that do not wet Schirmer strips out to 5 mm within 5 min indeed have much lower tear-production rates than eyes that do wet Schirmer strips out to 5 mm within 5 min (Kim et al. TVST 2019). As common for STTs, there is significant intra-subject variability in basal tear-production rate. Importantly, the proposed extended pre-wet modified STT provides a new quantitative tool to diagnose aqueous-deficient dry eye.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

Figure 1. Schirmer strip wetting lengths at 5 min of strip insertion with (a) pre-wetting and (b) without pre-wetting. Black dots next to Schirmer strips for (b) indicate location of the wetted-length end.

Figure 1. Schirmer strip wetting lengths at 5 min of strip insertion with (a) pre-wetting and (b) without pre-wetting. Black dots next to Schirmer strips for (b) indicate location of the wetted-length end.

 

Table 1. Determined Tear Production Rates

Table 1. Determined Tear Production Rates

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