Tear Osmolarity Part II: Choosing the Right Artificial Tear

Have you ever looked at all of the choices of artificial tears and other eye wetting stuff in the pharmacies in Cleveland? Pretty confusing, isn't it?! What's the difference? IS there a difference? How do doctors know which one to suggest?

Not only can TEAR OSMOLARITY, the measurement of how "salty" your tears are, help in making the diagnosis of certain types of dry eye syndrome, but it can also help the eye doctor choose which type of tear is best for you and your particular symptoms. Not all artificial tears are the same, and certain general types will be more appropriate in certain situations.

One way to put dry eye into different categories is to separate LOW TEAR PRODUCTION from TEAR EVAPORATION. This can be done by simply looking at your tears and measuring things like the amount of tears you have, or how long your tears stay smooth on the front of the eye. But these two things have lots of overlap. For example, some times low tear production can cause tear evaporation!

Here's where the tear osmolarity test from TEARLAB comes in. Internal findings made by Dr. Darrell White have shown that your symptoms can be effectively treated if we choose the type of artificial tear based on your osmolarity results. In other words, if you have both a low tear level AND a fast tear evaporation, the primary cause is likely to be found in the osmolarity test! For example, if your osmolarity is HIGH, poor tear production is probably what came first.

Make sure to check back here for more information on what tear products we suggest you use based on your TEAR OSMOLARITY results!

Using Your Tear Osmolarity Result Part I: Diagnosis

We use a test called TEAR OSMOLARITY when we are evaluating the surface of your eyes. Perhaps you shared some symptoms with one of the Skyvision staff that brought up the possibility of dry eye. Maybe one of our doctors looked at the front of your eye and was suspicious about something he saw. Sometimes your symptoms and your exam just don't add up. In all of these cases measuring your tear osmolarity, how salty your tears are, can help us determine if dry eye is part of the problem.

We use a very sophisticated instrument manufactured by the Tearlab company to do this test. It's basically a lab on a microchip! A very, very tiny sample of your tears is placed on the chip and a reading happens almost immediately. Normal osmolarity or "saltiness", is a measurement under 300, and abnormal is something over 308 (between the two is not really diagnostic).

Of course, this test can't be used all alone. Dr. White, Dr. Kaye, and Dr. Schlegel will use the results along with the information they get from your history and from looking at your eyes to come to a conclusion. But if your osmolarity is above 308, the chances are good that you have some kind of dry eye!

The tear osmolarity test is fully FDA approved, and we are hopeful that it will be covered by most insurances in 2011.

Dry eye is one of the most common causes of eye problems, not only in Cleveland but all over the world. Our doctors at the main Skyvision Centers office in Westlake are on the leading edge of the technology involved in making this important diagnosis.

A New Contact Lens From Bausch & Lomb

Here in Cleveland Skyvision Centers is your place to look for the latest developments in all parts of eye care! We thought we'd share a news release we just got from the folks at B&L, courtesy of the good people at BMC and Eyewire.


Bausch + Lomb Launches PureVision2 with High Definition Optics


Bausch + Lomb announced the launch of PureVision2 with High Definition Optics contact lenses, the latest development in the company's portfolio of lenses. Designed to reduce glare and halos while delivering excellent vision, these new monthly contact lenses bring together several improvements to help overcome the challenges that contact lens wearers face, including spherical aberration, an optical effect that can result in blurred vision, glare and halos. The result is a lens that provides crisp, clear vision, optimal comfort and breathability.

“The initial response from eye care professionals to the PureVision 2 with High Definition Optics was overwhelmingly positive based on patient reports of great vision and comfort,” said Dr. Michael Pier, director of Professional Relations, Vision Care - North America, Bausch + Lomb.

PureVision 2 with High Definition Optics optimizes design to reduce spherical aberration across the entire power range. The lenses are packaged in a unique solution that delivers outstanding comfort upon insertion. Additionally, the new lenses provide high levels of oxygen transmissibility during wear to ensure a healthy environment for the eyes. One of the thinnest lenses available, PureVision 2 with High Definition Optics are also exceptionally easy to handle.

Fulfilling unmet patient needs

The Needs, Symptoms, Incidence, Global Eye Health Trends (NSIGHT) study of 3,800 vision-corrected patients across seven countries revealed that vision is the most important feature when choosing eye-related products. Of the contact lens wearers experiencing glares or halos, 90 percent reported that they are interested in a solution that reduces glare, while 89 percent are interested in a solution that reduces halos. Fewer than 10 percent of the respondents reported having a complete solution for these symptoms. The survey, commissioned by Bausch + Lomb, was conducted by independent market research firm, Market Probe: Europe.

“When designing PureVision 2 with High Definition Optics, we looked to the lifestyles that millions of patients are living today. These lifestyles include activities in which vision is critical, including nighttime driving, classroom learning, and athletics,” said Lisa VanDeMark, vice president of Brand Marketing, Vision Care - North America, Bausch + Lomb. “With nearly 25 million Americans reporting that they drive between midnight and 6:30 a.m., and college students spending 11-15 hours in the classroom per week, PureVision 2 with High Definition Optics provides a contact lens designed for crisp, clear vision, especially in low light.”


We'll be evaluating the new Bausch & Lomb contacts at Skyvision Centers in our Westlake office soon.

Bifocal Contact Lenses and RevitalVision!

A recent article in the optometric literature cautions against wearing bifocal, multi-focal contact lenses and driving at night. The article goes on to explain that the focusing mechanism of the bifocal contact lenses decreases the "contrast sensitivity" of the people who wear them, and suggests that they wear regular, distance-only lenses at night.

We understand the concerns of the authors, but at Skyvision we also understand that it is important to provide the best vision possible in the simplest way you can. Multiple contact lens prescriptions for day and night use? Sure...if you are having lots of problems. But there's a better way!

Contrast sensitivity is the part of vision that determines how sharp or crisp images are. Like everything else the first part of contrast sensitivity is focusing light, in this case with a bifocal contact lens. Part 2 is processing the image in the brain, and here's where RevitalVision comes in! The RevitalVision Low Myopia and Sport programs are designed to increase contrast sensitivity! In all of the studies to date people who do this computer-based vision training program get at least a DOUBLING of their contrast sensitivity!

People see images that are TWICE as sharp and crisp after doing RevitalVision.

All of the doctors at Skyvision Centers in Westlake are fans of bifocal and multi-focal contact lenses. Most people have not difficulty with night vision, but everyone who wears them will see even better with RevitalVision!

Using Tear Osmolarity for Diagnosis and Treatment

Dr. Darrell White has been researching the best way to care for patients in Cleveland with Dry Eye since the mid-1990's. He was one of the first doctors to prescribe Restasis for inflammatory Dry Eye when it was approved some 10 years ago. Recently he began using a new medicine, AzaSite, in the treatment of Evaporative Dry Eye caused by inflammation in the eyelid glands that produce the oil part of our tears. Here is Dr. White talking about a TOTALLY NEW WAY to use the TearLab tear osmolarity measurement to diagnose and treat dry eye:

"Now that we have two very different, very effective treaments for dry eye it's very important that we make an accurate diagnosis about the TYPE  of dry eye that is present. Are there TOO FEW tears, or are the tears NOT WORKING PROPERLY? Not only that, but we need to try our very best to find out WHY the eye is dry, why the tear production is low or the tears aren't doing their job.

Skyvision Centers was the first eyecare practice in Cleveland to use the TearLab Osmolarity instrument. Not only has it helped us make the diagnosis of Dry Eye in difficult, confusing settings, but we are now using it to choose the most appropriate starting treatment for Dry Eye. As far as we know we are the ONLY eye doctors who are using this instrument to make this choice.

In a nutshell here is what we do: if you have a high, abnormal tear osmolarity, a reading greater than 308, we view this as a sign that your PRIMARY abnormality is in the microscopic glands that produce the salt water, or AQUEOUS portion of your tears. Treatment is directed at these glands and often involves Restasis. If your osmolarity measurement is between 300-308 we do not feel that it adds to the decision on how to treat, and that decision is made solely on other signs we see on your exam.

If your tear osmolarity is below 300 and you have other signs of an EVAPORATIVE Dry Eye, especially if you have some signs of inflammation in your tear oil (meibomian) glands, treatment is directed at these glands and often includes AzaSite."

Dr. White, Dr. Schlegel, and Dr. Kaye will be publishing their protocol in both the ophthalmic and optometric journals, as well as sharing the results of their pilot study when they are available.

Thinking about Dry Eye

Did you know that Dry Eye is the most frequently searched eye care term on Google? Isn't that amazing? With all of the stuff that we read about in the news (like LASIK), and all of the more well-known medical problems (like Glaucoma), the thing that gets the most search requests is DRY EYE!

Why is that, do you think? Well, here at Skyvision we have a few thoughts on that. First, it's INCREDIBLY common. Lots and lots of folks have symptoms that are from dryness in their eyes. Things like burning, scratchiness, discharge (you know...eye "winkers"), and blurred vision that comes and goes can all be caused by dryness. Even tearing can be caused by dry eye, and dry eye may be the most common cause of tearing.

Another reason why Dry Eye is searched for so frequently is because it's hard to get answers about your symptoms. It takes a long time to tell all of your symptoms in the doctor's office, and then it can be really hard to make the diagnosis. We know, because in Cleveland the doctors at Skyvision Centers are often the 3rd, 4th, or even 5th stop for people suffering from Dry Eye!

Well, WE hear you! We've turned ourselves into Dry Eye EXPERTS! Stay tuned as we talk about some of the true Dry Eye breakthroughs at Skyvision.

Glaucoma 202 The Nerve Analysis

The very first thing that is lost when we have glaucoma damage is the individual nerve fibers that make up the optic nerve. Remember the optic nerve is the nerve that brings "light" from the eye to the brain. It's made up of tiny nerve fibers that are the innermost layer of the retina, the film that "sees".

We can actually measure how healthy these nerve fibers are using one of several Nerve Fiber Analyzers. At Skyvision Centers in Cleveland we are now using the OCT made by Zeiss, the most advanced instrument of its kind.

The OCT gives us a 3-dimensional view of the nerve fiber layer. Not only that, but it also compares the first test with a group of "normal" studies from age-matched studies. Follow-up tests can then be compared with one another to see if the glaucoma is getting worse.

Don't let glaucoma, the "silent thief"  steal your vision. Visit Dr. Kaye, Dr. Schlegel, and Dr. White at Skyvision Centers in Westlake for a complete evaluation, especially if there is glaucoma in your family.