Update for 2017

As we enter 2017, we are very excited as Cary Eye Center approaches its two-year anniversary in March!  We continue to meet new patients through word-of-mouth referrals, Google and other internet searches, doctor and insurance referrals, and online reviews.  We appreciate the opportunity to serve you as we strive for excellence in eye care.  We also continue to owe a debt of gratitude to so many of my patients from my former practice, who continue to appear for the first time at Cary Eye Center.

Please contact my former practice if you would like to have your medical records transferred.  You can also sign a form at Cary Eye Center, which we will FAX over on your behalf.  They are charging a nominal fee for this service.

We welcome you to visit our new office with updated, state-of-the-art equipment and an excellent staff.  We have recently added a new test for Dry Eye (also called Dry Eye Disease (DED)) to Cary Eye Center.  We have found that DED is extremely common in our patient population, manifesting itself often as eye pain, red eyes, blurry vision, and contact lens intolerance.  TearLab is the company that has produced this new test equipment which measures how much salt is present in the tear film (called osmolarity).  We have been using this new technology for several months and we are finding clinically that this TearLab test typically correlates with the signs and symptoms of Dry Eye.  It stands to reason that there is a variation in sensitivity to DED depending on the sensory neurons in the cornea, which can be affected by a variety of factors including chronic diseases, use of contact lenses, medications (whether drops or pills), a history of certain eye infections, age, and occupation/activities.  So, some patients are very sensitive and bothered by Dry Eye while others may appear dry on examination, but are relatively comfortable.

This is one of the first “lab tests” in ophthalmology and can give an objective number to a patient’s Dry Eye Disease versus the more subjective “it’s burning pretty bad most of the time”.  DED is complex and thought to be caused by several different factors.  Due to inflammatory changes in the eye, eyelids, and associated glands, a Dry Eye patient will tend to have excessive salt in the tear film, which is termed hyperosmolar.  Increased severity of Dry Eye Disease tends to correlate with increased tear film osmolarity.  A test score below 300 milliosmoles (mOsM) is generally considered normal; 300-320 is mild, 320-340 is moderate, and >340 is severe Dry Eye.  Also, if there is a difference between the right and left eyes of more than 8 (mOsM), that is an indicator of “tear film instability” and is a separate, additional sign of Dry Eye.  Even scores in the normal range may indicate Dry Eye if they are different by 8 or more (for example 280 and 295).

In the office, a small sample of the patient’s tear is collected and analyzed on the machine.  Then, a readout gives a number for each eye.  That number is plotted on a chart as described above.  It is a useful tool to add to what a patient experiences daily plus what the eye looks like on clinical examination.  Together, the TearLab test allows a better understanding of the status of a patient’s Dry Eye and aids in management decisions.  We are also now seeing objective improvements in the tear film osmolarity after starting one of several prescriptions drops for the treatment of Dry Eye.  Click here to Learn More About Dry Eye Disease.  Thank you again for choosing Cary Eye Center and we look forward to another great year!

Sincerely yours,

Kevin D. O’Neal, MD, PhD

For a current review of the literature, see Potvin et al Clin Ophthalmol. 2015; 9: 2039–2047, a National Center for Biotechnology (NCBI) Information article.  You may click here to read it directly:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4636089/.