A New Look at Dry Eye



A member of the AOA Contact Lens and Cornea Section, Renee Reeder, O.D., has invested many years researching better methods for detecting and treating dry eye. After tenure as chief of the cornea and contact lens service at the Illinois College of Optometry (ICO) for 14 years, Dr. Reeder now serves as an associate professor at the college. In an excerpt from an interview with AOA Focus, she discusses the latest technology improvements for detecting dry eye and why it's important for ODs to work with other physicians to better determine the causes of this condition in patients.


What have been some of the more significant findings in your dry eye research over the past few years?

I've worked with several corneal ophthalmologists here at ICO to try to figure out what we can do to make things better. A lot of what we've been doing is some new testing to try to identify dry eye in patients earlier.


What's important to know about the new testing?

For a long time we were very dependent on symptoms and looking at the tear breakup time. As things have evolved, we've learned that tear osmolarity and inflammation are very important. Tear osmolarity is an indicator of inflammation, and it will fluctuate early on in patients with dry eye, and especially as they get more progressive. A few years back, we finally found a device that would help us assess osmolarity in the clinic. We are able to get osmolarity readings early on and identify earlier those patients with variability in those readings.


We're also using a meibography type of program. There's been a lot of research on how to best manage patients who have an evaporative form of dry eye where the mebiomian glands are not producing properly. They're either not producing at all, or they're clogged and producing a very thick expression. So we struggled with how we identify it and how we could look at those glands. For the past few years, research has been looking at the glands with infrared technology. What a lot of the contact lens topography companies have found is that their topographers do a good job of looking at the meibomian glands. We have an instrument that not only images the gland but traces around each gland and will calculate percentage of gland loss for you.


What advice can you offer to ODs who are interested in this area of work?

Start treating patients with symptoms early. Don't wait until there's a lot of damage. If they're working with more traditional dry eye where there's poor tear production, consider partnering with doctors in rheumatology, even in internal medicine, to help them better understand why that condition is the way it is, and why that patient has that dry eye. Sometimes we forget that there's a body attached to those dry eyes. There may be other things going on with that person and with their bodies.