Tearlab test results
I had a Tearlab test done yesterday. I measured 296 in the drier right eye and my left eye came out as 'below normal range' (twice). It would appear that my tears are low osmolarity, even though I have dry eyes. The TBUT was 2 and 5 and mild staining.
I was wondering if I should still be using Oasis Tears drops. Would they cause too much of a drop in osmolarity? Does anyone know of what the implications are for low Tearlab test results and dry eye?
On another note, I had numbing drops for a pressure test. I don't have this done often, but the drops stung like crazy and my eyes were exceptionally sore that night. Does this drop tend to dry out the eye?
Hey there. I usually experience issues after a visit to the eye doc as they always use multiple foreign drops, so I think that is normal.
I have tried Oasis tears and I can't say they really helped much, but that doesn't mean they won't work for you.
How low is 296? Is what you consider your bad eye technically lower than the better eye (ie, were the results accurate in your opinion)? And what did the doctor recommend as the course of action?
My doctor uses 308 as an indicator of dry eye. So a reading of 296 would be in the 'normal' range. My left eye was out of the normal range, therefore under 275. At first glance these results would appear to be great news, even though they do not seem to be consistent with my level of discomfort.
Okay . . . I have done some more research since posting this morning. I may have started celebrating prematurely. It turns out that the Tearlab test can not differentiate between reflex and basal tearing. Reflex tears are more watery and therefore have a lower osmolarity reading. I found a couple of sources that indicated that it can be difficult to get accurate results because you don't know if you are catching reflex or basal tears. In my case, I suspect that I had reflex tears.
My doctor said that he prefers to look at the whole spectrum of results and not just the results of the Tearlab. He also said that how I feel is a more important indicator than any test. Treatment wise, we are going to continue with compresses, doxy, fish oils and my relaxation and meditation exercises.
I must admit I am more than a little concerned about the increasing prevalence of the Tearlab testing and the implications for potential lasik patients. One web article talked about using the Tearlab results to screen patients for 'dry eye' prior to lasik. Given the minimal research I have done, I would like to wave a red flag here. If you look at my results, with possible reflex tearing giving a possible false negative, than potential lasik patients with pre-existing dry eye may be considered as good candidates for surgery. These Tearlabs appear to be present in clinics that also offer laser eye surgery. Hopefully, most doctors will use other dry eye tests, however, I fear this won't always be the case. The Tearlab test is being touted as the gold standard for measuring dry eye.
What do others make of this use of Tearlab testing? Anyone else have Tearlab results to share? What do our docs have to say?
Last edited by Hopeful2; 26-Nov-2011 at 12:03.
Osmolarity testing can be an art form. Before I read anything into TearLab osmolarity reading I would want to have several test over several months and I would want a diary of the previous 3-4 hours before the test and during the test.
diary for 10 hours prior to testing:
-7:00 a.m. two drops of Refresh Endura in each eye
-7:00 a.m. to 2:00 p.m. no drops of any kind
-no exposure to potential irritants: wind, fans, crying
-during test. . . nothing out of ordinary
Fluoroscene drop and anesthetizing drop for pressure reading were administered after the Tearlab test.
Hopeful is it possible the heat started blowing between the two tests? Was a door opened to the exam room? There are many more questions or circumstances that cold impact the testing. Osmolarity can change significantly by the second. The person taking the test could walk in front of you creating a breeze that would evaporate the tears and then take a test reading. If the reading was taken too soon the test would read high, if the reflex tears started then the test could read low.
I did a significant amount of research on this subject and an osmolarity test in a repeatable environment would be fantastic for monitoring the benefits of treatments there seem to be too many variables currently affecting the accuracy of these devices.
Thank you indrep for your interst and concern. The door to the exam room was closed and I did not discern any heat source or blowing air. I am usually very much aware of any air circulation as I find it bothersome. The technician did walk across in front of me when going from the right to left eye. Also, she lightly tapped my eye with the instrument. I don't know how this can be avoided as the area she was working in is quite minute.
I did do some further research on the latest in osmolarity testing. I have provided three interesting and current sources for those of you reading who might have some questions. Please feel free to share your thoughts on this new technology.
Last edited by Hopeful2; 27-Nov-2011 at 10:51.
Reason: activate links
TearLab test results
One thing that is very important to remember about TearLab testing is that osmolarity is a very sensitive marker to therapy. In several studies, once osmolarity has been normalized (to less than 308 mOsm/L), it may take several more months for symptoms to be alleviated. If you had been on therapy prior to the test, then the most likely situation is that the therapy is working well and you should keep up hope that your symptoms will subside. Markers such as TBUT and staining tend to lag several months behind symptoms, so it is common to have a normal osmolarity with the other abnormal signs once therapy has begun.
Once the doctor has normalized your tear osmolarity, the healing process of the ocular surface can begin. It is also important to ask your doctor about other types of conditions that may be causing "dry eye" like discomfort but have nothing to do with dry eye, and would show up as a low osmolarity. We find that people previously assumed to have dry eye based on symptoms actually have things like conjunctivochalasis, proprioception disparity, or toxicity from preserved eyedrops, that may show up as a symptomatic, low osmolarity condition. There is quite a bit of value knowing that your osmolarity has been normalized!
Finally, as a technical aside, the day-to-day variability of TBUT, staining and Schirmers meet or exceed that of tear osmolarity. Thus, in very rare cases you may have reflex tearing in both eyes, which would artificially lower the value, however, if the doctor measures both eyes and takes the higher of the two, this shouldn't be an issue.
Is there anyone else out there who has Tearlab results that they would like to share? I am curious to know if you found your results to be consistent with your symptoms?
Once again. Hopeful2
Hi there - mine was 327 in both eyes. I suspect that the reading for my left eye was off though since it's the one that always has felt the driest. I remember I questioned the accuracy of it all since it took the technician a while to get enough tears out of either eye to do the test. By the time she got to my left eye, I could feel reflex tearing because of the flourescent lights above me for one thing. The number I got put me in the moderate category, leaning severe so yes, I would find that consistent with my symptoms. Nine years and counting with no real or relief or improvement in sight.