Of the total, it was possible to grade 159, and an overall impression was generated for 163. Articles were further categorized by the nature of any reported financial support and by the overall impression they provided related to tear osmolarity.Ī total of 164 articles were identified as relevant to the search criteria, although some were editorials, and some were written in a foreign language. Relevant articles were graded according to quality of evidence and research, using the University of Michigan Practice Guideline and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) rating systems. In addition, to review the evidence for the role of tear osmolarity in the pathophysiology of DED and ocular surface disease.Ī literature review of all publications after the year 2000, which included the keywords "tear osmolarity", was conducted. To evaluate the evidence in the peer-reviewed literature regarding the use of tear osmolarity as a physiological marker to diagnose, grade severity, and track therapeutic response in dry eye disease (DED). The in situ osmometer has good repeatability for conducting this measurement. This highlights the importance of measuring tear film osmolarity directly on-eye. Tear film osmolarity measurement is influenced by the sample collection technique with the osmolarity of on-eye tears being higher than that of collected tears. This was a consistent effect because the measurements correlated well (r = 0.65, P < 0.05).The in situ osmometer showed good repeatability with a coefficient of repeatability of 9.4 mOsmol/L (r = 0.8, P < 0.05).Ĭorrelation between the two instruments was better when compared on collected tear samples. The mean (SD) osmolarity of on-eye tears was 5.0 (6.6) mOsmol/L higher than that of collected tears, when both measurements were conducted with the in situ osmometer. Mean (SD) tear film osmolarity with the in situ osmometer was 299.2 (10.3) mOsmol/L compared with 298.4 (10) mmol/kg with the vapor pressure osmometer, which correlated moderately (r = 0.5, P 0.05) but correlated well with those using the in situ osmometer (r = 0.9, P < 0.05). In a subset of 20 participants, tear osmolarity was measured twice on-eye with the in situ osmometer and was additionally determined on a sample of nonstimulated collected tears (3 μL) with both instruments. Osmolarity was measured in one randomly determined eye of 52 healthy participants using the in situ (TearLab Corporation, San Diego, CA) and the vapor pressure (Vapro 5520 Wescor, Inc., Logan, UT) osmometers. Repeatability of in situ measurements and the effect of sample collection techniques on tear film osmolarity were also evaluated. To compare tear film osmolarity measurements between in situ and vapor pressure osmometers.
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