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Prevalence of hyperosmolarity in NHS ophthalmology clinics in England

Poster Details

First Author: G.Smith UK

Co Author(s):    F. Harman              

Abstract Details


To determine the overall prevalence of normal and abnormal tear osmolarity from a typical patient population at three NHS ophthalmology clinics.


Hillingdon Hospital, Middlesex, Great Western Hospital, Swindon, Wiltshire and St. Peter's Hospital, Chertsey, Surrey, United Kingdom


This was an observational, multi-site clinical study to measure tear osmolarity using an in-vitro diagnostic device (TearLab Osmolarity System, TearLab Corp., San Diego, CA). Three NHS ophthalmology clinics recruited up to 250 subjects from each of their clinics. Tear osmolarity was measured in both eyes with the TearLab System and the higher value was used in the diagnosis of hyperosmolarity (>308 mOsm/L). Investigators were masked to the tear osmolarity test results. Demographic data and conventional tests for Dry Eye disease (DED) including OSDI, ocular surface staining, tear film break up, and Schirmer’s tests were performed. Tear osmolarity results were compared to the investigators’ diagnosis of DED from conventional tests.


The interim results on 596 subjects showed that elevated tear osmolarity was prevalent in 72.3% of subjects. In addition, the results found that conventional tests did not correlate well with the presence of dry eye disease (DED) and indicated that almost half of all DED cases would not have been diagnosed. An elevated osmolarity measurement (326.8 mOsm/L average) was the primary sign in 20.1% of patients (120 individuals) that had significant symptoms but no other sign of dry eye. Without an osmolarity test, 86 of these 120 symptomatic patients (71.7%) may not have been diagnosed with DED. Data analysis on the final cohort of patients will be presented.


The study demonstrated the benefit of using an objective DED test. The current practice of diagnosing DED can result in ophthalmologists discounting the patients’ own reported symptoms on the OSDI and relying heavily on the results of subjective tests.

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