VISITING A DRY EYE SPECIALIST --What tests to ask for

[Ariel]

If you've been lucky enough to find one, it may still be necessary for you to to tell him what tests will be necessary for him to perform in order to make an accurate diagnosis. I want to be thoroughly tested so that I can find the underlying causes of my condition before being subjected to any kind of treatment.

Rebecca mentioned in another link that asking our doctor if he can express our glands is a way to weed out the ones we should stay away from but finding a good eye doctor is not enough simply because he will never care about our eyes as much as you do and even if he does it is possible for him to miss something we won't want him to miss.

These are the test I would like to have made on my first visit.

● Schirmer's I
● Tear Breakup time
● Tear Meniscus height
● Fluorescein staining
● Rose Bengal staining
● Tear film osmolarity
● Impression cytology
● Brush cytology
● Tear lactoferrin
● mucin layer
● goblet cell density
● blepharitis
● meibonian glands
● skin disorders
● demodex
● H Pylory

I'd like to encourage those of you who have been battling with DE to mention anything else you'd like to see included on this list. We all need to take an active role in finding what's wrong with our eyes. We can't go from one doctor to the next hoping they would know what to do with us. I've found that most of them wont, even when it is we who pay for these expensive tests. For some reason, they seem to prefer prescribing medicine for a medical condition they know very little about and we waste our money without seeing our health improve.

With your help we can make sure this doesn't happen.

Ariel

[Guest]

Yeah... I would be surprised if a doc did all of those tests...

My understanding is that most of the tests for dry eye have a very poor correlation with patient symptoms anyhow...

A doc should be able to visually examine your MG's to see if they are producing proper oil...

As for the rest, I like it when a doc trusts the patient's assessment of how they are doing... if you say you are not doing well, they should trust that and treat you accordingly...

I think it is a good idea to check for things that may contribute to dry eye such as allergies, thyroid dysfunction etc... just to rule them out at least...

[Ariel]

Chenia,

I don't get it! The only reason a private doctor could have for objecting to doing any of these tests would be there being unnecessary and it that's the case he/she will have to convince me of it.

I hear of people with DES who spent years before being properly examined and diagnosed. I'm not interested in going through that so I'm planning on telling my eye doctor what I need from him instead of waiting for him to give it to me.

Rebecca mentioned in a related posting that she's asked doctors if they would express her glands, which I think is a great question. I may do the same thing through my doctor's secretary and if the answer is "No" I won't schedule a visit.

[Rebecca Petris]

I'm going to have to agree with Chemia and SAAG at least as regards the first part of your list. No eye doctor is going to do ALL these (much less in a single visit). Even if you fly to see one of the top dry eye specialists in the world they will not. In the medical literature there's a great deal of information that is inconsistent and confusing as to which of these test results are reproducible, which results consistently correspond to which others, and, critically, which actually correspond with SYMPTOMS (and... which may product a different answer... improving which result actually corresponds with improving symptoms IF it is possible to determine that?).

At the end of the day, while we all want to know exactly what's wrong and the best way to treat the cause... even more importantly we want to feel better and have dry eye interfere with our lives less. I think that it is possible to get bogged down in the technical diagnostic 'trees' of dry eye and miss the forest. I'm not saying that's happening to you, just suggesting it's something to be aware of.

Personally when I see a doctor, I want to know the following sorts of things.

- How's my basal tear production?
- How's my reflex tearing?
- How are my corneas looking? any dry spots?
- How are my meibomians: Are they producing oil? How much? What's the color and consistency?
- What signs of inflammation do you see, how much and where (cornea, conj, lids)?
- Flip my lids - how do they look underneath? (I have chronic GPC so this may not apply to others)
etc.

As to what technique the doctor uses to determine the answers, I don't care - every doctor I've been to has had their favorite tools and tests that they happen to be most comfortable with and that's fine with me.

And yes I stand by the gland expression litmus test ... Since MGD is a key problem for me, I want a hands-on eyelid savvy doctor.

EDIT / P.S.

I hear of people with DES who spent years before being properly examined and diagnosed.

I personally think this is not because their doctor just failed to do a specific test. It's because their doctor(s) did not have the necessary experience and/or interest in ocular surface diseases. Some of the best dry eye experts do very little specialized testing. They know the patterns to look for and can spot subtle signs of untreated diseases like MGD, ABMD or allergy very quickly.

[indrep]

Rebecca, et al. summed it up.

The one thing I would ask my doctor to do is take a baseline photo of my cornea with lissamine green staining and then one every 90 days to see if my corneal epithelium was healing from his/her treatment. Ninety days is a good time as that is about what it takes for new epithelial cells to completely cycle. If there were fewer "dots" then I would stay the course, the same or more "dots" I would change A something, as in one thing.

I woiuld also like an osmolarity test. Unfortunately few doctors have these currently and reliability is still questioned on these.

[Tempestuous]

And yes I stand by the gland expression litmus test ... Since MGD is a key problem for me, I want a hands-on eyelid savvy doctor.

Whats this?

P.S. Good thread. I was just thinking of making my own list for my next apt.

[mag]

Anyone found any doctor in London?

I am running at the moment from one hospital to another and getting info" I am not qualified enough,I have no knowledge etc." Any question I ask about dry eye I am getting answer "I do not know". I have dry eye almost 2 years now. Can't sleep.Asked doctors about Restasis -they have no idea what is that. The only thing they are doing and giving to anyone in UK is Systane or Viscotears.
That is it. Any test? They have no idea what test to do to check where is the problem. I had just shimmer test done by nurse which is showing that I have extremely dry eyes. I asked if I can have my hormones checked.The answer I got-i do not know.
Anyone found a doctor in UK? I am using this website and internet to find any medicine and buying it myself.Doing self treatment. Found recently ointment-Lacrilube.It helps me a little to survive night. during the day I have found on the internet-Celluvisc.
At the moment I think about going abroad to see a doctor.British medicine is like no medicine at all.

[irish eyes]

Is this with NHS, private or both?