Your opinions please...

[indrep]

To understand the "accreditation" issue is to understand how the company wants doctors to bill for the test. The test is not approved for a code in ophthalmology to be reimbursed by Medicare. So the doctor's office has to be approved/accredited as a "lab" so that the diagnostic test can be billed to insurance companies and medicare as if the doctors office is a legitimate lab. The accreditation, to my knowledge, really has nothing to do with being an accredited "dry eye center", it has to do with being an accredited "lab".

I am a big believer in lowering osmolarity of the tear film. The DEWS report lists hyperosmolarity as the starting point for inflammation.

[Hopeful2]

Great explanation of accreditation. . .not sure that I really understand what it is that the tearlab company is hoping to accomplish with labs and Mdeicare?

Is measuring the tear film's osmolarity an important step in reducing hyperosmolarity and thereby reducing inflammation? Is this something that should be routinely tracked as a measure of progress?

[indrep]

In the US 90% of eye patients in ophthalmologists offices are medicare patients. Medicare is the payment method of these patients. If there is no CPT code assigned to this diagnostic test then Medicare does not pay. This machine is quite costly and the disposable test itself is costly. If the insurance doesn't pay very few patients will pay out of pocket for the test. It is estimated there are up to 90 million people with some level of dry eye disease. Imagine if each of those people were tested only twice a year at $10 for each test that would be a 1.8 billion dollar expense to Medicare and the insurance companies. I think the charge for tearlab is around $35. So what tearlab wants, I assume, is for its doctors offices to become accredited as a lab and submit for insurance reimbursement as a lab test of tear film.

Increased osmolarity of the tear film is what opens the signaling pathways to the brain to start the inflammatory process. If we can lower the osmolarity we eliminate the environment for inflammation. Unfortunately a reliable, repeatable, cost effective test for measuring the osmolarity is elusive. Several companies are working on it.

[spmcc]

TearLab does not sell anything to consumers! Our objective for the site is simply to match people with dry eye problems with doctors that have the latest diagnostic technology (TearLab) and have shown a desire to treat patients with dry eye disease.

IMHO, "all about dry eye.com" is "all about selling a product.com". That it is hidden behind an "accredited" service is beside the point (for whatever reason this is being done).

The fact that the site mentions only one diagnostic test for dry eye screams to me that it is being sold. However, I am slightly informed. What about others?

If the site was really "all about dry eye", it would also mention such tests as Schirmer's, FCT, TBUT, dye staining, interferometry, etc. whether these test are "good" or not.

So, let's just be transparent... www.allaboutdryeye.com is a Tearlab site in disguise promoting its osmolarity test.

[Mawsky]

Well I confess I did not read every entry here yet, but my impression was that this reminded me of the advertisement for 1-800-DENTIST, so excuse the comparison if someone else saw that too. They make the same general statements and if you don't catch it (they count on you not) you would think that their Dentists (pre-screened) are the elite, top of their field, Dentists, what they are really are is members to 1-800-Dentist, and it is my understanding that they actually pay a fee to be a member, it is just a form of advertising, and it works. This is not to say that they are bad Dentists, or that tearlab is a bad testing tool, but I agreed and didn't find it all that informative, it did seem kind of superficial. Thank you Rebeca for pushing for the "about us" page.

[spmcc]

This is not to say that they are bad Dentists, or that tearlab is a bad testing tool

I agree! A few days ago, my cornea specialist said he was very excited about the "new" tests being developed for dry eye. He specifically mentioned interferometry (e.g., LipiView) and osmolarity tests (e.g., Tearlab).

I just believe that a site shouldn't pose as "caring, health care advice" when it is really selling a product (or service). Let's call a spade a spade.

Having said that, we should all know that everything on the internet needs to be taken with a large grain of salt!

[elias]

Rebecca, PotatoCakes, et al: your comments are very much appreciated
My conclusions after having read all the posts are that “Accredited Dry Eye Centers” appears to be evasive and if it was “TearLab Accredited Dry Eye Centers” it would be clear.
Coincidentally, this same discussion took place with our marketing folks who suggested TearLab Accredited Dry Eye centers would not look good in our seal/logo and we decided we were solving the issue by putting TearLab in large font in the middle. In fact, if you read the seal from top to bottom you get "Accredited TearLab Dry Eye Center".

Since we are also having an open forum discussion, here are my thoughts. Everyone on this site cares about dry eye disease and I have been reading it for years trying to understand the issues and concerns of dry eye sufferers which is one of the reasons I decided to get involved with TearLab.
We have received criticism about our marketing and logo from people whose lives I was personally hoping to be able to make a significant difference. I hope that there will be some recognition that finally there is an objective test that is sensitive enough to measure osmolarity, which is not just a marker, but believed to be one of the major causes of symptoms and damage associated with dry eye disease; and to also notice that we have been doing as lot of studies and research, including supporting a recently published study that showed how important the measurement of Osmolarity is in affecting post surgical Lasik results - an issue that is near and dear to many hearts.

We intend to continue our efforts to add to the body of knowledge in the area of dry eye disease, to continue research and to build public awareness, and yes to make our business successful. Success for us is selling doctors technology that will help better diagnose and manage dry eye disease.

I appreciate the opportunity to express my opinion.
Elias

[Guest]

I hope that there will be some recognition that finally there is an objective test that is sensitive enough to measure osmolarity, which is not just a marker, but believed to be one of the major causes of symptoms and damage associated with dry eye disease; and to also notice that we have been doing as lot of studies and research, including supporting a recently published study that showed how important the measurement of Osmolarity is in affecting post surgical Lasik results - an issue that is near and dear to many hearts.

We intend to continue our efforts to add to the body of knowledge in the area of dry eye disease, to continue research and to build public awareness, and yes to make our business successful. Success for us is selling doctors technology that will help better diagnose and manage dry eye disease.

I appreciate the opportunity to express my opinion.

The more research the better! I don't know a lot about your particular test, but assuming it's a good one (knowing folks with dry eye tend to have abnormal osmolarity of their tears), I think the most important thing will be to convince insurers that it's worth paying for. And if you ever bring this test to Canada, you'll have to get the provincial health dpt's to agree to cover it. If you can do THAT, I'm sure your test will be used a lot...

But I'm sure you already know that!

[poppy]

We have received criticism about our marketing and logo from people whose lives I was personally hoping to be able to make a significant difference. I hope that there will be some recognition that finally there is an objective test that is sensitive enough to measure osmolarity, which is not just a marker, but believed to be one of the major causes of symptoms and damage associated with dry eye disease; and to also notice that we have been doing as lot of studies and research, including supporting a recently published study that showed how important the measurement of Osmolarity is in affecting post surgical Lasik results - an issue that is near and dear to many hearts.

I do appreciate the fact that you guys are making some effort to help dry eye sufferers. Unfortunately by far the number one issue, in my opinion, that dry eye sufferers face is not the lack of research, tests and available treatments but the appalling and disinterested attitude of eye doctors. Many of the treatments, tests etc already out there are never offered to us because of the laziness and uncaring attitude of these doctors. Also I live in Australia which means it takes a very long time for treatments to be available for us even when they have been widely available in the US for years.

So, if you really want to help us the best way is to try to address the despicable attitudes of your colleagues.

[Argee]

Coincidentally, this same discussion took place with our marketing folks who suggested TearLab Accredited Dry Eye centers would not look good in our seal/logo and we decided we were solving the issue by putting TearLab in large font in the middle.

By all means, it's very important to have an attractive logo, regardless of how its meaning might be construed or misconstrued.

Your explanation of your intention with the logo might be credible except for what is plainly apparent to the eye, dry tho it may be. In the logos/seals on the homepage, "Tearlab" is in disappearing gray-on-gray type at, what, about 8-point flyspeck (depending on monitor size). Hardly a "large font." The center with the word "Tearlab" is surrounded by a bright orange border, where the "Accredited Dry Eye Center" text pops boldly in black, so much so that the center is nearly invisible. Very deft design when you're trying to hide something in plain sight. Further, the logos are buried on the bottom third of the page, one of them extreme bottom left.

Above the "fold" on the homepage, however, in nice, big, clearly legible italic white dropout type on medium blue ground...prominently indicated by a large ribbon graphic device whose points direct the eye immediately to the type that is more than double the size of the "Tearlab" in the logo...are the words "Accredited Dry Eye Centers." Oddly, the word "Tearlab" is missing.

We have received criticism about our marketing and logo from people whose lives I was personally hoping to be able to make a significant difference. I hope that there will be some recognition that finally there is an objective test

Recognition of new testing procedures, and their value, in no way precludes criticism about deceptive marketing. They are not mutually exclusive. You can have a great product and market it deceptively, which deserves criticism and, more importantly, which detracts from the value of a product. What adds value to a product, what wins customers from the very pool of people you are trying to target, is being 100% upfront about what you're doing. This means listening to your consumers instead of to the "marketing folks" who believe patients will be so dazzled by the fancy footwork that they won't notice you're stomping on their toes.

Success for us is selling doctors technology that will help better diagnose and manage dry eye disease.

How much more successful might you be if you "sold" dry eye patients on your company by demonstrating integrity, so that they would go to their practitioners and demand better diagnostics? Imagine the effect of a thread on a dry-eye message board where patients were crowing about a trustworthy company that not only developed a product that could help them but that also talked about it straight up! Treating patients honestly, representing your product honestly, could garner you thousand-fold the sales force you can reach by targeting physicians alone.

[Rebecca Petris]

I hope that there will be some recognition that finally there is an objective test that is sensitive enough to measure osmolarity, which is not just a marker, but believed to be one of the major causes of symptoms and damage associated with dry eye disease;

"...an objective test..." I'm sorry but I can't go that far. I've seen or heard of a number of osmolarity test development efforts over the years and don't have any competence to try to grasp how they compare. I have read many good things about yours and also read one or two things (example) that worried me about that selfsame sensitivity as regards the milder cases who arguably stand to gain the most from early treatment & prevention.

What I can recognize is this:
1) Osmolarity is a very important clinical feature/disease marker of our tear film.
2) A great deal of effort has gone into finding a reliable test for osmolarity and it is important this effort continue.
3) There are considerable economic hurdles to commercializing any osmolarity tests due to how the Medicare system works and what patients are willing/able to pay out of pocket. Disposable costs are a serious issue.
4) A successful metric has to have well established repeatability for the 'lowest common denominator' - the broadest customer base - the mild/mild-moderate dry eye patients.

So it is in that context that I appreciate TearLab's ongoing work.

and to also notice that we have been doing as lot of studies and research,

I do notice and appreciate it, in pretty much the same way that I appreciate the postmarket research funded by Allergan on Restasis. Collectively we accumulate an increasing body of knowledge. Individually I see a lot of studies with questionable methods or where I hear rumors in medical circles of various forms of data suppression. Even studies published in highly rated journals do not carry the weight they once did which is an unfortunate reality. In fact what this boils down to is that all of us here are struggling to find our way in a world where medicine - our doctor's office, not just drug/device companies - is business, and that is eloquently reflected in the spectrum of comments you're receiving on this topic. We are, collectively, viewing medical businesses with mingled hope and suspicion.

including supporting a recently published study that showed how important the measurement of Osmolarity is in affecting post surgical Lasik results - an issue that is near and dear to many hearts.

Yes, I saw that.

LASIK/PRK dry eye patients are a relatively small minority of our membership here at DryEyeTalk, but as you know it is a hot button for me.

In my opinion, the most important use of a reliable dry eye metric in LASIK practices should be to identify and exclude poor candidates. With fifteen years of LASIK behind us, there has been more than enough time to perform long term studies that would scientifically quantify a variety of risk factors for persistent dry eye, but the industry has not wanted it because who wants to shrink the candidate pool? Instead, the trend over the years - much as Dr. Donnenfeld suggests for TearLab - has been to more accurately identify those who can be pre-treated till their scores increase enough that they will, in the short term, be deemed to be healthy enough for the surgery while many of these, as we know in practice, actually suffer from chronic eyelid or autoimmune diseases. I have no doubt this approach improves short-term outcomes.

[brd888]

Hello

Hi.
I haven't read all the replies above but as for that site:
1-It seemed fairly honest to me and didn't appear to be selling anything.
2-The "find an accredited doctor" seemed interesting but then didn't seem to work.
3-It looks like a rudimentary copy of the Dry Eye Zone.
4-Not any different from any other dozen or so sites about dry eye apart from the similarities with Dry Eye Zone.

Regards
Bruce

[Eileen510]

I went to the site - here's my feedback:
1) first impression - too slick - too many picks of good looking people that haven't a clue about what it is to have dry eye. Can't tell who runs it or what their agenda is.
2) Find a doctor page starts with a form to enter a doctors name to recommend??? Odd.
I went back to the home page with the woman making her tea----I closed out - I had had enough.. this site is obviously sponsored but no place it states by who. Don't they know that they lose creditabilty in not stating their "agenda"

[eyemech]

I am going to try to chime in. Unfortunately, I appear to have been banned from posting. So, I won't waste key strokes on too long a post.
I have been using the TearLab for about 8 months. What it does afford me is the ability to measure a tear component, treat that with whatever means is available, and then remeasure it. There is no decent measurement otherwise. Schirmer is known to be pretty questionable. Staining...well, somewhat subjective. Lipiview..well, it probably works, but it costs 40,000 dollars and is only available if you drop an extra 60,000 in the machine and then $700 per test. Not billable, no reimbursement for the $1500 procedure...and you think that $35.00 out of pocket to measure osmolarity will ever make me rich? You think it will ever make the patient poor? And if you think anyone has ever come to my office because I am accredited, you are once again very very wrong. The company does need to increase awareness of their product which...no consumer can ever buy! So, where exactly is the scam? Do you feel that the company that makes schirmer strips is a scam? It doesn't even work...Is lissamine green a scam? Is lipiview a scam..? I have no idea, but how would you feel if you were a car dealer and General Motors didn't support you.
I personally don't pay a dime to have TearLab run their site. I am guessing what they mean is by my purchasing the strips, they can afford to pay a webmaster.
Enough said.

[Rebecca Petris]

Eyemech, you haven't been banned. I got your PMs about the problem you're having and I'm looking into it.

I didn't start this thread (which is an old one) to bash TearLab as a product, nor to reflect badly on any doctors using it. The concerns are about objectionable marketing methods.