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    How tear proteomics can help optometry

     

     

    Ocular surface disease

    The tear layer covering the ocular surface is a complex body fluid containing thousands of molecules of varied form and function from several origins. Close to 2,000 tear proteins have been reported in humans.3 At least 90 small molecule metabolites have been seen in human tears.4

    This comprehensive array of biomolecules in human tears is a potential source for the discovery of disease biomarkers.

    Related: In-office lab testing provides diagnositc information

    Ocular surface disease is among the first eye diseases studied using proteomics, and currently five POC tests that make use of human tears in the diagnosis of ocular disease:

    • Osmolarity, TearLab Corporation (Figure 1)

    • InflammaDry Matrix metalloproteinase (MMP) 9 inflammatory marker, Quidel Corporation

    • AdenoPlus, Quidel Corporation

    • Lactoferrin, Advanced Tear Diagnostics (ATD)

    • Immunoglobulin E (IGE), Advanced Tear Diagnostics

    Other possibilities exist for additional POC testing.

    Meibomian gland dysfunction (MGD) also contributes to dry eye, and one study demonstrated that levels of some lipids critical for the maintenance of tear film stability increased after a 12-week eyelid warming treatment in MGD.5

    Tear bioassays may have advantages over conventional clinical assessments (i.e., Schirmer test, tear break-up time, corneal staining) for patient diagnosis, prognosis, and monitoring treatment responses.6

    Potential

    The potential for in-office POC testing is colossal. The tear film proteomic profile has been found to provide basic biological information for many ocular diseases such as keratoconus,7 thyroid eye disease,8 vernal keratoconjunctivitis,9 diabetic retinopathy,10 and primary open-angle glaucoma.11

    While human tear proteins are different from blood plasma proteins, nonetheless there are about 500 to 600 plasma proteins found in tears.3 This overlap may yield opportunities to observe systemic disease proteins in tears. Examples include breast cancer,12 type 2 diabetes,13 Alzheimer’s disease,14 and rheumatoid arthritis.15 Because some systemic diseases affect the eye, tear film proteomics has the potential to use tears as a means to assess systemic as well as ocular disease.

     

    Ernie Bowling, OD, MS, FAAO
    Dr. Ernie Bowling is Chief Optometric Editor of Optometry Times. He received his Doctor of Optometry and Master of Science in ...

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