In Reply Aquavella discusses several possible factors (such as blinking effects and transitions from different environments) that have been studied in laboratory settings and may have contributed to the variability of measurements that we observed in our study.1 However, it is important to note that we conducted our study under conditions that can practically be controlled in a clinical setting and are similar to how the device is typically used in clinical practice. For example, all of our osmolarity testing was carried out in a climate-controlled room with closely monitored temperature and humidity. In addition, we were careful not to induce reflex tearing when obtaining measurements, and all readings were performed in accordance with the manufacturer’s instructions.
Bunya VY, Fuerst NM, Massaro-Giordano M. Accuracy, Reliability, and Consistency in the Collection of Tear Film Osmolarity Data—Reply. JAMA Ophthalmol. 2015;133(12):1483. doi:10.1001/jamaophthalmol.2015.3897