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Nättinen J, Aapola U, Nukareddy P, Uusitalo H. Looking deeper into ocular surface health: an introduction to clinical tear proteomics analysis. Acta Ophthalmol 2021; 100:486-498. [PMID: 34750985 DOI: 10.1111/aos.15059] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
Ocular surface diseases are becoming more prevalent worldwide. Reasons for this include the ongoing population ageing and increasing use of digital displays, although ophthalmologists have a wide selection of tools, which can be implemented in the evaluation of the ocular surface health, methods, which enable the in-depth study of biological functions are gaining more interest. These new approaches are needed, since the individual responses to ocular surface diseases and treatments can vary from person to person, and the correlations between clinical signs and symptoms are often low. Modern mass spectrometry (MS) methods can produce information on hundreds of tear proteins, which in turn can provide valuable information on the biological effects occurring on the ocular surface. In this review article, we will provide an overview of the different aspects, which are part of a successful tear proteomics study design and equip readers with a better understanding of the methods most suited for their MS-based tear proteomics study in the field of ophthalmology and ocular surface.
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Affiliation(s)
- Janika Nättinen
- SILK Department of Ophthalmology Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Ulla Aapola
- SILK Department of Ophthalmology Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Praveena Nukareddy
- SILK Department of Ophthalmology Faculty of Medicine and Health Technology Tampere University Tampere Finland
| | - Hannu Uusitalo
- SILK Department of Ophthalmology Faculty of Medicine and Health Technology Tampere University Tampere Finland
- Tays Eye Centre Tampere University Hospital Tampere Finland
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102
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Bakkar MM, El-Sharif AK, Al Qadire M. Validation of the Arabic version of the Ocular Surface Disease Index Questionnaire. Int J Ophthalmol 2021; 14:1595-1601. [PMID: 34667738 DOI: 10.18240/ijo.2021.10.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To develop an Arabic version of the ocular surface disease index (OSDI) and to assess its reliability and validity. METHODS A cross sectional study was carried out to validate the Arabic version of the OSDI questionnaire. Initially, forward-backward translation was used to translate the English version of OSDI into Arabic. The translated questionnaire was tested for equivalence and cultural adaptability. Totally 200 subjects were then recruited from a non-clinical population and asked to complete the Arabic version of the OSDI (ARB-OSDI). The reliability of the questionnaire was assessed using Cronbach's-α. A subgroup of 30 participants was asked to complete the questionnaire on two occasions to test the test-retest reliability. RESULTS A total of 200 participants were enrolled in the study. The average age of the study participants was 31.21±13.2y and 57% were male. An acceptable internal consistency level for the ARB-OSDI questionnaire measured by Cronbach's-α was revealed. All questions showed good internal consistency. Test-retest reliability analysis revealed good stability (interclass correlation coefficient, r=0.832, P<0.001). The construct validity for the questionnaire was also high. CONCLUSION The ARB-OSDI questionnaire shows very good psychometric properties (acceptable internal consistency and test-retest reliability). That makes the questionnaire a valid potential tool to use in Arabic-speaking countries to monitor symptoms of dry eye disease in a larger population.
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Affiliation(s)
- May M Bakkar
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ahmad K El-Sharif
- Department of English Language and Literature, Faculty of Arts and Humanities, Al Al-Bayt University, Mafraq 25113, Jordan
| | - Mohammad Al Qadire
- Department of Adult Health, Faculty of Nursing, Al Al-Bayt University, Mafraq 25113, Jordan.,College of Nursing, Sultan Qaboos University, Muscat 123, Oman
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103
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Koh S, Chalmers R, Yamasaki K, Kawasaki R, Nishida K. Factors influencing the 8-item contact lens dry eye questionnaire score and comparison of translations in Japanese soft contact lens wearers. Cont Lens Anterior Eye 2021; 45:101519. [PMID: 34620551 DOI: 10.1016/j.clae.2021.101519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/21/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To determine (1) the factors associated with a high degree of self-reported symptoms with Japanese translations of the 8-Item Contact Lens Dry Eye Questionnaire (J-CLDEQ-8) in a cross-section of soft contact lens (SCL) wearers in Japan and (2) whether the difference in translation of the CLDEQ-8 affects the scores between validated and non-validated versions of the Japanese translation. METHODS Habitual SCL wearers completed the validated J-CLDEQ-8 and a previous non-validated version. Demographics and SCL history questions were queried when they presented for routine eye care in nine geographically distinct clinics across Japan. The following risk factors for high J-CLDEQ-8 scores (≥11) were tested: sex, age, SCL replacement (daily disposable vs. bi-weekly and monthly reusable), years of SCL wear, and self-reported use of rewetting drops. The scores of the validated and non-validated questionnaires were compared. RESULTS Significant patient-related risk factors for high J-CLDEQ-8 scores were female sex, use of reusable SCLs, longer years of SCL wear, and use of rewetting drops. Scores for six out of eight questions in the validated J-CLDEQ-8 were significantly higher than those of the non-validated version, resulting in a significant difference in the average total score between the two questionnaires (validated J-CLDEQ-8: 10.5 ± 5.9 vs non-validated J-CLDEQ-8: 9.5 ± 5.8, P < 0.001). CONCLUSIONS Female sex, use of reusable SCLs, longer years of SCL wear, and use of rewetting drops were significant risk factors for high J-CLDEQ-8 scores in a cross-sectional clinical population of Japanese SCL wearers. Symptoms with SCL are not predicted by age and must therefore be queried at follow-up visits for all SCL wearers. Differences in the two translations affected the ability of the questionnaire to identify individuals with high symptoms associated with SCL wear.
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Affiliation(s)
- Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | | | | | - Ryo Kawasaki
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Vision Informatics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan
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104
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Talens-Estarelles C, García-Marqués JV, Cervino A, García-Lázaro S. Online Vs In-person Education: Evaluating the Potential Influence of Teaching Modality on Dry Eye Symptoms and Risk Factors During the COVID-19 Pandemic. Eye Contact Lens 2021; 47:565-572. [PMID: 34224445 DOI: 10.1097/icl.0000000000000816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the potential effects of switching to online lecture format on dry eye symptoms and dry eye disease (DED) risk factors. METHODS An anonymous cross-sectional online survey was conducted in 812 university students (mean age, 21.5±4.0 years). Participants were classified according to the number of hours the participants took online lectures into online students or in-person students. Respondents completed a total of three DED questionnaires (Ocular Surface Disease Index [OSDI]; 5-item Dry Eye Questionnaire; 8-item Contact Lens Dry Eye Questionnaire) and were surveyed on dry eye risk factors contemplated by the Tear Film and Ocular Surface Society Dry Eye Workshop II in addition to other factors potentially linked to dry eye. RESULTS Five hundred twenty-three subjects (64.4%) were classified into the online group and 289 (35.6%) into the in-person group. No statistically significant age (P=0.266) or sex (P=0.423) differences were found between groups. Students taking online lectures used the computer more, spent less time outdoors, practised more exercise, wore a face mask for less time, experienced fewer allergies and fewer psoriasis episodes, and obtained a higher OSDI score (P<0.029 for all). Multivariate logistic regression analysis revealed that the hours of online lectures taken per week was independently associated with having a positive OSDI score (P=0.022). CONCLUSIONS Taking online lectures is independently associated with having dry eye symptoms. Despite a lower prevalence of DED risk factors, a higher computer use is probably behind the greater ocular dryness reported by online students.
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Affiliation(s)
- Cristian Talens-Estarelles
- Optometry Research Group, Department of Optics & Optometry & Vision Sciences, University of Valencia, Valencia, Spain
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105
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Chatterjee S, Agrawal D, Chaturvedi P. Ocular Surface Disease Index © and the five-item dry eye questionnaire: A comparison in Indian patients with dry eye disease. Indian J Ophthalmol 2021; 69:2396-2400. [PMID: 34427230 PMCID: PMC8544040 DOI: 10.4103/ijo.ijo_3345_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Purpose: To compare the suitability of the Ocular Surface Disease Index (OSDI) and the 5-item Dry Eye Questionnaire (DEQ-5) in Indian patients with dry eyes. Methods: This cross-sectional study evaluated the OSDI and DEQ-5 in patients with tear film abnormalities. Tear film breakup time, tear film height, Schirmer’s I, lissamine green staining, and meibomian gland expressibility were performed on each patient. Results: There were 101 patients with symptoms and/or signs of tear film abnormality. Both OSDI and DEQ-5 questionnaires significantly correlated (ρ = 0.566, P < 0.0001) with each other. The OSDI questionnaire showed a good correlation with all dry eye tests, whereas the DEQ-5 correlated significantly only with the tear film breakup time and the lissamine green score. None of the questionnaires correlated with meibomian gland expressibility. The Bland–Altman analysis revealed a marginal bias (−0.01 unit) for DEQ-5. The DEQ-5 scored higher in patients with mild symptoms. While 101 (100%) patients answered all the questions in the DEQ-5, only 19 (18.8%) patients answered all the questions in the OSDI questionnaire. The least responses were recorded in the vision-function-related and environmental trigger subscales of the OSDI. Conclusion: The OSDI and DEQ-5 scores showed a moderate correlation. The OSDI questionnaire correlated with a higher number of dry eye tests than the DEQ-5. The large number of skipped questions in the vision-function-related and environmental trigger subscales of the OSDI suggests that the questionnaire is not adequately adapted to the Indian population. Patients with a negative OSDI score should be reassessed with the DEQ-5 to exclude symptom positivity.
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Affiliation(s)
- Samrat Chatterjee
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Deepshikha Agrawal
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
| | - Pravda Chaturvedi
- Cornea and Anterior Segment Services, MGM Eye Institute, Raipur, Chhattisgarh, India
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106
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Cheng AM, Hwang J, Dermer H, Galor A. Prevalence of Ocular Demodicosis in an Older Population and Its Association With Symptoms and Signs of Dry Eye. Cornea 2021; 40:995-1001. [PMID: 32956104 PMCID: PMC7981278 DOI: 10.1097/ico.0000000000002542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/05/2020] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate associations between Demodex and its symptoms and ocular surface parameters in individuals with dry eye (DE). METHODS A cross-sectional study of 119 individuals with DE symptoms or signs, grouped by the presence of ocular demodicosis, was performed. All individuals filled out questionnaires and underwent an ocular surface examination. Demographics, comorbidities, symptoms profiles, and ocular surface parameters were compared between the 2 groups. Multivariable regression analyses were used to determine which factors were associated with DE symptoms. Receiver operating curves analyses were performed to evaluate relationships between Demodex quantity and specific clinical phenotypes. RESULTS Demodex was highly prevalent in our population (68.9%) with average counts of 4.2 ± 3.9. Individuals with and without Demodex had comparable demographics. Overall, symptoms profiles were similar between individuals with and without Demodex using the Dry Eye Questionnaire 5 and Ocular Surface Disease Index. Individuals with Demodex, however, were more likely to report itching (58.5% vs. 35.1%, P = 0.03), with increasing frequency in those with higher Demodex counts. Individuals with Demodex also had more severe eyelid abnormalities [cylindrical dandruff (CD) and lid vascularity] and a more unstable tear film but similar tear production and corneal staining when compared with individuals without Demodex. Neither Demodex nor ocular surface findings related to DE symptoms in multivariable analyses. Receiver operating curves analysis revealed Demodex counts ≥2 maximized sensitivity and specificity for both itching (64.7% and 59.0%, respectively) and CD (80.4% and 60.4%, respectively). CONCLUSIONS Demodex is highly prevalent in an older population with DE. Symptom of itching and CD were the findings most specific for Demodex.
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Affiliation(s)
- Anny Mansim Cheng
- Miami Veterans Administration Medical Center, Miami, FL, USA
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Jodi Hwang
- Miami Veterans Administration Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Harrison Dermer
- Miami Veterans Administration Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA
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Cartes C, Segovia C, Salinas-Toro D, Goya C, Alonso MJ, Lopez-Solis R, Zapata C, Cabezas M, Yañez P, Flores-Rodriguez P, Lopez D, Matus G, Traipe L. Dry Eye and Visual Display Terminal-Related Symptoms among University Students during the Coronavirus Disease Pandemic. Ophthalmic Epidemiol 2021; 29:245-251. [PMID: 34251964 DOI: 10.1080/09286586.2021.1943457] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To evaluate dry eye (DE) and subjective visual display terminal (VDT)-related symptoms in university students who moved their classes online due to the COVID-19 pandemic.Methods: Cross-sectional study of students who were taking online classes. In May 2020, the participants completed a Dry Eye Questionnaire (DEQ-5) and a self-report survey, which included demographics, medical history, information on the use of VDT and presence of VDT-related symptoms. Participants were classified as having mild/moderate (7-12) or severe (>12) DE symptoms based on their DEQ-5 score. The associations between severe DE symptoms and relevant factors were also evaluated.Results: The data of 1450 eligible students were analyzed. The mean age of the participants was 21.1 (2.7) years. 42.8% of the participants had mild/moderate DE symptoms, whereas 34.7% had severe symptoms. Associated factors for severe DE were female sex (OR = 2.57, CI [1.97-3.35]), allergic disease (OR = 1.63, CI [1.24-2.13]), previous dry eye diagnosis (OR = 13.49, CI [7.10-25.63]), keratoconus (OR = 5.56, CI [1.27-24.44], contact lens use (OR = 1.77, CI [1.24-2.53]) and duration of VDT use (OR = 1.02, CI [1.01-1.05]). Prior to the pandemic, the mean reported duration of VDT use was 9.8 (4.7) hours; this increased to 15.9 (5.8) hours during the online classes (p < .001). 80.6% of the participants reported a global increase in VDT-related symptoms.Conclusion: Students taking online classes had a high frequency of DE symptoms. They also reported a significant increase in VDT-related symptoms. DE should be considered as an emerging health problem among the young population, which is probably related to the recent changes in lifestyle.
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Affiliation(s)
- Cristian Cartes
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile.,Departamento de Especialidades, Facultad de Medicina, Unidad Oftalmología, Universidad de La Frontera, Temuco, Chile.,Centro de la Visión, Red Centro Oftalmológico Laser, Santiago, Chile
| | | | - Daniela Salinas-Toro
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile.,Clínica Las Condes Santiago, Santiago, Chile
| | - Claudia Goya
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile
| | | | | | - Claudia Zapata
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile.,Centro de la Visión, Red Centro Oftalmológico Laser, Santiago, Chile
| | - Mauricio Cabezas
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile.,Clínica Las Condes Santiago, Santiago, Chile
| | - Patricio Yañez
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile
| | | | - Daniela Lopez
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile.,Clínica Las Condes Santiago, Santiago, Chile
| | - Gonzalo Matus
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile.,Clínica Las Condes Santiago, Santiago, Chile
| | - Leonidas Traipe
- Unidad de Lágrima y Superficie Ocular (ULSO), Santiago, Chile.,Clínica Las Condes Santiago, Santiago, Chile
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108
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Levine H, Hwang J, Dermer H, Mehra D, Feuer W, Galor A. Relationships between activated dendritic cells and dry eye symptoms and signs. Ocul Surf 2021; 21:186-192. [PMID: 34102312 PMCID: PMC8328957 DOI: 10.1016/j.jtos.2021.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/01/2021] [Accepted: 06/01/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE To examine whether "activated" dendritic cells (aDCs) could serve as a biomarker of systemic immune disorders in individuals with dry eye (DE) symptoms. Secondarily, to examine the impact of a topical anti-inflammatory agent on aDC number. METHODS Retrospective analysis was conducted to identify individuals with DE symptoms who had in-vivo confocal microscopy (IVCM) imaging between October 2018 and July 2020 at the Miami Veterans Hospital. aDCs were manually quantified based on morphology. Receiver operating curve (ROC) analysis examined relationships between aDC number and systemic immune disease status. Individuals were then grouped by aDC number (≥2 versus <2) and demographics and DE parameters were examined. Paired t-test was performed to evaluated aDC number pre-vs post-initiation of an anti-inflammatory agent. RESULTS 128 individuals were included. Their mean age was 57.1 ± 15.0 years; 71.1% were male, 53.1% self-identified as White and 24.2% as Hispanic. The mean number of aDCs in the central cornea was 1.28 ± 2.16 cells/image. The presence of ≥2 aDCs had a sensitivity of 60% and specificity of 77% for the diagnosis of a systemic immune disorder. Individuals with ≥2 aDCs were more likely to self-identify as Black, have Secondary Sjögren's, and have higher nerve fiber area and fractal dimension. In 12 individuals, aDC number decreased from 2.69 ± 2.36 to 0.58 ± 0.73 cells/image after initiation of an anti-inflammatory agent, p = 0.01. CONCLUSIONS The presence of ≥2 aDCs in the central cornea suggests a systemic immune disorder in individuals with DE symptoms. Topical anti-inflammatory therapy can reduce the number of aDCs in the central cornea.
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Affiliation(s)
- Harry Levine
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jodi Hwang
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Harrison Dermer
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Divy Mehra
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Anat Galor
- Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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109
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Abstract
PURPOSE OF REVIEW Dry eye disease (DED) is a multifactorial disease affecting approximately 5-50% of individuals in various populations. Contributors to DED include, but are not limited to, lacrimal gland hypofunction, meibomian gland dysfunction (MGD), ocular surface inflammation, and corneal nerve dysfunction. Current DED treatments target some facets of the disease, such as ocular surface inflammation, but not all individuals experience adequate symptom relief. As such, this review focuses on alternative and adjunct approaches that are being explored to target underlying contributors to DED. RECENT FINDINGS Neuromodulation, stem cell treatments, and oral royal jelly have all been studied in individuals with DED and lacrimal gland hypofunction, with promising results. In individuals with MGD, devices that provide eyelid warming or intense pulsed light therapy may reduce DED symptoms and signs, as may topical Manuka honey. For those with ocular surface inflammation, naturally derived anti-inflammatory agents may be helpful, with the compound trehalose being farthest along in the process of investigation. Nerve growth factor, blood-derived products, corneal neurotization, and to a lesser degree, fatty acids have been studied in individuals with DED and neurotrophic keratitis (i.e. corneal nerve hyposensitivity). Various adjuvant therapies have been investigated in individuals with DED with neuropathic pain (i.e. corneal nerve hypersensitivity) including nerve blocks, neurostimulation, botulinum toxin, and acupuncture, although study numbers and design are generally weaker than for the other DED sub-types. SUMMARY Several alternatives and adjunct DED therapies are being investigated that target various aspects of disease. For many, more robust studies are required to assess their sustainability and applicability.
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Affiliation(s)
- Rhiya Mittal
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Sneh Patel
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
- Research Services, Miami Veterans Affairs Medical Center, Miami, FL, USA
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110
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Therapeutic benefits of blinking exercises in dry eye disease. Cont Lens Anterior Eye 2021; 44:101329. [DOI: 10.1016/j.clae.2020.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/12/2020] [Accepted: 04/23/2020] [Indexed: 12/23/2022]
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111
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Ilechie A, Mensah T, Abraham CH, Addo NWA, Ntodie M, Ocansey S, Boadi-Kusi SB, Owusu-Ansah A, Ezinne N. Assessment of four validated questionnaires for screening of dry eye disease in an African cohort. Cont Lens Anterior Eye 2021; 45:101468. [PMID: 34016544 DOI: 10.1016/j.clae.2021.101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/27/2021] [Accepted: 05/09/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the 5-item dry eye questionnaire (DEQ-5) for measurement precision and unidimensionality, and assess the ability of Ocular Surface Disease Index (OSDI), McMonnies Dry Eye Questionnaire (MQ), Ocular Comfort Index questionnaires (OCI), and DEQ to predict clinical measures of DED in an African population. METHOD Participants (n = 113; mean age 24.7 ± 5.4 years) completed all four questionnaires administered in a randomized order. Internal consistency and test-retest reliability of the instruments were assessed. A masked examiner performed clinical dry eye tests in both eyes of participants and the results used to classify into either "dry" or "non-dry" groups. The diagnostic criteria for dry eye disease were tear break up time (TBUT) < 10 s plus at least one of Schirmer <15 mm in 5 min., > 5 corneal staining spot, or > 9 conjunctival staining spots. Rasch analysis was performed to assess the DEQ for unidimensionality and measurement precision, and receiver operating characteristic curve (AUC) analysis was used to assess the ability of the four questionnaires to predict clinical measures of DED. RESULTS The responses from the DEQ-5 met the Rasch analysis criterion of unidimensionality with infit and outfit values of between 0.74-1.43 mean-square and 0.69-1.49 mean-square, respectively, and measurement precision of 2.33. Internal consistency and test-retest reliability of each test was high, with Cronbach alpha >0.70 for the questionnaire and their respective subscales but internal consistency reliability of the MQ was poor (Cronbach's alpha = 0 .29-0 0.52). Each test segregated the "dry" and "non-dry" groups with moderate (all AUC 0.70-0.80) and similar accuracy (P > .05). CONCLUSION The DEQ -5 demonstrated adequate measurement precision and unidimensionality. Each of the four questionnaires showed psychometric validity for clinical use in the African population, and modest and similar accuracy when screening for dry eye signs but the performance of the McMonnies questionnaire was limited in terms of internal consistency reliability.
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Affiliation(s)
- Alex Ilechie
- Department of Optometry and Vision Science, University of Cape Coast, Ghana
| | - Thomas Mensah
- Department of Optometry and Vision Science, University of Cape Coast, Ghana
| | | | | | - Michael Ntodie
- Department of Optometry and Vision Science, University of Cape Coast, Ghana
| | - Stephen Ocansey
- Department of Optometry and Vision Science, University of Cape Coast, Ghana
| | | | - Andrew Owusu-Ansah
- Department of Optometry and Vision Science, University of Cape Coast, Ghana
| | - Ngozi Ezinne
- St Augustines Campus, University of West Indies, Trinidad and Tobago
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112
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Wolffsohn JS, Wang MTM, Vidal-Rohr M, Menduni F, Dhallu S, Ipek T, Acar D, Recchioni A, France A, Kingsnorth A, Craig JP. Demographic and lifestyle risk factors of dry eye disease subtypes: A cross-sectional study. Ocul Surf 2021; 21:58-63. [PMID: 33965652 DOI: 10.1016/j.jtos.2021.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate demographic and lifestyle factors associated with aqueous deficient and evaporative dry eye disease. METHODS A total of 1125 general public visitors (707 females, mean ± SD age, 33 ± 21, range 5-90 years) at the Royal Society Summer Science Exhibition were recruited in a cross-sectional study. A demographic and lifestyle factor questionnaire was administered, and dry eye symptomology (DEQ-5 score), ocular surface characteristics (conjunctival hyperaemia, and infrared meibography), and tear film parameters (tear meniscus height, non-invasive breakup time, and lipid layer grade) were evaluated for the left eye of each participant within a single session. The diagnostic criteria for dry eye disease subtypes were adapted from the rapid non-invasive dry eye assessment algorithm. RESULTS Overall, 428 (38%) participants fulfilled the diagnostic criteria for dry eye disease, 161 (14%) with aqueous deficient dry eye disease, and 339 (30%) with evaporative dry eye disease. Multivariate logistic regression demonstrated that advancing age, female sex, reduced sleep duration, higher psychological stress, and poorer self-perceived health status were independently associated with aqueous deficient dry eye disease (all p < 0.05). Significant risk factors for evaporative dry eye disease included advancing age, East and South Asian ethnicity, contact lens wear, increased digital device screen exposure, higher psychological stress, and poorer self-perceived health status (all p < 0.05). CONCLUSIONS Both subtypes of dry eye disease were associated with several unique and shared demographic and lifestyle factors. The findings of this study could inform future research design investigating the utility of targeted screening and risk factor modification for the prevention and management of dry eye disease.
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Affiliation(s)
- James S Wolffsohn
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Maria Vidal-Rohr
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Francesco Menduni
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Sandeep Dhallu
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Tugce Ipek
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK; Centre for Craniofacial Biology and Regeneration, King's College London, London, UK
| | - Duygu Acar
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Alberto Recchioni
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK; Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham and Midland Eye Centre, Birmingham, UK
| | | | - Alec Kingsnorth
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Jennifer P Craig
- Optometry and Vision Sciences, College of Health and Life Sciences, Aston University, Birmingham, UK; Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand.
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113
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Mehra D, Mangwani-Mordani S, Acuna K, C Hwang J, R Felix E, Galor A. Long-Term Trigeminal Nerve Stimulation as a Treatment for Ocular Pain. Neuromodulation 2021; 24:1107-1114. [PMID: 33945660 DOI: 10.1111/ner.13402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Ocular pain symptoms (e.g., hypersensitivity to light and wind, "burning" sensations) can be debilitating and difficult to treat. Neuromodulatory therapies targeting sensory trigeminal and central pain pathways may help treat chronic ocular pain refractory to traditional therapies. The current study evaluates the long-term effects of a trigeminal neurostimulator (TNS) on ocular pain. MATERIALS AND METHODS Retrospective review of 18 individuals at the Miami Veterans Affairs Eye Clinic with chronic, severe ocular pain who were prescribed and used TNS at home for ≥3 months. The primary outcome measures were 1) ocular symptom intensity over a 24-hour recall period (dryness, pain, light sensitivity, wind sensitivity, burning; rated on 0-10 scales) captured pre-TNS and at monthly follow-up intervals and 2) side effects. The frequency and duration of TNS was a secondary outcome measure. RESULTS The mean age of the population (n = 18) was 57.5 years (range, 34-85 years) with a male majority (67%). Two individuals discontinued use due to lack of efficacy and one due to confounding health issues. Initial mean weekly frequency of TNS use was 3.7 ± 1.9 sessions of 25.8 min at month 1 and 2.7 ± 2.3 sessions of 28.0 min at month 6. At six months, pain intensity (↓ 31.4%), light sensitivity (↓ 36.3%), wind sensitivity (↓ 32.6%), and burning sensation (↓ 53.9%) were all decreased compared to baseline (p < 0.01 for all); greater decreases in ocular pain were noted in individuals with migraine (n = 10) than those without migraine (n = 8). No significant change was noted in mean dryness scores. Fifteen subjects experienced sedation with TNS use, persisting throughout the follow-up visits. No other adverse effects were communicated by any subjects. CONCLUSION Our study suggests TNS is a safe, adjunctive treatment option in individuals with severe, chronic ocular pain. Individuals demonstrated gradual, continual improvement in pain symptoms over time within a multimodal approach.
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Affiliation(s)
- Divy Mehra
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA.,Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | | | - Kelly Acuna
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA
| | - Jodi C Hwang
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA.,University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Elizabeth R Felix
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA.,Physical Medicine and Rehabilitation, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Surgical and Research Services, Miami Veterans Affairs Medical Center, Miami, Florida, USA.,Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
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114
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Akowuah PK, Adjei-Anang J, Nkansah EK, Fummey J, Osei-Poku K, Boadi P, Frimpong AA. Comparison of the performance of the dry eye questionnaire (DEQ-5) to the ocular surface disease index in a non-clinical population. Cont Lens Anterior Eye 2021; 45:101441. [PMID: 33836971 DOI: 10.1016/j.clae.2021.101441] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare the performance of the dry eye questionnaire (DEQ-5) with the Ocular Surface Disease Index (OSDI) and further validate the DEQ-5 questionnaire. METHODS A population-based cross-sectional study conducted in Ghana. OSDI and DEQ-5 questionnaires were administered to participants. Cronbach's alpha was used to evaluate the reliability of the OSDI and DEQ-5 questionnaires. Analysis of variance was used to evaluate the discriminant validity of DEQ-5. Concurrent validity was evaluated using the Spearman correlation analysis. A receiver operating characteristic (ROC) curve was generated to describe the sensitivity and specificity of the DEQ-5 questionnaire for diagnosis of dry eye symptoms. Cohen Kappa was used to evaluate agreement between the two questionnaires. RESULTS The reliability of the overall OSDI and DEQ-5 scores were 0.919 and 0.819 respectively. The mean (SD) DEQ-5 scores for asymptomatic, mild, moderate and severe dry eye symptoms as defined by the OSDI grading were 3.05 (2.73), 5.13 (3.69), 7.65 (3.30) and 9.77 (4.16) respectively. There was a statistically significant correlation between total OSDI and total DEQ-5 scores (rs = 0.649, p < 0.0001). The area under the curve (AUC) of the ROC curve for DEQ-5 was 0.835 (95 % CI: 0.796 - 0.875). A DEQ-5 threshold of 5.5 yielded maximum sensitivity (0.712) and specificity (0.827). The Cohen kappa using a the DEQ-5 total score threshold of 5.5 was K = 0.539 (p < 0.0001). CONCLUSION In conclusion, performance of the DEQ-5 questionnaire in discriminating symptoms of dry eye is comparable to the OSDI questionnaire. The DEQ-5 questionnaire is a valid measure of dry eye symptoms and can be used as a dry eye symptoms assessment tool in both clinical and epidemiological studies.
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Affiliation(s)
- Prince Kwaku Akowuah
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; College of Optometry, University of Houston, Houston, TX, USA.
| | - Joseph Adjei-Anang
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Ernest Kyei Nkansah
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Jeremiah Fummey
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Kofi Osei-Poku
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Prince Boadi
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Asafo Agyei Frimpong
- Department of Optometry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Arora R, Sandhu N, Dokania P, Subramanian A. Ocular Manifestations in Patients of HIV(Human Immunodeficiency Virus) Infection on Combined Anti-Retroviral Therapy (CART). Ocul Immunol Inflamm 2021; 30:1399-1407. [PMID: 33793390 DOI: 10.1080/09273948.2021.1881562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim: To determine the prevalence and spectrum of ocular manifestations in PLHIV (people living with Human Immunodeficiency Virus) on cART (combined Antiretroviral Therapy) and correlate them with WHO clinical staging, CD4 count, duration & type of cART.Methods: Observational cross-sectional study. Ophthalmic evaluation of 350 PLHIV on cART (at least 6 months) was done. Logistic regression was done to correlate ocular findings with different variables. Results: Prevalence of ocular, anterior & posterior segment manifestations was 15.71%, 10.86%, and 4.00%, respectively. Dry eye(8.00%) being the most common finding. PLHIV with CD4 count ≤350 (OR = 3.1,p < 0.001), in WHO stage 3 (OR = 26.9,p = 0.004) & 4(OR = 60.7,p < 0.001) & on 3rdlineART were at much higher risk of ocular manifestations as compared to those on 2nd (OR = 2.83) and 1stline (OR = 6.6) of therapy. Duration of treatment had a protective (p = 0.01) effect on bilateral manifestations.Conclusion: With early initiation of ART, there is significant reduction in the overall prevalence of ocular findings, in the number of opportunistic ophthalmic infections and blinding disorders. Of all the reported ocular findings, anterior segment disorder emerged more often.
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Affiliation(s)
- Ritu Arora
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, Delhi University, New Delhi, India
| | - Neha Sandhu
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, Delhi University, New Delhi, India
| | - Pallavi Dokania
- Department of Ophthalmology, Guru Nanak Eye Centre, Maulana Azad Medical College, Delhi University, New Delhi, India
| | - Anuradha Subramanian
- Department of Medicine, Nodal Officer, ART Centre, Maulana Azad Medical College and Associated Lok Nayak Hospital, Delhi University, New Delhi, India
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Bitton E, Arsenault R, Bourbonnière-Sirard G, Wittich W. Low Vision and Dry Eye: Does One Diagnosis Overshadow the Other? Optom Vis Sci 2021; 98:334-340. [PMID: 33828043 DOI: 10.1097/opx.0000000000001673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE The prevalence of dry eye disease and low vision increases with age; they share risk factors and can be the result of underlying common causes. They are generally studied separately; however, combining these perspectives is relevant for research on assistive technology given that sustained focus affects the tear film because of decreased blinking rates. PURPOSE The objective of this study was to elucidate to which extent dry eye disease risk factors, signs, and symptoms are assessed in low vision patients who receive an eye examination as part of their vision rehabilitation services. METHODS Using a retrospective chart review, dry eye disease risk factors, signs, or symptoms were extracted from 201 randomly selected files that contained an eye examination in the past 5 years from two vision rehabilitation centers. RESULTS Demographic variables of charts from the two sites did not differ (mean visual acuity, 0.85 logMAR [standard deviation, 0.53; range, 0 to 2.3]; mean age, 71.2 years [standard deviation, 19 years; range, 24 to 101 years]). Fifty charts (25%) mentioned at least one dry eye disease symptom. Sixty-one charts (30.3%) reported systemic medications that can exacerbate dry eye disease, whereas 99 (49.2%) contained at least one systemic disease thought to contribute to dry eye disease symptoms; 145 (72.1%) mentioned at least one type of ocular surgery. Artificial tears were documented in 74 charts (36.8%). Few specific dry eye tests were performed, with the exception of corneal integrity assessment reported in 18 charts (8.95%). CONCLUSIONS Low vision patients have multiple risk factors for dry eye disease; however, dry eye disease tests were not frequently performed in comprehensive low vision eye examinations in this sample. More efforts should be made to assess dry eye disease to enhance comfort and functional vision, especially with the increasing demands of digital devices as visual aids.
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Affiliation(s)
| | - Roxanne Arsenault
- École d'optométrie, Université de Montréal, Montreal, Quebec, Canada
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Sahlu M, Giorgis AT. Dry eye disease among Glaucoma patients on topical hypotensive medications, in a tertiary hospital, Ethiopia. BMC Ophthalmol 2021; 21:155. [PMID: 33785013 PMCID: PMC8010960 DOI: 10.1186/s12886-021-01917-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/18/2021] [Indexed: 12/01/2022] Open
Abstract
Background Dry eye disease is a multifactorial disease; causing various ocular symptoms with potential damage to the ocular surface. Applying hypotensive eye drops are presumed to initiate or exacerbate existing dry eye disease. The purpose of this study was to determine the frequency of signs and symptoms and severity of dry eye disease among glaucoma patients on topical hypotensive medications and controls. Methods A cross-sectional comparative study, involving 320 glaucoma patients and controls. Ocular Surface Disease Index (OSDI) symptoms score and Schirmer, tear breakup time and corneal staining tests were used to assess dry eye disease. Data was analyzed using SPSS version 24 software; p-value less than 0.05 was considered as statistically significant. Results Among the 160 study glaucoma patients, the mean duration of topical hypotensive medication use was 5.2 ± 5.21 years (range, 4 months - 32 years). Mild to severe level of OSDI score was found in 122 (76%) glaucoma patients and in 137 (86%) controls (p = 0.033). Mild to sever abnormal clinical tests in the glaucoma patients and control, respectively, were 106 (66%) vs 80 (50%) corneal staining (p = 0.045), 79 (49%) vs 72 (45%) TBUT (p = 0.021), and 91 (57%) vs 83 (52%) Schirmer test (p = 0.242). Test results at the level of sever: 2 (1%) vs 0 (0%) corneal staining, 50 (31%) vs 39 (24%) TBUT and 65 (41%) vs 60 (38%) Schirmer test in the glaucoma patents and controls, respectively. Corneal staining and TBUT had correlation with the number of drugs (p = 0.004 and 0.031, respectively), and more relationship of the two tests with total number of drops applied per day (p = 0.01 and p < 0.001, respectively). Patients on pilocarpine and timolol had more corneal staining and lower TBUT [(p = 0.011 and p < 0.001) and (p = 0.04 and 0.012), respectively]. Conclusions The study has identified glaucoma patients to be more affected by dry eye disease than non-glaucoma patients, and presence of significantly lower TBUT and higher corneal staining in the glaucoma patients on multidrops and multidose per day. We recommend consideration of evaluation and management of DED for glaucoma patients on multidrops and multidose hypotensive medications.
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Affiliation(s)
- Miraf Sahlu
- Department of Ophthalmology, Menelik II Hospital, School of Medicine, College of Health Sciences, Addis Ababa University, P.O.Box 8079, Addis Ababa, Ethiopia
| | - Abeba T Giorgis
- Department of Ophthalmology, Menelik II Hospital, School of Medicine, College of Health Sciences, Addis Ababa University, P.O.Box 8079, Addis Ababa, Ethiopia.
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Al-Maskari AZ, Alarfaj K, Shaheen MS, Al-Yousuf N, Giledi O, Algehedan S, Navon S, Lazreg S. Middle East Preferred Practice Patterns for Dry Eye Disease: A Modified Delphi Consensus. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Dry Eye Disease (DED) is a common ophthalmic condition resulting from dysfunction in the ocular surface, main lacrimal gland, meibomian glands, or connecting nerves.
Objective: A group of local experts met to discuss local challenges and establish consensus in DED management across the Middle East.
Methods: A modified Delphi method was used to reach consensus, comprising two rounds of the survey and a face-to-face meeting. An expert panel of 8 ophthalmologists voted on 23 statements, with consensus reached if ≥75% responded “strongly agree” or “agree” to a statement.
Results: The expert panel reached consensus on 23 statements relating to the pathophysiology, diagnosis, treatment, and management of DED. Diagnosis begins with recording a detailed patient history and assessing subjective symptoms such as redness, burning, stinging, foreign body sensation, and/or photophobia. Tear Break-up Time (TBUT; <10 s), corneal spots (>5), and fluorescein staining are essential for diagnosing DED, assessing disease severity and ocular surface condition, and differentiating between types of DED. Ocular surface lubricants are the mainstay of treatment for DED. Treatment approaches should be categorized by etiology (if known). An improvement in symptoms can be observed objectively via an increase in TBUT, reduction in corneal and conjunctival spots, and restoration of normal tear production, or subjectively via less dependence on ocular surface lubricants, improved vision quality, and symptom amelioration.
Conclusion: This consensus will serve to provide a framework for clinical decisions relating to the management of DED across the region.
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Baksh BS, Garcia JC, Galor A. Exploring the Link Between Dry Eye and Migraine: From Eye to Brain. Eye Brain 2021; 13:41-57. [PMID: 33692643 PMCID: PMC7939506 DOI: 10.2147/eb.s234073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Dry eye and migraine are common diseases with large societal and economic burdens that have recently been associated in the literature. This review outlines the link between dry eye and migraine, which may have implications for reducing their respective burdens. We highlight possible shared pathophysiology, including peripheral and central sensitization, as the potential link between dry eye and migraine. Finally, therapies targeting similar pathophysiological mechanisms between dry eye and migraine are discussed.
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Affiliation(s)
- Brandon S Baksh
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julia Costa Garcia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Faculdade de Medicina (FMB) da Universidade do Estado de São Paulo (UNESP), Botucatu, Brazil
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
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Hossain P, Siffel C, Joseph C, Meunier J, Markowitz JT, Dana R. Patient-reported burden of dry eye disease in the UK: a cross-sectional web-based survey. BMJ Open 2021; 11:e039209. [PMID: 33664064 PMCID: PMC7934779 DOI: 10.1136/bmjopen-2020-039209] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To compare sociodemographics and vision-related quality of life (QoL) of individuals with or without dry eye disease (DED); and to explore the impact of DED symptom severity on visual function, activity limitations and work productivity. DESIGN Cross-sectional web-based survey. SETTING General UK population. PARTICIPANTS Adults ≥18 years with (N=1002) or without (N=1003) self-reported DED recruited through email and screened. MAIN OUTCOME MEASURES All participants completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), with six additional questions (items A3-A8), and the EuroQol 5 dimensions 5 levels. DED participants also completed Impact of Dry Eye on Everyday Life questionnaire, 5-item Dry Eye Questionnaire and the Standardised Patient Evaluation of Eye Dryness questionnaire along with the Ocular Comfort Index, Work Productivity and Activity Impairment and the Eye Dryness Score (EDS), a Visual Analogue Scale. RESULTS Baseline demographic and clinical characteristics were similar in participants with versus without DED (mean age, 55.2 vs 55.0 years; 61.8% vs 61.0% women, respectively) based on recruitment targets. Scores were derived from NEI VFQ-25 using the new 28-item revised VFQ (VFQ-28R) scoring. Mean (SD) VFQ-28R scores were lower in participants with versus without DED, indicating worse functioning (activity limitations, 73.3 (12.3) vs 84.4 (12.3); socioemotional functioning, 75.3 (21.5) vs 90.3 (16.2); total score, 71.6 (12.8) vs 83.6 (12.6)). Higher percentages of problems/inability to do activities were observed among those with versus without DED. The impact of DED on visual function was worse for participants with more severe DED symptoms, as assessed by EDS. In addition, a higher EDS was associated with worse symptoms on common DED scales and a worse impact on work productivity. CONCLUSIONS DED symptoms were associated with negative effects on visual function, activities and work productivity, whereas worse DED symptoms had a greater impact on vision-related QoL and work productivity.
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Affiliation(s)
- Parwez Hossain
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Eye Unit, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Csaba Siffel
- Global Evidence and Outcomes, Takeda, Lexington, Massachusetts, USA
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, Georgia, USA
| | - Corey Joseph
- Global Evidence and Outcomes, Takeda, Lexington, Massachusetts, USA
| | - Juliette Meunier
- Patient Centered Outcomes, Modus Outcomes, Lyon, France
- Patient Centered Outcomes, Modus Outcomes, Cambridge, Massachusetts, USA
| | - Jessica T Markowitz
- Patient Centered Outcomes, Modus Outcomes, Lyon, France
- Patient Centered Outcomes, Modus Outcomes, Cambridge, Massachusetts, USA
| | - Reza Dana
- Cornea and Refractive Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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121
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Rock S, Galor A, Kumar N. Indoor Airborne Microbial Concentration and Dry Eye. Am J Ophthalmol 2021; 223:193-204. [PMID: 33065065 DOI: 10.1016/j.ajo.2020.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To examine associations between indoor airborne microbial concentration and dry eye (DE) measures. DESIGN Prospective, observational, cross-sectional study. METHODS A total of 157 individuals with normal external ocular anatomy were recruited from the Miami Veterans Affairs eye clinic. Subjects underwent a clinical evaluation that included assessment of DE symptoms and signs. Indoor air was sampled using bioaerosol impactors with nutrient and soy media, and samples were incubated for 48 hours at 37 C with 5% CO2. Number of microbial colonies (CFU) was recorded. Outcome measures were DE symptoms and signs. RESULTS A total of 157 unique subjects participated in home and clinical visits and of these, 93 completed a 6-month follow-up of home and clinical visits. Older homes were found to have higher CFU compared to newer homes. A 1% increase in humidity was associated with a 3% increase in nutrient CFU (95% confidence interval [CI] = 0.01 to 0.04; P < .001). Instrumented CFU significantly associated with 2 DE measures: corneal epithelial disruption and lower eyelid meibomian gland (MG) dropout, adjusted for age and sex (odds ratio [OR] = 28.07, 95% CI =1.8, 443.8, P < .05; OR = 39.6, CI = 1.8, 875.2, P < .05 for soy, respectively). After adjusting for other confounders, CFU and age remained significantly associated with MG dropout. Other DE measures did not significantly associate with CFU. CONCLUSIONS Individuals with higher CFU counts in the home had more severe MG dropout, after adjusting for age and other confounders. This finding suggests that home CFU exposure may impact MG dropout, one of the DE measures, and may be a target for intervention.
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Affiliation(s)
- Sarah Rock
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Miller School of Medicine, University of Miami, Miami, Florida, USA; Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA; Ophthalmology, Miami Veterans Affairs (VA) Medical Center, Miami, Florida, USA
| | - Naresh Kumar
- Miller School of Medicine, University of Miami, Miami, Florida, USA.
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Rokohl AC, Trester M, Naderi P, Loreck N, Zwingelberg S, Bucher F, Pine KR, Heindl LM. Dry anophthalmic socket syndrome - morphological alterations in meibomian glands. Eye (Lond) 2021; 35:3358-3366. [PMID: 33564141 PMCID: PMC8602645 DOI: 10.1038/s41433-021-01426-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 12/15/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose To evaluate morphological alterations of meibomian glands (MGs) in the dry anophthalmic socket syndrome (DASS). Methods Fifteen unilateral anophthalmic patients wearing cryolite glass prosthetic eyes were enrolled. All patients with clinical blepharitis or other significant eyelid abnormalities were excluded. In vivo laser scanning confocal microscopy (LSCM) of the MGs in the lower eyelids both on the anophthalmic side and the healthy fellow eye was performed to quantify acinar unit density, acinar unit diameter, acinar unit area, meibum secretion reflectivity, the inhomogeneous appearance of the glandular interstice, and inhomogeneous appearance of the acinar walls. Results The lower eyelids of the anophthalmic sockets revealed a significant reduction of the acinar unit density (p = 0.003) as well as a significantly more inhomogeneous appearance of the periglandular interstices (p = 0.018) and the acinar unit walls (p = 0.015) than the healthy fellow eyelid. However, there were no significant differences regarding the acinar unit diameter, acinar unit area, and meibum secretion reflectivity of the MGs on the anophthalmic side compared to the healthy fellow eyelid (p ≥ 0.05, respectively). Conclusions The eyelids of anophthalmic sockets without clinical blepharitis demonstrate a reduced density of MG acinar units and a more inhomogeneous appearance of the periglandular interstices and the acinar unit walls. This can cause meibomian gland dysfunction contributing to DASS and suggests early treatment of these symptomatic patients, even in the clinical absence of any blepharitis signs.
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Affiliation(s)
- Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
| | - Marc Trester
- Trester-Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
| | - Parsa Naderi
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Niklas Loreck
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Sarah Zwingelberg
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Franziska Bucher
- UCL Institute of Ophthalmology, University College London, London, Great Britain
| | - Keith R Pine
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany
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Huang A, Janecki J, Galor A, Rock S, Menendez D, Hackam AS, Jeng BH, Kumar N. Association of the Indoor Environment With Dry Eye Metrics. JAMA Ophthalmol 2021; 138:867-874. [PMID: 32614410 DOI: 10.1001/jamaophthalmol.2020.2237] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance The ocular surface is continuously exposed to the environment. Although studies have focused on associations between outdoor environmental conditions and dry eye, information on associations between the indoor environment and dry eye is lacking. Objective To determine associations between the indoor environment and dry eye. Design, Setting, and Participants This prospective cross-sectional study sample of 97 veterans with a wide range of dry eye metrics was recruited from the Miami Veterans Affairs Healthcare eye clinic from October 19, 2017, to August 30, 2018. Dry eye metrics were first evaluated in the clinic, followed by indoor home environmental metrics within 1 week using a handheld particle counter. Data were analyzed from October 19, 2017, to August 30, 2018. Main Outcomes and Measures Symptoms of dry eye were assessed with standardized questionnaires. Dry eye signs were assessed via standard examination. Indoor environmental metrics included temperature, humidity, and particulate matter mass and count. Results Of the 97 participants included in the analysis, 81 (84%) were men, with a mean (SD) age of 58.2 (11.9) years. Dry eye symptoms were in the moderate range with a mean (SD) Ocular Surface Disease Index (OSDI) score of 31.2 (23.6). Humidity was associated with worse symptoms and signs, including OSDI score (r = 0.30 [95% CI, 0.07-0.49]; P = .01), inflammation (r = 0.32 [95% CI, 0.10-0.51]; P = .01), Schirmer score (r = -0.25 [95% CI, -0.45 to 0.02]; P = .03), eyelid vascularity (r = 0.27 [95% CI, 0.05-0.47]; P = .02), and meibomian gland dropout (r = 0.27 [95% CI, 0.05-0.47]; P = .02). In multivariate analyses, particulate matter of 2.5 μm or less (PM2.5) was associated with dry eye metrics when adjusted for demographic characteristics, comorbidities, medications, and interaction variables. For example, a 1-unit increase in instrumented PM2.5 level was associated with a 1.59 increase in the OSDI score (95% CI, 0.58-2.59; P = .002), a 0.39 reduction in Schirmer score (95% CI, -0.75 to -0.03; P = .04), a 0.07 increase in meibomian gland dropout (95% CI, 0.01-0.13; P = .02), and a 0.06 increase in inflammation (95% CI, 0.02-0.11; P = .009). Conclusions and Relevance When adjusting for humidity, this study found that increased particulate matter exposure was associated with worse dry eye metrics. Humidity was positively associated with dry eye metrics, potentially because higher humidity increases microbial growth and particulate matter size and mass.
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Affiliation(s)
- Amy Huang
- University of Central Florida College of Medicine, Orlando
| | - Julia Janecki
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Anat Galor
- Department of Ophthalmology, Miami Veterans Affairs (VA) Medical Center, Miami, Florida.,Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Sarah Rock
- Environmental Health Division, University of Miami, Miami, Florida
| | | | - Abigail S Hackam
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Bennie H Jeng
- Department of Ophthalmology, University of Maryland, Baltimore, Maryland
| | - Naresh Kumar
- Environmental Health Division, University of Miami, Miami, Florida
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Levitt AE, Galor A, Small L, Feuer W, Felix ER. Pain sensitivity and autonomic nervous system parameters as predictors of dry eye symptoms after LASIK. Ocul Surf 2021; 19:275-281. [PMID: 33096271 PMCID: PMC7867610 DOI: 10.1016/j.jtos.2020.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Differences in pain processing and autonomic function among patients have been implicated in the development of chronic pain after surgery. This study was designed to evaluate whether pain and autonomic metrics predict severity of chronic dry eye (DE) symptoms after LASIK, as there is increasing evidence that DE symptoms may be manifestations of persistent post-operative ocular pain. METHODS Secondary analysis of prospective randomized clinical trial. Patients were treated with either pregabalin or placebo. As no significant differences in DE symptoms were detected by treatment allocation at six months, all participants were grouped together for the present analyses. Subjects were evaluated pre-LASIK with regard to evoked pain sensitivity (utilizing quantitative sensory testing), autonomic metrics and DE and ocular pain symptoms (via validated questionnaires). Measures of DE and ocular pain were assessed post-LASIK, and the Dry Eye Questionnaire 5 (DEQ5) score 6-months after surgery was the primary outcome of interest. RESULTS 43 individuals were randomized to pregabalin (n = 21) or placebo (n = 22). 42 completed the 6-month visit. Several baseline autonomic metrics correlated with 6-month post-operative DEQ5 scores, including lower systolic (r -0.37, p = 0.02) and diastolic blood pressure (r -0.32, p = 0.04). Ocular pain at 6 months was also negatively correlated with blood pressure (r -0.31, p = 0.047). The presence of painful aftersensations was a significant predictor of chronic DE symptoms at 6 months (mean DEQ5 scores: 8.0 ± 1.9 versus 5.0 ± 5.0, p = 0.009). CONCLUSIONS Heightened parasympathetic tone and prolonged pain sensitivity measured prior to surgery predicted greater DE symptom severity 6 months after LASIK. TRIAL REGISTRATION NCT02701764.
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Affiliation(s)
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA.
| | - Leslie Small
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Elizabeth R Felix
- Department of Physical Medicine & Rehabilitation, University of Miami, Miami, FL, USA; Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA
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125
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Kobia-Acquah E, Ankamah-Lomotey S, Owusu E, Forfoe S, Bannor J, Koomson JA, Opoku M, Dzikpo DM, Mensah DNO, Amonoo JN, Akowuah PK. Prevalence and associated risk factors of symptomatic dry eye in Ghana: A cross-sectional population-based study. Cont Lens Anterior Eye 2021; 44:101404. [DOI: 10.1016/j.clae.2020.12.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
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126
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Al-Dairi W, Al Sowayigh OM, Alkulaib NS, Alsaad A. The Relationship of Dry Eye Disease With Depression in Saudi Arabia: A Cross-Sectional Study. Cureus 2020; 12:e12160. [PMID: 33489572 PMCID: PMC7813962 DOI: 10.7759/cureus.12160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective Estimate the prevalence of depression among individuals with a dry eye disease (DED) in Saudi Arabia using two questionnaires: Patient Health Questionnaire (PHQ-9) and Dry Eye Questionnaire (DEQ-5), and explore potential factors implicated in the development of depression among the DED population. Methods This is a descriptive cross-sectional study of 476 patients with DED which was conducted using a PHQ-9 questionnaire to screen for depression and a DEQ-5 questionnaire to diagnose DED. The questionnaires were merged and distributed using Google Forms through various social media platforms targeting the Saudi population. After data collection, it was revised, coded and fed to statistical software IBM SPSS version 22 (SPSS, Inc. Chicago, IL). Results Depression was diagnosed among 200 participants (42%) of the cases with dry eyes. From which 5.7% had mild depression, 13.9% had moderate depression, 12.6% had moderately severe depression, and 9.9% had severe depression. A female predominance was noticed; 44.7% of the females with dry eyes had depression compared to 32.4% of males with recorded statistical significance (P=0.023). Depression was detected among 55% of those who are less than 20 years old in comparison to 27% of those who are 30 years or older (P=0.001). Laser-assisted in-situ keratomileusis (LASIK), prolonged electronic device usage and contact lens wear are reported as risk factors associated with an increase in dry eye symptoms. However, there is no statistically significant relationship between contact lens wear and depression among dry eye disease patients. Conclusion Suffering from DED is a possible risk factor for developing depression as DED is associated with depression of higher degrees of severity. Depression among DED patients is found to be significantly more prevalent among females and the young adult population rather than older adults.
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Affiliation(s)
- Walaa Al-Dairi
- Surgery, College of Medicine, King Faisal University, AlAhsa, SAU
| | | | - Noura S Alkulaib
- Ophthalmology, College of Medicine, King Faisal University, AlAhsa, SAU
| | - Ali Alsaad
- Psychiatry, College of Medicine, King Faisal University, AlAhsa, SAU
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127
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Abstract
PURPOSE Animal models suggest that early markers of Sjögren syndrome (EMS)-antibodies against salivary protein 1, parotid secretory protein, and carbonic anhydrase 6 (CA6)-are more accurate signals of early Sjögren when compared with classic markers (anti-Ro and anti-La). To further understand the relationship between EMS and dry eye (DE), we compared symptoms and signs of DE in subjects who tested positive versus negative for EMS. METHODS In this cross-sectional study, patients at the Miami Veterans Affairs Eye Clinic who were tested for EMS underwent a standard ocular surface examination. Indications for EMS testing included DE symptoms in combination with dry mouth symptoms, low tear production, corneal staining, or a Sjögren disease-associated autoimmune disease. Statistical tests performed were the χ test, Fisher exact test, independent sample t test, and Spearman correlation. RESULTS Seventy-three percent of 44 patients tested positive for 1 or more EMS. CA6 IgG was most frequently elevated, followed by CA6 IgM and parotid secretory protein IgG. EMS-positive versus EMS-negative subjects were more likely to escalate DE treatment past artificial tears to topical cyclosporine (n = 32, 100% vs. n = 9, 75%, P = 0.02). There were no demographic or comorbidity differences between EMS-positive and EMS-negative subjects, and marker levels did not correlate with more severe tear film measures. CONCLUSIONS Most of the individuals with DE tested positive for 1 or more EMS antibodies, including men and Hispanics. Future studies will be needed to understand how to incorporate EMS data into the care of an individual with DE.
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128
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Labetoulle M, Benichou J, M'nafek N, Garnier F, Rabut G, Ben Hadj Salah W, Labbé A, Rousseau A, Baudouin C. Assessment of patient burden from dry eye disease using a combination of five visual analogue scales and a radar graph: a pilot study of the PENTASCORE. Br J Ophthalmol 2020; 106:467-473. [PMID: 33328188 DOI: 10.1136/bjophthalmol-2020-317473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/19/2020] [Accepted: 11/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Dry eye disease (DED) questionnaires would ideally be easy and fast to answer and explore the main aspects of disease burden and satisfaction (efficacy and tolerability) with treatment. This pilot study evaluates the Pentascore questionnaire for routinely assessing DED. METHODS The Pentascore combines five visual analogue scales (VAS) to assess the intensity and frequency of ocular pain/discomfort, the impact of DED on daily activities and visual tasks and the efficacy and tolerability of ongoing DED treatment(s). This retrospective study compared Pentascore to the Ocular Surface Disease Index (OSDI) questionnaire, fluorescein tear break-up-time, corneal staining and Schirmer I test. RESULTS For 161 DED patients, the algebraic mean (±SE) for the Pentascore was 52.6±1.8, the mean standardised area of the radar graph was 32.1±1.7 (out of 100) and the mean score for the OSDI was 52.6±1.8. Both questionnaires were highly statistically correlated (R=0.74 for both algebraic score and radar area, p<0.001), and each of five Pentascore VAS was significantly correlated with the OSDI (p<0.05). Corneal staining score (CSS) was correlated with two Pentascore VAS (impact of DED on daily activities and visual tasks), and there was a trend towards a correlation between CSS and the area of the radar graph (p=0.09). CONCLUSIONS This pilot study indicates that the Pentascore can rapidly and effectively assess the burden of DED and satisfaction with treatments. Compared with the algebraic mean, the estimation of the area of the radar graph likely improves the sensitivity for detecting differences/changes in symptoms and treatment follow-up.
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Affiliation(s)
- Marc Labetoulle
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France .,Center for Immunology of Viral infections and Autoimmune diseases. IDMIT Infrastructure, CEA,Université Paris Sud, Fontenay-aux-Roses Cedex, France
| | - Jérémie Benichou
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Nabila M'nafek
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Flavie Garnier
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France
| | - Ghislaine Rabut
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France
| | - Wassim Ben Hadj Salah
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Antoine Labbé
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France.,Institut de la Vision, Sorbonne Université, INSERM, CNRS, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| | - Antoine Rousseau
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France.,Center for Immunology of Viral infections and Autoimmune diseases. IDMIT Infrastructure, CEA,Université Paris Sud, Fontenay-aux-Roses Cedex, France
| | - Christophe Baudouin
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France.,Institut de la Vision, Sorbonne Université, INSERM, CNRS, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
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129
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Tsubota K, Pflugfelder SC, Liu Z, Baudouin C, Kim HM, Messmer EM, Kruse F, Liang L, Carreno-Galeano JT, Rolando M, Yokoi N, Kinoshita S, Dana R. Defining Dry Eye from a Clinical Perspective. Int J Mol Sci 2020; 21:ijms21239271. [PMID: 33291796 PMCID: PMC7730816 DOI: 10.3390/ijms21239271] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022] Open
Abstract
Over the past decades, the number of patients with dry eye disease (DED) has increased dramatically. The incidence of DED is higher in Asia than in Europe and North America, suggesting the involvement of cultural or racial factors in DED etiology. Although many definitions of DED have been used, discrepancies exist between the various definitions of dry eye disease (DED) used across the globe. This article presents a clinical consensus on the definition of DED, as formulated in four meetings with global DED experts. The proposed new definition is as follows: “Dry eye is a multifactorial disease characterized by a persistently unstable and/or deficient tear film (TF) causing discomfort and/or visual impairment, accompanied by variable degrees of ocular surface epitheliopathy, inflammation and neurosensory abnormalities.” The key criteria for the diagnosis of DED are unstable TF, inflammation, ocular discomfort and visual impairment. This definition also recommends the assessment of ocular surface epitheliopathy and neurosensory abnormalities in each patient with suspected DED. It is easily applicable in clinical practice and should help practitioners diagnose DED consistently. This consensus definition of DED should also help to guide research and clinical trials that, to date, have been hampered by the lack of an established surrogate endpoint.
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Affiliation(s)
- Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan
- Correspondence: ; Tel.: +81-3-5363-3219
| | | | - Zuguo Liu
- Eye Institute of Xiamen University, Xiamen 361102, China;
| | | | - Hyo Myung Kim
- Korea University Medical Center, Anam Hospital, Seoul 02841, Korea;
| | - Elisabeth M. Messmer
- Department of Ophthalmology, Ludwig Maximilian University, 80539 Munich, Germany;
| | - Friedrich Kruse
- Department of Ophthalmology, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Lingyi Liang
- Zhongshan Ophthalmic Center, Guangzhou 510060, China;
| | | | - Maurizio Rolando
- ISPRE OPHTHALMICS (Instituto di Medicina Oftalmica), 16129 Genoa, Italy;
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Reza Dana
- Cornea & Refractive Surgery, Massachusetts Eye & Ear, Boston, MA 02114, USA; (J.T.C.-G.); (R.D.)
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Wang EW, Gardner PA, Fraser S, Stefko ST, Fernandez-Miranda JC, Snyderman CH. Reduced Tearing With Stable Quality of Life After Vidian Neurectomy: A Prospective Controlled Trial. Laryngoscope 2020; 131:1487-1491. [PMID: 33247625 DOI: 10.1002/lary.29287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/13/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS Although vidian neurectomy (VN) is associated with decreased lacrimation, its impact on dry eye quality-of-life is not well-defined. Endoscopic endonasal transpterygoid approaches (EETA) may require vidian nerve sacrifice. STUDY DESIGN A prospective cohort trial. METHODS A prospective trial evaluating VN during EETA on lacrimation by phenol red thread testing and dry eye severity by the five-item Dry Eye Questionnaire (DEQ-5) was performed. Preservation of the contralateral vidian nerve allowed comparison between the eye subjected to VN and the control eye postoperatively. RESULTS Twenty-one subjects were enrolled with no preoperative difference in lacrimation between eyes (P = .617) and overall mild dry eye severity. Although the control eye had no difference in lacrimation pre- and postoperatively, decreased tearing was noted in the VN eye at 1 month (20.8 mm vs. 15.8 mm, P = .015) and at 3 months (23.2 mm vs. 15.8 mm, P = .0051) postoperatively. Overall, no difference was noted in the DEQ-5 score for dry eye severity between the pre- and postoperative measures. However, six patients were noted to have moderate to severe dry eye severity postoperatively and five of these six had decreased lacrimation (<20 mm) preoperatively. Patients with decreased tearing preoperatively demonstrated significantly worse postoperative DEQ-5 scores when compared to patients with normal tearing (P < .0056). CONCLUSIONS VN during EETA results in decreased tearing but is not associated with increased dry eye severity overall. However, patients with decreased tearing preoperatively are at risk for increased dry eye severity and should be counseled for this risk. LEVEL OF EVIDENCE 2 Laryngoscope, 131:1487-1491, 2021.
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Affiliation(s)
- Eric W Wang
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Shannon Fraser
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - S Tonya Stefko
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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131
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Chidi-Egboka NC, Golebiowski B, Lee SY, Vi M, Jalbert I. Dry eye symptoms in children: can we reliably measure them? Ophthalmic Physiol Opt 2020; 41:105-115. [PMID: 33222234 DOI: 10.1111/opo.12762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Many dry eye questionnaires are available, but these may not be suitable for paediatric eye care. The feasibility of use and repeatability of symptom questionnaires administered to children was examined. METHODS Participants aged 6-15 years (n = 62; 25M:37F; 40% male) completed six questionnaires twice in random order at a single visit: Symptoms assessment in dry eye (SANDE), ocular surface disease index (OSDI), numerical rating scale (NRS), ocular comfort index (OCI, n = 30), dry eye questionnaire 5 (DEQ-5) and the instant ocular symptoms survey (IOSS). Completion time and need for assistance were recorded and relationships with age examined (Pearson correlation, independent t-test). The number of participants requiring assistance and with which items were compared (linear mixed model, pairwise test). Repeatability (coefficient of repeatability (CoR), limit of agreement, bias) and intraclass correlation coefficient (ICC) were examined. RESULTS Completion time was ≤2 min for each individual questionnaire. Younger participants took longer to complete (r = -0.43 to -0.60, p ≤ 0.01), and required more assistance (p ≤ 0.001). Forty-eight participants required assistance with at least one questionnaire. Older children (13-15 years) only required assistance with OSDI (p ≤ 0.004) and NRS (p ≤ 0.003). Participants required more assistance with SANDE, OSDI and NRS than with DEQ-5 and IOSS (p ≤ 0.02) and with gritty (OSDI, 77% of participants; OCI, 100%) and foreign body sensation (NRS, 92%) items. CoR was similar for all questionnaires with no evidence of a learning effect (p > 0.05). ICC was moderate to excellent. CONCLUSIONS Dry eye questionnaires can be used reliably in paediatric eye care; more time and assistance may be required for younger children. The DEQ-5 and IOSS are recommended for use in younger age children.
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Affiliation(s)
| | - Blanka Golebiowski
- School of Optometry and Vision Science, UNSW, Sydney, NSW, 2052, Australia
| | - Sun-Young Lee
- School of Optometry and Vision Science, UNSW, Sydney, NSW, 2052, Australia
| | - Mimi Vi
- School of Optometry and Vision Science, UNSW, Sydney, NSW, 2052, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW, Sydney, NSW, 2052, Australia
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132
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Seror R, Bowman S. Outcome Measures in Primary Sjögren's Syndrome. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:134-149. [PMID: 33091252 DOI: 10.1002/acr.24331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/19/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Raphaèle Seror
- Hôpital Bicêtre Assistance Publique-Hôpitaux de Paris, Université Paris-Saclay, and Institut National de la Santé et de la Recherche Médicale U1012, Le Kremlin Bicêtre, France
| | - Simon Bowman
- Milton Keynes University Hospital, Milton Keynes, United Kingdom, and University Hospitals Birmingham and University of Birmingham, Birmingham, United Kingdom
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133
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Verjee MA, Brissette AR, Starr CE. Dry Eye Disease: Early Recognition with Guidance on Management and Treatment for Primary Care Family Physicians. Ophthalmol Ther 2020; 9:877-888. [PMID: 33090327 PMCID: PMC7708574 DOI: 10.1007/s40123-020-00308-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/24/2020] [Indexed: 02/01/2023] Open
Abstract
Primary care presentations of dry eye disease (DED) are common and pose a diagnostic challenge due to the variety of symptoms and the absence of certainty for family practitioners. While there are many published articles on the topic, the 2017 Tear Film and Ocular Surface Society Dry Eye Workshop was a landmark report in distinguishing multifactorial differences. Redefined terms clarified the DED disorder. The ocular surface—the tear/air interface—is the primary refractive component of the eye, which is why DED is so significant and impacts vision. There is a high prevalence of DED in the community, ranging from 5% to 30% of people across multiple studies. Elderly patients have up to 75% increased risk of DED and receive more intensive treatment than younger age groups. DED is also more common in women than men, occurring in 9.8% of postmenopausal women. The causes of DED span defective lacrimal apparatus and systemic disorders. Despite its prevalence, up to one-half of patients with confirmed DED do not receive proper alleviating treatment. Risk factors on functional and environmental bases follow. Tools to elicit a diagnosis more confidently are outlined using the Ocular Surface Disease Index (OSDI) and the Symptom Assessment in Dry Eye questionnaires (SANDE). Lacritin, lutein, vitamin A, and balanced nutrition are essential contributors to maintaining healthy eyes with appropriate management and treatment. The authors hope that this paper will prompt a more accurate and expedient diagnosis of DED in primary care practice and an earlier recognition of specialist referrals. Dry eye disease (DED) poses a diagnostic challenge to primary care physicians. The condition involves the tear/air interface, at the corneal (ocular) surface, where light enters the eye. Any change in light refraction affects regular sight. Symptoms of DED include itching, grittiness, foreign body sensation, redness, excessive tearing, and visual blurring, the lattermost being the most common presentation. Ultimately, the untreated disease leads to continued discomfort and visual deficit, but when severe, it can result in blindness. Up to 30% of the population suffers from DED, with the elderly, particularly women, more affected. Unfortunately, up to 50% of those affected have inadequate treatment. Questionnaires help in diagnosis. Simple office tests can indicate the severity of eye problems. Technology with smartphone photography can take high-resolution images, which are useful in education and teaching. A multitude of conditions cause DED, including blepharitis, an infection of the eyelids. Environmental risks also abound. Proper nutrition is essential in maintaining eye health. Intermittent eye symptoms are likely to be underrated by the public, by purchasing over-the-counter products such as artificial tears rather than seeking a proper medical check. Newer prescription medications are now available for DED relief before advancing to debility requiring specialist treatment. Dry Eye Disease: Early Recognition with Guidance on Management and Treatment for Primary CareFamily Physicians (MP4 95031 kb)
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Affiliation(s)
- Mohamud A Verjee
- Medical Student Affairs, & Medical Education, Weill Cornell Medicine - Qatar, Doha, Qatar.
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134
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Patel S, Hwang J, Mehra D, Galor A. Corneal Nerve Abnormalities in Ocular and Systemic Diseases. Exp Eye Res 2020; 202:108284. [PMID: 33045221 DOI: 10.1016/j.exer.2020.108284] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/23/2020] [Indexed: 12/19/2022]
Abstract
The trigeminal nerve gives rise to the corneal subbasal nerve system, which plays a crucial role in sensations of touch, pain, and temperature and in ocular healing processes. Technological advancements in instruments, in particular in vivo confocal microscopy and aethesiometry, have allowed for the structural and functional evaluation of corneal nerves in health and disease. Through application of these technologies in humans and animal models, structural and functional abnormalities have been detected in several ocular and systemic disorders, including dry eye disease (DED), glaucoma, migraine, and fibromyalgia. However, studies across a number of conditions have found that structural abnormalities do not always relate to functional abnormalities. This review will discuss instruments used to evaluate corneal nerves and summarize data on nerve abnormalities in a number of ocular and systemic conditions. Furthermore, it will discuss potential treatments that can alleviate the main manifestations of nerve dysfunction, namely ocular surface pain and persistent epithelial defects.
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Affiliation(s)
- Sneh Patel
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Jodi Hwang
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Divy Mehra
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Anat Galor
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Research Services, Miami Veterans Affairs Medical Center, Miami, FL, USA.
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Postnikoff CK, Held K, Viswanath V, Nichols KK. Enhanced closed eye neutrophil degranulation in dry eye disease. Ocul Surf 2020; 18:841-851. [DOI: 10.1016/j.jtos.2020.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/09/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023]
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136
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Alghamdi WM, Alrasheed SH. Impact of an educational intervention using the 20/20/20 rule on Computer Vision Syndrome. AFRICAN VISION AND EYE HEALTH 2020. [DOI: 10.4102/aveh.v79i1.554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Global estimates suggest that nearly 60 million people suffer from Computer Vision Syndrome (CVS).Aim: The goal of this research was to evaluate the effectiveness of an educational intervention using the 20/20/20 rule to reduce CVS symptoms.Setting: The study was conducted in the Qassim University eye clinic.Methods: An experiential intervention study was conducted amongst 40 patients with CVS, with their age ranging from 21 to 38 years. The sample was divided into two groups: (1) intervention patients (n = 20), who were given a structured advice booklet about how to reduce CVS symptoms using the 20/20/20 rule, and (2) control (n = 20) with CVS, who were given advice to simply drink more water. Both groups completed two questionnaires, namely, the CVS-Q and Dry Eye Questionnaire-5 (DEQ-5). Dry eye clinical tests were performed. The same procedures were repeated after 20 days to compare the outcomes before and after intervention.Results: The study findings revealed that patients complaining from dry eye symptoms showed significant changes after the educational intervention (pre-intervention: 9.05 ± 4.32; post-intervention: 7.10 ± 3.61) (p = 0.04). The symptoms of CVS were slightly reduced after educational intervention, from 9.00 ± 3.03 to 8.35 ± 1.89 (p = 0.38). However, TBUT showed a significant increase after the educational intervention (pre-intervention: 6.20 ± 2.02 s; post-intervention: 8.55 ± 2.84 s) (p = 0.005).Conclusion: The educational intervention of the 20/20/20 rule induces significant changes in dry eye symptoms and tear film and some limited changes for ocular surface integrity.
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Starr CE, Gupta PK, Farid M, Beckman KA, Chan CC, Yeu E, Gomes JAP, Ayers BD, Berdahl JP, Holland EJ, Kim T, Mah FS. An algorithm for the preoperative diagnosis and treatment of ocular surface disorders. J Cataract Refract Surg 2020; 45:669-684. [PMID: 31030780 DOI: 10.1016/j.jcrs.2019.03.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022]
Abstract
Any ocular surface disease (OSD), but most commonly, dry-eye disease (DED), can reduce visual quality and quantity and adversely affect refractive measurements before keratorefractive and phacorefractive surgeries. In addition, ocular surgery can exacerbate or induce OSD, leading to worsened vision, increased symptoms, and overall dissatisfaction postoperatively. Although most respondents of the recent annual American Society of Cataract and Refractive Surgery (ASCRS) Clinical Survey recognized the importance of DED on surgical outcomes, many were unaware of the current guidelines and most were not using modern diagnostic tests and advanced treatments. To address these educational gaps, the ASCRS Cornea Clinical Committee developed a new consensus-based practical diagnostic OSD algorithm to aid surgeons in efficiently diagnosing and treating visually significant OSD before any form of refractive surgery is performed. By treating OSD preoperatively, postoperative visual outcomes and patient satisfaction can be significantly improved.
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Affiliation(s)
- Christopher E Starr
- Weill Cornell Medicine, New York-Presbyterian Hospital, New York, New York, USA.
| | | | - Marjan Farid
- Gavin Herbert Eye Institute, University of California, Irvine, California, USA
| | - Kenneth A Beckman
- Department of Ophthalmology, The Ohio State University and Comprehensive EyeCare of Central Ohio, Westerville, Ohio, USA
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada
| | - Elizabeth Yeu
- Eastern Virginia Medical School, Virginia Eye Consultants, Norfolk, Virginia, USA
| | - José A P Gomes
- Paulista Medical School, Federal University of São Paulo, Brazil
| | | | | | | | - Terry Kim
- Duke University Eye Center, Durham, North Carolina, USA
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Naderi K, Gormley J, O’Brart D. Cataract surgery and dry eye disease: A review. Eur J Ophthalmol 2020; 30:840-855. [PMID: 32515220 PMCID: PMC7549290 DOI: 10.1177/1120672120929958] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 05/07/2020] [Indexed: 01/26/2023]
Abstract
AIM To review published literature concerning cataract surgery and dry eye disease (DED). METHODS A search was undertaken using the following: PubMed (all years), Web of Science (all years), Ovid MEDLINE(R) (1946 to 12 December 2019), Ovid MEDLINE(R) Daily Update 10 December 2019, MEDLINE and MEDLINE non-indexed items, Embase (1974-2019, week 49), Ovid MEDLINE (R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily (1946 to 12 December 2019), CENTRAL (including Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 12 of 12 December 2019), metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Search terms included 'cataract surgery', 'phacoemulsification' and 'cataract extraction', combined with 'dry eyes' and 'ocular surface'. Relevant in-article references not returned in our searches were also considered. RESULTS Publications identified included systematic reviews, meta-analysis, randomized controlled trials, cohort studies, case series and laboratory-based studies. Published data highlighting the burden of DED both prior and following cataract surgery were reviewed as well as studies highlighting the effects of cataract surgery on the ocular surface, intra-operative measures to reduce deleterious effects on the ocular surface and current evidence on the management options of post-operative DED. CONCLUSIONS DED is common and can be exacerbated by cataract surgery. Ophthalmologists need to assess for pre-existing DED and instigate treatment before surgery; be aware of reduced accuracy of measurements for surgical planning in the presence of DED; limit intra-operative surgical factors damaging to the ocular surface; and consider management to reduce DED post-operatively.
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Affiliation(s)
- Khayam Naderi
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
- King’s College London, London, UK
| | - Jack Gormley
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
| | - David O’Brart
- Department of Ophthalmology, Guy’s and St Thomas’ NHS Foundation
Trust, London, UK
- King’s College London, London, UK
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139
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Colorado LH, Pritchard N, Alzahrani Y, Edwards K, Efron N. Association between conjunctival goblet cells and corneal resident dendritic cell density changes in new contact lens wearers. Clin Exp Optom 2020; 103:787-791. [PMID: 32808398 DOI: 10.1111/cxo.13131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/26/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND To explore the interlink between conjunctival goblet and corneal dendritic cell density after six months of lens wear and to predict dendritic cell migration to the central cornea based on goblet cell loss in the conjunctiva as a response to contact lens wear. METHODS Sixty-nine subjects who had never previously worn contact lenses were observed for six months; 46 were fitted with contact lenses and 21 served as a control group. Corneal confocal microscopy was used to quantify goblet and dendritic cell density before and after six months of daily lens wear. Symptomatic and asymptomatic groups were identified in the lens-wearing group using a combination of signs and symptoms present. Pearson's correlation was used to determine associations between the total change of cell densities after six months of lens wear. RESULTS At baseline, there was no association between conjunctival goblet and corneal dendritic cell density (p > 0.05). After six months, there was an inverse association between the absolute change of conjunctival goblet and corneal dendritic cell density (ρ = -0.34, p = 0.03) in all participants (n = 69). Dendritic cell density in the central cornea was increased by 1.5 cells/mm2 for every decrease of 1 goblet cell/mm2 in the conjunctiva. CONCLUSIONS After six months of wear, contact lens-induced goblet cell loss can partially predict resident corneal dendritic cell migration to the central cornea (observed as an increase in dendritic cell density). The associations between total cell density change after six months was established in wearers regardless of lens symptomatology, suggesting that cell density changes as a physiological adaptation to regulate the effect of contact lens wear on the ocular surface.
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Affiliation(s)
- Luisa H Colorado
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Yahya Alzahrani
- General Department of Medical Services, Security Forces Hospital Makkah, Riyadh, Kingdom of Saudi Arabia
| | - Katie Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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A Review of Dry Eye Questionnaires: Measuring Patient-Reported Outcomes and Health-Related Quality of Life. Diagnostics (Basel) 2020; 10:diagnostics10080559. [PMID: 32764273 PMCID: PMC7459853 DOI: 10.3390/diagnostics10080559] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Dry eye disease (DED) is among the most common eye diseases and is becoming increasingly prevalent. Its symptoms cause a long-term decline in patients’ health-related quality of life (HRQL). Inconsistencies often occur between the clinical findings and the subjective symptoms of DED. Therefore, a holistic, balanced, and quantitative evaluation of the subjective symptoms and HRQL using patient-reported outcome questionnaires, in addition to clinical findings, is crucial for accurate DED assessment in patients. This paper reviewed the characteristics of current dry eye questionnaires, including their objectives, number of questions, inclusion of HRQL-related items, and whether they were properly evaluated for psychometric properties. Twenty-four questionnaires were identified; among them, the following six questionnaires that included items assessing HRQL and were properly evaluated for psychometric properties are recommended: the Ocular Surface Disease Index, Impact of Dry Eye in Everyday Life, Dry Eye-Related Quality-of-life Score, University of North Carolina Dry Eye Management Scale, Chinese version of Dry Eye-Related Quality of Life, and 25-Item National Eye Institute Visual Function Questionnaire. Dry eye questionnaires have different objectives and are available in different languages. Therefore, medical practitioners should confirm the characteristics of applicable questionnaires before selecting the most appropriate ones.
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141
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Dana R, Meunier J, Markowitz JT, Joseph C, Siffel C. Patient-Reported Burden of Dry Eye Disease in the United States: Results of an Online Cross-Sectional Survey. Am J Ophthalmol 2020; 216:7-17. [PMID: 32277941 DOI: 10.1016/j.ajo.2020.03.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate functional vision, general health status, and work productivity in individuals with and without dry eye disease (DED). DESIGN Cross-sectional study. METHODS Setting: General US population (2018). STUDY POPULATION Adults ≥18 years with (n = 1003) or without (n = 1006) self-reported DED. MAIN OUTCOME MEASURES All respondents completed the National Eye Institute Visual Function Questionnaire (VFQ) and the EuroQol 5-dimensions 5-levels (EQ-5D-5L). All respondents with DED completed the eye dryness score (EDS) visual analogue scale, Ocular Comfort Index (OCI), and Work Productivity and Activity Impairment (WPAI) questionnaire. Half of respondents with DED completed the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire; the other half completed the Dry Eye Questionnaire 5 (DEQ-5) and Standardized Patient Evaluation of Eye Dryness (SPEED), McMonnies, and Symptom Assessment in Dry Eye (SANDE) questionnaires. All analyses were descriptive. RESULTS Respondents with DED reported more comorbidities, greater exposure to adverse environmental conditions, and lower (worse) mean (standard deviation) scores on the modified Rasch-scored 28-item VFQ (VFQ-28R) total score (68.8 [11.9] vs 81.2 [12.7]) and EQ-5D-5L (0.82 [0.13] vs 0.88 [0.14]) than respondents without DED. Respondents with DED and EDS ≥60 (highest discomfort) fared worse on OCI, VFQ-28R, and WPAI than respondents with DED and EDS <40 (lowest discomfort). Similar findings were observed with IDEEL, DEQ-5, SPEED, McMonnies, and SANDE scores. CONCLUSIONS There is a substantial burden of DED on functional vision, general health status, and productivity; and further, these parameters appear to worsen with increasing EDS.
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Affiliation(s)
- Reza Dana
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
| | | | | | | | - Csaba Siffel
- Takeda, Lexington, Massachusetts, USA; College of Allied Health Sciences, Augusta University, Augusta, Georgia, USA
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142
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Willis KA, Postnikoff CK, Freeman A, Rezonzew G, Nichols K, Gaggar A, Lal CV. The closed eye harbours a unique microbiome in dry eye disease. Sci Rep 2020; 10:12035. [PMID: 32694705 PMCID: PMC7374690 DOI: 10.1038/s41598-020-68952-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/23/2020] [Indexed: 02/06/2023] Open
Abstract
Dry eye affects millions of individuals. In experimental models, dry eye disease is associated with T helper cell 17-mediated inflammation of the ocular surface that may cause persistent damage to the corneal epithelium. However, the initiating and perpetuating factors associated with chronic inflammation of the ocular surface remain unclear. The ocular microbiota alters ocular surface inflammation and may influence dry eye disease development and progression. Here, we collected serial samples of tears on awakening from sleep, closed eye tears, during a randomized clinical trial of a non-pharmaceutical dry eye therapy and used 16S rRNA metabarcoding to characterize the microbiome. We show the closed dry eye microbiome is distinct from the healthy closed eye microbiome, and that the microbiome remains distinct despite daily saline eye wash upon awakening. The ocular microbiome was described only recently, and this report implicates a distinct microbiome in ocular disease development. Our findings suggest an interplay between microbial commensals and inflammation on the ocular surface. This information may inform future studies of the pathophysiological mechanisms of dry eye disease.
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Affiliation(s)
- Kent A Willis
- Division of Neonatology, Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cameron K Postnikoff
- School of Optometry, University of Alabama At Birmingham, Birmingham, AL, USA
- CooperVision, Inc, Pleasanton, CA, USA
| | - Amelia Freeman
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Gabriel Rezonzew
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Kelly Nichols
- School of Optometry, University of Alabama At Birmingham, Birmingham, AL, USA
| | - Amit Gaggar
- Program in Protease and Matrix Biology, Department of Pediatrics, College of Medicine, Women and Infants Center, University of Alabama At Birmingham, 176F Suite 9380, 619 South 19th Street, Birmingham, AL, 35249-7335, USA
| | - Charitharth V Lal
- Division of Neonatology, Department of Pediatrics, College of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.
- Program in Protease and Matrix Biology, Department of Pediatrics, College of Medicine, Women and Infants Center, University of Alabama At Birmingham, 176F Suite 9380, 619 South 19th Street, Birmingham, AL, 35249-7335, USA.
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Periorbital botulinum toxin A improves photophobia and sensations of dryness in patients without migraine: Case series of four patients. Am J Ophthalmol Case Rep 2020; 19:100809. [PMID: 32671286 PMCID: PMC7350146 DOI: 10.1016/j.ajoc.2020.100809] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose Individuals receiving botulinum toxin A (BoNT-A) injections in the head and neck for migraine treatment have reported decreases in photophobia and sensations of dryness, independent of ocular surface parameters. We hypothesized that patients without migraine but with similar ocular neuropathic-like symptoms would also experience symptomatic improvement with periocular BoNT-A injections, independent of ocular surface changes. Observations We identified four individuals without a history of migraine but with neuropathic ocular pain (symptoms of dryness, burning, and photophobia that were out of proportion to ocular surface findings and unresponsive to ongoing dry eye (DE) therapies). Individuals underwent 1 session of periocular BoNT-A injections. Validated questionnaires (Visual Light Sensitivity Questionnaire-8, Dry Eye Questionnaire-5) assessed photophobia and DE symptoms pre- and 1-month post-injections. All four reported improvements in frequency and severity of photophobia and eye discomfort following BoNT-A injections. Tear film parameters (phenol red thread test, tear break-up time, corneal staining, and Schirmer test) and eyelid (palpebral fissure height and levator palpebrae superioris function) and eyebrow (position) anatomy were also evaluated before and after injections. Despite a unanimous improvement in symptoms, there were no consistent changes in ocular surface parameters with BoNT-A injections across individuals. Conclusions Periocular BoNT-A shows promise in reducing photophobia and sensations of dryness in individuals with neuropathic-like DE symptoms without a history of migraine, independent of tear film, eyelid, or eyebrow parameters.
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Tavazzi S, Origgi R, Anselmi M, Corvino A, Colciago S, Fagnola M, Bracco S, Zeri F. Effects of Aqueous-Supplementing Artificial Tears in Wearers of Biweekly Replacement Contact Lenses vs Wearers of Daily Disposable Contact Lenses. CLINICAL OPTOMETRY 2020; 12:75-84. [PMID: 32612403 PMCID: PMC7323791 DOI: 10.2147/opto.s249078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/07/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE To compare the effects of artificial tears (ATs) in wearers of biweekly replacement silicone hydrogel contact lenses (BW-Ws) and wearers of daily disposable contact lenses (DD-Ws) of the same material. MATERIALS AND METHODS The aqueous-supplementing ATs, OPTOyalA and OPTOidro, were assigned to be used for 2 weeks to healthy and young subjects: 1) 20 (8 and 12, respectively) BW-Ws wearing silicone hydrogel somofilcon A CLs (Clariti Elite), 2) 18 (9 and 9, respectively) DD-Ws wearing silicone hydrogel somofilcon A CLs (Clarity 1 Day), and 3) a control group of 33 (16 and 17, respectively) N-Ws. Ocular symptoms and comfort, tear volume and stability, and ocular surface condition were assessed by Ocular Surface Disease Index (OSDI), 5-Item Dry Eye Questionnaire (DEQ5), tear meniscus height (TMH), non-invasive tear break-up time (NIBUT), and evaluation of ocular redness (OR). The assessment was performed before and after 15 days of use of the ATs in the 3 groups (BW-Ws, DD-Ws, and N-Ws). RESULTS No clear significant difference was noted in symptoms and signs between OPTOyalA and OPTOidro irrespectively of the group of people studied. ATs use for 15 days produced a significant improvement in DEQ5 and OR in DD-Ws (Δ=-34%, p=0.006; Δ=-23%, p<0.001) and in N-Ws (Δ=-21%, p=0.001; Δ=-10%, p=0.006) but not in BW-Ws (Δ=-5%, p=0.072; Δ=-2%, p=0.257). No significant change was noted for TMH. CONCLUSION In young and healthy subjects, the aqueous-supplementing effect of the ATs under consideration is more a rinsing and tear replacem ent effect than an increase in tear volume, and it produces an improvement of the eye redness and ocular symptoms. Contact lens wear influenced the effectiveness of ATs in a way which is correlated with the CL replacement schedule.
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Affiliation(s)
- Silvia Tavazzi
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
- Research Centre in Optics and Optometry (COMiB), University of Milano-Bicocca, Milan, Italy
| | - Riccardo Origgi
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
| | - Martina Anselmi
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
| | - Andrea Corvino
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
| | - Sara Colciago
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
| | - Matteo Fagnola
- Research Centre in Optics and Optometry (COMiB), University of Milano-Bicocca, Milan, Italy
| | - Silvia Bracco
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
| | - Fabrizio Zeri
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
- Research Centre in Optics and Optometry (COMiB), University of Milano-Bicocca, Milan, Italy
- Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
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Evaluation of ocular surface disease in elderly patients with glaucoma: expression of matrix metalloproteinase-9 in tears. Eye (Lond) 2020; 35:892-900. [PMID: 32472047 DOI: 10.1038/s41433-020-0993-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate the symptoms and signs of ocular surface disease (OSD) and tear-film matrix metalloproteinase-9 (MMP-9) overexpression using point-of-care testing (InflammaDry test) in patients with primary open-angle glaucoma (POAG). METHODS This prospective, case-control study included 67 patients diagnosed with POAG and 47 healthy control subjects. The OSD assessment included Schirmer-I test, the Oxford corneal stain scale, tear breakup time (TBUT), and the five-item dry eye questionnaire (DEQ-5). Measurement of extracellular MMP-9 level was performed using the InflammaDry test. The OSD parameters and MMP-9 expression levels were compared between the POAG group and the control group. Additional subgroup analysis in POAG group was performed according to number of topical glaucoma medications (Bottle 1, 2, or 3 medications). RESULTS There were significant differences between the control and POAG groups for all OSD parameters. MMP-9 overexpression was observed in 71.6% of POAG group, whereas only 31.9% of control group showed MMP-9 overexpression. The subgroup analysis revealed that DEQ-5, Oxford stain score, Schirmer-I, and MMP-9 overexpression demonstrated no significant difference among the three groups. Abnormal TBUT (≤5 s) was observed in 37.5%, 59.1%, and 76.2% for each subgroup according to number of bottles (1, 2, and 3), and strong MMP-9 overexpression were also detected in 25.0%, 40.9%, and 61.9%, respectively (P = 0.032, P = 0.043). CONCLUSIONS The use of preservative-containing medications may affect the ocular surface in patients with POAG. Graded measurement of tear-film MMP-9 could provide more information on OSD and might be a more useful marker for inflammation than then conventional results obtained by using an MMP-9 kit.
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146
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Abstract
Chronic eye pain, which has previously been assumed to be due to ocular surface abnormalities (ie, "dry eye [DE] disease"), has recently garnered attention as a potential indicator of neuropathic ocular pain in some patients. The purpose of this study was to evaluate the psychometric properties of a modified version of the Neuropathic Pain Symptom Inventory in individuals with eye pain (NPSI-Eye). Enrolled participants (n = 397) completed the NPSI-Eye, general pain severity questionnaires, DE symptom report, and psychological health indices. Participants also underwent mechanical pain sensitivity testing of the cornea, tear film assessment, and evaluation of the efficacy of anesthetic eye drops to relieve pain. Short-term test-retest reliability of the NPSI-Eye was excellent (intraclass correlation coefficient = 0.98, P < 0.001). Correlations between the NPSI-Eye and indicators of general eye pain were ≥0.65 (P < 0.001), whereas correlations between the NPSI-Eye and DE symptom severity and psychological health indices were lower (rho = 0.56, 0.32, 0.37; all P < 0.001). Individuals who reported little or no decrease in pain after anesthetic eye drops (hypothesized to indicate eye pain with at least partial central involvement) had significantly higher NPSI-Eye scores than participants whose eye pain was completely relieved by anesthetic (P < 0.05). Overall, our results support preliminary validation of the NPSI-Eye, yielding similar metrics to those reported in Bouhassira et al.'s original NPSI publication (2004). However, additional evaluation and refinement of some questions may be desirable, including the potential elimination of items that were not highly endorsed.
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147
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Beckman K, Katz J, Majmudar P, Rostov A. Loteprednol Etabonate for the Treatment of Dry Eye Disease. J Ocul Pharmacol Ther 2020; 36:497-511. [PMID: 32391735 PMCID: PMC7482125 DOI: 10.1089/jop.2020.0014] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Dry eye disease (DED) is a common ocular condition that can impair vision and may adversely impact quality of life. Due to the inflammatory nature of this disorder, topical corticosteroids are an effective treatment option, particularly for moderate-to-severe DED when first-line treatments, such as ocular lubricants, are insufficient. Loteprednol etabonate (LE) is a retrometabolically designed corticosteroid with a low propensity to cause corticosteroid-related adverse effects, such as elevated intraocular pressure (IOP). This review was conducted to provide an assessment of published studies on the use of LE for treatment of inflammation associated with DED. Twelve prospective and 2 retrospective studies evaluating LE ophthalmic suspension 0.5% and 2 prospective studies evaluating LE ophthalmic gel 0.5% were identified. LE given as monotherapy or with artificial tears (AT) improved signs of DED, especially among patients with a more pronounced inflammatory component, and also improved DED symptoms compared to baseline and/or control. Treatment with LE before cyclosporine A (CsA) therapy reduced stinging upon CsA initiation and provided more rapid relief of DED signs and symptoms than CsA plus AT alone. In patients with meibomian gland dysfunction, LE alone, or in addition to eyelid scrubs/warm compresses, reduced clinical signs and symptoms, and tear proinflammatory cytokine levels. Overall, LE was safe and well tolerated, with minimal effects on IOP. While larger and longer-term studies are warranted, these data support the use of LE as a safe and effective treatment option for DED.
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Affiliation(s)
- Kenneth Beckman
- Comprehensive Eyecare of Central Ohio, Westerville, Ohio, USA.,Department of Ophthalmology, Ohio State University, Columbus, Ohio, USA
| | - James Katz
- The Midwest Center for Sight, Des Plaines, Illinois, USA
| | - Parag Majmudar
- Chicago Cornea Consultants, Hoffman Estates, Illinois, USA
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148
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Rokohl AC, Trester M, Guo Y, Adler W, Jaeger VK, Loreck N, Mor JM, Pine KR, Heindl LM. Dry anophthalmic socket syndrome - Standardized clinical evaluation of symptoms and signs. Ocul Surf 2020; 18:453-459. [PMID: 32387569 DOI: 10.1016/j.jtos.2020.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/26/2020] [Accepted: 05/02/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess symptoms and signs of the dry anophthalmic socket syndrome (DASS) in a standardized manner. METHODS 87 unilateral anophthalmic patients were evaluated using the Ocular Surface Disease Index (OSDI), the 5-Item Dry Eye Questionnaire (DEQ-5), and a modified version of Symptom Assessment iN Dry Eye (SANDE) questionnaire separately for the anophthalmic socket and for the healthy fellow eye. Conjunctival inflammation was semi-quantitatively graded and Schirmer I test with topical anesthesia was performed bilaterally. The correlations between scores of the dry eye questionnaires and the results of the Schirmer tests, conjunctival inflammation, and demographic data were examined. RESULTS Patients had significantly higher OSDI, DEQ-5 and SANDE scores at the anophthalmic side compared to the healthy eye (p ≤ 0.019, respectively). 63% of patients complained of anophthalmic socket dryness in at least one of the three questionnaires. Patients had higher inflammation (p < 0.001) and more tear volume in the Schirmer I test with topical anesthesia (p ≤ 0.024) on the anophthalmic side compared to the fellow eye. CONCLUSIONS Most anophthalmic patients have significantly more subjective dryness complaints on their anophthalmic side compared to the healthy fellow eye, even in absence of tear deficiency and clinical blepharitis. Eye care practitioners should consider the diagnosis criteria and the definition for DASS proposed in this study, when counseling anophthalmic patients. However, research should be undertaken to investigate the role and the interactions of causative etiological causes for DASS. Furthermore, there is a high priority to establish a standardized examination protocol and to develop an evidence-based treatment algorithm for DASS.
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Affiliation(s)
- Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany.
| | - Marc Trester
- Trester-Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
| | - Yongwei Guo
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Werner Adler
- Department of Biometry and Epidemiology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Viktoria K Jaeger
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Niklas Loreck
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Joel M Mor
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Keith R Pine
- School of Optometry and Vision Science, University of Auckland, New Zealand
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany; Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Dusseldorf, Cologne, Germany
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149
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Mendez R, Watane A, Farhangi M, Cavuoto KM, Leith T, Budree S, Galor A, Banerjee S. Gut microbial dysbiosis in individuals with Sjögren's syndrome. Microb Cell Fact 2020; 19:90. [PMID: 32293464 PMCID: PMC7158097 DOI: 10.1186/s12934-020-01348-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/05/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Autoimmune diseases have been associated with changes in the gut microbiome. In this study, the gut microbiome was evaluated in individuals with dry eye and bacterial compositions were correlated to dry eye (DE) measures. We prospectively included 13 individuals with who met full criteria for Sjögren's (SDE) and 8 individuals with features of Sjögren's but who did not meet full criteria (NDE) for a total of 21 cases as compared to 21 healthy controls. Stool was analyzed by 16S pyrosequencing, and associations between bacterial classes and DE symptoms and signs were examined. RESULTS Results showed that Firmicutes was the dominant phylum in the gut, comprising 40-60% of all phyla. On a phyla level, subjects with DE (SDE and NDE) had depletion of Firmicutes (1.1-fold) and an expansion of Proteobacteria (3.0-fold), Actinobacteria (1.7-fold), and Bacteroidetes (1.3-fold) compared to controls. Shannon's diversity index showed no differences between groups with respect to the numbers of different operational taxonomic units (OTUs) encountered (diversity) and the instances these unique OTUs were sampled (evenness). On the other hand, Faith's phylogenetic diversity showed increased diversity in cases vs controls, which reached significance when comparing SDE and controls (13.57 ± 0.89 and 10.96 ± 0.76, p = 0.02). Using Principle Co-ordinate Analysis, qualitative differences in microbial composition were noted with differential clustering of cases and controls. Dimensionality reduction and clustering of complex microbial data further showed differences between the three groups, with regard to microbial composition, association and clustering. Finally, differences in certain classes of bacteria were associated with DE symptoms and signs. CONCLUSIONS In conclusion, individuals with DE had gut microbiome alterations as compared to healthy controls. Certain classes of bacteria were associated with DE measures.
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Affiliation(s)
- Roberto Mendez
- Department of Surgery, University of Miami, Miami, FL USA
| | - Arjun Watane
- Bascom Palmer Eye Institute, University of Miami, Miami, FL USA
| | - Monika Farhangi
- Bascom Palmer Eye Institute, University of Miami, Miami, FL USA
- Miami Veterans Administration Medical Center, Miami, FL USA
| | - Kara M. Cavuoto
- Bascom Palmer Eye Institute, University of Miami, Miami, FL USA
| | | | | | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL USA
- Miami Veterans Administration Medical Center, Miami, FL USA
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150
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Garza-Leon M, Gonzalez-Dibildox A, Ramos-Betancourt N, Hernandez-Quintela E. Comparison of meibomian gland loss area measurements between two computer programs and intra-inter-observer agreement. Int Ophthalmol 2020; 40:1261-1267. [PMID: 31974824 DOI: 10.1007/s10792-020-01292-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/10/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Meibography is a diagnostic test that allows in vivo evaluation of meibomian gland (MG). Nowadays, it is unknown whether the two available computer programs are equivalent to evaluate the glandular loss area. METHODS This is a prospective, longitudinal, and observational study. A random selection of meibography photographs from healthy patients from the ocular surface clinic at Destellos de Luz foundation is made. The upper eyelid images were taken with the Antares® meibography (CSO, Florence, Italy); they were classified in five sessions with a week of separation between each measurement by an expert observer for each program, Phoenix (MAGL) and ImageJ (LAGB). An analysis of the meibomian gland loss area was performed, calculating it semiautomatically with Phoenix and manually with ImageJ. Intra-observer agreement was assessed through an intra-class correlation coefficient and the mean of standard deviations within subjects. Comparison between the two computational programs MG loss was made trough a nonparametric test. RESULTS Fifty-four images from x patients (n, 67.3% female) were analyzed. The limits of concordance analysis between the two programs showed a range between - 18.55 and 9.14%. The mean MG loss area through ImageJ by observer 1 was 27.91 ± 14.82% (IC 95% 23.87 to 31.96), and that by observer 2 was 29.05 ± 15.17% (95% CI 24.91 to 33.19). The mean MG loss area through Phoenix by observer 1 was 24.48 ± 13.97% (IC 95% 20.67 to 28.29), and that by observer 2 was 24.93 ± 12.70% (95% CI 21.46, 28.40) CONCLUSIONS: The comparison of the measurement of meibomian gland loss with both programs showed a statistically significant difference. Intra-observer repeatability and inter-observer repeatability were good, with no clinical or statistical difference.
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Affiliation(s)
- Manuel Garza-Leon
- Clinical Science Department, Science of Health Division, University of Monterrey, Ave Hidalgo # 2425 Poniente, Colonia Centro, C.P 64700, Monterrey, Nuevo León, Mexico.
- Cornea and Refractive Surgery Services, Hospital "Dr. Luis Sanchez Bulnes", Asociacion Para Evitar La Ceguera en Mexico, Mexico City, Mexico.
| | - Alejandra Gonzalez-Dibildox
- Cornea and Refractive Surgery Services, Hospital "Dr. Luis Sanchez Bulnes", Asociacion Para Evitar La Ceguera en Mexico, Mexico City, Mexico
| | - Nallely Ramos-Betancourt
- Cornea and Refractive Surgery Services, Hospital "Dr. Luis Sanchez Bulnes", Asociacion Para Evitar La Ceguera en Mexico, Mexico City, Mexico
| | - Everardo Hernandez-Quintela
- Cornea and Refractive Surgery Services, Hospital "Dr. Luis Sanchez Bulnes", Asociacion Para Evitar La Ceguera en Mexico, Mexico City, Mexico
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