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Liu Z, Chauhan A. Gold nanoparticles-loaded contact lenses for laser protection and Meibomian Gland Dysfunction (MGD) dry eye treatment. Colloids Surf A Physicochem Eng Asp 2022. [DOI: 10.1016/j.colsurfa.2021.128053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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102
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Min JS, Yoon SH, Kim KY, Jun I, Kim EK, Kim TI, Seo KY. Treatment Effect and Pain During Treatment With Intense Pulsed-Light Therapy According to the Light Guide in Patients With Meibomian Gland Dysfunction. Cornea 2022; 41:177-182. [PMID: 34469338 DOI: 10.1097/ico.0000000000002859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We investigated whether there is a difference in the treatment effect and pain during the treatment of meibomian gland dysfunction (MGD) with intense pulsed-light (IPL) between new light guide and conventional light guide. METHODS We retrospectively reviewed medical records of 85 patients (170 eyes) who underwent IPL treatment of the upper and lower eyelids 3 times, at 3-week intervals, for MGD. Patients treated with the 6-mm or 8 × 15-mm cylindrical light guide were designated as group A or group B, respectively. The ocular surface disease index (OSDI), dry eye (DE), and MGD parameters were obtained before the first and after the third IPL treatments. Visual analog scale (VAS) scores were obtained at every IPL treatment. OSDI, DE, and MGD parameters and VAS scores were compared between the groups. RESULTS VAS scores at the first, second, and third IPL treatments were lower in group A than in group B. OSDI, DE, and MGD parameters were improved after 3 IPL treatments in both groups. There were no significant differences in OSDI, DE symptoms, and MGD parameters between before the first IPL treatment and after the third IPL treatment between the groups. CONCLUSIONS Using the new 6-mm cylindrical light guide for IPL treatment in patients with MGD induced less pain during treatment and had similar treatment effects to the conventional 8 × 15-mm light guide. The new 6-mm cylindrical light guide can be useful when treating patients with dark or hyperpigmented skin and for pediatric patients with low compliance.
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Affiliation(s)
- Ji Sang Min
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea; and
| | - Sook Hyun Yoon
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea; and
| | - Kang Yoon Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea; and
| | - Ikhyun Jun
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea; and
- Department of Ophthalmology, Cornea Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Eung Kweon Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea; and
- Department of Ophthalmology, Cornea Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae-Im Kim
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea; and
- Department of Ophthalmology, Cornea Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea; and
- Department of Ophthalmology, Cornea Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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Hirabayashi T, Shibato J, Kimura A, Yamashita M, Takenoya F, Shioda S. Potential Therapeutic Role of Pituitary Adenylate Cyclase-Activating Polypeptide for Dry Eye Disease. Int J Mol Sci 2022; 23:664. [PMID: 35054857 PMCID: PMC8775530 DOI: 10.3390/ijms23020664] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 12/27/2022] Open
Abstract
Dry eye disease (DED) is caused by a reduction in the volume or quality of tears. The prevalence of DED is estimated to be 100 million in the developed world. As aging is a risk factor for DED, the prevalence of DED is expected to grow at a rapid pace in aging populations, thus creating an increased need for new therapies. This review summarizes DED medications currently in clinical use. Most current medications for DED focus on stimulating tear secretion, mucin secretion, or suppressing inflammation, rather than simply replenishing the ocular surface with moisture to improve symptoms. We recently reported that the neuropeptide PACAP (pituitary adenylate cyclase-activating polypeptide) induces tear secretion and suppresses corneal injury caused by a reduction in tears. Moreover, it has been reported that a PACAP in water and a 0.9% saline solution at +4 °C showed high stability and achieved 80-90% effectiveness after 2 weeks of treatment. These results reveal PACAP as a candidate DED medication. Further research on the clinical applications of PACAP in DED is necessary.
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Affiliation(s)
- Takahiro Hirabayashi
- Clinical Medicine Research Laboratory, Shonan University of Medical Sciences, 16-48, Kamishinano, Totsuka-ku, Yokohama 244-0806, Japan
| | - Junko Shibato
- Clinical Medicine Research Laboratory, Shonan University of Medical Sciences, 16-48, Kamishinano, Totsuka-ku, Yokohama 244-0806, Japan
| | - Ai Kimura
- Clinical Medicine Research Laboratory, Shonan University of Medical Sciences, 16-48, Kamishinano, Totsuka-ku, Yokohama 244-0806, Japan
| | - Michio Yamashita
- Department of Physiology and Molecular Sciences, School of Pharmacy, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Fumiko Takenoya
- Department of Physiology and Molecular Sciences, School of Pharmacy, Hoshi University, 2-4-41 Ebara, Shinagawa-ku, Tokyo 142-8501, Japan
| | - Seiji Shioda
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Shonan University of Medical Sciences, 16-48, Kamishinano, Totsuka-ku, Yokohama 244-0806, Japan
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A review of meibomian gland structure, function, and contact lens wear. Cont Lens Anterior Eye 2021; 45:101560. [PMID: 34955427 DOI: 10.1016/j.clae.2021.101560] [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: 06/18/2021] [Revised: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE To provide a balanced literature review of the studies that have evaluated the effect of contact lenses on meibomian gland (MG) health. METHODS A PubMed.gov literature search was conducted on or before May 15, 2021. No other time constraints were applied. Search terms included the following: "meibomian gland(s)" plus "contact lens(es)" or "meibography" plus "contact lens(es)". Only full text articles written in English were considered. The reference lists of recovered papers were used to identify articles missed during the primary search. Included articles were required to discuss the impact of contact lenses on MG morphology or function and were graded according to the level of evidence presented. RESULTS The literature indicates that contact lenses impact MG function; however, the data are equivocal regarding contact lenses inducing MG structural changes. The literature likewise indicates that the mechanism(s) by which contact lenses impact the MGs are likely multifactorial. Recent data suggests that MGs may have some plasticity. Detected differences between studies likely stem from varied populations evaluated, study designs, and the duration of the evaluation periods. CONCLUSIONS With this literature review finding conflicting relationships between MG health and contact lens use, future longitudinal studies with standardized clinical MG assessments are needed to determine the true impact of contact lenses on MG health. Until these data are obtained, contact lens wearers should undergo a full MG evaluation, especially because recent data suggest that MG treatments may restore MG structure and function.
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Walsh K, Jones L, Moody K. Addressing common myths and misconceptions in soft contact lens practice. Clin Exp Optom 2021; 105:459-473. [PMID: 34886744 DOI: 10.1080/08164622.2021.2003693] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Advances in contact lens technology over the past 50 years since the commercialisation of the first soft lenses in 1971 have been incredible, with significant changes in contact lens materials, frequency of replacement, care systems and lens designs occurring. However, despite the widespread availability of contact lenses, penetration rates for those who need vision correction remain in the low single digits and many practitioners seem to hold on to concepts around the potential value of contact lenses that appear based in the dim and distant past and are certainly no longer valid today. This review addresses 10 common 'myths and misconceptions' around soft contact lenses using an evidence-based approach that can hopefully dispel some of these incorrect assumptions.
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Affiliation(s)
- Karen Walsh
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada.,Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Shatin, Hong Kong
| | - Kurt Moody
- Johnson & Johnson Vision, Jacksonville, Florida, USA
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Badian RA, Utheim TP, Chen X, Utheim ØA, Ræder S, Ystenæs AE, Aakre BM, Sundling V. Meibomian gland dysfunction is highly prevalent among first-time visitors at a Norwegian dry eye specialist clinic. Sci Rep 2021; 11:23412. [PMID: 34862425 PMCID: PMC8642422 DOI: 10.1038/s41598-021-02738-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/22/2021] [Indexed: 11/08/2022] Open
Abstract
To investigate the prevalence of meibomian gland dysfunction (MGD) in patients presenting with subjective dry eye-related symptoms at their first-time consultation in a Norwegian specialized ocular surface clinic. Additionally, to explore the accuracy of the ocular surface disease index score (OSDI) as an extensively applied tool to assess the severity of dry eye symptoms and MGD diagnosis. Patients with subjective dry eye-related complaints (n = 900) attending the clinic for the first time, from 2012 to 2016, were included in the study. At the baseline, patients completed the OSDI questionnaire. Subsequently, objective clinical tests, including fluorescein break-up time (FBUT), Schirmer-I test, ocular surface staining (OSS), and meibomian gland function assessment using gland expressibility and meibum quality were performed. The association between MGD and its severity in relation to symptom severity defined by OSDI-score was examined. MGD was found in 93.8% of the study group. MGD prevalence was not significantly different between groups based on age (p = 0.302) or sex (p = 0.079). There was a significant association between severity of MGD and dry eye-related symptoms (p = 0.014). OSS was significantly higher in patients with severe symptoms (p = 0.031). Sensitivity and specificity of positive symptom-score (OSDI ≥ 13) for disclosing MGD were 85.5% and 30.4%, respectively. MGD was highly prevalent, not associated with age and sex. OSDI ≥ 13 had high sensitivity and high positive predictive value (PPV), but low specificity and negative predictive value (NPV) for disclosing MGD. This underscores the importance of meibomian gland assessment in patients with dry eye-related symptoms.
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Affiliation(s)
- Reza A Badian
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Notodden, Norway.
| | - Tor Paaske Utheim
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Notodden, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway
- The Norwegian Dry Eye Clinic, Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Ophthalmology, Drammen Hospital, Drammen, Norway
| | - Xiangjun Chen
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Notodden, Norway
- The Norwegian Dry Eye Clinic, Oslo, Norway
- Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway
- Department of Ophthalmology, Drammen Hospital, Drammen, Norway
| | - Øygunn Aass Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
- The Norwegian Dry Eye Clinic, Oslo, Norway
| | - Sten Ræder
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
- The Norwegian Dry Eye Clinic, Oslo, Norway
| | - Ann Elisabeth Ystenæs
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Notodden, Norway
| | - Bente Monica Aakre
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Notodden, Norway
| | - Vibeke Sundling
- National Centre for Optics, Vision and Eye Care, Department of Optometry, Radiography and Lighting Design, Faculty of Health and Social Sciences, University of South-Eastern Norway, Notodden, Norway
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107
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Mullick R, Annavajjhala S, Thakur P, Mohapatra A, Shetty R, D'Souza S. Efficacy of topical cyclosporine 0.05% and osmoprotective lubricating eye drops in treating dry eye disease and inflammation. Indian J Ophthalmol 2021; 69:3473-3477. [PMID: 34826977 PMCID: PMC8837309 DOI: 10.4103/ijo.ijo_3822_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: 11/04/2022] Open
Abstract
Purpose To evaluate the effect of topical cyclosporine 0.05% and osmoprotective lubricating eye drops on patients with dry eye disease (DED) with inflammation as measured by raised tear matrix metalloproteinases (MMP-9). Methods This prospective study included 106 eyes of 53 patients diagnosed with DED based on any of the following DED criteria (Ocular Surface Disease Index [OSDI] score >12, tear film breakup time [TBUT] <10 s, Schirmer's I test result <10 mm/5 min, ocular surface staining). Ocular surface inflammation was assessed by assessing MMP-9 positivity from tears of the patients in the study (Inflammadry kit Quidel corporation). Patients were prescribed osmoprotective lubricating eye drops (Osmodrops, Cipla Ltd) four times a day and cyclosporine A 0.05% eye drops (Imudrops, Cipla Ltd) twice a day for 6 months. Efficacy of the formulations was evaluated by OSDI scores, Schirmer's test, TBUT change, reduction in ocular surface staining, and reduction in MMP-9 levels after 6 months of usage. Check P value and add from results. Results After 6 months of topical therapy, improvement was observed in OSDI scores (mean pretreatment: 25.7 ± 12.8, and mean posttreatment: 15.2 ± 8.4), P < 0.001. There was also reduction number of patients who were MMP-9 positive. Out of 75 eyes that tested MMP-9 positive, 70.66% showed reduction in MMP-9 levels P < 0.0001). Ocular surface staining also improved. Conclusion Topical osmoprotective lubricating eye drops and cyclosporine A 0.05% reduce inflammation in cases of DED, which correlates with improvement in OSDI scores, ocular surface staining, and reduction in inflammation as measured by levels of tear MMP-9.
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Affiliation(s)
- Ritika Mullick
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sriram Annavajjhala
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Prashansa Thakur
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Ayushi Mohapatra
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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108
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Abokyi S, Mensah SN, Otchere H, Akoto YO, Ntodie M. Differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability in athletes and non-athletes. Exp Eye Res 2021; 214:108865. [PMID: 34848214 DOI: 10.1016/j.exer.2021.108865] [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: 05/21/2021] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
The study investigated the differential response to a single bout of maximal incremental treadmill exercise between athletes and non-athletes without dry eyes regarding tear secretion, tear film stability, visual acuity (VA), and stereoacuity. Additionally, the study examined the effect of gender and the duration of exercise on exercise-induced changes. Study participants included young university students aged 18-25 years who were athletes (male/female: 13/13) or non-athletes (male/female: 17/9). Participants underwent an aerobic exercise session using a treadmill and following the laid down Bruce treadmill test protocol till exhaustion. Measurements were taken in the order of distance VA, stereopsis, non-invasive tear break-up time (TBUT), and phenol red thread test, at baseline and after the exercise regimen. Within- and between-subject analyses using multiple t-tests with correction for multiple comparisons were performed to determine differences before and after exercise in athletes and non-athletes. Subsequently, ANCOVA was used to assess the influence of gender and the duration of exercise. The mean age (SD) of the athletes and the non-athletes was 22.4 ± 2.1 years and 21.8 ± 2.1 years, respectively (p = 0.357). Before exercise, the athletes had higher TBUT than non-athletes (14.6 ± 2.9 s vs. 11.9 ± 3.8 s; p = 0.021), but no difference was observed in any other ocular measurements. After exercise, the athletes showed significant improvement in tear secretion with the basal tear secretion increasing from 22.3 ± 2.5 mm to 25.8 ± 1.7 mm (p < 0.001). The non-athletes on the other hand had a borderline increase in tear secretion from 21.42 ± 2.85 mm to 23.73 ± 2.68 mm (p = 0.08). Also, the TBUT was much improved in the athletes after exercise compared to the non-athletes (17.7 ± 2.7 s vs. 14.8 ± 2.9 s, p = 0.004). Additionally, exercise improved the VA indifferently between the groups, while stereoacuity was unchanged after exercise in either group. Gender had no influence on the differences in the tear function measures between athletes and non-athletes after exercise. The duration of exercise, however, showed a borderline effect on the tear film stability (p = 0.068) after exercise. Our findings support the differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability between athletes and non-athletes. Thus, increased physical fitness and the duration of exercise might be crucial in the improvement of tear function through aerobic exercise.
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Affiliation(s)
- Samuel Abokyi
- Department of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana; School of Optometry, The Hong Kong Polytechnic University, Hong Kong, Hong Kong.
| | - Sekyere Nyamaah Mensah
- Department of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Heinz Otchere
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Yaw Osei Akoto
- Our Lady of Grace Hospital, Breman Asikuma, Central Region, Ghana
| | - Michael Ntodie
- Department of Optometry and Vision Science, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
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109
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Zhu HY, Liu XQ, Yuan YZ, Wang DH. Measurement of the Lid Margin Thickness in Meibomian Gland Dysfunction with Vernier Micrometer. Ophthalmol Ther 2021; 11:177-186. [PMID: 34762260 PMCID: PMC8770731 DOI: 10.1007/s40123-021-00421-7] [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: 10/05/2021] [Accepted: 10/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction To investigate the lid margin thickness (LMT) from the posterior lash line to the mucocutaneous junction at the middle position in adults with and without meibomian gland dysfunction (MGD) by vernier micrometer (VM). Methods This is a cross-sectional, observational study. A hundred eyes from 100 volunteers aged 20 to 79, including 56 normal participants and 44 participants with MGD, were recruited. Measurements of the LMT by VM were performed by the same person. Results The mean age of 56 normal subjects (24 males and 32 females) and 44 MGD subjects (16 males and 28 females) was 40.0 ± 13.2 years and 42.7 ± 17.1 years, respectively. There was a significant difference in the upper LMT between normal and MGD subjects (1.36 ± 0.25 vs. 1.60 ± 0.27 mm, P < 0.001), but not in the lower LMT (1.0 ± 0.23 vs. 1.10 ± 0.28 mm, P = 0.07). In both normal and MGD subjects, the upper or lower LMT was significantly positively correlated with age (P < 0.05), and the upper LMT was greater than the lower LMT (P < 0.001). In addition, the lower LMT in MGD subjects was significantly positively correlated with meibum expressibility (rs = 0.35, P = 0.02). Conclusions The LMT was closely related to age and could be an important indicator for detecting MGD. Furthermore, we found that the upper LMT was greater than the lower LMT, and the lower LMT in MGD subjects seemed to be related to meibum expressibility.
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Affiliation(s)
- Hua-Ying Zhu
- Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Xin-Quan Liu
- Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Yuan-Zhi Yuan
- Department of Ophthalmology, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.,Centre for Evidence-Based Medicine, Fudan University, Shanghai, China
| | - Da-Hu Wang
- Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China.
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110
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Murtaza F, Toameh D, Al-Habib S, Maini R, Chiu HH, Tam ES, Somani S. Safety and Efficacy of BroadBand Intense Pulsed Light Therapy for Dry Eye Disease with Meibomian Gland Dysfunction. Clin Ophthalmol 2021; 15:3983-3991. [PMID: 34629862 PMCID: PMC8495232 DOI: 10.2147/opth.s331289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
Background BroadBand light intense pulsed light (BBL-IPL) therapy has shown to reduce hordeolum and blepharitis frequency. This study aims to evaluate the efficacy and safety of BBL-IPL therapy in patients with dry eye disease (DED) from meibomian gland dysfunction (MGD). Methods This is a retrospective, consecutive case series of 48 patients with DED from MGD who underwent BBL-IPL therapy from October 2016 to January 2019 at a single, outpatient clinic in Ontario, Canada. Clinical outcomes included first and average non-invasive keratograph tear break-up times (NIKBUT), bulbar redness (BR) scores, tear meniscus heights (TMH), visual acuity (VA) and meibograph grades. Patient-reported outcomes included the Canadian dry eye assessment (CDEA) questionnaire and patient subjective assessment (PSA) scores. Outcomes were measured at baseline and after completion of 4 monthly BBL-IPL sessions. Results The mean severity of dry eye symptoms as measured by the CDEA and PSA decreased significantly from 19.78 ± 9.62 to 12.08 ± 7.40 (p<0.001) and from 7.65 ± 1.74 to 4.77 ± 2.03 (p<0.001), respectively. Twenty-five percent of patients reported no dry eye symptoms after treatment. The meibograph grade improved significantly in both eyes (p<0.001). Approximately 71.0% and 80.1% of patients had an improved meibograph grade in the right and left eye, respectively. Near-significant improvements were observed for BR scores and VA. There was also a trend towards improved first/average NIKBUT and TMH scores. No adverse events were noted. Conclusion BBL-IPL appears to be an effective and safe treatment modality in improving dry eye symptoms and meibomian gland function in patients with DED from MGD.
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Affiliation(s)
- Fahmeeda Murtaza
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Dana Toameh
- Uptown Eye Specialists, Brampton, Ontario, Canada
| | | | - Raj Maini
- Uptown Eye Specialists, Brampton, Ontario, Canada
| | - Hannah H Chiu
- Uptown Eye Specialists, Brampton, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,William Osler Health System, Brampton, Ontario, Canada
| | - Eric S Tam
- Uptown Eye Specialists, Brampton, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,William Osler Health System, Brampton, Ontario, Canada
| | - Sohel Somani
- Uptown Eye Specialists, Brampton, Ontario, Canada.,Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada.,William Osler Health System, Brampton, Ontario, Canada
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111
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Dry eye, its clinical subtypes and associated factors in healthy pregnancy: A cross-sectional study. PLoS One 2021; 16:e0258233. [PMID: 34618845 PMCID: PMC8496781 DOI: 10.1371/journal.pone.0258233] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 09/21/2021] [Indexed: 11/19/2022] Open
Abstract
The study determined the frequency of dry eye, its clinical subtypes and risk factors among pregnant women. This study was a hospital-based cross-sectional study of pregnant women visiting the antenatal clinic of the University of Cape Coast hospital. Clinical dry eye tests were performed along with the administration of a symptom questionnaire. Frequencies, chi-square analysis and logistic regression analyses were conducted to determine the frequency of dry eye disease, its clinical subtypes and associated factors. The prevalence of dry eye disease among the cohort of pregnant women was 82/201 (40.8% 95% confidence interval 34.3%-47.3%). Among the 82 pregnant women with dry eye disease, the frequencies of the clinical subtypes of dry eye were: evaporative dry eye [15/82(18.3%; 95% CI, 12.2%–25.2%)], aqueous deficient dry eye [10/82(12.2.%; 95% CI, 7.3%–18.3)], mixed dry eye [6/82(7.3%; 95% CI, 3.7%–11.0%)], and unclassified dry eye [51/82(62.2%; 95% CI, 52.4%–72.0%)]. Binary logistic regression analysis showed that the following factors were not significantly associated with dry eye: age, BMI, lipid profile, prolactin level, testosterone level, ocular protection index and blink rate. Only gestational age was significantly associated with dry eye disease in pregnancy. In conclusion, the current study showed that dry eye disease occurs frequently in pregnant women ranging from the first to the third trimester and it is associated with increasing gestational age. The evaporative dry eye was more common compared to the aqueous deficient dry eye, but most dry eye could not be classified.
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112
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Can Multi-Attribute Utility Instruments Adequately Capture Net Health Gains in Vision-Related Quality of Life (QoL)? JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/09720634211035264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Health states/outcomes evaluation is an integral part of medical economics. Generic utility instruments compare quality of life (QoL) effects of healthcare interventions across a wide spectrum of diseases and patient populations. This study seeks to determine whether these generic instruments are sensitive to ocular diseases, where expected QoL effects of treatment are patient comfort and symptoms relief, rather than additional quality-adjusted life years (QALYs). Methods: Targeted search and systematic review of refereed studies on dry eye therapy with omega-3 fatty acids (omega-3s) were performed across four databases to identify clinical effectiveness parameters and outcomes. An alternative utility instrument for measuring comparative vision/opthalmic-related QoL effects of pharmaceutical-grade fish oils is used for illustration. Results: Most studies utilise common parametric indices of omega-3 therapy in dry eye. VisQoL appears sufficiently sensitive and customisable to a QoL impact assessment of omega-3s. Clinical outcomes and covariates can be matched to VisQoL in capturing aspects of vision functioning that are vital for patient daily performance and well-being, U = x / n. In contrast, generic measures tend to be content-insensitive to changes in vision/opthalmic-related QoL. Conclusions: Relevance, reliability and validity of multi-attribute utility measures in ocular conditions, like dry eye, can be assessed in terms of four key factors addressed by VisQoL: (a) sensitivity to ocular condition; (b) correlation with clinical parametric data; (c) customisability based on presenting symptoms; and (d) suitability to comparative investigations of intervention effectiveness relative to vision-related QoL.
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113
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TearCare for the Treatment of Meibomian Gland Dysfunction in Adult Patients With Dry Eye Disease: A Masked Randomized Controlled Trial. Cornea 2021; 41:417-426. [PMID: 34581297 PMCID: PMC8895971 DOI: 10.1097/ico.0000000000002837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to demonstrate the safety and effectiveness of a single TearCare procedure compared with a single LipiFlow procedure in treatment of the dry eye disease associated with meibomian gland dysfunction.
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114
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Chen Y, Dana R. Autoimmunity in dry eye disease - An updated review of evidence on effector and memory Th17 cells in disease pathogenicity. Autoimmun Rev 2021; 20:102933. [PMID: 34509656 DOI: 10.1016/j.autrev.2021.102933] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 12/27/2022]
Abstract
The classic Th1/Th2 dogma has been significantly reshaped since the subsequent introduction of several new T helper cell subsets, among which the most intensively investigated during the last decade is the Th17 lineage that demonstrates critical pathogenic roles in autoimmunity and chronic inflammation - including the highly prevalent dry eye disease. In this review, we summarize current concepts of Th17-mediated disruption of ocular surface immune homeostasis that leads to autoimmune inflammatory dry eye disease, by discussing the induction, activation, differentiation, migration, and function of effector Th17 cells in disease development, highlighting the phenotypic and functional plasticity of Th17 lineage throughout the disease initiation, perpetuation and sustention. Furthermore, we emphasize the most recent advance in Th17 memory formation and function in the chronic course of dry eye disease, a major area to be better understood for facilitating the development of effective treatments in a broader field of autoimmune diseases that usually present a chronic course with recurrent episodes of flare in the target tissues or organs.
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Affiliation(s)
- Yihe Chen
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA
| | - Reza Dana
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA.
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115
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Zhou L, Wei X. Ocular Immune-Related Adverse Events Associated With Immune Checkpoint Inhibitors in Lung Cancer. Front Immunol 2021; 12:701951. [PMID: 34504488 PMCID: PMC8421677 DOI: 10.3389/fimmu.2021.701951] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are novel immunotherapy-based drugs that have become increasingly popular in the treatment of lung cancer. Researchers have recognized ocular immune-related adverse events (irAEs) secondary to ICIs because of their vision-threatening characteristics. However, they are incompletely characterized and no studies have reported the ICI-related ocular irAEs in lung cancer. Therefore, we aimed to comprehensively illustrate the clinical characteristics, contributory factors, diagnosis, and management of ICI-related ocular irAEs in lung cancer, based on previously reported 79 patients. Ophthalmoplegia (40.51%), uveitis (20.25%), and dry eye (17.72%) were the most common ICI-related ocular irAEs in lung cancer. Ptosis was the most common (36.71%) and the highest mortality (23.33%) of ophthalmoplegia. Patients in Asia and patients who underwent combination therapy with programmed cell death-1 and cytotoxic T-lymphocyte-associated antigen 4 inhibitors demonstrated significantly higher frequency of ophthalmoplegia than other ocular irAEs. Most ICI-related ophthalmoplegia and uveitis in lung cancer were observed in the first 10 weeks following the initiation of ICIs. Furthermore, the onset time of dry eye and other ocular irAEs was much longer. In addition, 92.31% of the patients with ocular irAEs other than ophthalmoplegia could be remised. In conclusion, ocular irAEs secondary to ICIs in lung cancer are non-negligible, particularly ophthalmoplegia. Ethnicity and the type of ICIs play important roles in the distribution of ocular irAEs. ICI-related ophthalmoplegia in lung cancer presented with early onset and worse prognosis features, thus necessitating further attention.
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Affiliation(s)
- Lin Zhou
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
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Tauber J, Wirta DL, Sall K, Majmudar PA, Willen D, Krösser S. A Randomized Clinical Study (SEECASE) to Assess Efficacy, Safety, and Tolerability of NOV03 for Treatment of Dry Eye Disease. Cornea 2021; 40:1132-1140. [PMID: 33369937 PMCID: PMC8330824 DOI: 10.1097/ico.0000000000002622] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE NOV03 has a unique dual mode of action to address dry eye disease (DED) associated with meibomian gland dysfunction. SEECASE evaluated the efficacy, safety, and tolerability of NOV03 at 2 dosing regimens compared with a saline comparator in patients with DED. METHODS SEECASE was a prospective, multicenter, randomized, double-masked, saline-controlled clinical study. A total of 336 DED patients [tear film breakup time ≤5 seconds, abnormal meibum secretion, total corneal fluorescein staining (tCFS) score of 4 ≤ X ≤ 11 (National Eye Institute scale), Schirmer of ≥5 mm] were randomized in a 2:2:1:1 manner to NOV03 4 times daily (QID), NOV03 twice daily (BID), saline BID, and saline QID, respectively. The primary efficacy endpoint was tCFS staining at 8 weeks for both regimens. Secondary endpoints included visual analog scales and the Ocular Surface Disease Index questionnaire for symptom assessment. RESULTS The study met its primary endpoint, change from baseline of tCFS over control, for both dosing regimens QID and BID (P < 0.001 and P = 0.009, respectively). NOV03 also showed pronounced improvement in various symptoms. For the Eye Dryness Score, changes from baseline were statistically significant compared with those of the control at week 8 [P < 0.001 (QID) and P = 0.002 (BID)]. Benefits on tCFS and symptoms started at 2 weeks after start of treatment and were maintained over the study duration. The effects were dosing schedule dependent. NOV03 was well tolerated with instillation site reactions below 3% in both treatment regimes. CONCLUSIONS The SEECASE study demonstrated that NOV03 improves signs and symptoms in patients with highly symptomatic evaporative dry eye disease.
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117
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Song Y, Yu S, He X, Yang L, Wu Y, Qin G, Zhang Q, Deep Singh Talwar G, Xu L, Moore JE, He W, Pazo EE. Tear film interferometry assessment after intense pulsed light in dry eye disease: A randomized, single masked, sham-controlled study. Cont Lens Anterior Eye 2021; 45:101499. [PMID: 34433517 DOI: 10.1016/j.clae.2021.101499] [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: 03/24/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inadequate meibomian glands (MGs) secretion can lead to dry eye signs and symptoms. Tear film lipid layer (TFLL) secreted by MGs protects and prevents rapid evaporation of tear film. The purpose was to assess TFLL alteration and function in patients with evaporative dry eye (EDE) using tear interferometry after optimal pulse light technology (OPT) intense pulsed light (IPL). METHODS This prospective randomized examiner-masked sham- controlled study included 86 participants (142 eyes) with DED. IPL or sham procedure was performed on day 0, 21, and 42. Ocular Surface Disease Index (OSDI), non-invasive breakup time (NITBUT), interferometric fringe pattern determined TFLL quality, fluorescein staining (FS), and meibum gland (MG) were assessed at day 0, 21, 42 and 3-month. RESULTS At 3-month, TFLL, NITBUT, MG drop-out, MG quality, MG expressibility, FS and OSDI improved significantly (P < 0.05) in the IPL group, while the sham group had no significant improvements. Except for Meibo-score and FS, all parameters significantly correlated with the improvement in TFLL following IPL treatment. Additionally, artificial tears usage was significantly less in the IPL group from D-42 onwards. CONCLUSION IPL treatment demonstrated the ability to improve TFLL quality and clinically reduced sign and symptoms of DED thereby reducing the frequency of artificial tears use.
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Affiliation(s)
- Yilin Song
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Sile Yu
- He University, Shenyang, China
| | | | - Lanting Yang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Wu
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing Zhang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Ling Xu
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China
| | - Jonathan E Moore
- Cathedral Eye Clinic, 89-91 Academy Street, Belfast, United Kingdom; Biomedical Sciences Research Institute, University of Ulster, Coleraine, United Kingdom
| | - Wei He
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; He University, Shenyang, China
| | - Emmanuel Eric Pazo
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; He University, Shenyang, China
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Association Between Dry Eye and Polycystic Ovary Syndrome: Subclinical Inflammation May Be Part of the Process. Eye Contact Lens 2021; 47:27-31. [PMID: 32496281 DOI: 10.1097/icl.0000000000000716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the changes in tear function in patients with polycystic ovary syndrome (PCOS) and establish whether there is a correlation between hormonal levels, novel hematologic biomarkers, and dry eye parameters. MATERIAL AND METHOD Forty-seven patients with PCOS and 43 age-matched patients with unexplained infertility were included in the control group. Follicle-stimulating hormone, luteinizing hormone, estradiol, thyroid-stimulating hormone, prolactin, dehydroepiandrosterone sulfate (DHEA-S), 17-OH progesterone, fasting and postprandial glucose, fasting insulin, and cholesterol metabolites were evaluated in both groups. In addition, the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio were obtained from a complete blood count. The Ocular Surface Disease Index (OSDI) questionnaire was administered, and all patients underwent tear break-up time (BUT) and Schirmer I tests. Bivariate correlations were investigated using Spearman correlation coefficient analysis. RESULTS The mean age of the PCOS group and the control group was 27.66±3.96 years and 29.28±6.83 years, respectively. Schirmer I test scores and BUT values were significantly lower and OSDI results were significantly higher in the PCOS group (P=0.003, P<0.001, and P=0.004). An inverse correlation was found between DHEA-S and BUT values in the PCOS group (r=-0.296, P=0.043). Similarly, a negative correlation was also present between NLR and BUT values in the PCOS group (r=-0.322, P=0.027). CONCLUSIONS Dry eye can be well established by sensitive tests in patients with PCOS. The severity of dry eye may be correlated with the level of inflammation and hyperandrogenism.
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Pult H, Khatum FS, Trave-Huarte S, Wolffsohn JS. Effect of Eye Spray Phospholipid Concentration on the Tear Film and Ocular Comfort. Eye Contact Lens 2021; 47:445-448. [PMID: 33813585 PMCID: PMC8294836 DOI: 10.1097/icl.0000000000000788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the effect of eye spray phospholipid concentration on symptoms and tear film stability. METHODS High-concentration (Tears Again, Optima Pharma GmbH, Hallbergmoos, Germany) and low-concentration (Ocuvers, Innomedis AG, Germany) phospholipid eye sprays were sprayed onto the closed eyelids of 30 subjects (33.2±1.8 years; 20 women) in a multicentered, prospective, crossover study. Ocular comfort (visual analog scale) and noninvasive tear film stability (NIBUT) of each eye were evaluated before application (along with the Ocular Surface Disease Index), 10 min after application, and 30 min after application. RESULTS Comfort (high concentration: 68.5±16.4 vs. low concentration: 70.7±14.5 phospholipid) and NIBUT (high concentration: 11.5±4.6 sec vs. low concentration: 11.2±6.0 sec phospholipid) were not different (P>0.3) between sprays before application, but comfort (by 12 points, P=0.001) and NIBUT (by 5 sec, P=0.016) were significantly better with a high-concentration phospholipid spray at both 10 min and 30 min time points than those with the low-concentration phospholipid spray. CONCLUSIONS The liposomal eye spray with higher concentration of phospholipids significantly improved ocular comfort and tear film stability in contrast to the eye spray with lower concentration of phospholipids, hence practitioners need to choose an appropriate eye spray to maximize the patient benefit.
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Affiliation(s)
- Heiko Pult
- Optometry and Vision Sciences Research Group (H.P., F.S.K., S.T.H., J.S.W.), College of Health and Life Sciences, Aston University, Birmingham, United Kingdom; Dr. Heiko Pult—Optometry and Vision Research (H.P.), Weinheim, Germany; and School of Biomedical & Life Sciences (H.P.), Cardiff University, Cardiff, United Kingdom.
| | - Farzana S. Khatum
- Optometry and Vision Sciences Research Group (H.P., F.S.K., S.T.H., J.S.W.), College of Health and Life Sciences, Aston University, Birmingham, United Kingdom; Dr. Heiko Pult—Optometry and Vision Research (H.P.), Weinheim, Germany; and School of Biomedical & Life Sciences (H.P.), Cardiff University, Cardiff, United Kingdom.
| | - Sonia Trave-Huarte
- Optometry and Vision Sciences Research Group (H.P., F.S.K., S.T.H., J.S.W.), College of Health and Life Sciences, Aston University, Birmingham, United Kingdom; Dr. Heiko Pult—Optometry and Vision Research (H.P.), Weinheim, Germany; and School of Biomedical & Life Sciences (H.P.), Cardiff University, Cardiff, United Kingdom.
| | - James S. Wolffsohn
- Optometry and Vision Sciences Research Group (H.P., F.S.K., S.T.H., J.S.W.), College of Health and Life Sciences, Aston University, Birmingham, United Kingdom; Dr. Heiko Pult—Optometry and Vision Research (H.P.), Weinheim, Germany; and School of Biomedical & Life Sciences (H.P.), Cardiff University, Cardiff, United Kingdom.
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120
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Vergés C, Salgado-Borges J, March de Ribot F, Ribas V. Current developments of intensive pulsed light treatment for dry eye disease and meibomian gland dysfunction. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1954504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Carlos Vergés
- Department of Ophthalmology, Hospital Universitario Dexeus, Area Oftalmológica Avanzada, Universidad Politécnica De Cataluña, Barcelona, Spain
| | - José Salgado-Borges
- Department of Ophthalmology, Hospital Universitario Dexeus, Area Oftalmológica Avanzada, Universidad Politécnica De Cataluña, Barcelona, Spain
- Universidade do Minho, Porto, Portugal
| | - Francesc March de Ribot
- Department of Ophthalmology, Hospital Universitario Dexeus, Area Oftalmológica Avanzada, Universidad Politécnica De Cataluña, Barcelona, Spain
- Department of Ophthalmology, Girona Hospital, Girona University, Girona, Spain
| | - Verónica Ribas
- Department of Ophthalmology, Hospital Universitario Dexeus, Area Oftalmológica Avanzada, Universidad Politécnica De Cataluña, Barcelona, Spain
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Khanal S, Bai Y, Ngo W, Nichols KK, Wilson L, Barnes S, Nichols JJ. Human Meibum and Tear Film Derived (O-Acyl)-Omega-Hydroxy Fatty Acids as Biomarkers of Tear Film Dynamics in Meibomian Gland Dysfunction and Dry Eye Disease. Invest Ophthalmol Vis Sci 2021; 62:13. [PMID: 34236383 PMCID: PMC8267210 DOI: 10.1167/iovs.62.9.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the association between precorneal tear film (PCTF)- and meibum-derived (O-Acyl)-omega-hydroxy fatty acids (OAHFAs) and PCTF thinning in meibomian gland health and dysfunction. Methods Of 195 eligible subjects (18-84 years, 62.6% female), 178 and 170 subjects provided both PCTF optical coherence tomography (OCT) imaging and mass spectrometry data for tears (n = 178) and meibum (n = 170). The PCTF thinning rate was measured in the right eye using an ultra-high-resolution, custom-built OCT. Tear and meibum samples from the right eye were infused into the SCIEX 5600 TripleTOF mass spectrometer in the negative ion mode. Intensities (m/z) of preidentified OAHFAs were measured with Analyst 1.7TF and LipidView 1.3 (SCIEX). Principal component (PC) analyses and Spearman's correlations (ρ) were performed to evaluate the association between OAHFAs and PCTF thinning rates. Results In meibum and tear samples, 76 and 78 unique OAHFAs were detected, respectively. The first PC scores of the meibum-derived OAHFAs had statistically significant correlations with PCTF thinning rates (ρ = 0.18, P = 0.016). Among 10 OAHFAs with the highest first PC loadings, six OAHFAs had negative correlations with PCTF thinning rate (18:2/16:2, ρ = -0.19, P = 0.01; 18:2/30:1, ρ = -0.21, P = 0.008; 18:1/28:1, ρ = -0.22, P = 0.004; 18:1/30:1, ρ = -0.22, P = 0.005; 18:1/25:0, ρ = 0.22, P = 0 .006; and 18:1/26:1, ρ = -0.22, P = 0.006), while one OAHFA had a positive correlation with PCTF thinning rate (18:2/18:1, ρ = 0.48, P = 0.006). Tear film-derived OAHFAs had no association with the PCTF thinning rate. Conclusions Several human meibum-derived OAHFAs showed significant associations with PCTF thinning, suggesting that these OAHFAs could be implicated in the mechanism underlying the stabilization and thinning of the PCTF. The tear-film derived OAHFAs were, however, independent of the rate of PCTF thinning.
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Affiliation(s)
- Safal Khanal
- Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Yuqiang Bai
- Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - William Ngo
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada.,Centre for Eye and Vision Research, 17W Hong Kong Science Park, Hong Kong
| | - Kelly K Nichols
- Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Landon Wilson
- Department of Pharmacology and Toxicology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.,Targeted Metabolomics and Proteomics Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Stephen Barnes
- Department of Pharmacology and Toxicology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States.,Targeted Metabolomics and Proteomics Laboratory, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Jason J Nichols
- Department of Optometry and Vision Science, School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama, United States
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Singh RB, Liu L, Anchouche S, Yung A, Mittal SK, Blanco T, Dohlman TH, Yin J, Dana R. Ocular redness - I: Etiology, pathogenesis, and assessment of conjunctival hyperemia. Ocul Surf 2021; 21:134-144. [PMID: 34010701 PMCID: PMC8328962 DOI: 10.1016/j.jtos.2021.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023]
Abstract
The translucent appearance of the conjunctiva allows for immediate visualization of changes in the circulation of the conjunctival microvasculature consisting of extensive branching of superficial and deep arterial systems and corresponding drainage pathways, and the translucent appearance of the conjunctiva allows for immediate visualization of changes in the circulation. Conjunctival hyperemia is caused by a pathological vasodilatory response of the microvasculature in response to inflammation due to a myriad of infectious and non-infectious etiologies. It is one of the most common contributors of ocular complaints that prompts visits to medical centers. Our understanding of these neurogenic and immune-mediated pathways has progressed over time and has played a critical role in developing targeted novel therapies. Due to a multitude of underlying etiologies, patients must be accurately diagnosed for efficacious management of conjunctival hyperemia. The diagnostic techniques used for the grading of conjunctival hyperemia have also evolved from descriptive and subjective grading scales to more reliable computer-based objective grading scales.
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Affiliation(s)
- Rohan Bir Singh
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Lingjia Liu
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sonia Anchouche
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA; Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ann Yung
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Sharad K Mittal
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Tomas Blanco
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Thomas H Dohlman
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Jia Yin
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Reza Dana
- Laboratory of Corneal Immunology, Transplantation and Regeneration, Schepens Eye Research Institute, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
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Meibomian Gland Dysfunction: Intense Pulsed Light Therapy in Combination with Low-Level Light Therapy as Rescue Treatment. ACTA ACUST UNITED AC 2021; 57:medicina57060619. [PMID: 34198493 PMCID: PMC8231972 DOI: 10.3390/medicina57060619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Evaporative dry eye disease is frequently associated with meibomian gland dysfunction. Patients are often unhappy because of daily drops, care burden, and suboptimal conventional treatments. In this study, we assessed the efficacy of a novel device, the Eye-light®, a combination of intense pulsed light therapy and low-level light therapy, as a novel treatment for meibomian gland dysfunction and dry eye disease. Materials and Methods: This was a retrospective, single-center study carried out over a 6-week period, in which 22 eyes from 11 patients were included. Each patient received four combined light therapy treatment sessions, once weekly over 4 weeks. Patients underwent a clinical examination and filled out a standardized questionnaire to evaluate symptoms one week prior to treatment, and one week after the fourth session. Results: Combined light therapy improved several ocular surface outcome measures in our patients. This study demonstrates that this adjunctive treatment significantly improves the ocular surface and quality of life of patients with dry eye disease and meibomian gland dysfunction. Conclusions: Combined light therapy may be included in meibomian gland dysfunction treatment protocols as an adjunctive rescue treatment.
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Ji YW, Seong H, Seo JG, Park SY, Alotaibi M, Choi M, Nam S, Kim TI, Lee HK, Seo KY. Evaluation of dry eye subtypes and characteristics using conventional assessments and dynamic tear interferometry. Br J Ophthalmol 2021; 106:1648-1654. [PMID: 34108224 DOI: 10.1136/bjophthalmol-2020-318624] [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] [Received: 12/10/2020] [Accepted: 05/29/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS To evaluate subtypes and characteristics of dry eye (DE) using conventional tests and dynamic tear interferometry, and to investigate determinants of disease severity in each DE subtype. METHODS 309 patients diagnosed with DE and 69 healthy controls were prospectively enrolled. All eyes were evaluated using Ocular Surface Disease Index (OSDI), Schirmer's test I (ST1) and Meibomian gland dysfunction (MGD) grade were analysed. The tear interferometric pattern and lipid layer thickness were determined using DR-1α and LipiView II, respectively. RESULTS Dynamic interferometric analysis revealed 56.6% of patients with DE exhibited Jupiter patterns, indicative of aqueous-deficiency, while 43.4% exhibited crystal patterns, indicative of lipid deficiency. These findings were in accordance with classification based on ST1 scores and MGD grade. Conventional assessment indicated 286 patients exhibited evidence of evaporative DE (EDE) due to MGD, while only 11 exhibited signs of pure aqueous-deficient DE (pure ADDE, only ST1 ≤5 mm). Interestingly, of 286 patients with EDE, 144 were categorised into the mixed-ADDE/EDE group, in which ST1 was identified as a strong negative determinant of OSDI. In contrast, 72.2% of patients with mixed-ADDE/EDE exhibited Jupiter patterns (Jupiter mixed), while 27.8% exhibited crystal patterns (crystal mixed). OSDI values were significantly higher in the crystal-mixed group than in the Jupiter mixed, in which OSDI scores were independently associated with ST1 values only. CONCLUSIONS Our findings indicate that majority of EDE patients also exhibit aqueous deficiency, which can aggravate symptoms even in patients with lipid-deficient mixed-ADDE/EDE. Conventional assessments should be combined with interferometric tear analysis to determine the most appropriate treatment for each DE patient.
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Affiliation(s)
- Yong Woo Ji
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyojin Seong
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Jeong Gi Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Si Yoon Park
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Mutlaq Alotaibi
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Prince Mohammad Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Moonjung Choi
- Department of Ophthalmology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Sangmin Nam
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Tae-Im Kim
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyung Keun Lee
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
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125
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Measurement of the Lower Lid Margin Thickness by Oculus Keratograph. Eye Contact Lens 2021; 47:341-346. [PMID: 33813586 DOI: 10.1097/icl.0000000000000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate the lower lid margin thickness (LLMT) from the posterior lash line to the anterior edge of tear meniscus with Oculus Keratograph 4 (K4). METHODS This was a prospective, single-center, observational study. A total of 90 volunteers aged 18 to 79 years with no ocular diseases were included in this study. The LLMT of 90 subjects was measured twice by the same person with K4. To determine the reliability of K4, measuring the LLMT of 30 normal subjects was separately performed by two operators. RESULTS The LLMT measurements with K4 between two operators demonstrated a good reproducibility (0.94±0.18 vs. 0.96±0.16 mm; intraclass correlation coefficient=0.88; P=0.18). The mean age of 90 volunteers (42 men and 48 women) was 45.5±14.1 years. The LLMT was 0.95±0.17 mm, which was a significant positive correlation with age (rs=0.57; P<0.001). In addition, there was no significant difference in the LLMT between genders (0.97±0.16 vs. 0.93±0.18 mm; P=0.32). CONCLUSIONS We found that K4 was a reliable tool in the LLMT measurements, and the LLMT seemed to be closely related to age but not to gender.
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126
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Changes in the expression of matrix metalloproteinase-9 after intense pulsed light therapy combined with meibomian gland expression in moderate and severe meibomian gland dysfunction. Cont Lens Anterior Eye 2021; 44:101339. [DOI: 10.1016/j.clae.2020.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 01/15/2023]
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127
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Sawai M, Watanabe K, Tanaka K, Kinoshita W, Otsuka K, Miyamoto M, Sassa T, Kihara A. Diverse meibum lipids produced by Awat1 and Awat2 are important for stabilizing tear film and protecting the ocular surface. iScience 2021; 24:102478. [PMID: 34113821 PMCID: PMC8169949 DOI: 10.1016/j.isci.2021.102478] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 12/16/2022] Open
Abstract
A lipid layer consisting of meibum lipids exists in the tear film and functions in preventing dry eye disease. Although the meibum lipids include diverse lipid classes, the synthesis pathway and role of each class remain largely unknown. Here, we created single and double knockout (KO and DKO, respectively) mice for the two acyl-CoA wax alcohol acyltransferases (Awat1 and Awat2) and investigated their dry eye phenotypes and meibum lipid composition. Awat2 KO and DKO mice exhibited severe dry eye with meibomian gland dysfunction, whereas Awat1 KO mice had mild dry eye. In these mice, specific meibum lipid classes were reduced: (O-acyl)-ω-hydroxy fatty acids and type 1ω wax diesters in Awat1 KO mice, wax monoesters and types 1ω and 2ω wax diesters in Awat2 KO mice, and most of these in DKO mice. Our findings reveal that Awat1 and Awat2 show characteristic substrate specificity and together produce diverse meibum lipids.
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Affiliation(s)
- Megumi Sawai
- Laboratory of Biochemistry, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Kita 12-jo, Nishi 6-chome, Kita-ku 060-0812, Japan
| | - Keisuke Watanabe
- Pharmaceutical Research Laboratories, Research and Development Headquarters, Lion Corporation, Odawara 256-0811, Japan
| | - Kana Tanaka
- Pharmaceutical Research Laboratories, Research and Development Headquarters, Lion Corporation, Odawara 256-0811, Japan
| | - Wataru Kinoshita
- Laboratory of Biochemistry, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Kita 12-jo, Nishi 6-chome, Kita-ku 060-0812, Japan
| | - Kento Otsuka
- Laboratory of Biochemistry, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Kita 12-jo, Nishi 6-chome, Kita-ku 060-0812, Japan
| | - Masatoshi Miyamoto
- Laboratory of Biochemistry, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Kita 12-jo, Nishi 6-chome, Kita-ku 060-0812, Japan
| | - Takayuki Sassa
- Laboratory of Biochemistry, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Kita 12-jo, Nishi 6-chome, Kita-ku 060-0812, Japan
| | - Akio Kihara
- Laboratory of Biochemistry, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Kita 12-jo, Nishi 6-chome, Kita-ku 060-0812, Japan
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128
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Monolayers of Cholesterol and Cholesteryl Stearate at the Water/Vapor Interface: A Physico-Chemical Study of Components of the Meibum Layer. COLLOIDS AND INTERFACES 2021. [DOI: 10.3390/colloids5020030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Langmuir monolayers containing different amounts of cholesterol and cholesteryl stearate were studied at two different temperatures (24 °C and 35 °C). The main goal was to contribute towards the understanding of how the variations in the chemical composition may affect the physico-chemical properties of these specific lipid monolayers. The model mixture was chosen considering that cholesteryl esters are present in cell membranes and some other biological systems, including human tear lipids. Therefore, an investigation into the effect of the lipid monolayer composition on their interfacial properties may elucidate some of the fundamental reasons for the deficiencies in cell membranes and tear film functioning in vivo. The experimental results have shown that the molar ratio of the mixture plays a crucial role in the modulation of the Langmuir film properties. The condensing effects of the cholesterol and the interactions between the lipids in the monolayer were the main factors altering the monolayer response to dilatational deformation. The modification of the mixture compositions leads to significant changes in the Langmuir films and the mechanical performance, altering the ability of the monolayer to reduce the surface tension and the viscoelastic properties of the monolayers. This suggests that subtle modifications of the biomembrane composition may significantly alter its physiological function.
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129
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Albietz JM, Lenton LM. Standardised antibacterial Manuka honey in the management of persistent post‐operative corneal oedema: a case series. Clin Exp Optom 2021; 98:464-72. [PMID: 26390910 DOI: 10.1111/cxo.12295] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 02/20/2015] [Accepted: 03/06/2015] [Indexed: 01/22/2023] Open
Affiliation(s)
- Julie M Albietz
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lee M Lenton
- Vision Eye Institute, Brisbane, Queensland, Australia
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130
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Moon SY, Han SA, Kwon HJ, Park SY, Lee JH, Chung HS, Kim JY, Tchah H, Lee H. Effects of lid debris debridement combined with meibomian gland expression on the ocular surface MMP-9 levels and clinical outcomes in moderate and severe meibomian gland dysfunction. BMC Ophthalmol 2021; 21:175. [PMID: 33845799 PMCID: PMC8040198 DOI: 10.1186/s12886-021-01926-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/29/2021] [Indexed: 11/28/2022] Open
Abstract
Background To evaluate the effects of lid debris debridement and meibomian gland expression (MGX) on extracellular matrix metalloproteinase-9 (MMP-9) levels and clinical outcomes of moderate and severe MGD. Methods In this retrospective case series study, a total 48 eyes of 24 patients with moderate and severe MGD underwent one session of lid debris debridement using the BlephEx combined with MGX. We evaluated the tear film break-up time (TBUT), corneal and conjunctival fluorescein staining scores, Schirmer 1 test, biomicroscopic examination of lid margins and meibomian gland (MG), ocular surface disease index (OSDI) questionnaire score, and extracellular MMP-9 levels using a point-of-care MMP-9 immunoassay device before and 4 weeks after lid debris debridement and MGX. Linear mixed model and generalized estimating equations model were used to evaluate possible differences. Results There were significant improvements in the TBUT (P = 0.002), SICCA and Oxford staining scores (all P < 0.001), lid margin telangiectasia (P < 0.001 for upper and lower eyelids), lid thickness (P < 0.001 for upper and lower eyelids), MG orifice plugging (P < 0.001 for upper and lower eyelids), meibum color (P = 0.026 for upper eyelid, P < 0.001 for lower eyelid), meibum consistency (P < 0.001 for upper and lower eyelids), meibum grade (P < 0.001), MGD stage (P < 0.001), and OSDI score (P = 0.002). MMP-9 immunoassay positivity rate significantly decreased from 83.3 to 50.0% 4 weeks after treatment (P = 0.014). Conclusions In patients with moderate to severe MGD, lid debris debridement using the BlephEx combined with MGX improved clinical findings, subjective symptoms, meibomian gland function, along with ocular surface MMP-9 level. We hereby suggest lid debris debridement using BlephEx combined with MGX as an effective clinical strategy for treatment of moderate to severe MGD.
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Affiliation(s)
- Su Young Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Sol Ah Han
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hye Ji Kwon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - So Young Park
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Hyuck Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Ho Seok Chung
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, South Korea.
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131
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Baiula M, Spampinato S. Experimental Pharmacotherapy for Dry Eye Disease: A Review. J Exp Pharmacol 2021; 13:345-358. [PMID: 33790661 PMCID: PMC8001578 DOI: 10.2147/jep.s237487] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/11/2021] [Indexed: 01/22/2023] Open
Abstract
Dry eye disease (DED) is a complex multifactorial disease showing heterogenous symptoms, including dryness, photophobia, ocular discomfort, irritation and burning but also pain. These symptoms can affect visual function leading to restrictions in daily life activities and reduction in work productivity with a consequently high impact on quality of life. Several pathological mechanisms contribute to the disease: evaporative water loss leads to impairment and loss of tear homeostasis inducing either directly or indirectly to inflammation, in a self-perpetuating vicious cycle. Dysregulated ocular immune responses result in ocular surface damage, which further contributes to DED pathogenesis. Currently, DED treatment is based on a flexible stepwise approach to identify the most beneficial intervention. Although most of the available treatments may control to a certain extent some signs and symptoms of DED, they show significant limitations and do not completely address the needs of patients suffering from DED. This review provides an overview of the emerging experimental therapies for DED. Several promising therapeutic strategies are under development with the aim of dampening inflammation and restoring the homeostasis of the ocular surface microenvironment. Results from early phase clinical trials, testing the effects of EnaC blockers, TRPM8 agonist or mesenchymal stem cells in DED patients, are especially awaited to demonstrate their therapeutic value for the treatment of DED. Moreover, the most advanced experimental strategies in the pipeline for DED, tivanisiran, IL-1R antagonist EBI-005 and SkQ1, are being tested in Phase III clinical trials, still ongoing. Nevertheless, although promising results, further studies are still needed to confirm efficacy and safety of the new emerging therapies for DED.
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Affiliation(s)
- Monica Baiula
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
| | - Santi Spampinato
- Department of Pharmacy and Biotechnology, University of Bologna, Bologna, Italy
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132
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Holtmann C, Finis D, Knop E, Borrelli M, Geerling G. Lateral Canthal Sling Procedure for Meibomian Gland Dysfunction? Results of a Pilot Study. Curr Eye Res 2021; 46:1489-1494. [PMID: 33749468 DOI: 10.1080/02713683.2021.1896741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Involutional changes of lid structures often induce horizontal lid laxity; this can result in a reduction of Meibomian gland expression, potentially leading to symptoms of dry eye. The aim of this study was to evaluate the effect of tightening the lower eyelid via a lateral canthal sling (LCS) procedure on dry eye parameters.Methods: Patients with Meibomian Gland Dysfunction (MGD), lower lid laxity (positive Snap-back Test and positive Pinch Test) and no previous lid surgery were evaluated before and 3 months after LCS procedure for symptoms by OSDI. The fellow eye without surgery functioned as a control group. MGD parameters included lipid layer thickness (LLT), non-invasive breakup time (NIBUT), tear meniscus height, loss of Meibomian glands, lid margin parallel conjunctival folds (LIPCOFs), Schirmer's test, the number of expressible Meibomian glands as well as quality of Meibum.Results: Fourteen patients (8 men and 6 women; 79.2 ± 4.0 years) were enrolled in this prospective clinical study. After 3 months, the OSDI showed a significant reduction (preop 42.9 ± 24.7; postop 23.8 ± 21.6; p = .002); NIBUT (5.5 ± 2.6 s to 9.9 ± 6.8 s p = .08) and LLT (64.3 ± 30.4 to 74.1 ± 27.8; p = .025) improved, while Schirmer Test (15.3 ± 4.7 mm to 11.9 ± 2.9 mm; p = .03) and tear meniscus height were reduced (0.8 ± 0.3 to 0.6 ± 0.2; p = .05). Meibomian gland loss scored by the meiboscale slightly increased postoperatively (1.2 ± 0.9 to 1.4 ± 0.9; p = .18). The number of expressible Meibomian glands improved (4.4 ± 2.6 to 6.8 ± 2.1, p = .002) as well as the quality of Meibum (0.9 ± 1.0 to 0.5 ± 0.8, p = .04). Snap back test as well the pinch test were negative in all patients postoperatively.Conclusion: Addressing lower lid laxity with an LCS procedure simultaneously enhances tear drainage, reduces tear film volume parameters and increases tear film stability results with an improvement of dry eye symptoms. It is likely that increased lower eyelid tension and thus excretory pressure on the Meibomian glands is responsible for these alterations.
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Affiliation(s)
- Christoph Holtmann
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - David Finis
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Erich Knop
- Ocular Surface Center Berlin (OSCB), Berlin, Germany
| | - Maria Borrelli
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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133
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Ross E, Furniss E, Chandramohan N, Markoulli M. The multi-faceted approach to dry eye disease. Clin Exp Optom 2021; 104:417-420. [PMID: 33689611 DOI: 10.1080/08164622.2021.1877534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Emilie Ross
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
| | - Emma Furniss
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia.,The Dry Eye Institute, Sydney, Australia
| | - Nivaasheni Chandramohan
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia.,Macular Disease Foundation, Sydney, Australia
| | - Maria Markoulli
- School of Optometry & Vision Science, University of New South Wales, Sydney, Australia
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134
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Sandford EC, Muntz A, Craig JP. Therapeutic potential of castor oil in managing blepharitis, meibomian gland dysfunction and dry eye. Clin Exp Optom 2021; 104:315-322. [PMID: 33037703 DOI: 10.1111/cxo.13148] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The multifactorial pathogenesis and interrelationship of blepharitis, meibomian gland dysfunction and dry eye disease poses challenges to any therapeutic approach. Current treatments are mostly palliative, with success limited by perceived inefficacy and poor patient compliance. Castor oil, a natural derivative of the Ricinus communis plant, is widely used as an emollient in cosmetics and personal care products, drug delivery systems and wound dressings. Castor oil is deemed safe and tolerable, with strong anti-microbial, anti-inflammatory, anti-nociceptive, analgesic, antioxidant, wound healing and vaso-constrictive properties. Its main constituent, ricinoleic acid, has a bipolar molecular structure that promotes the formation of esters, amides and polymers. These can supplement deficient physiological tear film lipids, enabling enhanced lipid spreading characteristics and reducing aqueous tear evaporation. Studies reveal that castor oil applied topically to the ocular surface has a prolonged residence time, facilitating increased tear film lipid layer thickness, stability, improved ocular surface staining and symptoms. This review summarises the properties, current uses of, and therapeutic potential of castor oil in managing ocular surface disease. The biochemical, medicinal actions of castor oil are explored from the perspective of ocular surface pathology, and include microbial and demodectic over-colonisation, inflammatory and oxidative processes, as well as clinical signs and symptoms of dryness and discomfort.
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Affiliation(s)
- Emma C Sandford
- Department of Ophthalmology, Tauranga Eye Specialists, Tauranga, New Zealand
| | - Alex Muntz
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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135
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Peng WY, Chen RX, Dai H, Zhu L, Li Y, Gao ZQ, Li XY, Zhou SY. Efficacy, Safety, and Tolerability of a Novel Cyclosporine, a Formulation for Dry Eye Disease: A Multicenter Phase II Clinical Study. Clin Ther 2021; 43:613-628. [PMID: 33546885 DOI: 10.1016/j.clinthera.2020.12.023] [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] [Received: 10/08/2020] [Revised: 12/27/2020] [Accepted: 12/31/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore the efficacy, safety, and tolerability of a novel cyclosporine formulation for dry eye disease (DED). METHODS This is an exploratory, multicenter, single-blind, randomized, positive-controlled Phase II clinical trial between cyclosporine ophthalmic gel (CyclAGel) and an open-label comparator (Restasis, positive control). A total of 240 eligible patients with moderate to severe DED were randomized to 4 study groups: CyclAGel 0.05%/once daily (QD) (n = 59), CyclAGel 0.05%/BID (n = 60), CyclAGel 0.1%/QD (n = 60), and Restasis 0.05%/BID (n = 61). After receiving BID dosing of hypromellose eye drops during a 2-week run-in period, patients were randomized to the respective treatment group and dosed QD or BID for 12 weeks. Efficacy was assessed based on a number of sign and symptom end points, including eye dryness score (visual analog scale), 6 other parameters of symptoms for dryness (burning/stinging, itching, foreign body sensation, discomfort, sensitivity to light, and pain), and corneal fluorescein staining. The Schirmer test was used to assess dry eye symptoms (visual analog scale severity) at visit 3 (week 2), visit 4 (week 6), and visit 5 (week 12). FINDINGS CyclAGel showed a consistent improvement in eye dryness score and the 6 other parameters of symptoms for dryness, corneal fluorescein staining, breakup time, and Schirmer test scores compared with Restasis over the 12-week treatment period. However, there were no statistically significant differences between CyclAGel and Restasis after baseline corrections were made, and the results of the full analysis set remained consistent with those of the per-protocol set (P > 0.05). Moreover, each CyclAGel-treated group (0.05%/QD, 0.05%/BID, and 0.1%/QD) exerted better effects than the Restasis group, and CyclAGel 0.05%/QD showed the most significant improvement. The number of ocular-related treatment-emergent adverse events was low in all treatment groups, with no serious drug-related treatment-emergent adverse events. IMPLICATIONS CyclAGel showed excellent safety, tolerability, and comfort profiles at 2 concentrations and frequency in moderate to severe DED.
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Affiliation(s)
- Wen-Yan Peng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Rong-Xin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hong Dai
- Beijing Hospital, Beijing, China
| | - Lei Zhu
- Henan Eye Institute (Henan Eye Hospital), Zhengzhou City, China
| | - Ying Li
- Peking Union Medical College Hospital, Beijing, China
| | - Zi-Qing Gao
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xiao-Yi Li
- Lee's Pharmaceutical Holdings Limited, Hong Kong, China
| | - Shi-You Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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136
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Magno M, Moschowits E, Arita R, Vehof J, Utheim TP. Intraductal meibomian gland probing and its efficacy in the treatment of meibomian gland dysfunction. Surv Ophthalmol 2021; 66:612-622. [PMID: 33352147 DOI: 10.1016/j.survophthal.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
Meibomian gland dysfunction (MGD) is a major cause of dry eye, affecting millions worldwide. Intraductal meibomian gland probing (MGP) aims to open obstructed meibomian glands using a small probe to promote meibum secretion. MGP has received increasing interest since 2010, and we critically evaluated the literature on the efficacy and safety of MGP. Despite positive results of MGP on dry eye symptoms in early single-group studies, MGP was not shown to consistently outperform controls in later controlled trials. Furthermore, MGP alone did not show improvement beyond placebo in the only placebo-controlled RCT conducted. Overall, the procedure appears safe. Self-limited intraoperative bleeding was frequent, but no major complications were reported. In conclusion, MGP has not yet been shown to be an effective treatment for MGD. Larger placebo-controlled trials need to be conducted to establish the potential effect of this novel treatment modality.
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Affiliation(s)
- Morten Magno
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Emily Moschowits
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Reiko Arita
- Department of Ophthalmology, Itoh Clinic, Saitama, Japan
| | - Jelle Vehof
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, London, United Kingdom; Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway
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Brooks CC, Gupta PK. Meibomian Gland Morphology Among Patients Presenting for Refractive Surgery Evaluation. Clin Ophthalmol 2021; 15:315-321. [PMID: 33542616 PMCID: PMC7851383 DOI: 10.2147/opth.s292919] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/05/2021] [Indexed: 01/27/2023] Open
Abstract
Purpose To report the prevalence of meibomian gland atrophy and gland tortuosity in patients presenting for refractive surgery evaluation. Methods Cross-sectional study of consecutive patients presenting for refractive surgery evaluation at the Duke Eye Center from December 2018 through January 2020. All patients underwent clinical examination and meibography imaging (Lippiview II, Johnson and Johnson Vision, CA) of the lower eyelids bilaterally. Images were graded by a masked rater using a previously validated 5-point meiboscale (0–4) for gland atrophy and 3-point scale for gland tortuosity (0–2). Lipid layer thickness and partial blinks were also recorded. Results One hundred and twenty patients (49 male) aged 21 to 62 years (mean 35.2 ± 9.2 years) were reviewed. The mean meiboscale was 1.1 ± 1.0 and the mean tortuosity score was 1.0 ± 0.7. Among all patients, 72.5% (n = 87) had any evidence of meibomian gland atrophy (meiboscale >0) and 69.2% (n = 83) had any evidence of meibomian gland tortuosity (tortuosity grade ≥1). The majority of patients (n = 52) with gland atrophy had mild gland atrophy (meiboscale = 1). The mean meiboscale was 0.89 ±0.79 and 1.38 ±1.07 for those <35 years and >/= 35 years old, respectively (p = 0.01). There was a moderate positive relationship between meiboscale and tortuosity (Spearman’s rho 0.3829, p <0.001). Conclusion Meibomian gland atrophy is a common occurrence in patients presenting for refractive surgery evaluation. Clinicians should consider incorporating meibography as part of refractive surgery evaluation, and proactively treat meibomian gland disease given the known association between meibomian gland dysfunction, dry eye disease, and the potential for suboptimal post-operative outcomes.
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Affiliation(s)
- Cassandra C Brooks
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA
| | - Preeya K Gupta
- Department of Ophthalmology, Duke University Eye Center, Durham, NC, USA
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A multicenter cross-sectional survey of dry eye clinical characteristics and practice patterns in Korea: the DECS-K study. Jpn J Ophthalmol 2021; 65:261-270. [PMID: 33469727 DOI: 10.1007/s10384-020-00803-7] [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: 05/26/2020] [Accepted: 10/07/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare the proportions of patients satisfying Korean dry eye guidelines and Asia Dry Eye Society (ADES) diagnostic criteria and to describe the clinical characteristics and practice patterns of dry eye patients in Korea. STUDY DESIGN Prospective observational study. METHODS This study enrolled 160 patients, with 158 patients analyzed. ADES guidelines were applied to dry eye patients satisfying the Korean dry eye guidelines. Risk factors for dry eye (e.g. visual display terminal [VDT] use) were evaluated. Dry eye subtypes were categorized as aqueous-deficient or evaporative. Objective signs (e.g. corneal and keratoconjunctival staining scores, tear break-up time [TBUT], and Schirmer test) and symptoms (Dry Eye-Related Quality of Life Score [DEQS] and Ocular Surface Disease Index [OSDI] questionnaire) were evaluated. Treatment patterns were also recorded. RESULTS Patients (mean age 43.1 years) were mainly women (85.4%), with a high proportion (77.2%) of VDT users. Concordance between Korean and ADES guidelines was high (94.3%), with most patients (94.3%) having tear film instability (TBUT ≤ 5 s). Evaporative dry eye occurred in 60.1% and aqueous-deficient in 39.9% of cases. Objective signs were significantly better in evaporative than in aqueous-deficient dry eye. The DEQS bothersome ocular symptoms' score was significantly higher in VDT users than in non-users. OSDI symptom severity and DEQS were significantly correlated (p < 0.001). The most common treatments were hyaluronic acid (33.5%) and diquafosol (15.2%), the latter used mainly for mild and evaporative dry eye. CONCLUSION The study showed high concordance between Korean and ADES diagnostic guidelines, with most patients having tear film instability.
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Egri S, Van Hollebecke I, Guindolet D, Manenti C, Rougier H, Gabison É, Cochereau I, Doan S. [Efficacy of intense pulsed light therapy in the treatment of Meibomian gland dysfunction-related severe dry eye]. J Fr Ophtalmol 2021; 44:169-175. [PMID: 33358077 DOI: 10.1016/j.jfo.2020.04.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Dry eye syndrome caused by Meibomian gland dysfunction (MGD) is a common disease in the general population and impairs quality of life. Intense Pulsed Light (IPL) has mainly been used in dermatology for the treatment of skin disorders, and more recently for MGD-related dry eye. The objective of our study is to evaluate the efficacy and tolerability of IPL with the E-Eye® device (E-Swin, Houdan, France) in severe MGD-related dry eye patients. MATERIALS AND METHODS This non-comparative study included 20 patients with MGD-related dry eye with a Break-Up Time (BUT)<10seconds, dry eye symptoms >30mm on a Visual Analog Scale (VAS), and failure of lid hygiene and artificial tears. Treatment consisted of 3 sessions of IPL on D0, D15, and D45 (5 flashes of 13J/cm2 per eye). The following parameters were assessed at each visit and at D75 : symptoms graded with a VAS and the Standard Patient Assessment of Eye Dryness questionnaire (SPEED), BUT, corneal fluorescein staining, Meibomian gland expression score, meibography, tear film lipid layer thickness by interferometry and the ocular scattering index by double-pass aberrometry (OQAS). Statistical analysis was performed on the eye most affected at baseline. RESULTS We included 40 eyes of 20 patients, 15 female and 5 male, mean age 47±15 years (24 to 74 years). The symptoms rated by VAS were severe, averaging 69±25mm. After treatment, there was a statistically significant decrease in symptoms, with a 14mm VAS decrease (55±29mm at D75 versus 69mm at D0, P=0.048) and SPEED score of 3.4 (19.0±6mm versus 22.4±4.6, P=0.03). The number of expressible Meibomian gland ducts increased significantly (from 5.9 to 8.1, P=0.04), lid redness decreased (from 1.4 to 0.6, P=NS) and BUT improved (from 4.2 to 5.9, P=NS). Other parameters remained unchanged. Three patients (15%) complained of transient ocular burning after each treatment. CONCLUSION IPL appears to be effective in improving signs and symptoms in patients with severe MGD-related dry eye, with a good safety profile. Its exact mechanism of action remains to be elucidated.
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Affiliation(s)
- S Egri
- Service d'Ophtalmologie, Fondation Adolphe-de-Rothschild, Paris, France
| | - I Van Hollebecke
- Service d'Ophtalmologie, Fondation Adolphe-de-Rothschild, Paris, France
| | - D Guindolet
- Service d'Ophtalmologie, Fondation Adolphe-de-Rothschild, Paris, France
| | - C Manenti
- Service d'Ophtalmologie, Fondation Adolphe-de-Rothschild, Paris, France
| | - H Rougier
- Service d'Ophtalmologie, Fondation Adolphe-de-Rothschild, Paris, France
| | - É Gabison
- Service d'Ophtalmologie, Fondation Adolphe-de-Rothschild, Paris, France
| | - I Cochereau
- Service d'Ophtalmologie, Fondation Adolphe-de-Rothschild, Paris, France
| | - S Doan
- Service d'Ophtalmologie, Fondation Adolphe-de-Rothschild, Paris, France.
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Gurnani B, Kaur K. Current approach in surgical management of dry eyes – Dry eye review II. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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141
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Yan X, Hong J, Jin X, Chen W, Rong B, Feng Y, Huang X, Li J, Song W, Lin L, Cheng Y. The Efficacy of Intense Pulsed Light Combined With Meibomian Gland Expression for the Treatment of Dry Eye Disease Due to Meibomian Gland Dysfunction: A Multicenter, Randomized Controlled Trial. Eye Contact Lens 2021; 47:45-53. [PMID: 32452923 PMCID: PMC7752242 DOI: 10.1097/icl.0000000000000711] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the efficacy of intense pulsed light (IPL) combined with Meibomian gland expression (MGX), and instant warm compresses combined with MGX, for treatment of dry eye disease (DED) due to meibomian gland dysfunction (MGD). METHODS In a prospective, multicenter, interventional study, 120 subjects with DED due to MGD were randomized 1:1 to an IPL arm or a control arm. Each subject was treated 3 times at 3-week intervals. The primary outcome measure was the tear break up time (TBUT). Tear break up time and a few additional outcome measures were evaluated at the baseline and at 3 weeks after the last treatment. RESULTS All outcome measures improved in both arms, but in general, the improvement was significantly larger in the IPL arm. Tear break up time increased by 2.3±1.9 and 0.5±1.4 sec, in the IPL and control arms respectively (P<0.001). SPEED was reduced by 38% and 22% in the IPL and control arms, respectively (P<0.01). Meibomian Gland Yielding Secretion Score was improved by 197% in the IPL arm and 96% in the control arm. Corneal fluorescein staining also decreased by 51% and 24% in the IPL and control arms respectively, but the differences between the two arms were not statistically significant (P=0.61). A composite score of lid margin abnormalities improved in both arms, but more in the IPL arm (P<0.05). CONCLUSIONS Intense pulsed light combined with MGX therapy was significantly more effective than instant warm compresses followed with MGX. This suggests that the IPL component has a genuine contribution to the improvement of signs and symptoms of DED.
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Affiliation(s)
- Xiaoming Yan
- Department of Ophthalmology (X.Y., B.R., W.S., Y.C.), Peking University First Hospital, Beijing, China; Department of Ophthalmology (J.H., Y.F.), Peking University Third Hospital. Beijing, China; Eye Center (X.J., X.H., L.L.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China; and The School of Ophthalmology and Optometry and Eye Hospital (W.C., J.L.), Wenzhou Medical University, Wenzhou, China
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Karpecki P, Wirta D, Osmanovic S, Dhamdhere K. A Prospective, Post-Market, Multicenter Trial (CHEETAH) Suggested TearCare ® System as a Safe and Effective Blink-Assisted Eyelid Device for the Treatment of Dry Eye Disease. Clin Ophthalmol 2020; 14:4551-4559. [PMID: 33408457 PMCID: PMC7779309 DOI: 10.2147/opth.s285953] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/23/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose This study evaluated the safety and effectiveness of TearCare® System to treat the signs and symptoms of dry eye disease (DED). Methods In this multicenter, prospective, post-market, exploratory, interventional trial, 58 eyes (29 subjects) received a single TearCare procedure and were assessed at baseline, post-procedure 1-week and 1-month. Effectiveness was assessed as mean change from baseline in tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), total Meibomian Gland Secretion Score (MGSS), and corneal/conjunctival staining. Adverse events (AE) and changes in visual acuity were used to asses safety. Results The baseline TBUT of 3.7±1.1 seconds was improved by 2.6±1.6 (70%) seconds at 1-week and by 3.1±2.2 (84%) seconds at 1-month (p < 0.0001). Mean baseline OSDI of 54.9±20.2 improved by 17.9±20.9 at 1-week and 25.8±24.3 at 1-month (p < 0.001). A clinically meaningful improvement was seen in 83% of subjects as per the Miller-Plugfelder definition and 66% of subjects improved by at least 1 OSDI category. The baseline MGSS of 5.6±4.0 improved by 9.3±4.0 at 1-week and 8.8±5.8 at 1-month (p < 0.0001). Corneal and conjunctival staining improved by 1.4±2.8 and 1.2±2.9 from a mean baseline of 4.8±2.5 and 5.9±3.2, respectively. Moreover, similar trajectories of improvement were observed for subgroups of subjects stratified by severity. Subjects with more severe gland obstruction at baseline had greater improvements in TBUT and staining compared to the less severe subgroup. No device-related adverse events or significant changes in visual acuity were observed. Conclusion These results suggest that single TearCare procedure is safe and effective in treating signs/symptoms of DED. Significant improvements were seen in all subjects (100%) in all signs and symptoms of DED within 1-week of treatment and 83% subjects experienced clinically meaningful symptom relief. Additionally, TearCare seems to be effective in treating DED associated with all severities of meibomian gland obstruction.
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Affiliation(s)
| | - David Wirta
- Eye Research Foundation, Newport Beach, CA, USA
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143
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Arita R, Fukuoka S, Kawashima M. Proposed Algorithm for Management of Meibomian Gland Dysfunction Based on Noninvasive Meibography. J Clin Med 2020; 10:jcm10010065. [PMID: 33375436 PMCID: PMC7795574 DOI: 10.3390/jcm10010065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/16/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022] Open
Abstract
Although the pathophysiology of meibomian gland dysfunction (MGD) remains incompletely understood, many treatment options have recently become available. According to an international workshop report, treatment selection for MGD should be based on a comprehensive stage classification dependent on ocular symptoms, lid margin abnormalities, meibum grade, and ocular surface staining. However, it is often difficult to evaluate all parameters required for such classification in routine clinical practice. We have now retrospectively evaluated therapeutic efficacy in MGD patients who received five types of treatment in the clinic setting: (1) meibocare (application of a warm compress and practice of lid hygiene), (2) meibum expression plus meibocare, (3) azithromycin eyedrops plus meibocare, (4) thermal pulsation therapy plus meibocare, or (5) intense pulsed light (IPL) therapy plus meibocare. Patients in each treatment group were classified into three subsets according to the meiboscore determined by noncontact meibography at baseline. Eyes in the IPL group showed improvement even if the meiboscore was high (5 or 6), whereas meibocare tended to be effective only if the meiboscore was low (1 or 2). The meiboscore may thus serve to guide selection of the most appropriate treatment in MGD patients. Prospective studies are warranted to confirm these outcomes.
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Affiliation(s)
- Reiko Arita
- Department of Ophthalmology, Itoh Clinic, 626-11 Minami-Nakano, Minumaku, Saitama 337-0042, Japan
- Lid and Meibomian Gland Working Group (LIME), Tokyo 112-0006, Japan; (S.F.); (M.K.)
- Correspondence: ; Tel.: +81-48-686-5588
| | - Shima Fukuoka
- Lid and Meibomian Gland Working Group (LIME), Tokyo 112-0006, Japan; (S.F.); (M.K.)
- Omiya Hamada Eye Clinic, 1-169-1, Sakuragicho, Omiyaku, Saitama 330-0854, Japan
| | - Motoko Kawashima
- Lid and Meibomian Gland Working Group (LIME), Tokyo 112-0006, Japan; (S.F.); (M.K.)
- Department of Ophthalmology, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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144
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Hura AS, Epitropoulos AT, Czyz CN, Rosenberg ED. Visible Meibomian Gland Structure Increases After Vectored Thermal Pulsation Treatment in Dry Eye Disease Patients with Meibomian Gland Dysfunction. Clin Ophthalmol 2020; 14:4287-4296. [PMID: 33324034 PMCID: PMC7733054 DOI: 10.2147/opth.s282081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/15/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the effect of vectored thermal pulsation treatment (VTP) on visible meibomian gland structure (VGS) in patients with meibomian gland dysfunction (MGD). Setting Private group practice (A.T.E.). Design Retrospective, single-blinded cohort study. Methods Visible meibomian gland structure was evaluated at baseline and at 1-year in treatment (30 patients, 48 eyes) and control (13 patients, 22 eyes) groups. Meibography images were captured using dynamic meibomian imaging. Images were assessed using a novel morphometric analysis technique and analyzed for change in area of VGS (pixels). Additional outcomes measured include tear break up time, corneal staining, tear osmolarity, matrix metalloproteinase-9 (MMP-9), meibography grading, and meibomian gland evaluation. Results As high as 69% of eyes in the treatment group showed an improvement in VGS versus 27% of eyes in the control group. As high as 31% of eyes in the treatment group showed a decline in VGS versus 73% of eyes in the control group. TBUT (p = 0.0001), corneal staining (p = 0.0063), and meibomian gland evaluation scores (p = 0.0038) all significantly improved after VTP treatment. However, SPEED scores, MMP-9, tear osmolarity, and meiboscale scores were not significantly improved 1-year post treatment. Conclusion A morphometric analysis protocol of meibography provides clinically meaningful information that is undetectable with the standard semiquantitative method of grading meibomian gland structure. This is the first report indicating that gland structure may increase post-VTP relative to untreated controls, thus presenting significant implications regarding benefits and timing of VTP therapy. The described protocol is currently more appropriate for research than for clinical practice.
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Affiliation(s)
- Arjan S Hura
- Department of Ophthalmology University of Cincinnati, Cincinnati, OH, USA
| | | | - Craig N Czyz
- Ophthalmology, Section Oculofacial Plastic and Reconstructive Surgery, Ohio University/OhioHealth Doctors Hospital, Columbus, OH, USA.,Ophthalmology, Oral and Maxillofacial Surgery, Grant Medical Center, Columbus, OH, USA
| | - Eric D Rosenberg
- New York Presbyterian Hospital - Cornell Campus, New York, NY, USA
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145
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Ji MH, Moshfeghi DM, Periman L, Kading D, Matossian C, Walman G, Markham S, Mu A, Jayaram A, Gertner M, Karpecki P, Friedman NJ. Novel Extranasal Tear Stimulation: Pivotal Study Results. Transl Vis Sci Technol 2020; 9:23. [PMID: 33244443 PMCID: PMC7683850 DOI: 10.1167/tvst.9.12.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/07/2020] [Indexed: 01/15/2023] Open
Abstract
Purpose To evaluate the efficacy and safety of iTEAR, a novel, portable, sonic external neuromodulation device, for the treatment of dry eye disease (DED). Methods This was a multicenter, open-label, single-arm clinical trial that included adult patients with DED with a Schirmer score of ≤10 mm in at least one eye. Enrolled subjects were instructed to apply the study device at least twice per day for 30 seconds bilaterally to the external nasal nerve. After the initial baseline visit, patients were followed up at days 3, 14, 30, 90, and 180. The primary efficacy endpoint was the Schirmer index (change from unstimulated to stimulated tear production as measured by the Schirmer test) at day 30. The major secondary endpoint was the change in symptoms of DED at day 30 evaluated using the Ocular Surface Disease Index (OSDI). Results A total of 101 subjects evaluated at day 30 had a mean Schirmer index of 9.4 mm (95% confidence interval [CI], 7.4–11.3), and the baseline OSDI improved by an average of 14.4 (95% CI, 11.1–17.7). Both endpoints were highly statistically and clinically significant at all time points. There were two mild unanticipated adverse events definitely related to the device. Conclusions The safety and efficacy of the iTEAR device observed in this study support its indication for treating DED. Translational Relevance Neurostimulation has the potential to improve signs and symptoms of DED.
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Affiliation(s)
- Marco H Ji
- Horngren Family Vitreoretinal Center, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Darius M Moshfeghi
- Horngren Family Vitreoretinal Center, Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | | | | | - Andy Mu
- NV Eye Surgery, Las Vegas, NV, USA
| | - Ann Jayaram
- Mid-Peninsula Ophthalmology Medical Group, Menlo Park, CA, USA
| | | | | | - Neil J Friedman
- Mid-Peninsula Ophthalmology Medical Group, Menlo Park, CA, USA
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146
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Li M, Yu Y, Yuan Y, Wang P, Hu X, Zhu C, Ke B. Rete Ridges in Eyelid Margin and Inflammatory Cytokines in Meibomian Gland Dysfunction Associated with Dry Eye Symptom. Curr Eye Res 2020; 46:202-209. [PMID: 32663037 DOI: 10.1080/02713683.2020.1788102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the morphology and function of rete ridges in eyelid margin and inflammatory cytokines in meibomian gland dysfunction (MGD) associated with dry eye symptom. METHODS A total of 63 subjects with OSDI score ≥13 were enrolled in MGD group and no-MGD group. Main measurements included tear cytokines levels and the rete ridges morphology. RESULTS Meibomian gland loss (MGL), corneal staining score (CSS), and IL-6 and TNF-α increased, meibomian gland secretion (MGS) decreased, the density of the rete ridges was lower, the longest diameters and shortest diameters of the rete ridges were longer in MGD group. The MGD group showed a negative correlation between MGL and BUT and MGS, but it showed a positive correlation with CSS. CSS was negatively correlated with IL-6. LLT was negatively correlated with IL-2 and IL-4. The shortest diameters of rete ridges in eyelid margin had a significant positive correlation with IL-2, IL-4, IL-10, and IFN-γ levels. CONCLUSION Change of meibomian gland function and the rete ridges morphology might have some correlation with the injury to ocular surface. Some inflammatory cytokines were correlated with the change of the rete ridges morphology, which might in turn affect the ocular surface function.
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Affiliation(s)
- Min Li
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai, China.,Department of Ophthalmology, Zhongshan Hospital Affiliated with Fudan University , Shanghai, China
| | - Yunjie Yu
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai, China.,Shanghai Key Laboratory of Fundus Disease , Shanghai, China
| | - Ying Yuan
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai, China.,Shanghai Engineering Center for Visual Science and Photomedicine , Shanghai, China
| | - Peng Wang
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai, China.,Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases , Shanghai, China
| | - Xiaojun Hu
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai, China.,National Clinical Research Center for Eye Diseases , Shanghai, China
| | - Chengcheng Zhu
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai, China.,Shanghai Key Laboratory of Fundus Disease , Shanghai, China
| | - Bilian Ke
- Department of Ophthalmology, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai, China.,National Clinical Research Center for Eye Diseases , Shanghai, China
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147
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Widjaja-Adhi MAK, Silvaroli JA, Chelstowska S, Trischman T, Bederman I, Sayegh R, Golczak M. Deficiency in Acyl-CoA:Wax Alcohol Acyltransferase 2 causes evaporative dry eye disease by abolishing biosynthesis of wax esters. FASEB J 2020; 34:13792-13808. [PMID: 32851726 PMCID: PMC7722226 DOI: 10.1096/fj.202001191r] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/21/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023]
Abstract
Lipids secreted by the meibomian glands (MGs) of the eyelids are essential to the protection of the eye's surface. An altered meibum composition represents the primary cause of evaporative dry eye disease (DED). Despite the critical importance of the meibum, its biosynthetic pathways and the roles of individual lipid components remain understudied. Here, we report that the genetic deletion of Acyl-CoA:wax alcohol acyltransferase 2 (AWAT2) causes the obstruction of MGs and symptoms of evaporative DED in mice. The lipid composition of the meibum isolated from Awat2-/- mice revealed the absence of wax esters, which was accompanied by a compensatory overproduction of cholesteryl esters. The resulting increased viscosity of meibum led to the dilation of the meibomian ducts, and the progressive degeneration of the MGs. Overall, we provide evidence for the main physiological role of AWAT2 and establish Awat2-/- mice as a model for DED syndrome that can be used in studies on tear film-oriented therapies.
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Affiliation(s)
| | - Josie A. Silvaroli
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Sylwia Chelstowska
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Thomas Trischman
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Ilya Bederman
- Department of Genetics and Genome Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Rony Sayegh
- Department of Ophthalmology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Marcin Golczak
- Department of Pharmacology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA,Cleveland Center for Membrane and Structural Biology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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148
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Abstract
The 2017 consensus report of the Asia Dry Eye Society (ADES) on the definition and diagnosis of dry eyes described dry eye disease as "Dry eye is a multifactorial disease characterized by unstable tear film causing a variety of symptoms and/or visual impairment, potentially accompanied by ocular surface damage." The report emphasized the instability of tear film and the importance of visual dysfunction in association with dry eyes, highlighting the importance of the evaluation of tear film stability. This report also discussed the concept of tear film-oriented therapy, which stemmed from the definition, and which is centered on provision of insufficient components in each tear film layer and ocular surface epithelium. The current ADES report proposes a simple classification of dry eyes based on the concept of tear film-oriented diagnosis and suggests that there are three types of dry eye: aqueous-deficient, decreased wettability, and increased evaporation. It is suggested that these three types respectively coincide with the problems of each layer: aqueous, membrane-associated mucins, and lipid/secretory mucin. Although each component cannot be quantitatively evaluated with the current technology, a practical diagnosis based on the patterns of fluorescein breakup is recommended. The Asia Dry Eye Society classification report suggests that for a practical use of the definition, diagnostic criteria and classification system should be integrated and be simple to use. The classification system proposed by ADES is a straightforward tool and simple to use, only through use of fluorescein, which is available even to non-dry eye specialists, and which is believed to contribute to an effective diagnosis and treatment of dry eyes.
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149
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Yeu E, Cuozzo S. Matching the Patient to the Intraocular Lens: Preoperative Considerations to Optimize Surgical Outcomes. Ophthalmology 2020; 128:e132-e141. [PMID: 32882308 DOI: 10.1016/j.ophtha.2020.08.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/16/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022] Open
Abstract
The intraocular lens (IOL) selection process for patients requires a complex and objective assessment of patient-specific ocular characteristics, including the quality and quantity of corneal astigmatism, health of the ocular surface, and other ocular comorbidities. Potential issues that could be considered complications after surgery, including dry eye disease, anterior or epithelial basement membrane dystrophy, Salzmann nodular degeneration, and pterygium, should be addressed proactively. Aspheric IOLs are designed to eliminate the positive spherical aberration added by traditional IOLs to the pseudophakic visual axis. Spherical aberration may be a consideration with patient selection. Patient desire for increased spectacle independence after surgery is one of the main drivers for the development of multifocal IOLs and extended depth-of-focus (EDOF) IOLs. However, no one single multifocal or EDOF IOL suits all patients' needs. The wide variety of multifocal and EDOF IOLs, their optics, and their respective impact on patient quality of vision have to be understood fully to choose the appropriate IOL for each individual, and surgery has to be customized. Patients who have undergone previous LASIK or who have radial keratotomy and ocular pathologic features, including glaucoma, age-related macular degeneration, and epiretinal membrane, require specific considerations for IOL selection. Subjectively, patient-centered considerations, including visual goals, lifestyle, personality, profession, and hobbies, are key elements for the surgeon to assess and factor into an IOL recommendation. This holistic approach will help surgeons to achieve optimal surgical outcomes and to meet (and exceed) the high expectations of patients.
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Affiliation(s)
- Elizabeth Yeu
- Department of Ophthalmology, Eastern Virginia Medical School, and Virginia Eye Consultants, Norfolk, Virginia.
| | - Susan Cuozzo
- Scientific and Strategic Insights, LLC, New York, New York
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Favre H, Lahoti S, Issa N, Johnson DA, Kheirkhah A. Topical Steroids in Management of Dry Eye Disease. CURRENT OPHTHALMOLOGY REPORTS 2020. [DOI: 10.1007/s40135-020-00249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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