351
|
Cockerham GC, Lemke S, Glynn-Milley C, Zumhagen L, Cockerham KP. Visual performance and the ocular surface in traumatic brain injury. Ocul Surf 2012; 11:25-34. [PMID: 23321357 DOI: 10.1016/j.jtos.2012.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 09/14/2012] [Accepted: 09/01/2012] [Indexed: 12/19/2022]
Abstract
The pathophysiology of neurotrauma is reviewed and an original study investigating the prevalence of dry eye disease in a sample of veterans with traumatic brain injury (TBI) is presented. Fifty-three veterans with TBI were evaluated by history of injury, past ocular history, and medication use. Ocular Disease Surface Index (OSDI), ocular examination, cranial nerve evaluation, tear osmolarity, tear film break-up time (TFBUT), ocular surface staining and tear production testing were performed. A matched comparison group underwent similar testing. TBI causes were blast (44) or non-blast (9). TBI subjects scored significantly worse on the OSDI (P<.001), and ocular surface staining by Oxford scale (P<.001) than non-TBI subjects. Scores for tear film breakup (P=.6), basal tear production less than 3 mm (P=.13), and tear osmolarity greater than 314 mOsm/L (P=.15) were all higher in TBI subjects; significantly more TBI subjects had at least one abnormal dry eye measure than comparisons (P<.001). The OSDI related to presence of dry eye symptoms (P<.01). These effects were present in both blast and non-blast TBI. Seventy percent of TBI subjects were taking at least one medication in the following classes: antidepressant, atypical antipsychotic, anticonvulsant, or h1-antihistamine. There was no association between any medication class and the OSDI or dry eye measures. Reduced corneal sensation in 21 TBI subjects was not associated with OSDI, tear production, or TFBUT, but did correlate with reduced tear osmolarity (P=.05). History of refractive surgery, previous contact lens wear, facial nerve weakness, or meibomian gland dysfunction was not associated with DED. In summary, we found a higher prevalence of DED in subjects with TBI, both subjectively and objectively. This effect is unrelated to medication use, and it may persist for months to years. We recommend that patients with TBI from any cause be evaluated for DED using a battery of standard testing methods described in a protocol presented in this article. Further research into the pathophysiology and outcomes of DED in neurotrauma is needed.
Collapse
Affiliation(s)
- Glenn C Cockerham
- Department of Ophthalmology, Veterans Administration Palo Alto Health Care System, Palo Alto, California 94304, USA.
| | | | | | | | | |
Collapse
|
352
|
Ubels JL, Gipson IK, Spurr-Michaud SJ, Tisdale AS, Van Dyken RE, Hatton MP. Gene expression in human accessory lacrimal glands of Wolfring. Invest Ophthalmol Vis Sci 2012; 53:6738-47. [PMID: 22956620 DOI: 10.1167/iovs.12-10750] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The accessory lacrimal glands are assumed to contribute to the production of tear fluid, but little is known about their function. The goal of this study was to conduct an analysis of gene expression by glands of Wolfring that would provide a more complete picture of the function of these glands. METHODS Glands of Wolfring were isolated from frozen sections of human eyelids by laser microdissection. RNA was extracted from the cells and hybridized to gene expression arrays. The expression of several of the major genes was confirmed by immunohistochemistry. RESULTS Of the 24 most highly expressed genes, 9 were of direct relevance to lacrimal function. These included lysozyme, lactoferrin, tear lipocalin, and lacritin. The glands of Wolfring are enriched in genes related to protein synthesis, targeting, and secretion, and a large number of genes for proteins with antimicrobial activity were detected. Ion channels and transporters, carbonic anhydrase, and aquaporins were abundantly expressed. Genes for control of lacrimal function, including cholinergic, adrenergic, vasoactive intestinal polypeptide, purinergic, androgen, and prolactin receptors were also expressed in gland of Wolfring. CONCLUSIONS The data suggest that the function of glands of Wolfring is similar to that of main lacrimal glands and are consistent with secretion electrolytes, fluid, and protein under nervous and hormonal control. Since these glands secrete directly onto the ocular surface, their location may allow rapid response to exogenous stimuli and makes them readily accessible to topical drugs.
Collapse
Affiliation(s)
- John L Ubels
- Department of Biology, Calvin College, Grand Rapids, Michigan 49546, USA.
| | | | | | | | | | | |
Collapse
|
353
|
Affiliation(s)
- Cintia S De Paiva
- Baylor College of Medicine; Ophthalmology; 6565 Fannin Street, NC 307 Houston Texas USA 77030
| | - Stephen C Pflugfelder
- Baylor College of Medicine; Ophthalmology; 6565 Fannin Street, NC 307 Houston Texas USA 77030
| | - Esen K Akpek
- Johns Hopkins University School of Medicine; Department of Ophthalmology; 600 N. Wolfe Street, Maumenee #317 Baltimore MD USA 21287
| |
Collapse
|
354
|
The role of medications in causing dry eye. J Ophthalmol 2012; 2012:285851. [PMID: 23050121 PMCID: PMC3459228 DOI: 10.1155/2012/285851] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/14/2012] [Accepted: 08/21/2012] [Indexed: 01/28/2023] Open
Abstract
The purpose of this paper is to review the possible role of polypharmacy in causing dry eye disease (DED), reflecting the complex interactions and complications associated with the use of multiple systemic and topical ocular medications. The pharmacological, physiological, anatomical, and histological mechanisms causing dry mouth differ little from those causing dry eye. Oral polypharmacy is the most common cause of dry mouth, but has not been investigated as a cause of dry eye. Topical ocular polypharmacy has been shown to cause DED. Information on drugs that likely cause or aggravate DED and the controversial role of preservatives in topical ocular medications are examined. Systemic or topical ocular medications and preservatives used in topical ocular drugs may cause dry eye through the drug's therapeutic action, ocular surface effects, or preservatives, and the effects probably are additive. Long-term use of topical ocular medications, especially those containing preservatives such as BAK, may play an important role in DED and the role of polypharmacy needs further study. We review possible ways to decrease the risk of medication-related dry eye.
Collapse
|
355
|
Li N, Deng XG, He MF. Comparison of the Schirmer I test with and without topical anesthesia for diagnosing dry eye. Int J Ophthalmol 2012; 5:478-81. [PMID: 22937509 DOI: 10.3980/j.issn.2222-3959.2012.04.14] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 06/27/2012] [Indexed: 11/02/2022] Open
Abstract
AIM To determine the value of Schirmer I test (S I t) without anesthesia and with topical anesthesia for diagnosing dry eye (DE). METHODS Totally 220 eyes in 110 patients, male (44) and female (66), (39.56±12.67) years old diagnosed with DE were examined. S I t without anesthesia was performed firstly, and 15 minutes later, it was applied again in the same person after topical anesthesia with 0.5% proparacaine hydrochloride eye drops. The wetting strips counted <10mm per 5 minutes were defined positive, while ≤5mm per 5 minutes were defined strong positive. RESULTS The wetting length in S I t after topical anesthesia was significantly lower than that in S I t without anesthesia (P<0.001). The positive rate and strong positive rate of S I t after topical anesthesia were significantly higher than that of S I t without anesthesia (P<0.001). The positive rate and strong positive rate of S I t without anesthesia and the strong positive rate of S I t after topical anesthesia in patients with aqueous-deficiency dry eye (ADDE) were significantly higher than those in total patients whereas those in patients with evaporative dry eye (EDE) were significantly lower than those in total patients (P<0.001). CONCLUSION S I t after topical anesthesia with 0.5% proparacaine hydrochloride eye drops is more objective and reliable than that without anesthesia in reflecting the status of DE, and its diagnostic value in patients with ADDE was even higher, making itself a meaningful evidence for the diagnosis and treatment of DE.
Collapse
Affiliation(s)
- Na Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, Guangdong Province, China
| | | | | |
Collapse
|
356
|
Galor A, Feuer W, Lee DJ, Florez H, Faler AL, Zann KL, Perez VL. Depression, post-traumatic stress disorder, and dry eye syndrome: a study utilizing the national United States Veterans Affairs administrative database. Am J Ophthalmol 2012; 154:340-346.e2. [PMID: 22541654 DOI: 10.1016/j.ajo.2012.02.009] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 02/01/2012] [Accepted: 02/03/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the scope of dry eye syndrome (DES) in veterans on a national level and to evaluate the relationship between psychiatric diagnoses and DES. DESIGN Case-control study. METHODS SETTING Patients were seen in a Veterans Affairs (VA) eye clinic between 2006 and 2011. PATIENT POPULATION Patients were divided into cases and controls with regard to their dry eye status (cases = ICD-9 code for DES plus dry eye therapy; controls = patients without ICD-9 code plus no therapy). MAIN OUTCOME MEASURES The prevalence of DES and the influence of psychiatric diagnoses on the risk of DES. RESULTS A total of 2 454 458 patients were identified as either a dry eye case (n = 462 641) or control (n = 1 991 817). Overall, 19% of male patients and 22% of female patients had a diagnosis of DES, with female sex imparting an increased risk of DES at each decade compared to male sex (odds ratio [OR] 1.22-2.09). Several conditions were found to increase DES risk, including post-traumatic stress disorder (OR 1.92, 95% CI 1.91-1.94) and depression (OR 1.92, 95% CI 1.91-1.94) (analyses adjusted for sex and age). The use of several systemic medications was likewise associated with an increased risk of DES, including antidepressant medications (OR 1.97, 95% CI 1.79-2.17) and antianxiety medication (OR 1.74, 95% CI 1.58-1.91). Multivariate analysis (adjusted for age and sex) revealed that for psychiatric diagnoses, both the use of medication and the diagnosis remained significant risk factors when considered concomitantly, although the magnitude of each association decreased. CONCLUSIONS DES is a disease associated with depression and post-traumatic stress disorder, and is prevalent among male and female veterans receiving eye care services. The association could be driven by underlying disease physiology or medications used to treat psychiatric conditions. Regardless of the causal link, this suggests that individuals with a known psychiatric diagnosis should be questioned about dry eye symptoms and, if applicable, referred to an eye care physician.
Collapse
Affiliation(s)
- Anat Galor
- Miami Veterans Administration Medical Center, Miami, Florida; Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA.
| | | | | | | | | | | | | |
Collapse
|
357
|
Abstract
PURPOSE To investigate dry eye disease (DED) and risk factors in patients with depressive or anxiety disorders at a psychiatric clinic in China. METHODS Cross-sectional study. Subjects (≥16 years) who had depressive or anxiety disorders were evaluated with history, questionnaires (Self-rating Anxiety Scale, Self-rating Depression Scale, and Ocular Surface Disease Index), and eye examination. RESULTS There were 472 psychiatric patients in the study, including 176 patients (37%) with depression, 170 patients (36%) with generalized anxiety disorder, 60 patients (13%) with depression and anxiety disorder, 55 patients (12%) with obsessive-compulsive disorder, and 11 patients (2%) with panic disorder. DED was present in 283 patients (60%). Compared with patients who did not have DED, patients with DED were significantly older, had longer duration of psychiatric disease and use of antianxiety or antidepressant medication, and more frequently were using a selective serotonin reuptake inhibitor (SSRI). Logistic regression analysis showed that older age, duration of psychiatric disorder, and use of an SSRI were significant independent predictors of the presence of DED. Older age, Self-rating Anxiety Scale >52, and use of tricyclic antidepressants were significant independent predictors of worse vision-targeted health-related quality of life (higher Ocular Surface Disease Index). CONCLUSIONS DED is frequent in patients with depressive and anxiety disorders, especially patients who are older, have longer duration of psychiatric disorder, and use an SSRI. Psychiatric disorders and use of antidepressants should be considered in the differential diagnosis of DED.
Collapse
|
358
|
Abstract
PURPOSE The purpose of this study was to determine whether changes in Medicare reimbursement for punctal plug insertion were associated with a decrease in the incidence of insertion and dry eye diagnosis. METHODS Incident cases of dry eye syndrome (DES) diagnoses and punctal plug insertions among Medicare beneficiaries were identified from Medicare 5% Part B from 1994 to 2008, using a 3-year look-back. Dry eye syndrome diagnoses and punctal plug insertion codes were ascertained from the international classification of diseases and current procedural terminology codes. Medicare payment data were obtained from the Centers for Medicare and Medicaid Services from 1994 to 2008 for punctal plug insertion. Rates were calculated for both the incidence of DES and the use of punctal plugs. RESULTS From 2001 to 2008, inflation-adjusted Medicare reimbursement for punctal plug insertion decreased 55.1%, whereas the Medicare population-adjusted incidence of dry eye diagnosis increased 23.3%. Nine percent of individuals diagnosed with DES between 1991 and 2008 underwent punctal plug placement with a mean of 2.0 plugs placed per patient. Total punctal plug placement increased 322.2% between 1994 and 2003, and then reached a plateau. First-time punctal plug insertion rates within 365 days of DES diagnosis increased 111.8% from 1994 to 2002, and then declined 47.0% from 2002 to 2008. CONCLUSIONS Although the frequency of DES diagnosis in the Medicare population has increased over time, first-time punctal plug insertion rates, especially within the first year following DES diagnosis, have declined coincidently with the increasing presence of a medical alternative and declining Medicare payment. Choice of therapies may have cost and care implications.
Collapse
|
359
|
Portello JK, Rosenfield M, Bababekova Y, Estrada JM, Leon A. Computer-related visual symptoms in office workers. Ophthalmic Physiol Opt 2012; 32:375-82. [PMID: 22775070 DOI: 10.1111/j.1475-1313.2012.00925.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Many individuals report visual symptoms during office work and specifically computer use. This study determined the prevalence of symptoms in a population of office workers, and examined the association between these symptoms and both dry eye disease and other demographic factors. METHOD A written questionnaire was used to quantify the prevalence of symptoms in 520 New York City office workers, and to determine the effect of risk factors including gender, ethnicity, age, smoking, type of refractive correction and hours spent doing computer work. The questionnaire also examined the prevalence of ocular surface disease. RESULTS A significant positive correlation was observed between the symptom score and the number of hours spent working on a computer in a typical day. The most prevalent symptom was tired eyes, which was reported by approximately 40% of subjects as occurring 'at least half the time'. 32% and 31% of subjects reported symptoms of dry eye and eye discomfort, respectively. Symptoms varied significantly with gender (being greater in females), ethnicity (being greater in Hispanics) and the use of rewetting drops. A significant positive correlation was observed between computer-related visual symptoms and the Ocular Surface Disease Index (OSDI), a measure of dry eye. CONCLUSIONS Visual symptoms associated with computer use occur frequently in the general population producing discomfort for extended periods of time. They are strongly associated with ocular surface disease. Therapeutic regimens need to be developed for this widespread condition.
Collapse
|
360
|
Pouyeh B, Viteri E, Feuer W, Lee DJ, Florez H, Fabian JA, Perez VL, Galor A. Impact of ocular surface symptoms on quality of life in a United States veterans affairs population. Am J Ophthalmol 2012; 153:1061-66.e3. [PMID: 22330309 DOI: 10.1016/j.ajo.2011.11.030] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 11/15/2011] [Accepted: 11/15/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the impact of ocular surface symptoms on quality of life in a veteran population receiving eye care services. DESIGN Cross-sectional survey study. METHODS setting: Miami Veterans Affairs Medical Center (VAMC). patient population: Patients seen at the eye clinic between June and August 2010 were asked to fill out the Dry Eye Questionnaire 5 (DEQ5) and the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire. main outcome measures: Correlation between ocular surface symptoms and functionality. RESULTS Four hundred eighty-nine patients elected to fill out the DEQ5 questionnaire (36% response rate). The mean age of respondents was 66 years (standard deviation 12). Ninety-four percent were male; 62% were white and 37% were black. Using the DEQ5 as a surrogate measure of ocular surface symptoms, 65% of respondents reported at least mild ocular surface symptoms (DEQ5 ≥6) and 27% of them reported severe symptoms (DEQ5 ≥12). Black subjects had a 2-fold increased risk of severe symptoms compared to white subjects (odds ratio 2.06, 95% confidence interval 1.33-3.19). Several medications were associated with a significantly increased risk of severe symptoms, including glaucoma medications (1.7-fold increase), antidepressants (2.3-fold increase), and antihistamines (2.1-fold increase). There was an inverse correlation between DEQ5 and IDEEL scores with regard to ability to perform activities of daily living (n = 391, r = -0.54, P < .001), emotional well-being (n = 386, r = -0.63, P < .001), and the ability to work (n = 205, r = -0.57, P < .001). Fifty percent of patients with severe symptoms had documentation that their symptoms were addressed during the visit. CONCLUSION Severe ocular surface symptoms reduce the quality of life of Miami VAMC veterans. Eye care professionals should be vigilant in eliciting ocular surface complaints from their patients.
Collapse
|
361
|
Zhang Y, Chen H, Wu X. Prevalence and risk factors associated with dry eye syndrome among senior high school students in a county of Shandong Province, China. Ophthalmic Epidemiol 2012; 19:226-30. [PMID: 22650150 DOI: 10.3109/09286586.2012.670742] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the prevalence and risk factors for dry eye syndrome (DES) among senior high school students in Shouguang, a county of Shandong Province, China. METHODS A cross-sectional survey was conducted in July 2010, and 1902 senior high school students were selected by multi-stage sampling to answer a questionnaire assessing the prevalence and risk factors for DES. DES was defined as the presence of a previous clinical diagnosis of DES or severe symptoms (both dryness and irritation constantly or often). Risk factors associated with DES were evaluated with a χ(2) test and logistic regression analyses. RESULTS The prevalence of DES was 23.7%. In univariate analysis, myopia (P < 0.0001), contact lens wear (P = 0.020), inadequate refractive correction (P < 0.0001), frequent self-administered topical ophthalmic medications (P < 0.0001), and poor sleep quality (P = 0.007) were significantly associated with DES. In multivariate analysis, inadequate refractive correction (P < 0.0001, odds ratio, OR 1.980; 95% confidence interval, CI 1.577-2.488), frequent self-administered topical ophthalmic medications (P < 0.0001, OR 1.838; 95% CI 1.399-2.410), and poor sleep quality (P = 0.001, OR 1.342; 95% CI 1.054-1.709) were significant risk factors for DES. CONCLUSIONS Senior high school students are a neglected population with a high prevalence of DES. Preventive measures directed against risks factors for DES among senior high school students may help reduce the prevalence and provide a positive impact on students' health.
Collapse
Affiliation(s)
- Ying Zhang
- Department of Ophthalmology, Qilu Hospital, Shandong University, China
| | | | | |
Collapse
|
362
|
Sagili S, Malhotra R. Dry eyes can be exacerbated by systemic antihypertensive medication. Scott Med J 2012; 57:121. [DOI: 10.1258/smj.2011.012011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dry eye disease (DED) is a frequent problem in ophthalmology, causing considerable morbidity. DED is a multifactorial disease and requires a comprehensive approach in identifying the potential contributing factors. Often, clinicians overlook the fact that systemic medications are a cause of dry eye. We report two patients who developed symptoms and signs of DED secondary to systemic antihypertensive medication that improved following cessation of systemic medication.
Collapse
Affiliation(s)
- S Sagili
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - R Malhotra
- Corneo Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| |
Collapse
|
363
|
Wang C, Shi X, Chen X, Wu H, Zhang H, Xie J, Yang X, Gou Z, Ye J. 17-β-estradiol inhibits hyperosmolarity-induced proinflammatory cytokine elevation via the p38 MAPK pathway in human corneal epithelial cells. Mol Vis 2012; 18:1115-22. [PMID: 22605923 PMCID: PMC3351403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 04/27/2012] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the effects of 17-β-estradiol on hyperosmolar stress-induced proinflammatory cytokine production of interleukin (IL)-6, IL-1, and tumor necrosis factor-alpha (TNF-α) in SV40-immortalized human corneal epithelial cells (hCECs) and the regulatory effects of the mitogen-activated protein kinase (MAPK) signaling pathways in this process. METHODS SV40 hCECs cultured in normal osmolar media were switched to a higher osmolarity (450 mOsM) by adding NaCl with or without pretreatment with 17-β-estradiol. Real-time polymerase chain reaction and ELISA were applied to characterize IL-6, IL-1, and TNF-α gene and protein expression. Cells were treated for 15-60 min, lysed in radioimmunoprecipitation assay (RIPA) buffer and subjected to a western blot with phospho (p)-specific antibodies against extracellular signal-regulated protein kinase 1/2 (ERK1/2), P38 kinase, and c-Jun N-terminal kinase 1/2 (JNK1/2). RESULTS The expression and production of IL-6, IL-1, and TNF-α in SV40 hCECs increased when the media osmolarity was switched to 450 mOsM. Pretreatment with 10(-10) M 17-β-estradiol greatly inhibited the increased expression and production of IL-6, IL-1, and TNF-α induced by hyperosmolarity, whereas with the administration of SB203580 (10 μM), an inhibitor of the p38 pathway, the inhibiting effect of 17-β-estradiol disappeared. The western blot results showed that the increased phosphorylation level of p38 caused by hyperosmolarity was greatly inhibited by 17-β-estradiol. CONCLUSIONS 17-β-estradiol greatly inhibited the expression and production of proinflammatory cytokines IL-6, IL-1, and TNF-α, which were stimulated by hyperosmolarity in SV40-immortalized hCECs. The results also suggested that the p38 MAPK signaling pathway was involved in the regulatory effects of estrogen on hCECs. These findings may contribute to an understanding of the etiologic roles and therapeutic implications of the hormone estrogen in dry eye disease.
Collapse
Affiliation(s)
- Changjun Wang
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Shi
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaoyi Chen
- Zhejiang-California International NanoSystems Institute, Zhejiang University, Hangzhou, China
| | - Han Wu
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huina Zhang
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiajun Xie
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianyan Yang
- Zhejiang-California International NanoSystems Institute, Zhejiang University, Hangzhou, China
| | - Zhongru Gou
- Zhejiang-California International NanoSystems Institute, Zhejiang University, Hangzhou, China
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
364
|
Ding J, Sullivan DA. Aging and dry eye disease. Exp Gerontol 2012; 47:483-90. [PMID: 22569356 DOI: 10.1016/j.exger.2012.03.020] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 03/21/2012] [Accepted: 03/23/2012] [Indexed: 12/21/2022]
Abstract
Dry eye disease is a prevalent eye disorder that in particular affects the elderly population. One of the major causes of dry eye, meibomian gland dysfunction (MGD), shows increased prevalence with aging. MGD is caused by hyperkeratinization of the ductal epithelium of meibomian gland and reduced quantity and/or quality of meibum, the holocrine product that stabilizes and prevents the evaporation of the tear film. Of note, retinoids which are used in current anti-aging cosmetics may promote the development of MGD and dry eye disease. In this review, we will discuss the possible mechanisms of age-related MGD.
Collapse
Affiliation(s)
- Juan Ding
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 20 Staniford St, Boston, MA 02114, USA.
| | | |
Collapse
|
365
|
Sullivan DA, Hammitt KM, Schaumberg DA, Sullivan BD, Begley CG, Gjorstrup P, Garrigue JS, Nakamura M, Quentric Y, Barabino S, Dalton M, Novack GD. Report of the TFOS/ARVO Symposium on Global Treatments for Dry Eye Disease: An Unmet Need. Ocul Surf 2012; 10:108-16. [DOI: 10.1016/j.jtos.2012.02.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 02/04/2012] [Accepted: 02/04/2012] [Indexed: 10/28/2022]
|
366
|
Barabino S, Chen Y, Chauhan S, Dana R. Ocular surface immunity: homeostatic mechanisms and their disruption in dry eye disease. Prog Retin Eye Res 2012; 31:271-85. [PMID: 22426080 DOI: 10.1016/j.preteyeres.2012.02.003] [Citation(s) in RCA: 207] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 01/17/2023]
Abstract
The tear film, lacrimal glands, corneal and conjunctival epithelia and Meibomian glands work together as a lacrimal functional unit (LFU) to preserve the integrity and function of the ocular surface. The integrity of this unit is necessary for the health and normal function of the eye and visual system. Nervous connections and systemic hormones are well known factors that maintain the homeostasis of the ocular surface. They control the response to internal and external stimuli. Our and others' studies show that immunological mechanisms also play a pivotal role in regulating the ocular surface environment. Our studies demonstrate how anti-inflammatory factors such as the expression of vascular endothelial growth factor receptor-3 (VEGFR-3) in corneal cells, immature corneal resident antigen-presenting cells, and regulatory T cells play an active role in protecting the ocular surface. Dry eye disease (DED) affects millions of people worldwide and negatively influences the quality of life for patients. In its most severe forms, DED may lead to blindness. The etiology and pathogenesis of DED remain largely unclear. Nonetheless, in this review we summarize the role of the disruption of afferent and efferent immunoregulatory mechanisms that are responsible for the chronicity of the disease, its symptoms, and its clinical signs. We illustrate current anti-inflammatory treatments for DED and propose that prevention of the disruption of immunoregulatory mechanisms may represent a promising therapeutic strategy towards controlling ocular surface inflammation.
Collapse
Affiliation(s)
- Stefano Barabino
- Clinica Oculistica, Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Viale Benedetto XV 5, 16132 Genoa, Italy
| | | | | | | |
Collapse
|
367
|
|
368
|
Tong L, Petznick A, Lee SY, Tan J. Assessment and Management of Dry Eye Patients for Non-Ophthalmic Healthcare Practitioners. PROCEEDINGS OF SINGAPORE HEALTHCARE 2012. [DOI: 10.1177/201010581202100104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Dry eye is a very common condition in many parts of the world. Both ophthalmologists and other healthcare professionals, such as optometrists and general practitioners, are often involved in the care of these patients. The main thrust of dry eye management is over-the-counter tear lubricants. There is a wide range of tear lubricants available today. These lubricants vary in viscosity, duration of action, type of preservatives, osmolarity/osmolality and pH. This article aims to educate healthcare professionals on 1) how to assess and manage patients with mild to moderate dry eyes and 2) how to identify patients who may need a referral to an ophthalmologist. Strategies on the use of available treatments and their limitations, as well as factors that may affect patient compliance will be discussed.
Collapse
Affiliation(s)
- Louis Tong
- Department of Cornea and External Eye Disease, Singapore National Eye Centre
- Office of Clinical Sciences, Duke-NUS Graduate Medical School
- Singapore Eye Research Institute, Singapore National Eye Centre
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore
| | - Andrea Petznick
- Singapore Eye Research Institute, Singapore National Eye Centre
| | - Sze Yee Lee
- Singapore Eye Research Institute, Singapore National Eye Centre
| | - Jeremy Tan
- Faith Medical Group
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| |
Collapse
|
369
|
You S, Avidan O, Tariq A, Ahluwalia I, Stark PC, Kublin CL, Zoukhri D. Role of epithelial-mesenchymal transition in repair of the lacrimal gland after experimentally induced injury. Invest Ophthalmol Vis Sci 2012; 53:126-35. [PMID: 22025566 DOI: 10.1167/iovs.11-7893] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Ongoing studies demonstrate that the murine lacrimal gland is capable of repair after experimentally induced injury. It was recently reported that repair of the lacrimal gland involved the mobilization of mesenchymal stem cells (MSCs). These cells expressed the type VI intermediate filament protein nestin whose expression was upregulated during the repair phase. The aim of the present study was to investigate the roles of vimentin, a type III intermediate filament protein and a marker of epithelial-mesenchymal transition (EMT) in repair of the lacrimal gland. METHODS Injury was induced by direct injection of interleukin (IL)-1 into the exorbital lacrimal gland. MSCs were prepared from injured glands using tissue explants. Expression of vimentin and the transcription factor Snai1, a master regulator of EMT, was determined by RT-PCR, Western blotting analysis, and immunofluorescence. RESULTS These data show that vimentin expression, at both the mRNA and the protein levels, was upregulated during the repair phase (2-3 days postinjury) and returned to the control level when repair ended. Temporal expression of Snai1 mirrored that of vimentin and was localized in cell nuclei. Cultured MSCs isolated from injured lacrimal glands expressed Snai1 and vimentin alongside nestin and alpha smooth muscle actin (another biomarker of EMT). There was a strong positive correlation between Snai1 expression and vimentin expression. CONCLUSIONS It was found that EMT is induced during repair of the lacrimal gland to generate MSCs to initiate repair, and that mesenchymal-epithelial transition is then activated to form acinar and ductal epithelial cells.
Collapse
Affiliation(s)
- Samantha You
- Department of General Dentistry, Tufts University School of Dental Medicine, Boston, Massachusetts 02111, USA
| | | | | | | | | | | | | |
Collapse
|
370
|
The corneal pain system. Part I: the missing piece of the dry eye puzzle. Ocul Surf 2012; 10:2-14. [PMID: 22330055 DOI: 10.1016/j.jtos.2012.01.002] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Revised: 12/09/2011] [Accepted: 12/12/2011] [Indexed: 01/23/2023]
Abstract
The traditional model of dry eye disease based on tear deficiency has presented us with many unanswered questions. Recent studies support the notion that dry eye-like symptoms represent non-specific corneal pain and provide new insights into the mechanisms that sustain the integrity of the optical tear layer. Thus, this enigmatic disease can be viewed with a new perspective, which involves the dysfunctional corneal pain system as a central pathogenetic feature of a series of disorders collectively known today as dry eye.
Collapse
|
371
|
Stevenson W, Chauhan SK, Dana R. Dry eye disease: an immune-mediated ocular surface disorder. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2012; 130:90-100. [PMID: 22232476 PMCID: PMC3677724 DOI: 10.1001/archophthalmol.2011.364] [Citation(s) in RCA: 411] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Dry eye disease is a multifactorial disorder of the tears and ocular surface characterized by symptoms of dryness and irritation. Although the pathogenesis of dry eye disease is not fully understood, it is recognized that inflammation has a prominent role in the development and propagation of this debilitating condition. Factors that adversely affect tear film stability and osmolarity can induce ocular surface damage and initiate an inflammatory cascade that generates innate and adaptive immune responses. These immunoinflammatory responses lead to further ocular surface damage and the development of a self-perpetuating inflammatory cycle. Herein, we review the fundamental links between inflammation and dry eye disease and discuss the clinical implications of inflammation in disease management.
Collapse
Affiliation(s)
- William Stevenson
- Department of Ophthalmology, Schepens Eye Research Institute and Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
| | | | | |
Collapse
|
372
|
Pflugfelder SC. Tear dysfunction and the cornea: LXVIII Edward Jackson Memorial Lecture. Am J Ophthalmol 2011; 152:900-909.e1. [PMID: 22019306 DOI: 10.1016/j.ajo.2011.08.023] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the cause and consequence of tear dysfunction-related corneal disease. DESIGN Perspective on effects of tear dysfunction on the cornea. METHODS Evidence is presented on the effects of tear dysfunction on corneal morphology, function, and health, as well as efficacy of therapies for tear dysfunction-related corneal disease. RESULTS Tear dysfunction is a prevalent eye disease and the most frequent cause for superficial corneal epithelial disease that results in corneal barrier disruption, an irregular optical surface, light scattering, optical aberrations, and exposure and sensitization of pain-sensing nerve endings (nociceptors). Tear dysfunction-related corneal disease causes irritation and visual symptoms such as photophobia and blurred and fluctuating vision that may decrease quality of life. Dysfunction of 1 or more components of the lacrimal functional unit results in changes in tear composition, including elevated osmolarity and increased concentrations of matrix metalloproteinases, inflammatory cytokines, and chemokines. These tear compositional changes promote disruption of tight junctions, alter differentiation, and accelerate death of corneal epithelial cells. CONCLUSIONS Corneal epithelial disease resulting from tear dysfunction causes eye irritation and decreases visual function. Clinical and basic research has improved understanding of the pathogenesis of tear dysfunction-related corneal epithelial disease, as well as treatment outcomes.
Collapse
Affiliation(s)
- Stephen C Pflugfelder
- Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
| |
Collapse
|
373
|
You S, Tariq A, Kublin CL, Zoukhri D. Detection of BrdU-label retaining cells in the lacrimal gland: implications for tissue repair. Cell Tissue Res 2011; 346:317-26. [PMID: 22101331 DOI: 10.1007/s00441-011-1271-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 10/24/2011] [Indexed: 10/15/2022]
Abstract
The purpose of the present study was to determine if the lacrimal gland contains 5-bromo-2'-deoxyuridine (BrdU)-label retaining cells and if they are involved in tissue repair. Animals were pulsed daily with BrdU injections for 7 consecutive days. After a chase period of 2, 4, or 12 weeks, the animals were sacrificed and the lacrimal glands were removed and processed for BrdU immunostaining. In another series of experiments, the lacrimal glands of 12-week chased animals were either left untreated or were injected with interleukin 1 (IL-1) to induce injury. Two and half days post-injection, the lacrimal glands were removed and processed for BrdU immunostaining. After 2 and 4 weeks of chase period, a substantial number of lacrimal gland cells were BrdU(+) (11.98 ± 1.84 and 7.95 ± 1.83 BrdU(+) cells/mm(2), respectively). After 12 weeks of chase, there was a 97% decline in the number of BrdU(+) cells (0.38 ± 0.06 BrdU(+) cells/mm(2)), suggesting that these BrdU-label retaining cells may represent slow-cycling adult stem/progenitor cells. In support of this hypothesis, the number of BrdU labeled cells increased over 7-fold during repair of the lacrimal gland (control: 0.41 ± 0.09 BrdU(+) cells/mm(2); injured: 2.91 ± 0.62 BrdU(+) cells/mm(2)). Furthermore, during repair, among BrdU(+) cells 58.2 ± 3.6 % were acinar cells, 26.4 ± 4.1% were myoepithelial cells, 0.4 ± 0.4% were ductal cells and 15.0 ± 3.0% were stromal cells. We conclude that the murine lacrimal gland contains BrdU-label retaining cells that are mobilized following injury to generate acinar, myoepithelial and ductal cells.
Collapse
Affiliation(s)
- Samantha You
- Department of General Dentistry, Tufts University School of Dental Medicine, Boston, MA 0211, USA
| | | | | | | |
Collapse
|
374
|
Dougherty BE, Nichols JJ, Nichols KK. Rasch analysis of the Ocular Surface Disease Index (OSDI). Invest Ophthalmol Vis Sci 2011; 52:8630-5. [PMID: 21948646 DOI: 10.1167/iovs.11-8027] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The Ocular Surface Disease Index (OSDI) is a 12-item scale for the assessment of symptoms related to dry eye disease and their effect on vision. Its reliability and validity have been investigated within the classical test theory framework and, more recently, using Rasch analysis. The purpose of the present analysis was to more completely investigate the functioning of its response category structure, the validity of its three subscales, and the unidimensionality of the latent construct it is intended to assess. METHODS Responses to the OSDI from 172 females participating in the Dry Eye in Postmenopause (DEiM) study who had previously been diagnosed with dry eye or reported significant ocular irritation and dryness were analyzed. Response category structure and item fit statistics were evaluated for assessment of model fit. Person separation statistics were used to examine the validity of the subscales. Unidimensionality was assessed by principal component analysis (PCA) of model residuals. RESULTS The recommended five-category response structure resulted in disordered response thresholds. A four-category structure resulted in ordered thresholds. Item infit statistics were acceptable for all 12 items. Person separation with this category structure was adequate, with a person separation index of 2.16. None of the three subscales demonstrated adequate person separation. PCA showed one other significant factor onto which the three environmental items loaded significantly. CONCLUSIONS All items demonstrated acceptable fit to the model after collapsing categories to order the response thresholds. The original subscales did not prove valid, and there is some evidence of multidimensionality and poor targeting.
Collapse
|
375
|
Pflugfelder SC, Baudouin C. Challenges in the clinical measurement of ocular surface disease in glaucoma patients. Clin Ophthalmol 2011; 5:1575-83. [PMID: 22125404 PMCID: PMC3218167 DOI: 10.2147/opth.s24410] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Ocular surface disease (OSD) is common among glaucoma patients. Clinical assessment of OSD can be challenging. This review focuses on some of the limitations relating to both subjective and objective measures of OSD, including dry eye. A survey of the literature was conducted to identify the caveats associated with different methods of assessing OSD. The effect of preservatives on the ocular surface, with respect to glaucoma patients in particular, was also reviewed. Objective methods for assessing ocular surface health and disease include the Schirmer test, tear break-up time, fluorescein turnover, corneal and conjunctival staining, tear osmolarity, and vital dyes. These measures all have limitations in terms of their ability to grade the severity of OSD. Previous studies using the OSD Index showed a mild-to-moderate correlation to dry eye disease severity. Other scoring systems for dry eye have shown a relationship to patient symptom scores or quality of life. Due to the challenges clinicians face concerning both subjective and objective ocular surface health assessments, discerning clinical improvement in ocular surface disease can be a challenge. Further research is needed in order to optimize existing clinical methods and/or identify alternative techniques for assessing OSD in the glaucoma population.
Collapse
|
376
|
Rao SN. Reversibility of dry eye deceleration after topical cyclosporine 0.05% withdrawal. J Ocul Pharmacol Ther 2011; 27:603-9. [PMID: 21999340 DOI: 10.1089/jop.2011.0073] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To assess the reversibility of clinical benefits of cyclosporine 0.05% (Restasis(®); Allergan, Inc., Irvine, CA) therapy and the therapeutic gain after its delayed use by switching treatment modalities in patients with dry eyes who completed a 1-year course of therapy with artificial tears (Refresh Endura(®); Allergan, Inc., Irvine, CA) or cyclosporine 0.05%. METHODS This was a single-center, prospective, investigator-masked, longitudinal extension trial. Patients who had been treated with cyclosporine 0.05% in the first year of study were randomized in a 2:1 ratio to either cyclosporine 0.05% (Cs-Cs; n=20) or artificial tears (Cs-At; n=8), and those who had been originally randomized to artificial tears were switched to cyclosporine 0.05% (At-Cs; n=20) in the second year of study. Patients received study drugs twice daily for 12 months. Disease severity was assessed according to the International Task Force consensus guideline at months 0 and 12. Signs and symptoms were evaluated at baseline (month 0) and months 4, 8, and 12. RESULTS At baseline, most patients with Cs-Cs and Cs-At (>90%) had level 2 disease severity, whereas almost half of the patients with At-Cs had level 3 disease severity. At month 12, a significantly higher percentage of patients with Cs-Cs and At-Cs than patients with Cs-At had the same or lower disease severity (P<0.001); whereas half of patients with Cs-At, compared with patients with no Cs-Cs and At-Cs, had disease progression at month 12. Throughout the study, dry eye signs and symptoms continuously improved in patients with Cs-Cs and At-Cs, whereas they constantly worsened in patients with Cs-At. At month 12, patients with Cs-Cs and At-Cs had significantly greater mean percentage improvement from baseline than did patients with Cs-At in Schirmer test scores, tear breakup time, Oxford staining scores, Ocular Surface Disease Index scores, and conjunctival goblet cell density (P<0.001). Overall, sign and symptom scores of patients with At-Cs did not improve as much as they did for patients with Cs-Cs. CONCLUSIONS Cyclosporine 0.05% withdrawal led to disease progression, thus indicating the necessity for maintenance therapy. Earlier treatment with cyclosporine 0.05% may result in improved outcomes.
Collapse
Affiliation(s)
- Sanjay N Rao
- Lakeside Eye Group, SC, Chicago, Illinois 60601, USA.
| |
Collapse
|
377
|
|
378
|
|
379
|
Prevalence and risk factors of dry eye disease in Japan: Koumi study. Ophthalmology 2011; 118:2361-7. [PMID: 21889799 DOI: 10.1016/j.ophtha.2011.05.029] [Citation(s) in RCA: 202] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 05/22/2011] [Accepted: 05/23/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To estimate the prevalence and risk factors of dry eye disease (DED) in a rural setting in Japan. DESIGN Cross-sectional study. PARTICIPANTS We included 3294 subjects, aged ≥ 40 years who were in the residential registry for Koumi town. INTERVENTION Subjects in a rural mountain area, Koumi town, completed questionnaires designed to detect dry eye diagnosis and risk factors. MAIN OUTCOME MEASURES Clinically diagnosed DED was defined as the presence of a previous clinical diagnosis of DED by ophthalmologists or severe symptoms of DED (both dryness and irritation constantly or often). Current symptoms of DED and possible risk factors such as age, gender, educational history, smoking history, alcohol drinking history, height and weight, visual display terminal (VDT) use, and contact lens (CL) wear, and past/current history of certain common systemic diseases were the main outcome measures. We used logistic regression analysis to examine associations between DED and other demographic factors. RESULTS Of the 3294 eligible residents, 2791 residents (85%) completed the questionnaire. The percentage of women with a composite outcome of clinically diagnosed DED or severe symptoms (21.6%; 95% confidence interval [CI], 19.5-23.9) was higher than that of men (12.5%; 95% CI, 10.7-14.5; P<0.001). A low body mass index (BMI; odds ratio [OR], 2.07; 95% CI, 0.98-4.39), CL use (OR, 3.84; 95% CI, 1.46-10.10), and hypertension (HT) (OR, 1.39; 95% CI, 0.94-2.06) were risk factors for DED in men. Use of a VDT (OR, 2.33; 95% CI, 1.12-4.85), CL use (OR, 3.61; 95% CI, 2.13-6.10), and myocardial infarction or angina were the risk factors (OR, 2.64; 95% CI, 1.51-4.62), whereas high BMI was a preventive factor (OR, 0.69; 95% CI, 0.48-1.01) for DED in women. CONCLUSIONS Among a Japanese cohort, DED leading to a clinical diagnosis or severe symptoms is prevalent. Use of CLs was a common dry eye risk factor in both genders. The condition is more prevalent in men with low BMI, HT, and in women with myocardial infarction or angina and VDT use. Relevant measures directed against the modifiable risks may provide a positive impact on public health and quality of life of Japanese. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
Collapse
|
380
|
Galor A, Feuer W, Lee DJ, Florez H, Carter D, Pouyeh B, Prunty WJ, Perez VL. Prevalence and risk factors of dry eye syndrome in a United States veterans affairs population. Am J Ophthalmol 2011; 152:377-384.e2. [PMID: 21684522 DOI: 10.1016/j.ajo.2011.02.026] [Citation(s) in RCA: 139] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 02/25/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the prevalence of dry eye syndrome (DES) and its associated risk factors in a US Veterans Affairs population receiving ocular care services. DESIGN Retrospective study. METHODS settings: Patients were seen in the Miami and Broward Veterans Affairs eye clinics between 2005 and 2010. patients population: Patients were divided into cases and controls with regard to their dry eye status (cases = ICD9 code for DES plus dry eye therapy; controls = patients without ICD9 code plus no therapy). main outcome measures: The prevalence of DES and its associated risk factors. RESULTS A total of 16 862 patients were identified as either a dry eye case (n = 2056) or control (n = 14 806). Overall, 12% of male and 22% of female patients had a diagnosis of DES, with female gender imparting a 2.40 increased risk (95% confidence interval [CI] 2.04-2.81) over male gender. Several medical conditions were found to increase DES risk including post-traumatic stress disorder (odds ratio [OR] 1.97, 95% CI 1.75-2.23), depression (OR 1.91, 95% CI 1.73-2.10), thyroid disease (OR 1.81, 95% CI 1.46-2.26), and sleep apnea (OR 2.20, 95% CI 1.97-2.46) (all analyses adjusted for gender and age). The use of several systemic medications, including anti-depressant medications (OR 1.97, 95% CI 1.79-2.17), anti-anxiety medication (OR 1.74, 95% CI 1.58-1.91), and anti-benign prostatic hyperplasia medications (OR 1.68, 95% CI 1.51-1.86), was likewise associated with an increased risk of DES. CONCLUSIONS The prevalence of DES was found to be high in both men and women in our eye care population. This is the first study to demonstrate that in a veteran population, several diagnoses were significantly associated with DES, including post-traumatic stress disorder and depression.
Collapse
|
381
|
Choy CKM, Cho P, Benzie IFF. Antioxidant content and ultraviolet absorption characteristics of human tears. Optom Vis Sci 2011; 88:507-11. [PMID: 21336228 DOI: 10.1097/opx.0b013e31820e9fe2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Dry eye syndrome is a common age-related disorder, and decreased antioxidant/ultraviolet (UV) radiation protection in tears may be part of the cause. This study aimed to compare the tear antioxidant content and flow rate in young and older adults. The total antioxidant content and UV absorbing properties of various commercially available ophthalmic solutions used to alleviate dry eye symptoms were also examined. METHODS Minimally stimulated tears were collected from 120 healthy Chinese adults with no ocular pathology. Two age groups were studied: 19 to 29 years (n = 58) and 50 to 75 years (n = 62). Tear samples from each subject and 13 ophthalmic solutions were analyzed for total antioxidant content (as the Ferric Reducing/Antioxidant Power value). Tear flow rates were estimated from time taken to collect a fixed volume of tear fluid. UV absorbance spectra of pooled fresh reflex tear fluid and the ophthalmic solutions were determined. RESULTS Results showed that the antioxidant content of minimally stimulated tears from older subjects (398 ± 160 μmol/l) was not significantly lower than that of younger subjects (348 ± 159 μmol/l; p = 0.0915). However, there was a significant difference in the tear flow rates between the two groups (p < 0.0001), with the younger group having three to four fold higher flow rate. None of the commercial preparations tested had detectable antioxidant content, and none showed the UV absorption characteristics of natural reflex tears. CONCLUSIONS The effect of low flow rate on the dynamic antioxidant supply to the corneal surface indicates that older subjects have poorer overall defense against photooxidative and other oxidative processes. This could predispose older persons to corneal stress and development of dry eye syndrome. The commercially available artificial tears tested lack both the antioxidant content and UV absorbing characteristics of natural tears. Artificial tears formulations that help restore natural antioxidant and UV absorbing properties to the tear film of the aging eye may help prevent or improve dry eye symptoms and promote ocular health.
Collapse
Affiliation(s)
- Camus Kar Man Choy
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | | | | |
Collapse
|
382
|
Abstract
PURPOSE The aim of this study was to estimate both the direct and indirect annual cost of managing dry eye disease (DED) in the United States from a societal and a payer's perspective. METHODS A decision analytic model was developed to estimate the annual cost for managing a cohort of patients with dry eye with differing severity of symptoms and treatment. The direct costs included ocular lubricants, cyclosporine, punctal plugs, physician visits, and nutritional supplements. The indirect costs were measured as the productivity loss because of absenteeism and presenteeism. The model was populated with data that were obtained from surveys that were completed by dry eye sufferers who were recruited from online databases. Sensitivity analyses were employed to evaluate the impact of changes in parameters on the estimation of costs. All costs were converted to 2008 US dollars. RESULTS Survey data were collected from 2171 respondents with DED. Our analysis indicated that the average annual cost of managing a patient with dry eye at $783 (variation, $757-$809) from the payers' perspective. When adjusted to the prevalence of DED nationwide, the overall burden of DED for the US healthcare system would be $3.84 billion. From a societal perspective, the average cost of managing DED was estimated to be $11,302 per patient and $55.4 billion to the US society overall. CONCLUSIONS DED poses a substantial economic burden on the payer and on the society. These findings may provide valuable information for health plans or employers regarding budget estimation.
Collapse
|
383
|
Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic Physiol Opt 2011; 31:502-15. [DOI: 10.1111/j.1475-1313.2011.00834.x] [Citation(s) in RCA: 288] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
384
|
Liu S, Richards SM, Lo K, Hatton M, Fay A, Sullivan DA. Changes in gene expression in human meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2011; 52:2727-40. [PMID: 21372006 PMCID: PMC3088560 DOI: 10.1167/iovs.10-6482] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 12/15/2010] [Accepted: 03/01/2011] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Meibomian gland dysfunction (MGD) may be the leading cause of dry eye syndrome throughout the world. However, the precise mechanism(s) underlying the pathogenesis of this disease is unclear. This study was conducted to identify meibomian gland genes that may promote the development and/or progression of human MGD. METHODS Lid tissues were obtained from male and female MGD patients and age-matched controls after eyelid surgeries (e.g., to correct entropion or ectropion). Meibomian glands were isolated and processed for RNA extraction and the analysis of gene expression. RESULTS The results show that MGD is associated with significant alterations in the expression of almost 400 genes in the human meibomian gland. The levels of 197 transcripts, including those encoding various small proline-rich proteins and S100 calcium-binding proteins, are significantly increased, whereas the expression of 194 genes, such as claudin 3 and cell adhesion molecule 1, is significantly decreased. These changes, which cannot be accounted for by sex differences, are accompanied by alterations in many gene ontologies (e.g., keratinization, cell cycle, and DNA repair). The findings also show that the human meibomian gland contains several highly expressed genes that are distinct from those in an adjacent tissue (i.e., conjunctival epithelium). CONCLUSIONS The results demonstrate that MGD is accompanied by multiple changes in gene expression in the meibomian gland. The nature of these alterations, including the upregulation of genes encoding small proline-rich proteins and S100 calcium-binding proteins, suggest that keratinization plays an important role in the pathogenesis of MGD.
Collapse
Affiliation(s)
- Shaohui Liu
- From the Schepens Eye Research Institute
- the Department of Ophthalmology, and
| | - Stephen M. Richards
- From the Schepens Eye Research Institute
- the Department of Ophthalmology, and
| | - Kristine Lo
- the Department of Ophthalmology, and
- the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - Mark Hatton
- From the Schepens Eye Research Institute
- the Department of Ophthalmology, and
- Ophthalmic Consultants of Boston, Boston, Massachusetts
| | - Aaron Fay
- the Department of Ophthalmology, and
- the Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; and
| | - David A. Sullivan
- From the Schepens Eye Research Institute
- the Department of Ophthalmology, and
| |
Collapse
|
385
|
Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci 2011; 52:1994-2005. [PMID: 21450917 DOI: 10.1167/iovs.10-6997e] [Citation(s) in RCA: 379] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Debra A Schaumberg
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | | |
Collapse
|
386
|
Abstract
PURPOSE This study aimed to determine whether patients with dry eye syndrome [DES] have more symptoms of anxiety and depression than controls without DES. METHODS In this case-control study, the sample consisted of 89 DES subjects (13 diagnosed with Sjögren's syndrome [SS]) and 73 control subjects. Each subject was diagnosed as having DES or was chosen as a control subject by an ophthalmologist. The Zung Self Rating Anxiety Scales (SAS), Zung Self Rating Depression Scales (SDS), and Ocular Surface Disease Index (OSDI) were administered to all subjects. Scores of SAS and SDS, measuring level of anxiety and depression symptoms, were compared between the DES group and the control group. Correlations with other health status measures were conducted. RESULTS The SAS and SDS scores of the DES group were significantly higher than the control group (P < 0.001, P < 0.001). The prevalence of DES subjects with anxiety or depression symptoms was significantly higher than in the control group (P = 0.003, P < 0.001). In the DES group, SAS scores were found to be correlated with OSDI and educational level. SDS scores were found to be correlated with OSDI. Neither SAS nor SDS scores were correlated with age, sex, household income, tear break up time (BUT), Schirmer Test 1 (S1T), corneal fluorescein staining (FL), or visual acuity. CONCLUSION Anxiety and depression are correlated with DES, demonstrating that DES is an important public health problem that merits increased attention and research.
Collapse
Affiliation(s)
- Meiyan Li
- Department of Ophthalmology, EYE & ENT Hospital of Fudan University, No. 83 Fenyang Road, Shanghai, China
| | | | | | | |
Collapse
|
387
|
Chen Y, Chauhan SK, Saban DR, Sadrai Z, Okanobo A, Dana R. Interferon-γ-secreting NK cells promote induction of dry eye disease. J Leukoc Biol 2011; 89:965-72. [PMID: 21402771 DOI: 10.1189/jlb.1110611] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
NK cells have been increasingly reported to be an important effector in autoimmune diseases. However, nothing is known in this regard in DED, the most common eye pathology, which is characterized by sustained inflammation on the ocular surface. In the present study, we have examined the profile of NK cells on the ocular surface as well as in the draining lymphoid tissues during the development of this disease. Our data demonstrate activated NK cells during the disease-induction phase. Moreover, in vivo depletion of NK cells in mice results in reduced disease severity and diminished proinflammatory cytokines. Furthermore, we show that NK cells are also able to modulate the maturation of APCs, which is correlated with IFN-γ from NK cells. Together, our findings provide new in vivo evidence that IFN-γ-secreting NK cells can promote induction of DED via direct target tissue damage and indirect influence on the priming phase of an adaptive immune response in secondary lymphoid tissue.
Collapse
Affiliation(s)
- Yihe Chen
- Schepens Eye Research Institute, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA.
| | | | | | | | | | | |
Collapse
|
388
|
Knop E, Knop N, Millar T, Obata H, Sullivan DA. The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest Ophthalmol Vis Sci 2011; 52:1938-78. [PMID: 21450915 PMCID: PMC3072159 DOI: 10.1167/iovs.10-6997c] [Citation(s) in RCA: 696] [Impact Index Per Article: 53.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/23/2011] [Indexed: 12/15/2022] Open
Affiliation(s)
- Erich Knop
- Ocular Surface Center Berlin, Department for Cell and Neurobiology, Center for Anatomy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | |
Collapse
|
389
|
Calonge M, Enríquez-de-Salamanca A, Diebold Y, González-García MJ, Reinoso R, Herreras JM, Corell A. Dry eye disease as an inflammatory disorder. Ocul Immunol Inflamm 2011; 18:244-53. [PMID: 20482396 DOI: 10.3109/09273941003721926] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Dry eye disease (DED) is a prevalent inflammatory disorder of the lacrimal functional unit of multifactorial origin leading to chronic ocular surface disease, impaired quality of vision, and a wide range of complications, eventually causing a reduction in quality of life. It still is a frustrating disease because of the present scarcity of therapies that can reverse, or at least stop, its progression. METHODS A comprehensive literature survey of English-written scientific publications on the role of inflammation in DED. RESULTS New investigations have demonstrated that a chronic inflammatory response plays a key role in the pathogenesis of human DED. Additionally, correlations between inflammatory molecules and clinical data suggest that inflammation can be responsible for some of the clinical symptoms and signs. CONCLUSIONS Research efforts to clarify its pathophysiology are leading to a better understanding of DED, demonstrating that inflammation, in addition to many other factors, plays a relevant role.
Collapse
|
390
|
Lin Z, Liu X, Zhou T, Wang Y, Bai L, He H, Liu Z. A mouse dry eye model induced by topical administration of benzalkonium chloride. Mol Vis 2011; 17:257-64. [PMID: 21283525 PMCID: PMC3030605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Accepted: 01/18/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To develop a dry eye model of mouse induced by topical administration of benzalkonium chloride (BAC) and investigate the possible mechanisms. METHODS BAC at concentration of 0.2% was applied to the mouse ocular surface for 7 days. Phenol red thread tear test, tear break-up time (BUT) test, corneal inflammatory index scoring, fluorescein and rose bengal test were performed to evaluate the toxic effects of BAC on the ocular surface. Global specimens were collected on day (D) 7 and labeled with a series of antibodies including cytokeratin 10 (K10) and mucin 5AC (MUC5AC). Apoptosis of ocular surface epithelium was evaluated by in situ terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Histologic analysis and transmission electron microscopy (TEM) were performed on D7. RESULTS BAC at a concentration of 0.2% successfully induced a dry eye condition with decreased tear volume and BUTs, increased corneal fluorescein and rose bengal scores. The Inflammatory index was increased in accompaniment with higher tumor necrosis factor-α (TNF-α) expression and more inflammatory infiltration in the cornea. Immunolabeling revealed positive K10 expression in BAC-treated corneal epithelium and fewer MUC5AC-positive cells in the BAC-treated conjunctival fornix. TUNEL assay showed more apoptotic cells in the corneal basal epithelium. TEM showed that the size and intervals of the microvillis were both reduced in the corneal epithelium. CONCLUSIONS Topical administration of 0.2% BAC in mouse induces changes resembling that of dry eye syndrome in humans, and thus, represents a novel model of dry eye.
Collapse
Affiliation(s)
- Zhirong Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People’s Republic of China,Eye Institute and affiliated Xiamen Eye Center of Xiamen University, Xiamen, People’s Republic of China,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, People’s Republic of China
| | - Xiaochen Liu
- Eye Institute and affiliated Xiamen Eye Center of Xiamen University, Xiamen, People’s Republic of China,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, People’s Republic of China
| | - Tong Zhou
- Eye Institute and affiliated Xiamen Eye Center of Xiamen University, Xiamen, People’s Republic of China,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, People’s Republic of China
| | - Yihui Wang
- Eye Institute and affiliated Xiamen Eye Center of Xiamen University, Xiamen, People’s Republic of China,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, People’s Republic of China
| | - Li Bai
- Eye Institute and affiliated Xiamen Eye Center of Xiamen University, Xiamen, People’s Republic of China,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, People’s Republic of China
| | - Hui He
- Eye Institute and affiliated Xiamen Eye Center of Xiamen University, Xiamen, People’s Republic of China,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, People’s Republic of China
| | - Zuguo Liu
- Eye Institute and affiliated Xiamen Eye Center of Xiamen University, Xiamen, People’s Republic of China,Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen, People’s Republic of China
| |
Collapse
|
391
|
Jeong HS, Lim JS, Oh DK, Chi MJ, Paik HJ, Shyn KH, Kim KH. Prevalence and Risk Factors of Dry Eye Syndrome in the Incheon Area. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.10.1135] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hoon Seok Jeong
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea
| | - Jung Soo Lim
- Department of Preventive Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Dae Kyu Oh
- Department of Preventive Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Mi Jung Chi
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea
| | - Hye Jung Paik
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea
| | | | - Kyun Hyung Kim
- Department of Ophthalmology, Gachon University Gil Hospital, Incheon, Korea
| |
Collapse
|
392
|
Long-Term Use of Hydroxypropyl Cellulose Ophthalmic Insert to Relieve Symptoms of Dry Eye in a Contact Lens Wearer: Case-Based Experience. Eye Contact Lens 2011; 37:39-44. [DOI: 10.1097/icl.0b013e3181f84f92] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
393
|
Delcourt C, Korobelnik JF, Barberger-Gateau P, Delyfer MN, Rougier MB, Le Goff M, Malet F, Colin J, Dartigues JF. Nutrition and age-related eye diseases: the Alienor (Antioxydants, Lipides Essentiels, Nutrition et maladies OculaiRes) Study. J Nutr Health Aging 2010; 14:854-61. [PMID: 21125205 PMCID: PMC3081304 DOI: 10.1007/s12603-010-0131-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Worldwide, degenerative eye diseases (age-related maculopathy (ARM), cataract, glaucoma) are the main causes of visual impairment and blindness, which contribute to disability in the elderly. Mainly three types of nutritional factors are investigated for their potential protection against eye ageing: antioxidants; lutein and zeaxanthin (carotenoids which accumulate specifically in the eye); omega 3 polyunsaturated fatty acids. Few epidemiological studies have been conducted in this field, particularly in Europe. OBJECTIVE The Alienor (Antioxydants, Lipides Essentiels, Nutrition et maladies OculaiRes) Study aims at assessing the associations of eye diseases with nutritional factors, determined from plasma measurements and estimation of dietary intakes. DESIGN, SETTING AND PARTICIPANTS Subjects were recruited in Bordeaux (France) from the ongoing population-based 3C study. In 2006-2008, 963 subjects from the 3C Study, aged 73 years or more, had an eye examination and will have follow-up eye examinations every 2 years. MEASUREMENTS Vascular, genetic and nutritional factors were assessed at baseline (1999-2001) and follow-up examinations of the 3C Study. Eye diseases were classified according to international classifications. RESULTS Nutritional status and vascular disease and risk factors were similar between participants and non participants, except for a slight difference in plasma triglycerides and HDL-cholesterol. As expected, the prevalence of eye diseases was high: early and late ARM (28.4 % and 5.6 %, respectively), open-angle glaucoma and treated ocular hypertension (4.8 % and 10.0 %, respectively), cataract extraction (45.2 %), retinopathy (8.4 %), retinal vein occlusion (1.1 %), epiretinal membrane (3.9 %), current use of artificial tears (17.3 %). CONCLUSIONS This study confirms the high prevalence of eye diseases in the elderly. Its main strength is the combination of nutritional, vascular and genetic information, collected over a 7 year period of time before the first eye examination. It may help design future interventional studies, which might be common with other age-related disorders, because of common nutritional factors.
Collapse
Affiliation(s)
- C Delcourt
- Inserm U897, Universite Victor Segalen Bordeaux 2, Bordeaux, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
394
|
Kojima T, Matsumoto Y, Dogru M, Tsubota K. The application of in vivo laser scanning confocal microscopy as a tool of conjunctival in vivo cytology in the diagnosis of dry eye ocular surface disease. Mol Vis 2010; 16:2457-64. [PMID: 21139693 PMCID: PMC2994731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 11/15/2001] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the applicability of in vivo laser scanning confocal microscopy as a tool of conjunctival cytology in a prospective case-control study. METHODS Nineteen right eyes of 19 Sjogren's syndrome dry eye patients (19 females; mean age: 55.8±15 years), and 18 right eyes of 18 normal healthy control subjects (12 females and 6 males; mean age: 50.8±14 years) were evaluated in this study. The eyes were analyzed by the Heidelberg retina tomography (HRTII)/Rostock cornea module (RCM). Ocular surface and tear function tests including vital stainings (fluorescein and Rose Bengal), Schirmer test, tear film break up time (BUT), and conjunctival impression cytology were performed. After obtaining the confocal microscopy images, the mean individual epithelial cell area (MIECA), and nucleocytoplasmic (N/C) ratio were analyzed. The correlation between confocal microscopy and impression cytology parameters was also investigated. RESULTS The BUT, Schirmer test values, vital staining scores and squamous metaplasia grades in impression cytology were significantly worse in dry eye patients compared to controls (p<0.0001). The MIECA and the mean N/C ratios were worse in dry eye subjects compared to controls both in impression cytology and in vivo confocal microscopy (p<0.0001) with no significant differences between these parameters when the two examination techniques were compared. The MIECA and N/C ratio in conjunctival impression cytology showed significant correlation with the corresponding confocal microscopy parameters (MIECA, r2:0.557 ; N/C, r2:0.765). CONCLUSIONS Laser scanning confocal microscopy seems to be an efficient non-invasive tool in the evaluation of phenotypic alterations of the conjunctival epithelium in dry eye disease. N/C ratio and MIECA appear to be two promising and new parameters of in vivo confocal cytology in the assessment of the ocular surface in dry eye disease.
Collapse
Affiliation(s)
- Takashi Kojima
- Johnson & Johnson Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Yukihiro Matsumoto
- Johnson & Johnson Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Murat Dogru
- Johnson & Johnson Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
395
|
Abstract
Dry eye (DED) is a multifactorial disease that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface, accompanied by increased osmolarity of the tear film and inflammation. DED is a common clinical problem and is among the most frequent diagnoses in ophthalmology. It substantially affects quality of life because of the constant ocular discomfort and decrease in visual function. This review discusses the etiology, classification, diagnosis procedures, clinical, and surgical treatments of dry eye.
Collapse
|
396
|
Nguyen CQ, Peck AB. Inflammation in dry eye diseases culminating in loss of ocular homeostasis. EXPERT REVIEW OF OPHTHALMOLOGY 2010. [DOI: 10.1586/eop.10.51] [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: 11/08/2022]
|
397
|
Abstract
PURPOSE OF REVIEW Recent increased awareness of dry eye disease (DED) by both clinicians and patients has been accompanied by improved recognition that it is a chronic disorder often requiring long-term management. DED, frequently associated with symptoms of discomfort and visual disturbance, also impairs quality of life (QoL), including aspects of physical, social, and psychological functioning. This review summarizes the available research on the impact of DED and its treatment on measures of QoL. RECENT FINDINGS A relative dearth of data supporting the effectiveness of DED treatments as assessed by QoL measures exists. Both cyclosporine ophthalmic emulsion 0.05% and hydroxypropyl cellulose ophthalmic inserts have been associated with improvements in Ocular Surface Disease Index scores, a disease-specific measure of QoL, and with enhancement of patients' ratings regarding their ability to perform activities of daily living. SUMMARY Because there is a lack of concordance between symptoms and diagnostic measures of DED, QoL measures provide clinicians a valuable tool for assessing the burden of disease as well as response to treatment. Such measures should be employed in clinical practice and in future trials of treatment modalities.
Collapse
|
398
|
Baum JL. Evaporative dry eye--signs and symptoms don't mesh--and other thoughts. Ophthalmology 2010; 117:1285-6. [PMID: 20609990 DOI: 10.1016/j.ophtha.2010.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 05/24/2010] [Accepted: 05/25/2010] [Indexed: 11/25/2022] Open
|
399
|
Schechter JE, Warren DW, Mircheff AK. A Lacrimal Gland is a Lacrimal Gland, But Rodent's and Rabbit's Are Not Human. Ocul Surf 2010; 8:111-34. [DOI: 10.1016/s1542-0124(12)70222-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
400
|
Current world literature. Refractive surgery. Corneal and external disorders. Curr Opin Ophthalmol 2010; 21:322-6. [PMID: 20548165 DOI: 10.1097/icu.0b013e32833bb58c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|