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Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf 2023; 28:262-303. [PMID: 37054911 DOI: 10.1016/j.jtos.2023.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Surgical Services, Miami Veterans Administration, Miami, FL, USA.
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Yun Feng
- Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Scientific Institute, Milan, Italy
| | - David Goldblum
- Pallas-Kliniken, Olten, Bern, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA; Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo, Principality of Asturias, Spain
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eduardo M Rocha
- Department of Ophthalmology, Othorynolaringology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Michael T M Wang
- 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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Abstract
OBJECTIVES The objective of this meta-analysis was to identify whether headache increase the risk of dry eye disease (DED). METHODS PubMed, Web of Science, Cochrane Library and EMBASE databases were searched for relevant studies. The odds ratio (OR) of DED in all-cause headache was calculated via Stata software. To explore the source of heterogeneity, subgroup and sensitivity analyses were conducted. Funnel plots and Egger's test were performed to assess publication bias. RESULTS This meta-analysis included 11 studies. Pooled analysis indicated that all-cause headache was related to a higher risk of DED (OR = 1.586, 95% CI : 1.409-1.785, I2 = 89.3%, p < .001). Migraine headache, tension headache and cluster headache were all related to a higher risk of DED (OR = 1.503, 95% CI: 1.369-1.650, I2 = 81.8%, p < .001; OR = 1.610, 95% CI: 1.585-1.635, p < .001; OR = 2.120, 95% CI: 1.104-4.073, p = .024), respectively. The risk of DED in case-control studies was slightly higher than in cross-sectional studies and cohort study (OR = 1.707, 95% CI: 1.291-2.258, I2 = 85.0%, p < .001; OR = 1.600, 95% CI: 1.590-1.610, I2 = 0.0%, p < .001; OR = 1.440, 95% CI: 1.096-1.893, p = .009), respectively. Subgroup analysis in territory type showed that all-cause headache in America, Europe, Asia and Oceania were all related to a higher risk of DED. CONCLUSIONS This study indicates that headache is related to a higher risk of DED, especially in the migraine patients. These results suggest that headaches should be regarded as an independent risk factor for DED.KEY MESSAGESIn this meta-analysis, 11 studies (one cohort study, four case-control studies and six cross-sectional studies) covering 3,575,957 individuals were included.Pooled analysis indicated that all-cause headache was related to a higher risk of dry eye (OR = 1.586, 95% CI: 1.409-1.785, I2 = 89.3%, p < .001).These results suggest that headaches should be regarded as an independent risk factor for dry eye.
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Affiliation(s)
- Shuyi Liu
- Graduate School, Dalian Medical University, Dalian, China.,Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - He Dong
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shifeng Fang
- Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lijun Zhang
- Graduate School, Dalian Medical University, Dalian, China.,Department of Ophthalmology, The Third People's Hospital of Dalian, Non-Directly Affiliated Hospital of Dalian Medical University, Dalian, China
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ŞİMDİVAR GHN, SARIGEÇİLİ E, İNCEKALAN T, KOÇ UÇAR H. Oküler biyometrik ölçümler ile pediatrik migren arasında ilişki. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1087155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Bu çalışmada pediatrik migren hastalarında biyometri ölçümlerinin ve ön segment parametrelerinin değerlendirilmesi ve sağlıklı çocuklarla karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu prospektif vaka-kontrol çalışmasına yaş ve cinsiyeti uyumlu 40 pediatrik migren hastası ve 45 sağlıklı çocuk dahil edildi. Ölçümlerden önce tüm katılımcılar tam bir oftalmolojik muayeneden geçirildi. Ön kamara derinliği (ÖKD), vitreus uzunluğu (VU), lens kalınlığı (LK), aksiyel uzunluk (AU), merkezi kornea kalınlığı (MKK), kornea hacmi (KH), ön kamara hacmi (ÖKH), iridokorneal açı (İKA), pupil çapı (PÇ) ve ortalama kornea kırıcılığı (Km) değerlendirildi. Tüm değerlendirmeler ataksız dönemde yapıldı. Fotofobisi olan ve olmayan migrenli hastalarda pupil çapı karşılaştırıldı. Diürnal varyasyondan en az oranda etkilenmek açısından göz içi basınç ölçümleri ve biyometri değerlendirmeleri günün aynı saatlerinde (10:00–12:00) yapıldı. Tüm katılımcıların sağ gözü çalışmaya dahil edildi.
Bulgular: Pediatrik migren grubuyla (27 kız, 13 erkek) kontrol grubu (30 kız, 15 erkek) arasında ÖKD, VU, LK, AU, MKK, KH, ÖKH, İKA, PÇ, göz içi basıncı, sferik eşdeğer ve Km ölçümleri bakımından istatistiksel olarak anlamlı farklılık görülmedi. Migren grubu içerisinde fotofobisi olan hastalar ile olmayanların pupil çapları arasında anlamlı farklılık görülmedi.
Sonuç: Pediatrik migren hastalarında biyometri, korneal topografi ve keratometri ölçümlerinde sağlıklı çocuklara göre farklılık görülmemektedir. Pediatrik migren ile oküler biyometrik ölçümler arasındaki ilişkiyi incelemek için daha geniş hasta popülasyonlu çalışmalara ihtiyaç vardır.
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Affiliation(s)
| | - Esra SARIGEÇİLİ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Tuğba İNCEKALAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Habibe KOÇ UÇAR
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Biscetti L, De Vanna G, Cresta E, Corbelli I, Gaetani L, Cupini L, Calabresi P, Sarchielli P. Headache and immunological/autoimmune disorders: a comprehensive review of available epidemiological evidence with insights on potential underlying mechanisms. J Neuroinflammation 2021; 18:259. [PMID: 34749743 PMCID: PMC8573865 DOI: 10.1186/s12974-021-02229-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/04/2021] [Indexed: 12/31/2022] Open
Abstract
Several lines of evidence support a role of the immune system in headache pathogenesis, with particular regard to migraine. Firstly, alterations in cytokine profile and in lymphocyte subsets have been reported in headache patients. Secondly, several genetic and environmental pathogenic factors seem to be frequently shared by headache and immunological/autoimmune diseases. Accordingly, immunological alterations in primary headaches, in particular in migraine, have been suggested to predispose some patients to the development of immunological and autoimmune diseases. On the other hand, pathogenic mechanisms underlying autoimmune disorders, in some cases, seem to favour the onset of headache. Therefore, an association between headache and immunological/autoimmune disorders has been thoroughly investigated in the last years. The knowledge of this possible association may have relevant implications in the clinical practice when deciding diagnostic and therapeutic approaches. The present review summarizes findings to date regarding the plausible relationship between headache and immunological/autoimmune disorders, starting from a description of immunological alteration of primary headaches, and moving onward to the evidence supporting a potential link between headache and each specific autoimmune/immunological disease.
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Affiliation(s)
- Leonardo Biscetti
- Istituto Nazionale di Riposo e Cura dell'Anziano a carattere scientifico, IRCSS- INRCA, Ancona, Italy
| | - Gioacchino De Vanna
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Cresta
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ilenia Corbelli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Letizia Cupini
- Headache Center, UOC Neurologia-Stroke Unit, Emergency Department, Ospedale S. Eugenio, Rome, Italy
| | - Paolo Calabresi
- Department of Neuroscience, Università Cattolica Sacro Cuore, Rome, Italy
| | - Paola Sarchielli
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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Chen H, Chen A, Wang S, Zou M, Young CA, Zheng D, Jin G. Association Between Migraine and Dry Eye: A Systematic Review and Metaanalysis. Cornea 2021; 41:740-745. [PMID: 34743091 DOI: 10.1097/ico.0000000000002851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to assess whether migraine might be associated with the increased risk of dry eye disease and to determine the strength of the association between migraine and dry eye disease. METHODS We searched EMBASE, PubMed, Web of Science databases and China National Knowledge Infrastructure, WanFang, and VIP databases for studies that investigated the association between dry eye and migraine from inception to September 8, 2020. Relevant data were extracted by 2 investigators independently. Publication bias and heterogeneity were evaluated. Odds ratio (OR) and 95% confidence interval (CI) were computed by metaanalysis using random-effects models. RESULTS Of the 565 studies identified, 7 studies met the inclusion criteria and were included in this metaanalysis. Patients with migraine had significantly higher morbidity of dry eye compared with the control group (OR = 1.55; 95% CI = 1.32-1.82; P < 0.001). Subgroup analysis showed that the association between dry eye and migraine was stronger in hospital-based studies (OR = 1.97, P = 0.036) than population-based studies (OR = 1.42, P < 0.001). In addition, differences in geographic location and diagnostic criteria have no effect on the results. CONCLUSIONS There was a significant association between dry eye and migraine. Patients with migraine are more prone to suffer from dry eye than subjects without migraine, and the association strength varies among populations studied.
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Affiliation(s)
- Hanlin Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China; Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China; Department of Pharmacy, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China; Guangdong General Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, China; and Nanchang Eye Hospital, Third Affiliated Hospital of Nanchang University, Nanchang, China
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Aninye IO, Digre K, Hartnett ME, Baldonado K, Shriver EM, Periman LM, Grutzmacher J, Clayton JA. The roles of sex and gender in women's eye health disparities in the United States. Biol Sex Differ 2021; 12:57. [PMID: 34670620 PMCID: PMC8527306 DOI: 10.1186/s13293-021-00401-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 10/08/2021] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND In the United States, women are at a higher risk of developing vision impairment or a serious eye disease (such as age-related macular degeneration, thyroid eye disease, or chronic dry eye disease) than men. Disparities in eye diseases due to biology widen even further when considering factors such as social determinants of health; gaps in research data, literature, and policy; insufficient provider and patient education; and limitations in screening and treatment options. Sex and gender disparities in eye health are clinically under-addressed and burdensome on both patient quality of life and the health care and economic systems, resulting in a pressing population health issue that negatively impacts women. DESIGN The Society for Women's Health Research convened a working group of expert clinicians, researchers, and patient advocates to review the current state of science regarding sex and gender disparities in women's eye health, identify knowledge gaps and unmet needs, and explore better means to advance research, improve patient care, and raise awareness of key issues. DISCUSSION The SWHR Women's Eye Health Working Group identified priority areas in research, clinical care, and education to reduce disparities and improve patient care in women's eye health. The working group recommends using a systems approach that incorporates a comprehensive research framework with a sex and gender lens to guide future work and that increases health care provider and public education, as well as engagement by expanding partnerships among ophthalmologic providers, researchers, and non-vision stakeholders.
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Affiliation(s)
- Irene O Aninye
- Society for Women's Health Research, 1025 Connecticut Avenue, NW, Suite 1104, Washington, DC, 20036, USA.
| | - Kathleen Digre
- Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | | | | | - Erin M Shriver
- Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | | | | | - Janine A Clayton
- Office of Research on Women's Health, National Institute of Health, Bethesda, MD, USA
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Baksh BS, Garcia JC, Galor A. Exploring the Link Between Dry Eye and Migraine: From Eye to Brain. Eye Brain 2021; 13:41-57. [PMID: 33692643 PMCID: PMC7939506 DOI: 10.2147/eb.s234073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/17/2021] [Indexed: 11/23/2022] Open
Abstract
Dry eye and migraine are common diseases with large societal and economic burdens that have recently been associated in the literature. This review outlines the link between dry eye and migraine, which may have implications for reducing their respective burdens. We highlight possible shared pathophysiology, including peripheral and central sensitization, as the potential link between dry eye and migraine. Finally, therapies targeting similar pathophysiological mechanisms between dry eye and migraine are discussed.
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Affiliation(s)
- Brandon S Baksh
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Julia Costa Garcia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Faculdade de Medicina (FMB) da Universidade do Estado de São Paulo (UNESP), Botucatu, Brazil
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA
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Yildiz MB, Yildiz E, Balci S, Hasirci Bayir BR, Çetinkaya Y. Effect of migraine attack on pupil size, accommodation and ocular aberrations. Eur J Ophthalmol 2020; 31:3450-3455. [PMID: 33246366 DOI: 10.1177/1120672120975334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the pupil size, accommodation, and ocular higher-order aberrations (HOAs) in patients with migraine during migraine attacks and compare them with interictal period and healthy controls. METHODS This prospective, case-control study included 48 eyes of 24 patients with migraine and 48 eyes of 24 age and sex-matched healthy controls. Measurements were performed using a Hartmann Shack aberrometer. Accommodative responses to accommodative stimulus ranging from 0 to 5 diopters (D) in increments of 0.5 D were recorded. Spherical, coma, trefoil aberration, and root mean square (RMS) of total HOAs were assessed. Patients with migraine were measured twice during the interictal phase and during migraine attack. RESULTS The mean pupil size significantly decreased during migraine attack (5.85 ± 0.19 mm) compared with the interictal phase (6.05 ± 0.19 mm) in the patients with migraine (p = 0.012). There was a significant increase in the accommodative response to accommodative stimulus of 1.5 to 5 D during migraine attack. No significant change was observed in HOAs during migraine attack. In addition, no ictal or interictal period measurements were statistically significantly different from the controls. Comparing symptomatic and non-symptomatic sides in 17 migraine patients with unilateral headache, no significant difference was found in any of the measurements in both ictal and interictal periods. CONCLUSION Our results suggest the presence of a subtle oculosympathetic hypofunction in patients with migraine during the ictal period compared to the interictal period. The accommodation status of the eye seems to be affected by this autonomic dysfunction.
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Affiliation(s)
- Merve Beyza Yildiz
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elvin Yildiz
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sevcan Balci
- Department of Ophthalmology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Buse Rahime Hasirci Bayir
- Department of Neurology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yılmaz Çetinkaya
- Department of Neurology, Haydarpaşa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Investigation of light-induced lacrimation and pupillary responses in episodic migraine. PLoS One 2020; 15:e0241490. [PMID: 33125423 PMCID: PMC7598498 DOI: 10.1371/journal.pone.0241490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022] Open
Abstract
The purpose of this pilot study was to investigate the light-induced pupillary and lacrimation responses mediated by intrinsically photosensitive retinal ganglion cells (ipRGCs) in migraine. Ten participants with episodic migraine and normal tear production, as well as eleven visually normal controls participated in this study. Following an initial baseline trial (no light flash), participants received seven incremental and alternating red and blue light flashes. Pupillometry recording of the left eye and a 1-min anesthetized Schirmer’s test of the right eye (using 0.5% proparacaine) were performed simultaneously. Intrinsic and extrinsic ipRGC photoactivities did not differ between migraine participants and controls across all intensities and wavelengths. Migraine participants, however, had significantly lower lacrimation than controls following the highest blue intensity. A positive correlation was found between melanopsin-driven post-illumination pupillary responses and lacrimation following blue stimulation in both groups. Our results show that participants with self-reported photophobia have normal ipRGC-driven responses, suggesting that photophobia and pupillary function may be mediated by distinct ipRGC circuits. The positive correlation between melanopsin-driven pupillary responses and light-induced lacrimation suggests the afferent arm of the light-induced lacrimation reflex is melanopsin-mediated and functions normally in migraine. Lastly, the reduced melanopsin-mediated lacrimation at the highest stimulus suggests the efferent arm of the lacrimation reflex is attenuated under certain conditions, which may be a harbinger of dry eye in migraine.
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Wang MT, Vidal-Rohr M, Muntz A, Diprose WK, Ormonde SE, Wolffsohn JS, Craig JP. Systemic risk factors of dry eye disease subtypes: A New Zealand cross-sectional study. Ocul Surf 2020; 18:374-380. [DOI: 10.1016/j.jtos.2020.04.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/05/2020] [Accepted: 04/12/2020] [Indexed: 02/06/2023]
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Ismail OM, Poole ZB, Bierly SL, Van Buren ED, Lin FC, Meyer JJ, Davis RM. Association Between Dry Eye Disease and Migraine Headaches in a Large Population-Based Study. JAMA Ophthalmol 2020; 137:532-536. [PMID: 30844042 DOI: 10.1001/jamaophthalmol.2019.0170] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Importance Reports in the literature have conflicting findings about an association between dry eye disease (DED) and migraine headaches. Objective To determine the strength of the association between DED and migraine headaches. Design, Setting, and Participants This retrospective case-control study included 72 969 patients older than 18 years from University of North Carolina-affiliated health care facilities from May 1, 2008, through May 31, 2018. Deidentified aggregate patient data were queried; data were analyzed from June 1 through June 30, 2018. Exposures Diagnosis of migraine headache. Main Outcomes and Measures Odds ratios calculated between DED and migraine headaches for participants as a whole and stratified by sex and age group. Results The base population consisted of 72 969 patients, including 41 764 men (57.2%) and 31 205 women (42.8%). Of these, 5352 patients (7.3%) carried a diagnosis of migraine headache, and 9638 (13.2%) carried a diagnosis of DED. The odds of having DED given a diagnosis of migraine headaches was 1.72 (95% CI, 1.60-1.85) times higher than that of patients without migraine headaches. After accounting for multiple confounding factors, the odds of having DED given a diagnosis of migraine headaches was 1.42 (95% CI, 1.20-1.68) times higher than that of patients without migraine headaches. Conclusions and Relevance These findings suggest that patients with migraine headaches are more likely to have comorbid DED compared with the general population. Although this association may not reflect cause and effect if unidentified confounders account for the results, these data suggest that patients with migraine headaches may be at risk of carrying a comorbid diagnosis of DED.
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Affiliation(s)
- Omar M Ismail
- Department of Ophthalmology, University of North Carolina, Chapel Hill
| | - Zachary B Poole
- Department of Ophthalmology, University of North Carolina, Chapel Hill
| | - Shane L Bierly
- medical student, School of Medicine, University of North Carolina, Chapel Hill
| | - Eric D Van Buren
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina, Chapel Hill
| | - Feng-Chang Lin
- Department of Biostatistics, Gillings School of Public Health, University of North Carolina, Chapel Hill
| | - Jay J Meyer
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Richard M Davis
- Department of Ophthalmology, University of North Carolina, Chapel Hill
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Ozudogru S, Neufeld A, Katz BJ, Baggaley S, Pippitt K, Zhang Y, Digre KB. Reduced Visual Quality of Life Associated with Migraine is Most Closely Correlated with Symptoms of Dry Eye. Headache 2019; 59:1714-1721. [PMID: 31557326 DOI: 10.1111/head.13662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Patients with migraine frequently report ocular or visual symptoms including aura, photophobia, and eye pain. Using validated instruments, our group previously reported that due to these symptoms, patients have marked reductions in visual quality of life. In chronic migraine, these reductions can be as substantial as those reported for other neuro-ophthalmic diseases such as multiple sclerosis with optic neuritis and idiopathic intracranial hypertension. Because the instruments take several different dimensions into account, we were unable to determine which ocular symptom(s) contributed to reduced visual quality of life. The purpose of this investigation was to attempt to determine which ocular symptom(s) were driving the observed reduction in visual quality of life. METHODS We designed a cross-sectional survey-based study to assess visual quality of life, headache impact, aura, dry eye, and photophobia in migraine patients. Subjects were recruited from the Headache Clinic and General Neurology Clinic at a tertiary teaching hospital. Subjects completed validated questionnaires including: The visual functioning questionnaire-25 (VFQ-25), the headache impact test (HIT-6), the visual aura rating scale (VARS), the ocular surface disease index (OSDI), and the Utah photophobia score (UPSIS-17). Associations between VFQ-25 and OSDI, VFQ-25 and VARS, VFQ-25 and UPSIS-17, HIT-6 and OSDI, HIT-6 and VARS, and HIT-6 and UPSIS-17 were calculated. RESULTS Of the 62 patients who completed all questionnaires, 17 had episodic migraine and 45 had chronic migraine. Twenty-three patients experienced aura and 39 did not report aura. The most striking correlations were observed between the VFQ-25 and the OSDI (-0.678; P < .001), between the HIT-6 and UPSIS-17 (0.489; P < .001), and between the HIT-6 and OSDI (0.453; P < .001). CONCLUSIONS Dry eye seems to be the most important symptom that reduces visual quality of life and worsens headache impact. This symptom may be a form of allodynia, a well-known feature of chronic migraine. Photophobia appears to have modest effects on headache impact. In the future, we hope to determine whether treatment of dry eye symptoms can improve visual quality of life and reduce headache impact.
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Affiliation(s)
- Seniha Ozudogru
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Anastasia Neufeld
- Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Bradley J Katz
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Susan Baggaley
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Karly Pippitt
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Family and Preventive Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Yue Zhang
- Department of Family and Preventive Medicine, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Population Health Sciences, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Veterans Affairs Medical Center, Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Kathleen B Digre
- Department of Neurology, University of Utah Health Sciences Center, Salt Lake City, UT, USA.,Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah Health Sciences Center, Salt Lake City, UT, USA
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Abstract
Migraine has long been associated with disturbances of vision, especially migraine with aura. However, the eye plays an important role in sensory processing as well. We have found that the visual quality of life is reduced in migraine. In this review, we discuss how the migraine and eye pain pathways are similar and affect many of the common complaints which are seen in ophthalmology and neuro-ophthalmology offices, such as dry eye and postoperative eye pain. We also review other related phenomena, including visual snow and photophobia, which also are related to altered sensory processing in migraine.
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14
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Farhangi M, Diel RJ, Buse DC, Huang AM, Levitt RC, Sarantopoulos CD, Felix ER, Galor A. Individuals with migraine have a different dry eye symptom profile than individuals without migraine. Br J Ophthalmol 2019; 104:260-264. [PMID: 31040130 DOI: 10.1136/bjophthalmol-2018-313471] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/28/2019] [Accepted: 04/03/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Many individuals with migraine report symptoms of dry eye (DE). However, it is not known whether DE profiles are similar between individuals with and without migraine. To bridge this gap, we evaluated symptoms and signs of DE, including symptoms suggestive of nerve dysfunction, in a large group of individuals with DE symptoms, and compared profiles between individuals with migraine and those without migraine or headache. METHODS Prospective cross-sectional study of individuals with DE symptoms seen at the Miami VA. RESULTS Of 250 individuals, 31 met International Classification of Headache Disorders criteria for migraine based on a validated screen. Individuals with migraine were significantly younger (57 vs 62 years) and more likely to be female (26% vs 6%) than controls. Individuals with migraine had more severe DE symptoms and ocular pain compared with controls (mean Ocular Surface Disease Index 53.93 ± 21.76 vs 36.30 ± 22.90, p=0.0001; mean Neuropathic Pain Symptom Inventory modified for the Eye 39.39 ± 23.33 vs 21.86 ± 20.17, p=0.0001). The difference in symptom profile occurred despite similar ocular surface parameters between the groups. CONCLUSIONS Individuals with migraine had a different DE symptom yet a similar DE sign profile when compared with controls without migraine. This suggests that DE symptoms in individuals with migraine may be driven by nerve dysfunction as opposed to ocular surface abnormalities.
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Affiliation(s)
- Monika Farhangi
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Ryan J Diel
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Roy C Levitt
- Department of Anesthesiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Elizabeth R Felix
- Physical Medicine & Rehabilitation, University of Miami, Miami, Florida, USA.,Miami Veterans Administration Medical Center, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA .,Miami Veterans Administration Medical Center, Miami, Florida, USA
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15
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Wong M, Dodd MM, Masiowski P, Sharma V. Tear osmolarity and subjective dry eye symptoms in migraine sufferers. Can J Ophthalmol 2017; 52:513-518. [PMID: 28985814 DOI: 10.1016/j.jcjo.2017.02.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/22/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Previous studies have suggested an association between dry eye and migraine. In a busy ophthalmologist clinic, quick identification of dry eye in migraine sufferers may improve their quality of life. Tear osmolarity is an objective and reliable tool for diagnosing dry eye. It has not been investigated in any population with migraine. Using tear osmolarity and questionnaires, we aimed to explore the relationship between dry eye and clinical symptoms in patients with migraine. DESIGN Prospective cross-sectional study. PARTICIPANTS Thirty-four adults with migraine sequentially recruited from a single neurologist's practice. METHODS Patients were assessed for subjective and objective signs of migraine and dry eye by using the Migraine Disability Assessment Score, the Ocular Surface Disease Index, and tear osmolarity (TearLab). Headache characteristics were compared by using χ2, Fisher's exact, and Mann-Whitney U tests. Osmolarity scores were compared with scores for headache features. RESULTS Median age of patients was 38 years, and 76.5% were females. Severe migraine disability was reported in 75.6%, and 34.5% reported moderate to severe dry eye symptoms. Objectively, 49.5% had evidence of dry eye, significantly higher than the 20% recognized in the general population (p < 0.0001). Aura was found to occur more frequently with dry eye (43.8% vs 5.9%; p = 0.02). Those with daily headaches were also more likely to have higher tear osmolarity with marginal significance (median osmolarity 310 mOsm/L vs 299 mOsm/L; p = 0.08). CONCLUSIONS Patients with migraine, especially those with aura, appear more likely to have dry eye, as indicated by tear osmolarity. Tear osmolarity may also be greater in those who suffer from daily headaches.
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Affiliation(s)
- Melody Wong
- College of Medicine, University of Saskatchewan, Saskatoon, Sask
| | | | - Paul Masiowski
- Department of Neurology, University of Saskatchewan, Saskatoon, Sask
| | - Vikas Sharma
- Department of Ophthalmology, Saskatoon City Hospital, Saskatoon, Sask
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16
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The impact of dysfunctional tear films and optical aberrations on chronic migraine. EYE AND VISION 2017; 4:4. [PMID: 28251169 PMCID: PMC5320710 DOI: 10.1186/s40662-017-0070-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 02/09/2017] [Indexed: 11/17/2022]
Abstract
Background Migraine is a multifactorial disorder with complex neuronal and vascular mechanisms that encompasses a wide clinical spectrum of symptoms, including ocular manifestations. Dry eye disease and dysfunction of ocular somatosensory pathways have been implicated in the pathogenesis. The current study investigates the association between a dysfunctional tear film and ocular aberrations with migraine. Methods Sixty eyes of 30 patients with migraine and 60 eyes of 30 controls were studied. Dry eye evaluation included Schirmer’s test, tear film break-up time, corneal esthesiometry and lipid layer analysis using Lipiview® interferometer. Wavefront aberrations were measured using Optical Path Difference before performing the dry eye evaluation. The intraocular light scatter was quantified using the objective scatter index (OSI) of the optical quality analysis system. Measured parameters were compared between the migraine and the control group using independent sample t-test. Statistical analysis was performed using commercial software. A p value of ≤ 0.05 was considered statistically significant. Results There were 19 females and 11 males in each group. Statistically significant difference was found between the two groups with respect to total aberrations (p = 0.049), higher order aberrations (p = 0.009), coma (p = 0.03), spherical aberrations (p = 0.018), Lipiview interferometric coloric units (p < 0.001) and OSI (p < 0.001). Trefoil (p = 0.26) and TBUT (p = 0.398) were not significantly different between both groups. Conclusions Ocular aberrations are higher in patients with migraine as compared with controls. Tear film abnormalities add to the aberrations in otherwise asymptomatic patients and may also be associated with migraineous attacks. Treating the ocular surface to obtain a healthy tear film might introduce a potential modifiable factor in the prevention of migraneous attacks.
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17
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Yang S, Kim W, Kim HS, Na KS. Association Between Migraine and Dry Eye Disease: A Nationwide Population-Based Study. Curr Eye Res 2017; 42:837-841. [PMID: 28129001 DOI: 10.1080/02713683.2016.1262876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE Despite the possible association between migraine and dry eye disease (DED), there are only a few studies investigating this link in a relatively limited number of patients. Therefore, we have analyzed the relationship between migraine and DED in the Korean population. MATERIALS AND METHODS This population-based cross-sectional study included 14 329 adults participating in the fifth annual Korea National Health and Nutrition Examination Survey from 2010 to 2012. Migraine, DED diagnosis, and DED symptoms were assessed using questionnaires and surveys. Data were analyzed using logistic regression to determine the association of migraine with DED while controlling for demographic, lifestyle, and medical factors. RESULTS Individuals with migraine were more likely to report a DED diagnosis (14.4% vs. 8.2%, p < 0.0001) and DED symptoms (22.0% vs. 15.1%, p < 0.0001). In a multivariate analysis, the association between migraine and DED diagnosis was significant after adjustments (OR, 1.577; 95% CI, 1.340-1.855). The association between migraine and DED symptoms showed a similar pattern (OR, 1.304; 95%CI, 1.151-1.502). CONCLUSIONS Although a causal relationship was not revealed, we found that patients who had a lifetime history of migraine were more likely to suffer from DED than individuals who did not present with headaches; this association may require confirmation. Large prospective cohort studies are required to evaluate the association between migraine and DED, as well as the influence of DED treatment on the frequency and severity of migraine attacks.
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Affiliation(s)
- Soonwon Yang
- a Department of Ophthalmology , Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Korea
| | - Woojun Kim
- b Department of Neurology , Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine , Seoul , Korea
| | - Hyun Seung Kim
- a Department of Ophthalmology , Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Korea
| | - Kyung-Sun Na
- a Department of Ophthalmology , Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Korea
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18
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Koban Y, Ozlece HK, Bilgin G, Koc M, Cagatay HH, Durgunlu EI, Burcu A. Intraocular pressure and ocular biometric parameters changes in migraine. BMC Ophthalmol 2016; 16:70. [PMID: 27245325 PMCID: PMC4886420 DOI: 10.1186/s12886-016-0258-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/27/2016] [Indexed: 01/03/2023] Open
Abstract
Background The aim of this study was to assess the intraocular pressure and ocular biometric parameters in migraine patients during acute migraine attacks and compare them with painless period and healthy controls using a new optical biometer AL-Scan. Methods In this prospective, case–control study, the axial length, corneal curvature radius, anterior chamber depth, central corneal thickness, and pupil size of 40 migraine patients during acute migraine attacks and painless period and 40 age- and sex-matched healthy subjects were measured using a AL-Scan optical biometer (Nidek Co., Gamagori, Japan). All patients underwent a complete ophthalmic examination before the measurements. IOP and biometer measurements were taken at the same time of day (10:00–12:00) in order to minimize the effects of diurnal variation. Results There was not a statistically significant difference in intraocular pressure between the migraine patients during acute migraine attacks (15.07 mmHg), painless period (14.10 mmHg), and the controls (15,73 ± 0,81). Also, the ocular biometric parameters did not significantly vary during the acute migraine attacks. Conclusions Further studies are needed to evaluate the etiopathologic relationship between intraocular pressure and ocular biometric parameters and acute migraine attack.
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Affiliation(s)
- Yaran Koban
- Department of Ophthalmology, Faculty of Medicine, University of Kafkas, Kars, Turkey. .,Kafkas University Medical School, Merkez, 36100, Kars, Turkey.
| | | | - Gorkem Bilgin
- Department of Ophthalmology, Hacettepe University Beytepe Health Center, Ankara, Turkey
| | - Mustafa Koc
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Halil Huseyin Cagatay
- Department of Ophthalmology, Faculty of Medicine, University of Kafkas, Kars, Turkey
| | - Emre I Durgunlu
- Department of Ophthalmology, Faculty of Medicine, University of Kafkas, Kars, Turkey
| | - Ayse Burcu
- Department of Ophthalmology, Faculty of Medicine, University of Kafkas, Kars, Turkey
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Sarac O, Kosekahya P, Yildiz Tasci Y, Keklikoglu HD, Deniz O, Erten Ş, Çağıl N. The Prevalence of Dry Eye and Sjögren Syndrome in Patients with Migraine. Ocul Immunol Inflamm 2016; 25:370-375. [PMID: 26910594 DOI: 10.3109/09273948.2015.1132739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the presence of dry eye and primary Sjögren syndrome (SS) in patients with migraine. METHODS In total, 46 eyes of 46 patients with migraine (group 1) and 50 eyes of 50 healthy subjects (group 2) were included in this study. Detailed ophthalmologic, neurologic and rheumatologic examination were performed on all participants. Ocular surface disease index questionnaire, tear function tests, visual analog scale for pain, serologic analysis were also performed. RESULTS Dry eye symptoms and findings were significantly higher and more severe in group 1 when compared with group 2. Primary SS was not found in any of the participants. The migraine lifetime duration was negatively correlated with the tear function tests while it was positively correlated with the ocular surface disease index scores. CONCLUSIONS Dry eye symptoms and findings are higher in migraine patients when compared with the healthy subjects without the presence of Sjögren syndrome.
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Affiliation(s)
- Ozge Sarac
- a Department of Ophthalmology , Yildirim Beyazit University Atatürk Research and Training Hospital , Ankara , Turkey
| | - Pinar Kosekahya
- b Department of Ophthalmology , Ulucanlar Eye Research and Training Hospital , Ankara , Turkey
| | - Yelda Yildiz Tasci
- c Department of Ophthalmology , Special Maya Eye Clinic , Ankara , Turkey
| | - Hava D Keklikoglu
- d Department of Neurology , Yildirim Beyazit University Atatürk Research and Training Hospital , Ankara , Turkey
| | - Orhan Deniz
- d Department of Neurology , Yildirim Beyazit University Atatürk Research and Training Hospital , Ankara , Turkey
| | - Şükran Erten
- e Department of Rheumatology , Yildirim Beyazit University Atatürk Research and Training Hospital , Ankara , Turkey
| | - Nurullah Çağıl
- a Department of Ophthalmology , Yildirim Beyazit University Atatürk Research and Training Hospital , Ankara , Turkey
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