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Lee G. Evidence-Based Strategies for Warm Compress Therapy in Meibomian Gland Dysfunction. Ophthalmol Ther 2024; 13:2481-2493. [PMID: 38990464 PMCID: PMC11341798 DOI: 10.1007/s40123-024-00988-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/19/2024] [Indexed: 07/12/2024] Open
Abstract
AIM Despite promising results from technological therapies like intense pulsed light application, warm compress therapy is a mainstay in meibomian gland dysfunction (MGD). However, applying warm compresses (WC) to the eyelids is palliative rather than curative and not always dispensed with specific instructions. The range of eyelid warming treatments available and lack of clear directives for use creates uncertainty for patients accustomed to explicit dosage information. This report examines data from clinical studies across the past 20 years to identify effective protocols for three types of WC-hot towel, microwavable eye mask, and self-heating eye mask (EM). METHOD Literature search for studies on WC and MGD published between 2004 and 2023 in English was conducted. Studies wherein hot towel, microwavable EM, and self-heating EM were used in a treatment arm were included and those wherein they served only as control or were used in conjunction with another intervention were excluded. 20 resulting studies were separated into 3 groups: 5 on temperature profiles of WC, 6 with single application of WC, and 9 with repeated applications. Study methods and outcomes were tabulated, and a qualitative review was performed, attending to WC protocol and efficacy, as indicated by measures of tear film, meibomian gland health, and dry eye questionnaires. RESULTS Data from the aforementioned studies revealed that each method can achieve target eyelid temperature of 40 °C. A single application of WC-ranging from 5 to 20 min-can significantly improve tear quality, while repeated applications significantly relieve symptoms associated with dry eyes from MGD and, in most studies, significantly improve meibomian gland health. Hot towels, however, require frequent reheating to maintain eyelid temperatures above 40 °C, rendering them relatively ineffective in longitudinal studies. Microwavable EM retain heat well across 10 min and were found to improve tear break-up time and/or meibomian gland score. Self-heating EM have variable activation times and were typically applied for longer periods, showing benefits akin to microwavable EM in short-term studies. Studies monitoring compliance indicate greater deviation from protocol with higher application frequencies or longer-term use. Evidence suggests superior heat retention and therapeutic effects on specific contributing factors in MGD (such as Demodex) with moist-heat compress. CONCLUSION Considering decreased patience adherence to therapy with increased usage frequencies, and balancing needs to provide succinct instructions for various compress types, an advisable strategy is for patients to apply a moist-heat generating EM (microwavable or self-heating) to each eye for at least 10 min, prepared according to manufacturer's instructions.
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Affiliation(s)
- Gladys Lee
- Division of Ophthalmology, Brown University, Providence, RI, USA.
- Private Practice, New York, NY, USA.
- , New York, USA.
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Wang DH, Guo H, Xu W, Liu XQ. Efficacy and safety of the disposable eyelid warming masks in the treatment of dry eye disease due to Meibomian gland dysfunction. BMC Ophthalmol 2024; 24:376. [PMID: 39187788 PMCID: PMC11348766 DOI: 10.1186/s12886-024-03642-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 08/16/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Warm compresses are the routine treatment for Meibomian gland dysfunction (MGD) in daily life, but in order to achieve satisfactory efficacy, the treatment needs to be sustained over a long time, which can have an impact on the patient compliance. A more convenient warm compresses will help improve the patient compliance. Therefore, the purpose of the study is to investigate the efficacy and safety of the disposable eyelid warming masks for treatment of dry eye disease (DED) due to MGD. METHODS This was a randomized, controlled, non-masked, two-center clinical trial. One hundred and forty-four patients were treated by the masks or the hot towel twice daily for 12 weeks. Patients were evaluated at baseline, 4-week and 12-week visits for subjective symptoms, objective signs and safety assessments, including ocular symptom scores, ocular surface disease index (OSDI), tear break-up time (BUT), corneal fluorescein staining (CFS), Schirmer I test (SIT), meibum quality, meibum expressibility, and adverse events (AEs). RESULTS A totle of 134 patients were followed in the study. The mean age of the masks group (14 males and 52 females) and the hot towel group (20 males and 48 females) was 43.7 ± 13.5 years and 39.5 ± 13.9 years, respectively. At 4-week visit, there were significant statistical differences in ocular symptom scores, OSDI and CFS between two groups (P < 0.05). Except for SIT, the treatment group showed a greater improvement in subjective symptoms and objective signs than the control group at 12-week visit. (P < 0.05). In addition, 40 AEs occurred in 27 patients (37.5%) in the treatment group, and 34 AEs occurred in 21 patients (29.17%) in the control group. No serious AEs were reported. CONCLUSIONS The masks had a good efficacy and safety in the treatment of DED due to MGD, and might offer an attractive treatment option for some patients. TRIAL REGISTRATION The study was registered at Chinese Clinical Trial Registry (ChiCTR1900025443) on August 26, 2019.
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Affiliation(s)
- Da-Hu Wang
- Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China
| | - Hua Guo
- Department of Ophthalmology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Xu
- Department of Ophthalmology, Tongji Hospital of Tongji University, Shanghai, China.
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai, China.
| | - Xin-Quan Liu
- Department of Ophthalmology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.725 South Wanping Road, Xuhui District, Shanghai, 200032, China.
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Xu L, Wu Y, Song Y, Zhang Q, Qin G, Yang L, Ma J, Palme C, Moore JE, Pazo EE, He W. Comparison Between Heated Eye Mask and Intense Pulsed Light Treatment for Contact Lens-Related Dry Eye. Photobiomodul Photomed Laser Surg 2022; 40:189-197. [PMID: 35298282 DOI: 10.1089/photob.2021.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Contact lens-related dry eye (CLDE) is common in contact lens (CL) wearers and can lead to ocular pain, decreased visual quality, and reduced quality of life. Objective: The purpose of this prospective, randomized, examiner masked study was to compare the effectiveness of intense pulsed light (IPL) and heated eye mask (HEM) for relieving CLDE. Methods: The final analysis included 60 patients (30 in the IPL group and 30 in the HEM group) who were using CL and had been suffering contact lens discomfort for more than a year. The IPL treatment group had two IPL treatments spaced 3 weeks apart, whereas the HEM group received HEM daily for 6 weeks (42 days). Non-invasive tear break-up time (NITBUT), tear-film lipid layer (TFLL), conjunctival fluorescein staining, meibum gland quality and expression, conjunctival redness score, ocular surface disease index (OSDI), best-corrected visual acuity, endothelial cell count, and intraocular pressure were assessed at baseline: first visit (V1), second visit (V2), and third visit (V3). Results: The mean age of the IPL group was 28.6 ± 4.3 years (16 females, 53%) and that of the HEM group was 28.6 ± 4.2 years (16 females, 53%). Mean NITBUT for the IPL group at V2 was 5.53 ± 0.77 sec (p < 0.001) and at V3 was 7.72 ± 0.88 sec (p < 0.001); the IPL group demonstrated a clinically and statistically significant improvement in mean NITBUT. In addition, the HEM group showed a clinically and statistically significant improvement in mean NITBUT at V3 (5.86 ± 0.76 sec, p < 0.001). At V3, the C-OSDI, TFLL score, and meibum gland quality and expressibility all increased considerably (p < 0.05) in both groups. Conclusions: Our results imply that IPL or HEM treatment of CLDE can be safely used to relieve symptoms of CLDE. In addition, IPL treatment is more effective in improving the general stability of the tear-film and decreasing the need for artificial tears in CLDE.
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Affiliation(s)
- Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yi Wu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yilin Song
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing Zhang
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanting Yang
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinfei Ma
- Breast Cancer, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Christoph Palme
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Jonathan E Moore
- Cathedral Eye Clinic, Belfast, United Kingdom.,Aston University, Birmingham, United Kingdom
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
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Yu H, Zeng W, Zhao G, Hong J, Feng Y. Response of tear cytokines following intense pulsed light combined with meibomian gland expression for treating meibomian gland dysfunction-related dry eye. Front Endocrinol (Lausanne) 2022; 13:973962. [PMID: 36187125 PMCID: PMC9520485 DOI: 10.3389/fendo.2022.973962] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study compared the changes in tear inflammatory cytokine levels after intense pulsed light (IPL) combined with meibomian gland expression (MGX) (IPL group) and instant warm compresses combined with MGX (physiotherapy group) as treatments for meibomian gland dysfunction (MGD)-related dry eye disease (DED) to explore their similarities and differences in therapeutic mechanisms. METHODS This study was a post-hoc analysis of a randomized controlled trial. Thirteen patients with MGD-related DED were enrolled in each group and received three treatments correspondingly with 3-week intervals. The levels of 20 tear cytokines, namely, TNF-α, IL-6, MMP-9, CXCL8/IL-8, CXCL10/IP-10, IL-10, EGF, IL-6R, IL-1β, IFN-γ, lactoferrin, Fas ligand, IL-17A, LT-α, S100A9, LCN2/NGAL, IL-13, IL-12/IL-23p40, Fas, and CCL11/Eotaxin, were measured at baseline, before the second and third treatments, and 3 weeks after the third treatment. The primary outcome was the difference in cytokine levels between baseline and the last measurement, and the trends were analyzed at each measurement point. RESULTS At the last measurement, a significant decrease was observed in all tear cytokines for both IPL and physiotherapy groups compared with baseline. The IPL group showed greater reductions in IL-6, IL-6R, IL-1β, IL-13, and CCL11/Eotaxin than the physiotherapy group. TNF-α, CXCL8/IL-8, CXCL10/IP-10, IL-10, EGF, IL-1β, IFN-γ, and Lipocalin-2/NGAL levels continued to decrease with treatment time. Important interactions were found in the changes of IL-6 and IL-13 levels, where the levels first decreased and then slightly increased in the physiotherapy group after treatment, while they continued to decrease in the IPL group. CONCLUSIONS The mechanisms of IPL and physiotherapy in treating MGD-related DED were both associated with reducing inflammation, and the superiority of IPL could be attributed to its better inhibitory effect on inflammatory cytokines like IL-6. In addition, several cytokines were on a downward trend during treatment, suggesting that the vicious cycle of DED was suppressed.
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Affiliation(s)
| | | | | | - Jing Hong
- *Correspondence: Jing Hong, ; Yun Feng,
| | - Yun Feng
- *Correspondence: Jing Hong, ; Yun Feng,
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García-Marqués JV, Talens-Estarelles C, Martínez-Albert N, García-Lázaro S, Cerviño A. Evaluation of the MGDRx eyebag treatment in young and older subjects with dry eye symptoms. J Fr Ophtalmol 2021; 45:20-27. [PMID: 34840000 DOI: 10.1016/j.jfo.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/20/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study aims to evaluate the relationship between application of the MGDRx thermal eyebag and dry eye signs and symptoms in young and older subjects and to compare the results between the two groups. METHODS Thirty young, healthily volunteers between 18 and 31 years of age (23.95±3.94 years) and thirty older subjects between 61 and 90 years of age (77.97±8.11 years) participated in this study. Ocular surface parameters were assessed using the Oculus Keratograph 5M, following the guidelines of the Tear Film and Ocular Surface Dry Eye Workshop II Diagnostic Methodology report. Only subjects with a positive score on at least one questionnaire and an initial Non-Invasive Keratograph Break-Up Time (NIKBUT) under 10seconds were included in the study. After thermal bag self-application in both eyes every day for 2 weeks, the protocol was carried out again. Lid massage was performed after lid warming. Compliance and degree of improvement were also assessed. MAIN RESULTS The young volunteer group showed an improvement in NIKBUT, lipid layer score, upper eyelid gland drop-out percentage and dry eye symptoms over the two week treatment period. Improvements in meibum quality, gland obstruction, telangiectasia scores, and dry eye symptoms were found in the older subjects. Mixed ANOVA revealed better NIKBUT and lipid layer values in the young subjects. Despite the treatment compliance being statistically higher in the older group than in the younger subjects (P=0.002), there were no significant differences in subjective improvement between groups (P=0.097). CONCLUSION Dry eye-related symptoms were improved after thermal bag application, while NIKBUT and lipid layer thickness were improved only in the younger subjects.
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Affiliation(s)
- J V García-Marqués
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain
| | - C Talens-Estarelles
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain
| | - N Martínez-Albert
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain
| | - S García-Lázaro
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain
| | - A Cerviño
- Optometry Research Group (GIO). Department of Optics and Optometry and Vision Sciences, University of Valencia, Burjassot, Valencia, Spain.
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Jeon J, Park S. Comparison of the efficacy of eyelid warming masks and artificial tears for dry eye symptoms in contact lens wearers. Cont Lens Anterior Eye 2021; 44:30-34. [DOI: 10.1016/j.clae.2020.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 02/25/2020] [Indexed: 12/01/2022]
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Craig JP, Wang MT, Ambler A, Cheyne K, Wilson GA. Characterising the ocular surface and tear film in a population-based birth cohort of 45-year old New Zealand men and women. Ocul Surf 2020; 18:808-813. [DOI: 10.1016/j.jtos.2020.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/26/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
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Therapeutic Instruments Targeting Meibomian Gland Dysfunction. Ophthalmol Ther 2020; 9:797-807. [PMID: 32968960 PMCID: PMC7708534 DOI: 10.1007/s40123-020-00304-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/11/2020] [Indexed: 01/14/2023] Open
Abstract
The most prevalent type of meibomian gland dysfunction (MGD), which is obstructive, is the main cause of evaporative dry eye and is characterized by changes in the meibum composition and duct obstruction. Eyelid hygiene has usually been the most common clinical approach. However, alternative therapies for MGD are emerging on the market. Some warming and humidity devices have led to an improvement in the signs and symptoms in MGD patients. Likewise, eyelid massaging and cleaning devices are also beneficial for ocular signs and symptoms; however, patients usually need more than one session to maintain the therapeutic effect. Thermal pulsation has been reported to be more efficient than other strategies, and the effects can last up to 12 months. Moreover, intense pulsed light therapy has been demonstrated to improve ocular signs and symptoms alone and in combination with other therapies. Proper counseling of clinicians considering MGD status and patient compliance will help patients to undergo the adequate technique that best suits their condition.
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Correlation between Blood Flow and Temperature of the Ocular Anterior Segment in Normal Subjects. Diagnostics (Basel) 2020; 10:diagnostics10090695. [PMID: 32942653 PMCID: PMC7554717 DOI: 10.3390/diagnostics10090695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose: To determine a correlation between temperature and blood flow in the ocular anterior segment, and their effects on corneal temperature. Methods: In experiment 1, we recruited 40 eyes and measured the temperature and blood flow in the ocular anterior-segment (upper/lower eyelid skin, palpebral and bulbar conjunctiva, and cornea) before and after application of warm compresses. In experiment 2, we recruited 20 eyes and measured the same tissues before and during stimulation using water and capsaicin solution in the oral cavity. Results: In experiment 1, the temperatures of the upper/lower eyelid skin and cornea increased significantly until 15 min after the application of the warm compress; the temperatures of the palpebral and bulbar conjunctiva increased significantly until 10 min. The blood flow in the upper/lower eyelid skin and bulbar conjunctiva increased significantly until 10 min, and that of the palpebral conjunctiva increased significantly until 15 min. In experiment 2, the temperatures were correlated significantly with the blood flow in the upper and lower eyelid skin and palpebral and bulbar conjunctiva. The temperature of all locations and palpebral conjunctival blood flow contributed independently to the corneal temperature. Conclusions: In the ocular anterior segment, the temperature and blood flow were correlated significantly, and contributed to the corneal temperature.
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Wang MTM, Muntz A, Lim J, Kim JS, Lacerda L, Arora A, Craig JP. Ageing and the natural history of dry eye disease: A prospective registry-based cross-sectional study. Ocul Surf 2020; 18:736-741. [PMID: 32758530 DOI: 10.1016/j.jtos.2020.07.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate the impact of ageing on ocular surface parameters, and empirically determine optimal prognostic cut-off ages for clinical markers of dry eye disease, aqueous tear deficiency, and meibomian gland dysfunction. METHODS A total of 1331 community residents (785 females, 546 males; mean ± SD age, 38 ± 19 years) were recruited in a prospective registry-based cross-sectional study. Dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session, in accordance with the global consensus recommendations of the TFOS DEWS II reports. RESULTS Multivariate regression analysis demonstrated positive associations between ageing and clinical markers of dry eye disease (all p ≤ 0.001). The Youden-optimal prognostic cut-off ages for signs of meibomian gland dysfunction occurred during the third decade of life (24-29 years); the optimal predictive ages for lid wiper epitheliopathy, tear film instability, hyperosmolarity, and dry eye symptoms occurred during the fourth decade of life (31-38 years); while the optimal prognostic thresholds for signs of aqueous tear deficiency and ocular surface staining occurred in the fifth and sixth decades of life (46-52 years). CONCLUSIONS Advancing age is a significant risk factor for dry eye disease, which represents a growing public health concern with the ageing population worldwide. Signs of meibomian gland dysfunction appeared earlier in the natural history of disease progression, and the brief delay prior to the development of other clinical dry eye signs might represent a window of opportunity for preventative interventions in the young adult age group.
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Affiliation(s)
- Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Alex Muntz
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Joevy Lim
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Ji Soo Kim
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Lucas Lacerda
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; Catholic University of Brasilia, Brazil
| | - Aditya Arora
- 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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12
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Travé-Huarte S, Wolffsohn JS. Efficacy of a novel water propelled, heating eye mask massager on tear film and ocular adnexa. Cont Lens Anterior Eye 2020; 44:101344. [PMID: 32620345 DOI: 10.1016/j.clae.2020.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To determine the effectiveness of the Aurai water propelled, heating Eye Massager (AEM) in managing dry eye disease and its effects on the ocular adnexa. METHODS This prospective, randomised cross-over study enrolled 15 participants (aged 25.8 ± 5.45 years, 5 male). Participants wore a smart watch 24 h a day to track their sleeping cycle and heart rate for 4 weeks, using the AEM twice a day for 2 of those weeks. A cycle of 6 min of a controlled heat and vibration pattern in the morning and another cycle in the evening were applied with the AEM. Primary outcomes of symptomatology (Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE)), tear film and ocular surface homeostasis markers (osmolarity, non-invasive breakup time (NIKBUT), tear meniscus height (TMH), lipid layer thickness and ocular staining) and safety measures (ocular redness and intraocular pressure), were assessed at baseline, after 2 weeks of AEM use and after 2 weeks of no treatment (in random-sequence). Sleeping tracking (ST) and heart rate/blood oxygen detection over these periods was also assessed. RESULTS There was a significant change in OSDI score from 34.3 ± 19.5 at baseline to 18.8 ± 17.5 after treatment (p = 0.001) and also for the SANDE (5.7 ± 2.4 vs 3.7 ± 2.1; p = 0.001). Heart rate was not affected by treatment (p = 0.956), nor sleep pattern (p = 0.529), but this varied by day (p = 0.001). Tear film and ocular surface homeostasis, the ocular adnexia and safety measures were not affected by treatment (p > 0.05). CONCLUSION The Aurai water propelled Eye Massager may reduce the severity of symptoms of dry eye, but there were no detectable effects on tear stability and ocular surface disease from two weeks use.
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13
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Efficacy of wheat hot pack (dry heat) and pottery hot pack (moist heat) on eyelid temperature and tissue blood flow in healthy eyes: a randomized control trial. Int Ophthalmol 2020; 40:1347-1357. [PMID: 32060679 DOI: 10.1007/s10792-020-01300-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/05/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate the eyelid temperature (Temp) and tissue blood flow (TBF) changes in healthy eyes using wheat hot pack (WHP) and pottery hot pack (PHP). METHODS A randomized, double-blind, within-subject crossover study design was conducted in a Thai tertiary care center. All healthy subjects received warm compress treatment with WHP and PHP. The subjects were randomized to receive the WHP or the PHP at the first sequence. Temp and TBF measurements were taken at baseline, and every 2 min during the 10-min application of the heated compresses, and every 2 min for a 10-min duration after the compresses were removed. RESULTS There were 29 females (96.7%) and 1 male. The mean (SD) age of the subjects was 33.17 (5.21) years. Two warm compresses were able to increase the surface lid Temp significantly from the baseline Temp at every time point of measurement and location. For the WHP application, the maximum surface Temp (SD) of the outer upper lid, outer lower lid, and inner lower lid were 40.07 (0.80) °C, 38.44 (0.91) °C, and 35.83 (0.71) °C, respectively (all P value < 0.001) and under the PHP application, the highest surface Temp (SD) were 40.63 (0.97) °C, 38.32 (1.27) °C, and 35.82 (0.71) °C, respectively (all P value < 0.001). Both WHP and PHP were able to increase TBF significantly with no adverse events and these effects can be sustained until 20 min. CONCLUSIONS The results of this study suggest the potential of using these warm compresses for meibomian gland dysfunction. Further clinical research is needed.
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Arita R, Fukuoka S. Non-pharmaceutical treatment options for meibomian gland dysfunction. Clin Exp Optom 2020; 103:742-755. [PMID: 31943385 PMCID: PMC7687252 DOI: 10.1111/cxo.13035] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/14/2019] [Accepted: 11/19/2019] [Indexed: 12/12/2022] Open
Abstract
This review examines currently available non‐pharmaceutical treatment modalities for meibomian gland dysfunction. A detailed search of the PubMed and MEDLINE databases was performed to identify original articles in English that have evaluated such nonpharmaceutical therapies in patients with this condition. Conventional therapies such as application of a warming compress, the practice of lid hygiene, and manual expression of meibomian glands as well as more technologically advanced approaches such as intraductal probing, thermal pulsation, and intense pulsed light therapy are included in the review. These non‐pharmaceutical treatment options may each have a role to play in the management of meibomian gland dysfunction, but more studies are necessary to compare treatments directly under identical experimental conditions in order to determine their relative efficacy. Additional large‐scale, randomised, controlled trials are also required to provide more information such as the specific indications best suited to each treatment modality, the efficacy of such approaches in combination with pharmaceutical‐based therapy, and the mechanisms of action of some of the more technologically advanced systems.
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Affiliation(s)
- Reiko Arita
- Itoh Clinic, Saitama, Japan.,Lid and Meibomian Gland Working Group, Tokyo, Japan
| | - Shima Fukuoka
- Lid and Meibomian Gland Working Group, Tokyo, Japan.,Omiya Hamada Eye Clinic, Saitama, Japan
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15
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Effect of virtual reality headset wear on the tear film: A randomised crossover study. Cont Lens Anterior Eye 2019; 42:640-645. [DOI: 10.1016/j.clae.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/29/2019] [Accepted: 08/14/2019] [Indexed: 12/30/2022]
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Wang MTM, Liu LJ, McPherson RD, Fuller JR, Craig JP. Therapeutic profile of a latent heat eyelid warming device with temperature setting variation. Cont Lens Anterior Eye 2019; 43:173-177. [PMID: 31578176 DOI: 10.1016/j.clae.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/08/2019] [Accepted: 09/13/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the effects on ocular temperature and tear film parameters following a single application of a latent heat eyelid warming device at a range of temperature settings. METHODS Fifteen subjects were enrolled in a prospective, investigator-masked, randomised, cross-over trial. On separate days, participants were randomised to 10-minute application of a research latent heat device (Laboratoires Théa) at device temperature settings of 45 °C, 50 °C and 55 °C. Outer eyelid and corneal temperatures, tear film lipid layer grade, and non-invasive tear film breakup time (NIBUT) were measured at baseline and immediately after 10 min of device application. RESULTS Baseline measurements did not differ between treatment groups (all p > 0.05). Ocular temperatures, lipid layer grade and non-invasive tear film stability rose significantly following device application in all treatment groups (all p < 0.05). The 55 °C setting effected a mean ocular surface temperature rise in the order of +4 °C from baseline, which was 1.46 and 1.26 times greater than at the 45 °C and 50 °C temperature settings, respectively (all p < 0.05). Similarly, improvements in mean non-invasive tear film stability from baseline in the order of +7 s were observed, which were 2.43 and 1.66 times greater than those at the lower temperature settings of 45 °C and 50 °C, respectively (all p < 0.05). CONCLUSIONS At all temperature settings, the latent heat device resulted in clinically and statistically significant increases in ocular temperature, lipid layer grade, and non-invasive tear film stability. However, the 55 °C setting proved to be most effective at raising ocular temperature (in the order of +4 °C from baseline) and improving tear film stability.
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Affiliation(s)
- Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Lucy J Liu
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; Neurodevelopmental Genomics Research Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Robert D McPherson
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | | | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand.
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Wang MTM, Feng J, Wong J, Turnbull PR, Craig JP. Randomised trial of the clinical utility of an eyelid massage device for the management of meibomian gland dysfunction. Cont Lens Anterior Eye 2019; 42:620-624. [PMID: 31358441 DOI: 10.1016/j.clae.2019.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 05/23/2019] [Accepted: 07/18/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE To compare the single application and two week treatment effects of device-applied (Eyepeace) and manually-applied eyelid massage techniques, as an adjunct to warm compress therapy, on ocular surface and tear film parameters. METHODS Twenty participants (11 females, 9 males; mean age, 27 ± 11 years) with dry eye symptoms were recruited in a two week, investigator-masked, randomised, contralateral-eye trial. Following 10 min of warm compress therapy application (MGDRx EyeBag®) on both eyes, eyelid massage therapy was applied to one eye (randomised) by device, and to the fellow eye by manual eyelid massage, once daily for 14 days. Ocular surface and tear film measurements were conducted at baseline, and 15 min post-application by a clinician, then again after 14 days of self-administered daily treatment at home. RESULTS Baseline clinical measurements did not differ between the treatment groups (all p > 0.05). Following two weeks of treatment, tear film lipid layer grade improved significantly with device massage (p = 0.008), and was marginally greater than manual massage by less than 1 grade (p = 0.03). Although immediate post-treatment improvements in tear film stability were observed in both groups (both p < 0.05), no significant long-term cumulative effects or inter-treatment differences in stability measures were detected (all p > 0.05). Visual acuity, tear meniscus height, conjunctival hyperaemia, ocular surface staining, and meibomian gland dropout did not change during the treatment period (all p > 0.05). CONCLUSIONS Two weeks of treatment with the eyelid massage device, as an adjunct to warm compress therapy, effected marginally greater improvements in tear film lipid layer thickness than the conventional manual technique, which were statistically but not clinically significant. Future parallel group trials with longer treatment periods and a greater range of disease severity are required.
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Affiliation(s)
- Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Jasmine Feng
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Joyce Wong
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Philip R Turnbull
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand.
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Natural history of dry eye disease: Perspectives from inter-ethnic comparison studies. Ocul Surf 2019; 17:424-433. [DOI: 10.1016/j.jtos.2019.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
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Efficacy of Vectored Thermal Pulsation and Warm Compress Treatments in Meibomian Gland Dysfunction: A Meta-Analysis of Randomized Controlled Trials. Cornea 2019; 38:690-697. [PMID: 30844843 DOI: 10.1097/ico.0000000000001907] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE Meibomian gland dysfunction is the main cause of dry eye disease (DED) and is traditionally managed using warm compress treatment (WCT). Vectored thermal pulsation treatment (VTPT) is a novel method for treating DED. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials that compared the efficacy of VTPT and WCT in treating DED. The primary outcome was the gland function. The secondary outcomes were the tear breakup time, Schirmer test, tear osmolarity, lipid layer thickness, Standard Patient Evaluation for Eye Dryness, and the improvement of subjective symptoms as assessed by using the Ocular Surface Disease Index. PubMed, Embase, Cochrane Library, and ClinicalTrials.gov registries were searched for studies published before July 2018. RESULTS This study consisted of 4 trials with 385 patients. Significantly greater improvement was observed in meibomian gland function [mean difference (MD): 2.19 (95% confidence interval (CI), 0.95, 3.43)], tear breakup time [MD: 1.08 (95% CI, 0.06, 2.10)], and Standard Patient Evaluation for Eye Dryness [MD: -2.76 (95% CI, -4.22, -1.30)] at 2 to 4 weeks in the VTPT group than in the WCT group. A significantly greater decrease in Ocular Surface Disease Index was observed at 2 to 4 weeks [MD: -8.61 (95% CI, -13.62, -3.61)] and 3 months [MD: -6.92 (95% CI, -11.95, -1.89)] in the VTPT group than in the WCT group. CONCLUSIONS A single 12-minute VTPT was more efficacious than traditional WCT in treating DED either in objective or subjective measurements. We recommended choosing an appropriate treatment after shared decision-making.
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Borchman D. The optimum temperature for the heat therapy for meibomian gland dysfunction. Ocul Surf 2019; 17:360-364. [PMID: 30794947 PMCID: PMC6529265 DOI: 10.1016/j.jtos.2019.02.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/06/2019] [Accepted: 02/15/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Numerous devices have been developed to warm the eyelid as a therapy for Meibomian gland dysfunction. The optimum temperature for such therapy was determined. METHODS Meibum lipid disorder versus temperature was calculated from previously published phase transition parameters measured using infrared spectroscopy. Phase transitions parameters were calculated from meibum obtained from donors with Meibomian gland dysfunction (MMGD), donors who were susceptible to dry eye after hematopoietic stem cell transplantations (MHSCT) and meibum from donors without dry eye (Mn). RESULTS Heating Mn to 40 °C increases the lipid disorder by 20.4%-90%. Heating the meibum another 4° increases the disorder to 95%. MMGD is 73.2% disordered with no heating. Heating MMGD to 41.5 °C increases the disorder by 26.8%-90% disordered. Heating MMGD another 5.1 °C increases the disorder to 95%. As MHSCT is much more ordered, 56.9% disordered compared with Mn and MMGD, a higher temperature above safety limits, 52 and 59 °C is need to disorder MHSCT to 90 and 95% disorder. CONCLUSIONS Heating the eye lid above the phase transition temperature of meibum increases the disorder of meibum lipid which could ameliorate dry eye symptoms. The optimum temperature for disordering Mn and MMGD to 90% maximum disorder is 40 and 41.5 °C, respectively. Safety issues and discomfort should be considered in obtaining an optimal level of disorder, especially for severe cases of dry eye.
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Affiliation(s)
- Douglas Borchman
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, 40202, USA.
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21
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Craig JP, Lim J, Han A, Tien L, Xue AL, Wang MTM. Ethnic differences between the Asian and Caucasian ocular surface: A co-located adult migrant population cohort study. Ocul Surf 2018; 17:83-88. [PMID: 30253249 DOI: 10.1016/j.jtos.2018.09.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 09/16/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate the ethnic differences in tear film quality, ocular surface parameters, and dry eye symptomology between co-located Asian and Caucasian populations. METHODS Two hundred and six participants (103 East Asian and 103 Caucasian) were recruited in an age and gender-matched cross-sectional study. Dry eye symptomology, ocular surface parameters, and tear film quality were evaluated for each participant within a single clinical session. RESULTS The mean ± SD age of the 206 participants (82 male, 124 female) was 45 ± 16 years. Overall, a greater proportion of Asian participants were symptomatic of dry eye and fulfilled the TFOS DEWS II dry eye diagnostic criteria than Caucasian participants (74% versus 51%, p = 0.002), with an odds ratio (95% CI) of 2.7 (1.5-4.8) times. Poorer OSDI scores, tear film stability, lipid layer quality, tear osmolarity, lid wiper epitheliopathy, meibomian gland dropout, and expressed meibum quality were observed in the Asian group (all p < 0.05). A significantly higher proportion of participants exhibited incomplete blinking in the Asian group than the Caucasian group (81% versus 45%, p < 0.001). CONCLUSIONS Asian participants exhibited more severe dry eye signs and symptoms than Caucasian participants. The poorer meibomian gland function and higher degree of incomplete blinking observed among Asian participants may potentially contribute towards the ethnic predisposition towards dry eye development.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand.
| | - Joevy Lim
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Alicia Han
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Leslie Tien
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Ally L Xue
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
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Nassiri N, Zhou XY, Rodriguez Torres Y, Meyer Z, Beyer MA, Mehregan CA, Vellaichamy G, Chungfat N, Hwang FS. Current and emerging therapy of dry eye disease. Part B: non-pharmacological modalities. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1344552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nariman Nassiri
- Department of Ophthalmology, School of Medicine, Wayne State University, Kresge Eye Institute, Detroit, MI, USA
| | - Xiao Yi Zhou
- Department of Ophthalmology, School of Medicine, Wayne State University, Kresge Eye Institute, Detroit, MI, USA
| | - Yasi Rodriguez Torres
- Department of Ophthalmology, School of Medicine, Wayne State University, Kresge Eye Institute, Detroit, MI, USA
| | - Zachary Meyer
- Department of Ophthalmology, School of Medicine, Wayne State University, Kresge Eye Institute, Detroit, MI, USA
| | - Michael A. Beyer
- Department of Ophthalmology, School of Medicine, Wayne State University, Kresge Eye Institute, Detroit, MI, USA
| | - Christian A. Mehregan
- Department of Ophthalmology, School of Medicine, Wayne State University, Kresge Eye Institute, Detroit, MI, USA
| | - Gautham Vellaichamy
- Department of Ophthalmology, School of Medicine, Wayne State University, Kresge Eye Institute, Detroit, MI, USA
| | - Neil Chungfat
- Department of Ophthalmology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Frank S. Hwang
- Department of Ophthalmology, School of Medicine, Wayne State University, Kresge Eye Institute, Detroit, MI, USA
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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Novack GD, Asbell P, Barabino S, Bergamini MVW, Ciolino JB, Foulks GN, Goldstein M, Lemp MA, Schrader S, Woods C, Stapleton F. TFOS DEWS II Clinical Trial Design Report. Ocul Surf 2017; 15:629-649. [PMID: 28736344 PMCID: PMC8557254 DOI: 10.1016/j.jtos.2017.05.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/06/2017] [Indexed: 12/17/2022]
Abstract
The development of novel therapies for Dry Eye Disease (DED) is formidable, and relatively few treatments evaluated have been approved for marketing. In this report, the Subcommittee reviewed challenges in designing and conducting quality trials, with special reference to issues in trials in patients with DED and present the regulatory perspective on DED therapies. The Subcommittee reviewed the literature and while there are some observations about the possible reasons why so many trials have failed, there is no obvious single reason other than the lack of correlation between signs and symptoms in DED. Therefore the report advocates for conducting good quality studies, as described, going forward. A key recommendation for future studies is conduct consistent with Good Clinical Practice (GCP), including use of Good Manufacturing Practice (GMP) quality clinical trial material. The report also recommends that the design, treatments, and sample size be consistent with the investigational treatment, the objectives of the study, and the phase of development. Other recommendations for pivotal studies are a priori selection of the outcome measure, and an appropriate sample size.
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Affiliation(s)
- Gary D Novack
- Pharma Logic Development, San Rafael, CA, USA; Departments of Pharmacology and Ophthalmology, University of California, Davis, School of Medicine, CA, USA.
| | - Penny Asbell
- Department of Ophthalmology, Icahn School of Medicine at Mt Sinai, New York, NY, USA
| | | | - Michael V W Bergamini
- Nicox Ophthalmics, Inc., Fort Worth, TX, USA; University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Joseph B Ciolino
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Gary N Foulks
- Emeritus Professor of Ophthalmology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Michael Goldstein
- Department of Ophthalmology, New England Medical Center and Tufts University, Boston, MA, USA
| | - Michael A Lemp
- Department of Ophthalmology, School of Medicine, Georgetown University, Washington, DC, USA
| | - Stefan Schrader
- Department of Ophthalmology, Heinrich-Heine University, Düsseldorf, Germany
| | - Craig Woods
- Deakin Optometry, School of Medicine, Deakin University, Geelong, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Australia, Sydney, NSW, Australia
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The correct diagnosis and therapeutic management of tear dysfunction: recommendations of the P.I.C.A.S.S.O. board. Int Ophthalmol 2017; 38:875-895. [PMID: 28397148 PMCID: PMC5932107 DOI: 10.1007/s10792-017-0524-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/04/2017] [Indexed: 11/22/2022]
Abstract
Purpose To describe a standard approach to manage tear dysfunction (TD), in order to obtain a clinically favourable outcome. TD is a highly prevalent, yet largely underdiagnosed, condition that affects from 5 to 30% of the population above 50 years old. Left untreated, TD is associated with eye discomfort and ocular surface disease, substantially affecting quality of life. Although the prevalence of this problem is increasing significantly, a standard approach to its prevention and treatment is not available yet. Methods In September 2015, a team of Ocular Surface Italian Experts convened for a roundtable to discuss on the latest knowledge about diagnosis and treatments for TD and the real issues in the management of these patients. The discussion centred on the appropriate definition of TD, proposing a new classification of risk factors and how to identify them, how to make a correct diagnosis choosing the rational therapy (questionnaires, symptoms’ time relation, seasonality, low tech diagnostic manoeuvres, specific tests for the detection of tear film disturbances leading to recognition of the level of disease and of the ocular system elements involved), which artificial tear matches the ideal profile for a rational therapy and which questions should be done to the patient. Results A multi-item flowchart for tear film dysfunction, with point-by-point explanatory guide, to better identify and manage the patient with this disorder is provided. Conclusions The growing prevalence of TD demands increased attention. An appropriate prevention and a treatment pattern for the patient, combined with greater patient–practitioner interaction, and patient education is offered.
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Chao W, Belmonte C, Benitez del Castillo JM, Bron AJ, Dua HS, Nichols KK, Novack GD, Schrader S, Willcox MD, Wolffsohn JS, Sullivan DA. Report of the Inaugural Meeting of the TFOS i2 = initiating innovation Series: Targeting the Unmet Need for Dry Eye Treatment. Ocul Surf 2016; 14:264-316. [DOI: 10.1016/j.jtos.2015.11.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 01/09/2023]
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