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Muñoz G, Millicovsky M, Cerrudo J, Peñalva A, Machtey M, Reta J, Torres R, Campana D, Zalazar M. Exploring tear viscosity with quartz crystal microbalance technology. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2024; 95:075107. [PMID: 39023347 DOI: 10.1063/5.0207182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 07/03/2024] [Indexed: 07/20/2024]
Abstract
Tear viscosity is a critical property affecting tear distribution and ocular surface stability. While not widely established as a primary diagnostic marker, deviations from normal viscosity can impact ocular health, potentially contributing to conditions such as dry eye syndrome. Despite their importance, traditional viscometers require sample volumes that are not feasible to use with tear volume. This research introduces a novel Quartz Crystal Microbalance (QCM)-based method for tear viscosity measurement, offering a viscometer prototype that operates with minimal sample volumes. Human tear samples, solutions used in artificial eye drops, and various commercial eye drop brands were evaluated. Results show that the QCM method aligns with established viscosity ranges. The average viscosity of healthy human tears was found to be 1.73 ± 0.61 cP, aligning with the typical range of 1-10 cP. Variability in the viscosities of eye drop can be attributed to differences in their chemical compositions. The QCM method offers benefits such as reduced sample consumption and rapid results, enhancing understanding of tear dynamics for ocular health. Further research with larger sample sizes is needed to establish normative viscosity values in healthy individuals and those with dry eye syndrome, which is crucial for validating the device's clinical efficacy.
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Affiliation(s)
- G Muñoz
- Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
| | - M Millicovsky
- Instituto de Investigación y Desarrollo en Bioingeniería y Bioinformática (CONICET-UNER), Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
| | - J Cerrudo
- Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
| | - A Peñalva
- Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
| | - M Machtey
- Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
| | - J Reta
- Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
| | - R Torres
- ROMAT Creator Center, Colonia Avellaneda, Entre Ríos, Argentina and Investigador Independiente, Colaborador de la Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
| | - D Campana
- Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
- Instituto de Investigación y Desarrollo en Bioingeniería y Bioinformática (CONICET-UNER), Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
| | - M Zalazar
- Facultad de Ingeniería, Universidad Nacional de Entre Ríos, Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
- Instituto de Investigación y Desarrollo en Bioingeniería y Bioinformática (CONICET-UNER), Ruta Prov. 11, Km 10, Oro Verde 3100, Entre Ríos, Argentina
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Lai HY, Chen A, Fang PC, Yu HJ, Kuo MT. Comparing Tear Film Viscosity between Sjögren and Non-Sjögren Dry Eye Disease. Life (Basel) 2023; 13:1484. [PMID: 37511859 PMCID: PMC10381532 DOI: 10.3390/life13071484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
This study aimed to compare tear film viscosity (TFV) in Sjögren and non-Sjögren dry eye diseases (DEDs). This was a cross-sectional observational study. A total of 68 DED patients were enrolled, including 32 patients with Sjögren syndrome (SS) and 36 without SS. TFV was assessed by a tear film analyzer and determined by the momentary moving speed (MMS; MMS (t) = α × t-β, t = time (s)) with its power-law fitting-derived parameters (α and β). Among the four indices of TFV (MMS (0.1 s), MMS (2.0 s), α, and β), the SS-DED patients had significantly lower MMS (0.1 s) (p = 2.01 × 10-5), α (p = 0.0375), and β (p = 0.0076). The SS-DED group also had significantly higher OSDI, lower central and nasal tear meniscus height (TMH), and higher OSS. MMS (0.1 s) was significantly correlated with nasal TMH and OSS (ρ = 0.2520, p = 0.0381 in nasal TMH; ρ = -0.3487, p = 0.0036 in OSS). Index β was not correlated with any non-TFV tests. In conclusion, MMS (0.1 s), α, and β are promising TFV indices in distinguishing SS-DED from non-SS-DED patients early. Among these TFV indices, lower MMS is the best alternative clue for detecting SS-DED.
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Affiliation(s)
- Hung-Yin Lai
- Department of Ophthalmology, China Medical University Hospital, China Medical University, Taichung City 40402, Taiwan
| | - Alexander Chen
- Department of Ophthalmology, Antai Medical Care Cooperation Antai Tian-Sheng Memorial Hospital, Pingtung City 92842, Taiwan
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
- School of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
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Phan CM, Ross M, Fahmy K, McEwen B, Hofmann I, Chan VWY, Clark-Baba C, Jones L. Evaluating Viscosity and Tear Breakup Time of Contemporary Commercial Ocular Lubricants on an In Vitro Eye Model. Transl Vis Sci Technol 2023; 12:29. [PMID: 37382574 PMCID: PMC10318592 DOI: 10.1167/tvst.12.6.29] [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: 03/14/2023] [Accepted: 05/31/2023] [Indexed: 06/30/2023] Open
Abstract
Purpose To evaluate the link between the viscosity of ophthalmic formulation and tear film stability using a novel in vitro eye model. Methods The viscosities and noninvasive tear breakup time (NIKBUT) of 13 commercial ocular lubricants were measured to evaluate the correlation between viscosity and NIKBUT. The complex viscosity of each lubricant was measured three times for each angular frequency (ranging from 0.1 to 100 rad/s) using the Discovery HR-2 hybrid rheometer. The NIKBUT measurements were performed eight times for each lubricant using an advanced eye model mounted on the OCULUS Keratograph 5M. A contact lens (CL; ACUVUE OASYS [etafilcon A]) or a collagen shield (CS) was used as the simulated corneal surface. Phosphate-buffered saline was used as a simulated fluid. Results The results showed a positive correlation between viscosity and NIKBUT at high shear rates (at 10 rad/s, r = 0.67) but not at low shear. This correlation was even better for viscosities between 0 and 100 mPa*s (r = 0.85). Most of the lubricants tested in this study also had shear-thinning properties. OPTASE INTENSE, I-DROP PUR GEL, I DROP MGD, OASIS TEARS PLUS, and I-DROP PUR had higher viscosity in comparison to other lubricants (P < 0.05). All of the formulations had a higher NIKBUT than the control (2.7 ± 1.2 seconds for CS and 5.4 ± 0.9 seconds for CL) without any lubricant (P < 0.05). I-DROP PUR GEL, OASIS TEARS PLUS, I-DROP MGD, REFRESH OPTIVE ADVANCED, and OPTASE INTENSE had the highest NIKBUT using this eye model. Conclusions The results show that the viscosity is correlated with NIKBUT, but further work is necessary to determine the underlying mechanisms. Translational Relevance The viscosity of ocular lubricants can affect NIKBUT and tear film stability, so it is an important property to consider when formulating ocular lubricants.
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Affiliation(s)
- Chau-Minh Phan
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Centre for Eye and Vision Research (CEVR), Hong Kong
| | - Mitchell Ross
- Department of Chemical Engineering, McMaster University, Hamilton, ON, Canada
| | | | | | | | - Vivian W. Y. Chan
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Connor Clark-Baba
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
- Centre for Eye and Vision Research (CEVR), Hong Kong
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Hedengran A, Freiberg JC, Hansen PM, Jacobsen J, Larsen SW, Harloff‐Helleberg S, Freude K, Boix‐Lemonche G, Petrovski G, Heegaard S, Kolko M. Generic benzalkonium chloride-preserved travoprost eye drops are not identical to the branded polyquarternium-1-preserved travoprost eye drop: Effect on cultured human conjunctival goblet cells and their physicochemical properties. Acta Ophthalmol 2022; 100:819-827. [PMID: 35527390 PMCID: PMC9790398 DOI: 10.1111/aos.15163] [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: 12/20/2021] [Revised: 03/07/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the effect of polyquaternium-1 (PQ)-preserved and benzalkonium chloride (BAK)-preserved travoprost eye drops on viability of primary human conjunctival goblet cell (GC) cultures and on secretion of mucin and cytokines. Furthermore, to evaluate the physicochemical properties of the branded travoprost eye drop Travatan® and available generics. METHODS The effect of travoprost eye drops was evaluated on GC cultures. Cell viability was assessed through lactate dehydrogenase (LDH) and tetrazolium dye (MTT) colorimetric assays. Mucin secretion was evaluated by immunohistochemical staining. Secretion of interleukin (IL)-6 and IL-8 was measured using BD Cytometric Bead Arrays. pH, viscosity, droplet mass, osmolality and surface tension were measured for all included eye drops. RESULTS In the LDH assay, BAK travoprost caused significant GC loss after 2 hrs of incubation compared to the control. PQ travoprost caused no GC loss at any time point. Both PQ- and BAK travoprost caused secretion of mucin to the cytoplasma. No difference in IL-6 and IL-8 secretion was identified compared to controls. The pH values for the generics were lower (pH 6.0) than the pH value for Travatan (pH 6.7; p < 0.0001). The viscosity was lowest for Travatan, while the mean droplet mass was higher for Travatan (35 mg) than the generics (28-30 mg; p ≤ 0.0318). The osmolality and surface tension did not differ between the eye drops investigated. CONCLUSION BAK travoprost caused GC loss, indicating that PQ preservation may be preferable in treatment of glaucoma. Furthermore, physicochemical properties of branded and generic travoprost eye drops can not be assumed to be identical.
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Affiliation(s)
- Anne Hedengran
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark,Department of OphthalmologyCopenhagen University Hospital, RigshospitaletGlostrupDenmark
| | | | - Pernille May Hansen
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark,Department of OphthalmologyCopenhagen University Hospital, RigshospitaletGlostrupDenmark
| | - Jette Jacobsen
- Department of PharmacyUniversity of CopenhagenCopenhagenDenmark
| | | | | | - Kristine Freude
- Pathobiological Sciences, Department of Veterinary and Animal SciencesUniversity of CopenhagenFrederiksberg CDenmark
| | - Gerard Boix‐Lemonche
- Center for Eye Research, Department of OphthalmologyOslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of OsloOsloNorway
| | - Goran Petrovski
- Center for Eye Research, Department of OphthalmologyOslo University Hospital and Institute for Clinical Medicine, Faculty of Medicine, University of OsloOsloNorway
| | - Steffen Heegaard
- Department of OphthalmologyCopenhagen University Hospital, RigshospitaletGlostrupDenmark,Department of PathologyUniversity Hospital RigshospitaletCopenhagenDenmark
| | - Miriam Kolko
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark,Department of OphthalmologyCopenhagen University Hospital, RigshospitaletGlostrupDenmark
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Recchioni A, Mocciardini E, Ponzini E, Tavazzi S. Viscoelastic properties of the human tear film. Exp Eye Res 2022; 219:109083. [PMID: 35460666 DOI: 10.1016/j.exer.2022.109083] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/25/2022] [Accepted: 04/18/2022] [Indexed: 12/21/2022]
Abstract
When considering eye blinking from a tribological perspective, tear viscosity is expected to play a fundamental role. The application of rheological techniques to describe the tear film dates back to the late 1980s, but there has been a continuous need of reappraisal due to new findings in tear film biochemistry and to the development of new methods of physico-chemical characterization. This review provides an overview on tear rheological behavior by analyzing the peer-reviewed literature on this topic. Specifically, examples of in-vitro and in-vivo viscosity measurements are detailed, highlighting experimental criticalities and the need of a standard convention for rheological techniques to compare data across different studies, of analyses on tears of single individuals even within the limits of the low volume available, and of a further development of in-vivo techniques. Then, the controversial role of specific tear components on viscosity is discussed, together with the alterations associated to dry eye disease and contact lens wear. Finally, an updated focus is reported on the viscosity of artificial tears formulations.
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Affiliation(s)
- Alberto Recchioni
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, UK; Optometry & Vision Sciences Group, School of Life & Health Sciences, Aston University, Birmingham, UK; Birmingham and Midland Eye Centre, Birmingham, UK
| | - Emanuele Mocciardini
- University of Milano Bicocca, Corso di laurea in Ottica e Optometria, via R. Cozzi 55, I-20125, Milan, Italy
| | - Erika Ponzini
- University of Milano Bicocca, Materials Science Department, via R. Cozzi 55, I-20125, Milan, Italy; University of Milano Bicocca, COMiB research center, via R. Cozzi 55, I-20125, Milan, Italy.
| | - Silvia Tavazzi
- University of Milano Bicocca, Materials Science Department, via R. Cozzi 55, I-20125, Milan, Italy; University of Milano Bicocca, COMiB research center, via R. Cozzi 55, I-20125, Milan, Italy
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6
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Musayeva A, Gericke A, Jäger F, Paulsen F, Braun M, Fabry B, Braun R, Pauly D, Holtmann C, Geerling G. [Results of the Dry Eye Research Grant Award 2016]. Ophthalmologe 2021; 118:337-344. [PMID: 32638094 PMCID: PMC8043874 DOI: 10.1007/s00347-020-01163-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The Sicca-Förderpreis (Dry Eye Award) supports the development of scientific research on the pathogenesis, diagnostics, and treatment of dry eye and ocular surface diseases. It is awarded after a limited call for proposals in German-speaking countries, written application and selection of the award winner after evaluation by a jury of ophthalmologists working in basic and clinical science. In this article examples of the results of funded projects of the Sicca-Förderpreis 2016 are cursorily described, which were presented at the Ophthalmological Academy of Germany 2019 (Augenärztliche Akademie Deutschland 2019) and therefore provide an insight into current scientific developments. The role of muscarinic receptors and those of urea in the pathogenesis of dry eye as well as the (missing) correlation of tear film stability, viscosity and surface tension are highlighted. A project on the early detection of ocular involvement in graft versus host disease and the idea of treating meibomian gland dysfunction with eyelid surgery techniques are also groundbreaking. The outlined projects represent the potential for further substantial developments in the understanding, diagnostics and treatment of dry eye; however, their long-term clinical relevance still needs to be established.
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Affiliation(s)
- A Musayeva
- Augenklinik und Poliklinik, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Gericke
- Augenklinik und Poliklinik, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - F Jäger
- Institut für Funktionelle und Klinische Anatomie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - F Paulsen
- Institut für Funktionelle und Klinische Anatomie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - M Braun
- Institut für Physik der kondensierten Materie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - B Fabry
- Institut für Physik der kondensierten Materie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Braun
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - D Pauly
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - C Holtmann
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - G Geerling
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Downie LE, Bandlitz S, Bergmanson JPG, Craig JP, Dutta D, Maldonado-Codina C, Ngo W, Siddireddy JS, Wolffsohn JS. CLEAR - Anatomy and physiology of the anterior eye. Cont Lens Anterior Eye 2021; 44:132-156. [PMID: 33775375 DOI: 10.1016/j.clae.2021.02.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
A key element of contact lens practice involves clinical evaluation of anterior eye health, including the cornea and limbus, conjunctiva and sclera, eyelids and eyelashes, lacrimal system and tear film. This report reviews the fundamental anatomy and physiology of these structures, including the vascular supply, venous drainage, lymphatic drainage, sensory innervation, physiology and function. This is the foundation for considering the potential interactions with, and effects of, contact lens wear on the anterior eye. This information is not consistently published as academic research and this report provides a synthesis from all available sources. With respect to terminology, the report aims to promote the consistent use of nomenclature in the field, and generally adopts anatomical terms recommended by the Federative Committee for Anatomical Terminology. Techniques for the examination of the ocular surface are also discussed.
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Affiliation(s)
- Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Australia.
| | - Stefan Bandlitz
- Höhere Fachschule für Augenoptik Köln, Cologne School of Optometry, Germany; School of Optometry, Aston University, Birmingham, UK
| | - Jan P G Bergmanson
- Texas Eye Research and Technology Center, University of Houston College of Optometry, United States
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Debarun Dutta
- School of Optometry, Aston University, Birmingham, UK
| | - Carole Maldonado-Codina
- Eurolens Research, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, UK
| | - William Ngo
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada; Centre for Eye and Vision Research (CEVR), 14W Hong Kong Science Park, Hong Kong
| | | | - James S Wolffsohn
- School of Optometry, Aston University, Birmingham, UK; Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
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New strategies for the management of ocular surface disease in glaucoma patients. Curr Opin Ophthalmol 2021; 32:134-140. [PMID: 33492867 DOI: 10.1097/icu.0000000000000739] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Glaucoma patients commonly suffer from ocular surface disease (OSD). As treatment strategies, medications and devices for the treatment of OSD as well as glaucoma surgical approaches evolve rapidly, it is important to consider their application to these patients. RECENT FINDINGS OSD in glaucoma patients may lead to reduced reliability of diagnostic tests, decreased medication compliance, poor surgical outcomes, and overall decreased quality of life. Chronic use of topical glaucoma medications has been linked to the development of limbal stem cell deficiency, and the role of preservatives in OSD continues to be demonstrated. Preservative free glaucoma medications as well as new anti-inflammatory agents for the treatment of OSD are now available. Omega-3 fatty acid supplementation and punctal plugs have been shown to benefit glaucoma patients with OSD. Drop burden may be reduced through the use of the new sustained-release delivery systems, selective laser trabeculoplasty, and minimally invasive glaucoma surgery. SUMMARY There are multiple emerging strategies for managing OSD that may be applied to patients with glaucoma. With continued research and clinical experiences, we hope to better understand the multifaceted relationship between glaucoma and OSD and develop evidence-based algorithms for the management of these complex patients.
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9
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van Setten GB. Impact of Attrition, Intercellular Shear in Dry Eye Disease: When Cells are Challenged and Neurons are Triggered. Int J Mol Sci 2020; 21:E4333. [PMID: 32570730 PMCID: PMC7352662 DOI: 10.3390/ijms21124333] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/02/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022] Open
Abstract
The mechanical component in the pathophysiology of dry eye disease (DED) deserves attention as an important factor. The lubrication deficit induced impaired mechano-transduction of lid pressure to the ocular surfaces may lead to the dysregulation of homeostasis in the epithelium, with sensations of pain and secondary inflammation. Ocular pain is possibly the first sign of attrition and may occur in the absence of visible epithelial damage. Attrition is a process which involves the constant or repeated challenge of ocular surface tissues by mechanical shear forces; it is enhanced by the thinning of corneal epithelium in severe DED. As a highly dynamic process leading to pain and neurogenic inflammation, the identification of the impact of attrition and its potential pathogenic role could add a new perspective to the current more tear film-oriented models of ocular surface disease. Treatment of DED addressing lubrication deficiencies and inflammation should also consider the decrease of attrition in order to stimulate epithelial recovery and neural regeneration. The importance of hyaluronic acid, its molecular characteristics, the extracellular matrix and autoregulative mechanisms in this process is outlined. The identification of the attrition and recognition of its impact in dry eye pathophysiology could contribute to a better understanding of the disease and optimized treatment regimens.
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Affiliation(s)
- Gysbert-Botho van Setten
- Department of Clinical Neuroscience (CNS), Karolinska Institutet, 11282 Stockholm, Sweden; ; Tel.: +46-8-672-3298
- St Eriks Eye Hospital, 11282 Stockholm, Sweden
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10
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Georgiev GA, Eftimov P, Yokoi N. Contribution of Mucins towards the Physical Properties of the Tear Film: A Modern Update. Int J Mol Sci 2019; 20:E6132. [PMID: 31817367 PMCID: PMC6941008 DOI: 10.3390/ijms20246132] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 12/18/2022] Open
Abstract
Instability of the tear film (TF) protecting the ocular surface results in dry eye syndrome (DES), the most prevalent public health ophthalmic disease affecting the quality of life of 10 to 30% of the human population worldwide. Although the impact of the tear film lipid layer (TFLL) and of the aqueous tears (AT) to the TF stability is extensively studied, in contrast the contribution of the secretory mucins (SM) and of the membrane-associated mucins (MAM), i.e., one of the most abundant molecular classes in AT and in the corneal epithelium respectively, remains poorly defined. However, it is well known that in DES both types of mucins are quantitatively or qualitatively deficient. Numerous studies since the 1990s until now have proposed direct involvement of SM and MAM in the material properties (viscoelasticity, hydration, and protection of the ocular surface; synergistic cooperation with the rest of the TF layers; etc.) and stability of TF. These theories will be reviewed here in the context of the classical and modern in vitro and in vivo results that allow their reappraisal and in view of the novel mucin secretion enhancing pharmaceuticals, which have opened innovative routes for the therapy of DES.
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Affiliation(s)
- Georgi As Georgiev
- Department of Optics and Spectroscopy, Faculty of Physics, St. Kliment Ohridski University of Sofia, 5 James Bourchier Blvd, 1164 Sofia, Bulgaria
| | - Petar Eftimov
- Department of Cytology, Histology and Embryology, Faculty of Biology, St. Kliment Ohridski University of Sofia, 8 Dragan Tzankov Blvd., 1164 Sofia, Bulgaria
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-0841, Japan
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11
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de Paiva CS. Highlights from the 22nd International Ocular Surface Society meeting. Ocul Surf 2019; 18:13-18. [PMID: 31785389 DOI: 10.1016/j.jtos.2019.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/26/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Cintia S de Paiva
- Department of Ophthalmology, Baylor College of Medicine, 6565 Fannin Street, NC 505G, Houston, TX, 77030, USA.
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12
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Regulatory and Developmental Aspects of Biomarkers in the Treatment of Ocular Surface Disease. Eye Contact Lens 2019; 46 Suppl 2:S106-S108. [PMID: 31283553 DOI: 10.1097/icl.0000000000000639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The ideal biomarker would be a simple laboratory or clinical evaluation before treatment, which would predict subsequent therapeutic response. This might include selection of which patients might respond to that treatment. While other disciplines such as neurology and oncology have biomarkers, ophthalmology is limited to one-elevated intraocular pressure as a surrogate for progressive glaucomatous field loss. US law in 2016 required the Food and Drug Administration (FDA) to set up a system to qualify biomarkers. The system now exists-with most validated or pending biomarkers limited to safety and infection. The American Academy of Ophthalmology selected dry eye disease as one of three diseases in which to standardize outcomes in ophthalmology research. There have been a number of biomarkers proposed for evaluating ocular surface disease and its treatment. None currently meets the scientific or regulatory basis for being a valid biomarker-however, additional research may result in validity. Given the FDA's scientific basis, it is unlikely that an unproven biomarker could be used for regulatory approval, even for a "SubPart H" conditional new drug application. Elsewhere in ophthalmology, we know that even patients who share the same disease gene or mutation may differ substantially in penetrance and clinical expression. Thus, it is not unexpected that ocular surface disease, a heterogeneous disease with a variable presentation of signs and symptoms, has yet to have validated biomarkers that reach the level of evidence that allows their use for diagnosis, prognosis, therapy, and for making decisions in drug development.
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