1
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Vidal-Rohr M, Craig JP, Davies LN, Wolffsohn JS. Classification of dry eye disease subtypes. Cont Lens Anterior Eye 2024; 47:102257. [PMID: 38969607 DOI: 10.1016/j.clae.2024.102257] [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: 11/11/2023] [Revised: 05/31/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
PURPOSE The current subclassifications of dry eye disease (DED) are aqueous deficient (ADDE) and evaporative (EDE) forms, but there lacks consistency in the clinical characteristics used to define each of these. This study used clinical data to inform cut-off values for the subclassification of ADDE and EDE, to allow more consistent study of the epidemiology of both DED subtypes. METHODS The study enrolled 261 residents from the UK, extracted from a cohort with demographics representing the population (mean 42.4 ± 18.7 years, 56 % females). The TFOS DEWS II diagnostic criteria were used to identify those with DED. Meibomian gland loss/drop-out (from meibography), lipid layer thickness (LLT - from interferometry graded on the Guillon-Keeler scale), and tear meniscus height (TMH - Keratograph 5M) along with tear evaporation (Delfin Vapometer) were used to characterise the subclassification. The Dry Eye Risk Factor Survey was used to assess risk factors associated with each DED subtype. RESULTS Compared to individuals who were not diagnosed with DED, EDE was characterized by signs of meibomian gland loss of > 28 %, LLT grade < 3 and tear evaporation > 46 g/m2/h. In contrast, ADDE was best characterized by a reduced TMH < 0.2 mm. Based on these criteria, the prevalence of ADDE was 6.2 %, EDE was 64.2 %, and 11.1 % exhibited features of both ADDE and EDE, with 18.5 % unclassified despite having a DED diagnosis. Contact lens wear and computer use were risk factors for ADDE (p < 0.05), whereas age was a positive risk factor for EDE (p < 0.01). Meibomian gland loss (occurring in 27.9 %) was the most commonly observed sign in EDE. CONCLUSIONS Data driven-classification of DED confirms that the evaporative form is most prevalent and identified that in a generalisable UK population, ADDE alone occurs only in approximately 1 in 16 cases of DED.
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Affiliation(s)
- M Vidal-Rohr
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - J P Craig
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK; Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - L N Davies
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - J S Wolffsohn
- School of Optometry, College of Health and Life Sciences, Aston University, Birmingham, UK; Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, New Zealand.
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2
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Di Zazzo A, Barabino S, Fasciani R, Aragona P, Giannaccare G, Villani E, Rolando M. One Soul and Several Faces of Evaporative Dry Eye Disease. J Clin Med 2024; 13:1220. [PMID: 38592038 PMCID: PMC10932174 DOI: 10.3390/jcm13051220] [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: 11/20/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 04/10/2024] Open
Abstract
The ocular surface system interacts with, reacts with, and adapts to the daily continuous insults, trauma, and stimuli caused by direct exposure to the atmosphere and environment. Several tissue and para-inflammatory mechanisms interact to guarantee such an ultimate function, hence maintaining its healthy homeostatic equilibrium. Evaporation seriously affects the homeostasis of the system, thereby becoming a critical trigger in the pathogenesis of the vicious cycle of dry eye disease (DED). Tear film lipid composition, distribution, spreading, and efficiency are crucial factors in controlling water evaporation, and are involved in the onset of the hyperosmolar and inflammatory cascades of DED. The structure of tear film lipids, and subsequently the tear film, have a considerable impact on tears' properties and main functions, leading to a peculiar clinical picture and specific management.
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Affiliation(s)
- Antonio Di Zazzo
- Ophthalmology Complex Operative Unit, Foundation Campus Bio-Medico University Hospital, 00128 Rome, Italy
- Ophthalmology Unit, Campus Bio-Medico University, 00128 Rome, Italy
| | - Stefano Barabino
- Ocular Surface & Dry Eye Center, ASST Fatebenefratelli SACCO, Kilan Univeristy, 20123 Milan, Italy;
| | - Romina Fasciani
- Ophthalmology Unit, “Fondazione Policlinico Universitario A. Gemelli IRCCS”, 00128 Rome, Italy;
- Ophtalmology Unit, Catholic University of “Sacro Cuore”, 00128 Rome, Italy
| | - Pasquale Aragona
- Ophthalmology Clinic, Department of Biomedical Sciences, University Hospital of Messina, 98122 Messina, Italy;
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy;
| | - Edoardo Villani
- Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, University of Milan, 20123 Milan, Italy;
| | - Maurizio Rolando
- Ocular Surface and Dry Eye Center, ISPRE Ophthalmics, 16129 Genoa, Italy;
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3
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Kim YH, Graham AD, Li W, Dursch TJ, Peng CC, Radke CJ, Lin MC. Tear-film evaporation flux and its relationship to tear properties in symptomatic and asymptomatic soft-contact-lens wearers. Cont Lens Anterior Eye 2023; 46:101850. [PMID: 37137757 DOI: 10.1016/j.clae.2023.101850] [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: 07/03/2022] [Revised: 02/18/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE With soft-contact-lens wear, evaporation of the pre-lens tear film affects the osmolarity of the post-lens tear film and this can introduce a hyperosmotic environment at the corneal epithelium, leading to discomfort. The purposes of the study are to ascertain whether there are differences in evaporation flux (i.e., the evaporation rate per unit area) between symptomatic and asymptomatic soft-contact-lens wearers, to assess the repeatability of a flow evaporimeter, and to assess the relationship between evaporation fluxes, tear properties, and environmental conditions. METHODS Closed-chamber evaporimeters commonly used in ocular-surface research do not control relative humidity and airflow, and, therefore, misestimate the actual tear-evaporation flux. A recently developed flow evaporimeter overcomes these limitations and was used to measure accurate in-vivo tear-evaporation fluxes with and without soft-contact-lens wear for symptomatic and asymptomatic habitual contact-lens wearers. Concomitantly, lipid-layer thickness, ocular-surface-temperature decline rate (i.e., °C/s), non-invasive tear break-up time, tear-meniscus height, Schirmer tear test, and environmental conditions were measured in a 5 visit study. RESULTS Twenty-one symptomatic and 21 asymptomatic soft-contact-lens wearers completed the study. A thicker lipid layer was associated with slower evaporation flux (p < 0.001); higher evaporation flux was associated with faster tear breakup irrespective of lens wear (p = 0.006). Higher evaporation flux was also associated with faster ocular-surface-temperature decline rate (p < 0.001). Symptomatic lens wearers exhibited higher evaporation flux than did asymptomatic lens wearers, however, the results did not reach statistical significance (p = 0.053). Evaporation flux with lens wear was higher than without lens wear but was also not statistically significant (p = 0.110). CONCLUSIONS The repeatability of the Berkeley flow evaporimeter, associations between tear characteristics and evaporation flux, sample-size estimates, and near statistical significance in tear-evaporation flux between symptomatic and asymptomatic lens wearers all suggest that with sufficient sample sizes, the flow evaporimeter is a viable research tool to understand soft-contact-lens wear comfort.
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Affiliation(s)
- Young Hyun Kim
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States
| | - Andrew D Graham
- Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States
| | - Wing Li
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States
| | - Thomas J Dursch
- Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States
| | - Cheng-Chun Peng
- Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States; CooperVision Inc., Pleasanton, CA 94588, United States
| | - Clayton J Radke
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States
| | - Meng C Lin
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States.
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4
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Amano S, Shimazaki J, Yokoi N, Hori Y, Arita R. Meibomian Gland Dysfunction Clinical Practice Guidelines. Jpn J Ophthalmol 2023; 67:448-539. [PMID: 37351738 DOI: 10.1007/s10384-023-00995-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 06/24/2023]
Affiliation(s)
- Shiro Amano
- Ochanomizu Inoue Eye Clinic, 4-3 Kandasurugadai, Chiyoda-ku, Tokyo, 101-0062, Japan.
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
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Abusharha A, Pearce IE, Afsar T, Alsaqr A, Fagehi R, Razak S. Evaluation of different treatment modalities on the efficacy of hydroxypropyl Guar (HP-Guar) formulation on tear film stability (TFS) in subjects exposed to adverse environmental conditions. BMC Ophthalmol 2023; 23:226. [PMID: 37211592 DOI: 10.1186/s12886-023-02977-3] [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: 02/02/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023] Open
Abstract
The study aimed to assess the efficacy of hydroxypropyl guar (HP) formulation (Systane) to protect tear film parameters under desiccating environment using protection and relief treatment modalities. The subjects were exposed to adverse environmental conditions using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the ambient temperature was 21 °C and screened for Tear break-up time (TBUT), Tear film evaporation rate (TFER) and lipid layer thickness (LLT) using the HIRCAL grid, Servomed EP3 Evaporimeter and Keeler's TearScope-Plus respectively. Significant improvement in LLT was noticed in the protection modality. The mean tear film evaporation rate doubled after exposure to the humidity of 5% to a value of 105.37 g/m2/h (0.29 µl/min). All subjects displayed a significant reduction in non-invasive tear break-up time (NITBUT) with a mean NITBUT of 7.7 s after exposure to a desiccating environment for 15 min. A significant increase in NITBUT after the instillation of the drops was recorded in both methods. The results obtained from this study showed that a solution containing HP-Guar significantly improves tear film parameters under a desiccating environment. Apart from the tear evaporation rate, all tear parameters showed improvement after the use of HP-Guar eye drops. It is evident that tear film parameters respond differently to the management modalities and using CEC has the potential to provide researchers with a readily available method to evaluate the efficiency of tear supplementation.
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Affiliation(s)
- Ali Abusharha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ian E Pearce
- Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK
| | - Tayyaba Afsar
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Ali Alsaqr
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Suhail Razak
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
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6
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King-Smith PE, Begley C, Braun RJ. A Perspective on the Use of Fluorescent Imaging to Reveal Mechanisms of Breakup. Curr Eye Res 2022; 47:1355-1361. [PMID: 35861694 DOI: 10.1080/02713683.2022.2098981] [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: 11/03/2022]
Abstract
Purpose: Tear film instability, which can lead to rapid tear film breakup (TBU), is considered to be a major etiological factor in dry eye. However, experimental support for many of the proposed theories for TBU mechanisms is relatively scarce. The major aim of this perspective is to show that fluorescence studies of TBU can be used to provide experimental evidence for two proposed underlying mechanisms of TBU, evaporation and divergent flow.Methods: To understand the effects of TBU on tear film fluorescence, we show that local fluorescence is the product of three main factors: tear film thickness, fluorescein concentration and fluorescent efficiency. In divergent tear flow, tear film thickness is reduced without change in fluorescein concentration and fluorescent efficiency, thus leading to reduced fluorescence intensity. Evaporation causes decreased fluorescence mainly by self-quenching due to high fluorescein concentration. Fluorescent efficiency is reduced by quenching at high fluorescein concentration but is independent of concentration for very low fluorescein concentration; thus, comparison of high and very low concentrations of fluorescein can be used to discriminate between divergent flow and evaporation. Finally, it is shown how the fluorescent pattern can change greatly during the development of breakup.Conclusions: This analysis demonstrates that the study of tear film fluorescence in TBU and dry eye may be underutilized as additional information pertinent to clinical practice may be obtained. A better understanding of TBU mechanisms may lead to improved diagnosis and treatment of dry eye.
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Affiliation(s)
| | - Carolyn Begley
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Richard J Braun
- Department of Mathematical Sciences, University of Delaware, Newark, DE, USA
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7
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González Cela Casamayor MA, López Cano JJ, Andrés Guerrero V, Herrero Vanrell R, Benítez Del Castillo JM, Molina Martínez IT. A novel osmoprotective liposomal formulation from synthetic phospholipids to reduce in vitro hyperosmolar stress in dry eye treatments. J Liposome Res 2022:1-12. [PMID: 35706400 DOI: 10.1080/08982104.2022.2087083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Dry eye disease (DED) is a worldwide, multifactorial disease mainly caused by a deficit in tear production or increased tear evaporation with an increase in tear osmolarity and inflammation. This causes discomfort and there is a therapeutic need to restore the homeostasis of the ocular surface. The aim of the present work was to develop a biodegradable and biocompatible liposomal formulation from the synthetic phospholipids 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC) and 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC) that is able to reduce the effects of hypertonic stress by helping to restore the lipid layer of the tear film. Liposomes were made using the lipid film hydration method with synthetic phospholipids (10 mg/mL) with and without 0.2% HPMC. They were characterised in terms of size, osmolarity, pH, surface tension, and viscosity. Additionally, the in vitro toxicity of the formulation at 1 and 4 h in human corneal epithelial cells (hTERT-HCECs) and human conjunctival cells (IM-HConEpiC) was determined. Furthermore, osmoprotective activity was tested in a corneal model of hyperosmolar stress. In vivo acute tolerance testing was also carried out in albino New Zealand rabbits by topical application of the ophthalmic formulations every 30 min for 6 h. All the assayed formulations showed suitable physicochemical characteristics for ocular surface administration. The liposomal formulations were well-tolerated in cell cultures and showed osmoprotective activity in a hyperosmolar model. No alterations or discomfort were reported when they were topically administered in rabbits. According to the results, the osmoprotective liposomal formulations developed in this work are promising candidates for the treatment of DED.
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Affiliation(s)
- Miriam Ana González Cela Casamayor
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Department of Pharmaceutics and Food Technology, Facultad de Farmacia, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
| | - José Javier López Cano
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Department of Pharmaceutics and Food Technology, Facultad de Farmacia, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
| | - Vanessa Andrés Guerrero
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Department of Pharmaceutics and Food Technology, Facultad de Farmacia, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain.,University Institute of Industrial Pharmacy (IUFI), Facultad de Farmacia, Universidad Complutense de Madrid, Spain
| | - Rocío Herrero Vanrell
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Department of Pharmaceutics and Food Technology, Facultad de Farmacia, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain.,University Institute of Industrial Pharmacy (IUFI), Facultad de Farmacia, Universidad Complutense de Madrid, Spain
| | - José Manuel Benítez Del Castillo
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Ocular Surface and Inflammation Unit (USIO), Departamento de Inmunología, Oftalmología y OLR, Hospital Clínico San Carlos, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain
| | - Irene Teresa Molina Martínez
- Innovation, Therapy and Pharmaceutical Development in Ophthalmology (InnOftal) Research Group, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Department of Pharmaceutics and Food Technology, Facultad de Farmacia, Universidad Complutense de Madrid (UCM); IdISSC, Madrid, Spain.,University Institute of Industrial Pharmacy (IUFI), Facultad de Farmacia, Universidad Complutense de Madrid, Spain
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8
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Arroyo CAD, Byambajav M, Fernández I, Martin E, González-García MJ, López-Miguel A, Valencia-Nieto L, Hagan S, Enríquez-de-Salamanca A. Diurnal variation on tear stability and correlation with tear cytokine concentration. Cont Lens Anterior Eye 2022; 45:101705. [PMID: 35562228 DOI: 10.1016/j.clae.2022.101705] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the effect of time of day on tear evaporation rate (TER) and tear break-up time, and its possible relationship with the concentration of inflammatory tear molecules (cytokines) in healthy subjects. METHODS Participants with healthy ocular surfaces attended 3 visits, including the screening visit (V0), the 2nd visit (V1) and the 3rd visit (V2). There were 7-day intervals between visits. Participants with Dry Eye Disease (DED) were excluded by using appropriate clinical tests during V0. Clinical evaluation (TER and Non-Invasive Tear Break-Up Time (NITBUT)) and tear collection were performed during V1 and V2, between 9 and 10AM and 3-4PM. The relative humidity and temperature of the examination room were also measured. The tear fluid concentrations of 15 cytokines were measured by multiplex bead analysis. RESULTS Seven men and 10 women (mean age ± S.D; 25.1 ± 6.63 years old) participated in the study. There were no differences in neither the TER and NITBUT outcomes, nor humidity and temperature among times or visits. Eleven out of the 15 cytokines measured were detectable in tear fluids in > 50% of the participants. In the tear levels, no significant (p > 0.05) inter- and/or intra-day differences were detected for EGF, fractalkine, IL-1RA, IL-1β and IP-10. However, significant inter-day differences were found in the tear levels of IL-10 (p = 0.027), IFN-γ (p = 0.035) and TNF-α(p = 0.04) and intra-day differences in the tear levels of IL-8/CXCL8 (p = 0.034) and MCP-1 (p = 0.002). A significant correlation between TER and IL1-β, IL-2, and Fractalkine (p = 0.03, p = 0.03 and p = 0.046, respectively) was found at V1. CONCLUSIONS NITBUT and TER values had no significant variability over the course of a day (AM versus PM), or on different days in healthy participants when humidity and temperature were constant. However, some tear molecule levels did show inter- and intra-day variability, having an inconsistent and moderate correlation with TER diurnal variation.
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Affiliation(s)
| | - Mungunshur Byambajav
- Department of Vision Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Itziar Fernández
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine), Valladolid, Spain
| | - Eilidh Martin
- Department of Vision Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | | | - Alberto López-Miguel
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Valladolid, Spain
| | - Laura Valencia-Nieto
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Valladolid, Spain
| | - Suzanne Hagan
- Department of Vision Sciences, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
| | - Amalia Enríquez-de-Salamanca
- IOBA (Institute of Applied Ophthalmobiology), Universidad de Valladolid, Valladolid, Spain; CIBER-BBN (Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine), Valladolid, Spain
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9
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Abusharha A, El-Hiti GA, Alharbi A, Fagehi R, Alanazi MA, Alsaqar A, Masmali AM, Almubrad T. Evaluation of Tear Evaporation Rate in Subjects with a High Body Mass Index. Klin Monbl Augenheilkd 2022; 240:283-287. [PMID: 35426102 DOI: 10.1055/a-1778-4435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Abstract
Aim This study evaluated the tear evaporation rate (TER) in subjects with a high body mass index (BMI) and tested the correlation between BMI and dry eye.
Methods Thirty male subjects aged 18 – 38 years (26.4 ± 4.0 years) with a high BMI (26.4 – 47.0 kg/m2) were enrolled in the study. In addition, a control group of 30 males
aged 20 – 36 years (24.0 ± 3.6 years) with a normal BMI (< 25 kg/m2) participated in the study for comparison. Each subject completed the ocular surface disease index (OSDI),
followed by the TER measurement using a handheld VapoMeter.
Results Significant differences (Wilcoxon test; p = 0.002 and 0.001) were found between the median scores of the OSDI (10.3 [3.7] vs. 5.9 [7.2]) and TER (35.5 [13.1] vs. 15.5 [12.8]
g/m2 h) in the study and control groups, respectively. The OSDI indicated dry eye in 60.0% of subjects in the study group (n = 18). The TER measurements showed that 76.7% of
subjects in the study group (n = 23) had dry eyes. A medium correlation (r = 0.569; p = 0.001) was found between the OSDI scores and TER measurements.
Conclusions The means of the tear evaporation rate and the ocular surface disease index scores are significantly higher in subjects with a high BMI compared with the control group.
Therefore, a high BMI is considered a risk factor for dry eye. The measurement of the tear evaporation rate using a handheld VapoMeter is a simple and rapid method to detect dry eyes in
combination with other tools.
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Affiliation(s)
- Ali Abusharha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Gamal A. El-Hiti
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdulhadi Alharbi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Mana A. Alanazi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali Alsaqar
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali M. Masmali
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Turki Almubrad
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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10
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Sergio P, Giancarlo I, Matteo F, Maria DSC, Gianni P, Parrilla R, Valente P, Luca B. Analysis of tear film in cystinosis patients treated with topical viscous cysteamine hydrochloride (Cystadrop ®). Eur J Ophthalmol 2022; 32:3358-3362. [PMID: 35125035 PMCID: PMC9527349 DOI: 10.1177/11206721221078649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The aim of this study was to evaluate in vivo the tear film
in infantile nephropathic cystinosis patients with corneal crystals treated
with topical viscous cysteamine hydrochloride (Cystadrops®). Methods Ten eyes of five patients with nephropathic cystinosis aged from 10 to 35
years were included in this study. The patients were under treatment with
viscous cysteamine hydrochloride formulation containing 3.8 mg/mL cysteamine
(vCH 0.55%, equivalent to 0.55% CH; Cystadrops®; Recordati rare
Diseases, Puteaux, France) to reduce corneal crystal density. Five age and
sex matched individuals were randomly selected as control group. Tear
osmolarity testing (TearLabTM) was performed to assess the
in vivo osmolarity of patients under treatment and
compared to control group values. Tear film break-up time (TBUT) and basic
tear secretion (Schirmer test) were also assessed. Results Mean tear osmolarity was 294.8 mOsms/L (±10.4), with a mean absolute
difference of 1.85 mOsms/L (±2.13) between the eyes. There was no
statistically significant difference between the osmolarity readings of
cystinosis and the control group (294.8 ± 10.4 vs 299.4 ± 6.2mOsm/L,
respectively; p = 0.39). The mean TBUT was 10.2 ± 0.83 s in the study group
versus 10 ± 0.7 s in controls (p = 0.62). The mean Schirmer test score was
9.2 ± 0.83 mm in the patients versus 10.2 ± 0.83 mm in the controls
(p = 0.14). Conclusions The TearLabTM osmolarity system test showed good reliability and
precision in repeated measurements. This is the first report using the
TearLab osmolarity system to assess tear film in patients with cystinosis
treated with vCH 0.55%. TearLabTM examination showed that the use
of vCH 0.55% drops does not determine alterations of the tear film
quality.
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Affiliation(s)
- Petroni Sergio
- Ophthalmology Department, 9342Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Iarossi Giancarlo
- Ophthalmology Department, 9342Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federici Matteo
- Ophthalmology Department, 9342Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Petrocelli Gianni
- Ophthalmology Department, 9342Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rosa Parrilla
- Ophthalmology Department, 9342Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Valente
- Ophthalmology Department, 9342Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Buzzonetti Luca
- Ophthalmology Department, 9342Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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11
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Protection against corneal hyperosmolarity with soft-contact-lens wear. Prog Retin Eye Res 2021; 87:101012. [PMID: 34597771 DOI: 10.1016/j.preteyeres.2021.101012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
Hyperosmotic tear stimulates human corneal nerve endings, activates ocular immune response, and elicits dry-eye symptoms. A soft contact lens (SCL) covers the cornea preventing it from experiencing direct tear evaporation and the resulting blink-periodic salinity increases. For the cornea to experience hyperosmolarity due to tear evaporation, salt must transport across the SCL to the post-lens tear film (PoLTF) bathing the cornea. Consequently, limited salt transport across a SCL potentially protects the ocular surface from hyperosmotic tear. In addition, despite lens-wear discomfort sharing common sensations to dry eye, no correlation is available between measured tear hyperosmolarity and SCL-wear discomfort. Lack of documentation is likely because clinical measurements of tear osmolarity during lens wear do not interrogate the tear osmolarity of the PoLTF that actually overlays the cornea. Rather, tear osmolarity is clinically measured in the tear meniscus. For the first time, we mathematically quantify tear osmolarity in the PoLTF and show that it differs significantly from the clinically measured tear-meniscus osmolarity. We show further that aqueous-deficient dry eye and evaporative dry eye both exacerbate the hyperosmolarity of the PoLTF. Nevertheless, depending on lens salt-transport properties (i.e., diffusivity, partition coefficient, and thickness), a SCL can indeed protect against corneal hyperosmolarity by reducing PoLTF salinity to below that of the ocular surface during no-lens wear. Importantly, PoLTF osmolarity for dry-eye patients can be reduced to that of normal eyes with no-lens wear provided that the lens exhibits a low lens-salt diffusivity. Infrequent blinking increases PoLTF osmolarity consistent with lens-wear discomfort. Judicious design of SCL material salt-transport properties can ameliorate corneal hyperosmolarity. Our results confirm the importance of PoLTF osmolarity during SCL wear and indicate a possible relation between PoLTF osmolarity and contact-lens discomfort.
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12
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Abusharha AA, Al Yami A, Alsreea K, Fagehi R, Alsaqr A, Alanazi S, Masmali A. Repeatability and Reproducibility of Tear Film Evaporation Rate Measurement using a new Closed-Chamber Evaporimeter. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose:
This study evaluates the repeatability and reproducibility of tear film evaporation rate measurement using a commercially available handheld closed-chamber evaporimeter (VapoMeter, Delfin Technologies, Finland).
Study Design:
This was a randomized observational study, in which two visits were required. At visit 1, screening tests were performed on the participants. Subsequently, tear evaporation was measured thrice by examiner 1 (E1). The procedure was then repeated by examiner 2 (E2) at visit 2.
Methods:
40 healthy participants with no ocular diseases were recruited for this study. A closed chamber evaporimeter was used in this study (VapoMeter, Delfin Technologies, Finland). Primary investigations, including slit-lamp examination, tear production test, and ocular discomfort, were performed during the first visit for the purpose of screening.
Results:
The mean of the three measurements of tear evaporation obtained by examiner 1 at visit 1 was 19.38 ± 0.79 g/m2/h, and the mean of the three readings obtained by examiner 2 at visit 2 was 20.49 ± 0.48 g/m2/h. The average Intraclass Correlation Coefficient (ICC) among the three readings of tear evaporation was 0.84 and 0.63 with a 95% confidence interval (CI) at visits 1 and 2, respectively. A comparison of the reliability of the measurements from the two examiners revealed an ICC of 0.69 with a 95% CI.
Conclusion:
The VapoMeter provides repeatable and reproducible measurements of tear film evaporation. This study demonstrates that the VapoMeter could provide clinicians with a readily available method for rapid evaluation of tear film evaporation. By considering the significance of tear evaporation as a diagnostic tool for dry eyes, the VapoMeter may help to diagnose better and manage dry eye syndrome.
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13
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Braun RJ, Luke RA, Driscoll TA, Begley CG. Dynamics and mechanisms for tear breakup (TBU) on the ocular surface. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2021; 18:5146-5175. [PMID: 34517482 DOI: 10.3934/mbe.2021262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The human tear film is rapidly established after each blink, and is essential for clear vision and eye health. This paper reviews mathematical models and theories for the human tear film on the ocular surface, with an emphasis on localized flows where the tear film may fail. The models attempt to identify the important physical processes, and their parameters, governing the tear film in health and disease.
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Affiliation(s)
- Richard J Braun
- Department of Mathematical Sciences, University of Delaware, Newark, DE 19711, USA
| | - Rayanne A Luke
- Department of Mathematical Sciences, University of Delaware, Newark, DE 19711, USA
| | - Tobin A Driscoll
- Department of Mathematical Sciences, University of Delaware, Newark, DE 19711, USA
| | - Carolyn G Begley
- School of Optometry, Indiana University, Bloomington, IN 47405, USA
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14
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Affiliation(s)
- Ulrike Stahl
- Vision Cooperative Research Centre, Sydney, Australia
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, Australia
| | - Mark Willcox
- Vision Cooperative Research Centre, Sydney, Australia
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, Australia
- Institute for Eye Research, Sydney, Australia. E‐mail:
| | - Fiona Stapleton
- Vision Cooperative Research Centre, Sydney, Australia
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, Australia
- Institute for Eye Research, Sydney, Australia. E‐mail:
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15
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Luke RA, Braun RJ, Driscoll TA, Awisi-Gyau D, Begley CG. Parameter Estimation for Mixed-Mechanism Tear Film Thinning. Bull Math Biol 2021; 83:56. [PMID: 33835298 DOI: 10.1007/s11538-021-00871-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/11/2021] [Indexed: 11/29/2022]
Abstract
Etiologies of tear breakup include evaporation-driven, divergent flow-driven, and a combination of these two. A mathematical model incorporating evaporation and lipid-driven tangential flow is fit to fluorescence imaging data. The lipid-driven motion is hypothesized to be caused by localized excess lipid, or "globs." Tear breakup quantities such as evaporation rates and tangential flow rates cannot currently be directly measured during breakup. We determine such variables by fitting mathematical models for tear breakup and the computed fluorescent intensity to experimental intensity data gathered in vivo. Parameter estimation is conducted via least squares minimization of the difference between experimental data and computed answers using either the trust-region-reflective or Levenberg-Marquardt algorithm. Best-fit determination of tear breakup parameters supports the notion that evaporation and divergent tangential flow can cooperate to drive breakup. The resulting tear breakup is typically faster than purely evaporative cases. Many instances of tear breakup may have similar causes, which suggests that interpretation of experimental results may benefit from considering multiple mechanisms.
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Affiliation(s)
- Rayanne A Luke
- Department of Mathematical Sciences, University of Delaware, Newark, DE, 19716, USA.
| | - Richard J Braun
- Department of Mathematical Sciences, University of Delaware, Newark, DE, 19716, USA
| | - Tobin A Driscoll
- Department of Mathematical Sciences, University of Delaware, Newark, DE, 19716, USA
| | - Deborah Awisi-Gyau
- Department of Mathematical Sciences, University of Delaware, Newark, DE, 19716, USA
| | - Carolyn G Begley
- Department of Mathematical Sciences, University of Delaware, Newark, DE, 19716, USA
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16
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Relation of Dietary Fatty Acids and Vitamin D to the Prevalence of Meibomian Gland Dysfunction in Japanese Adults: The Hirado-Takushima Study. J Clin Med 2021; 10:jcm10020350. [PMID: 33477594 PMCID: PMC7831319 DOI: 10.3390/jcm10020350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/29/2020] [Accepted: 01/14/2021] [Indexed: 01/04/2023] Open
Abstract
Intervention studies have shown that n-3 polyunsaturated fatty acid (PUFA) supplementation is effective for the treatment of meibomian gland dysfunction (MGD). Ointment containing an analog of vitamin D has also been found to improve symptoms and signs of MGD. We have now evaluated the relation of MGD prevalence to dietary intake of fatty acids (FAs) and vitamin D among a Japanese population. Subjects comprised 300 adults aged 20 to 92 years residing on Takushima Island. MGD was diagnosed on the basis of subjective symptoms, lid margin abnormalities, and meibomian gland obstruction. Dietary FA and vitamin D intake was estimated with a brief-type self-administered diet history questionnaire. MGD prevalence was 35.3%. Multivariate adjusted odds ratios (95% confidence intervals) between extreme quintiles of intake for MGD prevalence were 0.40 (0.16–0.97) for total fat, 0.40 (0.17–0.97) for saturated FAs, 0.40 (0.17–0.97) for oleic acid, 0.52 (0.23–1.18) for n-3 PUFAs, 0.63 (0.27–1.49) for n-6 PUFAs, 1.32 (0.59–2.95) for the n-6/n-3 PUFA ratio, and 0.38 (0.17–0.87) for vitamin D. Total fat, saturated FA, oleic acid, and vitamin D intake may thus be negatively associated with MGD prevalence in the Japanese.
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Abstract
The precorneal tear film keeps the eye surface moist and helps to maintain normal eye function. The outermost lipid layer of the tear film, which attenuates tear film evaporation, contains meibum secreted from the meibomian gland. Most meibum lipids are neutral, including wax esters (WEs), cholesteryl esters (CEs), and diesters (DEs), along with some polar lipids including free fatty acids (FFAs), O-acyl-ω-hydroxy fatty acids (OAHFAs), and trace phospholipids. Detection of neutral lipids by mass spectrometry (MS) is challenging due to interference from impurities, particularly when working with minute-volume meibum samples. Here, we describe procedures for sample preparation and MS analysis of these elusive meibum lipids that can be used to examine dry eye disease mechanisms. Because the method described here minimizes impurity peaks for lipids generally, neutral and otherwise, it may be applied to high-sensitivity analysis of other biological samples.
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Affiliation(s)
- Jianzhong Chen
- Department of Optometry and Vision Science, The University of Alabama at Birmingham, Birmingham, AL, USA.
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18
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Abusharha A, Alsaqar A, Fagehi R, Alobaid M, Almayouf A, Alajlan S, Omair M, Alahmad E, Masmali A. Evaluation of Tear Film Osmolarity Among Diabetic Patients Using a TearLab Osmometer. CLINICAL OPTOMETRY 2021; 13:257-261. [PMID: 34512064 PMCID: PMC8420776 DOI: 10.2147/opto.s325768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/24/2021] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of the present study is to determine the effects of type 2 diabetes mellitus on tear osmolarity using a TearLab Osmolarity system. Moreover, the relationship between tear film osmolarity and ocular surface discomfort in controlled and uncontrolled diabetic patients was assessed. MATERIALS AND METHODS This study included 20 male type 2 diabetic patients aged 20 to 70 years (mean ± SD 49±12). A control group (18-43 years; 32.2 ± 6.5 years) consisting of 40 male subjects was also enrolled for comparison. The tear osmolarity was measured using the TearLab Osmolarity System. The ocular surface disease index questionnaire (OSDI) was used to assess ocular discomfort symptoms. RESULTS The mean tear osmolarity was 297 ± 8.00 and 296 ± 11 mOsm/L for controlled and uncontrolled diabetic subjects, respectively, while the average osmolarity in the control group was 299 ± 8.00 mOsm/L. No significant differences were detected in tear osmolarity between the control and diabetes groups. The ocular surface disease index questionnaire (OSDI) score was significantly higher in the diabetic patient group. No significant correlation was found between tear osmolarity and OSDI scores. CONCLUSION The ocular discomfort symptoms score in diabetic patients was significantly higher compared to normal eye subjects. Tear osmolarity was not significantly different in diabetic patients. This finding may be explained by a lack of relationship between tear film parameters and diabetic severity; tear film parameters may correlate more with diabetic duration rather than severity. Therefore, studies focused on diabetes duration and tear film parameters are recommended.
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Affiliation(s)
- Ali Abusharha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
- Correspondence: Ali Abusharha Department of Optometry, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh, 11433, Saudi Arabia Email
| | - Ali Alsaqar
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Mohammad Alobaid
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Ali Almayouf
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Sulaiman Alajlan
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Mossab Omair
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Essa Alahmad
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
| | - Ali Masmali
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, 11433, Saudi Arabia
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19
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Luke RA, Braun RJ, Driscoll TA, Begley CG, Awisi-Gyau D. Parameter Estimation for Evaporation-Driven Tear Film Thinning. Bull Math Biol 2020; 82:71. [DOI: 10.1007/s11538-020-00745-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
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20
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Alshammeri S, Madden L, Hagan S, Pearce EI. Strip meniscometry tube: a rapid method for assessing aqueous deficient dry eye. Clin Exp Optom 2019; 103:469-473. [PMID: 31272130 DOI: 10.1111/cxo.12941] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/30/2019] [Accepted: 06/02/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the utility of strip meniscometry tube (SMTube) for the quantitative assessment of the tear film, by comparing it to measurements of tear turnover rate using the gold standard method, fluorophotometry. Also, to determine the viability of this test as a diagnostic tool for aqueous deficient dry eye (ADDE), to inform appropriate clinical management. METHODS Thirty-two participants (15 ADDE; 17 non-ADDE) were recruited. Tear turnover rate of the right eye of each subject was conducted with an automated scanning fluorophotometer and SMTube test was conducted. Tear meniscus height was assessed using a slitlamp biomicroscope and eyepiece graticule. RESULTS Significant differences between the ADDE and the non-ADDE groups were found for all measures: tear turnover rate 7.9 ± 1.8 versus 19.6 ± 5.9 per cent/minute (p < 0.001), SMTube 3.2 ± 1.1 versus 5.7 ± 2.3 mm (p = 0.001) and tear meniscus height 0.18 ± 0.05 versus 0.23 ± 0.04 mm (p = 0.004). Moreover, significant correlations were found between tear turnover rate and SMTube (rho = 0.78, p < 0.001), tear turnover rate and tear meniscus height (rho = 0.54, p < 0.001) and SMTube and tear meniscus height (rho = 0.47, p < 0.01). Using a receiver operating characteristic curve, SMTube showed a sensitivity of 67 per cent and a specificity of 88 per cent for the diagnosis of ADDE. CONCLUSION Given its performance, availability, speed and the fact it is relatively cheap, the study shows that the SMTube can be used as an alternative to fluorophotometry to assess tear production. It appears from the results that SMTube is a viable minimally invasive test for the diagnosis of ADDE.
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Affiliation(s)
- Saleh Alshammeri
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK.,Department of Optometry and Vision Sciences, Qassim University, Buraidah, Saudi Arabia
| | - Louise Madden
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagan
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
| | - E Ian Pearce
- Department of Vision Sciences, Glasgow Caledonian University, Glasgow, UK
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21
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Fukuoka S, Arita R. Tear film lipid layer increase after diquafosol instillation in dry eye patients with meibomian gland dysfunction: a randomized clinical study. Sci Rep 2019; 9:9091. [PMID: 31235821 PMCID: PMC6591396 DOI: 10.1038/s41598-019-45475-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/14/2019] [Indexed: 12/13/2022] Open
Abstract
Diquafosol promotes secretion of tear fluid and mucin at the ocular surface and is administered for treatment of dry eye (DE). Tear film lipid layer is secreted from meibomian glands and stabilizes the tear film. We recently showed that diquafosol administration increased lipid layer thickness (LLT) for up to 60 min in normal human eyes. We here evaluated tear film lipid layer in DE patients (n = 47) with meibomian gland dysfunction (MGD) before as well as 30, 60, and 90 min after diquafosol administration. One drop of artificial tears or one drop of diquafosol was applied randomly to the eyes of each patient. Diquafosol significantly increased LLT at 30 (P < 0.001) and 60 (P = 0.042) min and noninvasive tear film breakup time for at least 90 min (P < 0.001 at each assessment point). Artificial tears had no such effect. Diquafosol significantly improved the tear interferometric pattern compared with artificial tears (P < 0.001 at each assessment point). A single topical administration of diquafosol thus improved LLT and tear film stability in DE patients with MGD, suggesting that diquafosol is a potential treatment not only for aqueous-deficient DE but also for evaporative DE associated with MGD.
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Affiliation(s)
- Shima Fukuoka
- Omiya Hamada Eye Clinic, 1-169-1 Sakuragicho, Omiya-ku, Saitama, Saitama, 330-0854, Japan.,Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Lid and Meibomian Gland Working Group (LIME), 626-11 Minami-Nakano, Minuma-ku, Saitama, Saitama, 337-0042, Japan
| | - Reiko Arita
- Itoh Clinic, 626-11 Minami-Nakano, Minuma-ku, Saitama, Saitama, 337-0042, Japan. .,Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Lid and Meibomian Gland Working Group (LIME), 626-11 Minami-Nakano, Minuma-ku, Saitama, Saitama, 337-0042, Japan.
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22
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Yokoi N, Georgiev GA. Tear Film-Oriented Diagnosis and Tear Film-Oriented Therapy for Dry Eye Based on Tear Film Dynamics. Invest Ophthalmol Vis Sci 2019; 59:DES13-DES22. [PMID: 30481801 DOI: 10.1167/iovs.17-23700] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
In December 2010 and January 2012, 3% diquafosol sodium ophthalmic solution and 2% rebamipide ophthalmic suspension, respectively, appeared first in Japan as prescription drugs for the treatment of dry eye (DE). Since then, not only the diagnosis and treatment but also the understanding of the pathophysiology of DE have greatly advanced, and a new concept of layer-by-layer diagnosis and treatment for DE, respectively termed "tear-film-oriented diagnosis" (TFOD) and "tear-film-oriented therapy" (TFOT) was born. This new concept is currently in the process of expanding from Japan to other Asian countries. TFOD is the method used for the differential diagnosis of DE, which includes aqueous-deficiency DE (ADDE), decreased wettability DE (DWDE), and increased evaporation DE (IEDE), through the dynamics of tear film (TF) and breakup patterns (BUPs) after the eye is opened. BUPs and/or each diagnosed DE subtype are/is able to distinguish the insufficient components of the ocular surface that are responsible for each BUP in a layer-by-layer fashion. Aqueous fluid, membrane-associated mucins (especially MUC16), and the lipid layer and/or secretory mucins must be insufficient in ADDE, DWDE, and IEDE, respectively, and this allows for a layer-by-layer treatment to be proposed for each BUP via the supplementation of the insufficient components, using the topical therapy currently available. In Japan, TF breakup is regarded as a visible core mechanism for DE, and an abnormal breakup time (i.e., ≤5 seconds) and symptoms are currently used for the diagnosis of DE. Therefore, TFOD and TFOT could be an ideal and practical pathway for clinicians to manage DE.
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Affiliation(s)
- Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Georgi As Georgiev
- Department of Optics and Spectroscopy, Faculty of Physics, St. Kliment Ohridski University of Sofia, Sofia, Bulgaria
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23
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Herbaut A, Liang H, Denoyer A, Baudouin C, Labbé A. [Tear film analysis and evaluation of optical quality: A review of the literature (French translation of the article)]. J Fr Ophtalmol 2019; 42:226-243. [PMID: 30879832 DOI: 10.1016/j.jfo.2018.10.004] [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: 07/12/2018] [Revised: 10/15/2018] [Accepted: 10/22/2018] [Indexed: 01/20/2023]
Abstract
Dry eye is a complex multifactorial disease of the ocular surface and tears. It is associated with ocular surface symptoms and is one of the most common causes for ophthalmologic consultation. Despite their frequent use in clinical practice, the usual tests to evaluate dry eye and ocular surface disease-history of symptoms, tear break-up time (TBUT), Meibomian gland evaluation, corneal fluorescein staining, Schirmer test-have shown low reproducibility and reliability. In addition, subjective symptoms are often weakly or poorly correlated with objective signs. Since the tear film is the first system through which light must pass, the optical quality of the eye is highly dependent on the homogeneity of the tear film. Various investigative methods have been developed to evaluate both the structural and functional quality of the tear film, such as corneal topography, interferometry, tear meniscus measurement, evaporation rate, tear osmolarity and even aberrometry. Some are easily accessible to clinicians, while others remain in the field of clinical research. All of these tests provide a better understanding of the pathophysiology of the tear film. This review hopes to provide an overview of the existing tests and their role in evaluating the significance of the tear film in visual function.
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Affiliation(s)
- A Herbaut
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU Sight Restore, Paris, France
| | - H Liang
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU Sight Restore, Paris, France; CHNO des Quinze-Vingts, IHU ForeRestore, INSERM-DHOS CIC 1423, Paris, France; Inserm, U968; UPMC Université Paris 06, UMR_S968, institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France
| | - A Denoyer
- Inserm, U968; UPMC Université Paris 06, UMR_S968, institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France; Service d'ophtalmologie, CHU Robert Debré, Université Reims, Champagne-Ardenne, Reims, France
| | - C Baudouin
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU Sight Restore, Paris, France; CHNO des Quinze-Vingts, IHU ForeRestore, INSERM-DHOS CIC 1423, Paris, France; Inserm, U968; UPMC Université Paris 06, UMR_S968, institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - A Labbé
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU Sight Restore, Paris, France; CHNO des Quinze-Vingts, IHU ForeRestore, INSERM-DHOS CIC 1423, Paris, France; Inserm, U968; UPMC Université Paris 06, UMR_S968, institut de la Vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, INSERMDHOS CIC 503, Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin-en-Yvelines, Versailles, France.
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24
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Yokoi N, Georgiev GA. Tear-film-oriented diagnosis for dry eye. Jpn J Ophthalmol 2019; 63:127-136. [PMID: 30783943 DOI: 10.1007/s10384-018-00645-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/28/2018] [Indexed: 01/19/2023]
Abstract
Tear-film (TF) stability protects the ocular surface epithelium from desiccation and is ensured via cooperation between the ocular surface components including constituents of the TF and ocular surface epithelium. Thus, when those components are insufficient or impaired, the TF breakup that initiates dry eye occurs. Recently, new, commercially available eye drops have appeared in Japan that enable TF stabilization via targeted supplementation of deficient ocular surface components. Hence, a new layer-by-layer diagnosis and treatment concept for dry eye, termed tear-film-oriented diagnosis and tear-film-oriented therapy (TFOD and TFOT, respectively), have emerged and become widely accepted in Asian countries and beyond. TFOD is a diagnostic method for dry eye based on the TF dynamics and breakup patterns (BUPs), through which dry-eye subtypes, including aqueous-deficient dry eye, decreased-wettability dry eye, and increased-evaporation dry eye, are diagnosed. BUPs and/or each diagnosed dry-eye subtype can, in a layer-by-layer fashion, reveal the insufficient ocular surface components responsible for the TF breakup. Using these data, the optimal topical TFOT to treat dry eye can be proposed by addressing the TF breakup via the supplementation of the insufficient components. In Japan, TF breakup is now regarded as a visible core mechanism of dry eye, and abnormal breakup time (ie, ≤ 5 seconds) and symptoms are currently considered part of the diagnostic criteria for dry eye. In this review, the importance of TF instability as a core manifestation of dry eye, the molecular mechanism of TF breakup, the concept of TFOD, and the methods for implementing TFOD for TFOT are introduced.
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Affiliation(s)
- Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto, 602-0841, Japan.
| | - Georgi As Georgiev
- Department of Optics and Spectroscopy, Faculty of Physics, St. Kliment Ohridski University of Sofia, Sofia, Bulgaria
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Herbaut A, Liang H, Denoyer A, Baudouin C, Labbé A. Tear film analysis and evaluation of optical quality: A review of the literature. J Fr Ophtalmol 2019; 42:e21-e35. [PMID: 30679123 DOI: 10.1016/j.jfo.2018.12.001] [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: 11/14/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 12/19/2022]
Abstract
Dry eye is a complex multifactorial disease of the ocular surface and tears. It is associated with ocular surface symptoms and is one of the most common causes for ophthalmologic consultation. Despite their frequent use in clinical practice, the usual tests to evaluate dry eye and ocular surface disease-history of symptoms, tear break-up time (TBUT), Meibomian gland evaluation, corneal fluorescein staining, Schirmer test-have shown low reproducibility and reliability. In addition, subjective symptoms are often weakly or poorly correlated with objective signs. Since the tear film is the first system through which light must pass, the optical quality of the eye is highly dependent on the homogeneity of the tear film. Various investigative methods have been developed to evaluate both the structural and functional quality of the tear film, such as corneal topography, interferometry, tear meniscus measurement, evaporation rate, tear osmolarity and even aberrometry. Some are easily accessible to clinicians, while others remain in the field of clinical research. All of these tests provide a better understanding of the pathophysiology of the tear film. This review hopes to provide an overview of the existing tests and their role in evaluating the significance of the tear film in visual function.
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Affiliation(s)
- A Herbaut
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU ForeSight, 75012 Paris, France
| | - H Liang
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU ForeSight, 75012 Paris, France; Inserm-DHOS CIC 1423CHNO des Quinze-Vingts, IHU ForeSight, 75012 Paris, France; Inserm, U968; UPMC, université Paris 06, UMR_S968, institut de la vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, Inserm-DHOS CIC 503, 75012 Paris, France
| | - A Denoyer
- Inserm, U968; UPMC, université Paris 06, UMR_S968, institut de la vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, Inserm-DHOS CIC 503, 75012 Paris, France; Service d'ophtalmologie, CHU Robert-Debré, université Reims, Champagne-Ardenne, 51100 Reims, France
| | - C Baudouin
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU ForeSight, 75012 Paris, France; Inserm-DHOS CIC 1423CHNO des Quinze-Vingts, IHU ForeSight, 75012 Paris, France; Inserm, U968; UPMC, université Paris 06, UMR_S968, institut de la vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, Inserm-DHOS CIC 503, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, université de Versailles Saint-Quentin-en-Yvelines, AP-HP, 78000 Versailles, France
| | - A Labbé
- Service d'ophtalmologie III, CHNO des Quinze-Vingts, IHU ForeSight, 75012 Paris, France; Inserm-DHOS CIC 1423CHNO des Quinze-Vingts, IHU ForeSight, 75012 Paris, France; Inserm, U968; UPMC, université Paris 06, UMR_S968, institut de la vision; CNRS, UMR 7210; CHNO des Quinze-Vingts, Inserm-DHOS CIC 503, 75012 Paris, France; Service d'ophtalmologie, hôpital Ambroise-Paré, université de Versailles Saint-Quentin-en-Yvelines, AP-HP, 78000 Versailles, France.
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Abusharaha A, Alturki AA, Alanazi SA, Fagehi R, Al-Johani N, El-Hiti GA, Masmali AM. Assessment of tear-evaporation rate in thyroid-gland patients. Clin Ophthalmol 2019; 13:131-135. [PMID: 30662256 PMCID: PMC6327900 DOI: 10.2147/opth.s188614] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the tear-evaporation rate in thyroid-gland patients using a VapoMeter. Methods Twenty thyroid gland patients aged 18-43 years (mean 34.3±6.3 years) completed the study. Additionally, an age-matched control group of 20 patients aged 18-43 years (32.2±5.1 years) was enrolled in the study for comparison purposes. An Ocular Surface Disease Index dry-eye questionnaire was completed, followed by a test to determine the tear-evaporation rate using the VapoMeter. The test was performed three times per subject by the same examiner. Two readings were obtained each time. Results Significant differences (P<0.05) were found between mean Ocular Surface Disease Index and tear-evaporation-rate scores within the study and control groups. The average tear-evaporation rate was much higher in the study group (median 41.2 [IQR 41.4] g/m2⋅h) than the control group (15.7 [13.7] g/m2⋅h). Moreover, the average Ocular Surface Disease Index score for thyroid-gland patients was much higher (15.6 [23.4]) compared to the control group (5.5 [7.50]). Conclusion The tear-evaporation rate in thyroid-gland patients was found to be much higher than normal-eye subjects.
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Affiliation(s)
- Ali Abusharaha
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Abdulaziz A Alturki
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Saud A Alanazi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Naji Al-Johani
- Department of Endocrinology and Thyroid Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh 11433, Saudi Arabia
| | - Gamal A El-Hiti
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
| | - Ali M Masmali
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia,
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Lee SM, Chung SJ, Lew H. Evaluation of Tear Film Lipid Layer Thickness Measurements Obtained Using an Ocular Surface Interferometer in Nasolacrimal Duct Obstruction Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:445-450. [PMID: 30549467 PMCID: PMC6288021 DOI: 10.3341/kjo.2018.0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/16/2018] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare the tear film lipid layer thickness (LLT) between patients with incomplete nasolacrimal duct obstruction (NLDO) and normal controls and to analyze the changes in tear film LLT and blinking pattern after silicone tube intubation in NLDO patients. Methods We reviewed the medical records of 68 eyes in 52 incomplete NLDO patients who underwent silicone tube intubation from January 2017 to July 2017. The LLT, blinking pattern, and Meibomian gland image were measured with the LipiView II ocular surface interferometer. The Meibomian gland drop-out ratio was measured using the polygon selection tool in the Image J program. Tear meniscus height, which is the other lacrimal indicator, was assessed with spectral-domain optical coherence tomography. Results Tear meniscus height was significantly decreased after silicone tube intubation (p < 0.01). Preoperative minimum, maximum, and average LLT values were 62.4 ± 24.0, 86.7 ± 17.9, and 71.7 ± 23.3 nm, respectively. Significant changes in the minimum, maximum, and average LLT (74.8 ± 23.6, 98.8 ± 11.0, and 91.6 ± 16.1 nm, respectively) were observed after silicone tube intubation (p < 0.001, p = 0.001, and p < 0.001). The partial blinking/total blinking ratio in 20 seconds and the Meibomian gland drop-out ratio showed no significant change after silicone tube intubation. Conclusions Overall, the LLT was increased after silicone tube intubation. Silicone tube intubation may be helpful in maintaining LLT with a normalized of amount of tears.
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Affiliation(s)
- Sang Min Lee
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Sok Joong Chung
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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Postnikoff CK, Huisingh C, McGwin G, Nichols KK. Leukocyte Distribution in the Open Eye Tears of Normal and Dry Eye Subjects. Curr Eye Res 2018; 43:1253-1259. [PMID: 30005585 DOI: 10.1080/02713683.2018.1500611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
PURPOSE Leukocytes accumulate in the eye with sleep, but little is known about the presence or absence of leukocytes in awake, open eye tears. This study sought to compare normal and dry eye subjects for daily variation in open eye leukocyte composition. MATERIALS AND METHODS Ten normal subjects and nine dry eye subjects were enrolled. Subjects were trained for self-collection of tear samples using an ocular surface wash with 5 mL of phosphate buffered saline per eye. Subjects performed washes at awakening, between 8 and 9 am, between 11 am and 12 pm, and between 4 pm and 5 pm on four separate days. Leukocytes were isolated from the wash and were counted with a cell counter before staining with an anti-CD45 antibody and viability stain. Stained leukocytes were then analyzed via flow cytometry. Side scatter characteristics were used to distinguish granulocytes from lymphocytes. Results were interpreted both by time of wash as well as time from awakening. RESULTS At awakening, dry eye subjects had approximately twice as many recovered leukocytes and had a statistically significantly higher granulocyte-to-lymphocyte ratio as compared to normals. Leukocytes were rapidly cleared from the eye with a significant decrease in leukocyte counts at the 8 am time point as compared to awakening. Leukocyte counts across all open eye time points appeared to be consistent, with no differences between normal and dry eye subjects. CONCLUSIONS There is a low level, constitutively expressed population of leukocytes in the open eye tears of normal and dry eye subjects. Higher levels of granulocytes in dry eye disease subjects warrants further investigation into this population of cells, and their role in homeostasis and dysregulation.
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Affiliation(s)
- Cameron K Postnikoff
- a School of Optometry , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Carrie Huisingh
- a School of Optometry , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Gerald McGwin
- a School of Optometry , University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Kelly K Nichols
- a School of Optometry , University of Alabama at Birmingham , Birmingham , Alabama , USA
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Braun RJ, Driscoll TA, Begley CG, King-Smith PE, Siddique JI. On tear film breakup (TBU): dynamics and imaging. MATHEMATICAL MEDICINE AND BIOLOGY : A JOURNAL OF THE IMA 2018; 35:145-180. [PMID: 28339681 PMCID: PMC5998802 DOI: 10.1093/imammb/dqw023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 12/16/2016] [Accepted: 12/17/2016] [Indexed: 01/10/2023]
Abstract
We report the results of some recent experiments to visualize tear film dynamics. We then study a mathematical model for tear film thinning and tear film breakup (TBU), a term from the ocular surface literature. The thinning is driven by an imposed tear film thinning rate which is input from in vivo measurements. Solutes representing osmolarity and fluorescein are included in the model. Osmolarity causes osmosis from the model ocular surface, and the fluorescein is used to compute the intensity corresponding closely to in vivo observations. The imposed thinning can be either one-dimensional or axisymmetric, leading to streaks or spots of TBU, respectively. For a spatially-uniform (flat) film, osmosis would cease thinning and balance mass lost due to evaporation; for these space-dependent evaporation profiles TBU does occur because osmolarity diffuses out of the TBU into the surrounding tear film, in agreement with previous results. The intensity pattern predicted based on the fluorescein concentration is compared with the computed thickness profiles; this comparison is important for interpreting in vivo observations. The non-dimensionalization introduced leads to insight about the relative importance of the competing processes; it leads to a classification of large vs small TBU regions in which different physical effects are dominant. Many regions of TBU may be considered small, revealing that the flow inside the film has an appreciable influence on fluorescence imaging of the tear film.
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Affiliation(s)
- Richard J Braun
- Department of Mathematical Sciences, University of Delaware, Newark, DE, USA
| | - Tobin A Driscoll
- Department of Mathematical Sciences, University of Delaware, Newark, DE, USA
| | | | | | - Javed I Siddique
- Department of Mathematics, Pennsylvania State University, York, PA, USA
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Tear evaporation rates: What does the literature tell us? Cont Lens Anterior Eye 2018; 41:297-306. [DOI: 10.1016/j.clae.2017.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 10/18/2017] [Accepted: 12/01/2017] [Indexed: 12/15/2022]
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Bennet D, Estlack Z, Reid T, Kim J. A microengineered human corneal epithelium-on-a-chip for eye drops mass transport evaluation. LAB ON A CHIP 2018; 18:1539-1551. [PMID: 29736535 DOI: 10.1039/c8lc00158h] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Animals are commonly used for pharmacokinetic studies which are the most frequent events tested during ocular drug development and preclinical evaluation. Inaccuracy, cost, and ethical criticism in these tests have created a need to construct an in vitro model for studying corneal constraints. In this work, a porous membrane embedded microfluidic platform is fabricated that separates a chip into an apical and basal side. After functionalizing the membrane surface with fibronectin, the membrane's mechanical and surface properties are measured to ensure correct modeling of in vivo characteristics. Immortalized human corneal epithelial cells are cultured on the membrane to create a microengineered corneal epithelium-on-a-chip (cornea chip) that is validated with experiments designed to test the barrier properties of the human corneal epithelium construct using model drugs. A pulsatile flow model is used that closely mimics the ocular precorneal constraints and is reasonable for permeability analysis that models in vivo conditions. This model can be used for preclinical evaluations of potential therapeutic drugs and to mimic the environment of the human cornea.
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Affiliation(s)
- Devasier Bennet
- Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas 79409, USA.
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Li L, Braun RJ, Henshaw WD, King-Smith PE. Computed flow and fluorescence over the ocular surface. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2018; 35:51-85. [PMID: 29036609 DOI: 10.1093/imammb/dqx011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 08/21/2017] [Indexed: 11/14/2022]
Abstract
Fluorescein is perhaps the most commonly used substance to visualize tear film thickness and dynamics; better understanding of this process aids understanding of dry eye syndrome which afflicts millions of people. We study a mathematical model for tear film flow, evaporation, solutal transport and fluorescence over the exposed ocular surface during the interblink. Transport of the fluorescein ion by fluid flow in the tear film affects the intensity of fluorescence via changes in concentration and tear film thickness. Evaporation causes increased osmolarity and potential irritation over the ocular surface; it also alters fluorescein concentration and thus fluorescence. Using thinning rates from in vivo measurements together with thin film equations for flow and transport of multiple solutes, we compute dynamic results for tear film quantities of interest. We compare our computed fluorescent intensity distributions with in vivo observations. A number of experimental features are recovered by the model.
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Affiliation(s)
- Longfei Li
- Department of Mathematical Sciences, Rensselaer Polytechnic Institute, Troy NY, 12180, USA
| | - R J Braun
- Department of Mathematical Sciences, University of Delaware, Newark, DE 19711, USA
| | - W D Henshaw
- Department of Mathematical Sciences, Rensselaer Polytechnic Institute, Troy NY, 12180, USA
| | - P E King-Smith
- College of Optometry, The Ohio State University, Columbus, OH 43218, USA
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Willshire C, Bron AJ, Gaffney EA, Pearce EI. Basal Tear Osmolarity as a metric to estimate body hydration and dry eye severity. Prog Retin Eye Res 2018; 64:56-64. [PMID: 29476817 DOI: 10.1016/j.preteyeres.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/02/2018] [Accepted: 02/20/2018] [Indexed: 01/28/2023]
Abstract
The osmolarities of various bodily fluids, including tears, saliva and urine, have been used as indices of plasma osmolality, a measure of body hydration, while tear osmolarity is used routinely in dry eye diagnosis, the degree of tear hyperosmolarity providing an index of disease severity. Systemic dehydration, due to inadequate water intake or excessive water loss is common in the elderly population, has a high morbidity and may cause loss of life. Its diagnosis is often overlooked and there is a need to develop a simple, bedside test to detect dehydration in this population. We hypothesize that, in the absence of tear evaporation and with continued secretion, mixing and drainage of tears, tear osmolarity falls to a basal level that is closer to that of the plasma than that of a tear sample taken in open eye conditions. We term this value the Basal Tear Osmolarity (BTO) and propose that it may be measured in tear samples immediately after a period of evaporative suppression. This value will be particular to an individual and since plasma osmolarity is controlled within narrow limits, it is predicted that it will be stable and have a small variance. It is proposed that the BTO, measured immediately after a defined period of eye closure, can provide a new metric in the diagnosis of systemic dehydration and a yardstick against which to gauge the severity of dry eye disease.
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Affiliation(s)
- C Willshire
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK
| | - A J Bron
- Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK; Nuffield Department of Clinical Neurosciences and Nuffield Laboratory of Ophthalmology, University of Oxford, UK.
| | - E A Gaffney
- Wolfson Centre of Mathematical Biology, Mathematical Institute, University of Oxford, UK
| | - E Ian Pearce
- School of Health and Life Sciences, Glasgow Caledonian University, UK
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Garaszczuk IK, Montes Mico R, Iskander DR, Expósito AC. The tear turnover and tear clearance tests – a review. Expert Rev Med Devices 2018; 15:219-229. [DOI: 10.1080/17434440.2018.1435271] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Izabela K. Garaszczuk
- Department of Optics, Optometry and Vision Sciences, University of Valencia, Valencia, Spain
| | - Robert Montes Mico
- Department of Optics, Optometry and Vision Sciences, University of Valencia, Valencia, Spain
| | - D. Robert Iskander
- Department of Biomedical Engineering, Wroclaw University of Science and Technology, Wroclaw, Poland
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Abusharha AA, AlShehri TM, Hakami AY, Alsaqr AM, Fagehi RA, Alanazi SA, Masmali AM. Analysis of basal and reflex human tear osmolarity in normal subjects: assessment of tear osmolarity. Ther Adv Ophthalmol 2018; 10:2515841418794886. [PMID: 30151502 PMCID: PMC6104209 DOI: 10.1177/2515841418794886] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the difference between reflex and basal tear osmolarity among healthy normal subjects. METHOD The right eyes of 20 healthy normal male subjects aged 20 to 40 years were recruited for this study. The inclusion criteria for the subjects were the Ocular Surface Disease Index questionnaire score of less than 12 and wetting length of the phenol red thread of more than 10 mm. Tear film osmolarity was assessed using TearLab osmometer. Basic tear osmolarity was measured normally without inducing any irritation to the eye. In order to stimulate reflex tear, subjects were asked to open their eye as long as they can till they feel ocular surface irritation (minimum 20 s). RESULTS The mean score on the Ocular Surface Disease Index questionnaire was 5.5 ± 3. The mean value obtained from the phenol red thread was 21 ± 4.5 mm. There were no statistically significant differences between the osmolarity readings of basal and reflex tear osmolarity (p > 0.05). The mean value was 308 ± 12 and 306 ± 9 mOsm/l for basic and reflex tear osmolarity, respectively. CONCLUSION This study found that the osmolarity of the basal and reflex tears fell within the same range. The values found in this study are in agreement with published results for normal subjects.
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Affiliation(s)
- Ali A. Abusharha
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M. AlShehri
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Y. Hakami
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali M. Alsaqr
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Raied A. Fagehi
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Saud A. Alanazi
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Ali M. Masmali
- Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Stapf MR, Braun RJ, King-Smith PE. Duplex Tear Film Evaporation Analysis. Bull Math Biol 2017; 79:2814-2846. [DOI: 10.1007/s11538-017-0351-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 09/22/2017] [Indexed: 01/03/2023]
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Georgiev GA, Eftimov P, Yokoi N. Structure-function relationship of tear film lipid layer: A contemporary perspective. Exp Eye Res 2017; 163:17-28. [PMID: 28950936 DOI: 10.1016/j.exer.2017.03.013] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 01/29/2023]
Abstract
Tear film lipid layer (TFLL) stabilizes the air/tear surface of the human eye. Meibomian gland dysfunction (MGD) resulting in quantitative and qualitative modifications of TFLL major (>93%) component, the oily secretion of meibomian lipids (MGS), is the world leading cause of dry eye syndrome (DES) with up to 86% of all DES patients showing signs of MGD. Caused by intrinsic factors (aging, ocular and general diseases) and by extrinsic everyday influences like contact lens wear and extended periods in front of a computer screen, DES (resulting in TF instability, visual disturbances and chronic ocular discomfort) is the major ophthalmic public health disease of the present time affecting the quality of life of 10-30% of the human population worldwide. Therefore there is a pressing need to summarize the present knowledge, contradictions and open questions to be resolved in the field of TFLL composition/structure/functions relationship. The following major aspects are covered by the review: (i) Do we have a reliable mimic for TFLL: MGS vs contact lens lipid extracts (CLLE) vs lipid extracts from whole tears. Does TFLL truly consist of lipids only or it is important to keep in mind the TF proteins as well?; (ii) Structural properties of TFLL and of its mimics in health and disease in vitro and in vivo. How the TFLL uniformity and thickness ensures the functionality of the lipid layer (barrier to evaporation, surface properties, TF stability etc.); (iii) What are the main functions of the TFLL? In this aspect an effort is done to emphasize that there is no single main function of TFLL but instead it simultaneously fulfills plethora of functions: suppresses the evaporation (alone or probably in cooperation with other TF constituents) of the aqueous tears; stabilizes (due to its surface properties) the air/tear surface at eye opening and during the interblink interval; and even acts as a first line of defense against bacterial invasion due to its detergency action on the bacterial membranes. An effort is done to highlight how the concept on the importance of TFLL and TF viscoelasticity transpires from old and new studies and what are its clinical implications. An attempt is made to outline the future hot directions of research into the field ranging from quest for molecules that can significantly alter TFLL properties to addressing open questions on the contribution of TFLL to the overall performance of the TF.
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Affiliation(s)
- Georgi As Georgiev
- St. Kliment Ohridski University of Sofia, Department of Optics and Spectroscopy, Faculty of Physics, 5 James Bourchier Blvd., 1164 Sofia, Bulgaria.
| | - Petar Eftimov
- Department of Cytology, Histology and Embryology, Faculty of Biology, St. Kliment Ohridski University of Sofia, Sofia, Bulgaria
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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King-Smith PE, Begley CG, Braun RJ. Mechanisms, imaging and structure of tear film breakup. Ocul Surf 2017; 16:4-30. [PMID: 28935579 DOI: 10.1016/j.jtos.2017.09.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 08/10/2017] [Accepted: 09/15/2017] [Indexed: 12/14/2022]
Abstract
Tear film breakup (BU) is an important aspect of dry eye disease, as a cause of ocular aberrations, irritation and ocular surface inflammation and disorder. Additionally, measurement of breakup time (BUT) is a common clinical test for dry eye. The current definition of BUT is subjective; here, a more objective concept of "touchdown" - the moment when the lipid layer touches down on the corneal surface - is proposed as an aid to understanding processes in early and late stages of BU development. Models of BU have generally been based on the assumption that a single mechanism is involved. In this review, it is emphasized that BU does not have a single explanation but it is the end result of multiple processes. A three-way classification of BU is proposed - "immediate," "lid-associated," and "evaporative." Five different types of imaging systems are described, which have been used to help elucidate the processes involved in BU and BUT; a new method, "high resolution chromaticity images," is presented. Three directions of tear flow - evaporation, osmotic flow out of the ocular surface, and "tangential flow" along the ocular surface - determine tear film thinning between blinks, leading to BU. Ten factors involved in BU and BUT, both before and after touchdown, are discussed. Future directions of research on BU are proposed.
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Classification of Fluorescein Breakup Patterns: A Novel Method of Differential Diagnosis for Dry Eye. Am J Ophthalmol 2017; 180:72-85. [PMID: 28579061 DOI: 10.1016/j.ajo.2017.05.022] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE To investigate the relationship between fluorescein breakup patterns (FBUPs) and clinical manifestations in dry eye cases. DESIGN Cross-sectional study. METHODS In 106 eyes of 106 subjects (19 male, 87 female; mean age: 64.2 years), FBUPs were categorized into 1 of the following 5 break (B) types: area (AB, n = 19); spot (SB, n = 22); line (LB, n = 24); dimple (DB, n = 19); random (RB, n = 22 eyes); and dry eye-related symptoms using the visual analog scale (VAS, 100 mm = maximum), tear meniscus radius (TMR, mm), tear film lipid layer interference grade (IG) (grades 1-5; 1 = best) and spread grade (SG) (grades 1-4; 1 = best), tear film noninvasive breakup time (NIBUT, seconds), fluorescein breakup time (FBUT, seconds), corneal-epithelial damage (CED) score (15 points = maximum), ocular surface epithelial damage (OSED) score (9 points = maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBUP. RESULTS In each FBUP, eye dryness and fatigue were the severest symptoms. Characteristic symptoms were sensitivity to light, heavy eyelids, pain, foreign body sensation, difficulty opening the eye, and discharge for AB, heavy eyelids for SB, and foreign-body sensation for LB. Statistically significant differences were found in TMR (AB-SB, -DB, and -RB; LB-RB), IG (AB-all other FBUP; LB-SB and -DB), and SG (AB-all other FBUPs), FBUT (AB-LB, -DB, and -RB; SB-DB and -RB; LB-RB; DB-RB), and NIBUT (AB-all other FBUPs; SB-DB and-RB, and LB-RB), CED (AB-all other FBUPs; LB-SB, -DB, and -RB) and OSED (AB-SB, -LB, and -DB; LB-SB, -DB, and -RB), and ST1 (AB-SB, -DB, and -LB) (P < .05 in each comparison). CONCLUSIONS The 5 different FBUPs constituted different groups, reflecting different pathophysi-ologies.
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Bron AJ, de Paiva CS, Chauhan SK, Bonini S, Gabison EE, Jain S, Knop E, Markoulli M, Ogawa Y, Perez V, Uchino Y, Yokoi N, Zoukhri D, Sullivan DA. TFOS DEWS II pathophysiology report. Ocul Surf 2017; 15:438-510. [PMID: 28736340 DOI: 10.1016/j.jtos.2017.05.011] [Citation(s) in RCA: 1019] [Impact Index Per Article: 145.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 05/26/2017] [Indexed: 12/18/2022]
Abstract
The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjögren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.
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Affiliation(s)
- Anthony J Bron
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Vision and Eye Research Unit, Anglia Ruskin University, Cambridge, UK.
| | - Cintia S de Paiva
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Sunil K Chauhan
- Schepens Eye Research Institute & Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Stefano Bonini
- Department of Ophthalmology, University Campus Biomedico, Rome, Italy
| | - Eric E Gabison
- Department of Ophthalmology, Fondation Ophtalmologique Rothschild & Hôpital Bichat Claude Bernard, Paris, France
| | - Sandeep Jain
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Erich Knop
- Departments of Cell and Neurobiology and Ocular Surface Center Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Victor Perez
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Driss Zoukhri
- Tufts University School of Dental Medicine, Boston, MA, USA
| | - David A Sullivan
- Schepens Eye Research Institute & Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Abstract
The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership.
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Perényi K, Dienes L, Kornafeld A, Kovács B, Kiss HJ, Szepessy Z, Nagy ZZ, Barsi Á, Acosta MC, Gallar J, Kovács I. The Effect of Tear Supplementation with 0.15% Preservative-Free Zinc-Hyaluronate on Ocular Surface Sensations in Patients with Dry Eye. J Ocul Pharmacol Ther 2017; 33:487-492. [DOI: 10.1089/jop.2016.0194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristóf Perényi
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Lóránt Dienes
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Anna Kornafeld
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Balázs Kovács
- Department of Ophthalmology, Kaposi Mor Hospital, Kaposvár, Hungary
| | - Huba J. Kiss
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Z. Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Árpád Barsi
- Department of Photogrammetry and Geoinformatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - M. Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Estlack Z, Bennet D, Reid T, Kim J. Microengineered biomimetic ocular models for ophthalmological drug development. LAB ON A CHIP 2017; 17:1539-1551. [PMID: 28401229 DOI: 10.1039/c7lc00112f] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Current ophthalmological drug discovery and testing methods have limitations and concerns regarding reliability, ethicality, and applicability. These drawbacks can be mitigated by developing biomimetic eye models through mathematical and experimental methods which are often referred to as "eye-on-a-chip" or "eye chip". These eye chip technologies emulate ocular physiology, anatomy, and microenvironmental conditions. Such models enable understanding of the fundamental biology, pharmacology, and toxicology mechanisms by investigating the pharmacokinetics and pharmacodynamics of various candidate drugs under ocular anatomical and physiological conditions without animal models. This review provides a comprehensive overview of the latest advances in theoretical and in vitro experimental models of the anterior segment of the eye and its microenvironment, including eye motions and tear film dynamics. The current state of ocular modeling and simulation from predictive models to experimental models is discussed in detail with their advantages and limitations. The potential for future eye chip models to expedite new ophthalmic drug discoveries is also discussed.
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Affiliation(s)
- Zachary Estlack
- Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas 79409, USA.
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Bai Y, Nichols JJ. Advances in thickness measurements and dynamic visualization of the tear film using non-invasive optical approaches. Prog Retin Eye Res 2017; 58:28-44. [DOI: 10.1016/j.preteyeres.2017.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/09/2017] [Accepted: 02/20/2017] [Indexed: 12/13/2022]
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Fukuoka S, Arita R. Increase in tear film lipid layer thickness after instillation of 3% diquafosol ophthalmic solution in healthy human eyes. Ocul Surf 2017; 15:730-735. [PMID: 28363586 DOI: 10.1016/j.jtos.2017.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the effect of 3% diquafosol ophthalmic solution on tear film lipid layer thickness (LLT) in normal human eyes by tear interferometry. METHODS Forty-seven healthy men (mean age of 42.4 years) randomly received one drop of artificial tears in one eye and one drop of 3% diquafosol ophthalmic solution in the other. LLT of each eye was quantified by tear interferometry before and 15, 30, and 60 min after instillation. Ocular symptoms were assessed before and 30 min after instillation. Baseline LLT, tear film breakup time (TBUT), meibomian gland area (meiboscore) of the upper and lower eyelids, and Schirmer test value were evaluated on a different day before treatment. RESULTS LLT before and 15, 30, and 60 min after diquafosol instillation was 62.3 ± 31.1, 77.0 ± 39.5, 79.3 ± 40.5, and 77.7 ± 43.6 nm, respectively, with the diquafosol-induced increase in LLT being significant at each time point. Artificial tears did not result in a significant increase in LLT. TBUT (ρ = 0.32, P = 0.026), meiboscore of the lower eyelid (ρ = -0.33, P = 0.022), and the maximum difference in LLT between before and after diquafosol instillation (ΔLLTmax) (ρ = 0.35, P = 0.016) were significantly correlated with baseline LLT in the diquafosol group. Age was not significantly related to baseline LLT or ΔLLTmax. Symptoms did not differ significantly between the two groups. CONCLUSIONS Topical instillation of 3% diquafosol ophthalmic solution increased LLT for up to 60 min in normal human eyes regardless of age.
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Affiliation(s)
- Shima Fukuoka
- Omiya Hamada Eye Clinic, Saitama, Japan; Lid and Meibomian Gland Working Group (LIME), Japan; Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| | - Reiko Arita
- Lid and Meibomian Gland Working Group (LIME), Japan; Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan; Department of Ophthalmology, Itoh Clinic, Saitama, Japan.
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Rajabi MT, Sharifzadeh M. "Coffee Ring Effect" in Ophthalmology: "Anionic Dye Deposition" Hypothesis Explaining Normal Lid Margin Staining. Medicine (Baltimore) 2016; 95:e3137. [PMID: 27057835 PMCID: PMC4998751 DOI: 10.1097/md.0000000000003137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The process of formation of Marx line is studied in this article. Various theories have been proposed previously, in order to explain the mechanisms which lead to the development of Marx line. These theories are based on the characteristics of stained area and do not pay attention to the behavior of dye solution itself on the surface. The aim of this study is to investigate the latter behavior and introduce a new theory based on it, in order to explain the process of the Marx line formation.This study also introduces "Coffee Ring Effect" and its possible applications in explaining some ophthalmological phenomena.The effect of dye solution's behavior on the beneath surface is adopted in order to propose a novel theory. This new hypothesis is called "Anionic Dye Deposition" which was based on "Coffee Ring Effect" phenomenon. For evaluation of this theory, Evaporation pattern of Rose Bengal and fluorescein were analyzed on different surfaces. Furthermore, the effect of tear meniscus alteration on lid margin staining is studied.During the evaporation process of dye solutions, it was observed that almost all of the solute was deposited at the edge of the drop on hydrophilic surfaces. Furthermore, in the study of lid margin staining, it is observed that tear meniscus alteration during gaze affects staining pattern. This observation invalidates former hypotheses which only focus on stained surface characteristics.According to the observations in this study, it is proposed that Marx line staining occurs as a result of "anionic dye deposition" due to evaporation.
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Affiliation(s)
- Mohammad Taher Rajabi
- From the Farabi Eye Hospital (MTR, MS), Tehran University of Medical Sciences, Tehran, Iran
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Dienes L, Kiss HJ, Perényi K, Szepessy Z, Nagy ZZ, Barsi Á, Acosta MC, Gallar J, Kovács I. The Effect of Tear Supplementation on Ocular Surface Sensations during the Interblink Interval in Patients with Dry Eye. PLoS One 2015; 10:e0135629. [PMID: 26302222 PMCID: PMC4547761 DOI: 10.1371/journal.pone.0135629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 07/24/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the characteristics of ocular surface sensations and corneal sensitivity during the interblink interval before and after tear supplementation in dry eye patients. METHODS Twenty subjects (41.88±14.37 years) with dry eye symptoms were included in the dry eye group. Fourteen subjects (39.13±11.27 years) without any clinical signs and/or symptoms of dry eye were included in the control group. Tear film dynamics was assessed by non-invasive tear film breakup time (NI-BUT) in parallel with continuous recordings of ocular sensations during forced blinking. Corneal sensitivity to selective stimulation of corneal mechano-, cold and chemical receptors was assessed using a gas esthesiometer. All the measurements were made before and 5 min after saline and hydroxypropyl-guar (HP-guar) drops. RESULTS In dry eye patients the intensity of irritation increased rapidly after the last blink during forced blinking, while in controls there was no alteration in the intensity during the first 10 sec followed by an exponential increase. Irritation scores were significantly higher in dry eye patients throughout the entire interblink interval compared to controls (p<0.004). NI-BUT significantly increased after HP-guar (p = 0.003) but not after saline drops (p = 0.14). In both groups, either after saline or HP-guar the shape of symptom intensity curves remained the same with significantly lower irritation scores (p<0.004), however after HP-guar the decrease was significantly more pronounced (p<0.004). Corneal sensitivity to selective mechanical, cold and chemical stimulation decreased significantly in both groups after HP-guar (p<0.05), but not after saline drops (p>0.05). CONCLUSION Ocular surface irritation responses due to tear film drying are considerably increased in dry eye patients compared to normal subjects. Although tear supplementation improves the protective tear film layer, and thus reduce unpleasant sensory responses, the rapid rise in discomfort is still maintained and might be responsible for the remaining complaints of dry eye patients despite the treatment.
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Affiliation(s)
- Lóránt Dienes
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Huba J Kiss
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Kristóf Perényi
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Zoltán Z Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Árpád Barsi
- Department of Photogrammetry and Geoinformatics, Budapest University of Technology and Economics, Budapest, Hungary
| | - M Carmen Acosta
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Juana Gallar
- Instituto de Neurociencias, Universidad Miguel Hernandez-CSIC, San Juan de Alicante, Spain
| | - Illés Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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Li L, Braun RJ, Driscoll TA, Henshaw WD, Banks JW, King-Smith PE. Computed tear film and osmolarity dynamics on an eye-shaped domain. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2015; 33:123-57. [PMID: 25883248 PMCID: PMC5394582 DOI: 10.1093/imammb/dqv013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 03/12/2015] [Indexed: 12/15/2022]
Abstract
The concentration of ions, or osmolarity, in the tear film is a key variable in understanding dry eye symptoms and disease. In this manuscript, we derive a mathematical model that couples osmolarity (treated as a single solute) and fluid dynamics within the tear film on a 2D eye-shaped domain. The model includes the physical effects of evaporation, surface tension, viscosity, ocular surface wettability, osmolarity, osmosis and tear fluid supply and drainage. The governing system of coupled non-linear partial differential equations is solved using the Overture computational framework, together with a hybrid time-stepping scheme, using a variable step backward differentiation formula and a Runge–Kutta–Chebyshev method that were added to the framework. The results of our numerical simulations provide new insight into the osmolarity distribution over the ocular surface during the interblink.
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Affiliation(s)
- Longfei Li
- Department of Mathematical Sciences, University of Delaware, Newark, DE 19711, USA
| | - Richard J Braun
- Department of Mathematical Sciences, University of Delaware, Newark, DE 19711, USA
| | - Tobin A Driscoll
- Department of Mathematical Sciences, University of Delaware, Newark, DE 19711, USA
| | - William D Henshaw
- Department of Mathematical Sciences, Rensselaer Polytechnic Institute, Troy, NY 12180, USA
| | - Jeffrey W Banks
- Lawrence Livermore National Laboratory, Box 808, L-422, Livermore, CA 94551-0808, USA
| | - P Ewen King-Smith
- College of Optometry, The Ohio State University, Columbus, OH 43218, USA
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