Instability of Tear Film after Novel Coronavirus Disease: A Noninvasive and No Contact Method by a Scheimpflug-Placido Disc Topographer

Assessing blink dynamics with non-noticeable method

PURPOSE

The purpose of the study was to demonstrate the feasibility of blink dynamics with a contactless, non-noticeable method without any visible light being reflected to the participant's eye by the device, and to investigate the blink dynamics parameters in 39 participants whose blink dynamics were examined with this method. It was also aimed to explain the potential of corneal topography devices for non-noticeable blink dynamics and elucidate some tips to device manufacturers to make them practical.

METHODS

A one-minute real-time video image in the meibography module of the scheimpflug camera-based corneal topography device was recorded in the slow motion mode of the mobile phone. Detailed analysis of blink dynamics was made by advancing the video images manually at 10 ms intervals. Lid Closing Time (LCT), Lid Opening Time (LOT), third Interblink Interval times (IBI(3)), fifth Interblink Interval times (IBI(5)), Number of Blinks Per Minute (NoB), Number of Complete Blinks Per Minute (NoCB), Number of Incomplete Blinks Per Minute (NoICB) were investigated.

RESULTS

The average NoB, NoCB, and NoICB (blinks/minute) with ± standard deviation (SD) values were found to be 22.9 ± 14.4; 14.5 ± 12.4 and 8.4 ± 8, respectively. The average IBI(3) time(seconds) with ± SD was measured as 3.4 ± 4.5. The average IBI(5) time (seconds) with ± SD was 3.9 ± 3.7 The average LCT time (milliseconds) with ± SD was found to be 91.9 ± 36.9 in the 4 different blinks analyzed. The average LOT time (milliseconds) with ± SD was found to be 582.6 ± 196.5 in the 3 different blinks analyzed.

CONCLUSIONS

Blink dynamics can be examined in detail with corneal topography devices in a non-contact, no visible light, and most importantly, non-noticeable manner. Existing video imaging modules of corneal topography devices have the potential to investigate blink dynamics. It is anticipated that the clinical use of blink dynamics, which can be performed practically, will increase, particularly in the monitoring of ocular surface and neurological diseases.

Electroacupuncture for mild-to-moderate dry eye: study protocol for a multicentre, randomised, single-blind, sham-controlled trial

INTRODUCTION

Dry eye (DE) is a multifactorial ocular surface disease causing considerable medical, social and financial implications. Currently, there is no recognised long-term, effective treatment to alleviate DE. Clinical evidence shows that electroacupuncture (EA) can improve DE symptoms, tear secretion and tear film stability, but it remains controversial whether it is just a placebo effect. We aim to provide solid clinical evidence for the EA treatment of DE.

METHODS AND ANALYSIS

This is a multicentre, randomised, sham-controlled trial. A total of 168 patients with DE will be enrolled and randomly assigned to EA or sham EA groups to receive 4-week consecutive treatments and follow-up for 24 weeks. The primary outcome is the change in the non-invasive tear break-up time (NIBUT) from baseline to week 4. The secondary outcomes include tear meniscus height, the Schirmer I test, corneal and conjunctival sensation, the ocular surface disease index, corneal fluorescein staining, the numerical rating scale and the Chinese DE-related quality of life scale.

ETHICS AND DISSEMINATION

The trial protocol and informed consent were approved by the Ethics Committee of Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine (identifier: 2021-119), Shanghai Eye Disease Prevention and Treatment Center (identifier: 2022SQ003) and Eye and ENT Hospital of Fudan University (identifier: 2022014).

TRIAL REGISTRATION NUMBER

NCT05552820.

Investigating the Impact of COVID-19 Infection on Dry Eye Parameters

PURPOSE

This study aims to compare dry eye parameters before and after COVID-19 infection in dry eye patients.

METHODS

We included 44 dry eye patients (88 eyes) from our existing dry eye cohort, with 22 belonging to the post-COVID-19 group due to a prior COVID-19 infection and the other 22 forming the non-COVID-19 group as they had no history of COVID-19. We examined and compared the dry eye parameters of the post-COVID-19 group, including the ocular surface disease index (OSDI), Schirmer's test results (ST), non-invasive Keratography tear break-up time (NIKBUT), lipid layer thickness (LLT), Meibomian gland dysfunction (MGD), and the grading of papillae and follicles, both before and after the COVID-19 infection. We also compared the dry eye parameters difference of the post-COVID-19 group with the non-COVID-19 group.

RESULTS

The post-COVID-19 group was comprised of individuals with an average age of 38.36 ± 14.99 years, of which 82% were female. The time interval between the two tests was 16.92 ± 5.40 months, which did not differ significantly from the non-COVID-19 group. Compared to the pre-COVID-19 eyes, the post-COVID-19 eyes showed a significant decrease in the average LLT (52.86 ± 18.00 nm vs. 63.00 ± 22.40 nm, p < 0.001), as well as the maximum LLT (67.89 ± 20.81 nm vs. 78.48 ± 20.55 nm, p < 0.001). The MGD in both the upper (1.75 ± 0.84) and lower eyelids (1.43 ± 0.73) worsened after a COVID-19 infection. Additionally, the grading of papillae was worse following a COVID-19 infection (0.61 ± 0.69 vs. 0.16 ± 0.37, p < 0.001). The multivariate linear regression model revealed a negative association between COVID-19 infection and NIKBUT-average (β = -2.98, 95%CI: (-5.82, -0.15), p = 0.039), LLT-average (β = -14.12, 95%CI: (-22.66, -5.59), p = 0.001), and LLT max (β = -15.65, 95%CI: (-23.09, -8.20), p < 0.001).

CONCLUSION

From preliminary results, we concluded that dry eye patients who have been infected with COVID-19 appear to have a more severe dry eye condition, as evidenced by lower LLT, worse papillae and MGD, and shorter NIKBUT. It is important to raise awareness of this potential long-term symptom of COVID-19, especially among existing dry eye patients.

TFOS lifestyle: Impact of societal challenges on the ocular surface

Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.

Evaluation of the Effect of İnfection and İmmunity on the Tear Film by Scheimpflug-Placido Disc Topography- A Case Control Study

PURPOSE

We aimed to compare the tear film stability of individuals who had recovered from coronavirus disease (COVID-19), that of individuals vaccinated against COVID-19 and that of healthy individuals in a control group.

METHODS

This study included 61 eyes of 61 post-COVID-19 patients, 63 eyes of 63 participants who had received at least two doses of the SARS-CoV-2 mRNA BNT162b2 (Pfizer-BioNTech) vaccine, and 57 eyes of healthy individuals in a control group. We compared the groups' tear film stability.

RESULTS

The mean non-invasive first tear break-up time (NIF-BUT) value was 4.1±2.7 seconds in the post-COVID-19 group, 4.7±2.9 seconds in the vaccinated group, and 5.8±2.8 seconds in the control group. This value was statistically significantly lower in the post-COVID-19 and vaccinated groups than in the control group (p= 0.007). The rate of superotemporal (ST) quadrant breakup, statistically significantly higher in the vaccinated group than in the other two groups (p=0.001). According to a qualitative examination of the results, at least one breakup occurred in 47 (77%) of the post-COVID-19 participants' eyes, 50 (79.4%) of the vaccinated group's eyes, and 33 (57.9%) of the control group's eyes. In terms of this qualitative value, the post-COVID-19 and vaccinated groups had significantly higher breakup rates than the control group (p=0.018).

CONCLUSIONS

Destabilization in the tear film was more common in both the post covid group and the vaccinated group. In addition to individuals who have post-Covid, we think that post-vaccination individuals should be followed closely in terms of ocular surface diseases.

The effect of pregnancy on meibomian gland, tear film, cornea and anterior segment parameters

AIM

In this prospective study, we aimed to examine the effect of physiological and pathological changes that occur during pregnancy in regard to Meibomian Gland (MG) structure, tear film, cornea and anterior segment parameters.

METHODS

The following groups were compared: 49 eyes of 49 pregnant women at 16-20 weeks of pregnancy (P16 Group), 46 eyes of 46 pregnant women at 32-36 weeks of pregnancy (P32 Group) and 51 eyes of 51 participants who were not pregnant (P0 Group). The groups were compared in terms of the first break-up time (NIF-BUT) and average break-up time (NIAvg-BUT) values. Non-contact meibography and MG loss rates were also compared.

RESULTS

The groups were found to be compatible in terms of age (P=0.052). The mean NIF-BUT values in the P16, P32 and P0 groups were 4.7 ±2.7, 6 ±3 and 6.7 ±3.1 seconds, respectively (P=0.055). The mean MG loss rates for the upper lid in the P16, P32 and P0 groups were 35.3%±12.6, 33.4%±11.4 and 15.5%±5.4, respectively. The loss rates for the lower lid in the P16, P32 and P0 groups were found to be 40.5%±18.6, 40.5%± 14.4 and 20.1%±8.1, respectively (P=0.000, p=0.000). The mean anterior chamber value (ACV) was found in the P16, P32 and P0 groups with 160.8 ±31.8, 150.9 ±26.5 and 165.9 ±26.5 µm³, respectively (P=0.035).

CONCLUSION

MG loss was found to be higher in pregnant groups compared to the non-pregnant groups. We found minimal instability in the tear film of the pregnant groups. We believe that pregnant women should be followed closely in terms of ocular surface diseases.

Changes caused by fluorescein in tear film by hybrid break-up time test- part one; on quantitative values

PURPOSE

To examine the effect of fluorescein on the tear film by measuring tear break-up time (BUT).

METHODS

In this prospective study, after determining the natural BUT value of the tear with the non-invasive break-up time (NI-BUT) method, we re-evaluated the changes in the tear film stained with fluorescein using the topographical method. The topographic evaluation of tears stained with fluorescein was called as Hybrid-BUT (H-BUT) test. The first BUT (BUT₁), the second BUT (BUT₂), the third BUT (BUT₃), the fourth BUT (BUT₄), and the fifth BUT (BUT₅) values of each participant's NI-BUT and H-BUT tests were compared.

RESULTS

The present study was conducted with 82 participants. Although the mean BUT₁ value was 4.1 ± 2.7 s in the NI-BUT test, it was 5.1 ± 3.2 s in the H-BUT test (p = 0.029). The mean BUT₂ value was 5.0 ± 3.0 s in the NI-BUT test, and 6.2 ± 3.3 s in the H-BUT test (p = 0.029). The mean BUT₃ value in the NI-BUT test was 5.8 ± 3.4 s, and 7.2 ± 3.7 s in the H-BUT test (p = 0.021). The mean BUT₄ value in the NI-BUT test was 6.2 ± 3.4 s and 7.9 ± 3.9 s in the H-BUT test (p = 0.009).

CONCLUSIONS

Fluorescein causes changes in the break-up time test, and depending on this, in the tear film pattern. These changes can be compared and detected quantitatively and objectively of the fluorescein-stained tear film with the NI-BUT test and the topographic devices by using the H-BUT test.

Another Etiological Factor of Meibomian Gland Loss in Patients with Polycystic Ovary Syndrome: Inflammation

Purpose: The purpose of this prospective study was to compare the tear film pattern, meibomian gland (MG) losses in patients with polycystic ovary syndrome (PCOS) and healthy individuals in the control group, and to examine the correlation between peripheral blood values and findings in patients with PCOS. Methods: Eighty-one eyes of 81 patients with PCOS and 78 eyes of 78 healthy individuals were included in this study. Mean noninvasive first tear film break-up time (NIF-BUT) values and the mean noninvasive average tear film break-up time (NIAvg-BUT) values of all breaking-up occurring in the test were compared. MG losses were compared between the groups. In the second step of this study, we examined the correlation between NIF-BUT and NIAvg-BUT values and MG losses with inflammatory parameters. Results: NIF-BUT values were 7.21 ± 5.75 and 10.18 ± 5.90 s, respectively, in PCOS and control groups (P = 0.001). Loss of MG in the upper eyelids (SM-SCL) of PCOS and control group was 39.81 ± 16.34 and 17.84 ± 9.48, respectively (P = 0.000). Positive correlation was detected between SM-SCL value and neutrophil/lymphocyte ratio; platelet/lymphocyte ratio (P/L); and systemic immune-inflammation index, the value obtained from platelet count × (neutrophil/lymphocyte). Conclusion: Increased tear film instability and increased MG loss rates were detected in PCOS patients. In addition, we found a positive correlation between MG losses and inflammatory indices of patients with PCOS. We think that inflammatory processes also provide an additive effect, in addition to hormonal changes on the physiopathological process on the ocular surface in patients with PCOS.