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Lee CY, Yang SF, Chen YC, Chang CK. The Usage of Different Hyaluronic-Acid-Containing Artificial Tears and the Treatment Outcome of Intense Pulsed Light Therapy for Dry Eye Disease: A Retrospective Cohort Study. Diagnostics (Basel) 2024; 14:1796. [PMID: 39202284 PMCID: PMC11354216 DOI: 10.3390/diagnostics14161796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 08/10/2024] [Accepted: 08/16/2024] [Indexed: 09/03/2024] Open
Abstract
In this study, we aimed to investigate the effect of different hyaluronic acid (HA)-containing artificial tears on dry eye disease (DED) treatment in combination with intense pulsed light (IPL) therapy. A retrospective cohort study was conducted, and the participants received IPL therapy and HA-containing artificial tears. There were 42 and 40 eyes in the 0.10% and 0.15% HA groups after selection, respectively. The main outcomes were the postoperative non-invasive tear break-up time (NITBUT), Schirmer II test results, ocular surface stain, and numbers of DED-related symptoms. A generalized linear model was utilized to produce the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the main outcomes between groups. At the three-month follow-up, the NITBUT was significantly higher in the 0.15% HA group (p = 0.023), and the NITBUT recovery was also significantly better in the 0.15% HA group compared to the 0.10% HA group (p = 0.039). The multiple DED-related symptoms significantly correlated with no DED symptom improvement in both the 0.10% and 0.15% HA groups (both p < 0.05), while the low pre-treatment NITBUT was marginally related to no DED symptom improvement in the 0.10% HA group (p = 0.047). A low NITBUT and Schirmer II test result correlated with no DED symptom improvement in both the groups (all p < 0.05). In conclusion, the application of 0.10% and 0.15% HA-containing artificial tears revealed similar effects to IPL therapy for DED.
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Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Nobel Eye Institute, Taipei 10041, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 41265, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Yun-Chen Chen
- Nobel Eye Institute, Taipei 10041, Taiwan
- Chaomuhean Clinic, Taipei 10689, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei 10041, Taiwan
- Department of Optometry, Da-Yeh University, Chunghua 51591, Taiwan
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Chen J, Qin G, Li L, Qi Y, Xia Y, Zhang Q, Wu Y, You Y, Yang L, Guo N, Moutari S, Moore JE, Bu S, Xu L, He W, Yu S, Pazo EE, He X. The Combined Impact of Intense Pulsed Light Combined and 3% Diquafosol Ophthalmic Solution on Evaporative Dry Eye: A Randomized Control Study. Ophthalmol Ther 2023; 12:2959-2971. [PMID: 37589932 PMCID: PMC10640412 DOI: 10.1007/s40123-023-00784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION The primary objective of this study is to assess whether the combination of intense pulsed light (IPL) with 3% diquafosol (DQS) ophthalmic solution is more effective than intense pulsed light in alleviating signs and symptoms of dry eye disease (DED). METHODS This randomized study included 66 participants with evaporative dry eye (EDE) who received IPL + DQS therapy (n = 44 eyes), IPL therapy (n = 44 eyes), or sham therapy (n = 44 eyes). All participants were examined at baseline (D0), day 14 (D14), and day 28 (D28) for non-invasive break-up time (NITBUT), tear-film lipid layer (TFLL), corneal conjunctival staining (CS), meibomian gland quality (MGQ), meibomian gland expression (MGEx), and ocular surface disease index (OSDI). RESULTS At day 28, comparison among the IPL + DQS therapy, IPL therapy, and sham therapy found significant differences in the mean NITBUT (12.03 ± 1.27 versus 10.47 ± 3.48 versus 4.57 ± 0.46; p < 0.001), TFLL (2.09 ± 0.29 versus 2.27 ± 0.45 versus 2.89 ± 0.65; p < 0.001), CS (1.43 ± 0.82 versus 1.93 ± 1.32 versus 3.52 ± 1.00; p < 0.001), MGQ (1.55 ± 0.66 versus 1.91 ± 0.77 versus 2.66 ± 0.53; p < 0.001), MGEx (1.27 ± 0.45 versus 1.75 ± 0.44 versus 2.41 ± 0.50; p < 0.001), and OSDI score (19.36 ± 7.01 versus 24.77 ± 4.68 versus 42.61 ± 7.49; p < 0.001); significant improvements in NITBUT, TFLL, CS, MGQ, MGEx, and OSDI were found in the IPL + DQS therapy and IPL therapy, while the sham therapy had no significant improvements. CONCLUSION Combining 3% diquafosol ophthalmic solution with intense pulsed light was superior to IPL therapy alone in relieving the signs and symptoms of patients with severe evaporative DED. TRIAL REGISTRATION Clinical Trials Identifier: NCT05694026.
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Affiliation(s)
- Jiayan Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Liangzhe Li
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Yifan Qi
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Yang Xia
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Qing Zhang
- Tianjin Medical University, Tianjin, China
| | - Yi Wu
- China Medical University, Shenyang, China
| | - Yue You
- Sinqi Eye Hospital, Shenyang, China
| | | | - Naici Guo
- University of St Andrews, St Andrews, UK
| | | | | | | | - Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Sile Yu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China.
| | - Xingru He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, 110034, China.
- School of Public Health, He University, Shenyang, 110034, China.
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Chen J, Qin G, Li L, Qi Y, Che H, Huang H, Xia Y, Zhang Q, Wu Y, Yang L, Moutari S, Moore JE, Xu L, He W, Yu S, Pazo EE, He X. Protocol for a parallel assignment prospective, randomised, comparative trial to evaluate the safety and efficacy of intense pulsed light (IPL) combined with 3% diquafosol (DQS) ophthalmic solution in dry eye syndrome. BMJ Open 2023; 13:e073055. [PMID: 37643847 PMCID: PMC10465902 DOI: 10.1136/bmjopen-2023-073055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Evaporative dry eye (EDE) is common and can lead to ocular pain, decreased visual quality and reduced quality of life. Intense pulsed light (IPL) and 3% diquafosol ophthalmic solution have been found to be beneficial in reducing signs and symptoms of dry eye. METHODS AND ANALYSIS A randomised clinical trial will be performed at He Eye Specialist Hospital in Shenyang. 360 dry eye disease patients will be equally divided randomly into the IPL group, DQS group (3% diquafosol ophthalmic solution eye-drops) and IPL+group (IPL combined with 3% diquafosol eye-drops). All groups will be followed up for 4 weeks. The primary outcome measures will be the non-invasive tear break-up time and the Ocular Surface Disease Index change from the baseline. The secondary outcome measures willincludeconjunctival and cornea staining with fluorescein and lissamine, meibomian gland function and secretion quality, tear film lipid layer score, tear meniscus height, conjunctival hyperemia (redness score) changes . Adverse events also will be monitored and documented. DISCUSSION This study aimed to assess whether the combination of IPL with 3% diquafosol ophthalmic solution (study group), IPL+ (study group), is more effective than IPL (active control group) or DQS (active control group) in participants with EDE. ETHICS AND DISSEMINATION Management of dry eye with IPL combined with 3% diquafosol ophthalmic solution, registered on 23 January 2023. Ethics approval number: IRB (2022) K029.01. The study's findings will be shared regardless of the effect's direction. TRIAL REGISTRATION NUMBER NCT05694026.
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Affiliation(s)
- Jiayan Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Liangzhe Li
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yifan Qi
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Huixin Che
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - He Huang
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yang Xia
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Qing Zhang
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yi Wu
- Department of Ophthalmology, China Medical University Second Hospital, Shenyang, China
| | - Lanting Yang
- Department of Ophthalmology, Wenzhou Medical University Eye Hospital, Wenzhou, China
| | - Salissou Moutari
- School of Mathematics and Physics, Queen's University Belfast, Belfast, UK
| | | | - Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Sile Yu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- School of Public Health, He University, Shenyang, China
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Xingru He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- School of Public Health, He University, Shenyang, China
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Li L, Chen J, Qin G, Qi Y, Chen Y, Li M, Zhang Q, Cheng Y, Guo N, Moutari S, Moore JE, Yu S, He X, Pazo EE. Tear Film Lipid Layer Changes Following Combined Effect of Heated Eye Mask with Intense Pulsed Light Therapy for Evaporative Dry Eye: A Randomized Control Study. Photobiomodul Photomed Laser Surg 2023; 41:435-444. [PMID: 37579133 PMCID: PMC10460692 DOI: 10.1089/photob.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/22/2023] [Indexed: 08/16/2023] Open
Abstract
Background: Dry eye disease (DED) is a complex ocular surface inflammatory disorder with a multifactorial etiology. Therapies such as intense pulsed light (IPL) and heated eye mask (HEM) have been reported to improve the tear film lipid layer (TFLL) and signs and symptoms of DED. Methods: This randomized study aimed to compare the effects of IPL combined with HEM (IPL+HEM) group, IPL group, and control group in participants with evaporative DED. All participants were examined at baseline (D0), day 21 (D21), day 42 (D42), and day 84 (D84) for noninvasive tear breakup time (NITBUT), TFLL, corneal conjunctival staining (CS), meibomian gland quality (MGQ), meibomian gland expressibility (MGEx), and Ocular Surface Disease Index (OSDI). Results: The mean age of participants was IPL+HEM: 28.06 ± 3.88 years, IPL: 29.88 ± 4.68 years, and control: 28.52 ± 3.77 years. At D84, significant improvements in TFLL (p < 0.05), noninvasive tear breakup time (NITBUT) (p < 0.05), corneoconjunctival staining (CS) (p < 0.05), MGQ (p < 0.05), MGEx (p < 0.05), and OSDI (p < 0.05) were found in the IPL+HEM and IPL groups, whereas the control group had no significant improvements. Furthermore, ΔTFLL significantly correlated with ΔNITBUT (r = -0.678, p < 0.001), ΔCS (r = 0.321, p < 0.001), ΔMGQ (r = 0.669, p < 0.001), ΔMGEx (r = 0.598, p < 0.001), and ΔOSDI score (r = 0.649, p < 0.001). Conclusions: IPL therapy in combination with HEM and IPL therapy only can significantly improve the quality of TFLL and clinically reduce the sign and symptoms of evaporative DED. However, IPL therapy in combination with HEM was found to be more effective than IPL therapy alone.
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Affiliation(s)
- Liangzhe Li
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Jiayan Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yifan Qi
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yimeng Chen
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Mingze Li
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Qing Zhang
- Department of Ophthalmology, Tianjin Medical University, Tianjin, China
| | - Yuan Cheng
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
- Department of Ophthalmology, Dalian Medical University, Dalian, China
| | - Naici Guo
- School of Mathematics and Statistics, University of St Andrews, St Andrews, United Kingdom
| | - Salissou Moutari
- School of Mathematics and Physics, Queens University Belfast, Belfast, United Kingdom
| | - Jonathan E. Moore
- Department of Ophthalmology, Cathedral Eye Clinic, Belfast, United Kingdom
| | - Sile Yu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Xingru He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
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Demolin L, Es-Safi M, Soyfoo MS, Motulsky E. Intense Pulsed Light Therapy in the Treatment of Dry Eye Diseases: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12083039. [PMID: 37109374 PMCID: PMC10145895 DOI: 10.3390/jcm12083039] [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: 03/10/2023] [Revised: 04/06/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Intense pulsed light therapy (IPL) is a recently developed way of treating dry eye disease (DED). During the last decade, there was a multiplication of trials studying IPL efficacy. The goal of this review is to summarize the most important and significant results of these trials estimating effect sizes. METHODS The PubMed and sciencedirect databases were searched using a PICO model-based approach. Randomized controlled trials including at least 20 patients with DED and no other eye condition, with a control group and break-up time or symptom scores data available for extraction were included in this review. Statistical analysis evaluated the tear break-up time (TBUT), non-invasive break-up time (NIBUT), ocular surface disease index (OSDI), and standard patient evaluation of eye dryness (SPEED). Three comparisons were carried on for each outcome: longest follow-up values vs. baseline in the treatment group, longest follow-up values in the treatment group vs. control group, and changes from baseline in the treatment group vs. control group. A subgroup analysis was carried on. RESULTS Eleven randomized controlled trials, published between 2015 and 2021 were included in this systematic review with 759 patients in total. The longest follow-up values vs. baseline in the treatment group analyses were significantly in favor of IPL for all the parameters studied for instance: NIBUT (effect size (ES), 2.02; 95% confidence interval (CI), (1.43; 2.62)), TBUT (ES, 1.83; 95% CI, (0.96; 2.69)), OSDI (ES, -1.38; 95% CI, (-2.12; -0.64)) and SPEED (ES, -1.15; 95% CI, (-1.72; -0.57)). The longest follow-up values in the treatment group vs. control group analyses, and, the change from baseline in the treatment group vs. control group analyses, were both significantly in favor of IPL for NIBUT, TBUT, and SPEED but not for OSDI. CONCLUSIONS IPL seems to have a positive effect on tear stability evaluated by the break-up times. However, the effect on DED symptoms is less clear. Some confounding factors such as the age and the IPL device used influence the results indicating that the ideal settings still need to be found and personalized for the patient.
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Affiliation(s)
- Lilian Demolin
- Faculty of Medicine, Free University of Brussels, 1070 Brussels, Belgium
| | - Majda Es-Safi
- Faculty of Medicine, Free University of Brussels, 1070 Brussels, Belgium
- Ophthalmology Department, Erasme Hospital, Hôpital Universitaire de Bruxelles, Faculty of Medicine, Free University of Brussels, 1070 Brussels, Belgium
| | - Muhammad Shahnawaz Soyfoo
- Faculty of Medicine, Free University of Brussels, 1070 Brussels, Belgium
- Rheumatology Department, Erasme Hospital, Hôpital Universitaire de Bruxelles, Faculty of Medicine, Free University of Brussels, 1070 Brussels, Belgium
| | - Elie Motulsky
- Faculty of Medicine, Free University of Brussels, 1070 Brussels, Belgium
- Ophthalmology Department, Erasme Hospital, Hôpital Universitaire de Bruxelles, Faculty of Medicine, Free University of Brussels, 1070 Brussels, Belgium
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Managing Severe Evaporative Dry Eye with Intense Pulsed Light Therapy. Ophthalmol Ther 2023; 12:1059-1071. [PMID: 36693992 PMCID: PMC10011255 DOI: 10.1007/s40123-023-00649-5] [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: 12/05/2022] [Accepted: 01/04/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION This study assessed the efficacy and safety of intense pulsed light (IPL) therapy in participants with severe evaporative dry eye disease (DED). METHODS This randomized, controlled, single-center study included 49 adult participants (≥ 18 years) with severe evaporative DED who received either IPL therapy (n = 56 eyes) or sham therapy (n = 42 eyes) three times. The primary efficacy parameters were ocular surface disease index (OSDI) score, non-invasive tear breakup time (NITBUT), tear film lipid layer (TFLL), conjunctivocorneal staining score (CS), MG Score, meibomian gland (MG) quality, and MG expression score. RESULTS The mean ages for the IPL group and the control group were 28.05 ± 3.41 years (57.1% female) and 28.14 ± 3.53 years (52.4% female), respectively. Comparison between the IPL group and the control group found significant differences in the mean OSDI score (22.16 ± 6.08 vs. 42.38 ± 6.60; P < 00.01), NITBUT (6.27 ± 0.84 vs. 3.86 ± 0.68; P < 0.001), TFLL (2.14 ± 0.44 vs. 3.45 ± 0.50; P < 0.001), MG Score (1.34 ± 0.55 vs. 1.88 ± 0.33; P < 0.001), MG quality (1.59 ± 0.07 vs. 2.67 ± 0.08), and MG expression (1.54 ± 0.57 vs. 2.45 ± 0.55) at 12 weeks follow-up; however, there was no significant difference in CS (3.32 ± 1.11 vs. 3.74 ± 1.04; P = 0.063). CONCLUSION The findings suggest that IPL therapy is clinically beneficial in ameliorating the signs and symptoms of severe evaporative dry eye disease.
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Xu L, Wu Y, Song Y, Zhang Q, Qin G, Yang L, Ma J, Palme C, Moore JE, Pazo EE, He W. Comparison Between Heated Eye Mask and Intense Pulsed Light Treatment for Contact Lens-Related Dry Eye. Photobiomodul Photomed Laser Surg 2022; 40:189-197. [PMID: 35298282 DOI: 10.1089/photob.2021.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Contact lens-related dry eye (CLDE) is common in contact lens (CL) wearers and can lead to ocular pain, decreased visual quality, and reduced quality of life. Objective: The purpose of this prospective, randomized, examiner masked study was to compare the effectiveness of intense pulsed light (IPL) and heated eye mask (HEM) for relieving CLDE. Methods: The final analysis included 60 patients (30 in the IPL group and 30 in the HEM group) who were using CL and had been suffering contact lens discomfort for more than a year. The IPL treatment group had two IPL treatments spaced 3 weeks apart, whereas the HEM group received HEM daily for 6 weeks (42 days). Non-invasive tear break-up time (NITBUT), tear-film lipid layer (TFLL), conjunctival fluorescein staining, meibum gland quality and expression, conjunctival redness score, ocular surface disease index (OSDI), best-corrected visual acuity, endothelial cell count, and intraocular pressure were assessed at baseline: first visit (V1), second visit (V2), and third visit (V3). Results: The mean age of the IPL group was 28.6 ± 4.3 years (16 females, 53%) and that of the HEM group was 28.6 ± 4.2 years (16 females, 53%). Mean NITBUT for the IPL group at V2 was 5.53 ± 0.77 sec (p < 0.001) and at V3 was 7.72 ± 0.88 sec (p < 0.001); the IPL group demonstrated a clinically and statistically significant improvement in mean NITBUT. In addition, the HEM group showed a clinically and statistically significant improvement in mean NITBUT at V3 (5.86 ± 0.76 sec, p < 0.001). At V3, the C-OSDI, TFLL score, and meibum gland quality and expressibility all increased considerably (p < 0.05) in both groups. Conclusions: Our results imply that IPL or HEM treatment of CLDE can be safely used to relieve symptoms of CLDE. In addition, IPL treatment is more effective in improving the general stability of the tear-film and decreasing the need for artificial tears in CLDE.
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Affiliation(s)
- Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yi Wu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yilin Song
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing Zhang
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanting Yang
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinfei Ma
- Breast Cancer, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Christoph Palme
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Jonathan E Moore
- Cathedral Eye Clinic, Belfast, United Kingdom.,Aston University, Birmingham, United Kingdom
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
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Wu Y, Xu L, Song Y, Zhang Q, Qin G, Yang L, Ma J, Palme C, Moore JE, Pazo EE, He W. Management of Post-LASIK Dry Eye with Intense Pulsed Light in Combination with 0.1% Sodium Hyaluronate and Heated Eye Mask. Ophthalmol Ther 2022; 11:161-176. [PMID: 34741758 PMCID: PMC8770788 DOI: 10.1007/s40123-021-00418-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/25/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Laser in situ keratomelieusis (LASIK) is one of the most frequently performed refractive treatments. Dry eye (DE) is common in patients after LASIK and can be bothersome postoperatively. Therapies such as intense pulsed light (IPL), sodium hyaluronate (SH) and heated eye mask (HEM) have been reported to improve signs and symptoms of DE . AIM The purpose of this prospective study was to evaluate and compare the effects of IPL and 0.1% SH (IPL group, 50 eyes) and IPL in combination with 0.1% SH and HEM (IPL + group, 50 eyes) in participants with persistent post-LASIK DE. METHODS The final analysis included 100 patients (100 eyes) who had LASIK for myopic correction and had been experiencing moderate to severe DE following LASIK for over a year. Participants were randomly assigned to either the IPL group (2 IPL sessions) or IPL + group (2 IPL sessions and daily HEM for 4 weeks), and both groups continued the use of daily 0.1% SH (HYLO-COMOD®) preservative-free eye drops. Non-invasive tear break-up time (NITBUT), tear film lipid layer (TFLL), lower tear meniscus height (LTMH), meibomian gland quality (MGQ), meibomian gland expressibility (MGEx), corneal fluorescein staining (CFS), ocular surface disease index (OSDI) and artificial tear usage (ATU) survey were assessed at baseline (BL) and follow-up at 2 (F1) and 4 weeks (F2). RESULTS Following the treatment protocol, all dry eye (DE) parameters assessed in this study improved significantly (P < 0.05) in both groups at F2 compared with their respective BL measurements. Inter-group comparison at F2 found significant differences in their NITBUT (IPL: 6.06 ± 0.59 vs. IPL +: 6.67 ± 0.86, P < 0.001), TFLL (IPL: 1.90 ± 0.65 vs. IPL +: 1.60 ± 0.64, P = 0.021), LTMH (IPL: 0.186 ± 0.053 vs. 0.204 ± 0.034, P = 0.003), MGQ (IPL: 1.48 ± 0.54 vs. IPL +: 1.26 ± 0.56, P = 0.026), MGEx (IPL: 1.62 ± 0.53 vs. IPL +: 1.44 ± 0.50, P = 0.038) and OSDI (IPL: 32.54 ± 6.85 vs. IPL +: 29.76 ± 4.74, P = 0.001), while CFS score (IPL: 4.02 ± 0.65 vs. IPL +: 3.96 ± 0.73, P = 0.652) and ATU (IPL: 1.88 ± 0.63 vs. IPL +: 1.72 ± 0.50, P = 0.159) showed no significant difference. CONCLUSION Post-LASIK DE signs and symptoms can be improved by combining therapies such as IPL, HEM and 0.1% SH. Increased TFLL due to a combination of IPL, 0.1% SH and HEM had a greater positive impact on the subjective and objective DE measurements in participants with persistent post-LASIK DE.
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Affiliation(s)
- Yi Wu
- Department of Ophthalmology, He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, 1100 34, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, 1100 34, China
| | - Yilin Song
- Department of Ophthalmology, He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, 1100 34, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing Zhang
- Department of Ophthalmology, He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, 1100 34, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, 1100 34, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanting Yang
- Department of Ophthalmology, He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, 1100 34, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinfei Ma
- Zhejiang University School of Medicine First Affiliated Hospital, Breast Cancer, Hangzhou, Zhejiang, China
| | - Christoph Palme
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, 1100 34, China.
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, 1100 34, China.
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9
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Zhang Q, Wu Y, Song Y, Qin G, Yang L, Talwar SS, Lin T, Talwar GDS, Zhang H, Xu L, Moore JE, Pazo EE, He W. Screening Evaporative Dry Eyes Severity Using an Infrared Image. J Ophthalmol 2021; 2021:8396503. [PMID: 34484814 PMCID: PMC8410437 DOI: 10.1155/2021/8396503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dry eye disease (DED) is a multifactorial and one of the most common problems treated in an ophthalmic outpatient clinic. Due to the variability in presentation, diagnosis of DED consists of a combination of subjective and objective clinical tests. The purpose of this study was to assess the effectiveness of a handheld smartphone-based infrared thermal (IRT) camera for screening symptomatic evaporative DED. METHODS This observational sex-matched control study assessed IRT images of 184 right eyes (46 normal and 138 DED) of 184 participants. Evaporative DED was assessed using noninvasive tear breakup time, fluorescein staining, and the Chinese version of the ocular surface disease index (C-OSDI) questionnaire and categorized into their respective dry eye symptomology group (none, mild, moderate, or severe). The ocular surface temperature (OST) at 8 anatomical regions of interest (ROI) (nasal conjunctiva, nasal limbus, nasal cornea, central cornea, inferior cornea, temporal limbus, temporal cornea, and temporal conjunctiva) were measured and compared using a handheld smartphone-based IRT camera. The effectiveness of these 8 ROIs OST in detecting varying severity of DED was evaluated in terms of correlations with severity of DED and their area under the curve (AUC). RESULTS OST at the 8 anatomical ROI was significantly higher in DED participants than in the non-DED group (p < 0.05) except for inferior cornea, temporal limbus, and temporal conjunctival regions (>0.05). Analyzing 8 anatomical ROIs revealed that the nasal limbus had the highest Pearson correlation with the severity of DED (0.64, p < 0.001). Additionally, the nasal limbus ROI achieved the highest AUC of 0.79 (CI: 0.73-0.85; p < 0.05), sensitivity, and specificity (0.96 and 0.91) when comparing its ability to discriminated DED vs. non-DED eyes. CONCLUSIONS Rather than a diagnostic tool, handheld smartphone-based IRT images can be considered as a rapid, noninvasive, and hygienic screening tool in discriminating DED and non-DED and potentially alleviating inconvenience experienced during conventional tests.
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Affiliation(s)
- Qing Zhang
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Wu
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yilin Song
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanting Yang
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
- The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Tiezhu Lin
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
- Wenzhou Medical University, Jiaxing, China
| | | | - Hongda Zhang
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
| | - Ling Xu
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
| | | | - Emmanuel Eric Pazo
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
| | - Wei He
- He Eye Specialist Hospital, No. 128 North Huanghe Street, Shenyang, China
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10
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Song Y, Yu S, He X, Yang L, Wu Y, Qin G, Zhang Q, Deep Singh Talwar G, Xu L, Moore JE, He W, Pazo EE. Tear film interferometry assessment after intense pulsed light in dry eye disease: A randomized, single masked, sham-controlled study. Cont Lens Anterior Eye 2021; 45:101499. [PMID: 34433517 DOI: 10.1016/j.clae.2021.101499] [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: 03/24/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inadequate meibomian glands (MGs) secretion can lead to dry eye signs and symptoms. Tear film lipid layer (TFLL) secreted by MGs protects and prevents rapid evaporation of tear film. The purpose was to assess TFLL alteration and function in patients with evaporative dry eye (EDE) using tear interferometry after optimal pulse light technology (OPT) intense pulsed light (IPL). METHODS This prospective randomized examiner-masked sham- controlled study included 86 participants (142 eyes) with DED. IPL or sham procedure was performed on day 0, 21, and 42. Ocular Surface Disease Index (OSDI), non-invasive breakup time (NITBUT), interferometric fringe pattern determined TFLL quality, fluorescein staining (FS), and meibum gland (MG) were assessed at day 0, 21, 42 and 3-month. RESULTS At 3-month, TFLL, NITBUT, MG drop-out, MG quality, MG expressibility, FS and OSDI improved significantly (P < 0.05) in the IPL group, while the sham group had no significant improvements. Except for Meibo-score and FS, all parameters significantly correlated with the improvement in TFLL following IPL treatment. Additionally, artificial tears usage was significantly less in the IPL group from D-42 onwards. CONCLUSION IPL treatment demonstrated the ability to improve TFLL quality and clinically reduced sign and symptoms of DED thereby reducing the frequency of artificial tears use.
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Affiliation(s)
- Yilin Song
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Sile Yu
- He University, Shenyang, China
| | | | - Lanting Yang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Wu
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing Zhang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Ling Xu
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China
| | - Jonathan E Moore
- Cathedral Eye Clinic, 89-91 Academy Street, Belfast, United Kingdom; Biomedical Sciences Research Institute, University of Ulster, Coleraine, United Kingdom
| | - Wei He
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; He University, Shenyang, China
| | - Emmanuel Eric Pazo
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; He University, Shenyang, China
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Characterization and Prediction of the Clinical Outcome of Intense Pulsed Light-Based Treatment in Dry Eye Associated to Meibomian Gland Dysfunction. J Clin Med 2021; 10:jcm10163573. [PMID: 34441869 PMCID: PMC8396809 DOI: 10.3390/jcm10163573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/27/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
This non-comparative prospective case series was conducted to characterize the clinical impact of intense pulsed light (IPL)-based treatment in dry eyes associated to Meibomian gland dysfunction (MGD), defining the predicting factors for a successful outcome with this therapy in a large case series. A total of 390 eyes (195 patients, range: 23–93 years) received four sessions of Optima IPL system (Lumenis, Yokneam, Israel). Significant changes were observed in tear film osmolarity in both eyes (p < 0.001) and in meibum quality (p < 0.001), with more eyes showing clear or yellow secretions after therapy. Mean change in the ocular surface disease index (OSDI) was −8.61, ranging from −27.00 to 11.00. This change was significantly correlated with the baseline value of OSDI (r = −0.489, p < 0.001). The change in osmolarity correlated significantly with the baseline osmolarity in both eyes (right r = −0.636, left r = −0.620, p < 0.001). A linear predicting model of the change in OSDI with therapy was obtained: change OSDI = 10.99 − 0.35 × OSDI − 1.03 × NIBUTRE-LE (mean non-invasive break up time of right and left eye) − 2.03 × Meibum quality grade (p = 0.001; R2: 0.325). In conclusion, the improvement in symptomatology achieved with an IPL-based therapy can be predicted at baseline using a linear model considering the level of MGD and the magnitude of OSDI and NIBUT (non-invasive break-up time).
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12
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Zhang XM, Yang LT, Zhang Q, Fan QX, Zhang C, You Y, Zhang CG, Lin TZ, Xu L, Moutari S, Moore JE, Pazo EE, He W. Reliability of Chinese web-based ocular surface disease index questionnaire in dry eye patients: a randomized, crossover study. Int J Ophthalmol 2021; 14:834-843. [PMID: 34150537 DOI: 10.18240/ijo.2021.06.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/22/2021] [Indexed: 01/11/2023] Open
Abstract
AIM To assess the reliability of web-based version of ocular surface disease index in Chinese (C-OSDI) on clinically diagnosed dry eye disease (DE) patients. METHODS A total of 254 Chinese participants (51% male, 129/254; mean age: 27.90±9.06y) with DED completed paper- and web-based versions of C-OSDI questionnaires in a randomized crossover design. Ophthalmology examination and DED diagnosis were performed prior to the participants being invited to join the study. Participants were randomly designated to either group A (paper-based first and web-based second) or group B (web-based first and paper-based second). Final data analysis included participants that had successfully completed both versions of the C-OSDI. Demographic characteristics, test-retest reliability, and agreement of individual items, subscales, and total score were evaluated with intraclass correlation coefficients (ICC), Spearman rank correlation, Wilcoxon test and Rasch analysis. RESULTS Reliability indexes were adequate, Pearson correlation was greater than 0.8 and ICCs range was 0.827 to 0.982; total C-OSDI score was not statistically different between the two versions. The values of mean-squares fit statistics were very low compared to 1, indicating that the responses to the items by the model had a high degree of predictability. While comparing the favorability 72% (182/254) of the participants preferred web-based assessment. CONCLUSION Web-based C-OSDI is reliable in assessing DED and correlation with the paper-based version is significant in all subscales and overall total score. Web-based C-OSDI can be administered to assess individuals with DED as participants predominantly favored online assessment.
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Affiliation(s)
- Xin-Mei Zhang
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Lan-Ting Yang
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Qing Zhang
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
| | - Qing-Xia Fan
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China
| | - Can Zhang
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China
| | - Yue You
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China
| | - Chen-Guang Zhang
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China
| | - Tie-Zhu Lin
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China
| | - Ling Xu
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China
| | - Salissou Moutari
- School of Mathematics and Physics, Queens University Belfast, University Road, Belfast, Northern Ireland BT7 1NN, United Kingdom
| | - Jonathan E Moore
- Cathedral Eye Clinic, 89-91 Academy Street, Belfast, Northern Ireland BT1 2LS, United Kingdom.,Biomedical Sciences Research Institute, University of Ulster, Coleraine, Northern Ireland BT52 1SA, United Kingdom
| | - Emmanuel E Pazo
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialists Hospital, Shenyang 110034, Liaoning Province, China
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13
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Yang L, Pazo EE, Qin G, Zhang Q, Wu Y, Song Y, Zhang H, Lin T, Xu L, Moore JE, He W. Effect of Intense Pulsed Light on Anterior Corneal Aberrations and Quality of Vision in Patients with Evaporative Dry Eye. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:185-195. [PMID: 33617727 DOI: 10.1089/photob.2020.4953] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: To evaluate the improvement in the tear film lipid layer (TFLL) and its subsequent impact upon corneal aberrations following intense pulsed light (IPL) treatment in patients with evaporative dry eye disease (DED) due to meibomian gland dysfunction (MGD). Background: The prevalence of DED is common and can lead to ocular discomfort, reduced visual acuity, and lowered quality of vision (QoV) and life. Methods: In this self-control study, patients with moderate-to-severe evaporative DED due to MGD were consecutively enrolled and underwent two IPL treatments at 3-week intervals. Clinical assessments, such as Ocular Surface Disease Index (OSDI) and QoV questionnaires, anterior corneal aberrations, noninvasive tear breakup time (NITBUT), interferometric fringe pattern as determined by TFLL quality, corneal fluorescein staining (CFS), meibum gland (MG), conjunctival hyperemia (CH), best-corrected visual acuity, endothelial cell count, and intraocular pressure, were conducted at pretreatment (D-0), day 21 (D-21), and day 42 (D-42) after IPL treatment. Results: The final analysis included 124 eyes of 62 patients (29 females, 33 males; mean age 35.66 ± 11.09 years). Clinically and statistically significant improvement in NITBUT was observed at D-42 (p < 0.01). OSDI, QoV, TFLL score, and MG quality and expressibility all improved significantly (p < 0.05) at D-42, whereas CH (p = 0.073) and CFS (p = 0.058) showed minor not significant improvements at D-42 of assessment. Anterior corneal aberrations also improved significantly at D-42 of assessment (p < 0.05). Conclusions: IPL treatment reduced the severity of symptoms and improved the overall tear film (TF) stability in patients with moderate-to-severe evaporative dry eye (DE) due to MGD. Additionally, the significant improvement in QoV in DE patients can be attributed to the reduction in anterior corneal aberrations due to improved TF stability.
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Affiliation(s)
- Lanting Yang
- He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Guanghao Qin
- He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing Zhang
- He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Wu
- He Eye Specialist Hospital, Shenyang, China
| | - Yilin Song
- He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Tiezhu Lin
- He Eye Specialist Hospital, Shenyang, China
| | - Ling Xu
- He Eye Specialist Hospital, Shenyang, China
| | | | - Wei He
- He Eye Specialist Hospital, Shenyang, China
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