1
|
Lee CY, Chang LC, Chang CK, Lu PT, Huang JY, Yang SF, Sun CC. Improvement in signs and symptoms of severe dry eye disease after dual therapy with high-potency steroids and 0.05% cyclosporine. Ann Med 2024; 56:2391019. [PMID: 39155824 PMCID: PMC11334746 DOI: 10.1080/07853890.2024.2391019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/22/2024] [Accepted: 06/16/2024] [Indexed: 08/20/2024] Open
Abstract
OBJECTIVE To evaluate the effectiveness and safety of combining 0.05% cyclosporine A (CsA) with high-potency steroids for treating severe dry eye disease (DED). MATERIALS AND METHODS This retrospective comparative case series included 93 patients treated with 0.05% CsA for severe DED. Among them, we included data from 54 eyes of 27 patients who received high-potency steroids in the study group and from 132 eyes of 66 patients who did not receive high-potency steroids in the control group. Data on demographic characteristics, comorbidities, medications and intraocular pressure (IOP) were recorded. The primary outcomes were changes in symptom and sign scores. The ocular surface disease index was used as the symptom score, whereas tear break-up time, Schirmer I test without anaesthesia, ocular surface staining scores and presence of meibomian gland dysfunction were considered as sign scores. Repeated one-way ANOVA and generalized linear mixed models were used to evaluate differences. RESULTS In the control group, symptom scores decreased from 1 to 2 months and from 2 to 3 months after treatment (p = .002 and .049). In the high-potency steroid group, symptom scores improved during these intervals (p = .003 and .005). The sign score in the control group remained unchanged (all p > .05), while the high-potency steroid group exhibited progressive improvement in sign scores (all p < .05). The high-potency steroid group had more favourable symptom (p = .035) and sign (p < .001) scores than did the control group. However, multiple systemic diseases were associated with poor symptom (p = .025) and sign (p = .014) scores. The risks for glaucoma and cataract formation were similar between the two groups (all p > .05). CONCLUSIONS Dual therapy combining high-potency steroids and 0.05% CsA significantly improved the signs and symptoms of severe DED compared with 0.05% CsA monotherapy, without severe complications.
Collapse
Affiliation(s)
- Chia-Yi Lee
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, Taipei, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Li-Chun Chang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- School of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Kai Chang
- Nobel Eye Institute, Taipei, Taiwan
- Department of Optometry, Da-Yeh University, Changhua, Taiwan
| | - Pei-Ting Lu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
2
|
Heidari Z, Hashemi H, Sotude D, Ebrahimi-Besheli K, Khabazkhoob M, Soleimani M, Djalilian AR, Yousefi S. Applications of Artificial Intelligence in Diagnosis of Dry Eye Disease: A Systematic Review and Meta-Analysis. Cornea 2024; 43:1310-1318. [PMID: 38984532 DOI: 10.1097/ico.0000000000003626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/06/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Clinical diagnosis of dry eye disease is based on a subjective Ocular Surface Disease Index questionnaire or various objective tests, however, these diagnostic methods have several limitations. METHODS We conducted a comprehensive review of articles discussing various applications of artificial intelligence (AI) models in the diagnosis of the dry eye disease by searching PubMed, Web of Science, Scopus, and Google Scholar databases up to December 2022. We initially extracted 2838 articles, and after removing duplicates and applying inclusion and exclusion criteria based on title and abstract, we selected 47 eligible full-text articles. We ultimately selected 17 articles for the meta-analysis after applying inclusion and exclusion criteria on the full-text articles. We used the Standards for Reporting of Diagnostic Accuracy Studies to evaluate the quality of the methodologies used in the included studies. The performance criteria for measuring the effectiveness of AI models included area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy. We calculated the pooled estimate of accuracy using the random-effects model. RESULTS The meta-analysis showed that pooled estimate of accuracy was 91.91% (95% confidence interval: 87.46-95.49) for all studies. The mean (±SD) of area under the receiver operating characteristic curve, sensitivity, and specificity were 94.1 (±5.14), 89.58 (±6.13), and 92.62 (±6.61), respectively. CONCLUSIONS This study revealed that AI models are more accurate in diagnosing dry eye disease based on some imaging modalities and suggested that AI models are promising in augmenting dry eye clinics to assist physicians in diagnosis of this ocular surface condition.
Collapse
Affiliation(s)
- Zahra Heidari
- Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Danial Sotude
- Psychiatry and Behavioral Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kiana Ebrahimi-Besheli
- Cellular and Molecular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Khabazkhoob
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Soleimani
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Ali R Djalilian
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL
| | - Siamak Yousefi
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN; and
- Department of Genetics, Genomics, and Informatics, University of Tennessee Health Science Center, Memphis, TN
| |
Collapse
|
3
|
Krolo I, Behaegel J, Termote K, de Bruyn B, De Schepper M, Oellerich S, Ní Dhubhghaill S. The role of topical insulin in ocular surface restoration: A review. Surv Ophthalmol 2024; 69:805-817. [PMID: 38609022 DOI: 10.1016/j.survophthal.2024.04.003] [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: 01/02/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
Corneal epithelial defects are one of the most common ocular disorders. Restoring corneal integrity is crucial to reduce pain and regain function, but in cases of neurotrophic or desensitized corneas, healing can be significantly delayed. Treating neurotrophic corneas is challenging for ophthalmologists, and surgical intervention is often indicated to manage refractory cases that are unresponsive to medical therapy. Over the last decade, as more expensive therapeutics reach the market, topical insulin has returned to the forefront as an affordable option to improve corneal wound healing. There is still a paucity of data on the use and the efficacy of topical insulin, with no consensus regarding its indications, preparation, or posology. Here we review the literature on topical insulin for corneal and ocular surface pathologies, with a focus on the current evidence, its mechanisms of action, and its safety profile. Additionally, we share our experience in the field and provide a potential framework for future research.
Collapse
Affiliation(s)
- Iva Krolo
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Oftalmología Médica y Quirúrgica (OMIQ) Research, Barcelona, Spain.
| | - Joséphine Behaegel
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Karolien Termote
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Ophthalmology, Imelda Hospital, Bonheiden, Belgium
| | - Barbara de Bruyn
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Manon De Schepper
- Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Silke Oellerich
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sorcha Ní Dhubhghaill
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Jette, Belgium; Department of Medicine and Pharmacology, Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium; Department of Medicine, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
4
|
Patil S, Sawale G, Ghuge S, Sathaye S. Quintessence of currently approved and upcoming treatments for dry eye disease. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06587-7. [PMID: 39215848 DOI: 10.1007/s00417-024-06587-7] [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: 02/13/2024] [Revised: 06/11/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
Dry eye disease (DED), also known as dry eye syndrome, is a multifactorial ocular surface disease. The aim of this review is to present the details of currently approved and upcoming treatment options for DED in a nutshell. We conducted a thorough literature search using PubMed and searched US FDA website, clinicaltrials.gov, and data available in public domain for currently approved and upcoming treatment options for DED. Currently, the US Food and Drug Administration (FDA)-approved medical treatments for treatment of DED include cyclosporine formulations (RESTASIS® [cyclosporine 0.05% ophthalmic emulsion], VEVYE® [cyclosporine 0.1% ophthalmic solution], and CEQUA™ [cyclosporine 0.09% ophthalmic solution]), XIIDRA® (lifitegrast), a leukocyte function-associated antigen-1 (LFA-1)/intracellular adhesion molecule-1(ICAM-1) inhibitor, EYSUVIS™ (loteprednol etabonate ophthalmic suspension 0.25%), a corticosteroid, and MIEBO™ (perfluorohexyloctane ophthalmic solution), a semifluorinated alkane. TYRVAYA™ (varenicline solution nasal spray), a cholinergic agonist, is another formulation approved for the treatment of the signs and symptoms of DED. The medical devices approved for treating DED due to meibomian glands dysfunction (MGD) include Lumenis OptiLight™ (intense pulsed light [IPL] device), TearCare® system, and TearScience™ LipiFlow™ thermal pulsation system. Punctal plugs are another treatment option approved for management of DED. There are hundreds of clinical studies evaluating newer treatments for managing the signs and symptoms. Cyclosporine formulations TJO-087 (cyclosporine A nanoemulsion 0.08%), SCAI-001 eye drops (cyclosporine 0.01%, 0.02%) are being evaluated against RESTASIS® and other approved treatments. The potential treatments being assessed include IC 265, OK-101, PL9643, SYL1001 (tivanisiran), SHJ002, OXERVATE® (cenegermin-bkbj ophthalmic solution 0.002%), HBM9036 (tanfanercept ophthalmic solution), OCS-02 (licaminlimab), MIM-D3 (tavilermide ophthalmic solution 5%), AR-15,512, BRM421, reproxalap, and AZR-MD-001 (selenium sulphide ointment 0.5%). The pathophysiology of DED is complex and multifactorial; there is a need to understand it even deeper. The new treatments and different delivery systems seem promising and provide a hope of effective treatment for DED.
Collapse
Affiliation(s)
- Sunanda Patil
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, near Khalsa College, Matunga East, Mumbai, 400019, India
- Department of Pharmacology, MET Institute of Pharmacy, Mumbai, India
| | - Gayatri Sawale
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, near Khalsa College, Matunga East, Mumbai, 400019, India
| | - Santosh Ghuge
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, near Khalsa College, Matunga East, Mumbai, 400019, India
| | - Sadhana Sathaye
- Department of Pharmaceutical Sciences and Technology, Institute of Chemical Technology, Nathalal Parekh Marg, near Khalsa College, Matunga East, Mumbai, 400019, India.
| |
Collapse
|
5
|
Rocha KM, Farid M, Raju L, Beckman K, Ayres BD, Yeu E, Rao N, Chamberlain W, Zavodni Z, Lee B, Schallhorn J, Garg S, Mah FS. Eyelid margin disease (blepharitis and meibomian gland dysfunction): clinical review of evidence-based and emerging treatments. J Cataract Refract Surg 2024; 50:876-882. [PMID: 38350160 DOI: 10.1097/j.jcrs.0000000000001414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/27/2024] [Indexed: 02/15/2024]
Abstract
Blepharitis is a common ophthalmic condition with multiple etiologies and no definitive, universal treatment. The treatment modalities for managing lid margin diseases vary depending on the disease's cause, location, and severity. For anterior blepharitis, management options include eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers. Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid may accompany these. For posterior blepharitis/meibomian gland dysfunction (MGD), at-home warm compress or in-office administration of heat therapy/thermal pulsation treatment that aims to clear obstruction in the meibomian glands and restore meibum secretions to maintain a healthy tear film is recommended. In addition to the above treatment strategies, various other compounds to manage lid margin diseases are in the late stages of development. This review summarizes the available treatment modalities or those in the pipeline for treating blepharitis and MGD.
Collapse
Affiliation(s)
- Karolinne Maia Rocha
- From the Medical University of South Carolina, Storm Eye Institute, Charleston, South Carolina (Rocha); University of California, Irvine, Irvine, California (Farid); New York University, Langone, New York, New York (Raju); Wills Eye Institute, Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, Pennsylvania (Beckman); Cornea Service, Wills Eye Hospital, Philadelphia, Pennsylvania (Ayres); Virginia Eye Consultants, Norfolk, Virginia (Yeu); Ophthalmic Consultants of Boston and Tufts University School of Medicine, Boston, Massachusetts (Rao); Casey Eye Institute, Oregon Health & Science University, Portland, Oregon (Chamberlain); The Eye Institute of Utah, Salt Lake City, Utah (Zavodni); Eye Consultants of Atlanta and Georgia Eye Bank, Atlanta, Georgia (Lee); Department of Ophthalmology and Francis I Proctor Foundation, University of California, San Francisco, San Francisco, California (Schallhorn); Gavin Herbert Eye Institute, University of California, Irvine, Irvine, California (Garg); Scripps Clinic, La Jolla, California (Mah)
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Davey PG, Farid M, Karpecki P, Gaddie IB, Chan A, Mun J, Neervannan S, Yeu E. Lotilaner Ophthalmic Solution, 0.25%, for the Treatment of Demodex Blepharitis. Healthcare (Basel) 2024; 12:1487. [PMID: 39120190 PMCID: PMC11311291 DOI: 10.3390/healthcare12151487] [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: 06/27/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
Demodex blepharitis, a chronic lid margin disease, is caused by an infestation of Demodex mites, the most common ectoparasites in human skin and eyelids. Lotilaner ophthalmic solution, 0.25% (Xdemvy, Tarsus Pharmaceuticals), is the first therapy approved to treat Demodex blepharitis. This narrative review characterizes lotilaner ophthalmic solution, 0.25%, and describes its efficacy, safety, and tolerability. The safety and efficacy of lotilaner ophthalmic solution, 0.25%, for treating Demodex blepharitis was evaluated in four phase 2 and two phase 3 trials. The data of 980 patients included in these phase 2 and 3 clinical trials revealed that the proportion of eyes with a clinically meaningful reduction to 10 or fewer collarettes (the cylindrical, waxy debris found at the base of the eyelashes) ranged from 81 to 93%. The mite eradication rate confirmed by a microscopy of epilated lashes ranged from 52 to 78%. No serious treatment-related adverse events were reported in any of these clinical studies. As high as 92% of the patients receiving lotilaner eyedrops in the phase 3 trials found it to be neutral to very comfortable. Given the positive safety and efficacy outcomes, the drug is likely to become the standard of care in the treatment of Demodex blepharitis.
Collapse
Affiliation(s)
| | - Marjan Farid
- Gavin Herbert Eye Institute, University of California-Irvine, Irvine, CA 92697, USA;
| | | | | | - Arthur Chan
- Tarsus Pharmaceuticals, Inc., Irvine, CA 92618, USA; (A.C.); (J.M.); (S.N.)
| | - James Mun
- Tarsus Pharmaceuticals, Inc., Irvine, CA 92618, USA; (A.C.); (J.M.); (S.N.)
| | - Sesha Neervannan
- Tarsus Pharmaceuticals, Inc., Irvine, CA 92618, USA; (A.C.); (J.M.); (S.N.)
| | | |
Collapse
|
7
|
Chen Z, Zhang C, Jiang J, Ouyang J, Zhang D, Chen T, Chu Y, Hu K. The efficacy of vitamin D supplementation in dry eye disease: A systematic review and meta-analysis. Cont Lens Anterior Eye 2024:102169. [PMID: 39025755 DOI: 10.1016/j.clae.2024.102169] [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: 10/19/2023] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE Vitamin D (VD) is a vitamin with anti-inflammatory and immunomodulatory effects. Several studies have shown that VD deficiency is associated with the incidence and severity of dry eye disease (DED) in humans. This meta-analysis compared signs and symptoms in patients with DED before and after VD supplementation. METHODS Ten databases (PubMed, Cochrane, Web of science, Ovid, Embase, Scopus, CNKI, CSTJ, Wanfang, Sinomed) and four clinical trials registry websites (ISRCTN, CT, ICTRP, ICH GCP) were searched for studies on the efficacy of VD supplement in patients with DED that were published up to 2023 January. A total of 8 studies with 439 cases were included. Two reviewers independently assessed the quality of the literature and extracted data to calculate standard mean differences (SMD) for the Schirmer's test (SH test), tear film break-up time (TBUT), corneal fluorescein staining scores (CFSS, Oxford Scale, 0-5), lid hyperemia, ocular surface disease index (OSDI), and visual analogue pain scale (VAS). RESULTS The analysis showed that VD supplementation improved tear production (SMD 1.43, 95% CI 0.81, 2.05, p = 0.000) and tear film stability (SMD 1.19, 95% CI 0.83, 1.55, p = 0.000) and reduced lid hyperemia (SMD -0.71, 95% CI -1.09, -0.32, p = 0.000) and OSDI (SMD -1.10, 95% CI -1.45, -0.74, p = 0.000), which is effective in alleviating the signs and symptoms of DED. CONCLUSIONS VD supplementation could be an adjuvant treatment to alleviate the signs and symptoms of dry eye in the future. However, further studies regarding its most appropriate administration and dosage need to be conducted.
Collapse
Affiliation(s)
- Zeying Chen
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, PR China
| | - Chengxiao Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, PR China
| | - Jiaxuan Jiang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, PR China
| | - Junwen Ouyang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, PR China
| | - Di Zhang
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, PR China
| | - Taige Chen
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, PR China
| | - Yiran Chu
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, PR China
| | - Kai Hu
- Department of Ophthalmology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210008, PR China.
| |
Collapse
|
8
|
Eom Y, Jun I, Jeon HS, Lim DH, Lee H, Hwang HS, Chung SH, Chung TY, Kim JY, Kim SW, Choi CY, Song JS, Kim MK, Seo KY, Hyon JY. Re-Esterified Triglyceride ω-3 Fatty Acids in Dry Eye Disease With Meibomian Gland Dysfunction: A Randomized Clinical Trial. JAMA Ophthalmol 2024; 142:617-624. [PMID: 38753336 PMCID: PMC11099841 DOI: 10.1001/jamaophthalmol.2024.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 05/19/2024]
Abstract
Importance Taking ω-3 supplements has been associated with a reduction in symptoms of dry eye disease (DED) associated with meibomian gland dysfunction (MGD). However, a recent relatively large clinical trial concluded that treating DED with ω-3 consumption was ineffective, potentially warranting additional investigations. Objectives To investigate the effect of re-esterified triglyceride (rTG) ω-3 fatty acid supplementation on DED associated with MGD. Design, Setting, and Participants This double-masked, parallel-group, randomized clinical trial was conducted at 7 institutions from September 2020 to January 2023. Patients with DED associated with MGD were included and randomly assigned to the ω-3 group (received 1680 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid), whereas those in the grape-seed group received 3000 mg of grape-seed oil daily. Interventions rTG ω-3 Fatty acid supplementation vs grape-seed oil. Main Outcome Measures The primary end point was the Ocular Surface Disease Index (OSDI) from baseline to 6 and 12 weeks. The safety parameters were visual acuity and intraocular pressure change. Results A total of 132 patients (mean [SD] age, 50.6 [13.8] years; 103 female [78.0%]) were included in this study. The mean (SD) baseline OSDI scores of the ω-3 and grape-seed groups were 43.5 (16.5) and 44.1 (16.6), respectively. A total of 58 patients (87.9%) and 57 patients (86.4%) in the ω-3 and grape-seed groups, respectively, completed 12 weeks of follow-up. There were no differences in compliance with the dietary supplement intake between groups (ω-3, 95.8% and grape-seed, 95.4%). The OSDI (SD) change from baseline to 6 and 12 weeks was -20.5 (16.0) and -22.7 (15.7), respectively, in the ω-3 group and -15.1 (20.2) and -18.8 (21.7), respectively, in the grape-seed control group (difference at 6 weeks = -5.4; 95% CI, -12.15 to 1.33; P = .12 and at 12 weeks = -3.9; 95% CI, -10.90 to 3.13; P = .28). There were no changes in safety parameters or adverse events related to taking the dietary supplement in either group. Conclusions and Relevance This randomized clinical trial did not show a benefit of the rTG form of ω-3 for ameliorating symptoms of DED associated with MGD, although fewer than 60 participants were evaluated in each group. Any secondary outcomes from this study should be considered for hypothesis generation of future evaluations of the effect of the rTG form of ω-3 on DED associated with MGD. Trial Registration CRIS Identifier: KCT0004927.
Collapse
Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ikhyun Jun
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Hyang Chung
- Department of Ophthalmology, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Woong Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Republic of Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| |
Collapse
|
9
|
Vaccaro S, Borselli M, Scalia G, Rossi C, Toro MD, Rejdak R, Pellegrini M, Scorcia V, Giannaccare G. A Novel Noninvasive Screening Tool for Dry Eye Disease. Diagnostics (Basel) 2024; 14:1209. [PMID: 38928625 PMCID: PMC11202972 DOI: 10.3390/diagnostics14121209] [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: 03/08/2024] [Revised: 05/20/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE To assess the feasibility and the diagnostic accuracy of the new tool, DEvice© (AI, Rome, Italy), for screening patients with dry eye disease (DED). METHODS This study was performed at the University Magna Græcia of Catanzaro. Enrolled patients were classified as affected by DED (group 1) or not (group 2) using an already validated tool (Keratograph 5M, Oculus, Germany), evaluating the noninvasive keratograph breakup time (NIKBUT), tear meniscus height (TMH), meibomian gland loss (MGL), and bulbar redness. All the patients were then examined by means of DEvice©, which allowed the measurement of the relative humidity (RH) and temperature of the ocular surface. Symptoms were scored using the Ocular Surface Disease Index (OSDI) questionnaire. RESULTS Overall, 40 patients (17 males and 23 females, mean age 38.0 ± 17.1 years) were included: of these, 20 belonged to group 1 and the remaining 20 to group 2. Using Keratograph 5M, significant differences between groups 1 and 2 were detected for NIKBUT-first (respectively, 4.97 ± 1.85 vs. 13.95 ± 4.8 s; p < 0.0001) and for NIKBUT-average (10.55 ± 4.39 vs. 15.96 ± 4.08 s; p = 0.0003). No statistically significant changes were detected for TMH (p = 0.565), MGL (p = 0.051), and bulbar redness (p = 0.687). Using Device©, a statistically significant higher value of RH was found in group 1 compared to group 2 (respectively, 85.93 ± 10.63 vs. 73.05 ± 12.84%; p = 0.0049). A statistically significant correlation was found between RH and OSDI (r = 0.406; p = 0.009). The value RH showed a discriminating power to detect DED with an AUC = 0.782 (standard error 0.07264; 95% CI 0.6401-0.9249; p = 0.0022). CONCLUSIONS The DEvice© can effectively discriminate DED patients from healthy subjects. The parameter RH showed good sensitivity, making this tool ideal for a fast and noninvasive DED screening.
Collapse
Affiliation(s)
- Sabrina Vaccaro
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (S.V.); (M.B.); (G.S.); (C.R.); (V.S.)
| | - Massimiliano Borselli
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (S.V.); (M.B.); (G.S.); (C.R.); (V.S.)
| | - Giovanni Scalia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (S.V.); (M.B.); (G.S.); (C.R.); (V.S.)
| | - Costanza Rossi
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (S.V.); (M.B.); (G.S.); (C.R.); (V.S.)
| | - Mario Damiano Toro
- Eye Clinic, Public Health Department, University of Naples Federico II, Via S. Pansini 5, 80133 Naples, Italy;
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Marco Pellegrini
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Department of Ophthalmology, Ospedali Privati Forlì “Villa Igea”, 47122 Forlì, Italy
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, Viale Europa, 88100 Catanzaro, Italy; (S.V.); (M.B.); (G.S.); (C.R.); (V.S.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, Via Università 40, 09124 Cagliari, Italy
| |
Collapse
|
10
|
Takezawa Y, Kamon M, Hiraki-Kamon K, Mitani A, Shiraishi A, Kato H. Experimental interventions attenuate a conjunctival epidermal metaplasia model. Exp Eye Res 2024; 243:109916. [PMID: 38679224 DOI: 10.1016/j.exer.2024.109916] [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: 12/01/2023] [Revised: 01/22/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024]
Abstract
The conjunctiva is a non-keratinized, stratified columnar epithelium with characteristics different from the cornea and eyelid epidermis. From development to adulthood, a distinguishing feature of ocular versus epidermal epithelia is the expression of the master regulator PAX6. A conditionally immortalized conjunctival epithelial cell line (iHCjEC) devoid of stromal or immune cells established in our laboratory spontaneously manifested epidermal metaplasia and upregulated expression of the keratinization-related genes SPRR1A/B and the epidermal cytokeratins KRT1 and KRT10 at the expense of the conjunctival trait. In addition, iHCjEC indicated a significant decrease in PAX6 expression. Dry eye syndrome (DES) and severe ocular surface diseases, such as Sjögren's syndrome and Stevens-Johnson syndrome, cause the keratinization of the entire ocular surface epithelia. We used iHCjECs as a conjunctiva epidermal metaplasia model to test PAX6, serum, and glucocorticoid interventions. Reintroducing PAX6 to iHCjECs resulted in upregulating genes related to cell adhesion and tight junctions, including MIR200CHG and CLDN1. The administration of glucocorticoids or serum resulted in the downregulation of epidermal genes (DSG1, SPRR1A/B, and KRT1) and partially corrected epidermal metaplasia. Our results using an isolated conjunctival epidermal metaplasia model point toward the possibility of rationally "repurposing" clinical interventions, such as glucocorticoid, serum, or PAX6 administration, for treating epidermal metaplasia of the conjunctiva.
Collapse
Affiliation(s)
- Yuki Takezawa
- Department of Ophthalmology, Graduate School of Medicine, Ehime University, Toon, Japan.
| | - Masayoshi Kamon
- Department of Developmental Biology and Functional Genomics, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Keiko Hiraki-Kamon
- Department of Developmental Biology and Functional Genomics, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Arisa Mitani
- Department of Ophthalmology, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Atsushi Shiraishi
- Department of Ophthalmology, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Hidemasa Kato
- Department of Developmental Biology and Functional Genomics, Graduate School of Medicine, Ehime University, Toon, Japan.
| |
Collapse
|
11
|
Bui HL, Su YH, Yang CJ, Huang CJ, Lai JY. Mucoadhesive, antioxidant, and lubricant catechol-functionalized poly(phosphobetaine) as biomaterial nanotherapeutics for treating ocular dryness. J Nanobiotechnology 2024; 22:160. [PMID: 38589911 PMCID: PMC11000383 DOI: 10.1186/s12951-024-02448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 03/30/2024] [Indexed: 04/10/2024] Open
Abstract
Dry eye disease (DED) is associated with ocular hyperosmolarity and inflammation. The marketed topical eye drops for DED treatment often lack bioavailability and precorneal residence time. In this study, we investigated catechol-functionalized polyzwitterion p(MPC-co-DMA), composed of 2-methacryloyloxyethyl phosphorylcholine (MPC) and dopamine methacrylamide (DMA) monomers, as potential topical nanotherapeutics for DED. The copolymers were synthesized via random free-radical copolymerization, producing different proportions of catecholic functionalization. All as-prepared polymer compositions displayed good ocular biocompatibility. At a feeding ratio of 1:1, p(MPC1-co-DMA1) can facilitate a robust mucoadhesion via Michael addition and/or Schiff base reaction, thus prolonging ocular residence time after 4 days of topical instillation. The hydration lubrication of MPC and radical-scavenging DMA endow the nano-agent to ease tear-film hyperosmolarity and corneal inflammation. A single dose of p(MPC1-co-DMA1) (1 mg/mL) after 4 days post-instillation can protect the cornea against reactive oxygen species, inhibiting cell apoptosis and the over-expression of pro-inflammatory factors (IL-6 and TNF-α). In clinical assessment, DED-induced rabbit eyes receiving p(MPC1-co-DMA1) could increase lacrimal fluid secretion by 5-fold higher than cyclosporine A. The catechol-functionalized polyzwitterion with enhanced lubricity, mucoadhesion, and anti-oxidation/anti-inflammation properties has shown high promise as a bioactive eye drop formulation for treating DED.
Collapse
Affiliation(s)
- Hoang Linh Bui
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan, 32023, Taiwan
| | - Yun-Han Su
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Chia-Jung Yang
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, 33302, Taiwan
| | - Chun-Jen Huang
- Department of Chemical and Materials Engineering, National Central University, Taoyuan, 32023, Taiwan.
- R&D Center for Membrane Technology, Chung Yuan Christian University, Taoyuan, 32023, Taiwan.
- NCU-Covestro Research Center, National Central University, Taoyuan, 32023, Taiwan.
| | - Jui-Yang Lai
- Department of Biomedical Engineering, Chang Gung University, Taoyuan, 33302, Taiwan.
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, 33305, Taoyuan, Taiwan.
- Department of Materials Engineering, Ming Chi University of Technology, New Taipei City, 24301, Taiwan.
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, 33303, Taiwan.
- Center for Biomedical Engineering, Chang Gung University, Taoyuan, 33302, Taiwan.
| |
Collapse
|
12
|
Kim CK, Locatelli EVT, Prislovsky A, Cabrera K, Gary AA, Mandal N, Galor A. Is Meibomian Gland Dysfunction One Disease? Heterogeneity Among Phenotypes. Cornea 2024:00003226-990000000-00533. [PMID: 38563551 DOI: 10.1097/ico.0000000000003542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/18/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE The purpose of this study was to examine ocular surface symptoms, tear metrics, and tear cytokines by Meibomian gland dysfunction (MGD) features. METHODS Symptom questionnaires and an ocular surface evaluation were performed on 40 individuals with varied MGD signs [Meibomian gland (MG) plugging, eyelid vascularity, meibum quality, and MG dropout]. Tear proteins were extracted off Schirmer strips and analyzed for 23 human inflammation-related proteins. Statistical analysis was performed to examine associations between dry eye metrics inflammatory proteins and MGD features. RESULTS The study involved 40 South Florida veterans with a mean age of 61 ± 13 years; most individuals were male (95%), White (31%), and non-Hispanic (85%). MGD features differentially related to dry eye signs. Eyelid vascularity, meibum quality, and MG dropout, but not MG plugging, correlated with higher corneal staining and lower tear production. MGD features also differentially related to tear cytokines. Eyelid vascularity most closely related to inflammation with significant correlations for interferon-gamma-γ (r = 0.36, P = 0.02), interleukin-4 (IL-4) (r = 0.43, P = 0.006), IL-17A (r = 0.42, P = 0.007), matrix metalloproteinase-2 (r = 0.39, P = 0.01), C-X-C motif chemokine ligand 5 (Regulated upon Activation, Normal T-Cell Expressed and presumably Secreted [RANTES]) (r = 0.32, P = 0.04), and tumor necrosis factor α (r = 0.36, P = 0.02). The other 3 MGD signs were less related to inflammation. Multivariable models revealed IL-4 to be most closely related to eyelid vascularity (standardized β = 0.39, P < 0.0001). CONCLUSIONS Eyelid vascularity was the MGD sign most closely related to inflammatory cytokines, suggesting that different MGD features may be driven by different pathophysiological mechanisms.
Collapse
Affiliation(s)
- Colin K Kim
- Bascom Palmer Eye Institute, Miami, FL
- VA Miami Healthcare System, Miami, FL; and
| | | | - Amanda Prislovsky
- The University of Tennessee Health Science Center Department of Ophthalmology Hamilton Eye Institute, Memphis, TN
- VA Memphis Medical Center, Memphis, TN
| | | | - Ashlyn A Gary
- Bascom Palmer Eye Institute, Miami, FL
- VA Miami Healthcare System, Miami, FL; and
| | - Nawajes Mandal
- The University of Tennessee Health Science Center Department of Ophthalmology Hamilton Eye Institute, Memphis, TN
- VA Memphis Medical Center, Memphis, TN
| | - Anat Galor
- Bascom Palmer Eye Institute, Miami, FL
- VA Miami Healthcare System, Miami, FL; and
| |
Collapse
|
13
|
Yilmaz OF, Oguz H. Ocular surface lesions in clinical grades of Bell's phenomenon. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2024; 12:177-186. [PMID: 38601052 PMCID: PMC11002467 DOI: 10.51329/mehdiophthal1484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/26/2024] [Indexed: 04/12/2024]
Abstract
Background Bell's phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical grading scale for Bell's phenomenon that includes the inverse Bell's phenomenon. Using this scale, we investigated the characteristics of Bell's phenomenon among asymptomatic individuals in different age groups and examined the frequency of ocular surface lesions in asymptomatic and symptomatic participants with different grades. Methods In this cross-sectional study, we randomly included 330 eyes of 165 asymptomatic, healthy, White Turkish individuals who attended the outpatient eye clinic, with a male-to-female ratio of 1:1.4, in the control group. These were categorized into four age groups: 4 - 20 years, 21 - 40 years, 41 - 60 years, and > 60 years. Eighty eyes from 40 patients with ocular surface lesions and absence of grade + 2 Bell's phenomenon were included in the symptomatic group. Bell's phenomenon was classified into five grades: grade + 2 (strong positive), grade + 1 (weak positive), grade 0 (no Bell's phenomenon, no eye movement), grade -1 (weak inverse), and grade -2 (strong inverse). Results We detected higher frequencies of grade + 2, + 1, and 0 in individuals aged 4 - 40, 41 - 60, and > 60 years, respectively. There was a significant difference between age groups in the frequencies of different grades (P < 0.001). Pairwise analysis revealed a significantly lower frequency of grade + 2 in the age group > 60 years compared with the 4 - 20 and 21 - 40 year groups (both P < 0.05). Grade + 2 was the most frequent in both sexes. We detected grade 0 in 27.1% of men and 22.1% of women in the control group, with no significant difference in the frequencies of different grades between sexes (P > 0.05). We observed significant differences between grades with respect to the frequency of ocular surface lesions (P < 0.001). Pairwise analysis revealed a significantly higher frequency of ocular surface lesions in asymptomatic individuals with grade 0 and all four other grades (all P < 0.001). However, the frequency of ocular surface lesions was comparable between sexes (P > 0.05). Of the 40 symptomatic individuals, 28 (70%), 5 (12.5%), 4 (10%), and 3 (7.5%) had grade 0, + 1, -1, and -2, respectively. The number of symptomatic patients was higher in grade 0 (n = 28) than in other grades (grade + 1, -1, and -2: n = 12 patients), and these individuals had a higher frequency of ocular surface lesions (n = 38 lesions) than others (grade + 1, -1, and -2: 7 lesions). Conclusions Using a simple, practical grading scale for Bell's phenomenon that includes inverse Bell's phenomenon, we observed that inverse Bell's phenomenon is a reflex that may be present in healthy individuals and could have a protective effect on the eye, although not to such a degree as a strong Bell's phenomenon. Our observations imply that bilateral conjunctival calcifications/Vogt's limbal girdle may be associated with grades 0 and + 1 Bell's phenomenon. Further large-scale studies are needed to determine the frequency of Bell's phenomenon in the general population using this innovative, simple, practical grading scale, and to identify the protective or injurious effect of each grade on the ocular surface.
Collapse
Affiliation(s)
- Omer Faruk Yilmaz
- Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Halit Oguz
- Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Department of Ophthalmology, Istanbul, Turkey
- Istanbul Medeniyet University Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey
| |
Collapse
|
14
|
Wu J, Wang X, Zhao Y, Hou Y, Gong P. Overview of CFTR activators and their recent studies for dry eye disease: a review. RSC Med Chem 2023; 14:2459-2472. [PMID: 38107177 PMCID: PMC10718525 DOI: 10.1039/d3md00448a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/23/2023] [Indexed: 12/19/2023] Open
Abstract
The cystic fibrosis transmembrane conductance regulator (CFTR) gets activated via the cAMP signaling pathway and is present in various secretory epithelial cells, including conjunctival and corneal epithelial cells. Activation of CFTR leads to fluid secretion in both mouse and human ocular surfaces. Dry eye disease is a significant health problem for which limited therapeutic options are available. In this review, on the one hand, small molecule CFTR activators with different chemical structures are summarized, and on the other hand, the pharmacological activity test and structural optimization of small molecule CFTR activators in the treatment of dry eye are outlined. The purpose of this review is to highlight the important role of CFTR activators in the treatment of dry eye disease and their potential as a new strategy for the treatment of dry eye disease.
Collapse
Affiliation(s)
- Jie Wu
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Xiaoqian Wang
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Yanfang Zhao
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Yunlei Hou
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| | - Ping Gong
- School of Pharmaceutical Engineering, Shenyang Pharmaceutical University 103 Wenhua Road, Shenhe District Shenyang 110016 China
| |
Collapse
|
15
|
Harrell CR, Feulner L, Djonov V, Pavlovic D, Volarevic V. The Molecular Mechanisms Responsible for Tear Hyperosmolarity-Induced Pathological Changes in the Eyes of Dry Eye Disease Patients. Cells 2023; 12:2755. [PMID: 38067183 PMCID: PMC10706334 DOI: 10.3390/cells12232755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial disorder of the lacrimal system and ocular surface, characterized by a deficiency in the quality and/or quantity of the tear fluid. The multifactorial nature of DED encompasses a number of interconnected underlying pathologies, including loss of homeostasis, instability and hyperosmolarity of the tears, and the induction and propagation of detrimental inflammatory responses in the eyes, which finally results in the development of neurosensory dysfunction and visual disruption. Dryness, grittiness, scratchiness, discomfort, inflammation, burning, watering, ocular fatigue, pain, and decreased functional visual acuity are common symptoms of DED. Eye dysfunction drastically attenuates patients' quality of life. Accordingly, a better understanding of the pathogenic processes that regulate the development and progression of DED is crucially important for the establishment of new and more effective DED-related treatment approaches, which would significantly improve the quality of life of DED patients. Since the process of osmoregulation, which guards the ocular surface epithelia and maintains normal vision, is affected when the osmolarity of the tears is greater than that of the epithelial cells, tear hyperosmolarity (THO) is considered an initial, important step in the development, progression, and aggravation of DED. In order to delineate the role of THO in the pathogenesis of DED, in this review article, we summarize current knowledge related to the molecular mechanisms responsible for the development of THO-induced pathological changes in the eyes of DED patients, and we briefly discuss the therapeutic potential of hypo-osmotic eye drops in DED treatment.
Collapse
Affiliation(s)
- Carl Randall Harrell
- Regenerative Processing Plant, LLC, 34176 US Highway 19 N, Palm Harbor, FL 34684, USA;
| | - Lisa Feulner
- Advanced Eye Care & Aesthetics, 104 Plumtree Rd Suite 107, Bel Air, MD 21015, USA;
| | - Valentin Djonov
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012 Bern, Switzerland;
| | - Dragica Pavlovic
- Departments of Genetics and Microbiology and Immunology, Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozar Markovic Street, 34000 Kragujevac, Serbia;
| | - Vladislav Volarevic
- Departments of Genetics and Microbiology and Immunology, Center for Harm Reduction of Biological and Chemical Hazards, Faculty of Medical Sciences, University of Kragujevac, 69 Svetozar Markovic Street, 34000 Kragujevac, Serbia;
| |
Collapse
|
16
|
Li CR. Role of lymphotoxin alpha as a new molecular biomarker in revolutionizing tear diagnostic testing for dry eye disease. Int J Ophthalmol 2023; 16:1883-1889. [PMID: 38028523 PMCID: PMC10626360 DOI: 10.18240/ijo.2023.11.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/24/2023] [Indexed: 12/01/2023] Open
Abstract
Dry eye disease (DED), primarily classified as multifactorial ocular surface disorder, afflicts tens of millions of individuals worldwide, adversely impacting their quality of life. Extensive research has been conducted on tear film analysis over the past decades, offering a range of tests to evaluate its volume, health, and integrity. Yet, early diagnosis and effective treatment for DED continue to pose significant challenges in clinical settings. Nevertheless, by recognizing key phenomena in DED such as ocular surface inflammation, hyperosmolarity, and tear film instability, this article provides a comprehensive overview of both traditional and recently developed methods for diagnosing and monitoring DED. The information serves as a valuable resource not only for clinical diagnosis but also for further research into DED.
Collapse
Affiliation(s)
- Chao-Ran Li
- Tianjin Medical University Eye Hospital, Tianjin 310011, China
| |
Collapse
|
17
|
Nijm LM, Schweitzer J, Gould Blackmore J. Glaucoma and Dry Eye Disease: Opportunity to Assess and Treat. Clin Ophthalmol 2023; 17:3063-3076. [PMID: 37869041 PMCID: PMC10590113 DOI: 10.2147/opth.s420932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/07/2023] [Indexed: 10/24/2023] Open
Abstract
Dry eye disease (DED) has been found to occur at a higher prevalence in individuals with glaucoma than in individuals without glaucoma. The relationship between glaucoma and DED may be, in part, a result of glaucoma therapy. Greater number of antiglaucoma medications used and greater number of antiglaucoma eyedrops instilled per day have been associated with ocular surface disease in patients with glaucoma. Use of antiglaucoma medication has also been associated with higher levels of ocular surface inflammatory markers and ocular surface alterations. There is evidence to suggest that antiglaucoma medications with preservatives and, to some extent, antiglaucoma medication formulations without preservatives may contribute to ocular surface signs and symptoms. Trabeculectomy for glaucoma has also been associated with ocular surface signs related to DED; however, there may be benefits of trabeculectomy and other procedures for glaucoma due to reduced use of antiglaucoma medications. Patients with glaucoma with ocular surface disease have been found to have greater ocular surface symptoms, poorer vision-related quality of life, and poorer antiglaucoma medication adherence compared with patients with glaucoma without ocular surface disease. Because of the potential negative impact of DED on patients with glaucoma, patients with glaucoma may benefit from evaluation for DED. Management of DED in patients with glaucoma may include modifications to antiglaucoma medications and use of treatments for DED.
Collapse
Affiliation(s)
- Lisa M Nijm
- Warrenville EyeCare and LASIK, Warrenville, IL, USA
- Department of Ophthalmology and Visual Sciences, University of Illinois Eye and Ear Infirmary, Chicago, IL, USA
| | | | | |
Collapse
|
18
|
Yeu E, Holdbrook M, Baba SN, Ceballos JC, Massaro-Corredor M, Corredor-Ortega C, Ramos-Betancourt N, Quiroz-Mercado H, Gonzalez-Salinas R. Treatment of Demodex Blepharitis: A Prospective, Randomized, Controlled, Double-Masked Clinical Trial Comparing Topical Lotilaner Ophthalmic Solution, 0.25% Eyedrops to Vehicle. Ocul Immunol Inflamm 2023; 31:1653-1661. [PMID: 35914297 DOI: 10.1080/09273948.2022.2093755] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/20/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of lotilaner ophthalmic solution, 0.25% eyedrops compared to vehicle for the treatment of Demodex blepharitis. METHODS In this randomized, controlled, double-masked clinical trial, 54 participants were randomly assigned in a 1:1 ratio to receive either lotilaner ophthalmic solution, 0.25% (study group) or the vehicle (control group) bilaterally, twice daily for 42 days. Outcome measures were collarette cure (collarette grade 0, upper eyelid), mite eradication (mite density of 0 mites/lash), and composite cure (grade 0 for collarettes and erythema). RESULTS The proportion of participants achieving collarette cure (80.0% vs 15.8%; p < .001), mite eradication (73.3% vs 21.1%, p = .003) and composite cure (73.3% vs 10.5%, p < .001) at Day 42 was statistically significantly higher in the study group than the control group. CONCLUSION Twice-daily 42-day treatment with novel lotilaner ophthalmic solution, 0.25% is safe and effective for the treatment of Demodex blepharitis compared to the vehicle control. (Registry number: ACTRN12620000320954, dated 09/03/2020).
Collapse
Affiliation(s)
| | | | | | - Juan Carlos Ceballos
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Martha Massaro-Corredor
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Claudia Corredor-Ortega
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | | | - Hugo Quiroz-Mercado
- Research Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Roberto Gonzalez-Salinas
- Anterior Segment Surgery Department, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| |
Collapse
|
19
|
Wang H, Yin X, Li Y, Zhang Z, Zhao K, Hu F, Liu Q, Lu Q, Wang Y, Zhang L, Jia H, Han J, Guo J, Li M. Safety and efficacy of intense pulsed light in the treatment of severe chronic ocular graft-versus-host disease. Ocul Surf 2023; 30:276-285. [PMID: 37813151 DOI: 10.1016/j.jtos.2023.10.002] [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: 02/16/2023] [Revised: 08/27/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To investigate the safety and efficacy of intense pulsed light (IPL) in the treatment of severe chronic ocular graft-versus-host disease (coGVHD). METHODS A prospective cohort study. Seventeen patients with severe coGVHD were selected for inclusion in this study. All subjects were treated with IPL every fortnight together with conventional treatment, observation time points were pre-treatment (W0), 4 weeks post-treatment (W4), 8 weeks post-treatment (W8) and 12 weeks post-treatment (W12). Dry eye related examinations include Tear meniscus height (TMH), Non-invasive break-up time (NIBUT), Schirmer I test, Tear film lipid layer thickness (LLT), Ocular surface staining (OSS) and assessment of meibomian gland. Corneal epithelial cell morphology and inflammatory cell infiltration were analyzed by corneal confocal microscopy, while goblet cell density and squamous epithelial grade were assessed by conjunctival imprinted cytology. RESULTS Patients did not experience any adverse reactions during the follow-up period. All subjects showed significant improvement in clinical symptoms and most signs after IPL treatment. The corneal confocal microscopy showed that the number of dendritic cells infiltrates in the corneal stroma was significantly reduced after IPL treatment (p < 0.001). Conjunctival blot cytology suggested an increase in the number of conjunctival goblet cells from 5.12 ± 2.71 cells/mm2 before treatment to 22.00 ± 4.58 cells/mm2 after treatment, with a statistically significant difference (p < 0.001). An improvement in conjunctival epithelial cell morphology and a decrease in squamous epithelial grade was also observed. CONCLUSIONS IPL treatment can effectively increase tear film stability in patients with severe coGVHD without significant side effects.
Collapse
Affiliation(s)
- He Wang
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China
| | - Xiaoyue Yin
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Yue Li
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Zhaowei Zhang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Kai Zhao
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Fen Hu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Qian Liu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Qiuchen Lu
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Yining Wang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Ling Zhang
- Xuzhou Medical University, Xuzhou, 221002, Jiangsu Province, China
| | - Hui Jia
- From the Institute of Environment and Ecology, Institute of Environmental Health and Ecological Security, School of the Environment and Safety Engineering, Jiangsu University, Zhenjiang, 212013, Jiangsu Province, China
| | - Jiaxin Han
- College of Optometry, Wenzhou Medical University, Wenzhou, 325027, Zhejiang Province, China
| | - Jianxin Guo
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China
| | - Mingxin Li
- From the Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Huai Hai West Street 99, Xuzhou, 221000, Jiangsu Province, China.
| |
Collapse
|
20
|
Zhang Y, Yan P, Tang H, Zhang J. Rapid detection of tear lactoferrin for diagnosis of dry eyes by using fluorescence polarization-based aptasensor. Sci Rep 2023; 13:15179. [PMID: 37704755 PMCID: PMC10499909 DOI: 10.1038/s41598-023-42484-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/11/2023] [Indexed: 09/15/2023] Open
Abstract
Differentiating dry eye disease (DED) from allergic or viral conjunctivitis rapidly and accurately is important to ensure prompt diagnosis and treatment. Tear lactoferrin (LF), a multi-functional glycoprotein found in tears, decreases significantly in patients with DED, and has been considered as a DED diagnostic biomarker. Measuring tear LF level, however, takes time and requires the use of bulky instruments. Herein, a homogeneous carbon nanostructure-based aptasensor with high sensitivity and selectivity has been developed by applying fluorescence polarization (FP) technology. The FP of carbon dots (CDs) bioconjugated with LF aptamers (CDs-aptamer) is 21.2% higher than that of CDs, which can be further amplified (1.81 times) once interacting with graphene oxide nanosheets (GONS). In the presence of LF, GONS separates from CDs-aptamer because of the stronger binding affinity between CDs-aptamer to LF, resulting in the decrease of FP value. A linear relationship is observed between FP value and LF concentration in spiked tear samples from 0.66 to 3.32 mg/mL. The selectivity of the aptasensor has been investigated by measuring other proteins. The results indicate that the FP-based aptasensor is a cost-effective method with high sensitivity and selectivity in detection of tear LF.
Collapse
Affiliation(s)
- Yingqi Zhang
- Department of Chemical and Biochemical Engineering, University of Western Ontario, London, ON, N6A 5B9, Canada
| | - Peng Yan
- Kensington Eye Institute, Toronto Western Hospital, Kensington Eye Institute, 600-340 College St, Toronto, ON, M5T 3A9, Canada
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, ON, M5T 3A9, Canada
| | - Howyn Tang
- School of Biomedical Engineering, University of Western Ontario, London, ON, N6A 5B9, Canada
| | - Jin Zhang
- Department of Chemical and Biochemical Engineering, University of Western Ontario, London, ON, N6A 5B9, Canada.
- School of Biomedical Engineering, University of Western Ontario, London, ON, N6A 5B9, Canada.
| |
Collapse
|
21
|
Kim HW, Kim JY. Randomized comparison of in vivo performance of TearLab® and I-PEN® osmometry in normal dogs. Vet Ophthalmol 2023; 26:440-445. [PMID: 37565779 DOI: 10.1111/vop.13140] [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: 05/08/2023] [Revised: 07/13/2023] [Accepted: 07/30/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To compare tear film (TF) osmolarity measured using TearLab® and I-PEN® osmometers in the same dogs without any ocular surface disease. ANIMAL STUDIED Fifty-two dogs (98 eyes) of different breeds were evaluated. PROCEDURES Tear film (TF) osmolarity was evaluated at 2-min intervals. The test was randomly determined, and single measurements were performed using each osmometer. Subsequently, complete ophthalmologic examinations were performed based on Schirmer tear test-1 (STT-1) analysis, tear film breakup time (TFBUT), and slit-lamp biomicroscopy. For each osmometer, the mean ± standard deviation of the TF osmolarity was calculated, and a paired Student's t-test was used to compare the values obtained. Pearson correlation analysis was performed to assess the association between osmolarity and other values such as STT-1, TFBUT, and age. RESULTS Tear film osmolarity determined using TearLab® (340.42 ± 15.87 mOsm/L) and I-PEN® (321.58 ± 17.39 mOsm/L) were significantly different (p < .001). However, statistical significance could not be confirmed between osmolarity and other values, such as STT-1, TFBUT, and age. CONCLUSIONS In dogs, the TF osmolarity values obtained using TearLab® tend to be higher than those obtained using I-PEN®, contrary to that observed in humans. These findings can serve as a reference for establishing normal values for each osmometer for clinical use in measuring TF osmolarity in dogs.
Collapse
Affiliation(s)
- Hyun-Wook Kim
- Department of Veterinary Ophthalmology, College of Veterinary Medicine, Konkuk University, Seoul, Korea
| | - Joon-Young Kim
- Department of Veterinary Ophthalmology, College of Veterinary Medicine, Konkuk University, Seoul, Korea
- KU Center for Animal Blood Medical Science, Konkuk University, Seoul, Korea
| |
Collapse
|
22
|
Eom Y, Chung SH, Chung TY, Kim JY, Choi CY, Yoon KC, Ko BY, Kim HK, Kim MK, Lee HK, Song JS, Hyon JY, Seo KY, Lee JS, Kim HM. Efficacy and safety of 1% and 2% rebamipide clear solution in dry eye disease: a multicenter randomized trial. BMC Ophthalmol 2023; 23:343. [PMID: 37537533 PMCID: PMC10398964 DOI: 10.1186/s12886-023-03004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 05/31/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND To evaluate the efficacy of 1% and 2% rebamipide clear solution in the treatment of dry eye disease (DED). METHODS Two hundred twenty patients with DED were randomly assigned to one of three groups: the 1% rebamipide, 2% rebamipide, or placebo (eye drops containing the same ingredients, except for the active components). Each eye drop was instilled four times daily for 12 weeks. Changes in tear film break-up time (TBUT), corneal and conjunctival staining score, Schirmer 1 test, and the Ocular Surface Disease Index (OSDI) from baseline to 12-week visit between the study groups were compared for efficacy assessment. RESULTS The mean age of study patients was 43.8±14.2 years. The 1% and 2% rebamipide groups showed greater improvement in TBUT (1.99±1.87 and 2.02±2.21 s) at 12 weeks from baseline than the placebo group (1.25±2.93 s). The 2% rebamipide group showed greater improvement in the corneal staining score (- 3.15±2.00) at 12 weeks from baseline than the placebo group (- 2.85±1.80). The 1% and 2% rebamipide groups showed improvement in Schirmer 1 test (1.27±3.86 and 1.50±4.14 mm) at 12 weeks of treatment, but not the placebo group (0.55±2.99 mm). Both the rebamipide groups and the placebo group showed significantly improved OSDI after treatment for 12 weeks; however, there was no significant difference among the three groups. CONCLUSIONS 1% and 2% rebamipide clear solutions are an effective therapeutic option for improving TBUT and tear volume, and stabilizing the corneal staining score in DED.
Collapse
Grants
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
- KSR-001 Kukje Pharma (Gyeonggi-do, Republic of Korea) and Samil Co. Ltd. (Seoul, Republic of Korea)
Collapse
Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Ansan Hospital, Ansan, Gyeonggi-do Republic of Korea
| | - So Hyang Chung
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung Chul Yoon
- Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Byung Yi Ko
- Department of Ophthalmology, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Hong Kyun Kim
- Department of Ophthalmology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung Keun Lee
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyoung Yul Seo
- Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Soo Lee
- Department of Ophthalmology, Pusan National University College of Medicine, Pusan, Republic of Korea
| | - Hyo Myung Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Anam Hospital, Seoul, Republic of Korea
| |
Collapse
|
23
|
Ungureanu L, Chaudhuri KR, Diaconu S, Falup-Pecurariu C. Dry eye in Parkinson's disease: a narrative review. Front Neurol 2023; 14:1236366. [PMID: 37602267 PMCID: PMC10436221 DOI: 10.3389/fneur.2023.1236366] [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: 06/07/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
In Parkinson's disease (PD) patients, a wide range of ocular and visual disorders are present. Tear film instability, inflammation and dysfunction of the ocular surface, and the presence of symptoms of visual disturbance characterize dry eye, a multifactorial disease of the ocular surface. Based on a literature search, we discuss the frequency, pathogenesis, and influence on the quality of life of patients with dry eye in Parkinson's disease. Furthermore, we review the available means of diagnosis and management of dry eye. An improvement in awareness and recognition of dry eye is needed to provide suitable, personalized therapeutic options for PD patients, aiming to improve their quality of life, independence, and safety.
Collapse
Affiliation(s)
- Larisa Ungureanu
- Department of Neurology, County Clinic Hospital, Braşov, Romania
- Faculty of Medicine, Transilvania University, Braşov, Romania
| | - K. Ray Chaudhuri
- Department Basic and Clinical Neuroscience, Parkinson Foundation Centre of Excellence, King's College London, Denmark Hill Campus, King's College Hospital, The Maurice Wohl Clinical Neuroscience Institute, London, United Kingdom
| | - Stefania Diaconu
- Department of Neurology, County Clinic Hospital, Braşov, Romania
- Faculty of Medicine, Transilvania University, Braşov, Romania
| | - Cristian Falup-Pecurariu
- Department of Neurology, County Clinic Hospital, Braşov, Romania
- Faculty of Medicine, Transilvania University, Braşov, Romania
| |
Collapse
|
24
|
Han Y, Zhang Y, Yuan K, Wu Y, Jin X, Huang X. Hyperosmolarity promotes macrophage pyroptosis by driving the glycolytic reprogramming of corneal epithelial cells in dry eye disease. Front Med 2023; 17:781-795. [PMID: 37266854 DOI: 10.1007/s11684-023-0986-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 01/28/2023] [Indexed: 06/03/2023]
Abstract
Tear film hyperosmolarity plays a core role in the development of dry eye disease (DED) by mediating the disruption of ocular surface homeostasis and triggering inflammation in ocular surface epithelium. In this study, the mechanisms involving the hyperosmolar microenvironment, glycolysis mediating metabolic reprogramming, and pyroptosis were explored clinically, in vitro, and in vivo. Data from DED clinical samples indicated that the expression of glycolysis and pyroptosis-related genes, including PKM2 and GSDMD, was significantly upregulated and that the secretion of IL-1β significantly increased. In vitro, the indirect coculture of macrophages derived from THP-1 and human corneal epithelial cells (HCECs) was used to discuss the interaction among cells. The hyperosmolar environment was found to greatly induce HCECs' metabolic reprogramming, which may be the primary cause of the subsequent inflammation in macrophages upon the activation of the related gene and protein expression. 2-Deoxy-d-glucose (2-DG) could inhibit the glycolysis of HCECs and subsequently suppress the pyroptosis of macrophages. In vivo, 2-DG showed potential efficacy in relieving DED activity and could significantly reduce the overexpression of genes and proteins related to glycolysis and pyroptosis. In summary, our findings suggested that hyperosmolar-induced glycolytic reprogramming played an active role in promoting DED inflammation by mediating pyroptosis.
Collapse
Affiliation(s)
- Yu Han
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, 310009, China
| | - Yu Zhang
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, 310009, China
| | - Kelan Yuan
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, 310009, China
| | - Yaying Wu
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, 310009, China
| | - Xiuming Jin
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, 310009, China
| | - Xiaodan Huang
- Eye Center, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, 310009, China.
| |
Collapse
|
25
|
Kudasiewicz-Kardaszewska A, Grant-Kels JM, Grzybowski A. Meibomian gland dysfunction and blepharitis: A common and still unsolved ophthalmic problem. Clin Dermatol 2023; 41:491-502. [PMID: 37574151 DOI: 10.1016/j.clindermatol.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Blepharitis and meibomian gland dysfunction (MGD) are very common, usually underdiagnosed and underappreciated diseases. More than 50% of patients seeking ophthalmologic consultations have symptoms and signs indicating one or both entities. We summarize the key points of diagnosis and management of both diseases, comparing the work of Dry Eye Workshop II (2017) with the dry eye blepharitis syndrome unification theory. The impact of MGD/blepharitis on ocular surgery also is described. Although MGD and blepharitis seem to be uncurable, most of the time they can be successfully controlled. Different management options are available, but the key to success remains simple-routine eyelid hygiene and moisturizing with the use of preservative-free lubricants.
Collapse
Affiliation(s)
| | - Jane M Grant-Kels
- Dermatology Department, University of Connecticut School of Medicine, Farmington, Connecticut, USA; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznań, Poland
| |
Collapse
|
26
|
Leong CY, Naffi AA, Wan Abdul Halim WH, Bastion MLC. Usage of topical insulin for the treatment of diabetic keratopathy, including corneal epithelial defects. World J Diabetes 2023; 14:930-938. [PMID: 37383598 PMCID: PMC10294054 DOI: 10.4239/wjd.v14.i6.930] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/14/2023] [Accepted: 04/24/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Diabetic keratopathy (DK) occurs in 46%-64% of patients with diabetes and requires serious attention. In patients with diabetes, the healing of corneal epithelial defects or ulcers takes longer than in patients without diabetes. Insulin is an effective factor in wound healing. The ability of systemic insulin to rapidly heal burn wounds has been reported for nearly a century, but only a few studies have been performed on the effects of topical insulin (TI) on the eye. Treatment with TI is effective in treating DK.
AIM To review clinical and experimental animal studies providing evidence for the efficacy of TI to heal corneal wounds.
METHODS National and international databases, including PubMed and Scopus, were searched using relevant keywords, and additional manual searches were conducted to assess the effectiveness of TI application on corneal wound healing. Journal articles published from January 1, 2000 to December 1, 2022 were examined. The relevancy of the identified citations was checked against predetermined eligibility standards, and relevant articles were extracted and reviewed.
RESULTS A total of eight articles were found relevant to be discussed in this review, including four animal studies and four clinical studies. According to the studies conducted, TI is effective for corneal re-epithelialization in patients with diabetes based on corneal wound size and healing rate.
CONCLUSION Available animal and clinical studies have shown that TI promotes corneal wound healing by several mechanisms. The use of TI was not associated with adverse effects in any of the published cases. Further studies are needed to enhance our knowledge and understanding of TI in the healing of DK.
Collapse
Affiliation(s)
- Ching Yee Leong
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
| | - Ainal Adlin Naffi
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
| | - Wan Haslina Wan Abdul Halim
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
| | - Mae-Lynn Catherine Bastion
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Wilayah Persekutuan, Malaysia
| |
Collapse
|
27
|
Ezinne N, Alemu HW, Cheklie T, Ekemiri K, Mohammed R, James S. High Prevalence of Symptomatic Dry Eye Disease Among University Students During the COVID-19 Pandemic in University of West Indies, Trinidad and Tobago. CLINICAL OPTOMETRY 2023; 15:37-43. [PMID: 36896339 PMCID: PMC9990450 DOI: 10.2147/opto.s396135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Covid-19 pandemic lockdown obligated higher education students to attend online courses, leading to prolonged exposure to digital displays. Excessive time on digital devices could be a risk factor for ocular problems, including symptomatic dry eye. There are limited evidences to show the magnitude of symptomatic dry eye disease and its associated factors during COVID-19 pandemic. This study aimed to fill this gap, among university students in Trinidad and Tobago. METHODS An institutional-based cross-sectional study was conducted among undergraduate students attending the University of West Indies, Saint Augustine Campus from October 2020 to April 2021. The standardized ocular surface disease index questionnaire, descriptive statics and binary logistic regression were used to assess the prevalence and associated factors of dry eye diseases. Variables with a p-value of less than 0.05 were considered to be statistically significant. RESULTS Four hundred (96.3%) participants completed the questionnaire. Among all, 64.8% were female and 50.5% were east Indians. About 48% were using visual display units for average of 10-15 hours/day. The prevalence of symptomatic dry eye disease was 84.3% (95% CI = 80.8-87.5%) with OSDI score ≥13. Lack of education about dry eye 2.69 (95% CI: 1.41-5.13), use of the reading mode of computer 3.92 (95% CI: 1.57-9.80), refractive error 3.20 (95% CI: 1.66-6.20), previous systemic medications 2.80 (95% CI: 1.15-6.81), and average hours of visual display unit use/day (p<0.001) were significantly associated with symptomatic dry eye disease. CONCLUSION Symptomatic dry eye disease was a prominent problem among students at the University of West Indies. Average of >4 hours of visual display unit use/day, refractive error, positive history of systemic medication, lack of education about dry eye, and using computers in reading mode were associated factors.
Collapse
Affiliation(s)
- Ngozika Ezinne
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago, West Indies
| | - Haile W Alemu
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tarekegn Cheklie
- Department of Optometry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kingsley Ekemiri
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago, West Indies
| | - Ryan Mohammed
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago, West Indies
| | - Sakeem James
- Optometry Unit, Department of Clinical Surgical Sciences, University of the West Indies, Saint Augustine Campus, Trinidad and Tobago, West Indies
| |
Collapse
|
28
|
Fan M, Kim SA, Choi YJ, Tang Y, Yang HP, Kim EK. Anthocyanin oligomer (grape skin extract) administration improves dry eye disease: A randomised, double-blind, placebo-controlled study. Clin Exp Ophthalmol 2023; 51:122-130. [PMID: 36703096 DOI: 10.1111/ceo.14207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/02/2022] [Accepted: 12/18/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dry eye disease is a chronic, progressive ocular disease characterised by ocular discomfort and is one of the most common ophthalmological disorders that affects people's lives. METHODS This study investigated the clinical efficacy of anthocyanin oligomers (grape skin extract) for the treatment of dry eye. One hundred and eight patients with dry eye were randomly divided into placebo and treatment groups, each with 54 cases. The placebo group received maltodextrin (800 mg/day) and the treatment group received anthocyanin oligomers (800 mg/day). Clinical efficacy, clinical indices, and occurrence of adverse reactions were compared between the two groups. RESULTS Anthocyanin oligomers were safe and effective in mild-to-moderate dry eye disease, improving the tear break-up time, intraocular pressure, ocular surface disease, and patient symptomatology. CONCLUSIONS The use of oral anthocyanin oligomers in the treatment of dry eye patients can enhance the therapeutic effect and improve the quality of life of patients while ensuring the safety of treatment, making this therapeutic option suitable for wider application.
Collapse
Affiliation(s)
- Meiqi Fan
- Division of Food Bioscience, College of Biomedical and Health Sciences, Konkuk University, Chungju, Republic of Korea
| | - Su Ah Kim
- Department of Ophthalmology, SahmYook Medical Center, Seoul, Republic of Korea
| | - Young-Jin Choi
- Department of Food Science and Nutrition, College of Health Science, Dong-A University, Busan, Republic of Korea.,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus program, Dong-A University, Busan, Republic of Korea.,Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea
| | - Yujiao Tang
- Changchun University of Science and Technology, Changchun, China
| | - Hyun Pil Yang
- Technical R&D Center, Kitto Life Co., LTD, Pyeongtaek, Republic of Korea
| | - Eun-Kyung Kim
- Department of Food Science and Nutrition, College of Health Science, Dong-A University, Busan, Republic of Korea.,Center for Silver-targeted Biomaterials, Brain Busan 21 Plus program, Dong-A University, Busan, Republic of Korea.,Department of Health Sciences, The Graduate School of Dong-A University, Busan, Republic of Korea.,Center for Food & Bio Innovation, Dong-A University, Busan, South Korea
| |
Collapse
|
29
|
A Randomised Phase I Study to Assess the Safety, Tolerability and Pharmacokinetics of Palovarotene Ophthalmic Solution. Drugs R D 2023; 23:43-53. [PMID: 36542308 PMCID: PMC9985528 DOI: 10.1007/s40268-022-00410-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Palovarotene, a selective retinoic acid receptor γ agonist, is under investigation for the treatment of dry eye disease. This study aimed to determine the ocular and systemic safety, tolerability and pharmacokinetics of palovarotene ophthalmic solution (PVO-OS) in healthy adults. METHODS This was a randomised, vehicle-controlled phase I study (NCT04762355; retrospectively registered). Participants received either PVO-OS (at 0.025, 0.05 or 0.10 mg/mL) or a vehicle (placebo-to-match PVO-OS) once-daily or twice-daily for seven consecutive days. Safety was assessed by ocular and systemic assessments. Blood samples for pharmacokinetic assessments were collected before and after dose administration. RESULTS Thirty-six participants were randomised to PVO-OS and 12 to the vehicle. Overall, 89 treatment-emergent ocular adverse events (TEOAEs) were reported by 22 participants (61.1%) receiving PVO-OS and ten TEOAEs were reported by five participants (41.7%) receiving the vehicle. Erythema, irritation and skin dryness of the eyelid were the most common TEOAEs in participants receiving PVO-OS. The incidence of TEOAEs and eyelid-related findings in the PVO-OS groups increased with ascending dose and frequency compared with participants treated with the vehicle. All TEOAEs were mild (96.6%) or moderate (3.4%) and resolved without sequelae. Plasma palovarotene concentrations were generally measurable for up to 3-4 h for 0.025 mg/mL and 0.05 mg/mL and up to 12 h for 0.10 mg/mL dose regimens, independent of the frequency of administration. CONCLUSIONS PVO-OS was generally well tolerated at doses up to and including 0.10 mg/mL twice daily. Similar pharmacokinetic profiles were observed for the once-daily and twice-daily regimens following multiple ascending doses of PVO-OS.
Collapse
|
30
|
Narrative Review Concerning the Clinical Spectrum of Ophthalmological Impairments in Parkinson's Disease. Neurol Int 2023; 15:140-161. [PMID: 36810467 PMCID: PMC9944508 DOI: 10.3390/neurolint15010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 01/30/2023] Open
Abstract
Ophthalmic non-motor impairments are common in Parkinson's disease patients, from the onset of the neurodegenerative disease and even prior to the development of motor symptoms. This is a very crucial component of the potential for early detection of this disease, even in its earliest stages. Since the ophthalmological disease is extensive and impacts all extraocular and intraocular components of the optical analyzer, a competent assessment of it would be beneficial for the patients. Because the retina is an extension of the nervous system and has the same embryonic genesis as the central nervous system, it is helpful to investigate the retinal changes in Parkinson's disease in order to hypothesize insights that may also be applicable to the brain. As a consequence, the detection of these symptoms and signs may improve the medical evaluation of PD and predict the illness' prognosis. Another valuable aspect of this pathology is the fact that the ophthalmological damage contributes significantly to the decrease in the quality of life of patients with Parkinson's disease. We provide an overview of the most significant ophthalmologic impairments associated with Parkinson's disease. These results certainly constitute a large number of the prevalent visual impairments experienced by PD patients.
Collapse
|
31
|
Sall K, Foulks GN, Pucker AD, Ice KL, Zink RC, Magrath G. Validation of a Modified National Eye Institute Grading Scale for Corneal Fluorescein Staining. Clin Ophthalmol 2023; 17:757-767. [PMID: 36915716 PMCID: PMC10007867 DOI: 10.2147/opth.s398843] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/10/2023] [Indexed: 03/09/2023] Open
Abstract
Purpose Validation of the novel Lexitas modified NEI scale for use in assessment of corneal fluorescein staining. Patients and Methods A series of 18 illustrations and 14 clinical photographs depicting varying severity levels of corneal fluorescein staining were assessed by 3 independent examiners. Regions of the cornea were graded for staining severity based on 3 different grading scales: the original NEI staining scale (density-based scoring; 0-3 scale), a structured version of the NEI scale (dot-count scoring; 0-3 scale), and the Lexitas modified NEI staining scale (0-4 scale with half-point increments). Kappa statistics (simple and weighted) were computed to determine intra-examiner image grading repeatability for each examiner over 2 separate assessments. Inter-examiner assessment reliability utilized the scores from the first read of each examiner, and pairs of examiners to compute kappa statistics. Results Data was analyzed from the scores provided by the examiners from each gradable corneal region on 32 images (18 illustrations and 14 photographs) for a total of 154 corneal regions across the 3 grading scales for each validation run. The mean intra-examiner simple/weighted kappa values using the NEI density, NEI dot count, and the Lexitas modified NEI staining scales were 0.67/0.72, 0.91/0.94, 0.80/0.92 for the graded illustrations, and 0.83/0.88, 0.76/0.85, 0.77/0.88 for the graded photographs, respectively. The mean inter-examiner simple/weighted kappa values using the NEI density, NEI dot count, and the Lexitas modified NEI staining scales were 0.59/0.65, 0.86/0.90, and 0.78/0.91 for the graded illustrations, and 0.80/0.88, 0.84/0.89, 0.69/0.88 for the graded photographs, respectively. Conclusion The expanded scale of the Lexitas modified NEI staining scale demonstrated a high degree of reliability and repeatability of grading assessments within and across individual examiners, comparing favorably with the original NEI staining scale. A future investigation into the in-office utility of the Lexitas modified NEI staining scale is warranted.
Collapse
Affiliation(s)
| | - Gary N Foulks
- University of Louisville (Retired), Louisville, KY, USA
| | | | - Karen L Ice
- Lexitas Pharma Services, Inc, Durham, NC, USA
| | | | | |
Collapse
|
32
|
Jackson CJ, Naqvi M, Gundersen KG, Utheim TP. Role of stem cells in regenerative treatment of dry eye disease caused by lacrimal gland dysfunction. Acta Ophthalmol 2022; 101:360-375. [PMID: 36564971 DOI: 10.1111/aos.15629] [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: 07/08/2022] [Revised: 11/06/2022] [Accepted: 12/11/2022] [Indexed: 12/25/2022]
Abstract
An ageing population and increased screen use in younger people have contributed to a rise in incidence of dry eye disease (DED). Quality of life can be significantly affected by DED, with patients experiencing eye dryness, burning, pain and sensitivity to light. If left untreated, DED may progress to cause lasting damage to the delicate cell layers of the ocular surface. The aqueous-deficient form of DED is characterized by decreased tear volume. This can occur through underlying disease or damage to the lacrimal gland (LG), which results in increased inflammation at the ocular surface and decreased tear secretion. Regenerative therapy for treatment of aqueous-deficient DED would ideally restore LG function without causing adverse side effects and be feasible in terms of cost, production and practical application in the clinic. In this review, we evaluate research directed at the development of clinical procedures for regeneration of the LG using various stem cell types and their products. We also discuss work identifying potential therapeutic targets that may alter pathways to effect healing and ameliorate development of DED. Finally, we discuss shortcomings and recommend future avenues for research. These include determination of the best tissue of origin for mesenchymal cells and transference of knowledge gleaned from animal studies to clinical investigations.
Collapse
Affiliation(s)
- Catherine J Jackson
- Ifocus, Haugesund, Norway.,Institute of Oral Biology, University of Oslo, Oslo, Norway
| | - Maria Naqvi
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway.,Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway.,Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway.,Faculty of Medicine, Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, Stavanger, Norway.,Faculty of Dentistry, Department of Oral Biology, University of Oslo, Oslo, Norway.,National Centre for Optics, Vision and Eye Care, Faculty of Health Sciences, Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway.,The Faculty of Health and Sport Sciences, Department of Health and Nursing Science, University of Agder, Grimstad, Norway.,Department of Computer Science, Oslo Metropolitan University, Oslo, Norway.,The Norwegian Dry Eye Clinic, Oslo, Norway
| |
Collapse
|
33
|
Difficulties in Performing Daily Activities in Patients with Dry Eye before and after Treatment. Medicina (B Aires) 2022; 59:medicina59010025. [PMID: 36676649 PMCID: PMC9861134 DOI: 10.3390/medicina59010025] [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: 10/17/2022] [Revised: 11/24/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
Dry eye disease (DED) represents an important public health problem causing visual discomfort which affects the quality of life. This paper investigates the current comprehension of DED on life quality and vision. METHODS This research consists of a cross-sectional study of 121 patients, with a mean age of 70 ± 9 years, diagnosed with DED. All patients were treated in the University Clinic for Ophthalmology in "St. Spiridon" Emergency Hospital, Iasi. For all patients, we evaluated visual acuity on the Snellen chart, tear breakup time (TBUT), Schirmer I test scores, and contrast sensitivity. For this study, we used the Visual Functioning Questionnaire-25 (VFQ-25) version 2000, modified and adapted for this research (19 items). RESULTS Prior to treatment, patients had very high difficulty reading a text in a newspaper or on TV, reading prices on products in shops, or recognizing people they already met. Performing manual work or favorite activities was also very difficult. Post-treatment visual challenges improved in the majority of cases, regardless of the treatment method used. CONCLUSIONS We found that symptomatic dry eye disease was associated with reduced ability in performing several important vision-related daily tasks and has a significant impact on life quality and visual performance.
Collapse
|
34
|
Messmer EM, Ahmad S, Benitez del Castillo JM, Mrukwa-Kominek E, Rolando M, Vitovska O, Baudouin C. Management of inflammation in dry eye disease: Recommendations from a European panel of experts. Eur J Ophthalmol 2022; 33:1294-1307. [PMID: 36471573 PMCID: PMC10152565 DOI: 10.1177/11206721221141481] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction Early initiation of anti-inflammatory therapies is recommended for dry eye disease (DED) to break the vicious cycle of pathophysiology. However, there is limited guidance on how to implement topical ciclosporin (CsA) and corticosteroid treatment into clinical practice. This expert-led consensus provides practical guidance on the management of DED, including when and how to use topical CsA. Methods A steering committee (SC) of seven European DED experts developed a questionnaire to gain information on the unmet needs and management of DED in clinical practice. Consensus statements on four key areas (disease severity and progression; patient management; efficacy, safety and tolerability of CsA; and patient education) were generated based on the responses. The SC and an expanded expert panel of 22 members used a nine-point scale (1 = strongly disagree; 9 = strongly agree) to rate statements; a consensus was reached if ≥75% of experts scored a statement ≥7. Results A stepwise approach to DED management is required in patients presenting with moderate corneal staining. Early topical CsA initiation, alone or with corticosteroids, should be considered in patients with clinical risk factors for severe DED. Patient education is required before and during treatment to manage expectations regarding efficacy and tolerability in order to optimise adherence. Follow-up visits are required, ideally at Month 1 and every 3 months thereafter. Topical CsA may be continued indefinitely, especially when surgery is required. Conclusion This consensus fills some of the knowledge gaps in previous recommendations regarding the use of topical corticosteroids and CsA in patients with DED.
Collapse
Affiliation(s)
| | - Sajjad Ahmad
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ewa Mrukwa-Kominek
- Department of Ophthalmology, Medical University of Silesia, Katowice, Poland
| | | | | | - Christophe Baudouin
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital and Vision Institute, Paris, France
| | | |
Collapse
|
35
|
Eom Y, Song JS, Kim HM. Effectiveness of Topical Cyclosporin A 0.1%, Diquafosol Tetrasodium 3%, and Their Combination, in Dry Eye Disease. J Ocul Pharmacol Ther 2022; 38:682-694. [PMID: 36473191 DOI: 10.1089/jop.2022.0031] [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: 12/12/2022] Open
Abstract
Purpose: To compare the effectiveness of the topical use of cyclosporin A (CsA) 0.1%, diquafosol (DQS) tetrasodium 3% ophthalmic solution, and their combination in treating dry eye disease in a general health care setting. Methods: This prospective, nonrandomized, observational study analyzed 279 patients. Patients instilled topical CsA 0.1% (Ikervis®; Santen Pharmaceutical Co., Ltd., Japan) once daily and/or DQS tetrasodium 3% (Diquas-S®; Santen) six times a day for 12 weeks. Objective signs [tear break-up time (TBUT), National Eye Institute (NEI) corneal and conjunctival staining scores] and symptoms [Symptom Assessment in Dry Eye (SANDE) and Dry Eye-related Quality-of-Life Score (DEQS) questionnaires] were evaluated at baseline, week 4, and week 12. Results: Patients (n = 279) were mainly female (85.0%) with a mean (SD) age of 50.1 (14.8) years, and received CsA (n = 93), DQS (n = 99), or CsA/DQS (n = 87). Both monotherapies and CsA/DQS combination therapy significantly improved TBUT, NEI corneal and conjunctival staining scores, and SANDE and DEQS scores from baseline to week 12 (all P < 0.0001). The mean change in TBUT between baseline and week 12 was significantly higher in CsA/DQS combination therapy (2.13 ± 2.41 s) than in CsA monotherapy (1.07 ± 1.71 s; P = 0.0011). Conclusions: Monotherapy with CsA or DQS and CsA/DQS combination therapy all significantly improved the objective signs and symptoms of dry eyes during 12 weeks of treatment. CsA/DQS combination therapy provides an additional benefit in terms of TBUT compared with CsA alone; however, a randomized controlled trial still needs to be performed to confirm this result.
Collapse
Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Ansan Hospital, Gyeonggi-do, South Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Guro Hospital, Seoul, South Korea
| | - Hyo Myung Kim
- Department of Ophthalmology, Korea University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Korea University Anam Hospital, Seoul, South Korea
| |
Collapse
|
36
|
Chen N, Zhang JS, Zhang TX, Fan BL, Ning Y. The effect of sodium hyaluronate on tear film stability in patients with dry eye syndrome after cataract surgery. Graefes Arch Clin Exp Ophthalmol 2022; 261:1011-1017. [PMID: 36378338 DOI: 10.1007/s00417-022-05880-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/07/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aimed to observe the changes in the ocular surface after phacoemulsification in patients with age-related cataracts with respect to the addition of varying concentrations of hyaluronate. METHODS Patients with dry eye syndrome were treated with 0.3% and 0.1% sodium hyaluronate eye drops to evaluate the clinical improvement in each treatment group. A total of 73 patients (91 eyes) with age-related cataracts suffering from dry eye syndrome after phacoemulsification were divided into treatment group A (30 eyes), undergoing conventional therapy and treatment with 0.3% sodium hyaluronate; treatment group B (31 eyes), undergoing conventional therapy and treatment with 0.1% sodium hyaluronate; and the control group (group C; 30 eyes), undergoing conventional therapy only. Two groups were given different concentrations of sodium hyaluronate eye drops four times a day (should be completed between 8 AM and 8 PM), one drop at a time. RESULTS Seven days, 2 weeks, 1 month, and 2 months postoperatively, there were significant differences in the Schirmer I test (SIt), first noninvasive tear film break-up time (NIBUTf), average noninvasive tear film break-up time (NIBUTav), tear meniscus height (TMH), and irregularity (when the refractive force of different parts of different meridians on the same meridian is different. The main manifestation is that the two meridians on the anterior surface of the cornea do not show a 90-degree vertical distribution, which cannot be corrected by conventional astigmatism lenses) between the three groups (p < 0.05). When compared with group C, there were significant differences in the SIt, NIBUTf, NIBUTav, TMH, and irregularity of group A and group B (p < 0.05). When compared with group B, there were significant improvements in the SIt, NIBUTf, NIBUTav, and TMH in group A (p < 0.05). CONCLUSIONS In the early stage after phacoemulsification, the stability of the tear film is reduced. Adding sodium hyaluronate eye drops can restore tear film structure and improve corneal surface regularity, and a 0.3% solution of sodium hyaluronate eye drops is more effective than a 0.1% solution.
Collapse
Affiliation(s)
- Nan Chen
- Department of Ophthalmology, Key Laboratory of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Ophthalmological Center of China Medical University, China Medical University, No. 102 of Nanqi Street, Heping District, Shenyang, 110005, Liaoning, China
| | - Jin-Song Zhang
- Department of Ophthalmology, Key Laboratory of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Ophthalmological Center of China Medical University, China Medical University, No. 102 of Nanqi Street, Heping District, Shenyang, 110005, Liaoning, China
| | - Tian-Xiao Zhang
- Department of Ophthalmology, Key Laboratory of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Ophthalmological Center of China Medical University, China Medical University, No. 102 of Nanqi Street, Heping District, Shenyang, 110005, Liaoning, China
| | - Bao-Liang Fan
- Department of Ophthalmology, Key Laboratory of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Ophthalmological Center of China Medical University, China Medical University, No. 102 of Nanqi Street, Heping District, Shenyang, 110005, Liaoning, China
| | - Yuan Ning
- Department of Ophthalmology, Key Laboratory of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Ophthalmological Center of China Medical University, China Medical University, No. 102 of Nanqi Street, Heping District, Shenyang, 110005, Liaoning, China.
| |
Collapse
|
37
|
Therapeutic Potential of d-MAPPS™ for Ocular Inflammatory Diseases and Regeneration of Injured Corneal and Retinal Tissue. Int J Mol Sci 2022; 23:ijms232113528. [DOI: 10.3390/ijms232113528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/01/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
The invasion of microbial pathogens and/or sterile inflammation caused by physical/chemical injuries, increased ocular pressure, oxidative stress, and ischemia could lead to the generation of detrimental immune responses in the eyes, which result in excessive tissue injury and vision loss. The bioavailability of eye drops that are enriched with immunoregulatory and trophic factors which may concurrently suppress intraocular inflammation and promote tissue repair and regeneration is generally low. We recently developed “derived- Multiple Allogeneic Proteins Paracrine Signaling regenerative biologics platform technology d-MAPPS™”, a bioengineered biological product which is enriched with immunomodulatory and trophic factors that can efficiently suppress detrimental immune responses in the eye and promote the repair and regeneration of injured corneal and retinal tissues. The results obtained in preclinical and clinical studies showed that d-MAPPS™ increased the viability of injured corneal cells, inhibited the production of inflammatory cytokines in immune cells, alleviated inflammation, and restored vision loss in patients suffering from meibomian gland dysfunction and dry eye disease. Herewith, we emphasized molecular mechanisms responsible for the therapeutic efficacy of d-MAPPS™ and we presented the main beneficial effects of d-MAPPS™ in clinical settings, indicating that the topical administration of d-MAPPS™ could be considered a new therapeutic approach for the treatment of ocular inflammatory diseases and for the repair and regeneration of injured corneal and retinal tissues.
Collapse
|
38
|
Matossian C, Crowley M, Periman L, Sorkin S. Personalized Management of Dry Eye Disease: Beyond Artificial Tears. Clin Ophthalmol 2022; 16:3911-3918. [DOI: 10.2147/opth.s384819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
|
39
|
Park SH, Hwang JS, Shin YJ. Effect of multivitamin drug on intractable dry eye symptoms. Front Med (Lausanne) 2022; 9:978107. [PMID: 36148465 PMCID: PMC9486468 DOI: 10.3389/fmed.2022.978107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
Dry eye is a disorder of tear film and ocular surface characterized by ocular discomforts. It is associated with multiple causes and sometimes intractable. We investigated the effect of oral multivitamin supplementation (MVG) on dry eyes. Tear break-up time (TBUT), fluorescein ocular surface staining score, and tear secretion Schirmer test were measured in dry eye patients refractory to conventional topical treatment. The ocular surface disease index (OSDI), visual analog pain score (VAS), and modified standardized patient evaluation of eye dryness questionnaire were analyzed. In total, 42 eyes of 42 patients were included. TBUT increased at 1 and 3 months compared to baseline (p < 0.05). OSDI decreased at 1 and 3 months compared to baseline (p < 0.05). VAS score, impact on life, and frequency of total symptoms decreased at 3 months compared to baseline (p < 0.05). Oral administration of MVG, a vitamin complex formulation, was effective in stabilizing tear stability and alleviating symptoms in patients with intractable dry eye. Thus, it may be a viable treatment option for intractable dry eye.
Collapse
Affiliation(s)
- Se Hie Park
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
| | - Jin Sun Hwang
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
- Hallym BioEyeTech Research Center, Hallym University College of Medicine, Seoul, South Korea
| | - Young Joo Shin
- Department of Ophthalmology, Hallym University Medical Center, Hallym University College of Medicine, Seoul, South Korea
- Hallym BioEyeTech Research Center, Hallym University College of Medicine, Seoul, South Korea
- *Correspondence: Young Joo Shin,
| |
Collapse
|
40
|
Su YC, Hung JH, Chang KC, Sun CC, Huang YH, Lee CN, Hung MJ, Lai CC, Shao SC, Lai ECC. Comparison of Sodium-Glucose Cotransporter 2 Inhibitors vs Glucagonlike Peptide-1 Receptor Agonists and Incidence of Dry Eye Disease in Patients With Type 2 Diabetes in Taiwan. JAMA Netw Open 2022; 5:e2232584. [PMID: 36136333 PMCID: PMC9500553 DOI: 10.1001/jamanetworkopen.2022.32584] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been found to improve low-grade systemic and tissue inflammation; however, the association between SGLT2 inhibitor use and the incidence of dry eye disease (DED) has not been explored. OBJECTIVE To investigate the association between SGLT2 inhibitor use and dry eye disease in patients with type 2 diabetes (T2D). DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort analysis of the largest multi-institutional electronic medical records database in Taiwan was conducted to identify patients with T2D newly receiving SGLT2 inhibitors or glucagonlike peptide-1 receptor agonists (GLP-1 RAs) from 2016 to 2018. Data analysis was performed from March 1 to May 31, 2022. Propensity scores with inverse probability of treatment weighting were generated to enable homogeneous comparisons between the 2 groups. EXPOSURES Treatment with SGLT2 inhibitors or GLP-1 RAs. MAIN OUTCOMES AND MEASURES Incident dry eye disease, which was defined by clinical diagnoses, plus the related drug prescription. Cox proportional hazards regression models were used to estimate hazard ratios with 95% CIs for the risk of DED. RESULTS A total of 10 038 and 1077 T2D patients newly receiving SGLT2 inhibitors (mean [SD] age, 59.5 [12.1] years; 5689 [56.7%] men) or GLP-1 RAs (mean [SD] age, 58.5 [41.2] years; 587 [54.5%] men), respectively, were included in the analysis. The incidence of DED was lower in patients newly receiving SGLT2 inhibitors (9.0 events per 1000 person-years) compared with those receiving GLP-1 RAs (11.5 events per 1000 person-years), yielding a hazard ratio of 0.78 (95% CI, 0.68-0.89). Subgroup analyses indicated that the lowered DED risks associated with SGLT2 inhibitors in patients with T2D were similar across different age, sex, blood glucose level, and kidney function groups. Results from the sensitivity analyses (including the propensity score-matching approach, on-treatment analyses, and different follow-up periods of 1, 2, and 3 years) were similar to the main analyses. CONCLUSIONS AND RELEVANCE The findings of this study suggest that patients with T2D newly receiving SGLT2 inhibitors may have a lower risk for DED compared with those receiving GLP-1 RAs. Prospective studies are needed to analyze these results.
Collapse
Affiliation(s)
- Yu-Chen Su
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jia-Horung Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Cheng Chang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Chin Sun
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsun Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chaw-Ning Lee
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Jui Hung
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
41
|
Cunha CEXD, Castro LR, Mendonça VPV, Silveira EMDQFBD, Veras IL, Ribeiro MVMR. Olho seco e COVID-19: uma revisão narrativa. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
42
|
Mohamed HB, Abd El-Hamid BN, Fathalla D, Fouad EA. Current trends in pharmaceutical treatment of Dry Eye Disease: A review. Eur J Pharm Sci 2022; 175:106206. [PMID: 35568107 DOI: 10.1016/j.ejps.2022.106206] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 01/02/2023]
Abstract
Dry eye disease (DED), keratoconjunctivitis sicca or dysfunctional tear syndrome, is the most prevalent ophthalmic disease which affects a substantial segment of people worldwide with increasing frequency. It is considered a multifactorial disease of the ocular surface and tear film, characterized by a variation of signs and symptoms. The symptoms range from mild to severe itching, burning, irritation, eye fatigue, and ocular inflammation that may lead to potential damage to the cornea, conjunctiva and even vision loss. Correspondingly, depending on the different manifestations and pathophysiology, the treatment must be tailored specifically to each patient by targeting the specific mechanisms implicated in their disease. Currently, there are several medical products and techniques available or under investigation for the treatment of DED. The present article focused on the pathophysiology of DED, the new diagnostic approach and the recently developed drug delivery systems or devices reducing the progress of the disease and treating the causes.
Collapse
Affiliation(s)
- Hebatallah B Mohamed
- Department of Pharmaceutics, Faculty of Pharmacy, South Valley University, Qena, 83523, Egypt.
| | - Basma N Abd El-Hamid
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
| | - Dina Fathalla
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
| | - Ehab A Fouad
- Department of Pharmaceutics Faculty of Pharmacy, Assiut University, Assiut, 71526, Egypt
| |
Collapse
|
43
|
Borm CDJM, Werkmann M, de Graaf D, Visser F, Hofer A, Peball M, Smilowska K, Putz D, Seppi K, Poewe W, Hoyng C, Bloem BR, Theelen T, de Vries NM. Undetected ophthalmological disorders in Parkinson's disease. J Neurol 2022; 269:3821-3832. [PMID: 35262759 PMCID: PMC9217779 DOI: 10.1007/s00415-022-11014-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
Background Ophthalmological disorders are common and frequently disabling for people with Parkinson’s disease (PD). However, details on the prevalence, severity and impact of ophthalmological disorders thus far lacking. We aimed to identify PD patients with undetected ophthalmological disorders in a large cross-sectional, observational study. Methods We previously delivered a screening questionnaire to detect ophthalmological symptoms (Visual impairment in PD questionnaire; VIPD-Q) to 848 patients. Here, we report on a subgroup of 102 patients who received complete ophthalmological assessment aimed at identifying clinically relevant ophthalmological diseases, which were classified as either vison-threatening or not. Impact on daily life functioning was measured using the visual functioning-25 questionnaire (VFQ-25) and fall frequency. Results Almost all patients (92%) had one or more clinically relevant ophthalmological disorders. Of those, 77% had a potentially vision-threatening disease, while 34% had a potentially treatable ophthalmological disease which impacted on quality of life. The most prevalent ophthalmological disorders were dry eyes (86%), ocular misalignment (50%) and convergence insufficiency (41%). We found a weak but significant association between clinically relevant ophthalmological diseases and both fall frequency (R2 = 0.15, p = 0.037) and VFQ-25 score (R2 = 0.15, p = 0.02). The VIPD-Q could not correctly identify patients with relevant ophthalmological disorders. Conclusions Surprisingly, in our study sample, many participants manifested previously undetected ophthalmological diseases, most of which threatened vision, impacted on daily life functioning and were amenable to treatment. Screening for these ophthalmological disorders using a questionnaire asking about symptoms seems insufficient. Instead, episodic ophthalmological assessments should be considered for PD patients, aiming to identify vision-threatening yet treatable diseases. Trial registration Dutch Trial Registration, NL7421. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-022-11014-0.
Collapse
Affiliation(s)
- Carlijn D J M Borm
- Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Mario Werkmann
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Debbie de Graaf
- Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Femke Visser
- Department of Neurology, Onze Lieve Vrouwe Gasthuis (OLVG), Amsterdam, The Netherlands
| | - Arno Hofer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Marina Peball
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Katarzyna Smilowska
- Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Diana Putz
- Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Werner Poewe
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Carel Hoyng
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Thomas Theelen
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Nienke M de Vries
- Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| |
Collapse
|
44
|
Xu X, Li G, Zuo YY. Biophysical properties of tear film lipid layer I. Surface tension and surface rheology. Biophys J 2022; 121:439-450. [PMID: 34958775 PMCID: PMC8822608 DOI: 10.1016/j.bpj.2021.12.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/04/2021] [Accepted: 12/22/2021] [Indexed: 02/03/2023] Open
Abstract
Tear film lipid layer (TFLL) is the outmost layer of the tear film. It plays a crucial role in stabilizing the tear film by reducing surface tension and retarding evaporation of the aqueous layer. Dysfunction of the TFLL leads to dysfunctional tear syndrome, with dry eye disease (DED) being the most prevalent eye disease, affecting 10%-30% of the world population. To date, except for treatments alleviating dry eye symptoms, effective therapeutic interventions in treating DED are still lacking. Therefore, there is an urgent need to understand the biophysical properties of the TFLL with the long-term goal to develop translational solutions in effectively managing DED. Here, we studied the composition-function correlations of an artificial TFLL, under physiologically relevant conditions, using a novel experimental methodology called constrained drop surfactometry. This artificial TFLL was composed of 40% behenyl oleate and 40% cholesteryl oleate, representing the most abundant wax ester and cholesteryl ester in the natural TFLL, respectively, and 15% phosphatidylcholine and 5% palmitic-acid-9-hydroxy-stearic-acid (PAHSA), which represent the two predominant polar lipid classes in the natural TFLL. Our study suggests that the major biophysical function of phospholipids in the TFLL is to reduce the surface tension, whereas the primary function of PAHSA is to optimize the rheological properties of the TFLL. These findings have novel implications in better understanding the physiological and biophysical functions of the TFLL and may offer new translational insight to the treatment of DED.
Collapse
Affiliation(s)
- Xiaojie Xu
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu
| | - Guangle Li
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu
| | - Yi Y. Zuo
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu,Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu,Corresponding author
| |
Collapse
|
45
|
The Efficacy of Kohl (Surma) and Erythromycin in Treatment of Blepharitis: An Open-Label Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6235857. [PMID: 35111228 PMCID: PMC8803416 DOI: 10.1155/2022/6235857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 12/02/2022]
Abstract
Introduction Blepharitis is a common and chronic form of eyelid inflammation. Blepharitis treatment aims to decrease symptoms through antibacterial effects. One of the most common treatments of eyelid diseases in traditional medicine is using kohl. This clinical trial aimed to investigate its efficacy as a complementary treatment in staphylococcal blepharitis through an open-label clinical trial. Materials and Methods Thirty patients were randomized to receive kohl in one eye contralateral and erythromycin ointment in another eye for 90 days. At baseline and after 90 days of treatment, symptoms, clinical signs, and side effects of treatments were recorded. Statistical analysis was carried out using SPSS software, version 19. Results Despite randomization, there was a significant difference between the intervention and control eyes in the baseline mean clinical score (intervention eye: 9.86 (2.95) and control eye: 4.30 (2.81), P < 0.001). The degree of reduction of related signs and symptoms in the eyes treated with kohl was significantly higher than that in the control group: (5.2 vs. 2.20, P < 0.001) for symptoms and (7.40 vs. 2.46, P < 0.001) for clinical signs. Cohen's d statistic for mean difference of sign and symptom was 2.4 and 1.75, respectively, indicating a very strong effect. Conclusion The present study results demonstrated a significant improvement in blepharitis-related signs and symptoms. The degree of improvement in the eyes treated with kohl was much higher than that in the control eyes.
Collapse
|
46
|
Chien HW, Lin CW, Lee CY, Huang JY, Yang SF, Wang K. The use of androgen deprivation therapy for prostate cancer and its effect on the subsequent dry eye disease: a population-based cohort study. Int J Med Sci 2022; 19:1103-1109. [PMID: 35919811 PMCID: PMC9339409 DOI: 10.7150/ijms.73417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022] Open
Abstract
This study aimed to investigate the influence of androgen deprivation therapy (ADT) for the development of dry eye disease (DED) in subjects with prostate cancer via the use of national health insurance research database (NHIRD) of Taiwan. A retrospective cohort study was conducted and patients were selected as prostate cancer with ADT according to diagnostic and procedure codes. Each participant in that group was then matched to one patient with prostate cancer but without ADT and two subject s without prostate cancer and ADT. And a total of 1791, 1791 and 3582 participants were enrolled in each group. The primary outcome was set as the DED development according to the diagnostic codes. Cox proportional hazard regression was applied to calculate the adjusted hazard ratio (aHR) and 95% confidence interval (CI) of ADT and other parameters for DED development. There were 228, 126 and 95 new events of DED developed in the control group, the prostate cancer without ADT group and the prostate cancer with ADT group. The rate of DED in the prostate cancer with ADT group (aHR: 0.980, 95% CI: 0.771-1.246, P= 0.8696) and Prostate cancer without ADT group (aHR: 1.064, 95% CI: 0.855-1.325, P= 0.5766) were not significantly different compared to the control group. In addition, the patients aged 70-79 years old demonstrated a significantly higher incidence of developing DED compared to those aged 50-59 years old (aHR: 1.885, 95% CI: 1.188-2.989, P= 0.0071). In conclusion, the use of ADT did not alter the incidence of subsequent DED.
Collapse
Affiliation(s)
- Hsiang-Wen Chien
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan.,Departments of Ophthalmology, Sijhih Cathay General Hospital, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan.,School of Medicine, National Tsing Hua University, Hsinchu, Taiwan, Taiwan
| | - Chiao-Wen Lin
- Institute of Oral Sciences, Chung Shan Medical University, Taichung, Taiwan.,Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Yi Lee
- Department of Ophthalmology, Nobel Eye Institute, Taipei, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Kai Wang
- Department of Ophthalmology, Cathay General Hospital, Taipei, Taiwan.,Departments of Ophthalmology, Sijhih Cathay General Hospital, New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| |
Collapse
|
47
|
Mauduit O, Delcroix V, Umazume T, de Paiva CS, Dartt DA, Makarenkova HP. Spatial transcriptomics of the lacrimal gland features macrophage activity and epithelium metabolism as key alterations during chronic inflammation. Front Immunol 2022; 13:1011125. [PMID: 36341342 PMCID: PMC9628215 DOI: 10.3389/fimmu.2022.1011125] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
The lacrimal gland (LG) is an exocrine gland that produces the watery part of the tear film that lubricates the ocular surface. Chronic inflammation, such as Sjögren's syndrome (SS), is one of the leading causes of aqueous-deficiency dry eye (ADDE) disease worldwide. In this study we analyzed the chronic inflammation in the LGs of the NOD.B10Sn-H2b/J (NOD.H-2b) mice, a mouse model of SS, utilizing bulk RNAseq and Visium spatial gene expression. With Seurat we performed unsupervised clustering and analyzed the spatial cell distribution and gene expression changes in all cell clusters within the LG sections. Moreover, for the first time, we analyzed and validated specific pathways defined by bulk RNAseq using Visium technology to determine activation of these pathways within the LG sections. This analysis suggests that altered metabolism and the hallmarks of inflammatory responses from both epithelial and immune cells drive inflammation. The most significant pathway enriched in upregulated DEGs was the "TYROBP Causal Network", that has not been described previously in SS. We also noted a significant decrease in lipid metabolism in the LG of the NOD.H-2b mice. Our data suggests that modulation of these pathways can provide a therapeutic strategy to treat ADDE.
Collapse
Affiliation(s)
- Olivier Mauduit
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, United States
| | - Vanessa Delcroix
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, United States
| | - Takeshi Umazume
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, United States
| | - Cintia S de Paiva
- The Ocular Surface Center, Department of Ophthalmology, Baylor College of Medicine, Cullen Eye Institute, Houston, TX, United States
| | - Darlene A Dartt
- Schepens Eye Research Institute of Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, United States
| | - Helen P Makarenkova
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA, United States
| |
Collapse
|
48
|
Therapeutic Potential of „Derived-Multiple Allogeneic Proteins Paracrine Signaling-D-Mapps” in the Treatment of Dry Eye Disease. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Abstract
Dry eye disease (DED) is a chronic inflammatory disease of the lacrimal system and ocular surface. Considering the important role of inflammation in DED development, the main treatment strategy has shifted from hydration and lubrication of dry ocular surface to the immunomodulation and immunoregulationapproach that should address the main pathologic processes responsible for disease progression. Due to their capacity for production of immunosuppressive factors, mesenchymal stem cells (MSCs) and their secretome have been considered as potentially new agents in DED therapy. We recently developed an immunomodulatory ophthalmic solution “derived- Multiple Allogeneic Proteins Paracrine Signaling (d-MAPPS)” which activity is relied on immunosuppressive capacity of MSC-derived secretome. d-MAPPS contains MSC-derived exosomes, growth factors and immunosuppressive cytokines that are able to efficiently suppress generation of inflammatory phenotype in T cells and macrophages. Herewith, we demonstrated that d-MAPPS protected human corneal epithelial cells from chemical injury and efficiently alleviated ocular discomfort and pain in 131 DED patients during the 12-month follow-up, indicating d-MAPPS eye drops as potentially new remedy for the treatment of DED patients.
Collapse
|
49
|
Treatment of Severe Ptosis by Conjoint Fascial Sheath Suspension. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1837458. [PMID: 34840967 PMCID: PMC8626196 DOI: 10.1155/2021/1837458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Abstract
Objective To explore the role of conjoint fascial sheath (CFS) suspension in the treatment of severe ptosis. Methods A total of 110 patients with severe ptosis who were admitted to our hospital from May 2018 to December 2020 were included. Fifty-seven patients treated with frontalis suspension were assigned into group A, and the remaining 53 patients treated with CFS suspension were assigned into group B. The curative effect, ocular surface alterations, complications, and satisfaction in the two groups were compared. Results Patients in group B suffered from severe upper eyelid retraction and lid lag than those in group A, as well as more limited range of motion (ROM) (P < 0.05). The curative effect and patient satisfaction in group B were higher than those in group A (P < 0.05). Postsurgical complications in group B were fewer than those in group A (P < 0.05). Conclusion CFS suspension is effective in the treatment of severe ptosis.
Collapse
|
50
|
Hagi K, Hasegawa T, Yamamoto T, Tomihari M, Fujimoto Y, Sakamoto Y, Sawa S. Corneal protective effects of novel tear substitutes containing sodium hyaluronate and dodecahydrosqualene, squalane, in a porcine dry eye model. J Vet Med Sci 2021; 84:94-101. [PMID: 34789590 PMCID: PMC8810329 DOI: 10.1292/jvms.21-0496] [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: 11/24/2022] Open
Abstract
To develop a novel tear substitute (TS) containing sodium hyaluronate (SH) and dodecahydrosqualene (DHS, squalane), we improved the prescription of a previously developed TS containing
saline, 0.5% SH and 1% castor oil (CO), which had corneal protective effects against 60-min desiccation in a porcine dry eye model and viscosity of 106.8 mPa·S. Fresh porcine eyes were
treated with a TS containing saline, 0.1%, 0.25%, 0.3% or 0.5% SH, and 1% CO or 1%, 2.5% or 5% DHS, and TS-treated eyes were desiccated for up to 180 min. The corneal damage was evaluated by
the staining score of methylene blue (MB), absorbance of MB extracted from the cornea, the staining density of lissamine green (LG) and histopathology. The viscosities of the examined TS
were also measured. A saline/0.5% SH/1% DHS solution had corneal protective effects for 90 min under desiccation and a viscosity of 110.0 mPa·s. A TS with saline, 0.1%, 0.25% or 0.3% SH and
1% or 2.5% DHS did not have better protective effects than a saline/0.5% SH/1% DHS solution, although a saline/0.3% SH/5% DHS solution exhibited greater corneal protection against 180-min
desiccation on MB and LG staining and histopathological examination, and its viscosity was 34.5 mPa·s, which was similar to the 29.5 mPa·s of 0.3% SH. The saline/0.3% SH/5% DHS solution is
available as a novel 3-hr long-lasting TS containing mucinomimetic and liquid oil components to treat and relieve dry eye symptoms in animals and humans.
Collapse
Affiliation(s)
- Kiyomi Hagi
- Osaka Prefecture University Veterinary Medical Center, Osaka Prefecture University
| | - Takashi Hasegawa
- Department of Advanced Clinical Medicine, Division of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | - Takeshi Yamamoto
- Department of Advanced Clinical Medicine, Division of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | - Mizuki Tomihari
- Department of Advanced Clinical Medicine, Division of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | - Yuka Fujimoto
- Department of Advanced Clinical Medicine, Division of Veterinary Science, Graduate School of Life and Environmental Sciences, Osaka Prefecture University
| | | | | |
Collapse
|