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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.
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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.
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Vieira A, Meza J, Garreton R, Grau AE, Zoroquiain P. Low Expression of Vitamin D Receptor in Patients With Dry Eye Disease. Cornea 2024:00003226-990000000-00558. [PMID: 38743785 DOI: 10.1097/ico.0000000000003555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/15/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This study aimed to compare the expression of vitamin D receptor (VDR) on the ocular surface of patients with dry eye disease (DED) and controls without ophthalmological pathologies. METHODS Patients with DED without previous treatment were studied and compared with healthy subjects. Ocular Surface Disease Index assessement and ocular surface cytology were performed in all patients. The immunohistochemical expression of VDR was evaluated using fully automated immunohistochemistry. The evaluation involved multiplying the percentage of nuclear-labeled cells (0-100) by their intensity (0-3), resulting in a score ranging from 0 to 300 (VDR H-score). Squamous metaplasia was morphologically evaluated using liquid-phase cytology with Papanicolaou/periodic acid-Schiff staining using Nelson's grade (scale 0-3, higher grade to higher metaplastic change). RESULTS Eighteen patients with DED without previous treatment and 10 healthy subjects were studied. Squamous metaplasia was observed in 74% of patients with DED, in contrast to 0% in the control group. In patients with DED, there was a lower expression of VDR than in the control group (VDR H-score: 11.2 ± 13.9 vs. 80.9 ± 56; P = 0.0001). Furthermore, an inverse correlation was observed between Nelson grade and VDR H-score ( P = 0.0001, rs = -0.71). No correlation was observed between Ocular Surface Disease Index and VDR H-score. CONCLUSIONS This is the first study to evaluate the VDR in patients with DED. These patients presented with a lower expression of VDR than healthy subjects. No correlation was found with more severe symptoms. Patients with DED also had a higher frequency of squamous metaplasia.
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Affiliation(s)
- Antonia Vieira
- Ophthalmology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile ; and
| | - Javiera Meza
- Pathology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodolfo Garreton
- Ophthalmology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile ; and
| | - Arturo E Grau
- Ophthalmology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile ; and
| | - Pablo Zoroquiain
- Pathology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Hassanpour K, Langari F, Akbarzadeh AR, Kanavi MR, Barani M, Kheiri B, Karimian F, Ahmadieh H, Sadoughi MM. Safety and Efficacy of Topical Vitamin D in the Management of Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Placebo-Controlled Double-Blind Randomized Controlled Trial. Cornea 2024; 43:552-563. [PMID: 37815305 DOI: 10.1097/ico.0000000000003400] [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: 04/17/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE The aim of this study was to investigate the safety and efficacy of topical vitamin D in the management of dry eye disease associated with meibomian gland dysfunction (MGD). METHODS In this randomized controlled trial, patients with symptomatic MGD were divided into 2 groups to receive topical vitamin D drops or placebo in their randomized eyes. The exclusion criteria consisted of patients with vitamin D deficiency, previous ocular surgery, and patients with ocular diseases affecting the tear film. Patients and researchers were masked to the study groups. The outcomes included the score of Dry Eye Questionnaire (DEQ) 5 and Ocular Surface Disease Index (OSDI), corneal and conjunctival staining score, tear breakup time (TBUT), Schirmer, and MG expressibility score evaluated at baseline and weeks 4 and 8. RESULTS Twenty-eight eyes of 28 patients were recruited in each group. In addition to the improvement of subjective parameters in both groups, there was a statistically significantly greater improvement in the vitamin D group compared with control for average scores of OSDI (13.38 ± 7.32 vs. 27.94 ± 7.49) and DEQ5 (9.67 ± 1.86 vs. 14.14 ± 2.45) at week 8 (Ps <0.001). In addition, a significant improvement in TBUT and Schirmer test was observed in both groups in weeks 4 and 8 ( P value <0.05). There was a significant difference between the treatment and control groups after 8 weeks for OSDI, DEQ5, Schirmer, TBUT, corneal fluorescein staining, and MG expressibility score ( P value <0.05). CONCLUSIONS The preliminary results of this randomized controlled trial suggested that use of topical vitamin D drops with a lipid vehicle could be safe and might significantly improve the symptoms and signs of dry eye associated with MGD.
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Affiliation(s)
- Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farideh Langari
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mozhgan Rezaei Kanavi
- Ocular Tissue Engineering Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Barani
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Kheiri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Karimian
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Ahmadieh
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Sadoughi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Labbafinejad Medical Center, Department of Ophthalmology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gioia N, Gerson J, Ryan R, Barbour K, Poteet J, Jennings B, Sharp M, Lowery R, Wilson J, Morde A, Rai D, Padigaru M, Periman LM. A novel multi-ingredient supplement significantly improves ocular symptom severity and tear production in patients with dry eye disease: results from a randomized, placebo-controlled clinical trial. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1362113. [PMID: 38984118 PMCID: PMC11182317 DOI: 10.3389/fopht.2024.1362113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/22/2024] [Indexed: 07/11/2024]
Abstract
Introduction Dry eye disease (DED) is multifactorial and characterized by a loss of tear film homeostasis that causes a cycle of tear film instability, tear hyperosmolarity, and inflammation. While artificial tears are the traditional mainstay of treatment, addressing the underlying pathophysiology could relieve symptoms and prevent progression. Increasing evidence indicates a role for oral nutritional supplementation in multiple ophthalmic diseases, including DED. Lutein, zeaxanthin, curcumin, and vitamin D3 have demonstrated protective and anti-inflammatory properties in ocular models. This prospective, randomized, double-blind, parallel, placebo-controlled study evaluated the efficacy and safety of a proprietary blend of lutein, zeaxanthin isomers, curcumin, and vitamin D3 (LCD) as a daily supplement in adult participants with DED. Methods Participants were randomized to receive one LCD supplement capsule (lutein 20 mg, zeaxanthin isomers 4 mg, curcumin 200 mg curcuminoids, and vitamin D3 600 IU) or placebo per day for 8 weeks (LCD, n=77; placebo, n=78). Primary outcomes were changes in tear volume (Schirmer's test) and ocular symptoms (Ocular Surface Disease Index [OSDI]). Results The study met its primary endpoints: the LCD group demonstrated significantly better Schirmer's test scores and improvement in overall OSDI score, versus placebo, at Day 56 (p<0.001 for both). Scores for total OSDI, and symptoms and vision domains, significantly improved by Day 14 for LCD versus placebo, (p<0.05 for all) and were maintained to Day 56 (p<0.001). In addition, the LCD group demonstrated significantly improved tear film break-up time (TBUT) and tear film osmolarity, versus placebo, by Day 56 (p<0.001), along with significant improvements in corneal and conjunctival staining (p<0.001 for both), and inflammation (matrix metalloproteinase-9; p<0.001 for each eye). Total Standard Patient Evaluation of Eye Dryness (SPEED) score, and scores for the frequency and severity domains, were significantly improved by Day 14 for LCD versus placebo (p<0.05 for all) and maintained to Day 56 (p<0.001). There was no difference between groups for artificial tear usage. The supplement was well-tolerated. Discussion Once-daily LCD supplementation significantly improved tear production, stability and quality, reduced ocular surface damage and inflammation, and improved participants' symptoms. LCD supplementation could offer a useful adjunct to artificial tears for patients with DED (NCT05481450).
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Affiliation(s)
- Neda Gioia
- Integrative Vision Corp, Shrewsbury, NJ, United States
| | | | - Robert Ryan
- Medical Affairs Bausch + Lomb, Bridgewater, NJ, United States
| | - Krista Barbour
- Medical Affairs Bausch + Lomb, Bridgewater, NJ, United States
| | | | - Brooke Jennings
- Applied Science and Performance Institute, Tampa, FL, United States
| | - Matthew Sharp
- Applied Science and Performance Institute, Tampa, FL, United States
| | - Ryan Lowery
- Applied Science and Performance Institute, Tampa, FL, United States
| | - Jacob Wilson
- Applied Science and Performance Institute, Tampa, FL, United States
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Coco G, Buffon G, Taloni A, Giannaccare G. Recent Advances in Nanotechnology for the Treatment of Dry Eye Disease. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:669. [PMID: 38668163 PMCID: PMC11053557 DOI: 10.3390/nano14080669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024]
Abstract
Dry eye disease (DED) incidence is continuously growing, positioning it to become an emergent health issue over the next few years. Several topical treatments are commonly used to treat DED; however, reports indicate that only a minor proportion of drug bioavailability is achieved by the majority of eye drops available on the market. In this context, enhancing drug ability to overcome ocular barriers and prolonging its residence time on the ocular surface represent a new challenge in the field of ocular carrier systems. Therefore, research has focused on the development of multi-functional nanosystems, such as nanoemulsions, liposomes, dendrimers, hydrogels, and other nanosized carriers. These systems are designed to improve topical drug bioavailability and efficacy and, at the same time, require fewer daily administrations, with potentially reduced side effects. This review summarizes the different nanotechnologies developed, their role in DED, and the nanotechnology-based eyedrops currently approved for DED treatment.
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Affiliation(s)
- Giulia Coco
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (G.B.)
| | - Giacinta Buffon
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy; (G.C.); (G.B.)
| | - Andrea Taloni
- Department of Ophthalmology, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Kim JM, Choi YJ. Impact of Dietary Nutrients on the Prevalence of Dry Eye Syndrome among Korean Women Aged 40 and above: Evidence from the Korea National Health and Nutrition Examination Survey. Nutrients 2024; 16:372. [PMID: 38337657 PMCID: PMC10857437 DOI: 10.3390/nu16030372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/27/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to assess the prevalence of dry eye syndrome among Korean women aged 40 and above and explore the correlation between the syndrome and daily dietary nutrient intake. We analyzed data from 92,888 female participants (mean age: 63.35 ± 8.86 years) from the 8th Korea National Health and Nutrition Examination Survey (KNHANES 2019). Dietary intake was evaluated using a personalized 24 h recall method for 21 nutrients, including macronutrients, macro- and micro-minerals, and both water- and fat-soluble vitamins. Associations between nutrient intake and dry eye syndrome were determined using odds ratios from multivariate logistic regression. We found a 7.7% prevalence of dry eye syndrome in the population studied. Intake of dietary fiber (adjusted OR: 0.72), protein (adjusted OR: 0.84), omega-3 fatty acids (adjusted OR: 0.90), water (adjusted OR: 0.76), calcium (adjusted OR: 0.82), phosphate (adjusted OR: 0.87), potassium (adjusted OR: 0.88), magnesium (adjusted OR: 0.87), vitamin A (adjusted OR: 0.78), vitamin C (adjusted OR: 0.73), and vitamin E (adjusted OR: 0.86) was inversely associated with dry eye syndrome prevalence (p < 0.0001 for all). Conversely, a higher intake of carbohydrates (adjusted OR: 1.23), sugar (adjusted OR: 1.30), fat (adjusted OR: 1.25), cholesterol (adjusted OR: 1.32), sodium (adjusted OR: 1.18), iron (adjusted OR: 1.28), and zinc (adjusted OR: 1.26) correlated with an increased risk (p < 0.0001 for all). No significant associations were found between the prevalence of dry eye syndrome and the intake of omega-6 fatty acids and vitamin D. Our study identified significant associations between specific dietary nutrients and the risk of dry eye syndrome among Korean women aged 40 and above. These findings suggest that dietary choices could influence the likelihood of developing dry eye syndrome, indicating a potential role for dietary intervention in its management. However, it is important to note that these observations are preliminary, and further research is necessary to confirm these relationships and explore their implications for dietary recommendations in dry eye syndrome prevention and management.
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Affiliation(s)
- Jeong-Mee Kim
- Department of Visual Optics, Far East University, Eumseong 27601, Republic of Korea;
| | - Yean-Jung Choi
- Department of Food and Nutrition, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul 01795, Republic of Korea
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Markoulli M, Ahmad S, Arcot J, Arita R, Benitez-Del-Castillo J, Caffery B, Downie LE, Edwards K, Flanagan J, Labetoulle M, Misra SL, Mrugacz M, Singh S, Sheppard J, Vehof J, Versura P, Willcox MDP, Ziemanski J, Wolffsohn JS. TFOS Lifestyle: Impact of nutrition on the ocular surface. Ocul Surf 2023; 29:226-271. [PMID: 37100346 DOI: 10.1016/j.jtos.2023.04.003] [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: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.
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Affiliation(s)
- Maria Markoulli
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia.
| | - Sumayya Ahmad
- Icahn School of Medicine of Mt. Sinai, New York, NY, USA
| | - Jayashree Arcot
- Food and Health, School of Chemical Engineering, UNSW Sydney, Australia
| | - Reiko Arita
- Department of Ophthalmology, Itoh Clinic, Saitama, Japan
| | | | | | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Katie Edwards
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Judith Flanagan
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia; Vision CRC, USA
| | - Marc Labetoulle
- Ophthalmology Department, Hospital Bicêtre, APHP, Paris-Saclay University, Le Kremlin-Bicêtre, France; IDMIT (CEA-Paris Saclay-Inserm U1184), Fontenay-aux-Roses, France
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | | | - Sumeer Singh
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - John Sheppard
- Virginia Eye Consultants, Norfolk, VA, USA; Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jelle Vehof
- Departments of Ophthalmology and Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Section of Ophthalmology, School of Life Course Sciences, King's College London, London, UK; Department of Ophthalmology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Piera Versura
- Cornea and Ocular Surface Analysis - Translation Research Laboratory, Ophthalmology Unit, DIMEC Alma Mater Studiorum Università di Bologna, Italy; IRCCS AOU di Bologna Policlinico di Sant'Orsola, Bologna, Italy
| | - Mark D P Willcox
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Jillian Ziemanski
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - James S Wolffsohn
- College of Health & Life Sciences, School of Optometry, Aston University, Birmingham, UK
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Lu X, Chen Z, Lu J, Watsky M. Effects of Topical 1,25 and 24,25 Vitamin D on Diabetic, Vitamin D Deficient and Vitamin D Receptor Knockout Mouse Corneal Wound Healing. Biomolecules 2023; 13:1065. [PMID: 37509101 PMCID: PMC10377579 DOI: 10.3390/biom13071065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
Delayed or prolonged corneal wound healing and non-healing corneas put patients at risk for ocular surface infections and subsequent stromal opacification, resulting in discomfort or visual loss. It is important to enhance corneal wound healing efficiency and quality. Vitamin D (Vit D) is both a hormone and a vitamin, and its insufficiency has been linked to immune disorders and diabetes. For this study, wound healing and recruitment of CD45+ cells into the wound area of normoglycemic and diabetic mice were examined following corneal epithelial debridement and treatment with 1,25-dihyroxyvitamin D (1,25 Vit D) or 24,25-dihydroxyvitamin D (24,25 Vit D). Treatment with topical 1,25-dihyroxyvitamin D (1,25 Vit D) resulted in significantly increased corneal wound healing rates of normoglycemic, diabetic and diabetic Vit D deficient mice. Furthermore, 24,25-dihydroxyvitamin D (24,25 Vit D) significantly increased corneal wound healing of diabetic Vit D deficient and Vit D receptor knockout (VDR KO) mice. In addition, CD45+ cell numbers were reduced in diabetic and VDR KO mouse corneas compared to normoglycemic mice, and 24,25 Vit D increased the recruitment of CD45+ cells to diabetic mouse corneas after epithelial debridement. CD45+ cells were found to infiltrate into the corneal basal epithelial layer after corneal epithelial debridement. Our data indicate that topical Vit D promotes corneal wound healing and further supports previous work that the Vit D corneal wound healing effect is not totally VDR-dependent.
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Affiliation(s)
| | | | | | - Mitchell Watsky
- Department of Cellular Biology and Anatomy, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
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Malik D, Garg R, Sethi S, Mahendru R, Singh S. Serum Vitamin D Levels and Dry Eye Disease in Postmenopausal Women: A Case-Control Study at a Tertiary Care Center in Rural Haryana. Int J Appl Basic Med Res 2023; 13:83-88. [PMID: 37614839 PMCID: PMC10443445 DOI: 10.4103/ijabmr.ijabmr_637_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 04/13/2023] [Accepted: 06/20/2023] [Indexed: 08/25/2023] Open
Abstract
Background Despite the high prevalence of Vitamin-D insufficiency and high susceptibility to dry eye disease (DED) in postmenopausal women (PMW), correlation between DED and Vitamin D has not been explored in PMW in any Indian study. Aims and Objectives To explore the correlation between serum Vitamin D levels in PMW with and without DED, in a hospital-based population in rural Haryana. Materials and Methods Subjective (ocular surface disease index [OSDI] questionnaire) and objective clinical tests were undertaken for DED diagnosis. 25(OH) Vitamin D was measured in serum using enzyme-linked immunosorbent assay; insufficient (10-30 ng/ml) and deficient (<10 ng/ml). Descriptive statistics were analyzed by mean ± standard deviation for continuous and frequencies for the categorical variables; Student's t-test used to find out mean difference in Vitamin D levels; P < 0.05 was considered statistically significant. Results One hundred and forty PMW (60.1 ± 5.32 years) were included; Group-A (Controls; no DED; n: 70); Group-B (Cases; DED diagnosed by OSDI scores; n: 70); Subgroup-B1 (clinical tests negative; n: 30) and B2 (clinical tests positive; n: 40). There was no statistically significant difference in OSDI scores between B1 and B2. Significantly lower mean Vitamin D levels were found in cases (14.36 ± 4.08 ng/ml) as compared to controls (19.19 ± 6.4 ng/ml) (P = 0.001) and in B2 (13.15 ± 3.51 ng/ml) as compared to B1 (15.57 ± 4.66 ng/ml) (P = 0.01). Conclusion There were significantly low levels of Vitamin-D in clinically established DED. Evaluating Vitamin D levels as a part of the dry eye workup in PMW is recommended. OSDI scores were not aligned with the clinical test scores; questionnaire-based tests alone may not be sufficient for diagnosing DED.
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Affiliation(s)
- Diksha Malik
- BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Renu Garg
- BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Sumita Sethi
- BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Rajiv Mahendru
- BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana, India
| | - Sanjeet Singh
- BPS GMC for Women, Khanpur Kalan, Sonepat, Haryana, India
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10
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Dry Eye Disease: What Is the Role of Vitamin D? Int J Mol Sci 2023; 24:ijms24021458. [PMID: 36674972 PMCID: PMC9860626 DOI: 10.3390/ijms24021458] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial condition resulting from reduced tear secretion from the lacrimal glands, increased tear water evaporation or the production of poor-quality tears. Such tear instability can lead to inflammation and damage of the ocular surface, as well as to abnormal nociception. Historically, tear substitutes and corticosteroids have been the bastion of DED therapy, but a substantial number of patients still suffer from residual symptoms even after being treated with traditional treatments. Aiming to find safe and effective alternative therapies, recent efforts have been focused on the role of vitamin D in the cellular physiology of the eye. Possibly because of its positive effect in modulating the immune and inflammatory responses, the systemic supplementation of vitamin D seems, indeed, to be an effective therapeutic strategy, especially, but not only, for patients affected by DED that does not respond to conventional treatments. In this context, this review focuses on the literature reporting on the pathogenesis and treatment of DED, with a special emphasis on the recent investigations reporting on the potential role of the systemic administration of vitamin D as a therapeutic approach in the management of such condition.
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Bacteria and Dry Eye: A Narrative Review. J Clin Med 2022; 11:jcm11144019. [PMID: 35887783 PMCID: PMC9319739 DOI: 10.3390/jcm11144019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/17/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Dry eye is a multifactorial disease of the ocular surface, the incidence of which has been increasing sharply. The pathogenesis of dry eye, especially in terms of the bacterial flora, has drawn great attention. Additionally, the potential treatment methods need to be explored. (2) Methods: We reviewed more than 100 studies and summarized them briefly in a review. (3) Results: We summarized the bacterial communities found on the ocular surface in the general population and patients with dry eye and found a relationship between dry eye and antibiotic therapy. We identified the possible mechanisms of bacteria in the development of dry eye by discussing factors such as the destruction of the antibacterial barrier, infectious diseases, microbiome homeostasis, inflammatory factors on the ocular surface and vitamin deficiency. (4) Conclusion: We systematically reviewed the recent studies to summarize the bacterial differences between patients with dry eye and the general population and brought up several possible mechanisms and possible treatment targets.
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Aksoy Aydemir G, Ilhan C, Pehlıvanoglu B, Aydemir E, Kiziltoprak H, Bolu S. Conjunctival Histopathological Changes in Children With Vitamin D Deficiency. Eye Contact Lens 2022; 48:289-294. [PMID: 35580362 DOI: 10.1097/icl.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to investigate tear function-associated clinical findings and conjunctival histopathological changes in children with vitamin D (Vit-D) deficiency. METHODS This study used a prospective case-control design. Group 1 (n=38) comprised pediatric patients with Vit-D deficiency, and group 2 (n=45) was the control group. Tear break-up times (TBUTs), Schirmer-1 test measurements, ocular surface disease index (OSDI) scores, and conjunctival impression cytology (CIC) results of the groups were compared. RESULTS The participant demographic characteristics, including the mean age and the male-to-female ratio, were similar (P>0.05). The median TBUT and Schirmer-1 test measurement were 10 s (5-15) and 12 mm (6-19) in group 1 and 11 s (6-16) and 15 mm (8-21) in group 2 (P=0.004 and P=0.013, respectively). The median OSDI scores were 16 (10-20) in group 1 and 17 (10-21) in group 2 (P=0.092). According to the CIC, 25 samples in group 1 and 40 samples in group 2 were categorized as grade 0, 11 samples in group 1 and 5 samples in group 2 were categorized as grade 1, and 2 samples in group 1 and no sample in group 2 were categorized as grade 2 (P=0.027). CONCLUSION Significant conjunctival histopathological changes occur in children with Vit-D deficiency, and these changes have effects on some tear function-associated clinical findings including the Schirmer-1 test and TBUT measurements.
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Affiliation(s)
- Gozde Aksoy Aydemir
- Department of Ophthalmology (G.A.A., E.A., H.K.), Adıyaman University Research and Training Hospital, Adıyaman, Turkey ; Department of Ophthalmology (C.I.), Tayfur Ata Sokmen Medicine Faculty, Mustafa Kemal University, Hatay,Turkey; Department of Pathology (B.P.), Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey ; and Department of Pediatric Endocrinology (S.B.), Adıyaman University Research and Training Hospital,Adıyaman, Turkey
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Vitamin D, the Vitamin D Receptor, Calcitriol Analogues and Their Link with Ocular Diseases. Nutrients 2022; 14:nu14112353. [PMID: 35684153 PMCID: PMC9183042 DOI: 10.3390/nu14112353] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
The global prevalence of eye diseases continues to grow, bringing with it a reduction in the activity levels and quality of life of patients, and partial or complete blindness if left untreated. As such, there is considerable interest in identifying more effective therapeutic options and preventive agents. One such agent is vitamin D, known to have a range of anti-cancer, anti-angiogenic, anti-inflammatory and anti-oxidative properties, and whose deficiency is linked to the pathogenesis of a range of cardiovascular, cancer, and inflammatory diseases. This review presents the current stage of knowledge concerning the link between vitamin D and its receptor and the occurrence of eye disease, as well as the influence of analogues of calcitriol, an active metabolite of vitamin D. Generally, patients affected by various ocular disorders have vitamin D deficiency. In addition, previous findings suggest that vitamin D modulates the course of eye diseases and may serve as a marker, and that its supplementation could mitigate some disorders. However, as these studies have some limitations, we recommend further randomized trials to clarify the link between vitamin D and its activity with eye disease.
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Abstract
Dry eye disease (DED) is a major public health problem worldwide that seriously impairs the quality of life, reduces work productivity, and poses significant economic burden. In DED, tear film instability or hyperosmolarity activates a self-perpetuating vicious cycle that may aggravate ocular surface inflammation and damage. Thus, treatment approaches should focus on interrupting this cycle and ameliorating inflammation. In addition to anti-inflammatory medications, such as corticosteroids, cyclosporine, and lifitegrast, nutrients with anti-inflammatory and anti-oxidative properties may also be effective for the treatment of DED. Evidence indicates that vitamin deficiencies may be associated with an increased risk of DED and that vitamin supplementation can be an effective treatment for DED. In the present review, we introduce the results of clinical and experimental studies on the association between vitamin deficiencies and DED. The potential efficacy of systemic and topical supplementation in the treatment of DED is also discussed.
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Chan HN, Zhang XJ, Ling XT, Bui CHT, Wang YM, Ip P, Chu WK, Chen LJ, Tham CC, Yam JC, Pang CP. Vitamin D and Ocular Diseases: A Systematic Review. Int J Mol Sci 2022; 23:ijms23084226. [PMID: 35457041 PMCID: PMC9032397 DOI: 10.3390/ijms23084226] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 02/04/2023] Open
Abstract
The contributory roles of vitamin D in ocular and visual health have long been discussed, with numerous studies pointing to the adverse effects of vitamin D deficiency. In this paper, we provide a systematic review of recent findings on the association between vitamin D and different ocular diseases, including myopia, age-related macular degeneration (AMD), glaucoma, diabetic retinopathy (DR), dry eye syndrome (DES), thyroid eye disease (TED), uveitis, retinoblastoma (RB), cataract, and others, from epidemiological, clinical and basic studies, and briefly discuss vitamin D metabolism in the eye. We searched two research databases for articles examining the association between vitamin D deficiency and different ocular diseases. One hundred and sixty-two studies were found. There is evidence on the association between vitamin D and myopia, AMD, DR, and DES. Overall, 17 out of 27 studies reported an association between vitamin D and AMD, while 48 out of 54 studies reported that vitamin D was associated with DR, and 25 out of 27 studies reported an association between vitamin D and DES. However, the available evidence for the association with other ocular diseases, such as glaucoma, TED, and RB, remains limited.
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Affiliation(s)
- Hei-Nga Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Xiu-Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Xiang-Tian Ling
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Christine Huyen-Trang Bui
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Yu-Meng Wang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong, China;
| | - Wai-Kit Chu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
| | - Li-Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Jason C. Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong, China
- Department of Ophthalmology, Hong Kong Children’s Hospital, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Correspondence: (J.C.Y.); (C.-P.P.)
| | - Chi-Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (H.-N.C.); (X.-J.Z.); (X.-T.L.); (C.H.-T.B.); (Y.-M.W.); (W.-K.C.); (L.-J.C.); (C.C.T.)
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: (J.C.Y.); (C.-P.P.)
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Eslampoor A, Najjaran M, Arjmand Askari E, Zarei-Ghanavati S, Ziaei M. Effect of oral vitamin D supplementation on dry eye disease patients with vitamin D deficiency. Clin Exp Optom 2022; 106:257-262. [PMID: 35188874 DOI: 10.1080/08164622.2022.2033601] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE Dry eye disease (DED) and vitamin D deficiency are both common clinical entities. Vitamin D has been reported to play a significant role in ocular surface homeostasis. BACKGROUND This study aimed to determine the therapeutic effect of oral vitamin D supplementation in dry eye disease patients with vitamin D deficiency. METHODS A randomized, controlled study was completed in 100 patients with dry eye disease and concurrent vitamin D deficiency (< 20 ng/ml). Participants were randomly allocated to 8 weeks of oral vitamin D supplementation with both groups receiving conventional dry eye treatment with artificial tears. Schirmer's, tear break-up time (TBUT) and osmolarity tests were measured before and after eight weeks of treatment. RESULTS The mean age of participants was 36.8 ± 8.56 years in the treatment group (n: 50) and 34.8 ± 10.13 year in the control group (n: 50). After eight weeks of treatment the mean differences in Schirmer's, TBUT and tear osmolarity were 2.38 ± 1.55 mm, 3.95 ± 1.48 s and -16.9 ± 6.28 mOsm/L, respectively in the treatment group, and 0.7 ± 0.86 mm, 0.92 ± 1.57s and -3.34 ± 2.0 mOsm/L respectively in the control group (p < 0.001 for all parameters). The treatment group demonstrated a more significant improvement than the control group in Schirmer<apos;>s, TBUT and osmolarity values (p < 0.001). CONCLUSION Vitamin D supplementation as an adjuvant to routine dry eye treatment improves ocular surface hemostasis parameters, results in better tear stability and a more improved tear osmolarity in patients with vitamin D deficiency.
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Affiliation(s)
- Alireza Eslampoor
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Marzieh Najjaran
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Arjmand Askari
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Siamak Zarei-Ghanavati
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammed Ziaei
- Department of Ophthalmology, New Zealand National Eye Center, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Elmonem DHA, Zaky M, Marey H, Fayed AMS. Effect of vitamin D on the efficacy of topical artificial tears in patients with dry-eye disease. MENOUFIA MEDICAL JOURNAL 2022; 35:856. [DOI: 10.4103/mmj.mmj_245_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Reduced 25-hydroxyvitamin D concentration in the aqueous humor of cataract patients with open-angle glaucoma. Sci Rep 2021; 11:18785. [PMID: 34552148 PMCID: PMC8458404 DOI: 10.1038/s41598-021-98342-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/07/2021] [Indexed: 01/20/2023] Open
Abstract
Previous epidemiological studies have demonstrated that the lower serum concentration of vitamin D was associated with elevated risk of open-angle glaucoma (OAG). However, few studies have examined the association between aqueous humor vitamin D concentrations and OAG. Hence, we investigated the relationship between 25-hydroxyvitamin D (25(OH)D) concentrations in aqueous humor and OAG. We measured 25(OH)D concentrations in aqueous humor and serum of 126 patients who underwent cataract surgery. 36 were patients with OAG and 90 were control patients. The 25(OH)D concentrations were measured using Elecsys Vitamin D Total Kits with the Cobas e602 module (Roche Diagnostics, Mannheim, Germany), an electrochemiluminescence assay. Multiple linear regression analysis was performed to investigate factors associated with serum and aqueous humor 25(OH)D concentrations. Patients with OAG had significantly lower 25(OH)D concentrations in aqueous humor than control patients. Serum 25(OH)D concentrations were higher in patients with OAG than in the control, but this was not statistically significant. 25(OH)D concentrations in aqueous humor of patients with OAG were significantly associated with axial length but not with glaucoma severity, which was determined by the retinal nerve fiber layer thickness or mean deviation. Vitamin D concentrations in aqueous humor of patients with OAG were significantly lower than those in patients without OAG.
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D'Souza S, James E, Swarup R, Mahuvakar S, Pradhan A, Gupta K. Algorithmic approach to diagnosis and management of post-refractive surgery dry eye disease. Indian J Ophthalmol 2021; 68:2888-2894. [PMID: 33229664 PMCID: PMC7856989 DOI: 10.4103/ijo.ijo_1957_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Dry eye disease (DED) is a condition that is fast reaching epidemic proportions around the world. Dry eye post-refractive surgery is the leading cause of iatrogenically induced DED. The wide variety of presentations and the disparity between signs and symptoms in many patients make this a very challenging aspect of our clinical practice. There has been a paradigm shift in the way we approach and treat this condition. The International Dry eye workshop has added new knowledge and focus to our management of dry eye. A wide range of newer diagnostic modalities are available for the diagnosis of DED. Dry eye is one of the most common side effects of refractive surgery and can have a bearing the patient's perception of surgical outcomes as well. A thorough understanding of the possible underlying etiopathologies of this disease and the difference in etiopathogenesis of postrefractive dry eye is essential for optimal outcomes. It is important to approach each case in a unique fashion and customize the therapy to the patient presentation. This review article compiles all these aspects of management of dry eye in general, and postrefractive surgery dry eye in particular; from the ones commonly practiced in the clinic to the newer modalities of therapy with insights into the disease from a more practical point of view.
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Affiliation(s)
- Sharon D'Souza
- Department of Cornea and Refractive, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Edwin James
- Department of Ophthalmology, Government Medical College, Paripally, Kerala, India
| | - Rishi Swarup
- Director and Consultant Cornea, Cataract and Refractive, Swarup Eye Centre, Hyderabad, Telangana, India
| | - Sheetal Mahuvakar
- Consultant Cataract Cornea and Refractive Surgery, Retina Foundation, Ahmedabad, Gujarat, India
| | - Aditya Pradhan
- Consultant Cataract, Cornea and External Disease, Disha Eye Hospital, Barrakpore, Kolkata, West Bengal, India
| | - Krati Gupta
- Department of Cornea and Refractive, Narayana Nethralaya, Bangalore, Karnataka, India
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Donthineni PR, Shanbhag SS, Basu S. An Evidence-Based Strategic Approach to Prevention and Treatment of Dry Eye Disease, a Modern Global Epidemic. Healthcare (Basel) 2021; 9:healthcare9010089. [PMID: 33477386 PMCID: PMC7830429 DOI: 10.3390/healthcare9010089] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/02/2021] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
Dry eye disease (DED) is an emerging health concern causing significant visual, psychological, social, and economic impact globally. In contrast to visual rehabilitation undertaken at late stages of DED, measures instituted to prevent its onset, establishment, or progression can alter its natural course and effectively bring down the associated morbidity. This review attempts to present the available literature on preventive strategies of DED at one place, including strategies for risk assessment and mitigation, targeting a wide range of population. A literature search was conducted using PubMed and an extensive literature review on preventive strategies for DED was compiled to put forth a holistic and strategic approach for preventing DED. This can be undertaken at various stages or severity of DED directed at different tiers of the health care system. Conclusion: This review intends to put emphasis on preventive strategies being adopted as an integral part of routine clinical practice by general ophthalmologists and specialists to tackle the burden of DED and improve the quality of the lives of the patients suffering from it.
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Affiliation(s)
- Pragnya R. Donthineni
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad 500034, India; (P.R.D.); (S.S.S.)
| | - Swapna S. Shanbhag
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad 500034, India; (P.R.D.); (S.S.S.)
| | - Sayan Basu
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad 500034, India; (P.R.D.); (S.S.S.)
- Center for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad 500034, India
- Correspondence: ; Tel.: +91-040-30612555
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Kundu G, D'Souza S, Lalgudi VG, Arora V, Chhabra A, Deshpande K, Shetty R. Photorefractive keratectomy (PRK) Prediction, Examination, tReatment, Follow-up, Evaluation, Chronic Treatment (PERFECT) protocol - A new algorithmic approach for managing post PRK haze. Indian J Ophthalmol 2020; 68:2950-2955. [PMID: 33229676 PMCID: PMC7857001 DOI: 10.4103/ijo.ijo_2623_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to discuss the possible risk factors predisposing to post photorefractive keratectomy (PRK) haze formation and develop and validate a risk scoring system, so that this could be applied to our clinical practice as an algorithmic approach. Methods Study was divided into 2 arms, in the retrospective arm we looked at 238 eyes of patients undergoing PRK where certain presumed risk factors from literature and clinical experience were identified and statistical significance of association was studied in the development of corneal haze. The risk scoring system was applied to the 450 eyes in the prospective arm for validation. This was then used to formulate an algorithmic approach to manage post-PRK haze. Results 22 out of 238 eyes in the retrospective arm developed haze where risk factors such as contact lens intolerance, altered tear film break up time, meibomian gland drop out and vitamin d levels were significantly associated with post-PRK haze (p < 0.05) and these factors were identified in the prospective arm. Treatment of these modifiable factors led to a significant reduction in post-PRK haze. Conclusion Thus identifying and treating risk factors of haze in patients undergoing PRK could improve surgical outcomes and patient satisfaction.
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Affiliation(s)
- Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | | | | | - Aishwarya Chhabra
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
| | | | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya Eye Hospital, Bengaluru, Karnataka, India
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Pellegrini M, Senni C, Bernabei F, Cicero AFG, Vagge A, Maestri A, Scorcia V, Giannaccare G. The Role of Nutrition and Nutritional Supplements in Ocular Surface Diseases. Nutrients 2020; 12:nu12040952. [PMID: 32235501 PMCID: PMC7230622 DOI: 10.3390/nu12040952] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/16/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial disease of the ocular surface system whose chore mechanisms are tear film instability, inflammation, tear hyperosmolarity and epithelial damage. In recent years, novel therapies specifically targeting inflammation and oxidative stress are being investigated and used in this field. Therefore, an increasing body of evidence supporting the possible role of different micronutrients and nutraceutical products for the treatment of ocular surface diseases is now available. In the present review, we analyzed in detail the effects on ocular surface of omega-3 fatty acids, vitamins A, B12, C, D, selenium, curcumin and flavonoids. Among these, the efficacy of omega-3 fatty acid supplementation in ameliorating DED signs and symptoms is supported by robust scientific evidence. Further long-term clinical trials are warranted to confirm the safety and efficacy of the supplementation of the other micronutrients and nutraceuticals.
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Affiliation(s)
- Marco Pellegrini
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (C.S.); (F.B.)
- Correspondence: ; Tel.: +39-3343-308141
| | - Carlotta Senni
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (C.S.); (F.B.)
| | - Federico Bernabei
- Ophthalmology Unit, S.Orsola-Malpighi University Hospital, University of Bologna, 40138 Bologna, Italy; (C.S.); (F.B.)
| | - Arrigo F. G. Cicero
- Medical and Surgical Sciences Department, University of Bologna, 40138 Bologna, Italy;
| | - Aldo Vagge
- Eye Clinic of Genoa, Policlinico San Martino, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, 16132 Genoa, Italy;
| | - Antonio Maestri
- Medical Oncology Department, Santa Maria della Scaletta Hospital, 40026 Imola, Italy;
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.S.); (G.G.)
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.S.); (G.G.)
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Sridhar U, Tripathy K. Commentary: Dry eye syndrome and vitamin D deficiency. Indian J Ophthalmol 2020; 68:1026-1027. [PMID: 32461421 PMCID: PMC7508114 DOI: 10.4103/ijo.ijo_398_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Khamar P, Nair AP, Shetty R, Vaidya T, Subramani M, Ponnalagu M, Dhamodaran K, D'souza S, Ghosh A, Pahuja N, Deshmukh R, Ahuja P, Sainani K, Nuijts RMMA, Das D, Ghosh A, Sethu S. Dysregulated Tear Fluid Nociception-Associated Factors, Corneal Dendritic Cell Density, and Vitamin D Levels in Evaporative Dry Eye. Invest Ophthalmol Vis Sci 2019; 60:2532-2542. [PMID: 31195410 DOI: 10.1167/iovs.19-26914] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to study the status and association among tear-soluble factors, corneal dendritic cell density, vitamin D, and signs and symptoms in dry eye disease (DED). Methods A total of 33 control subjects and 47 evaporative dry eye patients were included in the study. DED diagnosis and classification was based on the 2017 Report of the Tear Film & Ocular Surface Society International Dry Eye Workshop (TFOS DEWS II). DED workup, including tear film break-up time (TBUT), Schirmer's test I (STI), corneal and conjunctival staining, ocular surface disease index (OSDI) scoring, and in vivo confocal microscopy (to assess corneal dendritic cell density [cDCD] and subbasal nerve plexus [SBNP] features) was performed in the study subjects. Tear fluid using Schirmer's strip and serum were collected from the subjects. Multiplex ELISA or single analyte ELISA was performed to measure 34 tear-soluble factors levels including vitamin D. Results Significantly higher OSDI discomfort score, lower TBUT, and lower STI were observed in DED patients. cDCD was significantly higher in DED patients. No significant difference was observed in SBNP features. Tear fluid IL-1β, IL-17A, MMP9, MMP10, MMP9/TIMP ratio, and VEGF-B were significantly higher in DED patients. Significantly lower tear fluid IL-2, IP-10, NPY, VEGF-A, and vitamin D was observed in DED patients. These dysregulated tear factors showed significant associations with DED signs and symptoms. Conclusions Altered tear fluid soluble factors with potential to modulate nociception exhibited a distinct association with ocular surface discomfort status, TBUT, STI, and cDCD. This implies a functional relationship between the various tear-soluble factors and dry eye pathogenesis, indicating new molecular targets for designing targeted therapies.
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Affiliation(s)
- Pooja Khamar
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Archana Padmanabhan Nair
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.,Manipal Academy of Higher Education, Manipal, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Tanuja Vaidya
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.,Manipal Academy of Higher Education, Manipal, India
| | - Murali Subramani
- Stem Cell Lab, GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Murugeswari Ponnalagu
- Stem Cell Lab, GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Kamesh Dhamodaran
- Stem Cell Lab, GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Sharon D'souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Anuprita Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Natasha Pahuja
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Prerna Ahuja
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Kanchan Sainani
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, India
| | - Rudy M M A Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Debashish Das
- Stem Cell Lab, GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
| | - Arkasubhra Ghosh
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India.,Singapore Eye Research Institute, Singapore
| | - Swaminathan Sethu
- GROW Research Laboratory, Narayana Nethralaya Foundation, Bangalore, India
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Meng YF, Xin Q, Lu J, Xiao P, Li J. Association Between Single Nucleotide Polymorphisms in the Vitamin D Receptor and Incidence of Dry Eye Disease in Chinese Han Population. Med Sci Monit 2019; 25:4759-4765. [PMID: 31243261 PMCID: PMC6611217 DOI: 10.12659/msm.915434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Dry eye disease (DED) is a chronic dysfunction of the ocular surface and has become an important public problem. Vitamin D receptor (VDR) gene polymorphism has been found to be associated with different kinds of diseases. The relationship between single nucleotide polymorphisms (SNPs) in the VDR gene should be studied. Material/Methods In the present case-control study, we investigated the association of VDR gene polymorphism with DED risk. Clinical data including age, gender, body mass index (BMI, kg/m2), smoking history, diabetes, and blood pressure were recorded. Serum 25-hydroxy vitamin D (25[OH]D) was chosen as the main parameter that reflected the level of vitamin D. We identified SNPs of VDR gene Apa-1, Bsm-1, Fok-1, and Taq-1 in both DED cases and healthy controls. Results A total of 124 DED cases and 135 healthy controls were included in this study. It was reported that aa in Apa-1 (OR=2.803, 95% CI, 1.350–5.820) and tt in Taq-1 (OR=0.362, 95% CI, 0.141–0.930) were associated with increased the risk of DED. Analysis of the allele frequencies of VDR gene polymorphisms among DED patients and healthy controls showed that allele differences in Apa-1 were significantly associated with higher risk. Conclusions SNPs of VDR gene (Apa-1 and Taq-1) were associated with the risk of DED. No significant association of Bsm-1 and Fok-1 in VDR gene demonstrated significant effect in the incidence of DED. Thus, we found that several SNPs of VDR gene could provide significant pathogenic effects in the risk of DED.
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Affiliation(s)
- Yi-Fang Meng
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China (mainland)
| | - Qian Xin
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China (mainland)
| | - Jiong Lu
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China (mainland)
| | - Pan Xiao
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China (mainland)
| | - Jian Li
- Department of Ophthalmology, Changshu No. 2 People's Hospital, Changshu, Jiangsu, China (mainland)
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