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Vera-Duarte GR, Jimenez-Collado D, Kahuam-López N, Ramirez-Miranda A, Graue-Hernandez EO, Navas A, Rosenblatt MI. Neurotrophic keratopathy: General features and new therapies. Surv Ophthalmol 2024; 69:789-804. [PMID: 38679146 DOI: 10.1016/j.survophthal.2024.04.004] [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: 12/20/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Neurotrophic keratopathy is an uncommon degenerative corneal disorder characterized by compromised corneal sensory innervation resulting in the formation of epithelial defects and nonhealing corneal ulcers. Various treatment modalities are available to stabilize disease progression, improve patient well-being, and prevent vision loss. For eligible patients, medical and surgical reinnervation have emerged as pioneering therapies, holding promise for better management. We present a comprehensive review of the disorder, providing an update relevant to ophthalmologists on pathogenesis, diagnosis, treatment options, and novel therapies targeting pathophysiological pathways.
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Affiliation(s)
- Guillermo Raul Vera-Duarte
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - David Jimenez-Collado
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Nicolás Kahuam-López
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Arturo Ramirez-Miranda
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Enrique O Graue-Hernandez
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Alejandro Navas
- Department of Cornea and Refractive Surgery, Instituto de Oftalmología "Conde de Valenciana, Mexico City, Mexico
| | - Mark I Rosenblatt
- Department of Ophthalmology and Visual Sciences, University of Illinois-Chicago (UIC), Chicago, IL 60612, USA.
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2
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Rodriguez JD, Kerti S, Hamm A, Ousler GW, Bensinger E, Burnham S, Abelson MB. Advantages of Lissamine Green Vital Staining as an Endpoint in Dry Eye Clinical Trials. Clin Ophthalmol 2024; 18:2193-2203. [PMID: 39131543 PMCID: PMC11316467 DOI: 10.2147/opth.s468457] [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: 05/10/2024] [Accepted: 07/16/2024] [Indexed: 08/13/2024] Open
Abstract
Purpose The absence of a standardized diagnostic method for clinical signs of Dry Eye Disease (DED) complicates clinical trials for future treatments. This paper evaluated Lissamine Green (LG) conjunctival staining as a valid, stable and modifiable endpoint for both clinical practice and clinical trials. Methods Screening and pre-randomization data from two identically designed clinical trials for DED resulted in a pooled dataset of 494 subjects. Inclusion was based on reported symptoms, lissamine green (LG) conjunctival staining, Fluorescein (Fl) corneal and conjunctival staining, and Schirmer's Test (ST). Outcome measures were assessed based on the modifiability of LG staining to exposure to a Controlled Adverse Environment (CAE®), correlation of LG to Fl staining, relative variation of LG staining scores and Schirmer test scores, and the correlation of LG staining with symptom scores. Results The modifiability of LG conjunctival staining to environmental exposure was demonstrated, with nasal LG and FL staining displaying the most similar percent change. Nasal LG conjunctival staining scores for subjects with ST scores of less than 8mm were significantly higher than for subjects with ST greater than 8mm. LG staining scores were more consistent (25% change from baseline threshold) than ST scores. Finally, statistically significant correlations were found between LG staining and a number of symptom scores. Conclusion This evaluation demonstrates the superiority of the utilization of a clinical endpoint focused on ocular surface damage. The reproducibility and modifiability of LG conjunctival staining to controlled adverse environment, coupled with its significant correlation with symptoms, positions it as an exemplary clinical sign endpoint for clinical management and in clinical trials. Our findings advocate for the adoption of LG conjunctival staining as a primary endpoint in both clinical research and drug development, offering a more effective means of identifying and addressing ocular surface damage in the realm of DED.
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Affiliation(s)
- John D Rodriguez
- Ora, Inc, Andover, MA, USA
- Andover Eye Institute, Andover, MA, USA
| | | | - Adam Hamm
- Statistics and Data Corporation, Tempe, AZ, USA
| | | | - Ethan Bensinger
- Ora, Inc, Andover, MA, USA
- Andover Eye Institute, Andover, MA, USA
| | - Sadie Burnham
- Ora, Inc, Andover, MA, USA
- Andover Eye Institute, Andover, MA, USA
| | - Mark B Abelson
- Ora, Inc, Andover, MA, USA
- Andover Eye Institute, Andover, MA, USA
- Ophthalmology, Harvard Medical School, Cambridge, MA, USA
- Mass Eye and Ear, Boston, MA, USA
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3
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Kahook MY, Rapuano CJ, Messmer EM, Radcliffe NM, Galor A, Baudouin C. Preservatives and ocular surface disease: A review. Ocul Surf 2024; 34:213-224. [PMID: 39098762 DOI: 10.1016/j.jtos.2024.08.001] [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: 03/06/2024] [Revised: 06/15/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
Ocular surface disease (OSD) is a complex condition that can cause a range of symptoms (e.g, dryness, irritation, and pain) and can significantly impact the quality of life of affected individuals. Iatrogenic OSD, a common finding in patients with glaucoma who receive chronic therapy with topical ocular antihypertensive drugs containing preservatives such as benzalkonium chloride (BAK), has been linked to damage to the ocular surface barrier, corneal epithelial cells, nerves, conjunctival goblet cells, and trabecular meshwork. Chronic BAK exposure activates inflammatory pathways and worsens symptoms, compromising the success of subsequent filtration surgery in an exposure-dependent manner. In eyes being treated for glaucoma, symptomatic treatment of OSD may provide some relief, but addressing the root cause of the OSD often necessitates reducing or, ideally, eliminating BAK toxicity. Strategies to decrease BAK exposure in patients with glaucoma encompass the use of preservative-free formulations or drugs with alternative and less toxic preservatives such as SofZia®, Polyquad, potassium sorbate, or Purite®. Though the benefits of these alternative preservatives are largely unproven, they might be considered when financial constraints prevent the use of preservative-free versions. For patients receiving multiple topical preserved drugs, the best practice is to switch to nonpreserved equivalents wherever feasible, regardless of OSD severity. Furthermore, nonpharmacological approaches, including laser or incisional procedures, should be considered. This review explores the effects of BAK on the ocular surface and reviews strategies for minimizing or eliminating BAK exposure in patients with glaucoma in order to significantly improve their quality of life and prevent complications associated with chronic exposure to BAK.
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Affiliation(s)
- Malik Y Kahook
- Department of Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, United States.
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Nathan M Radcliffe
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States; New York Eye Surgery Center, The Bronx, New York, United States
| | - Anat Galor
- Ophthalmology, VA Miami Healthcare System, Miami, FL, United States; Ophthalmology, University of Miami Health System Bascom Palmer Eye Institute, Miami, FL, United States
| | - Christophe Baudouin
- Paris-Saclay, Versailles Saint Quentin University, Paris, Île-de-France, France; Centre Hospitalier National D'Ophtalmologie des Quinze-Vingts, IHU ForeSight, Paris, Île-de-France, France
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4
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Troisi M, Caruso C, D’Andrea L, Rinaldi M, Piscopo R, Troisi S, Costagliola C. Compatibility of a New Ocular Surface Dye with Disposable and Bi-Weekly Soft Contact Lenses: An Experimental Study. Life (Basel) 2024; 14:653. [PMID: 38929636 PMCID: PMC11204805 DOI: 10.3390/life14060653] [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: 04/02/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Ocular surface staining for assessing corneal and conjunctival epithelium integrity is typically conducted using fluorescein, lissamine green, or rose Bengal dyes. Recently, a novel vital dye, REmark®, based on riboflavin, has been proposed for ocular surface examination. In the management of corneal and ocular surface diseases (OSD), the use of contact lenses is integral to therapeutic strategies. This study explores the compatibility of REmark® with four different types of disposable or bi-weekly soft contact lenses. Morphological variations observed under stereomicroscopy and ultraviolet (UV) ray transmittance in the visible spectrum (VIS) were evaluated at 2 and 4 h post-immersion of the contact lenses in both the original fluid and the new dye. The findings indicate no significant differences between the group treated with the original liquid and those immersed in REmark®, except for a yellow hue observed in the latter group, which dissipates after 8 h in physiological solution. This study highlights the potential of utilizing the new vital dye for ophthalmologic examinations even in the presence of applied soft contact lenses, offering a promising avenue for improved diagnostic practices and patient comfort.
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Affiliation(s)
- Mario Troisi
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini n. 5, 80131 Naples, Italy; (M.T.); (M.R.); (R.P.); (C.C.)
| | - Ciro Caruso
- Corneal Transplant Center, Pellegrini Hospital, Via Portamedina alla Pignasecca, 41, 80127 Napoli, Italy;
| | - Luca D’Andrea
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini n. 5, 80131 Naples, Italy; (M.T.); (M.R.); (R.P.); (C.C.)
- Public Health Department, University of Naples Federico II, Via Pansini n. 5, 80131 Naples, Italy
| | - Michele Rinaldi
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini n. 5, 80131 Naples, Italy; (M.T.); (M.R.); (R.P.); (C.C.)
| | - Raffaele Piscopo
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini n. 5, 80131 Naples, Italy; (M.T.); (M.R.); (R.P.); (C.C.)
| | - Salvatore Troisi
- Ophthalmologic Unit, Salerno Hospital University, 84100 Salerno, Italy;
| | - Ciro Costagliola
- Eye Clinic, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Via Pansini n. 5, 80131 Naples, Italy; (M.T.); (M.R.); (R.P.); (C.C.)
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5
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Choi M, Tichenor AA. Regional Conjunctival Differences in Glycocalyx Mucin Expression in Dry Eye and Normal Subjects. Invest Ophthalmol Vis Sci 2024; 65:20. [PMID: 38334701 PMCID: PMC10860684 DOI: 10.1167/iovs.65.2.20] [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: 07/12/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024] Open
Abstract
Purpose To compare regional conjunctival expression of membrane-associated mucins (MAMs) MUC1, MUC4, and MUC16 in normal and dry eye (DE) subjects. Methods Adults with and without signs and symptoms of DE were recruited. Impression cytology was performed to collect MAMs from four bulbar and upper eyelid palpebral conjunctival regions of both eyes. After protein extraction, samples from both eyes of a single subject were pooled by region, and expression was analyzed using a capillary electrophoresis nano-immunoassay system. The chemiluminescence intensity of each antigen binding signal was calculated after normalization to the total protein amount. Statistical analyses were conducted using GraphPad Prime 9. Results Samples from thirteen to sixteen DE and seven to eleven normal subjects were analyzed. In normal samples, MUC1 expression from the nasal bulbar conjunctiva was significantly greater than superior (P = 0.004) and inferior (P = 0.005). In DE samples, MUC1 expression was highest superiorly. Significant differences in MUC4 and MUC16 expression were not seen in normal samples. MUC4 and MUC16 expression was upregulated superiorly (P < 0.0001) and inferiorly (P < 0.0001) in DE compared with those regions in normal samples. Conclusions Although MAMs form a hydrophilic barrier called the glycocalyx, each mucin may have unique functions that are currently unexplored. All MAMs were expressed in the upper palpebral conjunctiva. Increased MUC1 expression nasally in healthy subjects suggests a functional need for increased protection. When comparing DE with normal eyes, upregulation of MUC1 superiorly, and in both MUC4 and MUC16 both superiorly and inferiorly, may indicate a need to decrease eyelid friction during blinking, especially in DE.
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Affiliation(s)
- Moonjung Choi
- New England College of Optometry, Boston, Massachusetts, United States
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Chester T, Garg S(S, Johnston J, Ayers B, Gupta P. How Can We Best Diagnose Severity Levels of Dry Eye Disease: Current Perspectives. Clin Ophthalmol 2023; 17:1587-1604. [PMID: 37304329 PMCID: PMC10254642 DOI: 10.2147/opth.s388289] [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: 03/24/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023] Open
Abstract
Dry eye disease (DED) is a common ocular condition, but the diagnosis relative to other ocular conditions and the evaluation of severity of the condition has often been difficult. This challenge can be due to clinical signs and symptoms not always correlating with each other. An understanding of the various components which create the condition, as well as the diagnostic measures used to evaluate these components, is useful to the clinician working with DED patients. This review paper will discuss traditional diagnostic options, diagnostic imaging, and Advanced Point of Care testing capabilities to determine the severity level of dry eye disease more adequately.
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Affiliation(s)
| | - Sumit (Sam) Garg
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California-Irvine, Irvine, CA, USA
| | - Josh Johnston
- Georgia Eye Partners, Atlanta, GA, USA
- Southern College of Optometry, Memphis, TN, USA
| | - Brandon Ayers
- Ophthalmic Partners PC, Cornea Service, Wills Eye Hospital, Philadelphia, PA, USA
| | - Preeya Gupta
- Triangle Eye Consultants, Raleigh, NC, USA
- Department of Ophthalmology, Tulane University, New Orleans, LA, USA
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7
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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.
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Affiliation(s)
| | - Gary N Foulks
- University of Louisville (Retired), Louisville, KY, USA
| | | | - Karen L Ice
- Lexitas Pharma Services, Inc, Durham, NC, USA
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Dhaini B, Wagner L, Moinard M, Daouk J, Arnoux P, Schohn H, Schneller P, Acherar S, Hamieh T, Frochot C. Importance of Rose Bengal Loaded with Nanoparticles for Anti-Cancer Photodynamic Therapy. Pharmaceuticals (Basel) 2022; 15:ph15091093. [PMID: 36145315 PMCID: PMC9504923 DOI: 10.3390/ph15091093] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Rose Bengal (RB) is a photosensitizer (PS) used in anti-cancer and anti-bacterial photodynamic therapy (PDT). The specific excitation of this PS allows the production of singlet oxygen and oxygen reactive species that kill bacteria and tumor cells. In this review, we summarize the history of the use of RB as a PS coupled by chemical or physical means to nanoparticles (NPs). The studies are divided into PDT and PDT excited by X-rays (X-PDT), and subdivided on the basis of NP type. On the basis of the papers examined, it can be noted that RB used as a PS shows remarkable cytotoxicity under the effect of light, and RB loaded onto NPs is an excellent candidate for nanomedical applications in PDT and X-PDT.
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Affiliation(s)
- Batoul Dhaini
- Reactions and Chemical Engineering Laboratory, Université de Lorraine, LRGP-CNRS, F-54000 Nancy, France
| | - Laurène Wagner
- Laboratory of Macromolecular Physical Chemistry, Université de Lorraine, LCPM-CNRS, F-54000 Nancy, France
| | - Morgane Moinard
- Reactions and Chemical Engineering Laboratory, Université de Lorraine, LRGP-CNRS, F-54000 Nancy, France
| | - Joël Daouk
- Department of Biology, Signals and Systems in Cancer and Neuroscience, Université de Lorraine, CRAN-CNRS, F-54000 Nancy, France
| | - Philippe Arnoux
- Reactions and Chemical Engineering Laboratory, Université de Lorraine, LRGP-CNRS, F-54000 Nancy, France
| | - Hervé Schohn
- Department of Biology, Signals and Systems in Cancer and Neuroscience, Université de Lorraine, CRAN-CNRS, F-54000 Nancy, France
| | - Perrine Schneller
- Department of Biology, Signals and Systems in Cancer and Neuroscience, Université de Lorraine, CRAN-CNRS, F-54000 Nancy, France
| | - Samir Acherar
- Laboratory of Macromolecular Physical Chemistry, Université de Lorraine, LCPM-CNRS, F-54000 Nancy, France
| | - Tayssir Hamieh
- Faculty of Science and Engineering, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Laboratory of Materials, Catalysis, Environment and Analytical Methods Laboratory (MCEMA), Faculty of Sciences, Lebanese University, Hadath 6573, Lebanon
| | - Céline Frochot
- Reactions and Chemical Engineering Laboratory, Université de Lorraine, LRGP-CNRS, F-54000 Nancy, France
- Correspondence:
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Li MS, Wong HL, Ip YL, Peng Z, Yiu R, Yuan H, Wai Wong JK, Chan YK. Current and Future Perspectives on Microfluidic Tear Analytic Devices. ACS Sens 2022; 7:1300-1314. [PMID: 35579258 DOI: 10.1021/acssensors.2c00569] [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: 12/20/2022]
Abstract
Most current invasive analytic devices for disease diagnosis and monitoring require the collection of blood, which causes great discomfort for patients and may potentially cause infection. This explains the great need for noninvasive devices that utilize other bodily fluids like sweat, saliva, tears, or urine. Among them, eye tears are easily accessible, less complex in composition, and less susceptible to dilution. Tears also contain valuable clinical information for the diagnosis of ocular and systemic diseases as the tear analyte level shows great correlation with the blood analyte level. These unique advantages make tears a promising platform for use in clinical settings. As the volume of tear film and the rate of tear flow are only microliters in size, the use of microfluidic technology in analytic devices allows minimal sample consumption. Hence, more and more microfluidic tear analytic devices have been proposed, and their working mechanisms can be broadly categorized into four main types: (a) electrochemical, (b) photonic crystals, (c) fluorescence, and (d) colorimetry. These devices are being developed toward the application of point-of-care tests with rapid yet accurate results. This review aims to provide a general overview of the recent developmental trend of microfluidic devices for tear analysis. Moreover, the fundamental principle behind each type of device along with their strengths and weaknesses will be discussed, especially in terms of their abilities and potential in being used in point-of-care settings.
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Affiliation(s)
- Man Shek Li
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 000000
| | - Ho Lam Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 000000
| | - Yan Lam Ip
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 000000
| | - Zhiting Peng
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 000000
| | - Rachel Yiu
- Department of Ophthalmology, Grantham Hospital, Hong Kong West Cluster, Hong Kong SAR 000000
| | - Hao Yuan
- School of Life Sciences and Engineering, Southwest Jiaotong University, Chengdu, Sichuan 610031, P R China
| | - Jasper Ka Wai Wong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 000000
- Department of Ophthalmology, Grantham Hospital, Hong Kong West Cluster, Hong Kong SAR 000000
| | - Yau Kei Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR 000000
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10
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Begley CG, Caffery B, Nelson JD, Situ P. The effect of time on grading corneal fluorescein and conjunctival lissamine green staining. Ocul Surf 2022; 25:65-70. [PMID: 35568371 DOI: 10.1016/j.jtos.2022.05.003] [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: 04/06/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the effect of time on grading corneal fluorescein and conjunctival lissamine green staining in dry eye disease (DED). METHODS Photographs of 68 subjects with non-Sjogren's DED (nSS DED) and 32 with Sjogren's DED (SS DED) were taken of corneal fluorescein staining, then conjunctival lissamine green staining every 30 s for at least 5 min. Photographs of one randomly selected eye were then randomly ordered and graded on a scale from 0 to 5 (severe staining) by two clinicians, masked to both site and subject. The average time required to reach the maximum grade of staining (Gmax) was calculated. RESULTS The median time (upper and lower quartiles) to corneal fluorescein Gmax was 2.6 (1.3-5.3) minutes for nSS DED and 3.8 (2.6-5.4) minutes for SS DED, a statistically significant difference (Mann Whitney U test, p = 0.018). In contrast, the median time to the Gmax for lissamine green staining of the nasal and temporal conjunctiva was 0.5 (0.5-1.1 nasal, 0.5-0.8 temporal) minutes for nSS DED and 0.5 (0.5-0.8 nasal, 0.5-0.5 temporal) minutes for SS DED subjects, which was not statistically significant (p ≥ 0.383). CONCLUSIONS The time required to reach the maximum grade of corneal fluorescein staining, but not conjunctival lissamine green staining, varied widely and was significantly longer in subjects with Sjögren's Syndrome. Early observation of corneal fluorescein staining can lead to under-grading, which may impact the diagnosis and assessment of treatment in DED. Further study of the best time to assess corneal fluorescein staining in various DED populations is warranted.
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Affiliation(s)
| | | | | | - Ping Situ
- Indiana University School of Optometry, Bloomington, IN, USA
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11
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Wang TZ, Guan B, Liu XX, Ke LN, Wang JJ, Nan KH. A topical fluorometholone nanoformulation fabricated under aqueous condition for the treatment of dry eye. Colloids Surf B Biointerfaces 2022; 212:112351. [PMID: 35091382 DOI: 10.1016/j.colsurfb.2022.112351] [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: 10/18/2021] [Revised: 12/11/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
Fluorometholone (FMT) is a frequently prescribed drug for the alleviation of dry eye. However, due to low aqueous solubility, it has been routinely used as an ophthalmic suspension, which is characterized by low bioavailability, inconvenience of administration, and difficulty in delivering accurate dose. Furthermore, the opaque appearance of the ophthalmic suspension is not desirable for optical purpose. In the present study, a transparent FMT nanoformulation (FMT-CD NPs) was fabricated by the cyclodextrin (CD) nanoparticle technology without organic solvents. It was demonstrated that FMT was encapsulated in an amorphous form, which was associated with increased release rate and enhanced corneal penetration efficiency. The biocompatibility of FMT-CD NPs was confirmed by the Live/Dead assay, CCK-8 assay and the wound healing assay. Most importantly, FMT-CD NPs alleviated dry eye signs more efficiently than the commercial eye drop, with one-fifth the dosage of FMT in the latter. Collectively, our study provides a promising FMT formulation for improved management of dry eye while reducing drug related side effects.
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Affiliation(s)
- Tian-Zuo Wang
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China; National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Bin Guan
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China; National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Xin-Xin Liu
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China; National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China
| | - Lin-Nan Ke
- National Institutes for Food and Drug Control, Beijing 102629, China
| | - Jing-Jie Wang
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China; National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China.
| | - Kai-Hui Nan
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China; National Engineering Research Center of Ophthalmology and Optometry, School of Biomedical Engineering, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China.
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12
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AS-OCT and Ocular Hygrometer as Innovative Tools in Dry Eye Disease Diagnosis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Dry eye disease (DED) is one of the conditions that most commonly leads patients to visit an ophthalmologist. Fast and accurate diagnosis relieves patient discomfort and spares them from long-term effects on the ocular surface. Many tests used in the diagnosis of DED may be considered subjective as they rely on an experienced observer for image interpretation, resulting in variations in diagnosis. On one hand, the non-contact nature of the anterior segment optical coherence tomography (AS-OCT) device and its rapid image acquisition enable the measurement of the tear meniscus parameter without reflex tearing. On the other hand, an ocular hygrometer allows a rapid, safe, but also efficient, analysis and is associated with low costs and the repeatability of the procedure.
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13
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Hirabayashi KJ, Akpek EK, Ahmad S. Outcome Measures to Assess Dry Eye Severity: A Review. Ocul Immunol Inflamm 2022; 30:282-289. [PMID: 35113753 DOI: 10.1080/09273948.2022.2027461] [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: 10/19/2022]
Abstract
Outcome measures used to assess efficacy of dry eye therapeutics have not been consistently applied in clinical settings, nor have they been shown to correlate with functional outcomes. We propose that corneal staining, a clinically meaningful dry eye parameter, should be used as a standard objective outcome measure across all clinical trials evaluating dry eye treatments. We justify this based on evidence regarding its relationship to vision and vision related quality-of-life. In addition, corneal staining has been shown to correlate with ocular surface inflammation, a well elucidated aspect of dry eye pathophysiology and an active area in therapeutics research. No one outcome measure explored herein correlates perfectly to this heterogenous disease. However, there is mounting evidence showing the correlation between corneal staining and functional visual indices. We hope that future clinical trials will standardize corneal staining as a measure to determine the efficacy of interventions and justify their clinical utility.
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Affiliation(s)
- Kyle J Hirabayashi
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumayya Ahmad
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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14
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Simpson T, Begley CG, Situ P, Feng Y, Nelson JD, Caffery B, Springs C, Connell SB. Canonical Grading Scales of Corneal and Conjunctival Staining Based on Psychophysical and Physical Attributes. Transl Vis Sci Technol 2021; 10:17. [PMID: 34403476 PMCID: PMC8374974 DOI: 10.1167/tvst.10.9.17] [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] [Indexed: 11/30/2022] Open
Abstract
Purpose In this study, we apply psychophysical scaling principles based on physical (photometric) attributes of images to better understand the factors involved in clinician judgement of ocular surface staining and, using that knowledge, to develop photographic scales for the assessment of staining for dry eye (DE) and related conditions. Methods Subjects with noninfectious ocular surface staining were enrolled at five clinical sites. Following instillation of fluorescein, photographs of corneal staining were taken every 30 seconds for at least 5 minutes. The same procedure was followed for conjunctival staining after instillation of 2 µl of 1% lissamine green. A subset of the best corneal and bulbar conjunctival staining images were anonymized and a spectroradiometer measured photometric attributes (luminance and chromaticity). The images were scaled psychophysically by study investigators, who participated in constructing grading scales based on physical and psychophysical analyses. The final grading scales were refined following consultation with outside DE experts. Results Photographs were collected from 142 subjects (81% women), with an average age of 58 ± 17 years; 89% were diagnosed with DE. There was a monotonic relationship between between physical measurements and psychophysically scaled staining of both corneal (fluorescein) and bulbar (lissamine green) staining. Michelson contrast and u’ (chromaticity) accounted for 66% and 64% of the variability in the psychophysically scaled images of fluorescein corneal and lissamine green conjunctival staining, respectively. Translational Relevance This paper provides examples of the first ever clinically usable ocular surface staining scales validated using psychophysical scaling and the physical attributes (luminance and chromaticity) of the staining itself. In addition, it provides a generalizable method for the development of other clinical scales of ocular appearance.
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Affiliation(s)
- Trefford Simpson
- University of Waterloo, School of Optometry and Vision Science, Waterloo, Ontario, Canada
| | | | - Ping Situ
- Indiana University School of Optometry, Bloomington, IN, USA
| | - Yunwei Feng
- University of Waterloo, School of Optometry and Vision Science, Waterloo, Ontario, Canada
| | | | | | - Clark Springs
- Indiana University Department of Ophthalmology, Indianapolis, IN, USA
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15
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Efron N. Putting vital stains in context. Clin Exp Optom 2021; 96:400-21. [DOI: 10.1111/j.1444-0938.2012.00802.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 06/17/2012] [Accepted: 06/19/2012] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nathan Efron
- Institute of Health and Biomedical Innovation, and School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
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16
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Smith SM, Holt E, Aguirre GD. Conjunctival staining with lissamine green as a predictor of tear film deficiency in dogs. Vet Ophthalmol 2020; 23:624-631. [PMID: 32386097 DOI: 10.1111/vop.12762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/04/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate a grading scheme for conjunctival staining patterns with lissamine green ocular dye in the diagnosis of tear film deficiencies in dogs. PROCEDURES Client-owned and research colony dogs were enrolled in a prospective study between February and October 2018 in which slit-lamp biomicroscopy, Schirmer tear test (STT), tear film breakup time (TFBUT), conjunctival lissamine green staining (LGS), and intraocular pressure (IOP) measurement were performed in both eyes of all dogs. Lissamine green staining of the temporal bulbar conjunctiva was graded from 0-3, with a higher grade corresponding to an increased stain intensity. RESULTS Fifty-four dogs (107 eyes), comprising 31 males and 23 females with a mean age of 5.0 ± 3.9 years (range 0.5-14.3), were enrolled in the study. STT was <15 mm/min in 21 eyes and ≥15 mm/min in 86 eyes. Lissamine green staining grade for eyes with a STT of <15 mm/min (2.0 ± 0.9) was significantly higher than for eyes with a STT ≥15 mm/min (0.2 ± 0.7) (P < .001). TFBUT for eyes with a STT <15 mm/min (6.5 ± 4.4 seconds) was significantly shorter than for eyes with a STT ≥ 15 mm/min (16.1 ± 3.6 seconds) (P < .001). As LGS grade increased, both STT (P < .001) and TFBUT (P < .001) significantly decreased. CONCLUSIONS A higher LGS grade was significantly associated with a lower STT and more rapid TFBUT in dogs. Lissamine green ocular dye can be considered as an adjunctive diagnostic test when evaluating tear film deficiency in dogs.
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Affiliation(s)
- Sara M Smith
- Section of Ophthalmology, Department of Clinical Sciences & Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
| | - Elaine Holt
- Section of Ophthalmology, Department of Clinical Sciences & Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
| | - Gustavo D Aguirre
- Section of Ophthalmology, Department of Clinical Sciences & Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania
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Bjordal O, Norheim KB, Rødahl E, Jonsson R, Omdal R. Primary Sjögren's syndrome and the eye. Surv Ophthalmol 2019; 65:119-132. [PMID: 31634487 DOI: 10.1016/j.survophthal.2019.10.004] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023]
Abstract
Primary Sjögren syndrome is an autoimmune disease that mainly affects exocrine glands such as the salivary and lacrimal glands. In addition, systemic involvement is common. Primary Sjögren syndrome is of particular interest to ophthalmologists as it constitutes an important differential diagnosis in conditions with dry eye disease. In addition, ocular tests for more precisely diagnosing and monitoring primary Sjögren syndrome have become increasingly important, and new therapeutics for local and systemic treatment evolve as a result of increased understanding of immunological mechanisms and molecular pathways in the pathogenesis of primary Sjögren syndrome. We provide an update of interest to ophthalmologists regarding pathogenesis, diagnosis, investigative procedures, and treatment options.
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Affiliation(s)
| | - Katrine Brække Norheim
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Eyvind Rødahl
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Roland Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Roald Omdal
- Clinical Immunology Unit, Department of Internal Medicine, Stavanger University Hospital, Stavanger, Norway; Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.
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18
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Rasmussen A, Stone DU, Kaufman CE, Hefner KS, Fram NR, Siatkowski RL, Huang AJW, Chodosh J, Rasmussen PT, Fife DA, Pezant N, Grundahl K, Radfar L, Lewis DM, Weisman MH, Venuturupalli S, Wallace DJ, Rhodus NL, Brennan MT, Montgomery CG, Lessard CJ, Scofield RH, Sivils KL. Reproducibility of Ocular Surface Staining in the Assessment of Sjögren Syndrome-Related Keratoconjunctivitis Sicca: Implications on Disease Classification. ACR Open Rheumatol 2019; 1:292-302. [PMID: 31453437 PMCID: PMC6710016 DOI: 10.1002/acr2.1033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective The objective of this study was to assess the performance and reproducibility of the two currently used ocular surface staining scores in the assessment of keratoconjunctivitis sicca in Sjögren syndrome (SS) research classification. Methods In a multidisciplinary clinic for the evaluation of sicca, we performed all tests for the American European Consensus Group (AECG) and the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria, including the van Bijsterveld score (vBS) and the Ocular Staining Score (OSS), in 994 participants with SS or with non-SS sicca. We analyzed the concordance between the scores, the diagnostic accuracy and correlation with clinical variables, and interrater and intrasubject reproducibility. Results A total of 308 (31.1%) participants had a discordant vBS and OSS that was due to extra corneal staining points in the OSS. The presence of one or more of the additional points was highly predictive of SS classification (odds ratio = 3.66; P = 1.65 × 10e-20) and was associated with abnormal results of all measures of autoimmunity and glandular dysfunction. Receiver operating characteristic curves showed optimal cutoff values of four for the vBS (sensitivity = 0.62; specificity = 0.71; Youden's J = 0.33) and five for the OSS (sensitivity = 0.56; specificity = 0.75; Youden's J = 0.31). Notably, there was very poor consistency in interobserver mean scores and distributions (P < 0.0001) and in intrasubject scores after a median of 5.5 years (35% changed status of the ocular criterion). Conclusion Ocular surface staining scores are useful for SS research classification; however, they are subject to significant interrater and intrasubject variability, which could result in changes in classification in 5%-10% of all subjects. These results highlight the need for objective and reproducible markers of disease that have thus far remained elusive for SS.
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Affiliation(s)
- Astrid Rasmussen
- Astrid Rasmussen, MD, PhD: Oklahoma Medical Research Foundation, Oklahoma City, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Donald U Stone
- Donald U. Stone, MD: Johns Hopkins University, Baltimore, Maryland (current address: Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City)
| | - C Erick Kaufman
- C. Erick Kaufman, MD, Lida Radfar, DDS, MS, David M. Lewis, DDS: University of Oklahoma, Oklahoma City
| | - Kimberly S Hefner
- Kimberly S. Hefner, DO: Hefner Eye Care and Optical Center, Oklahoma City, Oklahoma
| | - Nicole R Fram
- Nicole R. Fram, MD: David Geffen School of Medicine, University of California, Los Angeles
| | - Rhea L Siatkowski
- Rhea L. Siatkowski, MD: University of Oklahoma and Dean McGee Eye Institute, Oklahoma City
| | - Andrew J W Huang
- Andrew J. W. Huang, MD: School of Medicine, Washington University in St. Louis, St. Louis, Missouri (current address: University of Minnesota)
| | - James Chodosh
- James Chodosh, MD, MPH: Massachusetts Eye and Ear and Harvard University, Boston (current address: Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City)
| | | | - Dustin A Fife
- Dustin A. Fife, PhD (current address: Oklahoma Medical Research Foundation, Oklahoma City), Nathan Pezant, MS, Kiely Grundahl, BS, Courtney G. Montgomery, PhD: Oklahoma Medical Research Foundation, Oklahoma City
| | - Nathan Pezant
- Dustin A. Fife, PhD (current address: Oklahoma Medical Research Foundation, Oklahoma City), Nathan Pezant, MS, Kiely Grundahl, BS, Courtney G. Montgomery, PhD: Oklahoma Medical Research Foundation, Oklahoma City
| | - Kiely Grundahl
- Dustin A. Fife, PhD (current address: Oklahoma Medical Research Foundation, Oklahoma City), Nathan Pezant, MS, Kiely Grundahl, BS, Courtney G. Montgomery, PhD: Oklahoma Medical Research Foundation, Oklahoma City
| | - Lida Radfar
- C. Erick Kaufman, MD, Lida Radfar, DDS, MS, David M. Lewis, DDS: University of Oklahoma, Oklahoma City
| | - David M Lewis
- C. Erick Kaufman, MD, Lida Radfar, DDS, MS, David M. Lewis, DDS: University of Oklahoma, Oklahoma City
| | - Michael H Weisman
- Michael H. Weisman, MD, Swamy Venuturupalli, MD, Daniel J. Wallace, MD: Cedars-Sinai Medical Center, Los Angeles, California
| | - Swamy Venuturupalli
- Michael H. Weisman, MD, Swamy Venuturupalli, MD, Daniel J. Wallace, MD: Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniel J Wallace
- Michael H. Weisman, MD, Swamy Venuturupalli, MD, Daniel J. Wallace, MD: Cedars-Sinai Medical Center, Los Angeles, California
| | - Nelson L Rhodus
- Nelson L. Rhodus, DMD, MPH: School of Dentistry, University of Minnesota, Minneapolis
| | - Michael T Brennan
- Michael T. Brennan, DDS, MHS: Carolinas Medical Center, Charlotte, North Carolina
| | - Courtney G Montgomery
- Dustin A. Fife, PhD (current address: Oklahoma Medical Research Foundation, Oklahoma City), Nathan Pezant, MS, Kiely Grundahl, BS, Courtney G. Montgomery, PhD: Oklahoma Medical Research Foundation, Oklahoma City
| | - Christopher J Lessard
- Christopher J. Lessard, PhD, Kathy L. Sivils, PhD: Oklahoma Medical Research Foundation and University of Oklahoma, Oklahoma City
| | - R Hal Scofield
- R. Hal Scofield, MD: Oklahoma Medical Research Foundation, University of Oklahoma, and Department of Veterans Affairs Medical Center, Oklahoma City
| | - Kathy L Sivils
- Christopher J. Lessard, PhD, Kathy L. Sivils, PhD: Oklahoma Medical Research Foundation and University of Oklahoma, Oklahoma City
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19
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Honkanen R, Huang W, Huang L, Kaplowitz K, Weissbart S, Rigas B. A New Rabbit Model of Chronic Dry Eye Disease Induced by Complete Surgical Dacryoadenectomy. Curr Eye Res 2019; 44:863-872. [PMID: 30983427 DOI: 10.1080/02713683.2019.1594933] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose/Aim: Dry eye disease (DED), common and suboptimally treated, is in need of novel animal models to understand its pathophysiology and assess the efficacy and other parameters of new pharmacological agents for its treatment. The more than 10 rabbit models of DED described to date have significant limitations including induction of mild disease, lack of consistency, and off-target effects when chemical agents are used for disease induction. Our aim was to develop a new model of chronic DED in rabbits that overcomes the limitations of existing models. MATERIALS AND METHODS We performed a complete surgical resection of all orbital lacrimal glands (LGs; dacryoadenectomy) in normal adult New Zealand White rabbits. One week after removal of the nictitating membrane, we surgically removed the orbital superior LG, followed by removal of the palpebral superior LG, and finally removal of the inferior LG. Surgery was performed under anesthesia, required about 1 h/eye, and was well-tolerated. RESULTS Dacryoadenectomy induced severe DED, evidenced by >90% reduction in the tear break up time test, 50% reduction in the Schirmer tear test, 10% increase in tear osmolarity, and a marked increase in the rose bengal staining score. DED was sustained and essentially unchanged for the eight weeks of observation. Sham-operated rabbits showed no such changes, with the exception of a non-significant and transient reduction in the tear break up time test, a response to ocular surgery. CONCLUSIONS This model of stable, chronic, predominantly aqueous-deficient DED recapitulates key clinical and histological features of human DED and is suitable for the study of ocular surface homeostasis, of the pathophysiology of DED, and of the efficacy of candidate drugs for DED treatment.
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Affiliation(s)
- Robert Honkanen
- a Department of Ophthalmology, Health Sciences Center L2 , NY , USA
| | - Wei Huang
- a Department of Ophthalmology, Health Sciences Center L2 , NY , USA.,b Second Xiangya Hospital, Central South University , Hunan , China
| | - Liqun Huang
- c Department of Medicine, Health Sciences Center L17 , NY , USA.,d Medicon Pharmaceuticals, Inc, Long Island High Technology Incubator , Stony Brook , NY , USA
| | - Kevin Kaplowitz
- a Department of Ophthalmology, Health Sciences Center L2 , NY , USA
| | - Sarah Weissbart
- a Department of Ophthalmology, Health Sciences Center L2 , NY , USA
| | - Basil Rigas
- e Department of Preventive Medicine, Stony Brook University , Stony Brook , NY , USA
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20
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Begley C, Caffery B, Chalmers R, Situ P, Simpson T, Nelson JD. Review and analysis of grading scales for ocular surface staining. Ocul Surf 2019; 17:208-220. [PMID: 30654024 DOI: 10.1016/j.jtos.2019.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 11/29/2022]
Abstract
Vital dye staining has been used for over a century to assess the severity of ocular surface disease. However, despite common usage, a universally accepted "gold standard" grading scale does not exist for corneal and conjunctival staining, which can impact the ability to diagnose and monitor ocular surface conditions such as dry eye. The Food and Drug Administration (FDA) and other international regulatory agencies rely on ocular surface staining as a primary endpoint for new drug approvals, so that absence of a "gold standard" scale may affect approval of new drug treatments. To begin to address this problem, we review existing, published grading scales in an integrated fashion, highlighting their differences and similarities to emphasize common themes and the methods and elements that are important in creating a standardized scale. Our goal is to aid the field in moving towards an accepted standardized grading scale for ocular surface staining that can be applied in clinic and research settings for a variety of ocular conditions.
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Affiliation(s)
- Carolyn Begley
- Indiana University School of Optometry, Bloomington, IN, USA.
| | | | | | - Ping Situ
- Indiana University School of Optometry, Bloomington, IN, USA
| | - Trefford Simpson
- University of Waterloo, School of Optometry and Vision Science, Waterloo, ON, Canada
| | - J Daniel Nelson
- Department of Ophthalmology, HealthPartners Medical Group, Bloomington, MN, USA
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21
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Dry Eye Syndrome Preferred Practice Pattern®. Ophthalmology 2019; 126:P286-P334. [DOI: 10.1016/j.ophtha.2018.10.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 01/04/2023] Open
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22
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Baudouin C, Rolando M, Benitez Del Castillo JM, Messmer EM, Figueiredo FC, Irkec M, Van Setten G, Labetoulle M. Reconsidering the central role of mucins in dry eye and ocular surface diseases. Prog Retin Eye Res 2018; 71:68-87. [PMID: 30471351 DOI: 10.1016/j.preteyeres.2018.11.007] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 01/16/2023]
Abstract
Mucins are key actors in tear film quality and tear film stability. Alteration of membrane-bound mucin expression on corneal and conjunctival epithelial cells and/or gel-forming mucin secretion by goblet cells (GCs) promotes in ocular surface diseases and dry eye disease (DED). Changes in the mucin layer may lead to enhanced tear evaporation eventually contributing to tear hyperosmolarity which has been associated with ocular surface inflammation. Inflammatory mediators in turn may have a negative impact on GCs differentiation, proliferation, and mucin secretion. This sheds new light on the position of GCs in the vicious circle of DED. As contributor to ocular surface immune homeostasis, GC loss may contribute to impaired ocular surface immune tolerance observed in DED. In spite of this, there are no tools in routine clinical practice for exploring ocular surface mucin deficiency/dysregulation. Therefore, when selecting the most appropriate treatment options, there is a clear unmet need for a better understanding of the importance of mucins and options for their replacement. Here, we comprehensively revisited the current knowledge on ocular surface mucin biology, including functions, synthesis, and secretion as well as the available diagnostic tools and treatment options to improve mucin-associated homeostasis. In particular, we detailed the potential link between mucin dysfunction and inflammation as part of the uncontrolled chronic inflammation which perpetuates the vicious circle in DED.
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Affiliation(s)
- Christophe Baudouin
- Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, University Versailles Saint Quentin en Yvelines, Paris, France.
| | - Maurizio Rolando
- Ocular Surface & Dry Eye Center, ISPRE Ophthalmics, Genoa, Italy
| | | | | | - Francisco C Figueiredo
- Department of Ophthalmology, Royal Victoria Infirmary and Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Murat Irkec
- Department of Ophthalmology, Hacettepe Faculty of Medicine, Ankara, Turkey
| | | | - Marc Labetoulle
- Hôpital Bicêtre, APHP, South Paris University, Ophthalmology, Le Kremlin-Bicêtre, France
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23
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Stahl U, Jalbert I. Exploring the links between contact lens comfort, osmolarity and lid wiper staining. Cont Lens Anterior Eye 2018; 41:110-116. [DOI: 10.1016/j.clae.2017.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 12/23/2022]
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Abstract
PURPOSE Dry eye disease is a multifactorial disease with numerous well-documented risk factors. However, to date, sleep position has not been associated with this condition. After observing patients in our practice, we believe that the sleep position in some cases may significantly affect dry eye and meibomian gland dysfunction (MGD). METHODS This is a single-centered, cross-sectional, noninterventional, institutional review board-approved, single-masked, nonrandomized study of 100 patients whose complaints were related to dry eye disease and a control group of 25 age-matched asymptomatic patients. Two questionnaires were used: one to analyze patients' sleep habits and the other to assess patients' Ocular Surface Disease Index. Dry eye severity was graded based on the MGD stage, fluorescein corneal staining and lissamine green staining, Schirmer 1 testing, tear osmolarity levels, and clinical examination. RESULTS A statistically significant difference was shown with back sleeping compared with left side sleeping using lissamine green staining (analysis of variance, P = 0.005). The Ocular Surface Disease Index score was also found to be elevated in patients who slept on their right or left side (36.4 and 34.1, respectively) as opposed to back sleepers (26.7) with P < 0.05. There was no statistically significant correlation found between the sleep position and degree of MGD. CONCLUSIONS In addition to current treatment, patients who sleep on their side or face down might see a reduction in dry eye and MGD if they change their sleep pattern to the supine position.
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New Diagnostics in Ocular Surface Disease. Int Ophthalmol Clin 2017; 57:27-46. [PMID: 28590279 DOI: 10.1097/iio.0000000000000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Milner MS, Beckman KA, Luchs JI, Allen QB, Awdeh RM, Berdahl J, Boland TS, Buznego C, Gira JP, Goldberg DF, Goldman D, Goyal RK, Jackson MA, Katz J, Kim T, Majmudar PA, Malhotra RP, McDonald MB, Rajpal RK, Raviv T, Rowen S, Shamie N, Solomon JD, Stonecipher K, Tauber S, Trattler W, Walter KA, Waring GO, Weinstock RJ, Wiley WF, Yeu E. Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment. Curr Opin Ophthalmol 2017; 27 Suppl 1:3-47. [PMID: 28099212 PMCID: PMC5345890 DOI: 10.1097/01.icu.0000512373.81749.b7] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.
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Affiliation(s)
- Mark S. Milner
- Yale University School of Medicine, New Haven
- The Eye Center of Southern Connecticut, Hamden, Connecticut
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | - Kenneth A. Beckman
- Ohio State University, Columbus
- Comprehensive Eye Care of Central Ohio, Westerville, Ohio
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | - Jodi I. Luchs
- Hofstra Northwell School of Medicine, Hempstead
- South Shore Eye Care, Wantagh, New York
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | | | - Richard M. Awdeh
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | - John Berdahl
- Vance Thompson Vision, Sioux Falls, South Dakota
| | - Thomas S. Boland
- Northeastern Eye Institute, Scranton
- Commonwealth Medical College, Scranton, Pennsylvania
| | - Carlos Buznego
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | | | - Damien F. Goldberg
- Jules Stein Eye Institute, Los Angeles
- Wolstan & Goldberg Eye Associates, Torrance, California
| | | | - Raj K. Goyal
- Rush University Medical Center, Chicago
- Chicago Eye Specialists
| | | | - James Katz
- Midwest Center for Sight, Des Plaines, Illinois
| | - Terry Kim
- Duke Eye Center, Durham, North Carolina
| | - Parag A. Majmudar
- Rush University Medical Center, Chicago
- Chicago Cornea Consultants, Ltd, Hoffman Estates, Illinois
| | - Ranjan P. Malhotra
- Washington University Department of Ophthalmology and Ophthalmology Associates, St. Louis, Missouri
| | - Marguerite B. McDonald
- NYU Langone Medical Center, New York, New York
- Tulane University School of Medicine, New Orleans, Louisiana
- Ophthalmic Consultants of Long Island, Lynbrook, New York
- The Center for Ocular Surface Excellence of New Jersey, Woodland Park, New Jersey
| | - Rajesh K. Rajpal
- Georgetown University Medical Center, George Washington University Medical Center, Washington, DC
| | - Tal Raviv
- New York Eye and Ear Infirmary of Mount Sinai and Eye Center of New York, New York, New York
| | - Sheri Rowen
- NVision EyeCenters of Newport Beach, Newport Beach, California
- University of Maryland, Baltimore, Maryland
| | - Neda Shamie
- Advanced Vision Care, Century City, California
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Karl Stonecipher
- University of North Carolina and TLC Laser Eye Centers, Greensboro, North Carolina
| | | | - William Trattler
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | | | - George O. Waring
- Storm Eye Institute and Magill Vision Center, Medical University of South Carolina, Charleston
- Clemson University, Mt. Pleasant, South Carolina
| | - Robert J. Weinstock
- University of South Florida, Tampa
- The Eye Institute of West Florida, Largo, Florida
| | - William F. Wiley
- Cleveland Eye Clinic, Clear Choice Custom LASIK Center, Brecksville, Ohio
| | - Elizabeth Yeu
- Eastern Virginia Medical School and Virginia Eye Consultants, Norfolk, Virginia, USA
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Hsu S, Wang S, Hsieh Y, Cheng C, Liao Y. The physical and biomedical characteristics of the novel transmission type X-ray equipment. RADIAT MEAS 2016. [DOI: 10.1016/j.radmeas.2016.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Akil H, Celik F, Ulas F, Kara IS. Dry Eye Syndrome and Allergic Conjunctivitis in the Pediatric Population. Middle East Afr J Ophthalmol 2016; 22:467-71. [PMID: 26692719 PMCID: PMC4660534 DOI: 10.4103/0974-9233.167814] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: To assess the comorbidity of dry eye syndrome (DES) and changes in corneal curvature in children with allergies. Materials and Methods: This prospective, comparative, and observational interventional study included 49 patients, who presented to the Ophthalmology Clinic of a State Hospital in Turkey. There were 25 patients with clinically diagnosed seasonal allergic conjunctivitis (AC) (with complaints of itching and papilla formation of conjunctiva; AC group) and 24 healthy children (control group). There with no significant differences in age between groups. Using the ocular surface disease index (OSDI) questionnaire, we performed tear film break-up time (BUT), central reflex tear meniscus height (TMH-R) measurement, Schirmer test on both groups and evaluated keratometry (K1, K2) and spherical equivalent (SE). Results: Patients ranged in age from 6 to 18 years (median age, 11.79 years; 46.9% male; 53.1% female). The papillary reaction was severe in 10% of patients with AC. The prevalence of dry eye in children with AC was 12%. There was no statistically significant difference between groups for K1, K2, and SE (P > 0.05, all comparisons). BUT was statistically different (P = 0.004) between groups, indicating that a higher OSDI the tear film BUT was lower (ρ = 0.567). Statistically, significant negative moderate correlations were found between papillary reaction and the Schirmer test, BUT, and TMH-R (ρ = 0.454, −0.412, −0.419, and P = 0.001, 0.003, 0.002, respectively) Conclusions: The evaluation of pediatric patients with AC requires further attention to ensure an adequate diagnosis of DES.
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Affiliation(s)
- Handan Akil
- Ophtalmology Clinic, Gorele State Hospital, Giresun, Turkey
| | - Fatih Celik
- Ophtalmology Clinic, Nizip State Hospital, Gaziantep, Turkey
| | - Fatih Ulas
- Department of Ophtalmology, Abant Izzet Baysal Medical Faculty, Bolu, Turkey
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Efron N, Brennan NA, Morgan PB, Wilson T. Lid wiper epitheliopathy. Prog Retin Eye Res 2016; 53:140-174. [PMID: 27094372 DOI: 10.1016/j.preteyeres.2016.04.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/05/2016] [Accepted: 04/12/2016] [Indexed: 01/12/2023]
Abstract
Some recent research has resulted in a hypothesis that there is a common 'lid wiper' region that is apposite to the ocular surface or anterior lens surface (where contact lenses are worn), responsible for spreading tears during blinking. In the upper eyelid, it extends about 0.6 mm from the crest of the sharp posterior (inner) lid border (i.e. the mucocutaneous junction, or line of Marx) to the subtarsal fold superiorly and from the medial upper punctum to the lateral canthus horizontally. Histologically, it is seen as an epithelial elevation comprising of stratified epithelium with a transitional conjunctival structure of (moving posteriorly) squamous cells then cuboidal cells, with some parakeratinised cells and goblet cells. Lid wiper epitheliopathy (LWE) denotes staining of the lid wiper observed after instillation of dyes such as fluorescein, rose bengal or lissamine green. There have been some reports of higher rates of LWE in dry eye patients and contact lens wearers, but others have failed to find such associations. The primary cause of LWE is thought to be increased friction between the lid wiper and ocular or anterior contact lens surface due to inadequate lubrication, which could be caused by dry eye and may be exacerbated by factors such as abnormal blinking patterns, poor contact lens surface lubricity and adverse environmental influences. Recent evidence suggests that LWE is associated with sub-clinical inflammation. LWE has the potential to provide the missing mechanistic link between clinical observation and symptoms associated with dry eye and contact lens wear. Clinical and fundamental research into LWE is still in its infancy and in many instances equivocal; however, it is an idea that provides a potentially important new avenue for further investigation of anterior eye discomfort associated with ocular dryness and contact lens wear.
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Affiliation(s)
- Nathan Efron
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
| | - Noel A Brennan
- Johnson & Johnson Vision Care, Inc., 7500 Centurion Parkway, Jacksonville, FL 32256, USA
| | - Philip B Morgan
- Eurolens Research, The University of Manchester, Dover Street, Manchester, M13 9PL, UK
| | - Tawnya Wilson
- Johnson & Johnson Vision Care, Inc., 7500 Centurion Parkway, Jacksonville, FL 32256, USA
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Bartlett JD, Keith MS, Sudharshan L, Snedecor SJ. Associations between signs and symptoms of dry eye disease: a systematic review. Clin Ophthalmol 2015; 9:1719-30. [PMID: 26396495 PMCID: PMC4577273 DOI: 10.2147/opth.s89700] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The accurate diagnosis and classification of dry eye disease (DED) is challenging owing to wide variations in symptoms and lack of a single reliable clinical assessment. In addition, changes and severity of clinical signs often do not correspond to patient-reported symptoms. To better understand the inconsistencies observed between signs and symptoms, we conducted a systematic literature review to evaluate published studies reporting associations between patient-reported symptoms and clinical signs of DED. METHODS PubMed and Embase were searched for English-language articles on the association between clinical signs and symptoms of DED up to February 2014 (no lower limit was set). RESULTS Thirty-four articles were identified that assessed associations between signs and symptoms, among which 33 unique studies were reported. These included 175 individual sign-symptom association analyses. Statistical significance was reported for associations between sign and symptom measures in 21 of 33 (64%) studies, but for only 42 of 175 (24%) individual analyses. Of 175 individual analyses, 148 reported correlation coefficients, of which the majority (129/148; 87%) were between -0.4 and 0.4, indicating low-to-moderate correlation. Of all individual analyses that demonstrated a statistically significant association, one-half (56%) of reported correlation coefficients were in this range. No clear trends were observed in relation to the strength of associations relative to study size, statistical methods, or study region, although results from three studies did suggest that disease severity may be a factor. CONCLUSION Associations between DED signs and symptoms are low and inconsistent, which may have implications for monitoring the response to treatment, both in the clinic and in clinical trials. Further studies to increase understanding of the etiopathogenesis of DED and to identify the most reliable and relevant measures of disease are needed to enhance clinical assessment of DED and the measurement of response to therapeutic interventions.
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Affiliation(s)
- Jimmy D Bartlett
- Department of Optometry, School of Optometry, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael S Keith
- Global Health Economics, Outcomes Research, and Epidemiology Department, Research and Development Division, Shire, Wayne, PA, USA
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Koh JH, Lee J, Chung SH, Kwok SK, Park SH. Relation of Autoimmune Cytopenia to Glandular and Systemic Manifestations in Primary Sjögren Syndrome: Analysis of 113 Korean Patients. J Rheumatol 2015; 42:1817-24. [DOI: 10.3899/jrheum.150058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the characteristics of patients with primary Sjögren syndrome (pSS) who have autoimmune cytopenia.Methods.We analyzed 113 participants from the Korean Initiative of Primary Sjögren Syndrome, a prospective pSS cohort. Autoimmune cytopenia was defined as autoimmune origin neutropenia, anemia, and/or thrombocytopenia without vitamin or iron deficiency, or drug-induced cytopenia. To identify the association between autoimmune cytopenia and the clinical characteristics of pSS, extraglandular manifestations were analyzed according to the European League Against Rheumatism Sjögren’s syndrome disease activity index (ESSDAI) definition. Xerophthalmia was assessed with the Ocular Surface Disease Index, Schirmer I test, ocular stain score (OSS), and tear film breakup time.Results.The median total ESSDAI score was 2 (interquartile range 1–6). About a quarter of patients had no systemic activity. Autoimmune cytopenia was observed in 23.9% of patients (n = 27). Moderate biological features were more frequently observed in patients with autoimmune cytopenia than in patients without [10 (37%) and 11 (12.8%), respectively, p = 0.016]. Articular involvement was exhibited in 1 patient with autoimmune cytopenia, but in 23 patients (27.4%) without autoimmune cytopenia (p = 0.013). Higher OSS (p = 0.002) and lower mean Schirmer I test (p = 0.029) were observed in patients with autoimmune cytopenia than in those without. Neutrophils and lymphocytes negatively correlated with OSS (ρ = −0.204, p = 0.041 and ρ = −0.230, p = 0.020, respectively).Conclusion.Autoimmune cytopenia is closely associated with severe ocular surface damage in pSS. Therefore, assessment of xerophthalmia by ophthalmologists may be mandatory, particularly in patients with pSS with cytopenia, even if patients do not complain of eye dryness.
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Silpa-archa S, Lee JJ, Foster CS. Ocular manifestations in systemic lupus erythematosus. Br J Ophthalmol 2015; 100:135-41. [PMID: 25904124 DOI: 10.1136/bjophthalmol-2015-306629] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/04/2015] [Indexed: 12/19/2022]
Abstract
Systemic lupus erythematosus (SLE) can involve many parts of the eye, including the eyelid, ocular adnexa, sclera, cornea, uvea, retina and optic nerve. Ocular manifestations of SLE are common and may lead to permanent blindness from the underlying disease or therapeutic side effects. Keratoconjunctivitis sicca is the most common manifestation. However, vision loss may result from involvement of the retina, choroid and optic nerve. Ocular symptoms are correlated to systemic disease activity and can present as an initial manifestation of SLE. The established treatment includes prompt systemic corticosteroids, steroid-sparing immunosuppressive drugs and biological agents. Local ocular therapies are options with promising efficacy. The early recognition of disease and treatment provides reduction of visual morbidity and mortality.
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Affiliation(s)
- Sukhum Silpa-archa
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA Faculty of Medicine, Department of Ophthalmology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Joan J Lee
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Cambridge, Massachusetts, USA Ocular Immunology & Uveitis Foundation, Cambridge, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
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Bron A, Argüeso P, Irkec M, Bright F. Clinical staining of the ocular surface: Mechanisms and interpretations. Prog Retin Eye Res 2015; 44:36-61. [DOI: 10.1016/j.preteyeres.2014.10.001] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 10/24/2022]
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Carracedo G, Recchioni A, Alejandre-Alba N, Martin-Gil A, Crooke A, Morote IJA, Pintor J. Signs and Symptoms of Dry Eye in Keratoconus Patients: A Pilot Study. Curr Eye Res 2014; 40:1088-94. [PMID: 25495191 DOI: 10.3109/02713683.2014.987871] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare signs and symptoms of dry eye in keratoconus (KC) patients versus healthy subjects. METHODS A total of 15 KC patients (KC group, n = 15 eyes) and 16 healthy subjects (control group, 16 eyes) were enrolled in this study. The Schirmer I test with no anesthetic, tear break-up time (TBUT), corneal staining characteristics, and ocular surface disease index (OSDI) scores were evaluated for both groups. Impression cytology, combined with/scanning laser confocal microscopy (LCM), was performed to evaluate goblet cell density, mucin cloud height (MCH), and goblet cell layer thickness (CLT). Finally, tear concentrations of di-adenosine tetraphosphate (Ap4A) were assessed. Results were statistically analyzed using Shapiro-Wilk and non-parametric Wilcoxon rank sum tests. Statistical significance was set at p < 0.05. RESULTS KC patients had lower tear volumes and greater corneal staining than did healthy subjects (p < 0.05). OSDI scores were 44.96 ± 8.65 and 17.78 ± 6.50 for the KC and control groups, respectively (p < 0.05). We found no statistically significant differences in TBUT between groups. Impression cytology revealed lower goblet cell densities in KC group patients versus control group subjects (84.88 ± 32.98 and 128.88 ± 50.60 cells/mm,(2) respectively, p < 0.05). There was a statistically significant reduction in MCH and CLT in KC group patients compared with control group subjects. Ap4A tear concentrations were higher in KC group patients than in control group subjects (2.56 ± 1.10 and 0.15 ± 0.12 µM, respectively, p < 0.05). CONCLUSIONS The parameters evaluated in this study indicate that KC patients suffer greater symptoms of dry eye and greater tear instability, primarily due to the decreased mucin production in their tears, than do healthy patients with no KC.
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Affiliation(s)
- Gonzalo Carracedo
- a Department of Optics II, Optometry and Vision, Faculty of Optics , Universidad Complutense de Madrid , Madrid , Spain
| | - Alberto Recchioni
- a Department of Optics II, Optometry and Vision, Faculty of Optics , Universidad Complutense de Madrid , Madrid , Spain
| | | | - Alba Martin-Gil
- c Department of Biochemistry and Molecular Biology IV, Faculty of Optics , Universidad Complutense de Madrid , Madrid , Spain
| | - Almudena Crooke
- c Department of Biochemistry and Molecular Biology IV, Faculty of Optics , Universidad Complutense de Madrid , Madrid , Spain
| | | | - Jesús Pintor
- c Department of Biochemistry and Molecular Biology IV, Faculty of Optics , Universidad Complutense de Madrid , Madrid , Spain
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Abstract
Dry eye is one of the most commonly encountered problems in ophthalmology. Signs can include punctate epithelial erosions, hyperemia, low tear lakes, rapid tear break-up time, and meibomian gland disease. Current methods of diagnosis include a slit-lamp examination with and without different stains, including fluorescein, rose bengal, and lissamine green. Other methods are the Schirmer test, tear function index, tear break-up time, and functional visual acuity. Emerging technologies include meniscometry, optical coherence tomography, tear film stability analysis, interferometry, tear osmolarity, the tear film normalization test, ocular surface thermography, and tear biomarkers. Patient-specific considerations involve relevant history of autoimmune disease, refractive surgery or use of oral medications, and allergies or rosacea. Other patient considerations include clinical examination for lid margin disease and presence of lagophthalmos or blink abnormalities. Given a complex presentation and a variety of signs and symptoms, it would be beneficial if there was an inexpensive, readily available, and reproducible diagnostic test for dry eye.
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Affiliation(s)
| | - Darby Douglas Miller
- New York Eye and Ear Infirmary, New York, NY, USA ; Laser and Corneal Surgery Associates, New York, NY, USA
| | - Robert Latkany
- The Dry Eye Center at Physician Eyecare of New York, New York, NY, USA ; New York Eye and Ear Infirmary, New York, NY, USA
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Doughty MJ. Rose bengal staining as an assessment of ocular surface damage and recovery in dry eye disease—A review. Cont Lens Anterior Eye 2013; 36:272-80. [DOI: 10.1016/j.clae.2013.07.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/15/2013] [Accepted: 07/10/2013] [Indexed: 11/26/2022]
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Observation of solution-induced corneal staining with fluorescein, rose bengal and lissamine green. Cont Lens Anterior Eye 2013; 36:267-70. [DOI: 10.1016/j.clae.2013.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/21/2013] [Accepted: 02/22/2013] [Indexed: 11/22/2022]
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Toomey P, Kodumudi K, Weber A, Kuhn L, Moore E, Sarnaik AA, Pilon-Thomas S. Intralesional injection of rose bengal induces a systemic tumor-specific immune response in murine models of melanoma and breast cancer. PLoS One 2013; 8:e68561. [PMID: 23874673 PMCID: PMC3714270 DOI: 10.1371/journal.pone.0068561] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/30/2013] [Indexed: 11/18/2022] Open
Abstract
Intralesional (IL) injection of PV-10 has shown to induce regression of both injected and non-injected lesions in patients with melanoma. To determine an underlying immune mechanism, the murine B16 melanoma model and the MT-901 breast cancer model were utilized. In BALB/c mice bearing MT-901 breast cancer, injection of PV-10 led to regression of injected and untreated contralateral subcutaneous lesions. In a murine model of melanoma, B16 cells were injected into C57BL/6 mice to establish one subcutaneous tumor and multiple lung lesions. Treatment of the subcutaneous lesion with a single injection of IL PV-10 led to regression of the injected lesion as well as the distant B16 melanoma lung metastases. Anti-tumor immune responses were measured in splenocytes collected from mice treated with IL PBS or PV-10. Splenocytes isolated from tumor bearing mice treated with IL PV-10 demonstrated enhanced tumor-specific IFN-gamma production compared to splenocytes from PBS-treated mice in both models. In addition, a significant increase in lysis of B16 cells by T cells isolated after PV-10 treatment was observed. Transfer of T cells isolated from tumor-bearing mice treated with IL PV-10 led to tumor regression in mice bearing B16 melanoma. These studies establish that IL PV-10 therapy induces tumor-specific T cell-mediated immunity in multiple histologic subtypes and support the concept of combining IL PV10 with immunotherapy for advanced malignancies.
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Affiliation(s)
- Paul Toomey
- H. Lee Moffitt Cancer Center and Research Institute, Immunology Program, Tampa, Florida, United States of America
- University of South Florida, College of Medicine, Tampa, Florida, United States of America
| | - Krithika Kodumudi
- H. Lee Moffitt Cancer Center and Research Institute, Immunology Program, Tampa, Florida, United States of America
| | - Amy Weber
- H. Lee Moffitt Cancer Center and Research Institute, Immunology Program, Tampa, Florida, United States of America
| | - Lisa Kuhn
- H. Lee Moffitt Cancer Center and Research Institute, Immunology Program, Tampa, Florida, United States of America
| | - Ellen Moore
- H. Lee Moffitt Cancer Center and Research Institute, Immunology Program, Tampa, Florida, United States of America
| | - Amod A. Sarnaik
- H. Lee Moffitt Cancer Center and Research Institute, Immunology Program, Tampa, Florida, United States of America
- H. Lee Moffitt Cancer Center and Research Institute, Cutaneous Oncology Program, Tampa, Floria, United States of America
- University of South Florida, Department of Oncologic Sciences, Tampa, Florida, United States of America
| | - Shari Pilon-Thomas
- H. Lee Moffitt Cancer Center and Research Institute, Immunology Program, Tampa, Florida, United States of America
- H. Lee Moffitt Cancer Center and Research Institute, Cutaneous Oncology Program, Tampa, Floria, United States of America
- University of South Florida, Department of Oncologic Sciences, Tampa, Florida, United States of America
- * E-mail:
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Doughty M, Hagan S. On the staining of human tissue-cultured (Chang) conjunctival cells with rose bengal and lissamine green. Cont Lens Anterior Eye 2013; 36:32-40. [DOI: 10.1016/j.clae.2012.10.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/14/2012] [Accepted: 10/02/2012] [Indexed: 11/26/2022]
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Hernández-Molina G, Sánchez-Hernández T. Clinimetric methods in Sjögren's syndrome. Semin Arthritis Rheum 2013; 42:627-39. [PMID: 23352255 DOI: 10.1016/j.semarthrit.2012.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/15/2012] [Accepted: 09/21/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Clinimetric tools are useful in both clinical practice and research of Sjögren's syndrome. These instruments assist in the establishment of diagnosis and in the evaluation of disease status. We reviewed the available methods used to monitor sicca signs and symptoms, fatigue, quality of life as well as activity/chronicity in SS. METHODS PubMed and MEDLINE database were searched for the keywords "keratoconjunctivitis sicca diagnosis," "dry eye and dry mouth assessment," "sialometry," "sialochemistry," "Sjögren's syndrome outcomes," "Sjögren's syndrome activity," "Sjögren's syndrome damage," "fatigue scales in Sjögren's syndrome," and "Sjögren's syndrome quality of life." All relevant articles and pertinent secondary references were reviewed. RESULTS As there is a moderate correlation between sicca symptoms and signs, the assessment of both is crucial. Most of the tests focus on oral and ocular dryness (vital dye staining, tear quantification, tear composition, sialometry, sialochemistry, etc.) and may not be disease specific. Symptoms such as dryness and fatigue have been evaluated with different instruments, being the PROFAD and ESSPRI disease-specific tools. Standardized measures for activity (SSDAI, SCAI, and ESSDAI) and chronicity (SSDDI and SSDI) indexes are currently used, however these methods still present limitations such as low external validity and cross-validation. CONCLUSION The heterogeneous nature of the disease and its slow progression, challenge the evaluation of these patients. The use of composite measures might increase our ability to diagnose and evaluate disease activity and cumulative irreversible organ injury in this disease. However the distinction among oral and ocular activity vs. damage is still a matter of research.
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Affiliation(s)
- Gabriela Hernández-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Correlation between optical coherence tomography-derived assessments of lower tear meniscus parameters and clinical features of dry eye disease. Cornea 2012; 31:680-5. [PMID: 22378111 DOI: 10.1097/ico.0b013e3182261577] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To measure the correlation between subjective symptom score, conventional clinical tests, and Fourier-domain optical coherence tomography (FD-OCT) of lower tear meniscus parameters in patients with dry eye disease. METHODS Eighteen patients with dry eye disease requiring medical therapy and/or punctal occlusion were recruited for this prospective, nonrandomized, observational case series. Severity of symptoms of dry eye disease was assessed using the Indiana University Dry Eye Questionnaire 2002. Clinical assessments were completed using slit-lamp biomicroscopy, rose bengal dye staining, fluorescein tear breakup time (TBUT), and a 5-minute Schirmer test with topical anesthesia. The lower tear meniscus was imaged using an FD-OCT system with 5-μm axial resolution and measured manually by a masked grader using computer calipers. Correlation was assessed using Spearman correlation coefficient (ρ). RESULTS The mean (±SD) scaled symptom score was 58 ± 21, with a range of 0 to 100. Vital staining test averaged 1.7 ± 3.4, TBUT averaged 4.4 ± 1.8 seconds, and Schirmer tests averaged 10.2 ± 8.1 mm. As determined by optical coherence tomography, the meniscus height was 228 ± 153 μm, depth was 127 ± 79 μm, and cross-sectional area was 0.018 ± 0.021 mm. Optical coherence tomography meniscus area was negatively correlated with the symptom questionnaire score (P < 0.01) and positively correlated with Schirmer test results (P < 0.01). There was no significant correlation between symptom score and rose bengal staining, TBUT, or Schirmer test results (P > 0.01). CONCLUSIONS Lower tear meniscus measurement with FD-OCT is an objective noninvasive test that correlates well with symptoms of dry eye disease and the Schirmer test.
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Liew SH(M, Nichols KK, Klamerus KJ, Li JZ, Zhang M, Foulks GN. Tofacitinib (CP-690,550), a Janus Kinase Inhibitor for Dry Eye Disease. Ophthalmology 2012; 119:1328-35. [DOI: 10.1016/j.ophtha.2012.01.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 12/22/2011] [Accepted: 01/13/2012] [Indexed: 01/05/2023] Open
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44
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Usefulness of Double Vital Staining With 1% Fluorescein and 1% Lissamine Green in Patients With Dry Eye Syndrome. Cornea 2011; 30:972-6. [DOI: 10.1097/ico.0b013e31820687dd] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Figueroa-Ortiz LC, Jiménez Rodríguez E, García-Ben A, García-Campos J. [Study of tear function and the conjunctival surface in diabetic patients]. ACTA ACUST UNITED AC 2011; 86:107-12. [PMID: 21569919 DOI: 10.1016/j.oftal.2010.12.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 12/14/2010] [Accepted: 12/22/2010] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study was performed to investigate whether different grades of diabetic retinopathy correlate with tear and ocular surface function in diabetic patients without subjective symptoms of dry eye. METHODS A total of 129 eyes of 72 patients without dry eye, assessed using McMonnies questionnaire were recruited to the study. The tear film and ocular surface were evaluated using the Schirmer test, tear film break-up time (BUT), fluorescein and lissamine green staining test, and conjunctival impression cytology. The results were analysed. RESULTS A normal Schirmer test and BUT was obtained in 51 and 67% of the eyes of diabetics patients, respectively. Fluorescein and lissamine green staining were negative in 81 and 95% of the eyes. The area and density of goblet cells was 580.46 ± 370 μm(2) and 235.58 ± 109.03 goblets cell/mm(2), respectively. CONCLUSIONS Diabetic retinopathy patients without subjective symptoms of dry eye and normal Schirmer and BUT test showed pathological grades of squamous metaplasia.
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Affiliation(s)
- L C Figueroa-Ortiz
- Area de Oftalmo-Biología, Centro de Investigaciones Médico-Sanitarias, Universidad de Málaga, España
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Current world literature. Refractive surgery. Corneal and external disorders. Curr Opin Ophthalmol 2010; 21:322-6. [PMID: 20548165 DOI: 10.1097/icu.0b013e32833bb58c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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