1
|
Craig JP, Bitton E, Dantam J, Jones L, Ngo W, Wang MTM. Short-term tolerability of commercial eyelid cleansers: A randomised crossover study. Cont Lens Anterior Eye 2022; 45:101733. [PMID: 35842288 DOI: 10.1016/j.clae.2022.101733] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the short-term tolerability of five commercially available anti-demodectic eyelid cleansers; OCuSOFT Oust Demodex (OD), I-MED I-Lid'n Lash Plus (ILL+), Labtician BlephaDex (BD), Chrissanthe Eye Cleanse (EC), and Théa Blephademodex (BDdx). METHODS Thirty healthy non-contact lens wearers (18 female; mean ± SD age, 33 ± 12 years) were enrolled in a prospective randomised crossover study. On separate visits, spaced at least 48 h apart, participants were randomised to receive topical application of one of five eyelid cleansers or saline. Participants rated subjective ocular discomfort during the 10-minute post-application period. Visual acuity, non-invasive tear film stability, conjunctival hyperaemia, and ocular surface staining were assessed at baseline and 10 min. RESULTS No inter-group differences in ocular parameters were noted at baseline (all p > 0.05). Ocular discomfort scores significantly exceeded baseline scores for 60 s following BD application, 120 s with OD, 135 s with BDdx, 150 s with ILL+, and 195 s with EC (all p < 0.05). Deterioration in non-invasive tear film stability, limbal conjunctival hyperaemia, as well as corneal, conjunctival, and lid margin staining was detected following EC application (all p < 0.05), and increased bulbar conjunctival hyperaemia was observed following both EC and ILL+ treatment (both p < 0.05). CONCLUSIONS Study outcomes highlight varying tolerability profiles with different anti-demodectic lid cleanser preparations, and the potential to induce tear film instability, conjunctival hyperaemia and ocular surface staining on application. Awareness of possible adverse effects arising from topical application of commercial anti-demodectic lid cleanser formulations may help clinicians set realistic patient expectations and encourage better compliance in their use of lid hygiene therapies.
Collapse
Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; École d'optométrie, Université de Montréal, Quebec, Canada; Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada.
| | - Etty Bitton
- École d'optométrie, Université de Montréal, Quebec, Canada
| | - Jaya Dantam
- Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Lyndon Jones
- Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - William Ngo
- Centre for Ocular Research and Education, School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| |
Collapse
|
2
|
Automated vs. human evaluation of corneal staining. Graefes Arch Clin Exp Ophthalmol 2022; 260:2605-2612. [PMID: 35357547 PMCID: PMC9325848 DOI: 10.1007/s00417-022-05574-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/26/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND PURPOSE Corneal fluorescein staining is one of the most important diagnostic tests in dry eye disease (DED). Nevertheless, the result of this examination is depending on the grader. So far, there is no method for an automated quantification of corneal staining commercially available. Aim of this study was to develop a software-assisted grading algorithm and to compare it with a group of human graders with variable clinical experience in patients with DED. METHODS Fifty images of eyes stained with 2 µl of 2% fluorescein presenting different severity of superficial punctate keratopathy in patients with DED were taken under standardized conditions. An algorithm for detecting and counting superficial punctate keratitis was developed using ImageJ with a training dataset of 20 randomly picked images. Then, the test dataset of 30 images was analyzed (1) by the ImageJ algorithm and (2) by 22 graders, all ophthalmologists with different levels of experience. All graders evaluated the images using the Oxford grading scheme for corneal staining at baseline and after 6-8 weeks. Intrarater agreement was also evaluated by adding a mirrored version of all original images into the set of images during the 2nd grading. RESULTS The count of particles detected by the algorithm correlated significantly (n = 30; p < 0.01) with the estimated true Oxford grade (Sr = 0,91). Overall human graders showed only moderate intrarater agreement (K = 0,426), while software-assisted grading was always the same (K = 1,0). Little difference was found between specialists and non-specialists in terms of intrarater agreement (K = 0,436 specialists; K = 0,417 non-specialists). The highest interrater agreement was seen with 75,6% in the most experienced grader, a cornea specialist with 29 years of experience, and the lowest was seen in a resident with 25,6% who had only 2 years of experience. CONCLUSION The variance in human grading of corneal staining - if only small - is likely to have only little impact on clinical management and thus seems to be acceptable. While human graders give results sufficient for clinical application, software-assisted grading of corneal staining ensures higher consistency and thus is preferrable for re-evaluating patients, e.g., in clinical trials.
Collapse
|
3
|
Nagra M, Vianya-Estopa M, Wolffsohn JS. Could telehealth help eye care practitioners adapt contact lens services during the COVID-19 pandemic? Cont Lens Anterior Eye 2020; 43:204-207. [PMID: 32336578 PMCID: PMC7165279 DOI: 10.1016/j.clae.2020.04.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023]
Abstract
The COVID-19 pandemic has necessitated government-imposed restrictions on social interactions and travel. For many, the guidance has led to new ways of working, most notably a shift towards working remotely. While eye care practitioners (ECPs) may continue to provide urgent or emergency eye care, in many cases the travel restrictions present a unique challenge by preventing conventional face-to-face examination. Telephone triage provides a useful starting point for establishing at-risk and emergency patients; but patient examination is central to contact lens patient care. The indeterminate period over which conventional practice will be suspended, and the risk that resumption of 'normal' practice could be impeded by a potential secondary peak in COVID-19 cases, hastens the need for practitioners to adapt their delivery of eyecare. Specifically, it is prudent to reflect upon supportive evidence for more comprehensive approaches to teleoptometry in contact lens practice. Smartphone based ocular imaging is an area which has seen considerable growth, particularly for imaging the posterior eye. Smartphone imaging of the anterior eye requires additional specialised instrumentation unlikely to be available to patients at home. Further, there is only limited evidence for self-administered image capture. In general, digital photographs, are useful for detection of gross anterior eye changes, but subtle changes are less discernible. For the assessment of visual acuity, many electronic test charts have been validated for use by practitioners. Research into self-administered visual acuity measures remains limited. The absence of a comprehensive evidence base for teleoptometry limits ECPs, particularly during this pandemic. Knowledge gaps ought to be addressed to facilitate development of optometry specific evidence-based guidance for telecare. In particular, advances in ocular self-imaging could help move this field forwards.
Collapse
Affiliation(s)
- Manbir Nagra
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK.
| | | | | |
Collapse
|
4
|
Cardona G, Esterich N. Awareness of treatment: A source of bias in subjective grading of ocular complications. PLoS One 2019; 14:e0226960. [PMID: 31877190 PMCID: PMC6932789 DOI: 10.1371/journal.pone.0226960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 12/10/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Bias has been described as one important obstacle in scientific research. The aim of this study was to explore "awareness of treatment" as a possible source of bias in subjective grading of ocular complications. METHODS Thirty subjects with similar, basic experience with grading scales participated in the study. The Efron grading scales were used to grade 24 images of three different ocular conditions (eight images each of bulbar hyperaemia, limbal vascularization and corneal staining). Three consecutive, two weeks apart, grading sessions were scheduled, in which the same images were graded, although in the third session images were deceptively labelled as either "treated" or "untreated". Grading results from the first and second sessions were compared to determine grading reliability and discrepancies with the third session informed of grading bias originating from "awareness of treatment". RESULTS Moderate to good test-retest reliability was found for all conditions, with median intraclass correlation values of 0.80 (0.62-0.84) for bulbar hyperaemia, 0.68 (0.65-0.77) for limbal vascularization and 0.68 (0.66-0.74) for corneal staining. Grading values from the first and third sessions evidenced negative and positive systematic errors (bias) for "treated" and "untreated" conditions, respectively. Statistically significant differences were found between the average grading discrepancies of session 1 and session 2 and those of session 1 and session 3 (all p<0.001). CONCLUSIONS "Awareness of treatment" may be considered a source of bias of subjective grading of ocular complications, although the actual effect of bias is unlikely to be of clinical significance.
Collapse
Affiliation(s)
- Genis Cardona
- Optics and Optometry Department, Universitat Politècnica de Catalunya, Terrassa, Spain
| | - Noelia Esterich
- Optics and Optometry Department, Universitat Politècnica de Catalunya, Terrassa, Spain
| |
Collapse
|
5
|
Ngo W, Srinivasan S, Jones L. An Eyelid Warming Device for the Management of Meibomian Gland Dysfunction. JOURNAL OF OPTOMETRY 2019; 12:120-130. [PMID: 30341026 PMCID: PMC6449779 DOI: 10.1016/j.optom.2018.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 07/17/2018] [Accepted: 07/25/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To determine the effectiveness of the MGDRx EyeBag in managing meibomian gland dysfunction. METHODS This was a prospective, randomized, controlled, observer-masked, bilateral eye study that enrolled 29 participants. Participants were randomized into either the EyeBag group or the control group. The EyeBag group used the EyeBag 10minutes 2x/day, and the control group remained on their own dry eye treatment regimen (if applicable). All participants were observed at baseline, 2 weeks (2wk) and 4 weeks (4wk). At 4wk, participants in the EyeBag group were asked to stop using the EyeBag. All participants were seen again at 8 weeks (8wk). Primary outcomes were the Ocular Surface Disease Index (OSDI), Current Symptoms Questionnaire (CSQ), meibomian gland score (MG score), and non-invasive tear breakup time (NIBUT). RESULTS Twenty-five participants completed the study (mean age 38±15 years, 7 male). There was a significant change in OSDI over time for the EyeBag group (mean[lower 95% CI, upper 95% CI], baseline: 39.1[31.1,47.0], 2wk: 26.8[19.7,33.9], 4wk: 26.6[16.5,36.7], 8wk: 27.7[18.4,37.0]; p=0.01), but not in the control group (p=0.22), but no significant difference between groups at all time points (all p>0.27). Symptoms immediately improved after conducting the EyeBag based on at-home CSQ scores (Δ=-5.0 points, p<0.01), but not in the control group. For both groups, there was no significant change (p-value EyeBag,p-value control) in MG score (0.21,0.17) and NIBUT (0.49,0.06) over time. CONCLUSIONS The EyeBag may relieve symptoms of dry eye, but the effect on meibomian gland function and tear stability when used for only 4 weeks was undetectable.
Collapse
Affiliation(s)
- William Ngo
- The University of Alabama at Birmingham, UAB School of Optometry, USA
| | - Sruthi Srinivasan
- Centre for Ocular Research & Education (CORE), University of Waterloo School of Optometry & Vision Science, Cananda
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), University of Waterloo School of Optometry & Vision Science, Cananda.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Short-Term Comfort Responses Associated With the Use of Eyelid Cleansing Products to Manage Demodex folliculorum. Eye Contact Lens 2018; 44 Suppl 2:S87-S92. [PMID: 28945649 DOI: 10.1097/icl.0000000000000415] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To quantify the discomfort over time of various eyelid cleansers against Demodex. METHODS This was a prospective, randomized, controlled, crossover, open-label study that enrolled 26 participants. The cleansers used in this study were Biotissue Cliradex (CD), OCuSOFT Lid Scrubs Plus (OP), OCuSOFT OUST Demodex Swabstix (ODS), TheraTears Theralid (TT), NovaBay Avenova (NA). Bausch+Lomb Sensitive Eyes Plus saline was used as a control. Participants were asked to close their eyes as the product was gently rubbed (10 cycles of gentle lateral motion) into the eyelashes. Participants verbally rated their discomfort (0 = no discomfort, 10 = maximum tolerable discomfort) every 15 sec for the first 5 min, and every 30 sec for 5 min after, for a total of 10 min. The order of products used was randomized, and washout period between cleansing was 48 hr. RESULTS Twenty-five participants completed the study (mean age=26±6). There was no significant difference in discomfort scores at pre-application. The discomfort levels of saline, OP, and NA over the 10-min period were not significantly different than their pre-application discomfort at all time points (all P≥0.99). The discomfort of CD was significantly higher than pre-application levels between t=15 sec and t=180 sec (all P≤0.01), with maximum median (interquartile range [IQR]) discomfort of 3.0 (5.0) occurring at t=45 sec. The discomfort of TT was significantly higher than pre-application levels between t=45 and t=90 (all P<0.02), with maximum median (IQR) discomfort of 1.0 (1.5) occurring at t=75 sec. The discomfort of ODS was significantly higher than pre-application levels starting from t=60 sec and onward, with maximum median (IQR) discomfort of 6.0 (5.0) occurring at t=300 sec. CONCLUSION Of the cleansers used in this study, the ones that induced significant discomfort were CD, TT, and ODS. The results from this study may help clinicians educate patients about what to expect when approaching the topic of eyelid Demodex treatment.
Collapse
|
8
|
How to Tell If You Might Be a Scientist (Eight Risk Factors). Optom Vis Sci 2017; 94:1001-1002. [PMID: 29095796 DOI: 10.1097/opx.0000000000001150] [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] Open
|
9
|
Woodward MA, Musch DC, Hood CT, Greene JB, Niziol LM, Jeganathan VSE, Lee PP. Teleophthalmic Approach for Detection of Corneal Diseases: Accuracy and Reliability. Cornea 2017; 36:1159-1165. [PMID: 28820791 PMCID: PMC5646384 DOI: 10.1097/ico.0000000000001294] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Corneal and anterior segment diseases cause most of the urgent visits to eye care professionals. We evaluated the diagnostic accuracy of detecting corneal diseases using external photographs from 2 portable cameras for telemedicine purposes. METHODS This is a prospective study of adults with a clinical diagnosis of corneal pathology including corneal abrasions, ulcers, scars, and pterygia. A cornea specialist provided the gold standard diagnosis by slit-lamp examination. Images of both eyes were obtained using iTouch 5S and Nidek VersaCam cameras in multiple gazes and interpreted by 3 cornea specialists for the presence of pathology. Accuracy to detect disease was compared with gold standard diagnosis, stratified by the camera and grader. Reliability was evaluated with weighted kappa statistics. Graders assessed image quality on a Likert scale from 1 (poor) to 9 (optimal). RESULTS A total of 198 eyes (110 subjects) were photographed. By gold standard diagnosis, 59 eyes (30%) had corneal scars, 34 (17%) had ulcers, 13 (7%) had abrasions, 10 (5%) had pterygia, and 82 (41%) were normal. Sensitivity to detect AS pathology ranged from 54% to 71% for the iTouch and 66% to 75% for the Nidek, across graders; specificity ranged from 82% to 96% for the iTouch and 91% to 98% for the Nidek. The intergrader reliability was moderate to strong (kappa ranges: 0.54-0.71 for the iTouch; 0.75-0.76 for the Nidek). Quality ratings were variable between graders. CONCLUSIONS External photographs taken by standard, nonenhanced portable cameras and interpreted remotely by ophthalmologist graders yielded sensitivity values that are not yet suitable for telemedicine applications. Additional work is needed to improve the ability to detect AS pathology remotely.
Collapse
Affiliation(s)
- Maria A Woodward
- *Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan Medical School, Ann Arbor, MI; †Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; and ‡Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | | | | | | | | | | | | |
Collapse
|
10
|
|
11
|
Ngo W, Srinivasan S, Houtman D, Jones L. The relief of dry eye signs and symptoms using a combination of lubricants, lid hygiene and ocular nutraceuticals. JOURNAL OF OPTOMETRY 2017; 10:26-33. [PMID: 27425263 PMCID: PMC5219834 DOI: 10.1016/j.optom.2016.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/05/2016] [Accepted: 05/23/2016] [Indexed: 05/07/2023]
Abstract
PURPOSE To determine the combined effect of TheraTears® Lubricant Eye Drops, TheraTears® SteriLid Eyelid Cleanser, and TheraTears® Nutrition on dry eye signs and symptoms. METHODS This prospective study enrolled 28 dry eye participants. Participants were instructed to use the Lubricant Eye Drops at least 2-4× a day, SteriLid 1-2× a day, and Nutrition 3 gel caps once a day. Participants were followed up at baseline, 1 month and 3 months. Outcome variables were the Ocular Surface Disease Index (OSDI), Symptom Assessment iN Dry Eye (SANDE) questionnaire, non-invasive tear break-up time (NIBUT), osmolarity, number of meibomian glands blocked (#MG blocked), meibum quality, eyelid margin features, Schirmer's test, tear film lipid layer thickness (LLT), meniscus height, corneal and conjunctival staining. RESULTS Twenty participants (mean age=43, from 23 to 66, 17F, 3M) completed the study. Participants reported having used, on average, the Lubricant Eye Drop 2.4×/day, the SteriLid 1.1×/day, and the Nutrition 3 gel caps 1×/day. There was a significant change over time (p<0.05) for OSDI (-21.2 points), SANDE (-32.4 points), NIBUT (+0.43s), eyelid margin features (-1.1 grade), meibum quality (-1.0 grade), and #MG blocked (-4.0 glands). CONCLUSION By using a combination of TheraTears® Lubricant Eye Drop, SteriLid, and Nutrition, patients experience significant relief in both dry eye symptoms and signs.
Collapse
Affiliation(s)
- William Ngo
- Centre for Contact Lens Research, University of Waterloo School of Optometry & Vision Science, Waterloo, Ontario, Canada.
| | - Sruthi Srinivasan
- Centre for Contact Lens Research, University of Waterloo School of Optometry & Vision Science, Waterloo, Ontario, Canada
| | | | - Lyndon Jones
- Centre for Contact Lens Research, University of Waterloo School of Optometry & Vision Science, Waterloo, Ontario, Canada
| |
Collapse
|