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Aldawsari SA, Alzaidi N, Abdalla Elsayed MEA, Alhammadi AA, Alharthi HK, Alosaimi A, Al-Najmi Y. Prevalence and Determinants of Symptomatic Dry Eye Disease Among Adult Urban Residents of High-Altitude Areas of Southwest Saudi Arabia - A Survey. Clin Ophthalmol 2023; 17:2687-2695. [PMID: 37720009 PMCID: PMC10503548 DOI: 10.2147/opth.s427101] [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: 06/22/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose To estimate the prevalence and determinants of Ocular Surface Disease Index (OSDI) score based dry eye disease (DED) among the adult urban population of four cities located at high altitudes in Southwest Saudi Arabia. Methods This cross-sectional survey was held in 2023. OSDI questionnaire was used to collect the responses of the adult participants. The score was further graded into none, mild, moderate, and severe DED to estimate age-sex-adjusted DED prevalence. The OSDI score was correlated to demographic (age group, gender, education, occupation, city) and risk factors like smoking and co-morbidities. Results Of the 401 adults, 388 (response rate of 97.8%) participated. The age-sex-adjusted prevalence of mild, moderate, and severe DED was 21.7%, 13.1%, and 32%, respectively. The median ODSI score was 22.9 [Interquartile range (IQR) 10.4; 47.9)]. The score was significantly higher in females (Mann-Whitney U-test P = 0.038), residents of Taif city (KW P = 0.05), those with primary/middle school education (Kruskal-Wallis P = 0.004), comorbidities like hypertension, asthma (KW P < 0.001) and risk factors like past refractive surgeries, arthritis (KW P = 0.013). Education status (P <0.001) [B = -9.0 95%] and presence of comorbidity (P = 0.022), [B = -0.823] were significant predictors of DED. Conclusion The prevalence of DED and severe grade was high. The level of education and presence of comorbidities significantly influenced DED in the adult urban Saudi population of cities at high altitudes.
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Affiliation(s)
| | - Nazih Alzaidi
- Ophthalmology Department, Alhada Military Hospital, Taif, Saudi Arabia
| | | | | | | | - Abdulrahman Alosaimi
- Ophthalmology Department, College of Medicine, Majmaah University, Majmaah, Saudi Arabia
| | - Yahya Al-Najmi
- Ophthalmology Department, Saggaf Eye Center, Jeddah, Saudi Arabia
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Boboridis KG, Messmer EM, Benítez-Del-Castillo J, Meunier J, Sloesen B, O'Brien P, Quadrado MJ, Rolando M, Labetoulle M. Patient-reported burden and overall impact of dry eye disease across eight European countries: a cross-sectional web-based survey. BMJ Open 2023; 13:e067007. [PMID: 36931668 PMCID: PMC10030789 DOI: 10.1136/bmjopen-2022-067007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVE Dry eye disease (DED) is a multifactorial disease involving the tears and ocular surface. It impacts a patient's quality of life (QoL) and ability to perform daily activities. This study assessed the burden of self-reported DED among adults in eight European countries. DESIGN Online cross-sectional survey. SETTING General population in France, Italy, Germany, Greece, the Netherlands, Portugal, Spain and Sweden. PARTICIPANTS Adults aged ≥18 years with (n=6084) and without (n=6161) self-reported DED were recruited via emails and screened. MAIN OUTCOME MEASURES All participants completed National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and EuroQol-5 Dimension-5 Level Questionnaire (EQ-5D-5L). All DED participants completed the Eye Dryness Score (EDS) Visual Analogue Scale, and Ocular Comfort Index and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem questionnaires. In addition, half of the respondents with DED completed Survey A (Impact of Dry Eye on Everyday Life) and the other half completed Survey B (Standard Patient Evaluation of Eye Dryness Questionnaire) and Dry Eye Questionnaire-5. RESULTS Participants with self-reported DED had lower functional vision and lower overall health status than participants without self-reported DED as measured by the NEI-VFQ and EQ-5D-5L, respectively.Increasing self-reported DED severity as measured by the EDS was shown to correspond with worse symptom severity/frequency, lower functional vision, higher impact on work productivity, daily activities and QoL. CONCLUSION This study showed that patients' reported burden of self-reported DED was similar across the eight European countries. Those with self-reported DED reported lower health status and functional vision compared to those without self-reported DED and these parameters worsen with increasing disease severity.
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Affiliation(s)
- Kostas G Boboridis
- Third Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - José Benítez-Del-Castillo
- Hospital Clínico San Carlos, Clínica Rementería, Instituto Castroviejo, University Complutense, Madrid, Spain
| | | | - Brigitte Sloesen
- Department of Ophthalmology, HEOR, Novartis Pharma AG, Basel, Switzerland
| | | | - Maria Joao Quadrado
- Centro de Responsabilidade Integrado de Oftalmologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Maurizio Rolando
- Ocular Surface and Dry Eye Centre, ISPRE Ophthalmics, Genoa, Italy
| | - Marc Labetoulle
- Ophthalmology, Hôpital Bicêtre, APHP, Le Kremlin-Bicetre, France
- Center for Immunology of Viral and Auto-immune Disease (IMVA - IDMIt), Inserm U1184, Fontenay- aux-Roses, France
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Abstract
INTRODUCTION Dry Eye Disease (DED) is defined as a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film, and a vicious cycle of inflammation on the ocular surface. Despite its high prevalence and standing as one of the most common eye conditions seen by practitioners, the current treatment options available to patients have not proven adequate. AREAS COVERED This review will discuss the burden of DED, its pathophysiology, as well as emerging therapies. These therapies include immunosuppressants, immunomodulators, anti-inflammatory drugs, and corticosteroids. The mechanisms of these drugs will be discussed, as well as their phase of development and results from recent clinical trials. The literature search was performed using PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, and the Springer AdisInsight database. EXPERT OPINION The optimal therapy for DED is associated with improved bioavailability, minimal ocular side effects, and effective dosing. The ideal treatment has not yet been established, but this paper outlines a number of promising therapies. Continued development of therapies targeting the inflammation cascade, as well as the establishment of objective markers to quantify DED severity, are important aspects in the progression of treatment.
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Affiliation(s)
- Lauren Mason
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Saad Jafri
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Isabelle Dortonne
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - John D Sheppard
- Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, Virginia, USA
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Radkar P, Lakshmanan PS, Mary JJ, Chaudhary S, Durairaj SK. A Novel Multi-Ingredient Supplement Reduces Inflammation of the Eye and Improves Production and Quality of Tears in Humans. Ophthalmol Ther 2021; 10:581-599. [PMID: 34129210 PMCID: PMC8319251 DOI: 10.1007/s40123-021-00357-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/28/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Dry eye is a multifactorial condition of the eye caused by insufficient tear production and imbalance in tear composition leading to faster evaporation of tear fluid. It is also associated with inflammation that often leads to ocular surface damage. Symptoms of dry eyes include itchiness, soreness, red eyes, a burning sensation, eye fatigue and blurred vision. The objective of this study was to evaluate the efficacy and safety of our multi-ingredient supplement in subjects with dry eye syndrome (DES). METHODS We recruited 60 subjects with mild to moderate DES who were randomized in a 1:1 ratio in a single-center study to receive LCD (lutein 20 mg, zeaxanthin 4 mg, curcumin 200 mg curcuminoids, vitamin D3 600 IU) or placebo (soybean oil) capsules for 8 weeks. The primary outcomes evaluated were changes in tear volume by Schirmer's test and ocular symptoms by the Ocular Surface Disease Index (OSDI); secondary outcomes included evaluation of changes in Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear film break-up time (TBUT), corneal and conjunctival staining, tear osmolarity, matrix metalloproteinase-9 (MMP-9), artificial tear use and safety assessments. The outcomes were compared between the LCD and placebo groups at baseline and day 56 of supplementation. RESULTS Fifty-nine subjects, 30 from LCD and 29 from placebo group, completed the study. The LCD group showed significant improvements (P < 0.0001) for Schirmer's test, OSDI, TBUT, SPEED, ocular staining scores, tear osmolarity (P = 0.0005), MMP-9 (P = 0.0017) and reduced artificial tear use (P = 0.0004) and its frequency of use (P < 0.0001) in subjects compared to placebo from baseline to day 56. No safety issues were observed in the study. CONCLUSION The LCD supplement showed significant improvements in the production, stability and quality of tears by reducing ocular surface damage and tear inflammation and can be used as an adjuvant to artificial tears in subjects with DES. TRIAL REGISTRATION Clinical Trials Registry of India (http://ctri.nic.in/) identifier: CTRI/2021/01/030493.
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Affiliation(s)
- Pranav Radkar
- Lifepoint Multispeciality Hospital, 145/1, Mumbai-Bangalore Highway, Wakad, Pune, Maharashtra, 411057, India
| | - Prabhu Shankar Lakshmanan
- G7 Synergon Private Limited, 537, 5th Main, 9th Cross, Sahakarnagar Post, Tatanagar, Bangalore, Karnataka, 560092, India
| | - Jenet Jemila Mary
- G7 Synergon Private Limited, 537, 5th Main, 9th Cross, Sahakarnagar Post, Tatanagar, Bangalore, Karnataka, 560092, India
| | - Sunil Chaudhary
- Lifepoint Multispeciality Hospital, 145/1, Mumbai-Bangalore Highway, Wakad, Pune, Maharashtra, 411057, India
| | - Sathish Kumar Durairaj
- G7 Synergon Private Limited, 537, 5th Main, 9th Cross, Sahakarnagar Post, Tatanagar, Bangalore, Karnataka, 560092, India.
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Webber AL, Camuglia JE. A pragmatic approach to amblyopia diagnosis: evidence into practice. Clin Exp Optom 2021; 101:451-459. [DOI: 10.1111/cxo.12662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ann L Webber
- School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia,
| | - Jayne E Camuglia
- Department of Ophthalmology, Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia,
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia,
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Yang M, Hu Z, Yue R, Yang L, Zhang B, Chen Y. The Efficacy and Safety of Qiming Granule for Dry Eye Disease: A Systematic Review and Meta-Analysis. Front Pharmacol 2020; 11:580. [PMID: 32425798 PMCID: PMC7204435 DOI: 10.3389/fphar.2020.00580] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background Dry eye disease (DED) is a common complication in clinical practice. Qiming granule, a traditional Chinese patent medicine, is widely used in treating DED in China. However, its effect is still largely unknown. Objectives This research aims to evaluate the efficacy and safety of QG on DED. Methods Three English database and four Chinese databases without restriction on language and publication bias were searched. Qualified literature was selecting according to inclusion and exclusion criteria, extracted the data, and conducted a meta-analysis. Results A total of 11 articles were included in this meta-analysis. The methodological quality of included studies was low. The results showed that QG was effective for DED (RR:1.26, 95%CI:1.12 to 1.41, P=0.0001). The results combined with random effects model showed that QG could significantly prolong the tear film break up time (MD: 2.93, 95% CI: 2.22 to 3.65, P < 0.00001), increase the amount of tears in patients with DED (MD: 2.94, 95% CI: 1.83 to 4.04, P < 0.00001) and repair the corneal defects in patients (MD: -0.71, 95% CI: -1.25 to -0.17, P < 0.00001). Conclusions This study found that despite of the apparently positive results of some outcomes, it is premature to confirm the efficacy of QG in treating DED. More high-quality studies are still needed in the future to further confirm the efficacy and safety.
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Affiliation(s)
- Maoyi Yang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhipeng Hu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rensong Yue
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Liangjun Yang
- Department of Gastroenterology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Boxun Zhang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuan Chen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Downie LE, Ng SM, Lindsley KB, Akpek EK. Omega-3 and omega-6 polyunsaturated fatty acids for dry eye disease. Cochrane Database Syst Rev 2019; 12:CD011016. [PMID: 31847055 PMCID: PMC6917524 DOI: 10.1002/14651858.cd011016.pub2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Polyunsaturated fatty acid (PUFA) supplements, involving omega-3 and/or omega-6 components, have been proposed as a therapy for dry eye. Omega-3 PUFAs exist in both short- (alpha-linolenic acid [ALA]) and long-chain (eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) forms, which largely derive from certain plant- and marine-based foods respectively. Omega-6 PUFAs are present in some vegetable oils, meats, and other animal products. OBJECTIVES To assess the effects of omega-3 and omega-6 polyunsaturated fatty acid (PUFA) supplements on dry eye signs and symptoms. SEARCH METHODS CENTRAL, Medline, Embase, two other databases and three trial registries were searched in February 2018, together with reference checking. A top-up search was conducted in October 2019, but the results have not yet been incorporated. SELECTION CRITERIA We included randomized controlled trials (RCTs) involving dry eye participants, in which omega-3 and/or omega-6 supplements were compared with a placebo/control supplement, artificial tears, or no treatment. We included head-to-head trials comparing different forms or doses of PUFAs. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included 34 RCTs, involving 4314 adult participants from 13 countries with dry eye of variable severity and etiology. Follow-up ranged from one to 12 months. Nine (26.5%) studies had published protocols and/or were registered. Over half of studies had high risk of bias in one or more domains. Long-chain omega-3 (EPA and DHA) versus placebo or no treatment (10 RCTs) We found low certainty evidence that there may be little to no reduction in dry eye symptoms with long-chain omega-3 versus placebo (four studies, 677 participants; mean difference [MD] -2.47, 95% confidence interval [CI] -5.14 to 0.19 units). We found moderate certainty evidence for a probable benefit of long-chain omega-3 supplements in increasing aqueous tear production relative to placebo (six studies, 1704 participants; MD 0.68, 95% CI 0.26 to 1.09 mm/5 min using the Schirmer test), although we did not judge this difference to be clinically meaningful. We found low certainty evidence for a possible reduction in tear osmolarity (one study, 54 participants; MD -17.71, 95% CI -28.07 to -7.35 mOsmol/L). Heterogeneity was too substantial to pool data on tear break-up time (TBUT) and adverse effects. Combined omega-3 and omega-6 versus placebo (four RCTs) For symptoms (low certainty) and ocular surface staining (moderate certainty), data from the four included trials could not be meta-analyzed, and thus effects on these outcomes were unclear. For the Schirmer test, we found moderate certainty evidence that there was no intergroup difference (four studies, 455 participants; MD: 0.66, 95% CI -0.45 to 1.77 mm/5 min). There was moderate certainty for a probable improvement in TBUT with the PUFA intervention relative to placebo (four studies, 455 participants; MD 0.55, 95% CI 0.04 to 1.07 seconds). Effects on tear osmolarity and adverse events were unclear, with data only available from a single small study for each outcome. Omega-3 plus conventional therapy versus conventional therapy alone (two RCTs) For omega-3 plus conventional therapy versus conventional therapy alone, we found low certainty evidence suggesting an intergroup difference in symptoms favoring the omega-3 group (two studies, 70 participants; MD -7.16, 95% CI -13.97 to -0.34 OSDI units). Data could not be combined for all other outcomes. Long-chain omega-3 (EPA and DHA) versus omega-6 (five RCTs) For long-chain omega-3 versus omega-6 supplementation, we found moderate certainty evidence for a probable improvement in dry eye symptoms (two studies, 130 participants; MD -11.88, 95% CI -18.85 to -4.92 OSDI units). Meta-analysis was not possible for outcomes relating to ocular surface staining, Schirmer test or TBUT. We found low certainty evidence for a potential improvement in tear osmolarity (one study, 105 participants; MD -11.10, 95% CI -12.15 to -10.05 mOsmol/L). There was low level certainty regarding any potential effect on gastrointestinal side effects (two studies, 91 participants; RR 2.34, 95% CI 0.35 to 15.54). AUTHORS' CONCLUSIONS Overall, the findings in this review suggest a possible role for long-chain omega-3 supplementation in managing dry eye disease, although the evidence is uncertain and inconsistent. A core outcome set would work toward improving the consistency of reporting and the capacity to synthesize evidence.
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Affiliation(s)
- Laura E Downie
- The University of MelbourneDepartment of Optometry and Vision SciencesLevel 4, Alice Hoy BuildingMelbourneVictoriaAustralia3010
| | - Sueko M Ng
- Johns Hopkins Bloomberg School of Public HealthDepartment of Epidemiology615 N. Wolfe Street, W5010c/o Cochrane Eyes and Vision GroupBaltimoreMarylandUSA21205
| | | | - Esen K Akpek
- Johns Hopkins University School of MedicineWilmer Eye Institute600 N. Wolfe Street, Maumenee #317BaltimoreMarylandUSA21287
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Şimşek C, Doğru M, Kojima T, Tsubota K. Current Management and Treatment of Dry Eye Disease. Turk J Ophthalmol 2019; 48:309-313. [PMID: 30605938 PMCID: PMC6330664 DOI: 10.4274/tjo.69320] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A better understanding of the pathophysiology and etiology of dry eye disease leads to more efficient management and treatment of the disease process. However, there is substantial variation among both clinicians and countries in terms of dry eye treatment modalities. The latest 2017 International Dry Eye Workshop II report aimed to reduce these differences and emphasized the use of a stepped care algorithm. The algorithm includes treatment forms ranging from artificial tear drops, the primary conventional treatment method, to the latest surgical applications. The aims of the algorithm are to restore homeostasis in the ocular surface, break the vicious cycle of inflammation, and ensure long-term ocular surface comfort.
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Affiliation(s)
- Cem Şimşek
- Keio University Faculty of Medicine, Department of Ophthalmology, Tokyo, Japan
| | - Murat Doğru
- Keio University Faculty of Medicine, Department of Ophthalmology, Tokyo, Japan
| | - Takashi Kojima
- Keio University Faculty of Medicine, Department of Ophthalmology, Tokyo, Japan
| | - Kazuo Tsubota
- Keio University Faculty of Medicine, Department of Ophthalmology, Tokyo, Japan
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McDonnell A, Lee JH, Makrai E, Yeo LY, Downie LE. Tear Film Extensional Viscosity Is a Novel Potential Biomarker of Dry Eye Disease. Ophthalmology 2019; 126:1196-1198. [PMID: 30880107 DOI: 10.1016/j.ophtha.2019.03.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/16/2019] [Accepted: 03/11/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Amarin McDonnell
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Ji-Hyun Lee
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Eve Makrai
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Leslie Y Yeo
- School of Engineering, RMIT University, Melbourne, Victoria, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, Victoria, Australia.
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Matossian C, McDonald M, Donaldson KE, Nichols KK, MacIver S, Gupta PK. Dry Eye Disease: Consideration for Women's Health. J Womens Health (Larchmt) 2019; 28:502-514. [PMID: 30694724 PMCID: PMC6482917 DOI: 10.1089/jwh.2018.7041] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Dry eye disease (DED) is a multifactorial disorder of the ocular surface and tear homeostasis that can result in discomfort, pain, and visual disturbance. Untreated, DED can become chronic, progressive, and significantly affect an individual's quality of life. Women are disproportionately affected by DED, are diagnosed at a younger age, and experience more severe symptoms compared with men. DED is associated with a wide range of comorbid conditions; there is a strong association between DED and autoimmune disorders, especially those that affect women at many times the rate of men. Treatment response questionnaires indicate women respond better to a wellness model of treatment for DED than men. Furthermore, women's health care-seeking behaviors provide opportunities for general practitioners, specialists, and women's health centers to help identify women with DED or at risk for DED for referral to an eye care specialist. This review of the prevalence of DED in women, and gender and sex-specific aspects of DED, highlight a significant opportunity for action. Earlier diagnosis and treatment of this common but burdensome condition could significantly improve a woman's quality of life.
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Affiliation(s)
| | | | - Kendall E Donaldson
- 3 Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Kelly K Nichols
- 4 School of Optometry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sarah MacIver
- 5 School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - Preeya K Gupta
- 6 Division of Cornea and Refractive Surgery, Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
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12
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Gad A, Vingrys AJ, Wong CY, Jackson DC, Downie LE. Tear film inflammatory cytokine upregulation in contact lens discomfort. Ocul Surf 2018; 17:89-97. [PMID: 30321605 DOI: 10.1016/j.jtos.2018.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/05/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the ocular inflammatory response, using clinical and immunological techniques, in people experiencing contact lens (CL) discomfort. METHODS This study involved 38 adults who were full-time, silicone-hydrogel CL wearers. Participants were categorized into groups based upon a validated CL dry-eye questionnaire (CLDEQ-8) (n = 17 'asymptomatic', CLDEQ-8 score <9; n = 21 'symptomatic', CLDEQ-8 score ≥13). Examinations were performed at two visits (one with, and one without, CL wear), separated by one-week. Testing included: tear osmolarity, ocular redness, tear stability, ocular surface staining, meibography, tear production and tear collection. Tear osmolarity was taken from the inferior-lateral and superior-lateral menisci. The 'Inferior-Superior Osmotic Difference', I-SOD, was the absolute osmolarity difference between these menisci. Concentrations of seven cytokines (IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-gamma, TNF-alpha) were assayed from basal tears using multiplex cytometric bead array. RESULTS At baseline, there was no significant difference in key clinical signs between asymptomatic and symptomatic CL wearers (p > 0.05). The I-SOD was greater in symptomatic than asymptomatic CL wearers (23.1 ± 2.6 versus 11.3 ± 1.4 mOsmol/L, p = 0.001). People experiencing CL discomfort had higher tear IL-17A (122.6 ± 23.7 versus 44.0 ± 10.0 pg/mL, p = 0.02) and reduced tear stability (6.3 ± 1.1 versus 10.4 ± 1.6 s, p = 0.03) after several hours of CL wear. Tear IL-17A levels correlated with both the I-SOD (r = 0.43, p = 0.01) and CLDEQ-8 score (r = 0.40, p = 0.01). CONCLUSIONS CL discomfort occurs in individuals having no clinical dry eye signs, and is associated with higher tear levels of the pro-inflammatory cytokine IL-17A. These findings support an association between the discomfort response and low-grade, ocular surface inflammation.
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Affiliation(s)
- Anne Gad
- Department of Optometry and Vision Sciences, Australia
| | | | - Chinn Yi Wong
- Department of Microbiology and Immunology at the Peter Doherty Institute of Infection and Immunity, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - David Charles Jackson
- Department of Microbiology and Immunology at the Peter Doherty Institute of Infection and Immunity, The University of Melbourne, Parkville, Victoria, 3010, Australia
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The significance of meibomian gland changes in asymptomatic children. Ocul Surf 2018; 16:301-305. [DOI: 10.1016/j.jtos.2018.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/28/2018] [Accepted: 03/20/2018] [Indexed: 11/22/2022]
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14
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Downie LE, Craig JP. Tear film evaluation and management in soft contact lens wear: a systematic approach. Clin Exp Optom 2018; 100:438-458. [PMID: 28940531 DOI: 10.1111/cxo.12597] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/09/2017] [Accepted: 07/05/2017] [Indexed: 12/13/2022] Open
Abstract
The human tear film is a highly ordered structure consisting of a thin layer of lipid on the surface and a thicker aqueous-mucin phase, which increases in mucin concentration toward the corneal epithelial cell layer. The health of the tear film and ocular surface influences the likelihood of being able to achieve successful contact lens wear. Contact lens discomfort and dryness are the most frequent reasons why contact lens wearers experience reduced wearing times, which can eventually lead to contact lens discontinuation. Comprehensive clinical assessment of tear film integrity and ocular surface health is therefore essential prior to commencing contact lens wear, to enable the ocular surface environment to be optimised to support lens wear. These parameters should also be evaluated over the course of contact lens wear, in order to identify any aspects requiring clinical management and ensure maintenance of optimal lens-wearing conditions. This review summarises current knowledge relating to the effects of soft contact lens wear on the tear film and ocular surface. It also provides a systematic approach to evaluating tear film and ocular surface integrity, in order to guide the clinical management of tear film anomalies with respect to contact lens wear.
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Affiliation(s)
- Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Abstract
Dry eye disease is a chronic condition of the corneal surface marked by persistent symptoms of irritation or burning that can cause inflammatory damage to the cornea and conjunctiva if untreated. Common risk factors for this syndrome include advancing age, female sex, low humidity environments, systemic medications, and autoimmune disorders. Treatments to relieve symptoms include tear replacement, humidification, improved nutrition, and anti-inflammatory ocular agents. Home healthcare nurses can identify signs and symptoms of dry eye syndrome and initiate strategies that range from warm compresses to physician referrals for more aggressive treatment. Consistent management of this condition improves quality of life and minimizes damage to the ocular surface.
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Affiliation(s)
- Patricia A Rouen
- Patricia A. Rouen, PhD, FNP-BC, is a Professor, McAuley School of Nursing, University of Detroit Mercy, Detroit, Michigan. Mary L. White, PhD, FNP-BC, is an Associate Professor, McAuley School of Nursing, University of Detroit Mercy, Detroit, Michigan
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Automated Measurement of Tear Film Dynamics and Lipid Layer Thickness for Assessment of Non-Sjögren Dry Eye Syndrome With Meibomian Gland Dysfunction. Cornea 2017; 36:176-182. [PMID: 28060064 DOI: 10.1097/ico.0000000000001101] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate automated values from an advanced corneal topographer with a built-in real keratometer, color camera, and ocular surface interferometer for the evaluation of non-Sjögren dry eye syndrome (NSDES) with meibomian gland dysfunction (MGD). METHODS Sixty-four patients (64 eyes) diagnosed with NSDES with MGD were enrolled. All eyes were evaluated using the Ocular Surface Disease Index (OSDI), fluorescence staining score, tear film breakup time (TBUT), Schirmer test, and MGD grade. Noninvasive Keratograph average tear film breakup time (NIKBUTav), tear meniscus height (TMHk), meibomian gland (MG) dropout grade, and lipid layer thickness (LLT) using interferometry were measured. RESULTS Among automated indexes, NIKBUTav (mean 7.68 ± 4.07 s) and the MG dropout grade (mean 1.0 ± 0.5) significantly correlated with the OSDI (mean 40.6 ± 22.9) (r = -0.337, P = 0.006; and r = 0.201, P = 0.023, respectively), as did all conventional indicators, except the Schirmer score (mean 9.1 ± 5.9 mm). TMHk (mean 0.21 ± 0.18 mm) had significant correlation with the Schirmer score, the staining score (mean 1.2 ± 0.7), TBUT (mean 3.8 ± 1.8 s), and NIKBUTav (r = 0.298, P = 0.007; r = -0.268, P = 0.016; r = 0.459, P < 0.001; and r = 0.439, P < 0.001, respectively), but not any MGD indicator, even the MG dropout grade. NIKBUTav showed significant correlations with all clinical parameters and other automated values, except the Schirmer score and LLT (mean 83.94 ± 20.82 nm) (all (Equation is included in full-text article.)≥ 0.25 and P < 0.01). The MG dropout grade highly correlated with all indexes except TMHk (all (Equation is included in full-text article.)≥ 0.25 and P < 0.05). LLT was significantly associated with TBUT, MGD grade (mean 2.0 ± 0.7), and MG dropout grade (r = 0.219, P = 0.047; r = -0.221, P = 0.039; and r = 0.433, P < 0.001, respectively), although it was not related to patient symptoms. CONCLUSIONS Automated noninvasive measurements using an advanced corneal topographer and LLT measured with an ocular surface interferometer can be alternatives to conventional methods to evaluate tear conditions on the ocular surface; the former device can provide information about conformational MG changes in NSDES with MGD.
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Jones L, Downie LE, Korb D, Benitez-del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf 2017; 15:575-628. [DOI: 10.1016/j.jtos.2017.05.006] [Citation(s) in RCA: 578] [Impact Index Per Article: 82.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 02/06/2023]
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18
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TFOS DEWS II Diagnostic Methodology report. Ocul Surf 2017; 15:539-574. [DOI: 10.1016/j.jtos.2017.05.001] [Citation(s) in RCA: 836] [Impact Index Per Article: 119.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/01/2017] [Indexed: 01/09/2023]
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19
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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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Deinema LA, Vingrys AJ, Chinnery HR, Downie LE. Optical Coherence Tomography Reveals Changes to Corneal Reflectivity and Thickness in Individuals with Tear Hyperosmolarity. Transl Vis Sci Technol 2017; 6:6. [PMID: 28553560 PMCID: PMC5444496 DOI: 10.1167/tvst.6.3.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/19/2017] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To investigate whether tear hyperosmolarity, a feature of dry eye disease (DED), affects central corneal thickness (CCT), corneal light reflectivity, and/or tear film reflectivity. METHODS This prospective, cross-sectional study involved 48 participants (38 with hyperosmolar tears and 10 controls with normo-osmolar tears). Symptoms and signs of DED (tear osmolarity, sodium fluorescein tear break-up time, ocular surface staining, Schirmer test) were assessed. CCT, and the reflectivity of the cornea and the tear-epithelial interface were quantified relative to background noise using Fourier-domain optical coherence tomography (FD-OCT). RESULTS CCT of eyes with severe tear hyperosmolarity, defined as eyes in the upper quartile of the hyperosmolar group, was less than control eyes (539.1 ± 7.4 vs. 583.1 ± 15.0 μm, P = 0.02) and eyes with less severe tear hyperosmolarity, defined as hyperosmolar eyes in the lower quartile (622.7 ± 5.8 μm, P < 0.0001). CCT showed a negative linear relationship with tear osmolarity for values above 316 mOsmol/L (R2 = 0.17, P = 0.01). Central corneal reflectivity was lower in hyperosmolar eyes than normo-osmolar eyes (45.1 ± 0.3 vs. 48.1 ± 0.6 pixels, P = 0.02); the greatest relative difference was in the anterior stroma, where corneal reflectivity was 4.7 ± 1.9% less in hyperosmolar eyes (P < 0.01). Peak reflectivity of the tear-epithelial interface was 4.8% ± 3.5% higher in the hyperosmolar group than the normo-osmolar tear group (P = 0.04). CONCLUSION Individuals with significant tear hyperosmolarity and clinical signs of symptoms of DED show reduced CCT and altered corneal reflectivity. TRANSLATIONAL RELEVANCE Anterior segment FD-OCT provides novel insight into corneal microstructural differences in individuals with DED.
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Affiliation(s)
- Laura Adelaide Deinema
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia 3010
| | - Algis Jonas Vingrys
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia 3010
| | - Holly Rose Chinnery
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia 3010
| | - Laura Elizabeth Downie
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville, Victoria, Australia 3010
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Chinnery HR, Naranjo Golborne C, Downie LE. Omega-3 supplementation is neuroprotective to corneal nerves in dry eye disease: a pilot study. Ophthalmic Physiol Opt 2017; 37:473-481. [DOI: 10.1111/opo.12365] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/06/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Holly R. Chinnery
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Australia
| | | | - Laura E. Downie
- Department of Optometry and Vision Sciences; The University of Melbourne; Parkville Australia
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Xue AL, Downie LE, Ormonde SE, Craig JP. A comparison of the self-reported dry eye practices of New Zealand optometrists and ophthalmologists. Ophthalmic Physiol Opt 2017; 37:191-201. [DOI: 10.1111/opo.12349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Ally L. Xue
- Department of Ophthalmology; New Zealand National Eye Centre; The University of Auckland; Auckland New Zealand
| | - Laura E. Downie
- Department of Optometry and Vision Sciences; The University of Melbourne; Melbourne Australia
| | - Susan E. Ormonde
- Department of Ophthalmology; New Zealand National Eye Centre; The University of Auckland; Auckland New Zealand
| | - Jennifer P. Craig
- Department of Ophthalmology; New Zealand National Eye Centre; The University of Auckland; Auckland New Zealand
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Deinema LA, Vingrys AJ, Wong CY, Jackson DC, Chinnery HR, Downie LE. A Randomized, Double-Masked, Placebo-Controlled Clinical Trial of Two Forms of Omega-3 Supplements for Treating Dry Eye Disease. Ophthalmology 2017; 124:43-52. [DOI: 10.1016/j.ophtha.2016.09.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 10/20/2022] Open
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Downie LE, Rumney N, Gad A, Keller PR, Purslow C, Vingrys AJ. Comparing self-reported optometric dry eye clinical practices in Australia and the United Kingdom: is there scope for practice improvement? Ophthalmic Physiol Opt 2016; 36:140-51. [DOI: 10.1111/opo.12280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Laura E. Downie
- Department of Optometry and Vision Sciences; University of Melbourne; Parkville Australia
| | - Nicholas Rumney
- School of Life and Health Sciences; Aston University; Birmingham UK
| | - Anne Gad
- Department of Optometry and Vision Sciences; University of Melbourne; Parkville Australia
| | - Peter R. Keller
- Department of Optometry and Vision Sciences; University of Melbourne; Parkville Australia
| | - Christine Purslow
- School of Optometry and Vision Sciences; Cardiff University; Cardiff UK
| | - Algis J. Vingrys
- Department of Optometry and Vision Sciences; University of Melbourne; Parkville Australia
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