Impact of Dry Eye Symptoms and Daily Activities in a Modern Office

Sex Differences and Discordance Between Symptoms and Signs of Dry Eye Disease

PURPOSE

To examine the initial presenting symptoms in relation to sex and identify predictors of discordance between symptoms and signs of dry eye disease (DED) in Taiwan.

DESIGN

Retrospective cross-sectional study.

METHODS

This clinic-based cohort from a tertiary referral center in Taiwan included 1229 patients diagnosed with DED at Keelung Chang Gung Memorial Hospital in Taiwan between August 1, 2011, and July 31, 2018. Initial presenting symptoms were cross-sectionally and retrospectively collected. The composite score, indicating the discordance between symptoms and signs, was derived from the difference between the DED symptom severity score and the DED sign severity score.

RESULTS

Of 1229 patients, 975 (79.3%) were female, with a mean age of 56.7 ± 14.9 years. Initial presenting symptoms didn't show significant sex differences (all P > .05). In multivariate analysis, predictors of higher symptom severity score than sign severity score included being female (P = .011) and having a surgical history of cataract (P = .037), pterygium, or conjunctivochalasis (P = .014). Conversely, older age (P < .001) and artificial tear use (P < .001) were significant predictors of a lower symptom severity score than sign severity score.

CONCLUSIONS

Strong predictors of incongruity between DED symptoms and signs include age, gender, surgical history for cataract, pterygium or conjunctivochalasis, and artificial tear use. Ophthalmologists should prioritize symptoms for female patients and postsurgery cases. In addition, the absence of symptoms should not dismiss DED possibility in older adult patients and those using artificial tears. Notably, early recognition and enhancement of postoperative care can improve patient satisfaction and quality of life.

Prevalence and Risk Factors of Dry Eye Disease in Association With the Increased Use of Electronic Devices Among University Students in Western Saudi Arabia

AIM

Dry eye disease (DED) is a prevalent ocular condition that significantly impacts individuals' quality of life and performance. It is charac-terized by the instability of the tear film, which causes ocular surface inflamma-tion and damage that leads to ocular symptoms. However, this study aimed to determine the prevalence of DED and identify associated risk factors among university students in western Saudi Arabia.

METHODS

A total of 402 university students participated in this study. The sample size was determined using Raosoft software (Raosoft, Inc., Seattle, WA), considering an estimated student population of 20,000. Data were collected between January and March 2023 through an online questionnaire distributed to the participants. The questionnaire comprised three sections, covering general information, behaviors related to digital device (DD) use, and the validated Arabic version of the Ocular Surface Disease Index (OSDI) questionnaire. OSDI scores were calculated, and the severity of DED was categorized using established cutoff points.

RESULTS

Among the 402 university students who took part in the survey, the majority (63.2%) were aged between 21 and 25 years, with females representing the dominant gender (72.9%). Notably, 90.8% of participants reported using DDs at bedtime. Over 60% of students had been using DDs for more than 10 years, and approximately 61.7% reported having more than six hours of daily screen time. Mobile devices were the most commonly used electronic devices (67.2%), and TikTok emerged as the most frequently used application (35.6%). Based on the OSDI criteria, 21.1% of students had mild DED symptoms, 14.9% had moderate symptoms, and 38.6% had severe symptoms. Hence, the prevalence of students exhibiting positive DED symptoms was 74.6%, while 25.4% were negative.

Optometrists need to incorporate their understanding of the impact of dry eye disease in their patient management

SIGNIFICANCE

The impact of dry eye disease on patients' daily lives is understood by optometrists, but they seldom use this understanding in their patient management.

PURPOSE

Dry eye disease can significantly impact a person's daily life and is known to cause psychological symptoms. Treating and managing patients with dry eye disease can be challenging, as an approach based solely on signs is unlikely to reflect patients' true burden. Because optometrists play a crucial role in the care of dry eye disease patients, it is necessary to examine their awareness of the negative impact of dry eye disease on patients' daily lives and how they manage this during their consultation time, including diagnosis and management.

METHODS

This study has an exploratory, qualitative research design. Twelve semistructured online interviews were conducted with optometrists in second-line eye care through a convenience sample. The interviews were recorded, transcribed verbatim, and analyzed after a thematic analysis.

RESULTS

The main findings were that few optometrists actively asked about patients' perceived burden, many optometrists did not mention all the possible treatment options or practical advice that could benefit dry eye disease patients, and few were aware of the possible help that other health care providers could provide, besides the optometrist.

CONCLUSIONS

Dutch optometrists are aware of the impact that dry eye disease can have on their patients' daily lives, but seldom use this information as part of their management plan.

Real Life Impact of Dry Eye Disease

Dry Eye Disease (DED) is an increasingly common condition that affects between 5% and 50% of the global population. Even though DED is most frequently diagnosed in older people, it has also been diagnosed in young adults and adolescents more frequently in recent years (employees, gamers). People can experience different types of symptoms and find it challenging to read, watch TV, cook, climb stairs, and meet friends. Mild and severe dry eye can reduce quality of life similarly to mild psoriasis and moderate-to-severe angina. Furthermore, DED patients experience serious difficulties driving vehicles, especially at night, and show a decrease in work productivity, which, when combined with the relevant indirect cost that this condition produces, poses a serious challenge in our days. In addition, DED patients are more likely to develop depression and suicidal ideations and experience frequent sleep disorders. Finally, it is discussed how lifestyle changes, such as increased physical activity, blinking exercises, and a proper diet, have positive implications for the management of this condition. Our aim is to draw attention to the negative effects of dry eye in real life, which are unique to each patient, especially as they relate to the non-visual symptoms experienced by DED patients.

Elucidating the Molecular Interactions between Lipids and Lysozyme: Evaporation Resistance and Bacterial Barriers for Dry Eye Disease

Dry eye disease (DED) is a chronic condition characterized by ocular dryness and inflammation. The tear film lipid layer (TFLL) is the outermost layer composed of lipids and proteins that protect the ocular surface. However, environmental contaminants can disrupt its structure, potentially leading to DED. Although the importance of tear proteins in the TFLL functionality has been clinically recognized, the molecular mechanisms underlying TFLL-protein interactions remain unclear. In this study, we investigated tear protein-lipid interactions and analyzed their role in the TFLL functionality. The results show that lysozyme (LYZ) increases the stability of the TFLL by reducing its surface tension and increasing its surface pressure, resulting in increased TFLL evaporation and bacterial invasion resistance, with improved wettability and lubrication performance. These findings highlight the critical role of LYZ in maintaining ocular health and provide potential avenues for investigating novel approaches to DED treatment and patient well-being.

Prevalence and Determinants of Excessive Screen Viewing Time in Children Aged 3-15 Years and Its Effects on Physical Activity, Sleep, Eye Symptoms and Headache

Screen viewing time is the total time spent by a child on any digital/electronic device. The objective of the present study was to determine the prevalence and predictors of excessive screen viewing time in children in Ujjain, India. This cross-sectional, community-based study was conducted through a house-to-house survey using the three-stage cluster sampling method in 36 urban wards and 36 villages of Ujjain District, India. Excessive screen viewing time was defined as screen viewing for >2 h/day. The prevalence of excessive screen viewing time was 18%. Risk factors identified using the multivariate logistic regression model were age (OR: 1.63, p < 0.001); mobile phone use before bedtime (OR: 3.35, p = 0.004); parents' perception about the child's habituation to screen time (OR: 8.46, p < 0.001); television in the bedroom (OR: 35.91, p < 0.001); morning mobile screen viewing time (OR: 6.40, p < 0.001); not reading books other than textbooks (OR: 6.45, p < 0.001); and lack of outdoor play for >2 h (OR: 5.17, p < 0.001). The presence of eye pain was a protective factor for excessive screen viewing time (OR: 0.13, p = 0.012). This study identified multiple modifiable risk factors for excessive screen viewing time.

Prevalence and associated factors for self-reported symptoms of dry eye among Thai school children during the COVID-19 outbreak

PURPOSE

COVID-19 pandemic caused an increase in digital screen time, which seemed to increase the prevalence of dry eye symptoms among the population with abnormally high digital screen usage hours. However, there are no reports of dry eye symptoms in school children with high digital usage hours. Therefore, the present study aimed to assess the prevalence of dry eye symptoms and evaluate the associated factors among school children aged 12 to 18 years during the COVID-19 outbreak.

METHODS

Multistage cluster sampling was applied, and six sections of online questionnaires were distributed to selected respondents in November 2021. The odds ratio (OR) with confidence intervals (CIs) for the factors was calculated using binary logistic regression. All statistical significance was determined at p < 0.05.

RESULTS

The findings revealed that 62.5% of 603 students showed symptoms of dry eye (DEQ-5 score ≥ 6). Significant associated factors included being female (adjusted OR (aOR) 1.54; 95% CIs 1.05-2.25), higher-grade student (aOR 1.77; 95% CIs 1.23-2.57), digital screen time use (6 to < 12 hours: aOR 2.00; 95% CIs 1.12-3.57, ≥12 hours: aOR 2.54; 95% CIs 1.39-4.76), and perceived stress (aOR 1.12; 95% CIs 1.08-1.16). The Thai-Perceived Stress Scale-10 scores were positively correlated with the scores on the 5-item dry eye questionnaire (Spearman's r = 0.38, p-value < 0.01).

CONCLUSION

A high prevalence of dry eye symptoms might be common among school children during the COVID-19 outbreak. Significant risk factors include being female, being a higher-grade level student, prolonged use of digital screens, and perceived stress. However, contact lens use, smoking, and the most common digital device usage patterns were not found to be contributing factors.

Management of inflammation in dry eye disease: Recommendations from a European panel of experts

Introduction

Early initiation of anti-inflammatory therapies is recommended for dry eye disease (DED) to break the vicious cycle of pathophysiology. However, there is limited guidance on how to implement topical ciclosporin (CsA) and corticosteroid treatment into clinical practice. This expert-led consensus provides practical guidance on the management of DED, including when and how to use topical CsA.

Methods

A steering committee (SC) of seven European DED experts developed a questionnaire to gain information on the unmet needs and management of DED in clinical practice. Consensus statements on four key areas (disease severity and progression; patient management; efficacy, safety and tolerability of CsA; and patient education) were generated based on the responses. The SC and an expanded expert panel of 22 members used a nine-point scale (1  =  strongly disagree; 9  =  strongly agree) to rate statements; a consensus was reached if ≥75% of experts scored a statement ≥7.

Results

A stepwise approach to DED management is required in patients presenting with moderate corneal staining. Early topical CsA initiation, alone or with corticosteroids, should be considered in patients with clinical risk factors for severe DED. Patient education is required before and during treatment to manage expectations regarding efficacy and tolerability in order to optimise adherence. Follow-up visits are required, ideally at Month 1 and every 3 months thereafter. Topical CsA may be continued indefinitely, especially when surgery is required.

Conclusion

This consensus fills some of the knowledge gaps in previous recommendations regarding the use of topical corticosteroids and CsA in patients with DED.

Computer vision syndrome in healthcare workers using video display terminals: an exploration of the risk factors

AIMS

To estimate the prevalence of computer vision syndrome (CVS) in healthcare workers and its relationship to video display terminal (VDT) exposure, sociodemographic, optical correction and work characteristics, and to analyse whether there are differences among occupational groups.

DESIGN

Cross-sectional study.

METHODS

A sample of 1179 physicians and surgeons, nurses, and nursing assistants from two hospitals in Spain between January 2017 and February 2018 were invited to participate in this study. Of these, 622 workers from both hospitals were finally included. CVS was measured using a questionnaire, the CVS-Q^© . Logistic regression was used to identify the factors associated with CVS. All the results were stratified by occupational group.

RESULTS

The prevalence of CVS was 56.75% with nurses being the most affected occupational group (61.75%). It was associated significantly with female sex (aOR = 2.57; 95% CI 1.36-4.88) and morning shifts plus on-call (aOR = 2.33; 95% CI 1.11-4.88) in the physicians and surgeons group. Among the nurses, it was associated with female sex (aOR = 2.35; 95% CI 1.03-5.37), seniority between 10 and 20 years (aOR = 2.17; 95% CI 1.03-4.59), VDT exposure at work of 2-4 h/day (aOR = 6.14; 95% CI 1.08-35.02), VDT exposure at work >4 h/day (aOR = 7.14; 95% CI 1.29-39.62) and self-perception that using the software application was not easy (aOR = 2.49; 95% CI 1.23-5.01).

CONCLUSIONS

A high prevalence of CVS among healthcare workers was observed. The risk factors that increased the likelihood of suffering from this syndrome depended on the occupation.

IMPACT

The findings may be used as a reference for occupational health services to implement specific preventive measures to reduce CVS for each occupational group. Such measures should consider both individual factors and the working conditions.

Evaluation of VDT-Induced Visual Fatigue by Automatic Detection of Blink Features

This study evaluates the progression of visual fatigue induced by visual display terminal (VDT) using automatically detected blink features. A total of 23 subjects were recruited to participate in a VDT task, during which they were required to watch a 120-min video on a laptop and answer a questionnaire every 30 min. Face video recordings were captured by a camera. The blinking and incomplete blinking images were recognized by automatic detection of the parameters of the eyes. Then, the blink features were extracted including blink number (BN), mean blink interval (Mean_BI), mean blink duration (Mean_BD), group blink number (GBN), mean group blink interval (Mean_GBI), incomplete blink number (IBN), and mean incomplete blink interval (Mean_IBI). The results showed that BN and GBN increased significantly, and that Mean_BI and Mean_GBI decreased significantly over time. Mean_BD and Mean_IBI increased and IBN decreased significantly only in the last 30 min. The blink features automatically detected in this study can be used to evaluate the progression of visual fatigue.

Potential Therapeutic Role of Pituitary Adenylate Cyclase-Activating Polypeptide for Dry Eye Disease

Dry eye disease (DED) is caused by a reduction in the volume or quality of tears. The prevalence of DED is estimated to be 100 million in the developed world. As aging is a risk factor for DED, the prevalence of DED is expected to grow at a rapid pace in aging populations, thus creating an increased need for new therapies. This review summarizes DED medications currently in clinical use. Most current medications for DED focus on stimulating tear secretion, mucin secretion, or suppressing inflammation, rather than simply replenishing the ocular surface with moisture to improve symptoms. We recently reported that the neuropeptide PACAP (pituitary adenylate cyclase-activating polypeptide) induces tear secretion and suppresses corneal injury caused by a reduction in tears. Moreover, it has been reported that a PACAP in water and a 0.9% saline solution at +4 °C showed high stability and achieved 80-90% effectiveness after 2 weeks of treatment. These results reveal PACAP as a candidate DED medication. Further research on the clinical applications of PACAP in DED is necessary.

Work productivity among Sjögren's Syndrome and non-Sjögren's dry eye patients: a systematic review and meta-analysis

BACKGROUND

Dry eye disease (DED) is one of the most common conditions presenting to eye care providers and is increasingly recognized to have poor outcomes on quality of life, activities of daily living, and social and emotional well-being. Here, we aim to understand the association between dry eye symptoms and workplace productivity experienced by patients with non-Sjögren's dry eye and Sjögren's Syndrome.

METHODS

MEDLINE, PubMed, Embase, Cochrane Library, CINAHL, Healthstar, and PsycINFO were searched from inception to May 2019.

RESULTS

Thirty-one studies consisting of 50,446 study participants from 14 countries were included in this systematic review. Among non-Sjögren's dry eye patients, there was significant absenteeism (ES = 0.19; 95% CI: [0.04, 0.35]), presenteeism (ES = 0.25; 95% CI: [0.15. 0.35]), productivity impairment (ES = 0.24; 95% CI: [0.20, 0.27]), activity impairment (ES = 0.30; 95% CI: [0.21, 0.38]), and subjective difficulties at work (ES = 0.58; 95% CI: [0.40, 0.75]). Patients with Sjögren's Syndrome demonstrated significant absenteeism (ES = 0.13, 95% CI: [0.10, 0.17]), presenteeism (ES = 0.28, 95% CI: [0.24, 0.32]), productivity impairment (ES = 0.31, 95% CI: [0.27, 0.35]), and activity impairment (ES = 0.39, 95% CI: [0.32, 0.47]) in the workplace. In addition, patients with Sjögren's Syndrome demonstrated significantly lower employment rate (ES = 0.42, 95% CI: [0.34, 0.50]), decreased number of hours worked (SMD = -0.21, 95% CI: [-0.39, -0.02]), and increased work disability (ES = 0.18; 95% CI: [0.09, 0.27]).

CONCLUSIONS

This is the first systematic review and meta-analysis to demonstrate the negative association between DED and several work productivity measures.

Effect of Blue Light Filters on Tear and Contrast Sensitivity in Individuals Using Electronic Devices

OBJECTIVES

To investigate the effect of contact lenses with blue light filters on contrast sensitivity and any alteration in tear quantity and quality.

METHODS

This prospective longitudinal pilot study required three visits by each participant. Monocular visual acuity, contrast sensitivity, phenol red thread test, and tear breakup time were measured at each visit.

RESULTS

There were significant differences in logarithmic contrast sensitivity between the groups. The breakup time (BUT) was significantly lower after using video display terminals than before (P<0.05). No differences in BUT were found between groups video display terminals and contact lenses having the blue filter (P>0.05). However, higher mean values were observed in the group after video display terminal use with contact lenses having the blue filter than that with standard contact lenses (P>0.05 in both groups). Furthermore, the mean value of phenol red thread test on the group after video display terminal use with contact lenses having the blue filter was lower than the group before its use (P>0.05).

CONCLUSION

The results establish a possible relationship between tear stability, improved contrast sensitivity, and the use of a blue filter in contact lenses.

Validation of the Arabic version of the Ocular Surface Disease Index Questionnaire

AIM

To develop an Arabic version of the ocular surface disease index (OSDI) and to assess its reliability and validity.

METHODS

A cross sectional study was carried out to validate the Arabic version of the OSDI questionnaire. Initially, forward-backward translation was used to translate the English version of OSDI into Arabic. The translated questionnaire was tested for equivalence and cultural adaptability. Totally 200 subjects were then recruited from a non-clinical population and asked to complete the Arabic version of the OSDI (ARB-OSDI). The reliability of the questionnaire was assessed using Cronbach's-α. A subgroup of 30 participants was asked to complete the questionnaire on two occasions to test the test-retest reliability.

RESULTS

A total of 200 participants were enrolled in the study. The average age of the study participants was 31.21±13.2y and 57% were male. An acceptable internal consistency level for the ARB-OSDI questionnaire measured by Cronbach's-α was revealed. All questions showed good internal consistency. Test-retest reliability analysis revealed good stability (interclass correlation coefficient, r=0.832, P<0.001). The construct validity for the questionnaire was also high.

CONCLUSION

The ARB-OSDI questionnaire shows very good psychometric properties (acceptable internal consistency and test-retest reliability). That makes the questionnaire a valid potential tool to use in Arabic-speaking countries to monitor symptoms of dry eye disease in a larger population.

The Relationship Between Dry Eye Disease and Digital Screen Use

Dry eye disease is characterized by tear film instability that can result in ocular surface damage. Patients with dry eye disease may experience ocular pain/discomfort and visual disturbances that may negatively impact quality of life. Increased use of digital screens for work, communication, and entertainment, especially during times of pandemic, may contribute to dry eye. Extensive cross-sectional studies have shown that digital screen use duration is associated with an increased risk of severe symptoms and clinical diagnosis of dry eye disease in adults. Smartphone use duration has also been found to be greater in school-age children with dry eye disease than in those without dry eye disease. A commonly accepted hypothesis for the relationship between digital screen use and dry eye disease is that digital screen use changes blinking dynamics, leading to ocular dryness. This review describes evidence that digital screen use is associated with dry eye disease, that digital device use alters blinking dynamics, and that dry eye affects mental health and work productivity in digital screen users. Helpful prevention and management strategies for dry eye disease exist for those who use digital screens.

Evaluation of eyestrain with vertical electrooculogram

BACKGROUND AND OBJECTIVE

Eyestrain has been increasingly severe in our lives and works as the progress of computers and smartphones. Evaluating eyestrain helps to prevent and relieve eyestrain. Our study aimed to evaluate eyestrain by analyzing vertical electrooculogram (VEOG).

METHODS

21 young subjects were asked to watch a video on the computer for a totally 120 minutes each, during which the VEOG signal was acquired using only three electrodes, and the questionnaire was answered every 30 minutes. The VEOG signal was divided into four 30-minute phases, from which VEOG signal power probability (VEOGSPP) features and blink features were extracted. The blink features include the changes of blink number (BN), group blinks number (GBN) and ratio (GBR), mean blink amplitude (Mean_BA) and duration (Mean_BD), mean blink duration at 50% (Mean_BD50), mean closing duration (Mean_CD) and opening duration (Mean_OD), mean opening duration at early 50% (Mean_ODE50) and late 50% (Mean_ODL50), mean blink maximum rising slope (Mean_BMRS) and falling slope (Mean_BMFS).

RESULTS

The results showed that the VEOGSPP in the high-frequency band (0.8-6.3Hz), BN, GBN, and GBR significantly increased while the VEOGSPP in the low-frequency band (0.1-0.4Hz), Mean_BA, Mean_OD, and Mean_ODL50 significantly decreased with eyestrain (P<0.05).

CONCLUSIONS

In conclusion, eyestrain induced by watching videos for a long time could be well evaluated by analyzing the VEOG signal.

Impact of the COVID-19 pandemic on eye strain and dry eye symptoms

Purpose

Among adult individuals with dry eye, assess the self-reported impact of the COVID-19 pandemic on (1) dry eye-related visual function, (2) reading efficiency, and (3) dry eye treatments used.

Methods

In June–July 2020, we conducted an online survey of adults with dry eye who spent at least somewhat more time at home during the pandemic than before. Consistent with TFOS DEWS II guidelines, we categorized respondents into mild, moderate, or severe dry eye based on treatment usage.

Results

We included 388 respondents: 97 respondents (25%) with mild, 80 (21%) with moderate, and 211 (54%) with severe dry eye. In all three groups, screen/reading time generally doubled during the pandemic. Reduced work-related efficiency was noted by a considerable proportion of respondents (moderate dry eye: 51%, mild: 39%, and severe: 38%). Compared with respondents with mild dry eye, respondents with moderate dry eye were considerably more likely to note worsening symptoms: eye pain (OR = 2.57, 95% CI 1.22–5.41), headache from eye symptoms (OR = 2.34, 95% CI 1.11–4.90), and difficulty concentrating because of eye symptoms (OR = 2.79, 95% CI 1.37–5.66). Respondents with moderate dry eye with Sjögren's syndrome were most likely to note these. Respondents with severe dry eye were more likely than respondents with mild dry eye to report losing access to dry eye-related treatments (OR = 2.62, 95% CI 1.36–5.03).

Conclusions

The COVID-19 pandemic-related eye strain may be impacting symptoms, performance, and ultimately employment, especially for those with moderate dry eye. This may be compounding the already-high dry eye-related societal burden.

Association between dry eye disease, self-perceived health status, and self-reported psychological stress burden

Clinical relevance: Dry eye disease is a common chronic ocular condition, which is acknowledged to have adverse impacts on quality of life and work productivity.Background: The wide-reaching impacts of dry eye disease on mental health and quality of life have received growing attention in recent years. The purpose of this study was therefore to investigate the relationship between dry eye disease, self-perceived health status, and self-reported psychological stress burden.Methods: Three hundred and twelve community residents (178 females, 134 males; mean ± SD age, 38 ± 21 years) with no major systemic, ophthalmic, or psychiatric conditions (other than dry eye disease), were recruited in a cross-sectional study. Self-perceived health status and self-reported psychological stress burden were assessed, and dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session, in accordance with the global consensus recommendations of the Tear Film and Ocular Surface Society Dry Eye Workshop II reports.Results: Multivariate regression analysis, adjusted for age, sex, ethnicity, and contact lens wear, demonstrated that improved self-perceived health status was associated with decreased odds of dry eye disease, aqueous tear deficiency and meibomian gland dysfunction (all p < 0.05). Increased self-reported psychological stress burden was positively associated with dry eye disease, aqueous tear deficiency and meibomian gland dysfunction (all p ≤ 0.01).Conclusion: Dry eye disease is associated with poorer self-perceived health status and greater self-reported psychological stress burden. The findings of this study highlight the wide-reaching impacts of dry eye disease, and the importance of minimising the impacts of the condition with optimised management and actioning inter-disciplinary referral for affected patients where necessary.

A cross-sectional study of ocular surface discomfort and corneal nerve dysfunction after paclitaxel treatment for cancer

Ocular surface dysfunction is common in patients receiving anti-cancer drug treatment. The effects of paclitaxel, a neurotoxic chemotherapeutic drug, on ocular surface discomfort associated with dry eye disease was investigated. Patients with cancer who had completed paclitaxel treatment between 3 and 24 months prior to assessment (n = 29) and age- and sex-matched healthy control subjects (n = 29) were recruited and assessed with the Ocular Surface Disease Index (OSDI) to measure ocular surface discomfort. In-vivo corneal confocal microscopy was used to evaluate corneal nerve parameters in the right eye. Peripheral neurotoxicity was assessed using patient-reported outcomes and clinical grading scales. The paclitaxel group had significantly worse OSDI total scores compared with controls (Median, Md = 19.3 and Md = 0, p = 0.007, respectively). Corneal nerve fiber and inferior whorl lengths were reduced in the paclitaxel group compared with controls (14.2 ± 4.0 and 14.4 ± 4.0 mm/mm² vs. 16.4 ± 4.0 and 16.9 ± 4.9 mm/mm², respectively, p = 0.04). When analyzed by presence of peripheral neuropathy, paclitaxel-treated patients with neuropathy showed worse OSDI total scores compared to those without peripheral neuropathy post-treatment (p = 0.001) and healthy controls (p < 0.001). More severe ocular discomfort and worse visual function was associated with greater peripheral neurotoxicity symptoms (r = 0.60, p = 0.001) and neuropathy severity (r = 0.49, p = 0.008), respectively. Patients who have been treated with paclitaxel have a higher risk of ocular surface discomfort associated with dry eye disease, particularly those with peripheral neuropathy. Future longitudinal studies should investigate the clinical impact of corneal nerve reduction in dry eye disease.

Visible Meibomian Gland Structure Increases After Vectored Thermal Pulsation Treatment in Dry Eye Disease Patients with Meibomian Gland Dysfunction

Purpose

To assess the effect of vectored thermal pulsation treatment (VTP) on visible meibomian gland structure (VGS) in patients with meibomian gland dysfunction (MGD).

Setting

Private group practice (A.T.E.).

Design

Retrospective, single-blinded cohort study.

Methods

Visible meibomian gland structure was evaluated at baseline and at 1-year in treatment (30 patients, 48 eyes) and control (13 patients, 22 eyes) groups. Meibography images were captured using dynamic meibomian imaging. Images were assessed using a novel morphometric analysis technique and analyzed for change in area of VGS (pixels). Additional outcomes measured include tear break up time, corneal staining, tear osmolarity, matrix metalloproteinase-9 (MMP-9), meibography grading, and meibomian gland evaluation.

Results

As high as 69% of eyes in the treatment group showed an improvement in VGS versus 27% of eyes in the control group. As high as 31% of eyes in the treatment group showed a decline in VGS versus 73% of eyes in the control group. TBUT (p = 0.0001), corneal staining (p = 0.0063), and meibomian gland evaluation scores (p = 0.0038) all significantly improved after VTP treatment. However, SPEED scores, MMP-9, tear osmolarity, and meiboscale scores were not significantly improved 1-year post treatment.

Conclusion

A morphometric analysis protocol of meibography provides clinically meaningful information that is undetectable with the standard semiquantitative method of grading meibomian gland structure. This is the first report indicating that gland structure may increase post-VTP relative to untreated controls, thus presenting significant implications regarding benefits and timing of VTP therapy. The described protocol is currently more appropriate for research than for clinical practice.

Loss of Concentration May Occur by Blink Inhibition in DED Simulation Models

Purpose: Patients with dry eye disease (DED) often suffer productivity loss and distress due to bothersome symptoms. The aim of this study was to objectively quantify and compare productivity-related emotional states obtained from brain waveforms in natural and simulated DED conditions. Method: 25 healthy adults (6 females and 19 males; mean age ± standard deviation, 22.6 ± 8.3 years) were recruited for the study, which included an electroencephalogram (EEG), measurements of interblinking time, and questionnaires. DED was simulated by suppressing blinking, while spontaneous blinking served as a control. Elements of concentration, stress, and alertness were extracted from the raw EEG waveforms and the values were compared during spontaneous and suppressed blinking. The relation with DED-related parameters was then explored. Written informed consent was obtained from all participants. Results: All participants successfully completed the experimental protocol. Concentration significantly decreased during suppressed blinking in 20 participants (80%), when compared with spontaneous blinking, whereas there were no or small differences in stress or alertness between spontaneous and suppressed blinking. The change in concentration was correlated with interblinking time (β = −0.515, p = 0.011). Conclusion: Loss of concentration was successfully captured in an objective manner using the EEG. The present study may enable us to understand how concentration is affected during blink suppression, which may happen in office work, particularly during computer tasks. Further study using detailed ocular evaluation is warranted to explore the effect of different interventions.

Influence of Sociodemographic Factors on Disease Characteristics and Vision-related Quality of Life in Primary Open-angle Glaucoma Patients: The Italian Primary Open Angle Glaucoma Study (IPOAGS)

PURPOSE

The purpose of this article was to evaluate the potential association between sociodemographic factors with clinical characteristics, vision-related quality of life (QoL), and glaucoma-related symptoms scores in a large cohort of primary open-angle glaucoma patients.

MATERIALS AND METHODS

Multicenter, cross-sectional study involving academic and nonacademic centers. Previously diagnosed primary open-angle glaucoma patients aged >18 years were enrolled. At baseline, information on demographic characteristics, social, medical and ocular history, clinical presentation and treatments was collected. Vision-related QoL was evaluated by means of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), while glaucoma-related symptoms were evaluated using the Glaucoma Symptom Scale (GSS) questionnaire. The associations between sociodemographic factors with clinical characteristics (mean deviation, pattern standard deviation, best-corrected visual acuity), NEI-VFQ-25, and GSS scores were evaluated by means of univariate and multivariate general linear models.

RESULTS

A total of 3227 patients were enrolled. Older age and male sex were significantly associated with lower mean deviation (P<0.01) and higher pattern standard deviation (P<0.01), whereas older age was associated with lower best-corrected visual acuity (P<0.01). The composite GSS score was related to age (P=0.02), sex (P<0.01), employment (P=0.01), and profession (P=0.04), while the total NEI-VFQ-25 score was associated with sex (P<0.01), marital status (P=0.02), and employment (P=0.02).

CONCLUSIONS

Age and sex were significantly associated with almost all indicators of glaucoma severity at baseline. Other variables, such as employment, profession, and marital status were significantly associated with vision-related QoL scores.

Total Tear IgE Levels Correlate with Allergenic and Irritating Environmental Exposures in Individuals with Dry Eye

Dry eye (DE) and allergic conjunctivitis may present similarly, and it remains unclear whether some individuals have an underlying allergic component to their DE. To better understand this relationship, we performed a cross-sectional study in 75 individuals with DE symptoms and/or signs. Immunoglobulin E (IgE) levels in tear samples were quantified and home environmental exposures assessed via standardized survey. Tears were collected by Schirmer strip, and total tear IgE levels were quantified using enzyme-linked immunosorbent assay (ELISA). Data were analyzed using descriptive statistics and linear and logistic regressions. The main outcome measures were total tear IgE levels and their association with environmental exposures. The mean age of the subjects was 66.2 ± 7.8 years. Sixty-two individuals had dry eye symptoms (Dry Eye Questionnaire-5 ≥ 6), and 75 had one or more signs of DE. Detectable total tear IgE levels were observed in 76% of subjects, and 17.3% had high levels (>1 ng/mL). Individuals with exposure to pet(s) (odds ratio (OR) 11.5, p = 0.002) and smoke (OR 38.6, p = 0.008) at home were more likely to have high IgE levels compared to those not exposed. Individuals with tears collected during spring or summer were 3.9 times (p = 0.028) more likely to have high IgE compared to those sampled at other times of year. Subjects born in the US were 3.45 times (p = 0.010) more likely to have high IgE compared to individuals born outside the US. To conclude, a majority of individuals with DE symptoms and/or signs had detectable IgE levels in their tears. High tear IgE levels were correlated with allergy season and exposures in the home linked with allergy.

Patient-reported severity of dry eye and quality of life in diabetes

Purpose

The purpose of the study was to assess the relationship between patient-reported severity of dry eye disease (DED), quality of life (QoL), presence of diabetic retinopathy (DR) and length of disease duration in people with type 1 diabetes mellitus (DM1) and type 2 diabetes mellitus (DM2).

Patients and methods

A survey of 152 people (110 with and 42 without diabetes). All participants completed the Ocular Surface Disease Index (OSDI) and Dry Eye-related Quality of Life Score (DEQS) questionnaires.

Results

Forty-four percent of all diabetic subjects reported dry eye symptoms, compared to 29% in the control group. Patients with DM2 reported dry eye symptoms more frequently than those with DM1 (55% and 27% respectively, P=0.001). Dry eye severity was linked to a significant deterioration in QoL in both types of diabetes (DM1, r=0.609 and P=0.036; DM2, r=0.417 and P=0.011). Irrespective of DR, the presence of DED was significantly higher in DM2 compared to DM1 (with DR, P=0.011; without DR, P=0.018).

Conclusion

Dry eye symptoms are associated with reduced QoL and are more common in people with DM2 than in DM1, irrespective of DR status. Routine clinical screening for severe DED could potentially allow for a timely and more effective treatment and could contribute to mitigating the dry eye-associated reduction in QoL in those with DM2.

Bioinspired hydrogels for drug-eluting contact lenses

Efficient ocular drug delivery that can overcome the challenges of topical application has been largely pursued. Contact lenses (CLs) may act as light-transparent cornea/sclera bandages for prolonged drug release towards the post-lens tear fluid, if their composition and inner architecture are fitted to the features of the drug molecules. In this review, first the foundations and advantages of using CLs as ocular drug depots are revisited. Then, pros and cons of common strategies to prepare drug-loaded CLs are analyzed on the basis of recent examples, and finally the main section focuses on bioinspired strategies that can overcome some limitations of current designs. Most bioinspired strategies resemble a reverse engineering process to create artificial receptors for the drug inside the CL network by mimicking the human natural binding site of the drug. Related bioinspired strategies are being also tested for designing CLs that elute comfort ingredients mimicking the blinking-associated renewal of eye mucins. Other bioinspired approaches exploit the natural eye variables as stimuli to trigger drug release or take benefit of bio-glues to specifically bind active components to the CL surface. Overall, biomimicking approaches are being revealed as valuable tools to fit the amounts loaded and the release profiles to the therapeutic demands of each pathology. STATEMENT OF SIGNIFICANCE: Biomimetic and bioinspired strategies are remarkable tools for the optimization of drug delivery systems. Translation of the knowledge about how drugs interact with the natural pharmacological receptor and about components and dynamics of anterior eye segment may shed light on the design criteria for obtaining efficient drug-eluting CLs. Current strategies for endowing CLs with controlled drug release performance still require optimization regarding amount loaded, drug retained in the CL structure during storage, regulation of drug release once applied onto the eye, and maintenance of CL physical properties. All these limitations may be addressed through a variety of recently growing bioinspired approaches, which are expected to pave the way of medicated CLs towards the clinics.

Effects of long-term computer use on eye dryness

OBJECTIVE:

To evaluate the effects of long-term computer use on tear production and evaporation.

METHODS:

In this study, 30 eyes of 30 people using computer for 8 hours a day were taken as the study group. In the control group, 30 eyes of 30 healthy individuals who did not spend 1 hour using computer on a daily basis were evaluated. The cases were examined at 8 am and 5 pm. The Schirmer test, tear break-up time (TBUT), and ocular surface disease index (OSDI) were evaluated.

RESULTS:

There was no significant difference between the groups in terms of age and gender. The Schirmer test results, which measure the parameters of tear production, were 16.80±2.04 and 15.50±2.06 mm (p>0.05) in the study group, and 17.28±1.52 and 17.16±2.53 in the control group. The TBUT measurements were 9.15±2.93 and 6.80±1.11 sec in the study group. It was observed that the evening TBUT decreased (p<0.05). The TBUT measurements were 15.80±3.15 sec and 15.20±1.92 sec (p>0.05) in the control group. The OSDI scores were 26.7±3.36 and 28.3±1.19 in the study group, and 25.0±4.48 and 27.3±2.27 in the control group.

CONCLUSION:

As a result, it was found that a long-term computer use did not change the Schirmer test results significantly, but there were statistically significant changes in the tear break-up time (TBUT) results of the evaporative type eye dryness. According the our study results, long-term computer usage may cause an evaporative-type dry eye disease.

Personal, Psychosocial and Environmental Factors Related to Sick Building Syndrome in Official Employees of Taiwan

Sick building syndrome (SBS) is a combination of symptoms that can be attributed to exposure to specific building conditions. The present study recruited 389 participants aged 20–65 years from 87 offices of 16 institutions to examine if personal factors, work-related psychosocial stress, and work environments, were associated with five groups of SBS symptoms, including symptoms for eyes, upper respiratory tract, lower respiratory tract, skin, and non-specific systems. Indoor environmental conditions were monitored. Data were analyzed using multivariate logistic regression (MLR) analyses and were reported as adjusted Odds Ratios (aOR). SBS symptoms for eyes were associated with older age, sensitivity to tobacco, and low indoor air flow. Upper respiratory symptoms were related to smoking, low social support, longer work days, and dry air. High indoor air flow was associated with reduced upper respiratory symptoms (aOR = 0.29; 95% confidence interval (CI) = 0.13–0.67). Lower respiratory symptoms were associated with high work pressure, longer work hours, chemical exposure, migraine, and exposure to new interior painting. Recent interior painting exposure was associated with a high estimated relative risk of low respiratory symptoms (aOR = 20.6; 95% CI = 2.96–143). Smoking, longer work days, low indoor air flow, indoor dryness, and volatile organics exposure, were associated with other non-specified symptoms including headache, tiredness, difficulty concentrating, anger, and dizziness. In conclusion, there are various SBS symptoms associated with different personal characteristics, psychosocial, and environmental factors. Psychosocial factors had stronger relationships with lower respiratory symptoms than with other types of SBS symptoms. Good ventilation could reduce risk factors and may relieve SBS symptoms.