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Lin MX, Guo L, Saldanha IJ, VanCourt S, Zeng J, Karakus S, Hessen M, Li G, Akpek EK. Dexamethasone Intracanalicular Insert for Clinically Significant Aqueous-Deficient Dry Eye: A Randomized Controlled Trial. Ophthalmology 2024:S0161-6420(24)00186-6. [PMID: 38492864 DOI: 10.1016/j.ophtha.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
PURPOSE To evaluate a commercially available dexamethasone intracanalicular insert to treat dry eye. DESIGN Single-center, double-masked randomized controlled trial. PARTICIPANTS Patients with clinically significant aqueous-deficient dry eye (combined ocular surface staining score, ≥ 3 [0-12]; corneal fluorescein staining score, ≥ 2 [0-6]; and Schirmer's wetting, < 10 mm at 5 minutes in both eyes) with symptoms (dryness, eye discomfort, or visual fatigue, ≥ 30 [0-100]) despite treatment with at least 1 prescription drop and deemed candidates for topical steroid therapy. METHODS Seventy-five adult patients were enrolled. A 1:1 randomization sequence was used to determine which eye of each patient would receive the treatment (dexamethasone 0.4-mg intracanalicular insert with 30-day elution time) or sham (collagen plug). The fellow eye received the opposite treatment. Patients were masked to treatment assignment. Follow-up visits (at weeks 2, 4, and 6) were performed by a masked investigator. MAIN OUTCOME MEASURES Dry eye parameters and patient symptoms were used for efficacy, and intraocular pressure (IOP) was used for safety assessment. RESULTS The severity of dry eye was comparable between the treatment arms (fellow eyes) at baseline. Eyes that received the dexamethasone insert showed significantly less corneal staining at week 4 (mean difference [MD], -0.55; 95% confidence interval [CI], -0.91 to -0.19) and conjunctival staining at week 4 (MD, -0.68; 95% CI, -1.05 to -0.30) and week 6 (MD, -0.34; 95% CI, -0.65 to -0.02). Schirmer's wetting was comparable between the two treatment arms. Although the patients reported less dryness in eyes that received the insert at week 4 (MD, -5.5; 95% CI, -11.4 to 0.4), no statistically significant differences were found in any patient-reported symptoms. At week 4, dexamethasone-treated eyes were more likely to show an IOP increase (by 5-10 mmHg; 9 eyes vs. 1 eye; relative risk, 9.00; 95% CI, 1.14-71.0). All cases of increased IOP were managed with short-term topical β-blockers and subsided. CONCLUSIONS The dexamethasone intracanalicular insert may be considered a dropless dual treatment for clinically significant aqueous-deficient dry eye when topical steroid treatment is deemed appropriate. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Michael X Lin
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland; University of Maryland School of Medicine, Baltimore, Maryland
| | - Lee Guo
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian J Saldanha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shanna VanCourt
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Zeng
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Stritch School of Medicine, Loyola University, Chicago, Illinois
| | - Sezen Karakus
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Hessen
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gavin Li
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Icahn School of Medicine at Mount Sinai, New York, New York
| | - Esen K Akpek
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Akpek EK. Cornea Classic: "Grading of Corneal and Conjunctival Staining in the Context of Other Dry Eye Tests," Bron, Evans, and Smith, 2003. Cornea 2023:00003226-990000000-00398. [PMID: 37905990 DOI: 10.1097/ico.0000000000003411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/17/2023] [Indexed: 11/02/2023]
Abstract
ABSTRACT Dry eye is an increasingly common ocular condition with significant impact on quality of life due to eye discomfort and blurred vision complaints. In addition, the financial burden of dry eye on both patients and society is substantial. Although there has been a recent explosion of research in the field since 2002 with the approval of the first prescription topical treatment (Restasis, Allergan Inc, Irvine CA), dry eye lags behind other ophthalmic conditions where clinically meaningful outcome measures are closely tied with the metrics by which their therapeutics are evaluated. Unfortunately, current practice is such that physicians largely rely on patient symptoms to evaluate dry eye, and these do not always correlate with objective ocular surface and tear film parameters. In patients with severe dry eye, the patient-reported symptoms are likely dampened because of the neurotrophic state of the ocular surface, which accompanies any long-standing inflammatory ocular condition. Therefore, staining of the corneal and conjunctival surface using vital dyes is an invaluable dry eye test to provide information normally not visible during routine slit-lamp examination. The landmark article by Bron, Evans, and Smith published in Cornea in 2003 provides excellent guidance to clinicians to highlight and quantify ocular surface parameters in patients with dry eye. Validation studies correlating conjunctival or corneal staining with tangible quality-of-life parameters and metrics to measure those are needed to verify ocular surface staining as a clinically meaningful dry eye outcome to be used in clinical practice and clinical trials.
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Affiliation(s)
- Esen Karamursel Akpek
- The Ocular Surface Disease Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Sánchez-González JM, Silva-Viguera C, Sánchez-González MC, Capote-Puente R, De-Hita-Cantalejo C, Ballesteros-Sánchez A, Ballesteros-Durán L, García-Romera MC, Gutiérrez-Sánchez E. Tear Film Stabilization and Symptom Improvement in Dry Eye Disease: The Role of Hyaluronic Acid and Trehalose Eyedrops versus Carmellose Sodium. J Clin Med 2023; 12:6647. [PMID: 37892784 PMCID: PMC10607763 DOI: 10.3390/jcm12206647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
This study evaluated the effectiveness of hyaluronic acid and trehalose (HA/trehalose) eyedrops in managing dry eye disease (DED) symptoms by measuring tear stability and administering a DED questionnaire. Sixty patients were treated with either HA/trehalose eyedrops (Tear A) or carmellose sodium eyedrops (Tear B) as controls. The tear breakup time (TBUT) and non-invasive breakup time (NIBUT) were monitored, and patients completed the standard patient evaluation of eye dryness (SPEED) questionnaire. After two months of twice-daily applications, patients treated with the HA/trehalose eyedrops demonstrated significant improvements in the NIBUT (12.98 ± 3.22 s) and TBUT (12.95 ± 2.98 s), indicating increased tear stability. Moreover, they reported lower dry eye sensation (6.70 ± 4.94 SPEED score points), suggesting a reduction in DED symptoms. These findings underscore the efficacy of HA/trehalose eyedrops in improving both the objective and subjective signs of DED, with twice-daily application enhancing ocular surface conditions and reducing patient-reported symptoms.
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Affiliation(s)
- José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group (CIVIUS), Pharmacy School, University of Seville, 41012 Seville, Spain
| | - Carmen Silva-Viguera
- Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group (CIVIUS), Pharmacy School, University of Seville, 41012 Seville, Spain
| | - María Carmen Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group (CIVIUS), Pharmacy School, University of Seville, 41012 Seville, Spain
| | - Raúl Capote-Puente
- Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group (CIVIUS), Pharmacy School, University of Seville, 41012 Seville, Spain
| | - Concepción De-Hita-Cantalejo
- Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group (CIVIUS), Pharmacy School, University of Seville, 41012 Seville, Spain
| | - Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group (CIVIUS), Pharmacy School, University of Seville, 41012 Seville, Spain
| | - Lydia Ballesteros-Durán
- Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group (CIVIUS), Pharmacy School, University of Seville, 41012 Seville, Spain
| | - Marta-C García-Romera
- Department of Physics of Condensed Matter, Optics Area, Vision Sciences Research Group (CIVIUS), Pharmacy School, University of Seville, 41012 Seville, Spain
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Cui D, Mathews PM, Li G, Guo L, VanCourt S, Saldanha IJ, Karamursel Akpek E. Racial and Ethnic Disparities in Dry Eye Diagnosis and Care. Ophthalmic Epidemiol 2023; 30:484-491. [PMID: 36200798 DOI: 10.1080/09286586.2022.2131834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 07/10/2022] [Accepted: 09/26/2022] [Indexed: 10/10/2022]
Abstract
PURPOSE To investigate health disparities in racial and ethnic minorities with dry eye. METHODS Medical records were reviewed for demographics, socioeconomic factors, treatments, and objective dry eye parameters. Race/ethnicity was self-reported as delineated by the U.S. Census. The reference group comprised of randomly selected White patients, with number equal to the largest minority group. RESULTS The study included 465 patients (157 Black, 157 White, 85 Asian, and 66 Hispanic). Compared to White (3.2%) patients, larger proportion of minorities used Medicaid or lacked health insurance (Black 8.3%, P = .054; Asian 10.6%, P = .019; Hispanic 18.2%, P < .001). Black and Hispanic patients had lower estimated median household income than Whites (White $98,472, Black $75,554, P < .001; Asian $105,503, P = .088; Hispanic $86,839, P = .030). Prior to presentation, fewer minority patients received prescription treatments or procedures (White 61.8%; Black 30.6%, P < .001; Asian 43.5%, P = .006; Hispanic 43.9%, P = .014). Although at baseline visit minorities had worse mean conjunctival (White, 1.7; Black 2.2, P = .136, Asian 2.4, P = .022; Hispanic 2.6, P = .005) and corneal staining scores (White, 1.6; Black 2.5, P < .001; Asian 2.3, P = .003; Hispanic 2.4, P = .001), no differences were noted at final visit. CONCLUSION Minorities presented with worse objective dry eye parameters, and less prior dry eye care. Income and health care access may not fully explain the observed undertreatment at presentation. Differential management by eye care providers and patient attitudes warrant further investigation.
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Affiliation(s)
- David Cui
- The Ocular Surface Disease Clinic, the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- The Krieger Eye Institute of Sinai Hospital, Baltimore, Maryland, USA
| | - Priya M Mathews
- The Ocular Surface Disease Clinic, the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gavin Li
- The Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lee Guo
- The Ocular Surface Disease Clinic, the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shanna VanCourt
- The Ocular Surface Disease Clinic, the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Esen Karamursel Akpek
- The Ocular Surface Disease Clinic, the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ren X, Wang Y, Wu T, Jing D, Li X. Binocular dynamic visual acuity in dry eye disease patients. Front Neurosci 2023; 17:1108549. [PMID: 36968505 PMCID: PMC10030492 DOI: 10.3389/fnins.2023.1108549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/17/2023] [Indexed: 03/10/2023] Open
Abstract
PurposeTo investigate binocular dynamic visual acuity (DVA) for patients with dry eye disease (DED).MethodsThe prospective study included DED patients. The binocular DVA at 40 and 80 degrees per second (dps), Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), tear film break-up time first (TBUTF), corneal fluorescein staining (CFS), eyelid margin abnormalities and meibomian gland (MG) abnormalities morphology and function were evaluated. A deep learning model was applied to quantify the MG area proportion. The correlation between DVA and DED parameters was analyzed.ResultsA total of 73 DED patients were enrolled. The age, OSDI, CFS, MG expressibility, secretion quality, and eyelid margin abnormalities were significantly positively correlated with the DVA for 40 and 80 dps (all P < 0.05). The MG area proportion in the upper eyelid was negatively correlated with DVA at 40 dps (R = −0.293, P < 0.001) and at 80 dps (R = −0.304, P < 0.001). Subgroup analysis by MG grade demonstrated that the DVA of patients with severe MG dropout (<25% of the total area) was significantly worse than other mild and moderate groups, both in 40 and 80 dps (all P < 0.05). The patients with CFS showed worse 40 (P < 0.001) and 80 dps (P < 0.001) DVA than the patients without CFS.ConclusionBinocular DVA is significantly associated with DED symptoms and signs. The DED patients with CFS and severe MG dropout and dysfunction have worse DVA.
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Hirabayashi MT, Barnett BP. Solving STODS-Surgical Temporary Ocular Discomfort Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13050837. [PMID: 36899981 PMCID: PMC10000827 DOI: 10.3390/diagnostics13050837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 02/24/2023] Open
Abstract
The term STODS (Surgical Temporary Ocular Discomfort Syndrome) has been coined to describe the ocular surface perturbations induced by surgery. As one of the most important refractive elements of the eye, Guided Ocular Surface and Lid Disease (GOLD) optimization is fundamental to success in achieving refractive outcomes and mitigating STODS. Effective GOLD optimization and the prevention/treatment of STODS requires an understanding of the molecular, cellular, and anatomic factors that influence ocular surface microenvironment and the associated perturbations induced by surgical intervention. By reviewing the current understanding of STODS etiologies, we will attempt to outline a rationale for a tailored GOLD optimization depending on the ocular surgical insult. With a bench-to-bedside approach, we will highlight clinical examples of effective GOLD perioperative optimization that can mitigate STODS' deleterious effect on preoperative imaging and postoperative healing.
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Affiliation(s)
- Matthew T. Hirabayashi
- Department of Ophthalmology, University of Missouri School of Medicine, 1 Hospital Dr, Columbia, MO 65212, USA
| | - Brad P. Barnett
- California LASIK & Eye, 1111 Exposition Blvd. Bldg. 200, Ste. 2000, Sacramento, CA 95815, USA
- Correspondence:
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Sánchez-Brau M, Seguí-Crespo M, Cantó-Sancho N, Tauste A, Ramada JM. What Are the Dry Eye Questionnaires Available in the Scientific Literature Used for? A Scoping Review. Am J Ophthalmol 2023; 246:174-191. [PMID: 36336073 DOI: 10.1016/j.ajo.2022.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE Dry eye disease (DED) is a frequent chronic ophthalmic condition. Its diagnosis includes tests and patient reported outcomes (PRO) questionnaires. Although many PRO dry eye questionnaires (PRO-DEQs) are available, they differ greatly from each other and not all have been validated. The purpose of this study was to retrieve the PRO-DEQs present in the scientific literature by performing a descriptive analysis of them and identifying those with known validity and reliability characteristics and to perform a descriptive analysis of the geographic area, year of publication, and characteristics of the target population of the clinical studies that have used validated PRO-DEQs. DESIGN Scoping review of the literature. METHODS Searches were conducted in PubMed to retrieve PRO-DEQs published up to July 2018 and written in English, French, Italian or Spanish. RESULTS One thousand six hundred two records were identified and 973 were included in the final analysis. Of these, 56 provided information on the design and validation of PRO-DEQs and 49 PRO-DEQs were identified. Twenty-two PRO-DEQs were validated (17 original and 5 modified) and 27 had no associated design, validity, and reliability studies. Most of the validated PRO-DEQs were designed in English, the number of items varies from 1 to 57, the dimensions are generally not specified, and they are self-administered. The greatest use of validated PRO-DEQs in clinical studies has been in Asia since 2010, with the Ocular Surface Disease Index being the most used. These questionnaires have been used mostly in adults, retired professionals, and people with visual diseases to diagnose DED. CONCLUSIONS This study aims to encourage the use of validated PRO-DEQs to guarantee the quality of the results obtained and the comparability and replicability among studies.
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Affiliation(s)
- Mar Sánchez-Brau
- Doctoral Programme in Health Sciences (M.S-B., N.C-S.), University of Alicante, San Vicente del Raspeig, Spain
| | - Mar Seguí-Crespo
- Department of Optics, Pharmacology and Anatomy (M.S-C., N.C-S.), University of Alicante, San Vicente del Raspeig, Spain; Public Health Research Group (M.S-C.), University of Alicante, San Vicente del Raspeig, Spain.
| | - Natalia Cantó-Sancho
- Doctoral Programme in Health Sciences (M.S-B., N.C-S.), University of Alicante, San Vicente del Raspeig, Spain; Department of Optics, Pharmacology and Anatomy (M.S-C., N.C-S.), University of Alicante, San Vicente del Raspeig, Spain
| | - Ana Tauste
- Department of Optics, Optometry and Vision Sciences (A.T.), University of Valencia, Valencia, Spain
| | - José María Ramada
- Institut Hospital del Mar d'Investigacions Mèdiques (J.M.R.), Barcelona, Spain; CIBER of Epidemiology and Public Health (J.M.R.), Madrid, Spain
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Difficulties in Performing Daily Activities in Patients with Dry Eye before and after Treatment. Medicina (B Aires) 2022; 59:medicina59010025. [PMID: 36676649 PMCID: PMC9861134 DOI: 10.3390/medicina59010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/24/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
Dry eye disease (DED) represents an important public health problem causing visual discomfort which affects the quality of life. This paper investigates the current comprehension of DED on life quality and vision. METHODS This research consists of a cross-sectional study of 121 patients, with a mean age of 70 ± 9 years, diagnosed with DED. All patients were treated in the University Clinic for Ophthalmology in "St. Spiridon" Emergency Hospital, Iasi. For all patients, we evaluated visual acuity on the Snellen chart, tear breakup time (TBUT), Schirmer I test scores, and contrast sensitivity. For this study, we used the Visual Functioning Questionnaire-25 (VFQ-25) version 2000, modified and adapted for this research (19 items). RESULTS Prior to treatment, patients had very high difficulty reading a text in a newspaper or on TV, reading prices on products in shops, or recognizing people they already met. Performing manual work or favorite activities was also very difficult. Post-treatment visual challenges improved in the majority of cases, regardless of the treatment method used. CONCLUSIONS We found that symptomatic dry eye disease was associated with reduced ability in performing several important vision-related daily tasks and has a significant impact on life quality and visual performance.
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Soifer M, Azar NS, Mousa HM, Perez VL. Ocular Surface Inflammatory Disorders (OSID): A Collective of Systemic Etiologies Which Cause or Amplify Dry Eye Syndrome. Front Med (Lausanne) 2022; 9:949202. [PMID: 35872765 PMCID: PMC9301237 DOI: 10.3389/fmed.2022.949202] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/20/2022] [Indexed: 11/16/2022] Open
Abstract
The ocular surface inflammatory disorders (OSID) are caused by systemic disorders that conduct a persistent inflammatory reaction in the ocular adnexal connective tissues, such as the conjunctiva, lacrimal gland (LG) and meibomian glands (MGs), which cause an inflammatory dry eye. The etiologies of OSID are a subset of systemic pathologies such as graft versus host disease, Sjögren’s syndrome, allergies, cicatrizing conjunctivitis, and more. These cause a purely inflammatory dry eye syndrome as a consequence of the persistent surrounding inflammation in the adnexal tissues, which is distinct from the age-related dry eye disease. A limitation toward management of these conditions is the lack of available biomarkers that can detect presence of inflammation and quantify damage on the conjunctiva and LG, even though these are considered to be drivers of the inflammatory milieu. The OSID and dry eye syndrome are caused by different immune cells which are not exclusively limited to T cell lymphocytes, but rather derive from an orchestrated multicellular immunologic response. Recognition of this syndrome is crucial to direct research in a direction that clarifies the potential role of inflammation and its associated immune phenotype on the conjunctiva and adnexal ocular tissues in OSID and dry eye syndrome. On this paper, we review the basic and clinical research evidence for the existence of OSID with focus on the different immune cells involved, the target tissues and potential consequences and OSIDs diagnostic and therapeutic implications.
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Affiliation(s)
- Matias Soifer
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Nadim S. Azar
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Hazem M. Mousa
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
| | - Victor L. Perez
- Foster Center for Ocular Immunology, Duke Eye Institute, Durham, NC, United States
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States
- *Correspondence: Victor L. Perez,
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Camp AS, Long CP, Galor A, Yamane M, Proudfoot JA, Weinreb RN. Dry Eye Symptom Severity and Visual Field Reliability Metrics. J Glaucoma 2022; 31:305-309. [PMID: 35302539 PMCID: PMC9050914 DOI: 10.1097/ijg.0000000000002017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
PRCIS Tracking failure frequency (TFF) increases with dry eye symptom severity and in the left eye. PURPOSE Symptoms of dry eye disease are commonly encountered in glaucoma patients and can be exacerbated by topical glaucoma medications. Dry eye disease may influence the reliability of visual field (VF) tests and impact the accurate interpretation of the results. PATIENTS AND METHODS Patients at the Veterans Administration Medical Center San Diego completed the 5-item Dry Eye Questionnaire before VF testing between December 2018 and February 2019. VF reliability metrics were recorded for each patient. Standard reliability metrics included fixation losses, false positive, and false negative rates. Gaze tracking (GT) metrics included percent of stimuli with gaze deviations between 1 and 2 degrees, 3 and 5 degrees, 6 degrees or greater, and percent of stimuli with tracking failure (TFF). The use of glaucoma medications and artificial tears was also recorded. RESULTS A total of 494 patients completed the 5-item Dry Eye Questionnaire and VF testing. There was no association between dry eye symptom severity and standard reliability metrics or most GT metrics. However, TFF increased as dry eye symptom severity increased (P=0.015). TFF was also greater in the left eye, which was tested second (P=0.012); no other reliability metrics were related to laterality. Patients were more likely to use artificial tears with increased dry eye symptom severity (P<0.001), but there was no relationship between symptom severity and glaucoma medication use. DISCUSSION Dry eye symptom severity may influence the acceptable range or threshold of TFF when using GT metrics to determine VF reliability. Likewise, the acceptable range or threshold for TFF may be different between eyes.
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Affiliation(s)
- Andrew S Camp
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, San Diego, CA
| | - Christopher P Long
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, San Diego, CA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL
| | - Maya Yamane
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, San Diego, CA
| | - James A Proudfoot
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, San Diego, CA
| | - Robert N Weinreb
- Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, San Diego, CA
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AS-OCT and Ocular Hygrometer as Innovative Tools in Dry Eye Disease Diagnosis. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Dry eye disease (DED) is one of the conditions that most commonly leads patients to visit an ophthalmologist. Fast and accurate diagnosis relieves patient discomfort and spares them from long-term effects on the ocular surface. Many tests used in the diagnosis of DED may be considered subjective as they rely on an experienced observer for image interpretation, resulting in variations in diagnosis. On one hand, the non-contact nature of the anterior segment optical coherence tomography (AS-OCT) device and its rapid image acquisition enable the measurement of the tear meniscus parameter without reflex tearing. On the other hand, an ocular hygrometer allows a rapid, safe, but also efficient, analysis and is associated with low costs and the repeatability of the procedure.
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Hirabayashi KJ, Akpek EK, Ahmad S. Outcome Measures to Assess Dry Eye Severity: A Review. Ocul Immunol Inflamm 2022; 30:282-289. [PMID: 35113753 DOI: 10.1080/09273948.2022.2027461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Outcome measures used to assess efficacy of dry eye therapeutics have not been consistently applied in clinical settings, nor have they been shown to correlate with functional outcomes. We propose that corneal staining, a clinically meaningful dry eye parameter, should be used as a standard objective outcome measure across all clinical trials evaluating dry eye treatments. We justify this based on evidence regarding its relationship to vision and vision related quality-of-life. In addition, corneal staining has been shown to correlate with ocular surface inflammation, a well elucidated aspect of dry eye pathophysiology and an active area in therapeutics research. No one outcome measure explored herein correlates perfectly to this heterogenous disease. However, there is mounting evidence showing the correlation between corneal staining and functional visual indices. We hope that future clinical trials will standardize corneal staining as a measure to determine the efficacy of interventions and justify their clinical utility.
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Affiliation(s)
- Kyle J Hirabayashi
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Esen K Akpek
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sumayya Ahmad
- New York Eye and Ear Infirmary of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Cui D, Mathews P, Li G, VanCourt S, Akpek E. Outcomes of Sjögren's versus non-Sjögren's related dry eye in a longitudinal, tertiary clinic-based sample. PLoS One 2021; 16:e0261241. [PMID: 34919587 PMCID: PMC8682907 DOI: 10.1371/journal.pone.0261241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the long-term treatment outcomes of dry eye in patients with and without underlying primary Sjögren’s syndrome (SS). Design Retrospective longitudinal cohort. Methods SS and non-SS dry eye patients with clinic visits for a minimum of 5 consecutive years at a tertiary, dedicated dry eye clinic were included. Electronic health records were reviewed to collect data regarding demographics, objective dry eye parameters, treatments utilized at baseline and final visit, and corneal complications observed during follow-up. Results Two hundred and two patients (101 SS and 101 randomly selected non-SS), with a mean follow-up of 7.1 years were included. At baseline, mean conjunctival lissamine green staining score was 2.9 and mean corneal fluorescein staining score was 2.0. At last visit, notable improvement in staining score for cornea (–1.1, P < .001) and conjunctiva (–1.8, P < .001) was seen equally in both dry eye groups. Most patients (88.1%) had an escalation of treatment by the final visit, with similar rates in both groups (P = .51). Half (48.9%) of the patients had no conjunctival staining, and a third (34.4%) had no corneal staining at their last visit. Twenty (9.9%) patients experienced a vision-threatening corneal complication, including ulcers and melt, with no difference in occurrences between the groups (P = .64). Conclusions The majority of patients in this longitudinal, tertiary clinic-based sample demonstrated improvement in their ocular surface staining score by the final visit with escalation in treatment. Treatments used, improvement achieved, and corneal complication rates leading to loss of vision were similar in both SS and non-SS dry eye groups.
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Affiliation(s)
- David Cui
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Priya Mathews
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Gavin Li
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Shanna VanCourt
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Esen Akpek
- Ocular Surface Disease and Dry Eye Clinic, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
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14
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Bakkar MM, El-Sharif AK, Al Qadire M. Validation of the Arabic version of the Ocular Surface Disease Index Questionnaire. Int J Ophthalmol 2021; 14:1595-1601. [PMID: 34667738 DOI: 10.18240/ijo.2021.10.18] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/17/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- May M Bakkar
- Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Ahmad K El-Sharif
- Department of English Language and Literature, Faculty of Arts and Humanities, Al Al-Bayt University, Mafraq 25113, Jordan
| | - Mohammad Al Qadire
- Department of Adult Health, Faculty of Nursing, Al Al-Bayt University, Mafraq 25113, Jordan.,College of Nursing, Sultan Qaboos University, Muscat 123, Oman
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15
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Abstract
PURPOSE OF REVIEW Ocular surface disease is a prevalent, diverse group of conditions that cause patient discomfort and decreased visual acuity and present considerable expense to both patients and healthcare systems. Autologous serum eye drops are a topical treatment modality derived from the patient's own blood. Use of serum eye drops for ocular surface disease has been promising due to biochemical similarities to endogenous tears. RECENT FINDINGS Use of serum eye drops for moderate to severe ocular surface diseases such as dry eye, corneal epithelial defects, and inflammatory conditions has become more prevalent. Recent studies have demonstrated that the use of serum eye drops is well-tolerated by patients and associated with improvement in patient-reported outcomes and objective dry eye parameters. Production of serum eye drops may vary, treatment costs can be significant, and the quality of evidence for serum eye drop use published from randomized controlled trials is modest, particularly for long-term treatment. Accessibility remains an area for improvement and may be complemented by allogeneic serum eye drops. SUMMARY Serum eye drops are frequently used as a safe, well-tolerated, and effective treatment for ocular surface disease. Further research is needed to assess long-term outcomes and improve accessibility.
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16
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Sheppard JD, Wirta DL, McLaurin E, Boehmer BE, Ciolino JB, Meides AS, Schlüter T, Ousler GW, Usner D, Krösser S. A Water-free 0.1% Cyclosporine A Solution for Treatment of Dry Eye Disease: Results of the Randomized Phase 2B/3 ESSENCE Study. Cornea 2021; 40:1290-1297. [PMID: 34481407 PMCID: PMC8423142 DOI: 10.1097/ico.0000000000002633] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/09/2020] [Accepted: 10/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the efficacy, safety, and tolerability of a topical water-free cyclosporine A formulation (CyclASol 0.1% ophthalmic solution) in comparison with vehicle for the treatment of dry eye disease (DED). METHODS Three hundred twenty-eight patients were enrolled in this prospective, 12-week, multicenter, randomized, double-masked, confirmatory, vehicle-controlled clinical study. After a 2-week run-in period, eligible DED patients were randomized 1:1 to either CyclASol 0.1% or vehicle twice daily. The primary efficacy endpoint was change from baseline in total corneal fluorescein staining (National Eye Institute scale), and the second hierarchical primary efficacy endpoint was change from baseline in the Ocular Surface Disease Index score, both at 4 weeks. Secondary efficacy and safety assessments included conjunctival lissamine green staining (Oxford scale), visual analog scales for dry eye symptoms, and adverse event. RESULTS Treatment with CyclASol 0.1% was superior to vehicle in the primary endpoint: total corneal fluorescein staining at week 4 (Δ -0.8; 95% confidence interval, -1.3 to -0.4; P = 0.0002, analysis of covariance). This difference had already reached statistical significance after 2 weeks and was maintained throughout the study. The study did not statistically meet its second hierarchically tested primary endpoint: Ocular Surface Disease Index score (P = 0.2634). However, CyclASol 0.1% treatment showed statistically significant improvement compared with that of vehicle in the eye dryness score at week 4 (Δ -4.783; 95% confidence interval, -9.129 to -0.438; P = 0.0311). CONCLUSIONS CyclASol 0.1% was effective in treating signs and symptoms of DED. It significantly reduced corneal and conjunctival staining and improved ocular dryness compared with vehicle. CyclASol 0.1% was safe and showed excellent tolerability.
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Affiliation(s)
| | | | | | | | - Joseph B. Ciolino
- Massachusetts Eye and Ear Infirmary/Harvard Medical School, Boston, MA
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17
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Gao Y, Liu R, Liu Y, Ma B, Yang T, Hu C, Qi H. Optical quality in patients with dry eye before and after treatment. Clin Exp Optom 2021; 104:101-106. [PMID: 32618024 DOI: 10.1111/cxo.13111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
CLINICAL RELEVANCE Dry eye disease could result in vision-related subjective symptoms even in patients with good best-corrected visual acuity. The standard deviation of corneal power and the surface asymmetry index could be indicators of treatment efficacy in dry eye. BACKGROUND Few studies have examined changes in optical quality before and after dry eye treatment. Here, we evaluated changes in optical quality in patients with dry eye before and after treatment and identified potential indicators of dry eye-treatment efficacy. METHODS Twenty-five right eyes of 25 untreated patients with dry eye were included. The same ocular-surface and optical-quality examinations were performed before and after two-weeks of treatment with hyaluronate in conjunction with fluorometholone eye drops. The Ocular Surface Disease Index, tear film break-up time, and corneal fluorescein staining were measured. Contrast sensitivity was used to measure resolution capability, the double-pass Optical Quality Analysis System to examine the modulation transfer function, Strehl ratio, and objective scattering index, and OPD Scan III to measure anterior corneal aberrations over 4-mm analytical zones including total corneal and high-order aberrations. The standard deviation of corneal power, surface regularity index, and surface asymmetry index were also measured. Paired sample t-tests and Spearman's correlations were used for the analyses. RESULTS The Ocular Surface Disease Index, tear film break-up time, and corneal fluorescein staining improved after two weeks of treatment. Contrast sensitivity in photopic, photopic with glare, scotopic, and scotopic with glare conditions all improved (p < 0.05), as did the modulation transfer function, Strehl ratio, and objective scattering index (p = 0.001, p = 0.008, and p = 0.001, respectively). Total corneal aberrations and the surface regularity index did not significantly differ before and after treatment; corneal high-order aberrations, standard deviation of corneal power, and the surface asymmetry index significantly improved after treatment (p = 0.045, p = 0.019, and p = 0.049, respectively). Changes in standard deviation of corneal power and in surface asymmetry index correlated with change in corneal fluorescein staining (p = 0.006 and p = 0.007, respectively). CONCLUSION Optical quality in patients with dry eye improved after treatment. The standard deviation of corneal power and surface asymmetry index could be indicators of treatment efficacy in dry eye.
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Affiliation(s)
- Yufei Gao
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Rongjun Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Yiyun Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Baikai Ma
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Tingting Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
| | - Chenxi Hu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, China
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18
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Al-Mohtaseb Z, Schachter S, Shen Lee B, Garlich J, Trattler W. The Relationship Between Dry Eye Disease and Digital Screen Use. Clin Ophthalmol 2021; 15:3811-3820. [PMID: 34531649 PMCID: PMC8439964 DOI: 10.2147/opth.s321591] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Zaina Al-Mohtaseb
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA
| | - Scott Schachter
- Presbyopia and Ocular Surface Disease, Allergan, an AbbVie Company, Irvine, CA, USA
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19
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Saldanha IJ, Petris R, Makara M, Channa P, Akpek EK. Impact of the COVID-19 pandemic on eye strain and dry eye symptoms. Ocul Surf 2021; 22:38-46. [PMID: 34133976 PMCID: PMC8462938 DOI: 10.1016/j.jtos.2021.06.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/03/2021] [Accepted: 06/03/2021] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice (Primary), Department of Epidemiology (Secondary), Brown University School of Public Health, Providence, RI, USA.
| | | | - Matthew Makara
- Director of Research and Scientific Affairs, Sjögren's Foundation Reston, Virginia, USA.
| | - Prabjot Channa
- Department of Ophthalmology, Brown University Warren Alpert Medical School, Providence, RI, USA.
| | - Esen K Akpek
- Ocular Surface Disease Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine Baltimore, Maryland, USA.
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20
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Messmer EM. Funktionelle Sehschärfe beim Trockenen Auge. SPEKTRUM DER AUGENHEILKUNDE 2021. [DOI: 10.1007/s00717-021-00489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungDas Trockene Auge führt häufig zu Sehstörungen trotz guter Sehleistung in der Standardvisusprüfung. Die Beschwerden treten meist beim Lesen, Arbeiten am Computer und/oder beim Autofahren auf. Grund ist die schlechte optische Qualität der Augenoberfläche beim Trockenen Auge mit Zunahme von topometrischer Irregularität und Asymmetrie, Anstieg des irregulären Astigmatismus, Zunahme der kornealen und okulären Aberrationen höherer Ordnung, Abnahme der Kontrastsensitivität und Zunahme der Lichtstreuung. Die funktionelle Sehschärfe repräsentiert die Visusfunktion im Zeitverlauf und reflektiert die Visusleistung eines Individuums bei täglichen Aktivitäten. Sie ist beim Trockenen Auge signifikant reduziert im Vergleich zu Normalprobanden. Eine Vielzahl von Testmethoden zur Evaluierung der funktionellen Sehschärfe wurde beschrieben. Kein Verfahren hat sich bisher in der täglichen Praxis durchgesetzt.
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21
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Guo OD LW, Akpek E. The negative effects of dry eye disease on quality of life and visual function. Turk J Med Sci 2020; 50:1611-1615. [PMID: 32283910 PMCID: PMC7672346 DOI: 10.3906/sag-2002-143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/12/2020] [Indexed: 02/04/2023] Open
Abstract
In recent years, dry eye has become a hot topic within ophthalmology and optometry, especially in regards to new frontiers in treatment modalities which include novel devices, procedures, and medications. However, some of the more understudied areas in dry eye involve its impact on quality of life. Although ocular discomfort symptoms are well known to be associated with dry eye, its negative effects on visual function remain underrecognized. This paper reviews these topics within the currently published literature to heighten awareness among clinicians.
Key Words: D
ry eye, quality of life, visual function, functional visual acuity, patient questionnaire, OSDI, SPEED, SANDE, IDEEL, NEI VFQ-25
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Affiliation(s)
- Lee W Guo OD
- Department of Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Esen Akpek
- Department of Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
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22
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Affiliation(s)
- Ian J. Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
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23
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Idarraga MA, Guerrero JS, Mosle SG, Miralles F, Galor A, Kumar N. Relationships Between Short-Term Exposure to an Indoor Environment and Dry Eye (DE) Symptoms. J Clin Med 2020; 9:E1316. [PMID: 32370240 PMCID: PMC7290742 DOI: 10.3390/jcm9051316] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/21/2020] [Accepted: 04/26/2020] [Indexed: 01/05/2023] Open
Abstract
Air composition influences Dry Eye (DE) symptoms as demonstrated by studies that have linked the outdoor environment to DE. However, there is insufficient data on the effect of short-term exposure to indoor environments on DE symptoms. We conducted a prospective experimental research, in which an older building served as an experimental site, and a newer building served as the control site. Indoor air quality was monitored in both buildings. One-hundred-and-ninety-four randomly selected individuals were interviewed in the afternoon exiting the buildings and de-identified responses were recorded. Self-reported DE symptoms were modeled with respect to experimental and control buildings, adjusting for potential confounders. The experimental site had 2-fold higher concentration of airborne particulate matter (24,436 vs. 12,213 ≥ 0.5 µm/ft3) and microbial colonies (1066 vs. 400/m3), as compared to the control building. DE symptoms were reported by 37.5% of individuals exiting the experimental and 28.4% exiting the control building. In the univariate analysis, subjects exiting the experimental building were 2.21× more likely to report worsening of DE symptoms since morning compared to the control building (p < 0.05). When adjusting for confounders, including a history of eye allergy, subjects from the experimental building were 13.3× more likely to report worsening of their DE symptoms (p < 0.05). Our findings suggest that short-term exposure to adverse indoor environmental conditions, specifically air pollution and bioaerosols, has an acutely negative impact on DE symptoms.
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Affiliation(s)
- Maria A. Idarraga
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA; (M.A.I.); (J.S.G.)
| | - Juan S. Guerrero
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA; (M.A.I.); (J.S.G.)
| | - Samantha G. Mosle
- Environmental Health Division, University of Miami, Miami, FL 33136, USA; (S.G.M.); (F.M.); (N.K.)
| | - Frank Miralles
- Environmental Health Division, University of Miami, Miami, FL 33136, USA; (S.G.M.); (F.M.); (N.K.)
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA; (M.A.I.); (J.S.G.)
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL 33125, USA
| | - Naresh Kumar
- Environmental Health Division, University of Miami, Miami, FL 33136, USA; (S.G.M.); (F.M.); (N.K.)
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24
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Akpek EK, Karakus S, Ramulu PY, Mathews PM. Sustained Gazing Causes Measurable Decline in Visual Function of Patients with Dry Eye. Am J Ophthalmol 2020; 210:107-115. [PMID: 31606440 DOI: 10.1016/j.ajo.2019.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/21/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the effects of sustained gazing on visual function of dry eye patients. DESIGN Prospective, comparative before-and-after study. METHODS A total of 176 patients with dry eye and 33 control subjects ≥50 years old were included. Dry eye symptomatology along and clinical parameters were assessed. Out-loud reading speed was measured using the International Reading Speed Test (IReST) as words per minute (wpm). Reading speed was repeated using different IReST excerpts following 30-minute silent reading. RESULTS At baseline, there were no differences between dry eye patients and control subjects with respect to reading speed (172 vs 180 wpm, respectively; P = 0.21) or the time to read the excerpt (33 vs 30 seconds, respectively; P = 0.17). After silent reading, the dry eye patients had decreased reading speed and increases in the length of time to read the passage compared to baseline (161 vs 172 wpm, respectively; P = 0.002; and 38 vs 33 seconds, respectively; P < 0.001). The control subjects did not show significant differences for either parameter. There were significant differences with respect to both parameters between the dry eye and control groups after sustained gazing (161 vs 188 wpm, respectively; P = 0.006; and 38 vs 31 seconds, respectively; P = 0.003). Each 1-point increase in baseline corneal staining score (0-6) led to a 5-wpm reduction in reading speed (95% confidence interval, -8 to -1; P = 0.01). CONCLUSIONS Sustained gazing, such as in silent reading, has a measurable negative impact on visual performance of dry eye patients. Corneal staining represents a clinical parameter relevant to visual function.
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25
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Elhusseiny AM, Khalil AA, El Sheikh RH, Bakr MA, Eissa MG, El Sayed YM. New approaches for diagnosis of dry eye disease. Int J Ophthalmol 2019; 12:1618-1628. [PMID: 31637199 DOI: 10.18240/ijo.2019.10.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 08/12/2019] [Indexed: 12/31/2022] Open
Abstract
We reviewed the literature for different diagnostic approaches for dry eye disease (DED) including the most recent advances, contradictions and promising diagnostic tools and technique. We performed a broad literature search for articles discussing different methods for diagnosis of DED including assessment of tear osmolarity, tear film stability, ocular biomarkers and others. Articles indexed in PubMed and google scholar were included. With the growing cosmetic industry, environmental pollution, and booming of digital screens, DED is becoming more prevalent. Its multifactorial etiology renders the diagnosis challenging and invites the emergence of new diagnostic tools and tests. Diagnostic tools can be classified, based on the parameter they measure, into tear film osmolarity, functional visual acuity, tear volume, tear turnover, tear film stability, tear film composition, ocular biomarkers and others. Although numerous methods exist, the most accurate diagnosis can be reached through combining the results of more than one test. Many reported tests have shown potential as diagnostic/screening tools, however, require more research to prove their diagnostic power, alone or in combination. Future research should focus on identifying and measuring parameters that are the most specific to DED diagnosis.
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Affiliation(s)
- Abdelrahman M Elhusseiny
- Department of Ophthalmology, Kasr Al Ainy School of medicine, Cairo University, Dokki 12611, Egypt.,Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17 Street, Miami, FL 33136, USA
| | - Ali A Khalil
- Faculty of Medicine, American University of Beirut, Beirut 2341, Lebanon
| | - Reem H El Sheikh
- Department of Ophthalmology, Kasr Al Ainy School of medicine, Cairo University, Dokki 12611, Egypt
| | - Mohammad A Bakr
- Department of Ophthalmology, Kasr Al Ainy School of medicine, Cairo University, Dokki 12611, Egypt
| | - Mohamed Gaber Eissa
- Department of Ophthalmology, Kasr Al Ainy School of medicine, Cairo University, Dokki 12611, Egypt
| | - Yasmine M El Sayed
- Department of Ophthalmology, Kasr Al Ainy School of medicine, Cairo University, Dokki 12611, Egypt
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