Evaluation of Dry Eye Using Anterior Segment Optical Coherence Tomography in Patients With End-Stage Renal Disease Undergoing Hemodialysis

TFOS Lifestyle: Impact of nutrition on the ocular surface

Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.

Impact of Chronic Kidney Disease on Corneal Neuroimmune Features in Type 2 Diabetes

Aim: To determine the impact of chronic kidney disease on corneal nerve measures and dendritic cell counts in type 2 diabetes. Methods: In vivo corneal confocal microscopy images were used to estimate corneal nerve parameters and compared in people with type 2 diabetes with chronic kidney disease (T2DM-CKD) (n = 29) and those with type 2 diabetes without chronic kidney disease (T2DM-no CKD) (n = 29), along with 30 healthy controls. Corneal dendritic cell densities were compared between people with T2DM-CKD and those with T2DM-no CKD. The groups were matched for neuropathy status. Results: There was a significant difference in corneal nerve fiber density (p < 0.01) and corneal nerve fiber length (p = 0.04) between T2DM-CKD and T2DM-no CKD groups. The two diabetes groups had reduced corneal nerve parameters compared to healthy controls (all parameters: p < 0.01). Immature central dendritic cell density was significantly higher in the T2DM-CKD group compared to the T2DM-no CKD group ((7.0 (3.8−12.8) and 3.5 (1.4−13.4) cells/mm2, respectively, p < 0.05). Likewise, central mature dendritic cell density was significantly higher in the T2DM-CKD group compared to the T2DM-no CKD group (0.8 (0.4−2.2) and 0.4 (0.6−1.1) cells/mm2, respectively, p = 0.02). Additionally, total central dendritic cell density was increased in the T2DM-CKD group compared to T2DM-no CKD group (10.4 (4.3−16.1) and 3.9 (2.1−21.0) cells/mm2, respectively, p = 0.03). Conclusion: The study showed that central corneal dendritic cell density is increased in T2DM-CKD compared to T2DM-no CKD, with groups matched for peripheral neuropathy severity. This is accompanied by a loss of central corneal nerve fibers. The findings raise the possibility of additional local factors exacerbating central corneal nerve injury in people with diabetic chronic kidney disease.

Ocular manifestations in hemodialysis patients and short-term changes in ophthalmologic findings

The purpose of this study was to investigate the frequency of ocular manifestations in hemodialysis (HD) patients and short-term changes in ophthalmologic findings. A total of 142 eyes of 71 HD patients were included in this study. Patients with corneal and conjunctival deposits, diabetic retinopathy, hypertensive retinopathy, cataract, optic atrophy, or glaucoma were recorded. Schirmer I tests and the tear break up time (TBUT) were performed in the listed order to evaluate dry eye. Axial length (AL) and anterior chamber depth (ACD) were measured using ultrasound biometry using an infrared system. The TBUT test, Schirmer I test, intraocular pressure, AL, and ACD were applied within 30 minutes before and after a single session of HD. The most common ocular findings included conjunctival calcification (60.6%), cataract (50.7%), and proliferative diabetic retinopathy (21.1%). The average TBUT results decreased from 10.81 ± 4.90 to 9.43 ± 4.78 seconds after HD, and was statistically significant (P < .001). The mean Schirmer I test results decreased from 13.59 ± 4.67 to 12.07 ± 4.86 mm after HD. The decline in the Schirmer I test results was statistically significant (P = .005). The mean intraocular pressure decreased from 14.57 ± 4.40 to 13.43 ± 3.91 mm Hg after HD, and was statistically significant (P < .001). The mean ACD increased from 3.19 ± 0.53 to 3.25 ± 0.55 mm, and the mean AL increased from 23.05 ± 1.35 to 23.13 ± 1.35 mm, both increases being significant after HD (both P < .001). Eye diseases such as diabetic retinopathy, corneo-conjunctival calcification, and dry eye are common in HD patients; these patients should undergo early and frequent eye examinations.