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Aljarousha M, Badarudin NE, Che Azemin MZ, Aljeesh Y, Amer A, Abdul Rahim MAS. Prevalence and Risk Factors of Dry Eye Disease in the South of Palestine. Malays J Med Sci 2024; 31:72-97. [PMID: 38694574 PMCID: PMC11057840 DOI: 10.21315/mjms2024.31.2.8] [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: 02/08/2023] [Accepted: 09/21/2023] [Indexed: 05/04/2024] Open
Abstract
Background The prevalence of dry eye disease (DED) is rising globally and needs to be urgently addressed by medical professionals because it lowers patients' quality of life. There are as yet no available data in the literature about the prevalence of and risk factors for DED in the Gaza Strip, a gap that the present study seeks to address. Methods A cross-sectional study was carried out between March and August 2022 in Gaza governorates using a proportional stratified sampling technique. Only Gazan individuals ≥ 18 years old and able to follow the instructions were included. The Ocular Surface Disease Index (OSDI) questionnaire, which has previously been translated into Arabic and validated, was applied to evaluate DED symptoms. Subjective clinical tests for DED conducted were tear meniscus height (TMH), meibomian gland dysfunctions (MGDs), Marx line (ML), conjunctival Lissamine green staining (LGS), tear film break-up time test (TBUT), corneal fluorescein staining (CFS) and Schirmer II tear test (STT). DED was defined based on an Arab-OSDI score ≥ 13 and at least one positive clinical sign. Results A total of 426 participants were assessed from four areas (North Gaza Strip, 82; Gaza City, 147; Mid-Zone Gaza Strip, 62; South Gaza Strip, 135). The prevalence of DED in the present study was 31.5% (95% CI: 27.1, 36.1). Age > 50 years old (odds ratio [OR] = 10.45; 95% CI: 2.95, 37.05; P < 0.001), female gender (OR = 3.24; 95% CI: 1.40, 7.52, P = 0.006), menopause or pregnancy (OR = 2.59; 95% CI: 1.25, 5.35; P = 0.03) and pharmacotherapy (artificial tears; OR = 9.91; 95% CI: 2.77, 35.46; P < 0.001) were each associated with DED symptoms. South Gaza Strip (OR = 0.04; 95% CI: 0.01, 0.12; P < 0.001), unemployed (OR = 11.67; 95% CI: 1.43, 95.44; P = 0.02), non-consumption of caffeine (OR = 0.40; 95% CI: 0.19, 0.88; P = 0.02) and TMH < 0.2 (OR = 1.80; 95% CI: 1.02, 3.19; P = 0.04) were associated with TBUT < 5 s. LGS was associated with those > 50 years old (OR = 2.70; 95% CI: 1.38, 5.28; P = 0.004), previous refractive or ocular surface surgeries (OR = 2.97; 95% CI: 1.34, 6.59; P = 0.008) and CFS ≥ 1 (OR = 1.91; 95% CI: 1.07, 3.44; P = 0.03). Conclusion Various aspects of DED were linked with different risk factors, suggesting that DED subtypes have different underlying pathophysiologies.
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Affiliation(s)
- Mohammed Aljarousha
- Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
- Department of Optometry, Faculty of Health Science, Islamic University of Gaza, Gaza Strip, Palestine
- European Gaza Hospital, Department of Optometry, Gaza Strip, Palestine
| | - Noor Ezailina Badarudin
- Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
| | - Mohd Zulfaezal Che Azemin
- Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
| | - Yousef Aljeesh
- College of Nursing, Islamic University of Gaza, Gaza Strip, Palestine
| | - Abuimara Amer
- Department of Optometry, Faculty of Health Science, Islamic University of Gaza, Gaza Strip, Palestine
| | - Muhammad Afzam Shah Abdul Rahim
- Department of Optometry and Visual Science, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Pahang, Malaysia
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Jones L, Efron N, Bandamwar K, Barnett M, Jacobs DS, Jalbert I, Pult H, Rhee MK, Sheardown H, Shovlin JP, Stahl U, Stanila A, Tan J, Tavazzi S, Ucakhan OO, Willcox MDP, Downie LE. TFOS Lifestyle: Impact of contact lenses on the ocular surface. Ocul Surf 2023; 29:175-219. [PMID: 37149139 DOI: 10.1016/j.jtos.2023.04.010] [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: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
Several lifestyle choices made by contact lens wearers can have adverse consequences on ocular health. These include being non-adherent to contact lens care, sleeping in lenses, ill-advised purchasing options, not seeing an eyecare professional for regular aftercare visits, wearing lenses when feeling unwell, wearing lenses too soon after various forms of ophthalmic surgery, and wearing lenses when engaged in risky behaviors (e.g., when using tobacco, alcohol or recreational drugs). Those with a pre-existing compromised ocular surface may find that contact lens wear exacerbates ocular disease morbidity. Conversely, contact lenses may have various therapeutic benefits. The coronavirus disease-2019 (COVID-19) pandemic impinged upon the lifestyle of contact lens wearers, introducing challenges such as mask-associated dry eye, contact lens discomfort with increased use of digital devices, inadvertent exposure to hand sanitizers, and reduced use of lenses. Wearing contact lenses in challenging environments, such as in the presence of dust and noxious chemicals, or where there is the possibility of ocular trauma (e.g., sport or working with tools) can be problematic, although in some instances lenses can be protective. Contact lenses can be worn for sport, theatre, at high altitude, driving at night, in the military and in space, and special considerations are required when prescribing in such situations to ensure successful outcomes. A systematic review and meta-analysis, incorporated within the review, identified that the influence of lifestyle factors on soft contact lens dropout remains poorly understood, and is an area in need of further research. Overall, this report investigated lifestyle-related choices made by clinicians and contact lens wearers and discovered that when appropriate lifestyle choices are made, contact lens wear can enhance the quality of life of wearers.
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Affiliation(s)
- Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada.
| | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Kalika Bandamwar
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Melissa Barnett
- University of California, Davis Eye Center, Sacramento, CA, USA
| | - Deborah S Jacobs
- Massachusetts Eye & Ear, Harvard Medical School, Boston, MA, USA
| | - Isabelle Jalbert
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Heiko Pult
- Dr Heiko Pult Optometry & Vision Research, Weinheim, Germany
| | | | - Heather Sheardown
- Department of Chemical Engineering, McMaster University, Hamilton, Ontario, Canada
| | | | - Ulli Stahl
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | | | - Jacqueline Tan
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Silvia Tavazzi
- Department of Materials Science, University of Milano-Bicocca, Milan, Italy
| | | | - Mark D P Willcox
- School of Optometry and Vision Science, UNSW Sydney, NSW, Australia
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
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García-Marqués JV, Talens-Estarelles C, García-Lázaro S, Wolffsohn JS, Cerviño A. Systemic, environmental and lifestyle risk factors for dry eye disease in a mediterranean caucasian population. Cont Lens Anterior Eye 2021; 45:101539. [PMID: 34789408 DOI: 10.1016/j.clae.2021.101539] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess systemic, environmental and lifestyle risk factors for dry eye disease (DED) in a Mediterranean Caucasian population. METHODS A cross-sectional study was performed on 120 Caucasian participants aged between 18 and 89 years (47.0 ± 22.8 years). Medical history, information regarding environmental conditions and lifestyle, Ocular Surface Disease Index, Dry Eye Questionnaire-5, non-Invasive (Oculus Keratograph 5 M) breakup time, tear film osmolarity and ocular surface staining parameters were assessed in a single clinical session to allow DED diagnosis based on the guidelines of the Tear Film and Ocular Surface Society Dry Eye Workshop II Diagnostic Methodology Report. A multivariate logistic regression model was constructed including those variables with a p-value less than 0.15 in the univariate analysis. RESULTS A prevalence of 57.7 % for DED was found. No age differences were found between those with and without DED (U = 1886.5, p = 0.243). Nevertheless, the DED group had more females (X2 = 7.033, p = 0.008). The univariate logistic regression identified as potential risk factors for DED the following: female sex, sleep hours per day, menopause, anxiety, systemic rheumatologic disease, use of anxiolytics, daily medication, ocular surgery, poor diet quality, more ultra-processed food in diet, not drinking caffeine and hours of exposure to air conditioning per day. Multivariate logistic regression revealed that hours of sleep per day, menopause and use of anxiolytics were independently associated with DED (p ≤ 0.026 for all). CONCLUSIONS DED is associated with systemic, environmental and lifestyle risk factors. These findings are useful to identify potentially modifiable risk factors, in addition to conventional treatments for DED.
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Affiliation(s)
- José Vicente García-Marqués
- Department of Optics and Optometry and Vision Sciences, University of Valencia, Spain; Optometry and Vision Science Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Cristian Talens-Estarelles
- Department of Optics and Optometry and Vision Sciences, University of Valencia, Spain; Optometry and Vision Science Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Santiago García-Lázaro
- Department of Optics and Optometry and Vision Sciences, University of Valencia, Spain; Optometry and Vision Science Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - James S Wolffsohn
- Department of Optics and Optometry and Vision Sciences, University of Valencia, Spain; Optometry and Vision Science Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Alejandro Cerviño
- Department of Optics and Optometry and Vision Sciences, University of Valencia, Spain; Optometry and Vision Science Research Group, School of Life and Health Sciences, Aston University, Birmingham, UK.
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Tong L, Lim L, Tan D, Heng WJ, Lim J, Chan C, Arundhati A, Tan A. Assessment and Management of Dry Eye Disease and Meibomian Gland Dysfunction: Providing a Singapore Framework. Asia Pac J Ophthalmol (Phila) 2021; 10:530-541. [PMID: 34759232 PMCID: PMC8673856 DOI: 10.1097/apo.0000000000000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/04/2021] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT The purpose of this article is to provide a framework for general ophthalmologists in Singapore to manage dry eye. This framework considers the evidence in the literature as well as recommendations from expert panels such as the Tear Film & Ocular Surface Society Dry Eye Workshop II and the Asia Cornea Society Workgroup.This article covers the assessment of patient medical history and ask triage questions to identify local and systemic causes of dry eye disease (DED), excluding other possible causes, as well as the risk factors for DED and ocular surface inflammation. Evaluation of clinical signs to establish the diagnosis of DED and differentiation from other causes of irritable, red eyes are described. Tests for understanding the underlying disease processes and severity of DED are also presented.Management of dry eye should involve patient education and engagement. Information about the natural history and chronic nature of DED should be provided to improve long-term management of the disease and enhance compliance. Aggravating factors should be removed or lessened.We provide a guide to determine the most appropriate treatment (or combination of treatments) based on the severity and cause(s) of the disease, as well as the patient's needs and preferences. The aim of the management is to relieve ocular discomfort and prevent worsening of symptoms and signs, as well as to optimize visual function and minimize structural ocular damage. We also discuss the systematic follow-up and assessment of treatment response, as well as monitoring side effects of treatment, bearing in mind continuous support and reassurance to patients.
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Affiliation(s)
- Louis Tong
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore
| | - Li Lim
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore
| | - Donald Tan
- Yong Loo Lin School of Medicine, Singapore
- Eye Retina Surgeon, Singapore
| | - Wee Jin Heng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | | | - Anshu Arundhati
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Anna Tan
- Department of Ophthalmology, National University Hospital, Singapore
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Garza-León M, López-Chavez E, De La Parra-Colín P. Prevalence of Ocular Surface Disease Symptoms in High School Students in Monterrey, Mexico. J Pediatr Ophthalmol Strabismus 2021; 58:287-291. [PMID: 34180283 DOI: 10.3928/01913913-20210308-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the prevalence of dry eye disease symptoms and contact lens wear in Mexican high school students. METHODS A cross-sectional association study included a group of high school students who were selected from a random sampling of classrooms. The authors used the Ocular Surface Disease Index (OSDI) questionnaire as a surrogate measure for dry eye disease symptoms, and contact lens wear was also investigated. RESULTS Seven hundred fifty-nine students with a mean age of 16.12 ± 0.96 years were surveyed and 55.7% of the students were girls (423 of 759). The average OSDI score was 25.11 ± 20.61 points. Girls had higher scores (28.25 ± 21.48 points) than boys (21.14 ± 18.74 points), and the difference was statistically significant (P < .001). Forty-three students (6.1%) wore contact lenses and had higher OSDI scores (34.26 ± 23.13 and 24.51 ± 20.31 points, respectively) and the difference was also statistically significant (P = .002). CONCLUSIONS Symptoms of mild and moderate dry eye disease are prevalent in high school students and, as reported in previous studies, girls are more affected than boys. [J Pediatr Ophthalmol Strabismus. 2021;58(5):287-291.].
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Yu K, Bunya V, Maguire M, Asbell P, Ying GS. Systemic Conditions Associated with Severity of Dry Eye Signs and Symptoms in the Dry Eye Assessment and Management Study. Ophthalmology 2021; 128:1384-1392. [PMID: 33785415 DOI: 10.1016/j.ophtha.2021.03.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Certain systemic conditions are reported to be risk factors for dry eye disease (DED), but their associations with DED severity are not well studied. We evaluated whether systemic conditions reported to be DED risk factors are associated with severity of DED signs and symptoms. DESIGN Secondary analysis of data from the Dry Eye Assessment and Management Study, a large-scale multicenter randomized clinical trial of patients with moderate to severe DED. PARTICIPANTS Five hundred thirty-five adult patients with moderate to severe DED from 27 United States centers. METHODS Patients reported their medical history at baseline. They underwent ocular surface examinations and symptom evaluation using standardized protocols at baseline, 6 months, and 12 months. We analyzed the associations of systemic conditions (a systemic disease or smoking history) reported as potential DED risk factors with the severity of DED signs and symptoms using generalized linear regression models adjusted by age, gender, race, and visit. MAIN OUTCOME MEASURES Dry eye disease symptoms assessed using the Ocular Surface Disease Index (OSDI), 6 DED signs (tear film break-up time, anesthetized Schirmer testing, corneal fluorescein staining, conjunctival lissamine green staining, tear osmolarity, and meibomian gland dysfunction), and a composite signs severity score from 0 to 1 (1 = most severe). RESULTS The mean age was 58 years; 81% were women. More severe DED signs were associated significantly with Sjögren syndrome (mean composite signs severity score 0.52 with disease vs. 0.43 without disease; P < 0.001), facial rosacea (0.47 vs. 0.43; P = 0.002), rheumatoid arthritis (0.47 vs. 0.42; P = 0.002), peripheral artery disease (0.50 vs. 0.43; P < 0.001), and daily smoking history (0.45 vs. 0.43; P = 0.047). Thyroid dysfunction, osteoarthritis, diabetes, irritable bowel syndrome, hypercholesterolemia, hypertension, and hypertriglyceridemia were not associated significantly with DED signs. No conditions were associated significantly with OSDI. CONCLUSIONS In this large, well-characterized cohort of patients with DED assessed under standardized procedures, patients with certain systemic diseases and smoking history showed more severe DED signs compared with patients without the conditions. The profile of significant DED signs varied by systemic condition, reflecting different DED causes. Understanding the systemic conditions and underlying causes that predispose some patients to severe DED can improve management.
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Affiliation(s)
- Kimberley Yu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vatinee Bunya
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maureen Maguire
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Penny Asbell
- Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Gui-Shuang Ying
- Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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Kobia-Acquah E, Ankamah-Lomotey S, Owusu E, Forfoe S, Bannor J, Koomson JA, Opoku M, Dzikpo DM, Mensah DNO, Amonoo JN, Akowuah PK. Prevalence and associated risk factors of symptomatic dry eye in Ghana: A cross-sectional population-based study. Cont Lens Anterior Eye 2021; 44:101404. [DOI: 10.1016/j.clae.2020.12.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
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Study of Factors Influencing Dry Eye in Rheumatoid Arthritis. J Ophthalmol 2020; 2020:5768679. [PMID: 32832136 PMCID: PMC7429800 DOI: 10.1155/2020/5768679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 04/23/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose The present study investigated the relationship between dry eye and the disease activity in patients with rheumatoid arthritis (RA). Methods Patients with RA were divided by the Ocular Surface Disease Index (OSDI) into the symptomatic group (score ≥ 12) and the asymptomatic group (score < 12). By using the Disease Activity Score (DAS-28) questionnaire, they were divided into the active group (score > 2.6) and the stable group (score ≤ 2.6). In the control group, 20 healthy adults with matched sex and age were selected. RA patients and healthy adults were inspected for the tear film break time (TBUT), tear meniscus height (TMH), corneal fluorescein staining (CFS), meibomian scan (MS), meibomian gland secretion score (MSS), and eyelid margin assessment (EMS). Results The TBUT of the RA group was significantly less than that of the control group, while the CFS, MS, EMS, and MSS were higher. The TBUT of the symptomatic RA group was significantly less than that of the asymptomatic group, and the CFS was higher. In the active RA group, only the CFS was higher than that of the stable group, and there was no significant difference between the two groups for other parameters. Furthermore, there was no significant correlation between the course of RA and the dry eye (P > 0.05). Conclusion The rheumatoid activity does not necessarily lead to an aggravation of dry eye. Regardless of the duration, RA was not found to exhibit relation with the severity of dry eye. Translational Relevance. RA patients with disease active period cannot be ignored for the existence of dry eye, since patients with dry eye often lack the signs and symptoms.
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Makrynioti D, Zagoriti Z, Koutsojannis C, Morgan PB, Lagoumintzis G. Ocular conditions and dry eye due to traditional and new forms of smoking: A review. Cont Lens Anterior Eye 2020; 43:277-284. [PMID: 32111452 DOI: 10.1016/j.clae.2020.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/24/2020] [Accepted: 02/16/2020] [Indexed: 12/26/2022]
Abstract
Addiction to cigarette smoking has high prevalence rates recorded worldwide. Smoking has been linked to several life-threatening systemic conditions such as cancer, heart attack and stroke, in addition to a range of ocular pathologies. In recent years, electronic cigarettes (EC) have emerged as alternatives to smoking. ECs are nicotine delivery devices which produce an aerosol by heating, rather than combusting, a liquid which contains nicotine, flavours and preservatives. This review focuses on the association of traditional and new forms of smoking with dry eye disease, contact lens wear and four other common ocular diseases: cataract, age-related macular degeneration, glaucoma and Graves' ophthalmopathy. It is concluded that smoking and vaping appear as a risk factor for the aforementioned ocular conditions. An evidence-based, clear link between cigarette smoking, or EC vaping and ocular problems is yet to be discovered.
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Affiliation(s)
- Dimitra Makrynioti
- School of Health Rehabilitation Sciences, University of Patras, Psaron 6, GR 25100, Aιgio, Greece.
| | - Zoi Zagoriti
- Department of Pharmacy, Laboratory of Molecular Biology and Immunology, University of Patras, University Campus, GR26504, Patras, Greece.
| | - Constantinos Koutsojannis
- Department of Physiotherapy, Laboratory of Health Physics and Computational Intelligence, School of Health Rehabilitation Sciences, University of Patras, Psaron 6, GR 25100, Aιgio, Greece.
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, The University of Manchester, Carys Bannister Building, Dover Street, Manchester, M13 9PL, United Kingdom.
| | - George Lagoumintzis
- School of Health Rehabilitation Sciences, University of Patras, Psaron 6, GR 25100, Aιgio, Greece; Department of Pharmacy, Laboratory of Molecular Biology and Immunology, University of Patras, University Campus, GR26504, Patras, Greece.
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Chuang J, Shih KC, Chan TC, Wan KH, Jhanji V, Tong L. Preoperative optimization of ocular surface disease before cataract surgery. J Cataract Refract Surg 2019; 43:1596-1607. [PMID: 29335106 DOI: 10.1016/j.jcrs.2017.10.033] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 12/24/2022]
Abstract
An impaired ocular surface adversely affects preoperative planning for cataract surgery, including intraocular lens (IOL) calculations, toric IOL axis and magnitude estimates, keratometry, and topography measurements. It also increases surgical difficulty. We performed a review to evaluate the connection between cataract surgery and dry eye and to determine the best management for these patients. Of the 16 papers included in this review, 6 were randomized controlled trials. Cataract surgery was shown to worsen ocular parameters and aggravate dry-eye disease. Physicians should recognize and aggressively treat cataract patients with poor prognostic factors and/or with existing dry-eye disease. Increased incision extent, operation time, irrigation, and microscopic-light exposure time decreased the tear breakup time and mean goblet cell density. Postoperatively, the use of eyedrops was associated with worsening of goblet cell density; hence, these medications should be tapered off when no longer needed.
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Affiliation(s)
- Jasmine Chuang
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kendrick Co Shih
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Tommy C Chan
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kelvin H Wan
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vishal Jhanji
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Louis Tong
- From the Li Ka Shing Faculty of Medicine (Chuang) and the Department of Ophthalmology (Shih), University of Hong Kong, the Department of Ophthalmology and Visual Sciences (Chan, Jhanji), Faculty of Medicine, the Chinese University of Hong Kong, Department of Ophthalmology (Wan), Tuen Mun Eye Centre and Tuen Mun Hospital, Hong Kong, China; the Department of Ophthalmology (Jhanjij), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA; the Ocular Surface Research Group (Tong), Singapore Eye Research Institute, the Corneal and External Eye Disease Service (Tong), Singapore National Eye Centre, the Eye-Academic Clinical Program (Tong), Duke-NUS Medical School, and the Department of Ophthalmology (Tong), Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ward MF, Le P, Donaldson JC, Van Buren E, Lin FC, Lefebvre C, Weaver M, Van Der Vaart R, Davis RM. Racial and Ethnic Differences in the Association Between Diabetes Mellitus and Dry Eye Disease. Ophthalmic Epidemiol 2019; 26:295-300. [PMID: 31025588 DOI: 10.1080/09286586.2019.1607882] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose:To examine the association between dry eye and diabetes mellitus among a large North Carolina patient population. Methods:A retrospective cross-sectional study of patients seen within the University of North Carolina medical system between July 1, 2008, and September 1, 2017, was performed. De-identified medical records contained within the Carolina Data Warehouse of adult patients who have had an ocular evaluation were studied. Four categories of disease states were identified by ICD-9 and ICD-10 codes. Patients were grouped based on being diagnosed with Dry Eye Disease (ICD-9: 375.15, 370.33, and ICD-10: H04.12, H16.221), Diabetes Mellitus (ICD-9: 250.00-250.93 and ICD-10: E08-E11, E13), neither, or both diseases. Odds ratios of the association between diabetes and dry eye were calculated for the following racial/ethnic groups: Non-Hispanic White, Non-Hispanic Black/African American, Asian, and Hispanic. Results:A total of 81,480 patients were included in the analysis; of those, 8978 patients had dry eye disease and 18,361 patients had diabetes. The remaining 54,141 patients had neither disease. Dry eye prevalence among patients with diabetes was 14.39% (95% CI: 13.89-14.91%) and 10.11% (95%CI: 9.88-10.35%) among patients without diabetes. The odds of a patient with diabetes having dry eye are 1.15 (95% CI: 1.09-1.21) times that of a patient without diabetes. Asian patients with diabetes demonstrated the highest odds of having dry eye at 1.49 (95% CI: 1.12-1.98). Conclusions:Dry eye is common among patients with diabetes, and the association between these diseases is strongest among Asian patients. Race and ethnicity are important demographic factors that may guide providers in the diagnosis and treatment of dry eye in the setting of diabetes.
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Affiliation(s)
- Michael F Ward
- Department of Ophthalmology, University of North Carolina , Chapel Hill
| | - Patrick Le
- Department of Ophthalmology, University of North Carolina , Chapel Hill
| | - Jared C Donaldson
- Department of Ophthalmology, University of North Carolina , Chapel Hill
| | - Eric Van Buren
- Department of Ophthalmology, University of North Carolina , Chapel Hill
| | - Feng-Chang Lin
- Department of Ophthalmology, University of North Carolina , Chapel Hill
| | - Chelsea Lefebvre
- Department of Ophthalmology, University of North Carolina , Chapel Hill
| | - Mark Weaver
- Department of Ophthalmology, University of North Carolina , Chapel Hill
| | | | - Richard M Davis
- Department of Ophthalmology, University of North Carolina , Chapel Hill
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Lee CY, Chen HC, Sun CC, Lin HY, Lu KH, Huang JY, Yeh CB, Yang SF. Gout as a Risk Factor for Dry Eye Disease: A Population-Based Cohort Study. J Clin Med 2019; 8:jcm8010062. [PMID: 30634389 PMCID: PMC6352280 DOI: 10.3390/jcm8010062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 12/27/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023] Open
Abstract
This study evaluated the effect of gout on the risk of dry eye disease (DED) by using the National Health Insurance Research Database (NHIRD). Data for 30,192 gout patients (21,081 men and 9111 women) and 30,192 non-gout patients (21,005 men and 9187 women) were analyzed. Approximately 1 million patients were randomly sampled from the NHIRD registry. After applying exclusion criteria, patients diagnosed with gout were enrolled in the study group. Thereafter, each individual in the study group underwent the matching process via the propensity score with another non-gout individual, which constituted the control group. The main outcome was defined as the development of DED in accordance with the corresponding International Classification of Diseases, Ninth Revision. In addition to DED, other risk factors including age, sex, and urbanization, and several co-morbidities were included in the multivariate model. The incidence of DED with the adjusted hazard ratio (aHR) and cumulative probability were evaluated in the gout and non-gout patients. A total of 2913 DED events were observed in the study group, whereas 2631 DED events were observed in the control group. A higher incidence rate ratio was found in the study group after adjustment (aHR: 1.065). Moreover, the cumulative probability indicated a significantly increased risk of DED in the study group (p = 0.001). The other potential risk factors of DED according to the multivariate analysis include older age, female gender, higher degree of urbanization, keratopathy, age-related macular degeneration, glaucoma, cataract, ischemic heart disease, hyperlipidemia, peripheral vascular disease, chronic pulmonary disease, rheumatic disease, peptic ulcer disease, liver disease, and malignancy. In conclusion, gout increased the risk of DED after adjustment, and the risk is positively correlated to a longer disease period.
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Affiliation(s)
- Chia-Yi Lee
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
- Department of Optometry, College of Medicine and Life Science, Chung Hwa University of Medical Technology, Tainan 717, Taiwan.
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan 333, Taiwan.
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou 333, Taiwan.
| | - Chi-Chin Sun
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung 204, Taiwan.
- Department of Chinese Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Hung-Yu Lin
- Department of Ophthalmology, Show Chwan Memorial Hospital, Changhua 500, Taiwan.
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- College of Health, Chung Chou University of Science and Technology, Changhua 500, Taiwan.
- Department of Optometry, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan.
| | - Ko-Hsiu Lu
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Orthopedics, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
| | - Chao-Bin Yeh
- School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan.
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan.
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Trattler WB, Majmudar PA, Donnenfeld ED, McDonald MB, Stonecipher KG, Goldberg DF. The Prospective Health Assessment of Cataract Patients' Ocular Surface (PHACO) study: the effect of dry eye. Clin Ophthalmol 2017; 11:1423-1430. [PMID: 28848324 PMCID: PMC5557104 DOI: 10.2147/opth.s120159] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose To determine the incidence and severity of dry eye as determined by the International Task Force (ITF) scale in patients being screened for cataract surgery. Patients and methods This was a prospective, multi-center, observational study of 136 patients, at least 55 years of age, who were scheduled to undergo cataract surgery. The primary outcome measure was the incidence of dry eye as evaluated by grade on the ITF scale and secondary outcome measures include tear break-up time (TBUT), ocular surface disease index score, corneal staining with fluorescein, conjunctival staining with lissamine green, and a patient questionnaire to evaluate symptoms of dry eye. Results Mean patient age was 70.7 years. A total of 73.5% of patients were Caucasian and 50% were female. Almost 60% had never complained of a foreign body sensation; only 13% complained of a foreign body sensation half or most of the time. The majority of patients (62.9%) had a TBUT ≤5 seconds, 77% of eyes had positive corneal staining and 50% of the eyes had positive central corneal staining. Eighteen percent had Schirmer’s score with anesthesia ≤5 mm. Conclusion The incidence of dry eye in patients scheduled to undergo cataract surgery in a real-world setting is higher than anticipated.
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Garza León M, de Fátima Arroyo L, Ibañez Garcia M, Villarreal Calderón JR, Hernández Morales X, Chapa de la Peña A, Cárdenas Rodríguez II, Díaz Gómez M. Patrón de uso de lentes de contacto y sintomatología asociada en estudiantes universitarios. REVISTA MEXICANA DE OFTALMOLOGÍA 2017. [DOI: 10.1016/j.mexoft.2015.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Garza-León M, Valencia-Garza M, Martínez-Leal B, Villarreal-Peña P, Marcos-Abdala HG, Cortéz-Guajardo AL, Jasso-Banda A. Prevalence of ocular surface disease symptoms and risk factors in group of university students in Monterrey, Mexico. J Ophthalmic Inflamm Infect 2016; 6:44. [PMID: 27864795 PMCID: PMC5116015 DOI: 10.1186/s12348-016-0114-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 11/08/2016] [Indexed: 11/16/2022] Open
Abstract
Background The objective of this study was to determine the prevalence of symptoms of ocular surface disease and its relationship with associated risk factors in students from the University of Monterrey using Ocular Surface Disease (OSDI) questionnaire. Methods A cross-sectional survey was conducted between October and December 2014 to assess the prevalence and risk factors for ocular surface disease in a group of students from Universidad de Monterrey in Monterrey, Mexico. The severity of the disease was measured via the Ocular Surface Disease Index (OSDI) questionnaire. Results The OSDI average value was 26.85 ± 20.79 points, with 70.4% of students (579) had OSDI score higher than 12 points. Women had ocular surface disease 1.63 times more than men (OR 1.29, 95% CI 1.13,1.48). Students who used ophthalmic drops have an OR 2.00 (95% CI 1.65,2.40), and students who smoke have an OR 1.24 (95% CI 1.06,1.46). Use of contact lenses, hours in front of computer or history of refractive surgery has low-estimated effect on the probability of presenting an ocular disease. Conclusions University students have a prevalence of 70.4% of ocular surface disease (OSD). OSD was associated with gender (women have a higher prevalence), smoking and the use of eye drops. A program to modify these risk factors to reduce the prevalence is needed.
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Affiliation(s)
- Manuel Garza-León
- Dirección de Ciencias Médicas de la División de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Nuevo León, México. .,Fundación Destellos de Luz IBP, San Pedro Garza García, Nuevo León, México. .,, Hidalgo # 2425, consultorio 706, Colonia Obispado, Monterrey, Nuevo León, México.
| | | | - Bernardo Martínez-Leal
- Dirección de Ciencias Médicas de la División de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Nuevo León, México
| | - Pablo Villarreal-Peña
- Dirección de Ciencias Médicas de la División de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Nuevo León, México
| | - Hernán Gerardo Marcos-Abdala
- Dirección de Ciencias Médicas de la División de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Nuevo León, México
| | - Ana Lucía Cortéz-Guajardo
- Dirección de Ciencias Médicas de la División de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Nuevo León, México
| | - Arturo Jasso-Banda
- Dirección de Ciencias Médicas de la División de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Nuevo León, México
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Xu L, Zhang W, Zhu XY, Suo T, Fan XQ, Fu Y. Smoking and the risk of dry eye: a Meta-analysis. Int J Ophthalmol 2016; 9:1480-1486. [PMID: 27803868 DOI: 10.18240/ijo.2016.10.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To collect the evidence to estimate the correlation between smoking and the incidence of dry eye. METHODS The PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL, last issue), CBM (Chinese BioMedical Literature Database), and CNKI (China National Knowledge Infrastructure/Chinese Academic Journals full-text Database) were searched for eligible studies published from January 1964 to December 2015 to investigate the association of smoking with the risk of dry eye. The odds ratio (OR) and 95% confidence interval (CI) were summarized and calculated. The extracted studies were pooled by the fixed-effects model or a random-effects model. RESULTS Two cohort studies and eight cross-sectional surveys were included in our Meta-analysis. There was no statistically significant relationship between current (OR=1.32; 95% CI: 0.99-1.76; P=0.055) or ever smoking (OR=1.12; 95% CI: 0.98-1.28; P=0.107) and the risk of dry eye among the studies, even when age and gender were adjusted (OR=1.16; 95% CI: 0.83-1.64; P=0.383). In the sensitivity analysis in which only general population were included, the association was significant between smoking and dry eye (OR=1.50; 95% CI: 1.08-2.09; P=0.016). CONCLUSION This Meta-analysis suggests that smoking may associate with the risk of dry eye in general population.
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Affiliation(s)
- Li Xu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Wei Zhang
- Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai 200032, China
| | - Xiao-Yu Zhu
- Department of Ophthalmology and Vision Science, Eye, Ear, Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai 200031, China
| | - Tao Suo
- Department of General Surgery, Zhongshan Hospital, Institute of General Surgery, Fudan University, Shanghai 200032, China
| | - Xian-Qun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yao Fu
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Martinez JD, Galor A, Ramos-Betancourt N, Lisker-Cervantes A, Beltrán F, Ozorno-Zárate J, Sánchez-Huerta V, Torres-Vera MA, Hernández-Quintela E. Frequency and risk factors associated with dry eye in patients attending a tertiary care ophthalmology center in Mexico City. Clin Ophthalmol 2016; 10:1335-42. [PMID: 27499613 PMCID: PMC4959589 DOI: 10.2147/opth.s106451] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to ascertain the frequency and risk factors of dry eye (DE) among patients attending a tertiary care ophthalmology center in Mexico. METHODS Approximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer's test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected. RESULTS The frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22%) in our population than evaporative deficiency (94%). Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry mouth. CONCLUSION This is the first study to demonstrate the frequency of symptomatic and clinical DE in a tertiary care ophthalmology center in Mexico. The frequency of DE ranged from 30% using a symptomatic definition to 94% using objective measures. Different risk factors were found for different aspects of DE, suggesting differing underlying pathophysiologies behind different DE subtypes.
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Affiliation(s)
- Jaime D Martinez
- Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico), Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Anat Galor
- Department of Ophthalmology, Miami Veterans Affairs Medical Center; Cornea and External Diseases Division, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Nallely Ramos-Betancourt
- Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico), Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Andrés Lisker-Cervantes
- Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico), Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Francisco Beltrán
- Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico), Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jorge Ozorno-Zárate
- Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico), Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Valeria Sánchez-Huerta
- Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico), Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Marco-Antonio Torres-Vera
- Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico), Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Everardo Hernández-Quintela
- Cornea and External Diseases Service, Asociación Para Evitar la Ceguera en Mexico (Association to prevent blindness in Mexico), Universidad Nacional Autónoma de México, Mexico City, Mexico
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Selter JH, Gire AI, Sikder S. The relationship between Graves' ophthalmopathy and dry eye syndrome. Clin Ophthalmol 2014; 9:57-62. [PMID: 25584018 PMCID: PMC4287254 DOI: 10.2147/opth.s76583] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background A complex relationship between Graves’ ophthalmopathy (GO) and dry eye syndrome exists. New research brings more insight into the association between these two diseases. Methods A review of the literature was conducted using the query terms “Graves’ Ophthalmopathy”, “Thyroid Eye Disease”, and “Dry Eye” in MedLine (PubMed) and Scopus. A total of 55 papers were reviewed. Case reports were excluded. Conclusion This review paper shows the close relationship between dry eye syndrome and GO. The underlying mechanisms behind their association suggest mechanical impairment of orbital muscles and immune-mediated lacrimal gland dysfunction as the causes of dry eye in GO patients. However, there are a variety of treatment options available for patients with GO with signs of dry eye, which help combat this issue.
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Affiliation(s)
- Jessica H Selter
- Johns Hopkins School of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anisa I Gire
- Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shameema Sikder
- Wilmer Ophthalmological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
Rheumatoid arthritis (RA), the most common autoimmune disorder associated with dry eye syndrome, is also associated with sight-threatening ocular diseases such as peripheral ulcerative keratitis, scleritis and corneal melts. Tissue damage on the ocular surface of patients with RA is autoimmune-mediated. Findings from patients with dry eye have implicated defects in innate immunity (Toll-like receptors, S100A and resident antigen-presenting cells), cytokines, chemokines and T helper (TH)-cell subsets (including TH1 and TH17) in disease pathogenesis. Some of these features are probably important in dry eye related to RA, which can occur at a different time from articular disease and is more clinically severe than idiopathic dry eye. Ocular surface immune factors can be influenced by the systemic immune landscape. Depending on the severity of ocular inflammation in RA, treatment can include ciclosporin, topical corticosteroids, tacrolimus, autologous serum and systemic immunosuppression. Tissue damage is treated by inhibiting matrix metalloproteinases. Potential therapeutic strategies benefit from an improved understanding of ocular surface immunology, and include targeting of T-cell subsets, B-cell signalling or cytokines.
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Alves M, Reinach PS, Paula JS, Vellasco e Cruz AA, Bachette L, Faustino J, Aranha FP, Vigorito A, de Souza CA, Rocha EM. Comparison of diagnostic tests in distinct well-defined conditions related to dry eye disease. PLoS One 2014; 9:e97921. [PMID: 24848115 PMCID: PMC4029783 DOI: 10.1371/journal.pone.0097921] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 04/27/2014] [Indexed: 01/19/2023] Open
Abstract
PURPOSE This study compares signs, symptoms and predictive tools used to diagnose dry eye disease (DED) and ocular surface disorders in six systemic well-defined and non-overlapping diseases. It is well known that these tests are problematic because of a lack of agreement between them in identifying these conditions. Accordingly, we provide here a comparative clinical profile analysis of these different diseases. METHODS A spontaneous and continuous sample of patients with Sjögren's syndrome (SS) (n=27), graft-versus-host-disease (GVHD) (n=28), Graves orbitopathy (n=28), facial palsy (n=8), diabetes mellitus without proliferative retinopathy (n=14) and glaucoma who chronically received topical drugs preserved with benzalkonium chloride (n=20) were enrolled. Evaluation consisted of a comprehensive protocol encompassing: (1) structured questionnaire - Ocular Surface Disease Index (OSDI); (2) tear osmolarity (TearLab Osmolarity System - Ocusense); (3) tear film break-up time (TBUT); (4) fluorescein and lissamine green staining; (5) Schirmer test and (6) severity grading. RESULTS One hundred and twenty five patients (aged 48.8 years-old ± 14.1, male:female ratio=0.4) were enrolled in the study, along with 24 age and gender matched controls. Higher scores on DED tests were obtained in Sjögren Syndrome (P<0.05), except for tear film osmolarity that was higher in diabetics (P<0.001) and fluorescein staining, that was higher in facial palsy (P<0.001). TFBUT and OSDI correlated better with other tests. The best combination of diagnostic tests for DED was OSDI, TBUT and Schirmer test (sensitivity 100%, specificity 95% and accuracy 99.3%). CONCLUSIONS DED diagnostic test results present a broad range of variability among different conditions. Vital stainings and TBUT correlated best with one another whereas the best test combination to detect DED was: OSDI/TBUT/Schirmer.
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Affiliation(s)
- Monica Alves
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
- Pontific Catholic University of Campinas, Campinas, SP, Brazil
| | - Peter Sol Reinach
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Jayter Silva Paula
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
| | | | - Leticia Bachette
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
| | - Jacqueline Faustino
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
| | | | - Afonso Vigorito
- Faculty of Medical Sciences, University of Campinas, Campinas, SP, Brazil
| | | | - Eduardo Melani Rocha
- Faculty of Medicine Ribeirão Preto, São Paulo University, Ribeirão Preto, SP, Brazil
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21
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Armstrong RA. When to use the Bonferroni correction. Ophthalmic Physiol Opt 2014; 34:502-8. [DOI: 10.1111/opo.12131] [Citation(s) in RCA: 1269] [Impact Index Per Article: 126.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/13/2014] [Indexed: 12/19/2022]
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Bron AJ, Tomlinson A, Foulks GN, Pepose JS, Baudouin C, Geerling G, Nichols KK, Lemp MA. Rethinking dry eye disease: a perspective on clinical implications. Ocul Surf 2014; 12:S1-31. [PMID: 24725379 DOI: 10.1016/j.jtos.2014.02.002] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/07/2014] [Accepted: 02/01/2014] [Indexed: 01/18/2023]
Abstract
Publication of the DEWS report in 2007 established the state of the science of dry eye disease (DED). Since that time, new evidence suggests that a rethinking of traditional concepts of dry eye disease is in order. Specifically, new evidence on the epidemiology of the disease, as well as strategies for diagnosis, have changed the understanding of DED, which is a heterogeneous disease associated with considerable variability in presentation. These advances, along with implications for clinical care, are summarized herein. The most widely used signs of DED are poorly correlated with each other and with symptoms. While symptoms are thought to be characteristic of DED, recent studies have shown that less than 60% of subjects with other objective evidence of DED are symptomatic. Thus the use of symptoms alone in diagnosis will likely result in missing a significant percentage of DED patients, particularly with early/mild disease. This could have considerable impact in patients undergoing cataract or refractive surgery as patients with DED have less than optimal visual results. The most widely used objective signs for diagnosing DED all show greater variability between eyes and in the same eye over time compared with normal subjects. This variability is thought to be a manifestation of tear film instability which results in rapid breakup of the tearfilm between blinks and is an identifier of patients with DED. This feature emphasizes the bilateral nature of the disease in most subjects not suffering from unilateral lid or other unilateral destabilizing surface disorders. Instability of the composition of the tears also occurs in dry eye disease and shows the same variance between eyes. Finally, elevated tear osmolarity has been reported to be a global marker (present in both subtypes of the disease- aqueous-deficient dry eye and evaporative dry eye). Clinically, osmolarity has been shown to be the best single metric for diagnosis of DED and is directly related to increasing severity of disease. Clinical examination and other assessments differentiate which subtype of disease is present. With effective treatment, the tear osmolarity returns to normal, and its variability between eyes and with time disappears. Other promising markers include objective measures of visual deficits, proinflammatory molecular markers and other molecular markers, specific to each disease subtype, and panels of tear proteins. As yet, however, no single protein or panel of markers has been shown to discriminate between the major forms of DED. With the advent of new tests and technology, improved endpoints for clinical trials may be established, which in turn may allow new therapeutic agents to emerge in the foreseeable future. Accurate recognition of disease is now possible and successful management of DED appears to be within our grasp, for a majority of our patients.
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Affiliation(s)
- Anthony J Bron
- Professor emeritus - University of Oxford, Nuffield Laboratory of Ophthalmology, Nuffield Dept of Clinical Neurosciences, UK.
| | - Alan Tomlinson
- Professor of Vision Sciences, Glasgow Caledonian University, Scotland
| | - Gary N Foulks
- Emeritus Professor of Ophthalmology, University of Louisville; Editor-in-Chief, The Ocular Surface, USA
| | - Jay S Pepose
- Professor of Clinical Ophthalmology and Visual Sciences, Washington University School of Medicine, Director, Pepose Vision Institute, St. Louis, Missouri, USA
| | - Christophe Baudouin
- Quinze-Vingts National Ophthalmology Hospital, and Vision Institute, University Paris 6, Paris, France
| | - Gerd Geerling
- Professor and Chair, Department of Ophthalmology, Heinrich-Heine-University Moorenstr. 5 40225 Düsseldorf, Germany
| | - Kelly K Nichols
- FERV Professor (Foundation for Education and Research in Vision), The Ocular Surface Institute, University of Houston, College of Optometry, Houston, Texas, USA
| | - Michael A Lemp
- Clinical Professor of Ophthalmology, Georgetown University, Washington DC and George Washington University, Washington DC, USA
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Tong L, Zhao Y, Lee R. Corneal refractive surgery-related dry eye: risk factors and management. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2013.851602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE Dry eye is a prevalent condition with significant socioeconomic burden. This study evaluates the extent and reasons for loss to follow-up (LTF) in a dedicated dry eye clinic. LTF refers to patient who discontinued visits for >2 years. METHOD The proportion of patients LTF and the demographics in a cohort of dry eye patients (2006 to 2010) were determined. A telephone survey was prospectively conducted for patients who were LTF. RESULTS Of 505 patients, 240 (47.5%) were LTF. Associated demographic factors for LTF were male sex, non-Chinese ethnicity, and age group <30 years old (all P<0.05). The reasons for LTF through the telephone survey (response rate 77.9%) were categorized into three broad groups, stabilized dry eye condition (47%), personal/social factors (25%) and perceived insufficiency of healthcare delivery (28%). Only two (1.1%) were considered as management failures. The younger patients (age <50 years) were more likely to become LTF (P<0.001) due to stabilized dry eye disease, compared to older patients who were more likely to be LTF due to personal/social reasons (P=0.02). Poor communication and service factors under healthcare delivery were found to be higher (P=0.002) in those who visited once before they were LTF (8.5%) compared to those who visited multiple times before they were LTF (0.1%). CONCLUSION LTF was relatively common in hospital-based dry eye management. Female and older patients were less likely to stop consultation. Stabilized dry eye condition, common in younger patients, was the most common reason for LTF. Elderly patients have difficulty attending clinics due to nonmedical problems, which may require a more holistic approach.
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Affiliation(s)
| | - Sharon Yeo
- Singapore Eye Research Institute, Singapore
| | - Louis Tong
- Singapore Eye Research Institute, Singapore
- Singapore National Eye Centre, Singapore
- Yong Loo Lin School of Medicine, Singapore
- Duke-NUS Graduate Medical School, Singapore
- Correspondence: Louis Tong, Singapore National Eye Center, 11 Third Hospital Avenue, Singapore 168751, Tel +65 9818 6221, Fax +65 6227 7290, Email
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Pekel G, Cetin EN, Acer S, Yagci R, Altintas S, Ongun GT. Effect of chronic smoking on lens nucleus as assessed by Pentacam HR lens densitometry in young adults. Cutan Ocul Toxicol 2013; 33:145-9. [DOI: 10.3109/15569527.2013.814137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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