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Wolffsohn JS, Lingham G, Downie LE, Huntjens B, Inomata T, Jivraj S, Kobia-Acquah E, Muntz A, Mohamed-Noriega K, Plainis S, Read M, Sayegh RR, Singh S, Utheim TP, Craig JP. TFOS Lifestyle: Impact of the digital environment on the ocular surface. Ocul Surf 2023; 28:213-252. [PMID: 37062428 DOI: 10.1016/j.jtos.2023.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Eye strain when performing tasks reliant on a digital environment can cause discomfort, affecting productivity and quality of life. Digital eye strain (the preferred terminology) was defined as "the development or exacerbation of recurrent ocular symptoms and/or signs related specifically to digital device screen viewing". Digital eye strain prevalence of up to 97% has been reported, due to no previously agreed definition/diagnostic criteria and limitations of current questionnaires which fail to differentiate such symptoms from those arising from non-digital tasks. Objective signs such as blink rate or critical flicker frequency changes are not 'diagnostic' of digital eye strain nor validated as sensitive. The mechanisms attributed to ocular surface disease exacerbation are mainly reduced blink rate and completeness, partial/uncorrected refractive error and/or underlying binocular vision anomalies, together with the cognitive demand of the task and differences in position, size, brightness and glare compared to an equivalent non-digital task. In general, interventions are not well established; patients experiencing digital eye strain should be provided with a full refractive correction for the appropriate working distances. Improving blinking, optimizing the work environment and encouraging regular breaks may help. Based on current, best evidence, blue-light blocking interventions do not appear to be an effective management strategy. More and larger clinical trials are needed to assess artificial tear effectiveness for relieving digital eye strain, particularly comparing different constituents; a systematic review within the report identified use of secretagogues and warm compress/humidity goggles/ambient humidifiers as promising strategies, along with nutritional supplementation (such as omega-3 fatty acid supplementation and berry extracts).
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Affiliation(s)
- James S Wolffsohn
- College of Health & Life Sciences, School of Optometry, Aston University, Birmingham, UK; Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
| | - Gareth Lingham
- Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Byki Huntjens
- Division of Optometry and Visual Sciences, City, University of London, EC1V 0HB, UK
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Saleel Jivraj
- College of Health & Life Sciences, School of Optometry, Aston University, Birmingham, UK
| | | | - Alex Muntz
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Karim Mohamed-Noriega
- Department of Ophthalmology, University Hospital and Faculty of Medicine, Autonomous University of Nuevo León (UANL). Monterrey, 64460, Mexico
| | - Sotiris Plainis
- College of Health & Life Sciences, School of Optometry, Aston University, Birmingham, UK; Laboratory of Optics and Vision, School of Medicine, University of Crete, Greece
| | - Michael Read
- Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Rony R Sayegh
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sumeer Singh
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Tor P Utheim
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Jennifer P Craig
- College of Health & Life Sciences, School of Optometry, Aston University, Birmingham, UK; Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Vicente García-Marqués J, Talens-Estarelles C, García-Lázaro S, Cerviño A. Assessment of condition-induced changes on the ocular surface using novel methods to assess the tear film dynamics and the lipid layer. Cont Lens Anterior Eye 2022; 46:101799. [PMID: 36577612 DOI: 10.1016/j.clae.2022.101799] [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: 06/17/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess the effects of different condition-induced changes on current and novel ocular surface metrics. METHODS Eighty-four healthy volunteers (22.4 ± 2.6 years) participated in this study. The ocular surface and tear film response to (1) computer use, (2) contact lens insertion and (3) tear film instillation during computer use with contact lenses were assessed. Current metrics included the ocular surface disease (OSDI) questionnaire, 5-item dry eye questionnaire (DEQ-5), bulbar redness, tear meniscus height (TMH) and non-invasive keratograph break-up time (NIKBUT). Novel metrics included the lipid layer thickness obtained from the intensity of the reflected Placido disk and the speed of tear film particles post-blink. RESULTS Higher dry eye symptoms, TMH and bulbar redness, and lower values in metrics related to the intensity of the Placido disk pattern and to particle speed were found after the computer reading task (p < 0.036). When a contact lens was fitted, lower TMH, NIKBUT and particle speed metrics were obtained (p < 0.044). Mixed ANOVA revealed that artificial tears significantly ameliorated the effect of computer reading on OSDI, DEQ-5, NIKBUT, metrics related to the intensity of the Placido disk pattern and metrics related to particle speed (p < 0.033). CONCLUSIONS Computer use and contact lens wear worsened dry eye signs and symptoms, but artificial tears ameliorated this effect. Newly developed methods can serve as a tool to detect changes in the tear film triggered by different ocular surface-disturbing conditions.
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Affiliation(s)
| | | | - Santiago García-Lázaro
- Department of Optics and Optometry and Vision Sciences. University of Valencia. Valencia, Spain
| | - Alejandro Cerviño
- Department of Optics and Optometry and Vision Sciences. University of Valencia. Valencia, Spain.
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Kamøy B, Magno M, Nøland ST, Moe MC, Petrovski G, Vehof J, Utheim TP. Video display terminal use and dry eye: preventive measures and future perspectives. Acta Ophthalmol 2022; 100:723-739. [PMID: 35122403 PMCID: PMC9790652 DOI: 10.1111/aos.15105] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/07/2022] [Accepted: 01/20/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dry eye disease (DED) is a common cause of ocular pain and discomfort. Dry eye disease (DED) stems from a loss-of-tear film homeostasis and is frequently seen in video display terminal (VDT) users. Video display terminal (VDT) use reduces blink rates and increases incomplete blinks, leading to tear film instability and ocular inflammation, promoting DED. PURPOSE To assess and evaluate the methods for preventing VDT-associated DED and ocular discomfort. METHODS Studies were found using PubMed and Embase with the search terms: (digital visual terminal* OR computer use OR screen use OR smartphone OR display OR visual display terminal* OR computer vision syndrome OR tablet OR phone OR screen time) AND (dry eye OR DED). RESULTS Thirty-one relevant articles were found. Ten described single-visit studies, whereas 21 had a prolonged follow-up. Most preventive measures of VDT-associated DED aimed to increase blink rate or directly prevent tear film instability, ocular inflammation, mucin loss or ocular surface damage. Using an adjustable chair and ergonomic training, blink animations and omega-3 supplementation improved signs and symptoms of VDT-associated DED. Taking frequent breaks was associated with fewer symptoms, but no study assessed the commonly suggested 20-20-20 rule. CONCLUSION Preventive measures, such as blink animation programmes, oral intake of omega-3 fatty acids and improved ergonomics act on different parts of the vicious cycle of dry eye and could supplement each other. A comparison of the efficacy of the different interventions as well as more evidence of the effect of increased humidity, VDT filters and ergonomic practices, are required.
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Affiliation(s)
- Bjørnar Kamøy
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
| | - Morten Magno
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway,Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of OphthalmologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Sara T Nøland
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway
| | - Morten C Moe
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway,Department of OphthalmologyOslo University HospitalOsloNorway
| | - Goran Petrovski
- Institute of Clinical MedicineFaculty of MedicineUniversity of OsloOsloNorway,Department of OphthalmologyOslo University HospitalOsloNorway
| | - Jelle Vehof
- Department of OphthalmologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands,Department of OphthalmologyVestfold Hospital TrustTønsbergNorway,Department of EpidemiologyUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Tor P. Utheim
- Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of OphthalmologyOslo University HospitalOsloNorway,Department of OphthalmologySørlandet Hospital ArendalArendalNorway,Department of OphthalmologyStavanger University HospitalStavangerNorway,Department of Computer ScienceOslo Metropolitan UniversityOsloNorway,Department of Clinical MedicineFaculty of MedicineUniversity of BergenBergenNorway,Department of Quality and Health TechnologyThe Faculty of Health SciencesUniversity of StavangerStavangerNorway,Department of OphthalmologyVestre Viken Hospital TrustDrammenNorway,Department of Oral BiologyFaculty of DentistryUniversity of OsloOsloNorway,National Centre for Optics, Vision and Eye CareDepartment of Optometry, Radiography and Lighting DesignFaculty of Health SciencesUniversity of South‐Eastern NorwayKongsbergNorway,Department of Health and Nursing ScienceThe Faculty of Health and Sport SciencesUniversity of AgderGrimstadNorway,The Norwegian Dry Eye ClinicOsloNorway
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Abstract
OBJECTIVES To evaluate dry eye-related lifestyle and demographic factors associated with digital eye strain (DES). METHODS An anonymous online survey was conducted in 851 university students. Participants were classified into DES (computer vision syndrome questionnaire [CVS-Q]≥6) or non-DES (CVS-Q<6). Respondents completed three dry eye questionnaires (Ocular Surface Disease Index [OSDI]; 5-item Dry Eye Questionnaire [DEQ-5]; 8-item Contact Lens Dry Eye Questionnaire) and were surveyed on dry eye risk factors contemplated by the Tear Film and Ocular Surface Society Dry Eye Workshop II. RESULTS Six hundred twenty-eight participants were classified into the group with DES and 222 into the group without DES. Participants with DES slept fewer hours, spent more hours indoors with air conditioning, drank more caffeinated beverages, used the computer for longer periods, reported poorer health quality, and obtained a higher score in all questionnaires (P<0.025). A higher proportion of the participants were female, had several health disorders, and took several medications associated with dry eye (P<0.029). Multivariate logistic regression analysis revealed that stress (P=0.035), contact lens wear (P=0.011), hours of computer use per day (P=0.010), migraine headaches (P=0.013), and a higher OSDI (P<0.001) and DEQ-5 score (P<0.001) were associated with DES. CONCLUSIONS Several dry eye-related risk factors and health conditions are associated with suffering from DES. Clinicians should acknowledge the relevance of triaging questions and dry eye disease risk factors when dealing with patients who view screens for extended periods.
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Navel V, Sapin V, Henrioux F, Blanchon L, Labbé A, Chiambaretta F, Baudouin C, Dutheil F. Oxidative and antioxidative stress markers in dry eye disease: A systematic review and meta-analysis. Acta Ophthalmol 2022; 100:45-57. [PMID: 33938134 DOI: 10.1111/aos.14892] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/10/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis on the levels of oxidative stress markers and antioxidants in dry eye disease (DED) compared with healthy subject. METHOD The PubMed, Cochrane Library, Embase, Science Direct and Google Scholar databases were searched on 10 January 2021 for studies reporting oxidative and antioxidative stress markers in DED and healthy controls. Main meta-analysis was stratified by type of biomarkers, type of samples (tears, conjunctival cells or biopsies), Sjögren's syndrome (SS) (patients with or without SS) and by geographical zones (Asia or Europe). RESULTS We included nine articles, for a total of 333 patients (628 eye samples) with DED and 165 healthy controls (451 eye samples). There is an overall increase in oxidative stress markers in DED compared with healthy controls (standard mean deviation = 2.39, 95% confidence interval 1.85-2.94), with a significant increase in lipid peroxide (1.90, 0.69-3.11), myeloperoxidase (2.17, 1.06-3.28), nitric oxide synthase 3 (2.52, 0.95-4.08), xanthine oxidase/oxidoreductase (2.41, 1.40-5.43), 4-hydroxy-2-nonenal (4HNE) (4.75, 1.67-7.84), malondialdehyde (3.00, 2.55-3.45) and reactive oxygen species (1.31, 0.94-1.68). Oxidative stress markers were higher in tears, conjunctival cells and conjunctival biopsies of DED than controls. Even if small number of studies were included for antioxidants, catalase seemed to be decreased in DED compared with healthy controls (-2.17, -3.00 to -1.34), with an increase of antioxidants in tears of DED patients without SS (1.13, 0.76-1.49). CONCLUSION Oxidative stress markers, and probably antioxidants, were dysregulated in DED, establishing a local oxidative environment in tears, conjunctival cells and tissues.
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Affiliation(s)
- Valentin Navel
- University Hospital of Clermont‐Ferrand CHU Clermont‐Ferrand, Ophthalmology Clermont‐Ferrand France
- Université Clermont Auvergne CNRS UMR 6293 INSERM U1103 Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team Clermont‐Ferrand France
| | - Vincent Sapin
- Université Clermont Auvergne CNRS UMR 6293 INSERM U1103 Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team Clermont‐Ferrand France
- University Hospital of Clermont‐Ferrand CHU Clermont‐Ferrand, Biochemistry and Molecular Genetics Clermont‐Ferrand France
| | - Fanny Henrioux
- Université Clermont Auvergne CNRS UMR 6293 INSERM U1103 Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team Clermont‐Ferrand France
| | - Loïc Blanchon
- Université Clermont Auvergne CNRS UMR 6293 INSERM U1103 Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team Clermont‐Ferrand France
| | - Antoine Labbé
- Department of Ophthalmology III Quinze‐Vingts National Ophthalmology Hospital IHU FOReSIGHT Paris France
- Sorbonne Université INSERM CNRS Institut de la Vision Paris France
- Department of Ophthalmology Ambroise Paré Hospital APHP Université de Versailles Saint‐Quentin en Yvelines Versailles France
| | - Frédéric Chiambaretta
- University Hospital of Clermont‐Ferrand CHU Clermont‐Ferrand, Ophthalmology Clermont‐Ferrand France
- Université Clermont Auvergne CNRS UMR 6293 INSERM U1103 Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team Clermont‐Ferrand France
| | - Christophe Baudouin
- Department of Ophthalmology III Quinze‐Vingts National Ophthalmology Hospital IHU FOReSIGHT Paris France
- Sorbonne Université INSERM CNRS Institut de la Vision Paris France
- Department of Ophthalmology Ambroise Paré Hospital APHP Université de Versailles Saint‐Quentin en Yvelines Versailles France
| | - Frédéric Dutheil
- Université Clermont Auvergne CNRS LaPSCo Physiological and Psychosocial Stress CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand, Preventive and Occupational Medicine Witty Fit Clermont‐Ferrand France
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Auffret É, Gomart G, Bourcier T, Gaucher D, Speeg-Schatz C, Sauer A. [Digital eye strain. Symptoms, prevalence, pathophysiology, and management]. J Fr Ophtalmol 2021; 44:1605-1610. [PMID: 34657757 DOI: 10.1016/j.jfo.2020.10.002] [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] [Received: 08/19/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 10/20/2022]
Abstract
The digital revolution, which has been underway since the 1980's, is disrupting our daily routines with an exponential increase in the use of screens, which has not been without consequence to our visual system. Digital eye strain (DES), or computer vision syndrome (CVS), includes all the visual symptoms secondary to the use of digital devices. DES is present in at least 50% of regular users of digital media and is defined by blurred vision, difficulty focusing, ocular irritation or burning, dry eye, visual fatigue, headaches and increased sensitivity to light. Exposure time, age, female gender, and work environment are the main factors increasing its prevalence. Its pathophysiology, still poorly understood, is felt to be multifactorial and includes disturbances in the accommodative-convergence balance and changes in the ocular surface. Regarding accommodation and convergence, the studies are mostly old and their results heterogeneous. Conversely, many studies have shown an increase in the prevalence of dry eye in screen users. Although the retinal toxicity of blue light has been proven in in vitro models, the low level of evidence in the available studies does not allow it to be clearly correlated with the symptoms of DES. The objective of this review is to condense the knowledge available in the literature on the symptoms, prevalence, pathophysiology and management of DES.
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Affiliation(s)
- É Auffret
- Service d'ophtalmologie, Centre hospitalo-universitaire de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France.
| | - G Gomart
- Service d'ophtalmologie, Centre hospitalo-universitaire de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - T Bourcier
- Service d'ophtalmologie, Centre hospitalo-universitaire de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - D Gaucher
- Service d'ophtalmologie, Centre hospitalo-universitaire de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - C Speeg-Schatz
- Service d'ophtalmologie, Centre hospitalo-universitaire de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - A Sauer
- Service d'ophtalmologie, Centre hospitalo-universitaire de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
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Li Q, Liu J, Liu C, Piao J, Yang W, An N, Zhu J. Effects of intense pulsed light treatment on tear cytokines and clinical outcomes in meibomian gland dysfunction. PLoS One 2021; 16:e0256533. [PMID: 34437596 PMCID: PMC8389452 DOI: 10.1371/journal.pone.0256533] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/04/2021] [Indexed: 12/04/2022] Open
Abstract
Meibomian gland dysfunction (MGD) has become a prevalent ocular surface disorder. Its pathogenesis is regarded as a self-perpetuating inflammatory vicious circle. Intense Pulsed Light (IPL) treatment was recently applied to improve the meibomian gland function and reduce symptoms of MGD. However, studies investigating the change of specific inflammatory cytokines during IPL treatment remained sparse. To further figure out how IPL treatment modulates the inflammatory cytokines in tears of MGD, we therefore performed a cross-sectional study and enrolled 32 patients from March 2019 to December 2020. The patients received 3 sessions of IPL treatment (10 to 16 J/cm2) at 4-week interval. The signs and symptoms of MGD were evaluated by ocular surface disease index (OSDI), tear film breakup time (TBUT), and meibomian gland yield secretion score (MGYSS). The clinical evaluators and tear samples were analyzed at baseline and at each IPL treatment session. Concentrations of (chemokine ligand) CXCL1, (C-C motif chemokine) CCL11, (tumor necrosis factor) TNF-α, (interferon) IFN-γ, (interleukin) IL-2, IL-6 and (tissue inhibitor of metalloproteinase) TIMP-1were measured by Quantibody Human Dry Eye Disease Array1. OSDI significantly decreased after IPL treatment compared with baseline. TBUT and MGYSS increased consecutively during treatment. CXCL1, CCL11, TNF-α, IFN-γ, IL-2, IL-6 presented significantly decrease and TIMP-1 showed significantly increase from the pretreatment baseline. The changed concentrations of TNF-α, IFN-γ, IL-2, TIMP-1 correlated with TBUT, the changed values of CXCL1, TNF-α, IFN-γ, CCL11, IL-2, IL-6, TIMP-1 correlated with MGYSS, and the changed concentrations of CXCL1, IFN-γ, CCL11, IL-2, IL-6 correlated with TIMP-1. The data supported IPL treatment could significantly relieve both signs and symptoms of MGD. The therapeutic effect of IPL treatment may originate from regulation of inflammatory cytokines including CXCL1, TNF-α, IFN-γ, CCL11, IL-2, IL-6, and TIMP-1.
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Affiliation(s)
- Qian Li
- Department of Ophthalmology, Ningxia Eye Hospital, Peoples’ Hospital of Ningxia Hui Autonomous Region, Ningxia Clinical Research Center on Disease of Blindness in Eye, First Affiliated Hospital of Northwest University for Nationalities, Yinchuan, Ningxia, China
- * E-mail:
| | - Junxiu Liu
- Department of Ophthalmology, Ningxia Eye Hospital, Peoples’ Hospital of Ningxia Hui Autonomous Region, Ningxia Clinical Research Center on Disease of Blindness in Eye, First Affiliated Hospital of Northwest University for Nationalities, Yinchuan, Ningxia, China
| | - Cheng Liu
- Medical Sci-Tech Research Center of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Junfeng Piao
- Department of Ophthalmology, Ningxia Eye Hospital, Peoples’ Hospital of Ningxia Hui Autonomous Region, Ningxia Clinical Research Center on Disease of Blindness in Eye, First Affiliated Hospital of Northwest University for Nationalities, Yinchuan, Ningxia, China
| | - Wei Yang
- Department of Ophthalmology, Ningxia Eye Hospital, Peoples’ Hospital of Ningxia Hui Autonomous Region, Ningxia Clinical Research Center on Disease of Blindness in Eye, First Affiliated Hospital of Northwest University for Nationalities, Yinchuan, Ningxia, China
| | - Ningyu An
- Department of Ophthalmology, Ningxia Eye Hospital, Peoples’ Hospital of Ningxia Hui Autonomous Region, Ningxia Clinical Research Center on Disease of Blindness in Eye, First Affiliated Hospital of Northwest University for Nationalities, Yinchuan, Ningxia, China
| | - Jinyan Zhu
- Department of Ophthalmology, Ningxia Eye Hospital, Peoples’ Hospital of Ningxia Hui Autonomous Region, Ningxia Clinical Research Center on Disease of Blindness in Eye, First Affiliated Hospital of Northwest University for Nationalities, Yinchuan, Ningxia, China
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Signature of Circulating Biomarkers in Recurrent Non-Infectious Anterior Uveitis. Immunomodulatory Effects of DHA-Triglyceride. A Pilot Study. Diagnostics (Basel) 2021; 11:diagnostics11040724. [PMID: 33921773 PMCID: PMC8072877 DOI: 10.3390/diagnostics11040724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022] Open
Abstract
The purpose of this study was to identify circulating biomarkers of recurrent non-infectious anterior uveitis (NIAU), and to address the anti-inflammatory effects of triglyceride containing docosahexaenoic acid (DHA-TG). A prospective multicenter study was conducted in 72 participants distributed into: patients diagnosed with recurrent NIAU in the quiescence stage (uveitis group (UG); n = 36) and healthy controls (control group (CG); n = 36). Each group was randomly assigned to the oral supplementation of one pill/day (+) containing DHA-TG (n = 18) or no-pill condition (−) (n = 17) for three consecutive months. Data from demographics, risk factors, comorbidities, eye complications and therapy were recorded. Blood was collected and processed to determine pro-inflammatory biomarkers by bead-base multiplex assay. Statistical processing with multivariate statistical analysis was performed. The mean age was 50, 12 (10, 31) years. The distribution by gender was 45% males and 55% females. The mean number of uveitis episodes was 5 (2). Higher plasma expression of interleukin (IL)-6 was detected in the UG versus the CG (p = 5 × 10−5). Likewise, significantly higher plasma levels were seen for IL-1β, IL-2, INFγ (p = 10−4), and TNFα (p = 2 × 10−4) in the UG versus the CG. Significantly lower values of the above molecules were found in the +DHA-TG than in the -DHA-TG subgroups, after 3 months of follow-up, TNFα (p = 10−7) and IL-6 (p = 3 × 10−6) being those that most significantly changed. Signatures of circulating inflammatory mediators were obtained in the quiescent stage of recurrent NIAU patients. This 3-month follow-up strongly reinforces that a regular oral administration of DHA-TG reduces the inflammatory load and may potentially supply a prophylaxis-adjunctive mediator for patients at risk of uveitis vision loss.
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Jaiswal S, Asper L, Long J, Lee A, Harrison K, Golebiowski B. Ocular and visual discomfort associated with smartphones, tablets and computers: what we do and do not know. Clin Exp Optom 2021; 102:463-477. [DOI: 10.1111/cxo.12851] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/06/2018] [Accepted: 10/07/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sukanya Jaiswal
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Lisa Asper
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Jennifer Long
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Abigail Lee
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Kirsten Harrison
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia,
| | - Blanka Golebiowski
- School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia,
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Talens-Estarelles C, García-Marqués JV, Cervino A, García-Lázaro S. Use of digital displays and ocular surface alterations: A review. Ocul Surf 2020; 19:252-265. [PMID: 33053438 DOI: 10.1016/j.jtos.2020.10.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022]
Abstract
Digital display use has been accepted to be implicated as a contributing factor for dry eye disease (DED). Abnormal blinking during computer operation, including a reduced blink rate and an incomplete eyelid closure, increased palpebral fissure as consequence of high visualization angles, and meibomian gland dysfunction associated to long-term display use, are behind the increased prevalence of dry eye signs and symptoms found in digital display users. Previous research reveals significant reductions in tear volume and stability, alterations in tear film composition, including increased osmolarity, inflammatory cytokines, oxidative stress markers and reduced mucin secretion, eyelid abnormalities and ocular surface damage, encompassing corneal and conjunctival staining and bulbar redness, as a direct consequence of digital display use. In this regard, individual differences in the way that the various digital displays are typically set up and used may account for differences in their effects on induced dryness signs and symptoms. Furthermore, factors such as the use of contact lenses or inappropriate working environments, usually accompanying the use of displays, may significantly increase the prevalence and the severity of induced dry eye. Other factors, such as old age and female gender are also relevant in the appearance of associated alterations. Finally, clinicians should adopt a treatment strategy based on a multidirectional approach, with various treatments being applied in conjunction.
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Affiliation(s)
- Cristian Talens-Estarelles
- Department of Optics & Optometry & Vision Sciences. University of Valencia. Dr. Moliner, 50 46100, Burjassot (Valencia), Spain
| | - José Vicente García-Marqués
- Department of Optics & Optometry & Vision Sciences. University of Valencia. Dr. Moliner, 50 46100, Burjassot (Valencia), Spain
| | - Alejandro Cervino
- Department of Optics & Optometry & Vision Sciences. University of Valencia. Dr. Moliner, 50 46100, Burjassot (Valencia), Spain
| | - Santiago García-Lázaro
- Department of Optics & Optometry & Vision Sciences. University of Valencia. Dr. Moliner, 50 46100, Burjassot (Valencia), Spain.
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White DE, Zhao Y, Jayapalan H, Machiraju P, Periyasamy R, Ogundele A. Treatment Satisfaction Among Patients Using Anti-Inflammatory Topical Medications for Dry Eye Disease. Clin Ophthalmol 2020; 14:875-883. [PMID: 32256045 PMCID: PMC7089601 DOI: 10.2147/opth.s233194] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/20/2020] [Indexed: 01/16/2023] Open
Abstract
Purpose To assess patient satisfaction among current and former users of the anti-inflammatory topical medications, cyclosporine A 0.05% (CYC) and lifitegrast 5.0% (LIF), for the management of dry eye disease (DED). Patients and Methods Patients with DED were recruited via physician referral to participate in a survey. Current users of CYC or LIF were asked to rate their experience in terms of satisfaction, side effects, and limitation of activities. Switchers of CYC to LIF or LIF to CYC were asked to rate the importance of potential reasons for switching. Results Surveys were completed by 207 patients currently treated with CYC (n=98), LIF (n=96), or other DED medications (n=13). Although overall satisfaction with current treatment was high, current users of CYC and LIF reported ineffective relief of DED symptoms (31% and 22%, respectively) and dissatisfaction with the time to onset of effect (29% and 11%). Substantial proportions of patients reported ‘sometimes’, “usually”, or ‘always’ experiencing the following side effects: burning sensation (72% CYC, 64% LIF), itching (43% CYC, 44% LIF), altered sensation of taste (21% CYC, 56% LIF), blurred vision (37% CYC, 50% LIF), and discharge (28% CYC, 30% LIF). Of the 30 switchers of CYC to LIF and 31 switchers of LIF to CYC, the majority reported inability to relieve DED symptoms as a very or extremely important switching reason. Despite switching, one in four patients were somewhat dissatisfied or dissatisfied with their current medication, with 37% of patients reporting ineffective symptom relief. Conclusion Although the rate of overall satisfaction was generally high with both LIF and CYC, many patients were unable to achieve effective symptom relief and commonly experienced side effects. The proportion of patients who were dissatisfied and/or unable to achieve effective symptom relief even after switching suggests the need for additional treatment options for managing DED.
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Affiliation(s)
| | - Yang Zhao
- Sun Pharmaceutical Industries, Inc., Princeton, NJ, USA
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12
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Colorado LH, Edwards K, Dinh L, Ha S, Liu D, Luu A, Trang S, Yu-Ting TH, Schmid KL. Associations between the menstrual cycle, lifestyle factors and clinical assessment of the ocular surface: a prospective observational study. BMC Womens Health 2020; 20:23. [PMID: 32033559 PMCID: PMC7006113 DOI: 10.1186/s12905-020-0894-z] [Citation(s) in RCA: 4] [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: 04/22/2019] [Accepted: 01/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Little is known about the ocular surface changes over the menstrual cycle in young women and the interactions with lifestyle factors. Therefore, the purpose of this study was to explore the associations between modifiable lifestyle factors and menstrual cycle phases on the ocular signs and symptoms of dry eye in young healthy women. METHODS This was a prospective 1-month observational study. Thirty young healthy women with regular, 24 to 32-day menstrual cycles were recruited. Participants attended three visits at day 7, 14, and 21 (± 1) of their menstrual cycle. At baseline, general health questionnaire was conducted. At each visit, symptomology was quantified using Ocular Surface Disease Index (OSDI) and overall ocular comfort (OOC, visual analogue scale). Ocular signs were assessed using Efron scales, tear break-up time (TBUT) and phenol red thread (PRT). Pearson's correlation was used to determine associations between variables at each visit. RESULTS A total of 26 participants (mean age = 22.3 ± 3.7 years) with an average menstrual cycle of 28.3 ± 1.3 days completed the 3 visits. The interaction between signs/symptoms and lifestyle factors changed over the cycle. At the follicular phase (day 7), lifestyle factors such diet and levels of stress were correlated with PRT and OSDI, (r = - 0.4, p = 0.022; r = 0.4, p = 0.045 respectively). At the ovulation phase (day 14), the general health score was correlated with OOC scores (r = 0.4, p = 0.047). At day 14, exercise frequency correlated with PRT (r = - 0.4, p = 0.028) and caffeine intake was positively correlate with both; TBUT (r = 0.5, p = 0.020) and PRT (r = 0.5, p = 0.014). At the luteal phase (day 21), we found no correlations between lifestyle factors and dry eye signs or symptoms. CONCLUSIONS The associations between lifestyle factors and objective and subjective ocular surface assessment appeared to be more pronounced during the ovulation phase of the menstrual cycle compared to the follicular and luteal phases. Misalignment of these factors with the ocular health during the luteal phase could be attributed to central sensitization and changes in levels of luteinising hormone. Natural hormonal changes during menstrual cycle should be considered for diagnosis and treatment of dry eye in young healthy women.
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Affiliation(s)
- Luisa H Colorado
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia.
| | - Katie Edwards
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia
| | - Lynne Dinh
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia
| | - Sarah Ha
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia
| | - Danica Liu
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia
| | - Annie Luu
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia
| | - Shona Trang
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia
| | - Tina H Yu-Ting
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia
| | - Katrina L Schmid
- Institute of Health and Biomedical Innovation, School of Optometry and Vision Science, Queensland University of Technology, Room Q-504, Level 5, Kelvin Grove, Queensland, 4059, Australia
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13
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Fong PY, Shih KC, Lam PY, Chan TCY, Jhanji V, Tong L. Role of tear film biomarkers in the diagnosis and management of dry eye disease. Taiwan J Ophthalmol 2019; 9:150-159. [PMID: 31572651 PMCID: PMC6759547 DOI: 10.4103/tjo.tjo_56_19] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/26/2019] [Indexed: 02/06/2023] Open
Abstract
In recent years, there has been increasing scientific interest in the use of tear film biomarkers in the diagnosis and management of dry eye disease (DED), owing to their potential important roles in the pathogenesis of ocular surface damage, as well as the technical feasibility of tear sample collection techniques. An Entrez PubMed search was conducted on March 2, 2019, to include papers investigating the use of tear film biomarkers in DED, and the results were classified according to whether the DED is associated with systemic inflammatory disease or not and further classified within each section according to the molecular nature of the biomarker for further discussion. A total of 58 relevant articles were reviewed. Certain cytokines, including interleukin-6 (IL-6), tumor necrosis factor-alpha, IL-17, and IL-8, were found by a number of studies to consistently reflect disease severity well and had strong correlations with tear film metrics and tests for ocular surface damage in dry eye without systemic inflammatory disease. For dry eye with systemic inflammatory disease, IL-17, IL-8, and IL-1 receptor antagonists were shown to be consistently higher in affected eyes and correlated well with ocular surface disease severity in more than one type of inflammatory disease. With the advancement in technology and lowered costs in the future, tear film biomarker counts would allow better diagnosis and monitoring of DED, as well as facilitate personalized treatment strategies.
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Affiliation(s)
- Pak Yui Fong
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Kendrick Co Shih
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Pun Yuet Lam
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Tommy Chung Yan Chan
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, Hong Kong.,Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong SAR, Hong Kong
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh Medical Centre, Pittsburgh, USA
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Centre, Singapore.,Ocular Surface Research Group, Singapore Eye Research Institute, Singapore
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14
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Rodríguez González-Herrero ME, Ruiz M, López Román FJ, Marín Sánchez JM, Domingo JC. Supplementation with a highly concentrated docosahexaenoic acid plus xanthophyll carotenoid multivitamin in nonproliferative diabetic retinopathy: prospective controlled study of macular function by fundus microperimetry. Clin Ophthalmol 2018; 12:1011-1020. [PMID: 29881256 PMCID: PMC5983010 DOI: 10.2147/opth.s157635] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective There is little evidence of real-life outcomes of dietary supplementation with high-dose docosahexaenoic acid (DHA) and carotenoids in patients with diabetic retinopathy (DR). We assessed the effect of supplementation with DHA triglyceride (1,050 mg/d) + xanthophyll carotenoid multivitamin on macular function in nonproliferative DR. Methods Asymptomatic patients with nonproliferative DR were included in a prospective controlled study and assigned (1:1) to the DHA supplementation group or the control group. Macular sensitivity and macular integrity area were the main outcome measures. Functional vision measures (macular function [MAIA™ CenterVue], best-corrected visual acuity), structural retinal measures (central subfield macular thickness), and biochemical parameters (plasma total antioxidant capacity, DHA content of the erythrocyte membrane, and plasma IL-6) were evaluated at baseline and after 45 and 90 days of DHA supplementation. Results The study included 24 patients (48 eyes) (12 patients, 24 eyes in each group). Baseline clinical characteristics of patients in both groups were similar. Macular sensitivity increased from a mean (SD) of 25.9 (2.4) dB at baseline to 27.3 (2.3) dB at 90 days (P=0.030) in the DHA group only (between-group differences P<0.19). The macular integrity index decreased from 71.2 (33.2) at baseline to 63.5 (36.4) at 45 days and to 51.6 (35.9) at 90 days (P=0.002) in the DHA group only (between-group differences P<0.05). Best-corrected visual acuity and central subfield macular thickness did not vary significantly in any of the comparisons and in none of the groups. DHA content of erythrocyte membrane and total antioxidant capacity levels increased significantly only in the DHA group. Plasma IL-6 levels decreased significantly only in the DHA group. Conclusion In an early stage of DR, supplementation with high-dose DHA plus xanthophyll carotenoid multivitamin during 90 days was associated with a progressive and significant improvement of macular function measured by microperimetry. Biochemical changes supported the effect of DHA.
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Affiliation(s)
| | - Marcos Ruiz
- Service of Ophthalmology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Francisco Javier López Román
- Department of Exercise Physiology, Faculty of Health Sciences, San Antonio Catholic University of Murcia (UCAM), Murcia, Spain
| | | | - Joan Carles Domingo
- Department of Biochemistry and Molecular Biomedicine, Faculty of Biology, University of Barcelona, Barcelona, Spain
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Cortes M, Esposito G, Sacco R, Gillet VB, Ianni A, Micera A. NGF and iNOS Changes in Tears from Video Display Terminal Workers. Curr Eye Res 2018; 43:1119-1125. [DOI: 10.1080/02713683.2018.1475014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Magdalena Cortes
- Research Laboratories in Ophthalmology, IRCCS GB Bietti Foundation, Rome, Italy
- Occupational and Health Care Department, University Campus Bio-Medico, Rome, Italy
| | - Graziana Esposito
- Research Laboratories in Ophthalmology, IRCCS GB Bietti Foundation, Rome, Italy
| | - Roberto Sacco
- Occupational and Health Care Department, University Campus Bio-Medico, Rome, Italy
| | | | - Andrea Ianni
- Occupational and Health Care Department, University Campus Bio-Medico, Rome, Italy
| | - Alessandra Micera
- Research Laboratories in Ophthalmology, IRCCS GB Bietti Foundation, Rome, Italy
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16
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Wolkoff P. External eye symptoms in indoor environments. INDOOR AIR 2017; 27:246-260. [PMID: 27444579 DOI: 10.1111/ina.12322] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/19/2016] [Indexed: 05/22/2023]
Abstract
Eye irritation, for example dry or irritated eyes, is generally among top three reported symptoms in office-like environments, in particular among workplaces with cognitive demanding visual display unit (VDU) work. The symptoms are especially among middle and advanced ages and particularly among women more than men. The symptoms are also among the most commonly reported complaints in the eye clinic. To be in a position to interpret the high prevalence of eye symptoms, a multidisciplinary and integrated approach is necessary that involves the external eye physiology (separate from internal eye effects), eye diseases (evaporative dry eye (DE), aqueous-deficient DE, and gland dysfunctions), and risk factors that aggravate the stability of precorneal tear film (PTF) resulting in hyperosmolarity and initiation of inflammatory reactions. Indoor environmental, occupational and personal risk factors may aggravate the PTF stability; factors such as age, contact lenses, cosmetics, diet, draft, gender, low humidity and high temperature, medication, outdoor and combustion pollutants, and VDU work. Psychological stressors may further influence the reporting behavior of eye symptoms. The impact of the risk factors may occur in a combined and exacerbating manner.
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Affiliation(s)
- P Wolkoff
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Repeatability and Reproducibility of Noninvasive Keratograph 5M Measurements in Patients with Dry Eye Disease. J Ophthalmol 2016; 2016:8013621. [PMID: 27190639 PMCID: PMC4844888 DOI: 10.1155/2016/8013621] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/30/2016] [Indexed: 12/02/2022] Open
Abstract
Purpose. To determine the intraexaminer repeatability and interexaminer reproducibility of tear meniscus height (TMH) and noninvasive Keratograph tear breakup time (NIKBUT) measurements obtained with the Keratograph 5M (K5M) in a sample of healthy and dry eye populations. Methods. Forty-two patients with dry eye disease (DED group) and 42 healthy subjects (healthy group) were recruited in this prospective study. In all subjects, each eye received 3 consecutive measurements using the K5M for the TMH and NIKBUTs (NIKBUT-first and NIKBUT-average). And then a different examiner repeated the measurements. The repeatability and reproducibility of measurements were assessed by the coefficient of variation (CV) and intraclass correlation coefficient (ICC). Results. The repeatability and reproducibility of TMH and NIKBUTs were good in both DED and healthy groups (CV% ≤ 26.1% and ICC ≥ 0.75 for all measurements). Patients with DED showed better intraexaminer repeatability for NIKBUTs, but worse for TMH than healthy subjects. Average TMH, NIKBUT-first, and NIKBUT-average were significantly lower in DED group than in healthy group (all P values < 0.05). Conclusions. Measurements of TMH and NIKBUTs obtained with the K5M may provide a simple, noninvasive screening test for dry eye with acceptable repeatability and reproducibility. The NIKBUTs were more reliable, but TMH was less reliable in patients with DED.
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