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Borselli M, Toro MD, Rossi C, Taloni A, Khemlani R, Nakayama S, Nishimura H, Shimizu E, Scorcia V, Giannaccare G. Feasibility of Tear Meniscus Height Measurements Obtained with a Smartphone-Attachable Portable Device and Agreement of the Results with Standard Slit Lamp Examination. Diagnostics (Basel) 2024; 14:316. [PMID: 38337832 PMCID: PMC10855891 DOI: 10.3390/diagnostics14030316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE We aimed to evaluate the feasibility of using a novel device, the Smart Eye Camera (SEC), for assessing tear meniscus height (TMH) after fluorescein staining and the agreement of the results with measurements obtained using standard slit lamp examination. METHODS TMH was assessed using both SEC and conventional slit lamp examination. The images were analyzed using the software ImageJ 1.53t (National Institutes of Health, Bethesda, MD, USA). A common measurement unit scale was established based on a paper strip, which was used as a calibration marker to convert pixels into metric scale. A color threshold was applied using uniform parameters for brightness, saturation, and hue. The images were then binarized to black and white to enhance the representation of the tear menisci. A 2 mm area around the upper and lower meniscus in the central eye lid zone was selected and magnified 3200 times to facilitate manual measurement. The values obtained using SEC were compared with those obtained with a slit lamp. RESULTS The upper and lower TMH values measured using the SEC were not statistically different from those obtained with a slit lamp (0.209 ± 0.073 mm vs. 0.235 ± 0.085, p = 0.073, and 0.297 ± 0.168 vs. 0.260 ± 0.173, p = 0.275, respectively). The results of Bland-Altman analysis demonstrated strong agreement between the two instruments, with a mean bias of -0.016 mm (agreement limits: -0.117 to 0.145 mm) for upper TMH and 0.031 mm (agreement limits: -0.306 to 0.368 mm) for lower TMH. CONCLUSIONS The SEC demonstrated sufficient validity and reliability for assessing TMH in healthy eyes in a clinical setting, demonstrating concordance with the conventional slit lamp examination.
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Affiliation(s)
- Massimiliano Borselli
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Mario Damiano Toro
- Department of Ophthalmology, Federico II University Hospital, 80131 Naples, Italy;
- Department of Ophthalmology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Costanza Rossi
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Andrea Taloni
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Rohan Khemlani
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Yokohama Keiai Eye Clinic, Yokohama 240-0065, Japan
| | - Shintato Nakayama
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Hiroki Nishimura
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Eisuke Shimizu
- OUI Inc., Tokyo 160-0022, Japan; (R.K.); (S.N.); (H.N.); (E.S.)
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-0016, Japan
| | - Vincenzo Scorcia
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (M.B.); (C.R.); (A.T.); (V.S.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
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Pena-Verdeal H, Garcia-Queiruga J, Sabucedo-Villamarin B, Garcia-Resua C, Giraldez MJ, Yebra-Pimentel E. A Comprehensive Study on Tear Meniscus Height Inter-Eye Differences in Aqueous Deficient Dry Eye Diagnosis. J Clin Med 2024; 13:659. [PMID: 38337353 PMCID: PMC10856492 DOI: 10.3390/jcm13030659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: Dry eye disease (DED) is a chronic ocular surface condition that requires precise diagnostic tools. The present study aimed to investigate the diagnostic potential of the absolute inter-eye difference (|OD-OS|) in tear meniscus height (TMH) for the detection of the presence of aqueous deficient dry eye (ADDE). (2) Methods: A sample of 260 participants with dry eye complaints underwent ocular surface examinations thorough diagnostic assessments based on the Tear Film and Ocular Surface Society guidelines (TFOS DEWS II). Participants were subsequently categorized as No ADDE and ADDE based on TMH. Statistical analyses to determine the optimal TMH|OD-OS| cut-off value in a randomly selected study group (200 participants) were performed, while a separate validation analysis of the cut-off value obtained in a random cross-validation group (60 participants) was also performed. (3) Results: The significant diagnostic capability of TMH|OD-OS| (area under the curve = 0.719 ± 0.036, p < 0.001) was found. The identified cut-off value of 0.033 mm demonstrated reliable specificity (77.6%) and moderate sensitivity (59.1%). Cross-validation confirmed the cut-off value's association with the TFOS DEWS II diagnostic criterion (Cramer's V = 0.354, p = 0.006). (4) Conclusions: The present study provides evidence for the diagnostic potential of TMH|OD-OS| in identifying ADDE. The identified cut-off value enhances the specificity and offers moderate sensitivity, providing an objective tool for clinical decision making.
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Affiliation(s)
- Hugo Pena-Verdeal
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Jacobo Garcia-Queiruga
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Belen Sabucedo-Villamarin
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
| | - Carlos Garcia-Resua
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Maria J. Giraldez
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
| | - Eva Yebra-Pimentel
- GI-2092—Optometría, Departamento de Física Aplicada (Área de Optometría), Facultade de Óptica e Optometría, Universidade de Santiago de Compostela, Campus Vida S/N, 15705 Santiago de Compostela, Spain; (B.S.-V.); (C.G.-R.); (M.J.G.); (E.Y.-P.)
- Instituto de Investigación Sanitaria (IDIS), Travesía da Choupana S/N, 15706 Santiago de Compostela, Spain
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Tham ML, Mahmud A, Abdullah M, Md Saleh R, Mohammad Razali A, Cheah YK, Mohd Taib N, Ho KL, Mahmud M, Mohd Isa M. Tear Samples for Protein Extraction: Comparative Analysis of Schirmer's Test Strip and Microcapillary Tube Methods. Cureus 2023; 15:e50972. [PMID: 38259376 PMCID: PMC10800704 DOI: 10.7759/cureus.50972] [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] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Tear sampling is an attractive option for collecting biological samples in ophthalmology clinics, as it offers a non-invasive alternative to other invasive techniques. However, there are many tear sampling methods still in consideration. This study explores the suitability of Schirmer's test strip and microcapillary tube as reliable and satisfactory methods for tear sampling. METHODS Tear samples were collected from eight healthy volunteers using the standard Schirmer's test strip method with or without anesthesia and microcapillary tubes. The total tear protein concentrations were analyzed via spectrophotometry and bicinchoninic acid (BCA) protein assay. The protein profile was determined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). The optimal wetting length of Schirmer's strip and suitable buffer solutions were compared. Discomfort levels reported by participants and the ease of execution for ophthalmologists were also evaluated. RESULTS Tear samples exhibited typical protein profiles as shown by SDS-PAGE. The mean total protein obtained from an optimum wetting length of 20 mm using Schirmer's strip without anesthesia in phosphate-buffered saline (PBS) yielded substantial quantities of protein as measured by nanophotometer (220.20 ± 67.43 µg) and the BCA protein assay (210.34 ± 59.46 µg). This method collected a significantly higher quantity of protein compared to the microcapillary tube method (p=0.004) which was much more difficult to standardize. The clinician found it harder to utilize microcapillary tubes, while participants experienced higher insecurity and less discomfort with the microcapillary tube method. PBS used during the tear protein extraction process eluted higher tear protein concentration than ammonium bicarbonate, although the difference was not statistically significant. Using anaesthesia did not ease the sampling procedure substantially and protein quantity was maintained. CONCLUSION Good quality and quantity of protein from tear samples were extracted with the optimized procedure. Schirmer's strip test in the absence of local anesthesia provided a standard, convenient, and non-invasive method for tear collection.
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Affiliation(s)
- May Ling Tham
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Aidalina Mahmud
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Maha Abdullah
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Rafidah Md Saleh
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Amirah Mohammad Razali
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Yoke Kqueen Cheah
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Niazlin Mohd Taib
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Kok Lian Ho
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Mazaya Mahmud
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Muhammad Mohd Isa
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
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Xu X, Wilkerson A, Li G, Butovich IA, Zuo YY. Comparative Biophysical Study of Meibomian Lipids of Wild Type and Soat1-Null Mice: Implications to Meibomian Gland Dysfunction and Dry Eye Disease. Invest Ophthalmol Vis Sci 2023; 64:20. [PMID: 37585190 PMCID: PMC10434715 DOI: 10.1167/iovs.64.11.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023] Open
Abstract
Purpose The biophysical roles of Meibomian lipids (MLs) played in health and meibomian gland dysfunction (MGD) are still unclear. The purpose of this research is to establish the composition-structure-functional correlations of the ML film (MLF) using Soat1-null mice and comprehensive in vitro biophysical simulations. Methods MLs were extracted from tarsal plates of wild type (WT) and Soat1 knockout (KO) mice. The chemical composition of ML samples was characterized using liquid chromatography - mass spectrometry. Comprehensive biophysical studies of the MLFs, including their dynamic surface activity, interfacial rheology, evaporation resistance, and ultrastructure and topography, were performed with a novel experimental methodology called the constrained drop surfactometry. Results Soat1 inactivation caused multiple alternations in the ML profile. Compared to their WT siblings, the MLs of KO mice were completely devoid of cholesteryl esters (CEs) longer than C18 to C20, but contained 7 times more free cholesterol (Chl). Biophysical assays consistently suggested that the KO-MLF became stiffer than that of WT mice, revealed by reduced film compressibility, increased elastic modulus, and decreased loss tangent, thus causing more energy loss per blinking cycle of the MLF. Moreover, the KO mice showed thinning of their MLF, and reduced evaporation resistance. Conclusions These findings delineated the composition-structure-functional correlations of the MLF and suggested a potential biophysical function of long-chain CEs in optimizing the surface activity, interfacial rheology, and evaporation resistance of the MLF. This study may provide novel implications to pathophysiological and translational understanding of MGD and dry eye disease.
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Affiliation(s)
- Xiaojie Xu
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Amber Wilkerson
- Department of Ophthalmology and Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Guangle Li
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Igor A. Butovich
- Department of Ophthalmology and Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Yi Y. Zuo
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States
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Kim YH, Graham AD, Li W, Dursch TJ, Peng CC, Radke CJ, Lin MC. Tear-film evaporation flux and its relationship to tear properties in symptomatic and asymptomatic soft-contact-lens wearers. Cont Lens Anterior Eye 2023; 46:101850. [PMID: 37137757 DOI: 10.1016/j.clae.2023.101850] [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: 07/03/2022] [Revised: 02/18/2023] [Accepted: 04/17/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE With soft-contact-lens wear, evaporation of the pre-lens tear film affects the osmolarity of the post-lens tear film and this can introduce a hyperosmotic environment at the corneal epithelium, leading to discomfort. The purposes of the study are to ascertain whether there are differences in evaporation flux (i.e., the evaporation rate per unit area) between symptomatic and asymptomatic soft-contact-lens wearers, to assess the repeatability of a flow evaporimeter, and to assess the relationship between evaporation fluxes, tear properties, and environmental conditions. METHODS Closed-chamber evaporimeters commonly used in ocular-surface research do not control relative humidity and airflow, and, therefore, misestimate the actual tear-evaporation flux. A recently developed flow evaporimeter overcomes these limitations and was used to measure accurate in-vivo tear-evaporation fluxes with and without soft-contact-lens wear for symptomatic and asymptomatic habitual contact-lens wearers. Concomitantly, lipid-layer thickness, ocular-surface-temperature decline rate (i.e., °C/s), non-invasive tear break-up time, tear-meniscus height, Schirmer tear test, and environmental conditions were measured in a 5 visit study. RESULTS Twenty-one symptomatic and 21 asymptomatic soft-contact-lens wearers completed the study. A thicker lipid layer was associated with slower evaporation flux (p < 0.001); higher evaporation flux was associated with faster tear breakup irrespective of lens wear (p = 0.006). Higher evaporation flux was also associated with faster ocular-surface-temperature decline rate (p < 0.001). Symptomatic lens wearers exhibited higher evaporation flux than did asymptomatic lens wearers, however, the results did not reach statistical significance (p = 0.053). Evaporation flux with lens wear was higher than without lens wear but was also not statistically significant (p = 0.110). CONCLUSIONS The repeatability of the Berkeley flow evaporimeter, associations between tear characteristics and evaporation flux, sample-size estimates, and near statistical significance in tear-evaporation flux between symptomatic and asymptomatic lens wearers all suggest that with sufficient sample sizes, the flow evaporimeter is a viable research tool to understand soft-contact-lens wear comfort.
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Affiliation(s)
- Young Hyun Kim
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States
| | - Andrew D Graham
- Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States
| | - Wing Li
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States
| | - Thomas J Dursch
- Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States
| | - Cheng-Chun Peng
- Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States; CooperVision Inc., Pleasanton, CA 94588, United States
| | - Clayton J Radke
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Chemical and Biomolecular Engineering Department, University of California, Berkeley, CA 94720, United States
| | - Meng C Lin
- Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States; Clinical Research Center, Herbert Wertheim School of Optometry & Vision Science, University of California, Berkeley, CA 94720, United States.
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Xu X, Li G, Zuo YY. Effect of Model Tear Film Lipid Layer on Water Evaporation. Invest Ophthalmol Vis Sci 2023; 64:13. [PMID: 36656568 PMCID: PMC9872843 DOI: 10.1167/iovs.64.1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose A majority of in vitro models were incapable of reproducing the evaporation resistance of tear film lipid layer (TFLL) in vivo. The purpose of this research is to develop a novel in vitro model to study the effect of TFLL on water evaporation. Methods A ventilated, closed-chamber, droplet evaporimeter with a constant surface area has been invented to study the evaporation resistance of TFLL. This evaporimeter ensures a rigorous control of environmental conditions, including the temperature, relative humidity, airflow rate, surface area, and surface pressure, thus allowing for reproducible water evaporation measurements over a time period of only 5 minutes. The volumetric evaporation rate of this droplet evaporimeter is less than 2.7 µL/min, comparable to the basal tear production of healthy adults. Together with direct film imaging using atomic force microscopy (AFM), we have studied the effect of a model TFLL on water evaporation, as a function of the lipid composition and surface pressure. Results A model TFLL composed of 40% wax esters, 40% cholesteryl esters, and 20% polar lipids was capable of reducing the water evaporation rate by 11% at surface pressure 47 mN/m. AFM revealed that the model TFLL at high surface pressures consists of discrete droplets/aggregates of the nonpolar lipids residing atop a polar lipid monolayer with phase separation. Conclusions The TFLL may resist water evaporation with a combined mechanism by increasing film compactness of the polar lipid film at the air-water surface, and, to a lesser extent, by increasing film thickness of the nonpolar lipid film.
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Affiliation(s)
- Xiaojie Xu
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Guangle Li
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Yi Y. Zuo
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States,Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States
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Martín-Suárez EM, Mesa P, Portillo M, Morgaz J, Moreno O, Guisado A, Galán-Rodríguez A. A Modified Schirmer Tear Test in Clinically Normal Horses: Measurement at 30 Seconds versus 60 Seconds. J Equine Vet Sci 2023; 120:104162. [PMID: 36343832 DOI: 10.1016/j.jevs.2022.104162] [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: 07/04/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
This study sought to compare the Schirmer Tear Test (STT)-1 results at 30 (STT30) versus 60 (STT60) seconds in healthy horses. This study included a total of 56 healthy horses. STT-1 was performed in both eyes, right eye first, and the wetting lengths were measured in STT30 and STT60. To evaluate the reduction of the initial reflex phase, the wetting length velocity was measured during the first 30 seconds. The effects of eye, age, weight, sex, and ambient temperature and humidity on STT values were evaluated. Mean (standard deviation) STT30 and STT60 were 19.06 (3.88) and 24.26 (4.50) mm. There was a linear correlation between the STT 30 and STT60, expressed according to the following equation: STT60 = 2.20 + 1.18 × STT30 (P = .001). STT30 or STT60 values did not vary between the sexes or correlate with age, weight, ambient temperature, or humidity. In conclusion, STT30 allows for an accurate, reliable, and applicable diagnosis of tear production compared with the standard STT60 value. The proposed method is shorter and may be a suitable alternative to the 1-min test.
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Affiliation(s)
- Eva M Martín-Suárez
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Córdoba University, Córdoba, Spain.
| | - Pablo Mesa
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Córdoba University, Córdoba, Spain
| | - Miguel Portillo
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Córdoba University, Córdoba, Spain
| | - Juan Morgaz
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Córdoba University, Córdoba, Spain
| | - Ofelia Moreno
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Córdoba University, Córdoba, Spain
| | - Alicia Guisado
- Veterinary Teaching Hospital, Faculty of Veterinary Medicine, Córdoba University, Córdoba, Spain
| | - Alba Galán-Rodríguez
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Córdoba University, Córdoba, Spain
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Correlation between tear film lipid layer thickness and transepidermal water loss from the ocular area in patients with dry eye disease and in healthy controls. PLoS One 2022; 17:e0270810. [PMID: 35857784 PMCID: PMC9299348 DOI: 10.1371/journal.pone.0270810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/17/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to evaluate the correlation between tear film lipid layer thickness and transepidermal water loss (TEWL) from the ocular area in patients with short tear break-up time (TBUT)-type dry eye and healthy controls. Methods This prospective study included 25 eyes of patients with short TBUT-type dry eye disease and 25 eyes of healthy controls. Results Tear film lipid layer thickness was measured using an interferometer, and TEWL from the ocular area was measured using a Tewameter TM300 with custom-made goggles. The correlation between tear film lipid layer thickness and TEWL was evaluated. Additionally, other parameters such as TBUT, Schirmer I score, ocular surface staining, the presence and type of meibomian gland dysfunction (MGD), ocular surface disease index (OSDI), and visual analog scale (VAS) scores were evaluated. Tear film lipid layer thickness did not show a significant correlation with TEWL from the ocular area measured using a Tewameter TM300. However, tear film lipid layer thickness was significantly correlated with tear break-up time (p = 0.004) and ocular surface staining by NEI (National Eye Institute) scheme (p = 0.03). TEWL showed positive correlation with the Schirmer I score (p = 0.004). Conclusions The tear film lipid layer affected the stability of the tear film more than the amount of TEWL in patients with short TBUT dry eye and healthy controls.
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Proteomic Analysis of Tears and Conjunctival Cells Collected with Schirmer Strips Using timsTOF Pro: Preanalytical Considerations. Metabolites 2021; 12:metabo12010002. [PMID: 35050124 PMCID: PMC8778087 DOI: 10.3390/metabo12010002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 12/24/2022] Open
Abstract
This study aimed to investigate the human proteome profile of samples collected from whole (W) Schirmer strips (ScS) and their two parts—the bulb (B) and the rest of the strip (R)—with a comprehensive proteomic approach using a trapped ion mobility mass spectrometer, the timsTOF Pro. Eight ScS were collected from two healthy subjects at four different visits to be separated into three batches, i.e., 4W, 4B, and 4R. In total, 1582 proteins were identified in the W, B, and R batches. Among all identified proteins, binding proteins (43.4%) and those with catalytic activity (42.2%) constituted more than 80% of the molecular functions. The most represented biological processes were cellular processes (31.2%), metabolic processes (20.8%), and biological regulation (13.1%). Enzymes were the most represented protein class (41%), consisting mainly of hydrolases (47.5%), oxidoreductases (22.1%), and transferases (16.7%). The bulb (B), which is in contact with the conjunctiva, might collect both tear and cell proteins and therefore promote the identification of more proteins. Processing B and R separately before mass spectrometry (MS) analysis, combined with the high data acquisition speed and the addition of ion-mobility-based separation in the timsTOF Pro, can bring a new dimension to biomarker investigations of a limited sample such as tear fluid.
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McMonnies CW. Transdermal anti-inflammatory therapy for aqueous deficiency. Ophthalmic Physiol Opt 2021; 41:1267-1272. [PMID: 34605579 DOI: 10.1111/opo.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Lacrimal gland inflammation has been identified as an important limitation on aqueous production and associated dry eye disease. Ocular surface inflammation in dry eye disease can be a downstream response to reduced quantities of warmer hyperosmotic aqueous being delivered from an inflamed lacrimal gland with high concentrations of inflammatory mediators. This review examines evidence which shows how topical applications of anti-inflammatory drugs have very limited access to the lacrimal gland and an associated limited capacity to increase aqueous flow by reducing inflammation in the main lacrimal gland. RECENT FINDINGS Using cyclosporine as an exemplar immunomodulatory drug, this review examines problems associated with the topical administration of all anti-inflammatory drugs in the treatment of dry eye disease. SUMMARY Limited access to the lacrimal gland for topical applications and their very short on-eye residence times are compared with the therapeutic potential of prolonged therapeutic episodes that could be achieved with transdermal applications of a drug to the skin at the site of the lacrimal gland. Poor access to the lacrimal gland for topically administered drugs is a major barrier to the treatment of aqueous deficiency. While topical inflammatory drug access to the ocular surface is direct, poor access to the lacrimal gland is partly due to drop placement being downstream to the flow of aqueous (Eye Vis 2020;7:1; Eye Vis 2019;6:1). This barrier is much greater according to the degree that reflex tear flow is stimulated by irritation associated with adverse drop temperature, and/or pH and/or tonicity for example.
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Affiliation(s)
- Charles W McMonnies
- Faculty of Medicine and Health, School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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11
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Protection against corneal hyperosmolarity with soft-contact-lens wear. Prog Retin Eye Res 2021; 87:101012. [PMID: 34597771 DOI: 10.1016/j.preteyeres.2021.101012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
Hyperosmotic tear stimulates human corneal nerve endings, activates ocular immune response, and elicits dry-eye symptoms. A soft contact lens (SCL) covers the cornea preventing it from experiencing direct tear evaporation and the resulting blink-periodic salinity increases. For the cornea to experience hyperosmolarity due to tear evaporation, salt must transport across the SCL to the post-lens tear film (PoLTF) bathing the cornea. Consequently, limited salt transport across a SCL potentially protects the ocular surface from hyperosmotic tear. In addition, despite lens-wear discomfort sharing common sensations to dry eye, no correlation is available between measured tear hyperosmolarity and SCL-wear discomfort. Lack of documentation is likely because clinical measurements of tear osmolarity during lens wear do not interrogate the tear osmolarity of the PoLTF that actually overlays the cornea. Rather, tear osmolarity is clinically measured in the tear meniscus. For the first time, we mathematically quantify tear osmolarity in the PoLTF and show that it differs significantly from the clinically measured tear-meniscus osmolarity. We show further that aqueous-deficient dry eye and evaporative dry eye both exacerbate the hyperosmolarity of the PoLTF. Nevertheless, depending on lens salt-transport properties (i.e., diffusivity, partition coefficient, and thickness), a SCL can indeed protect against corneal hyperosmolarity by reducing PoLTF salinity to below that of the ocular surface during no-lens wear. Importantly, PoLTF osmolarity for dry-eye patients can be reduced to that of normal eyes with no-lens wear provided that the lens exhibits a low lens-salt diffusivity. Infrequent blinking increases PoLTF osmolarity consistent with lens-wear discomfort. Judicious design of SCL material salt-transport properties can ameliorate corneal hyperosmolarity. Our results confirm the importance of PoLTF osmolarity during SCL wear and indicate a possible relation between PoLTF osmolarity and contact-lens discomfort.
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12
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Lebrun SJ, Chavez S, Chan R, Nguyen L, Jester JV. Modeling the antioxidant properties of the eye reduces the false-positive rate of a nonanimal eye irritation test (OptiSafe). Toxicol In Vitro 2021; 76:105208. [PMID: 34216722 DOI: 10.1016/j.tiv.2021.105208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/17/2021] [Accepted: 06/29/2021] [Indexed: 10/21/2022]
Abstract
We recently identified a group of chemicals that are misclassified by most, if not all, in vitro alternative ocular irritation tests, suggesting that nonanimal tests may not fully model the ocular environment in which these chemicals interact. To address this, we evaluated the composition of tears, the first defense against foreign substances, and identified the presence of antioxidants that could detoxify reactive chemicals that otherwise may be falsely identified as irritants in alternative irritation tests. In this study, we evaluated the effects of tear antioxidants on the ocular irritation scoring of commonly overclassified chemicals (false positives) using the OptiSafe™ ocular irritation test. Six tear-related antioxidants were individually added to the OptiSafe formulation, and the effects on test outcome were determined. Ascorbic acid, the most abundant water-soluble antioxidant in tears, specifically reduced the OptiSafe false-positive rate. Titration curves showed that this reduction occurs at in vivo concentrations and is specific to chemicals identified either as producing reactive oxygen species or as crosslinkers. Importantly, the addition of tear antioxidants did not impact the detection of true negatives, true positives, or other false positives unassociated with reactive oxygen species or crosslinking. These results suggest that the addition of tear antioxidants to in vitro alternative test systems may substantially reduce the false-positive rate and improve ocular irritant detection.
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Affiliation(s)
| | - Sara Chavez
- Lebrun Labs LLC, Anaheim, CA, United States of America
| | - Roxanne Chan
- Lebrun Labs LLC, Anaheim, CA, United States of America
| | - Linda Nguyen
- Lebrun Labs LLC, Anaheim, CA, United States of America
| | - James V Jester
- Department of Ophthalmology and Biomedical Engineering, University of California Irvine, Irvine, CA, United States of America
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Yeh TN, Lin MC. Meibomian Gland Contrast Sensitivity and Specificity in the Diagnosis of Lipid-deficient Dry Eye: A Pilot Study. Optom Vis Sci 2021; 98:121-126. [PMID: 33534375 PMCID: PMC7897301 DOI: 10.1097/opx.0000000000001636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE Lipid deficiency due to meibomian gland (MG) dysfunction is believed to account for the vast majority of patients with dry eye compared with aqueous deficiency. Clinicians commonly evaluate MG length to determine a disease, but our research with isotretinoin users suggests that MG contrast is also an important characteristic to consider. PURPOSE This study aimed to determine the sensitivity and specificity of MG contrast for the diagnosis of lipid-deficient dry eye (LDDE). METHODS This case-control study used demographic data, Standard Patient Evaluation of Eye Dryness (SPEED) scores, average tear lipid layer thickness (TLLT), fluorescein tear breakup time (FTBUT), upper eyelid meibography images, and meibum quality and quantity scores for individuals with LDDE (SPEED score ≥10 and TLLT ≤35 interferometric color units) and normal individuals (SPEED ≤2 and TLLT ≥80 interferometric color units). RESULTS Thirty-one eyes of 22 controls (mean ± SD age, 22.7 ± 5.5 years) and 13 eyes of 12 cases (mean ± SD age, 43.9 ± 17.2 years) were included. Normalized MG contrast was significantly correlated with FTBUT (r = 0.35, P = .02), percent MG atrophy (r = -0.50, P < .001), and SPEED scores (r = -0.49, P < .001). The receiver operating characteristic curve for LDDE diagnosis classifiers MG contrast, MG atrophy, and meibum quantity score had areas under the curve of 0.83, 0.64, and 0.73, respectively. Meibomian gland contrast cutoff at 28.3 intensity units yielded optimal correct classification of subjects (84.1%; sensitivity, 0.69; specificity, 0.90). Cases had shorter FTBUT (P < .001), worse meibum quality (P = .02) and quantity (P = .02) scores, and lower MG contrast (P < .001) compared with controls. Subjects with low MG contrast (≤28.3) had 14.9 higher odds of having LDDE (95% confidence interval, 2.84 to 78.4) compared with subjects with high MG contrast (>28.3). CONCLUSIONS Meibomian gland contrast correlates well with clinical parameters and symptoms, shows good sensitivity and excellent specificity for diagnosing LDDE, and can be a useful diagnostic parameter for monitoring MG changes due to age, disease, or intervention.
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Affiliation(s)
- Thao N Yeh
- Clinical Research Center, and Vision Science Group, School of Optometry, University of California, Berkeley, Berkeley, California
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van Setten GB, Baudouin C, Horwath-Winter J, Böhringer D, Stachs O, Toker E, Al-Zaaidi S, Benitez-del-Castillo JM, Beck R, Al-Sheikh O, Seitz B, Barabino S, Reitsamer HA, Müller-Lierheim WG. The HYLAN M Study: Efficacy of 0.15% High Molecular Weight Hyaluronan Fluid in the Treatment of Severe Dry Eye Disease in a Multicenter Randomized Trial. J Clin Med 2020; 9:jcm9113536. [PMID: 33147751 PMCID: PMC7693312 DOI: 10.3390/jcm9113536] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/23/2020] [Accepted: 10/31/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of the HYLAN M study was to investigate if symptoms and/or signs of patients suffering from severe dry eye disease (DED) can be improved by substituting individually optimized artificial tear therapy by high molecular weight hyaluronan (HMWHA) eye drops. In this international, multicenter study, patients with symptoms of at least ocular surface disease index (OSDI) 33 and corneal fluorescein staining (CFS) of at least Oxford grade 3 were included. A total of 84 per-protocol patients were randomized in two study arms. The control group continued to use their individual optimum artificial tears over the study period of eight weeks; in the verum group, the artificial tears were substituted by eye drops containing 0.15% HMWHA. At the week 8 visit, the average OSDI of the verum group had improved by 13.5 as compared to the control group (p = 0.001). The best corrected visual acuity (BCVA) had improved by 0.04 logMAR (p = 0.033). CFS, tear film break-up time (TBUT), Schirmer I, lid wiper epitheliopathy (LWE), mucocutaneous junction (Yamaguchi score), and tear osmolarity were not significantly different between the verum and control groups (p > 0.050). We conclude that for most patients with severe DED, 0.15% HMWHA eye drops provide excellent improvement of symptoms without impairment of dry eye signs.
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Affiliation(s)
- Gysbert-Botho van Setten
- Karolinska Institutet, Department of Clinical Neuroscience, St. Eriks Eye Hospital, 11282 Stockholm, Sweden;
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU Foresight, 75571 Paris, France;
| | | | - Daniel Böhringer
- Eye Center, University Eye Hospital Freiburg and Medical Faculty, Albert Ludwigs University, 79106 Freiburg, Germany;
| | - Oliver Stachs
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany; (O.S.); (R.B.)
| | - Ebru Toker
- Department of Ophthalmology, Marmara University School of Medicine, 34899 Istanbul, Turkey;
| | - Sultan Al-Zaaidi
- Department of Ophthalmology, PSMMC Prince Sultan Military Medical City, MSD Medical Services Department, MODA Ministry of Defense and Aviation, Riyadh 12233, Saudi Arabia;
| | | | - Ria Beck
- Department of Ophthalmology, University Medical Center Rostock, 18057 Rostock, Germany; (O.S.); (R.B.)
| | - Osama Al-Sheikh
- KKESH–King Khaled Eye Specialist Hospital, Riyadh 11462, Saudi Arabia;
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, 66421 Homburg/Saar, Germany;
| | - Stefano Barabino
- Ocular Surface & Dry Eye Center, Ospedale L. Sacco, University of Milan, 20157 Milan, Italy;
| | - Herbert A. Reitsamer
- Department of Ophthalmology & Department of Experimental Ophthalmology and Glaucoma Research, University Clinic Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria;
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Lipiński P, Bogdańska A, Różdżyńska-Świątkowska A, Wierzbicka-Rucińska A, Tylki-Szymańska A. NGLY1 deficiency: Novel patient, review of the literature and diagnostic algorithm. JIMD Rep 2020; 51:82-88. [PMID: 32071843 PMCID: PMC7012742 DOI: 10.1002/jmd2.12086] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives Together with the lysosomal storage diseases, NGLY1 deficiency is a congenital disorder of deglycosylation (NGLY1‐CDDG). Since the first report in 2012, 26 patients have been described. All but one were diagnosed by exome or genome sequencing; the remaining one was identified by finding an increased concentration of an urinary marker. The aim of this study was to describe the clinical, biochemical, and molecular features of the first Polish patient diagnosed with NGLY1‐CDDG, to provide an overview of the literature and to propose a diagnostic algorithm. Results A Polish patient presented with global developmental delay, hyperkinetic movement disorder, stagnation of head growth, hypolacrimia, elevated serum transaminases, and hypolipidemia in infancy. Whole exome sequencing revealed two heterozygous nonsense variants in the NGLY1 gene (a novel and an unreported). Literature review revealed global developmental disability in all reported patients, and hyperkinetic movements as well as alacrima/hypolacrima in nearly all. Conclusions NGLY1‐CDDG should be considered in patients with developmental disability associated with a hyperkinetic movement disorder and alacrimia/hypolacrima. Absence of the latter two symptoms does not rule out this diagnosis.
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Affiliation(s)
- Patryk Lipiński
- Department of Pediatrics, Nutrition and Metabolic Diseases The Children's Memorial Health Institute Warsaw Poland
| | - Anna Bogdańska
- Department of Biochemistry, Radioimmunology and Experimental Medicine The Children's Memorial Health Institute Warsaw Poland
| | | | - Aldona Wierzbicka-Rucińska
- Department of Biochemistry, Radioimmunology and Experimental Medicine The Children's Memorial Health Institute Warsaw Poland
| | - Anna Tylki-Szymańska
- Department of Pediatrics, Nutrition and Metabolic Diseases The Children's Memorial Health Institute Warsaw Poland
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