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Liu YW, Guo SJ, Li JN, Zhang YT, Ouyang WJ, Wang YQ, Huang CH, Liao Y, Hu J, Liu Z. Psychometric validation of the Chinese version of the dry eye-related quality-of-life score questionnaire. Int J Ophthalmol 2024; 17:1614-1620. [PMID: 39296558 PMCID: PMC11367434 DOI: 10.18240/ijo.2024.09.06] [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: 12/18/2023] [Accepted: 05/29/2024] [Indexed: 09/21/2024] Open
Abstract
AIM To psychometrically validate the Chinese version of the dry eye-related quality-of-life score questionnaire (DEQS-CHN) among Chinese patients with dry eye. METHODS This study involved 231 participants, including 191 with dry eye disease (DED) comprising the dry eye disease group, and 40 healthy participants forming the control group. Participants were required to complete the DEQS-CHN, and Chinese dry eye questionnaire and undergo clinical tests including the fluorescein breakup time (FBUT), corneal fluorescein staining (CFS), and Schirmer I test. To assess the internal consistency and retest reliability, Cronbach's α and the intraclass correlation coefficient (ICC) were employed. Content validity was assessed by item-level content validity index (ICV) and an average scale-level content validity index (S-CVI/Ave). Construct validity was assessed by confirmatory factor analysis. The concurrent validity was assessed by calculating correlations between DEQS-CHN and Chinese dry eye questionnaire. Discriminative validity was evaluated through non-parametric tests, with receiver operating characteristic (ROC) curve serving as conclusive indicators of the questionnaire's distinguishing capability. RESULTS The Cronbach's α coefficients for frequency and degree of ocular symptoms, impact on daily life, and summary score were 0.736, 0.704, 0.811, 0.818, 0.861, and 0.860, respectively, and the ICC were 0.611, 0.677, 0.715, 0.769, 0.711, and 0.779, respectively. All I-CVI scores ranged from 0.833 to 1.000, with an S-CVI/Ave of 0.956. Confirmatory factor analysis results exhibited a well-fitting model consistent with the original questionnaire [χ 2/df=2.653, incremental fit index (IFI)=0.924, comparative fit index (CFI)=0.924, Tucker-Lewis index (TLI)=0.909, and root mean square error of approximation (RMSEA)=0.065]. There was a moderate positive correlation between the DEQS-CHN and the Chinese dry eye questionnaire (r 2=0.588). The dry eye group demonstrated significantly higher scores compared to the control group, and the area under the curve (AUC) value was 0.8092. CONCLUSION The DEQS-CHN has been demonstrated as a valid and reliable instrument for assessing the impact of dry eye disease on the quality of life among Chinese individuals with DED.
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Affiliation(s)
- Yu-Wen Liu
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Shu-Jia Guo
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Jia-Ni Li
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Yu-Ting Zhang
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Wei-Jie Ouyang
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Yu-Qian Wang
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Cai-Hong Huang
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Yi Liao
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
| | - Jiaoyue Hu
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Xiamen 361005, Fujian Province, China
| | - Zuguo Liu
- Xiamen University Affiliated Xiamen Eye Center; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science; Fujian Engineering and Research Center of Eye Regenerative Medicine; Eye Institute of Xiamen University; School of Medicine, Xiamen University, Xiamen 361005, Fujian Province, China
- Department of Ophthalmology, Xiang'an Hospital of Xiamen University, Xiamen 361005, Fujian Province, China
- Department of Ophthalmology, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
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Wang J, Liu Y, Zong B, Zhao S, Li Y, Zhang Z, Yao J. Qingxuan Runmu Yin alleviates dry eye disease via inhibition of the HMOX1/HIF-1 pathway affecting ferroptosis. Front Pharmacol 2024; 15:1391946. [PMID: 39329129 PMCID: PMC11425584 DOI: 10.3389/fphar.2024.1391946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
The prevalence of dry eye disease (DED), a multifactorial ocular surface disease characterized by tear film instability, is increasing yearly. Qingxuan Run Mu Yin (QXRMY) is a traditional Chinese medicine (TCM) consisting of Radix Rehmanniae, Radix Scrophulariae, Rhizoma Atractylodis macrocephalae, Herba Dendrobii, Flos Lonicerae, Forsythia suspensa, Ophiopogon japonicus, Saposhnikovia divaricata, Radix Platycodi, and Radix Glycyrrhizae. It has excellent therapeutic effects on dry eye syndrome and a good anti-inflammatory effect on immune-related inflammation. However, the molecular mechanism of Qing Xuan Run Mu Yin in treating dry eye syndrome is largely unknown. The present study used an online database to identify potential target genes of QXRMY for treating DED. The possible mechanisms of these target genes for the treatment of DED were obtained through Gene Ontology (GO) and Kyoto Encyclopaedia of Genes and Genomes (KEGG) databases, Hub genes screened by Cytoscape and intersected with ferroptosis-related genes, and the essential genes were finally obtained based on the results of the analyses. DED cell model and rat model were constructed in this study to validate the critical genes and pathways, and it was confirmed that QXEMY alleviated DED by repressing ferroptosis through inhibiting the HMOX1/HIF-1 pathway. In conclusion, this study integrated network pharmacological analyses and experimental validation to provide an effective method to investigate the molecular mechanism of QXRMY in treating DED.
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Affiliation(s)
- Jiadi Wang
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Yue Liu
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Beiting Zong
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Shanshan Zhao
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Yue Li
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Zhirui Zhang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Jing Yao
- The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin, China
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Zenouda A, Ajasse S, Lombardi M, Sahel JA, Liang H, Baudouin C. [Influence of screen brightness on reading in dry eye patients]. J Fr Ophtalmol 2024; 47:104290. [PMID: 39265285 DOI: 10.1016/j.jfo.2024.104290] [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: 10/25/2023] [Revised: 01/29/2024] [Accepted: 02/21/2024] [Indexed: 09/14/2024]
Abstract
PURPOSE This study examines the impact of dry eye on screen reading, with an emphasis on glare and visual comfort for patients. POPULATION AND METHODS We recruited ten patients with dry eye and nine healthy controls. Clinical signs of dry eye were quantified to determine the quality of the tear film and corneal aberrations. Questionnaires related to quality of life and light sensitivity were administered. All participants underwent a screen reading test under five different levels of brightness. RESULTS Patients with dry eye presented with more significant ocular inflammation (Oxford score) and reduced tear breakup time (BUT; DED: 4.1s, CO: 11.8s; W=90, P<0.001) compared to the control population. Patients also exhibited impaired quality of life (OSDI score: CO: 15.044±9.16, DED: 38.150±18.66, P=0.004) and increased light sensitivity (Glare test: CO: 96.56±65.5 arc.min, DED: 204.1±82.5 arc.min, W=15, P=0.013; VLSQ score: CO: 16.44±4.85, DED: 22.0±6.34, P=0.049). Reading tests did not show a significant difference between the groups (CO: 155±23.3 words/min and DED: 149±28.0, F=1.935, P=0.169). Brightness did not influence reading speed (F=1.308, P-value=0.275). A correlation was observed between reading speed and the OSDI quality of life questionnaire (R=-0.7, P=0.043). CONCLUSION Although screen brightness did not have a significant impact on reading speed, glare proved to be a major issue for patients with dry eye. The associations between clinical manifestations of dry eye and reading performance emphasize the importance of comprehensive management of this condition. The results suggest that dry eye can influence both quality of life and screen reading, highlighting the need for dedicated approaches to improve the visual comfort of patients.
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Affiliation(s)
- A Zenouda
- Streetlab, Vision Institute, IHU FOReSIGHT, 75012 Paris, France.
| | - S Ajasse
- Streetlab, Vision Institute, IHU FOReSIGHT, 75012 Paris, France
| | - M Lombardi
- Streetlab, Vision Institute, IHU FOReSIGHT, 75012 Paris, France
| | - J-A Sahel
- IHU FOReSIGHT, Inserm-DHOS CIC 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France; Inserm, U968, UMR_S968, Institut de la Vision, CNRS, UMR 7210, CHNO des Quinze-Vingts, Inserm-DHOS CIC 503, UPMC University of Paris 06, Paris, France
| | - H Liang
- IHU FOReSIGHT, Inserm-DHOS CIC 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - C Baudouin
- IHU FOReSIGHT, Inserm-DHOS CIC 1423, Quinze-Vingts National Ophthalmology Hospital, Paris, France; Inserm, U968, UMR_S968, Institut de la Vision, CNRS, UMR 7210, CHNO des Quinze-Vingts, Inserm-DHOS CIC 503, UPMC University of Paris 06, Paris, France; Department of Ophthalmology, Ambroise-Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Versailles, France
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Al-Dossary SK. Environmental and Occupational Triggers of Dry Eye Symptoms in the Ahsa Region of Saudi Arabia: A Cross-Sectional Study. Clin Ophthalmol 2024; 18:2427-2438. [PMID: 39224176 PMCID: PMC11368111 DOI: 10.2147/opth.s474832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Objective This cross-sectional study aimed to investigate the associations between environmental and occupational factors and the prevalence of dry eye symptoms among participants from the Ahsa region of Saudi Arabia. Methods Participants from urban, rural, and suburban areas seeking medical care at primary health centers were recruited through systematic random sampling. Data on demographics, exposures, and ocular health were captured using a structured questionnaire. Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI), Impact of Dry Eye on Everyday Life (IDEEL), and Symptom Assessment in Dry Eye (SANDE) questionnaires. Logistic regression analysis examined the relationships between environmental/occupational factors and the prevalence of dry eye symptoms. Results Key exposures included particulate matter (PM) (60%), low humidity (55%), wind/dust (50%), prolonged computer use (65%), and chemical irritants (45%). These factors were significantly associated with an increased prevalence of dry eye symptoms, with the following odds ratios (ORs): PM (1.85, 95% CI: 1.35-2.52), low humidity (1.45, 95% CI: 1.05-2.00), wind and dust (1.60, 95% CI: 1.20-2.14), prolonged computer use (2.10, 95% CI: 1.55-2.85), and chemical irritants (1.75, 95% CI: 1.30-2.35). All associations were statistically significant (p < 0.05). The use of protective equipment was associated with reduced odds of dry eye symptoms (OR 0.60, 95% CI: 0.42-0.85, p = 0.03). Conclusion This study identifies significant associations between specific environmental and occupational exposures and the prevalence of dry eye symptoms. Reducing modifiable exposures through policy, workplace enhancements, and clinical preventative strategies is essential to mitigate the burden of dry eye symptoms related to modern lifestyles and technology.
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Pisella PJ, Gain P, Cochener B, Baillif S, Kodjikian L, Creuzot-Garcher C, Touboul D, Gonzalvez M, Gabisson P, El Amali S, Galarreta D, Merayo Lloves J, Cano-Ortiz A, Ruiz Mesa R, Civiale C, Mazzone MG, Montero J. A randomised study comparing performance and safety of Eyestil Plus ® vs Vismed Multi ® in moderate-to-severe dry eye syndrome patients. Eur J Ophthalmol 2024:11206721241266874. [PMID: 39094552 DOI: 10.1177/11206721241266874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
PURPOSE This clinical investigation compared the performance and safety of Eyestil Plus® (SIFI) and Vismed Multi® (TRB Chemedica) for reducing keratitis lesions in moderate-to-severe dry eye disease (DED) patients. MATERIALS AND METHODS This was a randomised, double-blind, multicentre investigation. 96 adults (>18 years of age) with moderate-to-severe DED received Eyestil Plus® (N = 48) or Vismed Multi® (n = 48) 6 times daily for 3 months. The primary objective clinical performance after 1 month as global corneal and conjunctival staining scores. The secondary objectives were clinical performance after 3 months, tear film stability (tear break up time (TBUT), tear production (Schirmer test), patient-reported outcomes (PROs), investigator satisfaction, and safety. RESULTS 96 participants were randomised to receive the clinical investigations' treatments, 82.3% of them were female and their mean age was 65.8 years. The non-inferiority of Eyestil Plus® for moderate-to-severe DED was demonstrated at 1 month. No statistical difference was found for any of the study's objectives: change at 1 and 3 months of the global corneal and conjunctival staining score (p-value = 0.506 and 0.661, respectively), change at 1 and 3 months (p-value = 0.538 and 0.302) for TBUT test; change at 3 months for Schirmer test (p-value = 0.540). There were no changes for PROs either. Investigator satisfaction was high for both products. 16.6% of the participants experienced adverse events. CONCLUSION This clinical investigation showed the non-inferiority of Eyestil Plus® compared to Vismed Multi® regarding performance and safety in a moderate-to-severe DED population.
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Affiliation(s)
- P J Pisella
- University of Tours, France
- Service Ophtalmologie Hôpital Bretonneau, Tours, France
| | - P Gain
- Service d'Ophtalmologie, CHU Saint Etienne/Hôpital Nord, St Etienne, France
| | - B Cochener
- Service d'Ophtalmologie, CHU MORVAN, Brest, France
| | - S Baillif
- Service d'Ophtalmolgie, CHU de Nice - Hôpital Pasteur, Nice, France
| | - L Kodjikian
- Service d'Ophtalmologie, Hôpital universitaire de la Croix-Rousse, Lyon, France
- Laboratoire MATEIS, UMR-CNRS 5510, INSA, , France
| | | | - D Touboul
- Service d'Ophtalmolgie, CHU de Bordeaux - Hôpital Pellegrin, Bordeaux, France
| | - M Gonzalvez
- Service d'Ophtalmolgie, Hôpital la Timone Adultes, Marseille, France
| | - P Gabisson
- Point Vision Marseille, Marseille, France
| | - S El Amali
- Service d'Ophtalmolgie, CHU d'Amiens, Amiens, France
| | - D Galarreta
- Servicio de Oftalmología, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - J Merayo Lloves
- Instituto Universitario Fernandez-Vega. Universidad de Oviedo, Oviedo, Spain
| | - A Cano-Ortiz
- Instituto De Oftalmología La Arruzafa, Córdoba, Spain
| | - R Ruiz Mesa
- Clínica OFTALVIST, Jerez de la Frontera, Spain
| | | | | | - J Montero
- Hospital Universitario Virgen Macarena, Sevilla, Spain
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Watson SL, Le DTM. Corneal neuropathic pain: a review to inform clinical practice. Eye (Lond) 2024; 38:2350-2358. [PMID: 38627548 PMCID: PMC11306374 DOI: 10.1038/s41433-024-03060-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/25/2024] [Accepted: 04/02/2024] [Indexed: 08/09/2024] Open
Abstract
Corneal neuropathic pain (CNP) is a poorly defined disease entity characterised by an aberrant pain response to normally non-painful stimuli and categorised into having peripheral and central mechanisms, with the former responding to instillation of topical anaesthetic. CNP is a challenging condition to diagnose due to numerous aetiologies, an absence of clinical signs and ancillary tests (in vivo confocal microscopy and esthesiometry), lacking the ability to confirm the diagnosis and having limited availability. Symptomatology maybe mirrored by severe and chronic forms of dry eye disease (DED), often leading to misdiagnosis and inadequate treatment. In practice, patients with suspected CNP can be assessed with questionnaires to elicit symptoms. A thorough ocular assessment is also performed to exclude any co-existent ocular conditions. A medical and mental health history should be sought due to associations with autoimmune disease, chronic pain syndromes, anxiety and depression. Management begins with communicating to the patient the nature of their condition. Ophthalmologists can prescribe topical therapies such as autologous serum eyedrops to optimise the ocular surface and promote neural regeneration. However, a multi-disciplinary treatment approach is often required, including mental health support, particularly when there are central mechanisms. General practitioners, pain specialists, neurologists and psychologists may be needed to assist with oral and behavioural therapies. Less data is available to support the safety and efficacy of adjuvant and surgical therapies and the long-term natural history remains to be determined. Hence clinical trials and registry studies are urgently needed to fill these data gaps with the aim to improve patient care.
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Affiliation(s)
- Stephanie L Watson
- The University of Sydney, Save Sight Institute, Faculty of Medicine and Health, Sydney, NSW, Australia.
- Sydney Eye Hospital, Sydney, NSW, Australia.
| | - Damien Tuan-Man Le
- The University of Sydney, Save Sight Institute, Faculty of Medicine and Health, Sydney, NSW, Australia
- Sydney Eye Hospital, Sydney, NSW, Australia
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Wolffsohn JS, Travé-Huarte S, Craig JP, Muntz A, Stapleton FJ. Appropriateness of Questionnaires for the Diagnosis and Monitoring Treatment of Dry Eye Disease. J Clin Med 2024; 13:3146. [PMID: 38892857 PMCID: PMC11172740 DOI: 10.3390/jcm13113146] [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: 03/04/2024] [Revised: 04/23/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives: If questionnaires contributing to the diagnosis of dry eye disease are to be recommended as alternatives to existing questionnaires, they must be comparable, with similar repeatability and treatment sensitivity. Comparability was thus examined for three common dry eye questionnaires along with identifying the individual questions that most strongly predicted overall scores. Methods: Anonymised data (n = 329) collected via the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment in Dry Eye (SANDE) questionnaires (including responses to individual questions) from consenting patients were drawn from real-world dry eye clinics/registries in the United Kingdom, Australia and New Zealand; at follow-up, normalised changes were evaluated in 54 of these patients. Treatment data were also analysed from a 6-month, randomised controlled trial assessing artificial tear supplement treatments with 43 responders and 13 non-responders to treatment identified. The questions extracted from the OSDI which form the abbreviated 6-item OSDI were also analysed. Results: The agreement between the questionnaires ranged from r = 0.577 to 0.754 (all p < 0.001). For the OSDI, three questions accounted for 89.1% of the variability in the total score. The correlation between the OSDI and OSDI-6 was r = 0.939, p < 0.001. For the DEQ-5, two questions accounted for 88.5% of the variance in the total score. Normalised treatment changes were also only moderately correlated between the questionnaires (r = 0.441 to 0.595, p < 0.01). For non-responders, variability was 7.4% with both OSDI and OSDI-6, 9.7% with DEQ-5, 12.1% with SANDE-frequency and 11.9% with SANDE-severity scale. For responders, improvement with drops was detected with a 19.1% change in OSDI, 20.2% in OSDI-6, 20.9% in DEQ-5, and 27.5%/23.6% in SANDE-frequency/severity scales. Conclusions: Existing commonly used dry eye questionnaire scores do not show high levels of correlation. The OSDI was the least variable of the questionnaires and while displaying a slightly lower treatment effect than either the DEQ or SANDE, it was more sensitive to detection of a treatment effect. The quicker-to-complete OSDI-6 exhibited essentially the same outcome as the OSDI, with similar variability and treatment sensitivity.
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Affiliation(s)
- James S. Wolffsohn
- School of Optometry, College of Health & Life Sciences, Aston University, Birmingham B4 7ET, UK;
| | - Sònia Travé-Huarte
- School of Optometry, College of Health & Life Sciences, Aston University, Birmingham B4 7ET, UK;
| | - Jennifer P. Craig
- School of Optometry, College of Health & Life Sciences, Aston University, Birmingham B4 7ET, UK;
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland 1010, New Zealand;
| | - Alex Muntz
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland 1010, New Zealand;
- Institute of Optometry, University of Applied Sciences and Arts Northwestern Switzerland, 4600 Olten, Switzerland
| | - Fiona J. Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW 2052, Australia;
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Zou X, Nagino K, Okumura Y, Midorikawa-Inomata A, Eguchi A, Yee A, Fujimoto K, Miura M, Sung J, Huang T, Fujio K, Akasaki Y, Nakao S, Kobayashi H, Inomata T. Optimal cutoff value of the dry eye-related quality-of-life score for diagnosing dry eye disease. Sci Rep 2024; 14:4623. [PMID: 38409465 PMCID: PMC10897401 DOI: 10.1038/s41598-024-55358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/22/2024] [Indexed: 02/28/2024] Open
Abstract
This retrospective study aimed to determine the optimal cutoff values of the Dry Eye-Related Quality-of-Life Score (DEQS) questionnaire for diagnosing dry eye disease (DED) and classifying DED severities. Participants completed the DEQS questionnaire, the Japanese version of the Ocular Surface Disease Index (J-OSDI) questionnaire, and DED examinations. DED was diagnosed according to the 2016 Asia Dry Eye Society diagnostic criteria based on DED symptoms (J-OSDI ≥ 13 points) and tear film breakup time ≤ 5 s. Receiver operating characteristic (ROC) analysis was used to calculate the optimal cutoff values of the DEQS summary score for detecting DED and grading its severity. Among 427 patients, 296 (69.3%) and 131 (30.7%) were diagnosed with DED and non-DED, respectively. ROC analysis determined an optimal cutoff value of 15.0 points for DED diagnosis, with 83.5% sensitivity, 87.0% specificity, and an area under the curve of 0.915. The positive and negative predictive values for DEQS ≥ 15.0 points were 93.6% and 69.9%, respectively. DEQS cutoff values of 15.0, 20.0, and 26.8 points could be accepted for severity classification of DED subjective symptoms in clinical use and represent mild, moderate, and severe DED, respectively. Conclusively, the optimal cutoff values of DEQS enable DED detection and subjective symptom severity classification.
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Affiliation(s)
- Xinrong Zou
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Ophthalmology, Fengcheng Hospital, Fengxian District, Shanghai, China
| | - Ken Nagino
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuko Eguchi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Alan Yee
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Maria Miura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tianxiang Huang
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shintaro Nakao
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroyuki Kobayashi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
- AI Incubation Farm, Juntendo University Graduate School of Medicine, Tokyo, Japan.
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9
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Hamrah P, Massaro-Giordano M, Schanzlin D, Holland E, Berdy G, Goisis G, Pasedis G, Mantelli F. Phase IV Multicenter, Prospective, Open-Label Clinical Trial of Cenegermin (rhNGF) for Stage 1 Neurotrophic Keratopathy (DEFENDO). Ophthalmol Ther 2024; 13:553-570. [PMID: 38175466 PMCID: PMC10787719 DOI: 10.1007/s40123-023-00866-y] [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: 09/08/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Cenegermin is approved for treatment of neurotrophic keratopathy (NK) and has been studied in patients with stage 2 or 3 NK. This study evaluated the efficacy and safety of cenegermin in adults with stage 1 NK. METHODS This was a phase IV, multicenter, prospective, open-label, uncontrolled trial. Adults with stage 1 NK (Mackie criteria) and decreased corneal sensitivity (≤ 4 cm) received 1 drop of cenegermin 20 mcg/ml in the affected eye(s) 6 times/day for 8 weeks with a 24-week follow-up. RESULTS Of 37 patients, corneal epithelial healing was observed in 84.8% (95% confidence interval [CI] 68.1-94.9%; P < 0.001) at week 8; 95.2% (95% CI 76.2-99.9%; P < 0.001) of those patients remained healed at the end of the 24-week follow-up (week 32). At week 8, 91.2% (95% CI 76.3-98.1%; P < 0.001) of patients experienced improved corneal sensitivity; this improvement was observed in 82.1% (95% CI 63.1-93.9%; P < 0.001) of patients at week 32. Mean best-corrected distance visual acuity change from baseline at week 8 was - 0.10 logMAR (standard deviation [SD], 0.15; 95% CI - 0.16 to - 0.05; P < 0.001) and at week 32 was - 0.05 logMAR (SD, 0.16; 95% CI - 0.11 to 0.01; P = 0.122). At weeks 8 and 32, 15.2% (95% CI 5.1-31.9%; P < 0.001) and 10.7% (95% CI 2.3-28.2%; P < 0.001) of patients, respectively, had a 15-letter gain from baseline. At least one adverse event (AE) was reported by 73.0% and 45.7% of patients during the treatment and follow-up periods, respectively. The most common treatment-related, treatment-emergent AEs were eye pain (37.8%), blurred vision (10.8%), and eyelid pain (8.1%); these were mostly mild or moderate and were only reported during the treatment period. CONCLUSIONS These results support the potential use of cenegermin for treating patients with stage 1 NK, and future confirmatory studies would be beneficial to elaborate on these findings. TRIAL REGISTRATION DEFENDO; NCT04485546.
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Affiliation(s)
- Pedram Hamrah
- Cornea Service, Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Mina Massaro-Giordano
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Gregg Berdy
- Ophthalmology Associates, St. Louis, MO, USA
| | | | | | - Flavio Mantelli
- Dompé farmaceutici S.p.A., Milan, Italy.
- Dompé US, San Mateo, CA, USA.
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10
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Karpecki PM, Findley A, Sloesen BJ, Hodson N, Bentley S, Arbuckle R, O'Brien P, Montecchi-Palmer M, Naujoks C, Hamrah P. Qualitative Research to Understand the Patient Experience and Evaluate Content Validity of the Chronic Ocular Pain Questionnaire (COP-Q). Ophthalmol Ther 2024; 13:615-633. [PMID: 38183618 PMCID: PMC10787728 DOI: 10.1007/s40123-023-00860-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION Chronic ocular surface pain (COSP) is described as a persistent, moderate-to-severe pain at the ocular surface lasting more than 3 months. Symptoms of COSP have a significant impact on patients' vision-dependent activities of daily living (ADL) and distal health-related quality of life (HRQoL). To adequately capture patient perspectives in clinical trials, patient-reported outcome (PRO) measures must demonstrate sufficient evidence of content validity in the target population. This study aimed to explore the patient experience of living with COSP and evaluate content validity of the newly developed Chronic Ocular Pain Questionnaire (COP-Q) for use in COSP clinical trials. METHODS Qualitative, combined concept elicitation (CE) and cognitive debriefing (CD) interviews were conducted with 24 patients experiencing COSP symptoms in the USA. Interviews were supplemented with real-time data collection via a daily diary app task in a subset of patients (n = 15) to explore the day-to-day patient experience. Three healthcare professionals (HCPs) from the USA, Canada, and France were also interviewed to provide a clinical perspective. CE results were used to further inform development of a conceptual model and to refine PRO items/response options. CD interviews assessed relevance and understanding of the COP-Q. Interviews were conducted across multiple rounds to allow item modifications and subsequent testing. RESULTS Eye pain, eye itch, burning sensation, eye dryness, eye irritation, foreign body sensation, eye fatigue, and eye grittiness were the most frequently reported symptoms impacting vision-dependent ADL (e.g., reading, using digital devices, driving) and wider HRQoL (e.g., emotional wellbeing, social functioning, work). COP-Q instructions, items, and response scales were understood, and concepts were considered relevant. Feedback supported modifications to instruction/item wording and confirmed the most appropriate recall periods. CONCLUSIONS Findings support content validity of the COP-Q for use in COSP populations. Ongoing research to evaluate psychometric validity of the COP-Q will support future use of the instrument in clinical trial efficacy endpoints.
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Affiliation(s)
- Paul M Karpecki
- University of Pikeville Kentucky College of Optometry, Pikeville, KY, USA
- Kentucky Eye Institute, Lexington, KY, USA
| | - Amy Findley
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, Cheshire, UK
- Novo Norisk, Copenhagen, Denmark
| | | | - Nicola Hodson
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, Cheshire, UK.
| | - Sarah Bentley
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, Cheshire, UK
| | - Rob Arbuckle
- Patient-Centered Outcomes, Adelphi Values Ltd., Bollington, Cheshire, UK
| | - Paul O'Brien
- Novartis Ireland Ltd., Dublin, Ireland
- ViiV Healthcare, London, UK
| | | | | | - Pedram Hamrah
- Department of Ophthalmology, New England Eye Center and Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
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11
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Bickle K, Miller JR, Tauber J, Awisi-Gyau D. Multi-symptom Relief with Propylene Glycol-Hydroxypropyl-Guar Nanoemulsion Lubricant Eye Drops in Subjects with Dry Eye Disease: A Post-Marketing Prospective Study. Ophthalmol Ther 2024; 13:481-494. [PMID: 38079084 PMCID: PMC10787711 DOI: 10.1007/s40123-023-00853-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 11/03/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION The study aimed to evaluate multi-symptom relief of dry eye manifestations with the use of propylene glycol-hydroxypropyl-guar (PG-HPG) nanoemulsion lubricant eye drops, among subjects with dry eye disease (DED). METHODS This was a post-marketing, prospective, single-arm study conducted in the USA. Subjects aged ≥ 18 years, with tear breakup time (TBUT) ≤ 10 s for both eyes, dry eye questionnaire-5 (DEQ-5) "watery eyes" symptom score 1-4, symptoms of burning/stinging, sore and tired eyes as determined by impact of dry eye on everyday living-symptom bother (IDEEL-SB) questionnaire, and IDEEL-SB score 16-65 were included. Subjects were required to complete IDEEL-SB and DEQ-5 at days 0, 14 ± 2, and 28 ± 2, and self-administer one drop of PG-HPG four times daily for 28 ± 2 days. Primary endpoints were change from baseline at day 28 in symptoms of sore, stinging/burning, and tired eyes on IDEEL-SB; and symptom of watery eyes on DEQ-5. Other endpoints evaluated were corneal staining and TBUT at baseline and day 28 ± 2; symptom relief (5-point Likert scale) at day 28 ± 2, and safety. RESULTS Of 119 subjects enrolled, 95 completed the study (mean ± SD age 61.2 ± 13.0 years; female 69.5%). Mean IDEEL-SB scores reduced significantly from baseline at day 28 for symptoms of aching/sore eyes (change from baseline - 1.0 ± 1.1), burning/stinging eyes (change from baseline - 1.1 ± 0.9), and tired eyes (change from baseline - 1.1 ± 1.0) (all p < 0.0001). Mean DEQ-5 score for watery eye symptoms significantly reduced from baseline at day 28 (change from baseline - 0.9 ± 1.0, p < 0.0001). Corneal staining at day 28 was comparable to baseline. TBUT improved from baseline to day 28. On a Likert scale, more than 50% of subjects reported relief from symptoms of sore, stinging, and burning eyes. Three (3.1%) subjects reported treatment-emergent adverse events (non-ocular). CONCLUSIONS PG-HPG nanoemulsion lubricant eye drops significantly improved multiple dry eye symptoms in subjects with DED over 28 days, with no new safety concerns. TRIAL REGISTRATION ClinicalTrials.gov Identifier, NCT05056155.
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Affiliation(s)
- Katherine Bickle
- Procare Vision Center, 1955 Newark-Granville Road, Granville, OH, 43023, USA
| | - Jason R Miller
- Insight Research Clinic LLC d/b/a Eyecare Professionals, Inc., 9711-C Sawmill Parkway, Powell, OH, 43065, USA
| | - Joseph Tauber
- Tauber Eye Center, 4400 Broadway Suite 202, Kansas City, MO, 64111, USA
| | - Deborah Awisi-Gyau
- Alcon Research LLC, 6201 South Freeway, Fort Worth, TX, 76134-2099, USA.
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12
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Preoteasa LD, Preoteasa D. Assessment of the prevalence and risk factors for dry eye symptoms among Romanian medical students using the ocular surface disease index - a cross-sectional study. BMC Ophthalmol 2024; 24:12. [PMID: 38182974 PMCID: PMC10768241 DOI: 10.1186/s12886-023-03260-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND This study aims to assess how Romanian medical students suffer from dry eye disease symptoms, establish the prevalence and severity of dry eye (DE) symptoms and identify potential risk factors. METHODS An analytical, cross-sectional study was conducted on students from "Carol Davila" University of Medicine, Romania, after the final examination period of July 2022. The OSDI score (Ocular Surface Disease Index©) was applied in an online survey. The study adopted the standards used by other authors, who defined symptomatic DED as an OSDI score greater than 12. The chi-square test was used to establish statistical significance at a cutoff value of p < 0.05. The predictive model was created using linear logistic regression analysis. The goodness of fit of the logistic regression model was assessed using the Hosmer-Lemeshow test. When the severity outcome had a nominal categorical form, multinomial regression analysis with normal subjects as a reference was performed. The distribution of the severe type of symptomatology across sex categories and years of study was analyzed using a nonparametric test (Independent-Samples Kruskal-Wallis Test). RESULTS A total of 274 answers were received from 81.4% females and 18.6% males with a response rate of 35.58%. The mean age was 22.7 years ± 1.66 with an age range between 20 and 25 years old. Using the OSDI score, we established that the overall prevalence of DE symptoms was 83.6% (95%CI: 79.6%, 88%), with an 85.2% (95%CI: 80.5%, 89.8%) prevalence in females and 76.5% (95%CI: 65%,88%) in males. The severe form of DE was the most prevalent, regardless of the study year or sex. Increased screen time (p-value < 0.05) and non-smokers (p-value < 0.05) were proven risk factors. The predictive model which includes the explanatory variables (sex, contact lens wearers, smoking, oral contraceptives, screen time) proved an 84.7% predictability for symptomatic DE and was able to better predict the dependent variable than the intercept model only (p-value < 0.05). Smoking (p = 0.002) and screen time (p = 0.009) preserved their significance in the multinominal regression as well. CONCLUSIONS This is the first study to report the epidemiology of DE symptoms among Romanian medical students. OSDI revealed a high prevalence of symptomatic DE in medical students. Screen time, although not the only factor, likely plays a role in exacerbating the disease. This information can be used to inform healthcare policies, establish occupational health guidelines, and implement preventive measures for individuals in similar high-stress academic or professional environments.
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Affiliation(s)
- Laura Denisa Preoteasa
- Carol Davila University of Medicine and Pharmacy, Dionisie Lupu street, no 37, Bucharest, 030167, Romania.
- Department of Ophthalmology, Clinical Emergency Eye Hospital, Bucharest, Romania.
- Onioptic Hospital, Craiova, Romania.
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13
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Elbakary MA, Shalaby OE, Allam WA, Alagorie AR, Shafik HM. Quality of life improvement in dry eye patients after intense pulsed light therapy compared to punctal plugs. Oman J Ophthalmol 2024; 17:108-112. [PMID: 38524331 PMCID: PMC10957059 DOI: 10.4103/ojo.ojo_85_23] [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: 04/24/2023] [Revised: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 03/26/2024] Open
Abstract
PURPOSE The purpose of the study was to evaluate the quality of life (QOL) improvement in evaporative dry eye patients after treatment with intense pulsed light (IPL) therapy compared to punctal plug insertion. METHODS A prospective comparative interventional study included 30 patients with moderate-to-severe evaporative dry eye. Patients' QOL affection before and after treatment was assessed by the Ocular Surface Disease Index (OSDI) questionnaire. Fifteen patients were treated with IPL therapy (Group 1). The other 15 patients were treated with silicone punctal plug insertion (Group 2). RESULTS Improvement of patients' QOL was noticed in all patients of Group 1, with significant improvement of OSDI score from a mean value of 56.9 to 22.9 (P = 0.001). Improvement was noticed in 80% of Group 2 patients (mean OSDI score pretreatment: 53.8 and posttreatment: 31.7, P = 0.017). The tear breakup time (TBUT) in Group 1 significantly improved from a mean of 3.2 s to 5.9 s (P = 0.001), whereas it showed no significant changes in Group 2 (mean TBUT pretreatment: 3.6 s and posttreatment: 3.9 s, P = 0.654). Complications occurred in 13.3% in Group 2, including punctal granuloma and proximal canalicular obstruction. No adverse effects were recorded in Group 1. CONCLUSION IPL therapy had better results with more improvement of patients' QOL compared to punctal plugs. It also showed a better safety profile with no reported complications.
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Affiliation(s)
- Molham A. Elbakary
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Magrabi Eye Center, Doha, Qatar
| | - Osama E. Shalaby
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Waleed A. Allam
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed R. Alagorie
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Heba M. Shafik
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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Le DTM, Kandel H, Watson SL. Evaluation of ocular neuropathic pain. Ocul Surf 2023; 30:213-235. [PMID: 37748645 DOI: 10.1016/j.jtos.2023.09.009] [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: 06/13/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
AIM To identify and assess the quality of current validated questionnaires that could be used to evaluate ocular neuropathic pain and its associated aetiologies. METHODS A literature search was performed on MEDLINE, PubMed, EMBASE, PsycINFO and The Cochrane Library. Articles evaluating questionnaires for ocular neuropathic pain and its associated aetiologies were included. Data on psychometric properties, validity, and reliability of the questionnaires was extracted and analysed using a set of quality criteria. Clinical and demographical associations with ocular neuropathic pain were also reviewed. RESULTS The search generated 1738 results with 61 publications meeting the inclusion criteria. The 61 publications covered 28 questionnaires including 3 ocular pain, 12 dry eye disease, 2 blepharitis, 2 refractive surgery, 3 contact lens wear, 3 Sjogren's Syndrome, and 3 that were non-disease-specific. Only 57 publications provided enough data on psychometric properties and validity of the questionnaire to be included for quality assessment. The Contact Lens Discomfort Index (CLDI) had the highest rated psychometric properties, whereas the English version of the Ocular Comfort Index (OCI) provided the most data on psychometric properties (9 out of 10 criteria). Most ocular pain and disease-specific questionnaires contained appropriate items to assess ocular pain in specific populations. However, non-disease-specific ophthalmic questionnaires demonstrated poor reliability and validity when evaluating ocular pain. CONCLUSION Ocular pain questionnaires can potentially diagnose ocular neuropathic pain. Disease-specific questionnaires were limited to their target populations, and non-disease-specific ophthalmic questionnaires were unreliable. Further studies are required to determine the most appropriate questionnaire to evaluate ocular neuropathic pain.
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Affiliation(s)
- Damien Tuan-Man Le
- The University of Sydney, Save Sight Institute, Sydney, NSW, 2000, Australia; Sydney Eye Hospital, Sydney, NSW, 2000, Australia.
| | - Himal Kandel
- The University of Sydney, Save Sight Institute, Sydney, NSW, 2000, Australia; Sydney Eye Hospital, Sydney, NSW, 2000, Australia
| | - Stephanie L Watson
- The University of Sydney, Save Sight Institute, Sydney, NSW, 2000, Australia; Sydney Eye Hospital, Sydney, NSW, 2000, Australia
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15
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Martin R. Comparison of the Ocular Surface Disease Index and the Symptom Assessment in Dry Eye Questionnaires for Dry Eye Symptom Assessment. Life (Basel) 2023; 13:1941. [PMID: 37763343 PMCID: PMC10532939 DOI: 10.3390/life13091941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/03/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Patient-reported dry eye symptoms (DESs), assessed using the Ocular Surface Disease Index (OSDI) and the Symptom Assessment iN Dry Eye (SANDE) questionnaires, were compared in a large sample of patients. METHODS The correlation (Spearman coefficient) and agreement (Bland-Altman analysis) between the OSDI and SANDE questionnaire scores (with and without score normalization) were assessed in 1033 patients and classified according to the OSDI score as non-DES and DES in a cross-sectional analysis. RESULTS The normalized and non-normalized SANDE results were higher than the OSDI results in all samples (2.83 ± 12.40 (p = 0.063) and 2.85 ± 15.95 (p = 0.016), respectively) and in non-DES (p > 0.063) and DES (p < 0.001) with both OSDI cutoff values. Weak correlations were found (Spearman coefficient <0.53; p < 0.001) in all cases except DES (0.12, p = 0.126). Weak agreement was found with a Bland-Altman analysis of the normalized and non-normalized scores of both questionnaires (mean difference from -7.67 ± 29.17 (DES patients) to -1.33 ± 8.99 (non-DES patients) without score normalization, and from -9.21 ± 26.37 (DES patients) to -0.85 ± 4.01 (non-DES) with data normalization), with a statistically significant linear relationship (R2 > 0.32, p < 0.001). The SANDE questionnaire did not yield the same patient classification as OSDI. The same operative curves (ROC) of the SANDE normalized and non-normalized scores were used to differentiate among patients with DES using OSDI < 12 (0.836 ± 0.015) or OSDI < 22 (0.880 ± 0.015) cutoff values. CONCLUSIONS Normalized and non-normalized data collected from the SANDE questionnaire showed relevant differences from those of the OSDI, which suggests that the results of the SANDE visual analog scale-based questionnaire provide different patient classifications than the OSDI score.
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Affiliation(s)
- Raul Martin
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Paseo de Belén, 17—Campus Miguel Delibes, 47011 Valladolid, Spain
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Sloesen B, Young A, Forde K, Hodson N, Bentley S, Walsh O, Naujoks C, O'Brien P, Sharma G. Development and content validity assessment of the Dry Eye Disease Questionnaire in patients with dry eye disease, meibomian gland dysfunction, and Sjögren's syndrome dry eye disease. J Patient Rep Outcomes 2023; 7:64. [PMID: 37405617 DOI: 10.1186/s41687-023-00608-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Dry eye disease (DED), Meibomian gland dysfunction (MGD), and Sjögren's syndrome dry eye disease (SS-DED) are eye dryness conditions that show significant overlap in various symptoms of ocular discomfort. The aim of this study was to qualitatively explore the patient experience and evaluate content validity of the newly developed Dry Eye Disease Questionnaire (DED-Q). METHODS Semi-structured interviews were conducted with 61 US adults who reported experiencing ocular symptoms due to their physician-confirmed primary diagnosis of DED (n = 21), MGD (n = 20), or SS-DED (n = 20). The open-ended concept-elicitation phase was followed by cognitive debriefing (CD) of the DED-Q to evaluate participants' understanding and relevance of the instructions, items, response options, and recall periods. Interviews were also conducted with eight specialist healthcare professionals to assess clinical relevance of the concepts included. Verbatim interview transcripts were analyzed using thematic analysis in ATLAS.ti v8 software. RESULTS A total of 29 symptoms and 14 impacts on quality of life were reported across participant interviews. Primary ocular symptoms reported included eye dryness (n = 61/61; 100%), eye irritation (n = 55/61; 90%), eye itch (n = 54/61; 89%), burning sensation (n = 52/61; 85%), and foreign body sensation (n = 51/61; 84%). The most impacted aspects of daily life were using digital screens (n = 46/61; 75%), driving (n = 45/61; 74%), working (n = 39/61; 64%), and reading (n = 37/61; 61%). CD findings showed most participants had good understanding of DED-Q items and confirmed most concepts were relevant to the lived experience of their condition. Aside from few minor changes to the items and examples to facilitate more accurate interpretation, the proposed instruction wording was modified for various symptom and impact modules to encourage participants to focus only on dry eye vision problems. CONCLUSIONS This research identified multiple prevalent symptoms and impacts of DED, MGD, and SS-DED, most of which were similar across the conditions. The DED-Q was confirmed to be a content-valid PRO measure suitable for use in clinical studies to assess the patient experience of DED, MGD, and SS-DED. Future work will focus on evaluating the psychometric properties of the DED-Q for use as an efficacy endpoint in clinical trials.
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Affiliation(s)
| | - Alyson Young
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Katie Forde
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Nicola Hodson
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | - Sarah Bentley
- Adelphi Values, Patient-Centered Outcomes, Cheshire, UK
| | | | | | | | - Garima Sharma
- Novartis Healthcare Private Limited, Hyderabad, India
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Slade AL, Recchioni A, Aiyegbusi OL, Retzer A, Nice L, Dancey E, Calvert MJ, Rauz S. Identifying patient-valued outcomes for use in early phase trials of ocular surface disease interventions. Ocul Surf 2023; 29:550-556. [PMID: 37467894 DOI: 10.1016/j.jtos.2023.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) can be used to evaluate the impact of dry eye symptoms (DES) on daily life. Early-phase clinical trials provide an opportunity to evaluate PRO strategies. Existing measures identified through systematic review omitted important concepts that mattered to patients. The aim of our work was to develop a conceptual map of DES and assess the relative importance of identified concepts. METHODS Web-based group concept mapping software was used to develop a conceptual map. This semi-quantitative mixed-methods approach consists of three stages 1) statement generation, 2) thematic sorting, 3) rating of statements for importance [1 (not important), 2 (important), 3 (very important)] and relevance [1 (not my experience), 2 (sometimes my experience); 3 (definitely my experience)]. Thirty-nine participants were recruited from two UK-based patient support groups (British Sjögren's Syndrome Association, PemFriends). Three withdrew, two for health reasons and one struggled with the web-based format. RESULTS 125 statements and six thematic clusters were generated. The Environmental Impacts cluster scored highest for importance (2.45), followed by Pain and Discomfort (2.35), Eye Treatments (2.32), Daily Impact (2.07), Psychosocial Issues (1.78) and Miscellaneous (1.78). Mapping statements against existing PRO measures confirmed a number of important missing issues including the impact of 'UV levels' (2.50), hot dry weather (2.33), the temporal aspects of pain (2.64), and issues with night-driving (2.59). CONCLUSIONS Group concept mapping identified important issues for people living with DES not currently captured by existing PROs, highlighting the need for additional PRO items to be considered for use in clinical trials.
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Affiliation(s)
- Anita L Slade
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University of Birmingham, United Kingdom; NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, United Kingdom
| | - Alberto Recchioni
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, United Kingdom; Birmingham & Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom
| | - Olalekan L Aiyegbusi
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University of Birmingham, United Kingdom; NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, United Kingdom; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, United Kingdom; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, United Kingdom
| | - Ameeta Retzer
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University of Birmingham, United Kingdom
| | - Laura Nice
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, United Kingdom; Institute of Translational Medicine, Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Elizabeth Dancey
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, United Kingdom
| | - Melanie J Calvert
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom; National Institute for Health and Care Research (NIHR) Applied Research Collaboration West Midlands, Birmingham, United Kingdom; NIHR Birmingham Biomedical Research Centre, University of Birmingham, United Kingdom; NIHR Surgical Reconstruction and Microbiology Research Centre, University of Birmingham, United Kingdom; Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, United Kingdom; NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, United Kingdom
| | - Saaeha Rauz
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, United Kingdom; Birmingham & Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom.
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Wratten S, Abetz-Webb L, Arenson E, Griffiths P, Bowman S, Hueber W, Ndife B, Kuessner D, Goswami P. Development and testing of an alternative responder definition for EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI). RMD Open 2023; 9:e002721. [PMID: 36931685 PMCID: PMC10030922 DOI: 10.1136/rmdopen-2022-002721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES Dryness, fatigue and joint/muscle pain are typically assessed in Sjögren's trials using European Alliance of Associations for Rheumatology Sjögren's Syndrome Patient Reported Index (ESSPRI). A Patient Acceptable Symptom State of <5 and a Minimal Clinically Important Improvement (MCII)/responder definition (RD) of ≥1 point or 15% on ESSPRI have previously been defined. This study explored alternative RDs to better discriminate between active treatment and placebo in trials. METHODS Anchor-based and distribution-based methods were used to derive RD thresholds in blinded phase IIb trial data (N=190) and confirm these in blinded data pooled from three early phase II trials (N=126). The populations consisted of individuals with moderate-to-severe systemic primary Sjögren's. Anchors were prioritised by ESSPRI correlations and used in similar conditions. Triangulated estimates were discussed with experts (N=3). The revised RD was compared with the original using unblinded data to assess placebo and treatment responder rates. RESULTS Patients were predominantly female (>90%), white (90%), with mean age of 50 years. Receiver operating characteristic estimates supported an MCII threshold of 1.5-1.6 in the phase II data, whereas correlation-weighted mean change estimates supported a low/minimal symptom severity threshold of ≥2. A low/minimal symptom severity of ≤3 showed the greatest sensitivity/specificity balance. Analyses in the pooled data supported these thresholds (MCII: 1.5-2.1; low/minimal symptom severity: 2.7-3.7). Unblinded analyses confirmed the revised RD reduced placebo rates. CONCLUSIONS Completing a trial with an improvement of ≥1.5 points compared with baseline and an ESSPRI score of ≤3 points is a relevant RD for moderate-to-severe systemic Sjögren's and reduces placebo rates.
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Affiliation(s)
| | | | - Ethan Arenson
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Pip Griffiths
- Patient-Centered Outcomes, Adelphi Values, Bollington, UK
| | - Simon Bowman
- Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Wolfgang Hueber
- Department of Immunology, Novartis Pharma, Basel, Switzerland
| | - Briana Ndife
- Department of Oncology, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - Daniel Kuessner
- Department of Immunology, Novartis Pharma, Basel, Switzerland
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Dry Eye Disease: What Is the Role of Vitamin D? Int J Mol Sci 2023; 24:ijms24021458. [PMID: 36674972 PMCID: PMC9860626 DOI: 10.3390/ijms24021458] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open
Abstract
Dry eye disease (DED) is a multifactorial condition resulting from reduced tear secretion from the lacrimal glands, increased tear water evaporation or the production of poor-quality tears. Such tear instability can lead to inflammation and damage of the ocular surface, as well as to abnormal nociception. Historically, tear substitutes and corticosteroids have been the bastion of DED therapy, but a substantial number of patients still suffer from residual symptoms even after being treated with traditional treatments. Aiming to find safe and effective alternative therapies, recent efforts have been focused on the role of vitamin D in the cellular physiology of the eye. Possibly because of its positive effect in modulating the immune and inflammatory responses, the systemic supplementation of vitamin D seems, indeed, to be an effective therapeutic strategy, especially, but not only, for patients affected by DED that does not respond to conventional treatments. In this context, this review focuses on the literature reporting on the pathogenesis and treatment of DED, with a special emphasis on the recent investigations reporting on the potential role of the systemic administration of vitamin D as a therapeutic approach in the management of such condition.
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Tamimi A, Sheikhzadeh F, Ezabadi SG, Islampanah M, Parhiz P, Fathabadi A, Poudineh M, Khanjani Z, Pourmontaseri H, Orandi S, Mehrabani R, Rahmanian M, Deravi N. Post-LASIK dry eye disease: A comprehensive review of management and current treatment options. Front Med (Lausanne) 2023; 10:1057685. [PMID: 37113611 PMCID: PMC10126282 DOI: 10.3389/fmed.2023.1057685] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/14/2023] [Indexed: 04/29/2023] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is a unique corneal stromal laser ablation method that uses an excimer laser to reach beneath corneal dome-shaped tissues. In contrast, surface ablation methods, such as photorefractive keratectomy, include removing epithelium and cutting off the Bowman's layer and the stromal tissue of the anterior corneal surface. Dry eye disease (DED) is the most common complication after LASIK. DED is a typical multi-factor disorder of the tear function and ocular surface that occurs when the eyes fail to produce efficient or adequate volumes of tears to moisturize the eyes. DED influences quality of life and visual perception, as symptoms often interfere with daily activities such as reading, writing, or using video display monitors. Generally, DED brings about discomfort, symptoms of visual disturbance, focal or global tear film instability with possible harm to the ocular surface, the increased osmolarity of the tear film, and subacute inflammation of the ocular surface. Almost all patients develop a degree of dryness in the postoperative period. Detection of preoperative DED and committed examination and treatment in the preoperative period, and continuing treatments postoperatively lead to rapid healing, fewer complications, and improved visual outcomes. To improve patient comfort and surgical outcomes, early treatment is required. Therefore, in this study, we aim to comprehensively review studies on the management and current treatment options for post-LASIK DED.
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Affiliation(s)
- Atena Tamimi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sajjad Ghane Ezabadi
- Students’ Scientific Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Peyman Parhiz
- Student Research Committee, Zahedan Medical Sciences Branch, Islamic Azad University, Zahedan, Iran
| | - Amirhossein Fathabadi
- Student Research Committee, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Zahra Khanjani
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Pourmontaseri
- Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
- Bitab Knowledge Enterprise, Fasa University of Medical Sciences, Fasa, Iran
| | - Shirin Orandi
- Department of Clinical Biochemistry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Mehrabani
- Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
| | - Mohammad Rahmanian
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Niloofar Deravi,
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Review of Evidence for the Usage of Antioxidants for Eye Aging. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5810373. [PMID: 36225983 PMCID: PMC9550496 DOI: 10.1155/2022/5810373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 06/15/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
Abstract
Oxidative stress is one of the common factors leading to age-related eye diseases in older adults. Factors such as high oxygen consumption, high concentration of polyunsaturated fatty acids, and cumulative exposure to high-energy visible light in the eyes, lead to excessive generation of reactive oxygen species, hence triggering apoptosis of ocular cells and giving rise to ophthalmic diseases. Dietary supplements such as carotenoids, anthocyanins, and vitamins have antioxidant properties which may be of benefit in retaining better vision or reversing vision impairment; thus, studies have been conducted to understand the role of dietary supplements in the treatment or prevention of ophthalmic diseases. While high concentration of carotenoids such as lutein and zeaxanthin decrease the risk of developing age-related macular disease, anthocyanins and vitamins play a role in the treatment and prevention of other ophthalmic diseases: saffron extract reduced intraocular pressure in glaucoma patients; bilberry extract prevented impairments in lenses and retina, as well as alleviate symptoms of dry eye disease; high concentration of beta-carotene may reduce the risk of developing cataract. Further studies with clinical measurements are required to investigate the effectiveness of antioxidants on visual function and ophthalmic diseases.
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22
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Asamura S, Wada Y, Tanaka S, Saika S. Study to the Effect of Involutional Blepharoptosis Surgery Using Objective and Subjective Parameters. Arch Plast Surg 2022; 49:473-478. [PMID: 35919549 PMCID: PMC9340170 DOI: 10.1055/s-0042-1751101] [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: 11/04/2022] Open
Abstract
Background
We investigate the effect of involutional blepharoptosis (IB) surgery based on dry eye symptoms by analysis using objective and subjective measures.
Methods
We recorded various parameters from patients that underwent levator advancement surgery for IB, totaling 125 eyes (total 65 patients, 5 unilateral, 60 bilateral). Subjective assessment comprised a questionnaire on dry eye-related quality of life score (DEQS), a summary score calculated from DEQS, and six-grade evaluation, the patient's own measure of eye comfort. Objective assessment comprised marginal-reflex distance-1 (MRD-1), measurement of tear film breakup time, and superficial keratopathy (SPK) existence by slit lamp microscope.
Results
Subjective assessments showed that IB patients had improvement of dry eye symptoms and eye comfort when surgery increased MRD-1. On the other hand, objective assessments showed that the presence of SPK is suspected when the postoperative MRD-1 level is 3 mm or higher.
Conclusion
IB surgery must not only increase MRD-1 value, but also to perform maintenance of the appropriate ocular surface condition. From our parameters, we suggest postoperative MRD-1 value should be maintained at < 3 mm to safe and effective of IB surgery.
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Affiliation(s)
- Shinichi Asamura
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yoshitaka Wada
- Department of Plastic and Reconstructive Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Saiichi Tanaka
- Department of Ophthalmology, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Shizuya Saika
- Department of Ophthalmology, Wakayama Medical University, Wakayama City, Wakayama, Japan
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OSDI Questions on Daily Life Activities Allow to Detect Subclinical Dry Eye in Young Contact Lens Users. J Clin Med 2022; 11:jcm11092626. [PMID: 35566752 PMCID: PMC9101005 DOI: 10.3390/jcm11092626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
Dry eye disease (DED) is difficult to detect in young contact lens (CL) wearers, who usually have no signs, mild symptoms and an ocular surface disease index (OSDI) below the DED diagnosis values (OSDI ≥ 13). We investigate if some of the 12 OSDI questions (OSDI A—ocular symptoms; OSDI B—vision-related functionality; OSDI C—environmental triggers) contribute the most to classify young CL as symptomatic. TBUT and tear volume are also measured. Age, gender and refraction error-matched eye glasses (EG) wearers participated as the control. CL and EG data were compared with t-test and z-test. Confusion matrices and logistic correlation analyses were performed to define the contribution of each OSDI question to classify symptomatic subjects. OSDI classified symptomatic CL better than the tear volume or TBUT values. In CL, only OSDI B and C values were significantly higher in symptomatic vs. asymptomatic subjects (p < 0.001), while values of all twelve OSDI questions were significantly higher in symptomatic vs. asymptomatic EG (p < 0.05−0.001). All OSDI questions contribute equally to identify symptomatic EG, while only OSDI B questions on daily life visual functions are significant to classify symptomatic CL wearers at risk to develop DED or at a subclinical stage. CL wearers scoring ≥ 2 on the OSDI B questions should be considered for preventive treatments, even if their clinical sings are scarce or absent.
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Rodriguez-Garcia A, Babayan-Sosa A, Ramirez-Miranda A, Santa Cruz-Valdes C, Hernandez-Quintela E, Hernandez-Camarena JC, Ramos-Betancourt N, Velasco-Ramos R, Ruiz-Lozano RE. A Practical Approach to Severity Classification and Treatment of Dry Eye Disease: A Proposal from the Mexican Dry Eye Disease Expert Panel. Clin Ophthalmol 2022; 16:1331-1355. [PMID: 35520107 PMCID: PMC9061212 DOI: 10.2147/opth.s351898] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Dry eye disease (DED) has a higher prevalence than many important systemic disorders like cardiovascular disease and diabetes mellitus, representing a significant quality of life burden for the affected patients. It is a common reason for consultation in general eye clinics worldwide. Nowadays, the diagnostic and therapeutic approach at the high corneal and ocular surface specialty level should be reserved for cases of severe and chronic dry eye disease associated with systemic autoimmune diseases or complicated corneal and ocular surface pathologies. In such cases, the diagnostic and therapeutic approach is often complex, elaborate, time-consuming, and costly due to the use of extensive dry eye questionnaires, noninvasive electronic diagnostic equipment, and clinical laboratory and ancillary tests. However, other eye care specialists attend a fair amount of DED cases; therefore, its diagnosis, classification, and management should be simple, practical, achievable, and effective. Considering that many patients attending non-specialized dry eye clinics would benefit from better ophthalmological attention, we decided to elaborate a practical DED classification system based on disease severity to help clinicians discriminate cases needing referral to subspecialty clinics from those they could attend. Additionally, we propose a systematic management approach and general management considerations to improve patients' therapeutic outcomes according to disease severity.
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Affiliation(s)
- Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
| | - Alejandro Babayan-Sosa
- Cornea and Refractive Surgery Service, Fundación Hospital Nuestra Señora de la Luz, I. A. P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Arturo Ramirez-Miranda
- Cornea and Refractive Surgery Service, Instituto de Oftalmología Conde de Valenciana, I.A.P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Concepcion Santa Cruz-Valdes
- Cornea and Refractive Surgery Service, Instituto de Oftalmología Conde de Valenciana, I.A.P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | | | - Julio C Hernandez-Camarena
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
| | | | - Regina Velasco-Ramos
- Cornea and Refractive Surgery Service, Fundación Hospital Nuestra Señora de la Luz, I. A. P, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Raul E Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea and External Disease Service, Monterrey, Mexico
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Romano D, De Ruvo V, Fogagnolo P, Farci R, Rossetti LM. Inter-Eye Comparison of the Ocular Surface of Glaucoma Patients Receiving Surgical and Medical Treatments. J Clin Med 2022; 11:jcm11051238. [PMID: 35268329 PMCID: PMC8910944 DOI: 10.3390/jcm11051238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background: Ocular surface frequently affects glaucoma patients. In this paper we aimed at evaluating the impact of glaucoma surgery on the ocular surface of patients who received unilateral trabeculectomy. Methods: 26 consecutive patients successfully treated with trabeculectomy on one eye (Trab Eye) and under control with topical treatments on the fellow eye (Med Eye) were included in this observational study. They received IDEEL and OSDI questionnaires, Tear Film Osmolarity (TFO), grading of conjunctival hyperemia, fluorescein tear break-up time (tBUT), grading of corneal staining and Schirmer test. Results: IDEEL and OSDI scores were 48 ± 38 and 11 ± 12, respectively, with moderate correlation (r = 0.50, p = 0.03). Compared with Med eyes, Trab Eyes had higher tBUT (6.5 ± 3.5 vs. 5.1 ± 2.7 s, p = 0.004), lower conjunctival hyperemia (0.8 ± 0.9 and 1.7 ± 1.1 respectively, p < 0.001) and lower corneal staining (0.3 ± 0.5 and 0.6 ± 0.5, respectively, p = 0.03). Correlation between corneal staining and conjunctival hyperemia was 0.55 in Trab Eyes (p = 0.01) and 0.44 in Med Eyes (p > 0.05). Patients with bilateral corneal staining had had threefold worse questionnaire scores (p < 0.05). The duration of treatment and the daily exposure to preservatives did not directly affect OS parameters in this cohort of patients. Conclusions: Patients receiving successful trabeculectomy showed better OS homeostasis (higher TBUT, lower grading of conjunctival hyperemia and corneal staining) than fellow medically treated eyes. Presence of corneal epithelial damage in both eyes is the factor more consistently affecting questionnaire scores.
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Affiliation(s)
- Dario Romano
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
| | - Valentino De Ruvo
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
| | - Paolo Fogagnolo
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
- Department of Health Science, University of Milan, 20146 Milan, Italy;
- Correspondence:
| | - Roberta Farci
- Department of Health Science, University of Milan, 20146 Milan, Italy;
| | - Luca Mario Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo—San Paolo Hospital, University of Milan, 20143 Milan, Italy; (D.R.); (V.D.R.); (L.M.R.)
- Department of Health Science, University of Milan, 20146 Milan, Italy;
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Comparison of Two Thermal Pulsation Systems in the Treatment of Meibomian Gland Dysfunction. Optom Vis Sci 2022; 99:323-332. [DOI: 10.1097/opx.0000000000001892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wirta D, McLaurin E, Ousler G, Liu J, Kacmaz RO, Grieco J. Repository Corticotropin Injection (Acthar ® Gel) for Refractory Severe Noninfectious Keratitis: Efficacy and Safety from a Phase 4, Multicenter, Open-Label Study. Ophthalmol Ther 2021; 10:1077-1092. [PMID: 34669183 PMCID: PMC8589919 DOI: 10.1007/s40123-021-00400-y] [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: 07/23/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023] Open
Abstract
Introduction Noninfectious keratitis is a painful corneal inflammation treated with topical cyclosporine and other immunosuppressants. Additional treatment options are needed for keratitis that does not improve with standard therapies. Repository corticotropin injection (RCI; Acthar® Gel) is approved to treat severe acute and chronic allergic and inflammatory processes involving the eye and its adnexa, including keratitis. This phase 4, multicenter, open-label study assessed the efficacy and safety of RCI for refractory severe noninfectious keratitis. Methods Patients were ≥ 18 years old with persistent severe keratitis despite treatment with topical immunosuppressants. Patients received 80 U of RCI subcutaneously twice weekly for 12 weeks followed by a 4-week taper. Assessments included all domains of the Impact of Dry Eye on Everyday Life (IDEEL) Questionnaire, Ocular Discomfort and 4-Symptom Questionnaire, and Visual Analog Scale (VAS). Corneal fluorescein and conjunctival lissamine green staining, Conjunctival Redness Scale, tear production (Schirmer’s test), visual acuity, slit lamp examination, and intraocular pressure were also assessed. Safety was evaluated via treatment-emergent adverse events. Analyses were performed using the modified intent-to-treat (mITT) population (patients who received ≥ 1 dose of RCI and contributed any post-baseline efficacy data). Results In the mITT population (N = 35), 50.0% (95% confidence interval, 33.2% to 66.8%) of patients experienced clinically important improvements in the symptom bother domain of the IDEEL Questionnaire at week 12 of RCI therapy. All domains of the IDEEL and the Ocular Discomfort and 4-Symptom Questionnaire showed improvements at week 12 of RCI treatment. The most pronounced improvements in the VAS at week 12 were for eye dryness and eye discomfort. Corneal staining, conjunctival staining, conjunctival redness, and tear production showed early improvements that were sustained through week 12. No new safety signals for RCI were identified. Conclusions RCI is safe and effective for refractory severe noninfectious keratitis that has not improved with other approved therapies. Trial registration number ClinicalTrials.gov NCT04169061. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00400-y.
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Affiliation(s)
- David Wirta
- Eye Research Foundation, 520 Superior Ave. #235, Newport Beach, CA, 92663, USA.
| | | | | | - Jingyu Liu
- Mallinckrodt Pharmaceuticals, Hampton, NJ, USA
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Chan C, Ziai S, Myageri V, Burns JG, Prokopich CL. Economic burden and loss of quality of life from dry eye disease in Canada. BMJ Open Ophthalmol 2021; 6:e000709. [PMID: 34604535 PMCID: PMC8444260 DOI: 10.1136/bmjophth-2021-000709] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/03/2021] [Indexed: 11/12/2022] Open
Abstract
Objective To describe the direct and indirect cost estimates of dry eye disease (DED), stratified by disease severity, and the impact of DED on quality of life (QoL) in Canadian patients. Methods and analysis A prospective, multicentre, observational, cross-sectional study was conducted at six sites across Canada. Eligible patients completed a 20 min survey on demography, general health, disease severity, QoL and direct (resource utilisation and out-of-pocket expenses for the past 3–24 months) and indirect costs (absenteeism and presenteeism based on Work Productivity and Activity Impairment questionnaire responses). Subgroup analyses were performed according to DED severity and presence of Sjögren’s syndrome. Results Responses from 146 of 151 participants were included in the analysis. DED was rated as moderate or severe by 19.2% and 69.2% of patients, respectively. Total mean annual costs of DED were $C24 331 (Canadian dollars) per patient and increased with patient-reported disease severity. Mean (standard deviation [SD]) indirect costs for mild, moderate and severe disease were $C5961 ($C6275), $C16 525 ($C11 607), and $C25 485 ($C22,879), respectively. Mean (SD) direct costs were $C958 ($C1216), $C1303 ($C1574) and $C2766 ($C7161), respectively. QoL scores were lowest in patients with Sjögren’s syndrome (8.2% of cohort) and those with severe DED. Conclusion This study provides important insights into the negative impact of DED in a Canadian setting. Severe DED was associated with higher direct and indirect costs and lower QoL compared with those with mild or moderate disease. Increased costs and poorer QoL were also evident for patients with DED plus Sjögren’s syndrome versus DED alone.
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Affiliation(s)
- Clara Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Setareh Ziai
- University of Ottawa Eye Institute, Ottawa, Ontario, Canada
| | - Varun Myageri
- IQVIA Solutions Canada Inc, Kirkland, Quebec, Canada
| | - James G Burns
- Novartis Pharmaceuticals Canada Inc, Dorval, Quebec, Canada
| | - C Lisa Prokopich
- Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, Canada
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Tansanguan S, Tananuvat N, Wongpakaran N, Wongpakaran T, Ausayakhun S. Thai version of the dry eye-related quality-of-life score questionnaire: preliminary assessment for psychometric properties. BMC Ophthalmol 2021; 21:310. [PMID: 34454466 PMCID: PMC8400753 DOI: 10.1186/s12886-021-02077-0] [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: 12/15/2020] [Accepted: 08/13/2021] [Indexed: 01/02/2023] Open
Abstract
Background This study aimed to develop a Thai version of the Dry Eye–Related Quality-of-Life Score (DEQS-Th) questionnaire and evaluate its validity, reliability, and feasibility among Thai participants. Methods The DEQS-Th, a 15-item self-report measuring dry eye and its impact on quality of life (QOL) was developed based on the DEQS. The questionnaire was divided into two subscales: Bothersome Ocular Symptoms (six questions), and Impact on Daily Life (nine questions). It employed a 5-point Likert scale, addressing on both the frequency and the degree of symptoms. Backward and forward and cultural adaptation process translation methods were employed. Thirty healthy participants were enrolled to evaluate the feasibility of the DEQS-Th in terms of difficulty and convenience. Reliability was assessed using internal consistency determined by Cronbach’s alpha, with values > 0.7 considered acceptable. Convergent validity was determined by the correlation between DEQS-Th and overall health status. Confirmatory factor analysis was conducted for its factor structure. Results The participants’ mean age was 38.6 ± 12.9 years, and 23 (76.7%) were females. The mean time to complete the questionnaire was 9.3 ± 2.7 min. The Cronbach’s alpha of the ocular symptoms subscale, impact on QOL subscale, and summary score on frequency and degree were 0.80 and 0.70, 0.89 and 0.89, and 0.90 and 0.89, respectively. The overall health status significantly correlated with the summary score (r = 0.564, p = .001), subscale ocular symptoms (r = 0.594, p = .001), and impact on QOL scores (r = 0.626, p < .001) of the DEQS-Th, respectively. A one-factor model fitted the data the best for both the ocular symptoms subscale (CFI = 1.000, TLI = 1.000, RMSEA = 0.000) and the impact on QOL subscale (CFI = 0.998, TLI = 0.997, RMSEA = 0.053). Conclusion When tested among normal participants, the DEQS-Th is a valid and reliable measurement for dry eye symptoms and impact on QOL. Supplementary Information The online version contains supplementary material available at 10.1186/s12886-021-02077-0.
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Affiliation(s)
- Sasiwimon Tansanguan
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Napaporn Tananuvat
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
| | - Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
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A systematic review assessing the quality of patient reported outcomes measures in dry eye diseases. PLoS One 2021; 16:e0253857. [PMID: 34370748 PMCID: PMC8351938 DOI: 10.1371/journal.pone.0253857] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) can provide valuable insights on the impact of a disease or treatment on a patient’s health-related quality of life. In ophthalmology, particularly in dry eye disease (DED) and ocular surface disease (OSD), it is unclear whether the available PROMs were developed using comprehensive guidelines. To address this, we evaluated the methodological quality of studies assessing the psychometric properties of PROMs in DED and OSD [PROSPERO registration number CRD42019142328]. Methods Four databases were searched; reference list and citation searching of included studies was also conducted. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist was used to appraise the quality of the studies evaluating the psychometric properties of PROMs used in DED and OSD. Results The search strategy (S3 Table) retrieved 5,761 records, 573 duplicates were removed, 5,188 abstracts were screened and 127 full-text articles were retrieved for further review. Of these, 118 full-text articles did not meet the eligibility criteria and were excluded. Reference list and citation searching, identified an additional 8 articles bringing the total numbers of papers reviewed to 17. In general, psychometric properties such as content validity, measurement error and structural validity were not assessed by the studies included in this review. Studies reviewing The Impact of Dry Eye on Everyday Life (IDEEL) presented with the highest quality scores together with the Ocular Surface Disease Index (OSDI) questionnaire. Conclusions The quality of studies evaluating PROMs in DED and OSD was considered using the COSMIN standards. The majority of the studies evaluating PROMs included in this review did not meet the recommended COSMIN criteria and the quality of the PROMs evaluated is not assured. Further evaluation of their psychometric properties is required if these are going to be used in clinical practice or research.
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Simpson T, Begley CG, Situ P, Feng Y, Nelson JD, Caffery B, Springs C, Connell SB. Canonical Grading Scales of Corneal and Conjunctival Staining Based on Psychophysical and Physical Attributes. Transl Vis Sci Technol 2021; 10:17. [PMID: 34403476 PMCID: PMC8374974 DOI: 10.1167/tvst.10.9.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose In this study, we apply psychophysical scaling principles based on physical (photometric) attributes of images to better understand the factors involved in clinician judgement of ocular surface staining and, using that knowledge, to develop photographic scales for the assessment of staining for dry eye (DE) and related conditions. Methods Subjects with noninfectious ocular surface staining were enrolled at five clinical sites. Following instillation of fluorescein, photographs of corneal staining were taken every 30 seconds for at least 5 minutes. The same procedure was followed for conjunctival staining after instillation of 2 µl of 1% lissamine green. A subset of the best corneal and bulbar conjunctival staining images were anonymized and a spectroradiometer measured photometric attributes (luminance and chromaticity). The images were scaled psychophysically by study investigators, who participated in constructing grading scales based on physical and psychophysical analyses. The final grading scales were refined following consultation with outside DE experts. Results Photographs were collected from 142 subjects (81% women), with an average age of 58 ± 17 years; 89% were diagnosed with DE. There was a monotonic relationship between between physical measurements and psychophysically scaled staining of both corneal (fluorescein) and bulbar (lissamine green) staining. Michelson contrast and u’ (chromaticity) accounted for 66% and 64% of the variability in the psychophysically scaled images of fluorescein corneal and lissamine green conjunctival staining, respectively. Translational Relevance This paper provides examples of the first ever clinically usable ocular surface staining scales validated using psychophysical scaling and the physical attributes (luminance and chromaticity) of the staining itself. In addition, it provides a generalizable method for the development of other clinical scales of ocular appearance.
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Affiliation(s)
- Trefford Simpson
- University of Waterloo, School of Optometry and Vision Science, Waterloo, Ontario, Canada
| | | | - Ping Situ
- Indiana University School of Optometry, Bloomington, IN, USA
| | - Yunwei Feng
- University of Waterloo, School of Optometry and Vision Science, Waterloo, Ontario, Canada
| | | | | | - Clark Springs
- Indiana University Department of Ophthalmology, Indianapolis, IN, USA
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He H, Li H, Zeng X, Zhao H, Zhang Y. Development and validation of a patient-reported outcome measure for patients with chronic respiratory failure: The CRF-PROM scale. Health Expect 2021; 24:1842-1858. [PMID: 34337839 PMCID: PMC8483203 DOI: 10.1111/hex.13324] [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] [Received: 04/29/2021] [Revised: 06/05/2021] [Accepted: 07/18/2021] [Indexed: 12/01/2022] Open
Abstract
Background Various health‐related quality‐of‐life (HRQOL) tools are used to evaluate patients with chronic respiratory failure (CRF), but there is a relative lack of tools available for the evaluation of social support and treatment in these patients. The present study focused on the development of a systematic patient‐reported outcome measure (PROM) tool for use in patients with CRF. Methods The CRF‐PROM scale conceptual framework and item bank were generated after reviewing the corresponding literature and HRQOL scales, interviewing CRF patients and focus groups. After creation of the initial scale, the items in the scale were selected through two item selection theories, and the final scale was created. The reliability, validity and feasibility of the final scale were assessed. Results The CRF‐PROM scale includes four domains (i.e., physiological domain, psychological domain, social domain and therapeutic domain) and 10 dimensions. After the item selection process, the final scale included 50 items. Cronbach's α coefficients, which were all above 0.7, indicated the reliability of the scale. The results of structural validity met the relevant standards of confirmatory factor analysis. The response rates of the preinvestigation and the formal investigation were 93.3% and 97.6%, respectively. Conclusions The CRF‐PROM scale developed in the present study is effective and reliable. It could be used widely in the posthospital management of patients, in CRF studies and in clinical trials of new medical products and interventions. Patient or Public Contribution Participants from eight different hospitals and communities participated in the development or validation phase of the CRF‐PROM scale.
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Affiliation(s)
- Hangzhi He
- Department of Health Statistics, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Hao Li
- Department of Health Statistics, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xianhua Zeng
- Department of Health Statistics, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Hui Zhao
- Respiratory Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yanbo Zhang
- Department of Health Statistics, Shanxi Medical University, Taiyuan, Shanxi Province, China
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Binyousef FH, Alruwaili SA, Altammami AF, Alharbi AA, Alrakaf FA, Almazrou AA. Impact of Dry Eye Disease on Work Productivity Among Saudi Workers in Saudi Arabia. Clin Ophthalmol 2021; 15:2675-2681. [PMID: 34211260 PMCID: PMC8239165 DOI: 10.2147/opth.s313158] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the impact of dry eye disease (DED) on work productivity in Saudi Arabia and investigate its effect on daily activities. Patients and Methods We conducted a cross-sectional study on male and female Saudi workers age 20 years or older. The data were collected via self-administered questionnaires distributed electronically through social media. We used the Ocular Surface Disease Index questionnaire to diagnose DED patients and assess their DED severity as mild, moderate, and severe. Results A total of 463 respondents qualified for the study. All patients in the DED groups reported a loss of work productivity. Most patients in the severe DED group (59%) reported difficulty focusing on work due to DED, whereas 17.1% of patients with mild DED and 22.7% with moderate DED reported the same. These findings indicate significantly worsening productivity as DED progresses in severity (p<0.05). Participants with severe DED reported significantly more affected work hours weekly (35.8%) than participants with moderate (6.1%) and mild DED (7.1%). Conclusion DED has a significant impact on work productivity, with the most pronounced effect among office workers. It is essential to screen office workers for DED and enhance the awareness of its effect on work productivity among the workforce and healthcare providers.
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Affiliation(s)
- Faris H Binyousef
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Shahad A Alruwaili
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdulaziz F Altammami
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ahmed A Alharbi
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Feras A Alrakaf
- College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Abdulrhman A Almazrou
- Ophthalmology Department, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Al-Maskari AZ, Alarfaj K, Shaheen MS, Al-Yousuf N, Giledi O, Algehedan S, Navon S, Lazreg S. Middle East Preferred Practice Patterns for Dry Eye Disease: A Modified Delphi Consensus. Open Ophthalmol J 2021. [DOI: 10.2174/1874364102115010034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Dry Eye Disease (DED) is a common ophthalmic condition resulting from dysfunction in the ocular surface, main lacrimal gland, meibomian glands, or connecting nerves.
Objective: A group of local experts met to discuss local challenges and establish consensus in DED management across the Middle East.
Methods: A modified Delphi method was used to reach consensus, comprising two rounds of the survey and a face-to-face meeting. An expert panel of 8 ophthalmologists voted on 23 statements, with consensus reached if ≥75% responded “strongly agree” or “agree” to a statement.
Results: The expert panel reached consensus on 23 statements relating to the pathophysiology, diagnosis, treatment, and management of DED. Diagnosis begins with recording a detailed patient history and assessing subjective symptoms such as redness, burning, stinging, foreign body sensation, and/or photophobia. Tear Break-up Time (TBUT; <10 s), corneal spots (>5), and fluorescein staining are essential for diagnosing DED, assessing disease severity and ocular surface condition, and differentiating between types of DED. Ocular surface lubricants are the mainstay of treatment for DED. Treatment approaches should be categorized by etiology (if known). An improvement in symptoms can be observed objectively via an increase in TBUT, reduction in corneal and conjunctival spots, and restoration of normal tear production, or subjectively via less dependence on ocular surface lubricants, improved vision quality, and symptom amelioration.
Conclusion: This consensus will serve to provide a framework for clinical decisions relating to the management of DED across the region.
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Wang MT, Muntz A, Wolffsohn JS, Craig JP. Association between dry eye disease, self-perceived health status, and self-reported psychological stress burden. Clin Exp Optom 2021; 104:835-840. [PMID: 33689664 DOI: 10.1080/08164622.2021.1887580] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Clinical relevance: Dry eye disease is a common chronic ocular condition, which is acknowledged to have adverse impacts on quality of life and work productivity.Background: The wide-reaching impacts of dry eye disease on mental health and quality of life have received growing attention in recent years. The purpose of this study was therefore to investigate the relationship between dry eye disease, self-perceived health status, and self-reported psychological stress burden.Methods: Three hundred and twelve community residents (178 females, 134 males; mean ± SD age, 38 ± 21 years) with no major systemic, ophthalmic, or psychiatric conditions (other than dry eye disease), were recruited in a cross-sectional study. Self-perceived health status and self-reported psychological stress burden were assessed, and dry eye symptomology, ocular surface characteristics, and tear film quality were evaluated for each participant within a single clinical session, in accordance with the global consensus recommendations of the Tear Film and Ocular Surface Society Dry Eye Workshop II reports.Results: Multivariate regression analysis, adjusted for age, sex, ethnicity, and contact lens wear, demonstrated that improved self-perceived health status was associated with decreased odds of dry eye disease, aqueous tear deficiency and meibomian gland dysfunction (all p < 0.05). Increased self-reported psychological stress burden was positively associated with dry eye disease, aqueous tear deficiency and meibomian gland dysfunction (all p ≤ 0.01).Conclusion: Dry eye disease is associated with poorer self-perceived health status and greater self-reported psychological stress burden. The findings of this study highlight the wide-reaching impacts of dry eye disease, and the importance of minimising the impacts of the condition with optimised management and actioning inter-disciplinary referral for affected patients where necessary.
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Affiliation(s)
- Michael Tm Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Alex Muntz
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Ophthalmic Research Group, Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.,Ophthalmic Research Group, Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, UK
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Hossain P, Siffel C, Joseph C, Meunier J, Markowitz JT, Dana R. Patient-reported burden of dry eye disease in the UK: a cross-sectional web-based survey. BMJ Open 2021; 11:e039209. [PMID: 33664064 PMCID: PMC7934779 DOI: 10.1136/bmjopen-2020-039209] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To compare sociodemographics and vision-related quality of life (QoL) of individuals with or without dry eye disease (DED); and to explore the impact of DED symptom severity on visual function, activity limitations and work productivity. DESIGN Cross-sectional web-based survey. SETTING General UK population. PARTICIPANTS Adults ≥18 years with (N=1002) or without (N=1003) self-reported DED recruited through email and screened. MAIN OUTCOME MEASURES All participants completed the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), with six additional questions (items A3-A8), and the EuroQol 5 dimensions 5 levels. DED participants also completed Impact of Dry Eye on Everyday Life questionnaire, 5-item Dry Eye Questionnaire and the Standardised Patient Evaluation of Eye Dryness questionnaire along with the Ocular Comfort Index, Work Productivity and Activity Impairment and the Eye Dryness Score (EDS), a Visual Analogue Scale. RESULTS Baseline demographic and clinical characteristics were similar in participants with versus without DED (mean age, 55.2 vs 55.0 years; 61.8% vs 61.0% women, respectively) based on recruitment targets. Scores were derived from NEI VFQ-25 using the new 28-item revised VFQ (VFQ-28R) scoring. Mean (SD) VFQ-28R scores were lower in participants with versus without DED, indicating worse functioning (activity limitations, 73.3 (12.3) vs 84.4 (12.3); socioemotional functioning, 75.3 (21.5) vs 90.3 (16.2); total score, 71.6 (12.8) vs 83.6 (12.6)). Higher percentages of problems/inability to do activities were observed among those with versus without DED. The impact of DED on visual function was worse for participants with more severe DED symptoms, as assessed by EDS. In addition, a higher EDS was associated with worse symptoms on common DED scales and a worse impact on work productivity. CONCLUSIONS DED symptoms were associated with negative effects on visual function, activities and work productivity, whereas worse DED symptoms had a greater impact on vision-related QoL and work productivity.
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Affiliation(s)
- Parwez Hossain
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Eye Unit, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Csaba Siffel
- Global Evidence and Outcomes, Takeda, Lexington, Massachusetts, USA
- Department of Interdisciplinary Health Sciences, College of Allied Health Sciences, Augusta University, Augusta, Georgia, USA
| | - Corey Joseph
- Global Evidence and Outcomes, Takeda, Lexington, Massachusetts, USA
| | - Juliette Meunier
- Patient Centered Outcomes, Modus Outcomes, Lyon, France
- Patient Centered Outcomes, Modus Outcomes, Cambridge, Massachusetts, USA
| | - Jessica T Markowitz
- Patient Centered Outcomes, Modus Outcomes, Lyon, France
- Patient Centered Outcomes, Modus Outcomes, Cambridge, Massachusetts, USA
| | - Reza Dana
- Cornea and Refractive Surgery Service, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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McMonnies CW. Why the symptoms and objective signs of dry eye disease may not correlate. JOURNAL OF OPTOMETRY 2021; 14:3-10. [PMID: 33243674 PMCID: PMC7752964 DOI: 10.1016/j.optom.2020.10.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/07/2020] [Accepted: 10/10/2020] [Indexed: 05/10/2023]
Abstract
Cases of dry eye disease involving a neuropathic basis for symptoms and a poor correlation between symptoms and objective signs of dry eye disease can be associated with unsatisfactory responses to treatments which are limited to attempts to restore lacrimal function unit deficiencies. This review examines a wider range of circumstances under which the same kind of poor correlation between signs, symptoms and treatment results can be found. Some cases of computer vision syndrome can present for examination at times when objective signs related to reported symptoms have dissipated. A thorough history should explain this type of presentation for which symptoms might otherwise appear to be unexplained. However, mental health disorders can also be the basis for apparently unexplained levels of symptoms of dry eye disease. Anxiety, depression, hypochondriasis, stress, sleep and mood disorders as well as neuroticism for example, may be associated with exacerbation of symptoms to degrees that are not consistent with the levels of tear homeostasis anomalies that are assessed. The conclusion is drawn that failure to consider mental health comorbidities may result in symptomatic patients being exposed to less successful attempts to remediate tear dysfunctions when, for example, the symptoms have a somatic basis. Appropriate screening and referral to a psychologist or psychiatrist may be the key to managing some patients whose symptoms do not correlate with objective evidence of dry eye disease.
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Affiliation(s)
- Charles W McMonnies
- School of Optometry and Vision Science, Australia; University of New South Wales, Kensington, 2052, Australia.
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Labetoulle M, Benichou J, M'nafek N, Garnier F, Rabut G, Ben Hadj Salah W, Labbé A, Rousseau A, Baudouin C. Assessment of patient burden from dry eye disease using a combination of five visual analogue scales and a radar graph: a pilot study of the PENTASCORE. Br J Ophthalmol 2020; 106:467-473. [PMID: 33328188 DOI: 10.1136/bjophthalmol-2020-317473] [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: 07/13/2020] [Revised: 10/19/2020] [Accepted: 11/18/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Dry eye disease (DED) questionnaires would ideally be easy and fast to answer and explore the main aspects of disease burden and satisfaction (efficacy and tolerability) with treatment. This pilot study evaluates the Pentascore questionnaire for routinely assessing DED. METHODS The Pentascore combines five visual analogue scales (VAS) to assess the intensity and frequency of ocular pain/discomfort, the impact of DED on daily activities and visual tasks and the efficacy and tolerability of ongoing DED treatment(s). This retrospective study compared Pentascore to the Ocular Surface Disease Index (OSDI) questionnaire, fluorescein tear break-up-time, corneal staining and Schirmer I test. RESULTS For 161 DED patients, the algebraic mean (±SE) for the Pentascore was 52.6±1.8, the mean standardised area of the radar graph was 32.1±1.7 (out of 100) and the mean score for the OSDI was 52.6±1.8. Both questionnaires were highly statistically correlated (R=0.74 for both algebraic score and radar area, p<0.001), and each of five Pentascore VAS was significantly correlated with the OSDI (p<0.05). Corneal staining score (CSS) was correlated with two Pentascore VAS (impact of DED on daily activities and visual tasks), and there was a trend towards a correlation between CSS and the area of the radar graph (p=0.09). CONCLUSIONS This pilot study indicates that the Pentascore can rapidly and effectively assess the burden of DED and satisfaction with treatments. Compared with the algebraic mean, the estimation of the area of the radar graph likely improves the sensitivity for detecting differences/changes in symptoms and treatment follow-up.
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Affiliation(s)
- Marc Labetoulle
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France .,Center for Immunology of Viral infections and Autoimmune diseases. IDMIT Infrastructure, CEA,Université Paris Sud, Fontenay-aux-Roses Cedex, France
| | - Jérémie Benichou
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Nabila M'nafek
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Flavie Garnier
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France
| | - Ghislaine Rabut
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France
| | - Wassim Ben Hadj Salah
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Antoine Labbé
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France.,Institut de la Vision, Sorbonne Université, INSERM, CNRS, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
| | - Antoine Rousseau
- Service d'Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris Sud, Le Kremlin-Bicêtre, France.,Center for Immunology of Viral infections and Autoimmune diseases. IDMIT Infrastructure, CEA,Université Paris Sud, Fontenay-aux-Roses Cedex, France
| | - Christophe Baudouin
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, Paris, France.,Institut de la Vision, Sorbonne Université, INSERM, CNRS, Paris, France.,Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvelines, Boulogne-Billancourt, France
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Tsubota K, Pflugfelder SC, Liu Z, Baudouin C, Kim HM, Messmer EM, Kruse F, Liang L, Carreno-Galeano JT, Rolando M, Yokoi N, Kinoshita S, Dana R. Defining Dry Eye from a Clinical Perspective. Int J Mol Sci 2020; 21:ijms21239271. [PMID: 33291796 PMCID: PMC7730816 DOI: 10.3390/ijms21239271] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 12/21/2022] Open
Abstract
Over the past decades, the number of patients with dry eye disease (DED) has increased dramatically. The incidence of DED is higher in Asia than in Europe and North America, suggesting the involvement of cultural or racial factors in DED etiology. Although many definitions of DED have been used, discrepancies exist between the various definitions of dry eye disease (DED) used across the globe. This article presents a clinical consensus on the definition of DED, as formulated in four meetings with global DED experts. The proposed new definition is as follows: “Dry eye is a multifactorial disease characterized by a persistently unstable and/or deficient tear film (TF) causing discomfort and/or visual impairment, accompanied by variable degrees of ocular surface epitheliopathy, inflammation and neurosensory abnormalities.” The key criteria for the diagnosis of DED are unstable TF, inflammation, ocular discomfort and visual impairment. This definition also recommends the assessment of ocular surface epitheliopathy and neurosensory abnormalities in each patient with suspected DED. It is easily applicable in clinical practice and should help practitioners diagnose DED consistently. This consensus definition of DED should also help to guide research and clinical trials that, to date, have been hampered by the lack of an established surrogate endpoint.
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Affiliation(s)
- Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, Tokyo 160-8582, Japan
- Correspondence: ; Tel.: +81-3-5363-3219
| | | | - Zuguo Liu
- Eye Institute of Xiamen University, Xiamen 361102, China;
| | | | - Hyo Myung Kim
- Korea University Medical Center, Anam Hospital, Seoul 02841, Korea;
| | - Elisabeth M. Messmer
- Department of Ophthalmology, Ludwig Maximilian University, 80539 Munich, Germany;
| | - Friedrich Kruse
- Department of Ophthalmology, University of Erlangen-Nuremberg, 91054 Erlangen, Germany;
| | - Lingyi Liang
- Zhongshan Ophthalmic Center, Guangzhou 510060, China;
| | | | - Maurizio Rolando
- ISPRE OPHTHALMICS (Instituto di Medicina Oftalmica), 16129 Genoa, Italy;
| | - Norihiko Yokoi
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Reza Dana
- Cornea & Refractive Surgery, Massachusetts Eye & Ear, Boston, MA 02114, USA; (J.T.C.-G.); (R.D.)
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Guo OD LW, Akpek E. The negative effects of dry eye disease on quality of life and visual function. Turk J Med Sci 2020; 50:1611-1615. [PMID: 32283910 PMCID: PMC7672346 DOI: 10.3906/sag-2002-143] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/12/2020] [Indexed: 02/04/2023] Open
Abstract
In recent years, dry eye has become a hot topic within ophthalmology and optometry, especially in regards to new frontiers in treatment modalities which include novel devices, procedures, and medications. However, some of the more understudied areas in dry eye involve its impact on quality of life. Although ocular discomfort symptoms are well known to be associated with dry eye, its negative effects on visual function remain underrecognized. This paper reviews these topics within the currently published literature to heighten awareness among clinicians.
Key Words: D
ry eye, quality of life, visual function, functional visual acuity, patient questionnaire, OSDI, SPEED, SANDE, IDEEL, NEI VFQ-25
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Affiliation(s)
- Lee W Guo OD
- Department of Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Esen Akpek
- Department of Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
Dry eye disease (DED) is a chronic, multifactorial ocular surface disorder with multiple etiologies that results in tear film instability. Globally, the prevalence of DED is expected to increase with an aging society and daily use of digital devices. Unfortunately, the medical field is currently unprepared to meet the medical needs of patients with DED. Noninvasive, reliable, and readily reproducible biomarkers have not yet been identified, and the current mainstay treatment for DED relies on symptom alleviation using eye drops with no effective preventative therapies available. Medical big data analyses, mining information from multiomics studies and mobile health applications, may offer a solution for managing chronic conditions such as DED. Omics-based data on individual physiologic status may be leveraged to prevent high-risk diseases, accurately diagnose illness, and improve patient prognosis. Mobile health applications enable the portable collection of real-world medical data and biosignals through personal devices. Together, these data lay a robust foundation for personalized treatments for various ocular surface diseases and other pathologies that currently lack the components of precision medicine. To fully implement personalized and precision medicine, traditional aggregate medical data should not be applied directly to individuals without adjustments for personal etiology, phenotype, presentation, and symptoms.
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A Review of Dry Eye Questionnaires: Measuring Patient-Reported Outcomes and Health-Related Quality of Life. Diagnostics (Basel) 2020; 10:diagnostics10080559. [PMID: 32764273 PMCID: PMC7459853 DOI: 10.3390/diagnostics10080559] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/21/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Dry eye disease (DED) is among the most common eye diseases and is becoming increasingly prevalent. Its symptoms cause a long-term decline in patients’ health-related quality of life (HRQL). Inconsistencies often occur between the clinical findings and the subjective symptoms of DED. Therefore, a holistic, balanced, and quantitative evaluation of the subjective symptoms and HRQL using patient-reported outcome questionnaires, in addition to clinical findings, is crucial for accurate DED assessment in patients. This paper reviewed the characteristics of current dry eye questionnaires, including their objectives, number of questions, inclusion of HRQL-related items, and whether they were properly evaluated for psychometric properties. Twenty-four questionnaires were identified; among them, the following six questionnaires that included items assessing HRQL and were properly evaluated for psychometric properties are recommended: the Ocular Surface Disease Index, Impact of Dry Eye in Everyday Life, Dry Eye-Related Quality-of-life Score, University of North Carolina Dry Eye Management Scale, Chinese version of Dry Eye-Related Quality of Life, and 25-Item National Eye Institute Visual Function Questionnaire. Dry eye questionnaires have different objectives and are available in different languages. Therefore, medical practitioners should confirm the characteristics of applicable questionnaires before selecting the most appropriate ones.
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Dana R, Meunier J, Markowitz JT, Joseph C, Siffel C. Patient-Reported Burden of Dry Eye Disease in the United States: Results of an Online Cross-Sectional Survey. Am J Ophthalmol 2020; 216:7-17. [PMID: 32277941 DOI: 10.1016/j.ajo.2020.03.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE To evaluate functional vision, general health status, and work productivity in individuals with and without dry eye disease (DED). DESIGN Cross-sectional study. METHODS Setting: General US population (2018). STUDY POPULATION Adults ≥18 years with (n = 1003) or without (n = 1006) self-reported DED. MAIN OUTCOME MEASURES All respondents completed the National Eye Institute Visual Function Questionnaire (VFQ) and the EuroQol 5-dimensions 5-levels (EQ-5D-5L). All respondents with DED completed the eye dryness score (EDS) visual analogue scale, Ocular Comfort Index (OCI), and Work Productivity and Activity Impairment (WPAI) questionnaire. Half of respondents with DED completed the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire; the other half completed the Dry Eye Questionnaire 5 (DEQ-5) and Standardized Patient Evaluation of Eye Dryness (SPEED), McMonnies, and Symptom Assessment in Dry Eye (SANDE) questionnaires. All analyses were descriptive. RESULTS Respondents with DED reported more comorbidities, greater exposure to adverse environmental conditions, and lower (worse) mean (standard deviation) scores on the modified Rasch-scored 28-item VFQ (VFQ-28R) total score (68.8 [11.9] vs 81.2 [12.7]) and EQ-5D-5L (0.82 [0.13] vs 0.88 [0.14]) than respondents without DED. Respondents with DED and EDS ≥60 (highest discomfort) fared worse on OCI, VFQ-28R, and WPAI than respondents with DED and EDS <40 (lowest discomfort). Similar findings were observed with IDEEL, DEQ-5, SPEED, McMonnies, and SANDE scores. CONCLUSIONS There is a substantial burden of DED on functional vision, general health status, and productivity; and further, these parameters appear to worsen with increasing EDS.
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Affiliation(s)
- Reza Dana
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
| | | | | | | | - Csaba Siffel
- Takeda, Lexington, Massachusetts, USA; College of Allied Health Sciences, Augusta University, Augusta, Georgia, USA
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Hashmani N, Mustafa FG, Tariq MA, Ali SF, Bukhari F, Memon AS, Hashmani S. Distribution and Correlation of Ocular Surface Disease Index Scores in a Non-Clinical Population: The Karachi Ocular Surface Disease Study. Cureus 2020; 12:e9193. [PMID: 32821550 PMCID: PMC7429673 DOI: 10.7759/cureus.9193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction There is increasing recognition of dry eye disease (DED) as a significant factor influencing quality of life in seemingly normal individuals. Our goal was to determine the distribution of Ocular Surface Disease Index (OSDI) scores in non-clinical individuals in Karachi, Pakistan. Methods We distributed OSDI questionnaires to subjects aged > 18 years with no active ocular complaint. Examiners were selected from various areas of the city to administer questionnaires to students and the general population. The OSDI score was grouped as per the following: normal (0-12 points), mild (13-22 points), moderate (23-32 points), and severe (33-100 points). Results We surveyed 2433 individuals with a mean age of 30.7±15.6 years. Additionally, the mean OSDI score was 22.4±18.7. To estimate prevalence, we used two OSDI score cutoffs: >13 (64.4%) and >22 points (43.6%). Statistical significance was found using multivariate regression in the following variables: age (p<0.001), contact lens wear (p<0.001), ocular allergies (p<0.001), hypertension (p<0.001), diabetes (p=0.003), and smoking (p=0.047). When graphing mean age against OSDI score, there was a large jump between the third and fourth decades; thereafter, there was a steady increase. Similarly, when plotting smoking, the score was steady until five years and then there was a sharp incline. Conclusion There was a high prevalence of DED in the studied population. Additionally, many systemic and ocular factors were associated with this disease.
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Affiliation(s)
| | | | | | | | - Fakiha Bukhari
- Ophthalmology, Karachi Medical and Dental College, Karachi, PAK
| | | | - Sharif Hashmani
- Ophthalmology and Visual Sciences, Hashmanis Hospital, Karachi, PAK
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Hernandez-Llamas S, Paz-Ramos AK, Marcos-Gonzalez P, Amparo F, Garza-Leon M. Symptoms of ocular surface disease in construction workers: comparative study with office workers. BMC Ophthalmol 2020; 20:272. [PMID: 32646387 PMCID: PMC7346666 DOI: 10.1186/s12886-020-01548-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 07/03/2020] [Indexed: 12/01/2022] Open
Abstract
Background To investigate and contrast the prevalence of dry eye symptoms in construction workers and office workers using the OSDI questionnaire. Methods A cross-sectional, observational study was conducted using the OSDI questionnaire to evaluate dry eye symptoms and associated risk factors. Sampled size calculation with a power of 80% and a 95% degree of confidence suggested the inclusion of 298 participants. Results We studied 304 subjects (149 construction workers and 155 office workers). More than half (55%) of the participants presented dry eye symptoms (OSDI > 12). The average OSDI score was 21.30 ± 22.20 points, being lower in the group of construction workers (12.45 ± 17.50) than in-office workers (28.51 ± 22.99) (p < 0.001). Considering participants who had moderate and severe symptoms (23 to 100 points in OSDI), office workers presented dry eye symptoms 4.15 times more frequently than construction workers (OR 4.15, 95% CI 2.52, 6.85). Women presented statistical evidence of higher OSDI scores than men (32.47 ± 23.72 vs. 14.87 ± 18.48, respectively). Conclusions construction workers have four times less risk of presenting dry eye symptoms than people working in the average office space. This highlights the pernicious effects on the ocular surface of the office environment, which poses a significant risk for the development or worsening of dry eye symptoms.
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Affiliation(s)
- Sergio Hernandez-Llamas
- Department of Clinical Sciences, Division of Health Sciences, University of Monterrey, San Pedro Garza García, Nuevo León, Mexico
| | - Ana Karen Paz-Ramos
- Department of Clinical Sciences, Division of Health Sciences, University of Monterrey, San Pedro Garza García, Nuevo León, Mexico
| | - Patricio Marcos-Gonzalez
- Department of Clinical Sciences, Division of Health Sciences, University of Monterrey, San Pedro Garza García, Nuevo León, Mexico
| | - Francisco Amparo
- Department of Clinical Sciences, Division of Health Sciences, University of Monterrey, San Pedro Garza García, Nuevo León, Mexico.,Cornea Service, Mass Eye, and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Manuel Garza-Leon
- Department of Clinical Sciences, Division of Health Sciences, University of Monterrey, San Pedro Garza García, Nuevo León, Mexico.
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Jerkins G, Greiner JV, Tong L, Tan J, Tauber J, Mearza A, Srinivasan S. A Comparison of Efficacy and Safety of Two Lipid-Based Lubricant Eye Drops for the Management of Evaporative Dry Eye Disease. Clin Ophthalmol 2020; 14:1665-1673. [PMID: 32606581 PMCID: PMC7308126 DOI: 10.2147/opth.s256351] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/27/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this study was to compare the efficacy of two lipid-based lubricant eye drops in patients with lipid-deficient dry eye. Methods This Phase IV, multicenter, prospective, double-masked study enrolled adults (aged ≥18 years) who had a tear film breakup time (TFBUT) of ≤15 seconds(s), and unanesthetized Schirmer I test of ≥3 mm to ≤12 mm in at least one eye, at both screening and baseline visits. Eligible patients (n=231) were randomized (1:1) and received either Systane® Balance (SYSB; n=117) or Refresh® Optive Advanced (RFO-Ad, n=114), four-times a day, for 35 days. The primary endpoint was non-inferiority for change from baseline in TFBUT at Day 35 (non-inferiority was established if the lower limit of the 95% confidence interval (CI) for the difference between the treatment groups was > –1.0 s); secondary endpoints (test of superiority) were change in TFBUT and global ocular discomfort visual analog scale (VAS) score at Day 35. Other endpoints included the impact of dry eye on everyday life (IDEEL) treatment satisfaction scores (inconvenience and effectiveness) and safety. Results At Day 35, the mean change from baseline in TFBUT was 0.998 s in the SYSB and 0.868 s in the RFO-Ad groups with a treatment difference: 0.130 s; (95% CI −0.34, 0.60; P<0.0001) demonstrating non-inferiority of SYSB to RFO-Ad. The global ocular discomfort VAS scores improved in both groups, with a mean change from baseline of –9.7 and –8.8 in SYSB and RFO-Ad groups (treatment difference –0.8; P=0.62), respectively. No meaningful difference was observed in IDEEL treatment effectiveness and treatment inconvenience scores between SYSB vs RFO-Ad (P>0.05 for treatment difference). Both treatments were well tolerated. Conclusion SYSB lubricant eye drops were non-inferior to RFO-Ad for improvement in TFBUT in patients with lipid-deficient dry eye. Both lubricant eye drops improved TFBUT and ocular discomfort scores in patients with lipid-deficient dry eye.
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Affiliation(s)
- Gary Jerkins
- Advancing Vision Research, LLC, Nashville, TN, USA
| | - Jack V Greiner
- Clinical Eye Research of Boston, Boston, MA, USA.,Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Louis Tong
- Singapore National Eye Center, National University of Singapore, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-National University of Singapore Medical School, Singapore
| | | | | | - Ali Mearza
- Imperial College Healthcare NHS Trust, London, UK.,Ophthalmic Consultants of London, London, UK
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Bulat N, Cuşnir VV, Procopciuc V, Cușnir V, Cuşnir NV. Diagnosing the Dry Eye Syndrome in modern society and among patients with glaucoma: a prospective study. Rom J Ophthalmol 2020; 64:35-42. [PMID: 32292856 PMCID: PMC7141921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The dry eye syndrome (DES) is a disease of the ocular surface, which can become a social issue in our country, given the changes in lifestyle as a consequence of the economic and technological developments of the last decade. A current problem is the prevalence of DES in patients with glaucoma. The glaucoma treatment, especially the prolonged instillation of preservative-containing medicines, is an important factor in DES morbidity, especially in people aged over 40. In this paper, we presented the findings of our study, which was aimed at assessing the prevalence of DES in the Republic of Moldova and the effect of this impairment on the quality of life. 353 patients (706 eyes) were investigated using the data provided by the visual acuity (VA) and slit-lamp examinations, Schirmer's test results, and the Ocular Surface Disease Index (OSDI) score. Our findings showed a high estimate of signs and symptoms of DES (67.4%) and their impact on the quality of life. Simultaneously, we aimed to analyze the issue of DES in patients with glaucoma. To this end, we examined 30 cases with primary open angle (POA) glaucoma. We also presented a clinical case, in which the prospect of associating the two pathologies in a patient was considered.
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Affiliation(s)
- Nina Bulat
- ”Novamed” Polyvalent Hospital, Chişinău, Republic of Moldova
| | | | - Vitalie Procopciuc
- State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
| | - Vitalie Cușnir
- Clinical Hospital of Ministry of Health, Labour, and Social Protection,
Chişinău, Republic of Moldova
| | - Nicon Valeriu Cuşnir
- Department of Ophthalmology and Optometry, “Nicolae Testemiţanu” State University of Medicine and Pharmacy, Chişinău, Republic of Moldova
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Messmer E, Chan C, Asbell P, Johnson G, Sloesen B, Cook N. Comparing the needs and preferences of patients with moderate and severe dry eye symptoms across four countries. BMJ Open Ophthalmol 2019; 4:e000360. [PMID: 31909193 PMCID: PMC6936582 DOI: 10.1136/bmjophth-2019-000360] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/02/2019] [Accepted: 10/31/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/AIMS Understanding patients' perspectives of their disease can inform drug development and treatment decisions. In this study, we compared the preferences and needs of patients with moderate and severe dry eye symptoms from four different countries. METHODS A quantitative questionnaire was developed based on the self-explicated conjoint methodology and was administered to 160 patients with moderate or severe dry eye disease (DED) from Australia, Germany, UK and the USA. RESULTS Patients with moderate dry eye symptoms ranked 'treatment satisfaction' as the most important aspect, whereas 'symptom bother' was more relevant for those in the severe group. Both the moderate and severe groups classified treatment effectiveness as the most important treatment attribute. This result was consistent across the four countries, although US patients gave significantly higher scores than patients from other countries (p<0.001). Furthermore, patients from Australia ranked 'treatment experience' as significantly more important than the concern of side effects, whereas respondents from Germany exhibited the opposite trend (p<0.05 for both). The health burden of DED is reflected in the average European Quality of Life-5 Dimensions 5-level (EQ-5D) scores of 0.764 and 0.658 for patients with moderate and severe disease, respectively. CONCLUSION Our results confirm that across the countries in the study, moderate and severe DED has a major impact on patients' quality of life and daily activities. By providing insight into the patient perspective of DED, our study helps identify outcomes that are important to patients and may guide future drug development and clinical decision-making.
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Affiliation(s)
- Elisabeth Messmer
- Department of Ophthalmology, Ludwig Maximilians University, Munich, Germany
| | - Colin Chan
- Central Clinical School, University of Sydney Sydney Medical School, Sydney, New South Wales, Australia
| | - Penny Asbell
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | - Nigel Cook
- Global Patient Access, Novartis Pharma AG, Basel, Switzerland
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Asbell P, Messmer E, Chan C, Johnson G, Sloesen B, Cook N. Defining the needs and preferences of patients with dry eye disease. BMJ Open Ophthalmol 2019; 4:e000315. [PMID: 31909189 PMCID: PMC6936476 DOI: 10.1136/bmjophth-2019-000315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 09/04/2019] [Accepted: 11/09/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Dry eye disease is a multifactorial chronic disease, leading to ocular discomfort and visual disturbance with a substantial impact on quality of life. Therefore, the patient's perspective should be taken into account early in the drug development process. We have developed a step-by-step methodology based on the self-explicated conjoint approach to assess the needs and preferences of patients with moderate-to-severe dry eye disease. METHODS AND ANALYSIS Following a literature review and social media listening (step 0), qualitative phone call interviews were conducted with 12 patients (step 1). Patients' responses underwent content analysis and were coded, quantified and displayed as charts. Based on the emerging trends and attributes identified as relevant in steps 0 and 1, a quantitative online questionnaire was designed and conducted with 160 patients across four countries (step 2). RESULTS The online questionnaire was rated as easy/very easy to understand by 60% of respondents, 62% rated the survey as easy/very easy to complete and 71% rated it as interesting/very interesting. Treatment satisfaction was the most important aspect for patients, and the three most relevant attributes were as follows (with the most important indexed to 100%): 'treatment effectiveness on symptoms of dry eyes' (100%), 'frequency of treatment use' (96%) and 'how the treatment works' (95%). CONCLUSION Our methodology was well received by patients, and the results will help inform future clinical trial development and discussions with health technology assessment bodies and regulators on unmet needs and product attributes that are of most value to patients with dry eye disease.
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Affiliation(s)
- Penny Asbell
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Elisabeth Messmer
- Department of Ophthalmology, Ludwig Maximilians University, Munich, Germany
| | - Colin Chan
- Central Clinical School, University of Sydney, Sydney Medical School, Sydney, New South Wales, Australia
| | | | | | - Nigel Cook
- Global Patient Access, Novartis Pharma, Basel, Switzerland
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Automated Ocular Surface Image Analysis and Health-Related Quality of Life Utility Tool to Measure Blepharokeratoconjunctivitis Activity in Children. Cornea 2019; 38:1418-1423. [DOI: 10.1097/ico.0000000000002042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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