Associations between the menstrual cycle, lifestyle factors and clinical assessment of the ocular surface: a prospective observational study

Effects of physical activity/exercise on tear film characteristics and dry eye associated symptoms: A literature review

PURPOSE

To conduct a review of the literature in order to identify the potential association between physical activity or exercise and the objective signs and/or subjective symptoms of dry-eye disease.

METHODS

A review of PubMed and Web of Science databases was performed, according to the PRISMA guidelines. The papers included in the review addressed the relationship of physical activity or exercise with dry-eye associated signs (changes in tear volume, osmolarity or biochemical composition) and/or subjective symptoms.

RESULTS

A total of 16 papers were included. In eight, the changes in tear film volume, osmolarity and/or biochemical composition were studied after a single, acute bout of aerobic exercise. In another eight, changes in dry-eye associated symptoms were studied in relation to the habitual practice of physical activity or to prescribed exercise programmes. Acute responses of the tear film to exercise included: a) an increase of tear volume, without an increase of the tear break-up time; b) a trend to increase tear osmolarity, although within its physiological range; and c) a reduced concentration of several cytokines, and other molecular markers of inflammation or oxidative stress. Long-term exposure to physical activity or exercise programmes was associated with relief of dry-eye associated symptoms and a trend to increased tear break-up time.

CONCLUSIONS

Despite a high heterogeneity in the studied population, study designs and methods, the current body of evidence suggests a potential role for physical activity as a modulatory stimulus for the proper functioning of the tear film and/or the relief of dry-eye symptoms.

Current social determinants of health and social risk factors in conditions of the cornea: a scoping review

PURPOSE OF REVIEW

To achieve health equity in eye health and vision care, social determinants of health (SDoH) and the associated social risk factors must be addressed. To address SDoH and social risk factors in ophthalmology, they must first be identified. The purpose of this review was to determine the SDoH and social risk factors in conditions of the cornea that have most recently been explored.

RECENT FINDINGS

This review identified social risk factors associated with all five domains of SDoH, as outlined by Healthy People 2030. The neighborhood and built environment was the domain identified the most for both exploration and observation. The social and community context domain was the least explored, and healthcare access and quality and social and community context domains were the least observed. The cornea condition explored the most in relation to SDoH was dry eye syndrome.

SUMMARY

The findings from this review can inform clinicians on the social risk factors that could be screened for in eye care facilities, so patients can be connected with services to minimize the impact of social risk factors on cornea conditions. Furthermore, the findings have identified cornea conditions and domains of SDoH that are understudied which can be an area for future studies by vision researchers.

The Relationship Between Caffeine Intake and Dry Eye Disease

PURPOSE

The aim of this study was to determine the association between caffeine intake and dry eye disease (DED) in the large, population-based LifeLines cohort in the Netherlands.

METHODS

DED was cross-sectionally assessed in 85,302 participants (59% female participants) using the Women's Health Study dry eye questionnaire. Dietary caffeine was calculated from the intake of coffee, tea, cola, and energy drinks. Logistic regression was used to investigate the relationship between DED and caffeine, correcting for demographic variables, smoking status, alcohol intake, and 48 comorbidities of DED.

RESULTS

The mean (SD; range) age of participants was 50.7 years (12.4; 18-96), and 50,339 (59%) were female. The mean (SD) caffeine intake was 285 (182) mg/d. After correcting for demographics, body mass index, smoking status, and alcohol intake, higher caffeine intake was associated with a decreased risk of Women's Health Study-defined DED [odds ratio (OR) 0.971 per 100 mg/d, 95% CI, 0.956-0.986, P < 0.0005]. When additionally adjusting for medical comorbidities, no significant effect was observed (OR 0.985, 95% CI, 0.969-1.001, P = 0.06). Caffeine's effect on DED was similar in male and female participants and independent of sleep quality and stress at work. Decaffeinated coffee intake was significantly associated with an increased risk of DED, when adjusted for caffeinated coffee, demographics, alcohol intake, smoking status, and comorbidities (OR 1.046 per cup/d, 95% CI, 1.010-1.084, P = 0.01). None of the beverages were significantly associated with the risk of DED, when correcting for intake of the other caffeinated beverages, demographics, smoking status, alcohol intake, and all comorbidities.

CONCLUSIONS

Dietary caffeine intake does not seem to be a risk factor for DED in the general population.

The Effect of Meibomian Gland Dysfunction Treatment on Sleep Quality

Purpose

To assess the therapeutic efficacy of a combinational therapy, including conventional treatment and intense pulsed light (IPL) technique on sleep quality of patients with meibomian gland dysfunction (MGD).

Methods

Fifty participants with a clinical diagnosis of MGD were enrolled in this study. Participants underwent three sessions of IPL therapy. There was a 2-week interval between IPL sessions 1 and 2 and 1 month between sessions 2 and 3. Treatment was supplemented with conventional home-based therapy (including lid hygiene, warm compress, eyelid massage, and lid margin scrub) for MGD. Dry eye symptomatology, tear film, and ocular surface parameters were evaluated at baseline (day 0) and days 15, 45, and 75. Sleep quality was assessed before and after the study using Pittsburgh Sleep Quality Index (PSQI).

Results

PSQI components improved significantly at day 75 in comparison with the baseline (all P < 0.05). Ocular Surface Disease Index (OSDI) score, noninvasive Keratograph tear break-up time (NIKBUT), fluorescein tear break-up time (FTBUT), meibomian gland expressibility, meibum quality score, and tear osmolarity improved at follow-up visits (P < 0.05). Younger patients showed more improvement in NIKBUT, sleep quality, and duration (P = 0.024, P = 0.047, and P = 0.008). Sleep latency decreased with increased NIKBUT and FTBUT and decreased OSDI score (P = 0.001, P = 0.005, and P = 0.041).

Conclusions

The treatment of MGD is effective for improving sleep quality. Younger patients may preferentially benefit from the treatment.

Psychosocial impact of ocular surface allergic inflammatory disorders

PURPOSE OF REVIEW

Allergic rhinoconjunctivitis is one of the most common ocular surface allergic inflammatory conditions seen in primary care that impacts patient's quality of life. Allergic conjunctivitis is increasingly being recognized as its own symptom complex that negatively impacts patient's quality of life separate from allergic rhinitis. This article reviews the psychosocial impact of ocular surface allergic inflammatory disorders (namely seasonal allergic conjunctivitis, ocular allergy, perennial allergic conjunctivitis, and atopic keratoconjunctivitis) on adult and pediatric populations.

RECENT FINDINGS

Despite the perception that allergic conjunctivitis is a trivial condition, it imposes a burden on numerous psychosocial aspects of life for adolescents and adults. Several questionnaires specific to rhinoconjunctivitis have been found to be effective tools at gauging quality of life (QoL) and communicating impairments in specific behavioral domains for adult and pediatric populations. An emerging focus on the role of hormone fluctuations and age on ocular surface allergic inflammation underscores the importance of nuancing the physiologic effects on ocular allergy and QoL at every decade of life.

SUMMARY

Further exploration and research of symptoms by age would greatly improve our understanding of age's impact on QoL in these patients and contribute to improved management of allergic conjunctivitis.

Modifiable lifestyle risk factors for dry eye disease

PURPOSE

To examine the association between modifiable lifestyle factors and dry eye disease.

METHODS

Three hundred and twenty-two community residents (186 females, 136 males; mean ± SD age, 41 ± 22 years) with no major systemic or ophthalmic conditions (other than dry eye disease) were recruited in a cross-sectional study. A lifestyle factor questionnaire was administered, 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 TFOS DEWS II reports.

RESULTS

A total of 111 (34 %) participants fulfilled the TFOS DEWS II diagnostic criteria for dry eye disease. Multivariate regression analysis demonstrated that advancing age, female sex, East Asian ethnicity, and increased digital screen exposure time were positive risk factors for dry eye disease (all p < 0.05), while increased caffeine consumption was a protective factor (p = 0.04).

CONCLUSIONS

Increased digital screen exposure time and reduced caffeine consumption were modifiable lifestyle factors associated with higher odds of dry eye disease. These findings might contribute to informing the design of future prospective research investigating the efficacy of preventative intervention and risk factor modification strategies.