Mean Tear-Film Lipid Layer Thickness and Video Display Terminal Time as Risk Factors for Abnormal Blinking in Children

The Influence of Time Spent Viewing the Video Display Terminal, Sleep, Anxiety and Depression on the Thickness of the Lipid Layer of the Tear Film

OBJECTIVE

To investigate the influence of time spent viewing a video display terminal (VDTt), sleep, anxiety, and depression on the thickness of the lipid layer of the tear film (LLT).

METHODS

This is a cross-sectional study. A total of 102 patients were enrolled. Their ocular surface disease index (OSDI), Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale anxiety subscale (HADS-A), and depression subscale (HADS-D) were recorded. The LLT, meibomian gland secretion quality, tear film break-up time (TBUT), conjunctival hyperemia grade, corneal staining score, and VDTt were also evaluated. Spearman analysis was used to analyze the correlation. The patients were divided into the thinner LLT group (LLT < 75 nm) and the thicker LLT group (LLT ≥ 75 nm). The Mann-Whitney U test was used to analyze the characteristics and to compare the two groups. The receiver operating characteristic (ROC) curve was used to predict the relationship between VDTt and LLT.

RESULTS

Spearman correlation analysis showed a significant positive correlation between TBUT and average LLT, and significant negative correlations between mean LLT and OSDI, SPEED, meibomian gland secretion quality, conjunctival hyperemia, corneal staining, VDTt, PSQI, and HADS-A. In comparison to the thick LLT group, the thin LLT group had a worse OSDI score, shorter TBUT, longer VDTt, worse PSQI and HADS-A scores. The ROC curve indicated that the optimal cutoff value for using VDT to predict LLT less than 75 nm is 8.25 hours.

CONCLUSION

The thinner LLT had worse questionnaire scores and signs related to dry eye, which indicates that a thinner LLT is more prone to causing dry eye. Using VDTt for more than 8.25 hours is more likely to induce thinning of the LLT, thereby increasing the risk of dry eye. Patients with a sleep disorder and anxiety are more susceptible to thinning of the LLT, suggesting that they are prone to developing dry eye syndrome.

Epidemiology, Tear Film, and Meibomian Gland Dysfunction in Facial Palsy: A Comparative Analysis

Purpose

To compare the meibographies and dry eye parameters of paretic vs non-paretic sides of patients with a facial palsy diagnosis.

Patients and Methods

Twenty patients with unilateral facial palsy were recruited and the severity of the disease was staged using the House-Brackmann scale. A comprehensive dry eye evaluation was performed using the Oculus 5M Keratograph. A Pearson correlation coefficient was performed to determine correlation strength between House-Brackmann score and Meibomian gland atrophy. Meibographies were analyzed via ImageJ software to determine the affected area, and they were compared to the observer manual score. Cohen's Kappa coefficient was calculated to compare agreement between manual and ImageJ meibography scoring.

Results

Tear breakup time was reduced in the affected side (p = 0.21), tear meniscus height was much greater in the non-affected side (p = 0.02). Finally, Meibomian gland alterations were more evident in the affected side, with upper Meibomian glands having a loss of 29.55 ± 13.31% (p = 0.03) and lower glands presenting a loss of 44.44 ± 16.9% (p =< 0.001). Pearson correlation coefficient between House-Brackmann score and Meibomian gland atrophy was 0.841 (p < 0.001 [95% CI: 0.64-0.94]). Cohen's kappa coefficient was 0.643 (p < 0.001).

Conclusion

A clear difference in Meibomian gland and tear film dynamics can be observed in paretic vs non-paretic sides. A greater House-Brackmann score was correlated with a greater Meibomian gland atrophy area. A strong positive correlation is seen between the House-Brackmann score and Meibomian gland atrophy. Software-based analysis also showed a greater glandular area loss when compared to clinician's analysis. The level of agreement was moderate, so disparities are observed, especially in grade 2 Meibomian gland dropout where the least level of agreement was seen in cross tabulation. This study further incentivizes multimodal patient evaluation, which has been a growing area of interest in healthcare.

Tear film stability in children: Age and sex associations explored through non-invasive tear break-up time

PURPOSE

The stability of the tear film is crucial for maintaining good ocular health. Its assessment provides valuable insights into paediatric eye conditions. This study investigates the stability of the tear film in children and its association with predictive factors such as age and sex, for a better understanding of tear film dynamics in a paediatric population.

METHODS

A cross-sectional study was conducted in a semi-urban area in northern Portugal. Tear film stability was evaluated using non-invasive tear break-up time (NIBUT) measured with Tearscope Plus. The evaluation was conducted subjectively, with measurements obtained exclusively in the right eye. The mean of three consecutive measures of the NIBUT was considered in the statistical analysis.

RESULTS

A total of 2094 children (1072 females, 1022 males), with a mean age of 8.6 ± 1.3 years, were included. It was found a mean NIBUT of 14.8 ± 5.4 s (s), with no statistically significant difference between females (14.9 ± 5.4 s) and males (14.7 ± 5.4 s) (p = 0.407). Around 20 % of the children had a NIBUT < 10 s, and about 7 % had a NIBUT ≤ 5 s. A significant increase in NIBUT with age during the middle childhood stage (6 to 11 years old) was also found (p = 0.019), with NIBUT increasing from 14.1 ± 5.7 s in 6-year-olds to 16.3 ± 4.8 s in 11-year-olds (p = 0.006). However, when results were separated by the participants' sex, only the male group showed statistically significant differences (p = 0.021).

CONCLUSIONS

A significant increase in NIBUT was found during the middle childhood stage, primarily driven by male participants. These findings underscore the importance of considering age and sex in assessing tear film stability in paediatric populations.

Uveal melanoma distant metastasis prediction system: A retrospective observational study based on machine learning

Uveal melanoma (UM) patients face a significant risk of distant metastasis, closely tied to a poor prognosis. Despite this, there is a dearth of research utilizing big data to predict UM distant metastasis. This study leveraged machine learning methods on the Surveillance, Epidemiology, and End Results (SEER) database to forecast the risk probability of distant metastasis. Therefore, the information on UM patients from the SEER database (2000-2020) was split into a 7:3 ratio training set and an internal test set based on distant metastasis presence. Univariate and multivariate logistic regression analyses assessed distant metastasis risk factors. Six machine learning methods constructed a predictive model post-feature variable selection. The model evaluation identified the multilayer perceptron (MLP) as optimal. Shapley additive explanations (SHAP) interpreted the chosen model. A web-based calculator personalized risk probabilities for UM patients. The results show that nine feature variables contributed to the machine learning model. The MLP model demonstrated superior predictive accuracy (Precision = 0.788; ROC AUC = 0.876; PR AUC = 0.788). Grade recode, age, primary site, time from diagnosis to treatment initiation, and total number of malignant tumors were identified as distant metastasis risk factors. Diagnostic method, laterality, rural-urban continuum code, and radiation recode emerged as protective factors. The developed web calculator utilizes the MLP model for personalized risk assessments. In conclusion, the MLP machine learning model emerges as the optimal tool for predicting distant metastasis in UM patients. This model facilitates personalized risk assessments, empowering early and tailored treatment strategies.

Tear Fluid as a Matrix for Biomonitoring Environmental and Chemical Exposures

PURPOSE

Exposures to hazardous chemicals have been linked to many detrimental health effects and it is therefore critical to have effective biomonitoring methods to better evaluate key environmental exposures that increase the risk of chronic disease and death. Traditional biomonitoring utilizing blood and urine is limited due to the specialized skills and invasiveness of collecting these fluid samples. This systematic review focuses on tear fluid, which is largely under-researched, as a promising complementary matrix to the traditional fluids used for biomonitoring. The objective is to evaluate the practicability of using human tear fluid for biomonitoring environmental exposures, highlighting potential pitfalls and opportunities.

RECENT FINDING

Tear fluid biomonitoring represents a promising method for assessing exposures because it can be collected with minimal invasiveness and tears contain exposure markers from both the external and internal environments. Tear fluid uniquely interfaces with the external environment at the air-tear interface, providing a surface for airborne chemicals to diffuse into the ocular environment and interact with biomolecules. Tear fluid also contains molecules from the internal environment that have travelled from the blood to tears by crossing the blood-tear barrier. This review demonstrates that tear fluid can be used to identify hazardous chemicals from the external environment and differentiate exposure groups.

Environmental and Occupational Triggers of Dry Eye Symptoms in the Ahsa Region of Saudi Arabia: A Cross-Sectional Study

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.

Blinking and normal ocular surface in school-aged children and the effects of age and screen time

PURPOSE

Baseline ocular surface characteristics in children require investigation. This study characterised blinking and relationships with ocular symptoms, tear film and digital device use.

METHODS

45 children aged 6-15 years (56% female) participated in a cross-sectional study. Ocular surface symptoms (Instant Ocular Symptoms Survey, Dry Eye Questionnaire 5, Symptoms Assessment in Dry Eye, Ocular Surface Disease Index, Ocular Comfort Index and Numerical Rating Scale) and clinical indices (lipid layer thickness, tear secretion and stability, meibomian gland) were assessed. Blink rate and interblink interval were measured in situ using a wearable eye-tracking headset (Pupil Labs GmbH, Germany). Associations between blinking, ocular surface, age, and digital device use (bivariate and partial correlations) and between automated and manually counted blink rate (Bland & Altman) were examined.

RESULTS

Mean blink rate and interblink interval were 20.5±10.5 blinks/min and 2.9±1.9 s during conversation. There was no difference between automated and manual blink rate (p=0.78) and no relationship between blinking and digital device use, age or sex. Mean group symptoms were within normal range and not associated with clinical measurements including blinking. Greater tear volume was associated with a faster blink rate (r=0.46, p=0.001) and shorter interblink interval (r=-0.36, p=0.02). Older age was associated with improved tear volume (r=0.37, p=0.01) and stability (r=0.38, p=0.01).

CONCLUSIONS

Blinking characterised in situ was not impacted by age or habitual digital device use. A faster blink rate was associated with greater tear volume but not symptoms. Improved tear function was found with age suggesting that the ocular surface continues to develop through childhood.

Characteristic of red eye related diseases of Han and Uygur population in Urumchi compared with Shanghai, China

AIM

To study the characteristics, relative distribution and to compare causes of red eye in ophthalmic clinics in Urumchi and Shanghai, China.

METHODS

Data on continuous cases of red-eye patients admitted to the Ophthalmology Center of Xinhua Hospital Affiliated to Shanghai Jiao Tong University and the First Affiliated Hospital of Xinjiang Medical University were collected between November 2018 and September 2019. Demographic data, the incidence of red eye and related disease distribution of all cases were obtained. The independent t-test method was used for age comparison, while the Chi-square test was used to compare classified data information.

RESULTS

The information on 335 and 415 patients with red eyes in Shanghai and Urumchi were collected, respectively. The main causes of red eye were conjunctival disease and dry eye. The age of female patients with red eyes was significantly higher than that of males, and the proportion of female patients with dry eyes was also higher. Red-eye-related diseases occurred more frequently in patients over 46 years old than in those under 18, and dry eye was more common with increasing age. The incidence of infectious conjunctivitis in Urumchi was significantly higher than that in Shanghai, and allergic conjunctivitis occurred more frequently in spring, summer, or autumn than in winter (all P<0.05).

CONCLUSION

Significant differences exist in the distribution of red-eye-related diseases in Urumchi and Shanghai regions of China, and distribution varies with age and season, the latter being an important feature of allergic conjunctivitis.