The evaluation of dry eye mobile apps for screening of dry eye disease and educational tear event in Japan

Purpose

To evaluate the usefulness of a dry eye mobile application (app) for screening dry eye disease (DED) at educational tear events in Japan.

干眼对生活质量影响的相关研究进展

干眼是一种日益严重的公共卫生问题,临床常见的干眼引起的眼部不适包括眼部干涩、视疲劳、眼异物感、烧灼感及畏光等,进一步可导致视觉损害和对比敏感度降低.这些不适很大程度上影响了干眼患者的身体功能、社会功能、心理功能、日常活动及工作生产力等情况.但干眼的视觉障碍对患者生活质量的影响不易量化,本文中笔者结合现有相关文献,对干眼视觉障碍的评估方法 及其对生活质量的影响进行综述.旨在为临床工作提供指导.     

The impact of dry eye disease treatment on patient satisfaction and quality of life: A review

Several aspects of the quality of life (QoL) and treatment satisfaction of patients with dry eye disease (DED) may be underestimated. Ocular symptoms, which are assessed by validated patient-reported questionnaires and may include stinging, burning, itchiness, grittiness, dryness and discomfort, reduce QoL by affecting daily activities and work productivity. Self-reported symptoms do not always correlate with post-treatment improvements in clinical measures such as tear film break-up time, inflammation and osmolarity. Thus, treatments may improve clinical ocular features without improving symptoms that affect daily life.This review explores 1500 abstracts from congress presentations and peer-reviewed journals for QoL and treatment satisfaction data on the use of active lubricants, osmoprotectants, secretagogues, and immunomodulators present in topical formulations for DED treatment, and validated symptom questionnaires. Patient-reported symptoms of DED are generally improved after treatment with topical formulations for tear replacement, tear stimulation or anti-inflammatory therapy compared with baseline or a control treatment. However, more data are required to compare the performance of active ingredients. It is fundamental to diagnose patients with DED accurately, recognising the major cause behind their dry eyes. Studies are also necessary to identify how patient satisfaction and QoL may be improved through long-term use of topical preparations. We conclude that careful and thorough consideration of patient-reported symptoms should be integrated into DED management to help tailor treatment to patient needs.     

Enhanced closed eye neutrophil degranulation in dry eye disease

PurposeClosed eye neutrophils have demonstrated increased prevalence in dry eye disease, but the phenotype and extent of activation of these cells has yet to be described.Methods12 normal subjects and 12 subjects with dry eye disease were recruited and trained for self-collection of closed eye leukocytes, immediately upon awakening. Tear leukocytes were isolated and peripheral blood was collected, and stained with a panel of fluorescently-labeled antibodies to determine the activation phenotype of neutrophils. Extracellular matrix metalloproteinase 9 (MMP9) and neutrophil elastase (NE) was quantified by an enzyme-linked immunosorbent assay.ResultsTotal numbers of tear leukocytes recovered, at awakening, from normal and dry eye subjects were similar. Tear neutrophils from dry eye subjects had increased expression of membrane receptor CD66b, a marker associated with secondary granule degranulation. There was also a higher proportion of monocytes in the dry eye cohort, as compared to the normal cohort. Extracellular MMP9 was significantly higher in subjects with dry eye disease, and while NE was also elevated, it did not achieve statistical significance.ConclusionsIncreased inflammation can be observed in the closed eye tears of subjects with dry eye disease, and neutrophils may be a potential source of pathogenic species in dry eye disease. Further research is required to determine the diagnostic potential of closed eye tears.     

Subjective versus objective dry eye disease in patients with moderate-severe thyroid eye disease

Purpose

To compare the subjective versus Objective dry eye disease (DED) in patients with moderate-severe thyroid eye disease (TED).

干眼患者生活质量的研究进展

干眼对患者生活质量造成的损害正逐渐引起关注。干眼引起的症状、视功能损害、心理情绪障碍等,从各方面损害了干眼患者的生活质量。现就干眼患者的生活质量、相关影响因素、改善于眼患者生活质量的策略3个方面进行分析。     

Emerging strategies for the diagnosis and treatment of meibomian gland dysfunction: Proceedings of the OCEAN group meeting

Meibomian gland dysfunction (MGD) is a common and chronic disorder that has a significant adverse impact on patients' quality of life. It is a leading cause of evaporative dry eye disease (DED), as meibomian glands play an important role in providing lipids to the tear film, which helps to retard the evaporation of tears from the ocular surface. MGD is also often present in conjunction with primary aqueous-deficient DED. Obstructive MGD, the most commonly observed type of MGD, is the main focus of this article. MGD is probably caused by a combination of separate conditions: primary obstructive hyperkeratinization of the meibomian gland, abnormal meibomian gland secretion, eyelid inflammation, corneal inflammation and damage, microbiological changes, and DED. Furthermore, skin diseases such as rosacea may play a part in its pathology. Accurate diagnosis is challenging, as it is difficult to differentiate between ocular surface diseases, but is crucial when choosing treatment options. Ocular imaging has advanced in recent years, providing ophthalmologists with a better understanding of ocular diseases. This review presents a literature update on the 2011 MGD workshop and an optimized approach to accurate diagnosis of MGD using currently available methods and tests. It also outlines the emerging technologies of interferometry, non-contact meibography, keratography and in vivo confocal laser microscopy, which offer exciting possibilities for the future. Selected treatment options for MGD are also discussed.     

The physical and mental burden of dry eye disease: A large population-based study investigating the relationship with health-related quality of life and its determinants

PurposeThis large cross-sectional population-based study investigated the relationship between dry eye disease (DED) and health-related quality of life (HR-QoL).MethodsDry eye and HR-QoL were assessed in 78,165 participants (19–94 yrs, 59.2% female) from the Dutch population-based Lifelines cohort, using the WHS and the SF36 questionnaire, respectively. Logistic regression was used to assess the relationship between DED and below median Physical Component Summary (PCS) and Mental Component Summary (MCS) score, corrected for age, sex, education, BMI, and 52 comorbidities.ResultsOverall, 8.9% of participants had DED. Participants with DED had an increased risk of low PCS (OR 1.54 (95% CI 1.46–1.62)) and MCS scores (OR 1.39 (95% CI 1.32–1.46)), corrected for age and sex. This risk remained significant after correction for comorbidities (P < 0.0005). Increasing DED symptom frequency was associated with decreasing HR-QoL (P < 0.0005). Undiagnosed DED subjects had a significantly increased risk of low mental HR-QoL with increasing dry eye symptoms compared to diagnosed subjects (P < 0.0005). Compared to allergic conjunctivitis, glaucoma, macular degeneration and retinal detachment, DED showed the highest risk of low HR-QoL. Compared to other common systemic and chronic disorders, such as depression, rheumatoid arthritis, and COPD, DED was distinctive by having a substantial reduction in both PCS and MCS.ConclusionDED is associated with substantial reductions in both physical and mental HR-QoL, also after correction for associated comorbidities. Not having a diagnosis is associated with worse mental HR-QoL in subjects with severe DED. Our results underline the importance of recognizing dry eye as a serious disorder.     

Effectiveness of sodium hyaluronate eyedrops in the treatment of dry eye

Background Dry eye is a common condition, affecting approximately 10–20% of the adult population. Artificial tears are often effective in relieving symptoms in mild and moderate dry eye by replenishing deficient tear volume. Sodium hyaluronate has been proposed as a component in artificial tears, due to its viscoelastic rheology. This paper reports on a study carried out to assess the efficacy of two recently developed eyedrops containing 0.1% and 0.3% sodium hyaluronate (SH) in the treatment of moderate dry eye. Methods Thirteen subjects were recruited with moderate dry eye. Forty microlitres of 0.1% SH, 0.3% SH, or 0.9% saline were instilled in both eyes, and the subjects’ symptom intensity and non-invasive break-up time (NIBUT) were measured at 5, 15, 30, 45, and 60 min, and then hourly, until 6 h after drop instillation. This was repeated twice following an interval of 7(±1) days, but with a different treatment so that at the end of the final visit each subject had trialled all products. Drop allocation was randomized and double-masked. Results Both symptoms and NIBUT improved with all treatments. These changes were of a larger magnitude and longer duration with the SH containing eyedrops than with saline. SH of 0.3% tended to perform better than 0.1% SH and achieved statistical significance (P=0.04) for NIBUT when considered over the whole 6-h study period. Conclusions Sodium hyaluronate of 0.1% and 0.3% reduces symptoms of ocular irritation and lengthens NIBUT in subjects with moderate dry eye more effectively than saline, in terms of peak effect and duration of action.     

Sex and age differences in symptoms and signs of dry eye disease in a Norwegian cohort of patients

PurposeTo investigate sex and age differences in symptoms and signs in a Norwegian clinic-based cohort of patients with dry eye disease (DED).MethodsVisitors at the Norwegian Dry Eye Clinic were examined using Ocular Surface Disease Index (OSDI) questionnaire score, tear osmolarity, tear break-up time (TFBUT), ocular surface staining, corneal sensitivity, Schirmer I test, and meibum expressibility (ME) and quality (MQ). A diagnosis of DED was made by an ophthalmologist based on symptoms and signs, and only DED patients were enrolled in the study: 1823 patients (338 males; mean age 51.2 ± 16.2 years; 1485 females; mean age 52.5 ± 16.0 years). The patients were divided into age subgroups: 20–39 years, 40–59 years and ≥60 years. Sex differences in the aforementioned tests were analyzed. Values were reported as mean ± standard deviation (SD), and intergroup comparisons were performed using Mann-Whitney U test. Multiple regression was used to analyze sex and age influences on symptoms and signs.ResultsWhen patients of all ages were analyzed, females had increased osmolarity, shorter TFBUT, reduced MQ and ME and higher corneal sensitivity. OSDI, Schirmer I test, ocular surface staining and corneal staining were not significantly different between the sexes. Only with TFBUT and ME were the sex difference present in all age subgroups. Multiple regression showed that all parameters were influenced by either sex or age, but only TFBUT and ME were influenced by both sex and age. (all p < 0.05).ConclusionsSex and age differences in dry eye were most consistent in TFBUT and ME, that indicate differences in meibomian gland functionality. Sex and age subgroup stratification is important in future studies investigating DED in other populations.     

Post laser-assisted in-situ keratomileusis dry eye disease and temporary punctal plugs

Purpose:The aim of this study was to compare the incidence of post laser in situ keratomileusis (LASIK) dry eye with and without intraoperative extended duration temporary punctal plug placement.Methods:This retrospective study included myopicastigmatic eyes without a preoperative diagnosis of dry eye disease that underwent LASIK surgery between January 2017, and March 2018. Patients who received punctal plugs during surgery in addition to usual postoperative care were compared to a control group who received usual postoperative care alone. Visual acuity, safety and efficacy indices, as well as predictability and presence of dry eye disease were assessed 3–6 months after surgery.Results:A total of 345 eyes of 345 patients were included, 172 eyes received punctal plugs and 173 did not. The mean age was 30.4 ± 10 years (range: 17–60 years) and 46.1% (N = 159) were female. Both groups were similar in terms of preoperative parameters, including age, gender, spherical equivalent, pachymetry or contact lens use. Patients treated with punctal plugs had significantly less postoperative dry eye complaints (N = 37 vs. 58, 21.5% vs. 34.1% respectively, P = 0.001). Patients treated with plugs that did develop dry eye disease did so later (51.2 ± 77.64 days'' vs. 20.78 ± 26.9 days, P = 0.009). Postoperative visual acuities were similar between groups (P > 0.05) at all postoperative follow-up visits as were safety (0.95 ± 0.16 vs. 0.99 ± 0.09, P = 0.30) and efficacy (1.01 ± 0.13 vs. 1.00 ± 0.11, P = 0.52) indices.Conclusion:Preventative temporary punctal plug placement during LASIK appears to reduce dry eye disease in the short term, without affecting visual acuity outcomes.     

Characterization of tear production in subjects with dry eye disease during intranasal tear neurostimulation: Results from two pivotal clinical trials

PurposeThe intranasal tear neurostimulator (ITN) activates the nasolacrimal pathway, which is involved with basal and bolus tear secretion. These studies characterized the acute and long-term effectiveness of the ITN in stimulating tear production in subjects with dry eye disease (DED).MethodsStudy 1: Randomized, double-masked, dual-controlled, 1-day crossover. Study 2: Single-arm, open-label, 180-day prospective cohort. Eligible subjects had basal unstimulated Schirmer test (with anesthesia) ≤10 mm and intranasal cotton swab–stimulated Schirmer test at least 7 mm greater in the same eye, and Ocular Surface Disease Index^® ≥13 and ≥ 23, in Studies 1 and 2, respectively. Study 1: Subjects (n = 48) received three randomized test applications: active intranasal, extranasal (active control), and sham intranasal (inactive control) stimulation, 3 min/application with 1-hour minimum between applications. Primary outcome measure was the difference in Schirmer test scores during active intranasal and control applications. Study 2: Subjects (n = 97) performed intranasal neurostimulation for ≤3 min/application, 2–10 times/day. Primary outcome measure was the difference in Schirmer scores (stimulated minus unstimulated) at day 180. Both studies recorded device-related adverse events (AEs).ResultsStudy 1: Schirmer scores (mean ± SEM) were significantly greater (p < 0.0001) with active intranasal (25.3 ± 1.5 mm) vs extranasal (9.5 ± 1.2 mm) and sham (9.2 ± 1.1 mm) applications. Study 2: Schirmer scores were significantly greater (p < 0.0001) with ITN stimulation vs unstimulated at day 180 (17.3 ± 1.3 mm vs 7.9 ± 0.7 mm). No serious device-related AEs were reported in either study.ConclusionThe ITN was well-tolerated and effective in stimulating tear production with acute and long-term use in DED.Clinicaltrials.gov identifierNCT02680158 and NCT02526290.     

连续性功能性视力在眼科的应用进展

连续性功能性视力（FVA）被认为是一种可以较好体现自然状态下视功能的功能性视力检查方法,它的概念与测量方法随着技术的进步得到了不断的更新.FVA检查最初应用于干眼患者的评估,并在屈光不正、白内障、眼底病变、药物使用效果评估等领域逐渐得到推广,为一些眼病的早期诊断、治疗效果评价等提供了理论依据.就FVA的概念与方法、FVA的测量系统以及FVA在干眼、屈光不正、白内障和眼底病变患者中的应用和研究进展进行综述.     

Ageing and the natural history of dry eye disease: A prospective registry-based cross-sectional study

PurposeTo investigate the impact of ageing on ocular surface parameters, and empirically determine optimal prognostic cut-off ages for clinical markers of dry eye disease, aqueous tear deficiency, and meibomian gland dysfunction.MethodsA total of 1331 community residents (785 females, 546 males; mean ± SD age, 38 ± 19 years) were recruited in a prospective registry-based cross-sectional study. 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.ResultsMultivariate regression analysis demonstrated positive associations between ageing and clinical markers of dry eye disease (all p ≤ 0.001). The Youden-optimal prognostic cut-off ages for signs of meibomian gland dysfunction occurred during the third decade of life (24–29 years); the optimal predictive ages for lid wiper epitheliopathy, tear film instability, hyperosmolarity, and dry eye symptoms occurred during the fourth decade of life (31–38 years); while the optimal prognostic thresholds for signs of aqueous tear deficiency and ocular surface staining occurred in the fifth and sixth decades of life (46–52 years).ConclusionsAdvancing age is a significant risk factor for dry eye disease, which represents a growing public health concern with the ageing population worldwide. Signs of meibomian gland dysfunction appeared earlier in the natural history of disease progression, and the brief delay prior to the development of other clinical dry eye signs might represent a window of opportunity for preventative interventions in the young adult age group.     

Advances in the diagnosis and treatment of dry eye

The core mechanism of dry eye is the tear film instability. Tear film-oriented diagnosis (TFOD) is a concept to clarify the cause of tear film instability by tear film, and tear film-oriented treatment (TFOT) is a concept to treat dry eye disease by replacing the lacking components of the tear film layer based on the TFOD. In TFOD, the fluorescein breakup pattern of the tear film is important, and the subtype of dry eye can be judged to some extent from the breakup patterns. Current noninvasive devices related to the dynamic analysis of the tear film and visual acuity enabled the diagnosis of dry eye, subtype analysis, and the extent of severity. In Asian countries, secretagogues represent the main treatment in TFOT. Since meibomian gland dysfunction is a factor that greatly affects the tear breakup time, its treatment is also essential in the dry eye treatment strategy. A newly discovered dry eye subtype is the short breakup time-type (BUT) of dry eye. The only abnormal finding in this disease is the short BUT, suggesting a relationship with ocular neuropathic pain and eye strain. Recently, data from many studies have accumulated which show that dry eye is a life-style disease. In addition to the treatment of dry eyes, it is becoming possible to prevent the onset by intervening with the daily habits, diet, exercise and sleep, etc. It has been pointed out that oxidative stress is also involved in the pathology of dry eye, and intervention is being carried out by improving diet and taking supplements. Future research will be needed to link clinical findings to the molecular biological findings in the tear film.     

Exploring the Asian ethnic predisposition to dry eye disease in a pediatric population

Purpose

To investigate the differences in ocular surface characteristics, tear film parameters, and dry eye symptomology between co-located pediatric populations of Asian and Caucasian ethnicity.

Ocular Surface Disease Index© and the five-item dry eye questionnaire: A comparison in Indian patients with dry eye disease

Purpose:To compare the suitability of the Ocular Surface Disease Index (OSDI) and the 5-item Dry Eye Questionnaire (DEQ-5) in Indian patients with dry eyes.Methods:This cross-sectional study evaluated the OSDI and DEQ-5 in patients with tear film abnormalities. Tear film breakup time, tear film height, Schirmer’s I, lissamine green staining, and meibomian gland expressibility were performed on each patient.Results:There were 101 patients with symptoms and/or signs of tear film abnormality. Both OSDI and DEQ-5 questionnaires significantly correlated (ρ = 0.566, P < 0.0001) with each other. The OSDI questionnaire showed a good correlation with all dry eye tests, whereas the DEQ-5 correlated significantly only with the tear film breakup time and the lissamine green score. None of the questionnaires correlated with meibomian gland expressibility. The Bland–Altman analysis revealed a marginal bias (−0.01 unit) for DEQ-5. The DEQ-5 scored higher in patients with mild symptoms. While 101 (100%) patients answered all the questions in the DEQ-5, only 19 (18.8%) patients answered all the questions in the OSDI questionnaire. The least responses were recorded in the vision-function-related and environmental trigger subscales of the OSDI.Conclusion:The OSDI and DEQ-5 scores showed a moderate correlation. The OSDI questionnaire correlated with a higher number of dry eye tests than the DEQ-5. The large number of skipped questions in the vision-function-related and environmental trigger subscales of the OSDI suggests that the questionnaire is not adequately adapted to the Indian population. Patients with a negative OSDI score should be reassessed with the DEQ-5 to exclude symptom positivity.     

Association of meibomian gland morphology with symptoms and signs of dry eye disease in the Dry Eye Assessment and Management (DREAM) study

PurposeTo describe associations between symptoms and signs of dry eye disease (DED) and meibomian gland (MG) morphology.MethodsCross-sectional study utilizing data from the Dry Eye Assessment and Management (DREAM) Study. Readers graded MG features in the middle third of upper and lower lids on infrared meibography images. Associations with signs and symptoms of DED were evaluated with adjustment for age and sex.ResultsAmong 268 patients, no MG features were associated with symptom scores (p > 0.08). Among 394 upper eyelids, better tear break-up times (<2, >2- <3.2and ≥ 3.2 s) were associated with more tortuous glands (mean (SD) 0.58(0.95), 0.83(1.2) and 1.14 (1.4), p = 0.01) and with higher scores on a composite score of MG features (21.90 (9.76), 23.29 (9.50), 26.26 (10.27); p = 0.02). Longer Schirmer test wetting lengths (0–5, >5–10, and >10 mm) were associated with increasing composite scores (22.02 (9.29), 23.80 (10.34), 24.96 (9.96), p = 0.03). Patients with Sjogren syndrome compared to other patients had fewer distorted MGs (mean 3.4 (2.3) vs 4.3 (2.3), p = 0.03) and fewer ghost glands (mean 0.33 (0.88) vs 0.89 (1.8), p = 0.006) in the upper lid.ConclusionIn the DREAM study, most MG morphologic features were not associated with the severity of DED symptoms or signs. Tortuous glands and a higher composite score for MG features were associated with longer tear break-up times and longer Schirmer test length in the upper eyelid only. Patients with Sjogren syndrome had fewer distorted and ghost glands.