眼干燥症的高阶像差分析

目的比较干眼症与正常眼的高阶像差,描述干眼症的高阶像差变化特征,探寻干眼症的视觉质量下降原因。方法选取干眼症患者及正常对照各25人,用Nidek公司生产的OPD-Scan测量受试者眨眼后5秒的像差。结果瞳孔在4mm及6mm时,干眼症患眼较正常眼的总高阶像差、彗差、三叶草、像散像差均有显著升高,与正常眼的球差比较无显著性差异。干眼高阶像差中主要构成依次为三叶草、彗差、像散、球差;而正常眼则依次为三叶草、球差、彗差、像散。结论1.干眼症由于角膜表面泪膜的不规则致高阶像差增高。2.干眼症的高阶像差主要来源于彗差和三叶草散光及像散。3.像差技术对评估干眼的光学像质和泪膜状况有重要作用。     

Optical aberrations in the mouse eye

PURPOSE: The mouse eye is a widely used model for retinal disease and has potential to become a model for myopia. Studies of retinal disease will benefit from imaging the fundus in vivo. Experimental models of myopia often rely on manipulation of the visual experience. In both cases, knowledge of the optical quality of the eye, and in particular, the retinal image quality degradation imposed by the ocular aberrations is essential. In this study, we measured the ocular aberrations in the wild type mouse. METHODS: Twelve eyes from six four-week old black C57BL/6 wild type mice were studied. Measurements were done on awake animals, one being also measured under anesthesia for comparative purposes. Ocular aberrations were measured using a custom-built Hartmann-Shack system (using 680-nm illumination). Wave aberrations are reported up to fourth order Zernike polynomials. Spherical equivalent and astigmatism were obtained from the 2nd order Zernike terms. Modulation Transfer Functions (MTF) were estimated for the best focus, and through-focus, to estimate depth-of-focus. All reported data were for 1.5-mm pupils. RESULTS: Hartmann-Shack refractions were consistently hyperopic (10.12+/-1.41 D, mean and standard deviation) and astigmatism was present in many of the eyes (3.64+/-3.70 D, on average). Spherical aberration was positive in all eyes (0.15+/-0.07 microm) and coma terms RMS were significantly high compared to other Zernike terms (0.10+/-0.03 microm). MTFs estimated from wave aberrations show a modulation of 0.4 at 2c/deg, for best focus (and 0.15 without cancelling the measured defocus). For that spatial frequency, depth-of-focus estimated from through-focus modulation data using the Rayleigh criterion was 6D. Aberrations in the eye of one anesthetized mouse were higher than in the same eye of the awake animal. CONCLUSIONS: Hyperopic refractions in the mouse eye are consistent with previous retinoscopic data. The optics of the mouse eye is far from being diffraction-limited at 1.5-mm pupil, with significant amounts of spherical aberration and coma. However, estimates of MTFs from wave aberrations are higher than previously reported using a double-pass technique, resulting in smaller depth-of-field predictions. Despite the large degradation imposed by the aberrations these are lower than the amount of aberrations typically corrected by available correction techniques (i.e., adaptive optics). On the other hand, aberrations do not seem to be the limiting factor in the mouse spatial resolution. While the mouse optics are much more degraded than in other experimental models of myopia, its tolerance to large amounts of defocus does not seem to be determined entirely by the ocular aberrations.     

糖尿病干眼患者的波前像差分析

目的比较糖尿病干眼患者与正常人的眼波前像差的变化,探讨像差技术在糖尿病干眼诊断中的作用。方法随机选取2型糖尿病干眼患者45例、正常对照组50人,采用iTrace视功能分析仪,记录瞳孔直径3mm和5mm的总高阶像差、慧差、球差、三叶草差的均方根值(RMS)。采用独立样本t检验比较2型糖尿病干眼患者和正常人群的像差值。结果 3mm瞳孔直径下,总高阶像差:糖尿病干眼组0.344±0.082、正常对照组0.135±0.023(P<0.01);慧差:糖尿病干眼组0.115±0.061、正常对照组0.032±0.025(P<0.01);三叶草差:糖尿病干眼组0.053±0.042、正常对照组0.036±0.025(P<0.05);球差:糖尿病干眼组0.271±0.125、正常对照组0.124±0.015(P<0.05)。5mm瞳孔直径下,总高阶像差:糖尿病干眼组0.656±0.096、正常对照组0.294±0.015(P<0.01);慧差:糖尿病干眼组0.304±0.054、正常对照组0.107±0.237(P<0.01);三叶草差:糖尿病干眼组0.180±0.042、正常对照组0.131±0.106(P<0.05);球差:糖尿病干眼组0.419±0.027、正常对照组0.336±0.087(P<0.05)。3mm瞳孔直径下和5mm瞳孔直径下糖尿病干眼患眼较正常眼的总高阶像差、彗差、三叶草差、球差均有显著升高。结论 2型糖尿病患者的干眼与波前像差的增加密切相关,波前像差的增加可能成为诊断糖尿病干眼的指标之一。     

Impaired visual performance in patients with dry eye

Patients with dry eye disease (DED) often complain about poor vision, which is not easily quantifiable. This review assesses the current understanding of clinical evaluations of visual function in patients with DED. Several noninvasive techniques for the assessment of visual performance have been utilized in patients with DED, and these are critically reviewed in relation to the visual symptoms experienced by these patients. It is clear that none of the current techniques is ideal, and there is not one appropriate, simple, clinical test that can be used for assessing visual impairment in patients with DED. Evidence from a comprehensive literature search combined with clinical experience have been used to identify which tests are currently of most benefit and to highlight the future development of a more specific clinical test for visual impairment in the dry eye patient.     

Serial measurements of higher-order aberrations after blinking in patients with dry eye

PURPOSE: To study the sequential postblink changes in ocular higher-order aberrations (HOAs) in patients with dry eye. METHODS: A wavefront sensor was used to measure HOAs sequentially for 30 seconds in 20 eyes of 20 patients with dry eye. The 20 eyes were classified into two groups, with or without superficial punctate keratopathy (SPK) in the central cornea. During the measurement, subjects were required to blink every 10 seconds. The aberration data were analyzed in the central 4-mm diameter for coma-like, spherical-like, and total HOAs up to sixth-order Zernike polynomials. Total HOAs, as well as fluctuation index (FI) and stability index (SI) of the total HOAs over time were compared between the two groups. The sequential changes in coma-like aberration, spherical-like aberration, and total HOAs were also investigated. RESULTS: The total ocular HOAs were significantly (P = 0.001) greater in dry eyes with central SPK than in dry eyes without central SPK. The sequential pattern of the total ocular HOAs had higher initial and consistently higher values in dry eyes with central SPK, whereas that of dry eyes without central SPK showed consistently lower total HOAs that were similar to the pattern of normal eyes. CONCLUSIONS: Increased HOAs in dry eye at least partially result from SPK above the optical zone. The low tear volume in dry eye may not cause sequential increases in HOAs after blinking. Sequential measurement of HOAs may be useful for evaluating the sequential changes in optical quality in patients with dry eye.     

Endocrine disrupting chemicals associated with dry eye syndrome

BackgroundDry eye syndrome (DES) is a multifactorial disease that causes changes in the tear film and occurs more frequently in women. Sex hormones (SHs) influence tear production, and SHs imbalance is associated with DES. Endocrine-disrupting chemicals (EDCs) are compounds that can bind to SHs receptors, changing the SHs action in several organs and tissues.MethodsThe levels of 21 EDCs were measured in the urine of DES patients and healthy controls. All individuals were submitted to eye exams for DES and responded to the questionnaire “Ocular Surface Disease Index (OSDI)”. DES was considered present when the OSDI score was >20 and one of the DES tests surpassed the established thresholds.ResultsMethyl-protocatechuic acid (OHMeP), had higher urine levels in DES individuals than in control individuals (p = 0.0189). On the other hand, triclocarban (TCC) exhibited lower urine levels in DES individuals than in control individuals (p = 0.0081). Statistically significant positive associations were found between Methyl Paraben (MeP), EtP (ethyl paraben) and OHMeP with fluorescein staining test; between TCC and Tear breakup time test and between OHMeP and OSDI score. Significant negative associations were found between EtP and OHMeP and schirmer test; between OHMeP and Tear breakup time test; between TCC and the OSDI score and fluorescein and lissamine staining test.The quadratic discriminant function classified 94.4% of individuals in their groups based on the urine levels of EDCs.ConclusionThe following EDCs, MeP, EtP, and OHMeP, were associated with signs and symptoms of DES. TCC had a paradoxical protective effect against DES. These findings suggest that EDCs are associated with DES and the exposure should be included in the investigation of causes and risk factors for DES.     

Wavefront analysis of higher order aberrations in dry eye patients

PURPOSE: To compare ocular wavefront aberrations of normal and dry eyes and to describe the characteristics of higher order aberration in dry eyes. METHODS: Wavefront analysis of higher order ocular aberrations (total S3+4+5, spherical-like S4, coma-like S3+5) was performed with a Hartmann-Shack aberrometer in 20 dry eyes and 20 normal control eyes. RESULTS: Total, spherical-like, and coma-like aberrations were significantly greater in dry eyes than in normal controls (P < .01) both for a 4-mm (total S3+4: factor of 2.58; spherical S4: factor of 2.50; coma S3: factor of 2.70) and 6-mm-diameter pupil (S3+4+5: factor of 2.29, S4: x2.53, and S3+5: factor of 2.40). CONCLUSIONS: Eyes of dry eye patients showed greater optical aberrations compared with normal control eyes. Increase in higher order aberrations in dry eyes resulted from increased tear film irregularity.     

白内障超声乳化联合人工晶状体植入手术后干眼发生的相关因素分析

目的评估不同危险因素在白内障超声乳化联合人工晶状体植入术后干眼发生中的作用,为术后干眼发生的预测及防治提供依据。方法记录93例(98只眼)术前无干眼白内障患者手术前及术后3个月常见的全身疾病,并进行干眼问卷调查及相关眼部检查,包括睑板腺功能检查、BUT、SchirmerⅠ试验、角膜荧光素染色等,对检查结果进行多因素回归分析及多元线性回归分析,分析其危险因素。结果 44例47只眼(48%)白内障术后确诊为干眼,Logistic回归分析显示:睑脂粘度(OR=2.670,P=0.025)和结膜松弛(OR=4.537,P=0.004)是白内障术后干眼发生的独立危险因素。糖尿病(OR=3.778,P=0.037)、高血脂(OR=11.645,P=0.023)、睑板腺分泌物(OR=5.660,P=0.025)及睑脂粘度(OR=2.881,P=0.018)是BUT值缩短的独立危险因素。多元线性回归分析显示:睑脂粘度与角膜染色呈正相关(F=79.282,P<0.001)。结论白内障术后干眼的发生与全身及局部多种因素相关,术前针对相关危险因素进行评估,可有助于术后干眼发生的预测并提前进行综合干预治疗。     

视屏终端综合征与干眼症关系的研究

目的:研究视屏终端综合征(visual display terminal,VDT)与干眼症的关系,并分析视屏操作时间对它的影响。方法:对符合干眼诊断标准的60例VDT患者进行问卷调查和眼科常规检查,作为可疑干眼的观察组,取年龄与之匹配的正常患者60例作为对照组,分别做基础泪液分泌试验(schimerⅠtest,SⅠt)、泪膜破裂时间检查(break uptime,BUT)、角膜荧光素染色(fluorescent,FL)、结膜细胞印迹学检查(impression cytology,IC),分析观察组的症状、病因进行分析。结果:观察组比对照组SⅠt试验,BUT,IC均显著降低,观察组症状的严重程度与每日VDT操作时间有显著性差异。结论:VDT是干眼的相关危险因素,且VDT的症状严重程度与VDT使用电脑时间相关。     

Management of filamentary keratitis associated with aqueous-deficient dry eye.

PURPOSE: To review the incidence, underlying pathophysiology, and clinical features of filamentary keratitis and to identify evidence-based best-practice strategies for managing filamentary keratitis. METHODS: A comprehensive review of published literature was undertaken. Recommendations for best-practice management strategies were based on the available evidence. Three cases are presented to illustrate the clinical findings and management of patients with chronic filamentary keratitis. RESULTS: Although the evidence base is limited by the absence of well-designed studies, current evidence indicates the following: (1) Aqueous-deficient dry eye (keratoconjunctivitis sicca) is the most common ocular condition associated with filamentary keratitis. (2) Current best-practice management of filamentary keratitis involves treating the underlying dry eye and specific treatments for the corneal filaments. Proposed treatments include nonpreserved lubricants, topical steroidal and nonsteroidal anti-inflammatory agents, and punctal plugs for aqueous-deficient dry eye as well as mechanical removal of filaments, hypertonic saline, mucolytic agents, and bandage contact lenses for the filaments. (3) Filamentary keratitis can be induced or exacerbated by contact lens wear and ocular surgical procedures such as cataract surgery and corneal graft surgery. Pre- and postoperative ocular surface management strategies should be considered in the surgical planning of patients with, or who are susceptible to, filamentary keratitis. Filamentary keratitis can also be induced and/or exacerbated by chronic use of ocular and/or systemic medications, and alternate medications or additional measures to manage the tear film and ocular surface may be required in these cases. CONCLUSIONS: Filamentary keratitis can be a chronic, recurrent, and debilitating condition. With a systemic approach to diagnosis and management, the condition can be effectively controlled and the incidence and severity of recurrences minimized.     

Impaired functional visual acuity of dry eye patients.

PURPOSE: To report dry eye patients' functional visual acuity, which was measured after sustained eye opening for 10-20 seconds, as a simulation of visual function of daily acts of gazing, which is defined as looking at an object with involuntary blink suppression. METHODS: Interventional clinical nonrandomized comparative trial. We measured ordinary best-corrected visual acuity and functional visual acuity in non-Sj?gren's syndrome (non-SS, N = 10) and Sj?gren's syndrome (SS, N = 12) patients and in normal controls (N = 8), prospectively. Surface regularity index (SRI) of corneal topography was also measured under routine circumstances and after sustained eye opening. Blink rates while gazing were measured during reading in another 28 dry eye patients and during driving in another 8 normal controls. RESULTS: Functional visual acuity did not change (1.27-1.16) in normal controls, but decreased significantly from 1.18-0.336 in non-SS patients (P = .0007) and from 1.15-0.228 (P < .00001) in SS patients. SRI after sustained eye opening increased in non-SS (P = .032) and SS patients (P = .0007), but not in the normal controls. Blink rates during reading (P < .001) and driving (P = .012) were significantly decreased from baseline blink rates. CONCLUSIONS: This study shows that the visual function of dry eye patients becomes abnormal with ocular surface irregularity when the eye is kept open for 10-20 seconds. Our data indicate impaired visual function in dry eye patients while gazing. Functional visual acuity may be important in daily activities.     

干眼症患者功能视力初探

目的观察干眼症患者持续睁眼10～20s时其功能视力的变化,以模拟日常生活中因凝视物体瞬目减少情况下的视功能情况,即功能视力。方法观察正常对照组(非干眼症组10人)和干眼症组(非sjogren’s综合征患者10人)日常最好矫正视力和功能视力,并观察他们专注时如阅读和行视野检查时的瞬目频率。结果正常对照组功能视力没有改变(P=0.098),干眼症组由1.15±0.15减少为0.69±0.08,专注时的自然瞬目频率亦减少(P<0.01)。结论干眼症患者持续睁眼10～20s时其功能视力会下降,推测日常从事专注性工作时干眼症患者的视功能会受损,对干眼症患者功能视力的测试更有使用意义。     

眼科门诊干眼的流行病学调查及相关危险因素分析

目的 了解眼科门诊就诊者中干眼患病状况,并探讨干眼发病的相关危险因素.方法 收集2005年4月至6月、9月至11月眼科门诊就诊的650例30岁以上者作为研究对象,在获得知情同意后进行干眼问卷调查及泪膜破裂时间(break up time,BUT)试验,对其中干眼症状阳性及BUT<10 s者进行角膜荧光素染色、睑板腺功能检查、基础泪液分泌试验、虎红染色4项干眼的客观检查,对确诊的干眼患者按12配比的方法进行病例对照研究,分析其相关危险因素.结果 650例调查对象(年龄30～83岁,平均49.9岁)干眼总的患病率为20.6%,女性(26.2%)多于男性(15.0%,P＜0.001);干眼的患病率随年龄增长而增高,在60岁以上年龄组患病率高于60岁以下年龄组(P＜0.05),30岁年龄组患病率最低(11.1%),眼部不适症状中最多见的是干涩感182例(28.0%),其次为疲劳感158例(24.3%),最少见的症状为眼痛42例(6.5%);平均BUT为(9.50±2.86)s,男性(10.22±2.30)s高于女性(8.76±3.16)s,泪膜稳定性高于女性(t'＝6.641,P=0.000),BUT随年龄增长而缩短,60岁以下年龄组BUT高于60岁以上年龄组(P＜0.001);农民干眼的患病率高于其他职业(P＜0.001).多因素条件Logistic回归分析显示以下因素是与干眼相关的危险因素:滴眼液(P＜0.001,OR 1.890,CI 1.338～2.668)、糖尿病(P＜0.001,OR 3.144,CI 1.788～5.529)、翼状胬肉(P＜0.001,OR 3.982,CI 1.982～7.783)、使用视频终端(P＜0.05,OR 1.737,CI 1.192～2.532),而服用阿斯匹林、多种维生素,甲状腺疾病、高血压、过敏性疾病、青光眼、眼部手术及屈光不正病史与干眼无相关性.结论 干眼与年龄、性别及职业相关,糖尿病、翼状胬肉、长期使用滴眼液和视频终端这些因素可能是新疆干眼相关的危险因素.     

Evaluations of wavefront aberrations and corneal surface regularity in dry eye patients measured with OPD Scan III

AIM: To compare the wavefront aberrations and corneal surface regularity between dry eye (DE) patients and normal subjects and assess its diagnostic performance for DE measured with OPD Scan-III. METHODS: Fifty right eyes of 50 DE patients and 31 right eyes of normal subjects were included. The examinations for ocular surface including logarithm of the minimum angle of resolution best-corrected distance visual acuity (logMAR BCVA) the ocular surface disease index (OSDI), tear film break-up time (TBUT) and corneal fluorescein staining (CFS). OPD Scan-III was used to measure anterior corneal aberrations including total corneal aberrations, high order aberration (HOA), coma, trefoil, spherical aberration (SA), standard deviation of corneal power (SDP), surface regularity index (SRI) and surface asymmetry index (SAI). Statistical analysis were assessed with nonparametric tests and Spearman’s correlations. All parameters were also analyzed for sensitivity, specificity, and receiver operating characteristics (ROC) curves. RESULTS: Wavefront aberrations parameters including total corneal aberrations, HOA, coma, trefoil, and SA in DE group were significantly higher than those in normal group (P<0.001). Corneal surface regularity parameters including SRI and SAI in DE group were significantly higher than both in normal group (P<0.05). All the wavefront aberrations parameters had significant correlations with ocular surface parameters (P<0.05). The logMAR BCVA had positive correlations with SAI and SRI (all P<0.001). CFS scores had positive correlations with SAI and SRI (all P<0.001). All the wavefront aberrations parameters showed good diagnosis sensitivity and specificity, however, the corneal regularity parameters showed only good specificity but poor sensitivity. The cut-off value selected for trefoil in diagnosis DE showed the highest area under the curve (AUC, 0.921) values as compared to the other parameters with sensitivity of 0.955 and specificity of 0.867. CONCLUSION: Wavefront aberrations and corneal surface regularity are increased in DE patients and also correlated with ocular surface parameters. Wavefront aberrations parameters have potential to be indicators to diagnosis and monitor DE.     

Wavefront aberrations associated with the Ferrara intrastromal corneal ring in a keratoconic eye

PURPOSE: To describe the optical implications of the aberration pattern of a keratoconic eye implanted with an intrastromal corneal ring (Ferrara ring). METHODS: A 32-year-old man with bilateral keratoconus had a Ferrara intrastromal corneal ring implanted in his right eye. Surgery was uneventful and both uncorrected (UCVA) and best spectacle-corrected (BSCVA) visual acuity improved. Corneal topography was performed before and after surgery. Wavefront measurements were performed 1 month after the procedure in both eyes for comparison. The point spread function, modulation transfer function (MTF), and convolved acuity chart were analyzed. RESULTS: The right eye--implanted with the intrastromal Ferrara ring--had high root-mean-square (RMS) values for higher order aberrations. The left eye-keratoconus without an intrastromal ring-had moderate values. Point spread function, MTF, and convolution acuity charts are presented for each eye, with the latter two showing improved visual function in the implanted eye, despite a higher aberration value. CONCLUSION: The wavefront measurement device captured aberrations even in a highly aberrated eye. Despite better UCVA and BSCVA, the Ferrara ring notably increased higher order aberrations compared to the fellow eye, but with a more uniform central pattern. In this case, the larger RMS value was a poor predictor of good visual function; other metrics better predicted the patient's subjective response. Metrics other than RMS error may be necessary to better correlate aberration value with visual satisfaction in some eyes.     

糖尿病相关干眼发病机制的研究进展

糖尿病(DM)已成为世界范围内最严重的健康问题之一。糖尿病在眼部会引起角膜神经损伤、泪液成分改变、泪膜稳定性差、泪液渗透压升高、免疫炎症反应和细胞凋亡等,这增加了眼表疾病的风险。其中,眼表疾病又以干眼发病率高为著。本文就糖尿病相关干眼的患病相关因素、患病率及发病机制进行综述,以期对临床治疗提供思路。     

Laser-assisted subepithelial keratectomy for dry eye associated with soft contact lenses

PURPOSE: To evaluate the efficacy and safety of laser-assisted subepithelial keratectomy (LASEK) in myopic patients with preoperative dry eye associated with extended soft contact lens use. SETTING: Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. METHODS: This nonrandomized prospective interventional case series study comprised 9 patients (18 eyes) with dry eye and keratoconjunctivitis associated with long-term complicated soft contact lens use. Prior to LASEK surgery and for 1 year following surgery, measurements and comparisons were made of uncorrected visual acuity, best corrected visual acuity (BCVA), manifest refraction, symptoms, tear function, ocular surface abnormality, and corneal sensitivity. RESULTS: No significant differences (P > .05) in the mean results of the Schirmer test with anesthesia and tear breakup times before and after LASEK were evident. Corneal sensitivity recovered within 1 month after LASEK. No complications occurred during or after LASEK. Subepithelial haze and superficial punctate epithelial defects occurred in 1 eye, representing a loss of 1 Snellen line of BCVA. CONCLUSION: Laser-assisted subepithelial keratomileusis in dry eyes and keratoconjunctivitis associated with complicated soft contact lens wearing was safe and efficacious.