Abstract
ObjectiveTo elucidate the relationship between lipid layer thickness (LLT), incomplete blinking rate and tear film stability in patients with different myopia degrees after small-incision lenticule extraction (SMILE) and to determine whether there is a difference in the prevalence of dry eye disease (DED) after SMILE among patients with different myopia degrees.MethodsFifty patients (100 eyes) were enrolled in this study; they were divided into 3 groups according to the degree of spherical refraction: a low-myopia group (LMG; spherical refraction ≤-3.00 D, 20 eyes), a moderate-myopia group (MMG; -3.00 D < spherical refraction <-6.00 D, 40 eyes), and a high-myopia group (HMG; spherical refraction ≧-6.00 D, 40 eyes). Testing indicators included the ocular surface disease index (OSDI), fluorescein tear film breakup time (FBUT), corneal fluorescence staining (CFS), the Schirmer test (SI), lipid layer thickness (LLT), blink rate (BR) per 20 seconds, incomplete blinking rate, noninvasive keratograph assessment of first and average tear film breakup time (NIKBUTf, NIKBUTav), and tear meniscus height (TMH). Each indicator was evaluated preoperatively and postoperatively at 1 w, 1 mo and 3 mo.ResultsThe mean age was 29.12±5.95 years. There were no significant differences among the three groups (p>0.05), except preoperative age (p = 0.006). There were significant differences in the FBUT among the three groups at postoperative 1 w and 1 mo (p<0.05). There were significant differences in the incomplete blinking rate and FBUT between the LMG and the HMG at postoperative 1 mo (p<0.05). The number of first tear film breakup points located beyond the 6 mm diameter of the cornea was higher in the HMG than in the other groups. The prevalence of DED in the LMG, the MMG, the HMG was 15%, 8% and 23%, respectively, at 1 w postoperative and 30%, 45% and 53%, respectively, at postoperative 1 mo. The change in LLT was significantly correlated with the changes in FBUT (r = 0.408, p<0.001) and incomplete blinking rate (r = -0.266, p = 0.007). The change in OSDI was negatively correlated with the change in SI (r = -0.502, p = 0.000).ConclusionsThe changes in LLT and incomplete blinking rate decreased the stability of the tear film. The changes in LLT, FBUT and incomplete blinking rate differed postoperatively with different myopia degrees. The prevalence of DED was higher in the HMG than in the other two groups.
Highlights
Dry eye disease (DED) presents a multifactorial pathology at the ocular surface, including tear film changes with or without corneal damage, ocular symptoms, visual degradation, and increased tear osmolarity, which together lead to a reduction in quality of life[1]
The changes in lipid layer thickness (LLT) and incomplete blinking rate decreased the stability of the tear film
The prevalence of dry eye disease (DED) was higher in the high-myopia group (HMG) than in the other two groups
Summary
Dry eye disease (DED) presents a multifactorial pathology at the ocular surface, including tear film changes with or without corneal damage, ocular symptoms, visual degradation, and increased tear osmolarity, which together lead to a reduction in quality of life[1]. The lipid layer is located in the outermost layer of the tear film, which helps the tear film respread after blinking and prevents water evaporation. The change in its composition, distribution, and thickness are associated with DED[7]. Studies have shown that an increase in incomplete blinking leads to an inadequate lipid distribution and consequent exposure over the inferior ocular surface, which may increase evaporation[11,12,13]
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