TFOS DEWS II Diagnostic Methodology report

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To determine whether tear osmolarity contributes to the assessment of the ocular surface in soft contact lens (CL) wearers. Prospective, case-control series in 44 CL wearers (28 tolerant and 16 intolerant) and 34 healthy subjects. Every patient underwent a thorough ophthalmic examination with a tear osmolarity test (TearLab System), conjunctival impression cytology and meibomian lipid sampling. Symptoms, break-up time (BUT), tear osmolarity, conjunctival expression of HLA-DR and meibomian fatty acid composition were evaluated. Tear osmolarity did not differ between controls and CL wearers (p= 0.23). Flow cytometry results expressed in antibody-binding capacity (ABC) units and percentage of positive cells revealed a significant difference between the intolerant CL wearer group and the control group (p< 0.0001). Comparisons between tolerant and intolerant CL wearers showed only a significant difference for mean fluorescence levels expressed in ABC units (p< 0.0001). The BUT was significantly shorter in intolerant and tolerant CL wearers subjects than in healthy subjects (p< 0.0001), whereas there was no significant difference in meibomian fatty acid composition (p= 0.99) between the two groups. Contact lens wear is responsible for ocular surface alterations whose patterns are very similar to those reported in early dry-eye syndrome. However, tear osmolarity was not modified in these selected CL wearers. The yield of tear osmolarity with TearLab™ in assessing ocular surface disorders in CL wearers deserves further investigation.

Understanding the Dual Dilemma of Dry Eye and Glaucoma: An International Review.

To investigate the efficacy of umbilical cord serum eyedrops after laser epithelial keratomileusis (LASEK). Sixty patients (120 eyes) with myopia who underwent LASEK were studied. Thirty-two patients (64 eyes) were treated with 20% umbilical cord serum eyedrops in combination with conventional treatment (group A), and 28 patients (56 eyes) received conventional treatment only (group B). Epithelial healing time was analysed. Visual acuity, refraction, haze score (0-4) and tear film and ocular surface parameters were evaluated at 1, 2, 4 and 12 weeks after LASEK. The concentration of transforming growth factor (TGF)-β1 in tears was measured with ELISA at 1 week after LASEK. No significant differences in visual acuity and refraction were found between groups. The mean time to epithelial healing was 3.53 ± 1.19 days in group A and 3.91 ± 1.41 days in group B (p = 0.18). The mean haze scores at 2 and 4 weeks were 0.59 ± 0.80 and 0.31 ± 0.54 in group A and 1.06 ± 0.91 (p = 0.02) and 0.69 ± 0.78 (p = 0.03) in group B. Four and 12 weeks after LASEK, tear film break-up time was longer and keratoepitheliopathy score was lower in group A compared with group B. The mean concentration of TGF-β1 was lower in group A compared with group B (p = 0.01). Application of 20% umbilical cord serum eyedrops in addition to conventional treatment after LASEK can reduce early postoperative corneal haze and improve tear film and ocular surface parameters.

The Changing Times in Dry Eye Research

PurposeTo assess the effect of dry eye disease (DED) treatment according to the guidelines reported by the International Dry Eye WorkShop (DEWS) in 2007.MethodsDry eye disease patients with or without meibomian gland dysfunction (MGD), treated at the Norwegian Dry Eye Clinic, with at least 6 months follow‐up time were consecutively included in the study. The choice of treatment for DED was based on the dry eye severity level (DESL), according to the 2007 Report of the International Dry Eye WorkShop (DEWS). The values of tear film break‐up time (TBUT), Schirmer I test, ocular surface staining (Oxford scale), and dry eye severity level (DESL) on the right eye at 1, 3, 6, 12, and 24 months after the treatment were compared with those prior to treatment.ResultsA total of 237 eyes were included. At 6 months follow‐up, TBUT increased from 5.07 ± 3.63s to 8.54 ± 5.12s (p &lt; 0.001); Schirmer I test did not show significant change; ocular surface staining decreased from 1.64 ± 2.13 to 0.76 ± 1.20; and DESL decreased from 2.08 ± 0.47 to 1.72 ± 0.54 (p &lt; 0.001). The improvement of TBUT, ocular surface staining, and DESL remained significant at 24 months follow‐up.ConclusionsTreatment based on the 2007 Report of the International Dry Eye WorkShop (DEWS) was effective in a Norwegian cohort of DED patients with significant improvement in key parameters for assessing DED.

PurposeTo assess the effect of dry eye disease (DED) treatment according to the guidelines reported by the International Dry Eye WorkShop (DEWS) in 2007.MethodsDry eye disease patients with or without meibomian gland dysfunction (MGD), treated at the Norwegian Dry Eye Clinic, with at least 6 months follow‐up time were consecutively included in the study. The choice of treatment for DED was based on the dry eye severity level (DESL), according to the 2007 Report of the International Dry Eye WorkShop (DEWS). The values of tear film break‐up time (TBUT), Schirmer I test, ocular surface staining (Oxford scale), and dry eye severity level (DESL) on the right eye at 1, 3, 6, 12, and 24 months after the treatment were compared with those prior to treatment.ResultsA total of 237 eyes were included. At 6 months follow‐up, TBUT increased from 5.07 ± 3.63 s to 8.54 ± 5.12 s (p &lt; 0.001); Schirmer I test did not show significant change; ocular surface staining decreased from 1.64 ± 2.13 to 0.76 ± 1.20; and DESL decreased from 2.08 ± 0.47 to 1.72 ± 0.54 (p &lt; 0.001). The improvement of TBUT, ocular surface staining, and DESL remained significant at 24 months follow‐up.ConclusionsTreatment based on the 2007 Report of the International Dry Eye WorkShop (DEWS) was effective in a Norwegian cohort of DED patients with significant improvement in key parameters for assessing DED.

Purpose Inter-eye variability is a recognized characteristic of Dry Eye Disease (DED) and has been proposed as a diagnostic indicator in clinical practice. This study aimed to assess the diagnostic potential of the absolute difference between eyes in three key diagnostic tests recommended by the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Diagnostic Methodology report: tear film osmolarity, Fluorescein Break-Up Time (FBUT), and ocular surface staining. Methods A total of 180 participants were included in a cross-sectional study. Before a dry eye examination, participants completed an online self-administered OSDI questionnaire. The TFOS DEWS II diagnostic criteria for DED assessment were used: along with OSDI, osmolarity, FBUT and ocular surface staining were measured in all participants in both eyes following standardized methodology. Based on signs and symptoms, participants were diagnosed as having No DED or DED. After diagnosis, the parameters were computed as the right and left eyes’ absolute inter-eye difference (|OD-OS|). Results Receiver Operating Characteristics analyses for computed parameters were used based on the previous diagnosis. ROC analyses showed that Osmolarity|OD-OS| have a diagnostic capability to differentiate between No DED and DED participants with a cut-off value of 9.5 mOsm/L (AUC = 0.745 ± 0.052, p < 0.003), whereas FBUT|OD-OS| and Corneal Stainning|OD-OS| have not (AUC, both p ≥ 0.160). Conclusion The present study found that the Osmolarity|OD-OS| parameter could be used as a diagnostic indicator for DED assessment, while the FBUT|OD-OS| and the Corneal Staining|OD-OS| parameters do not have this capability.

Clinical subtypes of dry eye in youthful clinical sample in Ghana.

PurposeDry eye disease (DED) is a multifactorial condition characterized by the loss of ocular surface homeostasis, causing discomfort and ocular symptoms. Higher age, female sex, and meibomian gland dysfunction (MGD) are some of the reported risk factors for DED. However, age-specific studies of DED are rare. This study aimed to determine the prevalence of DED and MGD in a cohort of Norwegians in their mid-60s. Additionally, to investigate potential sex-related differences in the prevalence of DED and MGD.MethodsFor this cross-sectional study, a random sample of 137 demographically homogeneous Norwegian residents of Oslo in their mid-60s was recruited. Participants completed the Ocular Surface Disease Index (OSDI) dry eye symptom questionnaire and underwent clinical dry eye examinations. DED was defined as OSDI ≥ 13, accompanied by fluorescein break-up time (FBUT) < 10s and/or ocular surface staining (OSS) ≥ 1. The presence of MGD was defined as a score of 1 for both meibum quality (MQ) and meibum expressibility (ME) or a score > 1 for either MQ or ME.ResultsThe overall prevalence for DED was 20.4% [95% CI: 14.0 to 28.2], and for MGD was 90.5% [95% CI: 84.3–94.9]. No significant sex differences were observed for either condition. MGD was highly prevalent among both DED and non-DED participants: all individuals with DED (n = 28) had MGD, while among those without DED (n = 109), prevalence was 88.1% (males: 85.7%; females: 90.0%). No significant correlation was found between MGD and sex (rs ([137] = [0.075], p = 0.413). In the whole cohort, OPI and FBUT correlated positively with ME (rs ([132] = [0.437] and rs ([132] = [0.296], both p <0.001) and negatively with OSS (rs ([132] = [−0.315] and rs ([132] = [0.423], both p<0.001) and lid margin abnormality (rs ([130] = [−0.222], p = 0.011; rs ([132] = [0.234], p = 0.007). FBUT correlated also positively with tear production (rs ([128] = [0.308], p<0.001). A more frequent use of topical ocular lubricant was found among females (p = 0.043). In the symptomatic group, females had significantly lower OPI and FBUT values (p = 0.046 and 0.027, respectively). Among symptomatic participants, categorized as mild (OSDI 13–22), moderate (OSDI 23–32), and severe (OSDI 33–100), only in the severe group did females show higher OSDI scores (p=0.042) but lower OSS (p=0.031) compared to males.ConclusionIn this cohort of Norwegians in their mid-60s, DED and MGD were highly and equally prevalent among both sexes. The high prevalence of these conditions underscores the need to raise awareness of DED and MGD within the young elderly population.

Painful Dry Eye Symptoms: A Nerve Problem or a Tear Problem?

Dry eye disease (DED) is a leading cause of ocular morbidity worldwide. This study evaluates the effects of combined light therapy [intense pulsed light (IPL) and low-level light therapy (LLLT)] on clinical and molecular outcomes in evaporative DED with meibomian gland dysfunction (MGD). This prospective study evaluated 94 eyes (47 subjects) with chronic MGD treated with combined light therapy. Patients underwent a detailed evaluation of MGD and DED using the Ocular Surface Disease Index, dry eye tests-tear breakup time and Schirmer test, ocular surface staining, meibomian gland expressibility scoring, and meibography. Patients underwent a single session of combined light therapy (IPL + LLLT treatment) using the Eye-light device. All these tests were repeated at 3 and 6 months after treatment. Tear fluid and ocular surface wash samples were collected from a subset of patients before and after treatment for cellular and secreted immune factor profiling by flow cytometry. Combined light therapy (IPL + LLLT) demonstrated a marked improvement in the clinical metrics studied. Three months after treatment, Ocular Surface Disease Index showed a significant reduction in 95.6% ( P < 0.0001), tear breakup time increased in 72.3% ( P < 0.0001), and meibomian gland expressibility scoring increased in 80.8% ( P < 0.0001) of the eyes. These effects were observed to be sustained during the 6-month follow-up visit. Significant ( P < 0.05) reduction in tear fluid levels of interleukin-1β, interleukin-17F, and MMP9; MMP9/TIMP1 ratio; and ocular surface B-cell proportions was observed. Combined light therapy shows promising results in patients with chronic MGD and DED, even in recalcitrant cases. Clinical and molecular factor alterations support the improved symptomatology and reduced inflammation.

To determine the effects of clinical variables, including age, sex, history of refractive or cataract surgery, contact lens use, and ocular surface and meibomian gland parameters on the lipid layer thickness (LLT) in normal subjects and patients with dry eye syndrome (DES). A total of 64 normal subjects and 326 patients with DES were enrolled, and they underwent measurements of LLT with a LipiView interferometer and tear meniscus height using optical coherence tomography, tear film break-up time (TBUT) determination, ocular surface staining, Schirmer's test, examination of the lid margins and meibomian glands, and assessment using the Ocular Surface Disease Index (OSDI). In normal subjects, the median (range) LLT was 67 (33-100) nm, and age was the only factor that was significantly associated with LLT (β = 0.678, P = 0.028). In patients with DES, the median (range) LLT was 84 (20-100) nm, and 79.0% of the participants fulfilled the diagnostic criteria for meibomian gland dysfunction (MGD). In a multivariate analysis, increased age and female sex were significantly related to increased LLT (β = 0.282, P = 0.005 and β = 11.493, P < 0.001), and hypersecretory MGD and lid margin inflammation were independently associated with increased LLT (β = 11.299, P = 0.001 and β = 12.747, P = 0.001). Lipid layer thickness measurements using a new interferometer are significantly affected by demographic factors such as age, sex, ocular surgical history, and MGD type. Therefore, all of these factors must be considered in the diagnosis of ocular surface diseases.

To evaluate the effects of video display terminal (VDT) work and meibomian gland dysfunction (MGD) on ocular surface parameters, tear cytokine and substance P (SP) levels, and their association with dry eye disease (DED). This cross-sectional study included 60 patients with evaporative DED and 20 healthy individuals. The DED patients were divided into three groups according to daily VDT work time and presence of MGD. The ocular surface and tear film were assessed using the Ocular Surface Disease Index questionnaire (OSDI), tear film break-up time (TBUT), ocular surface staining, Schirmer II test, and corneal sensitivity. MGD was evaluated with meibography. Corneal nerve alterations were evaluated using in vivo confocal microscopy (IVCM). The tear levels of 30 cytokines and SP were examined. Compared to controls, DED patients had higher OSDI score (p < 0.001), increased corneal staining with fluorescein and lissamine green (p = 0.046, p = 0,038), and lower TBUT (p < 0.001). Tear interleukin-6 levels were higher in DED patients, while tear SP levels did not differ between the groups (p = 0.265). VDT work time showed a weak positive correlation with OSDI (r = 0.274, p = 0.014) and SP level (r = 0.284, p = 0.011). The results of this study show that VDT use and MGD have an adverse effect on the ocular surface. It was also observed that the combination of VDT use and MGD did not significantly increase the ocular surface disease, but longer VDT exposure may be associated with more complaints of ocular discomfort.

To evaluate the efficacy and safety of new moist cool air device (MCAD) for ocular symptoms, tear film stability and ocular surface status in office workers with dry eye disease (DED). In this prospective single-centre clinical trial, 40 eyes of 20 patients with DED were recruited and randomly divided into two groups (group with MCAD exposure and group without MCAD). All subjects are visual display terminals (VDTs) workers spending at least 4 h/day in front of VDTs. Patients using MCAD underwent moist air applications for 4 h/day for a total of five working weekdays during VDT works at their offices. The other group of patients performed their VDT work without moist cool air device exposure. The change in symptoms of ocular surface (OS) dryness, fatigue and discomfort was evaluated using visual analogue scale (VAS) scores. Changes in visual function, tear functions and ocular surface status were evaluated using best-corrected visual acuity (BCVA), the functional visual acuity (FVA) test, blink rate, BUT measurements, strip meniscometry (SM), tear evaporation rate, fluorescein staining and rose bengal staining scores. Tear film lipid layer interferometry was also performed to assess the status of the lipid layer over the tear film. In addition, adverse events were recorded. In group with MCAD, symptoms of OS dryness during VDTs work, and FVA and BUT were significantly improved. SM and tear evaporation rate were significantly improved. There were no statistically significant differences on lipid layer stability and corneal staining scores in both groups. Blink rate was significantly increased in group without MCAD. No adverse events were reported during this trial. Moist cool air device use provided symptomatic relief of ocular dryness and improvement on tear stability in office workers with DED. This new device seems to be a safe and promising alternative in the treatment of DED.