Dry Eye Assessment Research Articles

Agreement of noninvasive tear break-up time measurement between Tomey RT-7000 Auto Refractor-Keratometer and Oculus Keratograph 5M.

BackgroundIt is difficult to standardize assessment of dry eye in different clinical settings. Increasingly, tear stability is recognized to be important for the definition and assessment of patients with dry eye. Recently, two commercially available instruments have been made available for objectively measuring noninvasive tear break-up time (NIBUT), as an indicator of tear stability: the Tomey RT-7000 Auto Refractor-Keratometer and Oculus Keratograph (K)5M. We aim to assess the agreement of NIBUT measurements using these modalities.MethodsThis prospective cross-sectional study was carried out in a tertiary referral eye center and involved 126 consecutive dry eye patients. NIBUT assessment was performed on the right eyes of participants with both the RT-7000 and the K5M techniques, with the order of assessment randomized. The Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaires were administered to assess dry eye symptoms in the 2 weeks before assessment.ResultsThe age of the participants was 56.0±14.3 years (69.84% females). Measurements for both modalities were non-normally distributed (right-skewed). The median RT-7000 and K5M readings were 4.2 (range 0.1–10.0) and 6.4 (0.1–24.9) seconds, respectively. RT-7000 and K5M readings were poorly correlated (ρ=0.061, P=0.495). Intraclass correlation coefficient between the modalities was 0.187 (95% confidence interval −0.097 to 0.406). The Bland–Altman plot showed no systematic differences between the readings with these machines. The agreement between machines was not different in different SPEED categories.ConclusionWhile there are theoretical and practical benefits of NIBUT for assessment of tear stability over dye-based methods, the agreement between the two modalities was poor. Hence, studies and trials assessing NIBUT should avoid using these modalities interchangeably for NIBUT assessment. More research is needed to improve consensus on how to determine NIBUT.

A Cross Sectional Study to assess prevalence of Computer Vision Syndrome and vision related problems in Computer Users

The aim was to assess prevalence of computer vision syndrome and find association of various factors with occurrence of symptoms. Methods- In this cross-sectional study participant were surveyed using self administered questionnaire and underwent complete ophthalmological and dry eye assessment. Results- A total of 150 participants aged 18-40 years were examined. Majority of the patients were in the age group of 26-30 years, who accounted for 57 cases i.e. 38% of total cases. Male and Female sex distribution was unequal in this study. Males 81 (54%) and females 69 (46%). The prevalence of symptoms of CVS was found to be 75.33% (113/150); most disturbing symptom was headache 101/150 (67.33%), tired eyes 76(50.66%) ,pain behind eyes 74(49.33%) Majority of patients 97 (64.66%) used computer for 4-6 hours. Abnormal TBUT 56 (37.4%), Schirmer’s Test II 42 (28%), Tear height meniscus 59 (39.4%), fluroscein staining findings 15 (10%), lissamine green staining findings 20 (13.33%) and conjunctival impression cytology findings were reported as mild dysplasia in 25 (16.66%), moderate dysplasia 7(4.66%), severe dysplasia 3 (2%), acute inflammatory lesions 5 (3.33%) & inclusion of Chlamydia trachomatis body was seen in 1. Knowledge about CVS was present in 65(43.33%). Conclusion- Most participants had CVS and its severity was correlated with prolonged working hours on

IDEAS: A web-based system for dry eye assessment

Background and objectivesDry eye disease is a public health problem, whose multifactorial etiology challenges clinicians and researchers making necessary the collaboration between different experts and centers. The evaluation of the interference patterns observed in the tear film lipid layer is a common clinical test used for dry eye diagnosis. However, it is a time-consuming task with a high degree of intra- as well as inter-observer variability, which makes the use of a computer-based analysis system highly desirable. This work introduces iDEAS (Dry Eye Assessment System), a web-based application to support dry eye diagnosis. MethodsiDEAS provides a framework for eye care experts to collaboratively work using image-based services in a distributed environment. It is composed of three main components: the web client for user interaction, the web application server for request processing, and the service module for image analysis. Specifically, this manuscript presents two automatic services: tear film classification, which classifies an image into one interference pattern; and tear film map, which illustrates the distribution of the patterns over the entire tear film. ResultsiDEAS has been evaluated by specialists from different institutions to test its performance. Both services have been evaluated in terms of a set of performance metrics using the annotations of different experts. Note that the processing time of both services has been also measured for efficiency purposes. ConclusionsiDEAS is a web-based application which provides a fast, reliable environment for dry eye assessment. The system allows practitioners to share images, clinical information and automatic assessments between remote computers. Additionally, it save time for experts, diminish the inter-expert variability and can be used in both clinical and research settings.

Assessment of dry eye in rural hospital setting, B.G. Nagara, Karnataka

Background: Dry eye is a common condition that is often under diagnosed. Normal vision requires moist healthy ocular surface. A sufficient quality of tears, normal composition of tears film, lid closure to maintain healthy ocular surface. Due to lack of uniformity in definition and inability of any single diagnostic test or set of diagnostic test to confirm or rule out the condition. There has been a shift towards symptom based assessment as a key component in clinical diagnosis with grading of severity of dry eye. Use of symptom based validated questionnaire might be beneficial as it allows grading of symptoms and is repeatable for comparative purpose before, during and after treatment. Recent advances in treatment suggests the use of lubricants, anti-inflammatory drugs, plugs to augment the tear film. Objectives: A prospective study was conducted to assess the dry eye in rural hospital setting at B.G. Nagara Karnataka with the objective to study the frequency of occurrence of dry eye and identify risk factors, correlate dry eye status with clinical tests, demographic and disease profile and devise appropriate therapy. Methods: A total of 63 cases were chosen from the outpatient department of Sri Adichunchanagiri Institute Of Medical Sciences and assessment of dry eye were made by tests like Tear breakup time, Schirmer’s, Rose Bengal dye test with prior administered Ocular surface disease index (OSDI) questionnaire for subjective grading of dry eye. Results: In our study majority 31.7% patients were in the group 41-50 years. Prevalence of overall dry eye in our study was 85.7%. Prevalence was more in females as compared to males. Risk factors associated with dry eye were identified with diabetes mellitus type II being more prevalent among them. In the study Osdi questionnaire had a good reliability and consistency (p

Tear film osmolarity in ocular mucous membrane pemphigoid.

The aim of this study was to evaluate tear film osmolarity in patients with ocular mucous membrane pemphigoid (MMP). This observational cross-sectional study included 40 patients with biopsy-proven ocular MMP at Foster stage III referred to the tertiary-care Ocular Immunology and Uveitis Service at the San Raffaele Scientific Institute in Milan from June 2010 to August 2013. We evaluated the following clinical parameters: tear film osmolarity, ocular surface disease symptoms (OSDI) questionnaire, Schirmer test, tear film break-up time (TFBUT), and corneal and conjunctival staining. Forty patients (27 women and 13 men) were enrolled. All patients were undergoing systemic immunosuppressive therapy: 19 patients (47.5%) were on methotrexate, 9 (22.5%) were on mycophenolate mofetil, 9 (22.5%) were on low-dose corticosteroids, and 3 (7.5%) were on azathioprine. The mean osmolarity was 322.90 ± 33.39 mOsm/L, the mean OSDI score was 73.2 ± 17.9, the mean TFBUT was 6.60 ± 3.13 seconds, and the mean Schirmer test value was 4.07 ± 3.58 seconds. Tear film osmolarity significantly correlated with the TFBUT (r = 0.80; P < 0.0001), whereas no clinical correlation was found with the Schirmer test value (r = 0.01; P = 0.40) or with the OSDI score (r = 0.02; P = 0.29). Osmolarity did not turn out to be statistically different in the subgroups according to the Oxford corneal staining scale (P = 0.71) and to the Van Bijsterveld conjunctival staining score (P = 0.31). Tear osmolarity increased in patients with ocular MMP and correlated with the TFBUT. This result emphasizes the role of evaporative dry-eye condition in patients with ocular MMP. Tear osmolarity may be considered as a useful test in the diagnostic assessment of dry eye associated with MMP and for targeting therapeutic decisions.

The Effects of Smoking on Anterior Segment Parameters, Retinal Nerve Fiber Layer, and Pupillary Functions

Address for Correspondence/Yazisma Adresi: Bengu Ekinci Koktekir MD, Selcuk University School of Medicine, Department of Ophthalmology, Konya, Turkey Gsm: +90 532 353 27 16 E-mail: benguekinci@hotmail.com Received/Gelis Tarihi: 23.06.2013 Accepted/Kabul Tarihi: 23.07.2013 This study was presented as free paper presentation in the 46th Annual Turkish Ophthalmological Society Meeting, Antalya, Turkey, 2012 Objectives: To evaluate the alterations in the anterior segment parameters, retinal nerve fiber layer, and pupillary functions in smokers. Materials and Methods: In this case-control study, 45 eyes of 45 smokers and 45 eyes of 45 non-smoker control subjects were evaluated. All patients underwent measurement of anterior segment parameters with optical low coherence reflectometry (OLCR), mesopic and photopic pupillary diameter with an aberrometer device, retinal nerve fiber layer thickness with optical coherence tomography, and dry-eye assessment with Schirmer’s test. The results were compared with independent t-test by SPSS 16.0 Inc., and a p-value lower than 0.05 was determined as significant. Results: There was a significant difference between both groups in terms of mesopic pupil diameters that were measured with both OLCR and aberrometer device (p=0.03 and 0.02, respectively). Schirmer scores were also significantly decreased in smokers (p=0.001). The other measured parameters demonstrated no difference between smokers and non-smokers (p>0.05 for all). Conclusion: Smoking may affect pupillary functions, especially the mesopic pupillary diameter, and may cause a deficiency in pupil response under dark circumstances. (Turk J Ophthalmol 2014; 44: 11-4)

Corneal Inflammatory Events with Daily Silicone Hydrogel Lens Wear

This study aimed to determine the probability and risk factors for developing a corneal inflammatory event (CIE) during daily wear of lotrafilcon A silicone hydrogel contact lenses. Eligible participants (n = 218) were fit with lotrafilcon A lenses for daily wear and followed up for 12 months. Participants were randomized to either a polyhexamethylene biguanide-preserved multipurpose solution or a one-step peroxide disinfection system. The main exposures of interest were bacterial contamination of lenses, cases, lid margins, and ocular surface. Kaplan-Meier (KM) plots were used to estimate the cumulative unadjusted probability of remaining free from a CIE, and multivariate Cox proportional hazards regression was used to model the hazard of experiencing a CIE. The KM unadjusted cumulative probability of remaining free from a CIE for both lens care groups combined was 92.3% (95% confidence interval [CI], 88.1 to 96.5%). There was one participant with microbial keratitis, five participants with asymptomatic infiltrates, and seven participants with contact lens peripheral ulcers, providing KM survival estimates of 92.8% (95% CI, 88.6 to 96.9%) and 98.1% (95% CI, 95.8 to 100.0%) for remaining free from noninfectious and symptomatic CIEs, respectively. The presence of substantial (>100 colony-forming units) coagulase-negative staphylococci bioburden on lid margins was associated with about a five-fold increased risk for the development of a CIE (p = 0.04). The probability of experiencing a CIE during daily wear of lotrafilcon A contact lenses is low, and symptomatic CIEs are rare. Patient factors, such as high levels of bacterial bioburden on lid margins, contribute to the development of noninfectious CIEs during daily wear of silicone hydrogel lenses.

Tear function and ocular surface after muller muscle- conjunctival resection

Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function.

Prevalence of dry eye syndrome in an adult population

To determine the prevalence of dry eye syndrome in the general 40- to 64-year-old population of Shahroud, Iran. Population-based cross-sectional study. Through cluster sampling, 6311 people were selected and 5190 participated. Assessment of dry eye was done in a random subsample of 1008 people. Subjective assessment for dry eye syndrome was performed using Ocular Surface Disease Index questionnaire. In addition, the following objective tests of dry eye syndrome were employed: Schirmer test, tear break-up time, and fluorescein and Rose Bengal staining using the Oxford grading scheme. Those with an Ocular Surface Disease Index score ≥23 were considered symptomatic, and dry eye syndrome was defined as having symptoms and at least one positive objective sign. The prevalence of dry eye syndrome was 8.7% (95% confidence interval 6.9-10.6). Assessment of signs showed an abnormal Schirmer score in 17.8% (95% confidence interval 15.5-20.0), tear break-up time in 34.2% (95% confidence interval 29.5-38.8), corneal fluorescein staining (≥1) in 11.3% (95% confidence interval 8.5-14.1) and Rose Bengal staining (≥3 for cornea and/or conjunctiva) in 4.9% (95% confidence interval 3.4-6.5). According to the Ocular Surface Disease Index scores, 18.3% (95% confidence interval 15.9-20.6) had dry eye syndrome symptoms. The prevalence of dry eye syndrome was significantly higher in women (P = 0.010) and not significantly associated with age (P = 0.291). The objective dry eye syndrome signs significantly increased with age. Based on the findings, the prevalence of dry eye syndrome in the studied population is in the mid-range. The prevalence is higher in women. Also, objective tests tend to turn abnormal at higher age. Pterygium is associated with dry eye syndrome and increased its symptoms.

THU0349 Assessment of dry eye symptoms in primary fbromyalgia

BackgroundWhile dry eye symptoms and signs have been frequently reported in fibromyalgia patients, no study so far has specifically investigated the concordance between subjective symptoms and objective findings in this...

Ocular effects of pegylated interferon-α in patients with chronic hepatitis B

Purpose: To evaluate the early retinal changes and its reflection on the visual field examination in chronic hepatitis B (CHB) patients using pegylated interferon-α (PEGIFN-α) monotherapy.Patients and methods: Thirty eyes of fifteen patients with CHB were examined prospectively for changes in the fundus examination and visual field examination (both Humphrey Perimetry and Frequency Doubling Perimetry). The patients were examined before and in 3 months intervals after starting the PEGIFN-α treatment. The changes in the fundus examination were noted and the visual field examinations, retinal nerve fiber thickness, Schirmer scores and color vision before and at 3 months of the treatment were compared. The statistical evaluation was performed with paired-t test, using SPSS 16.0 Inc. (Chicago, IL).Results: The mean age of the 15 patients (seven male, eight female) was 52.5 ± 12.4 years. There was no significant retinal change in none of the patients. Neither the visual field examination with Humphrey Field Analyzer nor the Frequency Doubling Perimetry results has demonstrated any significant change during 3 months follow-up. There was a statistically significant increase in the retinal nerve fiber layer (RNFL) thickness; while Schirmer test scores for dry eye assessment was significantly decreased.Conclusion: PEGIFN-α monotherapy, which is used for treatment of CHB, may cause some changes in the thickness of RNFL that may necessitate the close follow-up for further morphological changes of the optic disc in these patients.

Clinimetric methods in Sjögren's syndrome

Clinimetric tools are useful in both clinical practice and research of Sjögren's syndrome. These instruments assist in the establishment of diagnosis and in the evaluation of disease status. We reviewed the available methods used to monitor sicca signs and symptoms, fatigue, quality of life as well as activity/chronicity in SS. PubMed and MEDLINE database were searched for the keywords "keratoconjunctivitis sicca diagnosis," "dry eye and dry mouth assessment," "sialometry," "sialochemistry," "Sjögren's syndrome outcomes," "Sjögren's syndrome activity," "Sjögren's syndrome damage," "fatigue scales in Sjögren's syndrome," and "Sjögren's syndrome quality of life." All relevant articles and pertinent secondary references were reviewed. As there is a moderate correlation between sicca symptoms and signs, the assessment of both is crucial. Most of the tests focus on oral and ocular dryness (vital dye staining, tear quantification, tear composition, sialometry, sialochemistry, etc.) and may not be disease specific. Symptoms such as dryness and fatigue have been evaluated with different instruments, being the PROFAD and ESSPRI disease-specific tools. Standardized measures for activity (SSDAI, SCAI, and ESSDAI) and chronicity (SSDDI and SSDI) indexes are currently used, however these methods still present limitations such as low external validity and cross-validation. The heterogeneous nature of the disease and its slow progression, challenge the evaluation of these patients. The use of composite measures might increase our ability to diagnose and evaluate disease activity and cumulative irreversible organ injury in this disease. However the distinction among oral and ocular activity vs. damage is still a matter of research.

Assessment of dry eye after LASIK by real‐time measurement of higher order aberrations variation

AbstractPurpose To evaluate tear break‐up time (BUT) with real‐time (RT) higher order wavefront aberrations (HOA) measurements in myopic patients after Laser‐Assisted In Situ Keratomileusis (LASIK) surgery.Methods HOA up to the sixth order for a 4‐mm pupil were measured in 20 normal subjects (Group 1) and in 20 myopic patients, with no history of dry eye (DE), before and after LASIK surgery (Group 2), using the IRX3 (Imagine Eyes, Orsay, France) Hartmann‐Shack (H‐S) aberrometer. The HOA measurements were performed (in triplicate) with a new dedicated software, once every second for up to 20 seconds. HOA variations were compared with the BUT by the conventional fluorescein method (CFM).Results Twenty percent of the patients from Group 2 were complaining from DE symptoms. There was an excellent correlation between the HOA variation and the BUT recorded by the CFM in both groups. Reproducibility of the HOA measurements in all subjects and patients was excellent. BUT was significantly decreased (P&lt;0.005) in 30% of the patients in Group 2 when compared to the normal tests subjects (Group 1).Conclusion HS aberrometry is a non invasive method that has been used for the last decade for the assessment of the quality of vision, in patients undergoing refractive surgery and cataract or clear lens extraction. Studying the HOA variation is a new interesting method for evaluating both the quality vision and the BUT in patients after LASIK surgery.

Development of the 4–3–2–1 Meibum Expressibility Scale

With increased interest in the assessment of meibomian gland dysfunction and evaporative dry eye, there remains a deficit in simple, clinically applicable grading scales for gland expression. A new scale to assess meibum expressibility is described. A meibum expressibility scale was developed using a new standardized meibomian gland expression device, which provides constant pressure along the inferior lid. For the scale development, 30 patients (53.0±8.49 years; 93.33% female) with mild-to-moderate dry eye were compared with 13 normal, non-dry eye subjects (25.6±4.3 years; 46.1% female) using the meibum expression device developed by Korb and Blackie. The device was placed 4 glands lateral to the inferior punctum and 1 mm below the lash line and was held stable for 15 sec. The glands expressing meibum were counted. The weighted κ statistic was used to evaluate the extent of agreement, and a receiver operating characteristic curve was created to test the proposed scale. The mean number of glands that expressed from the worse lid in the normal group was 3.54±1.61, whereas 1.53±1.28 glands expressed in the dry eye group. In the dry eye group, 1 subject showed 5 glands expressing, and 29 demonstrated scores of 4 or less. In the normal group, 3 or more glands were expressible in 11 of 13 subjects. A 4-3-2-1 scoring system is proposed, whereby 4 or greater=normal expressibility, 3=mildly reduced expressibility, 2=moderately reduced expressibility, and 1 or lesser=severely reduced expressibility. Further validation of the scale is warranted.

Dry Eyes in Rheumatic Disease

Dry eyes are a frequent feature of routine ophthalmic clinical practice, but also form one of the commonest ocular manifestations of rheumatological disease. The spectrum of dry eye disease ranges from mild tear film instability through to severe dry eye which can threaten the integrity of the ocular surface and even lead to ocular perforation. This article discusses the disease pathophysiology and clinical manifestations of dry eye disease and also explores methods of diagnosis and assessment of dry eye. Current and emerging treatment modalities are also discussed, including the different types of ocular lubricants, the role of topical cyclosporine in the management of associated ocular inflammation, and mechanical measures such as plugging of the lacrimal punctum. Keywords: Dry eye, tear film, Sjogren syndrome, autoimmune diseases, Rheumatic Disease, ocular perforation, ocular lubricants,, topical cyclosporine, ocular inflammation, lacrimal punctum, rheumatoid arthritis, sclero-derma, polymyositis, lymphoma, amyloidosis, haemochro-matosis, sarcoidosis, systemic lupus erythematosus, ophthalmologists, optometrists, Schirmer test, corneal neovascularisation, symblepharon, cicatrisation, conjunctival epithelium, autonomic nerves, Goblet, cornea, mucin, meibomian glands, fatty acid, phospholipids, sphingomyelin, ceramides, cerebrosides, lyso-zyme, lactoferrin, growth factor-alpha, pons, trigeminal nerve, pterygopalatine ganglion, hyperosmolarity, MAP kinases, NFB, IL-1a, IL-1, TNF-a, MMP-9, lacrimal exhaustion, immunohomeostasis, autoantigens, fodrin, anti-M3 antibody, autoantibodies, cirrhosis, connective tissue disease, Congenital, dysautonomia, graft versus host disease, hema multiforme, LASIK refractive eye surgery, diabetes melli-tus, Rose Bengal dye, Auxiliary tests, Fluorescein, Lissamine green, The Schirmer Test, tear meniscometry, tear osmolarity, xerostomia, salivary gland biopsy, non-Hodgkin's B cell lymphomas, hyper-gammaglobulinaemia, non-inflammatory rheumatic disorder, allogeneic bone marrow trans-plantation, haematopoietic stem cell, histocompati-bility antigens, polyarteritis nodosa, Wegener's granulomatosis, human T-lymphotropic virus type 1, human immunodeficiency, lymphadenopathy, hepatitis C, fibronectin, neurotrophic growth, vitamin A, Benzalkonium chloriade, sodium perborate, collagen, diquafosol, Cevilimine, loteprednol, fluorometholone, azathioprine, methotrexate, lefluno-mide, hydroxychloroqine, mycophenolic acid, anti-B cell therapy, rituximab, meibomian gland, acne rosacea

Prevention of radiochemotherapy-induced toxicity with amifostine in patients with malignant orbital tumors involving the lacrimal gland: a pilot study

BackgroundTo use amifostine concurrently with radiochemotherapy (CT-RT) or radiotherapy (RT) alone in order to prevent dry eye syndrome in patients with malignancies located in the fronto-orbital region.MethodsFive patients (2 males, 3 females) with diagnosed malignancies (Non-Hodgkin B-cell Lymphoma, neuroendocrine carcinoma) involving the lacrimal gland, in which either combined CT-RT or local RT were indicated, were prophylactically treated with amifostine (500 mg sc). Single RT fraction dose, total dose and treatment duration were individually adjusted to the patient's need. Acute and late adverse effects were recorded using the RTOG score. Subjective and objective dry eye assessment was performed for the post-treatment control of lacrimal gland function.ResultsAll patients have completed CT-RT or RT as indicated. The median total duration of RT was 29 days (range, 23 – 39 days) and the median total RT dose was 40 Gy (range, 36 – 60 Gy). Median lacrimal gland exposure was 35.9 Gy (range, 16.8 – 42.6 Gy). Very good partial or complete tumor remission was achieved in all patients. The treatment was well tolerated without major toxic reactions. Post-treatment control did not reveal in any patient either subjective or objective signs of a dry eye syndrome.ConclusionThe addition of amifostine to RT/CT-RT of patients with tumors localized in orbital region was found to be associated with absence of dry eye syndrome.

Prevalence of Dry Eye in Bangkok, Thailand

To estimate the prevalence of dry eye in the adult population of Bangkok, Thailand. Five hundred fifty volunteers 40 years of age or more who presented to the Ramathibodi Hospital for annual eye examinations were enrolled. Interviewers administered a dry eye symptoms questionnaire. Slit-lamp examination and objective dry eye assessment consisting of tear film breakup time (TBUT), fluorescein corneal staining, Schirmer tests, and meibomian gland evaluation were performed. Outcome measures included frequency of symptoms and positive dry eye tests. Thirty-four percent reported significant symptoms, which were defined as having one or more symptoms often or all of the time (95% confidence interval, 28.1-40.6). Approximately one half had meibomian gland disease (MGD) or pingueculum/pterygium (46.2 and 53.8%, respectively). Individuals with significant symptoms tended to be women (83.4%, P = 0.024), had MGD (63.6%, P = 0.006), had current artificial tear use (33.2%, P = 0.024), and had positive TBUT (80.7%, P = 0.000) and fluorescein staining (16.6%, P = 0.013.) The presence of pingueculum/pterygium and MGD were significantly associated with positive dry eye tests. This is the first report of prevalence of dry eye inclusive of signs and symptoms in an elderly Thai population. The prevalence of disease diagnosed on the basis of symptoms and dry eye tests was approximately 2 to 3 times higher than reported in whites. Women were more likely to report symptoms. Positive associations with dry eye tests were found in subjects with pingueculum/pterygium and MGD.

Fortschritte in der Diagnose und Therapie von Erkrankungen der Augenoberfläche: Trockenes Auge und okuläre Allergien

The 77th meeting of the Association for Research in Vision and Ophthalmology (ARVO) presented the latest developments in clinical research and practice across a range of ophthalmic disciplines. Of particular interest was the current status of research in dry eye and ocular allergy. With these conditions being very common to ophthalmologists, and the fact that they are difficult to differentiate due to the number of overlapping symptoms, there remains a need for more rapid and accurate methods for their diagnosis. Therefore, a number of new tools were presented that have the potential for use in clinical trials and practice to improve the diagnosis and assessment of dry eye and ocular allergy. Some of these tools have been developed based on a greater understanding of the pathophysiology of dry eye and ocular allergy, and the various molecular pathways involved. Indeed, a greater understanding of the molecular mechanisms involved in the pathogenesis of dry eye and ocular allergy has identified potential targets for the treatment of these conditions. Continuing research into new agents can provide ophthalmologists with a number of options that will ultimately benefit the patient.

The Agreement Between Self-Assessment and Clinician Assessment of Dry Eye Severity

The purpose of this analysis was to measure the degree of agreement between clinicians' assessment and subjects' self-assessment of dry eye severity in a cross-sectional, observational dry eye study. A secondary purpose was to identify the role of gender and age in that concordance. In a cross-sectional observational study, 162 dry eye subjects and 48 controls were recruited from clinical databases of ICD-9 codes in 6 clinical sites. Before examination, subjects gave a global self-assessment of the severity of their dry eye from "none" to "extremely severe." After a clinical examination that included dry eye tests, the clinician discussed the subjects' symptoms and then gave global clinician assessment of dry eye from "none" to "severe." We measured the degree of agreement in these global measures. Although the correlation and agreement between clinician and self-assessment was significant (r = 0.720, P = 0.000; weighted K = 0.471; 95% CI = 0.395, 0.548; P = 0.000), the clinician assessment underestimated the severity in 40.9% of the subjects by at least 1 grade compared with the subjects' self-assessment. Over 54% of subjects over age 65 and 43% of the female subjects had their condition underestimated by the clinician (P < 0.05). Clinicians often relatively underestimated the severity of the subjects' self-assessment of dry eye in this clinical study, especially among the elderly and women. Eye care practitioners need better, more quantitative tools for the assessment of ocular surface symptoms to improve the concordance in severity assessment and to meet the needs of this symptomatic patient population by offering them appropriate treatments.

Tear Film Tests in Parkinson’s Disease Patients

Parkinson's disease (PD) has both motor and nonmotor features. Parkinson's disease patients are prone to dry eye due to both autonomic dysfunction and motor symptoms affecting blinking. This study was conducted to investigate the changes in tear functions in PD patients. Nonrandomized, prospective, clinical study. Fifty-six eyes of 56 consecutive patients with PD were studied. Thirty-six eyes of age-matched non-PD patients without pathology affecting tear tests were examined as control subjects. Modified Hoehn-Yahr (H-Y) scale, blink rate (BR), and tear tests were examined. Modified H-Y scale, BR, dry eye assessment questionnaire, meibomian gland evaluation, tear meniscus height, tear breakup time, fluorescein stain, rose bengal stain, Schirmer's test, and phenol red thread test. Overall tear function abnormalities were significantly more common in PD patients (P = 0.001, Mann-Whitney U test). Each test was found to be significantly disturbed in PD patients relative to controls (P<0.05, Mann-Whitney U test). Each PD patient had at least 1 abnormal test. Overall tear function abnormalities as assessed by the total abnormal test count correlated with the H-Y score (P<0.001, Spearman rho correlation). Parkinson's disease patients' mean BR (12.7+/-7.42 per minute) was significantly less than the controls' (21.8+/-7.37) (P<0.01, Student's t test). The abnormality in each tear test, except those for meibomian gland function and tear meniscus height, was significantly related to the H-Y scores (P<0.05, chi2 linear-by-linear association). The results of this study indicate that PD is associated with disturbances in tear function. With the exception of meibomian gland disease and tear meniscus height, the tests were found to have a linear association with the H-Y scale, which may be attributed to associated dysfunctions of PD.