Dry Eye Disease Patients Research Articles

Repeatability of Non-invasive Keratograph Break-Up Time measurements obtained using Oculus Keratograph 5M.

The aim of this study is to assess the intraexaminer repeatability of Non-invasive Keratograph Break-Up Time (NIKBUT) obtained using the Oculus Keratograph 5M (K5M), given its relevance as a homeostasis marker in Dry Eye Disease (DED). In total, 80 healthy volunteers aged between 30 and 89years participated. Measurements were classified according to age, sex and the presence or not of DED. Repeatability was evaluated by the calculation of within-subject standard deviation (Sw), coefficient of repeatability (CoR) and coefficient of variation (CoV). Moreover, the Passing-Bablok regression method was applied. Sw, CoR and CoV coefficients showed low repeatability in all groups with values between 3.57 and 7.14; 9.90 and 19.79; and 51.90 and 65.49, for each coefficient, respectively. No statistically significant differences were found in the NIKBUT measurements between healthy and DED patients (p = 0.188). Groups with more DED risk had better repeatability. Passing-Bablok regression also confirmed a lack of agreement between the maximum and minimum NIKBUT measurement. NIKBUT measurement has low intraexaminer repeatability even when considering sex, age and DED diagnosis. Nevertheless, not only is this low repeatability due to the device, but also it is largely due to the intrinsic variability of the tear film.

Correlation of dry eye and diabetes mellitus

Diabetes is one of the leading causes of morbidity and mortality worldwide and various studies have shown that people with diabetes are more prone to suffer from dry eye disease than those without diabetes. This study was undertaken with the aim to find the prevalence of dry eye disease in patients of type 2 diabetes mellitus and to find the correlation between glycemic control and prevalence of dry eye.This study was carried out over a period of one year and cases of type 2 diabetes were selected from patients attending the out patient department. Diagnosis of dry eye was made if OSDI Score was more than 12 with one of the positive specific tests for dry eye.A total of 180 eyes of 100 patients were included in the study. It was noted that with increasing age the chance of dry eye increase. Our study found that with increased duration of diabetes, the chance of developing dry eye increases, and poor glycemic control increases the severity of dry eye. The severity of diabetes has a positive correlation with goblet cell loss and morphological changes in conjunctival impression cytology.It is established in our study that there is a positive correlation between prevalence of dry eye and poor glycemic control in a patient of diabetes. Since, the prevalence of dry eye in a hospital-based study with limited sample is significant hence the prevalence in the community must be higher and needs attention.

Factors associated with ocular surface epithelial damage in patients with primary Sj\xf6gren\u2019s syndrome

BackgroundThe aim of this study was to evaluate the effects of systemic parameters, laboratory findings, oral parameters, and other ocular surface parameters on ocular surface epithelial damage in patients with primary Sjögren’s syndrome (pSS).MethodsA total of 82 dry eye disease (DED) patients with pSS were enrolled in this study. Ocular surface epithelial damage was measured by ocular staining score (OSS). Systemic parameters, laboratory findings including serologic markers, oral parameters, and other ocular surface parameters were collected. Other ocular surface parameter assessments such as the Schirmer’s test, fluorescein tear breakup time, meibomian gland examinations, noninvasive keratographic tear film break-up time measurements using the Keratograph® 5 M were performed, and the Ocular Surface Disease Index was determined.ResultsIn a multivariate analysis, decreased age and increased duration of pSS were significantly related to increased logarithm-transformed OSS (β = -0.011, P = 0.043 and β = 0.003, P = 0.008). Among the ocular surface parameters, decreased fluorescein tear breakup time and increased MGD grade were significantly associated with increased logarithm-transformed OSS (β = -0.183, P < 0.001 and β = 0.192, P = 0.049).ConclusionsOcular surface epithelial damage in patients with pSS was associated with young age, long duration of disease, unstable tear film, and decreased meibomian gland function.

Neutrophil/Lymphocyte Ratio as an Inflammatory Predictor of Dry Eye Disease: A Case-Control Study

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been used as indicators of inflammation, however, their roles in dry eye disease (DED) patients require advanced studyMaterials and MethodsA total of 104 DED cases and 97 healthy controls from January 2020 to May 2020 were enrolled in this study. The dry eye related clinical variables, including Schirmer I test, tear break-up time (TBUT), corneal fluorescein staining (CFS) and Ocular Surface Disease Index (OSDI), were detected in all the participants. Besides, the NLR and PLR pattern in DED cases were detected and their potential value as inflammatory predictors of DED were evaluated. In advanced analyses, the correlation between NLR and DED severity was examined.ResultsThe NLR and PLR were 2.59 ± 1.25 and 117.48 ± 54.68 in the DED group, respectively, while they were 2.20 ± 1.24 and 115.48 ± 54.33 in the control group, respectively. The NLR was higher in the DED group (p = 0.027), however, PLR was not significantly different compared with the control group (p = 0.951). In advanced analyses, it was found that more severe TBUT, CFS, and OSDI scores were detected in the high NLR group (NLR ≥2.145, p = 0.003, 0.013, and 0.017, respectively) compared with the low NLR group (NLR <2.145).ConclusionThe NLR value, but not PLR, of DED patients was higher than that of healthy controls. The NLR could be used as an inflammatory predictor to estimate the severity of DED.

Experimental Pharmacotherapy for Dry Eye Disease: A Review.

Dry eye disease (DED) is a complex multifactorial disease showing heterogenous symptoms, including dryness, photophobia, ocular discomfort, irritation and burning but also pain. These symptoms can affect visual function leading to restrictions in daily life activities and reduction in work productivity with a consequently high impact on quality of life. Several pathological mechanisms contribute to the disease: evaporative water loss leads to impairment and loss of tear homeostasis inducing either directly or indirectly to inflammation, in a self-perpetuating vicious cycle. Dysregulated ocular immune responses result in ocular surface damage, which further contributes to DED pathogenesis. Currently, DED treatment is based on a flexible stepwise approach to identify the most beneficial intervention. Although most of the available treatments may control to a certain extent some signs and symptoms of DED, they show significant limitations and do not completely address the needs of patients suffering from DED. This review provides an overview of the emerging experimental therapies for DED. Several promising therapeutic strategies are under development with the aim of dampening inflammation and restoring the homeostasis of the ocular surface microenvironment. Results from early phase clinical trials, testing the effects of EnaC blockers, TRPM8 agonist or mesenchymal stem cells in DED patients, are especially awaited to demonstrate their therapeutic value for the treatment of DED. Moreover, the most advanced experimental strategies in the pipeline for DED, tivanisiran, IL-1R antagonist EBI-005 and SkQ1, are being tested in Phase III clinical trials, still ongoing. Nevertheless, although promising results, further studies are still needed to confirm efficacy and safety of the new emerging therapies for DED.

Safety and Tolerability of an Eye Drop Based on 0.6% Povidone-Iodine Nanoemulsion in Dry Eye Patients.

Purpose: To evaluate safety and tolerability on the ocular surface of an anti-septic formulation containing 0.6% povidone–iodine (0.6% PVI) for a 4 week period.Methods: An observational, prospective study included 20 mild-moderate dry eye disease (DED) patients who enrolled at the Ocular Surface Disease Unit of the University of Messina, receiving 0.6% PVI eye drops for 28 days, 2 drops twice daily (BID). The assessment included the Ocular Surface Disease Index questionnaire; symptoms score (0 = absent to 3 = severe) for burning, ocular dryness, foreign body sensation, watery eyes, tearing, photophobia, and ocular pain; fluorescein tear break-up time (TBUT); and corneal-conjunctival staining, performed at baseline (T0), after 7 (T7) and 28 (T28). Schirmer I-test, corneal endothelial cell count, intraocular pressure, and fundus examination were performed at T0 and T28. The main outcome measures were TBUT and corneal-conjunctival staining as markers of ocular surface homeostasis. For statistical analysis, Student's T-test and Wilcoxon test were used as appropriate.Results: No significant alterations of the safety parameters were found throughout the study. Further, at T28 a significant improvement of burning, ocular dryness, foreign body sensation, and watery eyes (T0 vs. T28 P < 0.03) were observed; corneal-conjunctival staining improved at T28 (T0 vs. T28 P < 0.0001), and TBUT improved already at T7 (T0 vs. T7 P = 0.0008) lasting so till the end of the study. The only adverse event was mild burning at instillation for the first 3 days of treatment in most of the patients.Conclusions: The treatment with 0.6% PVI was safe and well tolerated in a group of patients with a damaged ocular surface.

Dry eye disease is associated with retinal microvascular dysfunction and possible risk for cardiovascular disease.

To explore the presence of microvascular endothelial dysfunction as a measure for early cardiovascular disease in individuals diagnosed with dry eye disease (DED) as compared to age-matched normal controls. Systemic blood pressure, Body Mass Index, intraocular pressure, blood levels of glucose (GLUC), triglycerides, cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] as well as retinal and peripheral microvascular function were assessed in twenty-five 35-50year olds with diagnosed with DEDa (using the TFOS DEWS II criteria) and 25 age and sex-matched controls. After controlling all the influential covariates, individuals diagnosed with DED exhibited significant lower retinal artery baseline (p=0.027), artery maximum diameter (p=0.027), minimum constriction (p=0.039) and dilation amplitude (p=0.029) than controls. In addition, the time to reach the vein maximum diameter was significantly longer in the DED patients than in normal controls (p=0.0052). Only in individuals diagnosed with DED, artery maximum constriction correlated statistically significantly and positively with HDL-C blood levels (p=0.006). Similarly, artery slopeAD correlated positively with T-CHOL and LDL-C (p=0.006 & 0.011 respectively). Additionally, artery baseline diameter and maximum constriction were significantly and negatively correlated to T-CHOL/HDL-C ratio (p=0.032 and p=0.013 respectively) in DED individuals only. Individuals with positive diagnosis of DED exhibit abnormal retinal microvascular function and possible higher risk for CVD.

Early Onset and Broad Activity of Reproxalap in a Randomized, Double-Masked, Vehicle-Controlled Phase 2b Trial in Dry Eye Disease

To assess the activity of reproxalap, a novel reactive aldehyde species (RASP) inhibitor, relative to vehicle in patients with dry eye disease (DED) DESIGN: Randomized, double-masked, vehicle-controlled Phase 2b trial METHODS: Three hundred patients with DED were randomly assigned 1:1:1 at multiple US sites to receive 0.1% topical ocular reproxalap, 0.25% topical ocular reproxalap, or vehicle. Eyes were treated bilaterally 4 times daily for 12 weeks. Standard signs and symptoms of DED were assessed at baseline and at Weeks 2, 4, 8, and 12. A dose response was observed for signs and symptoms of DED. Relative to vehicle over 12 weeks of therapy, the largest symptomatic improvement was observed in ocular dryness (0.25%, P=.047), and the largest objective sign improvement was observed in nasal region fluorescein staining (0.25%, P=.030). A greater proportion of patients receiving 0.25% reproxalap vs. vehicle reported dryness scores of 0 (P=.012). Improvements in combined DED symptoms were evident by the first post-baseline visit (Week 2, 0.25%, P < .0001) in patients with baseline scores greater than or equal to median values. No significant changes in safety measures were observed. The novel RASP inhibitor reproxalap demonstrated rapid, broad, and clinically relevant symptomatic control, in conjunction with statistically significant improvement over vehicle in signs of DED as demonstrated by fluorescein staining, in DED patients over 12 weeks of therapy. The results represent the first vehicle-controlled evidence for the therapeutic potential of RASP inhibition to mitigate the signs and symptoms of dry eye disease.

Efficacy of bandage contact lens for the management of dry eye disease after cataract surgery

PurposeWe aimed to evaluate the efficacy of bandage contact lens (BCL) for the management of dry eye disease (DED) after cataract surgery.MethodsA total of 120 patients (140 eyes) with age-related cataract and DED were enrolled in this study. Patients underwent standard micro-incision phacoemulsification surgeries and were divided into control or BCL groups. Slit-lamp biomicroscopic examination, Ocular Surface Disease Index, keratograph analysis and Schirmer I test were executed, and the levels of tear inflammatory molecules were detected.ResultsIn the control group, the NIAvg-BUT and Schirmer I test scores were significantly decreased at 1 week post-operation compared with baseline levels (P = 0.035 and P = 0.009, respectively). In the BCL group, the NIF-BUT and Schemer I test scores were significantly improved at 1 month after operation compared with the control group (P = 0.012 and P < 0.001, respectively). Levels of IL-6, IL-8 and ICAM-1 were significantly increased in the control group at 1 month after the operation (P = 0.005, P = 0.038 and P = 0.022, respectively), while there was no difference in the BCL group. The increase in the IL-6 level in the control group was significantly higher compared with that in the BCL group (P = 0.047). In DED patients, there were significant correlations between ocular surface parameters and inflammatory molecules.ConclusionsCataract surgery could lead to the development or worsening of DED. The application of BCLs after cataract surgery could stabilize the ocular surface and tear film, improve the corneal healing and reduce the inflammation. Collectively, our findings suggested that proper use of BCLs after cataract surgery played an effective role in the management of DED.Trial registrationClinicalTrials, NCT04100031. Registered 18 September 2019—retrospectively registered

Frequency and impact of individual symptoms on quality of life in dry eye disease in patients presenting to a tertiary care hospital.

To assess the frequency of symptoms and impact on quality of life in individuals with dry eye disease. The cross-sectional, study was conducted from December 2018 to June 2019 at the outpatient clinic of the Department of Ophthalmology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, and comprised dry eye disease patients aged at least 13 years with ocular burning sensation, lacrimation, grittiness, photophobia, redness or itching. Tear Film Breakup time <10 sec and / or positive ocular surface staining >5 corneal spots, >9 conjunctival spots, lid margin staining ≥ 2mm in length were used to diagnose the disease. Data was collected using the Dry Eye Quality of Life Score questionnaire. Data was analysed using SPSS 25. of the 191 patients, 135(71%) were females and 56(29%) were males. The overall mean age was 39.8±16.6 years. Itching 155(81.2%), watering 151(79.1%) and burning 124(64.9%) were the most frequent symptoms, with watering (p<0.001) and photophobia (p=0.012) significantly impacting quality of life. The most common symptoms among patients of dry eye disease affecting their quality of life were itching, watering, burning, photophobia and low mood.

Characteristics of dry eye patients with thick tear film lipid layers evaluated by a LipiView II interferometer

PurposeTo investigate the characteristics of eyes with dry eye disease (DED) whose lipid layer thickness (LLT) measured 100 nm on a LipiView II interferometer and compare the DED parameters of them to those with LLT below 100 nm.MethodsA total of 201 eyes of 102 enrolled DED patients (mean age 56.4 ± 11.8 years) were classified into 3 groups according to their average LLT; < 60 nm as thin-LLT (n = 49), 60–99 nm as normal-LLT (n = 77), and 100 nm as thick-LLT (n = 75). LLT, meiboscore, Schirmer I test, tear film break-up time (TBUT), ocular surface staining (OSS), and ocular surface disease index (OSDI) were assessed.ResultsThe OSS and TBUT were significantly worse in the thick-LLT group than in the normal-LLT group (p = 0.020, and p = 0.028, respectively). The OSDI was significantly higher in the thick-LLT group than in the thin-LLT group (p = 0.006). However, the meiboscore was not different among the three groups (p = 0.33). Age, OSS, and OSDI showed a positive correlation with LLT (r = 0.16, p = 0.023; r = 0.213, p = 0.003; and r = 0.338, p = 0.001, respectively). In sensitivity analyses, eyes with corneal erosions had a significantly higher average LLT (p = 0.015), higher OSDI (p = 0.009), shorter TBUT (p < 0.001), and shorter Schirmer I value (p = 0.024) than those with clear corneas.ConclusionThe average LLT of eyes with corneal erosions was thicker than those without erosions, suggesting that the LLT of 100 nm in the eyes with corneal erosions should not be regarded as a stable physiologic condition. Cautious interpretation of LLT along with other dry eye parameters is required.

Tear Proteomics Study of Dry Eye Disease: Which Eye Do You Adopt as the Representative Eye for the Study?

Most studies about dry eye disease (DED) chose unilateral eye for investigation and drew conclusions based on monocular results, whereas most studies involving tear proteomics were based on the results of pooling tears from a group of DED patients. Patients with DED were consecutively enrolled for binocular clinical tests, tear biochemical markers of DED, and tear proteome. We found that bilateral eyes of DED patients may have similar but different ocular surface performance and tear proteome. Most ocular surface homeostatic markers and tear biomarkers were not significantly different in the bilateral eyes of DED subjects, and most clinical parameters and tear biomarkers were correlated significantly between bilateral eyes. However, discrepant binocular presentation in the markers of ocular surface homeostasis and the associations with tear proteins suggested that one eye’s performance cannot represent that of the other eye or both eyes. Therefore, in studies for elucidating tear film homeostasis of DED, we may lose some important messages hidden in the fellow eye if we collected clinical and proteomic data only from a unilateral eye. For mechanistic studies, it is recommended that researchers collect tear samples from the eye with more severe DED under sensitive criteria for identifying the more severe eye and evaluating the tear biochemical and proteomic markers with binocular concordance drawn in prior binocular studies.

Dry eye disease in patients with diabetes mellitus: An overview

Dry eye disease in patients with diabetes mellitus: An overview

The Relationship of Dry Eye Disease With Depression in Saudi Arabia: A Cross-Sectional Study.

ObjectiveEstimate the prevalence of depression among individuals with a dry eye disease (DED) in Saudi Arabia using two questionnaires: Patient Health Questionnaire (PHQ-9) and Dry Eye Questionnaire (DEQ-5), and explore potential factors implicated in the development of depression among the DED population.MethodsThis is a descriptive cross-sectional study of 476 patients with DED which was conducted using a PHQ-9 questionnaire to screen for depression and a DEQ-5 questionnaire to diagnose DED. The questionnaires were merged and distributed using Google Forms through various social media platforms targeting the Saudi population. After data collection, it was revised, coded and fed to statistical software IBM SPSS version 22 (SPSS, Inc. Chicago, IL).ResultsDepression was diagnosed among 200 participants (42%) of the cases with dry eyes. From which 5.7% had mild depression, 13.9% had moderate depression, 12.6% had moderately severe depression, and 9.9% had severe depression. A female predominance was noticed; 44.7% of the females with dry eyes had depression compared to 32.4% of males with recorded statistical significance (P=0.023). Depression was detected among 55% of those who are less than 20 years old in comparison to 27% of those who are 30 years or older (P=0.001). Laser-assisted in-situ keratomileusis (LASIK), prolonged electronic device usage and contact lens wear are reported as risk factors associated with an increase in dry eye symptoms. However, there is no statistically significant relationship between contact lens wear and depression among dry eye disease patients.ConclusionSuffering from DED is a possible risk factor for developing depression as DED is associated with depression of higher degrees of severity. Depression among DED patients is found to be significantly more prevalent among females and the young adult population rather than older adults.

Dendritic cells and vitamin D in dry eye disease

To study the role of dendritic cells and vitamin D in troublesome evaporative dry eye diseases. Materials and Methods: This is a cross sectional study which includes 108 patients having evaporative dry eye disease and 86 normal healthy volunteers. Ocular surface index, Shirmer’s test and tear film break up time, corneal dendritic cell density, vitamin D and cytokines in serum/tear were estimated. Vitamin D, cytokine in serum/tear and corneal dendritic cell density were estimated. Result: Higher dendritic cell density noticed in evaporative dry eye disease patients compared to control group volunteers and revealed positive correlation with ocular surface index (P Conclusion: Vitamin D has significant role in dry eye disease and its inflammation. Vitamin D therapy can be considered as an added treatment for dry eye disease. Keywords: Dendritic cells, Vitamin D, Inflammatory cells, Dry eye.

Efficacy and Safety of Houttuynia Eye Drops Atomization Treatment for Meibomian Gland Dysfunction-Related Dry Eye Disease: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial.

Purpose: To evaluate the efficacy and safety of Houttuynia eye drops (a Chinese traditional medicine) atomization treatment in meibomian gland dysfunction (MGD)-related dry eye disease (DED) patients. Methods: A total of 240 eligible patients diagnosed with MGD-related DED were assigned either Houttuynia eye drops or placebo for atomization once daily for four weeks in a multi-center, randomized, double-blind, placebo-controlled clinical study. Primary outcome evaluations used included eye symptom score (using the Chinese Dry Eye Questionnaire), meibum quality, and tear break-up time (TBUT), while safety evaluations included adverse events (AEs), visual acuity, and intraocular pressure monitoring. Indicators were measured at baseline as well as one week, two weeks, and four weeks after treatment. Results: Primary outcome measures of the Houttuynia group were improved compared with their placebo counterparts following four-week treatment. Eye symptom scores were significantly reduced relative to the baseline in the Houttuynia group (mean ± standard error of the mean, 9.00 ± 0.61) compared with the placebo group (6.29 ± 0.55; p = 0.0018). Reduction in meibum quality score in the Houttuynia group (0.91 ± 0.10) was also significantly higher compared with the placebo group (0.57 ± 0.10; p = 0.0091), while TBUT in the treatment group (6.30 ± 0.22) was also longer than in the latter (5.60 ± 0.24; p = 0.0192). No medication-related adverse events were observed. Conclusions: Atomization treatment with Houttuynia eye drops is both clinically and statistically effective for the treatment of mild to moderate MGD-related DED patients. This approach is generally safe and was tolerated well by patients.

PSS13 Risk Factors for Chronic Ocular PAIN: Evidence from a Literature Review

Chronic ocular pain (COP) is a persistent eye pain lasting for a period longer than 3-months. There is paucity of data to understand the etiological factors for COP. The objective of this review was to summarize the literature on the risk factors for COP. A targeted literature search was performed for publications in English from database inception to 19th August 2019 in Embase and Ovid platforms. Studies reporting risk factors for ocular pain were included. The review identified 84 publications reporting 55 unique risk factors (110 associations) for COP. Laser-assisted in situ keratomileusis (LASIK), dry eye disease (DED), pseudophakic bullous keratopathy (PBK), Sjögren's syndrome, photorefractive keratectomy (PRK), cataract surgery (CS), ocular trauma, migraine, blepharitis, keratitis, graft versus host disease (GVHD), herpes zoster, were the commonly reported risk factors for COP. These risk factors were broadly categorized into two types, i.e. ocular (surgical procedures, ocular inflammation, ocular melanoma and infections) and non-ocular (drug-induced and auto-immune diseases). Based on the number of publications and sample size (n), surgical procedures were the most common contributor for COP [LASIK: 18 publications; [n/total sample size (N) =3267/3283], PRK: 4; (n/N=159/159), CS: 3; (n/N=92/230)], followed by DED [9 publications; (n/N=1053/3097)], ocular inflammation [conjunctivitis: 2; (n/N=220/220), blepharitis: 2; (n/N=145/2610), scleritis: 2; (n/N=57/2604) and keratitis: 3; (n/N=20/2607)], ocular infection (7; n/N=114/178), autoimmune diseases [Sjögren's syndrome: 5; (n/N=46/57) and GVHD: 2; (n/N=28/115)], ocular trauma (6; n/N=112/136), PBK (4; n/N=30/167) and ocular melanoma (4; n/N=6/102). Patients who underwent ocular surgeries, DED patients, ocular inflammation or infection, ocular trauma and Sjögren's syndrome, seem major causes for developing COP. Ocular surgeries (LASIK, PRK, CS), DED, ocular inflammation, Sjögren's syndrome, seem to be common risk factors for developing COP. Heterogeneous studies in measuring ocular pain symptoms, paucity of data for COP definition and pain duration were the limiting factors of this review.

&lt;p&gt;Visible Meibomian Gland Structure Increases After Vectored Thermal Pulsation Treatment in Dry Eye Disease Patients with Meibomian Gland Dysfunction&lt;/p&gt;

PurposeTo assess the effect of vectored thermal pulsation treatment (VTP) on visible meibomian gland structure (VGS) in patients with meibomian gland dysfunction (MGD).SettingPrivate group practice (A.T.E.).DesignRetrospective, single-blinded cohort study.MethodsVisible meibomian gland structure was evaluated at baseline and at 1-year in treatment (30 patients, 48 eyes) and control (13 patients, 22 eyes) groups. Meibography images were captured using dynamic meibomian imaging. Images were assessed using a novel morphometric analysis technique and analyzed for change in area of VGS (pixels). Additional outcomes measured include tear break up time, corneal staining, tear osmolarity, matrix metalloproteinase-9 (MMP-9), meibography grading, and meibomian gland evaluation.ResultsAs high as 69% of eyes in the treatment group showed an improvement in VGS versus 27% of eyes in the control group. As high as 31% of eyes in the treatment group showed a decline in VGS versus 73% of eyes in the control group. TBUT (p = 0.0001), corneal staining (p = 0.0063), and meibomian gland evaluation scores (p = 0.0038) all significantly improved after VTP treatment. However, SPEED scores, MMP-9, tear osmolarity, and meiboscale scores were not significantly improved 1-year post treatment.ConclusionA morphometric analysis protocol of meibography provides clinically meaningful information that is undetectable with the standard semiquantitative method of grading meibomian gland structure. This is the first report indicating that gland structure may increase post-VTP relative to untreated controls, thus presenting significant implications regarding benefits and timing of VTP therapy. The described protocol is currently more appropriate for research than for clinical practice.

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.

High Molecular Weight Hyaluronan Promotes Corneal Nerve Growth in Severe Dry Eyes.

The purpose of this study was to investigate the effect of high molecular weight hyaluronan (HMWHA) eye drops on subbasal corneal nerves in patients suffering from severe dry eye disease (DED) and to evaluate the damage of subbasal corneal nerves associated with severe DED. Designed as an international, multicenter study, 16 patients with symptoms of at least an Ocular Surface Disease Index (OSDI) score of 33, and corneal fluorescein staining (CFS) of at least Oxford grade 3, were included and randomized into two study arms. The control group continued to use their individual optimum artificial tears over the study period of eight weeks; in the verum group, the artificial tears were substituted by eye drops containing 0.15% HMWHA. At the baseline visit, and after eight weeks, the subbasal nerve plexus of 16 patients were assessed by confocal laser scanning microscopy (CSLM). The images were submitted to a masked reading center for evaluation. Results showed a significant increase of total nerve fiber lengths (CNFL) in the HMWHA group (p = 0.030) when compared to the control group, where the total subbasal CNFL did not significantly change from baseline to week 8. We concluded that in severe DED patients, HMWHA from topically applied eye drops could cross the epithelial barrier and reach the subbasal nerve plexus, where it exercised a trophic effect.