Dry Eye Questionnaire Research Articles

Tear Stability, Corneal Staining and Dry Eye Symptoms in Contact Lens Wearers

The aim of this study was to examine tear stability of contact lens wearers (CLW) in young Malay adults aged 18 and above and to compare the results with non-contact lens wearers (NCLW). Corneal staining and McMonnies Dry Eye Questionnaires (MDEQ) scores between habitual soft CLW and NCLW were also compared. It also aimed to find correlation between tear stability and MDEQ scores. Quasi-experimental and case control study was conducted among 53 participants (53 right eyes) at UiTM Vision Care, UiTM Puncak Alam Campus. Twenty six participants were habitual soft CLW and twenty seven were NCLW. Tear stability was measured using non-invasive tear break-up time (NIBUT) and invasive tear break-up time (TBUT). Corneal staining was measured using Efron Grading Scale and dry eye symptoms evaluated using MDEQ. Mean scores of NIBUT and TBUT for CLW were 5.23 ± 7.3 sec and 2.19 ± 2.41 sec respectively; for NCLW were 8.71 ± 4.33 sec and 3.00 ± 1.69 sec respectively. There were significant differences in NIBUT (Mann-Whitney U, p=0.0001) and TBUT (Mann-Whitney U, p=0.001) between the CLW and NCLW. There was also significant difference in percentage of corneal staining found between the CLW (22.6%) and NCLW (7.5%), (Chi-square, p=0.013). However no significant difference was found in MDEQ scores between the CLW (7.54 ± 3.62) and the NCLW (8.15 ± 3.38) group, (Mann-Whitney U, p=0.42). There were also no correlations found between tear stability and MDEQ scores in the two groups. The results of this study showed NIBUT and TBUT values were significantly higher in NCLW than in CLW and corneal staining was more extensive in CLW. Contact lens practitioners need to be aware of changes in tear stability as results of contact lens wear and take the necessary action to improve on the management of their patients during aftercare consultation. DOI : http://dx.doi.org./10.17576/JSKM-2019-1702-04

Dysfunctional Coping Mechanisms Contribute to Dry Eye Symptoms.

Dysfunctional coping behaviors, such as catastrophizing, have been implicated in pain severity and chronicity across several pain disorders. However, the impact of dysfunctional coping has not been examined under the context of dry eye (DE). This study evaluates relationships between catastrophizing and measures of DE, including pain severity and pain-related daily interference. The population consisted of patients seen at Miami Veterans Affairs eye clinic between April 2016 and October 2017. Patients filled out standardized questionnaires assessing symptoms of DE and eye pain, non-ocular pain, mental health, coping behaviors (Pain Catastrophizing Scale, PCS), and pain-related daily interference as a perceived impact on quality of life (Multidimensional Pain Inventory, Interference Subscale, MPI-Interference), and all patients underwent an ocular surface examination. In total, 194 patients participated, with a mean age of 58.8 ± 9.6 years, the majority being male, non-Hispanic, and black. PCS (catastrophizing) was correlated with DE symptom severity, including Dry-Eye Questionnaire 5 (DEQ5; r = 0.41, p < 0.0005), Ocular Surface Disease Index (OSDI; r = 0.40, p < 0.0005), and neuropathic-like eye pain (Neuropathic Pain Symptom Inventory-Eye (NPSI-Eye; r = 0.48, p < 0.0005). Most tear metrics, on the other hand, did not correlate with PCS. Linear regressions showed that PCS, non-ocular pain intensity, and number of pain conditions were significant predictors of DEQ5 (overall DE symptoms), while PCS and non-ocular pain intensity were predictors of NPSI-Eye scores, as were insomnia scores and analgesic use. In a separate analysis, PCS and DE symptoms (OSDI) associated with pain-related interference (MPI-Interference) along with non-ocular pain intensity, post-traumatic stress disorder (PTSD), number of pain conditions, and non-Hispanic ethnicity. These findings suggest that catastrophizing is not significantly related to signs of DE, but is strongly associated to pain-related symptoms of DE and daily interference due to pain.

Response profiles to a controlled adverse desiccating environment based on clinical and tear molecule changes

PurposeTo investigate response profiles in the lacrimal functional unit of dry eye disease (DED) and healthy volunteers after exposure to a controlled adverse desiccating environment (CADE) by identifying groups of individuals with similar clinical and molecular changes. MethodsClinical parameters and tear molecule levels of 20 mild-moderate DED patients and 20 healthy volunteers were evaluated pre- (baseline) and post-CADE exposure. Clustering based on relative change from baseline values was used to identify response profiles. One-vs-all logistic regression was used to identify baseline predictors for response clusters. ResultsFour response profiles were identified. Cluster 1: tear break-up time (TBUT) decrease and matrix metalloproteinase 9 (MMP-9) increase. Cluster 2: marked increase in corneal staining, up-regulation of both MMP-9 and interleukin (IL)-6 levels, and down-regulation of epithelial growth factor (EGF). Cluster 3: increase in fractalkine, vascular endothelial growth factor (VEGF), MMP-9, IL-6, IL-8, IL-1 receptor antagonist (IL-1Ra) and RANTES (regulated on activation, normal T expressed and secreted) tear levels; and increased corneal staining and decreased TBUT and phenol red thread scores. Cluster 4: decreased single-item score dry eye questionnaire (SIDEQ) scores and increased corneal staining. Predictive models using baseline variables found that cluster membership depended on: corneal and conjunctival staining, SIDEQ score, interferon gamma-induced protein (IP)-10, VEGF, and IL-1Ra concentrations. ConclusionsThe response of both mild-moderate DED and healthy asymptomatic individuals to environmental stress (CADE) can be predicted based on baseline (pre-exposure) clinical and tear molecular parameters. Thus, identifying individuals with a predictable response could improve patient enrollment in DED clinical trials.

Translation and validation of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) among Japanese soft contact lens wearers: The J-CLDEQ-8

PurposeTo translate and validate a Japanese version of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) among a multicenter sample of Japanese-speaking soft contact lens (SCL) wearers in Japan. MethodsThe study comprised two phases, 1) forward and backward translation of the CLDEQ-8 into Japanese, 2) cross-sectional validation of Japanese CLDEQ-8 (J-CLDEQ-8) among Japanese spherical disposable SCL wearers (daily disposable, 2 week, or monthly disposable) against their Overall Opinion of SCLs, and 3) repeatability testing in a subset of subjects. Results300 subjects (118 males and 182 females) completed the J-CLDEQ-8 and anchoring Gestalt SCL questions. The J-CLDEQ-8 had a strong significant linear relationship to Overall Opinion of SCLs and the Self-Assessment of Eye Dryness. The Gestalt Eye Sensitivity question did not translate well in Japanese and the relationship between it and the J-CLDEQ-8 was not linear. A cutoff score of <11 points with the J-CLDEQ-8 related best to patients who reported “Excellent” or “Very Good” Overall Opinion of their SCLs, differing slightly from the North American CLDEQ-8 cutoff of <12 points. This <11 points cutoff yielded accuracy of 0.66, and a sensitivity of 0.67 and specificity of 0.66, very similar to the values for the original CLDEQ-8. ConclusionsThe J-CLDEQ-8 was capable of differentiating SCL wearers with different Overall Opinions of their SCLs, comparable to the original CLDEQ-8 in English.

3494 Naltrexone as a Diagnostic Tool in Ocular Neuropathic Pain

OBJECTIVES/SPECIFIC AIMS: The study aims to track and correlate ocular neuropathic symptoms, corneal sensitivity and dry-eye like pain, after scleral buckle and posterior vitrectomy surgeries. The goal is to identify a population of patients that receive these retinal surgeries that experience ocular neuropathic pain. METHODS/STUDY POPULATION: Methods - Prospective and Retrospective cohort studies were designed with the follow cohorts: scleral buckle, posterior vitrectomy, and control. Typical follow up for SB/PV surgeries are: 1 day, 1 week, 1, 3, 6, 12 months post surgery. CS and DELP metrics are measured at each visit. For study interventions, all subjects (from both arms) will undergo the same series of tests, in the same sequence at each visit. Phase 1 of the visit focuses on CS and phase 2 on DELP. These interventions are as follows: first, subjects will receive Drop A; Drop A will be administered in a randomized, double-blinded manner at each visit to either balanced salt solution (control) or Muro 128 5% hypertonic saline (experimental). Drop A will be administered to both eyes. After receiving the drops, subjects will complete a visual analog scale questionnaire to grade their corneal sensitivity. Next, subjects will undergo a five minute washout. After the washout, subjects will receive Drop B; Drop B will be whichever drop was not administered in the Drop A phase. After Drop B is given, subjects will complete the visual analog scale. To begin phase 2, subjects will be given the Ocular Surface Disease Index to record dry eye signs and symptoms. Finally, tear film parameters will be collected using Schirmer’s tear production test and tear film breakup time. Study Population. - Inclusion criteria: For retrospective cohort studies, subjects who have undergone unilateral SB or PV in the past year. For prospective cohort studies, subjects who will undergo unilateral SB or PV in the near future, and age-matched controls. Exclusion criteria: For both retrospective and prospective arms, the same exclusion criteria apply. They include: a previous diagnosis of dry eye; current use of neuropathic pharmacotherapies (including gabapentin, pregabalin, TCAs, SNRIs, carbamazepine, and opioids). RESULTS/ANTICIPATED RESULTS: As of 11/15/18, only the scleral buckle retrospective study arm had enough subjects for any meaningful preliminary report; the arm currently has 8 subjects. Of these 8 subjects, 5/8 subjects report increased surgical-eye corneal sensitivity and 6/8 show discordant dry eye symptoms and tearfilm parameters. Our power analysis showed that N=16 subjects in a group are required to detect a statistical significant difference in corneal sensitivity response. We expect to see a relapsing and remitting pattern of pain (as measured by corneal sensitivity and dry eye questionnaire), as is typical of neuropathic pain. Regarding dry eye symptoms, we anticipate subjects will have prominent dry eye symptoms (as measured by a validated questionnarie), but show no abnormalities in tearfilm parameters. DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, this is the first observational study of neuropathic pain symptoms of corneal sensitivity and dry-eye like pain, in post retinal surgery patients. We recognize the challenge of diagnosing neuropathic pain; currently the gold standard is clinical. However, symptoms of neuropathic pain are non-specific and subtle. Identification of a population suffering from post-retinal surgery ocular neuropathic pain will provide a foundation to test topical naltrexone as a diagnostic tool. If our hypothesis is correct, topical naltrexone could serve as a cheap, easy, and quick diagnostic test for ocular neuropathic pain. We envision this diagnostic test would allow many misdiagnosed and mistreated post-surgical patients to be treated with appropriate therapies aimed at neuropathic etiologies.

Assessment of Contact Lens with the High Definition (HD) Property

AbstractBackground: Contact lenses have been in use since the 1930s. During these years, many materials have been consid-ered with the aim of producing more advanced and biocom-patible devices. The 1940s was the era of the first modern contact lenses, with the debut of polymethyl methacrylate (PMMA). The lack of oxygen supply to the cornea was the main disadvantage of PMMA. This oxygen impermeability was solved with the development of different contact lens materials, new generation of contact lens use hydrogel and silicone to enhance oxygen permeability. Recently, the new contact lens material known as silicone hydrogel lenses has been used to produce a new lens with the HD property.Aim of Study: The aim of this study was to assess a new high definition silicone hydrogel contact lens.Patients and Methods: 22 subjects have been recruited from King Saud University students (male, age 21±1.5 years). The new Balafilcon A lenses (PUREVISION 2 HD); (Bausch + Lomb, Tokyo, Japan) has been assessed and compared with another (non HD) silicone hydrogel lens Balafilcon A (Pure-Vision, Bausch & Lomb Inc., Rochester, NY).The participants asked to wear each of the two lenses for one week (the lens was given randomly) and 48 hours wash out period was allowed between the lenses. Clinical tests including visual acuity (VA) and contrast sensitivity (CS) were applied to evaluate the lens performance at the end of each week. Additionally, contact lens dry eye questionnaire (CLDEQ-8) has been used to obtain the subjective feedback.Result: The mean of CLDEQ-8 with PureVision was 8.1 and with Pure Vision 2 HD was 6. For contrast sensitivity the mean with PureVision was 1.74 while with Pure Vision 2 HD was 1.77. The mean of Visual Acuity was equal with the two lenses 1.00 log. Statistical tests using Wilcoxon-signed rank test showed no significant difference exist between the HD PureVision 2 and PureVision lens. For Visual Acuity (p= 0.317), Contrast sensitivity (p=0. 150) (Fig. 2) and CLDEQ-8 (p=0.339).Conclusion: The silicone hydrogel HD lens evaluated in this study showed good performance. However, no significant difference in clinical performance was observed between the HD lens and the non HD silicone hydrogel lens.

Prevalence of dry eye disease in Ontario, Canada: A population-based survey

PurposePopulation-based cross-sectional survey in Ontario to estimate the 2016 prevalence of dry eye disease (DED) and associated risk factors among adults in Canada. MethodsWe emailed the 5-Item Dry Eye Questionnaire (DEQ-5) to 124,469 Ontario adults (age ≥18 years) in the IQVIA E360 database, March–April 2017. Inclusion criteria were: ≥2 visits to an Ontario based clinic, ≥1 visits in the 1 year before the study; database record with email. DED was defined as a DEQ-5 score of >6/22. The crude prevalence by age/sex of the Ontario sample was adjusted to the 2016 Canadian population (mean age 41.0 years, 51% female). Significance of DED risk factors (age, sex, selected diseases/medical conditions and medications) was evaluated by logistic regression analysis. ResultsOf the 5163 (4.1%) patients who completed the survey (59.5% female, median age, 46 years; 40.4% male, 56 years), 1135 respondents reported DED. Prevalence increased with age (p < 0.05) and was highest among those aged 55–64 years (24.7%; 95% CI, 22.1–27.3%) and lowest among those aged 25–34 years (18.4%; 95% CI, 15.9–21.0%). Prevalence was significantly higher (p < 0.001) among women (24.7%; 95% CI, 23.2–26.2%) than men (18.0%; 95% CI, 16.4–19.7%). Other risk factors were not significant. The age-/sex-adjusted Canadian DED prevalence estimate from this sample was 21.3% (95% CI, 19.8–23.2%), corresponding to ∼6.3 million people. ConclusionsBased on the Ontario sample, we estimate that >6 million Canadian adults may have DED, and that older people and females are more likely to be affected.

Transcultural validation of the 5-Item Dry Eye Questionnaire for the Mexican population.

To translate and validate a Spanish-language adaptation of the 5-Item Dry Eye Questionnaire for the Mexican population. Based on the MAPI Institute guidelines, the linguistic validation procedures consisted of four steps. Every step was reviewed by the committee. The translated validated questionnaire was applied to 25 Mexican subjects. The questionnaires were completed by the same subjects at three time points, 8h apart on the same day and then 3days later. Sensitivity and specificity of the DEQ-5 to predict DE signs was subsequently estimated in 200 patients see in the Asociación para Evitar la Ceguera ophthalmology clinic. During the forward translation step analysis, the committee decided to change the severity scale, as the words "constantly" and "frequently" are synonymous in Spanish, so it was modified by changing "constantly" to "always" for better understanding. Overall, the intra-test intra-class correlation coefficient from tests administered on the same day was 0.9 (95% CI 0.77-0.95, p = 0.0005). The intra-test intra-class correlation coefficient from tests administered 3days apart was 0.9 (95% CI 0.88-0.97, p = 0.0005). When applying the questionnaire to 200 patients seen in an eye clinic, we found a sensitivity of 76% and a specificity of 31% for a DEQ-5 score of ≥ 6, against 2 or more positive signs of dry eye. MAPI methodology proved to be a reliable strategy for the transcultural Dry Eye Questionnaire for translation from English to Spanish for the Mexican population.

Assessment of the Tear Evaporation Rate in Chronic Smokers Using Delfin VapoMeter

Background: Smoking cigarettes is associated with many chronic illnesses such as cancer, heart diseases, and cataract. In addition, smokers are more likely to develop dry eye symptoms compared with nonsmokers. Purpose: To assess the tear evaporation rate in chronic smokers using a VapoMeter. Materials and Method: This observational, case-control and non-randomized study included one hundred and twenty male smokers that ranged in age from 18 to 43 years (mean ± SD = 25.4±5.8 years). An age (18-43 years) matching control group (120 male subjects), with a mean age of 26.1±5.2 years participated in the study. Each participant completed the ocular surface disease index dry eye questionnaire, then a VapoMeter was used to determine the tear evaporation rate. Result: Significant (Kolmogorov-Smirnov test; p<0.05) differences were found between the average scores collected from the ocular surface disease index and the tear evaporation rate measurements within the smokers and nonsmokers groups. The average tear evaporation rate was significantly (p<0.05) higher in the study group [median (interquartile range; IQR) = 37.7 (59.3) g/m2h] compared with that obtained in control group [15.4 (13.1) g/m2h]. Moreover, the average score from the ocular surface disease index in smokers was significantly (p<0.05) higher [15.4 (13.1)] compared with that obtained in the control group [5.4 (5.5)]. Conclusion: Smokers have significant higher tear evaporation rates compared with nonsmokers and normal eye subjects. Clearly, VapoMeter can be used as a reliable tool to assess the eye dryness due to excessive evaporation of tears. Smoking is a risk factor for cancer, heart diseases, and cataract. In addition, smoking is a risk factor for eye dryness and contributes to evaporative dry eye disease, more likely due to the disturbance in the non-polar lipid layer within the tear film. Lipid-rich eye drops could be used to manage dry eye symptoms in smoker subjects. Moreover, smoking cessation remains the single most effective prophylactic measure to avoid dry eye symptoms.

Assessment of tear-evaporation rate in thyroid-gland patients.

ObjectiveTo assess the tear-evaporation rate in thyroid-gland patients using a VapoMeter.MethodsTwenty thyroid gland patients aged 18–43 years (mean 34.3±6.3 years) completed the study. Additionally, an age-matched control group of 20 patients aged 18–43 years (32.2±5.1 years) was enrolled in the study for comparison purposes. An Ocular Surface Disease Index dry-eye questionnaire was completed, followed by a test to determine the tear-evaporation rate using the VapoMeter. The test was performed three times per subject by the same examiner. Two readings were obtained each time.ResultsSignificant differences (P<0.05) were found between mean Ocular Surface Disease Index and tear-evaporation-rate scores within the study and control groups. The average tear-evaporation rate was much higher in the study group (median 41.2 [IQR 41.4] g/m2⋅h) than the control group (15.7 [13.7] g/m2⋅h). Moreover, the average Ocular Surface Disease Index score for thyroid-gland patients was much higher (15.6 [23.4]) compared to the control group (5.5 [7.50]).ConclusionThe tear-evaporation rate in thyroid-gland patients was found to be much higher than normal-eye subjects.

Intense regulated pulse light for the meibomian gland dysfunction.

To assess the effect of intense regulated pulse light (E-Eye; E-Swin, France) on the treatment of meibomian gland dysfunction. Health Sciences University, Ankara Numune Training and Research Hospital, Department of Ophthalmology. A total of 26 patients underwent intense pulsed light treatment (E-Eye; E-Swin), with homogeneously sequenced five light pulses delivered to one eye at 1, 15, and 45 days following baseline evaluation. At each visit, subjective clinical parameters (ocular surface disease index questionnaire and standard patient evaluation of eye dryness questionnaire) and objective clinical parameters (Schirmer I test scores, tear break-up times, Oxford grading, lid margin abnormality score, secretion quality and expressibility degree) were recorded. The subjective and objective parameters at Days 15 and 45 were compared with baseline values. Patients underwent three sessions of intense pulsed light treatment. Schirmer test and tear break-up time improved significantly from baseline to Day (D) 45 (8.53 ± 4.31 mm vs 12.6 ± 3.14 mm, 4.53 ± 1.33 sn vs 11.07 ± 2.87 sn, p = 0.003 and p < 0.001). Ocular surface disease index and standard patient evaluation of eye dryness scores improved from baseline to D15 and baseline to D45 (all with p < 0.05). All the subjects reported reduced symptoms by D45. There were no cases of adverse ocular effects. There was no significant change in Oxford grading, lid margin abnormality score, secretion quality, and expressibility degree. Intense regulated pulse light seems a safe treatment procedure for meibomian gland dysfunction, improving tear film quality and reducing symptoms of dry eye.

No Relation Between the Severity of Corneal Nerve, Epithelial, and Keratocyte Cell Morphology With Measures of Dry Eye Disease in Type 1 Diabetes.

Patients with diabetes have a propensity to develop dry eye symptoms (DES), with reduced tear secretion and corneal sensitivity. The underlying pathologic basis of DES was explored in patients with Type 1 diabetes. Forty-two patients with Type 1 diabetes mellitus (T1DM) (age: 49.21 ± 2.53 years, duration of diabetes: 29.98 ± 2.64 years) and 25 control subjects (age: 48.70 ± 2.84 years) underwent assessment of DES using a validated dry eye questionnaire, and tear stability and tear production were assessed using tear breakup time (TBUT) and Schirmer's test, respectively. Corneal confocal microscopy was undertaken to quantify corneal nerve fiber density (CNFD), branch density (CNBD), fiber length (CNFL), keratocyte density (KD), and corneal epithelial basal cell (CEBC) density and area. The prevalence of DES was significantly higher (P = 0.03), and TBUT (P = 0.006), corneal sensation (P < 0.0001), CNFD (P = 0.001), CNBD (P = 0.001), CNFL (P = 0.003), and KD (P = 0.04) were significantly lower in patients with T1DM compared to control subjects. However, these measures did not differ significantly between T1DM patients with and without dry eye. There was no correlation between DES and TBUT or corneal nerve keratocyte and CEBC morphology. DES and TBUT are significantly increased in patients with T1DM, but are not related to corneal nerve, basal epithelial, or keratocyte cell morphology.

Assessment of Dry Eye Symptoms: Current Trends and Issues of Dry Eye Questionnaires in Japan.

Dry eye disease (DED) is one of the most common disease in the ophthalmic clinic, and the reasons DED patients visit ophthalmic clinics are symptoms such as stinging, burning, or scratchy sensations. The symptoms and visual disturbances of DED have a negative impact on the daily routines and social lives of the patients (i.e., their quality of life [QOL]). The presence of symptoms was required in the definition of DED by the National Eye Institute/Industry Workshop in 1995; therefore, disease-specific questionnaires were essential for monitoring and managing patients with DED. Thereafter, many questionnaires have been developed to evaluate the specific symptoms of dry eyes. Although many questionnaires are available to assess the dry eye symptoms, it is essential that they provide valid answers and are easy to use to assess the effects of DED on the QOL. The Asia Dry Eye Society and Japan Dry Eye Society have proposed a new definition of DED that is a combination of symptoms and an unstable tear film, and information on these two factors is sufficient to make a definitive diagnosis of DED. Therefore, the assessments of the symptoms are fundamental in the diagnosis of DED.

The ability of the Contact Lens Dry Eye Questionnaire (CLDEQ)-8 to detect ocular surface alterations in contact lens wearers.

To study whether some ocular surface alterations could be associated with contact lens (CL) wearers suffering from CL discomfort (CLD) detected using the Contact Lens Dry Eye Questionnaire (CLDEQ)-8. Forty-one soft CL wearers further classified into symptomatic CL wearers (SCLW) and asymptomatic CL wearers (ACLW) by the CLDEQ-8, and 20 non CL wearers (NCLW) were included. Tear osmolarity, slit-lamp biomicroscopy findings, tear film break-up time, corneal and conjunctival staining, and Schirmer test were performed 24 h after CL removal. Data were compared among groups using the analysis of variance and the Student t-test or the Kruskal-Wallis H and the Mann-Whitney U tests, applying the Bonferroni correction. Correlations between the CLDEQ-8 and the clinical signs were performed using the Spearman correlation coefficient. Twenty-four SCLW, 17 ACLW and 20 NCLW were recruited. There were significant differences among groups for tear osmolarity (p < 0.001), limbal hyperaemia (p = 0.014), and tarsal hyperaemia (p = 0.031). Pairwise comparisons revealed that SCLW and ACLW had higher tear osmolarity (p < 0.003, both comparisons) and limbal hyperaemia (p = 0.027 and p = 0.048, respectively) than NCLW. Moreover, SCLW had higher tarsal hyperaemia (p = 0.030) than NCLW. No significant correlations were found (p > 0.05). The CLDEQ-8 was ineffective to detect clinical alterations between SCLW and ACLW; therefore, the use of questionnaires alone remains being the best approach to detect CLD. The role of the tarsal conjunctiva in the development of CLD should be analyzed in future studies.

Neuropathic-Like Ocular Pain and Nonocular Comorbidities Correlate With Dry Eye Symptoms.

To evaluate the association between dry eye (DE) symptoms and neuropathic-like ocular pain (NOP) features, chronic pain conditions, depression, and anxiety in patients presenting for routine ophthalmic examinations. Two hundred thirty-three consecutive patients ≥18 years of age presenting to a comprehensive eye clinic between January and August 2016 were included in this study. Information on demographics, chronic pain conditions, medication use, DE symptoms (dry eye questionnaire, DEQ5), NOP complaints (burning; wind, light, and temperature sensitivity), depression, and anxiety indices (patient health questionnaire 9, PHQ-9 and symptom checklist 90-revised, SCL-90-R) were collected for each individual. Pearson correlation was used to evaluate strengths of association. Logistic regression analysis examined risk factors for any (DEQ5≥6) and severe (DEQ5≥12) DE symptoms. The mean age of the population was 46.3 years (±13.0); 67.8% (n=158) were female. Per the DEQ5, 40.3% (n=94) had mild or greater DE symptoms and 12% (n=24) had severe symptoms. Severity of DE symptoms correlated with NOP complaints: burning (Pearson r=0.37, P<0.001); sensitivity to wind (r=0.37, P<0.001), sensitivity to light (r=0.34, P<0.001), and sensitivity to temperature (r=0.30, P<0.001). Sex, race, and ethnicity were not significant risk factors for DE symptoms. Risk factors for mild or greater DE symptoms included a greater number of chronic nonocular pain conditions (odds ratio [OR]=1.38, P<0.001), arthritic pain (OR=6.34, P<0.001), back pain (OR=2.47, P=0.004), headaches (OR=2.14, P=0.02), depression (OR=1.17, P<0.001), and anxiety (OR=1.13, P=0.02). Dry eye severity positively associated with NOP complaints, comorbid chronic pain conditions, and symptoms of depression and anxiety.

Predictive Potential of Eyelids and Tear Film in Determining Symptoms in Contact Lens Wearers.

Early diagnosis of clinical markers of contact lens discomfort can help clinicians set realistic expectations and monitor and provide prophylactic management for contact lens wearers. The purpose of this study was to evaluate the potential of eyelid- and tear film-related clinical markers to be used as predictive factors for diagnosing discomfort in contact lens wearers. A cross-sectional study was performed on 30 contact lens wearers (6 male, 24 female) with median age of 23 years (range, 18 to 41 years). Eyelid signs and tear film characteristics were evaluated during a single visit, and subjects completed the Contact Lens Dry Eye Questionnaire to evaluate ocular discomfort. Area under the curve (AUC) statistics and sensitivity and specificity values from receiver operating characteristic curves were analyzed to evaluate the predictive potential of clinical signs in discriminating symptoms of contact lens discomfort. The presence of foam at meibomian gland orifices (AUC, 0.944; P < .05; sensitivity >0.7), meibomian gland secretion volume (AUC, 0.935; P < .05; sensitivity >0.7), quality (AUC, 0.969; P < .05; sensitivity >0.7), and expressibility (AUC, 0.933; P < .05; sensitivity >0.7) were significant and strong predictors of discomfort in lens wear. Tear evaporation rates with (AUC, 0.779; P < .05; sensitivity >0.7) or without contact lenses (AUC, 0.788; P < .05; sensitivity >0.7), palpebral conjunctival roughness (AUC, 0.859; P < .05; sensitivity >0.7), palpebral conjunctival staining (AUC, 0.817; P < .05; sensitivity >0.7), palpebral conjunctival hyperemia (AUC, 0.746; P < .05; sensitivity >0.7), meibomian gland orifice capping (AUC, 0.873; P < .05; sensitivity >0.7), pouting (AUC, 0.891; P < .05; sensitivity >0.7), and lid-parallel conjunctival folds (AUC, 0.770; P < .05; sensitivity >0.7) were other acceptable discriminators of symptoms of discomfort during contact lens wear. An equation was developed to identify symptomatic from asymptomatic lens wearers based on the significant predictors: Symptom discriminant function score = 3.378 (meibomian gland secretion grade) + 0.224 (meibomian gland morphology grade) + 0.61 (tear evaporation rate without contact lenses) + 0.439 (lid-parallel conjunctival folds grade) - 0.346 (palpebral conjunctival health grade) - 4.625. This study demonstrated that clinical signs related to meibomian gland secretions and morphology, tear evaporation, lid-parallel conjunctival folds, and palpebral conjunctival health may successfully predict symptoms of discomfort in contact lens wearers.

Investigation of Ocular Tear Ferning in Controlled and Uncontrolled Diabetic Subjects.

To investigate the ocular tear film in controlled and uncontrolled diabetes mellitus (DM) subjects and the relationship between dry eye and diabetes. One hundred twenty-four diabetes adults (65 male and 59 female, with 62 controlled and 62 uncontrolled DM) were assessed by McMonnies dry eye questionnaire, tear break-up time (TBUT), phenol red thread (PRT) test. In addition, tear samples were collected from the lower tear meniscus of right eyes and dried onto glass slides under controlled room temperature (25°C) and humidity (40%). The glass slides were observed using a digital microscopy and the tear ferning (TF) patterns observed were graded based on Masmali TF grading scale. Patients with a HbA1c value below 6.5% were defined as "controlled DM" and those with a HbA1c value above 6.5% were defined as "uncontrolled DM." The Spearman's correlation coefficient was used to determine the relationship between various tests. Several subjects having dry eye varied depending on the test used. McMonnies questionnaire scores suggested that 28 subjects (23%) showed dry eye (score >14.5), of whom 23 subjects (82%) showed uncontrolled diabetes. The TF patterns showed that 44 subjects (35.5%) showed dry eyes (Grade ≥2), of whom 32 subjects (72.7%) showed uncontrolled diabetes. Phenol red thread test found that 46 subjects (37%) showed dry eye (wetting <10 mm), of whom 38 subjects (82.6%) showed uncontrolled diabetes. Tear break-up time found that 57 subjects (46%) showed dry eye (time <10 sec), of whom 45 subjects (78.9%) showed uncontrolled diabetes. In controlled diabetic subjects, TF grades showed medium negative correlations with both TBUT and PRT (-0.374 and -0.349, respectively). In uncontrolled subjects, TF grades have a strong negative correlation with TBUT (-0.539) and a medium negative correlation with PRT (-0.410). Dry eye disease is common in diabetic subjects, particularly in people with poor diabetic control. Uncontrolled blood glucose level seemed to be a risk factor for dry eye syndrome. Tear ferning test showed a correlation between diabetes and dry eye in diabetic subjects and can be used as a reliable test to evaluate the quality of the ocular tear film.

Tear film inflammatory cytokine upregulation in contact lens discomfort

PurposeTo investigate the ocular inflammatory response, using clinical and immunological techniques, in people experiencing contact lens (CL) discomfort. MethodsThis study involved 38 adults who were full-time, silicone-hydrogel CL wearers. Participants were categorized into groups based upon a validated CL dry-eye questionnaire (CLDEQ-8) (n = 17 ‘asymptomatic’, CLDEQ-8 score <9; n = 21 ‘symptomatic’, CLDEQ-8 score ≥13). Examinations were performed at two visits (one with, and one without, CL wear), separated by one-week. Testing included: tear osmolarity, ocular redness, tear stability, ocular surface staining, meibography, tear production and tear collection. Tear osmolarity was taken from the inferior-lateral and superior-lateral menisci. The ‘Inferior-Superior Osmotic Difference’, I-SOD, was the absolute osmolarity difference between these menisci. Concentrations of seven cytokines (IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-gamma, TNF-alpha) were assayed from basal tears using multiplex cytometric bead array. ResultsAt baseline, there was no significant difference in key clinical signs between asymptomatic and symptomatic CL wearers (p > 0.05). The I-SOD was greater in symptomatic than asymptomatic CL wearers (23.1 ± 2.6 versus 11.3 ± 1.4 mOsmol/L, p = 0.001). People experiencing CL discomfort had higher tear IL-17A (122.6 ± 23.7 versus 44.0 ± 10.0 pg/mL, p = 0.02) and reduced tear stability (6.3 ± 1.1 versus 10.4 ± 1.6 s, p = 0.03) after several hours of CL wear. Tear IL-17A levels correlated with both the I-SOD (r = 0.43, p = 0.01) and CLDEQ-8 score (r = 0.40, p = 0.01). ConclusionsCL discomfort occurs in individuals having no clinical dry eye signs, and is associated with higher tear levels of the pro-inflammatory cytokine IL-17A. These findings support an association between the discomfort response and low-grade, ocular surface inflammation.

Tear Lactoferrin and Features of Ocular Allergy in Different Severities of Meibomian Gland Dysfunction.

Meibomian gland dysfunction, but not atrophy, was associated with lower tear lactoferrin concentration, greater dry eye, and allergic symptoms, indicating greater inflammation and discomfort in patients with lower meibomian gland expressibility. Meibomian gland dysfunction can potentially damage adjacent palpebral structures, which may induce inflammation in accessory lacrimal glands and affect lactoferrin secretion. This study aimed to examine the relationships between the severity of meibomian gland dysfunction with tear lactoferrin, conjunctival cell morphology, and clinical features of ocular allergy. Forty subjects were divided into two groups based on the severity of meibomian gland plugging and expressibility and secondarily based on its atrophy. Dry eye and allergy questionnaires; slit-lamp examination, including lid telangiectasia; and meibography were performed. Tear lactoferrin concentration was measured using TearScan 270 MicroAssay. Impression cytology was performed on the upper palpebral conjunctiva, and goblet cell density and epithelial squamous metaplasia were quantified. Twenty-two subjects with meibomian gland dysfunction were categorized into severely obstructed group (case), whereas 19 subjects had minimal/no obstruction (comparison). Lower lactoferrin (1.3 ± 0.4 vs. 1.7 ± 0.4 mg/mL, P = .007), greater dry eye (7 [1 to 10] vs. 2 [0 to 5], P = .03), and allergy symptoms (9 [4 to 23] vs. 6 [0 to 9], P = .05) were found in the cases compared with the comparisons. There were no differences in conjunctival cell morphology between groups. The plugging score was correlated with lactoferrin concentration (ρ = -0.43, P = .006), dry eye (ρ = 0.36, P = .02), and allergic symptoms (ρ = 0.33, P = .04). Greater lid margin telangiectasia was associated with meibomian gland obstruction, but not atrophy. Meibomian gland activity/dysfunction, but not atrophy, may be associated with increased inflammation on the ocular surface. The inflammation may be sufficient to reduce tear lactoferrin production from damage to accessory lacrimal glands and/or meibomian gland and result in increased symptoms.

Safety and efficacy of lifitegrast 5% ophthalmic solution in contact lens discomfort.

PurposeThe aim of this study was to evaluate the safety and efficacy of lifitegrast 5% ophthalmic solution in improving contact lens discomfort (CLD) in patients wearing a low-modulus, nonionic, monthly replacement silicone hydrogel contact lenses (SHCLs).Patients and methodsA single center, prospective, open-label study was undertaken on patients wearing monthly replacement, low modulus silicone hydrogel contact lenses. Best-corrected visual acuity (BVA), lissamine staining (LS) and eight item contact lens dry eye questionnaire (CLDEQ-8) scores were assessed at baseline and after 8-week therapy of twice-a-day lifitegrast 5% ophthalmic solution use. Pre- and Posttreatment data were analyzed for statistical significance.ResultsTwenty-one subjects (15 female and six male) with the mean age of 31.7 (±5.29) years completed the study. No reduction or statistically significant change in monocular BVA or LS scores was observed. Data showed a statistically significant (P<0.05) reduction in total CLDEQ-8 score, questions 1A, 1B, 2A and 2B scores and nonstatistically significant reduction in questions 3A, 3B, 4 and 5 scores. Fifteen (n=15, 71.4%) study subjects found the therapy positive for their contact lens wear.ConclusionData suggest the use of topical lifitegrast 5% ophthalmic solution twice a day may be a safe and effective therapeutic intervention for managing patients with CLD in SHCL users; however further research is indicated.