Dry Eye Questionnaire Research Articles

A Possible Association Between Dry Eye Symptoms and Body Fat: A Prospective, Cross-Sectional Preliminary Study.

To examine the relationship between dry eye symptoms and adiposity in a population study. A prospective cross-sectional single-visit preliminary study was designed to sample ocular symptoms and indices of adiposity in the general adult population. Patients recruited from the UNSW optometry clinic, the university campus and surrounding community, and overseas were invited to complete a survey composed of the short form Dry Eye Questionnaire (SFDEQ) (Dry Eye Questionnaire-5 or Contact Lens Dry Eye Questionnaire-8) and the Ocular Comfort Index (OCI) via hardcopy or online. Participants self-measured their weight, height, waist circumference (WC), and body fat % (optional). Associations between measures of adiposity (Body mass index [BMI], WC, and body fat %) and ocular symptoms scores (SFDEQ and OCI) were determined using Spearman correlation coefficients. Group differences were compared using independent t test. Three hundred and five participants including 52 contact lens wearers completed the study and 78 of them measured body fat %. There was a moderate correlation between body fat % and dry eye symptoms (SFDEQ r=0.34, P=0.003; OCI r=0.32, P=0.004). The interaction between body fat % and gender, wear of contact lenses, and older age were shown to be significant predictors of less ocular comfort in multivariate analysis (F(3,74)=12.13, P<0.001). An association between adiposity measured by body fat % and symptoms of dry eye was demonstrated in the general adult population. Confirmation of these findings in a large study is required.

Dry eye signs and symptoms in night-time workers

PurposeTo determine the effect of night-time working on dry eye signs and symptoms. MethodsA total of 50 healthy subjects completed a dry eye questionnaire and underwent clinical examinations including basic Schirmer's test and tear breakup time (TBUT) test on two consecutive days, before and after the night shift (12-hrs night-shift). ResultsAll dry eye symptoms were aggravated significantly after the night shift (P < 0.05). Conjunctival redness increased after the night shift (P = 0.001). TBUT reduced significantly after the night-shift (8.06 vs 10.98 s) (P = 0.001). Basic Schirmer's test increased after the night-shift compared to its values before the shift (19.04 vs 17.34 mm) (P = 0.037). ConclusionOur study showed that night-time working can cause tear film instability and exacerbation of dry eye symptoms.

Incidence and risk factors of symptomatic dry eye disease in Asian Malays from the Singapore Malay Eye Study

PurposeTo evaluate the incidence of symptomatic dry eye disease (SDED) and associated risk factors in a well-characterized cohort of ethnic Malays in Singapore. MethodsWe included 1682 participants (mean age [SD]: 57 [10]years; 55.4% female) without SDED from the Singapore Malay Eye Study (SiMES), a population-based longitudinal study with baseline examination (SiMES-1) conducted between 2004 and 2006, and follow-up examination (SiMES-2) conducted between 2010 and 2013. SDED was considered to be present if a participant answered “often” or “all the time” to any of the six questions from the Salisbury Eye Evaluation Study dry eye questionnaire. Age-standardized incidence of SDED was calculated as the crude 6-year cumulative incidence standardized to Singapore's population census. Gender-stratified multivariable log-binomial regression models were utilized to determine the independent risk factors of incident SDED. ResultsAt the 6-year follow-up, 86 of 1682 participants had developed SDED, which was equivalent to an age-standardized 6-year incidence of 5.1% (95% CI 4.1–6.4%). There were no differences in the incidence of SDED between men and women (P = 0.9). Multivariable models revealed that presence of glaucoma and poorer self-rated health were independently associated with incident SDED in men (P = 0.003 and 0.03, respectively), while contact lens wear (P = 0.002), history of thyroid disease (P = 0.03), and having had cataract surgery (P = 0.02) were predictive of incident SDED in women. ConclusionOne in twenty adult Malays developed SDED over a 6-year period. Risk factors for incident SDED were different between men and women. Future studies and public health interventions should consider this gender-specific difference in risk factors.

Ocular surface effects of repeated application of povidone iodine in patients receiving frequent intravitreal injections

Background: The aim of this study was to investigate the patient reported symptoms and objective signs of tear film and ocular surface abnormalities experienced by patients undergoing repeated exposure to povidone iodine as a consequence of requiring frequent intravitreal injections for wet macular degeneration.Methods: This was a prospective study of consecutive patients who had received recent povidone 5% solution for sterile preparation of intravitreal injection less than 3 months prior to inclusion with a total of at least 3 intravitreal injections for macular degeneration. Each patient had one study eye which was undergoing regular intravitreal injection and a fellow eye which was not undergoing any injections. Each patient underwent evaluations of various tear film parameters on a single occasion for both eyes. The primary outcome was severity of dry eye symptoms as measured by the Schein dry eye questionnaire. The secondary outcomes were tear film osmolarity and corneal punctate staining using the Oxford Grading Scale.Results: A total of 90 patients were included in the study. 43.3% n = 39, were using ocular lubricating medication on a regular basis. A significantly greater proportion of study eyes had a Schein dry eye questionnaire score of 7 or higher; 12.2%, n = 11 amongst study eyes vs 4.4%, n = 4 amongst control, fellow eyes (p < 0.05). In terms of secondary outcomes, the study eyes had a slightly higher mean tear film osmolality compared to control, fellow eyes: 305.5 ± 1.7 in study eyes vs 302 ± 1.6 in control eyes although this difference was not statistically significant (p = 0.087). The study eyes had statistically significantly worse corneal staining as determined by the Oxford grading scale; 0.69 in study eyes vs 0.58 in control, fellow eyes (p = 0.02).Conclusion: Our results confirm the detrimental impact of repeated application of povidone iodine for intravitreal injection procedures on symptoms of dry eyes as experienced and reported by patients.

Prevalence of Dry Eye in Uyghur and Han Ethnic Groups in Western China

ABSTRACTPurpose: To describe and compare the prevalence and characteristics of dry eye among Han and Uyghur persons living in Kashi, the most inland city of China.Methods: A total of 1015 residents of Kashi participated in this 2013 cross-sectional study. To evaluate clinical characteristics, each subject completed (1) a dry-eye questionnaire detailing symptoms of dry eye, (2) Schirmer’s I-test (SIT), (3) tear-film break-up time (BUT) test, and fluorescein staining of the cornea. Dry eye was defined as the existence of dry eye symptoms and at least two positive clinical signs. Data were analyzed using SPSS software. The prevalence and risk factors of dry eye were evaluated using a multivariate model.Results: Overall, 282 (27.8%) of the 1015 participants were diagnosed with dry eye (95% confidence interval (CI): range, 25.5–30.1). The prevalence of dry eye among Han persons (37.9 %) (95% CI: range, 35.8–40.0) was higher than that among Uyghurs (21.8%) (95% CI: 19.6–24.0) (p < 0.05). The prevalence of dry eye was 25.6% (95% CI: range, 23.3–27.8) among men and 28.7% (95% CI: 26.5–30.9) among women (p > 0.05). Risk factors for dry eye included ethnicity, age, occupation, arthritis, and dry mouth.Conclusions: Our study revealed a higher prevalence of dry eye among Han than Uyghur persons in Kashi. Dry eye was significantly associated with environment and ethnicity.

Rasch analysis of three dry eye questionnaires and correlates with objective clinical tests

PurposeTo assess the psychometric properties of Chinese versions of the Ocular Comfort Index (OCI), Ocular Surface Disease Index (OSDI) and McMonnies questionnaires. Further, to assess the correlation between questionnaire scores and objective dry eye disease (DED) clinical tests. MethodsTranslated versions of the OCI, OSDI and McMonnies questionnaires were completed in a random order by 238 participants with DED. Objective clinical tests included visual acuity (VA), fluorescein tear film break-up time (TBUT), corneal fluorescein staining, Schirmer I testing and meibomian gland grading. Rasch analysis was used to assess questionnaire psychometrics and spearman rank for correlations. ResultsFor the OCI, the person separation was 2.31, item infit and outfit statistics ranged from 0.74–1.14 and 0.75–1.32, respectively, and targeting 1.54 logits. For the OSDI, person separation was 0.94. None of the three subscales provided valid measurements based on Rasch analysis. For the McMonnies questionnaire, person separation was 1.17, item infit and outfit statistics ranged from 0.7 to 1.21 and 0.51–3.49, respectively. There were weak correlations between questionnaire scores and clinical tests. There were weak correlations between OSDI scores and VA, fluorescein TBUT, Schirmer I testing and corneal fluorescein staining. There were weak correlations between McMonnies scores and VA, fluorescein TBUT, Schirmer I testing, and corneal fluorescein staining and meibomian gland grading. ConclusionsThe OCI questionnaire was the only questionnaire that provided valid measurement on the basis of Rasch analysis, although slight multidimensionality was found. There were weak correlations between OCI scores and fluorescein TBUT, Schirmer I testing, and corneal fluorescein staining. Due to this paradoxical disconnect between symptoms and signs and the repeatability of tests, the use of both subjective and objective markers in the clinical management of patients or as endpoints in clinical trials would appear prudent.

Dry Eye in Patients With Diabetic Retinopathy: A Clinical Study

Purpose: To study tear film changes in patients of Type 2 diabetes mellitus with and without diabetic retinopathy. Method: A hospital based, cross sectional, observational study including 40 patients of Type 2 diabetes mellitus with diabetic retinopathy and 40 patients without diabetic retinopathy. The parameters evaluated for each patient included a questionnaire (based on McMonnie’s Dry Eye questionnaire), Schirmer’s basic secretion test (BST) and Tear film break up time (TBUT). Results: The prevalence of dry eye in patients without diabetic retinopathy was 5% (Schirmer’s BST) and 42.5% (TBUT) as compared to 21.25% (Schirmer’s BST) and 82.5% (TBUT) in patients with diabetic retinopathy. Schirmer’s BST and TBUT were found decreased with the increase in severity of diabetic retinopathy (p<0.001). Conclusions: The prevalence and severity of dry eye, based on clinical parameters, was more in patients with diabetic retinopathy as compared to those without diabetic retinopathy.

RNA Collection From Human Conjunctival Epithelial Cells Obtained With a New Device for Impression Cytology.

To assess the ability of a new device (Eyeprim; Opia Technologies) designed for impression cytology (IC) to harvest RNA from conjunctival cells as compared with the conventional technique. Cell collection was performed in both eyes using both techniques (conventional and Eyeprim) in different eyes randomized to each technique to avoid bias. The collection order was also randomized. Subjective discomfort assessment was performed using the Symptom Assessment in Dry Eye questionnaire. RNA was quantified in a spectrophotometer. RNA yield and discomfort using each technique were evaluated. A P value ≤0.05 was considered significant. Twenty healthy subjects (8 men and 12 women) aged 24.7 ± 5.8 years were recruited. The mean corneal fluorescein staining scores were 0.10 ± 0.30 for both eyes (P = 1.0), and the mean phenol red thread tear scores were 28.6 ± 1.9 mm for the Eyeprim and 28.7 ± 2.5 mm for the conventional IC eye group (P = 0.64). No significant (P ≥ 0.45) differences were observed in the mean RNA yield between the Eyeprim and the conventional IC, neither in the total amount (0.32 ± 0.28 μg and 0.26 ± 0.28 μg, respectively) nor in the amount normalized to the membrane area (0.0046 ± 0.0040 μg/mm and 0.0040 ± 0.0043 μg/mm, respectively). No significant differences were observed during (P ≥ 0.17) and after sample collection (P ≥ 0.36) in the frequency or intensity of discomfort (Symptom Assessment in Dry Eye scores). This pilot study shows that the Eyeprim provides similar RNA yield as the conventional harvesting conjunctival IC technique. It provides enough quantities of material useful for molecular analysis producing comparable levels of discomfort without using anesthesia.

Effectiveness of an Eyelid Thermal Pulsation Procedure to Treat Recalcitrant Dry Eye Symptoms After Laser Vision Correction.

To provide an initial retrospective evaluation of the effectiveness of a thermal pulsation system to treat intractable patient-reported dye eye symptoms following laser vision correction. A total of 109 eyes of 57 patients underwent thermal pulsation therapy (LipiFlow; TearScience, Morrisville, NC) for the treatment of dry eye symptoms following laser vision correction. A standardized dry eye questionnaire, the Standard Patient Evaluation of Eye Dryness (SPEED II), was administered to all patients before and after thermal pulsation therapy. The primary outcome was patient-reported dry eye symptoms as measured by this questionnaire. The mean patient age was 49 years (interquartile range [IQR]: 38 to 60), 70% were female, and the primary refractive procedure was LASIK (n = 91, 83%) or photorefractive keratectomy (PRK) (n = 18, 17%). Patients underwent thermal pulsation therapy at a mean of 40.5 months (IQR: 27.6 to 55.0) after the primary procedure. The mean pre-therapy SPEED II questionnaire score was 17.5 (IQR: 14 to 21), with a reduced mean post-therapy score of 10.2 (IQR: 6 to 14; 95% confidence interval [CI]: 8.8 to 11.5, P < .001). Patients with PRK tended to report more improvement. At the follow-up clinical evaluation, objective improvements were noted in tear break-up time (+1.9 sec; 95% CI: 1.3 to 2.5), reduction in grade of meibomian gland dysfunction (-0.69; 95% CI: -0.54 to -0.84), and corneal staining (-0.74; 95% CI: -0.57 to -0.91). In this initial retrospective evaluation, a significant improvement in patient-reported dry eye symptoms was observed following thermal pulsation therapy. This treatment modality may have utility in the management of dry eye symptoms following laser vision correction, but further study is needed to define its role. [J Refract Surg. 2017;33(1):30-36.].

Longitudinal Examination of Frequency of and Risk Factors for Severe Dry Eye Symptoms in US Veterans

ImportanceDry eye syndrome is a common condition that affects millions of individuals. Many cross-sectional studies have evaluated risk factors for dry eye severity, but few have assessed risk factors or symptom progression over time.ObjectivesTo assess symptom progression in dry eye syndrome and determine risk factors associated with severe symptoms at 1 year.Design, Setting, and ParticipantsA longitudinal study was conducted from October 1, 2013, to April 30, 2015, among patients at the Miami Veterans Affairs Hospital with a wide variety of dry eye symptoms and signs (ranging from none to severe).Main Outcomes and MeasuresChange in dry eye symptom severity during 1 year, as assessed by responses to dry eye symptom questionnaires administered at the initial visit and 1 year later, as well as baseline risk factor analysis for severe dry eye symptoms at 1 year, defined as a Dry Eye Questionnaire 5 score of 12 or more.ResultsOf the 120 patients (mean [SD] age, 64 [11] years; 109 male and 11 female), 26 of 58 (44.8%) with either no symptoms or mild or moderate symptoms at baseline progressed to more severe symptoms at 1 year, while 46 of 62 patients (74.2%) with severe symptoms at baseline reported that severe symptoms persisted at 1 year. Baseline ocular risk factors for severe dry eye symptoms at 1 year included more severe dry eye symptoms, ocular pain, and neuropathic pain–like ocular symptoms. Nonocular risk factors included sleep disturbances (eg, sleep apnea and insomnia), mental health status (eg, posttraumatic stress disorder and depression), nonocular pain, and medications (eg, anxiolytics and analgesics). In a multivariable analysis, the most significant risk factors were sleep apnea (odds ratio [OR], 3.80; 95% CI, 1.00-14.49; P = .05), Dry Eye Questionnaire 5 score (OR, 1.15; 95% CI, 1.02-1.30; P = .02), and posttraumatic stress disorder score (OR, 1.04; 95% CI, 1.01-1.08; P = .02).Conclusions and RelevancePatients with severe dry eye symptoms and ocular pain at baseline were more likely to have persistent severe dry eye symptoms on 1-year follow-up. Furthermore, nonocular risk factors that have been associated with dry eye cross-sectionally, such as psychiatric comorbidities and nonocular pain, were also associated with severe dry eye symptoms at 1 year. Although this cohort was limited to US veterans, which may not be generalizable to other populations, our results suggest that pain perception and severity are important when evaluating and managing dry eye.

Tear lipid layer thickness with eye drops in meibomian gland dysfunction.

PurposeThe aim of this study was to evaluate the efficacy of a lipid containing emollient eye drop, Soothe XP, which was reformulated in 2014 with a more stable preservative and buffer system, compared to a control, non-emollient, eye drop (Systane Ultra) in improving lipid layer thickness (LLT) in subjects with dry eye due to meibomian gland dysfunction (MGD).Patients and methodsThis prospective single-center, open-label, cross-over, examiner masked-study enrolled subjects aged 30–75 years with lipid-deficient dry eye and a clinical diagnosis of MGD as determined by a slit lamp examination, an evaluation of meibomian gland drop out with meibography, and a standard patient evaluation of eye dryness questionnaire of >5. Eligibility was then determined by a LLT of <75 nm at baseline and the inability to increase LLT ≥15 nm with three blinks, as determined by interferometric methods. Subjects were randomized to receive a single emollient or non-emollient eye drop at Visit 1 and were crossed over for the alternate treatment at Visit 2. At each visit, LLT was measured prior to and 15 minutes following the instillation of the assigned eye drop. The primary endpoint was the change in LLT from baseline.ResultsSubjects (n=40) were enrolled and 35 completed the two study arms. Mean (±SD) patient age was 55.7 years (10.9) and 69% were female. Mean (±SD) LLT at baseline was 49.5 nm (9.2). Instillation of Soothe XP resulted in an increase in LLT to 77.5 nm (29.3) 15 minutes following drop instillation, which is an increase of 28.0 nm (27.4) (P<0.001). In contrast, LLT 15 minutes after the instillation of Systane Ultra was 50.8 nm (14.1), which was not statistically significant when compared to the baseline LLT.ConclusionIn this study of subjects with MGD, the emollient, or lipid containing eye drop, increased the LLT of tears when measured 15 minutes after instilling a single eye drop.

Effects of Lipid Supplements on Tear Biochemistry in Contact Lens Wearers.

To establish the effect of lipid supplements on tear lipid biochemistry and their influence on lens wear comfort in habitual lens wearers. Forty habitual soft contact lens wearers were recruited to a double-masked, randomized crossover trial. An emulsion drop containing phosphatidylglycerol (Systane Balance; Alcon) and a liposomal spray containing phosphatidylcholine (Tears again; BioRevive) along with saline placebos were used three times a day for 14 days with 48 hours of washout between each intervention. The Contact Lens Dry Eye Questionnaire categorized participants into symptomatic and asymptomatic wearers. Ocular comfort was measured using the Ocular Comfort Index. Basal tears (15 μl from each eye) were collected with lenses in situ and assayed for the concentration and activity of phospholipase (sPLA2) and the concentration of a malondialdehyde (MDA). Electrospray ionization mass spectrometry characterized the tear lipidome. Neither of the lipid supplements improved lens wear comfort compared to baseline. The spray treatment did not affect the concentration of the majority of lipid classes either at day 1 or at day 14. Both the lipid and placebo drops resulted in increased concentration of several lipid classes after day 1 of use, but by day 14, the concentration of most of the lipid classes had returned to baseline levels. With the lipid spray, sPLA2 activity (0.38 ± 0.2 vs. 0.73 ± 0.6 mmol/min/ml, p = 0.03) and lysophosphatidylethanolamine (LPE) (1.3 ± 0.5 vs. 2.7 ± 0.07 pmol/μl, p = 0.02) were higher in the symptomatic group compared to asymptomatic group at day 1 but not at day 14. The lipid drop resulted in increased LPE concentration in symptomatic wearers at day 1 (1.7 ± 0.3 vs. 2.4 ± 0.3 pmol/μl, p = 0.01) and at day 14 (1.7 ± 0.4 vs. 2.5 ± 0.5 pmol/μl, p = 0.04). Ocular comfort was inversely proportional to the level (r = -0.21, p = 0.007) and activity of sPLA2 (r = -0.20, p = 0.01). There was an association between sPLA2 and LPC (r = 0.41, p < 0.001) and LPE (r = 0.40, p = 0.001), and a negative association with (O-acyl)-ω-hydroxy fatty acids (OAHFAs) (r = -0.30, p = 0.03) in tears. Contact lens wear comfort was associated with sPLA2 concentration and activity in tears. Lipid biochemistry was transiently influenced by exogenous supplements. Although the specific supplement formulations tested did not differ from placebo in this study, the results do suggest a potential role for lysophospholipids and OAHFAs in modulating symptoms during contact lens wear.

Assessment of Somatosensory Function in Patients With Idiopathic Dry Eye Symptoms

Somatosensory dysfunction likely underlies dry eye (DE) symptoms in many individuals yet remains an understudied component of the disease. Its presence has important diagnostic and therapeutic implications. To assess the integrity of nociceptive system processes in persons with DE and ocular pain using quantitative sensory testing (QST) techniques applied at a site remote from the eye. A cross-sectional study conducted at Miami Veterans Affairs Hospital included 118 individuals with a wide variety of DE symptoms and signs. The study was conducted from October 31, 2013, to January 28, 2016. Individuals completed questionnaires regarding ocular symptoms (5-Item Dry Eye Questionnaire [DEQ5], Ocular Surface Disease Index [OSDI], and Neuropathic Pain Symptom Inventory modified for the eye [NPSI-E]), psychological status, and medication use and underwent an ocular surface examination. The QST metrics included measures of vibratory and thermal thresholds and cold and hot pain temporal summation (surrogate measures of central sensitization) on the forearm. Correlations among DE and ocular pain symptom severity with QST metrics measured on the forearm. The OSDI score ranges from 0 to 100, with 100 indicating the most severe DE symptoms. The DEQ5 score ranges from 0 to 22, with the highest score indicating the most severe symptoms, and the NPSI-E score ranges from 0 to 100, with the highest score indicating the most severe symptoms. Psychological state was measured with the 9-item Patient Health Questionnaire, the PTSD Checklist-Military Version for PTSD, and the Symptom Checklist-90 for anxiety. Of the 118 patients who participated in the study, 105 (88.9%) were men (mean [SD] age, 60 [10] years), and a mean of 41% had PTSD, 10% depression, and 0.93% anxiety. Using stepwise linear regression analyses, significant associations were identified between overall DE symptom severity and posttraumatic stress disorder scores and tear breakup time (DEQ5 model: R = 0.54; OSDI model: R = 0.61, P < .001). All other variables (ie, demographics, comorbidities, medications, tear film factors, and QST metrics) dropped out of these models. When specifically considering neuropathic-like qualities of DE pain, however, anxiety and hot pain temporal summation at the forearm explained 17% of the variability in ocular burning (R = 0.41; P < .001), and PTSD score, tear breakup time, and hot pain temporal summation at the forearm explained 25% of the variability in sensitivity to wind (R = 0.50; P < .001) and 30% of the variability in total NPSI-E scores (R = 0.55; P < .001). Our findings demonstrate that neuropathic-like DE pain symptom severity correlates with quantitative measures of pain sensitivity at a site remote from the eye. This result provides additional evidence that DE symptoms are not only manifestations of a local disorder but also involve somatosensory dysfunction beyond the trigeminal system.

Communication between the researcher and the researched. Designing an application based study regarding effects of air pollution on ocular surface diseases

PurposeTo inform application users about current air pollution and their ocular surface state. To gather data concerning correlation between air pollution and ocular surface diseases.MethodsAirPoll is a mobile application that serves as a gateway to a nation‐wide air pollution study. We designed it using Apple's Research Kit – an open source software framework for medical researchers. After all the permissions are granted and consent form is signed digitally, the application uses phone's Global Positioning System to determine user's location and then connects to the server of US Environmental Protection Agency to determine the level of various air pollutants. The built in questionnaire module allows us to gather data related to user's health, including past medical history and OSDI Dry Eye questionnaire. To raise user's engagement in the study and provide an information feedback, every user has access to his or her data presented in an easy to understand manner. Both current pollutants in the user's location and his approximate health state are displayed in a simple graph form.ResultsData concerning current air pollutants levels basing on geolocation of the application user (including particulate matter with a mean aerodynamic diameter of 2.5 μm and 10 μm, ozone, sulfur oxides and volatile organic compounds) and results concerning ocular surface obtained using OSDI Dry Eye questionnaire.ConclusionsThis innovative approach to sharing information in medical research not only raises user's involvement in the study, but also fulfils an educational purpose.

Assessing Scleral Contact Lens Satisfaction in a Keratoconus Population.

To assess perceived comfort and related experiences of adapted keratoconic scleral contact lens (17-18.2 mm) wearers with a history of wearing other contact lens modalities and to compare these subjective clinical effects with previous experiences. Twenty-four keratocones were recruited, signed an informed consent approved by the University Internal Review Board, and were asked to complete a survey and a dry eye questionnaire. Previous lens wearing experience included soft, piggy back, and hybrid lenses but predominantly was corneal gas permeable. An overwhelming majority strongly preferred the comfort and vision with the scleral contact lenses. This cohort of keratoconus patients were on average dry eye suspects according to a dry eye questionnaire but contained individuals with either normal or significantly dry eye scores. However, patients stated that they experienced less dryness with their scleral lenses, but slightly more than half of these patients experienced, at least occasionally, midday fogging. The scleral contact lenses are extremely well accepted by keratoconic patients because of comfort and vision these devices provide. For many patients, they offer further relief from dryness symptoms. However, midday fogging remains a limitation for many wearers.

Corneal Sensitivity and Inflammatory Biomarkers in Contact Lens Discomfort.

The aim of this study was to analyze whether symptoms of discomfort in hydrogel contact lens (HCL) wearers were associated with changes in corneal sensitivity or levels of tear inflammatory mediators. Sixty-six subjects were included: 47 HCL wearers, further divided into 24 symptomatic and 23 asymptomatic wearers by the Contact Lens Dry Eye Questionnaire short form and 19 non-contact lens wearers. At least 24 h after HCL removal, we obtained scores from the Ocular Surface Disease Index and mechanical, hot, and cold corneal thresholds using a Belmonte esthesiometer. We collected 4 μl of tears with a capillary micropipette and measured levels of 12 inflammatory markers using a bead-based array: epidermal growth factor, fractalkine, interleukin-10 (IL-10), IL-1β, IL-1 receptor antagonist, IL-2, IL-4, IL-6, IL-8, monocyte chemoattractant protein 1, tumor necrosis factor-α, and matrix metalloproteinase 9. There were no significant differences between groups in corneal sensitivity thresholds and levels of tear molecules. The following significant correlations were found in the total sample pooled: Ocular Surface Disease Index correlated with mechanical threshold (p < 0.01; rho = -0.324) and epidermal growth factor (p < 0.01, rho = -0.330), and mechanical threshold correlated with heat threshold (p < 0.01, rho = -0.321). Twenty-four hours after HCL removal, symptoms of discomfort in HCL wearers are not related to changes in corneal sensitivity or tear inflammatory mediator levels. This might indicate either that HCL wear has no effect on these parameters or that ocular surfaces recover from HCL-caused effects during the first hours after HCL removal. However, there were correlations for associations between symptoms, corneal sensitivity, and some molecules in tears.

Lid Papillae Improvement with Hydrogen Peroxide Lens Care Solution Use.

To assess changes in lid papillae and symptoms after use of a hydrogen peroxide-containing solution (H2O2) for 3 months by symptomatic contact lens wearers. This randomized, controlled, investigator-masked, parallel group study enrolled symptomatic lens wearers with at least mild lid papillae who habitually used a biguanide-preserved multipurpose solution (BMPS). Subjects were randomized to habitual BMPS or H2O2 for 3 months to care for their lenses. Lid papillae severity (0-4) was graded in four zones of each eye at baseline and at 30, 60, and 90 days. Subjects rated frequency and intensity of symptoms and completed the Contact Lens Dry Eye Questionnaire (CLDEQ-8) at the same time points. Lens cases used for 1 month were collected from subjects in the H2O2 group, and residual peroxide concentration was analyzed at disinfection time. In all, 131 subjects were randomized to H2O2 (n = 64) or BMPS (n = 67) and underwent post-baseline assessment. The H2O2 group showed significantly greater improvements in lid papillae from baseline to day 90 than the BMPS group (H2O2, least square mean [LSM] difference [baseline-day 90] in maximum score 0.904 [95% CI 0.744-1.064]; BMPS, LSM difference 0.423 [95% CI 0.271-0.576]; p < 0.001). Frequency and intensity of symptoms, including grittiness, end-of-day dryness, irritation, burning/stinging, itchiness, and blurry vision, were significantly lower for H2O2 than for BMPS at days 30, 60, and 90 (all p ≤ 0.045), as were mean CLDEQ-8 scores (3-mo scores 10.6 ± 6.30 vs.15.0 ± 7.29, p < 0.001). Residual peroxide concentration in 61 used lens cases ranged from 6 to 55 ppm (mean, 15 ± 8 ppm) and 95% of cases had residual peroxide less than 30 ppm. Symptomatic contact lens wearers using the H2O2 solution showed greater reductions in lid papillae and symptoms at 90 days than did subjects using BMPS. Cases used for 1 month neutralized peroxide at disinfection time to levels below those detectable by ocular tissues.

The relief of dry eye signs and symptoms using a combination of lubricants, lid hygiene and ocular nutraceuticals

PurposeTo determine the combined effect of TheraTears® Lubricant Eye Drops, TheraTears® SteriLid Eyelid Cleanser, and TheraTears® Nutrition on dry eye signs and symptoms. MethodsThis prospective study enrolled 28 dry eye participants. Participants were instructed to use the Lubricant Eye Drops at least 2–4× a day, SteriLid 1–2× a day, and Nutrition 3 gel caps once a day. Participants were followed up at baseline, 1 month and 3 months. Outcome variables were the Ocular Surface Disease Index (OSDI), Symptom Assessment iN Dry Eye (SANDE) questionnaire, non-invasive tear break-up time (NIBUT), osmolarity, number of meibomian glands blocked (#MG blocked), meibum quality, eyelid margin features, Schirmer's test, tear film lipid layer thickness (LLT), meniscus height, corneal and conjunctival staining. ResultsTwenty participants (mean age=43, from 23 to 66, 17F, 3M) completed the study. Participants reported having used, on average, the Lubricant Eye Drop 2.4×/day, the SteriLid 1.1×/day, and the Nutrition 3 gel caps 1×/day. There was a significant change over time (p<0.05) for OSDI (−21.2 points), SANDE (−32.4 points), NIBUT (+0.43s), eyelid margin features (−1.1 grade), meibum quality (−1.0 grade), and #MG blocked (−4.0 glands). ConclusionBy using a combination of TheraTears® Lubricant Eye Drop, SteriLid, and Nutrition, patients experience significant relief in both dry eye symptoms and signs.

Frequency and risk factors associated with dry eye in patients attending a tertiary care ophthalmology center in Mexico City.

PurposeThe purpose of this study was to ascertain the frequency and risk factors of dry eye (DE) among patients attending a tertiary care ophthalmology center in Mexico.MethodsApproximately 338 consecutive new patients attending a tertiary care ophthalmology center in Mexico City underwent an ocular surface examination, which included tear film break-up time, fluorescein corneal staining, Schirmer’s test, and evaluation of meibum quality. Symptoms of DE were evaluated by the Ocular Surface Disease Index and Dry Eye Questionnaire-5. Information on demographics, exposures, past medical and ocular history, and medications was also collected.ResultsThe frequency of severe DE symptoms was found to be 43% based on the Ocular Surface Disease Index and 30% based on Dry Eye Questionnaire-5. Risk factors significantly associated with increased DE symptoms included dry mouth and gastrointestinal ulcer medications. With regard to signs, aqueous tear deficiency was a less-frequent finding (22%) in our population than evaporative deficiency (94%). Risk factors associated with aqueous tear deficiency were dry mouth and diuretic use. No risk factors were associated with evaporative deficiency. Risk factors associated with meibomian gland dysfunction included old age, male sex, arthritis, and use of an antihypertensive. The only risk factor associated with corneal staining was dry mouth.ConclusionThis is the first study to demonstrate the frequency of symptomatic and clinical DE in a tertiary care ophthalmology center in Mexico. The frequency of DE ranged from 30% using a symptomatic definition to 94% using objective measures. Different risk factors were found for different aspects of DE, suggesting differing underlying pathophysiologies behind different DE subtypes.

The use of conjunctival ultraviolet autofluorescence (CUVAF) as a biomarker of time spent outdoors.

Conjunctival ultraviolet autofluorescence (CUVAF) has been used in previous Southern Hemisphere myopia research as a marker for time spent outdoors. The validity of CUVAF as an indicator of time spent outdoors is yet to be explored in the Northern Hemisphere. It is unclear if CUVAF represents damage attributed to UV exposure or dry eye. This cross-sectional study investigated the association between CUVAF measures, self-reported time spent outdoors and measures of dry eye. Participants were recruited from University staff and students (n=50, 19-64years; mean 41). None were using topical ocular medications (with the exception of dry eye treatments). Sun exposure and dry eye questionnaires (Ocular Surface Disease Index and McMonnies) were completed by the participant. Dryness was also assessed using slit lamp biomicroscopy and invasive tear break up time. Images of the temporal and nasal conjunctiva from the right and left eye were captured using a bespoke photography system. The total CUVAF area, average CUVAF pixel intensity per mm(2) and total CUVAF pixel intensity were analysed using MATLAB R2013a (The MathWorks Inc). Of the 50 participants, 42% were classified as having dry eye. Self-reported sunglasses use was negatively associated with all CUVAF measures (Kruskal Wallis total CUVAF area, p=0.04, ptrend =0.03, average CUVAF pixel intensity p=0.02, ptrend =0.02, total CUVAF pixel intensity: p=0.04, ptrend =0.02). Time spent outdoors was positively associated with all CUVAF measures (Spearman's correlation coefficients, total CUVAF area: r=0.37, p=0.01, average CUVAF pixel intensity: r=0.36, p=0.01, total CUVAF pixel intensity: r=0.37, p=0.01) and remained significant when sunglasses use was controlled for (partial correlation, total CUVAF area: r=0.32, p=0.03, average CUVAF pixel intensity: r=0.39, p=0.01, total CUVAF pixel intensity: r=0.39, p=0.03). Neither CUVAF area nor intensity measures were associated with any dry eye measure (Ocular Surface Disease Index: all p≥0.41, corneal staining: all p≥0.38, McMonnies: all r≤0.09 all p≥0.52, slit lamp biomicroscopy: all r≤0.20 all p≥0.17, invasive tear break up time: all r≤-0.07 all p≥0.31). CUVAF area and intensity were not associated with clinical measures of dry eye. Greater CUVAF area and intensity were associated with wearing sunglasses less frequently and spending more time outdoors. If sunglass wear is accounted for, CUVAF may be a useful biomarker of time spent outdoors in future myopia studies.