Evaluation Of Ocular Surface Diseases Research Articles

Anterior Segment Optical Coherence Tomography Angiography: A Review of Applications for the Cornea and Ocular Surface

Dye-based angiography is the main imaging modality in evaluating the vasculature of the eye. Although most commonly used to assess retinal vasculature, it can also delineate normal and abnormal blood vessels in the anterior segment diseases—but is limited due to its invasive, time-consuming methods. Thus, anterior segment optical coherence tomography angiography (AS-OCTA) is a useful non-invasive modality capable of producing high-resolution images to evaluate the cornea and ocular surface vasculature. AS-OCTA has demonstrated the potential to detect and delineate blood vessels in the anterior segment with quality images comparable to dye-based angiography. AS-OCTA has a diverse range of applications for the cornea and ocular surface, such as objective assessment of corneal neovascularization and response to various treatments; diagnosis and evaluation of ocular surface squamous neoplasia; and evaluation of ocular surface disease including limbal stem cell deficiency and ischemia. Our review aims to summarize the new developments and clinical applications of AS-OCTA for the cornea and ocular surface.

Evaluation of ocular surface disease due to digital usage during COVID-19 pandemic: A cross-sectional study

Evaluation of ocular surface disease due to digital usage during COVID-19 pandemic: A cross-sectional study

Corneal nerve structure in patients with primary Sj\xf6gren\u2019s syndrome in China

BackgroundThe aim of this study was to evaluate the in vivo confocal microscopic morphology of corneal subbasal nerves and its relationship with clinical parameters in patients with primary Sjögren’s syndrome in China.MethodsThis was a case control study of 22 dry eye disease (DED) patients with primary Sjögren’s syndrome (pSS) and 20 control subjects with non-Sjögren dry eye disease (NSDE). Each patient underwent an evaluation of ocular surface disease using the tear film break-up time (TBUT), noninvasive tear film break-up time (NIKBUT), noninvasive tear meniscus height (NIKTMH), corneal staining (National Eye Institute scale, NEI), Schirmer I test, meibography, and corneal subbasal nerve analysis with in vivo confocal microscopy (IVCM). The right eye of each subject was included in this study.ResultsSS patients showed a shorter TBUT (P = 0.009) and Schirmer I test results (P = 0.028) than the NSDE group. However, there was no significant difference in NIKBUT between the two groups (P = 0.393). The nerve density of subbasal nerves, number of nerves and tortuosity of the SS group were significantly lower than those of the NSDE group (P = 0.001, P < 0.001 and P = 0.039, respectively). In the SS group, the mean nerve length was correlated with age and the Schirmer I test (r = − 0.519, P = 0.013 and r = 0.463, P = 0.035, respectively). Corneal staining was correlated with nerve density and the number of nerves (r = − 0.534, P = 0.013 and r = − 0.487, P = 0.025, respectively).ConclusionsSjögren syndrome dry eye (SSDE) patients have more severe clinical dry eye parameters than non-Sjögren dry eye disease (NSDE) patients. Compared with NSDE patients, we found that SSDE patients showed decreased corneal subbasal nerve density and numbers.

Evaluation of ocular surface disease in elderly patients with glaucoma: expression of matrix metalloproteinase‐9 in tears

PurposeTo evaluate the symptoms and signs of ocular surface disease (OSD) and tear film matrix metalloproteinase‐9 (MMP‐9) overexpression using point‐of‐care testing (InflammaDry test) in patients with primary open‐angle glaucoma (POAG).MethodsThis prospective, case‐control study included sixty‐seven patients diagnosed with POAG and forty‐seven healthy control subjects. The OSD assessment included Schirmer‐I test, the Oxford corneal stain scale, tear breakup time (TBUT), and the 5‐Item Dry Eye Questionnaire (DEQ‐5). Measurement of extracellular MMP‐9 was performed using the InflammaDry test. The OSD parameters and MMP‐9 expression levels were compared between the POAG and control groups. Additional subgroup analysis in the POAG group was performed according to the number of topical glaucoma medications (1, 2, or 3 bottles).ResultsThere were significant differences between the control and POAG groups for all OSD parameters. MMP‐9 overexpression was observed in 71.6% of POAG group, whereas only 31.9% of control group showed MMP‐9 overexpression. The subgroup analysis revealed that DEQ‐5, Oxford stain score, Schirmer‐I, and MMP‐9 overexpression demonstrated no significant difference among the three groups. Abnormal TBUT (≤ 5sec) was observed in 37.5%, 59.1%, and 76.2% of each subgroup according to number of medications (1, 2, and 3), and strong MMP‐9 overexpression was detected in 25.0%, 40.9%, and 61.9%, respectively (p = 0.032, p = 0.043).ConclusionsThe use of preservative‐containing medications may affect the ocular surface in patients with POAG. Graded measurement of tear‐film MMP‐9 could provide more information on OSD and might be a more useful marker for inflammation than conventional results obtained using an MMP‐9 kit.

Topographic properties of the cornea in welders.

The aim of the present study was to evaluate the topographic status of the welders' corneas. In this historical cohort, a group of welders (with at least 5 years' experience in welding) and a control group were assessed and compared. Lack of exposure to welding for 3 months or more was considered an exclusion criterion. In all participants, after taking a complete history of visual and ocular problems, both eyes underwent Pentacam imaging. Then, all subjects received slit lamp biomicroscopy for evaluation of ocular surface diseases. The data of 140 welders (mean age: 46.66 ± 13.01 years) and 172 controls (mean age: 45.05 ± 12.61 years) were analyzed. The welders' corneas had significantly higher eccentricity (p < 0.0001), keratometry readings (p < 0.0001), and cylinder power (p < 0.0001). The central, inferior, and nasal cornea were significantly thinner in the welders than in controls (p < 0.0001) while the difference was not significant in the superior and temporal cornea. All indices of corneal irregularity except for the central keratoconus index (CKI) and index of height asymmetry (IHA) were higher in welders compared to the control group (p < 0.0001). According to the results of this study, the welders' corneas are topographically irregular. Welders exhibit characteristics like steeper keratometry readings; higher eccentricity indexes; thinner central, inferior, and nasal corneas; and higher indices of corneal irregularity, especially the CK index. Long-term ultraviolet exposure may be a possible reason for these corneal changes.

Evaluation of ocular surface disease in elderly patients with glaucoma: expression of matrix metalloproteinase-9 in tears.

To evaluate the symptoms and signs of ocular surface disease (OSD) and tear-film matrix metalloproteinase-9 (MMP-9) overexpression using point-of-care testing (InflammaDry test) in patients with primary open-angle glaucoma (POAG). This prospective, case-control study included 67 patients diagnosed with POAG and 47 healthy control subjects. The OSD assessment included Schirmer-I test, the Oxford corneal stain scale, tear breakup time (TBUT), and the five-item dry eye questionnaire (DEQ-5). Measurement of extracellular MMP-9 level was performed using the InflammaDry test. The OSD parameters and MMP-9 expression levels were compared between the POAG group and the control group. Additional subgroup analysis in POAG group was performed according to number of topical glaucoma medications (Bottle 1, 2, or 3 medications). There were significant differences between the control and POAG groups for all OSD parameters. MMP-9 overexpression was observed in 71.6% of POAG group, whereas only 31.9% of control group showed MMP-9 overexpression. The subgroup analysis revealed that DEQ-5, Oxford stain score, Schirmer-I, and MMP-9 overexpression demonstrated no significant difference among the three groups. Abnormal TBUT (≤5 s) was observed in 37.5%, 59.1%, and 76.2% for each subgroup according to number of bottles (1, 2, and 3), and strong MMP-9 overexpression were also detected in 25.0%, 40.9%, and 61.9%, respectively (P = 0.032, P = 0.043). The use of preservative-containing medications may affect the ocular surface in patients with POAG. Graded measurement of tear-film MMP-9 could provide more information on OSD and might be a more useful marker for inflammation than then conventional results obtained by using an MMP-9 kit.

Multi-modal Anterior Eye Imager Combining Ultra-High Resolution OCT and Microvascular Imaging for Structural and Functional Evaluation of the Human Eye

To establish complementary information for the diagnosis and evaluation of ocular surface diseases, we developed a multi-modal, non-invasive optical imaging platform by combining ultra-high resolution optical coherence tomography (UHR-OCT) with a microvascular imaging system based on slit-lamp biomicroscopy. Our customized UHR-OCT module achieves an axial resolution of ≈2.9 μm in corneal tissue with a broadband light source and an A-line acquisition rate of 24 kHz with a line array CCD camera. The microvascular imaging module has a lateral resolution of 3.5 μm under maximum magnification of ≈187.5× with an imaging rate of 60 frames/s, which is sufficient to image the conjunctival vessel network and record the movement trajectory of clusters of red blood cells. By combining the imaging optical paths of different modules, our customized multi-modal anterior eye imaging platform is capable of performing real-time cross-sectional UHR-OCT imaging of the anterior eye, conjunctival vessel network imaging, high-resolution conjunctival blood flow videography, fluorescein staining and traditional slit-lamp imaging on a single device. With self-developed software, a conjunctival vessel network image and blood flow videography were further analyzed to acquire quantitative morphological and hemodynamics parameters, including vessel fractal dimensions, blood flow velocity and vessel diameters. The ability of our multi-modal anterior eye imager to provide both structural and functional information for ophthalmic clinical applications was demonstrated on a healthy human subject and a keratitis patient.

Синдром «сухого глаза» у пациентов с впервые выявленной глаукомой без лечения

Синдром «сухого глаза» у пациентов с впервые выявленной глаукомой без лечения

Response: Evaluation of Ocular Surface Disease in Patients With Glaucoma: Clinical Parameters, Self-report Assessment, and Keratograph Analysis.

Portela, Renata C. MD; Fares, Nikoly T. MD; Machado, Lilian F. MD; Leão, Amanda F.S. MSc; de Freitas, Denise MD, PhD; Paranhos, Augusto Jr MD, PhD; Prata, Tiago S. MD, PhD; Gracitelli, Carolina P.B. MD, PhD Author Information

Evaluation of Ocular Surface Disease in Patients With Glaucoma: Clinical Parameters, Self Report Assessment, and Keratograph Analysis.

Evaluation of Ocular Surface Disease in Patients With Glaucoma: Clinical Parameters, Self Report Assessment, and Keratograph Analysis.

Evaluation of Ocular Surface Disease in Patients With Glaucoma

Evaluation of Ocular Surface Disease in Patients With Glaucoma

Evaluation of Ocular Surface Disease in Patients With Glaucoma: Clinical Parameters, Self-report Assessment, and Keratograph Analysis.

To assess ocular surface disease (OSD) in glaucoma using clinical parameters, self-report assessment, and keratograph analysis. A total of 30 glaucoma patients and 27 subjects with cataracts (control group) were enrolled in the study. Only glaucoma patients who were using at least 1 topical intraocular pressure-lowering medication were included. An ophthalmological examination was performed, including tear break-up time (BUT), assessment of conjunctival hyperemia and keratitis, and completion of the Ocular Surface Disease Index (OSDI) questionnaire. All the patients underwent keratograph analysis including noninvasive BUT, meibography, tear meniscus height, and redness scale. Quality of life was also assessed in all the patients using National Eye Institute Visual Function Questionnaire (NEI VFQ)-25. The comparison of OSD between the 2 groups was assessed. There was a significant difference in OSD: keratitis and conjunctival hyperemia were worse in the glaucoma group (P=0.009 and 0.008, respectively). The glaucoma group had significantly worse scores on the OSDI questionnaire (32.53±20.75 vs. 20.42±18.77; P=0.007). For the keratograph assessment, the glaucoma group had significantly smaller tear meniscus height (0.22±0.08 vs. 0.24±0.04, respectively; P=0.041); worse bulbar redness (2.06±0.67 vs. 1.70±0.45, respectively; P=0.021); higher meibography grades (2.34±1.01 vs. 1.52±0.64, respectively; P=0.001); and worse noninvasive keratograph tear BUT (5.45±4.16 vs. 8.40±5.65, respectively; P=0.023). Patients with glaucoma had a worse quality of life (60.73±18.25 vs. 76.62±8.03, respectively; P=0.039). Our findings not only confirm the high prevalence of clinical findings of OSD in glaucoma patients but also reveal new objective parameters measured by keratograph analysis.

Impact of environmental pollution on the ocular surface of Sjögren’s syndrome patients

To evaluate the effect of air pollution on the ocular surface of patients with Sjögren's syndrome. We investigated the ocular surfaces of thirty patients with Sjögren's syndrome and thirty healthy volunteers (control group) living in the Metropolitan Area of Buenos Aires. We used nitrogen dioxide as an indicator of exposure to air pollution. An ocular symptoms questionnaire was answered by all subjects, who also underwent a complete ocular surface ophthalmic examination-including an Ocular Surface Disease Index questionnaire, biomicroscopy, tear breakup time, Schirmer 1 test, corneal and conjunctival vital staining with fluorescein and lissamine green, tear lysozyme concentration, and impression cytology. In almost all ocular surface test findings, we found a positive and significant correlation between higher levels of exposure to air pollution and higher levels of ocular surface damage in both the control group and Sjögren's syndrome patients. In Sjögren's syndrome patients, the Ocular Surface Disease Index questionnaire, tear breakup time, vital staining and impression cytology showed a significant correlation between high levels of air pollution and ocular surface disease. In the control group, the Ocular Surface Disease Index questionnaire, tear breakup time, and impression cytology showed a significant correlation between high levels of air pollution and ocular surface disease. Here we demonstrated that in patients with dry eye syndrome associated with Sjögren, abnormalities of the ocular surface and eye irritation related to air pollution are more severe than those in the control group. We believe that measuring air quality should be not only an integral part of the evaluation of ocular surface disease but also a therapeutic consideration.

Evaluation of Ocular Surface Disease in Asian Patients with Primary Angle Closure.

Objective:To evaluate the incidence of ocular surface disease (OSD) and to determine the effects of topical pressure-lowering drugs on ocular surface disease in primary angle closure patients.Methods:This was a cross-sectional comparative study comparing primary angle closure glaucoma (PACG) patients (Group A) with primary angle closure and primary angle closure suspect (Group B). Group A was treated with topical pressure-lowering drugs; Group B was not. Data on ocular diagnosis and details of treatment were obtained from medical records. Ocular surface disease incidence was assessed using the Ocular Surface Disease Index (OSDI) questionnaire and from clinical signs using Schirmer’s test, tear break-up time and corneal fluorescein stain. Predictive Analytic Software 20 and STATA analysis software were used for statistical analyses.Results:Group A demonstrated a higher rate of OSD (OSDI 52.3%, Schirmer’s test 70.5%, tear break-up time (TBUT) 75%, corneal staining 77.3%) compared to Group B (OSDI 39.0%, Schirmer’s test 73.2%, TBUT 58.5% and cornea staining 14.6%) except for Schirmer’s test. There was a significant difference in mean score of OSDI (p=0.004), TBUT (p=0.008) and cornea staining (p<0.001) between two groups. Primary angle closure glaucoma treated with more than two medications and for more than three years had worse ocular surface disease parameters but without statistical significant difference.Conclusion:Ocular surface disease is common in PACG patients treated with topical pressure-lowering drugs. Topical pressure-lowering drugs caused significant OSD symptoms and signs except for tear production in PACG patients. Thorough evaluation of ocular surface disease is important to ensure appropriate treatment and intervention in PACG patients.

Evaluation of Ocular Surface Disease in Patients with Glaucoma

To evaluate the subjective and objective measures of ocular surface disease in patients with glaucoma. Cross-sectional study. Sixty-four glaucoma subjects with bilateral visual field (VF) loss and 59 glaucoma suspects with normal VFs. Consecutive patients were recruited prospectively from the Wilmer Eye Institute Glaucoma Clinic. Tear film breakup time (TBUT), corneal staining score (0-15), and Schirmer's test results were included as objective metrics, whereas the Ocular Surface Disease Index (OSDI) questionnaire was administered to assess symptoms. Total OSDI score, vision-related subscore (derived from questions about vision and task performance), and discomfort-related subscore (derived from questions about ocular surface discomfort) were calculated for each subject. Seventy-five percent (48/64) of glaucoma subjects and 41% (24/59) of glaucoma suspects were receiving topical medications. The corneal staining grade was greater in glaucoma subjects than in glaucoma suspects (6.4 vs. 4.1; P<0.001), but groups did not differ with regard to TBUT or Schirmer's results (P>0.20 for both). Multivariate regression models showed that topical glaucoma therapy burden was associated with a significantly higher total corneal staining grade (β, +0.9 for each additional glaucoma drop; 95% confidence interval [CI], 0.5-1.3; P<0.001), but not with TBUT or Schirmer's results (P>0.20 for both). Glaucoma subjects had significantly higher total OSDI scores than glaucoma suspects (16.7 vs. 7.9; P<0.001). This largely was the result of higher vision-related subscores in the glaucoma group (11.1 vs. 3.3; P<0.001). Ocular discomfort-related subscores, however, were similar in both groups (5.7 vs. 4.6; P = 0.30). In multivariate analyses, each 5-decibel decrement in better-eye VF mean deviation was associated with a 4.7-point increase in total OSDI score (95% CI, 1.9-7.5; P = 0.001) and a 3.7-point increase in the vision-related subscore (95% CI, 1.7-5.6; P<0.001) but did not predict a higher discomfort-related subscore (β, 1.1 point; P = 0.07). Topical glaucoma therapy burden was not associated with higher total OSDI score or vision- or discomfort-related subscore (P>0.20 for all). Glaucoma is associated with significant ocular surface disease, and topical glaucoma therapy burden seems predictive of corneal staining severity. However, OSDI is a poor metric for capturing ocular surface disease in glaucoma because symptoms seem to be related largely to VF loss.

HLA-DR expression as a biomarker of inflammation for multicenter clinical trials of ocular surface disease

There are currently no validated minimally invasive objective metrics for the classification and evaluation of ocular surface diseases and/or for evaluating treatment efficacy. We thus sought to establish a standardized methodology for determining the relative amount of the inflammatory biomarker HLA-DR on the ocular surface and to evaluate the precision, reliability and repeatability of its use for large multicenter clinical trials and translational research studies of ocular surface disease. Multiple studies were conducted to establish a Standard Operating Procedure (SOP) for utilizing HLA-DR expression as a minimally invasive, objective, ocular surface inflammatory biomarker. The established SOPs provide specific guidelines for HLA-DR collection and analysis, in order to incorporate it reliably into multicenter clinical trials and/or translational research. Duplicate cell samples from impression cytology (IC) samples of both normal and dry eye individuals were collected and split to assess repeatability (between the splits and between the duplicate samples). To determine storage capability, one duplicate was stained immediately and the other after 30 days cold storage. To demonstrate the feasibility of the use of the SOP for a multicenter clinical trial, clinicians out-of-state were trained to collect IC samples, and the samples shipped to our Biomarker Laboratory, logged, processed and analyzed. Demonstration of the ability to incorporate of IC into a randomized double masked clinical trial of dry eye disease (DED) was performed. In all cases, processing and analyses were performed by a masked independent observer. The validity/viability of the SOPs was established by demonstrating that: 1) sufficient numbers of cells can be collected via IC; 2) the precision/repeatability of the relative biomarker expression quantified in samples; 3) personnel at distant sites can be taught to collect, store and ship samples successfully; 4) samples can be stored for up to 30 days (refrigeration) before processing without affecting results; 5) IC can be incorporated into a double blind randomized clinical trial (RCT) of DED; and 6) the Biomarker Laboratory can track a large number of masked samples reliably. In conclusion, our standard operating procedure for impression cytology analysis of HLA-DR expression appears to be repeatable and reproducible for use in multicenter clinical trials, providing a minimally invasive objective biomarker of inflammation of the ocular surface.

Evaluation of Ocular Surface Disease Associated with Glaucoma Patients

The relationship between glaucoma medications and ocular surface disease (OSD) has been investigated for a long time by ophthalmologists. It has been well known that all preservatives used in topical medications have the potential to cause corneal and conjunctival changes, including dry eye. It is important to also consider the toxicity of the active ingredients. Objective tests for evaluating OSD are the Schirmer Test, Tear Break Up Time (TBUT), Fluorescein Clearance Test (FCT), impression cytology, confocal microscopy – the most common subjective test is Ocular Surface Disease Index (OSDI). Adverse effects associated with topical medication may have a negative effect on patient adherence to medical treatment, the patient’s life quality and the doctor–patient relationship. A favourable adherence to treatment will lead to more effective intraocular pressure (IOP) lowering and resultant decrease of glaucomatous vision loss.

Application of In Vivo Laser Scanning Confocal Microscopy for Evaluation of Ocular Surface Diseases

Cornea: August 2012 - Volume 31 - Issue 8 - p 968 doi: 10.1097/ICO.0b013e31824bd094

Comment on “Application of In Vivo Laser Scanning Confocal Microscopy for Evaluation of Ocular Surface Diseases

Comment on “Application of In Vivo Laser Scanning Confocal Microscopy for Evaluation of Ocular Surface Diseases

Application of In Vivo Laser Scanning Confocal Microscopy for Evaluation of Ocular Surface Diseases: Lessons Learned From Pterygium, Meibomian Gland Disease, and Chemical Burns

In vivo laser scanning confocal microscopy (LSCM) has been widely used to evaluate the alterations caused by ocular surface diseases at a cellular level in the living eye. In this review, we focus on its use in the diagnosis of pterygium, meibomian gland (MG) disease, and chemical burns. Histopathologic changes occurring in pterygium can be examined in situ using in vivo LSCM. Alterations at the junction of the pterygium and the cornea, which cannot be observed in excised tissue samples, can be observed. MGs play an important role in maintaining the health of the ocular surface. Meibomian gland dysfunction (MGD) is one of the most common ocular surface diseases. The use of in vivo LSCM helps in the diagnosis of MGD and provides a way to examine the microstructure of MG acinar units and measure their size. In vivo LSCM also provides a new perspective in understanding the contribution of the MG to the health of the ocular surface. Chemical burns are one of the most common ocular injuries, and in vivo LSCM can provide images of the goblet cells on the corneal surface. This is a hallmark of limbal stem cell deficiency. The application of in vivo LSCM to assessing chemical burns requires extension, allowing for evaluation of the limbus structure and ocular surface changes after reconstructive ocular surgery.