Lower Tear Meniscus Area Research Articles

The Effect of Therapy on the Ocular Surface in Patients with Unilateral Paediatric Glaucoma

Purpose: The aim of the study was to evaluate ocular surface and tear film in patients with pediatric (primary or secondary) unilateral glaucoma and compare results obtained from the treated eye and untreated healthy eye. Methods: Patients with unilateral pediatric glaucoma, followed in the outpatient department of the Department of Ophthalmology, Motol University Hospital, were included in this study. Tear osmolarity, corneal epithelial thickness, lower tear meniscus area, Schirmer test, corneal fluorescein staining and tear break-up time test (TBUT) were evaluated in both healthy and treated eye. The Ocular Surface Disease Index (OSDI) was used to establish subjective impairment. The values obtained through testing the healthy and treated eye were compared. Results: Thirteen patients met the inclusion criteria of the study. The mean age of the patients was 17.2 ± 8.1 years. There was statistically significant decrease in corneal epithelial thickness and TBUT in the treated eye (45.9 ± 5.3 µm, 6.0 ± 1.7 second resp.) compared to the healthy eye (50.2 ± 2.6 µm, 8.8 ± 3.2 second resp.; p = 0.0106, p = 0.0015 resp.). Fluorescein staining score of the ocular surface was higher in the treated eye (1.7 ± 2.1) than in the healthy eye (0.5 ± 0.8; p = 0.0243). We found no statistically significant difference in the other evaluated parameters between the treated and the healthy eyes. Conclusion: The results confirmed signs of ocular surface damage in treated eyes. The damage may be induced by chronic topical antiglaucoma therapy, but that could be a consequence of the previous ocular surgery as well. The possible damage of the ocular surface should be taken into account when selecting appropriate treatment in these patients.

THE EFFECT OF THERAPY ON THE OCULAR SURFACE IN PATIENTS WITH UNILATERAL PEDIATRIC GLAUCOMA Purpose: The aim of the study was to evaluate ocular surface and.

The aim of the study was to evaluate ocular surface and tear film in patients with pediatric (primary or secondary) unilateral glaucoma and compare results obtained from the treated eye and untreated healthy eye. Patients with unilateral pediatric glaucoma, followed in the outpatient department of the Department of Ophthalmology, Motol University Hospital, were included in this study. Tear osmolarity, corneal epithelial thickness, lower tear meniscus area, Schirmer test, corneal fluorescein staining and tear break-up time test (TBUT) were evaluated in both healthy and treated eye. The Ocular Surface Disease Index (OSDI) was used to establish subjective impairment. The values obtained through testing the healthy and treated eye were compared. Thirteen patients met the inclusion criteria of the study. The mean age of the patients was 17.2 ± 8.1 years. There was statistically significant decrease in corneal epithelial thickness and TBUT in the treated eye (45.9 ± 5.3 µm, 6.0 ± 1.7 second resp.) compared to the healthy eye (50.2 ± 2.6 µm, 8.8 ± 3.2 second resp.; p = 0.0106, p = 0.0015 resp.). Fluorescein staining score of the ocular surface was higher in the treated eye (1.7 ± 2.1) than in the healthy eye (0.5 ± 0.8; p = 0.0243). We found no statistically significant difference in the other evaluated parameters between the treated and the healthy eyes. The results confirmed signs of ocular surface damage in treated eyes. The damage may be induced by chronic topical antiglaucoma therapy, but that could be aconsequence of the previous ocular surgery as well. The possible damage of the ocular surface should be taken into account when selecting appropriate treatment in these patients.

Contact Lens Discomfort Management: Outcomes of Common Interventions.

To assess the consecutive implementation of habitual contact lens discomfort (CLD) management strategies: lid hygiene, daily disposable CL (DDCL) fitting, and artificial tear (AT) supplementation. Contact lens (CL) wearers with CLD symptoms (CLDEQ-8 ≥12 points) were included in the study. Subjects with Meibomian gland dysfunction (MGD) were instructed to perform lid hygiene. All participants were fitted with a DDCL (delefilcon A) and evaluated 1 month later. After, half of them were randomly assigned to use AT (Povidone-2%) at least three times/day, and all participants were evaluated 1 month later. Tests performed were: lower tear meniscus area (LTMA), bulbar, limbal, and tarsal hyperemia, noninvasive tear break-up time (NITBUT), and corneal and conjunctival staining. Weighted combined clinical scores (CS) were created to analyze signs. Changes in symptoms (CLDEQ-8) and CS were analyzed using linear mixed models. Forty-two subjects (mean age: 23.2±4.9 years) completed the study. Two CS were created, CS 1 was composed of bulbar, limbal, and tarsal hyperemia and corneal staining, and CS 2 by NITBUT, LTMA, and conjunctival staining. CLDEQ-8 was reduced after lid hygiene (mean: -2.73±2.13; P=0.012) and DDCL use (mean: -10.1±3.54; P<0.01), but not after AT use (P=0.62). CS 1 did not change after any intervention. CS-2 was higher (P=0.04) in DGM subjects after lid hygiene, it decreased (P=0.04) after DDCL use. Lid hygiene is effective for reducing CLD symptoms in MGD patients. Refitting subjects with delefilcon A is an effective intervention for CLD to reduce symptoms and achieve a healthier ocular surface. Simultaneous administration of AT did not further improve CLD.

Changes in corneal thickness, upper and lower tear film in seasonal allergic conjunctivitis by steroid treatment: anterior segment optical coherence tomography study.

To evaluate the effects of loteprednol etabonate on cornea and tear film in patients with seasonal allergic conjunctivitis by anterior segment optical coherence tomography (OCT). The right eyes of 52 subjects with seasonal allergic conjunctivitis were evaluated in the study. Central corneal thickness (CCT), the thicknesses of central corneal epithelium (CET) and central non-epithelial cornea (CnET), and lower and upper tear meniscus areas were measured by spectral-domain OCT and ocular surface disease index (OSDI) were obtained at baseline. After topical use of loteprednol etabonate 0.5% eye drop three times a day for 1week, the measurements were repeated. Paired T test was used for analysis. Mean CCT and mean thicknesses of CET and CnET at baseline were 528.19 ± 34.47µm, 64.10 ± 5.30µm and 462.84 ± 33.43µm, respectively, and these were 526.31 ± 33.37µm, 64.65 ± 4.84µm and 459.84 ± 32.11µm after the treatment, respectively. OSDI score was 21.55 ± 4.40 at baseline and 13.13 ± 2.39 after 1week. The lower and upper tear meniscus areas at baseline were 0.026 ± 0.017mm2 and 0.017 ± 0.007mm2, respectively, and they were 0.017 ± 0.009mm2 and 0.016 ± 0.007mm2, respectively, after the treatment. There is statistically significant difference between before and after values of CCT, CnET, lower tear meniscus area and OSDI score (p < 0.05). There is no change in corneal epithelial thickness and upper tear meniscus area after 1-week treatment with loteprednol etabonate in patients with seasonal allergic conjunctivitis, but it may cause decrease in non-epithelial corneal thickness and lower tear meniscus area.

Application of anterior segment optical coherence tomography in the measurement of the parameters of lower tear meniscus and central corneal thickness

Objective To evaluate the application of the lower tear meniscus parameters measured by anterior segment optical coherence tomography (AS-OCT) in dry eye diagnosis. Methods A prospective randomized clinical controlled study was conducted.One hundred and thirteen dry eye patients (226 eyes) and 206 healthy volunteers (410 eyes) were enrolled from May 2015 to October 2016 in Shanxi Eye Hospital.The lower tear meniscus height (LTMH), lower tear meniscus area (LTMA), lower tear meniscus depth (LTMD), the corneal epithelial thickness (CET) at central 6 mm and the corneal thickness at central 6 mm were measured by RTVue-XR.The measurement results of the two groups were compared and the ROC curve was drawn.The dry eye group and the control group were divided into four age groups: >20-30 years old, >30-40 years old, >40-50 years old and >50-60 years old.The changes of the parameters of the tear crescent in different age groups were compared.The changes of the lower tear meniscus with age were analyzed by linear regression equation.This study was approved by the Ethics Committee of Shanxi Eye Hospital.All operations were performed in accordance with the Helsinki Declaration, and written informed consent was obtained from each subject prior to any medical examination. Results The values of LTMH, LTMD and LTMA in dry eye group were (216.08±67.26)μm, (116.50±29.13)μm, (0.012 9±0.006 7)mm2, respectively, which were lower than (333.71±50.38)μm, (139.56±28.76)μm, (0.026 6±0.007 4)mm2 in control group, with statistical significance between the two groups (all at P 0.05); the corneal thickness values of the other quadrant in dry eye groups were lower than those in control group, the differences were statistically significant (all at P<0.05). The cut-off values of LTMH, LTMD, LTMA, CET at central 2 mm and corneal thickness at central 2 mm were 269.83 μm, 122.02 μm, 0.023 2 mm2, 54.16 μm, 531.50 μm, respectively, the sensitivity were 85.4%, 88.9% 96.5%, 77.0%, 66.8%, respectively; the specificity were 91.7%, 70.5%, 75.1%, 56.8%, 59.8%, respectively.The values of LTMA, LTMH and LTMD in each age group of dry eye group were significantly lower than those of the control group (all at P<0.05). Linear regression analysis showed that LTMH was decreased by 3.966 μm and LTMD was decreased by 2.381 μm along with the increase of 1 year age in the control group, while LTMH was decreased by 1.293 μm along with the increase of 1 year age in the dry eye group.Compared with the control group, the area of the lower tear crescent image in the dry eye group was reduced, the boundary line was blurred and the coherence was poor in varying degrees, and the turbidity of the tear was increased. Conclusions AS-OCT can objectively reflect the shape of the lower tear meniscus parameters, central CET and central corneal thickness changes.The LTMH and LTMD of normal people are decreased with the increase of age.LTMA and LTMH have high diagnostic efficacy for dry eye and are expected to become one of the important methods for dry eye screening. Key words: Anterior segment optical coherence tomography; Lower tear meniscus parameters; Central corneal epithelial thickness; Central corneal thickness

Factors that influence tear meniscus area and conjunctivochalasis: The Singapore Indian eye study

ABSTRACTPurpose: Assessment of tear film and conjunctiva is critical to define presence and severity of ocular surface disease. We aimed to characterize tear meniscus area (TMA) and conjunctivochalasis by anterior segment optical coherence tomography (ASOCT) in population-based patients and identify potential factors associated with low TMA and severe conjunctivochalasis.Methods: Study subjects were enrolled from The Singapore Indian Eye Study, a population-based study of Asian Indian in Singapore. Imaging with ASOCT was performed on three ocular regions (nasal, central and temporal). TMA was obtained by measuring the cross-sectional area of the inferior tear meniscus. Severity of conjunctivochalasis was quantified by measuring the conjunctivochalasis ratio (CCR), the ratio of area of redundant conjunctiva to the TMA. Ocular symptoms and demographic factors were assessed by standardized questionnaires.Results: A total of 403 participants (52.9% women) 40 years of age and older were included. TMA centrally was 2818 ± 5308 pixel2. Female sex and the presence of meibomian gland dysfunction (MGD), but not older age, were associated with a lower TMA (p = 0.031, p = 0.031 and p = 0.956 respectively). In this population, 9.2% had severe conjunctivochalasis (CCR>0.7) whereas 39.0% had mild to no conjunctivochalasis (CCR≤0.3). Conjunctivochalasis was more severe in temporal, followed by nasal and central sections. Older age was associated with severe conjunctivochalasis (p < 0.001).Conclusion: MGD and female gender were associated with lower TMA, while older age was associated with increased severity of conjunctivochalasis. Objective measurement of TMA and CCR using ASOCT imaging may be useful in the assessment of tear volume and ocular surface tear function.

Assessment of Corneal and Tear Film Parameters in Rheumatoid Arthritis Patients Using Anterior Segment Spectral Domain Optical Coherence Tomography

ABSTRACTPurpose: To study the corneal changes in rheumatoid arthritis (RA) patients in vivo, using spectral domain anterior segment optical coherence tomography (AS-OCT).Methods: A case–control study was done on 43 RA patients and 40 controls. The disease activity score (DAS28-ESR) was calculated and all participants had lower tear meniscus, corneal thickness, and epithelial thickness evaluation using AS-OCT.Results: The lower tear meniscus height (LTMH) and the lower tear meniscus area (LTMA) were significantly lower in the RA patients than in controls (p < 0.001). RA patients also had a significantly thinner central corneal thickness (p = 0.02) and their epithelium was found to be thinner in the superotemporal peripheral sector.Conclusions: The LTMH and LTMA are significantly reduced in RA patients, despite the absence of clinical diagnosis of dry eye. RA patients have thinner corneal thickness and epithelial thickness than controls, which did not correlate with either disease duration or activity.

Tear menisci and corneal subbasal nerve density in patients after laser in situ keratomileusis.

To investigate the relationship between tear menisci and corneal nerve density in patients after laser in situ keratomileusis (LASIK). Twenty-eight eyes of 14 myopic patients were enrolled. Height and area of the upper and lower tear menisci--upper tear meniscus height, upper tear meniscus area, lower tear meniscus height (LTMH), and lower tear meniscus area (LTMA)--were measured by spectral domain optical coherence tomography before surgery, 1 week, 1 month, and 3 months after surgery. Central, temporal, and nasal corneal nerve densities were measured by confocal microscopy before surgery, 1 month, and 3 months after surgery. After surgery, LTMH and LTMA increased significantly from 1 week to 1 month (P=0.009 and =0.011, respectively) and 1 month to 3 months (P=0.003 and =0.039, respectively); temporal and nasal nerve densities increased significantly from 1 month to 3 months (P<0.001, P=0.016, respectively). Lower tear meniscus area was significantly correlated with central and nasal nerve densities at 1 month (R=0.478 and 0.46, P=0.01 and 0.014, respectively), whereas LTMH and LTMA at 3 months were significantly correlated with central nerve density at 1 month (R=0.449 and 0.608, P=0.017 and 0.001, respectively). Lower tear menisci and peripheral corneal nerves recovered continually after LASIK during the early stage. However, tear volume might depend on residual central corneal nerves at 1 month, rather than on corneal nerve recovery.

Dynamic Changes in the Lower Tear Meniscus After Instillation of Artificial Tears

To compare the dynamic changes in lower tear meniscus area (TMA) and height after instillation of artificial tears in patients with dry eye and healthy controls. Twenty-two eyes of 11 patients with dry eye and twenty eyes of 10 age- and sex-matched healthy subjects were included. The inferior tear meniscus height and area measurements were taken before and after instillation of 35 μL carboxymethyl cellulose (CMC) 0.5% and 1.0% (Allergan, Irvine, CA) on 2 consecutive days. The measurements were obtained before and 1, 5, 10, 15, and 30 minutes after instillation using anterior segment optical coherence tomography, RTVue-100 (RTVue, Optovue, Inc). The baseline lower TMA and height in the dry eye group were significantly lower than in the control group. A significant increase in TMA and height was found at 1 minute post instillation of 0.5% CMC in both groups, with findings returning to baseline levels at 5 and 10 minutes post instillation in the control group and dry eye group, respectively. The increase in TMA and height persisted for a longer time period in both groups with 1% CMC, versus 0.5% CMC. At 15 and 30 minutes, both tear meniscus parameters were still significantly higher in the control group and dry eye group, respectively. Artificial tears provide a significant yet temporary improvement in the tear meniscus. The anterior segment optical coherence tomography is valuable to measure dynamic changes in the tear meniscus.