Management Of Dry Eye Disease Research Articles

Letter Regarding: Safety and Efficacy of Topical Vitamin D in the Management of Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Placebo-Controlled Double-Blind Randomized Controlled Trial

Letter Regarding: Safety and Efficacy of Topical Vitamin D in the Management of Dry Eye Disease Associated With Meibomian Gland Dysfunction: A Placebo-Controlled Double-Blind Randomized Controlled Trial

A cross-sectional study of optometrists' attitudes towards dry eye disease management in Hong Kong: A web-based survey in Hong Kong

PurposeThis study aimed to explore the practices of optometrists in Hong Kong towards diagnosing and managing dry eye disease (DED). MethodsFrom September 2021 to March 2022, an online questionnaire was distributed to optometrists in Hong Kong through several professional associations. The questionnaire included questions about the importance and usefulness of various diagnostic tests, as well as inquiries about management strategies and recommended follow-up schedules for DED. Responses were compared between optometrists who were more or less proactive in continuing education to identify potential differences. ResultsThe analysis included 68 valid responses. Sixty-one of them were Part 1 optometrists that represents 5.5 % of registered Part 1 optometrists back in 2022. Assessment of clinical symptoms was the most commonly performed investigation (93 %) and considered the most important (75 %) procedure in DED assessments, followed by corneal staining and fluorescein tear break-up time. Traditional diagnostic tests were preferred over newer methods, such as osmolarity, which were not yet commonly used. Unpreserved lubricants (90 %) and lid hygiene (63 %) were the primary treatments recommended for mild DED. Optometrists who had more experience and frequent participation in continuing education were more confident in diagnosing and managing DED, and more likely to recommend omega-3 supplements for moderate DED. ConclusionThe diagnostic and management strategies of optometrists in Hong Kong were generally consistent with the recommendations of the Dry Eye Workshop II report. However, standardized DED questionnaires and newer diagnostic tools were not commonly used. Evidence-based optometric care for dry eye management should be encouraged in Hong Kong optometric practice.

Nanoceria-Mediated Cyclosporin A Delivery for Dry Eye Disease Management through Modulating Immune-Epithelial Crosstalk.

Dry eye disease (DED) affects a substantial worldwide population with increasing frequency. Current single-targeting DED management is severely hindered by the existence of an oxidative stress-inflammation vicious cycle and complicated intercellular crosstalk within the ocular microenvironment. Here, a nanozyme-based eye drop, namely nanoceria loading cyclosporin A (Cs@P/CeO2), is developed, which possesses long-term antioxidative and anti-inflammatory capacities due to its regenerative antioxidative activity and sustained release of cyclosporin A (CsA). In vitro studies showed that the dual-functional Cs@P/CeO2 not only inhibits cellular reactive oxygen species production, sequentially maintaining mitochondrial integrity, but also downregulates inflammatory processes and repolarizes macrophages. Moreover, using flow cytometric and single-cell sequencing data, the in vivo therapeutic effect of Cs@P/CeO2 was systemically demonstrated, which rebalances the immune-epithelial communication in the corneal microenvironment with less inflammatory macrophage polarization, restrained oxidative stress, and enhanced epithelium regeneration. Collectively, our data proved that the antioxidative and anti-inflammatory Cs@P/CeO2 may provide therapeutic insights into DED management.

Ayurvedic management of Dry eye disease: A case report

Ayurvedic management of Dry eye disease: A case report

Evaluation of cyclosporine 0.05% and artificial tears for the management of dry eye disease following cataract surgery: a randomized controlled trial.

To compare the effects of cyclosporine 0.05% and artificial tears on dry eye disease following cataract surgery. This prospective, double-masked, randomized clinical trial enroled 60 eyes of 60 eligible cataract patients who completed the study. Patients were randomized to receive either cyclosporine 0.05% or artificial tear four times daily for 1 month following cataract surgery. Clinical assessments included refraction, corrected distance visual acuity, tear break-up time (TBUT), Schirmer's test, and the visual analogue scale (VAS). An independent sample t-test was used to compare the means of the variables between the two groups. Mean patient age was 64.15±9.17 (range, 45-90), of which 53% (n=32) were female. There was no significant difference in mean age (P=0.308) between the two groups. One month postoperatively, the cyclosporine 0.05% group had a significantly higher TBUT value (P=0.004). Schirmer's result (P=0.095) and the VAS questionnaire scores (P=0.374) did not show a statistically significant difference between the two groups. There was no significant difference in the visual outcomes (P>0.05). Cyclosporine 0.05% was superior to artificial tears in improving tear stability after cataract surgery in the management of immediate postoperative dry eye. It may provide a more effective therapeutic option for the management of dry eye symptoms in the clinical setting.

Perfluorohexyloctane Ophthalmic Solution: A Review in Dry Eye Disease.

Perfluorohexyloctane ophthalmic solution (Miebo®) is a single-entity, water-, steroid- and preservative-free, first-in-class semifluorinated alkane that is approved in the USA for the treatment of the signs and symptoms of dry eye disease (DED). DED is often linked with meibomian gland dysfunction (MGD), which causes an excessive evaporation of tears. Perfluorohexyloctane ophthalmic solution stabilizes the lipid layer of the tear film and inhibits tear evaporation by forming a monolayer at the air-liquid interface. In the phase III GOBI and MOJAVE trials in adults with DED associated with MGD, one drop of perfluorohexyloctane ophthalmic solution instilled in each eye four times daily over 8 weeks resulted in statistically significant and clinically meaningful improvements in the signs and symptoms of DED compared with hypotonic saline (0.6%). The agent was generally well tolerated, with most ocular adverse events being mild or moderate in severity. The efficacy and tolerability of perfluorohexyloctane ophthalmic solution was sustained for up to 52 weeks in an extension study (KALAHARI). As the first and currently the only prescription treatment approved in the USA directly addressing the pathophysiology of excessive tear evaporation, perfluorohexyloctane ophthalmic solution is a valuable emerging option for the management of DED.

Therapeutic Targets in the Management of Dry Eye Disease Associated with Sjögren's Syndrome: An Updated Review of Current Insights and Future Perspectives.

Dry eye disease (DED) is a continuing medical challenge, further worsened in the autoimmune inflammatory hyperactivation milieu of Sjögren's syndrome (SS) due to disturbances to innate and adaptive immunity with malfunctioning neuro-endocrine control. However, the pathogenetic mechanisms of SS DED are not fully established. This review summarized the available evidence, from systematic reviews, meta-analyses, and randomized clinical trials, for the efficacy and safety of the available ocular therapeutics for the management of SS DED. Relevant studies were obtained from major databases using appropriate keywords. The available largely empirical symptomatic, supportive, and restorative treatments have significant limitations as they do not alter local and systemic disease progression. Topical therapies have expanded to include biologics, surgical approaches, scleral lens fitting, the management of lid margin disease, systemic treatments, nutritional support, and the transplantation of stem cells. They are not curative, as they cannot permanently restore the ocular surface's homeostasis. These approaches are efficacious in the short term in most studies, with more significant variability in outcome measures among studies in the long term. This review offers an interdisciplinary perspective that enriches our understanding of SS DED. This updated review addresses current knowledge gaps and identifies promising areas for future research to overcome this medical challenge.

Comparative efficacy of cyclosporine 0.1%, rebamipide 2%, and carboxymethylcellulose-cyclosporine 0.05% combination eye drops in the management of dry eye disease among the Indian population

This comparative research study aims to evaluate and compare the results of three different eye drop formulations of Cyclosporine 0.1%, Rebamipide 2%, and a combination of Carboxymethylcellulose & Cyclosporine 0.05%, in treating dry eye cases among the Indian population. This investigation employed a randomized controlled trial design to assess the efficacy of three distinct eye drop formulations. A total of 120 patients diagnosed with dry eye disease participated in this study. Participants were assigned to one of three treatment groups: Group C (cyclosporine 0.1%), Group R (rebamipide 2%), or Group CC (combination of carboxymethylcellulose and cyclosporine 0.05%). Patients take prescribed medication for six weeks. Patients were evaluated at baseline for tear production time (TFBUT) at two weeks, four weeks, and six weeks, tear production score using the Schirmer test, and dry eye symptoms were assessed with the Ocular Surface Disease Index (OSDI). The collected data were analyzed using appropriate tests to compare the effectiveness of three eye drop formulations in treating dry eye in the Indian population. : Disease improvement compared to baseline was seen in all groups based on scoring of Schirmer's score, OSDI score, and TBUT. : All three treatment groups demonstrated improvements in tear film stability, tear production, and a reduction in dry eye symptoms over the six-week treatment period. However, further research with larger sample sizes and longer treatment durations is needed to establish the long-term efficacy and compare the effectiveness of these treatments.

New Korean Guidelines for the Diagnosis and Management of Dry Eye Disease.

New Korean guidelines for the diagnosis and management of dry eye disease were developed based on literature reviews by the Korean Dry Eye Guideline Establishment Committee, a previous dry eye guideline by Korean Corneal Disease Study Group, a survey of Korean Dry Eye Society (KDES) members, and KDES consensus meetings. The new definition of dry eye was also proposed by KDES regular members. The new definition by the regular members of the KDES is as follows: "Dry eye is a disease of the ocular surface characterized by tear film abnormalities and ocular symptoms." The combination of ocular symptoms and an unstable tear film (tear breakup time <7 seconds) was considered as essential components for the diagnosis of dry eye. Schirmer test and ocular surface staining were considered adjunctive diagnostic criteria. The treatment guidelines consisted of a simplified stepwise approach according to aqueous deficiency dominant, evaporation dominant, and altered tear distribution subtypes. New Korean guidelines can be used as a simple, valid, and accessible tool for the diagnosis and management of dry eye disease in clinical practice.

Utilization of Nitrogen-Doped Graphene Quantum Dots to Neutralize ROS and Modulate Intracellular Antioxidant Pathways to Improve Dry Eye Disease Therapy.

Patients afflicted with dry eye disease (DED) experience significant discomfort. The underlying cause of DED is the excessive accumulation of ROS on the ocular surface. Here, we investigated the nitrogen doped-graphene quantum dots (NGQDs), known for their ROS-scavenging capabilities, as a treatment for DED. NGQDs were prepared by using citric acid and urea as precursors through hydrothermal method. The antioxidant abilities of NGQDs were evaluated through: scavenging the ROS both extracellular and intracellular, regulating the nuclear factor-erythroid 2-related factor (Nrf2) antioxidant pathway of human corneal epithelial cells (HCECs) and their transcription of inflammation related genes. Furthermore, NGQDs were modified by Arg-Gly-Asp-Ser (RGDS) peptides to obtain RGDS@NGQDs. In vivo, both the NGQDs and RGDS@NGQDs were suspended in 0.1% Pluronic F127 (w/v) and delivered as eye drops in the scopolamine hydrobromide-induced DED mouse model. Preclinical efficacy was compared to the healthy and DPBS treated DED mice. These NGQDs demonstrated pronounced antioxidant properties, efficiently neutralizing free radicals and activating the intracellular Nrf2 pathway. In vitro studies revealed that treatment of H2O2-exposed HCECs with NGQDs induced a preservation in cell viability. Additionally, there was a reduction in the transcription of inflammation-associated genes. To prolong the corneal residence time of NGQDs, they were further modified with RGDS peptides and suspended in 0.1% Pluronic F127 (w/v) to create RGDS@NGQDs F127 eye drops. RGDS@NGQDs exhibited superior intracellular antioxidant activity even at low concentrations (10 μg/mL). Subsequent in vivo studies revealed that RGDS@NGQDs F127 eye drops notably mitigated the symptoms of DED mouse model, primarily by reducing ocular ROS levels. Our findings underscore the enhanced antioxidant benefits achieved by modifying GQDs through nitrogen doping and RGDS peptide tethering. Importantly, in a mouse model, our novel eye drops formulation effectively ameliorated DED symptoms, thereby representing a novel therapeutic pathway for DED management.

Efficacy of 2% Hydroxypropyl Methylcellulose and Bandage Contact Lens for the Management of Dry Eye Disease after Cataract Surgery

Objectives. To investigate the effect of 2% hydroxypropyl methylcellulose (HPMC) and bandage contact lens (BCL) on dry eye disease after cataract surgery. Methods. This prospective randomized controlled trial included 63 eyes which were divided into the balanced salt solution (BSS), HPMC, BCL, and combined HPMC and BCL (H&B) groups. The Ocular Surface Disease Index (OSDI), tear meniscus height (TMH), and average tear break-up time were measured before cataract surgery and 30 days postoperatively. Differences in corneal nerve fiber (CNF) and dendritic cell (DC) density in various directions were evaluated and compared. The CNFs and DCs in central and infratemporal directions were observed using in vivo confocal microscopy. Data were evaluated using the Kruskal–Wallis rank-sum test and analysis of variance. Results. The differences in variations in OSDI and TMH after cataract surgery between the four groups were statistically significant (P<0.05). The postoperative OSDI of the HPMC group decreased compared with their preoperative OSDI. A statistically significant difference in the variations of OSDI score was observed between the HPMC and other groups (P<0.05). The postoperative variations in TMH in the HPMC group were significantly higher than those observed preoperatively and significantly differed between HPMC and BCL groups and between BCL and H&B groups (P<0.05). Postoperatively, the density of corneal DCs decreased in BSS and HPMC groups and increased in BCL and H&B groups (P<0.001). Conclusions. The application of 2% HPMC in cataract surgery has a certain effect on managing dry eye after cataract surgery. Although the use of BCLs after cataract surgery has some benefits, it may cause mild ocular surface inflammation. Nevertheless, using 2% HPMC with BCLs in the perioperative phase of cataract surgery can alleviate the subjective discomfort of patients and can safely and effectively replace eye patch after cataract surgery.

In‐depth study of the mucoadhesive and lubricating properties of Hyalistil SYNFO and other sodium hyaluronate‐based eye drops

Purpose: Several sodium hyaluronate (SH) eye drops formulations are widely used for the management of dry eye disease (DED). Hyalistil SYNFO is an eye drops based on SH and xanthan gum and osmoprotectants (glycine and betaine). The aim of our study was to evaluate viscosity and mucoadhesion profiles of Hyalistil SYNFO with respect to other SH‐based eye drops, and to investigate their ability to protect the corneal surface from dehydration.Methods: The physicochemical properties, in term of viscoelastic and mucoadhesive behaviour, were evaluated by means of a rheometer, TA‐XT2 texture analyzer and zeta potential determination. An in vitro dehydration model was used to demonstrate the lubricant effect of Hyalistil SYNFO compared to other commercially available SH‐based eye drops on human corneal epithelial cells (HCE).Results: The rheological profiles indicated that Hyalistil SYNFO exhibits a viscoelastic behaviour under shear strain showing a characteristic curve owing to its specific molecular properties. Evaluations of detachment force of tested formulations resulting in a strengthening of the mucin‐formulation interface showed that Hyalistil SYNFO exhibited a stronger and significant mucoadhesion calculated as percentage compared to mucin and other SH‐based products. The occurring interaction between formulation and mucin was also demonstrated by the variations in zeta potential measured by the mucin‐eye drops mixture compared to mucin or product alone. The in vitro study on HCE cells demonstrated that Hyalistil SYNFO, compared to others formulation, was able to protect corneal epithelial cells from dehydration.Conclusions: The pseudoplastic profile and increased mucoadhesive strength, due to the presence of both SH and xanthan gum, may lead to an improved residence time of Hyalistil SYNFO on the corneal epithelium ensuring relief during the treatment of DED. Moreover, the effect against dehydration improves eye lubrication and corneal cell protection.

Current Advances in Regenerative Strategies for Dry Eye Diseases: A Comprehensive Review.

Dry eye disease (DED) is an emerging health issue affecting millions of individuals annually. Ocular surface disorders, such as DED, are characterized by inflammation triggered by various factors. This condition can lead to tear deficiencies, resulting in the desiccation of the ocular surface, corneal ulceration/perforation, increased susceptibility to infections, and a higher risk of severe visual impairment and blindness. Currently, the clinical management of DED primarily relies on supportive and palliative measures, including the frequent and lifelong use of different lubricating agents. While some advancements like punctal plugs, non-steroidal anti-inflammatory drugs, and salivary gland autografts have been attempted, they have shown limited effectiveness. Recently, there have been promising developments in the treatment of DED, including biomaterials such as nano-systems, hydrogels, and contact lenses for drug delivery, cell-based therapies, biological approaches, and tissue-based regenerative therapy. This article specifically explores the different strategies reported so far for treating DED. The aim is to discuss their potential as long-term cures for DED while also considering the factors that limit their feasibility and effectiveness. These advancements offer hope for more effective and sustainable treatment options in the future.

Current application of intense pulsed light for the management of dry eye disease: A systematic review and meta-analysis.

This review explored intense pulsed light (IPL) as an alternative treatment for dry eye disease (DED) symptom relief by correcting tear-film homeostasis. A systematic search was performed in March 2022 on five databases (Medline, Embase, SCOPUS, ProQuest, and EBSCO). Studies were extracted for the following outcomes of interest: standard patient evaluation of eye dryness questionnaire (SPEED), ocular surface disease index (OSDI), tear break-up time (TBUT), and corneal fluorescein staining (CFS). All studies published up to March 2022 were reviewed. Cochrane risk of bias tool (RoB 2) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data. Thirteen studies were included in this study. A total of 931 individuals and 1454 numbers of eyes were reviewed in this meta-analysis. Among studies that explored and reported the effect of IPL in individuals with DED, TBUT and OSDI improved significantly post intervention, with a standardized mean difference (SMD) of 1.02 [95% CI 0.41-1.64] and 0.28 [95% CI 0.04-0.52], respectively. CFS and SPEED scores, however, showed no statistically significant difference, with an SMD of 0.22 [95% CI -0.19 to 0.64] and 0.28 [95% CI -0.11 to 0.66], respectively. In conclusion, current evidence indicates IPL as a possible adjunctive treatment in individuals with DED in an otherwise limited treatment option. Further studies through more extensive trials are needed to validate this finding and elucidate its mechanism.

A tissue-adhesive F127 hydrogel delivers antioxidative copper-selenide nanoparticles for the treatment of dry eye disease

Dry eye disease (DED) is currently the most prevalent condition seen in ophthalmology outpatient clinics, representing a significant public health issue. The onset and progression of DED are closely associated with oxidative stress-induced inflammation and damage. To address this, an aldehyde-functionalized F127 (AF127) hydrogel eye drop delivering multifunctional antioxidant Cu2−xSe nanoparticles (Cu2−xSe NPs) was designed. The research findings revealed that the Cu2−xSe nanoparticles exhibit unexpected capabilities in acting as superoxide dismutase and glutathione peroxidase. Additionally, Cu2−xSe NPs possess remarkable efficacy in scavenging reactive oxygen species (ROS) and mitigating oxidative damage. Cu2−xSe NPs displayed promising therapeutic effects in a mouse model of dry eye. Detailed investigation revealed that the nanoparticles exert antioxidant, anti-apoptotic, and inflammation-mitigating effects by modulating the NRF2 and p38 MAPK signalling pathways. The AF127 hydrogel eye drops exhibit good adherence to the ocular surface through the formation of Schiff-base bonds. These findings suggest that incorporating antioxidant Cu2−xSe nanoparticles into a tissue-adhesive hydrogel could present a highly effective therapeutic strategy for treating dry eye disease and other disorders associated with reactive oxygen species. Statement of significanceA new formulation for therapeutic eye drops to be used in the treatment of dry eye disease (DED) was developed. The formulation combines copper-selenium nanoparticles (Cu2-xSe NPs) with aldehyde-functionalized Pluronic F127 (AF127). This is the first study to directly examine the effects of Cu2-xSe NPs in ophthalmology. The NPs exhibited antioxidant capabilities and enzyme-like properties. They effectively eliminated reactive oxygen species (ROS) and inhibited apoptosis through the NRF2 and p38 MAPK signalling pathways. Additionally, the AF127 hydrogel enhanced tissue adhesion by forming Schiff-base links. In mouse model of DED, the Cu2-xSe NPs@AF127 eye drops demonstrated remarkable efficacy in alleviating symptoms of DED. These findings indicate the potential of Cu2-xSe NPs as a readily available and user-friendly medication for the management of DED.

Prevailing practices for the management of dry eye disease in India: A questionnaire based survey 2023

: Dry eye disease is a common ophthalmic condition which is chronic in nature, It is major health issue especially in the current digital era. Dry eye disease is one of the most common reasons for visiting eye care practitioners. To understand the treatment pattern of medical management of dry eye disease across India.This single visit, cross-sectional, non-interventional, interview-based ophthalmologist survey on dry eye disease (DED) was conducted between 10-13 May 2023 at 81st Annual Conference of All India Ophthalmological Society, Kochi–AIOC 2023. A total of 71 registered ophthalmologist from all over India attending AIOC 2023 who were willing to provide their written consent participated in the survey and completed structured questionnaire on dry eye disease management. Approximately 39.44% ophthalmologist have 20-40% of patients who visiting to daily OPD are suffering from DED, and 40.85% ophthalmologist said the percentage is even more i.e. between 40-60%. 88.73% ophthalmologist responded environmental factors such as digital use specially increased usage of computers and mobile are responsible for dry eye. 49.30% patients suffered from aqueous - deficient dry eye (ADDE) and remaining 50.70% evaporative dry eye (EDE). Artificial Tears (AT) is the first line in management of DED said by all ophthalmologist & in certain cases, depending on type, severity, and cause of dry eye other drugs like cyclosporine, corticosteroids, antioxidant supplements and other medications might be used. Viscosity, pH and osmolarity are important for artificial tear said by 77.46% of ophthalmologist & 23% ophthalmologist opine that viscosity is major factor. 50% ophthalmologist believes that carboxymethylcellulose is the most suitable ingredient followed by sodium hyaluronate (29.58%). 61.43% Ophthalmologists replied, AT should provide continues relief from dry eye symptoms. 42.86% said AT should be used for long terms, it should be preservative free replied by 58.57% Ophthalmologists and 40% replied acceptance from patient should be there in terms of cost. Tear substitutes are the most commonly prescribed medications for the management of dry eye disease. Artificial tears are amongst the first-line agents in the management options for the management of dry eye disease, because of their ease for usage, with a better safety and tolerability profile and their availability in various formulations.

Efficacy of Omega-3 Intake in Managing Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

To explore the efficacy of omega-3 fatty acids (FAs) on patients suffering from dry eye disease (DED), a complex inflammatory condition, we reviewed data from PubMed, Embase, ClinicalTrials.gov, Web of Science, and Cochrane CENTRAL in the past 10 years (2013 to 2023). These sources provided randomized clinical trials (RCTs) that examined the efficacy of omega-3 FAs on DED patients with accessible pre- and post-intervention data, excluding trials with overlapping participants, without omega-3 supplementation, or those lacking placebo control or quantitative assessments. Two independent reviewers extracted data related to dry eye symptom scores, tear break-up time (TBUT), Schirmer's tests, osmolarity, and corneal fluorescein staining (CFS), and the results were analyzed by Comprehensive Meta-Analysis software version 4. We incorporated 19 related RCTs assessed by the Cochrane Risk of Bias tool, encompassing 4246 DED patients with various etiologies. Patients given omega-3 treatment demonstrated more significant improvements in dry eye symptoms (Hedges' g = -1.047; p < 0.001), TBUT [standardized mean difference (SMD) = -0.939; p < 0.001], scores from the Schirmer test (SMD = -0.372; p < 0.001), CFS (SMD = -0.299; p = 0.037), and osmolarity (SMD = -0.721; p < 0.001) compared to those on a placebo regimen. In the meta-regression analysis of DED symptoms, the daily dose of omega-3 (coefficient = -0.0005, p = 0.002), duration of omega-3 intake (coefficient = -0.1399, p = 0.021), and percentage of eicosapentaenoic acid (EPA) (coefficient = -0.0154, p < 0.001) exhibited a significant positive correlation with a reduction in dry eye symptom scores. Apart from CFS, similar trends were noted in TBUT, Schirmer tests, and osmolarity scores. Based on the evidence, omega-3 FAs effectively reduce DED symptoms, especially in high doses, for a long duration, and with increased EPA levels. However, given the heterogeneity in study results and diverse patient characteristics, caution is needed in generalizing these findings. In conclusion, omega-3 FA supplementation is still recommended for DED management in clinical settings.

Outcomes of the addition of oral administration of curcumin-phospholipid to hyaluronic acid-based tear substitute for the treatment of dry eye disease

The aim of this study is to report the clinical outcomes of oral supplementation with curcumin-phospholipid in addition to hyaluronic acid-based tear substitute for the management of dry eye disease (DED). Patients with a diagnosis of DED confirmed by pathological values of both NIKBUT &amp;lt;10 s. and OSDI Questionnaire score &amp;gt; 12 were included. Patients were randomized to receive 2 different treatments: 0.25% hyaluronic acid-based tear substitute 3 time daily (Group 1) or as above plus curcumin-phosphatidylcholine complex tablets once a day (Group 2). Patients were evaluated at baseline (T0) and after 90 days of treatment (T1) by means of Keratograph for the measurement of NIKBUT, TMH, meibomian gland dropout and bulbar redness. Overall, data from 90 eyes of 45 patients were included. Group 1 consisted of 48 eyes of 24 patients, while group 2 included 42 eyes of 21 patients. When comparing median values of both groups at T0, no statistically significant differences were found for all parameters; instead for T1, statistically significant differences were found for redness and OSDI compared to Group 1. In group 1, a statistically significant reduction after the treatment was detected for Nikbut average and OSDI questionnaire; while in group 2, a statistically significant reduction after treatment was recorded for Nikbut average, bulbar redness and OSDI questionnaire. The addition of an oral supplement containing curcumin-phospholipid may help in a greater improvement of bulbar redness and subjective ocular symptoms compared to the treatment with tear substitutes alone for the management of DED.

Glaucoma and Dry Eye Disease: Opportunity to Assess and Treat.

Dry eye disease (DED) has been found to occur at a higher prevalence in individuals with glaucoma than in individuals without glaucoma. The relationship between glaucoma and DED may be, in part, a result of glaucoma therapy. Greater number of antiglaucoma medications used and greater number of antiglaucoma eyedrops instilled per day have been associated with ocular surface disease in patients with glaucoma. Use of antiglaucoma medication has also been associated with higher levels of ocular surface inflammatory markers and ocular surface alterations. There is evidence to suggest that antiglaucoma medications with preservatives and, to some extent, antiglaucoma medication formulations without preservatives may contribute to ocular surface signs and symptoms. Trabeculectomy for glaucoma has also been associated with ocular surface signs related to DED; however, there may be benefits of trabeculectomy and other procedures for glaucoma due to reduced use of antiglaucoma medications. Patients with glaucoma with ocular surface disease have been found to have greater ocular surface symptoms, poorer vision-related quality of life, and poorer antiglaucoma medication adherence compared with patients with glaucoma without ocular surface disease. Because of the potential negative impact of DED on patients with glaucoma, patients with glaucoma may benefit from evaluation for DED. Management of DED in patients with glaucoma may include modifications to antiglaucoma medications and use of treatments for DED.

A-355 Eyescore, A Point of Care Smartphone App for Early Dry Eye Diagnosis and Management

Abstract Current diagnosis of dry eye disease (DED) has significant challenges with limited accuracy and poor correlation of clinical symptoms. The goal of this study is to develop a smartphone App, namely “EyeScore”, to provide a point of care (POC) and digital solution for early diagnosis of DED. The authors tested the hypothesis of measuring eye blink rate and partial blink count as early clinical biomarkers for the calculation of so called “eye healthiness score”, which allows a convenient, rapid eye exam at home with low resource settings. EyeScore uses an iPhone as an imaging and sensing device for in-App recordings of eyelid movements. The use of facial landmark recognition and eye aspect ratio (EAR) enabled comprehensive digital analysis of video frames for determination of the eye opening/closed states. The smartphone videos from 10 DED patients and 10 healthy controls were tested to optimize EAR derived thresholds for accurate measurements of blink rates and partial blink counts. The authors formulated a clinically relevant algorithm for the calculation of “eye healthiness score”. This 10-point scale score can be easily measured anytime with a non-invasive manner and remotely shared with the patient's eye doctor. As a result, both patients and doctors can monitor the eye conditions over time. Our results showed that EyeScore confirmed the diagnosis of all 10 DED patients. Importantly, Eyescore also identified three individuals with “pre-DED” conditions from 10 healthy controls, demonstrating its potential clinical values for early diagnosis and management of DED. Materials and Methods An Apple MacBook Pro installed with iOS software (iOS 16.1.2) and Xcode 14.0 was used for coding and debugging. Visionkit SDK from Apple Developer was adopted to extract coordinate data from six eye facial landmarks. EAR values were calculated based on the previously published formula, with a dynamic EAR developed as a threshold for the measurement of blink rate and half blink count. For eye healthiness score, a 10-point formula was formulated (0–3, normal; 4–5, Pre-DED; 6–10, DED) with several contributing factors including blink rate, half blink count, eye discomfort and demographic characteristics. Results A total of 20 iPhone videos from DED patients and healthy controls were analyzed and evaluated with EyeScore App. All DED patients obtained scores above 7, confirming their DED diagnosis. On the other hand, three controls obtained scores of 4 or 5, suggesting they were in the Pre-DED state with no noticeable clinical DED symptoms. All other controls obtain scores blow 3 with normal eye conditions. All tests were performed with the consents from the test participants. Conclusions Smart phone-based platform offers great potentials for point of care diagnostic methods. A POC enabled EyeScore App has been successfully developed for early diagnosis of DED. In the future, the authors plan to test EyeScore with a large-scale sample set of DED patients and controls to further validate the accuracy and predictability of eye healthiness score for its broader clinical applications.