Ocular Surface Disease Index Survey Research Articles

Body mass index, diet, and outdoor activity linked with meibomian gland abnormalities in children.

Dry eye disease is frequently underdiagnosed in pediatric patients. Meibomian gland morphology abnormalities (atrophy and tortuosity) may be associated with dry eye. This study examined risk factors for gland morphology abnormalities in children. This study aimed to characterize meibomian gland morphological abnormalities (atrophy and tortuosity) and identify risk factors for the same in children. A total of 160 children, primarily African American and Hispanic, aged 5 to <18 years underwent a comprehensive eye exam including slit-lamp examination to evaluate the meibomian glands, conjunctival papillae, and tear film. Infrared photography was performed including assessment of noninvasive tear film breakup time and tear meniscus height. Meibomian gland atrophy and tortuosity were assessed. A modified Ocular Surface Disease Index survey was administered along with surveys on screen time, diet, and outdoor activity. Linear multiple regression was performed to determine risk factors for meibomian gland abnormalities. The average age of participants (76 male, 84 female) was 10.9 ± 3.0 years. Severe meibomian gland atrophy (score ≥2) was found in 31.0% of participants in at least one eyelid. Severe meibomian gland tortuosity (score ≥2) was found in 84.0% of participants in at least one eyelid. The median symptom score was 9.8 (range, 0 to 71), with 16.9, 8.8, and 12.5% of the children having mild, moderate, and severe dry eye symptoms, respectively. Elevated body mass index (p<0.001), reduced outdoor activity (p=0.02), and unhealthy diet (p=0.01) were found to be risk factors for meibomian gland abnormalities. Screen time, symptom score, age, gender, and race/ethnicity were not associated with gland abnormalities (all p values >0.05). This study determined that meibomian gland morphological abnormalities were commonly found in children aged 5 to <18 years. Risk factors for these abnormalities include elevated body mass index, an unhealthy diet, and reduced outdoor activity.

INCIDENCE AND RISK FACTORS FOR DRY EYE DISEASE IN A TERTIARY HOSPITAL IN NORTH CENTRAL INDIA

Objectives: Dry eye disease (DED is a severe tear insufficiency condition that affects millions of people worldwide. Dry eye refers to conditions of the tear film brought on by decreased tear production and/or excessive tear evaporation. The study’s objective was to compile data on the incidence of DED and associated risk factors. Methods: The government hospital of Uttar Pradesh (India) served as the study’s site for this cross-sectional and observational study. Clinical observation and the ocular surface disease index survey were used to assess the aim of the study. Results: Patients were screened in total, 652. The incidence of DED was reported in 267 (40.9%) individuals. There were 130 DED patients (48.7%) above the age of 40, followed by those between the ages of 21 and 40 (47.2%). Both genders were equally impacted, with men (50.2%) and women (49.2%). Out of 267 DED patients, 128 (47.9%) had a desk job with a computer. Among the patients, 57 (21.3%) had mild DED, 74 (27.7%) had moderate DED, and 136 (50.9%) had severe DED. The severe DED also showed independent association between the desk job with a computer (Odds Ratio [OR]; 2.782, 95% confidence interval [CI]: 1.694–4.568, p&lt;0.001), cigarette smoking (OR; 1.849, 95% CI: 1.135–3.014, p=0.014), and use of contact lens (OR; 1.972, 95% CI: 1.206–3.223, p=0.007). Conclusion: The frequency of DED is high in Uttar Pradesh. The illness is particularly prevalent in older people, computer-using desk workers, smokers, and contact lens wearers.

Ocular Rosacea microBiome Study (ORBS)—sub-microbial versus antibiotic dosing of doxycycline versus placebo in treatment of symptomatic ocular rosacea: study protocol for a parallel-arm randomized clinical trial

BackgroundOcular rosacea is common and is often managed with long-term antibiotic treatment. Doxycycline is the most commonly selected antibiotic for the treatment of rosacea. As there is no established standard of care treatment dose for rosacea, prescribed doses of doxycycline vary widely. The FDA classifies 40 mg daily dose of doxycycline for ocular rosacea as sub-microbial in comparison to an antibiotic dose of 200 mg daily. However, this “sub-microbial” dose has never been evaluated in patients with ocular rosacea, and even the sub-microbial dose has potential to alter systemic mucosa flora. Here, we present a randomized controlled trial using RNA sequencing to fully characterize the impact of sub-microbial antibiotic dosing of doxycycline on antimicrobial resistance and bacterial composition of the ocular and gut flora.MethodsIn a triple-masked parallel randomized control trial, patients with ocular rosacea will be randomized to three arms: a 40-mg dose of doxycycline, a 200-mg antibiotic dose of doxycycline, or placebo. Collected rectal and lower eyelid samples will be compared for frequency of antimicrobial resistance genetic determinants and microbiome diversity. A subjective ocular surface disease index survey and objective tear breakup time measurement will be determined.DiscussionThese results will enhance our understanding of the overall systemic impact of long-term systemic sub-microbial antibiotic dosing for the treatment of chronic recurrent ocular inflammatory diseases.Trial registrationThis trial was registered on ClinicalTrials.org (NCT05296837) on March 22, 2022.

Prevalence of Dry Eye Disease and Its Risk Factors Among the General Population of Saudi Arabia: A Cross-Sectional Survey.

Dry eye disease is a multifactorial chronic disorder of the ocular surface, which leads to symptoms of discomfort and distress. Dry eye disease is a global health concern and is one of the most frequent ocular diseases encountered in an ophthalmology clinic. The estimated prevalence of dry eye disease in the literature ranged from 7.4% to 93.2%. Saudi Arabia's population, especially in the eastern province, is at great risk of developing dry eye disease, however, there is hardly any nationwide study that assesses the prevalence of dry eye disease among the general population and its risk factors. The aim is to estimate the prevalence of dry eye disease and determine its risk factors among the general population of Saudi Arabia. This study was a cross-sectional study conducted on the general population of Saudi Arabia between September 2022 and November 2022. A convenient sampling technique was deployed for participant recruitment, where a self-administered questionnaire was created and dispersed to the general population all over the country with an invitation to participate in the study. Dry eye disease prevalence was assessed using Ocular Surface Disease Index survey. The Chi-square test was used to test for factors associated with the prevalence of dry eye disease, and undiagnosed dry eye disease. Multivariate logistic regression was also used to determine risk factors for dry eye disease. A total of 1,381 participants were included in this study. The prevalence of dry eye disease among the general population of Saudi Arabia was observed to be (17.5%). Among the participants (11%) had mild dry eye disease, (4.7%) had moderate dry eye disease, and (1.7%) had a severe dry eye disease. Among those observed to have a dry eye disease, (58.09%) were not previously diagnosed. The following factors were observed to be significantly associated with having dry eye disease, being female, having thyroid disease, having systemic lupus erythematosus/rheumatoid arthritis, using antidepressants, using antihistamine/decongestants, using electronic devices for a prolonged time, using contact lenses, having a history of eye surgery, history of conjunctival/eyelid infection, and history corneal abrasions/erosions/ulceration. This study revealed that the prevalence of dry eye disease among the general population of Saudi Arabia is notably lower than what was observed in other local studies and similar to what was found in some global studies. Adjusted binary multivariate logistic regression revealed that the risk factors were only: being female, using antidepressants, using antihistamines/decongestants, and prolonged use of electronic devices.

Combined Low-Level Light Therapy and Intense Pulsed Light Therapy for the Treatment of Dry Eye in Patients with Sjögren's Syndrome.

Purpose To evaluate the effects of combined intense pulsed light therapy (IPL) and low-level light therapy (LLLT) in dry eye disease (DED) in patients affected by Sjögren's syndrome. Patients and Methods. This is a monocentric, prospective, interventional study. At baseline, all the study patients (n = 20) were on tear substitute therapy and underwent Schirmer type-1 test and breakup time (BUT) test. After baseline measurements, tear substitute therapy was suspended, and patients underwent IPL and LLLT. The same investigations were carried out at one (T1) and at three (T3) months after treatment. The Ocular Surface Disease Index (OSDI) survey was used to measure the severity of DED. Results BUT test showed an increase in tear film breakup time in patients with DED 1 month after the beginning of the treatment (T0 vs T1: p=0,01). This increase was even more statistically significant after 3 months of the IPL and LLLT treatment (T0 vs T3: p < 0.0001). Schirmer test values increased too, but there was not statistically significance between values at T0 and T1 or T3. The patients perceived an improvement in their condition, which resulted in a lower score on the OSDI survey. The OSDI score was lower at T1 than T0 (T0 vs T1: p=0.0003), while it tended to increase again after 3 months although it was still lower than baseline (T0 vs T3: p=0.02). No facial or ocular side effects were reported. Conclusions The use of combined IPL/LLLT for the treatment of DED in patients affected by Sjögren's syndrome appears to be beneficial.

Meibomian gland dropout is associated with immunodeficiency at HIV diagnosis: Implications for dry eye disease

AimTo characterize anterior eye health and tear film characteristics in individuals with human immunodeficiency virus (HIV) undergoing anti-retroviral therapy. MethodsThis cross-sectional study involved 35 adults, categorized as healthy controls (n = 18) or as HIV-positive patients (n = 17), with no history of opportunistic infection or current ocular fundus abnormalities. Participants underwent a comprehensive anterior eye assessment. Primary outcome measures were dry eye symptoms (Ocular Surface Disease Index survey), tear film osmolarity, and extent of meibomian gland dropout. Secondary outcomes measures were ocular redness, tear film stability, and ocular surface staining. Levels of 36 cytokines were assayed from basal tears using a multiplex bead array. ResultsThe HIV-positive group showed more extensive meibomian gland dropout relative to controls (mean ± SD, controls: 29.6 ± 5.8 versus 37.0 ± 13.9%, p = 0.045). The extent of meibomian gland dropout was negatively correlated with blood CD4 T-cell count (a marker of immunodeficiency) at diagnosis (r = −0.69, p = 0.006). All other tests of anterior ocular health, including dry eye symptom levels, were not significantly different between the groups. There were no significant inter-group differences for the 36 cytokines assayed in the tear film. ConclusionsWe find greater meibomian gland dropout in HIV-positive individuals that is related to disease severity at diagnosis. Given this feature predisposes to dry eye disease, it suggests the need for long-term studies of anterior eye health in people with HIV.

The effect of preservative-free treatment of primary open-angle glaucoma on the state of ocular surface in combination therapy (intermediate results)

To assess the state of ocular surface in patients with POAG when switching to preservative-free carbonic anhydrase inhibitor (ICA) containing 0.18% sodium hyaluronate in combination with prostaglandin analogues and beta-adrenergic blocking agents. The study was conducted in 2019; according to selection criteria, it included 46 patients (80 eyes) with POAG and a control group of healthy persons. At the start of the study and one month later, after a change of treatment to uninterrupted ICA containing 0.18% sodium hyaluronate, the patients had state of their ocular surface examined: Norn's test (tear break-up time; TBUT), Schirmer's test, vital staining with lissamine green and an Ocular Surface Disease Index (OSDI) survey. Replacing the ICA with benzalkonium chloride in the combination therapy of glaucoma with a preservative-free ICA containing 0.18% sodium hyaluronate - Dorzolan Solo (Solopharm, Russia) - expectedly did not lead to additional decrease of IOP, but resulted in a decrease in the width of the confidence interval according to both Maklakov's and Icare tonometers, which may be associated with increased treatment adherence. At the same time, the state of ocular surface in the observation group was statistically significantly improved according to Norn's test - from 3.57±1.3; 3.0 (3.0; 5.0) to 4.9±2.5; 5.0 (3.0; 6.0) (V=16.5; p=0.0039). According to Schirmer's test and vital staining with lissamine green, no statistically significant changes have occurred. OSDI survey did not reveal changes in the study patients during 4 weeks of the follow-up, while the control group exhibited improvement.

Utility of Prosthetic Replacement of the Ocular Surface Ecosystem Treatment in the Management of Patients with Refractory Intrinsic Evaporative Dry Eye Disease

Background: Dry eye disease is a multifactorial disease whose pathogenic mechanisms have not been investigated rigorously. The objective of this study was to evaluate the utility of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) treatment in the management of patients with intrinsic evaporative dry eye refractory to conventional therapies. Design: A retrospective clinical cohort study of patients with intrinsic evaporative dry eye disease refractory to conventional therapies seen between July 1, 2009 and May 31, 2012 at USC Eye Institute, a tertiary referral center. Participants: 36 eyes of 21 patients with intrinsic evaporative dry eye that completed PROSE fitting were included. Main outcomes measures: Outcomes based on pre and post PROSE visual acuity and visual function. Bestcorrected visual acuities were measured using a Snellen chart under standardized conditions. Visual function was assessed using the Ocular Surface Disease Index survey, a 12-item questionnaire that quantifies the severity of ocular discomfort and level of vision-related function. Results: Mean visual acuity improved from 0.33 ± 0.40 logMAR pre-PROSE to 0.10 ± 0.16 logMAR post-PROSE (Z=-4.3, p<0.0001, n=36). Thirteen of 21 patients completed pre-PROSE and post-PROSE surveys. Survey scores improved from 63.61 ± 15.76 pre-PROSE to 24.84 ± 29.58 post-PROSE (Z=-2.9, p=0.004, n=13). Conclusion: The results of our study strongly suggest PROSE treatment improves visual acuity and function in patients with refractory intrinsic evaporative dry eye disease and could serve as a viable alternative to more invasive procedures.

Prosthetic Replacement of the Ocular Surface Ecosystem Scleral Lens Therapy for Patients With Ocular Symptoms of Chronic Stevens-Johnson Syndrome

To evaluate the results of Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral lens treatment on visual acuity and function in patients with ocular symptoms of chronic Stevens-Johnson syndrome (SJS). Retrospective interventional case series. setting: Single multi-specialty institutional practice. study population: A chart review from July 2009 to July 2013 identified 19 patients with ocular symptoms from chronic SJS who were referred for PROSE fitting evaluation. Three patients deemed appropriate candidates were excluded because they were lost to follow-up during the fitting process. Only 1 eye was fitted in 4 patients because anatomic changes prohibited PROSE fitting in the fellow eye. Another patient chose to have PROSE fitting only in 1 eye. A total of 27 eyes of 16 patients who completed PROSE fitting were included in this study. intervention: PROSE scleral lens fitting. outcome measures: Visual acuity and visual function were assessed before and after PROSE fitting using Snellen acuity and Ocular Surface Disease Index (OSDI) survey. The OSDI survey is a validated questionnaire that assesses ocular surface disease in the context of vision-related function, ocular symptoms, and environmental triggers. Visual acuity improved from 0.43 ± 0.35 logMAR pre-PROSE to 0.14 ± 0.22 logMAR post-PROSE (P = .0007) in SJS patients. OSDI scores improved from 70.4 ± 19.0 pre-PROSE to 37.4 ± 23.2 post-PROSE (P = .0002) in the same cohort. The results of this study show that PROSE treatment is a viable option for improving visual acuity and function in SJS patients who failed conventional treatment.

Randomized Double-Blind Clinical Trial of Autologous Serum Versus Artificial Tears in Dry Eye Syndrome

Purpose: To determine symptoms improvement in dry eye patients with short-term autologous serum (AS) eyedrops treatment using the standardized Ocular Surface Disease Index (OSDI) survey.Materials and methods: A double-blind randomized crossover clinical trial was conducted, comparing short-term (2 weeks) topical treatment with AS eyedrops diluted at 20% versus conventional artificial tears treatment in adult severe dry eye syndrome (DES) patients. The main outcome measure was assessment of symptoms with OSDI survey. Secondary outcomes were corneal and conjunctival fluorescein staining score of OXFORD and tear break up time (TBUT). The protocol was registered in www.clinicaltrials.gov, ID number: NCT00779987.Results: Twelve severe DES patients were included. Autologous serum treatment showed a statistically significant (p = 0.002) higher OSDI decrease (50%) versus conventional treatment (22%). There were no significant changes in objectives parameters (OXFORD and TBUT).Conclusions: Severe DES patients treated with AS achieve better symptoms improvement compared to artificial tears in a short-term treatment.

Tear Osmolarity Measurements in Dry Eye Related to Primary Sjögren’s Syndrome

Background: To evaluate the tear osmolarity in patients with dry eye syndrome related to primary Sjögren’s Syndrome (SS).Materials and Methods: Twenty eyes of 10 patients with dry eye and primary SS (Group 1) and 20 eyes of 20 subjects who do not have dry eye syndrome (Group 2) were included in this cross-sectional study. In all eyes, ophthalmic examination was performed in the same order: International Ocular Surface Disease Index survey, visual acuity assessment, conjunctival hyperemia scoring, tear osmolarity measurement with TearLab™ Osmolarity System, tear film break-up time assessment, corneal fluorescein staining scoring, ocular surface Lissamine Green staining scoring, anesthetized Schirmer test. Dry eye severity was graded according to Dry Eye Workshop (DEWS) classification system.Results: Four eyes with grade 1, four eyes with grade 2, seven eyes with grade 3, and five eyes with grade 4 dryness, according to DEWS system, were included. The mean tear osmolarity value was 301.9 ± 11.40 mOsm/L (range: 290–328) in Group 1, and 294.85 ± 8.33 mOsm/L (range: 283–311) in Group 2 (p = 0.03). In Group 1, tear osmolarity values were positively correlated with OSDI scores (r(18) = 0.55, r2 = 0.31, p = 0.01), DEWS classification grades (r(18) = 0.73, r2 = 0.54, p < 0.01), temporal and total corneal staining scores (r(18) = 0.67, r2 = 0.44, p < 0.01, and r(18) = 0.51, r2 = 0.26, p = 0.02, respectively), temporal conjunctival staining scores (r(18) = 58, r2 = 0.34, p < 0.01); and negatively correlated with anesthetized Schirmer test results (r(18) = -0.62, r2 = 0.38, p < 0.01) and TFBUT (r(18) = -0.50, r2 = 0.25, p = 0.02).Conclusions: Tear osmolarity values were found to be greater in patients with dry eye syndrome related to primary SS compared to control subjects, and positively correlated with the severity of dry eye.

Utility assessment among patients with dry eye disease

Purpose To determine utilities (patient preferences) for dry eye disease. Design Survey study. Participants Fifty-six patients with mild, moderate, or severe dry eye treated by ophthalmologists in the Eye Care Services department of Henry Ford Health Care System. Testing Patients completed interactive software utility assessment questionnaires by the time trade-off (TTO) method. Utility scores were scaled such that a score of 1.0 = perfect health and 0 = death. Dry eye severity was independently classified using clinical parameters and physician/patient assessments. Global health status, visual functioning, and ocular symptoms were assessed by the Short Form-36 Health Survey, 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and Ocular Surface Disease Index survey instruments. Main outcome measures Utility scores for a range of dry eye severity states. These utilities were compared with utilities reported for other disease states. Correlations with the general and vision-related health status measures were conducted. Results Fifty-six patients completed the utility assessments with acceptable reliability. Mean utilities for moderate (0.78) and severe dry eye (0.72) by TTO were similar to historical reports for moderate (0.75) and more severe (class III/IV) angina (0.71), respectively. Utility scores correlated with the NEI VFQ-25 composite score (ρ = 0.32; P = 0.037) and with components of other health measures. Conclusions Utilities for the more severe forms of dry eye are in the range of conditions like class III/IV angina (0.71) that are widely recognized as lowering health utilities. Our results underscore how significantly dry eye impacts patients compared with other medical conditions.