Ocular Surface Disease Index Research Articles

Evaluation of the effect of Muller muscle-conjunctival resection on meibomian glands by meibography.

To evaluate the effect of upper eyelid ptosis repairwith Muller muscle-conjunctival resection on meibomian gland function and ocular surface parameters. Thirty-eight patients who underwent ptosis repair with Muller muscle-conjunctival resection were retrospectively reviewed. Meibomian gland loss, Ocular Surface Disease Index OXFORD score, meiboscore, and noninvasive keratograph break-up time were measured preoperatively and at 1st, 3rd, and 6th months postoperatively. Noninvasive keratograph break-up time values decreased significantly at 1st and 3rd months postoperatively compared to the preoperative level, but were similar to the preoperative level at 6th months postoperatively (p<0.001 and p=0.628, respectively). Ocular surface disease index, OXFORD score, meibomian gland loss, and meiboscore values increased significantly in the 1st and 3rd postoperative months compared to the preoperative period, but these values decreased to preoperative levels in the 6th postoperative month (p<0.001 and p>0.05, respectively). There is a transient deterioration in meibography findings and OSDI score in the early postoperative period afterMuller muscle-conjunctival resection. Patients undergoing Muller muscle-conjunctival resection may require topical lubricants, especially in the first 3 postoperative months.

Artificial Intelligence in Dry Eye Disease: Benefits, Challenges and Future Directions

Current Diagnostic Challenges in Dry Eye Disease Dry eye disease (DED) is a challenging condition to pin down, given the various probable aetiologies, signs, and symptoms. DED is characterised by its loss of tear-film homeostasis, ocular surface inflammation, hyperosmolarity, eye discomfort, and visual abnormalities [1]. However, the signs of DED are occasionally inconsistent with the symptoms stated by patients [1]. There is presently no one clinical test that can uniformly pinpoint DED [1]. DED is diagnosed using a variety of subjective tests and symptom questions, including tear breakup time (TBUT), Schirmer's test (ST), fluorescein and lissamine green staining of the corneal (CSS1) and conjunctival surface (CSS2), and the ocular surface disease index (OSDI) [1]. Furthermore, the differentiation of different tear film breakup patterns is thought to be at the centre of a tear film-oriented diagnosis, which helps elucidate the pathophysiology of DED (i.e., identify the insufficient component of the tear film or of the corneal surface epithelium responsible for TFBU), sub classify DED, and select the optimal topical therapy (decide on the most appropriate treatment) [2]. Additionally, although meibomian gland dysfunction (MGD) is the leading cause of evaporative DED and one of the most common conditions encountered in DED, diagnosing MGD can be difficult due to the non-specific nature of the symptoms and great inter-examiner variability in grading clinical variables associated with MGD [3]. As a result, standardised and universal diagnostic and decision-making tools in DED are highly valued. Artificial intelligence (AI) through machine learning (ML) and deep learning (DL) has garnered attention in the ophthalmological field, particularly in the screening and diagnosis of retinal and optic nerve conditions [4]. These AI algorithms perform imageintensive analyses on fundus or optical coherence tomography (OCT) images [4]. Similarly, in the current practices of DED, AI is expected to facilitate the data-intensive analysis of DED signs and symptoms when diagnosing, triaging, and managing DED patients.

Impact of TearCare on Reading Speed in Patients with Dry Eye Disease.

To evaluate the impact of TearCare (TC) treatment on clinical, quality of life, and functional visual outcome metrics in patients with dry eye disease (DED) and meibomian gland disease (MGD). This is a prospective, single-center clinical trial. Adults with MGD and a DED diagnosis and tear break-up time (TBUT) <10seconds were included. All subjects had at least 20/40 vision and no surgery or new treatment for DED within 60 days prior to enrollment. All patients had one baseline visit prior to undergoing TC and one follow-up visit 1 month after TC. At each visit, the meibomian gland secretion score (MGSS), TBUT, and corneal fluorescein staining (KFL) were assessed. DED symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Visual Function Questionnaire 25 (VFQ-25), and the Fatigue Severity Scale. Reading speed was determined through the International Reading Speed Texts (IReST), Minnesota Low Vision Reading Test (MNREAD), and Wilkins Rate of Reading Test (WRRT). Thirty-two subjects were included. The average age was 55.9 years. Sixteen (52%) participants had a clinically significant improvement in reading speed after treatment with TC, defined as >10 words per minute increase in their IReST score. Improvement on the IReST and the MNREAD reached statistical significance (p = 0.012 and p = 0.028, respectively). OSDI scores significantly decreased and VFQ-25 scores significantly increased after TC treatment (p < 0.001). All of the clinical exam parameters showed statistically significant improvements after treatment (p < 0.001). TC is an effective treatment both clinically and with respect to visual function. Patients who had TC exhibited improvements in quality of life and improved reading speed after a single treatment. This treatment should be frequently considered and utilized to reduce the disease burden of DED related to MGD.

Allogeneic serum eye drops Sjogren syndrome‐related dry eye disease: Clinical evaluation of the ocular surface and in vivo confocal microscopy of the cornea

Aims/Purpose: To evaluate the symptomatic and clinical efficacy and in vivo confocal microscopy (IVCM) changes of the cornea after allogeneic serum eye drop therapy in patients with Sjögren's syndrome (SS)‐related Dry Eye Disease (DED).Methods: In this prospective clinical study 15 patients (30 eyes) with primary or secondary SS‐related DED were evaluated for Ocular Surface Disease Index (OSDI) questionnaire, ocular inflammation grade, Schirmer's test, tear film break‐up time (TBUT), corneal and conjunctival staining, and in vivo confocal microscopy (IVCM) analysis.Results: The average age of patients was 63.87 ± 9.18 years. The patients received treatment for a mean of 81.13 ± 56.84 days. The difference between before and after treatment with allogeneic serum eye drop therapy was statistically significant for OSDI parameters (p = 0.001), ocular inflammation (p = 0.004), TBUT (p = 0.007), Oxford Staining Scale (p = 0.007), Van Bijsterveld score (p = 0.006), basal epithelium density (p = 0.005), intermediate epithelium density (p = 0.041), Corneal Nerve Branch Density (CNBD) (p = 0.040), Beadings density (p = 0.047) and Fibre Tortuosity (p = 0.002).Conclusions: Allogeneic SEDs treatment in SS related DED patients, showed great results in terms of improvement in dry eye symptoms, clinical signs and IVCM changes. Further studies that aim at propagating and standardizing its production with clear international guidelines are needed.

Associations of Near Work, Time Outdoors, and Sleep Duration With Myopic Regression 5 Years After SMILE and FS-LASIK: A Cross-sectional Study.

To investigate the association of near work, time outdoors, and sleep duration with myopic regression 5 years after small incision lenticule extraction (SMILE) and femtosecond laser-assisted in situ keratomileusis (FS-LASIK) . This cross-sectional study included patients who received SMILE or FS-LASIK at Beijing Tongren Hospital 5 years ago. The patients underwent ophthalmic examinations including visual acuity, intraocular pressure, subjective refraction, slit-lamp examination, keratometry, corneal topography, optical coherence tomography, and fundus examination from January 2020 to March 2023. Fluorescein break-up time was measured and the Ocular Surface Disease Index questionnaire was completed to exclude dry eye. A self-administered questionnaire was used to collect data on near work exposure, physical activities, and sleep duration. A total of 323 eyes were included in the analysis, with a 5-year incidence rate of myopic regression after SMILE or FSLASIK of 16.1%. After adjusted for all confounders, total near work more than 8 hours/day revealed a significant association with myopic regression (odds ratio: 2.461; 95% CI: 1.143 to 5.298, P = .021), particularly in younger adults, women, and patients with high myopia and FS-LASIK treatment. The significant association between sleep duration 8 hours/day or more and myopic regression was restricted to women and patients with FS-LASIK (near significant). However, no significant associations were observed between continuous near work or time outdoors and myopic regression. Excessive near work exposure was associated with greater myopic regression 5 years after SMILE or FS-LASIK. It is crucial to maintain good visual behavior and care for preventing regression after SMILE or FS-LASIK, especially for younger patients and eyes with high myopia. [J Refract Surg. 2024;40(1):e10-e19.].

Meibomian gland dysfunction in people who have been in the refuge for a long time during the hostilities in Ukraine

Aims/Purpose: To study the indicators of the eye surface in people who have been in the refuge for a long time during the hostilities in Ukraine.Methods: We recruited 58 patients (main group) aged 32–75 years, who have been in the basement or underground from 3 to 5 month during the hostilities in Ukraine. The control group – 42 patients, aged – 32–72 years, who have been in their houses or flats. Each patients underwent additional examination: the Schirmer's test, the Norn's test, determination of the ocular protection index (OPI), contact meibography (Pult et al., 2012), compression test for evaluation of excretory capacity (Korb, 2005) and quality of the secretion (The International Workshop on Meibomian Gland Dysfunction, 2011) of meibomian gland, and Ocular Surface Disease Index Questionnaire (OSDI). The International Workshop's Classification of Meibomian Gland Dysfunction, 2011 was used to evaluate the severity of MGD.Results: In 75.8% patients of the main group Schirmer test was 4.8 ± 0.7 mm, Norn test was 4.1 ± 0.8 s, OPI test was 0.54 ± 0.8, test for evaluation of excretory capacity and quality of the secretion of meibomian glands was 2 stage, the mean of OSDI was 56.6 ± 3.4 (p &lt; 0.05). In 71.4% patients of the control group Schirmer test was 14.1 ± 1.6 mm, Norn test was 9.7 ± 0.8 s, OPI test was 0.69 ± 0.1, test for evaluation of excretory capacity and quality of the secretion of meibomian glands was 1 stage, the mean of OSDI was 11.2 ± 1.7 (p &lt; 0.05).Conclusions: Our findings suggest that 75.8% of all patients who have been in the refuge from 3 to 5 month, have significant changes in the indicators of the eye surface, which corresponds to Meibomian Gland Dysfunction stage 3 and 4 (p &lt; 0.05). 71.4% patients of the control group who have been in their houses or flats have changes in the indicators of the eye surface, which corresponds to Meibomian Gland Dysfunction stage 1 and 2 (p &lt; 0.05). Long stays in the refuge caused significant changes in the surface of the eye, which required treatment for 75.8% of all patients (p &lt; 0.001, respectively).

The association of pre-photorefractive keratectomy Schirmer-1 test value with postoperative corneal epithelial thickness, ocular surface discomfort, and visual acuity.

To investigate the association of pre-photorefractive keratectomy Schirmer-1 test value with post-photorefractive keratectomy central corneal epithelial thickness, ocular surface disease index score, and uncorrected distance visual acuity. Patients were categorized according to preoperative Schirmer-1 value: the normal Schirmer Group (n=54; Schirmer-1 test value, >10 mm) and the low Schirmer Group (n=52; Schirmer-1 test value, between 6 and 10 mm). We analyzed ablation depth, visual acuity, result of Schirmer-1 test (with anesthesia), tear film break-up time, ocular surface disease index score, central corneal epithelial thickness, and spherical equivalent refraction. We found significant differences between the groups in Schirmer-1 test value, tear film break-up time, and ocular surface disease index score, both preoperatively and postoperatively (p<0.001). The preoperative central corneal epithelial thicknesses of the two groups were similar (p>0.05). After photorefractive keratectomy, the Schirmer-1 test value and spherical equivalent refraction decreased in both groups (p<0.05), and ocular surface disease index scores and central corneal epithelial thickness values increased in the low Schirmer Group (p<0.001) but not in the normal Schirmer Group (p>0.05). The postoperative central corneal epithelial thicknesses of the low Schirmer Group were significantly higher than those of the normal Schirmer Group (p<0.001). Postoperative uncorrected distance visual acuity did not differ significantly between the two groups (p>0.05). In patients with low Schirmer-1 test values before photorefractive keratectomy, the corneal epithelium thickened and ocular surface complaints increased during the postoperative period. However, changes in the corneal epithelium did not affect the postoperative uncorrected distance visual acuity. To reduce postoperative problems on the ocular surface in these patients, we recommend that dry eye be treated before photorefractive keratectomy.

Comparison of a single-dose vectored thermal pulsation procedure with 5-day course of daily oral azithromycin for meibomian gland dysfunction.

This study aims at comparing the efficacy of a single-dose vectored thermal pulsation (VTP) procedure versus 5 days once daily oral azithromycin in patients with meibomian gland disease (MGD) by measuring the symptomatology and ocular surface parameters. The study was conducted as a prospective, nonrandomized, comparative study over a period of 17 months at a tertiary care center. In this study, 60 patients with MGD were enrolled after they gave their informed consent according to the inclusion-exclusion criteria and were divided into two groups, 30 each in the azithromycin group and the VTP, i.e., the LipiFlow group. One group was treated with oral azithromycin for 5 days and the other group was given LipiFlow treatment. Postprocedure, follow-up was done for 2 weeks, 3 months, and 6 months. A statistically significant difference was noted in the score Standard Patient Evaluation of Eye Dryness questionnaire after 3 months of treatment in both the azithromycin and LipiFlow group (P < 0.0001), and the LipiFlow group showed sustained improvement at 6-month follow-up as score improved to 8.83 ± 2.32, whereas it deteriorated in azithromycin group to 13.77 ± 1.65. Pretreatment Ocular Surface Disease Index score (P = 0.126) and posttreatment (P < 0.0001) showed significant differences in both groups. The LipiFlow group showed an improved score of 25.65 ± 6.11 after 6 months of treatment, whereas it deteriorated to 34.79 ± 4.98 in the azithromycin group. Pretreatment, tear film break-up time (P = 0.28) and 6 months posttreatment score (P < 0.0001) showed significant differences in both groups, but in the LipiFlow group, it improved to 15.30 ± 1.76 after 6 months, whereas in the azithromycin group, it was 10.07 ± 1.60. The pretreatment MG score was 4.10 ± 0.99 and 4.23 ± 1.07 (P = 0.62) in the azithromycin and LipiFlow group, respectively. After 2 weeks, 3 months, and 6 months, the MG score was 24.20 ± 3.38, 21.67 ± 3.46, and 15.83 ± 2.41, respectively, in azithromycin group. In the LipiFlow group, the score was 13 ± 1.88, 14.27 ± 2.07, and 14.37 ± 1.85 at 2 weeks, 3 months, and 6 months, respectively, suggestive of improvement in all visits. Both oral azithromycin and LipiFlow treatment are effective in patients with MGD. The effect of LipiFlow treatment lasted longer as compared to azithromycin. The efficacy of azithromycin in resolving the symptoms of MGD was greater compared to LipiFlow in the initial 2 weeks of treatment. However, the effect deteriorated in the subsequent follow-up at 3 months and 6 months.

Our experience in managing patients with dry eye syndrome

Aims: To confirm the effectiveness of a comprehensive approach to the treatment of patients(PT) with moderate and moderate severity of dry eye syndrome (DES).Methods: 53 PT (106 eyes) with 2 and 3 stages of DES aged from 25 to 52 years were included in the examination. The control group (I gr) included 19 PT, in the studied group (II gr)–29 PT. In addition to the standard ophthalmological examination, the PT underwent a Schirmer's test (SCH), Symptomatic Break –Up Time (SBUT), compression test to assess the secretory capacity (Korb, 2005) of the meibomian glands(MG) (using a glass rod) and Ocular Surface Disease Index Questionnaire (OSDI). The TFOS DEWS II report was used to classify the stage of DES. The inclusion criteria: PT with the SCH‐values ≥3 mm, without systemic diseases, the degree of violation of the excretory ability of the MG corresponded to stages 1 and 2. PT of the II gr were offered complex treatment:1‐instillation of drops with hyaluronic acid 5 times a day; 2‐in 2–3 min use of drops with the LIPITECH system; 3– a carbomer‐gel once at night;4‐systematic massages of the eyelids a course of 5–10 sessions over 1.5 months. PT of the I gr continued to use artificial tears min 3 times a day. Control was at 2, 4 and 6 weeks.Results: Positive dynamics are noted in the II gr for all 4 control indicators. The average indicative of SCH increased by 54.7% (7.5 ± 0.04 mm), SBUT improved by 35.6% (3.6 ± 0.01 s), the duration (time from the beginning) of meibum evacuation decreased by 37.7% (2.3 ± 0.08 s); the OSDI decreased by 54.8% (38.0 ± 0.1) (p &lt; 0.05). The I gr: SCH increased by 20.8% (1.5 ± 0.01 mm), SBUT improved by 12.6% (0.9 ± 0.09 s), the duration of meibum evacuation decreased by 5.7% (0.4 ± 0.04 s); the OSDI‐36.2% (24.9 ± 0.7) (p &lt; 0.05).Conclusions: With a comprehensive approach to the problem and the patient's understanding of the need to comply with all recommendations, it is possible to achieve a prolonged positive result of treatment, and to preserve this effect in the future.

Symptomatic dry eye disease among university students.

Dry eye disease (DED) is a multifactorial condition often characterized by a reduction in tear film quantity or quality. This study aimed to determine the frequency of DED and its associated subjective symptoms among students of Mu'tah University. In this cross-sectional study conducted at Mu'tah University, Mu'tah, Jordan, from January to April 2022, 489 students completed an online patient-reported DED symptom questionnaire and the ocular surface disease index (OSDI) questionnaire. Moreover, 106 participants underwent clinical examinations using the Schirmer test I and fluorescein tear breakup time (TBUT). Approximately 74.6% of the students self-reported experiencing DED symptoms, and 72.6% had an OSDI score > 12, which is considered the threshold for an abnormal ocular surface. Clinical examinations revealed low Schirmer test scores ( < 10 mm) in 26.4% (n = 28) and 25.5% (n = 27) of the right and left eyes, respectively. We observed low TBUT scores ( < 5 s) in 19.8% (n = 21) and 18.9% (n = 20) of the right and left eyes, respectively. We noted significant differences between the self-reported DED symptoms and the Schirmer test scores (P = 0.003 for both right and left eyes), TBUT (P < 0.001 for both right and left eyes), and OSDI score (P < 0.001 for each self-reported DED symptom). We observed a weak significant positive correlation between Schirmer test scores and TBUT in the right (r = + 0.30; P = 0.002) and left (r = + 0.34; P < 0.001) eyes; a negligible significant inverse correlation between OSDI scores and Schirmer test scores in the right (r = - 0.24; P = 0.013) and left (r = - 0.23; P = 0.019) eyes; and a negligible significant inverse correlation between the OSDI score and TBUT of the left eye (r = - 0.25; P = 0.011) but not of the right eye (r = - 0.17; P = 0.077). The frequency of DED symptoms in this study was higher than that previously reported based on foreign statistics. The presence of self-reported DED symptoms was significantly associated with higher OSDI scores. Self-reported DED symptoms were more frequent than the abnormalities detected using objective methods. Therefore, a combination of subjective and objective measures may provide higher diagnostic yield for DED. Further studies are required to confirm this hypothesis.

Prevalence of Face Mask-Induced Dry Eye and Ocular Irritation Amid COVID-19 Among Health Workers in Jazan

Background: One of the most important defenses against the COVID-19 pandemic is the use of facemasks. Long-term facemask use can result in mask-associated dry eyes. This study explored the prevalence of face mask-associated dry eyes (MADE) and associated factors among health workers in Jazan. Methods: This prospective cross-sectional clinical study was carried out among healthcare workers (Physicians, Dentists, Pharmacists, Technicians, Nurses, and Administrative staff) who wore facemasks during duties at Prince Mohammed Bin Nair Hospital in Jazan, Sudi Arabia, from 2020 to 2022. Two hundred ninety-eight participants were randomly selected. The participants were given a questionnaire about their socio-demographic characteristics, occupational information, health information, and the duration they had used glasses, masks, and technological devices. The daily average quantity of time spent sleeping was also investigated. The severity of dry eye disease was determined using OSDI scores. The chi-square test and Fisher's exact test examined categorical variable connections. Mean differences were calculated using an independent -test. Logistic regression will discover COVID-19 severity predictors. A statistically significant P-value is . Result: Among 298 health workers in this study fulfilling the inclusion criteria. The mean age of the respondents was years old, consisting of 61.3% male and 38.7% female out of 298 respondents whom the majority of them were Saudi (89.6%) and the rest non-Saudi (10.4%). Based on the Ocular Surface Disease Index (OSDI) score, almost half of the respondents (49.0%) obtained an average score in terms of dry eye disease. Only gender and marital status were significantly associated with OSDI score and respectively). From the Health Information provided, most of the variables were significantly associated with the OSDI score. Conclusion: This study concluded that face mask-associated dry eye (MADE) prevalence among health practitioners stands at 51%, partly explaining the worsening dry eye disease symptoms among mask wearers.

Quantum Molecular Resonance Effects on Patients With Dry Eye Disease: A Randomized Controlled Trial.

The aim of the study was to evaluate the efficacy and safety of quantum molecular resonance in the treatment of dry eye disease. This study was a double-blind randomized control trial in 1 academic medical center, for 2 years. Participants received treatment or a placebo with the Rexon-Eye device, once per week for 4 weeks. The primary outcome was the change in dry eye symptoms assessed by the Ocular Surface Disease Index (OSDI). Secondary outcomes were clinical findings associated with the dry eye such as meibomian gland dysfunction (MGD) score, tear break-up time (TBUT), corneal fluorescein staining, Schirmer test, and best-corrected visual acuity (BCVA). Forty patients were recruited, 20 in each arm. The mean age was 63.5 ± 15.1 years and 27 (67.5%) were female. The mean OSDI score significantly improved in the intervention group from 19.15 ± 10.3 to 10.5 ± 7.0 ( P < 0.001), whereas the control group showed no significant change (14.4 ± 8.4 to 15.5 ± 8.6, P = 0.830). MGD scores significantly improved in the intervention group (1.57 ± 1.2 to 0.8 ± 0.9, P = 0.006), whereas showing no significant change in the control group (1.60 ± 0.9 to 1.99 ± 1.0, P = 0.244). The corneal staining score also showed significant improvement in the intervention group ( P = 0.045) and a nonsignificant decline in the placebo group ( P = 0.50). No significant difference was seen in TBUT, visual acuity, and Schirmer scores between groups. No harm resulting from treatment was reported during the duration of the trial. High-frequency electrotherapy may have a positive effect on symptoms and signs of dry eye. This emerging technology may become part of the arsenal of therapeutic modalities for this condition.

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.

Clinical Impact of Ambient Particulate Matters on Dry Eye Disease

Purpose: Dry eye disease (DED) has become a common ocular surface disorder in the recent decades, which can be influenced by environmental factors. This study aimed to examine the clinical association between DED and ambient air pollutants.Methods: A total of 216 patients (18 patients per each month) diagnosed with DED were enrolled in this retrospective study. Ocular surface disease index (OSDI), tear film breakup time (TFBUT), fluorescein corneal staining (FCS), and Schirmer’s test 1 (ST1) were examined. The monthly concentrations of air pollutants in 2018 were obtained from the data released by the Korean Ministry of Environment. Based on the mean of PM&lt;sub&gt;10&lt;/sub&gt; and PM&lt;sub&gt;2.5&lt;/sub&gt;, subgroup with exposure to low (L–PM) or high concentration of PM (H–PM) was analyzed.Results: Patients had moderate DED as high OSDI, low TFBUT, increased FSC, and decreased ST1. During the year 2018, monthly variation of PM showed that May to October was the period of L-PM and January to April and November to December was the period of H-PM. In subgroup analysis, patients in H-PM showed significantly higher OSDI, FCS, and lower ST1 compared to in L-PM. However, there was no significant difference in TFBUT between subgroups.Conclusions: DED was more severe in the period of H-PM than L-PM even though there was no difference in tear film instability between both periods. Ambient inflammatory factors including PM might deteriorate ocular surface as well as tear secretion, resulting in aggravating DED.

Contralateral eye comparison of the efficacy and safety of two artificial tear formulations for corneal subbasal nerve fiber regeneration after photorefractive keratectomy

Background: Currently, artificial tears (ATs) are the first-line agents for managing dry eye disease (DED). This study compared the efficacy and safety of two different AT formulations, Systane® Hydration (SH) and Systane® Ultra (SU), on symptoms of DED and regeneration of the subbasal corneal nerve fiber length (CNFL) in photorefractive keratectomy (PRK)-treated eyes.&#x0D; Methods: This prospective contralateral comparative study recruited myopic eyes scheduled for PRK, and either SH or SU were administered for up to 3 months postoperatively. All participants underwent a standard comprehensive preoperative ophthalmological examination, in vivo confocal microscopy to evaluate the subbasal CNFL, and completed Ocular Surface Disease Index (OSDI) questionnaire for assessing dry eye symptoms. Image analysis software was used to calculate the subbasal CNFL (micrometer/mm2). Assessments were repeated at the 1- and 3-month follow-up visits. Pre- and postoperative subbasal CNFL and OSDI scores were compared to determine inter- and intra-group differences.&#x0D; Results: Fifty eyes of 25 participants were included in this study. The mean (standard deviation) age of the participants was 22.7 (3.8) years. The OSDI scores for both groups increased significantly at 1 month (both P&lt;0.05), followed by a decrease at 3 months to values comparable to the preoperative scores (both P&gt;0.05). Although OSDI scores were comparable at baseline and at the 1-month postoperative visit (both P&gt;0.05), the SU-treated eyes had a significantly better OSDI score at the 3-month visit (P&lt;0.05), despite being clinically insignificant. Preoperative subbasal CNFL differed significantly between the groups (P=0.001), yet the mean values at both postoperative visits were comparable (both P&gt;0.05). In both groups, subbasal CNFL was significantly reduced at 1 month, followed by a significant increase at the 3-month postoperative visit compared to baseline (all P&lt;0.05). No treatment-related complications were observed at the end of the study period.&#x0D; Conclusions: No significant difference was found between the preoperative and 3-month postoperative OSDI scores in the SH- or SU-treated eyes. Subbasal CNFL regeneration indicated a positive effect of both ATs, with a longer mean CNFL noted in the SH-treated eyes at the final visit. This suggests that SH may be a better option for improving corneal reinnervation after PRK. These observations must be verified in further trials with longer follow-up periods and larger sample sizes.

Composition and diversity of meibum microbiota in meibomian gland dysfunction and the correlation with tear cytokine levels.

Meibomian gland dysfunction (MGD) leads to meibum stasis and pathogenic bacteria proliferation. We determined meibum microbiota via next-generation sequencing (NGS) and examined their association with tear cytokine levels in patients with MGD. This cross-sectional study included 44 moderate-severe patients with MGD and 44 healthy controls (HCs). All volunteers underwent assessment with the ocular surface disease index questionnaire, Schirmer without anesthesia, tear break-up time, Oxford grading of ocular surface staining, and lid and meibum features. Sample collection included tears for cytokine detection and meibum for 16S rRNA NGS. No significant differences were observed in the α-diversity of patients with MGD compared with that in HCs. However, Simpson's index showed significantly decreased α-diversity for severe MGD than for moderate MGD (p = 0.045). Principal coordinate analysis showed no significant differences in β-diversity in meibum samples from patients with MGD and HCs. Patients with MGD had significantly higher relative abundances of Bacteroides (8.54% vs. 6.00%, p = 0.015) and Novosphingobium (0.14% vs. 0.004%, p = 0.012) than the HCs. Significantly higher interleukin (IL)-17A was detected in the MGD group than in the HC group, particularly for severe MGD (p = 0.008). Although Bacteroides was more abundant in the MGD group than in the HC group, it was not positively correlated with IL-17A. The relationship between core meibum microbiota and tear cytokine levels remains unclear. However, increased Bacteroides and Novosphingobium abundance may be critical in MGD pathophysiology.

Efficacy and Safety of Quantum Molecular Resonance Electrotherapy in Patients with Aqueous-Deficient, Evaporative and Mixed-Type Dry Eye: A Randomized Interventional Study.

To evaluate the efficacy and safety of Quantum Molecular Resonance (QMR) treatment in patients with severe dry eye disease (DED), as well as its effects on aqueous-deficient (ADDE), evaporative (EDE), and mixed (MDE) dry eye. In this prospective, interventional study, 81 patients were randomly allocated to received four treatment sessions of QMR at 1-week intervals (Rexon-Eye®, Resono Ophthalmic, Trieste, Italy) (QRM group) or tear substitute four times daily, containing 0.15% sodium hyaluronate and 3% trehalose (Thealoz Duo®, Thea Pharma, France) (SH-TH group). Outcome measures included ocular surface disease index (OSDI) questionnaire, tear meniscus height (TMH), tear breakup time (TBUT), non-invasive breakup time (NIBUT), corneal fluorescein staining (CFS), lipid layer thickness (LLT), tear film osmolarity (OSM), and meibomian gland dysfunction (MGD) grade, which were assessed at baseline and 1-month and 3-month follow-up. The QMR group achieved better improvements than the SH-TH group in OSDI and SANDE questionnaires, NIBUT, LLT, and CFS. The mean differences between the groups were as follows: OSDI (- 12.4 ± 0.25 points, P = 0.01), SANDE (10.6 ± 1.7 points, P = 0.01), NIBUT (2 ± 0.25s, P = 0.01), LLT (18.7 ± 0.7nm, P = 0.01), and CFS (1.2 ± 0.1 points, P = 0.02). In subgroups analysis, QMR treatment demonstrated a beneficial role to improve DED symptoms and signs in ADDE, EDE, and MDE. QMR is an effective and well-tolerated treatment that seems to improve DED symptoms and signs in patients with severe DED. However, further studies are needed to confirm this. ClinicalTrials.gov identifier NCT06119386.

Dry eye in mind: Exploring the relationship between sleep and ocular surface diseases.

Dry Eye Disease (DED) is regarded as the most common ocular surface disease worldwide, entailing symptoms that have a major impact on the physical and psychological well-being of DED patients. In this context, the impact of sleep quality on DED has recently attracted attention. Indeed, although little is known about the mechanisms underlying the relationship between sleep and ocular surface diseases, recent evidence suggests that a reciprocal relationship exists between sleep quality and DED. Aim of the study was to investigate such relationship by means of both survey-based and instrumental analysis in a large population. The present cross-sectional study included 1182 DED patients who completed the Insomnia Severity Index (ISI) and the Ocular Surface Disease Index (OSDI) questionnaires. Moreover, tear break-up time (TBUT) and ocular surface staining (OSS) data of included patients were collected by physicians. According to the findings of this study, in DED patients, the severity of dry eye symptoms and signs, assessed by OSDI score, TBUT, and ocular surface staining, is associated with more severe insomnia symptoms. Furthermore, higher severity of DED symptoms seems to be associated with the occurrence of nocturnal awakenings rather than with problems in falling asleep. Present work contributes to the understanding of the complex relationship between DED and insomnia by showing that in a large population of DED patients, the more severe the insomnia, the more severe the DED symptoms and signs.

Association Between Tear Osmolarity and Dry Eye Signs in Patients with Obstructive Meibomian Gland Dysfunction

Purpose: To explore the correlations between tear osmolarity, as measured using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc., Dollard-des-Ormeaux, QC, Canada), and various dry eye indicators, including the Schirmer test, tear break-up time (TBUT), Oxford scale, and Ocular Surface Disease Index (OSDI), in patients with obstructive meibomian gland dysfunction (MGD).Methods: The medical records of 44 cases of obstructive MGD were reviewed. Tear osmolarity was obtained using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc.). The TBUT, Schirmer test, Oxford scale, OSDI, and MGD grade were used to assess the cases, and their correlations with tear osmolarity were analyzed.Results: Spearman and Pearson correlation analyses showed a significant correlation between tear osmolarity and MGD grade (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and OSDI (&lt;i&gt;p&lt;/i&gt; = 0.005). However, the results of the TBUT, Schirmer test, and Oxford scale were not significantly related to tear osmolarity. The patients were divided according to MGD severity into those with MGD grades ≤ 2 and those with MGD grades ≥ 3. Tear osmolarity (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and OSDI (&lt;i&gt;p&lt;/i&gt; = 0.014) showed significant differences between the two groups.Conclusions: In patients with obstructive MGD, tear osmolarity, assessed using I-PEN&lt;sup&gt;®&lt;/sup&gt; (I-MED Pharma, Inc.), is significantly correlated with MGD grade and OSDI.

Ocular surface changes in primary open-angle glaucoma on anti-glaucoma medications versus treatment-naïve patients.

To examine the ocular surface disease in primary open-angle glaucoma (POAG) patients already on treatment versus POAG patients without treatment. A prospective cohort study was conducted on 120 eyes of 60 POAG patients: 60 treatment-naïve eyes (group I) and 60 eyes already on topical anti-glaucoma medications (AGMs) (group II). All patients had filled out the Ocular Surface Disease Index (OSDI) questionnaire and underwent a comprehensive glaucoma workup. Tear break-up time (TBUT) test, Schirmer's test (type I), corneal sensitivity, anterior segment-optical coherence tomography (AS-OCT), and corneal and conjunctival staining were done at day 1, 1 month, 3 months, 6 months, and 12 months follow-up. On presentation, TBUT, Schirmer's test, tear meniscus height (TMH), and tear meniscus depth (TMD) were significantly higher in group I compared to group II. No significant difference was noted in OSDI score, corneal sensitivity, and tear meniscus area (TMA) between the groups on presentation. Both, lissamine green and rose bengal staining, had higher grades in group II compared to group I. Worsening of ocular surface disease was noted in both groups on follow-up. OSDI score, TBUT, Schirmer's test, TMH, and TMD had better values in group I in comparison to group II on follow-up. The study has identified glaucoma patients on AGMs to be more affected by dry eye disease (DED) compared to treatment-naive glaucoma patients. We found statistically significant differences in values of TBUT, Schirmer tests, lissamine and rose bengal staining, and AS-OCT parameters at baseline and 3, 6, and 12 months follow-up. OSDI scores showed significant differences at 6 and 12 months of follow-up. We recommend consideration of evaluation and management of DED/ocular surface disease in glaucoma patients on topical AGMs, particularly multiple drugs and doses.