Phenol Red Thread Test Research Articles

Spdef Null Mice Lack Conjunctival Goblet Cells and Provide a Model of Dry Eye

Goblet cell numbers decrease within the conjunctival epithelium in drying and cicatrizing ocular surface diseases. Factors regulating goblet cell differentiation in conjunctival epithelium are unknown. Recent data indicate that the transcription factor SAM-pointed domain epithelial-specific transcription factor (Spdef) is essential for goblet cell differentiation in tracheobronchial and gastrointestinal epithelium of mice. Using Spdef(-/-) mice, we determined that Spdef is required for conjunctival goblet cell differentiation and that Spdef(-/-) mice, which lack conjunctival goblet cells, have significantly increased corneal surface fluorescein staining and tear volume, a phenotype consistent with dry eye. Microarray analysis of conjunctival epithelium in Spdef(-/-) mice revealed down-regulation of goblet cell-specific genes (Muc5ac, Tff1, Gcnt3). Up-regulated genes included epithelial cell differentiation/keratinization genes (Sprr2h, Tgm1) and proinflammatory genes (Il1-α, Il-1β, Tnf-α), all of which are up-regulated in dry eye. Interestingly, four Wnt pathway genes were down-regulated. SPDEF expression was significantly decreased in the conjunctival epithelium of Sjögren syndrome patients with dry eye and decreased goblet cell mucin expression. These data demonstrate that Spdef is required for conjunctival goblet cell differentiation and down-regulation of SPDEF may play a role in human dry eye with goblet cell loss. Spdef(-/-) mice have an ocular surface phenotype similar to that in moderate dry eye, providing a new, more convenient model for the disease.

OCULAR HEALTH ASSESSMENT, TEAR PRODUCTION, AND INTRAOCULAR PRESSURE IN THE ANDROS ISLAND IGUANA (CYCLURA CYCHLURA CYCHLURA)

The purpose of this study was to assess the ocular health of a wild population of Andros Island iguanas (Cyclura cychlura cychlura) and determine reference values for tear production and intraocular pressure (IOP) for this species. Fifty-two iguanas, 20 males and 32 females, ranging in size from 11.1- to 51.0-cm snout-to-vent length (SVL), were included in the sample set, with measurements obtained from each eye. No abnormalities were found on ophthalmic examination, with the exception of mild, focal chemosis in one individual and periocular ticks in 52% of iguanas. Tear production was measured using the phenol red thread test, and IOP was measured using the TonoVet rebound tonometer set on the P (undefined species) setting. No significant difference was found between males and females for either measurement. No significant difference was found between right and left eyes for intraocular pressure; however, a significant difference was found between eyes for tear production values. The mean (+/- SD) of IOP in the left and right eyes were 4.77 +/- 1.88 mm Hg and 5.12 +/- 2.52 mm Hg, respectively, with a range of 1-11 mm Hg. The mean (+/- SD) of tear production in the left and right eyes were 10.63 +/- 6.89 mm/15 sec (range 1-28 mm/15 sec) and 12.44 +/- 7.52 mm/15 sec (range 1-23 mm/15 sec), respectively. A positive correlation was found between SVL and all ocular parameters measured. This study provides an assessment of ocular health, as well as baseline values for IOP and tear production, in the Andros Island iguana.

Safety and Efficacy of Topical Infliximab in a Mouse Model of Ocular Surface Scarring

To evaluate the safety/efficacy of topical infliximab, an anti-TNF-α monoclonal antibody, in a mouse model of ocular surface scarring. Twenty alkali burn mice were treated with infliximab (10 mg/mL) topically 6 times a day, while 20 alkali burn mice received saline for 7 days. Corneal opacity, epithelial wound healing, and ocular phimosis were examined at the slit-lamp. Tear production was quantified with phenol red thread test. Immunofluorescence for infliximab penetration, TNF-α localization, CD45+ cell infiltration, PAS, and Masson's trichrome staining were evaluated on ocular globes and eyelids. TNF-α and IL-1β expression levels were measured on treated murine corneas and eyelids. Finally, quantification of corneal CD31+ blood vessels and LYVE1+ lymphatic vessels were evaluated on 10 additional alkali burn mice receiving either infliximab or saline, after 14 days. Topical infliximab penetrated the cornea and the conjunctiva and was not toxic (negative fluorescein stain). Its molecular target, TNF-α, was detected in the cornea after injury. Infliximab significantly reduced corneal perforation, opacity index, phimosis, leukocyte infiltration, and fibrosis in the eyelids. It also significantly prevented goblet cell infiltration in epithelial cornea and loss in the conjunctiva (P < 0.05), improved tear secretion and epithelial healing (P < 0.05). Finally, it significantly reduced both corneal hem- (P < 0.05) and lymphangiogenesis (P < 0.01). Infliximab penetrates the cornea and is safe to the ocular surface in an animal model of ocular surface scarring. We suggest that topical application of infliximab may be a useful treatment in ocular caustications.

Influence of a Controlled Environment Simulating an In-Flight Airplane Cabin on Dry Eye Disease

To evaluate symptoms, signs, and the levels of 16 tears inflammatory mediators of dry eye (DE) patients exposed to an environment simulating an in-flight air cabin in an environmental chamber. Twenty DE patients were exposed to controlled environment simulating an in-flight airplane cabin (simulated in-flight condition [SIC]) of 23°C, 5% relative humidity, localized air flow, and 750 millibars (mb) of barometric pressure. As controls, 15 DE patients were subjected to a simulated standard condition (SSC) of 23°C, 45% relative humidity, and 930 mb. A DE symptoms questionnaire, diagnostic tests, and determination of 16 tear molecules by multiplex bead array were performed before and 2 hours after exposure. After SIC exposure, DE patients became more symptomatic, suffered a significant (P ≤ 0.05) decrease in tear stability (tear break up time) (from 2.18 ± 0.28 to 1.53 ± 0.20), and tear volume (phenol red thread test), and a significant (P ≤ 0.05) increase in corneal staining, both globally (0.50 ± 0.14 before and 1.25 ± 0.19 after) and in each area (Baylor scale). After SSC, DE patients only showed a mild, but significant (P ≤ 0.05), increase in central and inferior corneal staining. Consistently, tear levels of IL-6 and matrix metalloproteinase (MMP)-9 significantly increased and tear epidermal growth factor (EGF) significantly decreased (P ≤ 0.05) only after SIC. The controlled adverse environment conditions in this environmental chamber can simulate the conditions in which DE patients might be exposed during flight. As this clearly impaired their lacrimal functional unit, it would be advisable that DE patients use therapeutic strategies capable of ameliorating these adverse episodes.

Results of phenol red thread test in clinically normal Syrian hamsters (Mesocricetus auratus)

To determine the normal reference range for phenol red thread test (PRTT) values in clinically normal Syrian hamsters (Mesocricetus auratus). Sixteen healthy adult Syrian hamsters (eight males and eight females) were used in this study. Ophthalmic examinations were performed without chemical restraint. PRTT values were evaluated in both eyes of all Syrian hamsters using a commercial PRTT strip of a single lot number. No statistically significant differences between right and left eyes were found for any of the results. The mean ± SD PRTT values for the study population were 6.8 ± 2.5 mm/15 s with a range from 3 to 11.5 mm/15 s. Mean PRTTs in male animals were 5.1 ± 1.2 mm/15 s, whereas mean PRTTs in female hamsters were 8.5 ± 2.3 mm/15 s. Comparison between mean PRTT values in males and females showed a significant difference (P = 0.004). Mean weights for males and females were 80.9 ± 4.8 and 90.6 ± 8.5 g, respectively. No linear relationship between mean PRTT and body weight was found in female (P = 0.46) and male (P = 0.92) hamsters. This study provides novel data for normal reference ranges of PRTT values in healthy Syrian hamsters. Results of this study may assist veterinarians in the diagnosis of ocular surface disease and syndromes affecting the tear film in these species.

Correlations Among Symptoms, Signs, and Clinical Tests in Evaporative-Type Dry Eye Disease Caused by Meibomian Gland Dysfunction (MGD)

Purpose: To evaluate changes in symptoms, objective tests, and signs after medical treatment of subjects with evaporative-type dry eye disease (EDE) caused by Meibomian gland dysfunction (MGD), and to analyze correlations among symptoms, signs and test results in the worse eyes (W-eyes) of the subjects.Methods: Prospective clinical study of 21 symptomatic subjects with EDE caused by MGD. Subjects who were diagnosed with EDE in a first visit were treated for 6 weeks and re-evaluated in a second visit. The differences between initial and second visits were evaluated. Correlations among clinical symptoms, signs, and test results were performed using the data of the W-eyes. Variables evaluated included: dry eye symptoms, best corrected visual acuity (BCVA), contrast sensitivity, conjunctival hyperemia, phenol red thread test, tear break-up time (TBUT), tear meniscus height (TMH), corneal fluorescein and conjunctival rose Bengal staining, tear lysozyme concentration, Schirmer test, and lid margin assessment.Results: All items evaluated improved after treatment, but only conjunctival hyperemia and TMH improved significantly. TBUT and lid margin changes improved, but still remained abnormal. There were significant correlations among symptoms questionnaires and some clinical tests (TBUT, conjunctival hyperemia, TMH, and conjunctival rose Bengal staining).Conclusion: Despite the instability of the tear film and lid margin alterations that continued after treatment, subjects with MGD improved symptomatically. The low degree of correlations among W-eye signs, symptoms, and tests reflects the independency of symptoms and signs in this complex pathology.

Item by Item Analysis Strategy of the Relationship Between Symptoms and Signs in Early Dry Eye

Purpose: The present study aimed at analyzing the relationship between several particular symptoms, risk factors or global questionnaire scores and some tear clinical signs in early dry eye patients.Material and methods: A total of 77 volunteers were enrolled in the study without any prior classification, although patients with severe dry eye were excluded. Two questionnaires were used to assess ocular symptoms and risk factors, and clinical tear signs were evaluated with four tests (osmolarity, ferning, break-up time and the phenol red thread test). Multiple linear regression analysis was performed to determine the relative predictive value of each particular ocular symptom and risk factor, for each clinical sign. This analysis was repeated using symptoms and risk factors global scores.Results: The symptom “eyes stuck shut in the morning” was the only predictor variable for the sign “ferning crystallization” (R = 0.228, p < 0.05) and “dryness” for “break-up time” (R = –0.315, p < 0.01). “Burning sensation” and “computer use for more than 3 h” were predictor variables for “tear osmolarity” (R = 0.342, p < 0.01), while “itching” and “female gender” were found to predict the outcomes of the “phenol red thread test” (R = –0.462, p < 0.05). Global questionnaire scores were not found to predict any tear clinical sign.Conclusions: The present findings support the informative value of exploring the associations between clinical signs, ocular symptoms and risk factors by following an item by item strategy rather than opting for global questionnaire scores.

The Role of Dyslipidemia on Ocular Surface, Lacrimal and Meibomian Gland Structure and Function

Purpose: Dyslipidemia is characterized by high lipid blood levels that are risk factors for cardiovascular diseases, which are leading causes of death. However, it is unclear whether dyslipidemia is a cause of the dry eye syndrome (DES). Therefore we determined in transgenic mice models of dyslipidemia, whether there is an association with DES development.Methods: Dyslipidemic models included male and female adult mice overexpressing apolipoprotein CIII (Apo CIII), LDL receptor knockout (LDLR-KO) and ApoE knockout (ApoE-KO). They were compared with age- and gender-matched C57BL/6 mice. Ocular health was evaluated based on corneal slit lamp assessment, phenol red thread test (PRT) and impression cytology. Blood lipid profiles and histology of meibomian and lacrimal glands were also evaluated. Effects of high-fat diet and aging were observed in LDLR-KO and ApoCIII strains, respectively.Results: Body weight and lacrimal gland weight were significantly higher in male mice compared to females of the same strain (P < 0.05). Body weight was significantly lower in LDLRKO mice receiving high lipid diet compared to their controls (P = 0.0043). ApoE-KO were hypercholesterolemic and ApoCIII hypertriglyceridemic while LDLR-KO showed increases in both parameters. The PRT test was lower in male LDLR-KO mice with high-fat diet than control mice with standard diet (P = 0.0273). Aging did not affect lacrimal structural or functional parameters of ApoCIII strain.Conclusions: DES development is not solely dependent on dyslipidemia in relevant mice models promoting this condition. On the other hand, lacrimal gland structure and function are differentially impacted by lipid profile changes in male and female mice. This dissociation suggests that other factors beside dyslipidemia impact on tear film dysfunction and DES development.

Clinical evaluation of the therapeutic effects of atelocollagen absorbable punctal plugs

PurposeTo evaluate the therapeutic effects of atelocollagen absorbable punctal plugs.MethodSeventy-four eyes in 37 patients with dry eye disease (DED) underwent punctal plug occlusion using atelocollagen plugs and were followed up for 24 weeks. Subjective symptoms were evaluated using the ocular surface disease index (OSDI) questionnaire. Ocular surface disease parameters, including the Schirmer test, phenol red thread test, tear break-up time (TBUT), and fluorescein and Rose Bengal staining, were recorded before and 1, 4, 8, 16, and 24 weeks after treatment.ResultsIn comparison with the pretreatment data, the subjective symptoms and ocular surface disease parameters showed significant improvement after atelocollagen punctal occlusion. The average time of relapse was 17.4 ± 5.1 weeks. No severe complications occurred, and none of the plugs had to be removed because of local discomfort or epiphora.ConclusionAtelocollagen absorbable punctal plugs effectively improved ocular surface disorders in DED. These plugs are a safe and effective alternative in the treatment of DED.

Clinical Usefulness of the Phenol Red Thread Test as Diagnostic Tool in Dry Eye Patient

Clinical Usefulness of the Phenol Red Thread Test as Diagnostic Tool in Dry Eye Patient

Combination of the Schirmer I and Phenol Red Thread Tests as a Rescue Strategy for Diagnosis of Ocular Dryness Associated with Sjögren's Syndrome

To define a combination of the Schirmer I and phenol red thread (PRT) tests that improves the screening of patients with ocular sicca syndrome. The PRT test was performed before (PRT1) and after (PRT2) the Schirmer I test, in both eyes of 143 patients complaining of ocular dryness secondary to Sjögren's syndrome or sicca asthenia polyalgia syndrome (SAPS; 72 and 71 patients, respectively), and in 40 control patients. Groups were matched by age and sex. After determining the best cutoff values using the receiver operating characteristic procedure, several combinations of PRT and Schirmer I were assessed to improve the predictive values of the procedure. The best cutoff value for PRT2, estimated at 15 mm, provided a satisfying match between sensitivity and specificity indexes (68% and 90%, respectively), similar to those obtained with the Schirmer I test. If PRT1 alone was ineffective to screen SGS from control patients, the comparison between PRT1 and PRT2 (so-called "DeltaPRT") was found as a good marker to detect patients with persistent tear reflex. Interestingly, the combination of positive Schirmer I, PRT 2, and/or ΔPRT tests was found to be highly predictive of severe ocular sicca syndrome. The combination of the Schirmer I and PRT tests strongly improves the screening procedure to detect patients with ocular dryness related to Sjögren's syndrome or SAPS. It could be more widely used in daily clinical practice, aside from the Schirmer I test, to optimize the work-up of patients presenting with dry-eye subjective signs.

The relationship between clinical signs and dry eye symptoms.

To evaluate (i) the relationship between traditional and new clinical tests (lid-wiper epitheliopathy (LWE), lid-parallel conjunctival folds (LIPCOF)) and dry eye symptoms in non-contact lens wearers, and (ii) that a combination of these tests can improve predictive ability for the development of dry eye symptoms. Tear meniscus height (TMH), non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test (PRTT), corneal and conjunctival staining, and LWE grades were observed in a cohort of 47 healthy, non-lens wearers (male=17, female=30, median age=35 years, range=19-70). Symptoms were assessed using the Ocular Surface Disease Index (OSDI). LWE was significantly correlated to both temporal and nasal LIPCOF (0.537<r<0.607, P<0.05). LIPCOF and LWE were significantly correlated to NIBUT and PRTT (r > -0.248, P < 0.001). Significant correlations were found between NIBUT and TMH (r=0.461, P=0.001) and PRTT (r = 0.640, P < 0.001). OSDI scores were significant correlated to NIBUT, TMH, PRTT, LIPCOF, and LWE (r>∣0.31∣; P<0.05). Significant discriminators of OSDI+/- were NIBUT (area under the receiver operative characteristic curve (AUC)=0.895), TMH (0.715), PRTT (0.781), LIPCOF (temporal/nasal/Sum 0.748/0.828/0.816), and LWE (0.749). Best predictive ability was achieved by combining NIBUT with nasal LIPCOF (AUC=0.944). The individual tests NIBUT, TMH, PRTT, LIPCOF, and LWE were significantly, but moderately, related to OSDI scores. The strongest relationship appeared by combining NIBUT with nasal LIPCOF.

Evaluation of Phenol Red Thread test versus Schirmer test in dry eyes: A comparative study

Background:Dry eye is the most common ocular morbidity found in elderly patients. There is no gold standard/standard test for diagnosing dry eye.Objectives:The present study was conducted to compare the potential of Phenol Red Thread (PRT) test versus Schirmer Test in diagnosing dry eye.Materials and Methods:The study was conducted on 50 patients, aged 40 years and above. History of dry eye symptoms was taken and the symptoms were graded. Six-questions Bandeen Rosch questionnaire was administered to those having symptoms of dry eye. Patients whose response to any of the questions was often/all the time were included in the study. After performing standard clinical examination, Schirmer and PRT tests were done.Results:PRT is equally sensitive in detecting dry eye, and in addition, it has many advantages as compared to Schirmer. PRT is simpler and more comfortable to the patient and can be done in children. It causes less reflex tearing. Most important is the lesser time consumed (15 seconds) in comparison to Schirmer (5 minutes).Conclusion:Kappa value between PRT and Schirmer was found to be 0.96 in this study and shows a strong agreement between the two. So, PRT can be considered equally good in detecting dry eye.

Use of Phenol Red Thread Test as a rescue test in diagnostic strategy of severe ocular syndrome

Abstract Purpose To define a combination between Schirmer I and phenol red thread test (PRT) that improves the screening of patients with ocular sicca syndrome. Methods The PRT test was performed before (PRT1) and after (PRT2) the Schirmer I test, in both eyes of 143 patients complaining of ocular dryness secondary to Sjögren’s syndrome (SGS) or Sicca Asthenia Polyalgia Syndrome (SAPS) (72 and 71 patients respectively), and in 40 patients with no sign of dry eye. Groups were matched by age and gender. After determining the best cut‐off values using the ROC procedure, several combinations of PRT and Schirmer I were assessed to improve the predictive values of the procedure. Results The best cut‐off value for PRT2, estimated at 15mm, provided a satisfying match between sensitivity and specificity indexes (68% and 90% respectively), similar to those obtained with the Schirmer I test. If PRT1 alone was ineffective to screen SGS from control patients, the comparison between PRT 1 and PRT2 (”delta‐PRT”) was found as a good marker to detect patients with persistent tear reflex. The combination of positive Schirmer I, PRT 2 and/or delta‐PRT tests was found as highly predictive of severe ocular sicca syndrome. Conclusion The combination of Schirmer I and PRT test improves the screening procedure to detect patients with severe ocular dryness. Since PRT test is non‐invasive and time‐effective, it could be more widely used in daily clinical practice, besides Shirmer I test, to optimize the work‐up of patients presenting with dry‐eye subjective signs.

Measurement of phenol red thread tear test in Arabian and throughbred horses

To determine physiologic levels of tear production in Arabian (AH) and throughbred horses (TH) by using phenol red thread test (PRT). The study was performed on 16 AH and 14 TH, ranging from 2.5 to 24 years of age, housed in a stable situated in the Sanliurfa of Turkey. For the measurement of PRT, the strip was placed under the lower eyelid approximately one-third the distance from the temporal to nasal canthus and left for 15 s. The length of the wet area was measured in mm and compared among breed, sex, and age groups and between eyes of both sides. The mean length of the wet area was in AH and TH were 30.22 +/- 0.99 mm ranging from 16 to 41 and 31.00 +/- 1.4 mm ranging from 14 to 47, respectively. There were no significant differences in tear production among breed, sex, or age groups. The values measured for left eyes were significantly higher than those for right eyes (P < 0.05). Phenol red thread test measurement is easily used, with no pain, and a comfortable method. PRT can be used in equine ophthalmology on a routine basis to the measurement of tear production. These normal PRT values help diagnosis keratoconjunctivitis sicca in horses.

Tear lipocalin and lysozyme concentrations in postmenopausal women

To investigate the potential relationship between subjective symptomatology, tear volume, and tear break up time with tear film lipocalin and lysozyme concentrations in a group of symptomatic dry-eyed postmenopausal (PM) women compared to age-matched controls. Eighty-five healthy PM females (>50 years of age) were categorized as mild or moderate dry eye (DE), or asymptomatic [non-dry eye (NDE)] based on their responses to the Ocular Surface Disease Index (OSDI) questionnaire. Non invasive tear breakup time (NITBUT) and tear secretion were measured. Tears were collected via capillary tube and an eye wash method. Tear lysozyme and lipocalin concentrations were determined via Western blotting. Ocular Surface Disease Index responses revealed 16 mild DE, 30 moderate DE, and 39 NDE. The OSDI total score and sub scores for the DE groups were significantly greater than for the NDE group (p < 0.001). The mild and moderate DE groups exhibited significantly shorter NITBUTs compared to NDE (p < 0.004). Tear secretion using the Phenol Red Thread (PRT) test was found to be significantly lower in the moderate DE group compared to NDE (p < 0.001). No difference in tear lysozyme or lipocalin concentration was found between DE and NDE groups, irrespective of tear collection method, although method of collection significantly influenced absolute concentrations (p < 0.008). Significant correlations were not found between symptoms or signs of DE compared to either lipocalin or lysozyme concentration. Within a PM population, lipocalin and lysozyme are invariant, irrespective of the presence and severity of DE symptoms. This is the first comprehensive study of lipocalin and lysozyme in dry-eyed PM women and our results suggest that neither protein would offer utility as a biomarker of DE.

Use of phenol red thread tests to evaluate tear production in clinically normal Amazon parrots and comparison with Schirmer tear test findings

To determine phenol red thread test (PRTT) values in eyes of clinically normal Hispaniolan Amazon parrots before and after topical application of an ophthalmic anesthetic agent and compare findings with Schirmer tear test (STT) values. Evaluation study. 24 Amazona ventralis parrots from a research colony. On 4 occasions (1-week intervals), all birds underwent a thorough ophthalmic examination of both eyes, which included (in sequence) performance of a PRTT and an STT; topical ocular application of proparacaine hydrochloride; and performance of another PRTT and another STT. Correlations between PRTT and STT values recorded with and without topical anesthesia were assessed. Without topical anesthesia, mean +/- SD PRTT value was 12.5 +/- 5.0 mm/15 s (range, 1 to 25 mm/15 s). With topical anesthesia, the PRTT value was 12.6 +/- 5.4 mm/15 s (range, 2 to 24 mm/15 s). Without topical anesthesia, mean STT value was 7.9 +/- 2.6 mm/min (range, 0 to 13 mm/min). With topical anesthesia, the STT value was 5.1 +/- 3.3 mm/min (range, 0 to 18 mm/min). The correlation of PRTT and STT values recorded with or without topical anesthesia was weak (r = 0.51 and r = 0.32, respectively). Results indicated that the PRTT and STT were both viable methods for measurement of tear production in Hispaniolan Amazon parrots. Topical application of an ophthalmic anesthetic agent did not have a significant effect on the PRTT values but significantly decreased the STT values.

A Novel Method to Predict the Dry Eye Symptoms in New Contact Lens Wearers

Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) give moderate prediction levels for dryness symptoms in experienced contact lens (CL) wearers. This study investigated whether a combination of LWE and LIPCOF plus other tear film tests and subjective evaluation before contact lens fitting was better able to predict CL-induced dry eye (CLIDE) symptoms. Tear meniscus height, non-invasive break-up time (NIBUT), ocular hyperaemia, LIPCOF, phenol red thread test, corneal and conjunctival staining, and LWE of the right eye of 33 new soft CL wearers (12 males, 21 females, median age = 30.5 years; range = 19 to 44) were assessed in a prospective 2-mo longitudinal study. Symptoms were evaluated by the Ocular Surface Disease Index (OSDI) and subjects were grouped according to their response in the Contact Lens Dry Eye Questionnaire (CLDEQ) during the study (20 symptomatic and 13 asymptomatic). The subjects were fitted with vifilcon A and senofilcon A lenses for a 2-week period, consecutively. Limbal hyperaemia (repeated measures analysis of variance; p < 0.05) and LWE (Friedman; p < 0.004) increased significantly during the study but not LIPCOF (p > or = 0.318; temporal, nasal, and Sum), bulbar hyperaemia (p = 0.432), staining (p > or = 0.060), OSDI (p = 0.126), or CLDEQ (p = 0.317, kappa = 0.279). Limbal hyperaemia significantly decreased in senofilcon A lenses. Wearing comfort among symptomatics was significantly better with senofilcon A (p = 0.005). At the enrolment visit, the subjects who became symptomatic exhibited significantly decreased NIBUT and increased LIPCOF and OSDI (range, p < 0.027). The best test combination to predict CLIDE (logistic regression analyses) was LIPCOF Sum plus NIBUT and OSDI, (positive predictive value = 87% and accuracy = 91%). LIPCOF, NIBUT, and OSDI are significant discriminators for CLIDE in new CL wearers compared with hyperaemia, tear meniscus height, phenol red thread test, staining, and LWE. The best test combination is NIBUT plus LIPCOF Sum and OSDI (named the Contact-Lens-Predicting-Test).

The effectiveness of questionnaires in the determination of Contact Lens Induced Dry Eye

This study investigates how well the recently introduced Ocular Comfort Index (OCI) and the more established McMonnies Dry Eye Index are able to detect contact lens induced dry eye (CLIDE). Seventy volunteer contact lens wearers (mean age = 28.7 +/- 8.0; 52 female, 18 male) were grouped as CLIDE positive or CLIDE negative depending on three sets of criteria: Method I: objective (tear meniscus height, lid parallel conjunctival folds, phenol red thread test and tear break-up time); Method II: objective and/or subjective [contact lens dry eye questionnaire (CLDEQ)] (i.e. being positive by Method I and/or Method III); Method III: subjective (CLDEQ). Symptoms were measured using the McMonnies Dry Eye Index and the OCI. Discrimination was analysed by the receiver operating characteristic (ROC) curves; positive predictive values (PPV) and cut-off values were calculated. ROC results for Methods I and II were statistically significant only for the McMonnies (p = 0.008; p < 0.001; respectively). In Method III ROC results were statistically significant for both the McMonnies (p = 0.001) and OCI (p = 0.005). The McMonnies showed the best prediction of Method I [0.646/10.5 (PPV/cut-off value)], while the OCI gave the best predictability in Method III only (0.518/30.6). A McMonnies scoring of > or = 10.5 or an OCI scoring of > or = 30.6 indicates CLIDE. The McMonnies performs better in prediction of CLIDE than the OCI.

Survey of Oculoplastic Surgeons Regarding Clinical Use of Tear Production Tests

To determine by a survey of ophthalmic plastic surgeons with specific expertise in blepharoplasty surgery the perceived role of Schirmer testing and other evaluation features in determining patient predisposition to postoperative dry-eye complaints. A literature review of tear production tests was performed. An anonymous survey was mailed to all members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. The survey included questions on practice patterns, the role of different objective tests, and the occurrence of postblepharoplasty dry-eye or exposure complaints. Forty-eight percent (263 of 544) of those surveyed responded. All responding physicians perform a clinical history and examination to preoperatively evaluate for dry eye, 36% perform no additional tear production tests, 33% perform a test if indicated by signs or symptoms, 29% always perform a test, and 1% perform a test only if multiple procedures were planned. Schirmer testing with anesthetic is the predominant test used by physicians who perform tear production tests (89%), followed by Schirmer test without anesthetic (10%), and phenol red thread test (1%). Nevertheless, 74% of physicians felt that Schirmer testing should not be a medical standard of care in evaluating blepharoplasty patients. The preoperative evaluation of blepharoplasty patients may be severely limited in specialties that perform Schirmer testing or other tear production tests without the benefit of a directed clinical history and slit lamp examination. Current tear production tests are unreliable in detecting dry eye. The ideal approach to the evaluation of the blepharoplasty patient remains controversial.