Prevalence Of Ocular Surface Disease Research Articles

Transcriptomic analyses reveal the molecular mechanisms underlying the ocular surface damage in treated glaucoma patients

Aims/Purpose: Topical glaucoma drugs have a high prevalence of ocular surface disease (OSD), affecting to its compliance. The clinical signs of OSD are very similar to those observed in patients with dry eye syndrome; however, the mechanisms mediating the onset of symptoms are unknown. The purpose of this study is to identify conjunctival transcriptomic changes in patients treated with topical medication and patients with dry eye and compare them to healthy controls.Methods: Impression cytology was performed, and samples were selected for RNA sequencing; 33 patients treated for glaucoma, 9 with dry eye and 14 healthy controls. After a quality check, the reads were aligned, and gene expression was quantified by counting exonic regions. Ingenuity Pathway Analysis identified the routes and biologic processes associated with transcriptomic changes.Results: In treated patients, up‐regulation of immune‐related genes represented the 79% of the altered pathways. In dry eye samples, immune system and inflammation represented 39% of the altered routes; increased expression of genes related to mitochondrial metabolism and oxidative stress represented 16% and decreased expression of genes involved in maintaining conjunctival integrity and cell differentiation represented 15%.Conclusions: According to our results, an exacerbation of the immune system is observed in patients with glaucoma treatment as the main pathway involved in ocular surface damage. However, in the case of patients with dry eye, the damage is the result of multiple pathways. Knowledge of the mechanisms involved in ocular surface damage is essential in the search for effective treatments for these patients.

The Prevalence of Ocular Surface Disease in Glaucoma Patients

Introduction: Glaucoma is the third cause of blindness in developed countries after age-related macular degeneration (AMD) and diabetic retinopathy. The aim of this study was to determine the prevalence of ocular surface disease in patients treated for glaucoma or ocular hypertonia. Patients and methods: We conducted a one-year observational study including glaucoma patients older than 15 years, diagnosed and treated for more than six months. The impact of anti-glaucoma treatment on the ocular surface was assessed by a questionnaire derived from the Ocular Surface Disease Index (OSDI). Results: Antiglaucoma treatment caused an alteration of the ocular surface in 59% of patients. 61.7% of patients had a mean epithelial thickness below normal. Discussion: Several observational studies have shown a high prevalence of ocular surface disease in glaucoma patients. The prevalence of surface involvement in our study is close to most studies in the literature. The strong correlation between the number of eye drops prescribed and the severity of ocular surface involvement has been proven. This correlation is attributed to the preservative benzalkonium chloride (BAK). Among the cellular alterations, we noted a decrease in mucus cells with a decrease and instability of the thickness of the tear film, which was more important in patients under BAK preserved eye drops than in those without BAK. Conclusion: Our study allowed us to determine the frequency of ocular surface damage in patients treated long-term with hypotonizing eye drops. The mechanisms of this damage are multiple. Preservatives seem to play a central role in the genesis of these reactions.

Ocular surface disease signs and symptoms of glaucoma patients and their relation to glaucoma medication in Finland.

To evaluate the prevalence of ocular surface disease (OSD) signs and symptoms of glaucoma patients in private clinics in relation to topical glaucoma treatment and to compare them to non-glaucomatous population. A multicenter, cross-sectional study consisting of private ophthalmology clinic visits in southern Finland. Glaucoma patients had a diagnosis of primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma, or treated ocular hypertension. Control patients had no prior or current use of glaucoma medication. Recorded parameters included OSD signs and symptoms, used glaucoma medications during the past 6 months, and the product name, type, and duration of used antiglaucoma drugs. Glaucoma patients (n = 564) showed higher severity of OSD sign parameters excluding Schirmer's test, as well as increased dry eye sensation compared to controls (n = 51). Beta-blockers and preservative-free prostaglandins had the smallest effect on all parameters. The increasing number of active compounds and administered eye drops per day showed an association with increasing severity of OSD signs, as well as dry eye and foreign body sensation. Duration of glaucoma medication showed no significant association with OSD signs or symptoms. Glaucoma patients show higher prevalence of OSD signs and dry eye sensation compared to non-glaucomatous population. The use of preserved glaucoma medication, as well as high number of active compounds and eye drops increase the severity of these parameters. There are significant differences between the types of glaucoma medication used, and therefore the selection of them is important especially in patients suffering from OSD.

Old is the new young: A paradox for glaucoma patients

AbstractOlder/mature glaucoma patients are increasingly active these days and it is a myth that glaucoma patients are all passive and sedentary. Glaucoma does not only occur in the elderly, but even those glaucoma patients who are mature are working longer and staying more active. So perceptions of the ‘normal’ glaucoma patient need to be adjusted. Quality of life is increasingly important as older patients still feel young inside and want to enjoy their daily lives and interests and treatment must therefore be effective, but also tolerable so that patients' QoL is not limited by side effects. These patients have high expectations, but at the same time, this older population has a higher incidence of ocular and systemic comorbidities which can pose challenges. For instance, to start with ocular comorbidities it is well known that glaucoma patients have a higher risk of suffering from ocular surface disease and that the prevalence of ocular surface disease increases with increasing age. In this context therapeutic choices should be focused at lowering the intraocular pressure while preserving as much as possible the health of ocular surface for example by using preservative‐free medications to minimize ocular side‐effects. We know from published studies and from clinical experience that ocular surface disease shows improvements after switching from preserved to preservative free topical medications. Since glaucoma prevalence increases with age the prevalence of age‐related ocular comorbidities increases as well such as in the case of macular degeneration with additional deterioration of vision and increased impact on quality of life.Important to keep in mind that also systemic comorbidities that may particularly impact older patients, and the effect this might have on treatment (e.g. impairment in fine motor skills that can impact their ability of self‐administering the drops).Additionally, more mature patients may experience increased prevalence of systemic comorbidities such as cardiovascular or pulmonary ones limiting the therapeutic choices. More challenges to diagnosing and monitoring the disease might be posed by increased difficulties in performing psychophysical tests such as visual field testing.In this scenario it has to be highlighted the importance of communication to assess patients' level of comprehension and ability to cooperate with treatment and monitoring schedule.

Prevalence of Ocular Surface Disease and Associated Risk Factors in Glaucoma Patients: A Survey Study of Ophthalmologists.

This survey study of ophthalmologists investigated the prevalence and clinical manifestations of ocular surface disease (OSD) in glaucoma patients, assessment methods used, risk factors, glaucoma drugs considered responsible, and treatment approaches. A questionnaire prepared jointly by the Turkish Ophthalmological Association Cornea and Ocular Surface Society and Glaucoma Society using SurveyMonkey was sent to ophthalmologists via e-mail. The distribution of parameters was compared with chi-square test and p<0.05 was considered statistically significant. Forty-five percent of the ophthalmologists reported that OSD was evident in least 25% of their patients. The most common symptom was redness (91.9%), while the most common ocular surface finding was conjunctival hyperemia (75.6%). The tests considered to be the most important in ocular surface assessment were ocular staining (38.7%) and tear film break-up time (TBUT) (21.9%). Ninety percent of the physicians stated that the main cause of OSD was benzalkonium chloride (BAC) in medications. Prostaglandin analogs and alpha-2 agonists were reported to be the most common medications causing OSD. In case of OSD, the ophthalmologists often switch to a glaucoma drug from a different group (38%), a non-preservative glaucoma drug (33.7%) or a drug with a preservative other than BAC (20.4%). Most physicians prescribed artificial tears (84.6%). In this cross-sectional survey study, ophthalmologists detected varying rates of OSD in glaucoma patients depending on chronic drug use and BAC exposure. Although ocular surface examination was performed by physicians, tests such as TBUT and ocular surface staining were rarely used. Detecting OSD in glaucoma patients and planning personalized treatment increase patient comfort, drug compliance, and treatment effectiveness. For this reason, it is important to prepare an algorithm for the management of comorbid OSD in glaucoma patients.

An eye on the Shih Tzu dog: Ophthalmic examination findings and ocular surface diagnostics.

To characterize the ocular surface parameters and determine the prevalence of ocular pathology in Shih Tzu dogs. Fifty Shih Tzu dogs (28 male, 22 female). Each dog underwent a complete ophthalmic examination (recording any pathology) and a series of diagnostics, allowing for a 10min-interval between tests: intraocular pressure (IOP), blink rate, palpebral fissure length (PFL), corneal tactile sensation (CTS), Schirmer tear test and nasolacrimal reflex without (STT-1, NL-STT1) and with topical anesthesia (STT-2, NL-STT2), tear ferning, strip meniscometry test (SMT), tear film breakup time (TFBUT), and punctate fluorescein staining (PFS) of the cornea. Mean ± SD test values were as follows: IOP (17.9 ± 3.7 mmHg), blink rate (2.4 ± 1.4 blinks/min), PFL (23.8 ± 1.8 mm), CTS (1.8 ± 0.7cm), STT-1 (22.0 ± 5.5 mm/min), NL-STT1 (24.2 ± 4.7 mm/min), STT-2 (16.9 ± 6.5 mm/min), NL-STT2 (18.5 ± 7.5 mm/min), SMT (7.5 ± 3.5 mm/5s), TFBUT (5.3 ± 2.4s), tear ferning (1.3 ± 0.7), and PFS (1.6 ± 0.6). PFL was significantly greater in male vs. female Shih Tzus (p< .001). Age was negatively correlated with TFBUT results (r=-0.31, p=.027). Lagophthalmos was observed in 82% eyes. Ocular surface pathology was common, including adnexal abnormalities (100% eyes with caruncular trichiasis and medial lower lid entropion) and corneal opacification (27% pigmentation, 20% fibrosis, 12% neovascularization). Qualitative tear film deficiency (low TFBUT), along with several anatomical abnormalities that promote ocular irritation and reduce globe protection, together help explain the concerningly high prevalence of ocular surface disease in the Shih Tzu breed. Prophylactic measures (e.g., medial canthoplasty, topical lubrication) could be considered to improve ocular health in Shih Tzus.

Ocular surface disease in glaucoma patients on topical medications and its relation to duration of treatment and number of medications

Background: Topical antiglaucoma medications can alter the tear film and lead to ocular surface disease (OSD). Aim: This study was done to check for the presence of OSD in patients of glaucoma on topical antiglaucoma medications and to analyze the severity of OSD with duration of treatment and number of topical antiglaucoma medications. Setting and Design: This is a prospective observational study in a tertiary care hospital. Materials and Methods: The study was undertaken in 54 eyes of 54 glaucoma patients taking antiglaucoma medications for at least 6 months and control group of 54 subjects. All the participants were assessed for OSD by ocular surface disease index (OSDI) questionnaire, Schirmer's 1 test, and tear break up time test (TBUT). Statistical Analysis: Mean and percentage were used to analyze the variables. Comparison analysis was done with analysis of variance test. P < 0.05 was considered significant. Results: The prevalence of OSD in patients of glaucoma on topical antiglaucoma medications was found to be 74%, 69%, and 83% based on OSDI questionnaire, Schirmer's test, and TBUT test, respectively. There was increase in severity of OSD with increased duration of treatment and increase in number of topical antiglaucoma medications. Conclusion: Most patients of glaucoma on topical antiglaucoma medications were having OSD. Severity of OSD is directly proportional to duration of treatment and number of drugs used.

Prevalence of Ocular Surface Disorder and Dry Eye in Patients with Glaucoma using Topical Antiglaucoma Medications

Background: The main aim of the study is to establish the prevalence of ocular surface disorders in glaucoma patients treated with topical antiglaucoma medications. Methods: Investigation of 50 eyes of 25 patients has been performed using two or more antiglaucoma medications for six months, and compared with 50 eyes of 25 normal subjects without any ocular problem. After one year each patient was evaluated by Schirmer’s (SCH) test-I Tear break-up time (TBUT), Corneal staining score. Results: The mean values in the glaucoma cases and control groups respectively were as follows: Schirmer’s test-1 (7.63 ± 2.64mm / 12.86 ± 1.93mm; p= 0.001), Tear breakup time (9.44 2 ±.76 sec / 11.8 ± 1.88 sec; p=0.001), Corneal staining score (5.7 ± 2.33 /1.1 ± 0.58; p=0.001). Conclusion: Patients on antiglaucoma therapy have a greater prevalence of ocular surface disease and dry eye. The causative factors were medications with preservatives and longer treatment duration. Keywords: Antiglaucoma medication, dry eye, ocular surface diseases (OSD), Schirmer’s (SCH) test, Tear breakup time, Corneal staining score.

Association between functional status and ocular surface disease among local elderly population in Hong Kong

ABSTRACT Purpose: To evaluate the correlation between ocular surface disease (OSD) and functional status among elderly population over 60 years old in Hong Kong. Methods: Chinese subjects above 60 years old were recruited from the Ophthalmology clinic in Hong Kong West Cluster. Subjects demographic and questionnaires to evaluate the functional status were used to correlate with OSD objectively with clinical examination to assess the meibomian gland dysfunction (MGD), corneal staining, Schirmer’s test and tear break-up time (TBUT); and subjectively with ocular surface disease index (OSDI). Results: Twenty-eight patients were recruited, with a mean age of 71.5 ± 6.8 years. There was good correlation between the findings of the two eyes for bilateral measurements. Corneal staining was present in 75% of the subjects, while 92.9% of them had positive MGD grading. TBUT was reduced in 85.7% of the subjects. There is a negative association between MGD grading and Barthel index (r = −0.55, p< .01), indicating worse activities of daily living is related to worse MGD. OSDI is negatively associated with Schirmer’s test (r = −0.49, p< .01). A negative correlation is also found between TBUT value and corneal staining (r = −0.58, p< .01). Conclusions: There is a high prevalence of OSD among our subjects. Lower Barthel index (indicating worse Lawton’s instrumental activities of daily living) is associated with worse MGD grading. In elderly with poor functional status, care should be taken to manage their OSD.

Prevalence of Ocular Surface Disease in Glaucoma Patients on Long-Term Antiglaucoma Medications

Objective: Long term use of preservative-containing medications has been associated with the development or worsening of ocular surface disease (OSD). This study aimed to determine the prevalence of OSD in glaucoma patients on long-term antiglaucoma medications. Methods: A cross-sectional hospital-based study was carried out on 208 respondents using Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), and Schirmer 1 test. Data analysis was done using Statistical Package for Social Science version 22.0 (SPSS Inc, Chicago, Illinois, USA). Results: The prevalence of OSD was higher in those on antiglaucoma medication using all modalities of assessment. Prevalence of OSD in glaucoma patients on antiglaucoma drugs was highest using TBUT- 69.2% (P = 0.031), with OSDI questionnaire it was 62.5% (P = 0.005), and it was lowest for Schirmer 1 test - 59.6%. For those nonglaucoma cases/not on any antiglaucoma medication, the prevalence using TBUT was 42.3%, using OSDI it was 16.3%, and with Schirmer 1 test it was 25.9%. Prevalence also increased with the increase in the number of eye drops from 1 to 2 drops/day using all modalities of assessment (P = 0.004). Using multivariate analysis, adjusting for sex and age, subjects who instilled 2 drops/day had four to five times the odds of having OSD. Conclusion: The prevalence of OSD is higher in patients with glaucoma on topical antiglaucoma medication than the nonglaucoma population studied and this increased with the increase in number of drops per day.

Understanding the Dual Dilemma of Dry Eye and Glaucoma: An International Review.

Glaucoma-related ocular surface disease (G-OSD) is a significant, yet often underdiagnosed, ocular co-morbidity affecting 40% to 59% of glaucoma patients worldwide. Although the use of topical glaucoma medications represents a proven strategy to control the untoward effects of high intraocular pressure, this treatment can profoundly disrupt the homeostasis of the tear film. The cumulative effect of medications, preservatives, and excipients alter underlying cellular structures which results in tear film abnormalities and instability of the ocular surface. Furthermore, these chronic inflammatory changes have been shown to impact efficacy of glaucoma treatment, patient compliance with therapy and overall quality of life. The pathogenesis of G-OSD is multifactorial and involves a vicious self-perpetuating cycle of inflammatory cytokines and proteins. The diagnosis of such disease is based on similar tests used in assessing traditional dry eye, taking into consideration findings specific to this patient population. The hallmark of treatment for these patients is to minimize the ocular surface inflammatory response by choosing glaucoma therapies that spare the ocular surface such as preservative free formulations and initiating dry eye treatment early in the course of care. In summary, glaucoma affects millions of patients around the world and chronic use of topical glaucoma medications may negatively impact the patient's ocular surface, symptoms, and vision. Understanding the pathogenesis of G-OSD, recognizing its risk factors and incorporating diagnostic and therapeutic strategies that restore and maintain ocular surface homeostasis will result in improved care for our patients.

Prevalence of ocular surface disease symptoms in peri- and postmenopausal women.

The objective of the study was to determine the prevalence of ocular surface disease (OSD) symptoms and the possible existence of differences between peri- and postmenopausal women, based on the result of the Ocular Surface Disease Index (OSDI). A transversal observational study based on the results of an e-mail survey between October 2018 and January 2019 involving 1,947 women. The study was performed on a group of peri- and postmenopausal women aged between 45 and 79 years. The personal data in the survey included age, menopause status, age at menopause, prediagnosis of dry eye, undergoing dry eye treatment, and the OSDI questionnaire. Student's t test and Chi squared test were used to compare means or percentages between results on the survey and peri- and postmenopausal women. Finally, a univariate logistic regression was carried out to estimate the prevalence of OSD. The OSDI score is assessed on a scale of 0 to 100. The mean age of the entire sample was 54.2 ± 6.8 years, with a mean age at menopause of 49.45 ± 4.02 years. The mean OSDI score was 29.2 ± 19.4, considered as moderate dry eye. The global prevalence of OSD symptoms was 64% (1,247/1,947), which increased significantly in postmenopausal women, being 66.8% (820/1,228) (P = 0.001). The probability of OSD symptoms prevalence increases with age (odds ratio: 1.02; 95% CI [1.01-1.03]). The greater the age at menopause, the lower the probability of OSD symptoms prevalence (odds ratio: 0.96 95% CI [0.93-0.99]). Sixty-four percent of the pre- and postmenopausal women studied had OSD symptoms. There was a correlation between OSD symptoms and age, postmenopause, and earlier age at menopause, which was associated with an increased prevalence. : Video Summary:http://links.lww.com/MENO/A603.

Effect of Long-Term Topical Antiglaucoma Medication Use on the Ocular Surface.

Purpose:The purpose of this study was to describe the prevalence and pattern of ocular surface disease (OSD) in glaucoma patients using preserved topical antiglaucoma medications in a Nigerian population.Methodology:A comparative study of patients who had used topical preserved antiglaucoma medications for 6 months or more with age- and sex-matched individuals who were not on any other form of topical eye medication was carried out using fluorescein tear breakup time (FTBUT), Schirmer I test, and ocular surface staining with fluorescein and lissamine green. The right eyes of 103 eligible patients with primary open-angle glaucoma and that of 103 age- and sex-matched individuals (controls) were included in the study.Results:The prevalence of OSD among users of preserved topical antiglaucoma medications was significantly higher than among nonusers as assessed by FTBUT (83.5% vs. 57.3%;P < 0.001), Schirmer I (30.1% vs. 17.5%; P = 0.033), and ocular surface staining (62.1% vs. 31.1%;P < 0.001). Users of preserved topical antiglaucoma medications also had worse grades of OSD evaluated by FTBUT (P = 0.001), Schirmer I (P = 0.023), and ocular surface staining (P < 0.001).Conclusion:The prevalence of subjective OSD was significantly higher among users of topical antiglaucoma medications than nonusers. Hence, preserved topical medication use is a serious concern for increased ocular surface morbidity among glaucoma patients. This calls for more attention to be paid to the consequences of OSD among glaucoma patients on topical medications.

Prevalence of Ocular Surface Disease and Corneal Irregularity and Outcomes in Patients Using Therapeutic Scleral Lenses at a Tertiary Care Center.

To describe indications for scleral contact lens (ScCL) evaluation, previous treatments, and outcomes of patients prescribed ScCL at a tertiary referral center. This retrospective study reviewed 133 patients evaluated for ScCL between January 1, 2010, and December 31, 2015, at the University of Illinois at Chicago (UIC) Contact Lens Service. Patient demographics, ocular history, indications for evaluation, previous treatments, presence of punctate epithelial erosions, number of lenses ordered, follow-up visits, best-corrected visual acuity before ScCL, and visual acuity with ScCL were evaluated. Patients were categorized based on primary indication for ScCL evaluation as ocular surface disease (OSD) or corneal irregularity (CI). The primary outcome was visual acuity. Visual acuity improved from logarithm of the minimal angle of resolution 0.3±0.4 at presentation to 0.1±0.2 with ScCL in all eyes (n=223, P=0.0001), and from 0.3±0.5 to 0.1±0.2 (n=164, P=0.001) in the OSD group and 0.5±0.4 to 0.2±0.2 (n=59, P=0.0001) in the CI group. Seventy percent of patients were evaluated for bilateral ScCL evaluation. Indication for ScCL evaluation was OSD in 71% (n=95) of patients, with 20% having a secondary diagnosis of CI. Corneal irregularity was the primary diagnosis in 29% of patients (n=38), with 50% having a secondary diagnosis of OSD. Ocular surface disease was common in this tertiary referral patient population and was a primary or secondary indication for ScCL evaluation in 85.7% (n=114) of patients evaluated for ScCL. Scleral contact lenses improved visual outcomes in patients with both primary diagnoses of CI and OSD.

Influence of Treating Ocular Surface Disease on Intraocular Pressure in Glaucoma Patients Intolerant to Their Topical Treatments: A Report of 10 Cases.

The purpose of this study was to evaluate the effect of treating ocular surface disease (OSD) in patients with medically uncontrolled primary open-angle glaucoma (POAG) associated with OSD. We compiled a retrospective observational case series of 10 patients with POAG that remained uncontrolled with topical treatments and who were referred for filtering glaucoma surgery. All patients underwent a complete assessment of their glaucoma and ocular surface for both eyes. The main treatments were change of topical antiglaucoma medications to preservative-free equivalents, removal of allergenic treatments or those identified as causing side effects, switch to another therapeutic class with the same efficacy but with a better safety profile and treatment of OSD. After a minimum follow-up of 6 months, we observed improved ocular surface in all patients, associated with an intraocular pressure (IOP) decrease or stabilization even if some antiglaucoma medications were removed. The mean IOP significantly decreased from 23.75±9.98 mm Hg to 15.15±4.75 mm Hg (-36.2%; P=0.0001). The mean number of IOP-lowering medications was 3.7±1.06 at presentation and 2.8±0.63 after treatment (P=0.01). The Oxford score also decreased from a mean 1.7±0.67 to 0.4±0.51 (-76.5%; P<0.001). For 2 patients, IOP was not sufficiently reduced after treatment and they finally underwent filtering surgery. The prevalence of OSD in POAG patients is very high, particularly in patients with uncontrolled glaucoma with multiple topical medications. Careful management of the ocular surface associated with a reduction of the toxicity of eyedrops may result in improvement of ocular surface health and better IOP control.

Prevalence of ocular surface disease in patients with glaucoma on topical medications

Aim: To compare the prevalence of ocular surface disease (OSD) in patients using antiglaucoma medications vs normal subjects.&#x0D; Design: Prospective observational study.&#x0D; Methods: A total of 94 patients with glaucoma on topical medications were included in the study group. Age- and gender-matched normal subjects (n = 94) formed the control group. They were assessed for OSD using ocular surface disease index (OSDI) questionnaire, tear break-up time (TBUT), Lissamine green staining, and Schirmer’s test.&#x0D; Results: The prevalence of OSD was significantly more in the study group (72.4%) when compared to controls (44.6%) using the OSDI questionnaire. Schirmer’s test showed 84% patients had decreased tear production in the study group vs 53% in controls. TBUT was abnormal in 67.1% of the study group and of 47.8% controls. Lissamine green staining was positive in 36.2% of patients in the study group and 31.8% of controls.&#x0D; Conclusion: OSD was more common in patients using intraocular pressure (IOP)-lowering drugs than in controls. Long-term therapy and multiple medications were associated with severe OSD.

Prevalence of Ocular Surface Disease in Patients with Glaucoma using Topical Antiglaucoma Medications

Purpose: To establish the prevalence of ocular surface disease (OSD) in glaucoma patients using topical intraocular pressure-lowering (IOP) therapy and to compare the frequency and severity of symptoms with the control group of normal subjects.Methods: This prospective, multicenter, observational study included patients with glaucoma in four different Departments of Ophthalmology. A matched group of normal subjects served as controls. For each patient we have collected detailed family history, clinical records and calculated ocular surface disease index (OSDI) scores (0-100), based on the information obtained from OSDI questionnaires.Results: In total, we have evaluated 160 patients. Of those, 110 were glaucoma patients and 50 were normal subjects. Among 110 glaucoma treated patients 83 (75%) had OSDI scores indicating mild to severe OSD. Among 50 patients without glaucoma 15 (30%) had OSDI score indicating mostly mild to moderate OSD. The severity of symptoms correlates with the number of IOP medications used and the duration of treatment.Conclusion: This study confirms the high prevalence of OSD in patients treated for glaucoma with topical IOP medications. The adverse effect of these agents can influence the compliance and successful treatment of glaucoma patients.

Computer‐related visual symptoms in office workers

Many individuals report visual symptoms during office work and specifically computer use. This study determined the prevalence of symptoms in a population of office workers, and examined the association between these symptoms and both dry eye disease and other demographic factors. A written questionnaire was used to quantify the prevalence of symptoms in 520 New York City office workers, and to determine the effect of risk factors including gender, ethnicity, age, smoking, type of refractive correction and hours spent doing computer work. The questionnaire also examined the prevalence of ocular surface disease. A significant positive correlation was observed between the symptom score and the number of hours spent working on a computer in a typical day. The most prevalent symptom was tired eyes, which was reported by approximately 40% of subjects as occurring 'at least half the time'. 32% and 31% of subjects reported symptoms of dry eye and eye discomfort, respectively. Symptoms varied significantly with gender (being greater in females), ethnicity (being greater in Hispanics) and the use of rewetting drops. A significant positive correlation was observed between computer-related visual symptoms and the Ocular Surface Disease Index (OSDI), a measure of dry eye. Visual symptoms associated with computer use occur frequently in the general population producing discomfort for extended periods of time. They are strongly associated with ocular surface disease. Therapeutic regimens need to be developed for this widespread condition.

Prevalence of Ocular Surface Complaints in Patients With Glaucoma Using Topical Intraocular Pressure-Lowering Medications

To determine the prevalence of ocular surface disease (OSD) in patients with glaucoma using topical intraocular pressure (IOP)-lowering therapy. This prospective observational study enrolled patients with primary open-angle glaucoma or ocular hypertension who were on a topical IOP-lowering medication regimen. Enrolled patients completed the ocular surface disease index (OSDI) and OSDI scores (0-100, with 0 representing no symptoms) were calculated for each patient. Medical history, demographics, and concomitant medication information were also collected. Overall, 630 patients from 10 sites participated. Of these, 305 patients (48.4%) had an OSDI score indicating either mild (n = 134, 21.3%), moderate (n = 84, 13.3%), or severe (n = 87, 13.8%) OSD symptoms. OSDI scores were significantly different between patients with and without a prior diagnosis of dry eye syndrome (25.2 +/- 15.4 vs 15.4 +/- 15.8, respectively; P = 0.0036) and between patients who did and did not use artificial tears at the time of study participation (23.0 +/- 15.6 vs 15.3 +/- 15.8, respectively; P = 0.0046). Mean OSDI scores varied significantly with the number of topical IOP-lowering medications used, with higher (more severe) OSDI scores in patients using multiple IOP-lowering medications. Specifically, patients on a single medication had a mean OSDI score of 12.9 +/- 13.1, which was significantly lower than those of patients on 2 (16.7 +/- 17.0; P = 0.007) or 3 medications (19.4 +/- 18.1; P = 0.0001). OSD is prevalent among medically treated patients with glaucoma. The severity of OSD symptoms is positively correlated to the number of IOP-lowering medications used.

Prevalence of Ocular Surface Disease in Glaucoma Patients

To examine the prevalence of ocular surface disease (OSD) in glaucoma patients. This was a cross-sectional study. One hundred and one patients, 18 years of age or older, with open-angle glaucoma or ocular hypertension were consecutively recruited for the study. Patients with a history of use of cyclosporine, steroids, topical ocular nonsteroidal anti-inflammatory drugs, or punctal plugs within the last 3 months were excluded. Each patient completed an Ocular Surface Disease Index questionnaire and underwent evaluation by Schirmer test, corneal and conjunctival lissamine green staining, and tear break-up time. Using Ocular Surface Disease Index for measuring symptoms of dry eye, 60 (59%) patients reported symptoms in at least 1 eye. Severe symptoms were reported by 27 (27%) patients. Schirmer testing showed 62 (61%) patients with decrease in tear production in at least 1 eye. Severe tear deficiency was presented in 35 (35%) patients. Corneal and conjunctival lissamine green staining showed positive results in 22 (22%) patients. None had severe staining. Tear break-up time showed abnormal tear quality in 79 (78%) patients and severe decrease in tear quality was found in at least 1 eye in 66 (65%) patients. Multivariate logistic regression models were used to investigate the association between the number of benzalkonium chloride (BAK)-containing eyedrops and results on the clinical tests of OSD. After adjustment for age and sex, each additional BAK-containing eyedrop was associated with an approximately 2 times higher odds of showing abnormal results on the lissamine green staining test (odds ratio=2.03; 95% confidence interval: 1.06 to 3.89; P=0.034). A large proportion of patients with open-angle glaucoma or ocular hypertension had signs and/or symptoms of OSD in at least 1 eye. The coexistence of OSD and the use of BAK-containing medications may impact vision-related quality of life in this patient population.