Tear Film Research Articles

Prevalence of dry eye in people over 50 years old in Beichen district, Tianjin city: a cross-sectional population-based survey

BackgroundA cross-sectional population-based survey in the Beichen district of Tianjin was conducted to estimate the prevalence of dry eye disease (DED) among the population over 50 years old with Dry Eye Workshop (DEWS) II and Chinese expert consensus (CEC) criteria.MethodsA total of 5791 subjects over 50 years old were enrolled. Ocular surface disease index (OSDI) questionnaire, lipid layer thickness (LLT), partial blink ratio (PBR), fluorescein tear film breakup time (FBUT), Schirmer I test (SIT), fluorescein staining, meibomian gland dropout, meibomian gland expression scores (MES) and quantity scores (MQS) was assessed. Additionally, basic information, weight, disease history, living habits, anxiety, and depression condition were collected.ResultsAccording to the CEC, the prevalence of DED was 39.0%, whereas 44.0% based on DEWS II. The prevalence of DED increased with age and was substantially greater among women (41.1%, 95% CI, 39.5-42.6%) than males (35.1%, 95% CI, 33.1 -37.2%) (p < 0.001). Furthermore, the severity of DED was more severe in women (p = 0.006). The associated risk factors were age, female, depression, smoking, insomnia, and glaucoma. On the other hand, 53.6% of these populations were diagnosed as asymptomatic DED, and the morbidity was higher in males (p = 0.007).ConclusionsThe prevalence of DED in China was relatively high, which was associated with aging, female(sex), depression, smoking and sleep problems. Hence, it is crucial for clinicians and caregivers to be aware of the existence of asymptomatic DED within the susceptible population.

A randomised study comparing performance and safety of Eyestil Plus® vs Vismed Multi® in moderate-to-severe dry eye syndrome patients.

This clinical investigation compared the performance and safety of Eyestil Plus® (SIFI) and Vismed Multi® (TRB Chemedica) for reducing keratitis lesions in moderate-to-severe dry eye disease (DED) patients. This was a randomised, double-blind, multicentre investigation. 96 adults (>18 years of age) with moderate-to-severe DED received Eyestil Plus® (N = 48) or Vismed Multi® (n = 48) 6 times daily for 3 months. The primary objective clinical performance after 1 month as global corneal and conjunctival staining scores. The secondary objectives were clinical performance after 3 months, tear film stability (tear break up time (TBUT), tear production (Schirmer test), patient-reported outcomes (PROs), investigator satisfaction, and safety. 96 participants were randomised to receive the clinical investigations' treatments, 82.3% of them were female and their mean age was 65.8 years. The non-inferiority of Eyestil Plus® for moderate-to-severe DED was demonstrated at 1 month. No statistical difference was found for any of the study's objectives: change at 1 and 3 months of the global corneal and conjunctival staining score (p-value = 0.506 and 0.661, respectively), change at 1 and 3 months (p-value = 0.538 and 0.302) for TBUT test; change at 3 months for Schirmer test (p-value = 0.540). There were no changes for PROs either. Investigator satisfaction was high for both products. 16.6% of the participants experienced adverse events. This clinical investigation showed the non-inferiority of Eyestil Plus® compared to Vismed Multi® regarding performance and safety in a moderate-to-severe DED population.

Effect of low-level light therapy in individuals with dry eye disease.

Low-level light therapy (LLLT) or photobiomodulation, the application of red light to the eye, is used for the treatment of dry eye. Limited studies have investigated the efficacy of LLLT as a stand-alone treatment. The investigation aimed to evaluate the effect of LLLT on signs and symptoms of dry eye. Participants with mild to moderate dry eye were recruited for this three-visit study. Visits were 7 (±3) days apart and all participants received 633 nm LLLT (eye-light®) for 15 min at each visit. Clinical measures including first and average non-invasive keratograph tear break-up time (NIKBUT), tear meniscus height (TMH), meibomian gland (MG) loss for upper and lower eyelids, ocular surface disease index (OSDI) score, tear film lipid layer thickness, meibum quality score, Schirmer's test, corneal fluorescein staining and eyelid temperature for external upper (EUL) and external lower (ELL) eyelids were measured from the right eye of participants before and after treatment. Thirty participants (mean [SD] age: 31.1 [9.5] years) completed the study. Treatment with LLLT resulted in significant differences in first and average NIKBUT, TMH, tear film lipid layer thickness, OSDI score, Schirmer's test, meibum quality score and eyelid temperature over time (all p < 0.05). Compared to baseline, TMH, tear film lipid layer thickness and eyelid temperature significantly increased by 0.06 mm (95% CI: 0.01-0.11), 12.9 nm (95% CI: 1.18-24.55), and 7.0°C, respectively,for both EUL (95% CI: 6.17-7.84) and ELL (95% CI: 6.17-7.73). The respective decrease in the OSDI score and Schirmer's test was 10.2 (95% CI: -15.15 to -5.26) and 4.4 mm (95% CI: -7.31 to -1.42; all p < 0.05). There was no significant difference in corneal fluorescein staining and MG loss after LLLT. Low-level light therapy treatment significantly improved signs and symptoms of dry eye in the early phases of treatment, suggesting its efficacy for dry eye management.

Effects and Safety of 5% Lifitegrast Ophthalmic Solution in Patients With Dry Eye Disease Associated With Ocular Graft-Versus-Host Disease.

Introduction Graft-versus-host disease (GVHD) is a common sequela of hematopoietic stem cell transplant (HSCT). While HSCT is often curative for certain hematologic malignancies, acute and chronic GVHD remains an important cause of morbidity and mortality in post-transplant patients. Ocular involvement is one manifestation of chronic GVHD that can present similarly to chronic dry eye with tear film abnormalities, aqueous deficiency, and corneal epithelial defects through melting and perforation. Current management includes frequent use of artificial tears and oral or topical glucocorticoids as tolerated. There is a need for long-term, steroid-sparing therapeutics in the management of ocular GVHD (oGVHD). Lifitegrast is approved for the treatment of chronic dry eye and may have therapeutic potential in the treatment of oGVHD. The aim of this study was to investigate the efficacy and safety of topical lifitegrast in the management of oGVHD. Methodology A prospective randomized clinical trial (NCT04792580) was performed on 32 enrolled patients with diagnosed oGVHD. Subjects underwent a two-week washout period consisting of preservative-free artificial tears dosed twice a day, after which they were randomized to the treatment arm (5% lifitegrast ophthalmic solution) or placebo arm (vehicle solution) for four weeks. Endpoints included Symptom Assessment iN Dry Eye (SANDE) score, unanesthetized Schirmer score, Ocular Surface Disease Index questionnaire score, fluorescein staining, tear film breakup time, meibum quantity, and turbidity. Safety endpoints included intraocular pressure, visual acuity, and rate of treatment-related adverse effects. Statistical analysis was done with a t-test or Wilcoxon rank-sum test. Results The primary and secondary efficacy endpoints were met, with statistically significant reductions in mean SANDEand unanesthetized Schirmer score observed at four weeks post-randomization. No serious adverse events related to the use of either lifitegrast or vehicle were observed, and no worsening of visual acuity or intraocular pressure occurred in the intention-to-treat analysis. However, further inference was limited due to insufficient statistical power owing to significant washout and a 50% dropout rate from the all-enrolled analysis set. The most common causes of study dropout were worsening of unrelated medical conditions (not GVHD) and improvement of SANDE score or Schirmer score outside of the inclusion criteria range during the washout period. Conclusions Lifitegrast may be a useful steroid-sparing agent in the long-term management of oGVHD. This study provides further support for the clinical evidence of lifitegrast in the management of dry eye signs and symptoms, although further sufficiently powered clinical trials are warranted to better understand its efficacy in the oGVHD population. Personalized treatment options targeting distinct manifestations of oGVHD in the cornea, tear film, lid margin, and conjunctiva are needed in the effective management of this multifaceted and complex disease.

The Impact of Optimized Blinking on Vision and Related Parameters in Individuals With Computer Vision Syndrome: A Single-Blind Randomized Controlled Trial.

Computer vision syndrome (CVS) has become a significant issue for individuals working on computers and digital devices for extended periods. The ocular and periocular symptoms and signs associated with CVS are a major concern, affecting individuals physically and financially. Additionally, CVS has been linked to the rapid progression of myopia, exacerbating the situation. Blinking has been one of the major treatment methods for the treatment of CVS. This study presents a unique and novel randomized controlled therapeutic trial that evaluates the impact of extended blinking therapyon eyehealth and vision, along with other related parameters. Materialsandmethods: The present studyis a randomized controlled trial conducted from September 2022 to April 2024. Participants aged 18-40 with CVSand a computer vision syndrome questionnaire (CVS-Q)score of ≥6, with mild to moderate refractive error (between -6D and +4D), were included. The sample size was determined based on a pilot study, resulting in a minimum required sample size of 36 patients (18 cases and 18 controls). Participants were randomly assigned to either the case (interventional) or control (conventional) group and were followed up for six months. Cases received conventional CVS treatment plus optimized blinking exercises, while controls received conventional therapy only. Comprehensive ocular assessments were conducted bi-monthly over six months, evaluating changes in uncorrected visual acuity (UCVA), refractive error, near point of accommodation (NPA), near point of convergence (NPC), Schirmer's test, and tear film breakup time (TBUT). The study included 20 patients in the case group and 18 in the control group, primarily aged 20-29 (60.5%). Most patients used laptops for their activities (55.26%). The CVS-Q score significantly decreased in both groups following treatment, with both cases and controls showing significant improvement (p<0.001 for both groups). UCVA in the right eye (RE) and left eye (LE) of the cases improved significantly post-treatment in the interventional group (RE: p=0.002; LE: p<0.001). A significant change in refractive error, which is measured as spherical equivalent (SE), was seen among cases following treatment (RE: p<0.001; LE: p=0.021). Controls showed no significant changes in visual acuity or refractive error. The NPAin the cases improved significantly in the RE (p=0.027) but not in the left. The NPC in the intervention group showed no significant change, while controls showed considerable improvement (p=0.042). Schirmer's test results showed no significant change in either group. However, TBUTin the cases improved significantly (RE: p<0.001; LE: p<0.001). In the controls, TBUT decreased significantly, indicating a deterioration in tear film stability. Asthenopia grades improved considerably in cases, while controls showed only some improvement. Severe symptoms still remained in the control group, emphasizing the potential benefits of the blinking exercise in reducing asthenopia symptoms. Optimized blinking therapy significantly improves vision and refractive error, tear film stability, and discomfort, making it beneficial for chronic computer users to maintain ocular health and enhance productivity and quality of life.

Tear Film Hyperosmolarity is Associated with Increased Variation of Light Scatter Following Cataract Surgery.

To study the association between tear film hyperosmolarity and ocular light scatter in a cataract surgery population. Contiguous, 20-second objective scatter index (OSI) scans were recorded in hyperosmolar (≥320 mOsm/L) and normal subjects (<308 mOsm/L) with cataract nuclear opacity ≥3. OSI was measured at screening, baseline and 90 days following surgery. Along with symptoms of ocular surface disease, slit-lamp examination included corneal staining (0-3), tear film breakup time (TBUT) and evaluation of meibomian gland disease (MGD). An additional cohort of hyperosmolar subjects were measured for OSI at screening, baseline, and 5, 10, 15 and 30 minutes following instillation of 0.18% sodium hyaluronate (HA). Thirty-one eyes of 31 patients were included. There was a significant difference in post-operative OSI variation when comparing hyperosmolar (0.65±0.30, N=11) to normal subjects (0.33±0.11, N=10, p=0.005). Of note, there were no significant differences in OSI variation when subjects were sorted by staining (p=0.9), TBUT (p=0.7), symptoms (p=0.7), or MGD status (p=0.9). Instillation of 0.18% HA (N=10) did not alter OSI at 5 minutes, but significant reductions in OSI of 28.8%, 38.5% and 36.7% (all p < 0.001) were observed at 10, 15 and 30 minutes. Hyperosmolar patients exhibited significantly increased variation in light scatter following cataract surgery that was undifferentiated by staining or TBUT. Elevated osmolarity may be indicative of light scatter equivalent to that of a grade 2-3 cataract.

Spaceflight associated dry eye syndrome (SADES): Radiation, stressors, and ocular surface health

Crewed spaceflight missions require careful scrutinization of the health risks including alterations to the tear film lipid layer in astronauts. We review the current literature and prior published work on tear film lipid layer biophysics and secondary spaceflight-associated dry eye syndrome (SADES). We define the term spaceflight-associated dry eye syndrome to describe the collection of ocular surface signs and symptoms experienced by astronauts during spaceflight. Our review covers the ocular surface and lipidomics in the spaceflight environment. From our literature review, we extrapolate biophysical principles governing the tear film layer to determine the changes that may arise from the harsh conditions of spaceflight and microgravity. Our findings provide vital information for future long-duration spaceflight, including a return to the Moon and potential missions to Mars.

M2 macrophage-derived extracellular vesicles ameliorate Benzalkonium Chloride-induced dry eye

Dry eye disease (DED) is a common ocular condition affecting a significant portion of the global population, yet effective treatment options remain elusive. This study investigates the therapeutic potential of M2 macrophage-derived extracellular vesicles (M2-EVs) in a mouse model of DED. The DED model was established using 0.2% benzalkonium chloride (BAC) eye drops, applied twice daily for a week. Post induction, the mice were categorized into 5 groups: PBS, Sodium Hyaluronate (HA, 0.1%), Fluoromethalone (FM, 0.1%), M0-EVs, and M2-EVs. The efficacy of M2-EVs was assessed through tear production, corneal fluorescein staining and HE staining. RNA sequencing (RNA-seq) was employed to investigate the mechanisms underlying the therapeutic effects of M2-EVs in DED. Notably, the M2-EVs treated group exhibited the highest tear secretion, indicating improved tear film stability and reduced corneal surface damage. Histological analysis revealed better corneal structure organization in the M2-EVs group, suggesting enhanced ocular surface repair and corneal preservation. Furthermore, M2-EVs treatment significantly decreased pro-inflammatory cytokine levels and showed unique enrichment of genes related to retinal development. These findings suggest that M2-EVs could serve as a promising noninvasive therapeutic approach for human DED, targeting ocular surface inflammation.

Characterization of tear film and wettability dynamics over two daily disposable soft contact lenses

Characterization of tear film and wettability dynamics over two daily disposable soft contact lenses

Clinical Characteristic and Tear Film Biomarkers After Myopic FS-LASIK: 1-Year Prospective Follow-up.

To assess the long-term (1-year) effect of myopic femtosecond laser-assisted in situ keratomileusis (FSLASIK) on clinical characteristics and tear film biomarkers. Eighty eyes from 80 patients who underwent FSLASIK were evaluated. Ocular surface symptoms and signs were evaluated using specific questionnaires and tests. The corneal nerves and dendritic cells were examined using in vivo confocal microscopy. Corneal sensitivity was evaluated using a Cochet-Bonnet esthesiometer. Tear inflammatory cytokines and neuropeptides were evaluated using Luminex immunoassay. These examinations were performed preoperatively and at 1, 3, 6, and 12 months postoperatively. Seventy-three participants completed all follow-up visits. Following FS-LASIK, ocular symptoms and signs (except Schirmer I test) worsened at 1 month but corneal and conjunctival stainings improved by 3 months. The numbers of dendritic cells and activated dendritic cells increased at the 3-month postoperative visit and recovered to preoperative levels by the 6-month visit. Ocular symptoms and corneal sensitivity recovered to preoperative levels at the 12-month visit. Tear break-up time and corneal nerve morphology were not recovered to preoperative status at the 12-month visit. Interleukin (IL)-1β, IL-17A, tumor necrosis factor-α, and substance P tear levels significantly increased at all postoperative visits compared to preoperative levels. Corneal staining scores positively correlated with tear IL-1β and IL-17A levels, whereas corneal nerve morphology positively correlated with corneal sensitivity and negatively correlated with substance P levels. Although most clinical variables improved at 12 months postoperatively, some tear inflammatory cytokines and substance P remain altered beyond 12 months, indicating that ocular homeostasis is not completely recovered. [J Refract Surg. 2024;40(8):e508-e519.].

Tear meniscus particle analysis with anterior segment optical coherence tomography in keratoconus.

To perform tear meniscus particle analysis using anterior segment spectral domain-optical coherence tomography (SD-OCT) and ImageJ software in keratoconus patients. A total of 76 participants (76 eyes) were included in the study. A comprehensive analysis of tear meniscus parameters, including tear meniscus height (TMH), tear meniscus depth (TMD), tear meniscus turbidity (TMT), and percentage of area occupied by particles (PAOP) within the meniscus, was performed in kerataconus patients and healthy controls. TMT was significantly higher in the keratoconus group, while PAOP was significantly lower (P < 0.05). However, TMH and TMD did not show significant differences between the two groups (P > 0.05). There was a negative correlation observed between TMT and PAOP. In binary logistic regression analysis, TMT and Schirmer score were found to be the most influential factors in predicting keratoconus (odds ratio [OR] = 0.995, P = 0.039 and OR = 1.143, P = 0.021, respectively). This study revealed novel findings on analysis of the tear film in keratoconus patients, with higher TMT and lower POAP levels in the keratoconus group compared to the healthy control group.

Adverse effects of meteorological factors and air pollutants on dry eye disease: a hospital-based retrospective cohort study

Although previous studies have suggested that meteorological factors and air pollutants can cause dry eye disease (DED), few clinical cohort studies have determined the individual and combined effects of these factors on DED. We investigated the effects of meteorological factors (humidity and temperature) and air pollutants [particles with a diameter ≤ 2.5 μ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\upmu$$\\end{document}m (PM2.5), ozone (O3), nitrogen dioxide (NO2), and carbon monoxide (CO)] on DED. A retrospective cohort study was conducted on 53 DED patients. DED was evaluated by Symptom Assessment in Dry Eye (SANDE), tear secretion, tear film break-up time (TBUT), ocular staining score (OSS), and tear osmolarity. To explore the individual, non-linear, and joint associations between meteorological factors, air pollutants, and DED parameters, we used generalized linear mixed model (GLMM) and Bayesian kernel machine regression (BKMR). After adjusting for all covariates, lower relative humidity or temperature was associated with a higher SANDE (p < 0.05). Higher PM2.5, O3, and NO2 levels were associated with higher SANDE and tear osmolarity (p < 0.05). Higher O3 levels were associated with lower tear secretion and TBUT, whereas higher NO2 levels were associated with higher OSS (p < 0.05). BKMR analyses indicated that a mixture of meteorological factors and air pollutants was significantly associated with increased SANDE, OSS, tear osmolarity, and decreased tear secretion.

A Closer Look: Environmental Stressors and Their Effects on the Ocular Surface

Environmental variables have a considerable impact on the ocular surface, both structurally and functionally. The cornea, conjunctiva, and tear film form the ocular surface, which is essential for preserving visual clarity and comfort. UV radiation, air pollutants, allergens, and climatic changes can all upset the delicate balance of the ocular surface ecosystem, resulting in disorders such as dry eye disease (DED), allergic conjunctivitis, and photokeratitis. UV radiation is a well-documented environmental threat that can induce eye surface damage, both acute and chronic. Fine and ultrafine particles can get into the tear film and conjunctiva, producing oxidative stress and inflammation. Allergens such as pollen, dust mites, and pet dander cause allergic conjunctivitis, which is the most prevalent allergic eye illness. Climate variables such as temperature, humidity, and wind all have a substantial influence on ocular surface health. Understanding these environmental consequences necessitates a multidisciplinary strategy that combines ophthalmology, environmental science, and public health. Clinicians can measure the effect of environmental exposures on ocular health using diagnostic procedures such as tear film analysis, ocular surface imaging, and biomarker studies. Management options include preventative measures and therapies that are customized to individual illnesses. Preventive measures include wearing protective eyewear to shield against UV radiation and pollutants, using air purifiers to reduce indoor allergens, and avoiding outdoor activities during peak pollution hours. Emerging research focuses on elucidating molecular mechanisms underlying environmental-induced ocular surface disorders and developing novel therapies to mitigate their effects. By advancing knowledge in this field, we aim to enhance preventive strategies and therapeutic interventions, ultimately improving the quality of life for individuals affected by environmental-related ocular surface conditions.

The Ocular Surface–Gut Axis in Spaceflight: Implications of Intestinal Changes in Microgravity on Tear Film Physiology

With increasing space exploration, there is a rising need to evaluate the impact of spaceflight on astronauts’ health, including the effects of space-associated hazards such as microgravity. Astronauts’ reports of experienced symptoms upon spaceflight include a notable prevalence of dry eye disease (DED). Hence, there is a pressing need to understand the pathogenesis and mechanism behind space-associated DED onset, which will subsequently guide the development of necessary therapies to reduce dry eye symptoms among astronauts. One critical effect of spaceflight includes alterations to the gut microbiome. On Earth, the prior literature has established the presence of an ocular surface–gut axis and the potential role of gut dysbiosis in DED onset. Meanwhile, the literature about astronauts’ health underscores the presence of space-associated gut microbiome composition alterations and the presence of DED separately. Therefore, in this opinion article, we review and present the current literature regarding the ocular surface–gut axis on Earth and regarding potential translations to spaceflight. We present the view that, based on the existing literature, the ocular surface–gut axis may be a critical mechanism for the pathogenesis of DED in space, and this axis needs to be further explored in the context of identifying ways to reduce astronauts’ experiences of DED during spaceflight.

Dry eye disease as an occupational risk factor in operating room nurses

ABSTRACT Clinical relevance Knowing occupational risks in a multifactorial disease such as dry eye disease is important for disease diagnosis and treatment. Background Dry eye disease (DED) is a multifactorial disease of the ocular surface characterised by tear film instability, adversely affecting visual function and quality of life. The operating room environment has many risk factors for DED such as air conditioning, constant humidity, constant room temperature, intense lighting, surgical smoke, anaesthetic gases and irritating chemicals, and prolonged mask use. This study investigates the ocular surface findings and blink patterns of operating room nurses at risk of DED. Methods A total of 68 nurses (operating room, n = 34; outpatient clinic, n = 34) were included in this study. The diagnosis of DED was assessed using a questionnaire, best-corrected visual acuity, tear break-up time, corneal fluorescein staining, meibomian gland assessment, Schirmer I test. All the tests were conducted in the same area. Results According to the ocular surface disease index, the rate of dry eye symptoms was significantly higher among operating room nurses than among outpatient nurses (70.5% vs 41.1%). Severe dry eye symptoms were more common in the operating room group. The meibomian gland score was higher in the operating room group (29.4% vs 5.9%). The numbers of blinks (30.91 ± 12.81 vs 21.05 ± 7.77) and incomplete blinks (8.76 ± 4.68 vs 5.76 ± 3.20) at rest were higher in operating room nurses. Conclusion The occupational risk for DED was high among operating room staff. National and international standards for the prevention and management of DED in personnel involved in health care services are needed.

On modeling tear breakup dynamics with a nematic lipid layer

One of the main roles of the lipid layer (LL) of the tear film (TF) is to help prevent evaporation of the aqueous layer (AL). The LL thickness, composition, and structure all contribute to its barrier function. It is believed that the lipid layer is primarily nonpolar with a layer of polar lipids at the LL/AL interface. There is evidence that the nonpolar region of the LL may have liquid crystalline characteristics. We investigate the structure and function of the LL via a model of the tear film with two layers, using extensional flow of a nematic liquid crystal for the LL and shear-dominated flow of a Newtonian AL. Evaporation is taken into account and is affected by the LL thickness, internal arrangement of its rod-like molecules, and external conditions. We conduct a detailed parameter study with a focus on the evaporative resistance parameter, the Marangoni number, and primary liquid crystal parameters including the Leslie viscosities and director angle. This new model responds similarly to previous Newtonian models in some respects; however, incorporating internal structure via the orientation of the liquid crystal molecules affects both evaporation and flow. As a result, we see new effects on TF dynamics and breakup.

OPPORTUNITIES FOR IMPROVING THE LONG-TERM MANAGEMENT OF KERATOCONUS PATIENTS

Background and Objective: This study determined whether practitioners specializing in keratoconus (KC) adhere to published guidelines for disease management and to what extent comorbid conditions of dry eye, contact lens tolerance, and psychological consequences of KC are formally assessed as part oflong-term management. Materials and Methods: This cross-sectional study used an IRB-approved, Internet-based, REDCap platform. Descriptive statistics are presented. Results: A total of 222 participants qualified for participation. Most 134 (60%) followed young and unstable patients every 6 months and less frequent follow-up examinations for patients with stable findings, with 142 (64%) recommending annual examinations. Scleral lenses were the preferred optical correction method (36%), followed by corneal gas-permeable lenses (21%). A total of 118 (55%, n=216) participants recommend crosslinking to any patient with documented disease progression regardless of age. Fewer than 25% of patients were referred for surgical correction of KC. Half of respondents, 114 (51%), reported testing for tear film dysfunction, while 108 (49%) never tested. No participants used a depression screening instrument. Conclusion: Practitioners managing patients with KC largely adhere to current consensus recommendations. This survey identified several potentially high-impact, low-cost improvements to current practice patterns, including screening for dry eye and depression.

The Red Reflex Test and Leukocoria in Childhood.

The red reflex test, performed using a direct ophthalmoscope, serves as a critical diagnostic tool in identifying various ocular conditions. These conditions encompass retinal anomalies (such as retinoblastoma, Coats disease, retinopathy of prematurity, familial exudative vitreoretinopathy, myelinated nerve fibers, ocular toxocariasis, ocular toxoplasmosis, retinochoroidal coloboma, astrocytic, and combined hamartoma), vitreous abnormalities (including persistent fetal vasculature), lens issues (like cataract), anterior chamber and corneal conditions (comprising dysgenesis of the anterior segment, congenital glaucoma, birth trauma), and tear film disturbances. During this examination, the presence of leukocoria, characterized by a white pupillary reflex, can suggest the presence of underlying conditions. Any suspicion of an abnormal red reflex test warrants immediate evaluation by a qualified ophthalmologist. This article primarily underscores the paramount importance of the red reflex examination, not only to identify potential sight-threateningbut also life-threatening conditions. It delves into the most common causes of leukocoria in childhood and offers insights into a comprehensive diagnostic approach. The target audience for this article includes pediatricians, primary care clinicians, and ophthalmologists, all of whom play a pivotal role in the early detection and intervention of these critical eye disorders.

Clinical ocular surface characteristics and expression of MUC5AC in diabetics: a population-based study.

To investigate the clinical characteristics and the expression of mucin 5AC (MUC5AC) in in diabetic and non-diabetic subjects with or without dry eye disease. A total of 399 participants (796 eyes) aged 50-80 years were enrolled in this study. Participants were divided into 4 groups: non-diabetic without dry eye group (normal group), non-diabetic with dry eye group, diabetic without dry eye group and diabetic with dry eye group. Demographic information, fasting plasma glucose (FBG), and glycated haemoglobin A1C (HbA1C) data were collected. Additionally, ocular surface disease index (OSDI) questionnaire, signs of dry eye, tear osmolarity, and meibomian glands were evaluated. Tear MUC5AC expression and conjunctival goblet cells density (GCD) were tested. Compared with non-diabetic with dry eye group, diabetic with dry eye group showed significantly lower tear film osmolarity (TFO), but higher corneal fluorescein and conjunctival lissamine green staining scores. In comparison with diabetic without dry eye group, diabetic with dry eye group showed significantly higher TFO, corneal fluorescein and conjunctival lissamine green staining scorers. The MUC5AC concentration and GCD of diabetic with dry eye group was significantly lower than those of the non-diabetic with dry eye group. Diabetic subjects with higher HbA1c levels (≥7.8%) showed higher TFO and shorter fluorescein tear break time. Diabetics with dry eye exhibited notably higher corneal fluorescein and conjunctival lissamine green staining scores. Conjunctival goblet cells and MUC5AC were significantly reduced in diabetics. Higher TFO was associated with the duration of diabetes and HbA1c levels.

Demographic and lifestyle factors associated with dry eye disease in China: A cross-sectional multi-center study

PurposeAssociations were assessed between demographic/lifestyle factors and tear film breakup time (TBUT) defined dry eye disease (DED) in China. MethodsThe cross-sectional study involved 50,280 subjects (54 ± 17 y) in 217 clinics (25 provinces). Data included sleep disorders; digital screen exposure; and use of cosmetics, contact lenses, and eye drops (for asthenopia). Clinical examinations included TBUT; Schirmer I test; meibomian gland plug status. TBUT-defined DED was TBUT <10 s, with TBUT ≤5 s also considered (i.e., short TBUT-type DED), either unilateral or bilateral. ResultsTBUT-defined DED was present in 81.6 % overall. The highest rates were in those 71 years or older, living in the north, with chronic daily sleep disorder, or daily cosmetic application; or daily digital screen exposure for 5 years, contact lenses 4 h, or 3 months eye drops. Compared with those without TBUT-defined DED, those with TBUT-defined DED showed lower Schirmer I results and more severe meibomian gland plug status (each, P < 0.001). Independent risk factors of DED were: aging; living in the southwest; daily digital screen exposure ≥3 h; and occasional cosmetic use. Risk factors of DED TBUT ≤5 s were: living in the southwest; wearing contact lenses (>3 y); and using eye drops. Rates of unilateral and bilateral DED were comparable. ConclusionsDED in China is more likely in the aged and those in the north/southwest. DED rates increase with digital screen exposure, and use of cosmetics, contact lenses, or eye drops for asthenopia. Unilateral DED should be treated as promptly as bilateral.