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Brian J Nguyen,1 Angela S Gupta,1 Jocelyn He,1,2 Gui-Shuang Ying,1,2 Vatinee Y Bunya,1 Ilaria Macchi,1 Mina Massaro-Giordano1 1Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA, USA; 2Department of Ophthalmology, Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Mina Massaro-Giordano, Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, 51 North 39th St, Philadelphia, PA, 19104, USA, Email mina@pennmedicine.upenn.eduPurpose: This study was to assess corneal epithelial thickness (CET) in patients with Sjogren’s disease (SjD).Methods: A retrospective chart review was conducted of SjD patients from September 2021 to January 2022. Patient demographics, unanesthetized Schirmer’s test, serologic markers, and symptoms as measured by the Ocular Surface Disease Index (OSDI) were reviewed. Epithelial thickness from both eyes was measured using anterior segment OCT at the central 3mm and concentric 5mm, 7mm, and 9mm zones for the superior, temporal, inferior, and nasal corneal quadrants. Associations between corneal epithelial thickness with patient demographics, clinical characteristics, and symptoms were evaluated using regression models.Results: Fifteen SjD patients (100% female) were included with a mean age of 58.4 years. Patients with Sjogren’s disease had a significantly thinner superior corneal epithelium compared to the inferior epithelium (mean 47.7mm vs 53.1mm, p = 0.001). The epithelial thickness mean standard deviation (MSD) was significantly inversely correlated with the unanesthetized Schirmer test (r=− 0.39, p = 0.005), suggesting that an overall variability of CET correlates with decreased aqueous tear production. SS-A, SS-B, ANA, and RF positivity were not associated with any measures of CET.Conclusion: This pilot study suggests that there is significant superior versus inferior thinning of corneal epithelium in Sjogren’s patients. There was a significant correlation between variability of corneal epithelial thickness and decreased tear production in Sjogren’s patients. Further larger studies are needed to understand the relationship of CET with objective and subjective measurements of ocular surface disease.Keywords: Sjogren’s disease, corneal epithelial thickness, anterior segment OCT

Jennifer B Nadelmann,1,2 Vatinee Y Bunya,1 Gui-Shuang Ying,3 Peiying Hua,3 Mina Massaro-Giordano1 1Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Department of Ophthalmology, Weill Cornell Medicine, New York, NY, USA; 3Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Mina Massaro-Giordano, Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, Tel +1-215-662-8100, Email mina@pennmedicine.upenn.eduPurpose: Platelet rich plasma (PRP) is an autologous preparation that concentrates platelets in a small volume of plasma. The purpose of this study was to determine if PRP eye drops improved the symptoms and signs of ocular surface disease.Patients and Methods: A retrospective case series was conducted of patients who were prescribed PRP eye drops. Subjects were excluded if they did not have follow-up, underwent intraocular surgery prior to follow-up, received nerve growth factor treatments, or did not have a baseline examination with photography. Symptoms were assessed using the Ocular Surface Disease Index (OSDI). Patients also underwent a slit lamp exam, ocular surface staining with fluorescein and lissamine green, and Schirmer testing.Results: The charts of 47 patients treated with PRP drops for ocular surface disease were reviewed. Sixty-four eyes of 32 patients were included in the study who had photographs of lissamine green staining taken at baseline and at follow-up. Thirteen patients (28%) had ocular graft-versus-host disease, 16 patients (34%) had Sjögren’s syndrome, and 4 patients (8.5%) had rheumatoid arthritis. There was a statistically significant decrease in OSDI score from baseline to follow-up (39.5 vs 30.8 points, p = 0.02). Among the 64 eyes included, 9 (14%) had an improvement in conjunctival lissamine green staining, while 6 (9%) had an increase in staining at follow-up. Among the 20 eyes with Schirmer testing, there was a borderline significant increase in score from baseline to follow-up (5.9 vs 9.7, p = 0.06). Among the 44 eyes that had corneal fluorescein staining (CFS) reported, 8 (18.2%) had decreased staining and 2 (4.5%) had increased staining at follow-up.Conclusion: Treatment with PRP drops was associated with a significant improvement in symptoms in patients with ocular surface disease. Future larger prospective studies are needed to further evaluate the efficacy of PRP drops for treating ocular surface disease.Keywords: ocular surface disease, cornea, lissamine green, Ocular Surface Disease Index, platelet-rich plasma

Zujaja Tauqeer,1 Stephanie E Jinno,1,2 Caroline W Chung,1 Mina Massaro-Giordano,1 Vatinee Y Bunya1 1Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Drexel University School of Medicine, Philadelphia, PA, USACorrespondence: Vatinee Y Bunya, Tel +1-215-662-8100, Email Vatinee.Bunya@pennmedicine.upenn.eduPurpose: Ocular adverse events have been reported in association with dupilumab, a monoclonal antibody to treat allergic diseases including atopic dermatitis (AD). We describe clinical findings and treatment of dupilumab-related ocular complications.Patients and Methods: Retrospective study of 19 dupilumab-treated AD patients seen for a new ocular complaint. Primary outcomes were specific ocular exam findings (conjunctival injection, corneal fluorescein staining, blepharitis, meibomian gland dysfunction (MGD)), treatments, and follow-up.Results: Nineteen dupilumab-treated AD patients were included. Median age was 47 years (range 18– 73). Over half were women (11/19) and majority were Caucasian (13/19). Symptom onset occurred at a mean of 99 days (range 23– 520 days) from first dupilumab dose. The most common symptoms were redness (63%), tearing (47%), and pruritus (37%). Most common ocular findings were conjunctival injection (75%) and corneal staining (60%). Blepharitis was seen in about a third (30%), and 25% had MGD. Initially, 10% were observed without treatment, while 15% were treated with artificial tears alone. Other treatments included antihistamine drops (20%) and steroid drops alone (15%). In 40% of patients, a combination of steroids and various other topical eye drops were prescribed. Eighty-four percent (16/19) of patients were seen for follow-up. Steroid drops were required at follow-up in 3 out of 4 patients initially treated with antihistamines alone and in two-thirds of patients initially treated with artificial tears only. Mean follow-up period was 88 days (range 5– 369). Dupilumab was discontinued in 31.5% (6/19) of patients; of those who discontinued, 3 restarted it later.Conclusion: Conjunctival injection was the most frequent dupilumab-related ocular symptom and most common exam finding followed by corneal staining. Most patients initially treated with antihistamine drops or artificial tears alone subsequently required steroid drops to control symptoms. Some patients who discontinued dupilumab restarted the medication after achieving adequate control of ocular symptoms.Keywords: dupilumab, atopic dermatitis, conjunctivitis, cornea, dry eye

Jonathan Lilley,1 Erin C O’Neil,1 Vatinee Y Bunya,1 Kennedy Johnson,1 Gui-Shuang Ying,2 Peiying Hua,2 Mina Massaro-Giordano1 1Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; 2Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Mina Massaro-GiordanoDepartment of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, 51 N. 39th Street, Philadelphia, PA, 19104, USATel +1 215-662-9393Email mina@pennmedicine.upenn.eduPurpose: To assess the efficacy and safety of an intranasal tear neurostimulator (ITN) device in Sjögren syndrome (SS) patients.Methods: This was a two-visit prospective, randomized, controlled, same-day crossover study in participants with SS. Inclusion criteria were assessed at a baseline screening visit and included an Ocular Surface Disease Index (OSDI) score ≥ 13, and a Schirmer with anesthesia ≤ 10 mm/5 min (in at least one eye), with a cotton swab stimulation induced increase of ≥ 4 mm in the same eye. Participants returned for the application visit, where they received intranasal and extranasal applications of the ITN in random sequence, separated by at least 60 min. Schirmer scores were measured in both eyes after each application and compared to baseline values. Generalized linear models were performed to compare the change in Schirmer scores from baseline, and generalized estimating equations were used to account for correlations from repeated measurements in the same eye and measurements from two eyes of the same patient.Results: Fifty-five participants were screened and 35 were enrolled (all female), ranging in age from 31 to 72 years (mean, 57 years). The baseline OSDI score ranged from 14 to 91 (mean, 50.5), and the baseline Schirmer score had a mean (SD) of 6.4 (3.5) ranging from 0 to 20 (mm/5min). Improvement in Schirmer scores was significantly greater for intranasal device application (13.5 mm/5min, 95% CI: 10.4, 16.5) compared to extranasal device application (0.8mm/5min, 95% CI: − 0.9, 2.4) (p< 0.0001). The effects of the intranasal device application were significant regardless of the participant’s baseline Schirmer score and systemic SS medication usage (p< 0.05).Conclusion: Intranasal application of the ITN device significantly increased tear production in a subset of SS patients compared to baseline and was more effective than extranasal application. While production of the ITN device was recently discontinued, our findings suggest that other therapies that neurostimulate the lacrimal function unit may be effective in a subset of SS patients.Keywords: Sjögren syndrome, intranasal tear neurostimulation, tear production

Nicole Fuerst,1 Nicole Langelier,1 Mina Massaro-Giordano,1 Maxwell Pistilli,1 Kalliopi Stasi,1 Carrie Burns,2 Serena Cardillo,2 Vatinee Y Bunya1 1Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Purpose: To assess the relationship between tear osmolarity and dry eye symptoms in patients with diabetes. Patients and methods: Fifty patients with diabetes were enrolled. Demographic information and past medical history were recorded. Symptoms were assessed using the ocular surface disease index (OSDI). Tear osmolarity of each eye was measured with the TearLab® Osmolarity System. Results: The majority of the subjects were female (76%), African American (56%), and/or had a diagnosis of type 2 diabetes (82%). The mean ± standard deviation (SD) for age was 54.6±13.4, and maximum tear osmolarity was 304.6±12.7 mOsm/L. Men had higher osmolarity than women (mean ± standard error (SE) 311.8±4.0 mOsm/L versus 302.3±1.9 mOsm/L, P=0.02). Age, race, use of artificial tears, years of diabetes, and hemoglobin A1c did not have a statistically significant association with tear osmolarity. Longer duration of diabetes was associated with lower (less severe) OSDI scores (r=-0.35, P=0.01). Higher tear osmolarity was associated with lower (less severe) OSDI scores (r=-0.29, P=0.04). Conclusion: Approximately half of the diabetic subjects in our study had elevated tear osmolarity, and half of our population also reported symptoms consistent with dry eye disease. However, the two were slightly inversely related in that those with higher osmolarity reported fewer symptoms. Subjects with a longer duration of diabetes also reported fewer dry eye symptoms. Therefore, health care providers should be aware that patients who are most likely to have ocular surface disease, including those with long-standing diabetes, may not experience symptoms and seek care in a timely manner. Keywords: dry eye, osmolarity, diabetes

Background: Dry eye disease is one of the most common disorders we see in practice today. Perfluorohexyloctane (PFHO) ophthalmic solution (MIEBO®) (©Bausch + Lomb) is a novel, non-aqueous, single entity, preservative-free ophthalmic drop recently approved by the FDA for treatment of the signs and symptoms of dry eye disease. Purpose: While the safety and efficacy of PFHO has been demonstrated in non-contact lens wearers, its safety and potential benefits in habitual contact lens wearers have not been explored. This report presents the results of a trial designed to evaluate the safety of PFHO and its effect on contact lens comfort, specifically in established contact lens wearers. Patients and methods: The study included 47 patients who were adjusted contact lens wearers with a best corrected visual acuity of 20/25 or better at distance. All the patients were healthy contact lens wearers with no dry eye symptoms. Results: A significant improvement in comfort scoring was observed without any significant changes in osmolarity, meibography scores, and total fluorescein staining. Conclusion: These findings suggest that PCHO is safe for contact lens wearers to use and shows promise to reduce contact lens dropout. [ABSTRACT FROM AUTHOR]

Purpose: This prospective comparative study aimed to assess the effects on contact lens comfort, dryness, and wear time when symptomatic daily disposable (DD) contact lens (CL) wearers were refit with delefilcon A (DT1) lenses. Patients and Methods: Thirty five symptomatic DD CL wearers with dry eye disease as determined according to the TFOS DEWS 2 guidelines, were enrolled and completed the study. Participants wore their habitual DD CLs during an initial assessment and were subsequently refit with DT1 for 1 month. Participants were masked to the study lens type. Subjective ratings of end-of-day comfort and dryness, average wear time, and comfortable wear time were evaluated as primary endpoints. Results: Of the 35 participants, two participants were classified as aqueous deficient dry eye, while the remaining participants exhibited symptoms primarily due to evaporative causes. The median CLDEQ-8 score for dryness significantly improved from 17 (fair) with habitual lenses to 13 (good) with DT1 lenses (p < 0.01). Participants reported significantly better end-of-day comfort (p = 0.01) and less end-of-day dryness (p = 0.01) with DT1 compared to their habitual DD lenses. The comfortable wear time was significantly longer with DT1 (8.5 ± 4.1 hours) compared to habitual DD lenses (6.7 ± 3.2 hours) (p = 0.04). No significant differences were observed in vision ratings (p = 0.07). Conclusion: Refitting symptomatic DD CL wearers with DT1 resulted in improved end-of-day comfort, reduced end-of-day dryness, and extended comfortable wear time compared to their habitual lenses. These findings suggest that DT1 may offer benefits for symptomatic DD wearers with dry eye disease. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to investigate the associations between environmental and occupational factors and the prevalence of dry eye symptoms among participants from the Ahsa region of Saudi Arabia. Methods: Participants from urban, rural, and suburban areas seeking medical care at primary health centers were recruited through systematic random sampling. Data on demographics, exposures, and ocular health were captured using a structured questionnaire. Dry eye symptoms were evaluated using the Ocular Surface Disease Index (OSDI), Impact of Dry Eye on Everyday Life (IDEEL), and Symptom Assessment in Dry Eye (SANDE) questionnaires. Logistic regression analysis examined the relationships between environmental/occupational factors and the prevalence of dry eye symptoms. Results: Key exposures included particulate matter (PM) (60%), low humidity (55%), wind/dust (50%), prolonged computer use (65%), and chemical irritants (45%). These factors were significantly associated with an increased prevalence of dry eye symptoms, with the following odds ratios (ORs): PM (1.85, 95% CI: 1.35– 2.52), low humidity (1.45, 95% CI: 1.05– 2.00), wind and dust (1.60, 95% CI: 1.20– 2.14), prolonged computer use (2.10, 95% CI: 1.55– 2.85), and chemical irritants (1.75, 95% CI: 1.30– 2.35). All associations were statistically significant (p < 0.05). The use of protective equipment was associated with reduced odds of dry eye symptoms (OR 0.60, 95% CI: 0.42– 0.85, p = 0.03). Conclusion: This study identifies significant associations between specific environmental and occupational exposures and the prevalence of dry eye symptoms. Reducing modifiable exposures through policy, workplace enhancements, and clinical preventative strategies is essential to mitigate the burden of dry eye symptoms related to modern lifestyles and technology. [ABSTRACT FROM AUTHOR]

Background: This research aims to investigate the influence of environmental factors on the treatment efficacy of ocular lubricants in patients from urban areas with dry eye disease (DED). Methods: A phase IV clinical trial, which included 173 patients from major cities in Mexico, was randomly assigned to use ocular lubricants four times a day for 30 days. Ocular Surface Disease Index (OSDI), noninvasive tear film break-up time (NIBUT), ocular staining, and conjunctival hyperemia (CH) among other factors like weather, and air pollution as covariates were analysed. Results: After 30 days, OSDI score decreased by 14.8 points (p< 0.001), and NIBUT increased by 2.9 seconds (p< 0.001), with longer values observed in patients recruited in autumn and winter (additional 1.8 seconds, p< 0.05) compared to those recruited in spring. Patients living in cities with cooler weather and high humidity, but low air quality had higher OSDI and conjunctival stain scores of up to 4.4 and 0.3 points, respectively, as compared to those living in cities with similar pollution and humidity levels but with higher temperatures (p-values= 0.019 and 0.050). Patients with moderate CH had an increase of up to 0.8 points in their corneal stain score (p< 0.010). We also found that ozone levels were related to the predicted changes in OSDI and NIBUT. Conclusion: This study demonstrated the impact of environmental factors on the signs and symptoms of DED and suggests that patients residing in cities with inadequately controlled air pollution can benefit from using ocular lubricants to alleviate their symptoms. Trial Registration: Trial is registered at clinicaltrials.gov (NCT04702776). [ABSTRACT FROM AUTHOR]

Objective and subjective dry eye tests. The vision, endothelial cell count, and the pressure inside the eye were all found to be within normal limits after the IPL treatment. Even though the people in our study had glaucoma and had been taking glaucoma medicine for it for a year and the fact that the symptoms last for a long time may also change the results. Also, DED caused by glaucoma medication is complicated, with a lot of different symptoms and signs, even in the same stage. Also, subjective complaints may not match up with clinical signs. The type, amount, and length of anti-glaucoma drugs may have affected the results. [ABSTRACT FROM AUTHOR]

Purpose: To assess changes in symptoms and ocular surface signs following a bilateral sutureless treatment of dehydrated amniotic membrane (dAM) under a specialised bandage contact lens (sBCL) in patients with moderate-to-severe dry eye disease (DED). Patients and Methods: In this prospective pre-post interventional study, 35 patients diagnosed with moderate-to-severe DED, with an Ocular Surface Disease Index (OSDI) score > 30 on current treatment, were enrolled. Assessments were conducted at baseline (day − 30), after 30 days run-in with no additional treatment (day 0 – control), and 30 days post sBCL+dAM treatment (day 30 – treatment). Intervention involved two successive bilateral 4-5 day sutureless applications of dAM (17mm diameter, with a 6 mm central aperture, Omnigen® VIEW) under an 18mm sBCL (OmniLenz®). Symptomatology and ocular signs were measured using OSDI, Dry Eye Questionnaire-5 (DEQ-5), Symptom Assessment iN Dry Eye (SANDE), and other ocular surface health indicators including non-invasive breakup time, corneal and conjunctival staining, and lid wiper epitheliopathy length and width (LWE). Results: While symptomatology remained stable during the 30-day no-treatment run-in, 1-month post-dAM treatment, there was a significant reduction in OSDI scores (from 55.8 to 32.3, p< 0.001), DEQ-5 (from 14.6 to 10.0, p< 0.001), SANDE frequency (from 65.2 to 43.6, p< 0.001), and SANDE severity (from 59.8 to 41.1, p< 0.001). Additionally, there was a notable decrease in the width of LWE staining, from grade 2 (50– 75% of the lid wiper) to grade 1 (25– 50% of the lid wiper) (p=0.011). Conclusion: A bilateral 8– 10-day treatment duration with dAM applied with sBCL demonstrated a 31 to 42% improvement in symptomatology and a decrease in ocular surface signs of mechanical stress. This innovative bilateral treatment approach offers a promising treatment modality for patients with refractory moderate-to-severe DED. [ABSTRACT FROM AUTHOR]

Objectives were to investigate whether treatment with artificial tears improved refractive precision and whether subjects with non-dry eyes had better refractive precision than subjects with dry eyes. Design: Prospective randomized controlled trial with three arms. Patients and methods: Dry eye diagnostics according to DEWS II were performed, and subjects with dry eyes were randomized to no treatment (group A1) or treatment with artificial tears two weeks prior to cataract surgery (group A2), with the third group (Group B, non-dry eyes) as a control. Keratometry was performed twice at baseline and twice after two weeks at the time of cataract surgery with three different optical biometers. The change in mean variability of keratometry (average K and magnitude of vector differences) and percentages of outliers after two weeks versus baseline were compared for group A2. The refractive and astigmatism prediction errors were calculated eight weeks after cataract surgery and compared for all three groups. Results: One hundred thirty-one subjects were available for analysis. There was no statistically significant difference in the mean variability of keratometry or percentages of outliers for group A2 from baseline to the time of cataract surgery. There was no statistically significant difference in refractive precision (absolute error and astigmatism prediction error) between any groups. Conclusion: Subjects with dry eyes (treated and non-treated) achieved the same refractive precision and percentages of outliers as subjects with non-dry eyes. Treatment with artificial tears for two weeks appeared inadequate to significantly affect variability in biometric measurements for patients with dry eyes prior to cataract surgery. DEWS II criteria for DED may not be optimal in a cataract setting. [ABSTRACT FROM AUTHOR]

Aim: To determine the prevalence of dry eye (DE) and some related factors in patients with type 2 diabetic nephropathy (T2DN). Methods: We performed a cross-sectional study on 338 people, who were divided into 2 groups: 169 T2DN patients and 169 patients diagnosed with type 2 diabetic mellitus (T2DM) without renal complications as a control group. The Ocular Surface Disease Index (OSDI) and test fluorescein tear-film break-up time (TBUT) were done in all 338 subjects. Patients with OSDI scores < 13 and TBUT values equal to or under 10 seconds were diagnosed with dry eye. Results: The prevalence of DE in T2DN patients was significantly higher than T2DM group (55.6% versus 37.3%). The T2DN groups with dry eye had a median duration of DM, the proportion of hypertension, peripheral nerve complications, anemia, proportion of using insulin, and concentration of plasma glucose, HbA1C, urea, creatinine, CRP-hs significantly higher than those of T2DN without dry eye. Advanced age, high HbA1C level, and decreased eGFR were independent factors associated with dry eye in T2DN patients. Conclusion: Dry eye was a common condition associated with advanced age, high HbA1C levels, and decreased GFR in T2DN patients. [ABSTRACT FROM AUTHOR]

aime E Dickerson Jr9,101Private Practice, Philadelphia, PA, USA; 2Schwartz Laser Eye Center, Scottsdale, AZ, USA; 3Loh Ophthalmology Associates, Miami, FL, USA; 4Cleveland Eye Clinic, Brecksville, OH, USA; 5Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, TX, USA; 6LASIK San Antonio, Kerrville, TX, USA; 7Gordon Schanzlin New Vision Institute, La Jolla, CA, USA; 8Kannarr Eye Care, Pittsburg, KS, USA; 9Sight Sciences, Menlo Park, CA, USA; 10North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA Correspondence: Jaime E Dickerson Jr, Email [email protected] Purpose: To evaluate dry eye disease (DED) signs and symptoms six months after a single treatment with Localized Heat Therapy (LHT) (TearCare, Sight Sciences) for patients previously treated for six months with cyclosporine (0.05%) ophthalmic emulsion (CsA) BID (Restasis, Allergan). Setting: Nineteen ophthalmic and optometric practices in 11 US states. Design: Multicenter, cross-over, six month extension to the SAHARA randomized, controlled trial (RCT). Included patients were those randomized to CsA in Phase 1 of the SAHARA RCT. Methods: This was the second phase of the SAHARA RCT in which, following the 6-month endpoint, all patients that had been randomized to CsA discontinued CsA and were treated with LHT and subsequently followed for an additional six months. Outcome measures at 12 months for CsA patients crossed over to LHT included TBUT, OSDI and MGSS. Results: One hundred and sixty-one patients (322 eyes) were analyzed. Mean (SD) baseline TBUT prior to CsA was 4.4 (1.2) seconds, 5.6 (2.6) at 6 months which improved to 6.6 (3.2) and 6.1 (2.8) seconds (both P < 0.001) at 9 and 12 months (3, 6 months post LHT). Mean (SD) OSDI was 50.0 (14.9) at baseline and 34.2 (21.5) after CsA. With LHT at 6 months, this improved to 30.0 (20.6) and 31.0 (19.5) at 9 and 12 months (P = 0.162 vs month 6, P < 0.0001 vs baseline). MGSS was 7.1 (3.2) at baseline, 13.3 (8.2) at the end of CsA treatment which improved to 17.4 (8.8) and 16.1 (9.0) at 9 and 12 months; both P < 0.001. Conclusion: SAHARA showed 6-month superiority of LHT to CsA in clinical signs and non-inferiority in symptom scores. This extension shows that patients treated with CsA for 6 months can achieve meaningful additional improvement in signs and symptoms lasting for as long as 6 months following a single LHT treatment without the need for topical prescription therapy. [ABSTRACT FROM AUTHOR]

Background: Laser therapy has been proven as an effective technique for managing ophthalmological disorders. To guide future research, we conducted a bibliometric analysis of laser applications in eye diseases from 1990 to 2022, aiming to identify key themes and trends. Methods: We retrieved 3027 publications from the Web of Science Core Collection (WoSCC). Bibliometrix was used for science mapping of the literature, while VOSviewer and CiteSpace were applied to visualize co-authorship, co-citation, co-occurrence, and bibliographic coupling networks. Results: From a co-citation reference network, we identified 52 distinct clusters. Our analysis uncovered three main research trends. The first trend revolves around the potential evolution of corneal laser surgery techniques, shifting from the treatment of refractive errors to broader applications in biomedical optics. The second trend illustrates the advancement of laser applications in treating a range of disorders, from retinal and ocular surface diseases to glaucoma. The third trend focuses on the innovative uses of established technologies. Conclusion: This study offers significant insights into the evolution of laser applications in ophthalmology over the past 30 years, which will undoubtedly assist scientists in directing further research in this promising field. [ABSTRACT FROM AUTHOR]

In the Middle East and Northern Africa (MENA), dry eye disease (DED) is often misdiagnosed or overlooked. This review summarizes a series of conversations with ophthalmologists in the region around a variety of climatic, lifestyle, and iatrogenic factors that contribute to specific features of DED in the MENA region. These considerations are further classified by patient lifestyle and surgical choices. All statements are based on discussions and formal voting to achieve consensus over three meetings. Overall, a deeper understanding of the disease characteristics of DED specific to MENA can better guide local eyecare practitioners on appropriate management and follow-up care. Additionally, population-based studies and patient and physician education on ocular surface diseases, together with the use of culturally appropriate and language-specific questionnaires can help ease the public health burden of DED in this region. [ABSTRACT FROM AUTHOR]

Objective measurements of OSDI and osmolarity were the most consistent between sites. A large proportion of subjects exhibited high symptoms and hyperosmolarity but no other obvious signs of dry eye disease, most of whom were undiagnosed by clinical assessment without access to the osmolarity measurement. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the efficacy of using a combination of antibiotic and corticosteroid eye drops to using the same combination in addition to sodium hyaluronate eye drops. Patients and Methods: This study included patients who underwent phacoemulsification for age-related cataract and presented to the ophthalmology department or outpatient clinic of the two hospitals in the study with DED during the period from January 2020 to January 2023. The study involved a two-pronged approach in which we retrospectively analyzed the prospectively maintained data of the patients and prospectively called the patients for an evaluation of the dry eye impact on vision-related function. The study patients were recruited from two hospitals. During the study period, patients who were treated with a combination of antibiotic and corticosteroid eye drops were enrolled in Group A, and those who were treated with the same combination with sodium hyaluronate eye drops were enrolled in Group B. Results: The present study included 143 patients with post-phacoemulsification DED. Group A included 70 patients, and Group B included 73 patients. There was statistically significant improvement 4 weeks after treatment (p < 0.05) in the two groups. Comparing the two groups showed statistically significant improvements in group B compared to group A (p < 0.05). Assessment of the overall efficacy outcome revealed a statistically significant high percentage of cure (35.6% vs 1.4%) and high effectiveness (42.5% vs 13.6%) and a low percentage of effectiveness (21.9% vs 74.3%) and ineffectiveness (0.0% vs 5.7%) in Group B compared to Group A (p < 0.001). Conclusion: Combining sodium hyaluronate eye drops with tobramycin and dexamethasone eye drops yielded obviously better efficacy outcomes compared to using tobramycin and dexamethasone eye drops alone. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a chronic ocular surface disorder often characterized by decreased tear production and rapid tear evaporation that affect tear film stability and homeostasis. The common symptoms of DED include ocular discomfort, visual disturbances, dryness, and itching. Artificial tears are the mainstay of DED management and supplement one or more layers of the tear film. Artificial tear drops are available as a combination of viscosity-enhancing agents (demulcents/lubricants), humectants, and buffers either with or without preservatives. Artificial tears, as a combination of components (polymers/demulcents/viscosity-enhancing agents), can provide synergistic action compared with a single component for the management of multifactorial signs and symptoms of DED. This review describes the formulation components, physicochemical properties, mechanism of action, and summary of preclinical and clinical evidence on the hydroxypropyl guar-hyaluronic acid (HPG-HA) dual-polymer lubricant eye drops (SYSTANE™ HYDRATION). The dual-polymer eye drops consist of dual demulcents (propylene glycol and polyethylene glycol 400) and the polymers hydroxypropyl guar (HPG) and hyaluronic acid (HA). When instilled on the ocular surface, HPG forms a cross-linked gel matrix with borate ions that prolongs the retention of demulcents, thus providing long-lasting lubrication and ocular surface protection. Additionally, HA stabilizes the tear film, increases corneal wettability, and reduces friction during blinks due to its hygroscopic and viscoelastic properties. Preclinical evidence demonstrates that HPG HA dual-polymer lubricant eye drops provide protection against desiccation by cell hydration and surface retention, cell barrier protection, prolonged lubrication, and promotion of corneal re-epithelialization. Clinical scientific evidence demonstrates that HPG HA dual-polymer lubricant eye drops are safe and effective in the management of DED. Specifically, they reduce the signs and symptoms of DED, reduce dry eye symptoms post-cataract surgery, and improve tear film quality in healthy eyes. [ABSTRACT FROM AUTHOR]

Purpose: To assess the impact of varying centrifugation speeds on platelet and leucocyte-rich plasma (L-PRP) in liquid and gel form cellularity and growth factor concentrations for potential use against ocular surface disorders.Patients and Methods: L-PRP was collected from 16 healthy subjects using three different centrifugation speeds: 580, 1000, and 2000 g, each for 8 min at 25°C. Platelet and leukocyte counts were automatically evaluated. The concentrations of vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and transforming growth factor beta 1 (TGF-B1) were measured using enzyme-linked immunosorbent assays. L-PRP gel cellularity was assessed through hematoxylin-eosin and Masson's trichrome staining, categorized as moderate or abundant, and statistically analyzed. L-PRP gel membrane's chemical composition was analyzed using Fourier-transform infrared spectroscopy (FTIR), crystallization was investigated with X-ray diffraction (XRD), and ultrastructure was assessed using surface electron microscopy (SEM). Additionally, membrane degradation was evaluated over a 7-day period.Results: No significant differences in cellularity and growth factor concentrations among centrifugation speeds (p > 0.05) were found. Moderate cellularity predominated at 580 g and 2000 g, while abundant cellularity was observed at 1000 g. No significant differences were found techniques (p = 0.16). Masson's trichrome staining suggested the existence of abundant fibrin at 1000 g but without significant differences (p = 0.07). FTIR analysis exhibited the characteristic fibrin bands at all speeds, and XRD indicated a keratin-like pattern. SEM revealed greater porosity at 580 g and fibrin membrane degradation was lower at this speed (p = 0.0001).Conclusion: Centrifugation speed did not significantly affect growth factor concentration or cellularity in both liquid and gel L-PRP. Further studies should explore the impact of different separation techniques for L-PRP used in ophthalmic applications.Plain Language Summary: Background: Platelet and Leukocyte-rich plasma (L-PRP) is obtained from an individual's blood. It is currently being utilized successfully and showing encouraging outcomes in ophthalmology for various illnesses. The issue of standardization, particularly the centrifugation speed, is one of the main obstacles to its wider application because the preparation protocols vary depending on the disease type and the setting.Goal: We carried out this study to evaluate the effect of centrifugation speed in obtaining platelet and leucocyte-rich plasma in liquid and gel form and its impact on the quality of the product.Results: We discovered that centrifugation speed affected Platelet and Leukocyte-rich plasma cellularity. Furthermore, the centrifugation speed influenced the platelet and leucocyte-rich plasma gel deterioration after seven days. These findings highlight the significance of standardizing procedures, particularly centrifugation speed, to produce a high-quality product that lasts longer and may yield more encouraging outcomes when applied in the field of ophthalmology.Conclusion: L-PRP is a product with great clinical potential. Standardization is the biggest barrier to widespread use. We observed differences depending on the type of centrifugation speed used for its preparation, which opens the way for us to continue carrying out future studies until we obtain a product with the best therapeutic potential in patients with ophthalmological diseases. [ABSTRACT FROM AUTHOR]

Purpose: A randomized clinical trial was run to evaluate the effectiveness of a preservative-free 0.4% sodium hyaluronate eye drop (LOF) in different dosage schemes to alleviate signs and symptoms of dry eye disease (DED).Methods: A total of 116 subjects with mild-to-moderate DED were included, and 111 completed the study (from which 67.6% were female and 65.3% were users of oral contraceptives). Patients were randomly assigned to instill a drop of LOF either 2 (BID), 4 (QID) or 6 (6TD) times a day (at least 3 hours apart) for 30 days. The clinical parameters and symptom endpoints were Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), ocular surface staining, and conjunctival hyperemia. Other parameters evaluated were chemosis, best corrected visual acuity, and the incidence of adverse events (AE).Results: There was a significant reduction in OSDI scores by day 30 in all groups. The recovery of the OSDI score back to normal values was observed in 51.4% of patients treated (50%, 48.6%, and 55.6% in BID, QID, and 6TD, respectively, p = 0.822). Similar improvement was observed for TBUT, 50.5% of patients increased this variable to > 10 seconds (39.5%, 51.4%, and 61.1%, p = 0.175), and for ocular surface staining, ≥ 72% showed Grade 0. There were no significant differences among posology groups regarding ocular surface staining, conjunctival hyperemia, or any safety parameters. No overall improvement in OSDI and TBUT to normal values was noted for 31 patients (21 were female and 71.4% users of contraceptive drugs).Conclusion: The ophthalmic use of preservative free LOF, 2, 4 or 6 times a day, may alleviate clinical parameters and symptoms in 50% of patients with mild-to-moderate DED after a one-month treatment. This improvement seemed to be less ubiquitous in patients within reproductive age and using oral contraceptives.Trial Registration: This trial is registered at clinicaltrials.gov (NCT0704531). [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) has been found to occur at a higher prevalence in individuals with glaucoma than in individuals without glaucoma. The relationship between glaucoma and DED may be, in part, a result of glaucoma therapy. Greater number of antiglaucoma medications used and greater number of antiglaucoma eyedrops instilled per day have been associated with ocular surface disease in patients with glaucoma. Use of antiglaucoma medication has also been associated with higher levels of ocular surface inflammatory markers and ocular surface alterations. There is evidence to suggest that antiglaucoma medications with preservatives and, to some extent, antiglaucoma medication formulations without preservatives may contribute to ocular surface signs and symptoms. Trabeculectomy for glaucoma has also been associated with ocular surface signs related to DED; however, there may be benefits of trabeculectomy and other procedures for glaucoma due to reduced use of antiglaucoma medications. Patients with glaucoma with ocular surface disease have been found to have greater ocular surface symptoms, poorer vision-related quality of life, and poorer antiglaucoma medication adherence compared with patients with glaucoma without ocular surface disease. Because of the potential negative impact of DED on patients with glaucoma, patients with glaucoma may benefit from evaluation for DED. Management of DED in patients with glaucoma may include modifications to antiglaucoma medications and use of treatments for DED. [ABSTRACT FROM AUTHOR]

aimi,5 Yahya Al-Najmi61Ophthalmology Department, King Faisal Medical Complex, Taif, Saudi Arabia; 2Ophthalmology Department, Alhada Military Hospital, Taif, Saudi Arabia; 3Ophthalmology Department, Jeddah Eye Hospital, Jeddah, Saudi Arabia; 4Ophthalmology Department, Asir Central hospital, Abha, Saudi Arabia; 5Ophthalmology Department, College of Medicine, Majmaah University, Majmaah, Saudi Arabia; 6Ophthalmology Department, Saggaf Eye Center, Jeddah, Saudi ArabiaCorrespondence: Yahya Al-Najmi, Ophthalmology Department, Saggaf Eye Center, Abdullah Salman St., Al Faiha'a Dist., P.O. Box: 31903, Jeddah, 21418, Saudi Arabia, Tel +966 564844281, Email [email protected] Purpose: To estimate the prevalence and determinants of Ocular Surface Disease Index (OSDI) score based dry eye disease (DED) among the adult urban population of four cities located at high altitudes in Southwest Saudi Arabia.Methods: This cross-sectional survey was held in 2023. OSDI questionnaire was used to collect the responses of the adult participants. The score was further graded into none, mild, moderate, and severe DED to estimate age-sex-adjusted DED prevalence. The OSDI score was correlated to demographic (age group, gender, education, occupation, city) and risk factors like smoking and co-morbidities.Results: Of the 401 adults, 388 (response rate of 97.8%) participated. The age-sex-adjusted prevalence of mild, moderate, and severe DED was 21.7%, 13.1%, and 32%, respectively. The median ODSI score was 22.9 [Interquartile range (IQR) 10.4; 47.9)]. The score was significantly higher in females (Mann–Whitney U-test P = 0.038), residents of Taif city (KW P = 0.05), those with primary/middle school education (Kruskal–Wallis P = 0.004), comorbidities like hypertension, asthma (KW P < 0.001) and risk factors like past refractive surgeries, arthritis (KW P = 0.013). Education status (P < 0.001) [B = − 9.0 95%] and presence of comorbidity (P = 0.022), [B = − 0.823] were significant predictors of DED.Conclusion: The prevalence of DED and severe grade was high. The level of education and presence of comorbidities significantly influenced DED in the adult urban Saudi population of cities at high altitudes. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a common ocular condition, but the diagnosis relative to other ocular conditions and the evaluation of severity of the condition has often been difficult. This challenge can be due to clinical signs and symptoms not always correlating with each other. An understanding of the various components which create the condition, as well as the diagnostic measures used to evaluate these components, is useful to the clinician working with DED patients. This review paper will discuss traditional diagnostic options, diagnostic imaging, and Advanced Point of Care testing capabilities to determine the severity level of dry eye disease more adequately. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effectiveness of subconjunctival application of a novel sirolimus liposomal formulation for the treatment of dry eye. Methods: A randomized, triple-blind, Phase II clinical trial. Thirty-eight eyes of 19 patients were included. Nine patients (18 eyes) assigned to the sham group (Sham) and 10 patients (20 eyes) to sirolimus-loaded liposomes group (Sirolimus). The treatment group received three doses of subconjunctival liposome-encapsulated sirolimus and the sham group received three doses of liposomal suspension without sirolimus. Subjective (Ocular Surface Disease Index, OSDI) and measured (corrected distance visual acuity, conjunctival hyperemia, tear osmolarity, Schirmer's test, corneal/conjunctival staining and matrix metalloproteinase-9) variables were measured. Results: Sirolimus-entrapped liposomes-treated group OSDI scores changed from 62.19 (± 6.07) to 37.8 (± 17.81) (p=0.0024), and conjunctival hyperemia from 2.0 (± 0.68) to 0.83 (± 0.61) (p< 0.0001); Sham group with OSDI scores from 60.02 (± 14.2) to 36.02 (± 20.70) (p=0.01), and conjunctival hyperemia from 1.33 (± 0.68) to 0.94 (± 0.87) (p=0.048). All the other evaluated outcomes only showed significant differences in the sirolimus group: corneal/conjunctival staining score (p=0.0015), lipid layer interferometry (p=0.006), and inferior meibomian gland dropout (p=0.038). No local or systemic adverse effects regarding the medication itself were reported, and the administration route was well accepted. Conclusion: Our findings suggest that sub-conjunctival sirolimus-loaded liposomes are effective in reducing both signs and symptoms of dry eye in patients with poorly controlled moderate-to-severe DED, while avoiding other topical administration adverse effects. Further investigation with a larger sample size is required to determine long-term effects. [ABSTRACT FROM AUTHOR]

Purpose: To determine the prevalence of dry eye disease (DED) in patients scheduled for cataract surgery in a Norwegian eye clinic. Patients and Methods: 218 patients scheduled for cataract surgery were examined for DED in one randomly selected eye and questioned regarding symptoms and risk factors. Patients were diagnosed with DED if they fulfilled the DEWS II criteria with symptom score > 12/100 with Ocular Surface Disease Index (OSDI) questionnaire, and the presence of any of the three signs: tear osmolarity > 307 mOsm/L in either eye or a difference in osmolarity between the two eyes of > 8 mOsm/L, corneal fluorescein staining (CSF) ≥ grade 2 and non-invasive tear film breakup time (NIKBUT) of < 10 seconds. Additional tests were the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear meniscus height (TMH), Schirmer 1, tear film thickness (TFT), corneal sensitivity and meibography (meiboscore). Dry eye test outcomes were correlated with risk factors for DED. Results: The prevalence of DED was 55.5% according to the DEWS II criteria. The abnormal osmolarity percentage was 66.5, while 29.8% had shortened NIKBUT and 19.7% exhibited CFS ≥ 2. 57% had Schirmer 1 ≤ 10 mm/5 min, and 81.1% had a meiboscore of ≥ 1. 71.2% of subjects scored positive for DED symptoms using the OSDI questionnaire and 69.3% using SPEED. Logistic regression analysis showed that higher age correlated with a lower OSDI symptom score, reduced corneal sensitivity and increased meibomian gland atrophy. Female sex was associated with higher odds of having DED, abnormal NIKBUT and abnormal CFS. Ocular tests for DED did not correlate with OSDI symptom scores when assessed with Spearman's rank analysis. Conclusion: The prevalence of DED in an elderly Norwegian population scheduled for cataract surgery is high and associated with female sex. There was a lack of correlation between signs and symptoms of DED. [ABSTRACT FROM AUTHOR]

Purpose: We evaluate the treatment effect of OC-01 (varenicline solution) nasal spray (VNS) in dry eye disease (DED) subjects from two randomized trials who self-reported autoimmune disease (AID). Patients and Methods: Post hoc subgroup analysis of subjects reporting a history of AID from the integrated OC-01 VNS 0.03 or 0.06 mg and vehicle control (VC) treatment groups of the ONSET-1 and ONSET-2 trials. Mean change in Schirmer test with anesthesia score (STS, mm) and Eye Dryness Score (EDS) from baseline to 28 days was compared between OC-01 VNS and VC groups. Consistency of treatment effect in subjects with and without AID was evaluated using treatment–subgroup interaction terms in ANCOVA models for mean changes from baseline STS and EDS, and in a logistic regression model for proportion achieving ≥ 10 mm STS improvement. Results: Of the 891 participants, 31 reported comorbid AID. In all models, the treatment–subgroup interaction terms were not significant (p> 0.05), indicating consistency of therapeutic effect of OC-01 VNS in subjects with and without AID. In subjects with AID, the treatment difference for STS was 11.8 mm and − 9.3 for EDS and difference for proportion of subjects with ≥ 10 mm STS improvement was 61.1%. The most common adverse event was sneeze (82– 84%), graded as mild by 98% of subjects. Conclusion: OC-01 VNS demonstrated consistency in improving both tear production and patient-reported symptoms in subjects with AID, consistent with pivotal ONSET-1 and 2 trial results. Further investigation is warranted, and results may further support use of OC-01 VNS for DED in AID patients. [ABSTRACT FROM AUTHOR]

Purpose: Validation of the novel Lexitas modified NEI scale for use in assessment of corneal fluorescein staining. Patients and Methods: A series of 18 illustrations and 14 clinical photographs depicting varying severity levels of corneal fluorescein staining were assessed by 3 independent examiners. Regions of the cornea were graded for staining severity based on 3 different grading scales: the original NEI staining scale (density-based scoring; 0– 3 scale), a structured version of the NEI scale (dot-count scoring; 0– 3 scale), and the Lexitas modified NEI staining scale (0– 4 scale with half-point increments). Kappa statistics (simple and weighted) were computed to determine intra-examiner image grading repeatability for each examiner over 2 separate assessments. Inter-examiner assessment reliability utilized the scores from the first read of each examiner, and pairs of examiners to compute kappa statistics. Results: Data was analyzed from the scores provided by the examiners from each gradable corneal region on 32 images (18 illustrations and 14 photographs) for a total of 154 corneal regions across the 3 grading scales for each validation run. The mean intra-examiner simple/weighted kappa values using the NEI density, NEI dot count, and the Lexitas modified NEI staining scales were 0.67/0.72, 0.91/0.94, 0.80/0.92 for the graded illustrations, and 0.83/0.88, 0.76/0.85, 0.77/0.88 for the graded photographs, respectively. The mean inter-examiner simple/weighted kappa values using the NEI density, NEI dot count, and the Lexitas modified NEI staining scales were 0.59/0.65, 0.86/0.90, and 0.78/0.91 for the graded illustrations, and 0.80/0.88, 0.84/0.89, 0.69/0.88 for the graded photographs, respectively. Conclusion: The expanded scale of the Lexitas modified NEI staining scale demonstrated a high degree of reliability and repeatability of grading assessments within and across individual examiners, comparing favorably with the original NEI staining scale. A future investigation into the in-office utility of the Lexitas modified NEI staining scale is warranted. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the efficacy, safety and tolerability of topical omega-3 polyunsaturated fatty acids (PUFA) as an innovative treatment of dry eye disease (DED). Patients and Methods: In a pilot, multicenter, masked-observer, randomized, active-controlled, non-inferiority study in Germany, patients self-treated their eyes with daily instillations of eye drops containing either omega-3 PUFA or povidone as major components for three months. At four and twelve weeks, efficacy was among others evaluated based on Ocular Surface Disease Index (OSDI), ocular surface symptoms intensity, general clinical impression, tear break-up time (TBUT), corneal fluorescein staining using the Oxford grading scale, tear volume, and matrix metalloproteinase-9 (MMP-9) concentration in the tear film. Safety evaluation included visual acuity, intraocular pressure, and the incidence of adverse events. Co-primary endpoints were the mean percent changes from baseline of TBUT and OSDI after four weeks. Results: In total 80 patients were included, of whom 37 in the PUFA group and 39 in the povidone group were evaluable for the co-primary endpoints. Patients had a mean age of 52 years and > 80% were women. Both co-primary endpoints (TBUT and OSDI) significantly improved from baseline in both treatment groups, at Week 4 and Week 12 and the statistical analysis demonstrated topical omega-3 PUFA to be non-inferior to 2% povidone for these two parameters. Both treatments resulted in a significant improvement of most secondary efficacy endpoints as well, often with a slight difference in favor of PUFA, not reaching statistical significance though. One non-severe, treatment-related local AE was reported in each group. Conclusion: Omega-3 PUFA-based eye drops proved to be non-inferior to povidone-containing eye drops in the treatment of signs and symptoms of dry eye. This treatment may thus be an additional tool for the management of DED. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence of symptomatic dry eye disease (DED) in four Middle Eastern Countries and investigate the association between behavioral-based risk factors and severity of DED. Patients and Methods: Population-based cross-sectional study of 1463 participants from 4 Mediterranean countries (Lebanon, Syria, Jordan, and Palestine). The Arabic version of the Ocular Surface Disease Index (ARB-OSDI) questionnaire was used to estimate the prevalence and severity of symptomatic DED using an online format survey. The survey also included demographic questions and possible behavioral risk factors (tobacco and cosmetic use). One-Way ANOVA and multivariate regression analyses were used to investigate the association between OSDI mean scores and behavioral-based risk factors. Results: The prevalence of symptomatic DED (OSDI score ≥ 13) among the overall population (332 males and 1132 females) reached 70.2%. Tobacco and cosmetic users reported a higher significant prevalence and severity of symptomatic DED than non-users (p < 0.0001). Smoking habits (eg, smoking cigarettes or Ajami, smoking in closed areas, and daily smoking) were more likely to report symptomatic DED. Bad hygiene process during the use of any cosmetic product was behind the high prevalence and severity of symptomatic DED among the females of the study population. Conclusion: Symptomatic DED is substantial in Middle Eastern countries. It is statistically associated with cosmetic and tobacco use. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a multifactorial disease of the ocular surface that may be accompanied by discomfort and visual disturbances to a level that reduces quality of life. Artificial tears are a common first-line therapy for DED that aim to supplement the tear film but do not address the underlying causes of DED. Because of the complexity and variability of the disease, personalized treatment beyond artificial tears is important for successful management. This review describes artificial tears and the current knowledge in the personalized approach to the management of DED. There is evidence that artificial tears can reduce symptoms and signs of DED; however, a proportion of patients have been found to show limited or no improvement with artificial tears. Furthermore, the effectiveness of artificial tears may depend on patient compliance and type of artificial tear product used. Personalized management of DED with other treatments involves identifying features of the disease, including the subtype of DED, the presence of inflammation, and the coexistence of external and behavioral contributing factors. Various measures exist to characterize DED, including assessments of the tear film lipid layer, the meibomian glands, tear volume, tear osmolarity, and matrix metalloproteinase 9 levels. Because individuals can show variable features, the most prominent clinical findings, comorbidities, triggering events, and treatment history should be considered to determine the best treatment choices for patients. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate OC-01 [varenicline solution nasal spray (VNS)] tear production and symptom outcomes in patients with dry eye disease by age, gender, race, ethnicity, and artificial tear use status. Patients and Methods: Adults ≥ 22 years of age diagnosed with dry eye disease, with Ocular Surface Disease Index score ≥ 23, corneal fluorescein staining score ≥ 2 in ≥ 1 region or ≥ 4 for all regions, and baseline Schirmer Test Score (STS) ≤ 10 mm, with no restrictions on eye dryness score (EDS). Efficacy was assessed using integrated data from ONSET-1 and ONSET-2 [vehicle control (VC), n=294; OC-01 VNS 0.03 mg, n=308]. Subgroups included age (≤ 55, 56− 65, > 65 years), gender (male, female), race (White, Black or African American), ethnicity (Hispanic or Latino, Not Hispanic or Latino), and artificial tear use (yes, no). Analysis of covariance models, with the covariates treatment, study site, and baseline severity measures, were used to calculate treatment−VC differences. Consistency of effect among subgroups was evaluated by conducting interaction tests. Results: Consistency of treatment effect across subgroups was observed for all endpoints, with P value for all treatment−subgroup interaction terms > 0.05. For % of patients with ≥ 10mm improvement in STS and least squares (LS) mean change from baseline in STS and EDS, there was improvement in tear production across demographic group categories. Artificial tear use did not change STS or EDS outcomes with OC-01 VNS. Conclusion: OC-01 VNS improved tear production and patient-reported symptom outcomes across a broad range of patients by age, gender, race, and ethnicity, and regardless of artificial tear use status at baseline. OC-01 VNS demonstrated a consistent benefit across an extensive range of patients with dry eye disease. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a chronic condition of the ocular surface characterized by a loss of the tear film homeostasis and accompanied by symptoms such as eye discomfort and visual disturbances. DED is classified as aqueous deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed dry eye etiologies. The mainstay treatment in the management of DED is artificial tear drops or lubricant eye drops that replenish the aqueous and/or lipid layer of the tear film. These are available as both lipid-based and non-lipid-based formulations, with/without preservatives. Lipid-based lubricant eye drops can stabilize the tear film lipid layer, reduce tear evaporation, and improve signs of EDE. In this review, we present the formulation components, mechanism of action, and summary of preclinical and clinical evidence on a lipid-based formulation – propylene glycol-hydroxypropyl guar (PG-HPG) nanoemulsion lubricant eye drops (SystaneTM Complete). These eye drops consist of the demulcent (lubricant), PG (0.6%). HPG forms a soft, thin, cross-linked in situ gel matrix with borate ions, when exposed to the tear film, which prolongs lubricant retention and provides ocular surface protection. Dimyristoyl phosphatidyl glycerol, an anionic phospholipid, helps in replenishing the lipid layer of the tear film. Moreover, the nanoemulsion formulation serves as a depot for delivery of dimyristoyl phosphatidyl glycerol to enhance ocular surface coverage. Preclinical and clinical evidence demonstrate that PG-HPG nanoemulsion lubricant eye drops are safe and effective in providing temporary relief of symptoms of DED, regardless of its subtypes. Specifically, it provides sustained reduction in dry eye symptoms, improves tear film stability/lipid layer grade, and improves ocular surface characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Ocular involvement is frequent in autoimmune diseases and even can be the first manifestation. There are multiple descriptions in the literature around the world regarding this topic. However, we evidenced a lack of studies analyzing the relationship between the ocular manifestations and systemic biomarkers, especially in Latinamerica. Therefore, this study aimed to examine the relationship between the positivity of inflammatory biomarkers and the ocular manifestations in a Colombian cohort of rheumatological patients. Patients and Methods: We conducted an observational, descriptive, non-comparative cross-sectional study in a rheumatology center, in Bogotá, Colombia, from 2013 to 2019. We calculated a sample size of 797 patients to assess the prevalence of ocular manifestations and inflammatory biomarkers. We performed univariate analyses for categorical and continuous variables and bivariate analyses using the Chi-square and Fisher's exact test for categorical variables. Results: Women represented 84% of the population, and the mean age was 54.61± 15.64 years. Of 797 patients, 21.45% reported one or more ophthalmological diagnoses, being keratoconjunctivitis sicca (KCS) the most common (15.93%), followed by uveitis, and cataract (1.38%, each one). Regarding ophthalmological symptoms, 35% presented at least one, being dry eye sensation (DE) the most common (30.86%), followed by ocular pain (2.76%), red eye, and decreased visual acuity (2.63%, each one). The antibodies or inflammatory biomarkers most frequently found were antinuclear antibodies (ANAs) (35.3%), C-reactive protein (28.7%), and rheumatoid factor (27.9%). We found statistical associations between consumption of complement 3, anti-CCP, anti-RO, and anti-LA antibodies with ocular manifestations such as photophobia, DE, conjunctivitis, KCS, uveitis, retinal vasculitis, and maculopathy. Conclusion: Ocular manifestations are frequently found in patients with positive antibodies and inflammatory biomarkers. Our results suggest antibodies and inflammatory molecules could be biomarkers for ocular manifestations in patients with rheumatological diseases. This study provides the basis for future longitudinal studies. [ABSTRACT FROM AUTHOR]

Purpose: To describe the early real-world experience of physicians with an intracanalicular dexamethasone insert (DEX) in patients undergoing cataract surgery and to capture the clinical impact of adopting this therapy. Patients and Methods: 23 United States sites including Ambulatory Surgical Center Setting (ASC) and Outpatient Clinical settings. Respondents were physicians who had early experience with DEX in cataract surgery patients. This was a Phase 4 experiential cross-sectional survey study comprised of 3 sequential online physician surveys. Descriptive statistics summarized the surveys' responses to determine the early impressions of the respondents. Results: Forty-two physicians completed surveys. On average, physicians reported feeling comfortable administering DEX after placing 3 inserts (mean 2.7; standard deviation 1.9). Most physicians (92%) were satisfied with DEX, and all physicians (100%) reported that DEX improved patient compliance. Most physicians (62.5%) indicated they would highly prefer DEX over traditional steroid eyedrops for the management of post-surgical inflammation and pain. Conclusion: The surveys exploring the early use of DEX suggest that DEX is a clinically effective treatment with a rapid initial learning curve and integrates well into clinical use. Physicians had a very positive early experience with DEX, including comfort with insertion and satisfaction. DEX shows promise as a primary treatment choice of physicians for ocular inflammation and pain following cataract surgery by offering patients a hands-free innovative therapy that delivers a preservative-free steroid to the ocular surface over approximately 30 days. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of autologous platelet‐rich plasma (PRP) drops for evaporative dry eye (EDE) disease from meibomian gland dysfunction (MGD). Methods: This is a retrospective, consecutive case series of 20 eyes of 10 patients with EDE from MGD treated with PRP drops from November 2020 to November 2021 at a single outpatient clinic in Ontario, Canada. PRP drops were prepared from whole blood using a two-step centrifugation method. Patients were instructed to instill these drops six times daily for 4 weeks. The Canadian Dry Eye Assessment (CDEA) questionnaire score, patient subjective assessment (PSA) score, first and average non-invasive break-up times (f/a NIBUT), tear meniscus height (TMH), bulbar redness (BR), and meibograph grade (MG) were measured before and after the treatment course. Results: Significant improvements in dry eye symptoms and tear film parameters were observed. Dry eye symptoms significantly improved as per the CDEA (mean difference (MD) = − 5.45, 95% confidence interval (CI) = [− 7.9, − 3.1], p< 0.001) and PSA (MD = − 2.6, 95% CI = [− 3.9, − 1.2], p< 0.001). There were significant improvements in tear film parameters including fNIBUT (MD = 3.85s, 95% CI = [1.2, 6.8], p=0.006), aNIBUT (MD = − 6.81s, 95% CI = [5.7, 11.1], p< 0.001) and TMH (MD = 0.08, 95% CI = [0.003, 0.2], p=0.045). There was an improvement in conjunctival injection as measured by BR (MD = − 0.36, 95% CI = [− 0.4, − 0.15], p=0.373). Five eyes experienced a one-grade improvement in MG (p=0.453), and none experienced worsening in MG with treatment. No temporary or permanent adverse effects were noted. Conclusion: Four weeks of PRP therapy resulted in significant functional improvements in dry eye symptoms and tear film quality and quantity. Improvements in conjunctival injection and microstructural improvements in meibomian glands were also observed in some eyes. Overall, PRP is a promising treatment option for patients with EDE from MGD refractory to conventional treatments. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to determine changes detected by noncontact meibography and noninvasive break-up time test (NIBUT) in individuals with regular use of soft contact lenses and compare these findings with irregular soft contact lenses wearers who not compliant with them and non-wearers control group. Patients and Methods: A prospective nonrandomized case-control study in which individuals were recruited and distributed into three groups: Group A (regular contact lens wearers), group B (irregular contact lens wearers), and group C (non-wearers). Ocular Surface Disease Index (OSDI) was obtained. Noncontact meibography and noninvasive tear break-up time were measured without lenses on using Sirius® Scheimpflug Camera. Results: One hundred sixty-six eyes of 83 individuals were included; 36 eyes in group A, 50 eyes in group B, and 80 eyes in group C. The mean total meiboscore was 1.99, 1.61, and 1.28, respectively. The mean meibograde was 3.03, 2.86, and 1.99, respectively. Noninvasive break-up time (NIF-BUT) was 8.42, 11.76, and 13.57 seconds, respectively. Conclusion: There is a difference in OSDI score, meibomian score, and break-up time between different study groups. The study results show that there are trends in lens wearers and non-lens wearers. This is useful for the field to understand the differences between lens wearers and non-lens wearers. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) has a higher prevalence than many important systemic disorders like cardiovascular disease and diabetes mellitus, representing a significant quality of life burden for the affected patients. It is a common reason for consultation in general eye clinics worldwide. Nowadays, the diagnostic and therapeutic approach at the high corneal and ocular surface specialty level should be reserved for cases of severe and chronic dry eye disease associated with systemic autoimmune diseases or complicated corneal and ocular surface pathologies. In such cases, the diagnostic and therapeutic approach is often complex, elaborate, time-consuming, and costly due to the use of extensive dry eye questionnaires, noninvasive electronic diagnostic equipment, and clinical laboratory and ancillary tests. However, other eye care specialists attend a fair amount of DED cases; therefore, its diagnosis, classification, and management should be simple, practical, achievable, and effective. Considering that many patients attending non-specialized dry eye clinics would benefit from better ophthalmological attention, we decided to elaborate a practical DED classification system based on disease severity to help clinicians discriminate cases needing referral to subspecialty clinics from those they could attend. Additionally, we propose a systematic management approach and general management considerations to improve patients' therapeutic outcomes according to disease severity. [ABSTRACT FROM AUTHOR]

Purpose: Dry eye is a multifactorial ocular surface disease (DED) characterized by a loss of tear film homeostasis, which is widely associated with alterations in mental health. Problematic internet use (PIU) is defined as the feeling of concern about using this tool irresistibly, for longer periods than usual, accompanied by anguish that results from not doing so without reaching mania or hypomania behaviors. Both PIU and DED present a theoretical link; however, there are no published studies that report its relationship with problematic internet use. Therefore, this study aims to determine the association between PIU and symptomatic DED in Peruvian medical students. Patients and Methods: Analytical cross-sectional study that included human medical students from Peru. For the measurement of main variables, the Ocular Surface Disease Index (OSDI) and the Internet Addiction Test (IAT) were used. To study their relationship, the Poisson regression analysis was used, we consider a p-value < 0.05 as significant. Results: Data from 844 medical students were analyzed, 35.7% male and 64.3% female, with an average age of 21.8 ± 3.3 years. Likewise, the prevalence of symptomatic DED was 70.9%, and the internet's controlled use was 85.3%. In the analysis adjusted for symptomatic DED, the men showed significant differences in the controlled use of the internet (p < 0.003), of which those who had PIU, 50% had severe symptomatic DED, as well as 80% of those addicted to the internet. The adjusted model showed that the PIU increases the prevalence of symptomatic DED in men (PR = 1.17, 95% CI: 1.06– 1.29); however, in women, no association was found between both variables. Conclusion: PIU and symptomatic DED showed a significant association in male medical students from Peru. [ABSTRACT FROM AUTHOR]

Background: BroadBand light intense pulsed light (BBL-IPL) therapy has shown to reduce hordeolum and blepharitis frequency. This study aims to evaluate the efficacy and safety of BBL-IPL therapy in patients with dry eye disease (DED) from meibomian gland dysfunction (MGD). Methods: This is a retrospective, consecutive case series of 48 patients with DED from MGD who underwent BBL-IPL therapy from October 2016 to January 2019 at a single, outpatient clinic in Ontario, Canada. Clinical outcomes included first and average non-invasive keratograph tear break-up times (NIKBUT), bulbar redness (BR) scores, tear meniscus heights (TMH), visual acuity (VA) and meibograph grades. Patient-reported outcomes included the Canadian dry eye assessment (CDEA) questionnaire and patient subjective assessment (PSA) scores. Outcomes were measured at baseline and after completion of 4 monthly BBL-IPL sessions. Results: The mean severity of dry eye symptoms as measured by the CDEA and PSA decreased significantly from 19.78 ± 9.62 to 12.08 ± 7.40 (p< 0.001) and from 7.65 ± 1.74 to 4.77 ± 2.03 (p< 0.001), respectively. Twenty-five percent of patients reported no dry eye symptoms after treatment. The meibograph grade improved significantly in both eyes (p< 0.001). Approximately 71.0% and 80.1% of patients had an improved meibograph grade in the right and left eye, respectively. Near-significant improvements were observed for BR scores and VA. There was also a trend towards improved first/average NIKBUT and TMH scores. No adverse events were noted. Conclusion: BBL-IPL appears to be an effective and safe treatment modality in improving dry eye symptoms and meibomian gland function in patients with DED from MGD. [ABSTRACT FROM AUTHOR]

Dry eye disease is characterized by tear film instability that can result in ocular surface damage. Patients with dry eye disease may experience ocular pain/discomfort and visual disturbances that may negatively impact quality of life. Increased use of digital screens for work, communication, and entertainment, especially during times of pandemic, may contribute to dry eye. Extensive cross-sectional studies have shown that digital screen use duration is associated with an increased risk of severe symptoms and clinical diagnosis of dry eye disease in adults. Smartphone use duration has also been found to be greater in school-age children with dry eye disease than in those without dry eye disease. A commonly accepted hypothesis for the relationship between digital screen use and dry eye disease is that digital screen use changes blinking dynamics, leading to ocular dryness. This review describes evidence that digital screen use is associated with dry eye disease, that digital device use alters blinking dynamics, and that dry eye affects mental health and work productivity in digital screen users. Helpful prevention and management strategies for dry eye disease exist for those who use digital screens. [ABSTRACT FROM AUTHOR]

Purpose: To assess the subjective eye drop experience of patients with dry eye disease (DED) over approximately 1 hour after a single dose of two formulations of reproxalap versus lifitegrast. Methods: Two formulations of topical ocular reproxalap 0.25% were evaluated versus lifitegrast ophthalmic solution 5% in patients with DED in a single-center, double-masked, active-comparator, single-dose crossover clinical trial. Nineteen patients had test article topically administered to both eyes. Treatments were administered 2 to 4 days apart. Comfort assessments, including ocular discomfort, blurry vision, and dysgeusia assessments; ocular descriptive assessments; quality of life assessments; and overall experience questions were completed after each treatment over one hour, beginning at 90 seconds. Results: Both reproxalap formulations scored better in ocular discomfort score (ODS), blurry vision, and dysgeusia assessments than lifitegrast at each timepoint and cumulatively over all time points after instillation. There were lower rates of negative responses for both reproxalap formulations compared to lifitegrast across ocular discomfort, blurry vision, and dysgeusia assessments, and the durations of negative responses were shorter with reproxalap than with lifitegrast. The reproxalap groups experienced fewer quality of life impacts. No significant safety findings were observed following reproxalap or lifitegrast administration. Conclusion: The reproxalap eye drop experience over 1 hour after instillation was superior to that of lifitegrast. There were no statistically significant differences between reproxalap groups for ODS, blurry vision, or dysgeusia. The improved performance of reproxalap with regard to the most commonly reported side effects of lifitegrast (ie, ocular discomfort, blurry vision, and dysgeusia) may result in greater patient adherence and lower discontinuation rates. [ABSTRACT FROM AUTHOR]

Purpose: To report the subjective assessment of topical self-administered, cadaver-derived corneal epithelial stem cell supernatant for treatment of severe dry eye disease (DED). Methods: Thirty-four eyes of 17 patients with advanced DED as defined by Standardized Patient Evaluation of Eye Dryness (SPEEDTM) questionnaire ≥ 14, Ocular Surface Disease Index (OSDI©) score ≥ 40 and documented attempt of at least six conventional dry eye therapies were enrolled into a prospective clinical trial at a single private practice institution. Treatment consisted of patient self-administered topical instillation of the corneal epithelial stem cell-derived product four times daily in both eyes for 12 weeks. Patient-reported outcome measures (PROMs) were taken with the SPEEDTM questionnaire (the main outcome variable), OSDI© score and visual analog score (VAS; UNC Dry Eye Management Scale©), and objective clinical measurements were taken with best-corrected visual acuity (BCVA), corneal topographic index measurements and tear film osmolarity. These measurements were compared at baseline versus the endpoint at completion of the 12-week treatment. Results: All 34 eyes tolerated the treatment without any adverse events or significant side effects. Compared with baseline, both the SPEEDTM questionnaire and the VAS significantly improved at the conclusion of the 12-week treatment (p = 0.0054 and p = 0.0202, respectively). The OSDI© improved by an average of 10.9 points after the treatment but was not statistically significant (p = 0.1409). There were no significant changes in any of the objective clinical measurements. None of the study subjects failed to complete the treatment course, experienced decrease in any of the PROMs or lost one or more lines of BCVA during the follow-up period. Conclusion: Topical corneal epithelial stem cell-derived supernatant that can be self-administered by the patient shows promise at improving patient symptoms and quality of life in the setting of severe DED that is unresponsive to conventional therapies. [ABSTRACT FROM AUTHOR]

Purpose: To establish the prevalence of ocular involvement in a Colombian population with rheumatologic diseases. Design: Observational cross-sectional study. Methods: We included a probabilistic sample size of 797 patients who attended a rheumatologic disease center in Bogotá, Colombia. Statistical analysis with descriptive measures and Chi-square independence test between rheumatologic diseases and ophthalmological symptoms and diseases was performed. Results: Eighty-four percent of the population were women, and the mean age was 54.61± 15.64 years. The most common condition was rheumatoid arthritis (33.37%), followed by fibromyalgia (22.71%), Sjögren Syndrome (19.72%), and systemic lupus erythematosus (9.91%). Almost 7% of the patients presented polyautoimmunity. Thirty-five percent of the patients reported one or more ophthalmological symptoms, being dry eye sensation the most common (30.86%), followed by ocular pain (2.76%), red-eye, and decreased visual acuity (both 2.63%). Similarly, 21.45% of the patients presented one or more ophthalmological diagnoses, being keratoconjunctivitis sicca the most common (15.93%), followed by cataract, uveitis (1.38% each), and scleritis (1.25%). Conclusion: Almost a third of the patients reported any ocular involvement. It is crucial to be aware of the most common ophthalmic manifestations among the different rheumatologic diseases in our population, to offer early specialist referral and timely treatment. [ABSTRACT FROM AUTHOR]

Purpose: To assess the impact of dry eye disease (DED) on work productivity in Saudi Arabia and investigate its effect on daily activities. Patients and Methods: We conducted a cross-sectional study on male and female Saudi workers age 20 years or older. The data were collected via self-administered questionnaires distributed electronically through social media. We used the Ocular Surface Disease Index questionnaire to diagnose DED patients and assess their DED severity as mild, moderate, and severe. Results: A total of 463 respondents qualified for the study. All patients in the DED groups reported a loss of work productivity. Most patients in the severe DED group (59%) reported difficulty focusing on work due to DED, whereas 17.1% of patients with mild DED and 22.7% with moderate DED reported the same. These findings indicate significantly worsening productivity as DED progresses in severity (p< 0.05). Participants with severe DED reported significantly more affected work hours weekly (35.8%) than participants with moderate (6.1%) and mild DED (7.1%). Conclusion: DED has a significant impact on work productivity, with the most pronounced effect among office workers. It is essential to screen office workers for DED and enhance the awareness of its effect on work productivity among the workforce and healthcare providers. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effectiveness of a combination of intense pulsed light and low-level light therapy (IPL/LLLT) for the treatment of dry eye. Study Design: Retrospective before-after single-center clinical study. Materials and Methods: Patients diagnosed with dry eye, refractory to conventional treatment, underwent four sessions of combined IPL/LLLT over 3 months. The Ocular Surface Disease Index (OSDI) questionnaire, non-invasive breakup time (NIBUT), tear film osmolarity and meniscus height were measured 6 months before intervention, at baseline, post-intervention (3 months), 9 and 15 months. Results: NIBUT, osmolarity and meniscus height significantly worsened during the 6 months before treatment, whereas symptoms did not change. OSDI scores significantly improved at post-intervention (MD = − 44.0, 95% CI − 38.1, − 50.0), and then increased again until the at last follow-up, but still significantly different from baseline (MD = − 30.0, 95% CI − 23.4, − 36.8). The three clinical signs showed a similar pattern, with one-year improvements of 3.6 seconds for the NIBUT (95% CI 3.1, 4.2, p < 0.001), 28 mOsm/L for osmolarity (95% CI 23.6, 32.4, p < 0.001) and 0.03 mm for meniscus height (95% CI 0.02, 0.04, p < 0.001). No adverse effects were observed. Conclusion: IPL/LLLT is safe and produces an important reduction in symptoms and signs of dry eye disease, still relevant one year after the end of treatment in a sample with high symptoms' severity. Therefore, it represents a promising treatment option for patients who do not improve with conventional treatment. Randomized trials are needed to determine the added benefit provided by LLLT. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a condition frequently encountered in ophthalmology practice worldwide. The purpose of this literature review is to highlight the worldwide trends in DED diagnosis and therapy amongst practitioners and determine if a more uniform approach to manage this multifactorial condition has developed over the past two decades. A manual literature search utilizing PubMed was conducted to obtain papers with survey results relating to ophthalmology and optometry diagnosis and treatment of dry eye from January 2000 to January 2020. This did not include data from clinical trials as we were only interested in community clinical practice trends. The terms "dry eye" and "survey" were searched in combination with one or more of the following words or phrases: prevalence, diagnosis, treatment, therapy, etiology, risk factors, therapy, and quality of life. Papers were selected based on their direct applicability to the subject and were only included if they contained relevant survey data from community practitioners. The available literature suggests common trends worldwide in the diagnosis and treatment of DED. These trends have not modified substantially over the past two decades. Practitioner education on the benefits of measuring tear film homeostasis could increase its use as a diagnostic tool to complement current tools. Of the results found, 75% of the papers were published after 2006 and only one paper after 2017. More recent survey results are required to determine if research into DED pathophysiology is altering the current trend in DED management. [ABSTRACT FROM AUTHOR]

Background: OTX-101 is approved for treatment of keratoconjunctivitis sicca (KCS). We present results of a phase 3 worse-eye efficacy analysis and 1-year safety extension. Methods: During the double-masked treatment phase, patients with bilateral KCS were randomized 1:1 to 12 weeks OTX-101 or vehicle 1 drop per eye twice daily. Efficacy assessments included Schirmer's test and corneal and conjunctival staining. All patients who completed the treatment phase were eligible for enrollment in the open-label extension and received 1 drop OTX-101 twice daily for up to 52 weeks. Safety endpoints included adverse event (AE) monitoring, Snellen visual acuity (VA), intraocular pressure (IOP), slit-lamp examination (SLE), and dilated fundoscopy. Results: Overall, 745 and 258 patients enrolled in the treatment and safety extension phases, respectively. At 12 weeks, number (%) of patients with Schirmer's score increase of ≥ 10 mm from baseline was 76 (20.5%) vs. 42 (11.3%) for OTX-101 vs. vehicle (P=0.0005). OTX-101 significantly improved total conjunctival staining vs. vehicle at week 12 (least squares mean change from baseline − 1.65 [0.12] vs. − 1.12 [0.12], P=0.0013), and number (%) of patients with clear central corneas vs. vehicle at week 12 (222 [64.0%] vs. 199 [55.3%], P=0.0179). In the 1-year safety extension, AEs were mostly mild; instillation site pain was most common in 59 (22.9%) patients (17 [13.2%] vs. 42 [32.6%] patients receiving prior OTX-101 and vehicle). No safety concerns were raised by VA, IOP, SLE, and fundoscopy. Conclusion: OTX-101 efficacy was confirmed in the eye with lower baseline Schirmer's score. OTX-101 was well tolerated long term. Clinical Trial: Registered at ClinicalTrials.gov on July 27, 2016. NCT02845674 https://clinicaltrials.gov/ct2/show/NCT02845674?term=OTX-101&draw=2&rank=1. [ABSTRACT FROM AUTHOR]

Purpose: To assess the effect of vectored thermal pulsation treatment (VTP) on visible meibomian gland structure (VGS) in patients with meibomian gland dysfunction (MGD). Setting: Private group practice (A.T.E.). Design: Retrospective, single-blinded cohort study. Methods: Visible meibomian gland structure was evaluated at baseline and at 1-year in treatment (30 patients, 48 eyes) and control (13 patients, 22 eyes) groups. Meibography images were captured using dynamic meibomian imaging. Images were assessed using a novel morphometric analysis technique and analyzed for change in area of VGS (pixels). Additional outcomes measured include tear break up time, corneal staining, tear osmolarity, matrix metalloproteinase-9 (MMP-9), meibography grading, and meibomian gland evaluation. Results: As high as 69% of eyes in the treatment group showed an improvement in VGS versus 27% of eyes in the control group. As high as 31% of eyes in the treatment group showed a decline in VGS versus 73% of eyes in the control group. TBUT (p = 0.0001), corneal staining (p = 0.0063), and meibomian gland evaluation scores (p = 0.0038) all significantly improved after VTP treatment. However, SPEED scores, MMP-9, tear osmolarity, and meiboscale scores were not significantly improved 1-year post treatment. Conclusion: A morphometric analysis protocol of meibography provides clinically meaningful information that is undetectable with the standard semiquantitative method of grading meibomian gland structure. This is the first report indicating that gland structure may increase post-VTP relative to untreated controls, thus presenting significant implications regarding benefits and timing of VTP therapy. The described protocol is currently more appropriate for research than for clinical practice. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a multifactorial disease of the ocular surface and tear film that has gained awareness as a public health problem. Characteristics of DED include tear film instability, hyperosmolarity, and ocular surface inflammation, which can occur independently or may be a sequela of numerous ocular diseases, ocular surgery or contact lens wear. Much has been learned about the impact of the disease to help affected individuals who report symptoms of poor vision, pain, and tearing. Recently, new research highlights the importance of the role of ocular surface inflammation and damage in DED—leading to a vicious cycle of inflammation as well as loss of tear film homeostasis. DED immunopathophysiology is characterized by four stages: initiation, amplification, recruitment, and re-initiation. Cyclosporine is proven to be a valuable ophthalmic therapeutic for DED through its immunomodulatory actions and regulation of the adaptive immune response. Cyclosporine mechanism of action is well described in the published literature and the myriad of benefits in all four stages lend a broad-based immunomodulatory function particularly suitable for addressing DED. Furthermore, cyclosporine has unique goblet cell density improvement capabilities as well as anti-apoptotic properties. Topical formulations of cyclosporine are centered around addressing the highly lipophilic nature of the molecule. The poor aqueous solubility of cyclosporine traditionally presented technical challenges in drug delivery to the ocular surface. Newer formulations such as cationic emulsions and nanomicellar aqueous solutions address formulation, tissue concentration, and drug delivery challenges. [ABSTRACT FROM AUTHOR]