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Introduction: The purpose of this study was to compare the growth factor concentrations in undiluted autologous platelet-rich plasma (APRP) and autologous serum (AS) eye drops. Methods: This was a single-center, prospective trial conducted in a tertiary university hospital in Bangkok, Thailand. Ninety-six patients with moderate-to-severe dry eye disease, who were randomly assigned to receive either 100% APRP or 100% AS, were enrolled in the study. Primary outcome measures were the concentrations of epitheliotrophic factors, including epithelial growth factor (EGF), basic fibroblast growth factor (bFGF), hepatocyte growth factor (HGF), β-nerve growth factor (β-NGF), platelet-derived growth factor (PDGF)-AA, PDGF-BB, transforming growth factor (TGF)-α, TGF-β1, and vascular endothelial growth factor (VEGF) in 100% APRP and 100% AS. Secondary outcome measures were the correlations between baseline patient characteristics and each growth factor concentration. Results: Undiluted APRP contained more EGF, bFGF, and β-NGF than undiluted AS (P < 0.001, P < 0.001, P = 0.018, respectively). Meanwhile, undiluted AS yielded higher concentrations of HGF, PDGF-AA, PDGF-BB, and VEGF compared with undiluted APRP (P < 0.001 all). There were no significant differences in TGF-α and TGF-β1 concentrations between the two groups. In the 100% APRP group, the platelet concentrations had positive correlations with the concentrations of EGF (P = 0.028) and VEGF (P = 0.020). In the 100% AS group, Sjögren's syndrome negatively correlated with the concentrations of PDGF-BB (P = 0.028) and VEGF (P = 0.023). Diabetes mellitus (DM) showed negative correlations with the concentrations of HGF (P = 0.001), TGF-α (P = 0.001), and VEGF (P = 0.002). Conclusions: With our simple preparation protocols, 100% APRP contains higher concentrations of EGF, bFGF, and β-NGF, whereas 100% AS contains higher concentrations of HGF, PDGF-AA, PDGF-BB, and VEGF. This could allow ophthalmologists to tailor treatments to individual patients by targeting growth factor supply based on their underlying pathophysiology. Trial registration: ClinicalTrials.gov identifier, NCT04683796. [ABSTRACT FROM AUTHOR]

Introduction: This work aimed to evaluate the safety and efficacy of hydroxypropyl guar-hyaluronic acid (HPG-HA) dual-polymer lubricating drops in Indian subjects with dry eye disease (DED). Methods: This prospective, open-label, single-arm, phase IV study was conducted in India. Inclusion criteria: Adults (18–65 years) with an average total ocular surface staining (TOSS) score ≥ 4, best-corrected visual acuity of ≥ 20/40 in each eye, tear break-up time (TBUT) ≤ 10 s, and dry eye questionnaire (DEQ-5) score ≥ 6. Subjects received the first dose of HPG-HA eye drops on day 1 and self-administered 1–2 drops four times daily for 90 ± 5 days. Primary endpoints: Frequency and characteristics of treatment-emergent adverse events (TEAEs) throughout the study and TOSS score at day 90. Secondary/other endpoints: Dry eye symptoms score (through dry eye questionnaire [DEQ-5]) and TBUT. Results: Of 175 subjects, 36 (20.6%) had ≥ 1 TEAE, and 27 (15.4%) of this reported ≥ 1 mild drug-related TEAE (eye irritation [n = 9], eye pruritus [n = 8], blurred vision [n = 6], increased lacrimation [n = 4], ocular hyperemia [n = 3], and ocular discomfort [n = 1]). One subject discontinued due to TEAEs, and none led to drug interruptions. No serious adverse events were reported. The mean TOSS score reduced from day 1 (6.12 ± 1.69, OU [both eyes]) to day 90 (2.40 ± 1.97, OU). The mean DEQ-5 score reduced from day 1 (11.50 ± 2.27) to day 90 (5.50 ± 2.50). TBUT increased from day 1 (right eye [OD], 5.70 ± 1.94; left eye [OS], 5.70 ± 1.96) to day 90 (OD, 9.51 ± 3.08; OS, 9.63 ± 3.01). Conclusions: HPG-HA dual-polymer eye drop was safe and effective in relieving signs and symptoms of DED over 90 days in Indian subjects. Trial Registration: Clinical Trial Registry India, CTRI/2022/03/041175. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical efficacy of 0.1% cyclosporine A (CsA) in dry eye patients who have shown inadequate responses to previous treatment with 0.05% CsA. Design: This study was designed as a switching, prospective, multicenter, 12-week, open-label study. Methods: Patients with dry eye disease (DED), who experienced inadequate responses to at least 3 months of treatment with 0.05% cyclosporine, were enrolled in this study. Clinical evaluations included the National Eye Institute (NEI) corneal and conjunctival staining scores, tear film break-up time (TF-BUT), Symptom Assessment in Dry Eye (SANDE), ocular discomfort scale (ODS), and tear volume. These parameters were assessed at baseline, and again at 4, 8, and 12 weeks after switching to 0.1% CsA. Results: Ninety-one patients were enrolled in the study, and 70 patients completed the trial. Statistical analysis was performed on the full analysis set (FAS) using the Markov Chain Monte Carlo (MCMC) method to account for missing data. After switching to 0.1% CsA, subjective symptoms assessed by the Symptom Assessment in Dry Eye (SANDE) and Ocular Discomfort Scale (ODS) showed improvement (p < 0.0001). Objective signs of dry eye, including the National Eye Institute (NEI) score, tear film break-up time (TF-BUT), and tear volume also improved (p < 0.0001). Conclusions: In patients with dry eye disease (DED) who exhibited inadequate responses to 0.05% cyclosporine A (CsA), switching to 0.1% CsA resulted in significant improvements in both subjective symptoms and objective clinical signs. This finding suggests that higher concentrations of CsA may be more effective in treating individuals with moderate to severe DED. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the changes in meibomian gland (MG) structure in allergic conjunctivitis (AC) patients using an intelligent quantitative analysis algorithm and to explore the relationship between these changes and clinical parameters. Methods: A total of 252 eyes from patients with AC and 200 eyes from normal controls were examined. Infrared meibography was performed using the non-contact mode of the Keratograph 5M. MG images were analyzed using a deep learning-based a quantitative analysis algorithm to evaluate gland length, area, dropout ratio, and deformation. Clinical parameters, including tear meniscus height, tear break up time (TBUT), conjunctival hyperemia, and Ocular Surface Disease Index (OSDI) scores, were assessed and correlated with changes in the structure of MG. Results: The average MG length in AC patients was 4.48 ± 1.04 mm, shorter compared to the control group (4.72 ± 0.94 mm). The average length of the central 5 glands in AC patients was 4.94 ± 1.67 mm, which was also shorter than the control group's central 5 glands (5.38 ± 1.42 mm). Furthermore, the central 5 glands' area in AC patients (1.61 ± 0.64 mm2) was reduced compared to the control group (1.79 ± 0.62 mm2). Tear meniscus height was lower in the allergy group (0.26 ± 0.10 mm) compared to the control group (0.44 ± 0.08 mm) (P < 0.05). The non-invasive first tear film break-up time was shorter in the allergy group (8.65 ± 6.31 s) than in the control group (10.48 ± 2.58 s) (P < 0.05). Conjunctival congestion was higher in the allergy group (1.1 ± 0.52) compared to the control group (0.97 ± 0.30) (P < 0.05). The OSDI score in the allergy group (8.33 ± 7.6) was higher than that in the control group (4.00 ± 0.50) (P < 0.05). Correlation analysis revealed that the gland dropout ratio was positively associated with male gender and negatively associated with age and OSDI scores. Additionally, despite an increased number of MG, tear film stability was not improved. Conclusion: Through the intelligent quantitative algorithm, we found that AC leads to significant changes in MG structure, particularly affecting gland length and central area. [ABSTRACT FROM AUTHOR]

Background: Traffic-related air pollution especially in highly socioeconomically developed megacity is usually considered as a severe problem leading to inevitable adverse health outcomes. This study aimed to investigate the associations between traffic-related air pollutants with risk of dry eye disease (DED) outpatient visits in a megacity (Guangzhou) along the subtropical coast in South China. Methods: Daily data on DED outpatient visits and environmental variables from 1 January 2014 to 31 December 2020 in Guangzhou were obtained. A time-series study using a quasi-Poisson generalized linear model (GLM) combined with distributed lag non-linear model (DLNM) was adopted. Subgroup analyses stratified by age, gender, and season were conducted. Results: Totally, 27, 828 DED cases were identified during the study period including 2557 days. Daily number of outpatient visits for DED ranged from 0 to 41. An increase of 10 μg/m3 in PM2.5, NO2 and SO2 concentration was associated with 3.1%, 5.9% and 17.4% increase in the risk of DED outpatient visits, respectively (RRPM2.5 = 1.031, 95%CI: 1.004–1.059, lag 0–11 day; RRNO2 = 1.059, 95% CI: 1.027–1.092, lag0-14 day; RRSO2 = 1.174, 95% CI: 1.036–1.330, lag0-13 day). Subgroup analyses indicated that the effects of PM2.5 exposure on the risk of DED outpatient visits remained significant in aged < 60 years (RR max = 1.008, 95% CI: 1.003–1.013, lag0 day) and the effects of SO2 exposure on the DED outpatient visits risk remained significant in the females (RR max = 1.025, 95% CI: 1.006–1.044, lag0 day). The associations of PM2.5 (RR = 1.010, 95% CI: 1.003–1.016, lag0 day) and SO2 (RR = 1.030, 95% CI: 1.003–1.058, lag14 day) exposure with DED outpatient visits risk remained significant in warm seasons, whereas NO2 (RR = 1.006, 95% CI: 1.002–1.009, lag14 day) exposure was significantly associated with DED outpatient visits in cold seasons. The associations of PM2.5 (first visit, RR = 1.006, 95% CI: 1.001–1.011, lag0 day; re-visit, RR = 1.002, 95% CI: 1.000–1.005, lag6 day), NO2 (first visit, RR = 1.006, 95% CI: 1.001–1.012, lag0 day; re-visit, RR = 1.007, 95% CI: 1.002–1.012, lag0 day), and SO2 (first visit, RR = 1.023, 95% CI: 1.002–1.044, lag0 day; re-visit, RR = 1.023, 95% CI: 1.000–1.045, lag0 day) exposure with risk of DED outpatient visits were significant for both first- and re-visits. Conclusions: Our study revealed that short-term exposure to PM2.5, NO2 and SO2 were positively associated with risk of DED outpatient visits, especially for the youngers, females and during warm seasons, providing evidence for making public health policy to improve life quality in developed megacity. [ABSTRACT FROM AUTHOR]

Significance: Cataract surgery is one of the most performed surgical procedures worldwide. As a potential complication following cataract surgery, dry eye has the potential to impact visual outcomes, lower patient satisfaction, and be detrimental to quality of life. Purpose: To evaluate the effect of cataract surgery on dry eye outcomes postoperatively. Methods: We searched Ovid MEDLINE and Embase from 01/01/2010 to 16/08/2021 and included observational studies of participants ≥ 18 years old undergoing any cataract surgical procedure. We compared postoperative dry eye outcomes with baseline including Ocular Surface Disease Index (OSDI), tear break up time (TBUT), Schirmer's I test (ST1), and corneal fluorescein staining (CFS) at short-term (< 1 week) and medium-term (≥ 1 week to 3 months) follow-up. Results: Our search yielded 11,133 records. After title and abstract, and then full text screening, we included 20 studies with 1,694 eyes. There was some evidence indicating a decrease in the TBUT during the short-term (within 1 week) and medium-term (1 week up to 3 months) periods following cataract surgery. There was a considerable degree of heterogeneity between studies across other outcomes. At medium-term follow-up most studies that reported ST1 and CFS showed deterioration of these outcomes but there was conflicting evidence of the effect of cataract surgery on OSDI. The review is limited by variability in follow-up timeframes which were unable capture potential clinical course like peak occurrence and duration. Conclusion: Dry eye may persist up to three months postoperatively following cataract surgery. Further studies are required to determine if dry eye outcomes return to baseline at longer term follow-up. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a multifactorial, chronic, and often relapsing condition with a significant impact on patient quality of life (QoL). Symptoms such as ocular discomfort and visual disturbances are diverse and frequently misaligned with objective clinical signs, complicating diagnosis and management. DED not only interferes with daily activities like reading, driving, and computer use but also imposes a substantial economic burden due to direct healthcare costs and reduced work productivity. Beyond its ocular manifestations, DED has been associated with higher prevalence rates of depression and anxiety, with a complex bidirectional relationship. Patients with DED may experience psychological distress that exacerbates symptoms, leading to a vicious cycle that further impairs QoL. This underscores the importance of integrating mental health screening into the management of DED, particularly for high-risk populations. Optimizing the care of DED patients requires empathy, effective communication, and the establishment of a therapeutic alliance that acknowledges patient experiences and involves them in personalized treatment plans. Such an approach can improve patient satisfaction, enhance treatment adherence, and address both ocular and psychological dimensions of the disease. This paper highlights current evidence on the impact of DED symptoms and its association with mental health and recommends strategies to improve clinical management through a patient-centered approach. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye disease (DED) is a multifactorial condition of the ocular surface, primarily treated with tear substitutes, which do not fully restore natural tear functions. In this pilot study, we tested the hypothesis that T-Lysyal (T-Lys) improves symptoms and signs in patients with DED. Additionally, we provide a literature overview on the effects of T-Lys in ophthalmology and non-ophthalmology conditions to elucidate its mechanisms of action. Methods: A double-masked, randomized pilot study was conducted in patients with DED treated with T-Lys or hyaluronic acid (HA) 0.2% combined with tamarind seeds polysaccharide (control group) for 2 months. Inclusion criteria were a diagnosis of DED with symptoms lasting ≥ 6 months, Symptom Assessment in Dry Eye (SANDE) score ≥ 30, and at least one of the following: fluorescein staining of the cornea (score ≥ 3, NEI scale), conjunctival staining (Lissamine Green, score ≥ 3), or tear breakup time (T-BUT) ≤ 10 s. Data from the right eye were used for statistical analysis. A PubMed literature search of T-Lys studies was also performed without publication year restrictions. Results: Twelve patients in the T-Lys group and 15 in the control group completed the study (mean age 67 ± 11 years). T-Lys treatment resulted in significant improvements from baseline (V0) to 2 months (V2) in symptoms assessed by visual analogue scale (T-Lys: 4.58 ± 2.57 mm at V0, 2.92 ± 1.38 mm at V2, p < 0.05; control: 5.13 ± 2.29 mm at V0, 5.3 ± 2.4 mm at V2), T-BUT (T-Lys: 2.58 ± 1.31 s at V0, 3.58 ± 1.37 s at V2, p < 0.05; control: 3.07 ± 1.43 s at V0, 3 ± 1.13 s at V2), and corneal staining (T-Lys: 2.16 ± 4.17 at V0, 1.41 ± 3.70 at V2, p < 0.05; control: 1.4 ± 2.19 at V0, 1.4 ± 2.16 at V2). No adverse events were reported. Literature findings supported T-Lys's efficacy in managing both ophthalmology and non-ophthalmology conditions. Conclusion: This study provides the first clinical evidence of T-Lys efficacy in patients with DED, supporting preclinical data and highlighting its potential as a promising ocular surface modulator. Trial Registration: The study was registered in the ISRCTN registry for Clinical Studies with no. 13587929. [ABSTRACT FROM AUTHOR]

Dry Eye Disease (DED) is a common condition worldwide, with smoking being recognized as a possible aggravating factor. Although observational studies have indicated a potential correlation, the findings have been inconclusive. In the study, Mendelian randomization (MR) analysis is used to investigate this potential causal relationship. Adhering to STROBE-MR guidelines, a MR analysis was conducted using genetic instrumental variables from Genome-wide association studies (GWAS). The research investigated the impact of various smoking-related exposures (regular smoking, lifetime smoking, smoking intensity, and smoking cessation) on DED as an outcome. Three distinct methodologies were employed: the inverse variance weighted (IVW) method, the MR-Egger method, and the weighted median (WM) method. To ensure the robustness of the MR results, sensitivity analyses were conducted. In MR analyses, it was observed that both lifetime smoking and regular smoking were associated with a significant increase in the risk of DED (IVW method: P < 0.05). The results indicated that the odds ratios (ORs) for lifetime smoking and regular smoking in relation to DED were 1.757 (95% CI 1.021–3.025) and 2.121 (95% CI 1.017–4.423), respectively. However, there was no significant correlation found between smoking intensity, cessation, and the risk of DED. This study presents genetic evidence indicating that long-term smoking could potentially be a causal risk factor for DED. Subsequent research will need to conduct specifically designed randomized controlled trials to further investigate this association. [ABSTRACT FROM AUTHOR]

INTRODUCTION Pterygium is a common disease of the ocular surface characterized by the invasion of fibrovascular tissue from the bulbar conjunctiva onto the cornea. It can cause chronic ocular irritation, tear film disturbances, induced astigmatism, and decreased vision secondary to growth over the visual axis. OBJECTIVES To assess precorneal Tear film before and after pterygium surgery. METHOD This prospective observational study was done on all consecutive patients with pterygium came to ophthalmology OPD at R L Jalappa hospital in kolar from August 2022 to December 2023. A total of 39 eyes were included in each group of which 12 were males and 27 females. All the patients subjected for detail visual acuity (VA) assessment, slit lamp examination, intraocular pressure (IOP) estimation, tear film function tests and underwent Pterygium excision with conjunctival limbal autograft. They were followed post-operatively 1 week, 4 weeks and 6weeks. RESULTS Majority of the patients were females (69.2%), while 30.8% were males with average age (in years) as 51.33 years. Majority had Type 2 (51.3%), followed by Type 3 (26.6%) and Type 1 (23.1%). Schimers test 1 was significantly decreased in the affected eye compared to control eye at pre-op and 1 week following post-op. There was no significant difference in the ST1 at 4 weeks and 6 weeks between the affected and control eyes. Schimers test 2 was significantly decreased in the affected eye compared to control eye at pre-op, one week and four weeks following post-op. There was no significant difference in the ST-2 at 6 weeks between the affected and control eyes. TBUT was significantly decreased in the affected eye compared to control eye at pre-op, and 4 weeks following post-op. There was no significant difference in the TBUT at 1 week and 6 weeks between the affected and control eyes. TMH was significantly lower in the affected eye than the control eye at pre-op, and 1 week following post-op. No significant difference in the TMH at 4 weeks and 6 weeks between the affected and control eyes was noticed. Comparision of schirmers test 1, schirmers 2, TBUT and TMH at 1week, 4 week & 6 weeks between preop and post op in type 1 pterygium, among the affected eye, the tear film function significantly improved. CONCLUSION Our research found that after the pterygium was removed, the measurements, such as Schirmers and Tear Break-up Time (TBUT), showed improvement over time. After a month after the operation in the affected eye, the Schirmers and Tear Break-up Time were almost as close to the control eye's values. This suggests that the dry eye symptoms related to the pterygium got better after the surgery. Nonetheless, our research did not include a long-term check-up to explore if the pterygium would come back and how it might affect the tear film's function. [ABSTRACT FROM AUTHOR]

Introduction: This study investigated the efficacy of pooled human immune globulins (Flebogamma® DIF) to combat the formation of neutrophil extracellular traps (NETs) and NETosis, along with neutrophil adhesion to corneal epithelial cells in response to dry eye disease relevant stimuli. Methods: Human neutrophils were isolated by bead-based immunomagnetic depletion of non-target cells from human whole blood. NETosis was induced using phorbol 12-myristate 13-acetate (PMA) or anti-citrullinated histone 4 R3 antibody (H4R3 ACPA). Extracellular DNA was used as a surrogate biomarker of NETosis, and it was quantified using a 96-well, plate reader-based fluorescent assay and by confocal microscopy in 8-well chambers using the DNA dye, SYTOXTM Green. Neutrophils were labeled with calcein-AM and adhesion to human corneal epithelial cells was measured. The efficacy of a dose-range of pooled human immune globulin (Flebogamma® DIF, 0.01%–5%) was tested in all assays. Results: Pooled human immune globulins (Flebogamma® DIF) dose-dependently inhibited both PMA and H4R3 ACPA induced NETosis, with concentrations ≥2.5% fully preventing release of extracellular DNA over a 2–16 h time period. Similarly, Flebogamma® 5% DIF prevented NETosis against PMA (20 nM) and a dose range (0.1–10 μg/mL) of H4R3 ACPA. Both PMA and H4R3 ACPA increased adhesion of neutrophils to corneal epithelial cells by 20% and 5%, respectively. Flebogamma® DIF treatment resulted in a dose-dependent reduction of neutrophil adhesion, with Flebogamma® 5% DIF reducing adhesion to baseline levels. Discussion: These findings show the dose-dependent efficacy of pooled human immune globulins, specifically Flebogamma® DIF against experimentally and pathologically induced NETosis and neutrophil adhesion to corneal epithelial cells, in vitro. The results from this study support the continued clinical development of Flebogamma® 5% DIF as a novel and efficacious treatment for the signs and symptoms of dry eye disease. [ABSTRACT FROM AUTHOR]

Introduction: Graves' Orbitopathy (GO) is an autoimmune disorder characterized by inflammation of orbital tissues, leading to various ocular manifestations, including ocular surface disease. This cross-sectional study aimed to assess the presence of ocular surface disease using the Ocular Surface Disease Index (OSDI) in patients with Graves' disease (GD) and moderate-to-severe active GO compared to those with GD and mild non-active GO. Additionally, we aimed to investigate the correlation between ocular surface disease and the eye features of GO. Methods: Consecutive GD patients with GO referred to the Ophthalmology and Endocrinology Units of the University Hospital of Pisa between June 2022 and February 2023 were enrolled. OSDI scores were obtained from 79 GD patients, categorized into moderate-to-severe active GO and mild non-active GO groups. Results: OSDI scores were significantly higher in patients with moderate-to-severe active GO compared to those with mild non-active GO (P=0.0006). A cutoff value of 33 for positive tests revealed a higher frequency of pathological OSDI in moderate-to-severe active GO patients compared to mild non-active GO patients (P=0.0221; OR 3.673, CI 1.277-9.531). Within the moderate-to-severe active GO group, a significant positive correlation was found between OSDI and Clinical Activity Score (CAS) (R= 0.3867, 95% CI from 0.1403 to 0.5880; P=0.0030). Using a cutoff value of 55 (the 75th percentile of the study population), patients with CAS ≥ 3 had a significantly higher proportion of pathological OSDI compared to those with CAS <3 (P=0.0039; OR 4.075, CI 1.619-10.39). Proptosis values ≥ 22 mm and the presence of lagophthalmos were identified as significant risk factors for ocular surface disease development (P=0.0406 and P=0.0493, respectively). Discussion: Our study highlights a significantly higher prevalence of ocular surface disease, as measured by OSDI, in patients with moderate-to-severe active GO compared to those with mild non-active disease. The degree of GO activity positively correlates with ocular surface involvement, and proptosis and lagophthalmos increase the risk of its occurrence. These findings emphasise the importance of assessing and managing ocular surface health in GO patients. Early identification and appropriate treatment of ocular surface disease need to be pursued to improve patient management. [ABSTRACT FROM AUTHOR]

Ocular diseases such as cataract, refractive error, age-related macular degeneration, glaucoma, and diabetic retinopathy significantly impact vision and quality of life worldwide. Despite advances in conventional treatments, challenges like limited bioavailability, poor patient compliance, and invasive administration methods hinder their effectiveness. Nanomedicine offers a promising solution by enhancing drug delivery to targeted ocular tissues, enabling sustained release, and improving therapeutic outcomes. This review explores the journey of nanomedicine from bench to bedside, focusing on key nanotechnology platforms, preclinical models, and case studies of successful clinical translation. It addresses critical challenges, including pharmacokinetics, regulatory hurdles, and manufacturing scalability, which must be overcome for successful market entry. Additionally, this review highlights safety considerations, current marketed and FDA-approved nanomedicine products, and emerging trends such as gene therapy and personalized approaches. By providing a comprehensive overview of the current landscape and future directions, this article aims to guide researchers, clinicians, and industry stakeholders in advancing the clinical application of nanomedicine in ophthalmology. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye disease (DED) is a prevalent ocular condition that significantly impacts quality of life. Umbilical cord serum (UCS) has emerged as a promising therapeutic option, but its efficacy requires further investigation. This systemic review and meta-analysis aimed to evaluate the therapeutic effects of UCS eye drops in the treatment of DED. Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Web of science, Embase, Science Direct, Cochrane Library, and China National Knowledge Network, to identify relevant clinical trials. The efficacy of UCS was assessed based on key outcome measures, such as the ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer I test, and corneal fluorescein staining scores. Meta-analyses were performed to pool the results, and the findings were presented in a forest plot. Results: Eight studies were included in the meta-analysis, with two relevant randomized controlled trials (RCTs) involving a total of 204 patients. Most of the included studies had a follow-up time of less than 2 months. The pooled results showed that UCS treatment significantly improved the OSDI, with a mean difference (MD) of −9.16 (95% confidence interval [CI], −12.0, −6.36) compared to baseline. Additionally, the TBUT values were higher in the UCS group, with an MD of 2.65 (95% CI, 0.93, 4.36). The Schirmer I test results showed an improvement, with an MD of 1.18 (95% CI, 0.30, 2.06). The fluorescein staining score were also lower in the UCS treatment group, with an MD of −4.71 (95% CI, −5.72, −3.69). Conclusion: This meta-analysis suggested that UCS eye drops had a beneficial therapeutic effect on DED, significantly improving the OSDI, TBUT, Schirmer I test, and corneal fluorescein staining scores. However, larger RCTs with longer follow-up periods were needed to further evaluate the long-term efficacy and safety of UCS in the management of DED. [ABSTRACT FROM AUTHOR]

Background: Objectively compare the changes in ocular surface parameters in myopic patients who have undergone either SMILE or Implantable Collamer Lens (ICL V4c) surgery. Methods: This prospective cohort study enrolled 32 patients (32 eyes) undergoing SMILE surgery and 35 patients (35 eyes) receiving ICL V4c intraocular lenses. Examinations were performed at preoperative, 1-week, 1-month, and 3-month postoperative time points. The assessments included Schirmer's I Test (SIt), First Non-Invasive Break-Up Time (First-NIBUT), Average Non-Invasive Break-Up Time (Average-NIBUT), Tear Meniscus Height (TMH), Ocular Surface Disease Index (OSDI) score, conjunctival congestion score, meibomian gland loss score, lipid layer analysis score, lid margin opening detection score, and corneal fluorescein staining (CFS) score. Results: Repeated measures ANOVA revealed that SIT, TMH, and First-NIBUT initially decreased and then increased. At three months, SIT levels in the SMILE group were significantly lower than those in the ICL group. From the first month onward, TMH levels in the SMILE group remained significantly lower than those in the ICL group (P < 0.05). OSDI scores initially rose and then fell, with the SMILE group consistently showing higher OSDI levels than the ICL group. Conjunctival congestion scores in the SMILE group fluctuated less, while the ICL group exhibited a clear downward trend, with significant differences starting from the first week (P < 0.05). Over time, scores for meibomian gland loss, lipid layer analysis, and lid margin opening detection were all higher in the SMILE group compared to the ICL group. Conclusions: SMILE surgery has a more pronounced and prolonged impact on the ocular surface and meibomian gland function compared to ICL implantation. Objective dry eye parameters in the ICL group recover more quickly than those in the SMILE group one month post-surgery. [ABSTRACT FROM AUTHOR]

Background: Dry eye is a condition of the tear film and ocular surface that causes discomfort, visual disturbance, and tear film instability. The subjective symptoms in dry eye disease (DED) are often nonspecific. More or less common are conjunctival redness and damage to the ocular surface with punctate epithelial erosions. Rheumatoid arthritis (RA) is a systemic autoimmune disease with approximately 25% of patients having ocular manifestations. Methodology: A prospective observational study was carried out in the ophthalmology outpatient department of a tertiary care center. There were 200 RA patients enrolled. Dry eye workup was done using various tests and the Ocular Surface Disease Index questionnaire. RA patients were divided on the basis of duration of illness into two groups. The results of dry eye tests were compared between these two groups. Results: Out of 200 RA patients, 89% were females. The overall prevalence of dry eye was 52.5% according to Schirmer's test without anesthesia. There were 112 patients who were suffering from RA for <5 years and another group of 88 patients who were suffering for ≥5 years. Schirmer's test and corneal fluorescein staining suggested that the patients with longer duration of RA are more prone to DED. Conclusion: The prevalence of dry eyes in patients with RA is high. Chronic ocular surface changes were observed with the longer duration of RA disease activity which affects the quality of life in such patients. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a highly prevalent condition, resulting in reduced quality of life, lower participation in social life and impaired work efficiency. Hydroxypropyl methylcellulose (HPMC) is a cellulose‐based viscosity‐enhancing agent and is one of the most popular therapeutic ingredients in artificial tears. This review aims to evaluate the literature on the efficacy and safety of HPMC used in the treatment of DED. Literature searches were conducted in PubMed and Cochrane CENTRAL. A total of 28 clinical trials from 26 publications are included in this review, including 21 clinical intervention studies evaluating the effect of HPMC treatment over time and seven single instillation studies evaluating the short‐term physical and symptomatic effects of HPMC after drop‐instillation. The duration of clinical intervention studies ranged from 2 weeks to 5.5 months. DED severity ranged from mild to severe. Drop frequency ranged from two to up to 16 drops per day. HPMC concentration in artificial tears ranged from 0.2% to 0.5%. No major complications or adverse events were reported. Artificial tears containing HPMC were effective at improving symptoms and some signs of DED. However, combination drops with HPMC plus other therapeutic ingredients seem more effective than HPMC alone. HPMC appears to be equally effective or inferior to hyaluronic acid (HA). There is no evidence of superiority or inferiority to either carboxymethylcellulose (CMC) or polyethylene glycol 400/propylene glycol (PEG/PG). No single study explained the choice of drop frequency or HPMC concentration. More well‐designed studies are needed to determine an evidence‐based standard for HPMC treatment, including drop frequency, concentration and molecular weight for different DED severity and subgroups. [ABSTRACT FROM AUTHOR]

Background: Organ-on-a-chip models have emerged as transformative tools in ophthalmology, offering physiologically relevant platforms for studying ocular diseases and testing therapeutic interventions. These microfluidic devices replicate human eye tissue architecture, addressing limitations of traditional in vitro and animal models. Methods: A narrative review of recent advancements in organ-on-a-chip technology was conducted, focusing on models simulating ocular structures like the retina and cornea and their applications in studying diseases such as dry eye disease (DED), age-related macular degeneration (AMD), and glaucoma. Results: Advanced organ-on-a-chip models successfully mimic key ocular features, providing insights into disease mechanisms and therapeutic responses. Innovations in microengineering and cellular integration have enhanced these platforms' translational potential, though challenges like scalability and regulatory validation persist. Conclusions: Organ-on-a-chip models are poised to enhance preclinical research and clinical applications in ophthalmology. Addressing scalability and regulatory hurdles will be key to unlocking their full potential in drug discovery and disease modeling. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye disease (DED) is a multifactorial condition of the ocular surface (OS) characterized by loss of tear film homeostasis, ocular discomfort, and vision disturbances. Most available ocular lubricants target the aqueous deficiency of the tear, restoring only this layer, leaving the tear lipid stratum deficient, as occurs in most patients with evaporative DED. An innovative propylene glycol-hydroxypropyl guar enriched with a phospholipid nanoemulsion (PG-HPG-PH-N) is indicated to restore deficiencies in both the lipid and aqueous layers of the tear film, and its composition was designed to increase lubricant retention on the OS. The purpose of this study was to evaluate, through the Ocular Surface Disease Index (OSDI) and clinical assessment, the treatment of patients who had DED due to aqueous deficiency arising from mixed or evaporative DED subtypes with a PG-HPG-PH-N ocular lubricant at a reduced frequency of twice a day, in a prospective, multicenter, and single-arm study. Methods: Patients were screened from days − 7 to 0, and from day 1 (baseline and first day of treatment) to day 28 of treatment with this lubricant. After visit 1 (screening visit, days − 7 to 0), designed as pre-treatment OS assessment, patients returned to their research center on days 14 and 28 of treatment for a complete assessment, including anamnesis, the OSDI, corrected visual acuity, tear breakup time (TFBUT), OS staining evaluation, tolerability index, and environmental exposure questionnaire. Results: Seventy patients were enrolled in this study (60 women, 10 men), with a mean age of 45 (range 27–64) years. TFBUT results showed an improvement in tear film stability as vital dyes sodium fluorescein and lysamine green showed a decrease in corneal staining after 14 and 28 days of treatment. No significant adverse events were reported, demonstrating the good tolerability of the lubricant. Conclusions: The PG-HPG-PH-N nanoemulsion can be considered to be a safe and effective ocular lubricant for treating DED due to aqueous deficiency, both mixed and evaporative subtypes. Trial Registration: Brazilian National Research Ethics Commission (ReBEC registration number 16055). [ABSTRACT FROM AUTHOR]

Introduction: Dry eye disease (DED) is a frequently observed condition characterized by ocular discomfort and visual disturbance. It is highly prevalent and impairs patients' quality of life (QoL). This study assessed the benefit of a preservative-free bioprotectant eye drop formulation containing sodium hyaluronate and trehalose (SH-trehalose) with regards to DED, as well as patient satisfaction, through a large-scale real-life survey. Methods: In a multi-center, international, prospective observational study, subjects with DED received SH-trehalose for 84 days. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire-5 items (DEQ-5), and patient satisfaction were assessed at baseline, day 28, and day 84, and clinical evaluations included ocular surface staining, Schirmer test, tear film break-up time (TBUT), and conjunctival hyperemia at baseline and day 84. Results: A total of 312 patients were evaluated, of whom 82.4% were women. The mean age was 57.9 ± 15.2 years. The mean OSDI score at baseline was 41.7 ± 20.6. After 84 days, the mean OSDI score was 27.3 ± 19.8 (p < 0.001). The percentage of patients with a severe OSDI score decreased from 60.3 to 34.5%. The DEQ-5 score significantly (p < 0.001) improved after 28 and 84 days, as did patient satisfaction. Ocular surface staining, Schirmer test, TBUT, and conjunctival hyperemia scores improved significantly (all p < 0.001) for both eyes with SH-trehalose between baseline and day 84. Tolerance of SH-trehalose was good. Conclusions: SH-trehalose significantly improved the clinical signs and symptoms of DED after 84 days. Moreover, it significantly increased patient satisfaction and was well tolerated. Trial Registration: NCT04803240. [ABSTRACT FROM AUTHOR]

Background: Metformin, a commonly prescribed medication for managing diabetes, has garnered increasing interest as a potential therapeutic option for combating cancer and aging. Methods: The current study investigated the effects of metformin treatment on human meibomian gland epithelial cells (hMGECs) at morphological, molecular, and electron microscopy levels. HMGECs were stimulated in vitro with 1 mM, 5 mM, and 10 mM metformin for 24, 48, and 72 h. The assessed outcomes were cell proliferation assays, lipid production, ultrastructural changes, levels of IGF-1, Nrf2, HO-1, apoptosis-inducing factor 1 (AIF1) at the protein level, and the expression of oxidative stress factors (matrix metallopeptidase 9, activating transcription factor 3, CYBB, or NADPH oxidase 2, xanthine dehydrogenase). Results: Morphological studies showed increased lipid production, the differentiation of hMGECs after stimulation with metformin, and the differentiation effects of undifferentiated hMGECs. Proliferation tests showed a reduction in cell proliferation with increasing concentrations over time. AIF1 apoptosis levels were not significantly regulated, but morphologically, the dying cells at a higher concentration of 5-10 mM showed a rupture and permeabilization of the plasma membrane, a swelling of the cytoplasm, and vacuolization after more than 48 h. The IGF-1 ELISA showed an irregular expression, which mostly decreased over time. Only at 72 h and 10 mM did we have a significant increase. Mitochondrial metabolic markers such as Nrf2 significantly increased over time, while HO-1 decreased partially. The RT-PCR showed a significant increase in MMP9, CYBB, XDH, and ATF with increasing time and metformin concentrations, indicating cell stress. Conclusions: Our results using a cell line suggest that metformin affects the cellular physiology of meibomian gland epithelial cells and induces cell stress in a dose- and duration-dependent manner, causing changes in their morphology and ultrastructure. [ABSTRACT FROM AUTHOR]

Background: Dry eye disease is a common disorder of the ocular surface, leading patients to seek eye care. Clinical signs and symptoms are currently used to diagnose dry eye disease. Metabolomics, a method for analyzing biological systems, has been found helpful in identifying distinct metabolites in patients and in detecting metabolic profiles that may indicate dry eye disease at early stages. In this study, we explored the use of machine learning and metabolomics data to identify cataract patients who suffer from dry eye disease, a topic that, to our knowledge, has not been previously explored. As there is no one-size-fits-all machine learning model for metabolomics data, choosing the most suitable model can significantly affect the quality of predictions and subsequent metabolomics analyses. Methods: To address this challenge, we conducted a comparative analysis of eight machine learning models on two metabolomics data sets from cataract patients with and without dry eye disease. The models were evaluated and optimized using nested k-fold cross-validation. To assess the performance of these models, we selected a set of suitable evaluation metrics tailored to the data set's challenges. Results: The logistic regression model overall performed the best, achieving the highest area under the curve score of 0.8378 , balanced accuracy of 0.735 , Matthew's correlation coefficient of 0.5147 , an F1-score of 0.8513 , and a specificity of 0.5667 . Additionally, following the logistic regression, the XGBoost and Random Forest models also demonstrated good performance. Conclusions: The results show that the logistic regression model with L2 regularization can outperform more complex models on an imbalanced data set with a small sample size and a high number of features, while also avoiding overfitting and delivering consistent performance across cross-validation folds. Additionally, the results demonstrate that it is possible to identify dry eye in cataract patients from tear film metabolomics data using machine learning models. [ABSTRACT FROM AUTHOR]

Dry eye disease (DED) is a common multifactorial disorder characterized by a deficiency in the quality and/or quantity of tear fluid. Tear hyperosmolarity, the dysfunction of ion channel proteins, and eye inflammation are primarily responsible for the development and progression of DED. Alterations in the structure and/or function of ion channel receptors (transient receptor potential ankyrin 1 (TRPA1), transient receptor potential melastatin 8 (TRPM8), transient receptor potential vanilloid 1 and 4 (TRPV1 and TRPV4)), and consequent hyperosmolarity of the tears represent the initial step in the development and progression of DED. Hyperosmolarity triggers the activation of ion channel-dependent signaling pathways in corneal epithelial cells and eye-infiltrated immune cells, leading to the activation of transcriptional factors that enhance the expression of genes regulating inflammatory cytokine production, resulting in a potent inflammatory response in the eyes of DED patients. A persistent and untreated detrimental immune response further modifies the structure and function of ion channel proteins, perpetuating tear hyperosmolarity and exacerbating DED symptoms. Accordingly, suppressing immune cell-driven eye inflammation and alleviating tear hyperosmolarity through the modulation of ion channels in DED patients holds promise for developing new therapeutic strategies. Here, we summarize current knowledge about the molecular mechanisms responsible for the inflammation-induced modification of ion channels leading to tear hyperosmolarity and immune cell dysfunction in DED patients. We also emphasize the therapeutic potential of the newly designed immunomodulatory and hypo-osmotic solution d-MAPPS™ Hypo-Osmotic Ophthalmic Solution, which can activate TRPV4 in corneal epithelial cells, stabilize the tear film, enhance natural cytokine communication, and suppress detrimental immune responses, an important novel approach for DED treatment. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye disease (DED) is a very frequently encountered ocular disease, making it a growing public health burden. However, current treatments for DED present unmet medical needs owing to their side effects or ineffectiveness. Therefore, an effective and safe therapeutic agent to manage DED is needed. Method and Analysis: We planned a phase 2, dose-finding, double-blind, randomized placebo-controlled trial to evaluate the efficacy and safety of two different doses of USL (Useul), the extract of Achyranthis Radix, compared with placebo, for DED. USL has been found to protect against DED by inducing tear secretion and improving corneal irregularity via anti-inflammatory effects, which will provide new therapeutic options. One hundred and twenty participants will be enrolled, after assessing the inclusion/exclusion criteria, at Daejeon University Daejeon Korean Medicine Hospital. Enrolled participants will be allocated to standard-dose USL, high-dose USL, or placebo groups in a 1:1:1 ratio and will be required to administer the trial medication twice a day for 12 weeks and visit the clinic five times. For efficacy outcomes, objective endpoints of fluorescein corneal staining score, tear break-up time, Schirmer's test, and meibomian test and subjective endpoints of Ocular Surface Disease Index, visual analog scale, Standard Patient Evaluation for Eye Dryness-II, and biomarkers will be assessed throughout the trial. Safety will be assessed based on adverse events, vital signs, laboratory tests, visual acuity, and intraocular pressure. Discussion: Our study results are expected to provide clinical evidence for the use of DED as an effective and safe agent for DED. [ABSTRACT FROM AUTHOR]

Abstract Purpose To assess the clinical efficacy of 0.1% cyclosporine A (CsA) in dry eye patients who have shown inadequate responses to previous treatment with 0.05% CsA. Design This study was designed as a switching, prospective, multicenter, 12-week, open-label study. Methods Patients with dry eye disease (DED), who experienced inadequate responses to at least 3 months of treatment with 0.05% cyclosporine, were enrolled in this study. Clinical evaluations included the National Eye Institute (NEI) corneal and conjunctival staining scores, tear film break-up time (TF-BUT), Symptom Assessment in Dry Eye (SANDE), ocular discomfort scale (ODS), and tear volume. These parameters were assessed at baseline, and again at 4, 8, and 12 weeks after switching to 0.1% CsA. Results Ninety-one patients were enrolled in the study, and 70 patients completed the trial. Statistical analysis was performed on the full analysis set (FAS) using the Markov Chain Monte Carlo (MCMC) method to account for missing data. After switching to 0.1% CsA, subjective symptoms assessed by the Symptom Assessment in Dry Eye (SANDE) and Ocular Discomfort Scale (ODS) showed improvement (p

Abstract This study aimed to evaluate ocular surface temperature (OST) in post-COVID-19 patients with different degrees of fever via infrared thermal imaging. There were 16 participants (32 eyes) in the control group, 22 participants (44 eyes) in the moderate and low post-COVID-19 fever group (M & L fever group), and 18 participants (36 eyes) in the high post-COVID-19 fever group (H fever group). All participants underwent an ophthalmic slit lamp examination and ocular thermography. Among the control group, M & L fever group and H fever group, there were no significant differences in the upper eyelid temperature (UET), inner canthus temperature (ICT), outer canthus temperature (OCT), initial central corneal temperature (initial CCT), third-second central corneal temperature (3s-CCT), or sixth-second central corneal temperature (6s-CCT). However, the change in central corneal temperature measured within 1, 3, and 6 s (change in CCT within 1, 3, and 6 s) of the H fever group were significantly greater than those of the control group (0.15 ± 0.12 °C vs. 0.08 ± 0.09 °C, p = 0.007; 0.30 ± 0.22 °C vs. 0.17 ± 0.17 °C, p = 0.005; 0.45 ± 0.30 °C vs. 0.26 ± 0.23 °C, p = 0.004, respectively) and M & L fever group (0.15 ± 0.12 °C vs. 0.08 ± 0.08 °C, p = 0.008; 0.30 ± 0.22 °C vs. 0.16 ± 0.14 °C, p = 0.001; 0.45 ± 0.30 °C vs. 0.23 ± 0.20 °C, p

Abstract Significance Cataract surgery is one of the most performed surgical procedures worldwide. As a potential complication following cataract surgery, dry eye has the potential to impact visual outcomes, lower patient satisfaction, and be detrimental to quality of life. Purpose To evaluate the effect of cataract surgery on dry eye outcomes postoperatively. Methods We searched Ovid MEDLINE and Embase from 01/01/2010 to 16/08/2021 and included observational studies of participants ≥ 18 years old undergoing any cataract surgical procedure. We compared postoperative dry eye outcomes with baseline including Ocular Surface Disease Index (OSDI), tear break up time (TBUT), Schirmer’s I test (ST1), and corneal fluorescein staining (CFS) at short-term (

Caroline Guerrero-de Ferran, Daniel Bastán-Fabián, Alfredo del Castillo-Morales, I Jocelyn Rivera-Alvarado, Jorge E Valdez García School of Medicine, Tecnologico de Monterrey, Monterrey, NL, MéxicoCorrespondence: Jorge E Valdez García, School of Medicine, Tecnologico de Monterrey, Av. Ignacio Morones Prieto 3000, Colonia Los Doctores, Monterrey, NL, CP 64710, México, Tel +52 81 88 88 05 51, Email Jorge.valdez@tec.mxPurpose: To compare the meibographies and dry eye parameters of paretic vs non-paretic sides of patients with a facial palsy diagnosis.Patients and Methods: Twenty patients with unilateral facial palsy were recruited and the severity of the disease was staged using the House-Brackmann scale. A comprehensive dry eye evaluation was performed using the Oculus 5M Keratograph. A Pearson correlation coefficient was performed to determine correlation strength between House-Brackmann score and Meibomian gland atrophy. Meibographies were analyzed via ImageJ software to determine the affected area, and they were compared to the observer manual score. Cohen’s Kappa coefficient was calculated to compare agreement between manual and ImageJ meibography scoring.Results: Tear breakup time was reduced in the affected side (p = 0.21), tear meniscus height was much greater in the non-affected side (p = 0.02). Finally, Meibomian gland alterations were more evident in the affected side, with upper Meibomian glands having a loss of 29.55 ± 13.31% (p = 0.03) and lower glands presenting a loss of 44.44 ± 16.9% (p =< 0.001). Pearson correlation coefficient between House-Brackmann score and Meibomian gland atrophy was 0.841 (p < 0.001 [95% CI: 0.64– 0.94]). Cohen’s kappa coefficient was 0.643 (p < 0.001).Conclusion: A clear difference in Meibomian gland and tear film dynamics can be observed in paretic vs non-paretic sides. A greater House-Brackmann score was correlated with a greater Meibomian gland atrophy area. A strong positive correlation is seen between the House-Brackmann score and Meibomian gland atrophy. Software-based analysis also showed a greater glandular area loss when compared to clinician’s analysis. The level of agreement was moderate, so disparities are observed, especially in grade 2 Meibomian gland dropout where the least level of agreement was seen in cross tabulation. This study further incentivizes multimodal patient evaluation, which has been a growing area of interest in healthcare.Keywords: Meibomian gland dysfunction, facial palsy, meibography, dry eye disease, orbicularis oculi

Objective: To estimate the incidence of dry eye in post-operative patient undergoing cataract surgery. Materials and Methods: Schirmer’s test, tear break-up time (TBUT) test, and lissamine green staining of the cornea and conjunctiva for the evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery were performed on 100 patients with senile cataract. Results: The patients were 61.25 years old on average, and 71 (71%) of them were men. According to the requirements of our study, none of the patients experienced dry eyes at the time of participation. Schirmer’s test results during the first and second follow-ups, respectively, varied from 12-35 mm and 8-24 mm postoperatively. At the first and second follow-ups, the mean TBUT was 13.12 ± 2.44 and 9.61 ± 2.22 seconds, respectively, whereas the lissamine green staining score was 3 in 66 (66%) and 1 in 62 (62%) patients, respectively. At the initial follow-up, grade 2 dry eye was discovered in 89% of the 56 patients who received phacoemulsification (p 0.001) and in 92% of the 66 patients who underwent small-incision cataract surgery (SICS) (p 0.001). At the second follow-up, 83% of patients who had SICS and 93% of those who had phacoemulsification had grade 0 dry eyes, respectively (p 0.001). Conclusion: The incidence of dry eye following cataract surgery was significant and largely unrelated to demographic and anthropometric characteristics, surgical technique, length of microscope exposure, and energy input. This dryness was only temporary in character and exhibited a downward trend, with a tendency to return to normal by the end of 1 month.

Chung-Wei Lin,1,2,&ast; Yung-Chun Su,3 Jin-Dien Liu,2,4 Hsiao-Chun Su,5 Ting-Yi Chiang,6 Li-Wen Chiu,7 Hsin-Ching Lin,1,8– 11,&ast; Chun-Tuan Chang,9 Pei-Wen Lin7,8,10 1Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Department of Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 5School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 6Department of Urology, Chi Mei Medical Center, Tainan, Taiwan; 7Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 8College of Medicine, Chang Gung University, Taoyuan, Kaohsiung, Taiwan; 9Department of Business Management, Institute of Healthcare Management, National Sun Yat-Sen University, Kaohsiung, Taiwan; 10Institute of Biomedical Science, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; 11Sleep Center, Robotic Surgery Center and Center for Quality Management Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan&ast;These authors contributed equally to this workCorrespondence: Pei-Wen Lin, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, 123, Ta-Pei Road, Niao-Sung District, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 ext.2801, Fax +886-7-7777152, Email lpw324@cgmh.org.tw, lpw324@gmail.comAbstract: Obstructive sleep apnea (OSA) has been reported to influence the ocular surface and may lead to dry eye disease (DED). Continuous positive airway pressure (CPAP) is the first-line conservative treatment for OSA. However, CPAP might also have mask-related side effects that could deteriorate DED simultaneously. This study investigated the impact of OSA on DED (Aim 1), and CPAP on DED (Aim 2). Five databases were searched for articles published up to May, 2024. OSA severity, CPAP usage, and DED parameters, including tear breakup time (TBUT), Schirmer test, Ocular Surface Disease Index (OSDI), and Corneal Fluorescence Staining Score (CFS), were analyzed. For Aim 1, the random-effects model was used for meta-analysis, and the leave-one-out method was used for sensitivity analysis. For Aim 2, a narrative synthesis with critical appraisal of the literature was performed. Eleven studies with 1,526 patients for Aim 1 and three studies with 180 patients for Aim 2 were included. For Aim 1, OSA patients had poorer dry eye profiles of TBUT, Schirmer test, and OSDI when compared to non-OSA patients. For Aim 2, it seemed that those wearing CPAP for less than half a year did not have enough improvement in dry eye status. Instead, those wearing CPAP for at least a year reached greater therapeutic effects for OSA and DED. We concluded that OSA patients may suffer from poorer dry eye condition compared to non-OSA patients. Besides, wearing CPAP for long enough duration (at least 1 year) seemed to have better improvement in DED.Keywords: Obstructive sleep apnea, continuous positive airway pressure, dry eye disease, meta-analysis

Abstract Background Objectively compare the changes in ocular surface parameters in myopic patients who have undergone either SMILE or Implantable Collamer Lens (ICL V4c) surgery. Methods This prospective cohort study enrolled 32 patients (32 eyes) undergoing SMILE surgery and 35 patients (35 eyes) receiving ICL V4c intraocular lenses. Examinations were performed at preoperative, 1-week, 1-month, and 3-month postoperative time points. The assessments included Schirmer’s I Test (SIt), First Non-Invasive Break-Up Time (First-NIBUT), Average Non-Invasive Break-Up Time (Average-NIBUT), Tear Meniscus Height (TMH), Ocular Surface Disease Index (OSDI) score, conjunctival congestion score, meibomian gland loss score, lipid layer analysis score, lid margin opening detection score, and corneal fluorescein staining (CFS) score. Results Repeated measures ANOVA revealed that SIT, TMH, and First-NIBUT initially decreased and then increased. At three months, SIT levels in the SMILE group were significantly lower than those in the ICL group. From the first month onward, TMH levels in the SMILE group remained significantly lower than those in the ICL group (P

AIM: To quantify the severity and frequency of ocular pain in Tibetan plateau patients with dry eye, and to evaluate the related factors affecting ocular pain. METHODS: A retrospective study included 160 cases of dry eye disease (DED) patients who were treated from July 2022 to June 2023. Age, gender, occupation, illness course, anxiety, plateau duration, plateau protection, ocular surface disease index scale (OSDI), break-up time (BUT), Schirmer I test (SIT), conjunctivitis, history of ophthalmic medication, autoimmune disease, the workload of daily near vision range, smoking and overnight stay were obtained via comprehensive ophthalmic assessment, and their duration was followed up. Logistic regression analysis was used to determine the related factors affecting ocular pain. RESULTS: Totally 77.5% (124/160) of DED patients had ocular pain, of which the severity of ocular pain was mild, moderate, and severe in 30.0%, 36.3%, and 11.3% of patients, respectively. Frequency of ocular pain was reported occasional, half the time, frequent, and persistent pain in 19.4%, 36.9%, 16.9%, and 4.4%. OSDI score was 19.67±5.70 (13 to 36), and the level of pain was lowly correlated with OSDI (rs=0.316, P0.05). CONCLUSION: Ocular pain is a common complaint in high-altitude DED patients during the pandemic. Anxiety, eye protection, and adequate sleep during the epidemic period are significantly associated with the severity and frequency of ocular pain in patients with plateau DED, while symptoms of DED have relatively little influence on them.

Purpose: To study the ophthalmologic manifestations of systemic sclerosis (SSc) and its correlation with autoantibody profile. Methods: A cross-sectional study on 200 eyes of 100 consecutive adult patients diagnosed with SSc was performed at a tertiary care center in Northern India. The examination of ocular adnexa, anterior segment, and posterior segment with slit-lamp biomicroscopy, tear film break-up time (TBUT), Schirmer’s II test, and choroidal thickness measurement by swept-source ocular coherence tomography was done. Autoantibody profile was available for 85 patients, and its statistical association with the ocular examination findings was analyzed. Results: In total, 100 patients (93 females and 7 males) were included. The mean age was 45.11 ± 11.68 years, and the mean disease duration was 6.93 ± 3.68 years. Meibomian gland disease was more commonly found in patients with the diffuse subtype of SSc (P = 0.037). Choroidal thickness was increased in 34% and decreased in 7% (reference range = 307 ± 79 µm) patients. Reduced TBUT, meibomian gland dysfunction, and eyelid stiffness had a statistically significant association with the presence of anti-Scl-70 antibody (P = 0.003,

Abstract Objective The cross-sectional study was designed to evaluate the association of ocular surface inflammation with systemic conditions in patients with systemic lupus erythematosus (SLE). Methods The study enrolled 30 SLE patients and 30 controls. Ocular symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Tear samples from all participants were collected for tear multi-cytokine and chemokine concentration analysis. All participants were assessed for dry eye disease (DED), including Schirmer I test, tear break-up time (TBUT), corneal fluorescein staining (CFS), meibomian gland secretion (MGS), lid-parallel conjunctival folds (LIPCOF), corneal clarity, and symblepharon. Besides, all participants were also examined for conjunctival impression cytology to measure the density of conjunctival goblet cells (CGCs). The peripheral blood indicators from SLE patients were also collected to measure the SLE-associated autoantibody specificities and systemic inflammatory indicators. Pearson and Spearman’s analysis were uesd to examine the correlation between tear cytokines, CGCs, DED-related indicators, and systemic conditions. Results The two groups were matched for age and gender in this study. 36.67% of eyes (11 in 30) of SLE patients and 13.33% of eyes (4 in 30) of controls were diagnosed with DED. OSDI scores, abnormal TBUT percentages, CFS percentages, and DED grading were all higher in SLE patients than in control group, while density of CGCs was lower. There were no significant differences in Schirmer I test, MGS, LIPCOF, corneal clarity, and symblepharon between SLE patients and controls. The levels of tear chemokine (C-X-C motif) ligand 11 (CXCL11) and cytokine interleukin-7 (IL-7) in patients with SLE were significantly higher than those in control group. Moreover, among SLE patients, the severity of DED and the level of tear chemokine CXCL11 were significantly positively correlated with SLE-associated autoantibody specificities. Conclusion Dry eye and tear cytokines and chemokines-mediated ocular surface inflammation persist in SLE patients and are associated with systemic conditions. Therefore, it is necessary for patients with SLE to combine systemic and ocular assessments.

Hongyu Duan,1,&ast; Yifan Zhou,2,&ast; Baikai Ma,1,&ast; Rongjun Liu,3 Tingting Yang,4 Hongling Chu,5 Zejun Huo,6 Hong Qi1 1Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, People’s Republic of China; 2Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 3Department of Ophthalmology, Peking University First Hospital, Beijing, People’s Republic of China; 4Department of Ophthalmology, Guangdong Provincial People’s Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 5Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, People’s Republic of China; 6Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hong Qi, Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, 49 North Garden Road, Haidian District, Beijing, 100191, People’s Republic of China, Email doctorqihong@163.com Zejun Huo, Department of Traditional Chinese Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People’s Republic of China, Email huozejun@163.comBackground: Ocular pain is a prevalent symptom of dry eye disease (DED), which often accompanies potential psychological issues. The study aimed to explore whether acupuncture could improve ocular pain, mental state, and dry eye parameters in patients with DED.Methods: The non-randomized pilot study included 48 patients divided into two groups: the acupuncture group (n=27) and the 0.3% sodium hyaluronate (SH) group (n=21). Participants in the acupuncture group underwent treatments on six bilateral acupuncture points (BL1, BL2, ST1, LI 20, SI1 and SI3) 3 times per week for 4 weeks. Patients in the SH group received 0.3% SH 4 times per day for 4 weeks. Ocular pain was assessed using the numerical rating scale (NRS), and mental state was evaluated through the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Ocular surface parameters, concentrations of inflammatory cytokines, and corneal nerve morphological indicators were measured at baseline, the first week, and the fourth week. Randomization procedures were not used in this study, and outcome assessors and statistical analysts were blinded.Results: Compared with baseline, both NRS scores (from 5.91 ± 1.52 to 1.94 ± 1.57) and ocular surface discomfort index (OSDI) scores (from 49.75 ± 14.92 to 29.64 ± 18.79) were decreased after 1 and 4 weeks of treatment in both groups (all p < 0.05). At 4 weeks, the acupuncture group showed significant improvements, including increased tear break-up time (TBUT) and corneal perception, decreased SAS and SDS scores, and reduced concentrations of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α concentration in tears (all p < 0.05). These changes were not observed in the SH group (all p > 0.05).Conclusion: Acupuncture treatment could improve ocular surface characteristics in patients with DED, and more importantly, it alleviates their ocular pain and depressive state. The anti-inflammatory effect of acupuncture may be involved in this process. Future research with larger, randomized controlled trials (RCTs) is necessary to confirm these findings and clarify the mechanisms involved.Keywords: acupuncture, dry eye disease, ocular pain, depression, inflammatory cytokines

Dry eye disease (DED) is one of the most common eye problems in the aging population. Hyperosmolarity triggers the immune response in DED and consequently activates the self-perpetuating immune cycle, leading to chronic damage of the ocular surface. This event causes symptoms such as a burning sensation, irritation, redness, photophobia, and blurred vision in DED patients. Subsequently, the quality of life gets significantly affected. The rising demand for DED management and treatment solutions, and the desirable outcomes from innovative therapies that draw global interest provide evidence to demonstrate the role of diet and nutrition in DED. Nutritional deficiency and a Westernized diet contribute to the chronic systemic progression of DED symptoms. It has been revealed in several published studies that the use of nutrients and dietary supplements improves the ocular surface and acts as a protective factor against DED. - We reviewed nutrition and dietary aspects in managing DED and its associated consequences, based on published studies, and reached an evidence-based conclusion.

Tanner J Ferguson,1 Kristen Walton,2 John G Goertz,2 Brandon J Baartman2 1Vance Thompson Vision, Sioux Falls, SD, USA; 2Vance Thompson Vision, Omaha, NE, USACorrespondence: Tanner J Ferguson, Vance Thompson Vision, 3101 W. 57 th Street, Sioux Falls, SD, 57108, USA, Email tannerferg@gmail.comPurpose: To evaluate the use of varenicline solution nasal spray 0.03 mg (VNS) as a treatment option for the signs and symptoms of dry eye disease following photorefractive keratectomy (PRK).Patients and methods: Subjects electing to undergo PRK were randomized to VNS (study group) or vehicle (control group) twice daily and started treatment with VNS 28 days prior to surgery with continued use of the treatment for 84 days after PRK. After starting treatment, subjects were seen on the day of the procedure and postoperatively at days 2, 3, 4, 7, 28 and 84. The primary outcome measure was the mean change in NEI-VFQ-25, a dry eye item questionnaire, from baseline to day 84. The second primary outcome measure was the rate of corneal epithelial healing following PRK. Secondary outcome measures included eye dryness score (EDS), tear break up time and visual outcomes. The use of rescue therapy was also evaluated.Results: Twenty-one subjects were enrolled in the study group, and twenty subjects were enrolled in the control group. Results from the NEI-VFQ-25 questionnaire revealed positive results in both groups and the between-group difference was not statistically significant (P > 0.05). There was a trend towards faster re-epithelialization in patients treated with VNS vs placebo, where 100% epithelial closure was observed by Day 3 in the VNS group versus Day 4 in the control group; however, the between-group difference was not statistically significant (P > 0.05). Three subjects had rescue therapy in the control group while a single subject was rescued in the study group. A higher rate of eyes achieved vision of 20/16 or better in the study group (82.5%) versus the control group (72.5%) at 3 months.Conclusion: VNS is a favorable dry eye treatment option for patients following PRK, particularly in patients hoping to avoid additional topical medications or punctal occlusion. The higher percentage of eyes with UCDVA of 20/16 or better in the treatment group may suggest optimization of epithelial recovery after PRK.Keywords: dry eye disease, dry eye syndrome, varenicline, neurostimulation, ocular inflammation, ocular pain

Yilin Feng,1 Nandini Venkateswaran,1 Amanda Steele,2 Eric D Rosenberg,3 Preeya K Gupta2,4 1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; 2Triangle Eye Consultants, Raleigh, NC, USA; 3Department of Ophthalmology, New York Medical College, Valhalla, NY, USA; 4Department of Ophthalmology, Tulane University, New Orleans, LA, USACorrespondence: Preeya K Gupta, Email preeyakgupta@gmail.comPurpose: To evaluate the impact of TearCare (TC) treatment on clinical, quality of life, and functional visual outcome metrics in patients with dry eye disease (DED) and meibomian gland disease (MGD).Methods: This is a prospective, single-center clinical trial. Adults with MGD and a DED diagnosis and tear break-up time (TBUT) < 10 seconds were included. All subjects had at least 20/40 vision and no surgery or new treatment for DED within 60 days prior to enrollment. All patients had one baseline visit prior to undergoing TC and one follow-up visit 1 month after TC. At each visit, the meibomian gland secretion score (MGSS), TBUT, and corneal fluorescein staining (KFL) were assessed. DED symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Visual Function Questionnaire 25 (VFQ-25), and the Fatigue Severity Scale. Reading speed was determined through the International Reading Speed Texts (IReST), Minnesota Low Vision Reading Test (MNREAD), and Wilkins Rate of Reading Test (WRRT).Results: Thirty-two subjects were included. The average age was 55.9 years. Sixteen (52%) participants had a clinically significant improvement in reading speed after treatment with TC, defined as > 10 words per minute increase in their IReST score. Improvement on the IReST and the MNREAD reached statistical significance (p = 0.012 and p = 0.028, respectively). OSDI scores significantly decreased and VFQ-25 scores significantly increased after TC treatment (p < 0.001). All of the clinical exam parameters showed statistically significant improvements after treatment (p < 0.001).Conclusion: TC is an effective treatment both clinically and with respect to visual function. Patients who had TC exhibited improvements in quality of life and improved reading speed after a single treatment. This treatment should be frequently considered and utilized to reduce the disease burden of DED related to MGD.Keywords: thermal pulsation, tearcare, meibomian gland dysfunction, dry eye disease, reading speed