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Objective: To develop and validate a noninvasive method for measuring tear break-up time (NIBUT) using readily available materials and comparing it to the standard fluorescein tear break-up time (TBUT) assessment. Methods: A prototype xeroscope was made from an ordinary round plastic lid. At its inner lining, a fluorescent green sticker paper printed with black circular concentric grid pattern was fixed to simulate modified placido rings on the precorneal reflection. A central rectangular cut-out measuring 2 cm x 1 cm was made into the base frame serving as the viewfinder for the device through which the precorneal grid reflection was observed. A 30-LED blue light strip was fixed in the inner rim of the lid using a double-sided adhesive tape and was powered by a multivoltage AC-DC power adapter set at 6-volts at 350mA (2 watts). The prototype device was tested on fifty (50) patients (100 eyes), aged 21 to 65 years old, with no apparent ocular surface disorders and eyelid abnormalities. Measurement of NIBUT was done on both eyes using the prototype xeroscope followed by fluorescein TBUT measurement. The two values were compared and their correlation determined by linear-regression. Results: Fifty (50) patients (100 eyes) were enrolled into the study. The mean age was 48.52 years (range 21 to 62 years). The mean NIBUT for both eyes was 20.10 secs, ranging from 11.56 to 36.17 secs, and the mean TBUT was 18.70 secs, ranging from 10.20 to 30.40 secs. The mean difference between NIBUT and TBUT was 1.40 sec. Regression analysis revealed a strong positive linear correlation between the 2 measurements with a computed Rsquared value of 0.9697. Conclusion: The noninvasive technique using the prototype device provided a good alternative approach for measuring tear film stability without disturbing normal tear physiology and dynamics at a fraction of the cost of current commercially-available xeroscopes and tearscopes. [ABSTRACT FROM AUTHOR]

Sloan Rush,1,2 Cory J Pickett,1 Ryan B Rush2 1Department of Ophthalmology, Rush Eye Associates, Amarillo, TX, USA; 2Department of Surgery, Texas Tech University Health Sciences Center, Amarillo, TX, USACorrespondence: Ryan B Rush, Chosen Eye Mission, 8201 Valcour Dr, Amarillo, TX, 79119, USA, Tel +1-806-353-0125, Email Ryan.rush.md@gmail.comPurpose: To evaluate patient-reported outcomes in relation to dry eye symptoms following femtosecond LASIK (FS-LASIK).Methods: This study was conducted as a prospective, observational case series of patients undergoing bilateral myopic FS-LASIK at a single private practice institution. Enrolled patients were prospectively administered a standardized Dry Eye Symptom Index survey (analog score of 1 to 5 with 5 being the worst) prior to treatment and at 6-months after FS-LASIK. The following objective measurements were also recorded: objective scatter index (OSI), tear film osmolarity (TFO), and automated tear break-up times (TBUT).Results: There were 40 enrolled patients who underwent bilateral myopic FS-LASIK and completed the 6-month study period. The Dry Eye Symptom Index score improved from 2.3 (2.0– 2.6, 95% Confidence Intervals) prior to treatment to 1.3 (1.0– 1.5) at 6 months (p < 0.0001). Subset analysis of the subjective dry eye symptoms showed improvement in “grittiness” (p = 0.001) but not in “light sensitivity” or “soreness” (p = 0.13 and p = 0.24, respectively). There were no significant changes in the OSI, TFO, or TBUT measurements at 6 months (p > 0.05 for all), and there were no adverse events or complications during the study period.Conclusion: Patient-reported dry eye symptoms improve after 6 months following myopic FS-LASIK. This did not correlate with the objective dry eye measurement changes at 6 months.Keywords: LASIK, tear film osmolarity, tear break-up time, patient-reported outcomes, dry eye

Highlight: • Computer vision syndrome (CVS) that causes dry eyes becomes a health problem for college students. • Sodium hyaluronate eyedrops can be used as one of the CVS therapy strategies for students suffering from CVS. Abstract: The use of computers and mobile devices is increasing. Computers and mobile devices help our daily work or study. However, prolonged use of them may cause computer vision syndrome (CVS). Nowadays, CVS becomes a health problem for everyone working with computers or mobile devices including college students because it causes dry eyes. It may disrupt reading, doing professional work, or using a computer which is important for college students to complete academic tasks. Sodium hyaluronate can be used to overcome the dry eye problem due to CVS. To assess the effectiveness of sodium hyaluronate eyedrops on students suffering from CVS, pre- and post-administration of sodium hyaluronate was measured for two weeks. Inclusion criteria for this study were college students aged 20-35 years, using a computer for >2 hours a day, not using nonsteroidal anti-inflammatory drugs (NSAIDs), not consuming drugs, or having a disease that affects tear production and bearing no pregnancy. Parameters assessed include tear break-up time using the Tear Break-Up Time (TBUT) test, tear production using the Schirmer I test, the number of clinically subjective symptoms, and Ocular Surface Disease Index (OSDI) scores. Data were analyzed using student paired t-tests or Wilcoxon Rank Test. There were statistically significant differences before and after the TBUT (4.4 vs 6.7 seconds; p0.05), but there was a positive impact from moderate to mild dry eye. Sodium hyaluronate eyedrops can be used as one of the CVS therapy strategies for students suffering from CVS.

In this study, we aimed to investigate the effect of different hyaluronic acid (HA)-containing artificial tears on dry eye disease (DED) treatment in combination with intense pulsed light (IPL) therapy. A retrospective cohort study was conducted, and the participants received IPL therapy and HA-containing artificial tears. There were 42 and 40 eyes in the 0.10% and 0.15% HA groups after selection, respectively. The main outcomes were the postoperative non-invasive tear break-up time (NITBUT), Schirmer II test results, ocular surface stain, and numbers of DED-related symptoms. A generalized linear model was utilized to produce the adjusted odds ratio (aOR) and 95% confidence interval (CI) of the main outcomes between groups. At the three-month follow-up, the NITBUT was significantly higher in the 0.15% HA group (p = 0.023), and the NITBUT recovery was also significantly better in the 0.15% HA group compared to the 0.10% HA group (p = 0.039). The multiple DED-related symptoms significantly correlated with no DED symptom improvement in both the 0.10% and 0.15% HA groups (both p < 0.05), while the low pre-treatment NITBUT was marginally related to no DED symptom improvement in the 0.10% HA group (p = 0.047). A low NITBUT and Schirmer II test result correlated with no DED symptom improvement in both the groups (all p < 0.05). In conclusion, the application of 0.10% and 0.15% HA-containing artificial tears revealed similar effects to IPL therapy for DED.

The aim of this study is to survey the effectiveness of preservative-free artificial tears containing hyaluronic acid (HA) on post-cataract surgery dry eye disease (DED) prevention. A retrospective cohort study was performed, and patients that received cataract surgeries were divided into either an HA group or non-HA group depending on the artificial tear they used. A total of 37 and 74 eyes were enrolled into the HA and non-HA groups, respectively, after the selection. The primary outcomes are postoperative superficial keratitis and multiple (>3) DED symptoms. The generalized linear model was utilized to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI) of primary outcomes between the two groups. There were 10 and 2 episodes of superficial keratitis in the non-HA group and HA group, respectively, and the HA group demonstrated a significantly lower incidence of superficial keratitis (p < 0.001). Moreover, 13 and 5 patients developed multiple DED symptoms in the non-HA and HA groups, and the HA group illustrated fewer multiple DED symptoms (p = 0.024). The lower preoperative tear break-up time (TBUT) was correlated with superficial keratitis in the HA group (p = 0.043), while old age, low preoperative TBUT and ocular surface staining were associated with superficial keratitis in the non-HA group (all p < 0.05). Lower preoperative TBUT was correlated with multiple DED symptoms in the HA group (p = 0.020), while female sex, low preoperative TBUT and any DED symptoms were associated with multiple DED symptoms in the non-HA group (all p < 0.05). In conclusion, the usage of preservative-free artificial tears containing HA is associated with lower postoperative DED events.

Purpose: To assess the non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) after instilling the three different types of anesthetic eye drops by Oculus Keratograph 5M. Methods: In this prospective study, 85 healthy subjects (85 eyes) were randomly divided into three groups. The groups were randomly received lidocaine hydrochloride 2%, proparacaine hydrochloride 0.5%, and tetracaine hydrochloride 0.5%. The qualitative and quantitative parameters of tear film were assessed using NITBUT and TMH, respectively. In all groups, the quantity of tear film using TMH was measured in the right eye of subjects, while the quality of tear film using NITBUT was assessed in the left eye. The analysis of variance (ANOVA) was used to compare the difference between before and after the intervention. A P-value < 0.05 was considered significant. Results: Differences for TMH and NITBUT between before and after applying lidocaine hydrochloride 2% were not statistically significant (P > 0.05). The mean values of NITBUT and TMH after the instillation of proparacaine hydrochloride 0.5% showed a significant decrease than before the intervention (P < 0.05). Also, after the use of tetracaine hydrochloride 0.5%, the mean value of NITBUT was significantly increased (P < 0.05), but the mean value of TMH was significantly decreased than before the intervention (P < 0.05). Conclusion: Our study showed that lidocaine hydrochloride 2% as an anesthetic eye drops can be an appropriate choice for eye examinations due to a lack of significant effect on the quantity and quality of tear film. [ABSTRACT FROM AUTHOR]

AIM: To explore the difference of tear film stability among different lipid layer thickness.METHOD: A total of 194 dry eye patients(384 eyes)admitted to our hospital from June 2020 to December 2021 were enrolled in this study. The tear meniscus height, the first tear film break-up time and lipid layer thickness were measured by corneal topographer. The tear meniscus height and the first tear film break-up time among different lipid layer thickness were compared and the correlation between them was analyzed.RESULTS: The included patients(384 eyes)were divided into lipid rich group(49 eyes), lipid balance group(27 eyes), slight lipid deficiency group(266 eyes)and significant lipid deficiency group(42 eyes)according to the lipid layer thickness. The differences of the tear meniscus height were statistically different(P=0.022), while the differences of the first tear film break-up time were not statistically different(P=0.322). The lipid layer thickness was positively correlated with tear meniscus height(rs=0.143, P=0.006). There was no correlation between lipid layer thickness and the first tear film break-up time(rs=-0.090, P=0.083), nor was there correlation between tear meniscus height and the first tear film break-up time(rs=0.038, P=0.460).CONCLUSION: There was no significant difference in tear film stability in dry eye patients with different lipid layer thickness.

Gina Wesley,1 Katherine Bickle,2 Johnathon Downing,3 Bret Fisher,4 Brennan Greene,5 Colton Heinrich,6 David Kading,7 Shane Kannarr,8 Jason Miller,9 Satish Modi,10 David Ludwick,11 Joseph Tauber,12 Thao N Yeh,13 Sruthi Srinivasan14 1Complete Eye Care of Medina, Hamel, MN, USA; 2ProCare Vision Center, Granville, OH, USA; 3East West Eye Institute, Los Angeles, CA, USA; 4Eye Center of N Florida, Panama City, FL, USA; 5The Eye Care Institute, Louisville, KY, USA; 6Clarke EyeCare Center, Wichita Falls, TX, USA; 7Specialty Eyecare Group, Bellevue, WA, USA; 8Kannarr Eye Care LLC, Pittsburg, KS, USA; 9Insight Research Clinic, Powell, OH, USA; 10Alterman, Modi & Wolter, Poughkeepsie, NY, USA; 11Ludwick Eye Center, Chambersburg, PA, USA; 12Tauber Eye Center, Kansas City, MO, USA; 13Alcon Vision, LLC, Fort Worth, TX, USA; 14Alcon Research, LLC, Johns Creek, GA, USACorrespondence: Sruthi Srinivasan, Alcon Research, LLC, 11460 Johns Creek Parkway, Johns Creek, GA, 30097, USA, Tel +1 678 415 5315, Email sruthi.srinivasan@alcon.comPurpose: This study aimed to demonstrate the effectiveness of Systane iLux, a thermal pulsation device, in patients with MGD, over 12 months post-single treatment.Methods: This is a post-hoc analysis of a previous prospective, assessor-masked, parallel-group, multicenter study (NCT03956225) that compared the effectiveness and safety of iLux with LipiFlow in subjects with MGD. The original study included subjects with meibomian gland score (MGS) ≤ 12 in lower eyelids, Impact of Dry Eye on Everyday Life-Symptom Bother (IDEEL-SB) module score > 16, and non-invasive tear break-up time (NITBUT) < 10 seconds. Subjects were randomized (1:1) to receive a single bilateral treatment of iLux or LipiFlow. In this post-hoc analysis, mean changes in MGS, NITBUT (first break-up; seconds), IDEEL-SB module score, and corneal staining, from baseline to 12 months were analyzed post-single treatment with iLux.Results: Data from 119 patients (n=238 eyes) treated with iLux were analyzed. The mean±SD age of the subjects was 58.4± 13.4 years, with majority being female (79.0%). MGS (mean±SD) for both eyes improved significantly from baseline to 12 months (OD [baseline: 6.9± 3.69; month 12: 22.8± 11.31; change: 15.9± 11.57, p< 0.0001]; OS [baseline: 6.4± 3.66; month 12: 23.0± 11.33; change: 16.7± 11.40, p< 0.0001]). Similarly, significant improvements were observed in NITBUT (OD [baseline: 5.2± 1.97; month 12: 7.0± 3.68; change: 1.9± 3.69, p< 0.0001]; OS [baseline: 5.6± 1.96; month 12: 7.9± 4.58; change: 2.3± 4.59, p< 0.0001]) and IDEEL-SB score (p< 0.0001). Corneal staining reduced significantly from baseline to 12 months (OD [baseline: 2.1± 2.96; month 12: 0.7± 1.56; change: − 1.4± 2.65, p< 0.0001]; OS [baseline: 2.1± 2.94; month 12: 0.7± 1.44; change: − 1.4± 2.75, p< 0.0001]). Improvements in MGS, NITBUT, IDEEL-SB module score, and corneal staining were seen as early as week 2, and at months 1, 3, 6, and 9 (all p< 0.001).Conclusion: A single treatment with iLux significantly improved clinical parameters of MGS, NITBUT, and corneal staining, and patient-reported symptom assessment with IDEEL-SB in patients with MGD over 12 months.Keywords: corneal staining, meibomian gland dysfunction, meibomian gland score, tear break-up time

Per Graae Jensen,1 Morten Gundersen,1 Christian Nilsen,1 Kjell Gunnar Gundersen,1 Rick Potvin,2 Parisa Gazerani,3 Xiangjun Chen,4– 6 Tor P Utheim,3,4,7,8 Øygunn A Utheim4,7,8 1Ifocus Eye Clinic, Haugesund, Norway; 2Science in Vision, Bend, OR, USA; 3Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway; 4Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; 5Department of Ophthalmology, Sørlandet Sykehus Arendal, Arendal, Norway; 6Department of Ophthalmology, Vestre Viken Hospital Trust, Drammen, Norway; 7Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; 8The Norwegian Dry Eye Clinic, Oslo, NorwayCorrespondence: Per Graae Jensen, Ifocus Eye Clinic, Djupaskarvegen 64 b, Haugesund, 5561, Norway, Tel +47 906 13 685, Email per@ifocus.noPurpose: 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.Keywords: dry eye disease, cataract surgery, corneal fluorescein staining, ocular surface, osmolarity, non-invasive keratograph tear break up time, NIKBUT, meibomian gland dysfunction

Background: Deficiency of vitamin-D led to dry eye disease and its supplementations improves this condition.Aim of the work: This study aims to assess conjunctival impression cytology [CIC] and tear-film parameters in patients of vitamin-D deficiency [VDD], as well as how vitamin-D supplementation affects them.Patients and Methods: This prospective study included 20 participants [40 eyes] with serum vitamin D levels below normal, 20 control subjects [40 eyes] with normal serum vitamin D levels, and 20 participants [40 eyes] after treatment with supplementation of vitamin D. A thorough ophthalmological examination, tear break-up time [TBUT], Schirmer II test, and CIC tests were performed on each subject.Results: Regarding mean serum vitamin D levels [p< 0.001], TBUT scores [p< 0.001], and Schirmer II values [p< 0.001], there was a statistically significant difference among the groups. 65% of patients in the deficient group showed grades 2 or 3 impression cytology, compared to 30% in the control group and 25% in the post-treatment group, according to the Nelson staging system [p< 0.001].Conclusion: Our findings show that VDD causes dry eye, resulting in decreased tear film parameters, conjunctival squamous metaplasia, and loss of goblet cell, whereas vitamin D supplementation improves parameters of the tear film and impression cytology.

AIM: To investigate the efficacy of optimal pulse technology(OPT)in the treatment of demodex blepharitis and its influence on ocular surface function.METHODS: A retrospective study was conducted from February 2018 to October 2020. A total of 127 patients(254 eyes)with demodex blepharitis were assigned to the observation group and the control group according to the treatment method. The control group(63 patients, 126 eyes)were given conventional hot compress, eye cleansing and drug therapy. On this basis, the observation group(64 patients, 128 eyes)was treated with OPT. Both groups were given 6wk of continuous treatment. Demodex count, Marx's line scores, meibum character scores, ocular surface disease index(OSDI)scores, non-invasive tear break-up time(NIBUT), non-invasive tear meniscus height(NITMH)and lipid layer thickness(LLT)were compared between the two groups, and safety was evaluated.RESULTS: After 6wk of treatment, demodex count, Marx's line scores, meibum character scores and OSDI scores of the two groups decreased. NIBUT, NITMH and LLT increased. Meanwhile, demodex count, Marx's line scores, meibum character scores and OSDI scores of the observation group were significantly lower than those in the control group. NIBUT, NITMH and LLT were longer/larger than those in the control group(P

Background: Pterygium is an extra-ocular disorder related to progressive subepithelial growth of degenerative conjunctival tissue over the cornea. There are multifactorial causes that lead to the growth of pterygium. The tear film becomes unstable due to the degenerative growth of the conjunctiva. The tear film is divided into three different layers. The lipid layer is secreted by the meibomian gland, which is the exterior layer exposed to the environment and prevents tears from drying out too rapidly. The lacrimal gland releases the middle layer, the aqueous layer, which provides oxygen to the corneal epithelial layer. The goblet cells secrete mucus, the innermost layer that makes the corneal epithelium hydrophilic. Due to uneven wettability brought on by the progression of pterygium, the tear film becomes unstable and may damage the ocular surface. It has been found that pterygium excision increases tear film stability. According to a study, the incidence of pterygium in central rural India is 12.9%. Incidence increases with age, gender, and occupation. Methods: The patients with pterygium will be divided into two groups for the pterygium excision surgery: Group 1 consists of patients in which conjunctival autograft will not be done after pterygium excision, and Group 2 consists of patients in which conjunctival autograft will be done after pterygium excision. Preoperatively and postoperatively, visual acuity was assessed in all the patients on day 1, 4 weeks, and 8 weeks on follow-up. Tear film evaluation was done through Tear film Break Up Time (T-BUT) and Schirmer’s Test in patients preoperatively and postoperatively on day 1, 4 weeks, and 8 weeks follow up. CTRI Registration: REF/2023/07/071130 (30/07/2023) Protocol version: v1 dated 7/08/2023

Background: It is difficult to standardize assessment of dry eye in different clinical settings. Increasingly, tear stability is recognized to be important for the definition and assessment of patients with dry eye. Recently, two commercially available instruments have been made available for objectively measuring noninvasive tear break-up time (NIBUT), as an indicator of tear stability: the Tomey RT-7000 Auto Refractor-Keratometer and Oculus Keratograph (K)5M. We aim to assess the agreement of NIBUT measurements using these modalities. Methods: This prospective cross-sectional study was carried out in a tertiary referral eye center and involved 126 consecutive dry eye patients. NIBUT assessment was performed on the right eyes of participants with both the RT-7000 and the K5M techniques, with the order of assessment randomized. The Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaires were administered to assess dry eye symptoms in the 2 weeks before assessment. Results: The age of the participants was 56.0±14.3 years (69.84% females). Measurements for both modalities were non-normally distributed (right-skewed). The median RT-7000 and K5M readings were 4.2 (range 0.1-10.0) and 6.4 (0.1-24.9) seconds, respectively. RT-7000 and K5M readings were poorly correlated (ρ=0.061, P=0.495). Intraclass correlation coefficient between the modalities was 0.187 (95% confidence interval -0.097 to 0.406). The Bland-Altman plot showed no systematic differences between the readings with these machines. The agreement between machines was not different in different SPEED categories. Conclusion: While there are theoretical and practical benefits of NIBUT for assessment of tear stability over dye-based methods, the agreement between the two modalities was poor. Hence, studies and trials assessing NIBUT should avoid using these modalities interchangeably for NIBUT assessment. More research is needed to improve consensus on how to determine NIBUT. [ABSTRACT FROM AUTHOR]

Lacrimal and meibomian glands contribute to the aqueous and lipid components of tear film, respectively. Their evaluation remains central to diagnosing and managing dry eye disease (DED). The review discusses the differences and reliability of various diagnostic tests and commercially available devices used for DED diagnosis. Slit-lamp-based techniques are direct palpebral lobe and tear flow assessment, Schirmer test, meibum quality and expressibility, and evaluation of tear meniscus height. Non-invasive tear meniscus height (TMH), tear break-up time (TBUT), lipid layer thickness (LLT), and meibography are machine-based diagnostic tests. The structure–function correlation of the tear-producing glands gives more comprehensive details than either information alone. Many devices are available in the market, which make DED diagnosis an easy feat, but the tests should be interpreted keeping in mind the intra-observer and inter-observer repeatability. Also, the tear film displays a huge variability as per the environmental conditions and impact of blinking. Hence, the examiner should be well versed with the techniques and repeat the test two to three times to obtain an average reading, which is more reliable. The recommended sequence of tests for diagnosing DED is a dry eye questionnaire, TMH, LLT, NIBUT (FBUT if non-invasive test is unavailable but should be performed after osmolarity), tear osmolarity, meibography, and ocular surface staining. Invasive tests such as Schirmer should be performed after the non-invasive tear film diagnostic testing.

Purpose: This present prospective, cross-sectional study aims to comprehensively evaluate the ocular surface in asymptomatic patients with diffuse blebs after trabeculectomy versus chronic anti-glaucoma medication use and compare it with the age-matched normal population. Methods: Objective clinical evaluation was done by tear film break-up time (TBUT) and Schirmer's test (ST) in the three groups–trabeculectomy >6 months with a diffuse bleb (Wurzburg bleb classification score ≧10), chronic anti-glaucoma medication (AGM >6 months) group, and normal population. In all groups, tear film osmolarity was checked with the TearLab® device (TearLab Corp., CA, USA), and subjective evaluation was performed by administering Ocular Surface Disease Index (OSDI) questionnaire. Patients already on chronic lubricants or any other drug for the treatment of dry eyes (viz. steroids, cyclosporin) or having symptoms suggestive of an abnormal ocular surface, who had undergone refractive or intraocular surgery, and contact lens users were excluded. Results: In total, 104 subjects/eyes were recruited over 6 weeks. Thirty-six eyes recruited in the trab group were compared with 33 eyes studied in the AGM group, and both these groups were compared to 35 normal eyes. When compared to normals, TBUT and ST were significantly lower (P = 0.003 and 0.014) and osmolarity and OSDI were statistically significantly higher (P = 0.007 and 0.003) in the AGM group, whereas only TBUT was statistically significantly different (P = 0.009) when the trab group was compared to normals. Also, when the trab group was compared to the AGM group, ST was found to be higher (P = 0.003) and osmolarity was lower (P = 0.034). Conclusion: To conclude, ocular surface is affected even in asymptomatic patients on AGM but near normalcy is possible following trabeculectomy when blebs are diffuse.

Purpose: Dry eye disease (DED) is because of a decrease in the tear film's volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED. Methods: A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break-up time (TBUT) and Schirmer's test (SCH I and II). Meibomian gland morphology was examined with a slit-lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non-contact meibography using an auto refracto-keratometer (ARK). Results: Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence. Conclusion: TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.

This study aimed to investigate the effect of palpebral fissure height in primary gaze position in healthy individuals on tear film stability. In this cross-sectional study, 120 subjects (60 male and female each) were enrolled and divided according to age into two groups, i.e., group 1 (aged 18-50 years) and group 2 (aged 51 and older). Palpebral fissure height on both eyes was measured in primary gaze position with a clear plastic ruler held in a central vertical position between the upper and lower lid margin, and the standard tear break-up time (TBUT) test was performed to evaluate tear film stability. Palpebral fissure height was significantly higher in younger than older subjects in all measurements on both eyes (p

Objectives:To compare dry eye parameters in prolactinoma patients and healthy controls and evaluate their correlation with prolactin (PRL) levels and the duration of hyperprolactinemia.Materials and Methods:Consecutive patients with prolactinoma and healthy controls were included in the study. Schirmer, tear break-up time (TBUT), tear osmolarity values, and ocular surface disease index (OSDI) scores were evaluated for each patient. Follow-up time and total duration of hyperprolactinemia were recorded for prolactinoma patients.Results:The study included 39 eyes of 39 patients with prolactinoma and 39 eyes of 39 age- and gender-matched healthy controls. Prolactinoma patients showed lower Schirmer (14.1±8.4 vs. 24.8±8.9 mm; p

Objective indicator of tear film stability in diagnostic DED. A novel smartphone attachment, namely SEC (smart eye camera), could mimic conventional slit lamp to assess TBUT and beneficial in facilitating DED diagnosis. Reliability between a non and an ophthalmologist in TBUT assessment and DED diagnosis is observed in this study.Purpose: To determine interobserver reliability of TBUT measurement for diagnosing DED using SEC.Design: This a cross-sectional analytic study involving 99 participants (198 eyes) aged 40 years who visited Pratama Gema Santi Hospital, Nusa Penida, from September 2nd to 4th, 2022, with consecutive sampling technique.Methods: Fluoresceined eyes were filmed using the SEC device and apps, continued by masked ophthalmologist and resident assessing TBUT based on the video. The primary outcome is interobserver reliability for TBUT measurement and DED diagnosis.Results: The mean age of participants was 55.22± 9.78 years, 48.5% male and 51.5% female. The reliability of interobserver in assessing DED based on TBUT test is 0.78 (95% CI=0.31– 1.26, P-value=0.001), and interobserver reliability in diagnosing DED based on OSDI and TBUT showed good agreement (weighted kappa=0.71). Good interobserver reliability underscores that non-ophthalmologists can diagnose DED based on TBUT video using SEC.Conclusion: SEC video has good interobserver reliability to assess TBUT for DED diagnosis. SEC can be used as one of the methods in assessing DED in limited health care facilities. The high reliability of interobserver assessment indicates that DED diagnosis using video taken with SEC may be useful for telemedicine evaluation in remote areas. [ABSTRACT FROM AUTHOR]

PurposeTo evaluate the distribution of various Meibomian gland morphologies across different age groups in healthy individuals.MethodsThe infrared meibographic morphologies of the Meibomian glands from the upper and lower eyelids of 236 healthy individuals (472 eyes; mean age 38.4 ± 17.5 years; 80 female participants: 156 male participants) were evaluated for their prevalence and differences across six decades of life, from 10 to 80 years. A linear mixed-effects modeling test was performed for statistical analysis.ResultsOf 14,452 glands, 8,830 (61%) glands were located in the upper eyelid. No significant differences in frequency were noted between different age groups for distorted, tortuous, hooked, overlapping, abnormal gap, fluffy areas, dropout (except for 51–60 vs. 10–20 years, P = 0.023), and thick and thin morphologies. Short glands were significantly more common in individuals aged over 30 years (P = 0.015), whereas moderately short and severely short glands were more common in the upper eyelids of individuals older than 50 years compared to those aged 10–20 years (P = 0.035). The frequency of distorted, hooked, tortuous, overlapping, and tadpole-shaped Meibomian glands was significantly higher in the upper eyelids than in the lower eyelids for all age groups. Dropout glands were more common in the lower eyelids of individuals younger than 50 years, but no difference was observed in the upper and lower eyelids of individuals over 50 years. Dropout (P = 0.006) and severely short glands (0.026) of the lower eyelid were associated with low non-invasive tear break-up time (NIBUT) values.ConclusionVarious morphologic characteristics of the Meibomian glands that are considered abnormal can be present in healthy individuals, and only moderate to severely short glands display an increase in abnormal morphologic characteristics of the Meibomian glands with age.

The aim of this retrospective chart review study was to evaluate the 5-year trend of ocular surface examination results in participants who visited the eye clinic from 2015 to 2019, underwent corneal and lacrimal examinations, refraction, and intra-ocular pressure measurements, and reported six dry eye-related symptoms. A total of 1468 patients were analyzed. Tear break-up time (BUT) decreased continuously for five consecutive years: 4.76 ± 1.84 s in 2015, 4.57 ± 1.70 s in 2016 (p = 0.999, vs 2015), 4.35 ± 2.06 s in 2017 (p = 0.662), 3.83 ± 2.18 s in 2018 (p < 0.001), and 3.63 ± 2.10 s in 2019 (p < 0.001). The decrease of BUT was more prominent in women than men (p < 0.001) and the correlation coefficient between calendar year and BUT was greater in women than men (p = 0.002). Schirmer test value, strip tear meniscometry value, and corneal staining score did not exhibit significant changes. Prevalence of blurring, photophobia, and pain increased toward 2019 among symptoms surveyed (eye fatigue, blurring, photophobia, dryness, irritation, and pain) and regression analysis indicated blurring (p < 0.001), photophobia (p < 0.001), and pain (p < 0.001) were correlated with BUT. In conclusion, BUT decreased continuously for five consecutive years from 2015 to 2019 and was associated with dry-eye related symptoms. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship between tear ferning patterns (TFP) and non-invasive tear break-up time (NIBUT) in normal Asian subjects., Methods: One hundred and forty-five adults with no ocular surface disorders were recruited. TFP and NIBUT were determined. Tears were collected using a capillary tube and allowed to air dry at room temperature for 10min. TFP was later observed using a light microscope and classified according to Rolando's classification. Measurement for NIBUT was obtained using a Tearscope with the slit lamp magnification., Results: It was found that there is no significant difference between gender in TFP (Z=-1.77, P>.05) and NIBUT (Z=-1.475, P>.05). There is also no significant difference between Malay, Chinese, Indian, and other races in TFP, (H(3)=4.85, P>.05) and NIBUT (H(3)=2.18, P>.05). However, there is a significant difference between age groups of 20-29, 30-39, 40-49,and 50-60 years old in both TFP (H(3)=28.25, P<.01) and NIBUT (H(3)=36.50, P<.001). Spearman's correlation showed there was a significant relationship between TFP and NIBUT (r=-0.55, P<.001), age and NIBUT (r=-0.50, P<.001), age and TFP (r=0.41, P<.001), McMonnies score and NIBUT (r=-0.40, P<.001), McMonnies score and TFP (r=0.31, P<.001), as well as age and McMonnies score (r=0.52, P<.001)., Conclusion: TFP and NIBUT was age dependent but not gender and race dependent. Older subjects had higher grade of TFP and McMonnies questionnaire score but lower NIBUT value. TFP and NIBUT can be used to assess the tear film quality., (Copyright © 2015 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.)

Abstract Background To compare the Ocular surface disease index (OSDI) score, Schirmer I test (SIT), fluorescein break up time (FBUT) and fluorescence staining (FLCS) score of dry eye patients at different ages. Methods 90 eyes of 90 patients with mild to moderate dry eye from September 2020 to September 2021 were retrospectively included and were divided into young group (20–39 years, n = 29), middle-age group (40–59 years, n = 30), and elder group (> 60 years, n = 31). Patients were given a 28-day topical lubricating ocular surface and repair-promoting drugs combined with local physical therapy. Patients were followed up at 7, 14 and 28 days. The OSDI score, SIT, FBUT and FLCS score were examined. Results There were differences between the OSDI score in three groups at each time point (all P