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Purpose: To assess the prevalence of dry eye disease (DED) and Meibomian gland dysfunction (MGD) in a very old population. Methods: The Ural Very Old Study (UVOS), a population‐based cohort study performed in rural and urban Bashkortostan/Russia, included 1526 (81.1%) out of 1882 eligible individuals aged 85+ years. The participants underwent a detailed medical and ophthalmological examination including Schirmer´s test, slit‐lamp based assessment of the Meibomian glands and an interview. Results: The study included 1493 (97.8%) individuals with available information about DED (mean age: 88.3 ± 2.9 years). Schirmer´s test was ≤5 mm in 388 individuals (34.3%; 95% confidence interval (CI): 31.5, 37.1), and the mean score of subjective dry eye symptoms was 7.52 ± 2.14 (median: 6; range: 6–18; 95%CI: 7.41, 7.63). An MGD grade 1, 2, 3 and 4 was diagnosed in 367 (31.4%), 309 (26.4%), 89 (7.6%) and 39 (3.3%) eyes, respectively. The prevalence of DED diagnosis definition #2 (dry eye score ≥8, Schirmer´s test ≤5 mm) and definition #4 (dry eye score ≥7, Schirmer test ≤5 mm, MGD grade 1+), were 164/1132 (14.5%; 95%CI: 12.4, 16.5), and 167/1131 (14.8%; 95%CI: 12.7, 16.8), respectively. In multivariate analysis, higher DED prevalence was associated with female sex (odds ratio (OR): 2.36; 95%CI: 1.18, 4.71; p = 0.02), rural region of habitation (OR: 2.72; 95%CI: 1.10, 6.70; p = 0.03), longer axial length (OR: 1.30; 95%CI: 1.04,1.62; p = 0.02), higher hearing loss score (OR: 1.03; 95%CI: 1.01, 1.05; p = 0.001) and lower self‐reported salt consumption (OR: 0.64; 95%CI: 0.54, 0.75; p < 0.001). Conclusions: In this population‐based recruited very old study sample aged 85+ years, higher DED prevalence (dry eye score ≥8, Schirmer´s test <5 mm; mean: 14.5%) and MGD prevalence (any grade:68.8%) was associated with female sex, rural region of habitation, longer axial length, higher hearing loss score and lower salt consumption. [ABSTRACT FROM AUTHOR]

Purpose: To observe the changes of the ocular surface and meibomian glands by non-contact meibography in patients with type 1 diabetic children. Methods: A total of forty-three patients with type 1 diabetic children and 43 age-matched healthy subjects were included in the study. The ocular surface disease index (OSDI) questionnaire, invasive tear film break-up time (TF-BUT), fluorescein staining of the ocular surface and Schirmer II test were performed for all participants. Ocular surface and lid margins were evaluated by slit lamp. Non-contact meibography was performed with the Phoenix-Meibography module in Sirius corneal topographic device. Results: Both groups consisted of 25 (58.1%) female and 18 (41.9%) male children and the mean age was 14.4 ± 2.5 years. In the T1DM group, the mean disease duration was 6.8 ± 3.1 years. The mean TF-BUT (p = 0.002) and Schirmer II test (p = 0.007) measurements were lower in the diabetic group than those of in controls. Total eyelid score (p = 0.027) and meibomian gland (MG) secretion score (p = 0.007) were significantly high in diabetic children. MG area loss was also significantly high in both lower and upper eyelid (p < 0.001). In morphological analyses of meibomian glands thinning, shortening and presence of ghost areas (p = 0.05, p = 0.027 and p = 0.000, respectively) were more common in the diabetic group. There was no correlation between both lower and upper eyelid meiboscores and disease duration (p = 0.51 and p = 0.61), BMI (p = 0.08 and p = 0.51), serum HbA1c level (p = 0.06 and p = 0.49) and IGF-1 SDS (p = 0.38 and p = 0.68). Conclusion: The study revealed that the MG loss area increases and morphological alterations of meibomian glands occur in type 1 diabetic children. Disease duration and metabolic control of diabetes do not affect meibography measurements. Clinical trials registration: The study was organized in accordance with the ethical standards settled by the Ethics Committee of Faculty of Medicine, Afyonkarahisar Health Sciences University. Trial registration number: 2011-KAEK-2, 2021/106. Trial registration date: 02.05.2021. [ABSTRACT FROM AUTHOR]

Objective: The tear miRNAome of the male NOD mouse, a model of ocular symptoms of Sjögren's syndrome (SS), was analyzed to identify unique miRNAs. Methods: Male NOD mice, aged 12-14 weeks, were used to identify tear miRNAs associated with development of autoimmune dacryoadenitis. Age- and sex-matched male BALB/c mice served as healthy controls while age-matched female NOD mice that do not develop the autoimmune dacryoadenitis characteristic of SS were used as additional controls. Total RNA was isolated from stimulated tears pooled from 5 mice per sample and tear miRNAs were sequenced and analyzed. Putative miRNA hits were validated in additional mouse cohorts as well as in tears of SS patients versus patients with another form of dry eye disease, meibomian gland disease (MGD) using qRT-PCR. The pathways influenced by the validated hits were identified using Ingenuity Pathway Analysis. Results: In comparison to tears from both healthy (male BALB/c) and additional control (female NOD) mice, initial analy1sis identified 7 upregulated and 7 downregulated miRNAs in male NOD mouse tears. Of these, 8 were validated by RT-qPCR in tears from additional mouse cohorts. miRNAs previously implicated in SS pathology included mmu-miR-146a/b-5p, which were significantly downregulated, as well as mmu-miR-150-5p and mmu-miR-181a-5p, which were upregulated in male NOD mouse tears. All other validated hits including the upregulated miR-181b-5p and mmu-miR-203-3p, as well as the downregulated mmu-miR-322-5p and mmu-miR-503-5p, represent novel putative indicators of autoimmune dacryoadenitis in SS. When compared to tears from patients with MGD, miRNAs hsa-miR-203a-3p, hsa-miR-181a-5p and hsa-miR-181b-5p were also significantly increased in tears of SS patients. Conclusions: A panel of differentially expressed miRNAs were identified in tears of male NOD mice, with some preliminary validation in SS patients, including some never previously linked to SS. These may have potential utility as indicators of ocular symptoms of SS; evaluation of the pathways influenced by these dysregulated miRNAs may also provide further insights into SS pathogenesis. [ABSTRACT FROM AUTHOR]

Outcome measures used to assess efficacy of dry eye therapeutics have not been consistently applied in clinical settings, nor have they been shown to correlate with functional outcomes. We propose that corneal staining, a clinically meaningful dry eye parameter, should be used as a standard objective outcome measure across all clinical trials evaluating dry eye treatments. We justify this based on evidence regarding its relationship to vision and vision related quality-of-life. In addition, corneal staining has been shown to correlate with ocular surface inflammation, a well elucidated aspect of dry eye pathophysiology and an active area in therapeutics research. No one outcome measure explored herein correlates perfectly to this heterogenous disease. However, there is mounting evidence showing the correlation between corneal staining and functional visual indices. We hope that future clinical trials will standardize corneal staining as a measure to determine the efficacy of interventions and justify their clinical utility. [ABSTRACT FROM AUTHOR]

Introduction: Meibomian gland dysfunction (MGD) is a common eye condition that causes excessive evaporation of tears by changing the tear film composition. Current treatments often fail to produce satisfactory results, which is mostly due to poor patient adherence. This study aimed to evaluate the effectiveness and safety of the MiBoFlo Thermoflo® on both subjective symptoms and objective signs in Chinese patients with MGD. Methods: This prospective, randomized, controlled clinical trial included 108 eyes of 54 patients with MGD who were recruited in Beijing Tongren Hospital and randomized 1:1 to MiBoFlo (n = 54 eyes) or LipiFlow® (n = 54 eyes) treatment group. In the MiBoFlo group, patients received three 10-min treatments, each spaced 2 weeks apart, and the treatment was followed by eyelid compression each time. Patients in the LipiFlow group received a single 12-min treatment. The primary parameters measured included changes in Ocular Surface Disease Index (OSDI) score, Meibomian Glands Yielding Liquid Secretion (MGYLS) score, and Meibomian Glands Secretion (MGS) score from baseline to 2 months. The secondary parameters included tear meniscus height (TMH), non-invasive keratograph break-up time (NIKBUT), corneal fluorescein staining (CFS), and meibomian glands (MG) loss from baseline to 2 months. Safety parameters include visual acuity (VA), intraocular pressure (IOP), anterior segment, and facial skin. Results: The OSDI, MGYLS, and MGS scores all improved from baseline to 1 month in both MiBoFlo and LipiFlow groups, and these improvements were maintained at 2 months. CFS score, NIKBUT, and MG loss showed no significant change in both groups. Conclusion: As a portable and comfortable device, MiBoFlo can improve the treatment of MGD and achieve a sustained improvement in both symptoms and meibomian gland function lasting at least 2 months. [ABSTRACT FROM AUTHOR]

Background: To study the effects of aerobic exercise (AE) on tear secretion and tear film stability in dry eye patients.Methods: This study consisted of two parts, each part included 3 groups, namely dry eye without AE group, dry eye with AE group and pre-clinical dry eye with AE group. In part 1, we studied the variations of Schirmer I test and six tear compositions before and after AE (34 eyes in each group). In part 2, we studied the variations of tear meniscus height, first and average non-invasive tear breakup time (F-NITBUT and A-NITBUT), lipid layer thickness, number of incomplete and complete blinks, partial blink rate (PBR) and visual acuity before and after AE (30 eyes in each group).Results: In dry eye with AE group, Schirmer I test at 0 min after AE increased significantly compared to baseline (P < 0.001), the oxidative stress marker 8-hydroxy-2'-deoxyguanosine after AE decreased significantly compared to baseline (P = 0.035, P = 0.045), F-NITBUT and A-NITBUT after AE prolonged significantly compared to baseline (P < 0.001, P = 0.007, P = 0.036; P < 0.001, P = 0.001, P = 0.044), number of incomplete blinks and PBR at 10 min after AE decreased significantly compared to baseline (P < 0.001; P < 0.001) while number of complete blinks increased significantly (P < 0.001). Besides, significant differences were also found between dry eye with AE group and dry eye without AE group at all above corresponding time point (P < 0.05).Conclusion: AE promotes tear secretion and improves tear film stability in dry eye patients. AE may be a potential treatment for dry eye.Trial Registration: Chinese Clinical Trial Registry, ChiCTR2000038673 . Registered 27 September 2020. [ABSTRACT FROM AUTHOR]

Background: To compare the effect of two different prostaglandin analogues (Travatan® vs. Xalatan®) on ocular surface parameters. Methods: This study includes 44 eyes of 44 patients with newly diagnosed primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Patients were randomly divided into two groups and treated with either benzalkonium chloride (BAK)-preserved latanoprost and polyquad-preserved travoprost. Changes in intraocular pressure (IOP) levels and ocular surface parameters including ocular surface disease index (OSDI) questionnaire, tear breakup time (TBUT), ocular surface staining scores, and Schirmer test scores of patients were performed at baseline, 1, 3, 6, and 12 months of treatment and compared. Results: The age, sex ratio, visual acuity, central corneal thickness, and cup/disc ratio were similar between the groups. A decrease in IOP levels (23.3 ± 2.5 to 15.5 ± 2.3), TBUT (5.5 ± 2.3 to 4.1 ± 1.7 s), Schirmer test values (11.3 ± 5.9 to 8.6 ± 4.7 s), and a worsening in OSDI scores (44.6 ± 15.2 to 55.1 ± 13.1) and staining scores (1.7 ± 1.6 to 2.3 ± 1.8) were observed in all patients in the first month of treatment (p < 0.05, for all). No further worsening was detected during the 1-year follow-up. There was no difference between the groups in terms of alterations in IOP levels and ocular surface parameters. Conclusion: Travatan® and Xalatan® have a similar effect on IOP levels and ocular surface parameters in patients with POAG and OHT. [ABSTRACT FROM AUTHOR]

Purpose: To provide estimates for the prevalence of dry eye disease globally and in sub‐groups defined by: diagnostic criterion, sex, geographic location and age, using a Bayesian approach. Methods: Modelling prevalence as a Beta distribution, estimates were inferred from Bayesian posterior distributions obtained by combing an uninformed prior with likelihood functions generated from all relevant studies reporting dry eye prevalence between 1997 and 2021. Results: Global prevalence of dry eye disease was estimated at 11.59% (standard deviation (SD) = 0.04). For symptomatic disease, the estimate was 9.12% (SD = 0.04), with women 9.5% (SD = 0.05) and men 6.8% (SD = 0.06); prevalence was lowest in North America, 4.6% (SD = 0.03) and highest in Africa, 47.9% (SD = 1.8). For signs, prevalence was 35.2% (SD = 0.3), with woman 34.7% (SD = 0.7) and men 37.6% (SD = 0.7); North America showed the lowest regional prevalence, 3.5%, (SD = 0.4) with Eastern Asia the highest, 42.8% (SD = 0.4). Using TFOS DEWS II diagnostic criteria resulted in a global prevalence of 29.5% (SD = 0.8), with women 28.1% (SD = 1.2) and men 24.9% (SD = 1.4). Prevalence was lowest during the fifth decade, increasing approximately linearly with age thereafter. Estimates for other categories are given in accompanying tables. Conclusion: A simple, flexible, yet powerful means of combining data from multiple sources to yield prevalence estimates across a range of circumstances is described, that is compatible with published guidelines for conducting meta‐analysis. Estimates can be readily updated as new information emerges, or according to need. Understanding the specific characteristics of studies chosen for inclusion is critical to the validity of the outcome. Although dry eye disease is evidently common, affecting about one in 11 people world‐wide, data are sparse for the young and all geographical locations except Eastern Asia. [ABSTRACT FROM AUTHOR]

Copyright of Türkiye Klinikleri Journal of Ophthalmology is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de la Facultad de Medicina de la UNAM is the property of UNAM, Facultad de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This study aimed to develop a Thai version of the Dry Eye-Related Quality-of-Life Score (DEQS-Th) questionnaire and evaluate its validity, reliability, and feasibility among Thai participants.Methods: The DEQS-Th, a 15-item self-report measuring dry eye and its impact on quality of life (QOL) was developed based on the DEQS. The questionnaire was divided into two subscales: Bothersome Ocular Symptoms (six questions), and Impact on Daily Life (nine questions). It employed a 5-point Likert scale, addressing on both the frequency and the degree of symptoms. Backward and forward and cultural adaptation process translation methods were employed. Thirty healthy participants were enrolled to evaluate the feasibility of the DEQS-Th in terms of difficulty and convenience. Reliability was assessed using internal consistency determined by Cronbach's alpha, with values > 0.7 considered acceptable. Convergent validity was determined by the correlation between DEQS-Th and overall health status. Confirmatory factor analysis was conducted for its factor structure.Results: The participants' mean age was 38.6 ± 12.9 years, and 23 (76.7%) were females. The mean time to complete the questionnaire was 9.3 ± 2.7 min. The Cronbach's alpha of the ocular symptoms subscale, impact on QOL subscale, and summary score on frequency and degree were 0.80 and 0.70, 0.89 and 0.89, and 0.90 and 0.89, respectively. The overall health status significantly correlated with the summary score (r = 0.564, p = .001), subscale ocular symptoms (r = 0.594, p = .001), and impact on QOL scores (r = 0.626, p < .001) of the DEQS-Th, respectively. A one-factor model fitted the data the best for both the ocular symptoms subscale (CFI = 1.000, TLI = 1.000, RMSEA = 0.000) and the impact on QOL subscale (CFI = 0.998, TLI = 0.997, RMSEA = 0.053).Conclusion: When tested among normal participants, the DEQS-Th is a valid and reliable measurement for dry eye symptoms and impact on QOL. [ABSTRACT FROM AUTHOR]

Objective: Sjögren syndrome (SS) is a common autoimmune disease primarily affecting the eyes and mouth. With no single gold standard test for its diagnosis, accurate identification of patients with SS continues to be challenging. We aimed to assess the correlation of ocular and oral symptoms of dryness with objective measures in order to evaluate reliability in the screening of primary SS (pSS) in clinical practice.Methods: We conducted a cross-sectional analysis of pre-screened pSS and sicca control patients assessed in the Multidisciplinary Sjögren's Clinic at the University Health Network in Toronto. The signs, symptoms, and objective measure of oral and ocular dryness and damage of each patient were prospectively recorded using a standardized protocol.Results: Subjective measures of severity for xerophthalmia and xerostomia correlated in general with objective severity. Oral symptoms tend to have a stronger correlation with objective findings than ocular symptoms. Many patients with few or insignificant eye symptoms had profound ocular dryness and damage. Similarly, some patients with few or no symptoms of oral dryness had profound objective salivary hypofunction. The absence of symptoms does not rule out profound eye and mouth dryness or damage.Conclusion: Although objective measures of xerostomia may not be practical for general population screening, it is crucial that practicing specialists perform objective testing of all patients suspected of pSS, instead of relying on symptoms. Without objective testing, the physician cannot ensure the diagnosis of pSS and that the existence of significant damage is not overlooked and left untreated. [ABSTRACT FROM AUTHOR]

Dry eye (DE) disease is a multifactorial disease in which uncontrolled inflammation can lead to corneal epithelium lesions and symptoms of discomfort. The aim of the present study was to evaluate the efficacy of two cyclosporine emulsions in a mouse model of DE with corneal epithelium lesions. Six- to 9-week-old female C57BL/6 N mice were housed in a controlled-environment room to induce DE. Following DE development, mice were instilled with: QD 0.1%CsA cationic emulsion (CaEm), BID 0.05%CsA anionic emulsion (AEm), or left untreated. Aqueous tear production and corneal epithelium lesions were assessed throughout the experiment. At the end of the treatment period, left eyes were sampled, fixed, and stained for histology, while the cornea, conjunctiva, and lacrimal gland of right eyes were sampled for transcriptomic analysis. Corneal lesion scores were reduced by 10.4%, 18.4%, and 10.9% at day 6, 10, and 14, respectively, with CaEm (QD), and by 2.6%, 3.0%, and 5.5% at day 6, 10, and 14, respectively, with AEm (BID). Histology demonstrated that 7 out of 10 DE mice presented moderate to severe ocular lesions, while only 2 and 5 out of 10 mice presented slight to moderate ocular lesions when treated with the CaEm (QD) and AEm (BID), respectively. The transcriptomic profile analysis suggests that a different set of inflammatory genes are modulated in the cornea, conjunctiva, and lacrimal gland upon DE development. In addition, the two emulsions distinctively modulate the gene expression profile. This study demonstrates that both emulsions were effective at reducing corneal lesions, with the CaEm (QD) being slightly better than the AEm (BID). Interestingly, this study suggests that ocular tissues may not respond similarly to a dry environment and that a different set of genes is modulated by the two formulations in the ocular tissues. [ABSTRACT FROM AUTHOR]

The purpose of this review is to delve into the clinical and research understanding of the pathophysiology and presentation of Sjögren's-related keratoconjunctivitis sicca in order address the diagnostic and management challenge that it represents, as well as to provide a basis for appreciating the pharmacotherapies designed to treat the ophthalmic symptoms of Sjögren's disease. [ABSTRACT FROM AUTHOR]

The incidence and prevalence of dry eye disease (DED) after cataract surgery is greatly underestimated. The severity of dry eye symptoms has been reported to peak 7 days after cataract surgery and may persist for months, significantly affecting patients' quality of life (QoL). The importance of considering surgical outcomes not only in terms of visual acuity, but also in terms of the patients' QoL, necessitates the assessment and evaluation of the ocular surface by the cataract surgeon prior to the procedure. This narrative review, drafted by the P.I.C.A.S.S.O. (Italian Partners for the Correction of Ocular Surface Alterations) board, analyses the physiopathology of post-cataract surgery DED and highlights the pre-, intra- and postoperative risk factors that may alter ocular surface homeostasis; it proposes a practical comprehensive algorithm for the prevention, treatment and management of DED associated with cataract surgery. Particular attention needs to be paid to the pre- and intraoperative risk factors to reduce the incidence of postoperative dry eye and to improve cataract surgery outcome. [ABSTRACT FROM AUTHOR]

Background: Dry eye is often the first presenting manifestation of primary Sjögren's syndrome (pSS). Because of the high prevalence of dry eye disease in normal population, ophthalmologists urgently need a non-invasive and reliable screening test to diagnose dry eye associated SS patients, other than ocular symptoms and signs. Currently, there is no single test available. The correlation of serum IL-14α with pSS has been found in pSS mouse model. Purpose: To evaluate whether IL-14α can serve as a biomarker to stratify dry eye in primary Sjögren's syndrome and its correlation to BAFF in a cohort of patients with non-SS dry eye (NSDE), pSS with dry eye disease, rheumatoid arthritis (RA), and healthy controls (HC). Methods: Retrospective study based on serum levels of IL-14α (defined by Western Blot) and BAFF (measured by ELISA) were evaluated among pSS with dry eye disease, NSDE, RA, and HC groups. Serum levels of SS related autoantibodies (Ro, La, SP1, PSP, and CA6) were also measured by ELISA. Results: One hundred and eighty patients were included for the current study, patients were separated into four groups as defined by pSS (n=65), NSDE (n=20), RA (n=50) and HC (n=45). The level of serum IL-14α in pSS was significantly higher compared to NSDE, RA, and HC (p=0.0011, p=0.0052 and p<0.0001, respectively). The levels of serum BAFF in pSS was significantly higher than in NSDE and HC (p=0.0148 and p<0.0001, respectively, whereas the levels of serum BAFF in RA was only significantly higher than in HC (p=0.001), but the level of BAFF was no significant difference between pSS and RA. In pSS, there was a decrease in the serum levels of IL-14α associated with a longer duration of the disease. Also, there was a correlation between the serum levels of IL-14α and SS related autoantibodies such as anti-SSA/Ro and anti-SSB/La in pSS patients. Conclusions: This is the first paper to report both IL-14α and BAFF could serve as a critical cytokine biomarker for the stratification of dry eye in primary Sjögren's syndrome. This may help ophthalmologists to develop non-invasive metrics for the diagnosis of dry eye associated pSS. [ABSTRACT FROM AUTHOR]

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

Objective: Diabetes can affect the eye in many ways beyond retinopathy. This study sought to evaluate ocular disease and determine any associations with peripheral neuropathy (PN) or cardiac autonomic neuropathy (CAN) in type 2 diabetes (T2D) and Charcot arthropathy (CA) patients. Design: A total of 60 participants were included, 16 of whom were individuals with T2D/CA, 21 of whom were individuals with T2D who did not have CA, and 23 of whom were healthy controls. Ocular surface evaluations were performed, and cases of dry eye disease (DED) were determined using the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface staining, Schirmer test, and Oculus Keratograph 5M exams. All variables were used to classify DED and ocular surface disorders such as aqueous deficiency, lipid deficiency, inflammation, and ocular surface damage. Pupillary and retinal nerve fiber measurements were added to the protocol in order to broaden the scope of the neurosensory ocular evaluation. PN and CAN were ascertained by clinical examinations involving the Neuropathy Disability Score (for PN) and Ewing's battery (for CAN). Results: Most ocular variables evaluated herein differed significantly between T2D patients and controls. When the controls were respectively compared to patients with T2D and to patients with both T2D and CA, they differed substantially in terms of visual acuity (0.92 ± 0.11, 0.73 ± 0.27, and 0.47 ± 0.26, p=0.001), retinal nerve fiber layer thickness (96.83 ± 6.91, 89.25 ± 10.44, and 80.37 ± 11.67 µm, p=0.03), pupillometry results (4.10 ± 0.61, 3.48 ± 0.88, and 2.75 ± 0.81 mm, p=0.0001), and dry eye symptoms (9.19 ± 11.71, 19.83 ± 19.08, and 24.82 ± 24.40, p=0.03). DED and ocular surface damage also differed between individuals with and without CA, and were associated with PN and CAN. Conclusion: CA was found to be significantly associated with the severity of ocular findings. DED in cases of CA was also associated with PN and CAN. These findings suggest that intrinsic and complex neurosensory impairment in the eyes, peripheral sensory nerves, and the autonomic nervous system are somehow connected. Thus, a thorough ocular evaluation may be useful to highlight neurological complications and the impact of diabetes on ocular and systemic functions and structures. [ABSTRACT FROM AUTHOR]

Dry eye disease is one of the most common pathologies of the ocular surface. In parallel with increased screen exposure, environmental changes and modern life in recent years, the prevalence and severity of dry eye have been increasing. Ergoophthalmology is the study of visual ergonomic conditions. It is concerned with injuries to the eyes caused by occupational factors and uses a multidisciplinary approach to understand the causes of occupational vision- related and ocular diseases and to prevent and manage these conditions. Vision-related risks in the operating room are critical for patients and health care providers. There are many predisposing factors in the operating room environment - air conditioning, constant humidity, constant room temperature, intense lighting, surgical smoke, anaesthetic gases and the use of irritant chemicals and biological aerosols. In addition, surgery itself is a critical task requiring long-term mental effort and concentration which can also predispose operating room staff to dry eye disease. In this review, we discuss occupational and environmental ergoophthalmological risk factors for dry eye disease in the operating room. [ABSTRACT FROM AUTHOR]

Dry eye and migraine are common diseases with large societal and economic burdens that have recently been associated in the literature. This review outlines the link between dry eye and migraine, which may have implications for reducing their respective burdens. We highlight possible shared pathophysiology, including peripheral and central sensitization, as the potential link between dry eye and migraine. Finally, therapies targeting similar pathophysiological mechanisms between dry eye and migraine are discussed. [ABSTRACT FROM AUTHOR]

Purpose: To compare the proportions of patients satisfying Korean dry eye guidelines and Asia Dry Eye Society (ADES) diagnostic criteria and to describe the clinical characteristics and practice patterns of dry eye patients in Korea. Study design: Prospective observational study. Methods: This study enrolled 160 patients, with 158 patients analyzed. ADES guidelines were applied to dry eye patients satisfying the Korean dry eye guidelines. Risk factors for dry eye (e.g. visual display terminal [VDT] use) were evaluated. Dry eye subtypes were categorized as aqueous-deficient or evaporative. Objective signs (e.g. corneal and keratoconjunctival staining scores, tear break-up time [TBUT], and Schirmer test) and symptoms (Dry Eye-Related Quality of Life Score [DEQS] and Ocular Surface Disease Index [OSDI] questionnaire) were evaluated. Treatment patterns were also recorded. Results: Patients (mean age 43.1 years) were mainly women (85.4%), with a high proportion (77.2%) of VDT users. Concordance between Korean and ADES guidelines was high (94.3%), with most patients (94.3%) having tear film instability (TBUT ≤ 5 s). Evaporative dry eye occurred in 60.1% and aqueous-deficient in 39.9% of cases. Objective signs were significantly better in evaporative than in aqueous-deficient dry eye. The DEQS bothersome ocular symptoms' score was significantly higher in VDT users than in non-users. OSDI symptom severity and DEQS were significantly correlated (p < 0.001). The most common treatments were hyaluronic acid (33.5%) and diquafosol (15.2%), the latter used mainly for mild and evaporative dry eye. Conclusion: The study showed high concordance between Korean and ADES diagnostic guidelines, with most patients having tear film instability. [ABSTRACT FROM AUTHOR]

Primary SS (pSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands leading to glandular dysfunction, resulting in dryness of the eyes, mouth and other mucosal surfaces. Systemic manifestations also occur in the majority of patients. There has been increasing interest in recent years, with a number of publications regarding the classification criteria, diagnostic tools, disease activity, damage, impact and potential treatments. This article reviews recent advances in the diagnosis and treatment of ocular and oral involvement in pSS. Recent stand-out developments include measurement of tear osmolarity as a marker in dry eye disease diagnosis, new devices measuring tear constituents and meibomian gland structure and treatment of its dysfunction. Lip biopsy is still valuable despite emerging evidence of non-invasive diagnostic techniques, notably salivary gland ultrasound. [ABSTRACT FROM AUTHOR]

Introduction: This study sought to assess ocular surface disease changes following cataract surgery combined with trabecular micro-bypass stent(s) implantation (iStent or iStent inject). Methods: This prospective interventional single-arm clinical trial enrolled 47 eyes with mild-to-moderate open-angle glaucoma (OAG) on 1–4 glaucoma medications who underwent phacoemulsification and trabecular micro-bypass stent(s) implantation. Key glaucoma and ocular surface data through 3 months postoperatively included the Ocular Surface Disease Index score (OSDI), corneal/conjunctival staining (Oxford Schema), fluorescein tear break-up time (FTBUT), conjunctival hyperemia (Efron Scale), glaucoma medications, and intraocular pressure (IOP). Results: Mean OSDI scores improved from 40.1 ± 21.6 (severe) preoperatively to 17.5 ± 15.3 (mild) at 3 months (p < 0.0001). While 73% of eyes had moderate or severe OSDI scores preoperatively, 29% had such scores at 3 months, and the OSDI score was normal in 57% of eyes versus 9% preoperatively. Mean FTBUT increased from 4.3 ± 2.4 s preoperatively to 6.4 ± 2.5 s at 3 months (p < 0.0001); mean Oxford corneal/conjunctival staining reduced from 1.4 ± 1.0 preoperatively to 0.4 ± 0.6 at 3 months (p < 0.0001); mean Efron conjunctival hyperemia score reduced from 1.4 ± 0.7 preoperatively to 1.2 ± 0.6 at 3 months (p = 0.118). The number of glaucoma medications decreased from 1.5 ± 0.9 to 0.6 ± 0.8 mean medications (60% reduction, p < 0.0001), with all eyes maintaining or reducing medications versus preoperatively and 55% of eyes becoming medication-free (versus 0% preoperatively). Mean IOP reduced from 17.4 ± 4.2 mmHg to 14.5 ± 3.2 mmHg (p < 0.0001). The safety profile was excellent. Conclusion: Implantation of trabecular micro-bypass stent(s) (iStent or iStent inject) with cataract surgery produced significant improvements in ocular surface health, alongside significant reductions in IOP and medications. Trial registration: ClinicalTrials.gov identifier, NCT04452279. [ABSTRACT FROM AUTHOR]

Background: Dry eye symptoms as a complication of double-eyelid blepharoplasty are controversial. This article evaluates tear film dynamics and changes in dry eye symptoms after cosmetic double-eyelid blepharoplasty in young Asian female. Methods: One hundred and twenty patients underwent full-incisional double-eyelid blepharoplasty. Subjective and objective parameters were documented before surgery, at 1 week, 1 month and 3 months post-surgery, which included Ocular Surface Disease Index questionnaire (OSDI), tear meniscus height (TMH), noninvasive breakup time (NIBUT), Schirmer I test, corneal and conjunctival fluorescein staining scores, and palpebral fissure height. Dry eyes were defined based on the DEWS II criteria: OSDI ≥ 13 points and NIBUT < 10 s. Patients were divided into two groups, group A included patients with redundant skin, while group B included patients with absence of redundant skin. Results: The incident rate of dry eyes preoperatively, and at 1 week, 1 month and 3 months were 12.5%, 12.5%, 32.5%, and 16.67%. OSDI scores were significantly increased at 1 week (9.71 ± 10.07, P < 0.001) and 1 month (11.35 ± 12.28, P < 0.001) postoperatively. A significant increase in TMH, NIBUT and Schirmer's test I values were observed at 1 week post-surgery (P < 0.001). Patients in group A showed higher OSDI scores compared to group B at 1 week and 1 month (P = 0.051) post-surgery, and the other variables showed no difference between the groups. Conclusions: Cosmetic double-eyelid blepharoplasty may temporarily affect tear film dynamics and aggravate dry eye symptoms in young females. However, these changes generally recover 3 months postoperatively. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

In recent years, dry eye has become a hot topic within ophthalmology and optometry, especially in regards to new frontiers in treatment modalities which include novel devices, procedures, and medications. However, some of the more understudied areas in dry eye involve its impact on quality of life. Although ocular discomfort symptoms are well known to be associated with dry eye, its negative effects on visual function remain underrecognized. This paper reviews these topics within the currently published literature to heighten awareness among clinicians. [ABSTRACT FROM AUTHOR]

Aim: To compare differences in clinical dry eye features and meibomian gland health status between dry eye patients from rural and urban populations in Ghana. Methods: We examined 211 (rural=109, urban=102) participants with subjective dry eye symptoms. Tear film break -up time (TBUT), Schirmer's test and ocular surface staining (OSS) were assessed. Symptoms were evaluated using the SPEED II questionnaire. Meibomian glands (MG) in the right eye upper (UL) and lower lids (LL) were imaged using a custom meibographer. MG area was determined by intensity threshold segmentation using Image J software. MG loss (MGL) was also graded based on Pult's grading scheme. Mann–Whitney, Spearman correlation, chi-square and odds analyses were performed; p< 0.05 was considered significant. Results: Rural participants showed greater SPEED scores, reduced TBUT, and lower Schirmer scores, p < 0.05. The proportion of rural participants with MGL were significantly more (82.3%) than urban participants (63.3%), p < 0.05. They also showed greater MGL than urban participants, p < 0.05. Chi-square test revealed significantly different meiboscale distributions (UL: χ2=13.58, LL: χ2=15.29) between the groups, p < 0.05. Overall significant relationships were observed between MGL and age [rs= 0.61], OSS [rs= 0.35], TBUT [rs= − 0.52], and Schirmer scores [rs= − 0.40], p < 0.05. Conclusion: The data suggest that the participants from the rural population have worse dry eye and meibomian gland health status than those from the urban population. The significant relationships between the various clinical variables suggest important links between MGD and DED. Subtle differences in the everyday working and living environment could likely account for the differences in the severity of DED and MGD between the two groups. And considering the increased pattern of urbanization, industrialization and modernization and the related environmental effects in Africa, future longitudinal studies on specific environmental risk factors or mediators of DED and MGD are necessary to ascertain the MGD and DED situation in Ghana and Africa at large. [ABSTRACT FROM AUTHOR]

Purpose: Dry eye symptoms after conventional cataract surgery are a very common problem. Until now, only few data are available on objective tear film parameters in regard to femtosecond laser-assisted cataract surgery (LCS). Aim of this study was therefore to analyze and compare tear film parameter changes between LCS and conventional cataract surgery. Methods: A consecutive group of 34 patients, scheduled for cataract surgery, were randomly selected for either LCS or conventional cataract surgery (17 patients/group). Tear film assessments including tear film osmolarity, Schirmer test, MMP-9 analysis via quantitative ELISA, corneal sensitivity, corneal fluorescein staining, and conjunctival fluorescein staining were sequentially evaluated pre- as well as 1 and 3 months postoperatively. Results: Both groups showed no significant difference in baseline characteristics. All surgeries were performed without any complications. After 1 and 3 months, there was no statistically significant difference in regard to tear film osmolarity (1 month: p = 0.81, 3 months: p = 1.0), Schirmer test (1 month: p = 0.35, 3 month: p = 0.08), and MMP-9 concentration (1 month: p = 0.36, 3 month: p = 0.28) between the two groups. Conclusions: Neither LCS nor conventional cataract surgery affected objective tear film parameters significantly during our 3-month postoperative observation period. Hence, both surgical techniques can be equally used to treat patients without prior dry eye symptoms. [ABSTRACT FROM AUTHOR]

Summary: Dry eye disease (DED) is a highly prevalent ocular surface disorder with neuroimmune pathophysiology. Tear hyperosmolarity (THO), a frequent finding in affected patients, is considered a key element in DED pathogenesis, yet existing animal models are based on subjecting the ocular surface to the more complex desiccating stress − decreased tear production and/or increased evaporation − instead of strict hyperosmolar stress. Here we characterized a murine model of THO that does not involve desiccating stress, thus allowing us to dissect the contribution of THO to DED. Our results showed that THO is sufficient to disrupt neuroimmune homeostasis of the ocular surface in mice, and thus reproduce many sub‐clinical DED findings. THO activated nuclear factor‐κB signalling in conjunctival epithelial cells and increased dendritic cell recruitment and maturation, leading to more activated (CD69+) and memory (CD62lo CD44hi) CD4+ T‐cells in the eye‐draining lymph nodes. Ultimately, THO impaired the development of ocular mucosal tolerance to a topical surrogate antigen in a chain of events that included epithelial nuclear factor‐κB signalling and activation of transient receptor potential vanilloid 1 as the probable hypertonicity sensor. Also, THO reduced the density of corneal intraepithelial nerves and terminals, and sensitized the ocular surface to hypertonicity. Finally, the adoptive transfer of T‐cells from THO mice to naïve recipients under mild desiccating stress favoured DED development, showing that THO is enough to trigger an actual pathogenic T‐cell response. Our results altogether demonstrate that THO is a critical initiating factor in DED development. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy and safety of an artificial tear combining the polymers carboxymethylcellulose (CMC) and hyaluronic acid (HA), to a formulation of CMC alone in subjects with dry eye. Methods: A preservative-free artificial tear (CMC-HA) was compared with an existing artificial tear (CMC). Subjects with mild-to-severe signs and symptoms of dry eye were enrolled in this double-masked, randomized, multicenter trial, and dosed at least twice daily for 90 days, with follow-up visits at Days 7, 30, 60, and 90. Ocular Surface Disease Index (OSDI) was the primary outcome measure. Secondary outcome measures were tear break-up time (TBUT), ocular surface staining, Schirmer test with anesthesia, and visual analog scale (VAS) scores of dry eye symptom severity and formulation acceptability. Safety measures included adverse events, biomicroscopy, and visual acuity. Results: A total of 460 subjects were enrolled across 45 sites (38 in Europe; 7 in Australia), of whom 454 were randomized to receive treatment. The per-protocol (PP) population consisted of 394 subjects, 364 (92.4%) of whom completed the study. In the PP population, the mean ± SD change from baseline in OSDI score at the primary timepoint, Day 90, was − 16.9± 17.5 for CMC-HA and − 16.0± 16.1 for CMC. CMC-HA was non-inferior to CMC based upon a confidence interval method. Both treatments significantly improved (P< 0.001) OSDI, symptom VAS scores, TBUT, and ocular surface staining from baseline at all follow-up visits, with minimal differences between groups. Greater reduction of overall ocular pain/discomfort was reported in subjects using CMC-HA versus CMC (P=0.048). Approximately 10% of subjects in each group reported treatment-related adverse events of generally mild to moderate severity. Conclusion: The new CMC-HA formulation was effective and well tolerated, and demonstrates a greater potential for symptom relief compared with CMC. These data support implementation of this formula for the management of dry eye patients. [ABSTRACT FROM AUTHOR]

Purpose The aim was to study the prevalence and related risk factors of dry eye disease (DED) in a random population sample from Cairo and upper Egypt. Materials and methods A clinic-based, cross-sectional, observational, multicenter study was conducted on eyes of healthy individuals accompanying ophthalmological patients coming for ocular examination in outpatient clinics of Ain Shams University Hospital and Al Watany Eye Hospital, Cairo; Saint Mary Hospital, Qena; and Aswan Eye center, Aswan, Egypt. Eyes were selected by systematic random sampling. Two questionnaires were used: the Ocular Surface Disease Index and another one covering medical history and risk factors for DED. External ocular examination, tear film break-up time, and Schirmer's tests were done. Diagnosis of DED was established on an Ocular Surface Disease Index score of 50 or above associated with at least one of DED symptoms together with either tear film break-up time of less than or equal to 5 s or Schirmer's test measurement of less than or equal to 10 mm. Results A total of 603 eyes were included; 290 of which were of male participants and 313 were of female ones. The age range was 18–94 years, with a mean age of 50.06±19.06 years. The prevalence of DED was 77.6% (468 eyes). There was a statistically highly significant difference in DED prevalence among all age groups (P<0.0001), with higher prevalence in age group of 41–50 years old, but the trend between consecutive age groups was not statistically significant (P=0.4747). Moreover, DED was statistically more common in females [86.9% of female participants versus 67.6% of male participants (P<0.0001)]. Blepharitis was found in 81% (379 eyes) and smoking in 43.8% (205 eyes). Moreover, 29.7% (139 eyes) of detected DED cases had associated dry mouth. Conclusion DED was quite common among our studied subjects, and most of them had associated blepharitis. Smoking was also a major risk factor. Moreover, DED was more common in female sex. There was a statistically significant difference in DED prevalence among the age groups. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Harran University Medical Faculty / Harran Üniversitesi Tıp Fakültesi Dergisi is the property of Harran University Medical Faculty and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To describe the prevalence of dry eye disease (DED) and its subtypes in elderly population with cataracts prior to surgery in Jakarta, Indonesia. Patients and Methods: Forty-nine eyes of 49 patients (16 males, 33 females; mean age: 66.6 years) planned for phacoemulsification surgery were consecutively recruited from two tertiary eye hospitals in this hospital-based cross-sectional study. Symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, and the patient was defined as symptomatic if their OSDI score was ≥ 13. Objective examinations included the noninvasive tear film break up time (NIBUT) and Schirmer tests. The results were deemed abnormal if they were < 10 seconds and < 10 mm for NIBUT and Schirmer, respectively. Results: Participants were classified into four groups: DED (positive symptoms and short NIBUT), preclinical dry eye (positive symptoms without short NIBUT), predisposition to dry eye (short NIBUT without symptoms), and normal group. Median OSDI score was 12.5 (0– 45.0), NIBUT was 10.4 (5.1– 28.9) seconds, and Schirmer score was 8.0 (2.0– 28.0) mm. The prevalence of DED, preclinical dry eye, and predisposition to dry eye were 22.5%, 22.5%, and 26.5%, respectively, while the other 28.5% subjects were normal. The DED group had significantly lower Schirmer test results (4.0 [2– 17] mm) compared to all other groups. Older age (> 70 years) was associated with poorer NIBUT and Schirmer test results and a significant difference between age groups was observed, especially in males. Conclusion: Dry eye is a common problem among the elderly population with cataracts in Indonesia. Almost half of the subjects presented with dry eye symptoms and either categorized as DED or preclinical dry eye, while more than one quarter were predisposed to dry eye. Care must be taken prior to cataract surgery to rule out existing dry eye with additional attention on those presenting without any symptoms as dry eye may develop after surgery. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the efficacy of two lipid-based lubricant eye drops in patients with lipid-deficient dry eye. Methods: This Phase IV, multicenter, prospective, double-masked study enrolled adults (aged ≥ 18 years) who had a tear film breakup time (TFBUT) of ≤ 15 seconds(s), and unanesthetized Schirmer I test of ≥ 3 mm to ≤ 12 mm in at least one eye, at both screening and baseline visits. Eligible patients (n=231) were randomized (1:1) and received either Systane® Balance (SYSB; n=117) or Refresh® Optive Advanced (RFO-Ad, n=114), four-times a day, for 35 days. The primary endpoint was non-inferiority for change from baseline in TFBUT at Day 35 (non-inferiority was established if the lower limit of the 95% confidence interval (CI) for the difference between the treatment groups was > – 1.0 s); secondary endpoints (test of superiority) were change in TFBUT and global ocular discomfort visual analog scale (VAS) score at Day 35. Other endpoints included the impact of dry eye on everyday life (IDEEL) treatment satisfaction scores (inconvenience and effectiveness) and safety. Results: At Day 35, the mean change from baseline in TFBUT was 0.998 s in the SYSB and 0.868 s in the RFO-Ad groups with a treatment difference: 0.130 s; (95% CI − 0.34, 0.60; P< 0.0001) demonstrating non-inferiority of SYSB to RFO-Ad. The global ocular discomfort VAS scores improved in both groups, with a mean change from baseline of – 9.7 and – 8.8 in SYSB and RFO-Ad groups (treatment difference – 0.8; P=0.62), respectively. No meaningful difference was observed in IDEEL treatment effectiveness and treatment inconvenience scores between SYSB vs RFO-Ad (P> 0.05 for treatment difference). Both treatments were well tolerated. Conclusion: SYSB lubricant eye drops were non-inferior to RFO-Ad for improvement in TFBUT in patients with lipid-deficient dry eye. Both lubricant eye drops improved TFBUT and ocular discomfort scores in patients with lipid-deficient dry eye. [ABSTRACT FROM AUTHOR]

Objective: To study the relationship between time length of digital devices usage and dry eye conditions in pterygium patients. Materials and Methods: This is a retrospective study at Thammasat University Hospital. Consequently, information regarding demographic characteristics, characteristic and related data of pterygium, time spent on using digital devices and Ocular Surface Disease Index (OSDI) were collected. The quantitative data was analyzed to determine the mean and relationships by using statistical tools of ANOVA, simple linear regression and Pearson correlation. Results: In total, 328 samples were collected which comprised of 314 patients with primary pterygium (95.7 percent) and 14 of recurrent pterygium (4.3 percent). An average of 3.73 hours was the time spent on using digital devices per day. There were 249 patients (75.91 percent) which reported a history of using digital devices. The studies revealed that time spent on digital devices had no influence on pterygium size but the duration more than or equal 2 hours per day were statistically significant affected to the OSDI scores. Relationship between the duration of the digital device usage and the eye pain (R2 = 0.026), blurred vision (R2 = 0.014) and the OSDI scores (R2 = 0.014) were found to be related in the same way. Conclusion: Patients with pterygium were found to have the history of digital devices usage (75.91 percent). Moreover, the time spent using digital devices more than or equal 2 hours per day were statistically significant affected to the OSDI scores. The correlation between time spent using digital devices, eye pain, blurred vision, and the severity level of the OSDI scores were found to be related. [ABSTRACT FROM AUTHOR]

Copyright of Journal of China Medical University is the property of Journal of China Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Parkinson's disease (PD) is a movement disorder with many symptoms responsive to treatment with dopamine agonists, anti-cholinergics and the dopamine precursor, levodopa. The cardinal features of PD include tremor, rigidity, bradykinesia, and postural instability. There also are non-motor features that include sleep disorders, cognitive and affective dysfunction, hyposmia, pain and dysautonomia (constipation, bloating, orthostasis, urinary symptoms, sexual dysfunction, dysphagia). Among these non-motor features are signs and symptoms of visual system impairment that range from subtle examination findings to those causing severe disability. In this review we describe common PD-related abnormalities in the visual system, how they present, and potential treatments. [ABSTRACT FROM AUTHOR]

Copyright of Firat Universitesi Sağlik Bilimleri Tip Dergisi is the property of Firat Universitesiu, Saglik Bilimleri Enstitusu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To compare the outcomes of non-invasive break-up time (NI-BUT) test and the other conventional dry eye tests.Methods: The right eyes of 170 subjects were included in the study. In order to evaluate the tear quality of the patients, NI-BUT levels were measured by the Scheimplug-Placido disk system (Sirius topography). Tear osmolarity test was performed with TearLab Osmolarity System. Topical anesthesia-assisted type I Schirmer test and topical anesthesia-assisted BUT were lastly applied to all patients in order not to affect other measurements.Results: The mean NI-BUT value was 9.59 ± 4.37 sec, tear osmolarity was 292.93 ± 9.30 mOsm/L, Schirmer test was 15.32 ± 6.05 mm/5 min, and biomicroscopic BUT value was 8.98 ± 3.79 sec. The Schirmer test results were statistically significantly correlated with biomicroscopic BUT and NI-BUT values (p = .019, r = 0.180 and p = .030, r = 0.166; respectively). It was also found that tear osmolarity was strongly and inversely correlated with biomicroscopic BUT and topographic NI-BUT values (p < .001, r = -0.554 and p < .001, r = -0.528; respectively). There was no significant correlation between Schirmer test and tear osmolarity.Conclusion: It is important to use a sensitive, reproducible and non-invasive method in the evaluation of tear functions. We think that the objective and noninvasive topographic NI-BUT measurements and the minimally invasive osmolarity measurements should be used more frequently in practice because they are correlated with the measurements obtained by invasive methods and should be widespread in clinics. [ABSTRACT FROM AUTHOR]

Background: Dry eye is the most common eye disorder of tears and ocular surface. However, the extent to which diabetes mellitus may confer risk of dry eye remains uncertain. The aim of this study was to perform a meta-analysis that synthesizes the association between diabetes mellitus and dry eye. Methods: Case–control studies were selected from the Medline, Embase, Cochrane database from January 2000 to March 2018. Two reviewers screened potential studies, and eligible studies were included according to keywords and predefined criteria. We calculated the overall risk estimates by using a fixed-effect model or a random-effects model in relation to heterogeneity. Results: A total of four studies were included in our meta-analysis consisting of 2,504,794 persons. Our study showed a significant association between diabetes mellitus and the risk of dry eye syndrome (OR 1.30; 95% CI 1.08–1.57; P value = 0.006). However, the heterogeneity was observed (P value < 0.001, I2 = 95.2%). Conclusion: Our meta-analysis suggests that diabetes mellitus has a significant association with the risk of dry eye. However, this result is limited by heterogeneity. Further prospective and concise studies are needed to confirm the association between diabetes mellitus and dry eye. [ABSTRACT FROM AUTHOR]

Introduction: Dry Eye (DE) is a multifactorial condition with a variable clinical presentation. This highly prevalent disease has multiple symptoms and signs that often do not correlate with one another. As such, the diagnosis of DE can be challenging to make, and a systematic approach must be taken. Areas covered: We review the different methods commonly utilized to evaluate a patient complaining of DE symptoms. Included in this review are clinical examination techniques, point of care tests, and imaging techniques. Expert opinion: DE is an umbrella term that encompasses different etiologies and pathophysiological mechanisms. The current definition recognizes tear instability, high osmolarity, inflammation, and neuro-sensory dysfunction as causative entities. The approach to DE begins with a systematic assessment of symptoms and signs, evaluating for both nociceptive and neuropathic sources of symptoms. Future research is needed to develop tests that assess neurosensory status in DE and couple point of care tests with therapeutic algorithms. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of soft contact lens (CL) wear on the morphology of the epithelial‐lamina propria junction as well as the possible association with symptoms of discomfort. Methods: Ninety‐two subjects were recruited, including 60 soft CL wearers, 16 previous wearers, and 16 non‐wearers. Additionally, subjects were classified as symptomatic or asymptomatic using the Contact Lens Dry Eye Questionnaire 8 for the CL wearers (a score ≥ 12 was considered symptomatic) and the Dry Eye Questionnaire 5 for the previous wearers and non‐wearers (a score ≥ 5 was considered symptomatic). In vivo confocal microscopy of the tarsal conjunctiva was performed on a single occasion. Papillae density, shortest diameter, longest diameter, area, circularity, lumen/wall brightness ratio, irregularity, reflectivity, inhomogeneous appearance of wall and inhomogeneous appearance of rete ridges were evaluated. Effects of CL wear, symptoms and their interaction were analysed using two‐way analysis of variance. Correlations were investigated using Spearman's coefficient. Data are presented as mean (standard deviation) or median [interquartile range]. Results: Contact lens wearers, compared to previous wearers and non‐wearers, showed higher circularity [0.65 (0.08) vs 0.59 (0.10) vs 0.57 (0.11), p = 0.003]. Subjects with symptoms, compared to asymptomatic participants, showed higher circularity [0.64 (0.08) vs 0.61 (0.10), p < 0.001] and lower irregularity (1.0 [0.7–2.0] vs 1.3 [1.0–2.3], p = 0.009). For previous wearers, those with symptoms showed greater density (135.4 [107.3–183.3] vs 87.5 [85.4–116.7], p = 0.013) and circularity [0.64 (0.07) vs 0.54 (0.10), p = 0.016]. For non‐wearers, those with symptoms showed higher circularity [0.65 (0.08) vs 0.50 (0.08), p < 0.001]. DEQ‐5 correlated with circularity (ρ = 0.55, p = 0.001). Conclusions: Soft CL wear modifies papillae of the epithelial‐lamina propria junction into a more rounded shape; however, CL cessation appears to resolve this alteration. Additionally, a more rounded papillae shape is associated with ocular symptoms in subjects not actively wearing CLs. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Zhejiang University: Science B is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To estimate the prevalence of dry eye among video-terminal (VDT) users and to assess risk factors for dry eye in this population. Study design: A single-centre, cross-sectional study was carried out on subjects employed as VDT workers and on a control group. Methods: Demographic data, years spent working at a VDT, number of effective hours at VDT/day, number and hours of breaks/day were considered. All subjects underwent a complete ophthalmic examination and completed the Italian version of the computer vision symptom scale 17-item (CVSS17) questionnaire. Both groups were classified as definite, suspect and non-dry eye syndrome (DES). Results: One-hundred and ninety four subjects completed the study; 70 (36.1%) of which represented the control group, and 124 (63.9%) represented the VDT group. Among VDT workers, 29 (23.4%) presented definite DES and 55 (44.4%) suspect DES, while among controls, only 2 (2.9%) presented definite DES and 37 (52.8%) suspect DES. In the univariate analysis, the DES group was older (p < 0.001), spent more time a day at VDT (p < 0.001), used VDT from more time (p < 0.001), instilled artificial tears (p = 0.031), and presented worst quality of life (p < 0.001). At the multivariate analysis, only age and time at VDT retained association with DES (OR 1.05; 95% CI 1.01–1.09; p = 0.01 and OR 1.57; 95% CI 1.07–2.02; p = 0.017, respectively). Conclusions: The global increase of VDT workers is accompanied by a higher frequency of ocular complaints. Older subjects and people spending more than 4 h a day at VDT are at major risk to develop DES and should take precautions to prevent the onset of the disease. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the prevalence of dry eye symptoms among lecturers. Materials and Methods: The study included 254 lecturers employed at Mersin University. The lecturers were selected by simple random sampling from lists obtained from the personnel department. Data were obtained between November 15 and December 15, 2017 using a questionnaire developed by the researchers and the Ocular Surface Disease Index (OSDI). The data were evaluated using descriptive statistics, Student's t-test, ANOVA, and correlation tests with the SPSS package program. Results: Of the lecturers who participated in the study, 52.8% were male and 47.2% were female, and the mean age was 39.29±9.41 years. According to OSDI scores, 20.5% of the participants had mild, 15% had moderate, and 36.5% had severe disease. There were significant differences in mean OSDI score based on sex (p<0.001), alcohol use (p = 0.01), continuous drug use (p = 0.03), wearing glasses (p = 0.04), history of dry eye (p<0.001), and presence of dry eye symptoms (p<0.001). There were also significant differences between the OSDI score categories in terms of sex (p<0.001), smoking status (p = 0.04), wearing glasses (p = 0.03), history of dry eye (p<0.001), and presence of dry eye symptoms. The only factor significantly correlated with OSDI score was daily duration of computer usage (p = 0.009). Conclusion: Our study showed that a substantial proportion of lecturers experience dry eye symptoms, and OSDI scores were associated with daily duration of computer use. Determining the factors associated with dry eye is important for the planning of preventive interventions. [ABSTRACT FROM AUTHOR]

Introduction: dry eye is a fairly common ocular surface disorder which significantly affects the quality of life of patients. This study aimed to determine the prevalence, and relationship between dry eye and glycosylated haemoglobin (HbA1c) among patients with diabetes mellitus. Methods: this was a descriptive hospital-based study conducted among patients diagnosed with diabetes mellitus and attending the Diabetic Clinic at a tertiary health facility in Ibadan, south-western Nigeria. Dry eye was assessed using the standardized Ocular Surface Disease Index Questionnaire administered to the eligible respondents on dry eye symptoms. Detailed ocular examination including the tear break-up time (TBUT) and Schirmer I test were carried out and a recent glycosylated haemoglobin value was also obtained. Results: one hundred and eighty-nine Type 2 diabetic patients were studied, with 68.8% female and a mean age of 60.2 ± 10.3 years. The frequency of dry eye among patients was 21.7% (95% CI, 15.8-27.6). The most commonly reported symptoms of dry eye were "feeling of gritty sensation" (78%, 95% CI, 65.4-90.7) and "blurred vision" (73.2%, 95% CI, 59.6-86.7) while "discomfort in windy areas" (61%, 95% CI, 46.0-75.9) was the most common environmental trigger. No statistically significant correlation was noted between dry eye and HbA1c (r = 0.086, p= 0.239), and age (r = 0.096, p = 0.1) Conclusion: dry eye is fairly common among patients with diabetes mellitus with most frequent symptoms being gritty sensation and blurred vision. No significant correlation was noted between dry eye and glycosylated haemoglobin (HbA1c). [ABSTRACT FROM AUTHOR]

Purpose: Evaluate the safety and efficacy of cryopreserved amniotic cytokine extract (ACE) in the treatment of subjects with dry eye disease (DED). Patients and methods: This was a retrospective, multicenter, chart review of adult patients with DED that instilled cryopreserved ACE drops twice-daily for 4 or 12 weeks. Patients had corneal fluorescein staining (0–20 range) and/or a lissamine green conjunctival staining score (0–18 range) of ≥3 and ≤9 in at least 1 eye and a score ≥40 (0–100 range) of eye dryness/irritation on a visual analog scale (VAS). Following completion of a treatment course, medical records were reviewed from the initiation of therapy (baseline), and at post-treatment visits (4 weeks, 8 weeks, and 12 weeks). Patient records for visual acuity, adverse events, corneal fluorescein staining, conjunctival lissamine green staining, and symptom scores of ocular dryness/irritation were reviewed for each visit, as available. Safety and tolerability were assessed through the evaluation of patient-reported adverse events recorded in the medical records. Results: A total of 54 eligible patients were identified at 7 clinical sites; 16 patients administered ACE drops for 4-weeks, and 38 patients instilled ACE drops for 12 weeks. Significant improvements in the mean changes from baseline were observed for corneal fluorescein staining, lissamine green staining, visual acuity (LogMar) and VAS ocular symptom scores at the 4-week post-treatment visit (p<0.01). Additional improvements continued out to the 12-week follow-up assessment visits. Two patients discontinued therapy due to reports of ocular burning or foreign body sensation. Conclusion: The cryopreserved ACE formulation was well-tolerated and effective in reducing the clinical signs and symptoms of DED. Conduct of a vehicle-controlled prospective study is warranted. [ABSTRACT FROM AUTHOR]

Purpose/aim: To assess the effectiveness of polytetrafluoroethylene (PTFE) tubes in the collection of human tears and meibum. Materials and methods: This was a prospective study that enrolled 10 healthy human subjects. Both the tear film and meibum were sampled using PTFE tubes in the right eye of all subjects. In the left eyes, either 5-µL or 1-µL glass microcapillary tubes were used to collect tears, and 0.5-µL glass microcapillary tubes were used to collect meibum. The lipids from the samples were extracted and analyzed using mass spectrometry (SCIEX TripleTOF 5600, Framingham, MA, USA). The absolute peak intensities of the omega-acyl hydroxy fatty acids (OAHFA), cholesterol esters (CE), and wax esters (WE) obtained for both methods were summed and compared between collection methods. Results: A total of 10 subjects completed the study (five female, mean age: 35.7 ± 7.9 years). Using the mass spectrometer output, the median (first quartile, third quartile) summed intensity units of OAHFA, CE, and WE collected associated with tears using PTFE were 516 (125, 1315), 7946 (2571, 19,915), and 38,892 (139,630, 174,082), all of which were significantly higher (all p ≤ 0.04) than those collected from glass microcapillaries (91 (41, 408), 2463 (1389, 6042), and 11,109 (7465, 37,371), respectively). The median summed intensity units of OAHFA, CE, and WE associated with meibum (1958 (1417, 3502), 11,726 (8434, 87,691), and 84,771 (52,657, 206,050), respectively) using PTFE were not significantly different (all p ≥ 0.13) than those associated with glass microcapillaries (1502 (699, 4407), 10,781 (3287, 38,205), and 77,381 (26,590, 178,213), respectively). Conclusions: PTFE tubes, which are thought to be lipophilic, were associated with more measurable lipids from the tear film than glass microcapillaries. There was no difference between collection methods in lipid profiles when used with meibum. [ABSTRACT FROM AUTHOR]

Purpose: To investigate Nerve Growth Factor (NGF) and nitric oxide synthase (iNOS) levels in tears obtained from Video Display Terminal (VDT) workers and correlate their expression with ocular signs and symptoms. Methods: A total of 120 VDT workers (62M/58F; 31-63 years old) and 40 age/sex matched no-VDT volunteers (19M/21F; 30-60 years old) were enrolled in the study. Participants completed the OSDI questionnaire and were subjected to clinical assessment of ocular surface status, including ocular symptoms and tear film parameters. NGF and iNOS levels were quantified in tear samples and their expressions correlated with OSDI, ocular symptoms and tear film parameters. Results: 59.17% of the studied population was symptomatic based on OSDI scores. Women were more commonly affected. The most frequent symptom was asthenopia and except for dryness, no differences were found between genders regarding other symptoms. A statistically significant decrease in NGF levels was found between normal and moderate (p < 0.05) and between mild and moderate (p < 0.05) OSDI grading. iNOS expression was increased in moderate OSDI grading compared to normals (p < 0.05). A negative correlation was found between NGF and respectively OSDI results, dryness and blurry vision (p < 0.05). No correlations were found among NGF, iNOS and ocular surface parameters (Schirmer, BUT, ocular surface staining). Conclusion: Our data suggest that NGF and iNOS levels contribute to VDT ocular discomfort. Further studies are required to better understand the relationship between NGF and iNOS in VDT ocular surface. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to report the evaluation of efficacy and safety of cyclosporine A cationic emulsion (CsA CE) 0.1% for the treatment of severe keratitis in adults with dry eye disease (DED) in a French early-access program. Methods: Patients with DED and severe keratitis (corneal fluorescein staining [CFS] score of 3-5 on the Oxford scale and/or the presence of corneal lesions [filaments or ulcers]) were enrolled in a compassionate use program (Authorization for Temporary Use [ATU]) for oncedaily CsA CE, which was approved by French health authorities prior to its registration. Efficacy and safety at 1, 3, 6, and 12-month follow-up visits were evaluated. Results: The ATU cohort (n=1,212; mean age =60.5 years; 79.5% female; 98.1% with severe keratitis; 74.5% with corneal lesions) consisted of 601 CsA-naïve patients and 611 patients treated previously with other CsA formulations. The primary DED etiology was Sjögren's syndrome (48.7%). Clinical benefit could be discerned among 548 evaluable patients from months 1 to 12: keratitis improvement, 44.8% at month 1 and 42.1% at month 12; keratitis stabilization, 47.2% and 45.7%, respectively; symptom improvement, 47.2% and 48.6%; and symptom stabilization, 44.8% and 45.0%. Corneal clearing (CFS score =0) increased from 4.8% (month 1) to 11.4% (month 12). No unexpected safety concerns were identified; instillation site pain (10.2%) and eye irritation (7.8%) were the most common adverse events. Conclusion: The French ATU cohort provides supportive data on the clinical benefit of CsA CE in improving/stabilizing symptoms and corneal damage in DED patients with severe keratitis in real-world clinical practice. [ABSTRACT FROM AUTHOR]