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Background: Using traditional patient-reported outcomes (PROs), such as paper-based questionnaires, is cumbersome in the era of web-based medical consultation and telemedicine. Electronic PROs may reduce the burden on patients if implemented widely. Considering promising reports of DryEyeRhythm, our in-house mHealth smartphone app for investigating dry eye disease (DED) and the electronic and paper-based Ocular Surface Disease Index (OSDI) should be evaluated and compared to determine their equivalency. Objective: The purpose of this study is to assess the equivalence between smartphone app–based and paper-based questionnaires for DED. Methods: This prospective, nonblinded, randomized crossover study enrolled 34 participants between April 2022 and June 2022 at a university hospital in Japan. The participants were allocated randomly into 2 groups in a 1:1 ratio. The paper-app group initially responded to the paper-based Japanese version of the OSDI (J-OSDI), followed by the app-based J-OSDI. The app-paper group responded to similar questionnaires but in reverse order. We performed an equivalence test based on minimal clinically important differences to assess the equivalence of the J-OSDI total scores between the 2 platforms (paper-based vs app-based). A 95% CI of the mean difference between the J-OSDI total scores within the ±7.0 range between the 2 platforms indicated equivalence. The internal consistency and agreement of the app-based J-OSDI were assessed with Cronbach α coefficients and intraclass correlation coefficient values. Results: A total of 33 participants were included in this study. The total scores for the app- and paper-based J-OSDI indicated satisfactory equivalence per our study definition (mean difference 1.8, 95% CI –1.4 to 5.0). Moreover, the app-based J-OSDI total score demonstrated good internal consistency and agreement (Cronbach α=.958; intraclass correlation=0.919; 95% CI 0.842 to 0.959) and was significantly correlated with its paper-based counterpart (Pearson correlation=0.932, P <.001). Conclusions: This study demonstrated the equivalence of PROs between the app- and paper-based J-OSDI. Implementing the app-based J-OSDI in various scenarios, including telehealth, may have implications for the early diagnosis of DED and longitudinal monitoring of PROs. [ABSTRACT FROM AUTHOR]

Background: Dry eye (DE) and hay fever (HF) show synergistic exacerbation of each other's pathology through inflammatory pathways. Objective: This study aimed to investigate the association between DE and HF comorbidity and the related risk factors. Methods: A cross-sectional observational study was conducted using crowdsourced multidimensional data from individuals who downloaded the AllerSearch smartphone app in Japan between February 2018 and May 2020. AllerSearch collected the demographics, medical history, lifestyle and residential information, HF status, DE symptoms, and HF-related quality of life. HF symptoms were evaluated using the nasal symptom score (0-15 points) and nonnasal symptom score (0-12 points). HF was defined by the participants' responses to the questionnaire as HF, non-HF, or unknown. Symptomatic DE was defined as an Ocular Surface Disease Index total score (0-100 points), with a threshold score of 13 points. HF-related quality of life was assessed using the Japanese Allergic Conjunctival Disease Standard Quality of Life Questionnaire (0-68 points). We conducted a multivariable linear regression analysis to examine the association between the severity of DE and HF symptoms. We subsequently conducted a multivariable logistic regression analysis to identify the factors associated with symptomatic DE (vs nonsymptomatic DE) among individuals with HF. Dimension reduction via Uniform Manifold Approximation and Projection stratified the comorbid DE and HF symptoms. The symptom profiles in each cluster were identified using hierarchical heat maps. Results: This study included 11,284 participants, classified into experiencing HF (9041 participants), non-HF (720 participants), and unknown (1523 participants) groups. The prevalence of symptomatic DE among individuals with HF was 49.99% (4429/9041). Severe DE symptoms were significantly associated with severe HF symptoms: coefficient 1.33 (95% CI 1.10-1.57; P <.001) for mild DE, coefficient 2.16 (95% CI 1.84-2.48; P <.001) for moderate DE, and coefficient 3.80 (95% CI 3.50-4.11; P <.001) for severe DE. The risk factors for comorbid symptomatic DE among individuals with HF were identified as female sex; lower BMI; medicated hypertension; history of hematologic, collagen, heart, liver, respiratory, or atopic disease; tomato allergy; current and previous mental illness; pet ownership; living room and bedrooms furnished with materials other than hardwood, carpet, tatami, and vinyl; discontinuation of contact lens use during the HF season; current contact lens use; smoking habits; and sleep duration of <6 hours per day. Uniform Manifold Approximation and Projection stratified the heterogeneous comorbid DE and HF symptoms into 14 clusters. In the hierarchical heat map, cluster 9 was comorbid with the most severe HF and DE symptoms, and cluster 1 showed severe HF symptoms with minimal DE-related symptoms. Conclusions: This crowdsourced study suggested a significant association between severe DE and HF symptoms. Detecting DE among individuals with HF could allow effective prevention and interventions through concurrent treatment for ocular surface management along with HF treatment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the corneal subbasal nerve morphology, corneal sensitivity, and anterior segment alterations in short-term silicone hydrogel contact lens (SiHCL) users by confocal microscopy. Materials and Methods: The study included 25 right eyes of 25 male volunteers aged 25-30 years who had never used SiHCLs before. ocular surface disease index (OSDI), tear break-up time, Schirmer test, tear meniscus area, strip meniscometry tube, corneal sensitivity, and corneal subbasal nerve morphology were evaluated before and after 1 month of CL use. Results: OSDI was 10.6±1.1 before CL use and 17.2±1.2 after 1 month of CL use (p<0.01). Schirmer test distance was 16.3±2.3 mm before and 14.3±1.9 mm after 1 month of CL use (p>0.05). Tear film break-up time was 7.1±0.4 s before and 6.2±0.3 s after CL use (p>0.05). The tear meniscus area was 0.026±0.002 mm² before and 0.024±0.001 mm² after 1 month of CL use (p>0.05). Strip meniscometry tube results were 5.4±0.9 mm before and 4.9±0.8 mm after 1 month of CL use (p>0.05). Corneal sensitivity values were 3.2±0.4 mm before and 2.95±0.3 mm after 1 month of CL use (p>0.05). Dendritic cell density evaluated by confocal microscopy was 14.84±3.1 cells/mm² before and 32.57±4.2 cells/mm² after 1 month of CL use (p<0.01). Subbasal nerve tortuosity was 0.92±0.2 before and 1.03±0.2 after 1 month of CL use (p>0.05). Subbasal nerve density was measured as 4726±310 pixels/frame before and 4570±272 pixels/frame after 1 month of CL use (p>0.05). Conclusion: After a month of SiHCL use, no significant changes were observed in tear secretion, corneal sensitivity, tear meniscus volume, subbasal corneal nerve density, reflectivity, or tortuosity, while a significant increase was found in OSDI and dendritic cell density. [ABSTRACT FROM AUTHOR]

Rakan Jaser Alsahly,1 Abdulrahman Abbas Aldawsari,1 Nawaf Fahad Alzaidy,1 Faisal Ali Al Jabr,2 Mamdouh Mohammed Alotaibi,1 Elsadig Yousef Mohammed3 1College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia; 2College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia; 3Department of Community Medicine and Public Health, College of Medicine, Majmaah University, Al Majmaah, Saudi ArabiaCorrespondence: Rakan Jaser Alsahly, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia, Tel +966 566023995, Email RakanJaser1@gmail.comPurpose: To evaluate the association between dry eye disease (DED) symptoms and daily beverage intake among adults in Saudi Arabia.Patients and Methods: In this cross-sectional, questionnaire-based study, we distributed an online questionnaire to men and women older than 18 years living in Saudi Arabia. The questionnaire consisted of items related to the sociodemographic characteristics of the participants and two validated indices: the Ocular Surface Disease Index (OSDI) and the brief 15-item Beverage Intake Questionnaire (BEVQ-15). Participants were excluded if they were aged less than 18 years; wore contact lenses; had existing eye disease (excluding refractive errors), history of eye surgery (including corrective eye surgeries), or autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome); or were currently taking specific medications including antidepressants, antihistamines, and diuretics.Results: After applying the study exclusion criteria, a total of 615 participants were included in the statistical analysis. The majority of participants were 18– 34 years old (450, 73.2%), and men (381, 62%) exceeded women (234, 38%) by approximately 1.5-fold. OSDI scores showed that 344 participants (55.9%) had DED symptoms, 145 (23.6%) had mild dry eyes; and 106 (17.2%) and 93 (15.1%) had moderate and severe dry eyes, respectively. There was a significant association between sex and DED symptoms (p = 0.012); the frequency of DED symptoms in women exceeded that in men. However, no significant differences were observed with other demographic data such as age and location of residence. Although beverage intake was moderately correlated to OSDI score (R = 0.27), we found no significant association between beverage intake and DED symptoms.Conclusion: This is the first study to highlight the association between DED symptoms and daily beverage intake. We found a significant association between DED symptoms and female sex. However, no significant association was found between DED symptoms and other demographic characteristics or beverage intake.Keywords: Ocular Surface Disease Index, Beverage Intake Questionnaire, adult, ophthalmology, cross-sectional study

Hisataka Fujimoto,1,&ast; Shintaro Ochi,2,&ast; Yasushi Inoue,2 Junichi Kiryu1 1Department of Ophthalmology, Kawasaki Medical School, Kurashiki, 701-0192, Okayama, Japan; 2Inoue Eye Clinic, Tamano, 706-0011, Okayama, Japan&ast;These authors contributed equally to this workCorrespondence: Hisataka FujimotoDepartment of Ophthalmology, Kawasaki Medical School, 577 Matsushima, Kurashiki, 701-0192, Okayama, Japan, Tel +81-86-462-1111, Fax +81-86-462-1199, Email fujimoto-h@med.kawasaki-m.ac.jpYasushi InoueInoue Eye Clinic, 1-14-31 Uno, Tamano, 706-0011, Okayama, Japan, Tel +81-86-331-1030, Fax +81-86-331-1114, Email inoue@oka.urban.ne.jpPurpose: To evaluate perioperative dry eye (DE) syndrome and meibomian gland (MG) dysfunction parameters associated with cataract surgery-induced DE symptoms.Patients and Methods: This retrospective, single-centered, observational study included 82 eyes of 43 patients without previous subjective DE symptoms, treatment, ocular comorbidities, and previous use of ophthalmic treatment, except for anti-allergic eye drops, who underwent uncomplicated cataract surgery. MG dropout, lid margin abnormality, meibum quality, meibum expressibility, MG orifice obstruction, ocular surface disease index, non-invasive tear break-up time, tear meniscus height, and Schirmer test score were measured at baseline and 1 month postoperatively. Multivariable logistic regression with generalized estimating equation models was used to determine the risk factors for cataract surgery-induced DE symptoms.Results: Twenty-one patients had subjective DE symptoms 1 month following the cataract surgery. Preoperative and postoperative parameters, preoperative upper eyelid MG loss, and female sex (odds ratio [OR] 6.72, P = 0.012; OR 4.20, P = 0.037, respectively) were identified as risk factors for cataract surgery-induced DE symptoms.Conclusion: Ocular parameters, including upper eyelid MG findings at baseline, were considered important in predicting persistent DE symptoms following cataract surgery.Keywords: meibomian gland dysfunction, dry eye syndrome, retrospective, ocular surface disease index

Purpose: To evaluate the correlation of Meiboscale with symptom score (Ocular Surface Disease Index [OSDI]) and meibomian gland dysfunction (MGD) sign score. Methods: We performed a cross-sectional hospital-based study of 53 patients of primary MGD who filled the OSDI questionnaire form and underwent complete ocular examination. The MGD sign score was calculated in both eyes using the sum of six grading systems proposed by Arita et al. in 2016. The participants underwent imaging of the upper and lower eyelids of both eyes (212 eyelids) by specular microscope. The area of meibomian gland loss (MGL) was visually assessed and scored using the Meiboscale photographic card. Correlation between these three values – OSDI score, sign score, and MGL score based on Meiboscale - was calculated using Spearman's correlation analysis and Jonckheere–Terpstra (J–T) test. Correlation coefficient rs > 0.5 was considered clinically significant. Results: Associations between MGL score and OSDI score, as well as between OSDI and sign score were statistically significant, but not clinically significant (rs = 0.3684, P < 0.001 and rs = 0.41179, P < 0.001, respectively). The association between MGL score and MGD sign score was statistically as well as clinically significant (rs = 0.8392, P < 0.001). J–T test revealed large effect size (P < 0.001, r-effect = 0.93). Conclusion: The Meiboscale card had not been tested for utility in the Indian outpatient setting yet. Meiboscale can be used for reliable assessment and grading of MGD, and has clinical utility similar to the sum of six MGD sign scores. Additionally, assessment of symptoms using OSDI or a similar questionnaire is also recommended.

PURPOSE: The symptoms of dry eye disease (DED) are influenced by environmental factors, but the effect of ambient temperature is less certain. Our purpose was to investigate the relationship between the severity of DED symptoms and the ambient temperature. MATERIALS AND METHODS: This retrospective study reviewed the symptom scores, including ocular surface disease index (OSDI) and standardized patient evaluation of eye dryness (SPEED), as well as tear film parameters of first-time DED patients between June 2018 and June 2019. The contribution of tear film parameters and environmental factors, including ambient temperature, humidity, wind speed, and the concentration of air pollutants, to the severity of dry eye symptoms was evaluated by univariate and multivariate linear regression analyses. RESULTS: There were 351 patients included aged 52.8 ± 13.6 years, and 257 (73.2%) were female. The average tear film break-up time, Schirmer test value, and lipid layer thickness were 2.6 ± 0.7 s, 5.5 ± 4.3 mm, and 64.1 ± 6.0 μm, respectively. The average OSDI and SPEED were 41.8 ± 19.8 and 12.1 ± 5.1, respectively. In winter, the patients reported higher OSDI and SPEED. Both scores were significantly correlated with low ambient temperature. Regression analysis showed that low ambient temperature and Schirmer test value contributed to higher OSDI, while low ambient temperature and younger age contributed to higher SPEED. CONCLUSION: Low ambient temperature plays a significant role in DED symptom severity.

Background: Topical antiglaucoma medications can alter the tear film and lead to ocular surface disease (OSD). Aim: This study was done to check for the presence of OSD in patients of glaucoma on topical antiglaucoma medications and to analyze the severity of OSD with duration of treatment and number of topical antiglaucoma medications. Setting and Design: This is a prospective observational study in a tertiary care hospital. Materials and Methods: The study was undertaken in 54 eyes of 54 glaucoma patients taking antiglaucoma medications for at least 6 months and control group of 54 subjects. All the participants were assessed for OSD by ocular surface disease index (OSDI) questionnaire, Schirmer's 1 test, and tear break up time test (TBUT). Statistical Analysis: Mean and percentage were used to analyze the variables. Comparison analysis was done with analysis of variance test. P < 0.05 was considered significant. Results: The prevalence of OSD in patients of glaucoma on topical antiglaucoma medications was found to be 74%, 69%, and 83% based on OSDI questionnaire, Schirmer's test, and TBUT test, respectively. There was increase in severity of OSD with increased duration of treatment and increase in number of topical antiglaucoma medications. Conclusion: Most patients of glaucoma on topical antiglaucoma medications were having OSD. Severity of OSD is directly proportional to duration of treatment and number of drugs used.

AimTo assess the severity of dry eye disease (DED) in humans, its impact on quality of life (QoL) and to grade the damage incurred by the anterior ocular surface in patients diagnosed with type 2 diabetes mellitus (T2DM).Patients and methodsForty-six patients (mean age ± SD = 63.8 ± 6.7 years) diagnosed with T2DM were enrolled in the experimental group and 26 healthy individuals constituted the control group (67.9 ± 8.9 years). The diagnosis and gradation of DED were conducted in accordance with the International Task Force severity grading scheme. Disease-specific questionnaires were used to obtain the Ocular Surface Disease Index (OSDI) and assess the negative effects of the disease on the patient’s QoL. The severity of conjunctival redness and corneal/conjunctival staining was assessed by Efron and Oxford scales, respectively.ResultsAccording to OSDI scores, the entire experimental group presented symptoms of DED: 54.4% were diagnosed with mild DED and 46.6% with moderately severe DED. No cases of severe DED were diagnosed in either the experimental or control group. In the control group, 57.7% of individuals did not have the disease. A significant difference between the experimental and control groups was recorded for both OSDI scores (p < 0.01) and health-related QoL (p < 0.01). It was observed that keratopathy influenced the mean OSDI values of patients. The mean OSDI value was 25.14 ± 3 in the experimental group diagnosed with keratopathy, 19.3 ± 3.5 in the subgroup with no indications of corneal injury (p = 0.000002), and 13.0 ± 3.0 in the control group (p < 0.000002). Based on the DEWS scheme, a grade I severity level was observed in 46% of control subjects and 33% of patients diagnosed with T2DM (p = 0.4915); grades II and III were detected in the bulk of the experimental group (p = 0.0051; p = 0.1707). None of the subjects in the control or experimental groups manifested grade IV severity of DED.ConclusionIn comparison to healthy adults, DED adversely impacts the QoL of type 2 DM patients, regardless of the disease’s association with keratopathy.

Purpose: To review the indications and efficacy of Intense Pulsed Light (IPL) application in the treatment of Meibomian Gland Dysfunction (MGD). Its main purpose is to describe its physiology, efficacy, indications, and adverse effects. Patients and Methods: A two database (PubMed, EMBASE) search was performed from July 2017 to July 2022 using the MeSH terms ("Intense Pulsed Light" AND ("Meibomian Gland Dysfunction" OR "Dry Eye"). We included randomized studies and systematic reviews with meta-analysis. Exclusion criteria were non-randomized trials, studies enrolling non-MGD dry eye disease, and other works older than 5 years. Results: Current literature shows that IPL is an effective and safe treatment modality for severe dry eye. Available evidence shows improvement of symptoms and objective indicators, such as noninvasive breakup time, thickness of lipid layer, and Schirmer test. However, our review concluded that the beneficial effects of IPL may lose some efficacy at 6-months after the initial session, and subsequent sessions may be required. Thus, IPL treatment should not be considered as first-line therapy for MGD but instead as an adjuvant option to the standard of care. The optimal treatment modality remains unknown and should be tailored according to each patient's phenotype, clinician's experience, and available technology. There is evidence that IPL treatment may down-regulate pro-inflammatory markers (such as interleukin (IL) 6, IL17a, IL-1) and Prostaglandin E2 (PGE2). Conclusion: MGD is a multifactorial disease and IPL treatment seems a promising treatment modality. Despite this, more evidence is needed to study its benefits – since this is an emerging technology, it is expected an increase in comparative studies in the following years, with longer follow-up periods, which may enable more precise conclusions about this treatment modality. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye disease is a rising occupational hazard in India. Firozabad, is known for its glass manufacturing work worldwide. As there is limited evidence available on dry eye prevalence in glass industry workers, the present study was undertaken. Aim: To find out the prevalence and severity of Dry Eye Disease (DED) in glass industry workers of Firozabad, Uttar Pradesh, India. Materials and Methods: The cross-sectional observational study was conducted in Department of Ophthalmology at Sarojini Naidu Medical College, Agra, Uttar Pradesh, India, from March 2020 to September 2021 among the glass industry workers at Firozabad. It was a field survey, conducted in the factories only. Ocular Surface Disease Index (OSDI) Questionnaire was presented to 500 randomly selected glass industry workers to screen for dry eye disease. Based on subject's response to OSDI questionnaire, score was calculated and then evaluated with an OSDI chart to assess the magnitude of dry eye symptoms. The final diagnosis and grading of dry eye was done on the basis of Schirmer's test. Chi-square test was used to detect the association between variables. Statistical Package for Social Sciences (SPSS) software (version 28.0) was used for analysis. A p-value <0.05 was regarded as significant. Results: In the present study, the overall dry eye prevalence in glass industry workers was 28%. Mild dry eye was present in 3.2% of workers, moderate dry eye in 16.8%, and severe dry eye was present in 8% of glass workers. There was significant association between dry eye and working hours (per day) in two different study groups (<8 hrs and >8 hrs) (χ²=20.9, p-value <0.001). There was also a significant association between the prevalence of dry eye and the years of exposure (in years) in the glass industry (χ²=51.4, p-value <0.001). Conclusion: Prevalence of dry eye in glass industry workers is significantly high. Glass industry workers should undergo regular eye checkups to pick up DED as the earliest. [ABSTRACT FROM AUTHOR]

Introduction: Working in closed wards at hospitals during night-time shifts and using electronic health records may raise the risk of dry eye disease in nurses. Objective: The purpose of the current study was to assess the prevalence and associated factors of dry eye disease among hospital nurses in the North West Bank, Palestine. Methods: A descriptive cross-sectional study. The study included 300 nurses who work at hospitals in the North West Bank, Palestine. The Ocular Surface Disease Index (OSDI) questionnaire on dry eye disease was used to estimate the prevalence of symptomatic dry eye disease. Results: The percentage of dry eye disease prevalence among study participants was 62% with an OSDI score of >13 (mild to moderate and severe OSDI status). Nurses who wore contact lenses worked during the night-time, and worked in the intensive care unit were more likely to report significantly higher OSDI scores (p <.05). Moreover, gender, smoking, and computer use were not statistically associated with dry eye disease (p >.05). Conclusion: Symptomatic dry eye disease is one of the most common ocular diseases among hospital nurses in Palestine. [ABSTRACT FROM AUTHOR]

AIM: To assess the reliability of web-based version of ocular surface disease index in Chinese (C-OSDI) on clinically diagnosed dry eye disease (DE) patients. METHODS: A total of 254 Chinese participants (51% male, 129/254; mean age: 27.90±9.06y) with DED completed paper- and web-based versions of C-OSDI questionnaires in a randomized crossover design. Ophthalmology examination and DED diagnosis were performed prior to the participants being invited to join the study. Participants were randomly designated to either group A (paper-based first and web-based second) or group B (web-based first and paper-based second). Final data analysis included participants that had successfully completed both versions of the C-OSDI. Demographic characteristics, test-retest reliability, and agreement of individual items, subscales, and total score were evaluated with intraclass correlation coefficients (ICC), Spearman rank correlation, Wilcoxon test and Rasch analysis. RESULTS: Reliability indexes were adequate, Pearson correlation was greater than 0.8 and ICCs range was 0.827 to 0.982; total C-OSDI score was not statistically different between the two versions. The values of mean-squares fit statistics were very low compared to 1, indicating that the responses to the items by the model had a high degree of predictability. While comparing the favorability 72% (182/254) of the participants preferred web-based assessment. CONCLUSION: Web-based C-OSDI is reliable in assessing DED and correlation with the paper-based version is significant in all subscales and overall total score. Web-based C-OSDI can be administered to assess individuals with DED as participants predominantly favored online assessment.

Purpose: To evaluate the correlation of Meiboscale with symptom score (Ocular Surface Disease Index [OSDI]) and meibomian gland dysfunction (MGD) sign score.Methods: We performed a cross-sectional hospital-based study of 53 patients of primary MGD who filled the OSDI questionnaire form and underwent complete ocular examination. The MGD sign score was calculated in both eyes using the sum of six grading systems proposed by Arita et al. in 2016. The participants underwent imaging of the upper and lower eyelids of both eyes (212 eyelids) by specular microscope. The area of meibomian gland loss (MGL) was visually assessed and scored using the Meiboscale photographic card. Correlation between these three values - OSDI score, sign score, and MGL score based on Meiboscale - was calculated using Spearman's correlation analysis and Jonckheere-Terpstra (J-T) test. Correlation coefficient rs > 0.5 was considered clinically significant.Results: Associations between MGL score and OSDI score, as well as between OSDI and sign score were statistically significant, but not clinically significant (rs = 0.3684, P < 0.001 and rs = 0.41179, P < 0.001, respectively). The association between MGL score and MGD sign score was statistically as well as clinically significant (rs = 0.8392, P < 0.001). J-T test revealed large effect size (P < 0.001, r-effect = 0.93).Conclusion: The Meiboscale card had not been tested for utility in the Indian outpatient setting yet. Meiboscale can be used for reliable assessment and grading of MGD, and has clinical utility similar to the sum of six MGD sign scores. Additionally, assessment of symptoms using OSDI or a similar questionnaire is also recommended. [ABSTRACT FROM AUTHOR]

Background: Dry eye is a common disorder of the tear film that results in epithelial damage and the disruption of normal homeostasis at the ocular surface. It is a common ocular condition that is often missed in clinical diagnosis. The objectives of this study were to determine the prevalence and pattern of dry eye symptoms using the Ocular Surface Disease Index (OSDI) among commercial motorcyclists and also identify factors that may be responsible for dry eye symptoms in this population. Methods: This was a descriptive, cross-sectional, population-based study. Using a multistage random sampling technique, 422 commercial motorcyclists were surveyed from 10 units of registered commercial motorcyclists. Interviewer-administered OSDI questionnaires (face to face) were used, and visual acuity (VA) measurement was done. Results: The prevalence of dry eye symptoms in this study was 83.42%. Using the OSDI, the pattern of dry eye symptoms in this study showed that 21.56% had mild dry eye, 54% had moderate dry eye, and 7.82% had severe dry eye. Riders aged >50 years (86.90%), P < 0.05, 95% confidence interval: 0.012–0.021; nonuse of protective spectacles (87.46%), P < 0.05, 95% confidence interval: −0.235–−0.087; and use of helmets with face shields while riding (92.89%), P < 0.05, 95% confidence interval: −0.160–−0.062, were risk factors for dry eye symptoms. All respondents who had diabetes mellitus (P < 0.05, 95% confidence interval: 0.084–0.429) and a larger proportion (84.86%) of those not on topical medications (P < 0.05, 95% confidence interval: −0.365–−0.066) had dry eye. Visual impairment (VA

Purpose: To compare the suitability of the Ocular Surface Disease Index (OSDI) and the 5-item Dry Eye Questionnaire (DEQ-5) in Indian patients with dry eyes. Methods: This cross-sectional study evaluated the OSDI and DEQ-5 in patients with tear film abnormalities. Tear film breakup time, tear film height, Schirmer's I, lissamine green staining, and meibomian gland expressibility were performed on each patient. Results: There were 101 patients with symptoms and/or signs of tear film abnormality. Both OSDI and DEQ-5 questionnaires significantly correlated (ρ = 0.566, P < 0.0001) with each other. The OSDI questionnaire showed a good correlation with all dry eye tests, whereas the DEQ-5 correlated significantly only with the tear film breakup time and the lissamine green score. None of the questionnaires correlated with meibomian gland expressibility. The Bland–Altman analysis revealed a marginal bias (−0.01 unit) for DEQ-5. The DEQ-5 scored higher in patients with mild symptoms. While 101 (100%) patients answered all the questions in the DEQ-5, only 19 (18.8%) patients answered all the questions in the OSDI questionnaire. The least responses were recorded in the vision-function-related and environmental trigger subscales of the OSDI. Conclusion: The OSDI and DEQ-5 scores showed a moderate correlation. The OSDI questionnaire correlated with a higher number of dry eye tests than the DEQ-5. The large number of skipped questions in the vision-function-related and environmental trigger subscales of the OSDI suggests that the questionnaire is not adequately adapted to the Indian population. Patients with a negative OSDI score should be reassessed with the DEQ-5 to exclude symptom positivity.

Aim: To study the prevalence of computer vision syndrome (CVS) and dry eyes in computer operators. Materials and Methods: The cross-sectional study was conducted at teaching institute. Hundred participants were included in our study according to the inclusion criteria. Questionnaire was prepared to ask symptoms of CVS. Ocular surface disease index (OSDI), refraction, Schirmer's test 1, and tear film break-up time (TBUT) were performed. Data were collected and analyzed by SPSS software. Results: The prevalence of CVS was 74%. In the study population, 61 were male and 39 were female. Mean age was 29.58 years (7.85). Most of the participants were of age 21–30 years. Depending on the working hours, most of the participants (37.84%) were working for 4–8 h. About 37.84% of participants were working for 4–8 h. The most common eye complaint was eye strain. According to the OSDI score, mild dry eye was present in 23 individuals and moderate dry eye was present in 41 individuals. According to Schirmer's test 1, dry eye was present in 59% in the right eye and 58% in the left eye. According to TBUT, dry eye was present 59% in the right eye and 57% in the left eye. Dry eye was diagnosed in 59 (59.0%) individuals. Conclusion: The prevalence of CVS has increased due to the increased use of computer in our daily life. Its prolonged use causes dry eyes and inefficiency in their working, though most computer users are unaware of this fact. Hence, a lot of work has to be done to aware the community about the disease.

Biljana Kuzmanović Elabjer, Leon Marković, Mirjana Bjeloš, Mladen Bušić, Daliborka Miletić, Eva Kos University Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, Zagreb, CroatiaCorrespondence: Mladen BušićUniversity Eye Clinic, Faculty of Dental Medicine and Health Care Osijek, Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, University Hospital “Sveti Duh”, WHO Collaborating Centre for Child Eye Care, Sveti Duh 64, Zagreb 10 000, CroatiaTel +385913712167Email mbusic@kbsd.hrBackground: Inflammation is among the most important mechanisms in the pathogenesis of dry eye disease (DED), triggering the vicious circle of the disease. Reducing inflammation is an important target in dry eye disease treatment. Hydrocortisone is a low-potency corticosteroid with a low ocular penetration potential.Aim: To document the effect of topical preservative-free hydrocortisone 0.335% (PFH, Softacort®, Laboratoires Théa, France) on DED.Methods: Retrospective data review of patients with mild to moderate DED, treated with PFH for 15 days. Clinical evaluations at Days 0 and 15 included the assessment of the central precorneal tear film thickness (CPTFT), fluorescein tear breakup time, Schirmer test, corneal grading staining (Oxford schema), ocular surface disease index (OSDI) spatial distribution of the precorneal tear film thickness, intraocular pressure (IOP) and local tolerance.Results: Data from 13 women and 2 men were collected. Mean age±SD was 51± 5 years for women and 53± 4 years for men. Clinical signs and symptoms significantly (all p< 0.05) improved after 15 days of treatment. A significant positive correlation between the percentage of change in left eye CPTFT and that in the contralateral eye CPTFT was observed (p=0.003) as well as for both eyes and the left eye FTBUT (p=0.03). For the percentage of change in OSDI, the only significant correlation was with the percentage of change in right eye and FTBUT (p=0.03). IOP remained unchanged. No adverse events were recorded.Conclusion: This retrospective data review confirms that topical PFH twice daily for 2 weeks significantly improves clinical signs and symptoms in patients with mild to moderate DED with no safety issues.Keywords: dry eye disease, inflammation, topical preservative-free hydrocortisone, corticosteroids, central precorneal tear film, ocular surface disease index

AIM: To evaluate the clinical significance of outer zona pellucid in tear ferning image in dry eye patients and explore a new method for evaluation tear lipid layer. METHODS:Forty-seven patients were randomly selected from the outpatient department of ophthalmology, He Eye hospital, Shenyang from May 2018 to July 2019. The right eye was selected as the study object. All patients were investigated by the ocular surface disease index(OSDI)questionnaire and performed lipid layer classification by DR-1 tear interferometry, NIBUT and tear meniscus height examination by OCULUS Keratograph. Then tears were collected and tear ferning tests was performed. The whole tear crystallization images were observed and photographed by microscopy, then measured by Digimizer software and the area ratios of outer transparent belt were calculated. Pearson correlation analysis were performed between area ratios of outer transparent belt and OSDI scores, lipid layer levels, tear meniscus height values, NIBUT values. RESULTS: The area ratios of outer transparent belt were negatively correlated with OSDI scores(r=-0.764, Pr=-0.838, Pr=0.575, Pr=-0.237, P=0.112). CONCLUSION: The outer transparent belt in tear crystallization image can be used to evaluate the lipid layer of tear film; the larger area ratios of outer transparent belt, the thicker the lipid layer. This method has the advantages of quantified results, good repeatability, low requirement on equipment, and is worth popularizing.

Objectives:To study the incidence of dry eye and its determinants in patients undergoing cataract surgery.Materials and Methods:One hundred twenty patients with senile cataract underwent Schirmer’s test, tear break-up time (TBUT) test, lissamine green staining of the cornea and conjunctiva, and Ocular Surface Disease Index (OSDI) for evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery.Results:Mean age of the patients was 59.25+9.77 years and 73 (60.8%) were men. None of the patients had dry eye at the time of enrollment as per the criteria of our study. Postoperatively, Schirmer’s test values ranged from 12-35 mm and 8-24 mm at first and second follow-ups, respectively. Mean TBUT was 13.16±2.45 and 9.64±2.20 seconds, while lissamine green staining score was 3 in 67 (55.8%) and 1 in 67 (55.8%) subjects at first and second follow-up, respectively. OSDI values ranged from 1-30 and 10-33 with a mean of 25.97±5.34 and 11.96±7.47 respectively at first and second follow-up. At first follow-up, 89.1% of the 56 patients who underwent phacoemulsification were found to have grade 2 dry eye (p

Pedro Molina-Solana,1 Francisco de Borja Domínguez-Serrano,1 Antonio Manuel Garrido-Hermosilla,1,2 Jesús Montero-Iruzubieta,1,2 Ana Fernández-Palacín,3 Enrique Rodríguez-de-la-Rúa-Franch,1,2 Manuel Caro-Magdaleno1,2 1Ophthalmology, Virgen Macarena Hospital Seville, Seville, Spain; 2Surgery Department, University of Seville, Seville, Spain; 3Preventive Medicine and Public Health Department, University of Seville, Seville, SpainCorrespondence: Manuel Caro-Magdaleno Calle Bogotá 7, Bloque 3, 1ºB, Seville 41013, SpainTel +34 609030403Email mcaro79@gmail.comPurpose: Artificial tears only provide transient relief for dry eye. To the best of our knowledge, this is the first study to objectively compare treatment with artificial tears with Keratograph 5M, which allows accurate and objective investigation of dry eye and artificial tear treatment. We aimed to evaluate whether a preservative-free combination of 0.4% hyaluronic acid and 0.2% galactoxyloglucan can improve dry eye using the new topographer, Keratograph 5M.Patients and Methods: This prospective longitudinal, single-arm interventional cohort study was performed at a tertiary referral center and involved 20 patients with dry eye (40 eyes). Preservative-free artificial tears were administered every 3 h. The participants underwent clinical and instrumental evaluations at baseline, 15, 30, 60, 90 and 120 min after instillation and 1 week and 1 month after treatment. Baseline values were considered as the controls. All patients were assessed with Keratograph 5M for non-invasive Keratograph first break-up time and non-invasive Keratograph average break-up time, conjunctival hyperemia, and tear meniscus height. Ocular surface staining with fluorescein was evaluated using the slit-lamp and fluorescein break-up time examinations, and the Ocular Surface Disease Index score was recorded for each patient.Results: The signs and symptoms improved after 1 month of preservative-free 0.4% hyaluronic acid and 0.2% galactoxyloglucan treatment. There was a significant increase in the non-invasive Keratograph first break-up time and non-invasive Keratograph average break-up time at 15, 30, 60, and 90 min, and 1 week and 1 month (P < 0.05) and a decrease in hyperemia, corneal staining, and Ocular Surface Disease Index scores after 1 week and 1 month (P < 0.05). No treatment-related adverse event was observed.Conclusion: A combination of 0.4% hyaluronic acid and 0.2% galactoxyloglucan artificial tears seems effective for treating dry eye. Keratograph 5M can objectively detect these changes during the follow-up period.Keywords: artificial tears, Keratograph, non-invasive Keratograph break-up time, Ocular Surface Disease Index, dry eye

Purpose: To evaluate conjunctival impression cytology (CIC) findings and tear film parameters in patients with multiple sclerosis (MS) compared with controls. Methods: Thirty-three patients with MS (MS group) and 33 age- and sex-matched healthy subjects (control group) were included in this cross-sectional comparative study. CIC grades, tear break-up time (TBUT), Schirmer 1 test results, and Ocular Surface Disease Index (OSDI) scores were compared between the two groups, and correlations between CIC grade, TBUT, Schirmer 1 test result, OSDI score, Expanded Disability Status Scale score, and disease duration were analyzed. Results: Mean CIC grade was higher in the MS group than in the control group (1.48 ± 0.71 and 0.39 ± 0.56, respectively; p < 0.001). In the MS group, CIC of the 14 participants (42.4%) was grade 2–3. In the control group, CIC of the only one participant (3.3%) was grade 2, and none of them was grade 3. TBUT (8.12 ± 3.16, 13.06 ± 4.23 s in MS and control groups, respectively; p < 0.001) and Schirmer 1 test results (8.45 ± 5.75, 17.36 ± 10.89 mm in MS and control groups, respectively; p < 0.001) were lower, and OSDI score (36.36 ± 19.19, 13.70 ± 15.36 in MS and control groups, respectively; p < 0.001) was higher in the MS group compared to the control group. Conclusion: In patients with MS, objective findings of dry eye, subjective symptoms related to dry eye, and CIC abnormalities, including high grades of conjunctival squamous metaplasia and goblet cell loss, are more common. Patients with MS should be monitored for ocular surface alterations and dry eye disease. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to determine the magnitude and severity of dry eye disease (DED) in medical students as per assessed by the questionnaire Ocular Surface Disease Index (OSDI) and Schirmer's test. Materials and Methods: A cross-sectional study of a 2-month duration involving medical students was conducted to determine the magnitude and severity of DED. Dry eye was assessed through self-administered questionnaire, Schirmer's test, and OSDI scoring. Results: The most common symptom among the participants was eyestrain in 39% (N = 31) followed by headache in 33% (N = 26). Based on Schirmer's test, 75% (n = 60) of the participants were normal, 8% (n = 6) students had mild DED, 5% (N = 4) students with moderate DED, and 11% (N = 9) students had severe DED. Based on OSDI scoring, 59% (n = 47) participants were normal, 28% (n = 21) had mild DED, 11% (N = 9) had moderate, while 2% (N = 2) had severe DED. Conclusion: In this era of digitalization, DED has engulfed the younger population who are spending greater hours on different digital devices. The prevalence of symptomatic dry eyes in our study was 41% while it was 25% based on signs. This should raise concern among the caregivers to increase awareness regarding dry eyes and give strict guidelines restricting screen time. The use of ergonomic practices such as appropriate lighting in a room, adjusting digital screen parameters (resolution, text size, contrast, and luminance), and taking frequent breaks while using the screen should be encouraged. [ABSTRACT FROM AUTHOR]

Aims: To compare the efficacy of the combination of 0. 05% azelastine and 0.1% tacrolimus eye drops with 0.1% tacrolimus monotherapy in pediatric patients with vernal keratoconjunctivitis (VKC).Methods: Prospective study. Seventy-six patients with VKC were randomized 1:1 into monotherapy group with 0.1% tacrolimus or combination therapy group with 0.1% tacrolimus and 0.05% azelastine. The Ocular Surface Disease Index (OSDI) scores and the signs of conjunctival hyperemia, corneal involvement, and palpebral conjunctiva papillae were assessed at baseline and at 1, 2, and 6 weeks after treatment.Results: Two groups were comparable in age, sex, duration of VKC, OSDI, and clinical signs of VKC at baseline. Significant improvements in OSDI score and clinical signs were observed in both groups at all follow-up visits (all p < 0.001), compared with baseline. The combination therapy group showed a larger decrease in OSDI score from baseline (10.30 ± 0.9) compared with monotherapy group (7.30 ± 0.7, p =0.0085) at 1 week. Greater improvements in conjunctival hyperemia and conjunctival papillae were identified in the combination therapy group, compared with in the monotherapy group, at all follow-up visits (all p < 0.05). The corneal involvement scores in the combination group is significantly lower than the monotherapy group at 2 weeks after the treatment (p = 0.0488). No severe adverse effect was found in either group during the study.Conclusions: Compared with a monotherapy of 0.1% tacrolimus, the combination of 0.05% azelastine and 0.1% tacrolimus eye drops lead to faster and greater improvements in clinical signs and symptoms of vernal keratoconjunctivitis in pediatric patients.

Purpose: To evaluate the correlation between ocular surface disease (OSD) and functional status among elderly population over 60 years old in Hong Kong. Methods: Chinese subjects above 60 years old were recruited from the Ophthalmology clinic in Hong Kong West Cluster. Subjects demographic and questionnaires to evaluate the functional status were used to correlate with OSD objectively with clinical examination to assess the meibomian gland dysfunction (MGD), corneal staining, Schirmer's test and tear break-up time (TBUT); and subjectively with ocular surface disease index (OSDI). Results: Twenty-eight patients were recruited, with a mean age of 71.5 ± 6.8 years. There was good correlation between the findings of the two eyes for bilateral measurements. Corneal staining was present in 75% of the subjects, while 92.9% of them had positive MGD grading. TBUT was reduced in 85.7% of the subjects. There is a negative association between MGD grading and Barthel index (r = −0.55, p<.01), indicating worse activities of daily living is related to worse MGD. OSDI is negatively associated with Schirmer's test (r = −0.49, p<.01). A negative correlation is also found between TBUT value and corneal staining (r = −0.58, p<.01). Conclusions: There is a high prevalence of OSD among our subjects. Lower Barthel index (indicating worse Lawton's instrumental activities of daily living) is associated with worse MGD grading. In elderly with poor functional status, care should be taken to manage their OSD. [ABSTRACT FROM AUTHOR]

Purpose: To compare the suitability of the Ocular Surface Disease Index (OSDI) and the 5-item Dry Eye Questionnaire (DEQ-5) in Indian patients with dry eyes.Methods: This cross-sectional study evaluated the OSDI and DEQ-5 in patients with tear film abnormalities. Tear film breakup time, tear film height, Schirmer's I, lissamine green staining, and meibomian gland expressibility were performed on each patient.Results: There were 101 patients with symptoms and/or signs of tear film abnormality. Both OSDI and DEQ-5 questionnaires significantly correlated (ρ = 0.566, P < 0.0001) with each other. The OSDI questionnaire showed a good correlation with all dry eye tests, whereas the DEQ-5 correlated significantly only with the tear film breakup time and the lissamine green score. None of the questionnaires correlated with meibomian gland expressibility. The Bland-Altman analysis revealed a marginal bias (-0.01 unit) for DEQ-5. The DEQ-5 scored higher in patients with mild symptoms. While 101 (100%) patients answered all the questions in the DEQ-5, only 19 (18.8%) patients answered all the questions in the OSDI questionnaire. The least responses were recorded in the vision-function-related and environmental trigger subscales of the OSDI.Conclusion: The OSDI and DEQ-5 scores showed a moderate correlation. The OSDI questionnaire correlated with a higher number of dry eye tests than the DEQ-5. The large number of skipped questions in the vision-function-related and environmental trigger subscales of the OSDI suggests that the questionnaire is not adequately adapted to the Indian population. Patients with a negative OSDI score should be reassessed with the DEQ-5 to exclude symptom positivity. [ABSTRACT FROM AUTHOR]

Joseph Tauber,1 James Owen,2 Marc Bloomenstein,3 John Hovanesian,4 Mark A Bullimore5 1Tauber Eye Center, Kansas City, MO 64111, USA; 2TLC Laser Eye Centers-La Jolla, La Jolla, CA 92122, USA; 3Schwartz Laser Eye Center, Scottsdale, AZ 85260, USA; 4Harvard Eye Associates, Laguna Hills, CA 92653, USA; 5University of Houston, College of Optometry, Houston, TX 77204, USACorrespondence: Joseph TauberTauber Eye Center, 4400 Broadway, Suite 202, Kansas City, MO 64111, USATel +1 816 531 9100Fax +1 816 531 9105Email jt@taubereye.comPurpose: To compare the effects of eyelid treatment with the iLUX MGD Treatment System and the LipiFlow Thermal Pulsation System on objective and subjective parameters of meibomian gland function and symptoms.Patients and Methods: In this randomized, open-label, controlled, multicenter clinical trial, both eyes of 142 patients aged ≥ 18 years with Ocular Surface Disease Index (OSDI) scores ≥ 23, total meibomian gland scores (MGS) ≤ 12 in the lower eyelid of each eye, and tear break-up time (TBUT) < 10 s were randomized 1:1 to iLUX or LipiFlow treatment, with stratification by test center. The primary effectiveness endpoints were changes in total MGS (masked) and TBUT from baseline to 4 weeks. The secondary effectiveness endpoint was changed in OSDI score from baseline to 4 weeks.Results: Both devices significantly improved effectiveness outcomes, with no differences between the two devices. At the 4-week visit, mean MGS, TBUT, and OSDI scores improved at least 16.9 ± 11.5, 2.6 ± 3.2 s, and 28.0 ± 22.8, respectively, across treatment groups and treated eyes. Four device/procedure-related events occurred in the iLUX group, compared with none in the LipiFlow group, but there were no device-related adverse events that involved changes in lid margins, eyelids, or lash integrity. Corneal staining, intraocular pressure, and visual acuity did not differ in the two groups.Conclusion: Both treatments produced significant improvements in meibomian gland function and symptoms. For all effectiveness measures, there were no statistically significant differences between the two treatments.Keywords: meibomian gland dysfunction, meibomian gland score, tear break-up time, ocular surface disease index

INTRODUCTION[|]This study was performed to evaluate the Schirmer II test (ST2) results, tear breakup time (TBUT) findings, and Ocular Surface Disease Index (OSDI) scores of pterygium patients under 30 years of age, and to compare the results with pterygium patients aged 30 years and older and healthy controls.[¤]METHODS[|]Eighty-four eyes of 60 patients who had primary pterygium and were younger than 30 years of age (Group 1), 79 eyes of 53 patients who had primary pterygium and were 30 years of age and older (Group 2), and 64 eyes of 64 healthy controls (Group 3) were included in the study. The results of ST2 and TBUT tests and the OSDI questionnaire scores were recorded and compared. [¤]RESULTS[|]Group 1 had lower TBUT values compared to Group 2 and the control group (p= 0.03 and p

Background Dry eye after uneventful phacoemulsification has been a common cause for patients’ dissatisfaction, despite good visual outcome. Tear film instability after cataract extraction has been attributed to multiple intraoperative and postoperative causes. Oral antioxidants have been proposed to decrease the objective and subjective symptoms of dry eye. Objective The aim of this study was to evaluate the effectiveness of oral antioxidant supplementation on dry eye after phacoemulsification. Patients and methods This is a randomized controlled clinical case series study that included 60 eyes of 60 patients. They were divided into two groups: group 1 was treated with oral antioxidants after surgery, whereas group 2 was not treated with oral antioxidants. The study was conducted at the Ophthalmology Department of Menoufia University Hospital in the period between January 2018 and January 2019. Follow-up for those patients were done by Schirmer’s test 1, break-up time test, and ocular surface disease index questionnaire preoperatively and at 1, 2, and 3 months postoperatively to evaluate oral antioxidant supplementation effect on dry eye after surgery. Results Three months after oral antioxidant supplementation following phacoemulsification, statistically significant differences (P

Larissa Gouvea,1 George Oral Waring IV,2 Ashley Brundrett,1,3 Michelle Crouse,4 Karolinne Maia Rocha1,3 1Storm Eye Institute, Medical University of South Carolina, Charleston, SC, USA; 2Waring Vision Institute, Mount Pleasant, SC, USA; 3Department of Ophthalmology, Medical University of South Carolina, Charleston, SC, USA; 4Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USACorrespondence: Larissa GouveaStorm Eye Institute, Medical University of South Carolina, 167 Ashley Avenue, Charleston, SC 29425, USAEmail gouveaalarissa@gmail.comPurpose: To assess optical quality dynamics using a double-pass (DP) system in patients with dry eye disease (DED).Methods: Seventy-six eyes with DED and 44 control subjects were enrolled in this study. Each patient underwent ocular surface evaluation including fluorescein corneal staining and Schirmer’s II test. Ocular Surface Disease Index (OSDI) questionnaire was used to assess subjective symptoms. Optical quality dynamics and tear film instability was analyzed using a DP system (HD AnalyzerTM, Visiometrics, Spain). Mean objective scatter index (OSI), maximum and minimum OSI, difference between maximum and minimum OSI (ΔOSI) were recorded with 40 consecutive scans over 20 s.Results: The DED group had pronounced impairment of optical quality compared to the control group. Mean OSI (4.29±4.07), minimum (3.22±3.51) and maximum (5.72±4.52) OSI, ΔOSI (2.50±1.96), OSDI score (36.94±16.55), and fluorescein corneal staining (0.79±0.96) were statistically significantly higher than controls (p

Asunción Alfaro-Juárez,1,* Manuel Caro-Magdaleno,1,2,* Jesús Montero-Iruzubieta,1,2 Ana Fernández-Palacín,3 Ana Muñoz-Morales,1 Manuel Alberto Castilla-Martino,1 Consuelo Spínola-Muñoz,1 Enrique Rodríguez de la Rúa1,2 1U.G.C. Oftalmología, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; 2Deparmento de Cirugía, Universidad de Sevilla, Sevilla, Spain; 3Deparmento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, Spain*These authors contributed equally to this workCorrespondence: Manuel Caro-MagdalenoU.G.C. Oftalmología, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, C/Bogota 7, Bloq.3, 1st-B, Sevilla 41013, SpainTel +34609030403Email mcaro79@gmail.comPurpose: In limbal stem cell deficiency, both the Ocular Surface Disease Index (OSDI) questionnaire and tear break-up time (BUT) are comparable between traditional methods and the Keratograph 5M. In this study, we aimed to correlate OSDI with Keratograph 5M interviewed OSDI, as well as slit-lamp tear BUT with Keratograph 5M noninvasive tear break-up time (NIKBUT) in limbal stem cell deficiency.Patients and methods: Thirty-eight limbal stem cell-deficiency patients (76 eyes) from Virgen Macarena-Rocio Hospital (Seville, Spain) underwent this diagnostic test study. All patients completed the traditional OSDI. We measured the BUT, performed a Keratograph 5M analysis of NIKBUT first (employed for the analysis) followed by the average NIKBUT, the level of dryness, and conducted the OSDI questionnaire through an interview. For each pair of tests, we analyzed the means and applied an intraclass correlation coefficient (r), creating a Bland-Altman plot for data dispersion.Results: Average values were 47.5 points (±25.8), and 47.3 points (±27.5) for traditional OSDI and Keratograph OSDI, respectively (P =0.87); the r value indicates good agreement (0.72). The Bland-Altman plot followed a linear pattern, and the results were similarly distributed. The NIKBUT mean was shorter than the BUT mean (P = 0.007); the r value indicates moderate agreement (0.574). The Bland-Altman plot formed an almost horizontal line, with almost all values between the mean and two standard deviations.Conclusion: Keratograph 5M is useful for the evaluation of the ocular surface in limbal stem cell deficiency. NIKBUT can substitute BUT based on its advantages of being noninvasive, objective, with intraobserver and interobserver repeatability and reliability. The Keratograph 5M OSDI is comparable to the traditional questionnaire.Keywords: keratograph, limbal stem cell deficiency, noninvasive keratograph tear break-up time, ocular surface desease index, tear break-up time

AIM: To observe the effect of corneal bandage lens on ocular surface repair after pterygium excision combined with limbal stem cell transplantation.METHODS: Totally 52 patients with unilateral primary pterygium were selected from January 2016 to January 2018 in the ophthalmology department of our hospital. All 26 cases(26 eyes)underwent pterygium excision combined with limbal stem cell transplantation and who were placed with bandage lens as the experimental group, the other 26 cases(26 eyes)without bandage lens placed as the control group. Ocular surface disease index(OSDI)questionnaires, tear break-up time(BUT), and corneal fluorescein staining(CFS)were recorded before operation and after operation.RESULTS: BUT in the experimental group was longer than that in the control group(PPPP>0.05), but in the corresponding period, BUT in the control group was still shorter, OSDI and CFS scores were still higher than those before the operation(PCONCLUSION: Surgical excision combined with autologous limbal stem cell transplantation and placing corneal bandage lens is a safe method to promote corneal healing, improve tear film stability and reduce postoperative discomfort in pterygium patients in the early stage after surgery, which is conducive to the repair of the ocular surface and has certain clinical application value.

Abstract Background This study is aim to compare the clinical effectiveness between the two most prominent dry eye disease (DED)-specific eye drops, 0.05% cyclosporine (CN) and 3% diquafosol (DQ). Methods This is a multi-centered, randomized, masked, prospective clinical study. A total of 153 DED patients were randomly allocated to use CN twice per day or DQ six times daily. Cornea and conjunctival staining scores (NEI scale), tear break-up time (TBUT), Schirmer test scores, and ocular surface disease index (OSDI) score were measured at baseline, 4 and 12 weeks after treatment. Results At 12 weeks after treatment, NEI scaled scores were significantly reduced from the baseline by − 6.60 for CN and − 6.63 for DQ group (all P

Karl Stonecipher,1 Thomas G Abell,2 Bennett Chotiner,3 Erik Chotiner,3 Rick Potvin41Physicians Protocol, Greensboro, NC, USA; 2Abell Eyes, Lexington, KY, USA; 3Memorial Eye Institute, Harrisburg, PA, USA; 4Science in Vision, Akron, NY, USAPurpose: To evaluate the effects of combined intense pulsed light therapy (IPL) and low-level light therapy (LLLT) on clinical measures of dry eye related to severe meibomian gland disease (MGD) in subjects unresponsive to previous medical management.Patients and Methods: This was a retrospective chart review of patients treated by 4 physicians at 3 centers. All patients were documented treatment failures with traditional pharmaceutical therapy. They all had their MGD evaluated before treatment using a grading scale (0–4), tear breakup time in seconds and the Ocular Surface Disease Index (OSDI) questionnaire. To be included, all patients had to have had a short course of adjunct pharmaceutical or device-related therapy, along with a combined IPL/LLLT treatment. As well, a second MGD evaluation with the same three measures had to have been conducted 1–3 months post treatment.Results: A total of 460 eyes of 230 patients were identified for inclusion in the data set. Mean OSDI scores were significantly lower after treatment; 70.4% of patients had pretreatment OSDI scores indicative of dry eye; this dropped to 29.1% of patients after treatment. A 1-step or greater reduction in MGD grading was observed in 70% of eyes, with 28% of eyes having a 2-step or greater reduction. Tear breakup time was ≤6 seconds in 86.7% of eyes pretreatment, dropping to 33.9% of eyes after treatment. There were no ocular or facial adverse events or side effects related to the combined light treatment.Conclusion: The use of combined IPL/LLLT for the treatment of severe MGD appears to be beneficial in patients who have failed topical and/or systemic therapy.Keywords: LLLT, low level light therapy, IPL, intense pulsed light, meibomian gland dysfunction, ocular surface disease index

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

Eduardo Chávez-Mondragón,1 Claudia Palacio,2 Abraham Soto-Gómez,3 Miguel Villanueva-Nájera,4 Guillermo De Wit-Carter,5 Ruben Suárez-Velasco,6 Leopoldo Baiza-Duran,7 Oscar Olvera-Montaño,7 Patricia Muñoz-Villegas71Fundación de Asistencia Privada Conde de Valenciana, IAP, CDMX, Mexico; 2Fundación Hospital Nuestra Señora de la Luz, IAP, CDMX, Mexico; 3Catarata y Glaucoma de Occidente, SA de CV, Guadalajara, Jalisco, Mexico; 4Private Office, CDMX, Mexico; 5Asociación para Evitar la Ceguera en Mexico IAP, CDMX, Mexico; 6Novam y Vita, Guadalajara, Jalisco, Mexico; 7Clinical Research Department, Laboratorios Sophia, SA de CV, Zapopan, Jalisco, MexicoPurpose: This study evaluated the clinical efficacy and safety of bromfenac 0.09%, sodium hyaluronate 0.4% (SH) combination therapy, versus placebo and SH in a clinical model of pterygium I–III.Methods: A total of 166 eyes (99 patients) with pterygium grade I–III were randomized to bromfenac 0.09% ophthalmic solution+SH 0.4% or placebo+SH 0.4%. This was a Phase IV, prospective, parallel, double-masked, multicenter clinical trial. One drop of bromfenac or placebo was instilled two times a day (BID) for 20 days, both groups accompanied treatments with one drop of SH three times a day (TID). The primary efficacy endpoints were the conjunctival hyperemia and the Ocular Surface Disease Index (OSDI) score. Other results measured included burning, foreign body sensation, and photophobia. The safety was assessed by the tear break-up time (TBUT), visual acuity (VA), IOP, lissamine green, fluorescein stains, and the incidence of adverse events (AEs).Results: Compared with baseline, there was a significant reduction in the conjunctival hyperemia (p=0.0001) and OSDI score in both groups (p=0.0001). There was a significant improvement in ocular symptomatology for both, placebo/SH and bromfenac/SH groups (p=0.0001), the decrement in the ocular burning was 41.1% vs 24.6%, the foreign body sensation was 31.5% vs 36.2% and, for photophobia was 23.3% vs 30.5%, respectively. A statistically significant difference was observed in TBUT for bromfenac/SH (p=0.045), at day 20. There were no significant alterations in IOP (p=0.068) or VA (p=0.632). Similar improvements were observed in the fluorescein and green lissamine staining. Finally, the incidence of AE was similar between groups.Conclusion: The treatment with bromfenac 0.09% ophthalmic solution and SH 0.4% combination therapy for 3 weeks reduced clinical signs, in patients with pterygium I–III. The results suggest that bromfenac 0.09% can improve the symptomatology, reduce the presentation of clinical signs associated with superficial ocular inflammation.Keywords: nonsteroidal anti-inflammatory drug, Ocular Surface Disease Index, conjunctival hyperemia, ocular lubricant

AIM: To study the recovery of cornea sensitivity after small incision lenticule extraction(SMILE)surgery by different incision sites.METHODS: Totally 30 SMILE patients(60 eyes)were selected from 05/12/2016-01/18/2018. The incision in the right eye was designed at 135° while that in the left eye was designed at 90°. Cornea sensitivity were examined and noted by an experienced examiner preoperative, 1d, 7d,1mo and 3mo 3mm from central cornea postoperative at 3, 6, 9,12 o'clock and the central cornea. The eye surface disease index(ocular surface disease index, OSDI)was also noted at the same time.RESULTS: The comparison of corneal sensitivity results from different eyes showed that there was no significant difference on all time points at different position(P>0.05). After further comparison, cornea sensitivity of both eyes was found to be lower on 1d postoperative than that preoperative, 1mo postoperative and 3mo postoperative(PP>0.05). The OSDI scores on different time points are 10.739±7.576, 15.003±11.296, 16.357±14.467, 14.020±10.128, 11.968±7.586 respectively. The comparison showed no significant difference(F=1.583, P=0.204).CONCLUSION: There is no significant difference on cornea sensitivity between two eyes after SMILE surgeries. The corneal sensitivity declined at 1d postoperative and the recovery was faster at about 1mo.

Objective: This study aimed to evaluate dry eye disease (DED) symptoms and quality of life (QoL) in a group of perimenopausal and postmenopausal women, based on the Ocular Surface Disease Index (OSDI) questionnaire.Methods: An observational study was performed in a group of 1947 perimenopausal and postmenopausal women, aged between 45 and 79 years. The personal data collected were age, menopause status, age at menopause, and OSDI score.Results: The mean age of the group was 54.18 ± 6.84 years, with a mean age at menopause of 49.45 ± 4.02 years. The average OSDI score was 29.20 ± 19.4. The overall prevalence of DED symptoms was 79%, increasing significantly in postmenopausal women, 76.4% vs. 80.5% (p = 0.029). In our group, 37.7% had severe DED symptoms. Ocular symptoms, vision-related functions, and environmental trigger scores were higher in postmenopausal women, leading to a lower QoL. The severity of OSDI score increases with age (β coefficient: 0.15 [95% confidence interval: 0.02; -0.28]), while the severity of OSDI score decreases with a later onset age of menopause (β coefficient: -0.27 [95% confidence interval: -0.55; -0.01]).Conclusions: DED symptoms are highly prevalent in perimenopausal and postmenopausal women. Postmenopausal women had a higher prevalence of symptoms and higher OSDI scores than perimenopausal women. The severity of DED symptoms and vision-related functions leads to poorer QoL. [ABSTRACT FROM AUTHOR]

Background: Traumatic dislocation of laser-assisted in situ keratomileusis (LASIK) corneal flaps is an uncommon postoperative complication that could occur any time after LASIK, and could be visually devastating. We evaluated the visual outcomes, corneal sensation, tear function, and dry eye questionnaire results of patients with traumatic dislocation of LASIK flaps, including one LASIK flap amputation.Methods: This is a retrospective case series. Seven patients who were diagnosed with traumatic displacement of the LASIK flap and underwent flap replacement surgery between August 2014 and January 2019 were included.Patient's visual acuity, refraction, corneal sensitivity, non-invasive tear breakup time (NIBUT), tear meniscus height (TMH), and ocular surface disease index (OSDI) results were evaluated.Results: The patients' mean age was 35.86 ± 5.84 years, and 42.9 % (3/7) were male. The mean duration from LASIK to trauma was 8.86 ± 2.48 years.The mean preoperative and postoperative six-month corrected distance visual acuity (CDVA) were 0.55 ± 0.34 and 0.02 ± 0.03, respectively. The mean spherical equivalent and astigmatism at six months postoperatively was - 1.0 ± 0.95 D and - 0.5 ± 0.25 D, respectively. The corneal flap was clear and well-positioned at the final follow-up (mean: 28.57 ± 6.9 months). 85.71 % (6/7) of the patients showed worse corneal sensation in the injured eye. Interocular OSDI discrepancy was less in those whose last visit was more than 30 months after the trauma.Conclusions: Postoperative CDVAat six months was improved, and the refractive data also showed some improvement. The corneal nerve and tear function recovery peaked before 30 months, while the OSDI continued to show a strong trend of improvement beyond 30 months. [ABSTRACT FROM AUTHOR]

Objective: The objectives of this study were to develop a cross-culturally adapted, Filipino version of the Ocular Surface Disease Index (OSDI) questionnaire and to assess its reliability. Methods: A Filipino-adapted version of the OSDI was developed following guidelines for language-specific questionnaires: forward translation into Filipino by 2 independent bilingual translators, back-translation into English by a language institution, and a final forward translation to Filipino resolved by a review committee. To check for equivalence, the English and Filipino versions of the OSDI were pretested on 16 patients in a dry eye clinic. The Filipino version was then administered to 36 participants, and a Cronbach alpha coefficient for reliability of the overall instrument and the alpha that would result if each item were removed were computed. Finally, the questionnaire was then retested on 11 dry eye patients to see if the coefficient would increase. Results: All reported no difficulty with the Filipino questionnaire, with 81.3% expressing preference in answering it. Most (81.3%) chose the same answer in at least half of the items in both languages, though the range of similar responses varied from 41.7% to 91.7%. Reliability testing of the Filipino questionnaire showed this to have fair internal consistency (α=0.5958). The value increased to moderate internal consistency (0.7576) when 3 items were removed. Conclusion: A culturally-adapted OSDI in Filipino was successfully produced and was the preferred tool by most patient participants.

Abstract Background International Task Force (ITF) guidelines established a grading scheme to support treatment of dry eye disease based on clinical signs and symptoms. The purpose of this study was to assess the impact of dry eye on vision-related function across ITF severity levels using the Ocular Surface Disease Index (OSDI) questionnaire. Methods Non-interventional, cross-sectional study of prescription treatment-naïve dry eye patients seeking symptom relief at 10 ophthalmology and optometry practices. Clinicians assessed corneal and conjunctival staining, tear break-up time, Schirmer’s test (type I with anesthesia), and best-corrected visual acuity. Patients completed the OSDI questionnaire and OSDI overall and domain (Symptoms, Visual Function, and Environmental Triggers) scores were compared across ITF guidelines severity levels (1–4). Results Of 158 patients (mean age, 55 years) enrolled, 52 (33%) were ITF level 1, 54 (34%) ITF level 2, and 52 (33%) ITF levels 3/4 combined. No significant differences were observed in most baseline characteristics. Overall OSDI scores (mean [standard deviation]) were 26.5 [20.0] for ITF level 1, 33.8 [17.5] for ITF level 2, and 44.9 [26.1] for ITF level 3/4 cohorts (P

AIM: To suspect laryngopharyngeal reflux (LPR) in patients with ocular surface disease (OSD). METHODS: The present study evaluated a group of subjects with OSD assessing the Ocular Surface Disease Index (OSDI) and the Reflux Symptom Index (RSI) to detect patients with suspected LPR and define a possible relationship between tests. RESULTS: Two hundred and ninety subjects (175 females, mean age: 60.41±15.68y) were consecutively visited at ophthalmologist offices. One hundred and one (34%) patients had pathological RSI (>13) and consequently a suspected LPR. CONCLUSION: The current study shows that suspected LPR may be common (34%) in patients with OSD and a suspected LPR may be considered in OSD patients when RSI score is >13 and OSDI score is >42.

Purpose: To assess tear film transforming growth factor-beta (TGF-β) and ocular microbiome changes after intense pulsed light with meibomian gland expression (IPL-MGX) vs only MGX in treating ocular rosacea with dry eye symptoms. Methods: Twenty patients were randomly assigned to IPL-MGX or MGX. Patients were examined, treated, and administered the ocular surface disease index (OSDI) survey every 4– 6 weeks for four total treatments. Tear film and conjunctival samples were collected at first and last visits, and analyzed for TGF-β concentration and 16s rRNA amplicon sequencing of ocular microbiome. Wilcoxon Rank Sum and Sign-Rank were used to examine changes from baseline. Results: OSDI revealed significantly greater improvement in symptoms after IPL-MGX (p=0.030) compared to MGX. There was no significant difference in mean TGF-β 1, 2, or 3 concentration after IPL-MGX (p=0.385, 0.709, 0.948, respectively). Quantities of Clostridium, Klebsiella, Brevibacterium, Lactobacillus, Neisseria, Streptococcus, Corynebacterium, Butyricicoccus, and Actinomyces were significantly reduced from baseline in both groups but without a significant difference between the two treatment groups. Conclusion: IPL-MGX improved dry eye symptoms more than MGX alone. IPL treatment offered no additional benefit to MGX in decreasing virulent bacteria present on the ocular surface and did not influence TGF-β levels in tears. Prospective studies on IPL-MGX with larger sample sizes are needed to further investigate cytokines and IPL in patients suffering from ocular rosacea with dry eye symptoms. ClinicalTrials.gov Identifier: NCT03194698. [ABSTRACT FROM AUTHOR]

Objective: Dry eye is reported to be associated with several neurological diseases. The aim of this study is to evaluate the patients with hemiplegia after stroke for dry eye and compare their results with a control group. Materials and methods: Forty-five patients with hemiplegia and 45 individuals as the control group were included in the study. Tear function tests (Schirmer and tear breakup time) and a dry eye questionnaire for dry eye symptoms (ocular surface disease index) were performed and the results of the two groups were compared. Results: Schirmer test results were significantly lower in the post-stroke hemiplegia group compared to the control group (11.3 ± 8.2 mm and 20.6 ± 11.6 mm, respectively, p <.001). Tear breakup time results were significantly lower in the post-stroke hemiplegia group compared to the control group (7.9 ± 3.1 s and 12.1 ± 4.3 s, respectively, p <.001). Ocular surface disease index scores were not significantly different between hemiplegia and control groups (21.6 ± 20.0 and 19.8 ± 13.9, respectively, p =.635). Schirmer scores lower than 10 mm (60% and 30%, p <.001) and tear breakup time results lower than 10 s (65.6% and 28.9%, p <.001) were also higher in the hemiplegia group compared to control group. Conclusion: We found lower Schirmer test and tear breakup time results and similar OSDI scores in hemiplegia patients compared to controls. Hemiplegia patients may have dry eye without typical symptoms. This should be taken into consideration in the follow-up and rehabilitation of post-stroke hemiplegia patients. [ABSTRACT FROM AUTHOR]

Background: Inflammation is among the most important mechanisms in the pathogenesis of dry eye disease (DED), triggering the vicious circle of the disease. Reducing inflammation is an important target in dry eye disease treatment. Hydrocortisone is a low-potency corticosteroid with a low ocular penetration potential. Aim: To document the effect of topical preservative-free hydrocortisone 0.335% (PFH, Softacort®, Laboratoires Théa, France) on DED. Methods: Retrospective data review of patients with mild to moderate DED, treated with PFH for 15 days. Clinical evaluations at Days 0 and 15 included the assessment of the central precorneal tear film thickness (CPTFT), fluorescein tear breakup time, Schirmer test, corneal grading staining (Oxford schema), ocular surface disease index (OSDI) spatial distribution of the precorneal tear film thickness, intraocular pressure (IOP) and local tolerance. Results: Data from 13 women and 2 men were collected. Mean age±SD was 51± 5 years for women and 53± 4 years for men. Clinical signs and symptoms significantly (all p< 0.05) improved after 15 days of treatment. A significant positive correlation between the percentage of change in left eye CPTFT and that in the contralateral eye CPTFT was observed (p=0.003) as well as for both eyes and the left eye FTBUT (p=0.03). For the percentage of change in OSDI, the only significant correlation was with the percentage of change in right eye and FTBUT (p=0.03). IOP remained unchanged. No adverse events were recorded. Conclusion: This retrospective data review confirms that topical PFH twice daily for 2 weeks significantly improves clinical signs and symptoms in patients with mild to moderate DED with no safety issues. [ABSTRACT FROM AUTHOR]

Purpose: To estimate the prevalence of symptomatic dry eye disease (DED) and investigate its associated risk factors in the Lebanese population.Methods: Population-based cross-sectional study of 602 participants from Lebanon aged 18 years and older. Ocular Surface Disease Index (OSDI) questionnaire on dry eye symptoms was used to evaluate the prevalence of symptomatic DED. Chi-square test was used to investigate the association between DED status and risk factors such as age, gender and smoking tobacco.Results: The percentage of DED among the study population (271 males and 331 females) was 36.4% with OSDI score ≥ 13 (mild to moderate and severe OSDI status). The most reported DED symptom in the population was sensitivity to light. Smokers reported higher DED symptoms than non-smokers. Older and smoker populations were more likely to report significantly higher OSDI scores (p < 0.05). Moreover, gender was not statistically associated with DED (p > 0.05).Conclusion: Symptomatic DED is substantial in Lebanon. It is statistically associated with the age of population and their tobacco exposure. [ABSTRACT FROM AUTHOR]

Objectives: To study the incidence of dry eye and its determinants in patients undergoing cataract surgery. Materials and Methods: One hundred twenty patients with senile cataract underwent Schirmer's test, tear break-up time (TBUT) test, lissamine green staining of the cornea and conjunctiva, and Ocular Surface Disease Index (OSDI) for evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery. Results: Mean age of the patients was 59.25 + 9.77 years and 73 (60.8%) were men. None of the patients had dry eye at the time of enrollment as per the criteria of our study. Postoperatively, Schirmer's test values ranged from 12-35 mm and 8-24 mm at first and second follow-ups, respectively. Mean TBUT was 13.16±2.45 and 9.64±2.20 seconds, while lissamine green staining score was 3 in 67 (55.8%) and 1 in 67 (55.8%) subjects at first and second follow-up, respectively. OSDI values ranged from 1-30 and 10-33 with a mean of 25.97±5.34 and 11.96±7.47 respectively at first and second follow-up. At first follow-up, 89.1% of the 56 patients who underwent phacoemulsification were found to have grade 2 dry eye (p<0.001), while 92.2% of the 64 patients who underwent small-incision cataract surgery (SICS) had grade 2 dry eye (p<0.001). At second follow-up, grade 0 dry eye was observed in 92.2% of the patients who underwent phacoemulsification and 82.1% of the patients who underwent SICS (p<0.001). Conclusion: The incidence of dry eye after cataract surgery was high and mostly independent of demographic and anthropometric profile, type of surgical procedure, time of microscope exposure, and amount of energy used. This dryness was transient in nature and showed a declining trend, tending to achieve normalization by the end of 1 month. [ABSTRACT FROM AUTHOR]