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Masahiko Ayaki, Motoko Kawashima, Miki Uchino, Kazuo Tsubota, Kazuno Negishi Department of Ophthalmology, Keio University, Shinjuku, Tokyo, Japan Purpose: The purpose of this study was to evaluate the influence of seasons on the signs and symptoms of dry eye disease (DED). Methods: This is a cross-sectional, case-control study, and participants were non-DED subjects (n=1,916, mean age 54.4±14.4 years) and DED patients (n=684, 54.2±12.1 years) visiting six eye clinics at various practices and locations in Japan. We evaluated the signs and symptoms of DED and the seasons with the most severe results were compared to those with the least severe results in both groups. Main outcome measures were differences in the severity of the signs and symptoms of DED between the most and least severe seasons. Results: The majority of DED symptoms were most severe during spring and least severe in summer. Significant differences between these two seasons were found for irritation (P=0.001), pain (P=0.007), blurring (P=0.000), and photophobia (P=0.007) in the DED group. Superficial punctate keratopathy (P=0.001) and tear break-up time (BUT; P=0.000) results also indicated that DED was most severe in spring. In contrast, fewer patients had low Schirmer test results in spring, although this was not statistically significant (P=0.061). Conclusion: Our results demonstrated that the severity of DED is seasonal, which may explain the increase of short BUT-type DED cases observed in spring when air pollen counts are highest. Keywords: dry eye disease, seasonality, tear break-up time, cornea, ocular surface, tear production, hay fever, air pollen, allergic conjunctivitis

Miki Uchino,1 Motoko Kawashima,1 Minako Kaido,1 Kazuhisa Suwaki,2 Yuichi Uchino,1 Ichiro Kawachi,3 Kazuno Negishi,1 Kazuo Tsubota1 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, 2Santen Pharmaceutical Co., Ltd, Osaka, Japan; 3Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA Purpose: To validate a paper-based visual acuity (PBVA) questionnaire.Methods: In 2015, a cross-sectional survey was conducted among 301 young and middle-aged, mostly male, Japanese subjects. The participants were asked to self-rate their visual acuity (VA) on a scale from 1 to 5. Self-ratings of VA were categorized into three groups: good (1 and 2), normal (3), and poor (4 and 5). For objective validation, we performed a functional VA (FVA) assessment in the same subjects.Results: A total of 301 subjects answered the PBVA and completed the FVA test including initial VA. We found out that the result of PBVA was significantly correlated with FVA test and initial VA (r=0.33, P

Motoko Kawashima,1 Miki Uchino,1,2 Norihiko Yokoi,3 Yuichi Uchino,1,2 Murat Dogru,1 Aoi Komuro,3 Yukiko Sonomura,3 Hiroaki Kato,3 Shigeru Kinoshita,3 Kazuo Tsubota1 1Department of Ophthalmology, Keio University School of Medicine, Shinjuku-ku, 2Ryogoku Eye Clinic, Sumida-ku, Tokyo, 3Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan Purpose: To investigate the association of dry eye disease with sleep quality. Methods: In 2011, a cross-sectional survey was conducted among all the employees, mainly young and middle-aged Japanese office workers, who used visual display technology, at a company in Osaka, Japan (N=672; age range =26–64 years). The participants were classified according to the Japanese dry eye diagnosis criteria by dry eye examination results including the Schirmer test, fluorescein and lissamine green staining, tear film break-up time, and symptom questionnaire into three groups as follows: definite dry eye disease, probable dry eye disease, and no dry eye disease. To determine sleep quality, Japanese version of the Pittsburgh Sleep Quality Index (global score) was implemented. The global score (range =0–21) was calculated by summing seven sleep variable scores (scale, 0–3); scores ≥5.5 indicated poor sleep. Results: The total mean global score was 5.1±2.3 (completed N=383); 45% of the dry eye disease participants reported having poor sleep quality, while 34% of the no dry eye disease participants did so, with a significant difference found in the global score (P=0.002). Furthermore, a statistically significant association was observed between the global score and dry eye disease (P=0.005). Conclusion: Poor sleep quality is associated with dry eye disease, especially with dry eye symptoms. Keywords: dry eye, sleep quality, symptom, questionnaire, Pittsburgh Sleep Quality Index, tear film break-up time, visual display terminals