Alleviation of computer-induced eye discomfort syndrome and associated lipid layer changes

A prospective, randomised, placebo-controlled, double-masked, three-armed, multicentre phase II/III trial for the Study of a Topical Treatment of Ischaemic Central Retinal Vein Occlusion to Prevent Neovascular Glaucoma - the STRONG study: study protocol for a randomised controlled trial

Background

Neovascular glaucoma (NVG) is rare, comprising only 3.9% of all glaucoma cases. The most common cause of NVG is ischaemic central retinal vein occlusion (iCRVO). NVG frequently results in blindness and painful end-stage glaucomatous damage leading to the need for enucleation. Currently, there is no preventive therapy for NVG following iCRVO. Rescue treatments have severe drawbacks. Accordingly, there is a great need for preventing the often visually devastating outcomes of NVG. The STRONG study is designed to test whether the topically active anti-angiogenic agent aganirsen is able to inhibit the formation of neovascularisation leading to the development of secondary NVG in eyes with iCRVO. At the same time, STRONG will provide important information on the natural course of iCRVO and NVG in a large and well-characterised cohort of such patients.

Methods/design

This protocol describes a phase II/III, prospective, randomised, placebo-controlled, double-masked, three-armed multicentre study for the investigation of aganirsen, a new topical treatment for iCRVO in order to prevent NVG. The study will evaluate the efficacy of two different doses of this newly developed antisense oligonucleotide formulated in an eye emulsion to avoid new vessel formation by blocking insulin receptor substrate-1 (IRS)-1. This leads to subsequent down-regulation of both angiogenic as well as proinflammatory growth factors such as vascular endothelial growth factor (VEGF) and tumour necrosis factor (TNF). Eligible patients (n = 333) will be treated with topical aganirsen or placebo for a period of 24 weeks. They will also be invited to participate in substudies involving analysis of gonioscopic images, detection of biomarkers for NVG and risk factors for iCRVO.

Discussion

The STRONG study has the potential to offer a new treatment modality for patients suffering from iCRVO with a high risk of developing NVG. The topical administration can reduce patients’ burden and risk related to rescue treatment, such as destructive laser treatment or enucleation, but requires a high level of patient compliance.

Trial registration

EudraCT: 2014-000239-18; ClinicalTrials.gov, ID: NCT02947867. (Registered on 15 October 2016); see also http://strong-nvg.com.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1861-3) contains supplementary material, which is available to authorized users.

Research in Dry Eye: Report of the Research Subcommittee of the International Dry Eye WorkShop (2007)

Members of the DEWS Research Subcommittee reviewed research into the basic mechanisms underlying dry eye disease. Evidence was evaluated concerning the tear film, lacrimal gland and accessory lacrimal glands, ocular surface epithelia (including cornea and conjunctiva), meibomian glands, lacrimal duct system and the immune system. Consideration was given to both animal and human research data. Results are presented as a series of information matrices, identifying what is known and providing supporting references. An attempt is made to identify areas for further investigation.

Comparison of the Efficacy of Two Lipid Emulsion Eyedrops in Increasing Tear Film Lipid Layer Thickness

PURPOSE

The lipid layer of the tear film is critical to maintaining the thickness of the multilayered tear film. This study was designed to determine whether a single drop of Refresh Dry Eye Therapy or Soothe, both lipid emulsion eyedrops, significantly increased the lipid layer thickness (LLT) of patients with self-reported dry eyes and thin lipid layers.

METHODS

Lipid layer interference patterns were used to quantify the LLT of both eyes of eligible patients before and after test drop instillation. Patients (n=41) reporting dry eye symptoms and having baseline LLT of no more than 75 nm received 40 microL of Refresh Dry Eye Therapy in one eye and 40 microL of Soothe in the contralateral eye. After instillation, LLT was quantified at 1, 5, and 15 minutes. LLT after drop instillation was averaged for the three time points.

RESULTS

The mean +/- standard error baseline LLT was 59.6 +/- 1.7 nm for eyes treated with Refresh Dry Eye Therapy and 61.5 +/- 1.6 nm for eyes treated with Soothe. These means were not significantly different (P>0.05). The overall mean LLT after drop instillation was 83.2 +/- 3.6 nm for Refresh Dry Eye Therapy (P<0.0001) and 121.5 +/- 3.8 nm for Soothe (P<0.0001). The mean LLT increase from Soothe (60.0 nm) was significantly greater than that from Refresh Dry Eye Therapy (23.6 nm) (P<0.0001).

CONCLUSIONS

The application of a lipid emulsion eyedrop will increase LLT and benefit patients with deficient lipid layers who experience dry eye symptoms. Although both products are lipid emulsions, one drop of Soothe essentially doubled LLT and provided a mean increase in LLT that was 2.5 times greater than that of Refresh Dry Eye Therapy.