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Bonilla-Vidal L, Espina M, García ML, Baldomà L, Badia J, González JA, Delgado LM, Gliszczyńska A, Souto EB, Sánchez-López E. Novel nanostructured lipid carriers loading Apigenin for anterior segment ocular pathologies. Int J Pharm 2024; 658:124222. [PMID: 38735632 DOI: 10.1016/j.ijpharm.2024.124222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/23/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
Dry eye disease (DED) is a chronic multifactorial disorder of the ocular surface caused by tear film dysfunction and constitutes one of the most common ocular conditions worldwide. However, its treatment remains unsatisfactory. While artificial tears are commonly used to moisturize the ocular surface, they do not address the underlying causes of DED. Apigenin (APG) is a natural product with anti-inflammatory properties, but its low solubility and bioavailability limit its efficacy. Therefore, a novel formulation of APG loaded into biodegradable and biocompatible nanoparticles (APG-NLC) was developed to overcome the restricted APG stability, improve its therapeutic efficacy, and prolong its retention time on the ocular surface by extending its release. APG-NLC optimization, characterization, biopharmaceutical properties and therapeutic efficacy were evaluated. The optimized APG-NLC exhibited an average particle size below 200 nm, a positive surface charge, and an encapsulation efficiency over 99 %. APG-NLC exhibited sustained release of APG, and stability studies demonstrated that the formulation retained its integrity for over 25 months. In vitro and in vivo ocular tolerance studies indicated that APG-NLC did not cause any irritation, rendering them suitable for ocular topical administration. Furthermore, APG-NLC showed non-toxicity in an epithelial corneal cell line and exhibited fast cell internalization. Therapeutic benefits were demonstrated using an in vivo model of DED, where APG-NLC effectively reversed DED by reducing ocular surface cellular damage and increasing tear volume. Anti-inflammatory assays in vivo also showcased its potential to treat and prevent ocular inflammation, particularly relevant in DED patients. Hence, APG-NLC represent a promising system for the treatment and prevention of DED and its associated inflammation.
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Affiliation(s)
- L Bonilla-Vidal
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, University of Barcelona, 08028 Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN(2)UB), University of Barcelona, 08028 Barcelona, Spain
| | - M Espina
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, University of Barcelona, 08028 Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN(2)UB), University of Barcelona, 08028 Barcelona, Spain
| | - M L García
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, University of Barcelona, 08028 Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN(2)UB), University of Barcelona, 08028 Barcelona, Spain
| | - L Baldomà
- Department of Biochemistry and Physiology, University of Barcelona, 08028 Barcelona, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Institute of Research of Sant Joan de Déu (IRSJD), 08950 Barcelona, Spain
| | - J Badia
- Department of Biochemistry and Physiology, University of Barcelona, 08028 Barcelona, Spain; Institute of Biomedicine of the University of Barcelona (IBUB), Institute of Research of Sant Joan de Déu (IRSJD), 08950 Barcelona, Spain
| | - J A González
- Department of Endodontics, Faculty of Dentistry, International University of Catalonia (UIC), 08195 Barcelona, Spain
| | - L M Delgado
- Bioengineering Institute of Technology, International University of Catalonia (UIC), 08028 Barcelona, Spain
| | - A Gliszczyńska
- Department of Food Chemistry and Biocatalysis, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
| | - E B Souto
- REQUIMTE/UCIBIO, Laboratory of Pharmaceutical Technology, Department of Drug Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313 Porto, Portugal; Associate Laboratory i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - E Sánchez-López
- Department of Pharmacy, Pharmaceutical Technology and Physical Chemistry, University of Barcelona, 08028 Barcelona, Spain; Institute of Nanoscience and Nanotechnology (IN(2)UB), University of Barcelona, 08028 Barcelona, Spain; Unit of Synthesis and Biomedical Applications of Peptides, IQAC-CSIC, 08034 Barcelona, Spain.
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Valdés-Arias D, Locatelli EVT, Sepulveda-Beltran PA, Mangwani-Mordani S, Navia JC, Galor A. Recent United States Developments in the Pharmacological Treatment of Dry Eye Disease. Drugs 2024:10.1007/s40265-024-02031-6. [PMID: 38652355 DOI: 10.1007/s40265-024-02031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 04/25/2024]
Abstract
Dry eye disease (DED) can arise from a variety of factors, including inflammation, meibomian gland dysfunction (MGD), and neurosensory abnormalities. Individuals with DED may exhibit a range of clinical signs, including tear instability, reduced tear production, and epithelial disruption, that are driven by different pathophysiological contributors. Those affected often report a spectrum of pain and visual symptoms that can impact physical and mental aspects of health, placing an overall burden on an individual's well-being. This cumulative impact of DED on an individual's activities and on society underscores the importance of finding diverse and effective management strategies. Such management strategies necessitate an understanding of the underlying pathophysiological mechanisms that contribute to DED in the individual patient. Presently, the majority of approved therapies for DED address T cell-mediated inflammation, with their tolerability and effectiveness varying across different studies. However, there is an emergence of treatments that target additional aspects of the disease, including novel inflammatory pathways, abnormalities of the eyelid margin, and neuronal function. These developments may allow for a more nuanced and precise management strategy for DED. This review highlights the recent pharmacological advancements in DED therapy in the United States. It discusses the mechanisms of action of these new treatments, presents key findings from clinical trials, discusses their current stage of development, and explores their potential applicability to different sub-types of DED. By providing a comprehensive overview of products in development, this review aims to contribute valuable insights to the ongoing efforts in enhancing the therapeutic options available to individuals suffering from DED.
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Affiliation(s)
- David Valdés-Arias
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL, 33136, USA
| | - Elyana V T Locatelli
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL, 33136, USA
- Surgical Services, Miami Veterans Affairs Medical Center, 1201 Northwest 16th Street, Miami, FL, 33125, USA
| | | | | | - Juan Carlos Navia
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL, 33136, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17th St, Miami, FL, 33136, USA.
- Surgical Services, Miami Veterans Affairs Medical Center, 1201 Northwest 16th Street, Miami, FL, 33125, USA.
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Aldarwesh A, Almustanyir A, Fagehi R, Alruways K, Bin Turki A, Alghamdi M, Alanazi MK, Alabdulkader B, Alotaibi W, Alhassan M. Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes: a pilot study. Int J Ophthalmol 2024; 17:659-664. [PMID: 38638253 PMCID: PMC10988074 DOI: 10.18240/ijo.2024.04.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/17/2024] [Indexed: 04/20/2024] Open
Abstract
AIM To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters. METHODS This study enrolled 48 healthy participants aged 20-35y (both males and females). Clinical assessment included the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), and lipid layer pattern (LLP). Based on these initial results, participants were categorized as either non-dry eye or dry eye. Participants in each group were randomly allocated to either Blephaclean® or Systane® treatments. Changes in NITBUT, TMH, and LLP levels before and after lid wipe treatment were assessed. RESULTS The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group (P<0.001). Following the application of eyelid wipes (Systane® wipes), dry eye subjects experienced a significant improvement in NITBUT levels (P=0.0014) compared to the non-dry eye individuals. Although the remaining participants showed a marginal increase in TMH and NITBUT levels, these changes did not achieve statistical significance (P>0.05). Similarly, the LLP levels were significantly improved with Systane® (P<0.001) post-treatment compared to individuals in the non-dry eye group. However, the dry eye subjects showed higher post-treatment LLP levels than the untreated group (P<0.02). CONCLUSION The short-term effects of Systane® eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease. Nonetheless, further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.
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Affiliation(s)
- Amal Aldarwesh
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Ali Almustanyir
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Khalaf Alruways
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Abdulaziz Bin Turki
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Mansour Alghamdi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Muteb Khalaf Alanazi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Balsam Alabdulkader
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Wafa Alotaibi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Mosaad Alhassan
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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Zhuang-Yan A, Syed YY. Perfluorohexyloctane Ophthalmic Solution: A Review in Dry Eye Disease. Drugs 2024; 84:441-448. [PMID: 38554243 DOI: 10.1007/s40265-024-02016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/01/2024]
Abstract
Perfluorohexyloctane ophthalmic solution (Miebo®) is a single-entity, water-, steroid- and preservative-free, first-in-class semifluorinated alkane that is approved in the USA for the treatment of the signs and symptoms of dry eye disease (DED). DED is often linked with meibomian gland dysfunction (MGD), which causes an excessive evaporation of tears. Perfluorohexyloctane ophthalmic solution stabilizes the lipid layer of the tear film and inhibits tear evaporation by forming a monolayer at the air-liquid interface. In the phase III GOBI and MOJAVE trials in adults with DED associated with MGD, one drop of perfluorohexyloctane ophthalmic solution instilled in each eye four times daily over 8 weeks resulted in statistically significant and clinically meaningful improvements in the signs and symptoms of DED compared with hypotonic saline (0.6%). The agent was generally well tolerated, with most ocular adverse events being mild or moderate in severity. The efficacy and tolerability of perfluorohexyloctane ophthalmic solution was sustained for up to 52 weeks in an extension study (KALAHARI). As the first and currently the only prescription treatment approved in the USA directly addressing the pathophysiology of excessive tear evaporation, perfluorohexyloctane ophthalmic solution is a valuable emerging option for the management of DED.
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Affiliation(s)
- Amy Zhuang-Yan
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Yahiya Y Syed
- Springer Nature, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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5
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Roucaute E, Huertas-Bello M, Sabater AL. Novel treatments for dry eye syndrome. Curr Opin Pharmacol 2024; 75:102431. [PMID: 38277944 DOI: 10.1016/j.coph.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 01/28/2024]
Abstract
Dry eye syndrome (DES) is a prevalent and multifactorial disease that leads to a self-perpetuating cycle of inflammation and damage to the ocular surface. This results in symptoms such as redness, burning, and blurred vision, which can negatively affect a patient's quality of life. While treatments are available to manage DES, they only temporarily relieve symptoms. Furthermore, long-term use of certain medications can cause harm to the ocular surface. Therefore, there is a need for safer and effective treatments for DES. This review highlights the latest advancements in DES therapy, providing valuable insights into ongoing efforts to improve patient outcomes.
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Affiliation(s)
- Esther Roucaute
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Marcela Huertas-Bello
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alfonso L Sabater
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, United States.
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Tey KY, Cheong EZK, Ang M. Potential applications of artificial intelligence in image analysis in cornea diseases: a review. EYE AND VISION (LONDON, ENGLAND) 2024; 11:10. [PMID: 38448961 PMCID: PMC10919022 DOI: 10.1186/s40662-024-00376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
Artificial intelligence (AI) is an emerging field which could make an intelligent healthcare model a reality and has been garnering traction in the field of medicine, with promising results. There have been recent developments in machine learning and/or deep learning algorithms for applications in ophthalmology-primarily for diabetic retinopathy, and age-related macular degeneration. However, AI research in the field of cornea diseases is relatively new. Algorithms have been described to assist clinicians in diagnosis or detection of cornea conditions such as keratoconus, infectious keratitis and dry eye disease. AI may also be used for segmentation and analysis of cornea imaging or tomography as an adjunctive tool. Despite the potential advantages that these new technologies offer, there are challenges that need to be addressed before they can be integrated into clinical practice. In this review, we aim to summarize current literature and provide an update regarding recent advances in AI technologies pertaining to corneal diseases, and its potential future application, in particular pertaining to image analysis.
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Affiliation(s)
- Kai Yuan Tey
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
| | | | - Marcus Ang
- Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Wan X, Wu Y, Zhai Z, Yang P, Zhou S, Ye H, Lu Y, Zhou F, Zhou X, Hong J. Factors affecting long-term changes of meibomian gland in MGD patients. Graefes Arch Clin Exp Ophthalmol 2024; 262:527-535. [PMID: 37650897 DOI: 10.1007/s00417-023-06210-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/01/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023] Open
Abstract
PURPOSE To explore the long-term course of patients with meibomian gland dysfunction (MGD), and to analyse potential factors affecting the recovery of meibomian gland (MG) dropout. METHODS Seventy-nine MGD patients (79 eyes) aged 36.03±15.78 years old who underwent more than one year of follow-up were enrolled in this retrospective study. Corneal fluorescein staining (CFS), tear meniscus height (TMH), noninvasive breakup time (NIBUT), and noncontact meibography at baseline and last visit were collected and analysed. Then an automatic MG analyzer was used to measure the morphological and functional parameters of MGs, including their area ratio (AR), tortuosity index (TI), and signal index (SI). The patients whose AR increased by more than 5% were defined as MG improvement, and AR decreased by more than 5% was MG worsening. RESULTS A total of 79 patients (79 eyes) were assessed with at least 1-year of follow-up. More than 1/3 of MGD patients (27 eyes, 34.2%) underwent MG improvement, and 30.4% of MGs became worsened. Age (P=0.002), gender (P<0.001), IPL treatment (P=0.013), the change of CFS (P=0.0015), and the recovery of SI (P=0.035) showed significant differences among different recovery groups. Age(P<0.001), female sex (P=0.003), ΔCFS (P<0.001), AR at baseline (P<0.001) were negative correlation with AR recovery, and the change of SI (P=0.003) and IPL treatment (P=0.003) had a positive correlation with it. Among them, age (P=0.038), the change of CFS (P=0.004), and AR at baseline (P=0.007) were confirmed as negatively correlated factors predicting the long-term change of the MG. CONCLUSION Although the MGD treatment has continued for more than 1 year, only 34.2% of MGD patients were observed to undergo MG improvement. Younger patients and patients with better CFS recovery seem to have more opportunities to improve their MGs.
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Affiliation(s)
- Xichen Wan
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Yuqing Wu
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Zimeng Zhai
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Pei Yang
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Shuyun Zhou
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Han Ye
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Yiteng Lu
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Feng Zhou
- Institutes of Biomedical Sciences of Fudan University, Shanghai, China
| | - Xujiao Zhou
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Jiaxu Hong
- Department of Ophthalmology, Eye, Ear, Nose and Throat Hospital of Fudan University, Shanghai, China.
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Jung V, Krösser S, Burian G, Grillenberger R, Korward J, Roesky C. Further contribution to the discussion on perfluorohexyloctane eye drops in dry eye disease. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 906:168040. [PMID: 37879467 DOI: 10.1016/j.scitotenv.2023.168040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Verena Jung
- Novaliq GmbH Heidelberg, Im Neuenheimer Feld 515, 79120 Heidelberg, Germany.
| | - Sonja Krösser
- Novaliq GmbH Heidelberg, Im Neuenheimer Feld 515, 79120 Heidelberg, Germany
| | - Gabriela Burian
- Novaliq GmbH Heidelberg, Im Neuenheimer Feld 515, 79120 Heidelberg, Germany
| | - Ralf Grillenberger
- Novaliq GmbH Heidelberg, Im Neuenheimer Feld 515, 79120 Heidelberg, Germany
| | - Johannes Korward
- Novaliq GmbH Heidelberg, Im Neuenheimer Feld 515, 79120 Heidelberg, Germany
| | - Christian Roesky
- Novaliq GmbH Heidelberg, Im Neuenheimer Feld 515, 79120 Heidelberg, Germany
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Niazi S, del Barrio JA, Doroodgar F, Javadi MA, Alió JL. Main issues in deep anterior lamellar keratoplasty: A systematic narrative review. Taiwan J Ophthalmol 2024; 14:34-43. [PMID: 38654987 PMCID: PMC11034680 DOI: 10.4103/tjo.tjo-d-23-00175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/01/2024] [Indexed: 04/26/2024] Open
Abstract
Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK's advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet's membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK's lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK's role as a transformative force in the field.
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Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge Alió del Barrio
- Department of Cornea, Cataract and Refractive Surgery, Vissum Corporación, Alicante, Spain
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Labbafinezhad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge L. Alió
- Division of Ophthalmology, Miguel Hernández University of Elche, Alicante, Spain
- Vissum Miranza, Alicante, Spain
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Lee JM, Choi A, Lee HH, Park SJ, Kim BH. Purple Corn Extract Improves Dry Eye Symptoms in Models Induced by Desiccating Stress and Extraorbital Lacrimal Gland Excision. Nutrients 2023; 15:5063. [PMID: 38140323 PMCID: PMC10745618 DOI: 10.3390/nu15245063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Dry eye disease (DED) occurs when there are not enough tears, and the associated symptoms-burns, itching, and a gritty feeling in the eye-can cause great discomfort. The purpose of this study was to evaluate the therapeutic effect of purple corn extract (PCE) on DED. Pretreatment with PCE prevented desiccation-stress-induced cell damage in human retinal pigment epithelial cells and primary human corneal epithelial cells. Furthermore, PCE reduced the mRNA expression of inflammatory mediators in the induction of desiccation stress. The therapeutic effects of PCE on DED were evaluated in an animal model with induced unilateral excision of the exorbital lacrimal gland. The administration of PCE was effective at recovering tear production, corneal surface irregularity, and conjunctival goblet cell density, as well as at reducing apoptotic cell death in the outer layer of the corneal epithelium. Collectively, PCE improved dry eye symptoms, and, therefore, it could be a potential agent to ameliorate and/or treat DED.
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Affiliation(s)
| | | | | | | | - Byung-Hak Kim
- MEDIENCE Co., Ltd., Chuncheon 24232, Republic of Korea; (J.-M.L.); (A.C.); (H.-H.L.); (S.J.P.)
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11
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Protzko EE, Segal BA, Korenfeld MS, Krösser S, Vittitow JL. Long-Term Safety and Efficacy of Perfluorohexyloctane Ophthalmic Solution for the Treatment of Patients With Dry Eye Disease: The KALAHARI Study. Cornea 2023:00003226-990000000-00408. [PMID: 37921522 DOI: 10.1097/ico.0000000000003418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/23/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE The aim of this study was to assess the long-term safety and efficacy of perfluorohexyloctane (PFHO) ophthalmic drop (formerly NOV03) for treatment of dry eye disease (DED). METHODS KALAHARI was a phase 3, multicenter, single-arm, open-label extension study in patients aged 18 years or older with DED associated with Meibomian gland dysfunction who completed the randomized, double-masked, hypotonic saline-controlled GOBI study. Patients instilled 1 drop of PFHO (MIEBO, Bausch + Lomb) 4 times daily in both eyes for 52 weeks. Safety assessments included adverse events, best-corrected visual acuity, slit-lamp biomicroscopy, intraocular pressure, and dilated fundoscopy. Efficacy end points included change from GOBI study baseline in total corneal fluorescein staining and eye dryness score (0-100 visual analog scale). RESULTS Overall, 208 patients from GOBI (PFHO [n = 97]; saline [n = 111]) were rolled over into KALAHARI. Twenty-nine patients (13.9%) had ≥1 ocular adverse event, with most being mild or moderate in severity; the most common ocular adverse events were vitreous detachment (1.9%), allergic conjunctivitis (1.4%), blurred vision (1.4%), and increased lacrimation (1.4%). Other safety end points were unremarkable. For patients continuing PFHO from GOBI, improvements in total corneal fluorescein staining and visual analog scale dryness scores observed in GOBI were maintained throughout KALAHARI. Patients treated with saline in GOBI and switched to PFHO in KALAHARI showed improvements in total corneal fluorescein staining and visual analog scale scores by week 4 that were maintained for the rest of the study. CONCLUSIONS PFHO was safe and well tolerated and maintained efficacy for improving signs and symptoms of DED in this year-long study of patients with DED associated with Meibomian gland dysfunction.
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12
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Casemore RK, Wolffsohn JS, Dutta D. Human Tear Protein Analysis Using a Quantitative Microfluidic System: A Pilot Study. Eye Contact Lens 2023; 49:498-504. [PMID: 37713618 DOI: 10.1097/icl.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVES Human tears have the potential to be used as biomarkers to aid in the diagnosis and management of dry eye disease (DED). This prospective, controlled pilot study aimed to investigate the hypothesis that a panel of tear protein profiles can be detected and are repeatable when analyzed using a miniaturized quantitative microfluidic system. METHODS Ten participants were recruited following institutional ethics committee approval. Participants attended two visits 1 week apart when the following measurements were taken in a sequence: tear meniscus height, noninvasive breakup time, ocular redness, tear collection, and corneal and conjunctival staining. Basal tears (>4 µL) were collected using glass microcapillary tubes. Tears were processed to analyze a panel of proteins (14-230 kDa) following the manufacturer's guidelines using a miniaturized quantitative microfluidic system (Protein 230 LabChip with Agilent 2100 Bioanalyzer). Demographics of the clinical measurements and a comparison of the panel of identified proteins and their repeatability were made. RESULTS Mean age of the participants was 20.8±1.6 years, nine were females, three fulfilled the TFOS DEWS-II diagnostic criteria for DED. The total protein concentration across participants was 6.72±3.56 mg/mL. Several proteins (lysozyme C, lipocalin 1, IgA light chain, zinc-α2-glycoprotein, albumin, and lactoferrin) were identified at both visits for seven or more participants. There were no significant differences ( P >0.05) in individual protein concentrations between the two visits. A high correlation was found between the two visits for all proteins where correlation coefficient ranged between 0.63 and 0.98 ( P <0.05). CONCLUSION The protein profiles measured by the quantitative microfluidic system are repeatable, thus validating quantitative microfluidic system as a reliable method for investigating a panel of tear proteins. This method is quick, affordable, requires only 4 μL of tear, and is relatively easy method to perform that can be incorporated in a clinical setting. Further studies in larger clinical setting may be beneficial exploring the usability of this method in various patient groups.
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Affiliation(s)
- Rachel K Casemore
- Optometry and Vision Science Research Group, Optometry School, Aston University, Birmingham, United Kingdom
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Chelnis J, Garcia CN, Hamza H. Multi-Frequency RF Combined with Intense Pulsed Light Improves Signs and Symptoms of Dry Eye Disease Due to Meibomian Gland Dysfunction. Clin Ophthalmol 2023; 17:3089-3102. [PMID: 37881780 PMCID: PMC10595163 DOI: 10.2147/opth.s426564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
Purpose To evaluate the efficacy of multi-frequency RF and IPL + MGX combination for treatment of Meibomian Gland Dysfunction (MGD). Patients and Methods Eligible subjects had signs and moderate-to-severe symptoms of DED (Dry Eye Disease) due to MGD. Subjects underwent 4 treatments at 2-week intervals. Each treatment consisted of intense pulsed light (IPL) followed by radiofrequency (RF) on the periocular skin, followed by meibomian gland expression (MGX). The main outcome measure was the quality of meibum in 15 meibomian glands along the lower eyelid, using the modified Meibomian Gland Score (mMGS). The main hypothesis was a reduction of mMGS between the baseline (BL) and the follow-up (FU). Other outcome measures, such as symptoms measured with the OSDI (Ocular Surface Disease Index) questionnaire, meibography, non-invasive tear break-up time (NIBUT), and matrix metallopeptidase 9 (MMP-9) levels in tear samples were evaluated as well. Results 31 subjects completed the FU. Between BL and FU, mMGS decreased from 30.4 (8.5) to 9.3 (9.5) (-69.3%, 95% CI: -55.6% to -82.9%, p<0.0001); OSDI decreased from 63.6 (17.2) to 25.0 (20.6) (-60.7%, 95% CI: -47.8% to -73.5%, p<0.0001); NIBUT did not change (p=0.92). An adjusted model with a historical control was constructed to allow the comparison of these subjects with those treated similarly with IPL+MGX (but without RF) in a different study. This analysis identified that the change in mMGS was larger when RF was included (-20.9 vs -18.3, adjusted p-value (p_adjusted) <0.05). The difference in OSDI change was not significant (-38.1 vs -25.5, p_adjusted = 0.196). Conclusion Combination of multi-frequency RF and IPL+MGX improves signs and symptoms of MGD. In comparison to a historical control, improvements were generally larger. A randomized controlled study comparing the combination of RF and IPL+MGX with IPL+MGX alone is required to further elaborate the relative contribution of RF.
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Affiliation(s)
- James Chelnis
- New York Eye & Ear Infirmary of Mount Sinai, New York, NY, USA
- Manhattan Face and Eye, New York, NY, USA
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14
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Jäntti J, Viitaja T, Sevón J, Lajunen T, Raitanen JE, Schlegel C, Viljanen M, Paananen RO, Moilanen J, Ruponen M, Ekholm FS. Early-Stage Development of an Anti-Evaporative Liposomal Formulation for the Potential Treatment of Dry Eyes. ACS Pharmacol Transl Sci 2023; 6:1518-1530. [PMID: 37854619 PMCID: PMC10580384 DOI: 10.1021/acsptsci.3c00147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 10/20/2023]
Abstract
Dry eye disease (DED), the most common ocular disorder, reduces the quality of life for hundreds of millions of people annually. In healthy eyes, the tear film lipid layer (TFLL) stabilizes the tear film and moderates the evaporation rate of tear fluid. In >80% of DED cases, these central features are compromised leading to tear film instability and excessive evaporation of tear fluid. Herein we assess the potential of liposomal formulations featuring phosphatidylcholines and tailored lipid species from the wax ester and O-acyl-ω-hydroxy fatty acid categories in targeting this defect. The developed lead formulation displays good evaporation-resistant properties and respreadability over compression-expansion cycles in our Langmuir model system and a promising safety and efficacy profile in vitro. Preclinical in vivo studies will in the future be required to further assess and validate the potential of this concept in the treatment of DED.
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Affiliation(s)
- Janika Jäntti
- School
of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Tuomo Viitaja
- Department
of Chemistry, University of Helsinki, P.O. Box 55, FI-00014 Helsinki, Finland
- Ophthalmology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, FI-00290 Helsinki, Finland
| | - Julia Sevón
- Department
of Chemistry, University of Helsinki, P.O. Box 55, FI-00014 Helsinki, Finland
| | - Tatu Lajunen
- School
of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Faculty
of Pharmacy, University of Helsinki, FI-00790 Helsinki, Finland
| | - Jan-Erik Raitanen
- Department
of Chemistry, University of Helsinki, P.O. Box 55, FI-00014 Helsinki, Finland
| | - Cordula Schlegel
- Department
of Chemistry, University of Helsinki, P.O. Box 55, FI-00014 Helsinki, Finland
| | - Mira Viljanen
- Department
of Chemistry, University of Helsinki, P.O. Box 55, FI-00014 Helsinki, Finland
| | - Riku O. Paananen
- Department
of Chemistry, University of Helsinki, P.O. Box 55, FI-00014 Helsinki, Finland
- Ophthalmology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, FI-00290 Helsinki, Finland
| | - Jukka Moilanen
- Ophthalmology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 8, FI-00290 Helsinki, Finland
| | - Marika Ruponen
- School
of Pharmacy, University of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Filip. S. Ekholm
- Department
of Chemistry, University of Helsinki, P.O. Box 55, FI-00014 Helsinki, Finland
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Muttuvelu DV, Cehofski LJ, Holtz J, Utheim TP, Chen X, Vorum H, Heegaard S, Rasmussen MLR, Khan AM, Abduljabar AB, Honoré B. Meibomian Gland Dysfunction Is Associated with Low Levels of Immunoglobulin Chains and Cystatin-SN. Int J Mol Sci 2023; 24:15115. [PMID: 37894795 PMCID: PMC10606780 DOI: 10.3390/ijms242015115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Meibomian gland dysfunction (MGD) is a highly prevalent condition and the most common cause of evaporative dry eye disease. Studying the proteome of MGD can result in important advances in the management of the condition. Here, we collected tear film samples from treatment naïve patients with MGD (n = 10) and age-matched controls (n = 11) with Schirmer filtration paper. The samples were analyzed with label-free quantification nano liquid chromatography-tandem mass spectrometry. The proteins were considered differentially expressed if p < 0.05. A total of 88 proteins were significantly regulated. The largest change was observed in cystatin-SN, which was downregulated in MGD and correlated negatively with tear meniscus height. The downregulation of cystatin-SN was confirmed with targeted mass spectrometry by single reaction monitoring (SRM). Eighteen immunoglobulin components involved in B cell activation, phagocytosis, and complement activation were downregulated in MGD including Ig alpha-1 chain C region, immunoglobulin J chain, immunoglobulin heavy variable 3-15, and Ig mu chain C region. The changes in cystatin-SN and immunoglobulin chains are likely to result from the inflammatory changes related to tear film evaporation, and future studies may assess their association with the meibum quality.
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Affiliation(s)
| | - Lasse Jørgensen Cehofski
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark;
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Jeppe Holtz
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark;
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, 5000 Oslo, Norway; (T.P.U.); (X.C.)
- Norwegian Dry Eye Clinic, 0366 Oslo, Norway
| | - Xiangjun Chen
- Department of Medical Biochemistry, Oslo University Hospital, 5000 Oslo, Norway; (T.P.U.); (X.C.)
- Norwegian Dry Eye Clinic, 0366 Oslo, Norway
| | - Henrik Vorum
- Department of Ophthalmology, Aalborg University Hospital, 9000 Aalborg, Denmark;
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark; (S.H.)
| | | | - Asif Manzoor Khan
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark; (A.M.K.); (A.B.A.)
| | | | - Bent Honoré
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
- Department of Biomedicine, Aarhus University, 8000 Aarhus, Denmark; (A.M.K.); (A.B.A.)
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16
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Ballesteros-Sánchez A, De-Hita-Cantalejo C, Sánchez-González MC, Jansone-Langine Z, de Sotomayor MA, Culig J, Sánchez-González JM. Perfluorohexyloctane in dry eye disease: A systematic review of its efficacy and safety as a novel therapeutic agent. Ocul Surf 2023; 30:254-262. [PMID: 37813152 DOI: 10.1016/j.jtos.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
Perfluorohexyloctane (F6H8), a physically and chemically inert synthetic compound, has recently emerged as a promising candidate for the treatment of DED due to its unique properties. A systematic review that only include full-length randomized controlled studies (RCTs), reporting the effects of F6H8 in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement. The search period was performed between June 1, 2023, and June 21, 2023. The Cochrane risk of bias tool was used to analyze the quality of the studies selected. A total of six RCTs were included in this systematic review. F6H8 tear substitutes treatment achieved a higher improvement than control group interventions in most of the reported variables. The mean differences between both groups were in favor of F6H8 and were as follow: eye dryness score (EDS) base on a visual analogue scale (VAS) of -6.12 ± 4.3 points, ocular surface disease index (OSDI) questionnaire score of -2.8 ± 2.3 points, lipid layer thickness (LLT) of 11.4 ± 10.4 μm, total corneal fluorescein staining (tCFS) of -0.8 ± 0.3 points and ocular treatment-emergent adverse events (TEAEs) of -0.66 ± 1.7. Tear film break-up time (TBUT) was the only variable in favor of control group with a mean of -0.5 ± 0.4 s. Patient satisfaction after F6H8 tear substitutes treatment was high. Therefore, F6H8 tear substitutes improve dry eye symptoms and signs with a satisfactory tolerability and could be recommended in patients with DED.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; Department of Ophthalmology, Clínica Novovision, 30008 Murcia, Spain.
| | | | | | - Zane Jansone-Langine
- University of Latvia, Jelgavas Street 1, Riga, Latvia; The Dr. Solomatin Eye Center, Marijas Street 2, Riga, Latvia
| | | | - Josip Culig
- Department of Medicine and Clinical Pharmacology, University of Applied Health Sciences, Zagreb, Croatia
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17
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Xu X, Wilkerson A, Li G, Butovich IA, Zuo YY. Comparative Biophysical Study of Meibomian Lipids of Wild Type and Soat1-Null Mice: Implications to Meibomian Gland Dysfunction and Dry Eye Disease. Invest Ophthalmol Vis Sci 2023; 64:20. [PMID: 37585190 PMCID: PMC10434715 DOI: 10.1167/iovs.64.11.20] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023] Open
Abstract
Purpose The biophysical roles of Meibomian lipids (MLs) played in health and meibomian gland dysfunction (MGD) are still unclear. The purpose of this research is to establish the composition-structure-functional correlations of the ML film (MLF) using Soat1-null mice and comprehensive in vitro biophysical simulations. Methods MLs were extracted from tarsal plates of wild type (WT) and Soat1 knockout (KO) mice. The chemical composition of ML samples was characterized using liquid chromatography - mass spectrometry. Comprehensive biophysical studies of the MLFs, including their dynamic surface activity, interfacial rheology, evaporation resistance, and ultrastructure and topography, were performed with a novel experimental methodology called the constrained drop surfactometry. Results Soat1 inactivation caused multiple alternations in the ML profile. Compared to their WT siblings, the MLs of KO mice were completely devoid of cholesteryl esters (CEs) longer than C18 to C20, but contained 7 times more free cholesterol (Chl). Biophysical assays consistently suggested that the KO-MLF became stiffer than that of WT mice, revealed by reduced film compressibility, increased elastic modulus, and decreased loss tangent, thus causing more energy loss per blinking cycle of the MLF. Moreover, the KO mice showed thinning of their MLF, and reduced evaporation resistance. Conclusions These findings delineated the composition-structure-functional correlations of the MLF and suggested a potential biophysical function of long-chain CEs in optimizing the surface activity, interfacial rheology, and evaporation resistance of the MLF. This study may provide novel implications to pathophysiological and translational understanding of MGD and dry eye disease.
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Affiliation(s)
- Xiaojie Xu
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Amber Wilkerson
- Department of Ophthalmology and Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Guangle Li
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States
| | - Igor A. Butovich
- Department of Ophthalmology and Graduate School of Biomedical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Yi Y. Zuo
- Department of Mechanical Engineering, University of Hawaii at Manoa, Honolulu, Hawaii, United States
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, United States
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18
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Nagar S, Ajouz L, Nichols KK, Kumar S, Zhao C, Naidoo KK, Robinson MR, Borchman D. Relationship Between Human Meibum Lipid Composition and the Severity of Meibomian Gland Dysfunction: A Spectroscopic Analysis. Invest Ophthalmol Vis Sci 2023; 64:22. [PMID: 37466951 PMCID: PMC10362926 DOI: 10.1167/iovs.64.10.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Purpose Information on the relationship between meibum lipid composition and severity of meibomian gland dysfunction (MGD) is limited. The purpose of this study was to analyze the molecular components of meibum collected from individuals with no MGD, mild-to-moderate MGD, and severe MGD. Methods Adults with and without MGD were enrolled in a prospective, multicenter, exploratory clinical trial (ClinicalTrials.gov Identifier: NCT01979887). Molar ratios of cholesteryl ester to wax ester (RCE/WE) and aldehyde to wax ester (Rald/WE) in meibum samples were measured with 1H-NMR spectroscopy. Results were evaluated for participants grouped by MGD disease status and severity (non-MGD, mild-to-moderate MGD, and severe MGD), as defined by maximum meibum quality scores, Schirmer test results, and Subject Ocular Symptom Questionnaire responses. Results Sixty-nine meibum samples from 69 individuals were included in the analysis: 24 non-MGD, 24 mild-to-moderate MGD, and 21 severe MGD. Mean RCE/WE was 0.29 in non-MGD, 0.14 in mild-to-moderate MGD (P = 0.038 vs. non-MGD, 51% lower), and 0.07 in severe MGD (P = 0.16 vs. mild-to-moderate MGD, 52% lower; P = 0.002 vs. non-MGD, 76% lower). Mean Rald/WE was 0.00022 in non-MGD, 0.00083 in mild-to-moderate MGD (P = 0.07 vs. non-MGD, 277% higher), and 0.0024 in severe MGD (P = 0.003 vs. mild-to-moderate MGD, 190% higher; P < 0.001 vs. non-MGD, 992% higher). Conclusions RCE/WE was lowest and Rald/WE was highest in the severe MGD cohort, suggesting that these meibum constituent molar ratios may result from the pathophysiology associated with MGD and can impact ocular surface lipid and tear film homeostasis. These findings may potentially help identify targets for MGD treatment.
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Affiliation(s)
- Saumya Nagar
- Allergan, an AbbVie company, Irvine, CA, United States
| | - Layla Ajouz
- Allergan, an AbbVie company, Irvine, CA, United States
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Sandeep Kumar
- Allergan, an AbbVie company, Irvine, CA, United States
| | - Cathy Zhao
- Allergan, an AbbVie company, Irvine, CA, United States
| | - Kugen K Naidoo
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, United States
| | | | - Douglas Borchman
- Department of Ophthalmology and Visual Sciences, University of Louisville, Louisville, KY, United States
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