Natural course of lid wiper epitheliopathy (LWE) in symptomatic contact lens wearers

Translation and validation of the 8-item contact lens dry eye questionnaire (CLDEQ-8) among Chinese soft contact lens wearers

PURPOSE

To develop a Chinese version of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) with cross-cultural adaption and clinical validation among soft contact lens wearers (SCL) in China.

METHODS

The translation and adaptation of the Chinese CLDEQ-8 (C-CLDEQ-8) followed a rigorous methodological process based on cross-cultural research guidelines consisting of three main phases: 1) forward and backward translation of original CLDEQ-8 into Chinese, 2) cross-cultural adaptation performed by medical advising committee, and 3) clinical validation and repeatability test of the translated questionnaire on Chinese SCL wearers. Rasch analysis was also performed to investigate the psychometric properties of C-CLDEQ-8.

RESULTS

134 experienced SCL wearers aged 18-45 completed the C-CLDEQ-8. C-CLDEQ-8 score was linearly related to the overall opinion of SCLs (beta = 2.16, p = 0.002), gestalt eye dryness response (beta = 2.90, p < 0.001), and sensitivity response (beta = 1.83, p = 0.001). The questionnaire showed excellent test-retest repeatability with an intra-class correlation coefficient (ICC) of 0.95 and great internal consistency with a Cronbach's alpha of 0.83. The corrected index of homogeneity for each item was more significant than 0.5. In Rasch analysis, the infit and outfit values for eight items were all within 0.6-1.4, suggesting a good fit for the Rasch model. Martin-Löf test result indicated that the Rasch model was unidimensional (p = 1.0). Item characteristics curves suggested combining categories 3-4 and 5-6 in item 5 of C-CLDEQ-8.

CONCLUSIONS

This study produced a Chinese version of CLDEQ-8 with great validity and reliability and proved capable of evaluating SCL-related symptoms.

Investigating the Effect of Reducing the Signs and Symptoms of Lid Wiper Epitheliopathy in Patients With Dry Eye Disease With Perfluorohexyloctane

Background

Perfluorohexyloctane (PFHO) acts to prevent the evaporation of the tear film. It has the potential to limit friction related issues between the eye lid margin and the ocular surface. Prior to the present work, this had not yet been evaluated.

Objective

To examine the potential of using perfluorohexyloctane for reducing the signs and symptoms of lid wiper epitheliopathy (LWE).

Methods

Data were collected at 4 visits spanning 2 months. Patients who had symptomatic dry eye and a LWE score of ≥1.0 on the Korb LWE scale were recruited. Participants were randomized to PFHO 4 times a day or no treatment. Lid wiper epitheliopathy was graded at each visit with the Korb and photographic LWE (PLWE) scales. Symptoms were assessed using the Standard Patient Evaluation of Eye Dryness questionnaire and visual analog scales (0-100).

Results

A total of 52 participants were enrolled (mean ± SD age, 49.7 ± 15.7 years; 79% female). Right eyes in the treatment group were significantly more likely to show an improvement of ≥0.5-units in PLWE scores at 2 months than the no treatment group (P = 0.04), but no left eye differences were noted. Korb and PLWE scores were significantly better in the treatment group compared with the no treatment group starting at 2 weeks and remained so for the duration of the study (all P < 0.001). Standard Patient Evaluation of Eye Dryness scores and dry eye symptoms were significantly better in the treatment than in the no treatment group at the 2-month visit (all P ≤ 0.01).

Conclusions

Perfluorohexyloctane significantly reduced LWE and improved dry eye symptoms compared with no treatment, suggesting that PFHO may enhance ocular lubrication and reduce friction-related damage. Masked, randomized, trials are still needed to compare PFHO to other treatments in participants with LWE to support generalizability of results. ClinicalTrials.gov study NCT06671041.

Effect of lid-wiper epitheliopathy on the corneal epithelial thickness distribution: a novel semiautomatic quantitative method

BACKGROUND

To explore a novel semi-automatic quantitative method for detecting lid-wiper epitheliopathy (LWE) and analyze its impact on the distribution of corneal epithelial thickness (CET).

METHODS

A total of 37 eyes from 37 adults were included in this study. The lid wipers were stained with lissamine green strips, and the stained areas were recorded using a digital slit-lamp biomicroscopy and analyzed using ImageJ software. Factors such as age, sex, and refraction were included as variables that influenced LWE. The CET was divided into 25 regions and recorded using spectral-domain optical coherence tomography.

RESULTS

Methodological consistency and repeatability were verified through intra- and inter-operator intraclass correlation coefficients, with values of 0.889 and 0.922, respectively. After adjusting for age, sex, and spherical equivalent refraction, a negative correlation was observed between LWE and epithelial thickness. Specifically, negative correlations were observed in the nasal, subnasal, and inferior regions within the 2-5 mm range; subnasal and infratemporal regions within the 5-7 mm range; and the infratemporal region within the 7-9 mm range.

CONCLUSIONS

This study validated a novel method for assessing the severity of LWE by quantitatively analyzing the LWE area. Additionally, LWE is associated with thinning of the inferior corneal epithelium.

The effect of type 2 diabetes mellitus on lid wiper epitheliopathy and ocular surface parameters

Introduction

This cross-sectional study was conducted to investigate the impact of type 2 diabetes mellitus(DM) and its duration on indicators such as lid wiper epitheliopathy(LWE), and to assess the significance of LWE for early diagnosis of dry eye disease(DED) in DM patients.

Methods

A total of 137 subjects with ocular surface disease index(OSDI) score ≥13 were divided into the non-DM group, the short-term DM group (duration <5 years), and the mid-to-long-term DM group(duration ≥5 years). Evaluations were conducted for LWE, OSDI, lipid layer thickness (LLT), partial blinking rate (PBR), fluorescein tear breakup time (FTBUT), corneal fluorescein staining score (CFS), eyelid margin score, and meibomian gland dropout (MGd).

Results

The upper-LWE score and total LWE score in the mid-to-long-term group were higher than those in the non-DM group (p = 0.008 and p = 0.031, respectively). The lower-LWE scores were more severe than upper-LWE scores in the non-DM and short-term groups (p = 0.001 and p = 0.045, respectively).The confirmed diagnosis rate of DEWSII dry eye with LWE as the primary diagnostic indicator was significantly higher than that which utilize FTBUT<5s as the primary diagnostic indicator(p < 0.05). Compared to the non-DM group, the LLT was thinner and the MGd was more severe in the mid-to long-term group. The upper-LWE score was moderately positively correlated with the MGd, and the lower LWE score was moderately negatively correlated with LLT.

Conclusion

LWE, LLT, and MGd worsen with the progression of diabetes. Additionally, changes in LWE may precede the FTBUT, indicating that LWE could be considered as an important indicator for early diagnosis of DED in diabetic patients.

Conjunctival Chalasis Should Not be Overlooked: Investigation Into Postoperative Ocular Surface Changes in Involutional Blepharoptosis

BACKGROUND

Involutional blepharoptosis is common among elderly people. The tightening of eyelids postptosis surgery could potentially increase friction between the eyelid and the ocular surface, but this hypothesis has not yet been substantiated by research. The authors explored the relationship between involutional blepharoptosis surgery and friction-related diseases, namely conjunctivochalasis, lid wiper epitheliopathy, and superior limbic keratoconjunctivitis.

METHODS

We conducted a prospective study involving 31 patients who underwent levator advancement for involutional blepharoptosis. Both preoperatively and 6 weeks postoperatively, the authors assessed a range of outcome measures, including margin reflex distance-1, 2, tear film break-up time, superficial punctate keratopathy, inferior conjunctivochalasis, upper lid wiper epitheliopathy, and superior limbic keratoconjunctivitis.

RESULTS

Conjunctivochalasis was detected in 18 eyes preoperatively and 20 eyes postoperatively. Lid wiper epitheliopathy was detected in 2 eyes preoperatively and in no eyes postoperatively. Superior limbic keratoconjunctivitis was detected in 2 eyes preoperatively and 1 eye postoperatively. From preoperative to postoperative assessments, conjunctivochalasis worsened in 11 eyes (17.2%), and there were no eyes with worsening lid wiper epitheliopathy or superior limbic keratoconjunctivitis. There was a significant worsening of superficial punctate keratopathy in the group with exacerbated conjunctivochalasis compared with the unchanged group (0.72 vs. 0.12, P =0.0222). The superficial petechial keratopathy in the 6 cases in which there was worsening of both conjunctivochalasis and superficial petechial keratopathy were all located inferiorly in the cornea.

CONCLUSIONS

Conjunctivochalasis can worsen following ptosis surgery, potentially leading to an increase in inferior superficial punctate keratopathy. When performing involutional blepharoptosis surgery, surgeons should be mindful of the potential implications of friction-related diseases, particularly conjunctivochalasis.