The effects of blood glucose regulation on tear function tests in diabetic patients

Dry Eye in Diabetes: The Indian Diabetic and Endocrine Eye Diseases (INDEED) Review

Dry eye disease (DED) is an inadequately addressed condition in the diabetes management process and can significantly impact the quality of life and self-care. Therefore, it was imperative to review DED in the diabetic population. The aim of this article was to obtain insights into the correlation between dry eye and diabetes, with a focus on data published in the Indian population. A comprehensive literature review was performed using MEDLINE and Google Scholar, along with an internet-based search of publicly available information and peer-reviewed publications that may not have been indexed in these databases. The recommendations from several important societies for patients with DED have also been reviewed. Major aspects commonly associated with DED and diabetes have been addressed, and specific suggestions for screening, diagnosis and treatment have been described. Therefore, this review could be an invaluable resource for doctors managing patients with both conditions.

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.

Evaluation of Tear Film Osmolarity Among Diabetic Patients Using a TearLab Osmometer

PURPOSE

The purpose of the present study is to determine the effects of type 2 diabetes mellitus on tear osmolarity using a TearLab Osmolarity system. Moreover, the relationship between tear film osmolarity and ocular surface discomfort in controlled and uncontrolled diabetic patients was assessed.

MATERIALS AND METHODS

This study included 20 male type 2 diabetic patients aged 20 to 70 years (mean ± SD 49±12). A control group (18-43 years; 32.2 ± 6.5 years) consisting of 40 male subjects was also enrolled for comparison. The tear osmolarity was measured using the TearLab Osmolarity System. The ocular surface disease index questionnaire (OSDI) was used to assess ocular discomfort symptoms.

RESULTS

The mean tear osmolarity was 297 ± 8.00 and 296 ± 11 mOsm/L for controlled and uncontrolled diabetic subjects, respectively, while the average osmolarity in the control group was 299 ± 8.00 mOsm/L. No significant differences were detected in tear osmolarity between the control and diabetes groups. The ocular surface disease index questionnaire (OSDI) score was significantly higher in the diabetic patient group. No significant correlation was found between tear osmolarity and OSDI scores.

CONCLUSION

The ocular discomfort symptoms score in diabetic patients was significantly higher compared to normal eye subjects. Tear osmolarity was not significantly different in diabetic patients. This finding may be explained by a lack of relationship between tear film parameters and diabetic severity; tear film parameters may correlate more with diabetic duration rather than severity. Therefore, studies focused on diabetes duration and tear film parameters are recommended.

Individualized Chinese medicine for the treatment of diabetic patients with dry eye disease: A single-case randomized controlled protocol

BACKGROUND

The high incidence of Diabetes mellitus (DM) has become a serious challenge for the global epidemic. Increased blood glucose leads to abnormal ocular surface structure and metabolic disorder in patients. DM is a high-risk factor for dry eye disease (DED), with high incidence and increased difficulty in treatment. The disease can cause discomfort, visual impairment, tear film instability and ocular surface damage, and even cause corneal erosion in severe cases, which has a serious impact on people's daily life. Traditional Chinese Medicine (TCM) plays an important role in the evaluation and treatment of DM and its complications. However, whether TCM treatment could improve the treatment efficacy of DM suffering from DED remains poorly understood.

OBJECTIVE

To investigate the curative effect of TCM for the alleviation of clinical symptoms in Diabetic patients with DED, and to evaluate its long-term efficacy.

METHODS

This trial is a single-case randomized, single-blind, placebo-controlled study. A total of 12 subjects will be recruited in this trial. The trial is divided into three cycles, and one cycle has 2 treatment periods. There is a washout period at each adjacent treatment stage. TCM individualized treatment and placebo will be randomized during the treatment period. The test period will last for 29 weeks, with 4 weeks for each treatment period and 1 week for each washout period to minimize carryover effects. Subjects will be selected by the researcher strictly in accordance with the inclusion and exclusion criteria. The outcomes will evaluate the efficacy of treatment by changes in the various observation indicators.

DISCUSSION

This study will realize a patient-centered outcome approach necessary to provide clinical researchers with the evidence that TCM treatment can effectively improve the objective indicators of the eye and systemic symptoms in Diabetic patients with DED.

TRIAL REGISTRATION

This study has been registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn, No. ChiCTR1900024481), (October, 2019).

Clinical Evaluation of Dry Eye Syndrome in Patients with Proliferative Diabetic Retinopathy and Laser Therapy Indication

Background:

Studies have shown a higher incidence of dry eye among patients with diabetes compared to patients without diabetes. However, information regarding dry eye in patients with proliferative diabetic retinopathy and laser therapy indication is not sufficient.

Objective:

To estimate the clinical manifestation of dry eye syndrome in patients with proliferative diabetic retinopathy and laser therapy indication.

Method:

A cross-sectional study was performed during a local evaluation campaign of diabetic patients with vision disabilities at the Instituto Cearense de Oftalmologia in Fortaleza, CE, Brazil. Patients with proliferative diabetic retinopathy and laser therapy indication were included in the study. An anamnesis directly to dry eye complaints was performed, and eligible participants completed the Ocular Surface Disease Index (OSDI) questionnaire. The slit lamp examination was performed with fluorescein staining; the tear break-up time (TBUT) was measured, and conjunctiva and corneal was evaluated using Rose Bengal (RB) staining. Finally, the Schirmer I test was performed.

Results:

Twenty-five patients were included in the study with a diagnostic time of Diabetes Mellitus ranged from 1 to 35 years, with an average of 17.2 ± 8.7 years. In our sample, 14 patients (56%) reported glycemic control with insulin, while 11 patients (44%) had oral hypoglycemic agents. The most prevalent complaint was blurred vision (96% of patients) followed by low visual acuity (92%). A less prevalent complaint was pain (44%). The mean OSDI score was 49.4 ± 24.2. TBUT was less than 10 seconds in 21 patients (84%), and RB staining grade was more than 3 in 13 patients (52%). The results of the Schirmer I test ranged from 2 to 35 mm, with a mean of 13.57 ± 9.78 mm. It was smaller than 10 mm in 15 patients (60%).

Conclusion:

The frequency of manifestation of dry eye syndrome was very common in patients with proliferative diabetic retinopathy and laser therapy indication. Ocular surface care should be provided for those patients with significant ocular morbidity.