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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 2024; 43:1100-1107. [PMID: 37921522 PMCID: PMC11296276 DOI: 10.1097/ico.0000000000003418] [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: 07/24/2023] [Revised: 09/22/2023] [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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Blackie CA, Murakami D, Donnenfeld E, Oliff HS. Vectored Thermal Pulsation as a Treatment for Meibomian Gland Dysfunction: A Review Spanning 15 Years. Ophthalmol Ther 2024; 13:2083-2123. [PMID: 38879718 PMCID: PMC11246355 DOI: 10.1007/s40123-024-00976-1] [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: 04/05/2024] [Accepted: 05/17/2024] [Indexed: 07/14/2024] Open
Abstract
The LipiFlow Thermal Pulsation System received its first marketing clearance for the treatment of meibomian gland dysfunction (MGD) 13 years ago. Since then, the evidence evaluating the effectiveness and safety of LipiFlow as a treatment for MGD has grown significantly. The objective of this comprehensive review was to summarize all clinical reports evaluating the effectiveness and safety of LipiFlow over the past 15 years. The literature was systematically reviewed, and 55 unique articles had subjective (patient-reported outcomes) and objective (meibomian gland function, tear production, and ocular staining) outcomes for extraction. Data were collected from 2101 patients and 3521 eyes treated with LipiFlow. Of these, effectiveness was evaluated in 2041 patients and 3401 eyes, and safety was evaluated in 1448 patients and 2443 eyes. Taken together, the studies demonstrate that a single 12-min treatment with LipiFlow safely improves signs and symptoms of MGD and associated evaporative dry eye disease (DED), and the benefits persist up to 3 years in some cases. The findings are corroborated by multiple meta-analyses and consensus guidelines. While some studies showed that daily eyelid hygiene, warm compress, and/or massage had a similar benefit to a single LipiFlow, these treatments were limited by inconvenience, discomfort, and non-compliance. The majority of studies evaluating safety reported no discomfort or pain associated with LipiFlow treatment, which supports the patient acceptability of LipiFlow therapy. All adverse events (AEs) related to LipiFlow were transient, non-vision-threatening, and did not require treatment. No studies reported serious AEs. The data obtained from 55 studies conducted globally overwhelmingly show that LipiFlow is effective and safe for the treatment of MGD and associated evaporative DED. The conclusions are supported by the diversity of the patient populations (geography, race, disease severity, and diagnosis), the large population treated with LipiFlow, the meta-analyses, and that this review analyzed all published clinical studies to date.
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Affiliation(s)
| | - David Murakami
- Johnson & Johnson Surgical Vision, Inc., Irvine, CA, 92618, USA
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Eom Y, Jun I, Jeon HS, Lim DH, Lee H, Hwang HS, Chung SH, Chung TY, Kim JY, Kim SW, Choi CY, Song JS, Kim MK, Seo KY, Hyon JY. Re-Esterified Triglyceride ω-3 Fatty Acids in Dry Eye Disease With Meibomian Gland Dysfunction: A Randomized Clinical Trial. JAMA Ophthalmol 2024; 142:617-624. [PMID: 38753336 PMCID: PMC11099841 DOI: 10.1001/jamaophthalmol.2024.1482] [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: 12/08/2023] [Accepted: 03/10/2024] [Indexed: 05/19/2024]
Abstract
Importance Taking ω-3 supplements has been associated with a reduction in symptoms of dry eye disease (DED) associated with meibomian gland dysfunction (MGD). However, a recent relatively large clinical trial concluded that treating DED with ω-3 consumption was ineffective, potentially warranting additional investigations. Objectives To investigate the effect of re-esterified triglyceride (rTG) ω-3 fatty acid supplementation on DED associated with MGD. Design, Setting, and Participants This double-masked, parallel-group, randomized clinical trial was conducted at 7 institutions from September 2020 to January 2023. Patients with DED associated with MGD were included and randomly assigned to the ω-3 group (received 1680 mg of eicosapentaenoic acid and 560 mg of docosahexaenoic acid), whereas those in the grape-seed group received 3000 mg of grape-seed oil daily. Interventions rTG ω-3 Fatty acid supplementation vs grape-seed oil. Main Outcome Measures The primary end point was the Ocular Surface Disease Index (OSDI) from baseline to 6 and 12 weeks. The safety parameters were visual acuity and intraocular pressure change. Results A total of 132 patients (mean [SD] age, 50.6 [13.8] years; 103 female [78.0%]) were included in this study. The mean (SD) baseline OSDI scores of the ω-3 and grape-seed groups were 43.5 (16.5) and 44.1 (16.6), respectively. A total of 58 patients (87.9%) and 57 patients (86.4%) in the ω-3 and grape-seed groups, respectively, completed 12 weeks of follow-up. There were no differences in compliance with the dietary supplement intake between groups (ω-3, 95.8% and grape-seed, 95.4%). The OSDI (SD) change from baseline to 6 and 12 weeks was -20.5 (16.0) and -22.7 (15.7), respectively, in the ω-3 group and -15.1 (20.2) and -18.8 (21.7), respectively, in the grape-seed control group (difference at 6 weeks = -5.4; 95% CI, -12.15 to 1.33; P = .12 and at 12 weeks = -3.9; 95% CI, -10.90 to 3.13; P = .28). There were no changes in safety parameters or adverse events related to taking the dietary supplement in either group. Conclusions and Relevance This randomized clinical trial did not show a benefit of the rTG form of ω-3 for ameliorating symptoms of DED associated with MGD, although fewer than 60 participants were evaluated in each group. Any secondary outcomes from this study should be considered for hypothesis generation of future evaluations of the effect of the rTG form of ω-3 on DED associated with MGD. Trial Registration CRIS Identifier: KCT0004927.
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Affiliation(s)
- Youngsub Eom
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Ikhyun Jun
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
- Corneal Dystrophy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ho Sik Hwang
- Department of Ophthalmology, Yeouido St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Hyang Chung
- Department of Ophthalmology, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Woong Kim
- Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chul Young Choi
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Suk Song
- Department of Ophthalmology, Korea University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Republic of Korea
| | - Kyoung Yul Seo
- The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Agnifili L, Figus M, Sacchi M, Oddone F, Villani E, Ferrari G, Posarelli C, Carnevale C, Nucci P, Nubile M, Mastropasqua L. Managing the ocular surface after glaucoma filtration surgery: an orphan topic. Graefes Arch Clin Exp Ophthalmol 2024; 262:2039-2056. [PMID: 38091058 DOI: 10.1007/s00417-023-06333-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 11/06/2023] [Accepted: 12/05/2023] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Ocular surface (OS) disorders before glaucoma filtration surgery (GFS) have been considered to play a crucial role influencing the surgical outcome. Conversely, the impact of surgery itself on the OS is almost completely overlooked, though evidence suggest that ocular surface disease (OSD) may be induced in patients by GFS. This review analyzes the determinants involved in the OSD development after GFS, the clinical features and related consequences, the main diagnostic hallmarks, as well as the therapeutic strategies for its management. METHODS The PubMed database was utilized for the literature examination. Keywords that were searched included ocular surface disease, glaucoma filtration surgery, filtration bleb, post-surgical management, and quality of life. RESULTS After GFS, OSD is promoted by peri- and post-operative factors, such as the filtration bleb (FB) development, combined surgical approach with phacoemulsification, the use of antifibrotic agents and the reintroduction of antiglaucoma medications. This particular form of OSD that present similar clinical features to mild to moderate dry eye, can be named as post-glaucoma surgery-OSD (PGS-OSD). PGS-OSD may negatively affect the FB functionality, thus potentially hindering the disease control, and significantly worsen the patient quality of life (QOL). CONCLUSIONS Clinicians are encouraged to routinely include the OS evaluation after GFS and to consider proper management when the occurrence of PGS-OSD worsen the patient's QOL or exert negative effects to the FB functionality. An outline summarizing the main risk factors and the most appropriate therapeutic options to mitigate the PGS-OSD was proposed to support the routine practice.
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Affiliation(s)
- Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy.
| | - Michele Figus
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy
| | - Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | | | - Edoardo Villani
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Giulio Ferrari
- IRCCS San Raffaele Scientific Institute, Division of Neuroscience, Cornea and Ocular Surface Disease Unit, Eye Repair Lab, Milan, Italy
- Vita-Salute San Raffaele University, Department of Ophthalmology, Milan, Italy
| | - Chiara Posarelli
- Ophthalmology Unit, Department of Surgery, Medicine, Molecular and Emergency, University of Pisa, Pisa, Italy
| | | | - Paolo Nucci
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | - Mario Nubile
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Leonardo Mastropasqua
- Ophthalmology Clinic, Department of Medicine and Aging Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy
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5
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Gupta AS, Massaro M, Bunya VY. Intense pulsed light treatment for the management of meibomian gland dysfunction. Curr Opin Ophthalmol 2024; 35:322-328. [PMID: 38813738 DOI: 10.1097/icu.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW Meibomian gland dysfunction (MGD) is one of the most common disorders encountered by ophthalmologists, and its management can prove challenging for both clinicians and patients. Intense pulsed light (IPL), which has been historically used in the field of dermatology, has emerged as a tool to help improve meibomian gland function. The goal of this review is to assess the clinical efficacy, utility, and safety of IPL for the treatment of MGD. RECENT FINDINGS In recent randomized controlled trials, IPL has been shown to improve meibomian gland function, and subsequently tear film quality and dry eye symptoms. The mechanism of action still remains unclear. Recent literature suggests that IPL may also be used in conjunction with other therapies, such as meibomian gland expression, low-level light therapy, and thermal pulsation. Careful attention should be placed on each patient's Fitzpatrick skin type, as well as protecting the ocular structures to reduce the risk of adverse effects. Cost, accessibility, as well as a limited duration of efficacy may be drawbacks. SUMMARY There is significant evidence supporting that IPL may be used as a potential well tolerated and effective treatment for MGD, though there are certain caveats regarding its long-term efficacy, accessibility, and cost.
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Affiliation(s)
- Angela Satya Gupta
- Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Francisco ZM, Sara MM, José-María SG, Facundo U, Carlos RDL, María GL, Jessica M, Carmen AL, Santiago OP, Juan Carlos SE. Standardized clinical evaluation of dry anophthalmic socket syndrome in a real-world approach. Cont Lens Anterior Eye 2024; 47:102149. [PMID: 38521700 DOI: 10.1016/j.clae.2024.102149] [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: 06/19/2023] [Revised: 03/08/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To assess which signs and eye prosthesis care habits are related to subjective discomfort in patients with dry anophthalmic socket syndrome (DASS), using standardized tools from daily practice. METHODS 62 anophthalmic sockets were compared with their healthy fellow eye using the Standard Patient Evaluation of Eye Dryness (SPEED) score. The correlations between SPEED questionnaire and the prosthesis care, discharge characteristics score, conjunctival inflammation score, meibomian gland dysfunction (MGD) scores and Schirmer I test were studied. RESULT The anophthalmic sockets group achieved a higher SPEED test score (p < 0.01), discharge score (p < 0.01), conjunctival inflammation score (p < 0.01), MGD scores (p < 0.01) and lower Schirmer I test (p < 0.01) compared with their fellow, healthy eye. Patients with a prosthesis replacement of one year or less, those with a current fit time of one year or less and those with a cleaning frequency above one month reported better SPEED, (p < 0.01), conjunctiva inflammation (p < 0.01) and MGD scores (p < 0.01). CONCLUSION Most anophthalmic patients suffer mild to severe DASS, which seems related to discharge, conjunctival inflammation and MGD. Moreover, certain practices related to the care of the prosthesis such as replacing with a frequency lower than yearly, current fitting time inferior to one year and a removing and cleaning regime above one month, were related to a lower discomfort sensation, conjunctival inflammation and MGD. Clinicians should consider the DASS when facing patients with anophthalmic socket and discomfort symptoms.
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Affiliation(s)
- Zamorano-Martín Francisco
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Malaga, Spain; Deparment of Radiology and Physical Medicine, Ophthalmology and Otorhinolaryngology, Ophthalmology Area, Facultad de Medicina, Universidad de Málaga, Malaga, Spain
| | | | - Sánchez-González José-María
- Department of Physics of Condensed Matter, Optics Area, Universidad de Sevilla, Seville, Spain; Department of Ophthalmology (Tecnolaser Clinic Vision), Refractive Surgery Centre, Seville, Spain.
| | - Urbinati Facundo
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Rocha-de-Lossada Carlos
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Malaga, Spain; Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almeria, Spain
| | - García-Lorente María
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Malaga, Spain; Deparment of Radiology and Physical Medicine, Ophthalmology and Otorhinolaryngology, Ophthalmology Area, Facultad de Medicina, Universidad de Málaga, Malaga, Spain
| | - Mata Jessica
- Department of Ophthalmology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alba-Linero Carmen
- Deparment of Radiology and Physical Medicine, Ophthalmology and Otorhinolaryngology, Ophthalmology Area, Facultad de Medicina, Universidad de Málaga, Malaga, Spain; Department of Ophthalmology, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Ortiz-Pérez Santiago
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Departamento de Cirugía y sus especialidades, Universidad de Granada, Spain; Granada Vision and Eye Research Team (VER), Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
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7
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Price EJ, Benjamin S, Bombardieri M, Bowman S, Carty S, Ciurtin C, Crampton B, Dawson A, Fisher BA, Giles I, Glennon P, Gupta M, Hackett KL, Larkin G, Ng WF, Ramanan AV, Rassam S, Rauz S, Smith G, Sutcliffe N, Tappuni A, Walsh SB. Executive summary: British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease. Rheumatology (Oxford) 2024:keae218. [PMID: 38785300 DOI: 10.1093/rheumatology/keae218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Stuart Benjamin
- The Academy Library and Information Service, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Barts Health NHS Trust, London, UK
- Centre for Experimental Medicine and Rheumatology, The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon Bowman
- Department of Rheumatology, Milton Keynes University Hospital, Milton Keynes, UK
- Department of Rheumatology, University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sara Carty
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Coziana Ciurtin
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Bridget Crampton
- Patient Representative, Sjogren's UK helpline lead, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Annabel Dawson
- Patient Representative, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Peter Glennon
- General Practice, NHS Staffordshire & Stoke on Trent ICB, Stafford, UK
| | - Monica Gupta
- Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - Wan-Fai Ng
- Translational and Clinical Research Institute & Newcastle NIHR Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Department of Rheumatology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Athimalaipet V Ramanan
- Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Saad Rassam
- Haematology and Haemato-Oncology, KIMS Hospital, Maidstone, Kent, UK
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Guy Smith
- Department of Ophthalmology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | | | - Anwar Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, University College London, London, UK
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Dash N, Choudhury D. Dry Eye Disease: An Update on Changing Perspectives on Causes, Diagnosis, and Management. Cureus 2024; 16:e59985. [PMID: 38854318 PMCID: PMC11162257 DOI: 10.7759/cureus.59985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/11/2024] Open
Abstract
Dry eye disease is a common clinical problem encountered by ophthalmologists worldwide. Interest in this entity has increased in recent years due to the consequences it has on the ocular surface after any surface procedure. With changing times, several new factors have come to light that can influence this disease. The effect of the COVID-19 pandemic has also been greatly felt, with a range of causes, starting from increased screen work to inflammatory processes, exacerbating the condition in many. With changes in the concepts of the etiopathogenesis of the disease, a paradigm shift has taken place in the approaches to treatment. More researchers are in favor of a new tear film-oriented approach that tries to localize the disease to a single component in the tear film. Innovation of newer techniques for the treatment of meibomian gland disease has also made its foray into clinical ophthalmology. Newer drug formulations and molecules are underway to better treat the inflammatory component of the disease. Many other receptors and targets for the treatment of dry eyes are being researched. This review hopes to provide a succinct, narrative summary of the relevant research on dry eye disease to date to increase awareness about the nature and future course of this disease and its management.
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Affiliation(s)
- Nikita Dash
- Ophthalmology, Sir Ganga Ram Hospital, New Delhi, IND
| | - Deepak Choudhury
- Ophthalmology, Maharaja Krishna Chandra Gajapati (MKCG) Medical College, Berhampur, IND
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9
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Benitez-Del-Castillo JM, López-Pérez MD, Cano-Ortiz A, Peris-Martinez C, Pinar-Sueiro S, Gessa-Sorroche M, García-Franco-Zuñiga C, Iradier MT, Amesty MA, Burgos-Blasco B. Efficacy and safety of intense pulsed light of upper and lower eyelids in Meibomian gland dysfunction: A prospective multicentric study. Eur J Ophthalmol 2024; 34:700-707. [PMID: 37671407 DOI: 10.1177/11206721231199121] [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] [Indexed: 09/07/2023]
Abstract
PURPOSE To demonstrate that intense pulsed light therapy (IPL) of the upper and lower eyelids with meibomian gland expression (MGX) is effective in improving dry eye disease due to meibomian gland dysfunction (MGD). METHODS Patients with ocular discomfort (Ocular Surface Disease Index -OSDI- above 13) and signs of MGD were recruited. All patients underwent OSDI, visual acuity (VA), intraocular pressure, Schirmer test, meibography, non-invasive tear breakup time (NITBUT), slit-lamp examination (corneal and conjunctival staining, hyperemia, gland expressibility, and meibum quality), tear osmolarity and lipid layer thickness. IPL was performed with Optima IPL (Lumenis Ltd.) following a standardized protocol on upper and lower eyelids of both eyes, with inferior eyelid MGX. Patients received four sessions separated by two weeks each. Four weeks after, examinations were repeated. RESULTS 160 patients (320 eyes) were included, of which 108 (67.5%) were women and mean age was 59.2 ± 15.08 (range 20-89). After four sessions, VA, OSDI, tear osmolarity, lipid layer thickness, NITBUT, hyperemia, corneal and conjunctival staining, gland expressibility, meibum quality, inferior eyelid Meiboscore and Schirmer test improved (all, p < 0.027). Changes in OSDI, initial and average NITBUT increased with dry eye disease severity (according to OSDI). Increased pre-treatment OSDI, hyperemia, corneal and conjunctival staining and Schirmer test were associated with an improvement in OSDI (all, p < 0.040). No adverse events were noted. CONCLUSIONS The combination of IPL on upper and lower eyelids with MGX is safe and effective for the treatment of MGD. Patients with severe dry eye disease present greater improvements.
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Affiliation(s)
- Jose Manuel Benitez-Del-Castillo
- Department of Ophthalmology, Hospital Clinico San Carlos, Madrid, Spain
- Universidad Complutense de Madrid, Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Madrid, Spain
- Clínica Rementería, Madrid, Spain
| | | | - Antonio Cano-Ortiz
- Ophthalmology Department, Unidad de córnea y segmento anterior, Hospital Arruzafa, Córdoba, Spain
| | - Cristina Peris-Martinez
- Aviño Peris Eye Clinic, Valencia, Spain
- Ophthalmology Department, University of Valencia, Valencia, Spain
| | - Sergio Pinar-Sueiro
- Ophthalmology Department, Hospital Universitario Donostia, San Sebastián, Spain
- Vista Instituto Oftalmológico Bilbao, Bilbao, Spain
- Centro Oftálmico San Sebastián (COSS), San Sebastián, Spain
| | - Maria Gessa-Sorroche
- Ophthalmology Department, Unidad de córnea y superficie ocular, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Unidad de córnea, catarata, refractiva y segmento anterior. Clínica Miranza Virgen de Luján, Sevilla, Spain
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Price EJ, Benjamin S, Bombardieri M, Bowman S, Carty S, Ciurtin C, Crampton B, Dawson A, Fisher BA, Giles I, Glennon P, Gupta M, Hackett KL, Larkin G, Ng WF, Ramanan AV, Rassam S, Rauz S, Smith G, Sutcliffe N, Tappuni A, Walsh SB. British Society for Rheumatology guideline on management of adult and juvenile onset Sjögren disease. Rheumatology (Oxford) 2024:keae152. [PMID: 38621708 DOI: 10.1093/rheumatology/keae152] [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: 11/06/2023] [Accepted: 03/02/2024] [Indexed: 04/17/2024] Open
Abstract
Sjögren disease (SD) is a chronic, autoimmune disease of unknown aetiology with significant impact on quality of life. Although dryness (sicca) of the eyes and mouth are the classically described features, dryness of other mucosal surfaces and systemic manifestations are common. The key management aim should be to empower the individual to manage their condition-conserving, replacing and stimulating secretions; and preventing damage and suppressing systemic disease activity. This guideline builds on and widens the recommendations developed for the first guideline published in 2017. We have included advice on the management of children and adolescents where appropriate to provide a comprehensive guideline for UK-based rheumatology teams.
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Affiliation(s)
- Elizabeth J Price
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Stuart Benjamin
- The Academy Library and Information Service, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Michele Bombardieri
- Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Barts Health NHS Trust, London, UK
- Centre for Experimental Medicine and Rheumatology, The William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Simon Bowman
- Department of Rheumatology, Milton Keynes University Hospital, Milton Keynes, UK
- Department of Rheumatology, University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Sara Carty
- Department of Rheumatology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | - Coziana Ciurtin
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Bridget Crampton
- Patient Representative, Sjogren's UK Helpline Lead, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Annabel Dawson
- Patient Representative, Sjogren's UK (British Sjögren's Syndrome Association), Birmingham, UK
| | - Benjamin A Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ian Giles
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Peter Glennon
- General Practice, NHS Staffordshire & Stoke on Trent ICB, Stafford, UK
| | - Monica Gupta
- Department of Rheumatology, Gartnavel General Hospital, Glasgow, UK
| | - Katie L Hackett
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - Wan-Fai Ng
- Translational and Clinical Research Institute & Newcastle NIHR Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
- Department of Rheumatology, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Saad Rassam
- Haematology and Haemato-Oncology, KIMS Hospital, Maidstone, Kent, UK
| | - Saaeha Rauz
- Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Guy Smith
- Department of Ophthalmology, Great Western Hospital NHS Foundation Trust, Swindon, UK
| | | | - Anwar Tappuni
- Institute of Dentistry, Queen Mary University of London, London, UK
| | - Stephen B Walsh
- London Tubular Centre, University College London, London, UK
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Chen X, Liu Y, Zheng T, Zhang Q, Ren Y, Shen Y, Ke M. Eyes on the Lid: The Impact of Fibroblast Growth Factor Receptor Targeting Drug on Human Meibomian Gland. Eye Contact Lens 2024; 50:102-105. [PMID: 37988104 DOI: 10.1097/icl.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To determine whether fibroblast growth factor receptor (FGFR)-targeting drug could impact human meibomian gland. METHODS We followed up with three patients who were using pemigatinib for 4 to 10 weeks. The patients were evaluated for their ocular surface disease index, best-corrected visual acuity, Schirmer test, cornea staining, meibum expressibility score, tear meniscus height, noninvasive tear film breakup time, and meibomian gland area. The distribution of the FGFR family, FGF7, and FGF10 were evaluated by immunofluorescence staining and Western blot in fresh tarsal tissues from deidentified patients who underwent lid plastic surgeries. RESULTS All patients developed apparent meibomian gland atrophy, shortening and narrowing of ducts, and significantly increased meibum expressibility and decreased noninvasive tear film breakup time within 5 to 8 weeks. Laboratory evaluations confirmed that human meibomian gland expresses abundant fibroblast growth factor receptors. CONCLUSIONS These findings indicate that meibomian gland is a target tissue of FGFR inhibitors, and patients who use these drugs may develop meibomian gland dysfunction.
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Affiliation(s)
- Xiaomin Chen
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
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12
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Huang WL, Huang CM, Chu CY, Hu FR. Comorbidity of Ocular and Facial Demodicosis. Am J Ophthalmol 2024; 257:201-211. [PMID: 37739203 DOI: 10.1016/j.ajo.2023.09.010] [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: 05/03/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE To determine the association between ocular and facial demodicosis, and the effect of facial treatment on ocular demodicosis. DESIGN Prospective clinical cohort study. METHODS Ocular demodicosis outpatients from a tertiary medical center were enrolled from April to December 2020. The diagnosis was based on epilation of 4 eyelashes from each upper eyelid. High ocular Demodex load (ODL) was defined as ≥8 mites per eye. Facial infestation was assessed by direct microscopic examination, with facial Demodex overgrowth (FDO) defined as a density >5 mites/cm2. All patients were prescribed 3 months of ocular treatment, and FDO patients received dermatologic treatment. RESULTS Eighty-nine patients were enrolled. Among those that completed the treatment course, 39 presented high ODL. Lower cylindrical sleeve counts were found in low ODL patients (low ODL vs high ODL: 8 vs 14, P = .009). FDO was less prevalent in this group (49% vs 77%, P = .012). The Ocular Surface Disease Index score decreased in patients without FDO (20.0 ± 17.1 to 14.0 ± 16.6, P = .027) after 3 months of topical tea tree oil treatment. Topical ivermectin treatment on the facial skin provided a higher ocular Demodex eradication rate in FDO patients (76% vs 16%, P < .001). CONCLUSION Concurrence of ocular and facial demodicosis is common, especially in cases of severe ocular demodicosis. Although ocular treatment alone is effective for patients with ocular demodicosis only, cotreatment with topical ivermectin on the facial skin enhances ocular Demodex eradication in patients with comorbid facial Demodex overgrowth.
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Affiliation(s)
- Wei-Lun Huang
- From the Department of Ophthalmology, National Taiwan University Hospital Hsinchu Branch (W.-L.H.), Hsinchu, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University (W.-L.H.), Taipei, Taiwan
| | - Chang-Ming Huang
- Department of Dermatology, National Taiwan University Hospital, College of Medicine, National Taiwan University (C.-M.H., C.-Y.C.), Taipei, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital, College of Medicine, National Taiwan University (C.-M.H., C.-Y.C.), Taipei, Taiwan
| | - Fung-Rong Hu
- Department of Ophthalmology, National Taiwan University Hospital, College of Medicine, National Taiwan University (F.-R.H.), Taipei, Taiwan.
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13
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Moreno I, Verma S, Gesteira TF, Coulson-Thomas VJ. Recent advances in age-related meibomian gland dysfunction (ARMGD). Ocul Surf 2023; 30:298-306. [PMID: 37979775 PMCID: PMC11092925 DOI: 10.1016/j.jtos.2023.11.003] [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: 08/01/2023] [Revised: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Meibomian glands (MGs), located within the tarsal plate of the eyelid, secrete meibum which is the lipid-rich secretion necessary for stabilizing the tear film and preventing tear evaporation. Changes in the quality and quantity of meibum produced causes MG dysfunction (MGD), the leading cause of evaporative dry eye disease (EDED). MGD is an underdiagnosed disease and it is estimated that, in the US, approximately 70 % of the population over 60 have MGD. Three forms of MGD occur based on their meibum secretion: hyposecretory, obstructive, and hypersecretory MGD. The pathophysiology of MGD remains poorly understood, however aging is the primary risk factor. With age, MGs undergo various age-related changes, including decreased acinar basal cell proliferation, hyperkeratinization, MG atrophy, and eventual MG drop-out, leading to age-related MGD (ARMGD). Additionally, studies have suggested that MGs can suffer inflammatory cell infiltration and changes innervation patterns with aging, which could also contribute towards ARMGD. This review focuses on how the aging process affects the MG, and more importantly, how age-related changes to the MG can lead to MG atrophy and MG drop-out, ultimately leading to ARMGD. This review also highlights the most recent developments in potential therapeutic interventions for ARMGD.
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Affiliation(s)
| | - Sudhir Verma
- College of Optometry, University of Houston, USA; Department of Zoology, Deen Dayal Upadhyaya College, University of Delhi, Delhi, India.
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14
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Aly Zaky M, Galal Zaky A, Fayez Elsawy M, Fatehy Shehata K, Samy Abd Elaziz M. Efficacy of Topical Azithromycin versus Systemic Doxycycline in Treatment of Meibomian Gland Dysfunction. J Ophthalmol 2023; 2023:4182787. [PMID: 37588518 PMCID: PMC10427234 DOI: 10.1155/2023/4182787] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 03/10/2023] [Accepted: 07/13/2023] [Indexed: 08/18/2023] Open
Abstract
Background Ocular surface disease (OSD) is a multifactorial and highly frequent problem. Inadequate or unstable tear film is the main cause, which leads to visual impairments. One of the primary causes of OSD is meibomian gland dysfunction (MGD), with a prevalence of 3.5 to 70%. The aim of this work was to compare the efficacy of azithromycin topical eye drops versus oral doxycycline in MGD individuals. Methods This prospective comparative cohort research was carried out on 56 patients of both sexes of any age with symptomatic MGD. Randomly, patients were classified into two equal groups: Group 1 was treated twice daily for 4 weeks with topical azithromycin 1% eye drops, while group 2 received oral doxycycline 100 mg capsules twice daily for 4 weeks. Results In the 1st follow-up, there was a significant difference between the studied groups in pain and discomfort degree (P value = 0.024) as group 1 showed a higher number of patients with a mild pain degree (P value = 0.013) while group 2 showed a higher number of patients with a severe pain degree (P value = 0.022). There was an insignificant difference between the studied groups in moderate pain degree and lid margin telangiectasia. Conjunctivitis, frothy discharge, and meniscus floaters were significantly higher in group 2 than in group 1 (P value = 0.013, 0.028, and 0.031, respectively). In group 1, the break-up time test was significantly higher than in group 2 (P value = 0.023). In the 2nd follow up, in group 2 only meniscus floaters were significantly higher than in group 1 (P value = 0.044), while in group 1 break-up time test was significantly higher than in group 2 (P value = 0.029). Otherwise, there is no significant difference between both the groups. Conclusions Meibomian gland dysfunction (MGD) could be treated effectively with oral doxycycline and topical azithromycin by improving symptoms, clinical signs, and stabilization of tear film. Moreover, the topical azithromycin group seemed to be superior over the oral doxycycline group in improving the quality of tear film in the short term, having fewer side effects, more compliance, and better tolerability.
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Affiliation(s)
- Marwa Aly Zaky
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Adel Galal Zaky
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | - Moataz Fayez Elsawy
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
| | | | - Mohamed Samy Abd Elaziz
- Ophthalmology Department, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Menoufia, Egypt
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15
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Sheppard JD, Kurata F, Epitropoulos AT, Krösser S, Vittitow JL. NOV03 for Signs and Symptoms of Dry Eye Disease Associated With Meibomian Gland Dysfunction: The Randomized Phase 3 MOJAVE Study. Am J Ophthalmol 2023; 252:265-274. [PMID: 36948372 DOI: 10.1016/j.ajo.2023.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of NOV03 (perfluorohexyloctane) ophthalmic drop for the treatment of signs and symptoms of dry eye disease (DED) associated with meibomian gland dysfunction (MGD). DESIGN Randomized, double-masked, controlled trial. METHODS Patients ≥18 years of age with a history of DED and signs of MGD were randomly assigned 1:1 to treatment with NOV03 or hypotonic saline (0.6%) 4 times daily for 8 weeks. The primary sign and symptom endpoints were change from baseline to week 8 in total corneal fluorescein staining (tCFS; National Eye Institute scale) and eye dryness score (0-100 visual analog scale), respectively. RESULTS A total of 620 patients (NOV03, n = 311; saline, n = 309) were randomized and treated. Least-squares (LS) mean change from baseline to week 8 was statistically significantly greater for NOV03 compared with saline for both tCFS (-2.3 vs -1.1; LS mean treatment difference, -1.2 [95% confidence interval -1.7 to -0.8]; P < .001) and visual analog scale dryness score (-29.4 vs -19.2; LS mean treatment difference, -10.2 [95% CI -14.4 to -6.1]; P < .001), with statistically significant between-group differences observed as early as week 2. The incidence of ocular adverse events was similar for NOV03 (12.9%) and saline (12.3%). There were no serious adverse events and no adverse events leading to treatment discontinuation. CONCLUSIONS In this randomized controlled trial of patients with DED associated with MGD, NOV03 significantly reduced both signs and symptoms of DED compared with hypotonic saline control. NOV03 was well tolerated, with an adverse event profile similar to that of saline.
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Affiliation(s)
- John D Sheppard
- From Virginia Eye Consultants (J.D.S.), Norfolk, Virginia, USA.
| | - Fred Kurata
- East West Eye Institute (F.K.), Los Angeles, California, USA
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16
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Wang Y, Jia X, Wei S, Li X. A deep learning model established for evaluating lid margin signs with colour anterior segment photography. Eye (Lond) 2023; 37:1377-1382. [PMID: 35739245 PMCID: PMC10170093 DOI: 10.1038/s41433-022-02088-1] [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: 09/18/2021] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of applying a deep learning model to identify lid margin signs from colour anterior segment photography. METHODS We collected a total of 832 colour anterior segment photographs from 428 dry eye patients. Eight lid margin signs were labelled by human ophthalmologists. Eight deep learning models were constructed based on VGGNet-13 and trained to identify lid margin signs. Sensitivity, specificity, receiver operative characteristic (ROC) curves and area under the curve (AUC) were applied to evaluate the models. RESULTS The AUC for rounding of posterior lid margin was 0.979 and was 0.977 and 0.980 for lid margin irregularity and vascularization. For hyperkeratinization, the AUC was 0.964. The AUCs for meibomian gland orifice (MGO) retroplacement and plugging were 0.963 and 0.968. For the mucocutaneous junction (MCJ) anteroplacement and retroplacement model, the AUCs were 0.950 and 0.978. The sensitivity and specificity for rounding of posterior lid margin were 0.974 and 0.921. For irregularity, the sensitivity and specificity were 0.930 and 0.938, and those for vascularization were 0.923 and 0.961. The hyperkeratinization model achieved a sensitivity and specificity of 0.889 and 0.948. The model identifying MGO plugging and retroplacement achieved a sensitivity of 0.979 and 0.909 with a specificity of 0.867 and 0.967. The sensitivity of MCJ anteroplacement and retroplacement were 0.875/0.969, with a specificity of 0.966/0.888. CONCLUSIONS The deep learning model could identify lid margin signs with high sensitivity and specificity. The study provided the potentiality of applying artificial intelligence in lid margin evaluation to assist dry eye decision-making.
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Affiliation(s)
- Yuexin Wang
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Xingheng Jia
- School of Vehicle and Mobility, Tsinghua University, Beijing, China
| | - Shanshan Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing, China
| | - Xuemin Li
- Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China.
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17
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Du YL, Peng X, Liu Y, Wang JS, Ye YF, Xu KK, Qu JY, Chen H, Xie HT, Zhang MC. Ductal Hyperkeratinization and Acinar Renewal Abnormality: New Concepts on Pathogenesis of Meibomian Gland Dysfunction. Curr Issues Mol Biol 2023; 45:1889-1901. [PMID: 36975492 PMCID: PMC10047716 DOI: 10.3390/cimb45030122] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/18/2023] [Accepted: 02/21/2023] [Indexed: 03/02/2023] Open
Abstract
Meibomian gland dysfunction (MGD) is a functional and morphological disorder of the meibomian glands which results in qualitative or quantitative alteration in meibum secretion and is the major cause of evaporative dry eye (EDE). EDE is often characterized by tear film instability, increased evaporation, hyperosmolarity, inflammation, and ocular surface disorder. The precise pathogenesis of MGD remains elusive. It has been widely considered that MGD develops as a result of ductal epithelial hyperkeratinization, which obstructs the meibomian orifice, halts meibum secretion, and causes secondary acinar atrophy and gland dropout. Abnormal self-renewal and differentiation of the acinar cells also play a significant role in MGD. This review summarizes the latest research findings regarding the possible pathogenesis of MGD and provides further treatment strategies for MGD-EDE patients.
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Affiliation(s)
- Ya-Li Du
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xi Peng
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yang Liu
- Department of Ophthalmology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jia-Song Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - You-Fan Ye
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Kang-Kang Xu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jing-Yu Qu
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua Chen
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Hua-Tao Xie
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ming-Chang Zhang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Intense pulsed light treatment of the upper and lower eyelids in patients with moderate-to-severe meibomian gland dysfunction. Int Ophthalmol 2023; 43:73-82. [PMID: 35794405 DOI: 10.1007/s10792-022-02389-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE We investigated the subjective and objective outcome after intense pulsed light (IPL) treatment and meibomian gland expression on the upper and lower eyelids compared with those after IPL treatment on the lower eyelid alone in patients with moderate-to-severe meibomian gland dysfunction (MGD). METHODS Patients who underwent four IPL treatment sessions with meibomian gland expression were divided into upper and lower treatment group and conventional treatment group treated with lower eyelid alone. All patients underwent an ophthalmologic examination and answered a symptom questionnaire before the first treatment and 1 month after the last treatment. An ophthalmologic examination included tear break-up time (TBUT), fluorescein staining score, Schirmer's test, matrix metalloproteinase-9 (MMP-9), meibum grade, color, consistency, and lid margin telangiectasia. Additionally, visual acuity and adverse effects were checked on every visit. RESULTS Of 115 patients, 75 in the upper and lower treatment group and 40 in the conventional treatment group were included. TBUT, fluorescein staining score, subjective symptom, and meibum grade were significantly improved in both groups. Additionally, meibum color and consistency of upper and lower eyelids significantly decreased post-treatment in both groups. The lid margin telangiectasia of the upper and lower eyelids significantly decreased post-treatment in the upper and lower treatment group. MMP-9 positivity and grading scores significantly decreased post-treatment in both groups, and no severe adverse effects occurred during the follow-up period. CONCLUSION Additional IPL treatment on the upper eyelid using a protective device was proven safe and provided an additive improvement in treating moderate-to-severe MGD.
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Tauber J, Berdy GJ, Wirta DL, Krösser S, Vittitow JL. NOV03 for Dry Eye Disease Associated with Meibomian Gland Dysfunction: Results of the Randomized Phase 3 GOBI Study. Ophthalmology 2022; 130:516-524. [PMID: 36574848 DOI: 10.1016/j.ophtha.2022.12.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/29/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To evaluate the efficacy and safety of NOV03 (perfluorohexyloctane) ophthalmic drop in patients with dry eye disease (DED) associated with meibomian gland dysfunction (MGD). DESIGN Eight-week, phase 3, multicenter, randomized, double-masked, saline-controlled study. PARTICIPANTS Adults ≥ 18 years with a history of DED for ≥ 6 months, tear film breakup time of ≤ 5 seconds, Schirmer I test (without anesthesia) score ≥ 5 mm, MGD score ≥ 3 (0-15 scale), and total corneal fluorescein staining (tCFS) score ≥ 4 and ≤ 11 (0-15 National Eye Institute [NEI] scale). METHODS Patients were randomized 1:1 to NOV03 or hypotonic (0.6%) saline 4 times daily. MAIN OUTCOME MEASURES The primary sign and symptom end points were change from baseline in tCFS and eye dryness score (0-100 visual analog scale [VAS]) at week 8. Key secondary end points were change from baseline in eye dryness score at week 2, tCFS at week 2, eye burning or stinging score (0-100 VAS) at week 8, and central corneal fluorescein staining (cCFS; 0-3 NEI scale) at week 8. RESULTS Of the 599 patients randomized, 597 were treated (NOV03, n = 303; saline, n = 294). At week 8, improvement from baseline was significantly greater (P < 0.001) with NOV03 versus saline for tCFS (least square [LS] mean treatment difference, -0.97; 95% confidence interval [CI]: -1.40, -0.55) and VAS dryness score (-7.6; 95% CI: -11.8, -3.4). Improvement from baseline also significantly (P < 0.01) favored NOV03 on all key secondary end points: LS mean treatment difference (95% CI) was -4.7 (-8.2, -1.2) for VAS dryness score at week 2, -0.6 (-0.9, -0.2) for tCFS at week 2, -5.5 (-9.5, -1.6) for VAS burning or stinging score at week 8, and -0.2 (-0.4, -0.1) for cCFS at week 8. Most ocular adverse events (AEs) were mild in severity; no serious ocular AEs occurred. One patient discontinued NOV03 because of an AE (eye irritation). CONCLUSIONS In patients with DED associated with MGD, NOV03 demonstrated statistically significant and clinically meaningful improvements versus hypotonic saline in signs and symptoms of DED and was well tolerated. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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20
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Design of a Functional Eye Dressing for Treatment of the Vitreous Floater. J Pers Med 2022; 12:jpm12101659. [PMID: 36294798 PMCID: PMC9604789 DOI: 10.3390/jpm12101659] [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: 07/22/2022] [Revised: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 11/25/2022] Open
Abstract
With the rapid development of display technology, related diseases of the human eye are also increasing day by day. Eye floaters are one of the diseases that affect humans. Herein, we present a functional ophthalmic dressing that can permeate the skin tissues of the eyes through oxygen and hydrogen to improve the symptoms of floaters. In clinical tests, the symptoms of sensory floaters improved in 28 patients, and the recovery rates of mild, moderate, and severe floaters were about 70%, 66.7%, and 83.3%, respectively.
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21
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Antibiotic treatment for dry eye disease related to meibomian gland dysfunction and blepharitis – A review. Ocul Surf 2022; 26:211-221. [DOI: 10.1016/j.jtos.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022]
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22
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Meduri A, Oliverio GW, Tedesco G, Aragona P. Combined intense pulsed light and low-level light therapy for the treatment of refractory Meibomian gland dysfunction. Eur J Ophthalmol 2022; 33:11206721221127206. [PMID: 36112864 DOI: 10.1177/11206721221127206] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
PURPOSE To evaluate the efficacy of combined Intense Pulsed Light (IPL) and Low-Level Light Therapy (LLLT) in treatment of Meibomian Gland Dysfunction (MGD). METHODS AND ANALYSIS In this prospective study, 70 patients with refractory MGD were enrolled; group 1 received 3 consecutive sessions of IPL + LLLT treatment using Eye-light® on day 1, day 15 and day 45; group 2 received hyaluronate sodium 2 mg/ml drops 3 times a day for 6 months. Patients underwent at baseline, and after 3 and 6 months Ocular Surface Disease Index (OSDI) questionnaire, Symptom Assessment in Dry Eye (SANDE), tear-film breakup time (TBUT), fluorescein ocular surface staining, meibum expressibility and quality evaluations. Keratograph 5M (Oculus, Germany) was used to assess NIBUT, tear meniscus height (TMH), meibography, and bulbar redness score. RESULTS At 6 months a significant improvement of OSDI (p = 0.03), SANDE (p = 0.02), NIBUT (p = p < 0.0001), TMH (p = 0.04), TBUT (p = 0.02), corneal-conjunctival staining score (p = 0.02), lid margin score (p < 0.0001), and bulbar redness score (p = 0.001) were recorded in group 1. Comparing the two groups, statistically significant differences were observed at 6 months in TBUT (p = 0.03), lid margin score (p < 0.001), Meibum expressibility (p = 0.03) and NIBUT (p < 0.001). No adverse events were recorded throughout the follow-up period. CONCLUSION This study confirmed the efficacy and safety of combined IPL and LLLT demonstrating its superiority compared to topical treatment.
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Affiliation(s)
- Alessandro Meduri
- Department of Biomedical Sciences, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | | | | | - Pasquale Aragona
- Department of Biomedical Sciences, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
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Trone MC, Garcin T, Ollier E, Thuret G, Gain P. A retrospective study of the efficacy of intense pulsed light delivered by the Lacrystim® for meibomian gland dysfunction therapy. BMC Ophthalmol 2022; 22:335. [PMID: 35933379 PMCID: PMC9356507 DOI: 10.1186/s12886-022-02531-7] [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: 04/28/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background Meibomian gland dysfunction is the most common etiology of dry eye disease worldwide and intense pulsed light appears to be a promising treatment with encouraging results. Lacrystim® is a new IPL device (CE marking in 2019) and no studies have yet been published on it. We propose the first study on this device with an objective assessment of its efficacy and an extended follow-up over 6 months. Methods Patients presenting with a dry eye disease (DED) with stable mild to moderate MGD and having received Lacrystim® treatment between june 2019 and june 2020 were included. 3 IPL sessions were performed at D0, D15 and D45 with 4 shots per side at a fluence of 8 mJ/cm2. DED clinical evaluation was performed at D0, D15, D45, 3rd month and 6th month: Oxford scale and break up time, Schirmer test and Ocular Surface Disease Index (OSDI) questionnaire. Lacrydiag® imaging device carried out an objective examination of tear film: interferometry, meibography, tear meniscus height and non-invasive break up time (NIBUT). The primary endpoint was the evolution in NIBUT between the first visit D0 and 3rd month. Data collection was done retrospectively. Statistical analysis was done using a linear mixed-effects model and a non-parametric linear mixed-effects model (R software). Results Forthy five consecutive patients were included. NIBUT significantly increased between D0 and 3rd month: mean difference of 1.63 seconds, IC95% [0.51; 2.62], (p = 0.002) with a prolonged effect at 6th month. OSDI and OXFORD scores and interferometry were also significantly improved at 3rd month and 6th month. There was no significant change in BUT, Schirmer test and tear meniscus height. No adverse event was noted. Conclusions IPL delivered by Lacrystim® appears effective and safe to treat MGD although a randomized controlled trial is needed to validate its results. Trial registration This work was approved by a local ethics committee “Terre d’éthique” (institutional review board number: IRBN672019/CHUSTE) and registered on the clinicaltrial.gov website (NCT04147962, 01/11/2019).
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Affiliation(s)
- Marie-Caroline Trone
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France. .,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France.
| | - Thibaud Garcin
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Edouard Ollier
- Clinical Research, Innovation and Pharmacology Unit, University Hospital, Saint-Etienne, France.,Health engineering biology (SAINBIOSE) Inserm U1059, vascular hemostasis dysfunction (DVH) team, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Gilles Thuret
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
| | - Philippe Gain
- Ophthalmology department, University Hospital, 42055 Saint-Etienne Cedex1, Saint-Etienne, France.,Corneal Graft Biology, Engineering and Imaging Laboratory BiiGC, EA2521, Health innovation campus, faculty of Medicine, Jean Monnet University, Saint-Etienne, France
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24
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Chung HS, Rhim JW, Park JH. Combination treatment with intense pulsed light, thermal pulsation (LipiFlow), and meibomian gland expression for refractory meibomian gland dysfunction. Int Ophthalmol 2022; 42:3311-3319. [PMID: 35536456 DOI: 10.1007/s10792-022-02330-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 04/18/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the clinical efficacy and safety of combination treatment with intense pulsed light (IPL), LipiFlow thermal pulsation, and manual meibomian gland expression (MGX) for patients with refractory meibomian gland dysfunction (MGD). METHODS A total of 23 eyes from 23 patients who underwent combination treatment with IPL, LipiFlow, and MGX for refractory MGD were included in the study. All patients were followed up for 12 months after the first treatment. All patients were examined prior to treatment and underwent three sessions of IPL, LipiFlow, and MGX, a subsequent three sessions of IPL and MGX, and six subsequent sessions of MGX. Patients were examined 10 weeks, 6 months, and 12 months after the first treatment. The ophthalmologic examination included ocular surface disease index (OSDI), non-invasive tearfilm break-up time (NIBUT), lipid layer thickness (LLT), meibomian gland expressibility (MGE), meibomian gland morphology (meiboscore), and tear meniscus height (TMH). RESULTS OSDI, NIBUT, LLT, and MGE significantly improved with treatment, which was maintained during the follow-up period. TMH and meiboscore remained unchanged throughout follow-up. No serious adverse events occurred during follow-up. CONCLUSIONS Combination therapy with IPL, LipiFlow, and MGX was clinically effective and safe for the treatment of refractory MGD. Combination treatment could be considered for patients with insufficient improvement despite conventional MGD treatments, including IPL treatment with MGX.
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Affiliation(s)
- Ho Seok Chung
- Department of Ophthalmology, Dankook University Hospital, Dankook University College of Medicine, Cheonan, South Korea
| | - Jae Won Rhim
- Miso Eye Clinic, 5th floor 310, Wiryegwangjang-ro, Sujeong-gu, Seongnam-si, Gyeonggi-do, South Korea
| | - Jin Hyoung Park
- Miso Eye Clinic, 5th floor 310, Wiryegwangjang-ro, Sujeong-gu, Seongnam-si, Gyeonggi-do, South Korea. .,Research Institute for Biomacromolecules, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
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25
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Rolando M, Merayo-Lloves J. Management Strategies for Evaporative Dry Eye Disease and Future Perspective. Curr Eye Res 2022; 47:813-823. [PMID: 35521685 DOI: 10.1080/02713683.2022.2039205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Dry eye disease (DED) is a common disorder that remains challenging from a clinical perspective. Unstable or deficient tear film is a major factor contributing to DED and the inability to resolve the loss of tear film homeostasis that accompanies DED can result in a vicious circle of inflammation and treatment-refractory disease. Recently recognized as a multifactorial disease, the main etiological subtypes of DED are aqueous-deficient and evaporative which exist on a continuum, although evaporative dry eye (EDE) is the more frequent classification. Although attaining greater recognition in recent years, there is currently no consensus and no clear recommendation on how to manage EDE. Clarity on the early diagnosis and treatment of EDE may facilitate the avoidance of progression to chronic inflammation, permanent damage to the ocular surface, and treatment-refractory disease. The purpose of this review was to identify current best practice for management of EDE in order to help clinicians in providing accurate diagnosis and optimized treatment. We summarize recent literature considering the role of the lipid layer on tear film stability, the importance of its composition and of its dynamic behavior, and the link between its malfunction and the insurgence and maintenance of tear film-related diseases. We have provided an assessment of the best management of lipid-deficient EDE based upon an understanding of disease pathophysiology, while indicating the flow of current treatments and possible future evolution of treatment approaches. Lipid containing eye drops may be considered as a step closer to natural tears from artificial aqueous tears because they more closely mimic the aqueous and lipid layers and may be used in combination with other management approaches. As a next step, we recommend working with a wider expert group to develop full guidelines to enable patient-centered management of EDE. Key pointsDry eye is a multifactorial disease of variable presentation with the tendency to become a chronic disease for which it is essential to identify and treat the main pathogenic mechanisms involved and tailor the treatment to the individual patient.Early intervention is needed to prevent the vicious cycle of DED and may require a multi-faceted management approach.EDE is not just a problem of MGD but can be the result of anything affecting blinking, mucin spreading, aqueous layer volume and content.Lipid-containing eye drops may provide significant relief of symptoms by improving the lipid layer and its spreading ability and, as such, are an appropriate component of the overall management of lipid-deficient EDE; natural lipid-containing eye drops should be the preferred treatment.
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Affiliation(s)
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica & Universidad de Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
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26
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Xu L, Wu Y, Song Y, Zhang Q, Qin G, Yang L, Ma J, Palme C, Moore JE, Pazo EE, He W. Comparison Between Heated Eye Mask and Intense Pulsed Light Treatment for Contact Lens-Related Dry Eye. Photobiomodul Photomed Laser Surg 2022; 40:189-197. [PMID: 35298282 DOI: 10.1089/photob.2021.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Contact lens-related dry eye (CLDE) is common in contact lens (CL) wearers and can lead to ocular pain, decreased visual quality, and reduced quality of life. Objective: The purpose of this prospective, randomized, examiner masked study was to compare the effectiveness of intense pulsed light (IPL) and heated eye mask (HEM) for relieving CLDE. Methods: The final analysis included 60 patients (30 in the IPL group and 30 in the HEM group) who were using CL and had been suffering contact lens discomfort for more than a year. The IPL treatment group had two IPL treatments spaced 3 weeks apart, whereas the HEM group received HEM daily for 6 weeks (42 days). Non-invasive tear break-up time (NITBUT), tear-film lipid layer (TFLL), conjunctival fluorescein staining, meibum gland quality and expression, conjunctival redness score, ocular surface disease index (OSDI), best-corrected visual acuity, endothelial cell count, and intraocular pressure were assessed at baseline: first visit (V1), second visit (V2), and third visit (V3). Results: The mean age of the IPL group was 28.6 ± 4.3 years (16 females, 53%) and that of the HEM group was 28.6 ± 4.2 years (16 females, 53%). Mean NITBUT for the IPL group at V2 was 5.53 ± 0.77 sec (p < 0.001) and at V3 was 7.72 ± 0.88 sec (p < 0.001); the IPL group demonstrated a clinically and statistically significant improvement in mean NITBUT. In addition, the HEM group showed a clinically and statistically significant improvement in mean NITBUT at V3 (5.86 ± 0.76 sec, p < 0.001). At V3, the C-OSDI, TFLL score, and meibum gland quality and expressibility all increased considerably (p < 0.05) in both groups. Conclusions: Our results imply that IPL or HEM treatment of CLDE can be safely used to relieve symptoms of CLDE. In addition, IPL treatment is more effective in improving the general stability of the tear-film and decreasing the need for artificial tears in CLDE.
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Affiliation(s)
- Ling Xu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Yi Wu
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yilin Song
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing Zhang
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lanting Yang
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China.,The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Jinfei Ma
- Breast Cancer, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Christoph Palme
- Department of Ophthalmology and Optometry, Medical University of Innsbruck, Innsbruck, Austria
| | - Jonathan E Moore
- Cathedral Eye Clinic, Belfast, United Kingdom.,Aston University, Birmingham, United Kingdom
| | - Emmanuel Eric Pazo
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
| | - Wei He
- Department of Ophthalmology, He Eye Specialist Hospital, Shenyang, China
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27
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Messmer EM. Pathophysiology of dry eye disease and novel therapeutic targets. Exp Eye Res 2022; 217:108944. [DOI: 10.1016/j.exer.2022.108944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 01/08/2023]
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28
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Yu H, Zeng W, Zhao G, Hong J, Feng Y. Response of tear cytokines following intense pulsed light combined with meibomian gland expression for treating meibomian gland dysfunction-related dry eye. Front Endocrinol (Lausanne) 2022; 13:973962. [PMID: 36187125 PMCID: PMC9520485 DOI: 10.3389/fendo.2022.973962] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study compared the changes in tear inflammatory cytokine levels after intense pulsed light (IPL) combined with meibomian gland expression (MGX) (IPL group) and instant warm compresses combined with MGX (physiotherapy group) as treatments for meibomian gland dysfunction (MGD)-related dry eye disease (DED) to explore their similarities and differences in therapeutic mechanisms. METHODS This study was a post-hoc analysis of a randomized controlled trial. Thirteen patients with MGD-related DED were enrolled in each group and received three treatments correspondingly with 3-week intervals. The levels of 20 tear cytokines, namely, TNF-α, IL-6, MMP-9, CXCL8/IL-8, CXCL10/IP-10, IL-10, EGF, IL-6R, IL-1β, IFN-γ, lactoferrin, Fas ligand, IL-17A, LT-α, S100A9, LCN2/NGAL, IL-13, IL-12/IL-23p40, Fas, and CCL11/Eotaxin, were measured at baseline, before the second and third treatments, and 3 weeks after the third treatment. The primary outcome was the difference in cytokine levels between baseline and the last measurement, and the trends were analyzed at each measurement point. RESULTS At the last measurement, a significant decrease was observed in all tear cytokines for both IPL and physiotherapy groups compared with baseline. The IPL group showed greater reductions in IL-6, IL-6R, IL-1β, IL-13, and CCL11/Eotaxin than the physiotherapy group. TNF-α, CXCL8/IL-8, CXCL10/IP-10, IL-10, EGF, IL-1β, IFN-γ, and Lipocalin-2/NGAL levels continued to decrease with treatment time. Important interactions were found in the changes of IL-6 and IL-13 levels, where the levels first decreased and then slightly increased in the physiotherapy group after treatment, while they continued to decrease in the IPL group. CONCLUSIONS The mechanisms of IPL and physiotherapy in treating MGD-related DED were both associated with reducing inflammation, and the superiority of IPL could be attributed to its better inhibitory effect on inflammatory cytokines like IL-6. In addition, several cytokines were on a downward trend during treatment, suggesting that the vicious cycle of DED was suppressed.
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Affiliation(s)
| | | | | | - Jing Hong
- *Correspondence: Jing Hong, ; Yun Feng,
| | - Yun Feng
- *Correspondence: Jing Hong, ; Yun Feng,
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29
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Zarei-Ghanavati S, Hassanzadeh S, Khorasani AA, Ehsaei A. The Effect of Meibomian Gland Dysfunction Treatment on Sleep Quality. J Curr Ophthalmol 2021; 33:272-276. [PMID: 34765814 PMCID: PMC8579795 DOI: 10.4103/joco.joco_171_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To assess the therapeutic efficacy of a combinational therapy, including conventional treatment and intense pulsed light (IPL) technique on sleep quality of patients with meibomian gland dysfunction (MGD). Methods Fifty participants with a clinical diagnosis of MGD were enrolled in this study. Participants underwent three sessions of IPL therapy. There was a 2-week interval between IPL sessions 1 and 2 and 1 month between sessions 2 and 3. Treatment was supplemented with conventional home-based therapy (including lid hygiene, warm compress, eyelid massage, and lid margin scrub) for MGD. Dry eye symptomatology, tear film, and ocular surface parameters were evaluated at baseline (day 0) and days 15, 45, and 75. Sleep quality was assessed before and after the study using Pittsburgh Sleep Quality Index (PSQI). Results PSQI components improved significantly at day 75 in comparison with the baseline (all P < 0.05). Ocular Surface Disease Index (OSDI) score, noninvasive Keratograph tear break-up time (NIKBUT), fluorescein tear break-up time (FTBUT), meibomian gland expressibility, meibum quality score, and tear osmolarity improved at follow-up visits (P < 0.05). Younger patients showed more improvement in NIKBUT, sleep quality, and duration (P = 0.024, P = 0.047, and P = 0.008). Sleep latency decreased with increased NIKBUT and FTBUT and decreased OSDI score (P = 0.001, P = 0.005, and P = 0.041). Conclusions The treatment of MGD is effective for improving sleep quality. Younger patients may preferentially benefit from the treatment.
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Affiliation(s)
- Siamak Zarei-Ghanavati
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hassanzadeh
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Azimi Khorasani
- Refractive Error Research Center, Paramedical College, Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Ehsaei
- Refractive Error Research Center, Paramedical College, Department of Optometry, Mashhad University of Medical Sciences, Mashhad, Iran
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30
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Delicado-Miralles M, Velasco E, Díaz-Tahoces A, Gallar J, Acosta MC, Aracil-Marco A. Deciphering the Action of Perfluorohexyloctane Eye Drops to Reduce Ocular Discomfort and Pain. Front Med (Lausanne) 2021; 8:709712. [PMID: 34765614 PMCID: PMC8577568 DOI: 10.3389/fmed.2021.709712] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022] Open
Abstract
Perfluorohexyloctane (F6H8) eyedrops have been recently introduced in Europe as a product to treat dry eye disease, based on its ability to reduce tear film instability in Meibomian gland dysfunction and evaporative dry eye disease, although its mechanism of action is still unknown. In the present pilot study, we evaluated the effects of the ocular instillation of a single drop of commercial F6H8 eyedrops in 20 healthy humans (9 women/11 men), measuring: (a) Corneal surface temperature (CST) from infrared video images; (b) tear volume using phenol red threads; (c) blinking frequency; and (d) ocular surface sensations (cold, dryness, pricking, foreign body, burning, itching, gritty, eye fatigue, watering eyes, and light-evoked discomfort sensations; scored using 10 cm Visual Analog Scales), before and 5–60 min after F6H8 or saline treatment. CST decreased and tearing and blinking frequency increased significantly after F6H8 but not after saline solution. When applied unilaterally, CST decreased only in the F6H8-treated eye. No sensations were evoked after F6H8 or saline. The corneal surface temperature reduction produced by topical F6H8 does not evoke conscious ocular sensations but is sufficient to increase the activity of corneal cold thermoreceptors, leading to an increased reflex lacrimation and blinking that may relieve dry eye condition thus reducing ocular discomfort and pain.
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Affiliation(s)
- Miguel Delicado-Miralles
- Cellular and Systems Neurobiology Unit, Instituto de Neurociencias, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas, San Juan de Alicante, Spain
| | - Enrique Velasco
- Cellular and Systems Neurobiology Unit, Instituto de Neurociencias, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas, San Juan de Alicante, Spain.,The European University of Brain and Technology-NeurotechEU, San Juan de Alicante, Spain
| | - Ariadna Díaz-Tahoces
- Cellular and Systems Neurobiology Unit, Instituto de Neurociencias, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas, San Juan de Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante, San Juan de Alicante, Spain
| | - Juana Gallar
- Cellular and Systems Neurobiology Unit, Instituto de Neurociencias, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas, San Juan de Alicante, Spain.,The European University of Brain and Technology-NeurotechEU, San Juan de Alicante, Spain.,Instituto de Investigación Sanitaria y Biomédica de Alicante, San Juan de Alicante, Spain
| | - M Carmen Acosta
- Cellular and Systems Neurobiology Unit, Instituto de Neurociencias, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas, San Juan de Alicante, Spain.,The European University of Brain and Technology-NeurotechEU, San Juan de Alicante, Spain
| | - Adolfo Aracil-Marco
- Cellular and Systems Neurobiology Unit, Instituto de Neurociencias, Universidad Miguel Hernández-Consejo Superior de Investigaciones Científicas, San Juan de Alicante, Spain
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31
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Tong L, Lim L, Tan D, Heng WJ, Lim J, Chan C, Arundhati A, Tan A. Assessment and Management of Dry Eye Disease and Meibomian Gland Dysfunction: Providing a Singapore Framework. Asia Pac J Ophthalmol (Phila) 2021; 10:530-541. [PMID: 34759232 PMCID: PMC8673856 DOI: 10.1097/apo.0000000000000417] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/04/2021] [Indexed: 01/10/2023] Open
Abstract
ABSTRACT The purpose of this article is to provide a framework for general ophthalmologists in Singapore to manage dry eye. This framework considers the evidence in the literature as well as recommendations from expert panels such as the Tear Film & Ocular Surface Society Dry Eye Workshop II and the Asia Cornea Society Workgroup.This article covers the assessment of patient medical history and ask triage questions to identify local and systemic causes of dry eye disease (DED), excluding other possible causes, as well as the risk factors for DED and ocular surface inflammation. Evaluation of clinical signs to establish the diagnosis of DED and differentiation from other causes of irritable, red eyes are described. Tests for understanding the underlying disease processes and severity of DED are also presented.Management of dry eye should involve patient education and engagement. Information about the natural history and chronic nature of DED should be provided to improve long-term management of the disease and enhance compliance. Aggravating factors should be removed or lessened.We provide a guide to determine the most appropriate treatment (or combination of treatments) based on the severity and cause(s) of the disease, as well as the patient's needs and preferences. The aim of the management is to relieve ocular discomfort and prevent worsening of symptoms and signs, as well as to optimize visual function and minimize structural ocular damage. We also discuss the systematic follow-up and assessment of treatment response, as well as monitoring side effects of treatment, bearing in mind continuous support and reassurance to patients.
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Affiliation(s)
- Louis Tong
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore
| | - Li Lim
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
- Singapore Eye Research Institute, Singapore
| | - Donald Tan
- Yong Loo Lin School of Medicine, Singapore
- Eye Retina Surgeon, Singapore
| | - Wee Jin Heng
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | | | | | - Anshu Arundhati
- Corneal and External Eye Disease Service, Singapore National Eye Centre, Singapore
- Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Anna Tan
- Department of Ophthalmology, National University Hospital, Singapore
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Efficacy of hyaluronic acid 0.3%, cyanocobalamin, electrolytes, and P-Plus in menopause patients with moderate dry eye disease. Graefes Arch Clin Exp Ophthalmol 2021; 260:529-535. [PMID: 34562113 PMCID: PMC8786773 DOI: 10.1007/s00417-021-05415-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/08/2021] [Accepted: 09/10/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose To study the treatment efficacy of hyaluronic acid 0.3%, cyanocobalamin (vitamin B12), electrolytes, and P-Plus in menopausal patients with moderate dry eye disease. Methods Thirty female patients of mean age 53.06 ± 5.20 years (45–65) were enrolled in this prospective longitudinal study. Meibomian gland loss assessment was determined using a scale with four levels. The Ocular Surface Disease Index (OSDI) questionnaire, phenol red thread (PRT) test, and tear film break-up time (TFBUT) were also completed by the patients. Tear eye drops were formulated with 0.3 g of sodium hyaluronate, P-Plus ™, vitamin B12, sodium chloride, potassium chloride, calcium chloride, magnesium chloride, and SCO® (stabilized complex oxychloride). After 30 days, the patients were re-evaluated. Results The mean meibomian gland loss percentage was 37.97 ± 19.02 % (7.20 to 88.30%). Before treatment, the OSDI was 22.53 ± 14.03 score points (6.25 to 77.08). Posterior OSDI decreased to 16.26 ± 13.69 score points (0.00 to 70.83) (W = 58.00, P < 0.01). Before treatment, PRT was 10.31 ± 4.48 mm (4.00 to 21.00). Posterior PRT increased to 15.41 ± 6.27 mm (4.00 to 21.00) (W = 1520.50, P < 0.01). Before treatment, TFBUT was 6.23 ± 1.75 s (3.00 to 9.00). The posterior TFBUT increased to 8.10 ± 2.06 s (4.00 to 14.00) (W= 1382.50, P < 0.01). Conclusion The hyaluronic acid 0.3% and vitamin B12 eye drops effectively decreased dry eye symptoms in menopausal women and improved tear stability and volume. ![]()
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Zarei-Ghanavati S, Hassanzadeh S, Azimi Khorasani A, Ehsaei A, Bakhtiari E. Efficacy of five-flash intense pulsed light therapy technique in patients with meibomian gland dysfunction. Clin Exp Optom 2021; 105:687-693. [PMID: 34538227 DOI: 10.1080/08164622.2021.1976595] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CLINICAL RELEVANCE Meibomian gland dysfunction is the main cause of evaporative dry eye disease and can lead to ocular discomfort and ocular surface damage. Early diagnosis and management of this condition can prevent its impact on patients 'visual health and quality of life. BACKGROUND In the last decade, intense pulsed light therapy (IPL) has been introduced as a therapeutic option for patients with meibomian gland dysfunction (MGD). Various treatment modalities and protocols have been reported to increase the efficacy of this technique. This study aimed to assess the efficacy of a novel five-flash IPL technique in combination with home-based therapy and to compare it with conventional home care alone in patients with MGD. METHODS In a randomised controlled trial, 100 symptomatic MGD patients were enrolled. The treatment group underwent three sessions of a five-flash IPL therapy. For all participants, eyelid warming, lid hygiene and lubricant therapy was prescribed. Ocular surface parameters were compared for control and treatment groups. RESULTS Ocular Surface Disease Index (OSDI), non-invasive keratograph tear break up time (NIKBUT), fluorescein TBUT, MG expressibility, meibum quality and tear osmolarity were improved at follow up visits in both groups (p < 0.05). On day 75, NIKBUT was significantly higher in the IPL group (p = 0.045). The IPL treatment effect was not statistically significant (p > 0.05), except for bulbar and limbal hyperaemia (p = 0.02 and p = 0.02). In both groups, younger patients showed more improvement in NIKBUT (p = 0.02, r = -0.32; p < 0.001, r = -0.52). CONCLUSION IPL therapy combined with conventional home-based therapy, and home care alone are both effective for patients with MGD. IPL may have an additional role in the improvement of ocular hyperaemia.
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Affiliation(s)
- Siamak Zarei-Ghanavati
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Hassanzadeh
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Azimi Khorasani
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Asieh Ehsaei
- Department of Optometry, Paramedical College, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Bakhtiari
- Eye Research Center, Department of Ophthalmology, Mashhad University of Medical Sciences, Mashhad, Iran
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Zhou X, Shen Y, Shang J, Zhou X. Effects of warm compress on tear film, blink pattern and Meibomian gland function in dry eyes after corneal refractive surgery. BMC Ophthalmol 2021; 21:330. [PMID: 34503464 PMCID: PMC8431912 DOI: 10.1186/s12886-021-02091-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background To assess the effects of warm compress (WC) on tear film lipid layer, blink pattern and Meibomian gland function in patients with dry eye following femtosecond laser small incision lenticule extraction (SMILE) and laser-assisted subepithelial keratomileusis (LASEK). Methods We enrolled 37 eyes of 37 participants, each with dry eye for more than 2 years following SMILE (25 eyes) or LASEK (12 eyes). WC was performed using a spontaneously heating eye mask. Tear film break-up time (TBUT), tear film lipid layer thickness (TFLLT), blink pattern, Meibomian secretory function scores (MGS), visual acuity, spherical equivalent (SE), keratometry, central corneal thickness (CCT) and aberration were assessed before and after WC. Results After WC, the following mean values all increased relative to baselines: CCT, SE, minimum (Min-), maximum (Max-) and average (Ave-) TFLLT, TBUT, total MGS (TMGS), number of glands secreting any liquid (MGL), and complete blink rate (CBR) (p values ranging from < 0.001 to 0.042). Partial blink frequency (PBF) and partial blink rate (PBR) decreased (p = 0.002 in both cases). The decrease of PBF was higher in SMILE subgroup than in LASEK (p = 0.030). TBUT variation was positively correlated with that of Ave-TFLLT and TMGS (p = 0.046, 0.028, respectively). Max-TFLLT variation was correlated with that of TMGS (p = 0.020). Conclusions WC may temporarily increase tear film thickness and stability, decrease partial blink, and partly augment Meibomian gland function in dry eye patients after corneal refractive surgeries. Future studies are required to investigate long term clinical efficacy and safety.
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Affiliation(s)
- Xueyi Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,China Eye Institute and Department of Ophthalmology, Eye and ENT Hospital of Fudan University, No.19 Baoqing Road, 200031, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 200031, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Yang Shen
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 200031, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 200031, Shanghai, China.,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye and ENT Hospital of Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, 200031, Shanghai, China. .,Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China. .,Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000), Shanghai, China.
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Tauber J, Wirta DL, Sall K, Majmudar PA, Willen D, Krösser S. A Randomized Clinical Study (SEECASE) to Assess Efficacy, Safety, and Tolerability of NOV03 for Treatment of Dry Eye Disease. Cornea 2021; 40:1132-1140. [PMID: 33369937 PMCID: PMC8330824 DOI: 10.1097/ico.0000000000002622] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE NOV03 has a unique dual mode of action to address dry eye disease (DED) associated with meibomian gland dysfunction. SEECASE evaluated the efficacy, safety, and tolerability of NOV03 at 2 dosing regimens compared with a saline comparator in patients with DED. METHODS SEECASE was a prospective, multicenter, randomized, double-masked, saline-controlled clinical study. A total of 336 DED patients [tear film breakup time ≤5 seconds, abnormal meibum secretion, total corneal fluorescein staining (tCFS) score of 4 ≤ X ≤ 11 (National Eye Institute scale), Schirmer of ≥5 mm] were randomized in a 2:2:1:1 manner to NOV03 4 times daily (QID), NOV03 twice daily (BID), saline BID, and saline QID, respectively. The primary efficacy endpoint was tCFS staining at 8 weeks for both regimens. Secondary endpoints included visual analog scales and the Ocular Surface Disease Index questionnaire for symptom assessment. RESULTS The study met its primary endpoint, change from baseline of tCFS over control, for both dosing regimens QID and BID (P < 0.001 and P = 0.009, respectively). NOV03 also showed pronounced improvement in various symptoms. For the Eye Dryness Score, changes from baseline were statistically significant compared with those of the control at week 8 [P < 0.001 (QID) and P = 0.002 (BID)]. Benefits on tCFS and symptoms started at 2 weeks after start of treatment and were maintained over the study duration. The effects were dosing schedule dependent. NOV03 was well tolerated with instillation site reactions below 3% in both treatment regimes. CONCLUSIONS The SEECASE study demonstrated that NOV03 improves signs and symptoms in patients with highly symptomatic evaporative dry eye disease.
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Song Y, Yu S, He X, Yang L, Wu Y, Qin G, Zhang Q, Deep Singh Talwar G, Xu L, Moore JE, He W, Pazo EE. Tear film interferometry assessment after intense pulsed light in dry eye disease: A randomized, single masked, sham-controlled study. Cont Lens Anterior Eye 2021; 45:101499. [PMID: 34433517 DOI: 10.1016/j.clae.2021.101499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inadequate meibomian glands (MGs) secretion can lead to dry eye signs and symptoms. Tear film lipid layer (TFLL) secreted by MGs protects and prevents rapid evaporation of tear film. The purpose was to assess TFLL alteration and function in patients with evaporative dry eye (EDE) using tear interferometry after optimal pulse light technology (OPT) intense pulsed light (IPL). METHODS This prospective randomized examiner-masked sham- controlled study included 86 participants (142 eyes) with DED. IPL or sham procedure was performed on day 0, 21, and 42. Ocular Surface Disease Index (OSDI), non-invasive breakup time (NITBUT), interferometric fringe pattern determined TFLL quality, fluorescein staining (FS), and meibum gland (MG) were assessed at day 0, 21, 42 and 3-month. RESULTS At 3-month, TFLL, NITBUT, MG drop-out, MG quality, MG expressibility, FS and OSDI improved significantly (P < 0.05) in the IPL group, while the sham group had no significant improvements. Except for Meibo-score and FS, all parameters significantly correlated with the improvement in TFLL following IPL treatment. Additionally, artificial tears usage was significantly less in the IPL group from D-42 onwards. CONCLUSION IPL treatment demonstrated the ability to improve TFLL quality and clinically reduced sign and symptoms of DED thereby reducing the frequency of artificial tears use.
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Affiliation(s)
- Yilin Song
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Sile Yu
- He University, Shenyang, China
| | | | - Lanting Yang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Wu
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qing Zhang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | | | - Ling Xu
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China
| | - Jonathan E Moore
- Cathedral Eye Clinic, 89-91 Academy Street, Belfast, United Kingdom; Biomedical Sciences Research Institute, University of Ulster, Coleraine, United Kingdom
| | - Wei He
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; He University, Shenyang, China
| | - Emmanuel Eric Pazo
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; He University, Shenyang, China
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Kasetsuwan N, Uthaithammarat L, Piyacomn Y, Reinprayoon U, Chatchavalvanich C, Panchaprateep R. Effectiveness and Safety of Combined Application of Three Modes of 2940-nm Erbium:YAG and 1064-nm Neodymium:YAG Lasers in Treatment of Meibomian Gland Dysfunction. Clin Ophthalmol 2021; 15:3065-3073. [PMID: 34295145 PMCID: PMC8291964 DOI: 10.2147/opth.s318013] [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: 04/29/2021] [Accepted: 06/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the effectiveness and safety of upper and lower eyelid treatment with combined application of three modes of 2940-nm erbium-doped yttrium aluminium garnet (Er:YAG) and 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers in patients with baggy eyelids (formed by intraorbital fat herniation) who exhibited meibomian gland dysfunction (MGD). Patients and Methods In this prospective cohort study, patients with baggy eyelid who exhibited MGD received combined laser treatment at baseline, as well as at the 4-, 8-, and 12-week follow-ups. The primary endpoint was meibum quality score at 16- and 24-week follow-ups; secondary endpoints were ocular surface index scores, tear film lipid layer thicknesses, tear break up times (TBUTs), Oxford scheme grades, and meibography grades at 16- and 24-week follow-ups. Adverse events, uncorrected visual acuities, best-corrected visual acuities, and intraocular pressures were also recorded. Results Sixteen patients (four men and 12 women; mean age, 56.38 ± 8.64 years) were included. Meibum quality scores at the 16-week follow-up were significantly lower than scores at baseline (p=0.043) and at the 24-week follow-up (p=0.015). TBUT was significantly exacerbated at the 24-week follow-up, compared with baseline (p=0.001) and the 16-week follow-up (p=0.006). There were no significant changes in other parameters. All adverse events were mild and resolved without additional treatment. Conclusion Combined application of three modes of 2940-nm Er:YAG and 1064-nm Nd:YAG lasers on upper and lower eyelids significantly improved meibum quality in patients with MGD; it ameliorated symptoms and signs of dry eye disease at 4 weeks after completion of laser treatment.
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Affiliation(s)
- Ngamjit Kasetsuwan
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Lita Uthaithammarat
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yonrawee Piyacomn
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Usanee Reinprayoon
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chayanon Chatchavalvanich
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ratchathorn Panchaprateep
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Yang L, Pazo EE, Zhang Q, Wu Y, Song Y, Qin G, Zhang H, Li J, Xu L, He W. Treatment of contact lens related dry eye with intense pulsed light. Cont Lens Anterior Eye 2021; 45:101449. [PMID: 33933353 DOI: 10.1016/j.clae.2021.101449] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/25/2021] [Accepted: 04/21/2021] [Indexed: 01/11/2023]
Abstract
AIM The prevalence of contact lens related dry eye (CLDE) is high and can lead to ocular discomfort, reduced quality of vision and life. The aim of this study was to assess the efficacy of intense pulsed light (IPL) treatment in alleviating signs and symptoms of CLDE. DESIGN Prospective, randomised, examiner masked study. METHODS This prospective study was conducted on 152 eyes of 76 patients (IPL group, n = 76 eyes; control group, n = 76 eyes) wearing contact lens (CL) and experiencing CLDE for more than 1 year. The IPL treatment group underwent two IPL treatment sessions at 3-week intervals while the control group received sham IPL treatment. Best-corrected visual acuity (BCVA), ocular surface disease index (OSDI), non-invasive breakup time (NITBUT), tear film lipid layer (TFLL) quality, fluorescein staining (FS), meibum gland (MG) quality and expression, endothelial cell count (ECC) and intraocular pressure (IOP) were assessed at baseline (D-0), day-21 (D-21) and day-42 (D-42) after IPL treatment. RESULTS The mean age of treatment group and control group was 28.47 ± 5.16 years (21 females, 28 %) and 28.58 ± 4.33 years (23 females, 30 %) respectively. IPL treatment group had clinically and statistically significant improvement in mean NITBUT was observed at D14 (5.24 s, P<0.001) and D28 (6.08 s, P<0.001). OSDI, TFLL score and MG quality and expressibility all improved significantly (P<0.001) at D-42, whereas BCVA, ECC and IOP showed no significant changes at D-21 and D-42 in IPL treatment group. The control group showed no significant improvement in all parameters at D-21 and D-42. CONCLUSION Our findings suggest that CL related DE can be safely alleviated with IPL treatment as it reduced the severity of symptoms, improved the overall tear film stability and reduced artificial tear use in participants with CLDE.
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Affiliation(s)
- Lanting Yang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Emmanuel Eric Pazo
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China.
| | - Qing Zhang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yi Wu
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yilin Song
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guanghao Qin
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China; The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongda Zhang
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China
| | - Jun Li
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China
| | - Ling Xu
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China
| | - Wei He
- He Eye Specialist Hospital, No.128 North Huanghe Street, Shenyang, China.
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Singh PP, Yu C, Mathew R, Perez VL, Saban DR. Meibomian gland dysfunction is suppressed via selective inhibition of immune responses by topical LFA-1/ICAM antagonism with lifitegrast in the allergic eye disease (AED) model. Ocul Surf 2021; 21:271-278. [PMID: 33812087 DOI: 10.1016/j.jtos.2021.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The etiology of meibomian gland dysfunction (MGD) is incompletely understood, despite being a common ophthalmic condition and an area of unmet medical need. It is characterized by an insufficiency in glandular provision of specialized lipids (meibum) to the tear film and is a major cause of dry eye. Work in the allergic eye disease (AED) mouse model has revealed an immunopathogenic role in MGD causation, now raising interest in the applicability of immunomodulatory therapies. As such, we herein ask whether inhibition of lymphocyte function associated antigen (LFA)-1/intracellular adhesion molecules (ICAM)-1 signaling via topical lifitegrast administration has a therapeutic effect on MGD in AED mice. METHODS Mice were induced with AED by i.p. injection of ovalbumin (OVA) mixed with alum and pertussis toxin, followed 2 weeks later by once daily topical OVA challenges for 7 days. Mice were treated topically with 5% lifitegrast ophthalmic solution or vehicle (PBS) 30 min prior to challenge. We developed a clinical ranking method to assess MGD severity, and also scored clinical allergy. Conjunctivae and draining lymph nodes were collected for flow cytometry. RESULTS Topical lifitegrast significantly inhibited clinical MGD severity, which was associated with diminished pathogenic TH17 cell and neutrophil numbers in the conjunctiva. No significant change in conjunctival TH2 cells or eosinophils, and only marginal differences in ocular allergy were observed. CONCLUSIONS In AED mice, lifitegrast inhibited MGD severity marked by a reduction in select immune populations in the conjunctiva. Our findings warrant future examination of lifitegrast in the treatment of patients with forms of MGD.
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Affiliation(s)
- Pali P Singh
- Duke University School of Medicine, Durham, NC, USA
| | - Chen Yu
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA
| | - Rose Mathew
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Daniel R Saban
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA; Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, 27710, USA; Department of Immunology, Duke University School of Medicine, Durham, NC, 27710, USA.
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Wolffsohn JS, Dumbleton K, Huntjens B, Kandel H, Koh S, Kunnen CME, Nagra M, Pult H, Sulley AL, Vianya-Estopa M, Walsh K, Wong S, Stapleton F. CLEAR - Evidence-based contact lens practice. Cont Lens Anterior Eye 2021; 44:368-397. [PMID: 33775383 DOI: 10.1016/j.clae.2021.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 12/15/2022]
Abstract
Evidence-based contact lens -->practice involves finding, appraising and applying research findings as the basis for patient management decisions. These decisions should be informed by the strength of the research study designs that address the question, as well as by the experience of the practitioner and the preferences and environment of the patient. This reports reviews and summarises the published research evidence that is available to inform soft and rigid contact lens history and symptoms taking, anterior eye health examination (including the optimised use of ophthalmic dyes, grading scales, imaging techniques and lid eversion), considerations for contact lens selection (including the ocular surface measurements required to select the most appropriate lens parameter, lens modality and material selection), evaluation of lens fit, prescribing (teaching self-application and removal, adaptation, care regimen and cleaning instructions, as well as -->minimising risks of lens wear through encouraging compliance) and an aftercare routine.
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Affiliation(s)
| | - Kathy Dumbleton
- School of Optometry, University of California, Berkeley, CA, USA
| | - Byki Huntjens
- Division of Optometry and Visual Sciences at City, University of London, London, UK
| | - Himal Kandel
- Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Japan
| | | | - Manbir Nagra
- Vision and Eye Research Institute, ARU, Cambridge, UK
| | - Heiko Pult
- Optometry and Vision Research, Weinheim, Germany
| | | | - Marta Vianya-Estopa
- Department of Vision and Hearing Sciences Research Centre, Anglia Ruskin University, Cambridge, UK
| | - Karen Walsh
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Stephanie Wong
- Centre for Ocular Research & Education, School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Fiona Stapleton
- School of Optometry and Vision Science, UNSW Sydney, Australia
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Meibomian gland dysfunction in geriatric population: tehran geriatric eye study. Int Ophthalmol 2021; 41:2539-2546. [PMID: 33763795 DOI: 10.1007/s10792-021-01812-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To determine the prevalence of Meibomian gland dysfunction (MGD) and its risk factors in an elderly Iranian population METHODS: This cross-sectional study was conducted in 2019. The target population was the subjects aged 60 and over living in Tehran. Multistage cluster sampling was done to select the subjects from all Tehran districts. After an initial interview, all subjects underwent complete ophthalmic examinations including the measurement of visual acuity and refraction as well as slit lamp biomicroscopy to evaluate Meibomian glands. RESULTS Of 3791 selected subjects, 3310 participated in the study. The data of 3284 participants were analyzed. The mean age of the subjects was 68.24 ± 6.53 years (range: 60-97 years) and 57.8% of them were female. The total prevalence of MGD was 71.2% (68.3-74.1), and 38.1% (8.35-40.4), 30.3% (27.4-33.2), and 2.8% (2-3.6) of the subjects had MGD stage 2, 3, and 4, respectively. The prevalence of MGD was significantly higher in men (p < 0.001) and increased with age from 64.4% in the age group 60-64 years to 82.4% in subjects aged 80 years and over. There was no significant difference in the prevalence of MGD between smokers and nonsmokers; however, severe MGD was more common in smokers. The prevalence of MGD was 76.3% and 68.52% in subjects with and without a history of ocular surgery, respectively. The prevalence of MGD stage 3 and 4 was higher in subjects with a history of ocular surgery. CONCLUSIONS In line with the results of other studies in Asian countries, this study found a high prevalence of MGD in an elderly population of Iran. It was found that male gender and advanced age were risk factors of MGD and smoking and history of ocular surgery might worsen this disease in MGD patients.
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Magno M, Moschowits E, Arita R, Vehof J, Utheim TP. Intraductal meibomian gland probing and its efficacy in the treatment of meibomian gland dysfunction. Surv Ophthalmol 2021; 66:612-622. [PMID: 33352147 DOI: 10.1016/j.survophthal.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
Meibomian gland dysfunction (MGD) is a major cause of dry eye, affecting millions worldwide. Intraductal meibomian gland probing (MGP) aims to open obstructed meibomian glands using a small probe to promote meibum secretion. MGP has received increasing interest since 2010, and we critically evaluated the literature on the efficacy and safety of MGP. Despite positive results of MGP on dry eye symptoms in early single-group studies, MGP was not shown to consistently outperform controls in later controlled trials. Furthermore, MGP alone did not show improvement beyond placebo in the only placebo-controlled RCT conducted. Overall, the procedure appears safe. Self-limited intraoperative bleeding was frequent, but no major complications were reported. In conclusion, MGP has not yet been shown to be an effective treatment for MGD. Larger placebo-controlled trials need to be conducted to establish the potential effect of this novel treatment modality.
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Affiliation(s)
- Morten Magno
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Emily Moschowits
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
| | - Reiko Arita
- Department of Ophthalmology, Itoh Clinic, Saitama, Japan
| | - Jelle Vehof
- Department of Twin Research & Genetic Epidemiology, King's College London, St Thomas' Hospital, London, United Kingdom; Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tor Paaske Utheim
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Oslo University Hospital, Oslo, Norway; Department of Ophthalmology, Sørlandet Hospital Arendal, Arendal, Norway; Department of Ophthalmology, Stavanger University Hospital, Stavanger, Norway
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Zhang-Nunes S, Guo S, Lee D, Chang J, Nguyen A. Safety and Efficacy of an Augmented Intense Pulse Light Protocol for Dry Eye Syndrome and Blepharitis. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 39:178-184. [PMID: 33370543 DOI: 10.1089/photob.2020.4913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective: We evaluated the safety and efficacy of an augmented BroadBand Light (BBL™) protocol on the upper and lower eyelids in improving meibomian gland dysfunction (MGD) and/or dry eye disease (DED). Background: DED, often associated with MGD, can cause significant morbidity and accounts for 3.54 billion U.S. dollars of health care spending yearly. Intense pulsed light (IPL) has been used to treat MGD DED with some success. BBL therapy, a high-quality IPL machine, shows much promise for decreasing inflammation and redness in rosacea, as well as hyperpigmentation from sun damage. Methods: A retrospective medical chart review was performed for MGD DED and/or hyperpigmentation patients who received BBL therapy between January 1, 2015, and February 28, 2020. Inclusion criteria included patients who underwent at least one BBL treatment. Each treatment involved the upper and lower eyelids, as well as cheeks, nose, and face. Each MGD DED subject completed the Ocular Surface Disease Index (OSDI) and underwent pre- and post-treatment standard clinical examinations. Results: Forty-seven patients had treatment without significant adverse effects; all patients with MGD DED reported improvement in their dry eye or blepharitis. BBL was determined to be a safe and effective treatment. There were no changes in visual acuity (p = 0.555) and OSDI scores were improved (p = 0.016). There was one case each of mild corneal/conjunctival abrasion, temporary hyperpigmentation, and two of temporary eyelash thinning. Patients with MGD also showed significant improvement in blepharitis and reduced hordeolum frequency after BBL treatment. Conclusions: This novel IPL/BBL protocol appears safe and effective for treating dry eye and blepharitis.
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Affiliation(s)
- Sandy Zhang-Nunes
- Oculofacial Plastic Surgery Division, USC Roski Eye Institute, Los Angeles, California, USA
| | - Sarah Guo
- USC Keck School of Medicine, Los Angeles, California, USA
| | - Diana Lee
- Keck School of Medicine, USC Roski Eye Institute, Los Angeles, California, USA
| | - Jessica Chang
- Oculofacial Plastic Surgery Division, USC Roski Eye Institute, Los Angeles, California, USA
| | - Annie Nguyen
- Cornea Division, USC Roski Eye Institute, Los Angeles, California, USA
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Pazo EE, Huang H, Fan Q, Zhang C, Yue Y, Yang L, Xu L, Moore JE, He W. Intense Pulse Light for Treating Post-LASIK Refractory Dry Eye. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2020; 39:155-163. [PMID: 33296261 DOI: 10.1089/photob.2020.4931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Optimal pulse technology-intense pulse light (OPT-IPL) treatment on patients with post-LASIK refractory dry eye (DE). Background: The prevalence of dry eye disease is common and can lead to ocular discomfort, reduced visual acuity, lowered quality of vision and life. Materials and methods: A prospective study was conducted on 72 eyes of 36 patients (treatment group, n = 42 eyes; control group, n = 30 eyes) who had previously undergone myopic LASIK correction with subsequent refractory DE. All eyes fulfilled the Japanese DE criteria and had not responded to conventional DE treatment. The treatment group underwent two OPT-IPL treatment sessions at 2-week intervals, while the control group received no treatment. Best-corrected visual acuity (BCVA), ocular surface disease index (OSDI), noninvasive breakup time (NITBUT), tear film lipid layer (TFLL) quality, corneal fluorescein staining, meibum gland (MG), endothelial cell count (ECC), and intraocular pressure (IOP) were assessed at baseline (D0), day-14 (D14) and day-28 (D28) after OPT-IPL treatment. Results: The mean age of treatment group and control group was 30.48 ± 5.16 years (12 females, 57%) and 31.00 ± 4.33 years (8 females, 53%), respectively. Treatment group had clinically and statistically significant improvement in NITBUT and was observed at D14 (p < 0.001) and D28 (p < 0.001). OSDI, TFLL score, and MG quality and expressibility improved significantly (p < 0.05) at D28, whereas BCVA, ECC, and IOP showed no significant changes at D14 and D28 between the groups. Conclusions: Our results suggest that post-LASIK refractory DE is safely treated with OPT-IPL treatment. OPT-IPL treatment reduced the severity of symptoms and improved the overall tear film stability in patients with severe refractory DE post-LASIK surgery. In addition, the frequency of artificial tears usage was significantly less and can be attributed to the reduction in OSDI scores due to improved TFLL and tear film stability.
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Affiliation(s)
| | - He Huang
- He Eye Specialist Hospital, Shenyang, China
| | | | - Can Zhang
- He Eye Specialist Hospital, Shenyang, China
| | - You Yue
- He Eye Specialist Hospital, Shenyang, China
| | | | - Ling Xu
- He Eye Specialist Hospital, Shenyang, China
| | | | - Wei He
- He Eye Specialist Hospital, Shenyang, China
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Maselli del Giudice A, Gelardi M, Marano PG, D’Ecclesia A, Campobasso G, Cariti F, Palumbo A, Loglisci M, de Vincentiis M, Cassano M, Barbara F. The secretory senescence of the airway. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Suwal A, Hao JL, Zhou DD, Liu XF, Suwal R, Lu CW. Use of Intense Pulsed Light to Mitigate Meibomian Gland Dysfunction for Dry Eye Disease. Int J Med Sci 2020; 17:1385-1392. [PMID: 32624695 PMCID: PMC7330664 DOI: 10.7150/ijms.44288] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/24/2020] [Indexed: 12/16/2022] Open
Abstract
Dry Eye Disease (DED) is a common ocular condition that needs prompt diagnosis and careful treatment interventions. If left untreated, it can lead to numerous sight-threatening complications, including ulceration of the cornea, blepharitis, alterations of the tear film, conjunctivitis, and in severe cases, may lead to scarring, thinning, and even perforation of the cornea. Intense pulsed light (IPL) is a non-laser high-intensity light source that has shown to play a valuable role in dry eye disease. Recent evidence from various research works has shown that IPL modifies the mechanism of meibomian gland dysfunction (MGD), which helps to relieve the symptoms of DED. In this review, we demonstrated the mechanism of action of IPL, including its benefits on DED. The emerging evidence shows that the role of IPL in DED is novel and therapeutic. These results direct us to conclude that IPL is a potentially beneficial tool and essential future therapy for dry eye disease. Advances in the treatment of DED will lead to a better quality of life. However, tools to recognize potentially severe side effects of DED earlier in order to treat or prevent them must be developed.
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Affiliation(s)
- Abhishek Suwal
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Ji-Long Hao
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Dan-Dan Zhou
- Department of Radiology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Xiu-Fen Liu
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
| | - Raja Suwal
- Department of Radiology, Koshi Zonal Hospital, Biratnagar, Province No. 1, Nepal
| | - Cheng-Wei Lu
- Department of Ophthalmology, The First Hospital of Jilin University, No. 71 of Xinmin St., Changchun, Jilin Province, 130021, China
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