Novel Treatments for Chronic Ocular Surface Pain

Validation of the Ocular Pain Assessment Survey Instrument With Rasch Analysis

Purpose

The Ocular Pain Assessment Survey (OPAS) has been used to quantify chronic ocular pain and quality of life (QOL). We aim to investigate the psychometric properties of individual OPAS items with the Rasch analysis in an Asian population of dry eye disease and neuropathic corneal pain (NCP).

Methods

Question responses were obtained from 196 patients; 138 with dry eye disease (DED) and 58 with NCP, at the Singapore National Eye Centre. Item hierarchy, item fit statistics, item separation, reliability indices, and Yen's Q3 values were calculated.

Results

Individual dimensions that quantify eye pain levels in the past 24 hours and QOL showed good discriminative ability according to their person separation index values. However, individual dimensions that measured eye pain in the past 2 weeks, non-eye pain, as well as aggravating and associated factors showed suboptimal person separation index values. Significant correlations were found between the individual item pairs of the aggravating factors dimension as well as between some of the items in the QOL and associated factors dimensions.

Conclusions

Two dimensions of the OPAS questionnaire were validated with the Rasch analysis. Based on these findings, we shorten the number of questions in some dimensions to improve the performance of the tool in similar Asian populations.

Translational Relevance

Our study provides insights to improve the existing OPAS for real-world clinical applications and clinical trials.

CORONIS symposium 2023: Scientific and clinical frontiers in ocular surface innervation

The 5th CORONIS Symposium, held during the 2023 Congress of the European Association for Vision and Eye Research (EVER), highlighted the growing importance of ocular surface innervation in eye surface disorders. This article summarises the insights and perspectives shared during the symposium, which focused on the clinical relevance of ocular surface innervation, as well as on the development of innovative diagnostic and therapeutic approaches for ocular surface pathologies linked to disturbed sensory innervation. Through robust interdisciplinary collaborations, these developments hold great potential to improve patient outcomes and quality of life.

Evaluating the efficacy and safety of therapeutic interventions for corneal neuropathy: A systematic review

Corneal neuropathy involves corneal nerve damage that disrupts ocular surface integrity, negatively impacting quality-of-life from pain and impaired vision. Any ocular or systemic condition that damages the trigeminal nerve can lead to corneal neuropathy. However, the condition currently does not have standardized diagnostic criteria or treatment protocols. The primary aim of this systematic review was to evaluate the efficacy and safety of interventions for treating corneal neuropathy. Randomized controlled trials (RCTs) that investigated corneal neuropathy treatments were eligible if the intervention(s) was compared to a placebo or active comparator. Comprehensive searches were conducted in Ovid MEDLINE, Ovid Embase and clinical trial registries from inception to July 2022. The Cochrane Risk-of-Bias 2 tool was used to assess study methodological quality. Certainty of the body of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Overall, 20 RCTs were included. Evaluated interventions comprised regenerative therapies (n = 6 studies), dietary supplements (n = 4), anti-glycemic agents (n = 3), combination therapy (n = 3), supportive therapies (n = 2) and systemic pain pharmacotherapies (n = 2). Nine RCTs were judged at high risk of bias for most outcomes. Definitions for corneal neuropathy in the populations varied substantially across studies, consistent with lack of consensus on diagnostic criteria. A diverse range of outcomes were quantified, likely reflecting absence of an agreed core outcome set. There was insufficient evidence to draw definitive conclusions on the efficacy or safety of any intervention. There was low or very low certainty evidence for several neuroregenerative agents and dietary supplements for improving corneal nerve fiber length in corneal neuropathy due to dry eye disease and diabetes. Low or very low certainty evidence was found for neuroregenerative therapies and dietary supplements not altering corneal immune cell density. This review identifies a need to standardize the clinical definition of corneal neuropathy and define a minimum set of core outcome measures. Together, this will provide a foundation for improved phenotyping of clinical populations in studies, and improve the capacity to synthesize data to inform evidence-based care. Protocol registration: PROSPERO ID: CRD42022348475.

Rethinking Sjögren Beyond Inflammation: Considering the Role of Nerves in Driving Disease Manifestations

ABSTRACT

Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease characterized by destruction of mucosal glands resulting in dry eye and dry mouth. Ocular presentations can be heterogenous in SS with corneal nerves abnormalities that are structural, functional, or both. Some individuals present with corneal hyposensitivity, with a phenotype of decreased tear production and epithelial disruption. Others present with corneal hypersensitivity, with a phenotype of neuropathic pain including light sensitivity and pain out of proportion to signs of tear dysfunction. A similar correlate can be found outside the eye, with dry mouth predominating in some individuals while pain conditions predominate in others. Understanding how nerve status affects SS phenotype is an important first step to improving disease management by targeting nerve abnormalities, as well as inflammation.