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Yeu E, Koetting C, Calvelli H. Prevalence of Meibomian Gland Atrophy in Patients Undergoing Cataract Surgery. Cornea 2023; 42:1355-1359. [PMID: 36728320 PMCID: PMC10538615 DOI: 10.1097/ico.0000000000003234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/27/2022] [Accepted: 11/20/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to determine the prevalence of meibomian gland (MG) atrophy in a US-based population of patients presenting for cataract surgery. METHODS In this retrospective study, case records of 391 patients aged 50 years or older, who had undergone a preoperative cataract surgery workup with meibography, were included. The amount of atrophy in the lower eyelid was graded as described by Arita et al (grade 0 = no atrophy, grade 1 = 1%-33% atrophy, grade 2 = 34%-66% atrophy, and grade 3 = >66% atrophy), and the prevalence of MG atrophy was determined. Associations between MG atrophy and demography, comorbidities, and risk factors were evaluated. RESULTS Overall, 95.1% of patients (372/391) had MG atrophy ≥grade 1, with 50.4% (197/391) having grade 1, 25.8% (101/391) grade 2, and 18.9% (74/391) grade 3. MG atrophy had a statistically significant correlation with MG expressibility (R = 0.22; P = 0.001), but not with meibum grade (R = 0.103; P = 0.123) and telangiectasia (R = 0.014; P = 0.787). The prevalence of MG atrophy (≥grade 1) was comparable among patients who had previously been diagnosed with dry eye disease (DED) versus those who had not; however, the severity of MG atrophy was higher in patients with previous DED diagnosis (grade 2/3: 59% vs. 30.9%). Among patients with no previous history of DED, 18% (35/194) had moderate and 13% (25/194) had severe MG atrophy. CONCLUSIONS MG atrophy is common in patients presenting for cataract surgery evaluation, indicating potential underdiagnosis. Routine use of meibography during preoperative screening in cataract surgery patients may facilitate more timely and effective diagnosis and treatment.
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Fjærvoll K, Fjærvoll H, Magno M, Nøland ST, Dartt DA, Vehof J, Utheim TP. Review on the possible pathophysiological mechanisms underlying visual display terminal-associated dry eye disease. Acta Ophthalmol 2022; 100:861-877. [PMID: 35441459 PMCID: PMC9790214 DOI: 10.1111/aos.15150] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 03/13/2022] [Accepted: 03/23/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Visual display terminal (VDT) use is a key risk factor for dry eye disease (DED). Visual display terminal (VDT) use reduces the blink rate and increases the number of incomplete blinks. However, the exact mechanisms causing DED development from VDT use have yet to be clearly described. PURPOSE The purpose of the study was to conduct a review on pathophysiological mechanisms promoting VDT-associated DED. METHODS A PubMed search of the literature investigating the relationship between dry eye and VDT was performed, and relevance to pathophysiology of DED was evaluated. FINDINGS Fifty-five articles met the inclusion criteria. Several pathophysiological mechanisms were examined, and multiple hypotheses were extracted from the articles. Visual display terminal (VDT) use causes DED mainly through impaired blinking patterns. Changes in parasympathetic signalling and increased exposure to blue light, which could disrupt ocular homeostasis, were proposed in some studies but lack sufficient scientific support. Together, these changes may lead to a reduced function of the tear film, lacrimal gland, goblet cells and meibomian glands, all contributing to DED development. CONCLUSION Visual display terminal (VDT) use appears to induce DED through both direct and indirect routes. Decreased blink rates and increased incomplete blinks increase the exposed ocular evaporative area and inhibit lipid distribution from meibomian glands. Although not adequately investigated, changes in parasympathetic signalling may impair lacrimal gland and goblet cell function, promoting tear film instability. More studies are needed to better target and improve the treatment and prevention of VDT-associated DED.
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Affiliation(s)
- Ketil Fjærvoll
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway
| | - Haakon Fjærvoll
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway
| | - Morten Magno
- Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway,Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of Ophthalmology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Darlene A. Dartt
- Schepens Eye Research Institute of Massachusetts Eye and EarHarvard Medical SchoolBostonMassachusettsUSA
| | - Jelle Vehof
- Department of Ophthalmology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands,Department of Twin Research & Genetic EpidemiologyKing's College LondonSt Thomas' HospitalLondonUK,Department of Epidemiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Tor P. Utheim
- Department of Medical BiochemistryOslo University HospitalOsloNorway,Department of Plastic and Reconstructive SurgeryOslo University HospitalOsloNorway,Department of OphthalmologyOslo University HospitalOsloNorway,Department of OphthalmologySørlandet Hospital ArendalArendalNorway,Department of Quality and Health Technology, The Faculty of Health SciencesUniversity of StavangerStavangerNorway,Department of OphthalmologyStavanger University HospitalStavangerNorway,Department of Computer ScienceOslo Metropolitan UniversityOsloNorway,Department of Clinical Medicine, Faculty of MedicineUniversity of BergenBergenNorway
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Cortés-Albornoz MC, Ramírez-Guerrero S, Rojas-Carabali W, de-la-Torre A, Talero-Gutiérrez C. Effects of remote learning during the COVID-19 lockdown on children's visual health: a systematic review. BMJ Open 2022; 12:e062388. [PMID: 35922104 PMCID: PMC9352565 DOI: 10.1136/bmjopen-2022-062388] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Increased exposure to digital devices as part of online classes increases susceptibility to visual impairments, particularly among school students taught using e-learning strategies. This study aimed to identify the impact of remote learning during the COVID-19 lockdown on children's visual health. DESIGN Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Scopus, PubMed and ScienceDirect databases from the year 2020 onwards. ELIGIBILITY CRITERIA We included cross-sectional, case-control, cohort studies, case series and case reports, published in English, Spanish or French, that approached the effects of remote learning during the COVID-19 lockdown on visual health in neurotypical children. DATA EXTRACTION AND SYNTHESIS We included a total of 21 articles with previous quality assessments using the Joanna Briggs checklist. Risk of bias assessment was applied using the National Institutes of Health quality assessment tool for before-and-after studies with no control group; the tool developed by Hoy et al to assess cross-sectional studies; the Murad et al tool to evaluate the methodological quality of case reports and case series; and the Newcastle-Ottawa Scale for cohort studies. RESULTS All but one study reported a deleterious impact of the COVID-19 lockdown on visual health in children. Overall, the most frequently identified ocular effects were refractive errors, accommodation disturbances and visual symptoms such as dry eye and asthenopia. CONCLUSIONS Increased dependence on digital devices for online classes has either induced or exacerbated visual disturbances, such as rapid progression of myopia, dry eye and visual fatigue symptoms, and vergence and accommodation disturbances, in children who engaged in remote learning during the COVID-19 lockdown. PROSPERO REGISTRATION NUMBER CRD42022307107.
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Affiliation(s)
- María Camila Cortés-Albornoz
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Sofía Ramírez-Guerrero
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
| | - Claudia Talero-Gutiérrez
- Neuroscience Research Group (NeURos), NeuroVitae Center for Neuroscience, School of Medicine and Health Sciences, Universidad del Rosario, Bogota D.C, Colombia
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Wang MT, Craig JP, Vidal-Rohr M, Menduni F, Dhallu S, Ipek T, Acar D, Recchioni A, France A, Kingsnorth A, Speakman S, Wolffsohn JS. Impact of digital screen use and lifestyle factors on dry eye disease in the paediatric population: Secondary analysis of a cross-sectional study. Ocul Surf 2022; 24:64-66. [DOI: 10.1016/j.jtos.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
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Muntz A, Turnbull PR, Kim AD, Gokul A, Wong D, Tsay TSW, Zhao K, Zhang S, Kingsnorth A, Wolffsohn JS, Craig JP. Extended screen time and dry eye in youth. Cont Lens Anterior Eye 2021; 45:101541. [PMID: 34840070 DOI: 10.1016/j.clae.2021.101541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Extended screen time amongst youth is a pervasive global phenomenon, with wide-ranging implications for health and quality of life. Dry eye disease is increasingly reported as emerging in paediatric populations and is associated with modified blinking behaviour during extended screen time. This study sought to evaluate spontaneous blink rates, dry eye symptomology and screen use habits of young extended screen time users. METHODS Attendees of a gaming convention in Auckland, NZ, completed a self-directed iPad-based survey on personal screen use habits and ocular symptoms using the 5-item Dry Eye Questionnaire (DEQ-5) and the Symptom Assessment in Dry Eye (SANDE) questionnaire. Blink rate was covertly and concomitantly recorded using the front-facing iPad camera and quantified by automated software. A validated, self-assessment blink test was administered as a proxy for tear film stability measurements. RESULTS A total of 456 respondents (mean age ± SD: 24 ± 10 years, range: 13 - 75, 38% female) reported an average weekly screen time of 43.7 ± 24.4 h. DEQ-5 and SANDE scores were 10 ± 3 and 34 ± 19; 90% of respondents qualified as symptomatic for dry eye disease (DEQ-5 ≥ 6). Blink test results suggested a tear film stability < 10 s in 24% of cases. Poorer symptomology correlated with increased screen use, elevated blink rates and reduced proxy tear film stability (r = 0.15 to 0.22, all p < 0.01). CONCLUSION Extended screen time in a young population was associated with blinking behaviour and symptomology consistent with patients with dry eye. Implementing routine clinical screening, educational interventions, and developing official guidance on safe screen use may help prevent an accelerated degradation of ocular surface health and quality of life in young people.
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Affiliation(s)
- Alex Muntz
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand.
| | - Philip Rk Turnbull
- School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Andy D Kim
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Daniel Wong
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Tricia Shau-Wei Tsay
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Karyn Zhao
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Simo Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, New Zealand National Eye Centre, The University of Auckland, New Zealand
| | - Alec Kingsnorth
- School of Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - James S Wolffsohn
- School of Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand; School of Optometry and Vision Science, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
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Tao Z, Wang J, Zhu M, Lin Z, Zhao J, Tang Y, Deng H. Does Orthokeratology Wearing Affect the Tear Quality of Children? Front Pediatr 2021; 9:773484. [PMID: 35118029 PMCID: PMC8804288 DOI: 10.3389/fped.2021.773484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022] Open
Abstract
Orthokeratology is currently known as one of the most effective methods of myopia control in the process of rapid deterioration of the global myopia prevalence. As orthokeratology is widely used, it is necessary to evaluate its complications reasonably and accurately. Eye surface problems in children, such as dry eyes, have received increasing attention. At present, there is no conclusive evidence on how orthokeratology affects the ocular surface, especially the tears. To our knowledge, this is the first study to explore the relationship between orthokeratology lenses and tears through meta-analysis. However, it is still challenging to get a convincing conclusion and a higher level of evidence in this meta-analysis. Reasons for this include limitation of study design, lack of clarity on important confounding factors, lack of appropriate statistical tools, and other biases. This paper will analyze the dilemma existing in the current research from different perspectives to provide meaningful information for future studies in this field.
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Affiliation(s)
- Zhengyang Tao
- The Second Clinical Medical College, Jinan University, Shenzhen, China
| | - Jiao Wang
- Department of Strabismus and Pediatric Ophthalmology, Shenzhen Eye Hospital, TheClinical Medical College of Shenzhen University, Shenzhen, China
| | - Minjuan Zhu
- Department of Strabismus and Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Zhihong Lin
- Department of Strabismus and Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Jun Zhao
- Department of Ophthalmology, The Second Clinical Medical College of Jinan University, Longhua Branch Institute of Shenzhen People's Hospital, Shenzhen, China
| | - Yu Tang
- Department of Strabismus and Pediatric Ophthalmology, Shenzhen Eye Hospital Affiliated to Jinan University, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Hongwei Deng
- Department of Strabismus and Pediatric Ophthalmology, The Jinan University of Shenzhen Eye Hospital, Shenzhen University of Medicine, Shenzhen, China
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