The Enduring Experience in Dry Eye Diagnosis: A Non-Interventional Study Comparing the Experiences of Patients Living With and Without Sjögren's Syndrome

INTRODUCTION

Previous studies have examined the patient experience regarding the diagnosis and management of dry eye disease (DED). The current study explored the ways in which the DED diagnostic pathway differs for those living with and without Sjögren's syndrome (SS), to identify aspects that influence the patient experience and associated quality of life (QoL).

METHODS

An observational/descriptive, non-interventional, retrospective, self-reported online survey was conducted among adults living in France, Spain and Italy who were diagnosed with DED (with/without SS), were using topical DED treatments (≥ 6 months), and were not contact lens users. Recruitment was via an online database for non-SS participants and through local patient advocacy groups for SS respondents.

RESULTS

The analysis included 827 respondents; 416 (50.3%) had SS and 82% were female. The mean age was 55 (SD 11; range 16-99) years. The mean age at diagnosis was 46 (SD 12; range 13-78) years and 50 (SD 10; range 21-73) years for SS and non-SS groups, respectively (p < 0.0001). The mean time to diagnosis was extended for SS participants [32 (SD 62) months] versus non-SS individuals [8.6 (SD 28) months (p < 0.0001)] and was associated with reduced QoL scores (r = 0.113; p = 0.0169). More SS participants (31%) consulted ≥ 4 healthcare professionals (HCPs) before DED diagnosis, versus non-SS individuals (6%) (p < 0.0001). Diagnosing clinician varied for SS respondents according to country, probably due to differences in healthcare systems/structures. More SS participants viewed their condition as a handicap than a discomfort, reporting greater QoL impact (p < 0.0001).

CONCLUSIONS

Patient experiences in DED diagnosis vary substantially when comparing SS and non-SS individuals. Time to diagnosis significantly impacts QoL for SS patients, who see more HCPs ahead of DED diagnosis. The number of HCPs consulted before diagnosis and perceptions of DED are important for both groups. Country-specific variations highlight opportunities to improve consistency and efficiency across DED diagnostic pathways. These data should be considered alongside existing evidence from high-quality sources (e.g. clinical records).

Evidence of seasonality and effects of psychrometry in dry eye disease

PURPOSE

Current models consider the development of dry eye disease (DED) as a more or less continuous process with only minor daily variations. Clinical evidence, however, does suggest the existence of phase-like recurring dry eye complaints that may be linked to seasonal environmental conditions. In this survey-based study, we examined the influence of seasonality in dry eye pathophysiology.

METHODS

A specific protocol for a telephone interview was created. Then, 738 patients suffering from dry eye and/or Sjögren's syndrome were interviewed and asked about the impact of the four seasons and other weather conditions on their ocular symptoms. Data were statistically analysed. All data were compared in respect to the relation between season, gender, country of origin and the presence of comorbidities.

RESULTS

Overall, 47% of respondents stated that seasonal conditions had a high impact on their DED symptoms, with only 15% reporting that there was no seasonal impact on their symptoms. Wind was the most commonly reported weather condition to impact dry eye symptoms (for 71% of patients), followed by sunshine (60%) and heat (42%). Cold weather was also reported to aggravate dry eye sensation by 34% of patients. The two seasons most commonly associated with dry eye complaints were summer and winter (for 51% and 43% of patients, respectively). Only 8% stated that no weather conditions affected their symptoms.

DISCUSSION

This study confirms the seasonal enhancement of dry eye sensations and symptoms. Environmental characteristics such as cold and heat as well as wind were the most commonly cited triggering factors. Geographical differences do exist between the countries surveyed and the seasonal peak of complaints appears related to temperature and humidity. The main seasons of dry eye complaints in Europe were winter and summer. Such seasonal characteristics in ocular surface disease should be kept in mind when considering diagnosis and treatment as well when investigating the ocular surface.

CONCLUSION

Our study confirmed high prevalence of both seasonal and weather-related enhancement of dry eye sensations and symptoms.

Dysfunctional Tear Syndrome

PURPOSE

To develop current treatment recommendations for dry eye disease from consensus of expert advice.

METHODS

Of 25 preselected international specialists on dry eye, 17 agreed to participate in a modified, 2-round Delphi panel approach. Based on available literature and standards of care, a survey was presented to each panelist. A two-thirds majority was used for consensus building from responses obtained. Treatment algorithms were created. Treatment recommendations for different types and severity levels of dry eye disease were the main outcome.

RESULTS

A new term for dry eye disease was proposed: dysfunctional tear syndrome (DTS). Treatment recommendations were based primarily on patient symptoms and signs. Available diagnostic tests were considered of secondary importance in guiding therapy. Development of algorithms was based on the presence or absence of lid margin disease and disturbances of tear distribution and clearance. Disease severity was considered the most important factor for treatment decision-making and was categorized into 4 levels. Severity was assessed on the basis of tear substitute requirements, symptoms of ocular discomfort, and visual disturbance. Clinical signs present in lids, tear film, conjunctiva, and cornea were also used for categorization of severity. Consensus was reached on treatment algorithms for DTS with and without concurrent lid disease.

CONCLUSION

Panelist opinion relied on symptoms and signs (not tests) for selection of treatment strategies. Therapy is chosen to match disease severity and presence versus absence of lid margin disease or tear distribution and clearance disturbances.

Detection of PEDF in Subretinal Fluid of Retinal Detachment: Possible Role in the Prevention of Subretinal Neovascularization

PEDF (pigment-epithelium-derived factor) is a member of the serpin family of protease inhibitors. It is considered to be an important regulator of human eye disease and is known to inhibit angiogenesis. We have therefore investigated the presence of PEDF in the subretinal fluid of patients with retinal detachment.

METHODS

Eighteen samples from SRF were collected from patients during retinal detachment surgery. Specific ELISA analysis was performed with specific IgG against human PEDF.

RESULTS

PEDF was detected in the subretinal fluid of all cases. The mean concentration of PEDF was 33.9 ng/ml (SD 23.7 ng/ml; range 5.3-74.7 ng/ml). The majority of samples had however a concentration of more than 22 ng PEDF/ml fluid.

CONCLUSION

PEDF appears to be a constant component of the fluid accumulating in the subretinal space after retinal detachment. The known effects of PEDF, however, suggest that it may be involved in physiological processes of wound healing in the subretinal space.

Detection of connective tissue growth factor in subretinal Fluid following retinal detachment: possible contribution to subretinal scar formation, preliminary results

Connective tissue growth factor (CTGF) has been shown to be substantially involved in various processes of fibrosis. Herein we report on the presence of CTGF in the subretinal fluid (SRF) of patients with retinal detachment.

METHODS

Samples of SRF were collected from 10 patients during retinal detachment surgery. Specific ELISA analysis was performed with goat IgG against human CTGF.

RESULTS

CTGF was above the detection limit of the assay in all samples. On average the concentration of CTGF in SRF was 10 ng/ml (SD 3.7, range 3.7-15.7 ng/ml). There was an increase in the CTGF concentration with time between the diagnosis of retinal detachment and surgery (correlation r = 0.67).

CONCLUSION

CTGF appears to be a constant component of the fluid accumulating in the subretinal space after retinal detachment. The origin of subretinal CTGF and its physiological importance is still unclear. The known effects of CTGF, however, suggest that it may be involved in both the physiological processes of wound healing in the subretinal space and also in the pathological events such as subretinal fibrosis. The observed increase in CTGF concentration with time suggest that CTGF plays a role in the pathophysiology of subretinal scarring in cases of delayed retinal surgery.

Basic fibroblast growth factor (bFGF) in saliva and oral mucosa in patients with oral lichen planus: preliminary observations

OBJECTIVE

Basic fibroblast growth factor (bFGF) is important for wound healing and tissue repair. This study measures the concentration of bFGF in oral lichen planus (OLP) affected mucosa and in the saliva of patients with OLP.

STUDY DESIGN

Samples of saliva, OLP-affected mucosa, and clinically healthy mucosa were obtained from 11 patients. Control samples were obtained from healthy volunteers. The bFGF content of tissue samples and saliva was examined by ELISA.

RESULTS

The mean bFGF concentration in saliva from OLP patients was 5.9 pg/mL, SD 2.9, compared with 0.3 pg/mL, SD 0.3, in the control group, (P>.01). The bFGF content in the OLP tissue was 90.6 microg/mg protein, SD 39.5, in clinically normal mucosa from OLP individuals it was 46.2 microg/mg protein, SD 12.0 (P=.02), and in the control group 46.2 microg/mg protein, SD 11.5 (P>.01).

CONCLUSION

OLP-affected mucosa contained significant more bFGF than nonaffected mucosa in OLP and healthy mucosa in control group. There is no difference between nonaffected mucosa in OLP and control group. Saliva in OLP patients contained more bFGF than saliva in control patients.

Connective tissue growth factor in pterygium: simultaneous presence with vascular endothelial growth factor - possible contributing factor to conjunctival scarring

BACKGROUND

Various growth factors have been detected in pterygium and been associated with its vasculogenesis. The basic pathophysiological mechanisms responsible especially for the fibrotic activity in pterygium are, however, not yet known. Connective tissue growth factor (CTGF) has been shown to be substantially involved in various processes of fibrosis. We report on the presence of CTGF in pterygium and its simultaneous presence with vascular endothelial growth factor (VEGF).

METHODS

Samples of pterygium were collected during surgery with informed consent of the patients. Specific, non-commercial primary antibodies against CTGF were used to detect CTGF using immunohistochemistry. Specificity of antibodies was confirmed with Western-blot analysis. The same specimens were stained with commercial antibodies for VEGF. Additionally RT-PCR analysis was performed from pterygium samples.

RESULTS

CTGF was detected in the epithelium of all samples as well as in some stromal keratocytes. The RT-PCR confirmed the identity of CTGF in these samples. The staining pattern differed slightly from that of VEGF, which was detected in all samples. The control sections were negative.

CONCLUSION

CTGF is present in the epithelium of a majority of pterygia and probably contributes to fibrosis. Simultaneous presence with VEGF suggests growth factor interaction and possible involvement in apoptotic dysregulation.

Elevated intraocular levels of insulin-like growth factor I in a diabetic patient with acromegaly

Growth factors have become increasingly associated with various events of vitreoretinal disease. In the presence of proliferative retinopathy, elevated levels of insulin growth factor I (IGF-I) have been demonstrated in the vitreous. IGF-I expression itself is regulated by growth hormone, a hormone that is involved in the pathogenesis of acromegaly. In the present paper we report on the detection of very high IGF-levels in the subretinal fluid of a patient with acromegaly who was operated for retinal detachment. With a very sensitive RIA assay we found a four-fold elevation of the serum levels of IGF-I (604 ng/ml) and a high level of IGF-1 in the subretinal fluid (13 ng/ml). It is concluded that acromegaly may lead to an overexpression of IGF-I not only seen as increased concentrations in serum and vitreous, but in the subretinal space as well. This study emphasizes the need for further investigation of growth factor presence in pathological cavities, such as the subretinal space during retinal detachments.

Basic fibroblast growth factor in human saliva decreases with aging

OBJECTIVE

Basic fibroblast growth factor (bFGF) has significant properties in wound healing and tissue repair and is suggested to be of importance for the maintenance of mucosal integrity in the upper digestive tract. The purpose of the present study was to identify any age-dependent variations in the concentration of bFGF in human saliva.

STUDY DESIGN

Nonprospective, cross-sectional pilot study.

METHODS

The study was based on findings from 182 healthy volunteers with ages ranging from 4 to 97 years. Mixed saliva samples were obtained by drooling. The saliva concentration of bFGF was determined with a commercially available enzyme-linked immunosorbent assay kit.

RESULTS

The mean saliva concentration of bFGF was 0.41 pg/mL with no gender differences. In persons aged 4 to 19 years, the mean concentration was 0.72 pg/mL; in those aged 20 to 65 years, 0.33 pg/mL; and in those aged 66 to 97 years, 0.005 pg/mL. These age-dependent differences were highly significant. In the youngest group the saliva concentration of bFGF varied more than in the other groups.

CONCLUSIONS

The saliva concentration of bFGF varies with individual age, with the highest levels among young individuals, even levels during a mature phase of life, and low levels toward the end of the life cycle. This strongly suggests a physiological implication of bFGF in saliva.