Perception and awareness of the public about presbyopia and its corrective approaches in Saudi Arabia: a population-based survey.

BACKGROUND: This study investigated patients' awareness of presbyopia and its management approaches and their preferred methods for near vision correction. METHODS: In Saudi Arabia, 785 participants (aged between 35 and 60 years) completed a structured survey online, consisting of hard copies and direct interviews. The survey consisted of twenty-eight items divided into three parts. It was designed to record participants' awareness of and preferences for presbyopia and its refractive corrections. Nonparametric tests and descriptive analyses were conducted to analyse participants' responses. RESULT: Approximately half of the participants had difficulty with near vision activities, such as reading newspapers or using mobile phones. Among all the participants, 76% were not aware of presbyopia. The prevalence of uncorrected presbyopia was 48% of the 785. The majority (82%) felt that spectacles were acceptable for correction of presbyopia. Most reported that they did not experience social stigma when using reading spectacles (87% of participants). When asked if they were aware of management approaches other than spectacles, 72% responded with not at all. Most participants had no earlier knowledge of the use of multifocal contact lenses or eye drops for presbyopia correction (67% and 82%, respectively). In the present study, some tendencies to use corrective approaches to presbyopia other than spectacles were noted. Finally, participants' age, sex, region, education, and income had a statistically significant impact on essential parts of their responses (p < 0.05). CONCLUSION: Presbyopia is a highly prevalent age-related ocular disorder, and a significant percentage of cases are uncorrected due to a lack of awareness or reluctance to wear spectacles. More efficient health education about presbyopia and its corrective alternatives is urgently needed.

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes: a pilot study.

AIM: To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters. METHODS: This study enrolled 48 healthy participants aged 20-35y (both males and females). Clinical assessment included the Ocular Surface Disease Index (OSDI) questionnaire, non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), and lipid layer pattern (LLP). Based on these initial results, participants were categorized as either non-dry eye or dry eye. Participants in each group were randomly allocated to either Blephaclean® or Systane® treatments. Changes in NITBUT, TMH, and LLP levels before and after lid wipe treatment were assessed. RESULTS: The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group (P<0.001). Following the application of eyelid wipes (Systane® wipes), dry eye subjects experienced a significant improvement in NITBUT levels (P=0.0014) compared to the non-dry eye individuals. Although the remaining participants showed a marginal increase in TMH and NITBUT levels, these changes did not achieve statistical significance (P>0.05). Similarly, the LLP levels were significantly improved with Systane® (P<0.001) post-treatment compared to individuals in the non-dry eye group. However, the dry eye subjects showed higher post-treatment LLP levels than the untreated group (P<0.02). CONCLUSION: The short-term effects of Systane® eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease. Nonetheless, further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.

Efficacy of hydroxypropyl-guar drops in improving tear film index and ocular surface dynamics using two treatment methods under a controlled desiccating environment.

AIM: This study aimed to assess the efficacy of hp-guar eye drops on tear film index and ocular surface dynamics under desiccating conditions using protection and relief treatment modalities. METHODOLOGY: The 12 normal, non-dry eye participants were subjected to adverse environmental conditions using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the ambient temperature was 21 °C. The participants were screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST), tear production using the Ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620, and Schirmer strips. Tear production was calculated by the Tear Function Index test (TFI). RESULTS: The mean tear film osmolarity decreased significantly from 296 mOsm/L at 40% RH to 285 mOsm/L at 5% RH (p = 0.01). Conflicting responses were seen for osmolarity in protection and relief. Mean tear osmolarity was significantly higher in the protection method in comparison to the relief method (p = 0.005). The mean TFI increased from 557 at 40% to 854 at 5% (p = 0.02). A significant increase in TFI was observed in the relief method in comparison with both 40% (p = 0.001) and 5% (p = 0.04). In the relief method, the mean TFI score went up to 1139 when hp-guar was installed. A significant improvement in ocular comfort was experienced in both the protection (p = 0.041) and relief (p = 0.010) methods at 5% RH. The instillation of hp-guar drops in the relief method resulted in a significant reduction in OST. The mean OST dropped to 33.01 ºC, significantly lower than the recorded OST for both normal (p = 0.040) and dry (p = 0.014) environmental conditions. CONCLUSION: Hp-guar drops significantly improve tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, an improvement in tear production and a decrease in ocular surface temperature were seen. Hp-guar performance could be maximized for the management of exposure to adverse environments by using a treatment protocol that targets the most affected parameters in each group of patients. Using CEC has the potential to provide researchers with a readily available method to evaluate the efficiency of tear supplementation.

The Breastfeeding Effect On The Tear Film Of Women: An Observational Study.

OBJECTIVE: To assess the tear film parameters in breastfeeding women. satisfaction. Methods: The observational study was conducted at the College of Applied Medical Sciences, Riyadh, Saudi Arabia, from December 15, 2021, to February 12, 2022, and comprised healthy women aged 18-40 years who had no ocular diseases. Breastfeeding women were in group A and non-breastfeeding women formed the control group B. Ocular surface disease index, phenol red thread, and tear ferning tests were used in that order to assess the tear film for all the subjects. A gap of 5 minutes was allowed between phenol red thread and tear ferning tests. Data was analysed using SPSS, version 22. RESULTS: Of the 50 subjects, 25(50%) were in group A with mean age 30.4±5.9 years having a mean breastfeeding period of 5.4±5.0 months. The remaining 25(50%) women were in group B with mean age 28.5±2.1 years. Significant differences were found between the groups for ocular surface disease index, phenol red thread, and tear ferning (p<0.05). Significant moderate correlation was found between tear ferning grades and breastfeeding duration (p<0.05). Conclusion: Breastfeeding was found to increase dry eye symptoms in women.

Evaluation of different treatment modalities on the efficacy of hydroxypropyl Guar (HP-Guar) formulation on tear film stability (TFS) in subjects exposed to adverse environmental conditions.

The study aimed to assess the efficacy of hydroxypropyl guar (HP) formulation (Systane) to protect tear film parameters under desiccating environment using protection and relief treatment modalities. The subjects were exposed to adverse environmental conditions using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the ambient temperature was 21 °C and screened for Tear break-up time (TBUT), Tear film evaporation rate (TFER) and lipid layer thickness (LLT) using the HIRCAL grid, Servomed EP3 Evaporimeter and Keeler's TearScope-Plus respectively. Significant improvement in LLT was noticed in the protection modality. The mean tear film evaporation rate doubled after exposure to the humidity of 5% to a value of 105.37 g/m2/h (0.29 µl/min). All subjects displayed a significant reduction in non-invasive tear break-up time (NITBUT) with a mean NITBUT of 7.7 s after exposure to a desiccating environment for 15 min. A significant increase in NITBUT after the instillation of the drops was recorded in both methods. The results obtained from this study showed that a solution containing HP-Guar significantly improves tear film parameters under a desiccating environment. Apart from the tear evaporation rate, all tear parameters showed improvement after the use of HP-Guar eye drops. It is evident that tear film parameters respond differently to the management modalities and using CEC has the potential to provide researchers with a readily available method to evaluate the efficiency of tear supplementation.

Evaluation of Tear Evaporation Rate in Subjects with a High Body Mass Index.

AIM: This study evaluated the tear evaporation rate (TER) in subjects with a high body mass index (BMI) and tested the correlation between BMI and dry eye. METHODS: Thirty male subjects aged 18 - 38 years (26.4 ± 4.0 years) with a high BMI (26.4 - 47.0 kg/m2) were enrolled in the study. In addition, a control group of 30 males aged 20 - 36 years (24.0 ± 3.6 years) with a normal BMI (< 25 kg/m2) participated in the study for comparison. Each subject completed the ocular surface disease index (OSDI), followed by the TER measurement using a handheld VapoMeter. RESULTS: Significant differences (Wilcoxon test; p = 0.002 and 0.001) were found between the median scores of the OSDI (10.3 [3.7] vs. 5.9 [7.2]) and TER (35.5 [13.1] vs. 15.5 [12.8] g/m2 h) in the study and control groups, respectively. The OSDI indicated dry eye in 60.0% of subjects in the study group (n = 18). The TER measurements showed that 76.7% of subjects in the study group (n = 23) had dry eyes. A medium correlation (r = 0.569; p = 0.001) was found between the OSDI scores and TER measurements. CONCLUSIONS: The means of the tear evaporation rate and the ocular surface disease index scores are significantly higher in subjects with a high BMI compared with the control group. Therefore, a high BMI is considered a risk factor for dry eye. The measurement of the tear evaporation rate using a handheld VapoMeter is a simple and rapid method to detect dry eyes in combination with other tools.

Correlation between osmolarity measurements using the TearLab™ and I-Pen® systems in subjects with a high body mass index.

BACKGROUND: Osmolarity is used to detect symptoms of dry eye disease (DED) and can be measured using TearLab™ and I-Pen® systems. OBJECTIVES: To investigate the correlation between osmolarity measurements using the TearLab™ and I-Pen® systems in subjects with a high body mass index (BMI). MATERIAL AND METHODS: Thirty male subjects with a high BMI (27-48 kg/m2; 23.3 ±2.1 years old) participated in this study. The control group consisting of 30 healthy males (24.9 kg/m2; 22.9 ±2.1 years old) was also enrolled. Osmolarity measurements were recorded from the right eye using the TearLab™ and I-Pen® systems, and interviews were conducted to determine ocular surface disease index (OSDI) scores. RESULTS: The OSDI (p = 0.042), TearLab™ (p < 0.001) and I-Pen® (p < 0.001) scores were significantly higher in the study group than in the control group. In the study group, OSDI scores ranged from 2 to 16 (median 8.0, interquartile range (IQR) 6.8), while it was from 0 to 10 (median 6.3, IQR 4.1) in the control group. The TearLab™ osmolarity scores were in the range of 278-309 mOsm/L in the study group, whereas the I-Pen® osmolarity measurements were in the range of 294-336 mOsm/L in the study group, compared with 263-304 mOsm/L and 278-317 mOsm/L in the control group, respectively. In the study group, there was a strong correlation between the TearLab™ and I-Pen® osmolarity scores (r = 0.934; p = 0.001). In addition, strong correlations were found between the BMI and both TearLab™ (r = 0.736; p = 0.001) and I-Pen® (r = 0.707; p = 0.001) scores, as well as between the OSDI scores and both TearLab™ (r = 0.731; p = 0.001) and I-Pen® measurements (r = 0.666; p = 0.001). CONCLUSION: Osmolarity measurements using the I-Pen® system were significantly higher than those recorded using the TearLab™ system in subjects with a high BMI. The I-Pen® measurements showed large variations in osmolarity scores and were highly unreliable in correctly identifying normal eyes compared to the TearLab™ system. Also, a strong correlation was found between the osmolarity scores obtained from the TearLab™ and I-Pen® systems.

Effect of surgical face mask wearing on tear film in women with a high body mass index.

PURPOSE: Due to the COVID-19 pandemic, wearing a face mask has become an essential measure to reduce the rate of virus spreading. The aim of the study was to assess the effect of wearing a surgical face mask for a short period on the tear film parameters in subjects with a high body mass index (BMI). METHODS: Twenty-five females with a high BMI (31.4 ± 5.5 kg/m2) aged 18-35 years (22.7 ± 4.6 years) participated in the study. In addition, a control group consisting of 25 females (23.0 ± 6.7 years) with a high BMI (29.9 ± 4.1 kg/m2) participated in the study in which no mask was worn. The standardized patient evaluation of eye dryness (SPEED) questionnaire was completed first, followed by the phenol red thread (PRT) and tear ferning (TF) tests, before wearing the face mask. The subjects wore the face mask for 1 hour, and the measurements were performed again immediately after its removal. For the control group, the measurements were performed twice with one hour gap. RESULTS: Significant (Wilcoxon test, p < 0.05) differences were found between the SPEED scores (p = 0.035) and the PRT measurement (p = 0.042), before and after wearing the surgical face mask. The PRT scores have improved after wearing the surgical face mask, while the dry eye symptoms detected by the SPEED questionnaire have increased. On the other hand, no significant (Wilcoxon test, p = 0.201) differences were found between the TF grades before and after wearing a surgical face mask. For the control group, no significant (Wilcoxon test, p > 0.05) differences were found between the two scores from the SPEED questionnaire and the PRT, and TF tests. CONCLUSIONS: Wearing a surgical face mask for a short duration leads to a change in volume and quality of tears as well as dry eye symptoms in women with a high BMI.

Assessment of Tear Osmolarity in Smokers Using TearLab and I-Pen Systems.

Purpose: Smoking has a negative effect on health and ocular tear film. The purpose of the current study is to investigate the correlation between the TearLab and I-Pen osmolarity scores in smokers and compare them with those of non-smoking healthy males. Methods: Thirty male smokers (25.3 ± 2.2 years) participated in the study. An age-matched (22.9 ± 2.0 years) control group of non-smoking healthy males (N = 30) was also recruited for comparison purposes. The ocular surface disease index (OSDI) was completed first, followed by the TearLab and I-Pen osmolarity measurements. Results: The median TearLab osmolarity score was lower (P < 0.001) than that obtained using the I-Pen in both the study and the control groups. The OSDI scores and osmolality measurements were higher (P < 0.001) in smokers than in the control subjects. In the smoker group, there were moderate correlations between the OSDI scores and the measurements obtained using the TearLab (Spearman's correlation coefficient, r = 0.463; P = 0.010) and I-Pen (r = 0.449; P = 0.013) systems. In addition, there was a strong correlation between the osmolarity scores obtained from the TearLab and I-Pen systems in smokers (r = 0.911; P < 0.001). Conclusion: The I-Pen scores in smokers were significantly higher than those obtained using TearLab. The TearLab scores showed small variations compared with those obtained using I-Pen. A strong correlation was found between the TearLab and I-Pen scores in smokers. The osmolarity TearLab and I-Pen scores were significantly higher in smokers compared with normal eye subjects.

Assessment of the Effect of Wearing a Surgical Face Mask on Tear Film in Normal Eye Subjects.

Purpose: To assess the effect of wearing a face mask for a short time on the tear film parameters in normal eye subjects. Methods: Fifty-four normal eye subjects (14 female and 40 male) aged 18-40 years (23.8 ± 4.4 years) were recruited. A standardized patient evaluation of eye dryness was completed first, followed by noninvasive tear break-up time, phenol red thread, and tear ferning tests. A 5-minute gap was allowed between the tests. The subjects were asked to wear a surgical mask for one hour. The measurements were taken both before wearing a face mask and immediately after its removal. Results: Significant (Wilcoxon test) differences were found between the standardized patient evaluation of eye dryness (p=0.002) and the noninvasive tear break-up time scores (p < 0.001) before and after wearing face masks. No significant differences (Wilcoxon test, p > 0.05) were found between the phenol red thread scores and tear ferning grades before and after wearing face masks. Strong correlations (Spearman's rank correlation coefficient, r) were found among the standardized patient evaluation of eye dryness score (r = 0.590; p < 0.001), noninvasive tear break-up time measurements (r = 0.631; p < 0.001), and the tear ferning grades (r = 0.517; p < 0.001) before and after wearing the mask. A medium correlation (r = 0.377; p=0.005) was found between the noninvasive tear break-up time scores and tear ferning grades before wearing the mask. Conclusions: Wearing a surgical face mask for a short duration of one hour has an effect on ocular tear film in normal eye subjects. Dry eye symptoms and tear break-up increased after wearing a face mask compared with those experienced before wearing one.

Assessment of Tear Film Parameters in Smokers and Subjects with a High Body Mass Index.

SIGNIFICANCE: The current study compares the ocular tear film parameters in three different groups using a single noninvasive, practical, and easy-to-use tool. PURPOSE: This study aimed to assess the tear film in smokers, those with a high body mass index (BMI), and healthy subjects using the EASYTEAR view+. METHODS: Thirty men with a high BMI (>25 kg/m2; 24.4 ± 6.4 years), 30 smokers (25.1 ± 6.1 years), and 30 healthy subjects (22.2 ± 3.5 years) were recruited. Each subject completed the Ocular Surface Disease Index, followed by the assessment of noninvasive tear breakup time, tear meniscus height (TMH), and lipid layer patterns (LLPs). RESULTS: Significant differences were found in the median TMH scores between smokers and healthy subjects (P = .03) and between subjects with a high BMI and the healthy ones (P = .04). The median LLP score was significantly (P < .001) higher in normal subjects (4.0 [1.0]) than in smokers (2.4 [1.0]) and subjects with high BMI (2.0 [1.3]). For subjects with a high BMI, the noninvasive tear breakup time score was strongly correlated (Spearman rank correlation coefficient; r) with TMH (r = 0.552, P = .002) and LLP (r = 0.555, P = .001). The LLP showed that grade B (lipid layer thickness, 30 to 50 nm; more compact) was common in subjects with a high BMI, grade C (50 to 80 nm, gray waves) was predominant in smokers, and grade D (~80 nm, dense white-blue layer) represented the majority of normal eye subjects. CONCLUSIONS: Smokers and individuals with a high BMI showed significantly lower lipid layer grades and tear meniscus height scores compared with the control group. The assessment of tear film parameters using the EASYTEAR view+ supports the findings of previous studies that implicate smoking and high BMI as risk factors for dry eye.

The Effect of the Addition of Electrolyte Solutions on the Ferning Patterns of Tears Collected from Normal Eye Subjects.

SIGNIFICANCE: The current study is the first report to describe the improvement of ferning patterns of human tears using electrolyte solutions. The results can help in the production of new artificial tears to improve the quality of tears. PURPOSE: This study aimed to investigate the effect of the addition of different volumes of various electrolyte solutions on ferning patterns of human tears. METHODS: Tear samples (20 µL) were collected from the right eye of 13 subjects (5 men and 5 women) aged 19 to 36 years (27.1 ± 5.1 years) with normal eyes. Then, 1 µL of each tear sample was dried on a microscopic glass slide, and obtained ferns were observed using light microscopy and graded using the 5-point tear ferning (TF) grading scale. Homogenous mixtures of each tear sample (0.5 µL) and different volumes (0.5 to 5 µL) of each electrolyte were prepared. A sample (1 µL) of each mixture was dried, and the ferns obtained were graded and compared with those of the corresponding tears collected from subjects before the addition of electrolyte solutions. RESULTS: After the addition of electrolyte solutions, the TF grades of tears collected from healthy humans were generally improved. Significant (Wilcoxon test) improvements have been seen in the TF grades of the tear samples after the addition of a solution of potassium chloride (P = .03), calcium chloride (P = .01), magnesium chloride hexahydrate (P = .002), and sodium dihydrogen phosphate (P = .002). No significant improvements in the TF grades were seen after the addition of sodium chloride solution (P = .33). CONCLUSIONS: Ferning grades of human tears improved with most of the electrolytes used.

Measurements of Tear Evaporation Rate in Subjects with Refractive Errors Using a Portable Evaporimeter.

Dry eye symptoms are associated with refractive errors. We aimed to measure the tear evaporation rate (TER) in subjects with refractive errors (RE) using a portable evaporimeter. This nonrandomized, case-control, and observational study included 75 subjects, including 25 subjects aged 18-38 years (28.8 ± 6.8 years) with myopia (-0.75 to -3.75 D) and 25 subjects aged 18-39 years (27.7 ± 5.5 years) with hyperopia (+0.50 to +3.75 D). In addition, a control group of 25 subjects with emmetropic eyes aged 20-30 years (23.6 ± 2.6 years) was recruited. The ocular surface disease index (OSDI) was completed, followed by the TER measurements using a portable evaporimeter. The OSDI score and TER measurements showed dry eye symptoms in 36% and 48% of myopic subjects, respectively. For hyperopic participants, dry eye was observed in 24% and 56% of the subjects based on the OSDI and TER scores, respectively. Significant differences (Mann-Whitney U test; p < 0.001) were found among the OSDI and TER scores recorded within the study (myopic and hyperopic subjects) and control groups. Significant strong positive correlations were detected between the OSDI and TER scores in both myopic (p = 0.004; r = 0.559) and hyperopic (p = 0.001; r = 0.619) subjects. The TER scores were significantly higher in subjects with RE (myopic and hyperopic) as compared with individuals with normal eyes.

Improving tear ferning patterns collected from goats and camels after adding various electrolyte solutions.

BACKGROUND: Good quality of tear film is essential for healthy vision in both animals and humans. Therefore, improving the quality of tears through the addition of electrolytes is important. OBJECTIVES: To assess the effect of adding various electrolyte solutions on tear ferning (TF) patterns collected from goats and camels. MATERIAL AND METHODS: Tear samples (20 ƒÊL) were collected from 5 goats (2 males and 3 females; 3.4 }1.6 years) and 5 camels (2 males and 3 females; 4.0 }1.1 years) using microcapillary tubes. A tear sample (0.5 ƒÊL) from each animal was mixed with various volumes (0.5.5 ƒÊL) of each electrolyte solution to produce homogenous mixtures. A sample (1 ƒÊL) of each mixture was dried on a microscopic glass at 22°C with a humidity .40%. The obtained TF pattern was observed, graded and compared with those obtained for the corresponding pure tear samples. The effect of dilution using purified water on the TF patterns of animals was also tested. RESULTS: The TF grades of animals were generally enhanced when mixed with electrolyte solutions. Specifically, the TF grade for tears collected from a goat was improved from 1.4 to 0.7 and to 0.8 when magnesium chloride hexahydrate and calcium chloride were added, respectively. Similarly, the TF grade for tears collected from a camel was improved from 1.8 to 0.9 and to 1.1, when calcium chloride and sodium dihydrogen phosphate solutions were added, respectively. CONCLUSIONS: The TF grades of tears collected from both goats and camels were improved after adding electrolyte solutions, and they were most remarkably improved when divalent electrolyte solutions were added, followed by the hydrogenated electrolyte.

Evaluation of Tear Evaporation Rate in Patients with Diabetes Using a Hand-Held Evaporimeter.

Diabetes is a very common disease and is considered a risk factor for many diseases such as dry eye. The aim of the current work was to evaluate the tear evaporation rate (TER) in patients with diabetes using a hand-held evaporimeter. This observational, case-control and non-randomized study included 30 male patients with diabetes (17 controlled and 13 uncontrolled) with a mean ± standard deviation (SD) of 33.1 ± 7.9 years. An age-matched (18-43 years; 32.2 ± 6.5 years) control group consisting of 30 male subjects was also enrolled for comparison. Subjects with thyroid gland disorder, a high body mass index, high blood cholesterol, or thalassemia, contact lens wearers, and smokers were excluded. The TER was measured after the completion of the ocular surface disease index (OSDI) by each participant. The OSDI and TER median scores were significantly (Wilcoxon test, p < 0.05) higher in patients with diabetes (median (interquartile range; IQR) = 12.0 (8.3) and 46.4 (36.7) g/m2h, respectively) compared to the subjects within the control group (5.6 (7.0) and 15.1 (11.9) g/m2h, respectively). The median scores for the OSDI and TER measurements were significantly (Wilcoxon test, p < 0.05) higher among uncontrolled diabetes patients (13.0 (11.5) and 53.4 (14.2) g/m2h, respectively) compared to those obtained for patients with controlled diabetes (11.0 (8.0) and 27.3 (32.6) g/m2h, respectively). The tear evaporation rate in patients with diabetes was significantly higher compared to those obtained in subjects without diabetes. Uncontrolled diabetes patients have a higher tear evaporation rate compared to controlled diabetes patients. Therefore, diabetes can lead to eye dryness, since these patients possibly suffer excessive tear evaporation.

Evaluation of the Significance of Tear Ferning Patterns in beta-Thalassemia Patients.

AIM: This study was designed to evaluate the tear film in beta-thalassemia patients using tear ferning (TF) and phenol red thread (PRT) tests. METHODS: Forty beta-thalassemia patients, aged 18 - 38 years (25.7 ± 6.0 years), along with a control group of 40 age-matched subjects with healthy eyes completed the study. All subjects completed the ocular surface disease index (OSDI) first, followed by the TF and PRT tests with a 5-minute gap between the tests. RESULTS: Significant differences (Wilcoxon test, p < 0.05) were observed between the beta-thalassemia and control groups in all scores. Among beta-thalassemia patients, OSDI scores indicated eye dryness in 35 subjects (87.5%). PRT showed dryness in 31 subjects (77.5%) in the right and left eyes, and the TF grades were ≥ 2 for the tears collected from 35 subjects (87.5%). There was a strong correlation (r = 0.851, p = 0.001) between the PRT measurements in the right and left eyes. There was a medium correlation between OSDI and TF scores (r = 0.309, p = 0.026) and between OSDI and age (r = 0.365, p = 0.010). Age had a moderate negative correlation (r = - 0.328, p = 0.019) with the PRT obtained from the right eye. CONCLUSION: Significant ocular dryness symptom was observed in beta-thalassemia patients, based on the scores collected from TF and PRT tests. Beta-thalassemia patients develop dry eyes, possibly due to several factors, including reduced tear secretion. Therefore, it is important to regularly evaluate both the quality and quantity of tears in patients with beta-thalassemia.

Improvement in Tear Ferning Patterns of Sheep Tears After Addition of Various Electrolyte Solutions.

Objective: This study aimed to improve the tear ferning (TF) patterns in the sheep tears after the addition of various electrolyte solutions in different proportions. Animal Studied: Sheep were located at a small farm in the outskirts of Riyadh, Saudi Arabia. The sheep had no ocular disorders or diseases, and none of the female sheep were pregnant. Methods: Tear samples (20 µl) were collected from the right eyes of seven healthy sheep (five female sheep and two male sheep; age 7-36 months with an average of 17.0 ± 10.3 months). A tear sample (1 µl) from each sheep was dried on a microscopic glass slide at 22°C and <40% humidity. The TF patterns were graded based on the five-point grading scale in 0.1 increments. Homogenous mixtures were prepared by mixing tears from each sheep (0.5 µl) with various electrolyte solutions in different proportions (1:1, 1:2, 1:4, 1:6, 1:8, and 1:10). A sample of each mixture (1 µl) was dried on a glass slide, and the TF patterns for each mixture were observed, recorded, graded, and compared with those of the corresponding pure sheep tears. In addition, each sheep tear sample (0.5 µl) was diluted with pure water (0.5 µl) and the TF images were recorded and graded to test the dilution effect. Results: General improvement was noted in TF grades after the addition of electrolyte solutions, ranging from 1.7-1.4 to 1.3-0.3 regardless of the ratio between the electrolyte solutions and sheep tears within the mixture. TF grades of sheep tear samples improved significantly after adding different volumes of calcium chloride solution. Similar improvements in TF grades were observed when magnesium chloride hexahydrate and sodium dihydrogen phosphate solutions were used as the electrolytes. Some improvements in the TF grades occurred with the addition of potassium chloride to sheep tear samples. There was little improvement in TF grades after the addition of sodium chloride solution. Conclusion: Tear ferning grades of sheep tear samples improved when mixed with a number of electrolyte solutions at different volumes, in particular with calcium chloride or magnesium chloride solutions. Some improvements in TF grades were seen with sodium dihydrogen phosphate or potassium chloride solution added as the electrolyte. Clearly, divalent electrolytes lead to a greater improvement in TF grades of sheep tear samples as compared with sodium dihydrogen phosphate or monovalent electrolytes.

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

PURPOSE: The purpose of the present study is to determine the effects of type 2 diabetes mellitus on tear osmolarity using a TearLab Osmolarity system. Moreover, the relationship between tear film osmolarity and ocular surface discomfort in controlled and uncontrolled diabetic patients was assessed. MATERIALS AND METHODS: This study included 20 male type 2 diabetic patients aged 20 to 70 years (mean ± SD 49±12). A control group (18-43 years; 32.2 ± 6.5 years) consisting of 40 male subjects was also enrolled for comparison. The tear osmolarity was measured using the TearLab Osmolarity System. The ocular surface disease index questionnaire (OSDI) was used to assess ocular discomfort symptoms. RESULTS: The mean tear osmolarity was 297 ± 8.00 and 296 ± 11 mOsm/L for controlled and uncontrolled diabetic subjects, respectively, while the average osmolarity in the control group was 299 ± 8.00 mOsm/L. No significant differences were detected in tear osmolarity between the control and diabetes groups. The ocular surface disease index questionnaire (OSDI) score was significantly higher in the diabetic patient group. No significant correlation was found between tear osmolarity and OSDI scores. CONCLUSION: The ocular discomfort symptoms score in diabetic patients was significantly higher compared to normal eye subjects. Tear osmolarity was not significantly different in diabetic patients. This finding may be explained by a lack of relationship between tear film parameters and diabetic severity; tear film parameters may correlate more with diabetic duration rather than severity. Therefore, studies focused on diabetes duration and tear film parameters are recommended.

Investigation of the repeatability of tear osmolarity using an I-PEN osmolarity device.

PURPOSE: To investigate the repeatability of tear osmolarity in healthy Saudi subjects using an I-PEN osmolarity device. MATERIALS AND METHODS: Thirty typical male subjects with healthy eyes (27.4 ± 4.9 years) participated in the study. Eye abnormalities were tested with a slit lamp, and eye comfort was determined with the surface disease index. Measurements of the tear break-up time and phenol red thread tests were used for as exclusion criteria. The tear osmolarity test, using an I-PEN osmolarity system, was performed three times in the right eye of each subject with a 5 min' gap between tests. RESULTS: The average osmolarity test score was 303.8 ± 4.8 mOsm/L. Tear osmolarity measurements showed tear osmolarity of 280-299 mOsm/L, 300-309 mOsm/L, and 310-329 mOsm/L in 14 (46.7%), three (10%), and 13 (43.3%) subjects, respectively. Correlations among the three I-PEN measurements were significant (Spearman's correlation coefficient; r = 0.036, 0.501, and 0.603; P = 0.050, 0.006, and 0.001, respectively). The mean coefficient of variance among the three measurements was 4.4%. CONCLUSION: The mean measurement of an I-PEN tear osmolarity was 303.8 ± 4.8 mOsm/L which is in agreement with the range of those reported for healthy subjects. The I-PEN is reliable and has the advantage of portability (hand-held) compared to the other osmolarity systems.

Accommodative Response in Patients with Central Field Loss: A Matched Case-Control Study.

Purpose: This study was conducted to evaluate the accommodative response in young participants with visual impairment in comparison with visually normal participants. Methods: Fifteen participants with confirmed visual impairment and 30 visually normal participants aged 12-15 years were recruited. Accommodative response was measured using autorefractor (Grand Seiko WV500) at distances of accommodative demand of 33, 25, and 20 cm. The targets were one-line-above participant threshold acuity. The participants' accommodative responses were compared between both groups after calibration for refractive errors and the vertex distance of the glasses. Visual acuity and refractive status were also assessed. Results: The age was not significantly different between both participant groups. The visual acuity of visually impaired patients was 6/30 to 6/240, and that of visually normal participants was 6/7.5 or better. Ten of the visually impaired patients and 29 of visually normal participants were myopic. In total, 61-73% of visually impaired patients showed an accommodative lead. Five subtypes of accommodative response were observed. In general, the accommodative inaccuracy increased with increasing accommodative demand. However, the visually normal participants largely exhibited an accommodative lag. A mild-to-moderate relationship was observed between visual acuity and accommodative response (r = 0.3-0.5, p < 0.05). Conclusion: Accommodative response in young visually impaired patients can be variable and on an individual basis. Low vision specialists should anticipate accommodative response outside the normal range. Therefore, we shall consider evaluating each patient's accommodative response before prescribing any near addition lenses. Accommodation inaccuracy is often more complex than predicted due to increased depth of focus caused by reduced visual acuity.