Symptomatic Presbyopia may Develop Earlier in Patients With Glaucoma-A Cross-Sectional Retrospective Cohort Study.

Purpose: The purpose of this study was to explore risk factors for symptomatic presbyopia, defined as near add power ≥1.50 diopters, in patients with glaucoma. Methods: Treated glaucoma (n = 56), untreated glaucoma (n = 21), and control individuals (n = 376), aged 40 to 55 years at first visit, were enrolled in the study, and near add power, retinal thickness, and visual field were examined. The association between near add power and ocular parameters and the odds ratios (ORs) for symptomatic presbyopia were investigated. Survival analysis for symptomatic presbyopia was conducted. Results: Age, astigmatic power, mean deviation, and ganglion cell complex thickness were associated with near add power. The OR for symptomatic presbyopia was significant for age (OR = 1.51), astigmatism (OR = 1.01), mean deviation (OR = 0.72), ganglion cell complex thickness (OR = 0.98), treated and untreated glaucoma (OR = 2.09), and use of glaucoma eye drops (OR = 3.33). Survival analysis showed that the treated glaucoma group reached the near add power endpoint of ≥1.50 D (symptomatic presbyopia) significantly earlier than the other two groups, and there was no difference between the control and untreated glaucoma groups. Conclusions: Glaucoma patients treated with eye drops may start near correction earlier. Translational Relevance: Symptomatic presbyopia may develop earlier in patients with glaucoma, and our findings could further contribute to better management and understanding of presbyopia with glaucoma.

A Possible Reciprocal Relationship Between Myopia and Dry Eye Disease in Japanese Teenagers.

Purpose: To investigate the relationship between dry eye disease (DED) and myopia in Japanese teenagers. Methods: This clinic-based, retrospective, cross-sectional study assessed DED condition in 10- to 19-year-old teenagers presenting at Japanese eye clinics. They included 106 high myopic patients (HM; mean age, 16.4 ± 2.2 years), 494 mild myopic patients (15.0 ± 2.6 years) and 82 non-myopic teenagers (NM; 13.8 ± 2.6 years). Subjective refraction and anisometropia were measured. Myopia grade was classified as HM (≤ -6.00 D), MM (> -6.00 D, < -0.50 D), or NM (≥ -0.5 D). The presence of DED-related symptoms including dryness, irritation, pain, fatigue, blurring and photophobia were assessed through a questionnaire. Tear film break-up time (BUT) and fluorescein corneal staining were investigated. Comparison among three groups and regression analysis of myopic error and other variables were conducted. Results: Anisometropia and astigmatic error were greatest in the HM group compared with the other groups (p < 0.001). The HM group reported less photophobia (p < 0.001) and less pain (p = 0.039) compared with the NM group. Regression analysis revealed that myopic error was correlated with astigmatic error (ß = -0.231, p <0.001), anisometropia (ß = -0.191, p <0.001), short BUT (ß = -0.086, p = 0.028) and the presence of diagnosed DED (ß = -0.112, p = 0.003). Dryness (ß = -0.127 p = 0.004), photophobia (ß = 0.117, p = 0.002) and pain (ß = 0.084, p = 0.034) correlated with myopic error. Conclusion: This study associated clinical findings of DED in HM teenagers. The present results suggest DED might be associated with myopia, possibly in a reciprocal relationship.

Accuracy of new intraocular lens power calculation formula for short and long eyes using segmental refractive indices.

PURPOSE: To evaluate the accuracy of a new intraocular lens power calculation formula using segmental refractive index-based axial length (AL). SETTING: Chukyo Eye Clinic, Nagoya, Japan. DESIGN: Retrospective observational study. METHODS: This study included patients undergoing preoperative examination for cataract surgery with the new Barrett True AL (BTAL) and Emmetropia Verifying Optical (EVO) formulas using segmental refractive index, and conventional Barrett Universal II (BU II) formula using equivalent refractive index. The predicted refractive error of each formula was compared with the postoperative subjective spherical equivalent. RESULTS: The mean prediction error (MPE) in the short AL group (≤ 22 mm; 44 eyes) was 0.32 ± 0.40 D for BU II, 0.22 ± 0.37 D for BTAL, and 0.10 ± 0.37 D for EVO (P < 0.0001). MPE in the long AL group (≥ 26 mm; 92 eyes) was 0.01 ± 0.32 D for BU II, 0.04 ± 0.32 D for BTAL, and 0.09 ± 0.32 D for EVO (P < 0.0001). In patients with an AL ≥ 28 mm, BU II showed a myopic trend in 57.1% of cases, while BTAL and EVO showed a hyperopic trend in 71.4%. The MPE for patients with an AL ≥ 28 mm was -0.16 ± 0.34 D for BU II, 0.18 ± 0.33 D for BTAL, and 0.16 ± 0.32 D for EVO (P < 0.0001). CONCLUSIONS: The new EVO and BTAL formulas showed higher accuracy than BU II in short eyes, whereas there was no difference in long eyes.

Effect of Eyelid Hygiene on Functional Visual Acuity After Cataract Surgery: A Randomized Controlled Study.

Purpose: To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study. Methods: Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively. Results: In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048). Conclusions: Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test.

Cell viability score (CVS) as a good indicator of critical concentration of benzalkonium chloride for toxicity in cultured ocular surface cell lines.

Cytotoxicity of benzalkonium chloride (BAK) is a major factor affecting drug cytotoxicity. This study aimed to determine the critical concentration of BAK for cultured ocular cells, using SIRC (rabbit corneal epithelium), BCE C/D-1b (bovine corneal epithelial cells), RC-1 (rabbit corneal epithelium), and Chang (human conjunctival cells). Cell viability was determined following the exposure of cells to 11 concentrations of BAK for 10, 30, or 60 min using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and neutral red assays, and the cell viability score (CVS) was used to evaluate comprehensively the toxicity of BAK. The CVS system consists of two values. The CVS50 was determined by the number of measurements for viability ≥50% of control. The CVS40/80 was calculated as follows: CVS40/80=(number of measurements for viability values >80%)-(number of measurements for viability values <40%). Both %CVS50 and %CVS40/80 decreased with concentrations of BAK. When BAK concentrations were 0.01% or higher, %CVS50 and %CVS40/80 became 0 and less than -90, respectively. Meanwhile, when BAK concentrations were 0.001% or lower, %CVS50 became 100. In the case of %CVS40/80, when the BAK concentrations were 0.002% or lower, the values reached 75 or more, and when 0.0005% or lower, the %CVS40/80 value reached 100. Accordingly, BAK induced very low cytotoxicity in the cultured ocular cell lines at concentrations of 0.002% or lower. The concentration-dependency confirmed that the CVS score is useful for expressing drug cytotoxicity in a simple and comprehensive manner.

Seasonality of Tear Meniscus Volume and Dry Eye-Related Symptoms - A Cross-Sectional Retrospective Cohort Study.

Purpose: We aimed to determine the seasonal variation in the tear meniscus level on strip meniscometry and its association with ocular parameters and symptoms. In Japan, there are four distinct seasons characterized by marked differences in temperature and humidity, which may contribute to an observed seasonality of ocular surface symptoms. Methods: We conducted a cross-sectional study in two Japanese clinics and recruited first-visit patients for 3 years. Tear strip meniscometry, tear break-up time (BUT), Schirmer test, and corneal staining were examined, and major ocular symptoms (dryness, irritation, pain, fatigue, blurred vision, and photophobia) were determined through interviews. Results: The 1196 participants had a mean age of 58.9±15.2 years; 37.1% were of male sex. Strip meniscometry values and BUT revealed significant seasonality with one-way analysis of variance. The mean strip meniscometry value (mm) was 2.15±2.59 in spring (p=0.025 vs winter), 2.37±2.79 in summer (p<0.001), 2.38±2.80 in fall (p<0.001), and 1.64±2.29 in winter. Regression analysis indicated that strip meniscometry levels were correlated with BUT (p<0.001), Schirmer test values (p<0.001), corneal staining scores (p=0.022), and presence of dryness (p<0.001). Conclusion: Strip meniscometry values exhibited distinct seasonality, being lowest in winter when the ambient condition is dry and cool, and were correlated with BUT, Schirmer test values, corneal staining scores, and the presence of subjective dryness.

Association of eye strain with dry eye and retinal thickness.

PURPOSE: The purpose of this cohort study was to investigate the association between the prevalence of abnormal ocular examination results and the common visual symptoms of eye strain, blurred vision and photophobia. METHODS: Consecutive first-visit outpatients with best-corrected visual acuity better than 20/30 in both eyes were enrolled and those with a history of intra-ocular lens implantation and glaucoma were excluded. Dry eye-related examinations and retinal thickness measurement were conducted. The odds ratio (OR) was calculated with logistic regression analyses of ocular data in relation to the presence of visual symptoms. RESULTS: A total of 6078 patients (3920 women, mean age 49.0 ± 20.4 years) were analyzed. The prevalence of each symptom was 31.8% for eye strain, 22.5% for blurred vision and 16.0% for photophobia. A significant risk factor for eye strain was short tear break-up time (TBUT) (OR 1.88), superficial punctate keratitis (SPK) (OR 1.44), and thickness of ganglion cell complex (GCC) (OR 1.30). Risk factors for blurred vision were short TBUT (OR 1.85), SPK (OR 1.24) and GCC (OR 0.59). Risk factors for photophobia were short TBUT (OR 1.77) and SPK (OR 1.32). Schirmer test value, peripapillary nerve fiber layer thickness and full macular thickness were not associated with the tested symptoms. CONCLUSION: The current study successfully identified female gender, short TBUT, and SPK as significant risk factors for eye strain, blurred vision, and photophobia with considerable ORs.

Sex differences in the relationship between axial length and dry eye in elderly patients.

Purpose: The aim of this study was to explore the association between myopia and dry eye (DE)-related ocular parameters. Methods: We recruited a total of 460 patients (mean age, 73.6 years; 40.2% men) and performed DE-related, axial length (AL) and retinal examinations. Statistical analysis revealed a significant sex difference in AL, strip meniscometry value, corneal staining score, corneal endothelial cell density, ganglion cell complex (GCC) thickness, and full macular thickness. AL was strongly age- and sex-dependent, so subsequent analyses were stratified by sex. Results: Among DE-related parameters, strip meniscometry value (ß = -0.167, p = 0.033) and corneal endothelial cell density (ß = -0.139, p = 0.023) were correlated with AL in women but not in men. Regarding retinal parameters, GCC thickness and full macular thickness were correlated with AL in women but not in men. Conclusion: The current results suggest a relationship between tear production and AL in elderly women and support the hypothesis that there may be a common upstream factor including the parasympathetic nervous system in the association between tear production and AL or DE and myopia.

Breakfast Skipping is associated with More Deleterious Lifestyle Behaviors among Japanese Men: The TRF-Japan Study Using the Original "Taberhythm" Smartphone Application.

Background: Time-restricted eating has been increasingly recognized as a promising option to reduce food intake and combat obesity. Especially in Asian countries such as Japan, because of the wide variety of food choices available, a dietary approach that emphasizes meal timing can be more practical and easier to implement and adhere to, compared with approaches that focus on specific dietary content, such as low-fat or low-carbohydrate diets. Objectives: We aimed to identify eating patterns among Japanese men and women using a smartphone application (app) called "Taberhythm." In addition, we sought to evaluate the relationship of breakfast eating habits with lifestyle behaviors and body mass index, and determine whether sex differences were present. Methods: A total of 3369 smartphone users were eligible to participate in this observational study. Users recorded 1 mo of lifestyle logs using the app; 254 participants (178 women, 38 ± 12 y old, body mass index 23.3 ± 4.9 kg/m2) had sufficient records to calculate daily fasting duration and sleep duration, and were eligible for the analyses. Results: Fasting duration was ∼12.6 h and was longer in women than men, among participants who never skipped breakfast. Breakfast skipping was associated with longer screen time, and more frequent snacking, only in men. Men with irregular breakfast eating patterns had a longer duration of fasting after awakening that was associated with obesity. Conclusions: We investigated eating patterns among Japanese people using a smartphone app and revealed that skipping breakfast was more deleterious in men than in women.

Clinical Results and Factors Affecting Visual Function in Eyes Implanted with an Enhanced Monofocal Intraocular Lens.

Purpose: To compare the clinical results achieved with the enhanced monofocal intraocular lenses (IOLs) with those of the monofocal IOL and investigate factors affecting the distance, intermediate, and near vision. Patients and Methods: Patients were included who underwent bilateral consecutive cataract surgeries using the same IOLs with follow-up to 1 month postoperatively. Refractions, monocular UDVA and CDVA, and binocular distance-corrected functional visual acuity at 5 meters (BDCFVA), at 66 centimeters (BDCIFVA) and at 40 centimeters (DCNVA) were assessed. Multiple regression analysis was used to assess the factors affecting binocular BDCFVA, BDCIFVA, and BDCNFVA. Subjective symptoms were assessed using the Near Activity Visual Questionnaire (NAVQ) and visual analogue scale (VAS). Results: Sixty patients (120 eyes) implanted with the Tecnis Eyhance IOL (30 patients, 60 eyes) or the Tecnis monofocal IOL (30 patients, 60 eyes) were included. The Tecnis Eyhance IOL provided significantly better binocular BDCIFVA than the Tecnis monofocal IOL in patients under 70 years of age. Multiple regression analysis showed that age was the only factor affecting distance and intermediate visual function in eyes with the Tecnis Eyhance IOL; gender, pupillary diameter, axial length, and average keratometry were not significant. There were no significant differences in subjective symptoms. Conclusion: The comprehensive cohort analysis did not confirm the advantage on the intermediate vision of the Tecnis Eyhance IOL. Younger age may be an important factor to benefit from the unique optical characteristics of this IOL.

Promoter demethylation of Keap1 gene in human diabetic cataractous lenses.

Age-related cataracts (ARCs) are the major cause of visual impairments worldwide, and diabetic adults tend to have an earlier onset of ARCs. Although age is the strongest risk factor for cataracts, little is known how age plays a role in the development of ARCs. It is known that oxidative stress in the lens increases with age and more so in the lenses of diabetics. One of the central adaptive responses against the oxidative stresses is the activation of the nuclear transcriptional factor, NF-E2-related factor 2 (Nrf2), which then activates more than 20 different antioxidative enzymes. Kelch-like ECH associated protein 1 (Keap1) targets and binds to Nrf2 for proteosomal degradation. We hypothesized that hyperglycemia will lead to a dysfunction of the Nrf2-dependent antioxidative protection in the lens of diabetics. We studied the methylation status of the CpG islands in 15 clear and 21 diabetic cataractous lenses. Our results showed significant levels of demethylated DNA in the Keap1 promoter in the cataractous lenses from diabetic patients. In contrast, highly methylated DNA was found in the clear lens and tumorized human lens epithelial cell (HLEC) lines (SRA01/04). HLECs treated with a demethylation agent, 5-aza-2'deoxycytidine (5-Aza), had a 10-fold higher levels of Keap1 mRNA, 3-fold increased levels of Keap1 protein, produced higher levels of ROS, and increased cell death. Our results indicated that demethylation of the CpG islands in the Keap1 promoter will activate the expression of Keap1 protein, which then increases the targeting of Nrf2 for proteosomal degradation. Decreased Nrf2 activity represses the transcription of many antioxidant enzyme genes and alters the redox-balance towards lens oxidation. Thus, the failure of antioxidant protection due to demethylation of the CpG islands in the Keap1 promoter is linked to the diabetic cataracts and possibly ARCs.

Virucidal activity of alcohol-based hand rub disinfectants.

We investigated the virucidal activity of commercially available alcohol-based hand rub products against coxsackievirus A7, B5, feline calicivirus F9, and human adenovirus type 3, type 7, type 8 using susceptible cell lines, Vero cells, CRFK cells, and A549 cells. Fifteen tested hand rub products were ethanol (EtOH) for disinfection (Japanese Pharmacopoeia Grade), two EtOH-based products, one povidone iode-containing product, one alkyldiaminoethylglycine hydrochloride-containing product, six benzalkonium chloride (BAK)-containing products, and four chlorohexidine gluconate (CHG)-containing products. Some active ingredients (BAK, benzetonium chloride, and CHG) were diluted with EtOH to make 0.5% and 0.2% solutions. Virus inactivation rates were calculated after contact with each hand rub product for 10 or 60 seconds. Of the hand rub products tested, only the povidone iode-based product showed antiviral activity superior to that of EtOH against all the strains. EtOH solutions of active ingredients (0.2% and 0.5%) also showed decreased antiviral activity. In conclusion, antiviral activity of all the commercially available alcohol-based hand rub products except that containing povidone idode was dependent on their active ingredients. The povidone idode-containing hand rub product kept its effectiveness even after the dilution with EtOH. Although alcohol-based hand rub products are convenient and suitable for the control of some microbes, they are not generally recommended for the control of viral infections.

In vitro assessment of the cytotoxicity of six topical antibiotics to four cultured ocular surface cell lines.

To determine the cytotoxicity of antibiotic eyedrops to ocular surface cells using a semi-quantitative method, a range of commercially available antibiotic eyedrops were assessed by using three corneal cell lines and one conjunctival cell line. All antibiotic solutions were free of benzalkonium chloride. Cell viability was determined by the MTT assay and neutral red assay following the exposure of cells to the undiluted, 2- and 10-fold diluted drugs for 10, 30, and 60 min. Toxicity was compared using % cell viability score (%CVS) . The tested eyedrops and values of %CVS50 and %CVS40/80 were Bestron(®) (cefmenoxime, 100, 94) , Panimycin(®) (dibekacin, 86, 58) , Noflo(®) (norfloxacin, 90, 50) , Cravit(®) (levofloxacin, 86, 46) , Tosfulo(®) (tosufloxacin, 57, -3) , and Vigamox(®) (moxifloxacin, 57, -6) . Cell viability markedly increased after dilution. For instance, cell viability assayed by MTT was > 80% for all the measurements in antibiotics diluted 10-fold, and the rate of the measurements showing > 80% cell viability decreased to 43% (31 out of 72 measurements) in the solutions diluted 2-fold. Of the drugs tested, Bestron(®) containing cefmenoxime showed the weakest toxicity. Vigamox(®) containing moxifloxacin and Tosuflo(®) containing tosufloxacin were more toxic when compared with the other antibiotics. CVS was useful for the comparison of the cytotoxicity of the drugs.

Decrease of tear break-up time at Japanese eye clinics during five consecutive years.

The aim of this retrospective chart review study was to evaluate the 5-year trend of ocular surface examination results in participants who visited the eye clinic from 2015 to 2019, underwent corneal and lacrimal examinations, refraction, and intra-ocular pressure measurements, and reported six dry eye-related symptoms. A total of 1468 patients were analyzed. Tear break-up time (BUT) decreased continuously for five consecutive years: 4.76 ± 1.84 s in 2015, 4.57 ± 1.70 s in 2016 (p = 0.999, vs 2015), 4.35 ± 2.06 s in 2017 (p = 0.662), 3.83 ± 2.18 s in 2018 (p < 0.001), and 3.63 ± 2.10 s in 2019 (p < 0.001). The decrease of BUT was more prominent in women than men (p < 0.001) and the correlation coefficient between calendar year and BUT was greater in women than men (p = 0.002). Schirmer test value, strip tear meniscometry value, and corneal staining score did not exhibit significant changes. Prevalence of blurring, photophobia, and pain increased toward 2019 among symptoms surveyed (eye fatigue, blurring, photophobia, dryness, irritation, and pain) and regression analysis indicated blurring (p < 0.001), photophobia (p < 0.001), and pain (p < 0.001) were correlated with BUT. In conclusion, BUT decreased continuously for five consecutive years from 2015 to 2019 and was associated with dry-eye related symptoms.

Short Tear Breakup Time Could Exacerbate the Progression of Presbyopia in Women.

PURPOSE: The contributory factors and symptoms for presbyopia progression have not been fully determined. The purpose of the study was to compare presbyopia progression in subjects with short and normal tear breakup time and to explore the severity of common ocular symptoms associated with presbyopia progression. METHOD: We conducted a clinic-based, retrospective, cross-sectional study. Inclusion criteria were bilateral phakic patients aged 40-69 years with best-corrected distance visual acuity better than 20/30, and exclusion criteria were the use of glaucoma eye drops, any disease affecting vision, or history of ocular surgery. We measured the binocular near add power and compared the results using Kaplan-Meier analysis. Association between near add power and ocular symptoms was explored. RESULTS: There were 1411 participants (mean age of 50.1 years). There were no significant differences in age, intraocular pressure, spherical equivalent, astigmatism, or anisometropia between the sexes. Kaplan-Meier analysis indicated that women with short tear breakup time reached the endpoint (near add power of +3.00 D) significantly earlier than those with normal tear breakup time (P = 0.043; Cox-Mantel test). Eye fatigue was most severe in the group with an add power of 1.25-2.00 D. Near add power was correlated with hyperopia, astigmatic errors, and anisometropia. CONCLUSIONS: This study suggests an exacerbation of presbyopia progression in women with short tear breakup time. Eye fatigue was most severe in those with an add power of 1.25-2.00 D.

The ocular symptoms and signs during the COVID-19 pandemic.

PURPOSE: The aim of this cohort study was to describe the change in ocular surface signs and symptoms before and during the COVID-19 pandemic, and to associate changes with potential pandemic-related events. METHODS: First-visit patients from 2019 to 2021 were examined for corneal staining, lacrimal function and refraction. We assessed the presence of seven common ocular symptoms. Patients with glaucoma and macular disease were excluded. Dry eye (DE) was diagnosed according to the criteria of the Asia Dry Eye Society. RESULTS: The mean age of 3,907 participants was 59.6±18.6y and 63.8% were female. Mean age and the prevalence of diagnosed DE and shortened tear break-up time decreased from 2019 to 2021. The prevalence of eye fatigue, blurring and photophobia decreased in 2020. CONCLUSIONS: The prevalence of diagnosed DE did not increase among first-visit patients during the pandemic compared with 2019, despite many survey results suggesting that DE may have worsened due to frequent masking, increased screen time, mental stress, and depression under quarantine and social infection control. It might be considered however, that many elderly DE patients might have refrained from consulting an ophthalmologist and possibly delayed treatment of DE during the pandemic.

Tear Strip Meniscometry and Its Clinical Application: Analysis of More Than 2000 Cases.

Purpose: To evaluate the association of strip meniscometry tear meniscus volume measurement with signs and symptoms related to dry eye. Methods: This cross-sectional study enrolled 2234 consecutive outpatients and used dry eye symptomatology and related ocular surface examinations, including the Schirmer test, fluorescein tear film break-up time (BUT), corneal fluorescein vital staining and strip meniscometry. The strip meniscometry cut-off was estimated using a receiver operating characteristic analysis. The subjective symptoms consisted of six binarized items: dryness, fatigue, photophobia, pain, irritation, and blurring. The clinical signs were also binarized by the cut-off in each test. The presence of all signs and symptoms were then analyzed using Hayashi's quantification theory type III analysis. Results: The mean age of the participants was 59.3 ± 17.3 years. The mean values for Schirmer test, BUT, corneal fluorescein staining, and strip meniscometry were 13.6 ± 9.6 mm, 3.1 ± 2.1 seconds, 0.40 ± 0.66, and 2.4 ± 2.7 mm, respectively. The Schirmer test was negatively correlated with age (r = -0.152; P < 0.01), whereas the BUT and strip meniscometry were not. All pairs of Schirmer test, BUT, and strip meniscometry had significant correlations, but the greatest correlation was found between BUT-strip meniscometry (r = 0.238; P < 0.01). An strip meniscometry cut-off length of 2.5 mm (area under the curve = 0.618) was calculated. Hayashi's analysis found high similarity among the presence of signs by strip meniscometry, BUT. and corneal fluorescein staining, and three nonvisual symptoms (pain, irritation, and dryness) had a distinct similarity. Conclusions: Strip meniscometry results using the cut-off of 2.5 mm could be a useful clinical indicator for the initial screening of dry eye. Translational Relevance: This large-scale case-control study further confirmed tear strip meniscometry with the new cut-off is a useful tear function examination for dry eye; it is a 5-second noninvasive procedure and associated with clinical symptoms and corneal parameters.

Starting Time of Presbyopic Eyeglasses Wear and Lifestyle.

Purpose: Presbyopia is a serious burden in the aged population, however, the factors affecting its progression have not been fully determined. The aim of this study was to explore the association between the time of starting to wear presbyopic eyeglasses and lifestyle, in participants aged from 40 to 59 years. Methods: We selected the sample to be representative of sex and age for the age group 40 to 59 years. Participants completed a web-based survey on presbyopia-related questions, symptomatic dry eye, sleep habits, Pittsburgh Sleep Quality Index, subjective happiness scale (SHS), and other lifestyle-related questions including marital status, income, screen time, sun exposure, family history of myopia, and the frequency of regular visits to medical services. Results: We found 529 participants (26.5%) used near correction, with a mean age for first near correction of 47.8±4.8 years. An earlier commencement of near correction correlated with hyperopia (P = 0.013), late wake-up time (P = 0.010), a poor subjective sleep quality score (P = 0.019), and a low annual income score (P = 0.025), after adjusting for age and sex. Stratification by income demonstrated the low-income group exhibited more dry eye, later wake-up time, longer sleep latency, longer sleep duration, worse sleep efficacy, lower SHS score, and a higher prevalence of living alone compared with the high-income group. The usage of corrective devices did not differ between the two groups. Conclusions: The current study suggests a healthy sleep habit may delay the need for near correction, in addition to myopia. Shift work and circadian rhythm disruption might exacerbate presbyopia progression.

Cell viability of four corneoconjunctival cell lines exposed to five preservatives and a surfactant used for infection control in eyedrops.

The aim of this study was to evaluate the cytotoxicity of six ingredients used in eyedrops with regard to four corneoconjunctival cell lines. Cells were treated with the undiluted solution, and 2-fold, and 10-fold dilutions of each solution for 10, 30, and 60 min and cell viability was measured with the neutral red assay and the MTT assay. The degree of toxicity was based on the cell viability score (CVS). The CVS50 was determined by the number of measurements with a viability ≥ 50% of control. The CVS40/80 was calculated as follows: CVS40/80 = (number of measurements with a viability value >80%) - (number of measurements with a viability value <40%). Results were expressed as % of total measurements (%CVS). The results of each ingredient for %CVS50, and %CVS40/80 were 0.01% benzalkonium chloride (51, -13), 1% boric acid (100, 99), 0.4% methyl paraoxybenzoate (100, 100), 0.4% propyl paraoxybenzoate (100, 100), 1.0% polysorbate 80 (68, 18), and 0.5% chlorobutanol (100, 100). The use of benzalkonium chloride led to apparently low cell viability compared to the other five solutions.

Bactericidal effects and cytotoxicity of new aromatic dialdehyde disinfectants (ortho-phthalaldehyde).

We investigated the bactericidal effects and cytotoxicity of an ortho-phthalaldehyde product in comparison with those of its predecessor glutaraldehyde products. Bactericidal effects ware examined on Mycobacterium terrae, a standard organism used for investigating the bactericidal effect of high-level disinfectants. Cytotoxicity as determined by the MTT assay was examined by using four cell lines. The colony forming test, a method to examine residual toxicity, and the evaporation test, a newly developed method to examine the toxicity of the evaporated ingredients, were performed. Test solutions were 2.25% and 3.5% glutaraldehyde (GA) products and a 0.55% ortho-phthalaldehyde (OPA) product, and glutaraldehyde itself. All the disinfectants showed sufficient bactericidal effects on M. terrae. Meanwhile, the OPA product was less toxic than GA products and GA itself to all the cell lines tested. The colony forming test showed that GA products and GA itself exerted residual cytotoxicity more potently than did the OPA product. The evaporation test showed that GA products and GA itself exerted cytotoxicity via evaporation more potently than did the OPA product. In conclusion, OPA appears to be less cytotoxic than GA even though bactericidal effects were comparable. This may be due to the lower concentration of the active ingredient (ortho-phthalaldehyde) in the OPA product.