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1.
Medicina (Kaunas) ; 60(6)2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38929602

RESUMO

Background and Objectives: Dry Eye Disease (DED) is a chronic condition characterised by tear film instability and ocular surface disruption, significantly impacting patients' quality of life. This study aimed to provide top-level clinical evidence for the long-term efficacy of dehydrated amniotic membrane (dAM, Omnigen®) delivered via a specialised bandage contact lens (sBCL, OmniLenz) for managing moderate-to-severe DED. Materials and Methods: This randomised controlled trial (NCT04553432) involved 93 participants with moderate-to-severe DED, randomised to receive a 1-week bilateral treatment of either dAM (17 mm diameter with 6 mm central 'window') applied under a sBCL or sBCL alone. Participants were assessed at baseline and followed up at 1, 3, and 6 months post-treatment. Outcomes included changes in symptomatology, tear film and ocular surface measurements, and in vivo confocal microscopy imaging of corneal nerve parameters and corneal dendritic cell (CDC) counts. Results: The dAM-sBCL group demonstrated a 65% reduction in OSDI scores at 6 months (p < 0.001), with 88% of participants showing improvement at 1 month. Corneal staining was significantly reduced in both groups. dAM-sBCL provided significant improvements in corneal nerve parameters at 1 month, with sustained positive trends at 3 months. Additionally, dAM-sBCL significantly reduced mature CDC counts, suggesting an anti-inflammatory effect. Conclusions: Treatment with dAM-sBCL for just 1 week significantly and rapidly improved dry eye symptoms as well as ocular surface signs for at least 3 months. It also enhanced corneal nerve health while reducing activated/mature corneal inflammatory cell numbers, presenting a safe and promising new treatment for moderate-to-severe DED.


Assuntos
Âmnio , Síndromes do Olho Seco , Humanos , Síndromes do Olho Seco/terapia , Masculino , Feminino , Âmnio/transplante , Pessoa de Meia-Idade , Adulto , Lentes de Contato , Resultado do Tratamento , Idoso , Qualidade de Vida , Bandagens , Córnea
2.
Int Ophthalmol Clin ; 64(3): 9-12, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38910500

RESUMO

Intense pulsed light has a growing body of research supporting its use in skin rejuvenation, dermatologic conditions, as well as ocular rosacea, dry eyes and meibomian gland dysfunction. This paper will start with the conception of one protocol for treating dry eyes, blepharitis and styes using broad band light, a version of intense pulsed light, and its evolution into a life-changing in-office procedure for many patients. The approach for optimizing the settings, considerations during the consultation, the procedure in detail, after treatment care, and potential complications to avoid are all explained. Periocular and facial rejuvenation treatment protocols are discussed as well. This should be a useful guide for clinicians looking to add intense pulsed light to their in-office treatment armamentarium to significantly improve the lives of their patients.


Assuntos
Blefarite , Síndromes do Olho Seco , Rejuvenescimento , Humanos , Síndromes do Olho Seco/terapia , Blefarite/terapia , Terapia de Luz Pulsada Intensa/métodos , Fototerapia/métodos , Face
3.
Curr Opin Ophthalmol ; 35(4): 322-328, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38813738

RESUMO

PURPOSE OF REVIEW: Meibomian gland dysfunction (MGD) is one of the most common disorders encountered by ophthalmologists, and its management can prove challenging for both clinicians and patients. Intense pulsed light (IPL), which has been historically used in the field of dermatology, has emerged as a tool to help improve meibomian gland function. The goal of this review is to assess the clinical efficacy, utility, and safety of IPL for the treatment of MGD. RECENT FINDINGS: In recent randomized controlled trials, IPL has been shown to improve meibomian gland function, and subsequently tear film quality and dry eye symptoms. The mechanism of action still remains unclear. Recent literature suggests that IPL may also be used in conjunction with other therapies, such as meibomian gland expression, low-level light therapy, and thermal pulsation. Careful attention should be placed on each patient's Fitzpatrick skin type, as well as protecting the ocular structures to reduce the risk of adverse effects. Cost, accessibility, as well as a limited duration of efficacy may be drawbacks. SUMMARY: There is significant evidence supporting that IPL may be used as a potential well tolerated and effective treatment for MGD, though there are certain caveats regarding its long-term efficacy, accessibility, and cost.


Assuntos
Terapia de Luz Pulsada Intensa , Disfunção da Glândula Tarsal , Humanos , Disfunção da Glândula Tarsal/terapia , Terapia de Luz Pulsada Intensa/métodos , Glândulas Tarsais , Resultado do Tratamento , Síndromes do Olho Seco/terapia , Síndromes do Olho Seco/fisiopatologia
4.
J Proteome Res ; 23(6): 2206-2218, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38723043

RESUMO

Acupuncture is widely used to treat dry eye disease (DED), but its effect has not been reported in treating video display terminal (VDT)-related dry eye, and the mechanism of acupuncture on VDT-related dry eye is also unknown. In our study, the tear proteome was compared with identifying possible mechanisms and biomarkers for predicting acupuncture effectiveness in VDT-related dry eye. The results showed that the ocular surface disease index scores were significantly different between the acupuncture group (AC group) and artificial tears group (AT group) at the end of the study, whereas tear film breakup time (TFBUT) and Schirmer I test (SIT) were not significantly different between the groups. Proteome changes pre- and post-treatment in the AC group were associated with B cell-related immune processes, inflammation, glycolysis, and actin cytoskeleton. Furthermore, the proteins hexosaminidase A and mannose-binding lectin 1 could prospectively predict whether acupuncture treatment was effective. Therefore, we believe that acupuncture can provide greater improvement in the clinical symptoms of VDT-related dry eye than artificial tears. The mechanism of acupuncture in VDT-related dry eye treatment may be associated with glycolysis- and actin cytoskeleton remodeling-mediated inflammatory and immune processes. Additionally, hexosaminidase A and mannose-binding lectin 1 are biomarkers for predicting the efficacy of acupuncture for VDT-related dry eye.


Assuntos
Terapia por Acupuntura , Síndromes do Olho Seco , Proteômica , Lágrimas , Humanos , Síndromes do Olho Seco/terapia , Síndromes do Olho Seco/metabolismo , Lágrimas/metabolismo , Terapia por Acupuntura/métodos , Masculino , Feminino , Proteômica/métodos , Pessoa de Meia-Idade , Terminais de Computador , Adulto , Biomarcadores/metabolismo , Biomarcadores/análise , Proteoma/análise , Proteoma/metabolismo , Proteínas do Olho/metabolismo
5.
Cell Mol Biol (Noisy-le-grand) ; 70(5): 111-118, 2024 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-38814228

RESUMO

Bioinformatics analysis was performed to reveal the underlying pathogenesis of type 2 diabetes (T2DM) dry eye(DE) and to predict the core targets and potential pathways for electroacupuncture (EA) treatment of T2DM DE, in which key targets such as Toll-likereceptor4 (TLR4), NF-κB and Tumor necrosis factor-α (TNF-α) may be involved. Next, streptozotocin and a high-fat diet were used to generate T2DM-DE rats. Randomly picked EA, fluorometholone, model, and sham EA groups were created from successfully modelled T2DM DE rats. Six more rats were chosen as the blank group from among the normal rats. The results of DE index showed that EA improved the ocular surface symptoms.HE staining showed that EA attenuated the pathological changes in the cornea, conjunctiva and lacrimal gland of T2DM DE rats. EA decreased the expression of TLR4, MyD88, P-NF-κB P65, and TNF-α in the cornea, conjunctiva, and lacrimal gland, in accordance with immunofluorescence and Western blot data. Thus, EA reduced ocular surface symptoms and improved pathological changes of cornea, conjunctiva, and lacrimal gland induced by T2DM DE inT2DM DE rats, and the mechanism may be related to the inhibition of overactivation of the TLR4/NF-κB signaling pathway by EA and thus attenuating ocular surface inflammation.


Assuntos
Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2 , Síndromes do Olho Seco , Eletroacupuntura , NF-kappa B , Transdução de Sinais , Receptor 4 Toll-Like , Fator de Necrose Tumoral alfa , Animais , Receptor 4 Toll-Like/metabolismo , Eletroacupuntura/métodos , NF-kappa B/metabolismo , Síndromes do Olho Seco/terapia , Síndromes do Olho Seco/metabolismo , Síndromes do Olho Seco/patologia , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Experimental/terapia , Diabetes Mellitus Experimental/metabolismo , Masculino , Fator de Necrose Tumoral alfa/metabolismo , Inflamação/patologia , Inflamação/metabolismo , Ratos Sprague-Dawley , Ratos , Aparelho Lacrimal/metabolismo , Aparelho Lacrimal/patologia , Túnica Conjuntiva/metabolismo , Túnica Conjuntiva/patologia , Córnea/patologia , Córnea/metabolismo , Fator 88 de Diferenciação Mieloide/metabolismo
6.
Eye Contact Lens ; 50(6): 259-264, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38625757

RESUMO

OBJECTIVES: Dry eye is a common condition that can decrease the quality of life. This survey-based study of persons with dry eye investigated self-reported treatments (initial, current), out-of-pocket expenses, time spent on self-management, sources of care, and sources of information about their condition. METHODS: Online dry eye newsletters and support groups were emailed a link to an electronic survey asking members to participate. Survey respondents were not required to answer every question. RESULTS: In total, 639 persons with self-reported dry eye responded (86% women, 14% men [n=623]; mean ± SD age, 55 ± 14 years [n=595]). Artificial tears were the most reported intervention (76% initially, 71% currently). The median (interquartile range) out-of-pocket treatment cost annually was $500 ($200-$1,320 [n=506]). In addition, 55% (n=544) estimated 5 to 20 min daily on self-management; 22% spent an hour or more. Ophthalmologists provided most dry eye care (67%, n=520). Only 48% (n=524) reported that their primary source of dry eye information came from their eye care clinician. CONCLUSIONS: Artificial tears are the primary treatment for dry eye. Ophthalmologists provide most dry eye care, but half of patients report that their eye care provider is not their primary source of information. Almost one fourth of patients spend an hour or more daily on treatments.


Assuntos
Efeitos Psicossociais da Doença , Síndromes do Olho Seco , Síndromes do Olho Seco/economia , Síndromes do Olho Seco/prevenção & controle , Síndromes do Olho Seco/terapia , Fonte de Informação/estatística & dados numéricos , Lubrificantes Oftálmicos/economia , Lubrificantes Oftálmicos/uso terapêutico , Oftalmologistas/estatística & dados numéricos , Autogestão/economia , Autogestão/estatística & dados numéricos , Inquéritos e Questionários , Tempo , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso
7.
J Vis Exp ; (206)2024 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-38682910

RESUMO

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with myopia. Needle prickling has been shown to be effective in providing symptom relief in patients with myopia and dry eye. Press needle is a long-lasting, easy-to-operate, and inexpensive traditional Chinese medicine treatment. The standard practice of needle insertion is very important for the treatment of myopia and dry eye. The specific steps include selecting the appropriate acupoints, piercing them with appropriate needles, and fixing them in the skin or subcutaneously at the acupoints, burying them for 2 days, resting for 1 day; the course of treatment lasts for 2 weeks. Specifically, the following indicators were assessed: uncorrected visual acuity and the ocular surface disease index. This article will explain how to standardize the operation of a press needle in the treatment of myopia and dry eye.


Assuntos
Terapia por Acupuntura , Síndromes do Olho Seco , Medicina Tradicional Chinesa , Miopia , Humanos , Síndromes do Olho Seco/terapia , Miopia/terapia , Medicina Tradicional Chinesa/métodos , Terapia por Acupuntura/métodos , Terapia por Acupuntura/instrumentação , Agulhas
8.
Cont Lens Anterior Eye ; 47(3): 102164, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38594154

RESUMO

PURPOSE: To determine the changes in keratometry measurements and refraction in patients having the thermo-mechanical periorbital skin treatment, Tixel®, to treat dry eye disease (DED). METHODS: A multi-centre, prospective, non-masked study was conducted. DED patients were recruited in 3 international centres and were evaluated in 5 visits separated by an interval of 2 weeks except for the last visit which took place after 18 weeks from visit 1. The same clinical examination was performed at all visits: OSDI questionnaire, tear stability, keratometry, best corrected visual acuity and refraction. Tixel® treatment was applied at the first 3 visits. RESULTS: 89 participants (24 males/65 females; mean age: 55.0 ± 14.2 years) were included: 20 presented moderate DED symptoms and 69 severe DED symptoms. Significant differences were found for the spherocylindrical refraction (vector analysis) between visit 1 and visits 2 and 3. Following cumulative analysis, 11.86 % and 16.94 % of participants had more than 0.5 dioptre (D) change in mean keratometry and keratometric astigmatism, respectively, at 3 months post-treatment. A total of 5.40 % had a sphere and cylinder change greater than 0.50D and 16.21 % had the axis changed more than 10 degrees (vector analysis). These changes were particularly significant in patients with severe DED symptoms. CONCLUSIONS: Keratometry readings and refraction can change following thermo-mechanical skin treatment for DED, especially in those patients with severe DED symptoms. This should be considered as potential errors in intraocular lens calculations may be induced.


Assuntos
Extração de Catarata , Síndromes do Olho Seco , Refração Ocular , Acuidade Visual , Humanos , Síndromes do Olho Seco/fisiopatologia , Síndromes do Olho Seco/terapia , Síndromes do Olho Seco/diagnóstico , Feminino , Pessoa de Meia-Idade , Masculino , Estudos Prospectivos , Refração Ocular/fisiologia , Acuidade Visual/fisiologia , Idoso , Adulto , Córnea/fisiopatologia
9.
Lasers Med Sci ; 39(1): 111, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38656565

RESUMO

Intense pulsed light (IPL) is a non-laser, high-intensity light source that has been shown to play a valuable role in dermatology and has been adopted in ophthalmology for treating meibomian gland dysfunction (MGD). In this review, we discuss the mechanism of action of IPL, including its benefits in ophthalmology. IPL therapy has been shown to improve tear film stability, meibomian gland (MG) function, and subjective symptoms of ocular dryness in MGD patients. Moreover, emerging evidence suggests that IPL therapy is beneficial for other ocular surface diseases, such as blepharitis and chalazia. Hence, it can be inferred that IPL has potential as a therapeutic modality in future applications. Large clinical and experimental trials are needed to exploit the full potential of IPL as a treatment for recurrent chalazia, Sjögren's syndrome, and other causes of dry eye disease (DED). This paper reviews the published literature related to the application of IPL for treating ocular surface diseases.


Assuntos
Síndromes do Olho Seco , Terapia de Luz Pulsada Intensa , Disfunção da Glândula Tarsal , Humanos , Terapia de Luz Pulsada Intensa/métodos , Síndromes do Olho Seco/terapia , Disfunção da Glândula Tarsal/terapia , Blefarite/terapia , Glândulas Tarsais
11.
Korean J Ophthalmol ; 38(2): 156-163, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38433323

RESUMO

New Korean guidelines for the diagnosis and management of dry eye disease were developed based on literature reviews by the Korean Dry Eye Guideline Establishment Committee, a previous dry eye guideline by Korean Corneal Disease Study Group, a survey of Korean Dry Eye Society (KDES) members, and KDES consensus meetings. The new definition of dry eye was also proposed by KDES regular members. The new definition by the regular members of the KDES is as follows: "Dry eye is a disease of the ocular surface characterized by tear film abnormalities and ocular symptoms." The combination of ocular symptoms and an unstable tear film (tear breakup time <7 seconds) was considered as essential components for the diagnosis of dry eye. Schirmer test and ocular surface staining were considered adjunctive diagnostic criteria. The treatment guidelines consisted of a simplified stepwise approach according to aqueous deficiency dominant, evaporation dominant, and altered tear distribution subtypes. New Korean guidelines can be used as a simple, valid, and accessible tool for the diagnosis and management of dry eye disease in clinical practice.


Assuntos
Síndromes do Olho Seco , Lacerações , Humanos , Síndromes do Olho Seco/terapia , Síndromes do Olho Seco/tratamento farmacológico , Olho , Lágrimas , República da Coreia
12.
Indian J Ophthalmol ; 72(Suppl 3): S381-S392, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38454841

RESUMO

This study aimed to investigate the efficacy and safety of trigeminal parasympathetic pathway (TPP) stimulation in the treatment of dry eye. A comprehensive search for randomized clinical trials was performed in seven databases (MEDLINE, Embase, CENTRAL, etc.) up to 28 February 2023. After screening the suitable studies, the data were extracted and transformed as necessary. Data synthesis and analysis were performed using Review Manager 5.4, and the risk of bias and quality of evidence were evaluated with the recommended tools. Fourteen studies enrolling 1714 patients with two methods (electrical and chemical) of TPP stimulation were included. Overall findings indicate that TPP stimulation was effective in reducing subjective symptom score (standardized mean difference [SMD], -0.45; 95% confidence interval [CI], -0.63 to -0.28), corneal fluorescence staining (mean difference [MD], -0.78; 95% CI, -1.39 to -0.18), goblet cell area (MD, -32.10; 95% CI, -54.58 to -9.62) and perimeter (MD, -5.90; 95% CI, -10.27 to -1.53), and increasing Schirmer's test score (SMD, 0.98; 95% CI, 0.65 to 1.31) and tear film break-up time (SMD, 0.57; 95% CI, 0.19 to 0.95). Compared to inactive or low-activity stimulation controls, it has a higher incidence of adverse events. Therefore, TPP stimulation may be an effective treatment for dry eye, whether electrical or chemical. Adverse events are relatively mild and tolerable. Due to the high heterogeneity and low level of evidence, the current conclusions require to be further verified.


Assuntos
Síndromes do Olho Seco , Humanos , Síndromes do Olho Seco/fisiopatologia , Síndromes do Olho Seco/terapia , Nervo Trigêmeo/fisiologia , Sistema Nervoso Parassimpático/fisiologia , Sistema Nervoso Parassimpático/fisiopatologia , Terapia por Estimulação Elétrica/métodos , Lágrimas/fisiologia , Lágrimas/metabolismo , Resultado do Tratamento
13.
Eye Contact Lens ; 50(5): 222-232, 2024 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-38477832

RESUMO

OBJECTIVE: To perform a longitudinal study for determining the development of ocular graft-versus-host disease (oGVHD) after allogeneic hematopoietic stem cell transplant (HSCT) and report cases that illustrate the "window of opportunity" concept in oGVHD treatment. METHODS: Patients (n=61) were examined at prescheduled clinic visits before HSCT and three-month intervals after HSCT for 2 years. The presence or absence of oGVHD was determined using the international chronic oGVHD consensus group diagnostic criteria. Ocular surface washings (OSW) were obtained at each visit and analyzed for cytokine levels. RESULTS: In the longitudinal study, 26.2% (n=16; progressed group) developed either probable (11.5%, n=7) or definite oGVHD (14.8%, n=9). In the progressed group, clinically significant changes in signs (corneal staining and Schirmer I test) and symptoms at the post-HSCT visit as compared with the pre-HSCT visit occurred at 9 months. Significant differences in clinical signs and symptoms (whether average post-HSCT values or changes in values over pre-HSCT levels) between the progressed and nonprogressed groups occurred at a 9-month visit or later. In the progressed group, 55.6% of eyes that had negative matrix metalloproteinase 9 (MMP-9) test at pre-HSCT turned MMP-9 positive at 3 to 6 months post-HSCT. In the progressed group, interleukin 8 levels in OSW were significantly increased at 6 months post-HSCT. In the case reports, the "window of opportunity" was detected by MMP-9 turning positive, early corneal staining, interleukin 8 increase in OSW, and peripheral corneal epithelial thinning, which resolved with treatment initiation. CONCLUSIONS: A "window of opportunity" exists before patients developing symptomatic tear-deficient dry eye after HSCT for initiating treatment that may preempt oGVHD development; however, larger-scale longitudinal studies are needed for definitive recommendations.


Assuntos
Doença Enxerto-Hospedeiro , Transplante de Células-Tronco Hematopoéticas , Humanos , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/terapia , Síndromes do Olho Seco/diagnóstico , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/terapia , Estudos Longitudinais
14.
Curr Eye Res ; 49(7): 698-707, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38450655

RESUMO

PURPOSE: Bone marrow mesenchymal stem cells (BMSC) have multiple biological functions and are widely involved in regulating inflammatory diseases, tissue repair and regeneration. However, the mechanism of their action in dry eye disease (DED) is currently unclear. The purpose of this study was to investigate the effect of BMSCs in the treatment of dry eye mice and to explore its specific therapeutic mechanism. METHODS: Mouse corneal epithelial cells (MCECs) were treated with 500 mOsM sodium chloride hypertonic solution to induce a DED cell model. The dry eye animal model was constructed by adding 5 µL 0.2% benzalkonium chloride solution to mouse eyes. Western blotting was used to detect the expression of related proteins, and flow cytometry, enzyme-linked immunosorbent assay (ELISA), terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) staining, hematoxylin-eosin (HE) staining, and periodic acid schiff (PAS) staining were used to detect cell and eye tissue damage. RESULTS: The experimental results showed that BMSCs can reduce the levels of reactive oxygen species (ROS) and inflammatory factors in MCECs, promote cell proliferation, inhibit cell apoptosis, improve the integrity of the corneal epithelial layer in vivo, promote an increase in the number of goblet cells, and alleviate DED. Further exploration of the molecular mechanism of BMSCs treatment revealed that BMSCs alleviate the progression of DED by inhibiting the ROS-NLRP3-IL-1ß signaling pathway. CONCLUSION: BMSCs inhibit ROS-NLRP3-IL-1ß signaling axis, reducing inflammation levels and alleviating dry eye symptoms. These findings provide new ideas and a basis for the treatment of DED and provide an experimental basis for further research on the application value of BMSCs in alleviating DED.


Assuntos
Modelos Animais de Doenças , Síndromes do Olho Seco , Epitélio Corneano , Interleucina-1beta , Células-Tronco Mesenquimais , Proteína 3 que Contém Domínio de Pirina da Família NLR , Espécies Reativas de Oxigênio , Transdução de Sinais , Animais , Síndromes do Olho Seco/metabolismo , Síndromes do Olho Seco/terapia , Camundongos , Proteína 3 que Contém Domínio de Pirina da Família NLR/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais/fisiologia , Interleucina-1beta/metabolismo , Epitélio Corneano/metabolismo , Epitélio Corneano/efeitos dos fármacos , Células-Tronco Mesenquimais/metabolismo , Western Blotting , Camundongos Endogâmicos C57BL , Ensaio de Imunoadsorção Enzimática , Células Cultivadas , Citometria de Fluxo , Apoptose , Transplante de Células-Tronco Mesenquimais/métodos , Proliferação de Células , Inflamação/metabolismo , Marcação In Situ das Extremidades Cortadas
16.
Cochrane Database Syst Rev ; 2: CD015448, 2024 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-38314898

RESUMO

BACKGROUND: Meibomian gland dysfunction (MGD) is the most common underlying cause of dry eye disease (DED). MGD leads to pathological alteration of the composition or quantity of meibum, or both, which subsequently results in tear evaporation and the typical signs and symptoms associated with DED. The LipiFlow Thermal Pulsation System (LipiFlow) is a medical device used to treat MGD in office; however, it is unclear if LipiFlow can outperform other DED treatments. OBJECTIVES: To evaluate the effectiveness of LipiFlow for treating DED signs and symptoms and the safety of LipiFlow compared with sham or other available treatments for MGD in adults. SEARCH METHODS: The Cochrane Eyes and Vision Information Specialist searched the electronic databases for randomized controlled trials. There were no restrictions on language or date of publication. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, including the Cochrane Eyes and Vision Trials Register; 2022, Issue 6), MEDLINE Ovid, Embase.com, PubMed, LILACS (Latin American and Caribbean Health Science Information database), ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) electronic databases. We also examined the reference lists of identified trials, review articles, and guidelines for information about relevant trials that may not have been identified by our search strategy. We contacted investigators regarding ongoing trials. The last database search was performed on 24 October 2022. SELECTION CRITERIA: We included studies conducted in adults (over 18 years of age) with DED or MGD as defined by the primary trial investigators. We imposed no restrictions on race, ethnicity, or sex. We considered trials involving contact lens wearers if they were equally represented between groups. DATA COLLECTION AND ANALYSIS: We applied standard Cochrane methodology. MAIN RESULTS: We included 13 trials that randomized a total of 1155 participants (28 to 236 participants randomized per study). Six trials were conducted in the USA, three in China, two in Thailand, one in France, and one in Italy. Eight trials were of single-center design, while four trials were of multicenter design; one trial did not report the number of participating centers. Study characteristics The study population of the included trials was 66% female (range 48% to 80%), with an age range of 19 to 86 years. LipiFlow, used as a stand-alone intervention, was compared with basic warm compresses in five studies, thermostatic device in five studies, oral intervention in one trial, and topical dry eye medications in one trial. LipiFlow was also evaluated together with eyelid hygiene product versus eyelid hygiene products alone in one trial. Findings Five trials compared LipiFlow with a basic warm compress applied for varying durations and frequencies during the trial period; only one of these trials combined a warm compress with eyelid massage. Analyzing symptom scores by different questionnaires (Ocular Surface Disease Index [OSDI] and Standard Patient Evaluation of Eye Dryness [SPEED]) yielded conflicting evidence of a difference in symptoms between LipiFlow and basic warm compresses after four weeks. There was no evidence of a difference in meibomian gland expression, meibum quality, or tear breakup time when comparing LipiFlow with basic warm compresses. Another five trials compared LipiFlow with thermostatic devices. Analysis of symptom scores at four weeks showed that thermostatic devices had reduced OSDI scores by a mean difference (MD) of 4.59 (95% confidence interval [CI] 1.23 to 7.95; I2 = 0, P = 0.007; 553 participants; very low certainty evidence) as compared with LipiFlow. When we compared LipiFlow plus eyelid hygiene with eyelid hygiene alone, there was no evidence of difference in signs or symptoms at any time point evaluated. Only one trial compared LipiFlow with a topical DED medication (lifitegrast 5%). The single-trial estimate suggested that 5% lifitegrast may increase meibomian gland expression scores compared with LipiFlow at day 42 (MD -1.21, 95% CI -2.37 to -0.05; 50 participants; low certainty evidence) by using a meibomian gland expression scale of 0 to 8. One trial compared LipiFlow with an oral intervention (doxycycline), finding that LipiFlow may result in significantly better SPEED scores than doxycycline at three months (MD -4.00, 95% CI -7.33 to -0.67; 24 participants; very low certainty evidence). No other significant differences in signs or symptoms were found between LipiFlow and doxycycline at three months. We did not find any other statistically significant differences in symptoms or signs for any other analysis performed in this review at the one- to four-week time point. Adverse events No trial reported any intervention-related, vision-threatening adverse events. AUTHORS' CONCLUSIONS: LipiFlow performs similarly to other commonly used DED treatments with regard to DED signs and symptoms. The best available evidence was deemed to have a high level of bias, leading to low or very low certainty evidence. Additional research with adequate masking, a standardized testing methodology, and a sample representative of the MGD population is therefore needed before any firm conclusions can be drawn regarding comparative benefits and harms.


Assuntos
Síndromes do Olho Seco , Disfunção da Glândula Tarsal , Fenilalanina/análogos & derivados , Sulfonas , Adulto , Humanos , Feminino , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Masculino , Doxiciclina , Síndromes do Olho Seco/terapia , China , Estudos Multicêntricos como Assunto
17.
Optom Vis Sci ; 101(1): 55-61, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38350058

RESUMO

SIGNIFICANCE: The impact of dry eye disease on patients' daily lives is understood by optometrists, but they seldom use this understanding in their patient management. PURPOSE: Dry eye disease can significantly impact a person's daily life and is known to cause psychological symptoms. Treating and managing patients with dry eye disease can be challenging, as an approach based solely on signs is unlikely to reflect patients' true burden. Because optometrists play a crucial role in the care of dry eye disease patients, it is necessary to examine their awareness of the negative impact of dry eye disease on patients' daily lives and how they manage this during their consultation time, including diagnosis and management. METHODS: This study has an exploratory, qualitative research design. Twelve semistructured online interviews were conducted with optometrists in second-line eye care through a convenience sample. The interviews were recorded, transcribed verbatim, and analyzed after a thematic analysis. RESULTS: The main findings were that few optometrists actively asked about patients' perceived burden, many optometrists did not mention all the possible treatment options or practical advice that could benefit dry eye disease patients, and few were aware of the possible help that other health care providers could provide, besides the optometrist. CONCLUSIONS: Dutch optometrists are aware of the impact that dry eye disease can have on their patients' daily lives, but seldom use this information as part of their management plan.


Assuntos
Síndromes do Olho Seco , Optometristas , Optometria , Humanos , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/terapia , Projetos de Pesquisa , Padrões de Prática Médica
18.
Optom Vis Sci ; 101(2): 84-89, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38408305

RESUMO

BACKGROUND: Managing dry eye disease (DED) is expensive. Often, prescribed treatments improve clinical signs but not patient-reported symptoms. In large surveys, clinicians and patients ranked environmental and behavioral modifications among the most important DED-related research priorities. Our purpose was to investigate the barriers to and facilitators of use of these modifications by patients with DED in the United States and how their use may be impacted by socioeconomic status (SES). METHODS: Using Qualtrics, we conducted an anonymous online survey of adults with DED living in the United States in August to September 2022. Patients were identified through the Dry Eye Foundation, Sjögren's Foundation, and a DED clinic in Colorado. We used an established index for classifying respondent SES based on education, household income, and employment. Outcomes included use of environmental and behavioral modifications and barriers to and facilitators of their use. RESULTS: We included 754 respondents (SES: 382 low, 275 high, and 97 unclear). Most were aged 18 to 49 years (67%), female (68%), and White (76%) and reported dealing with DED for ≤5 years (67%). The most frequent modifications were taking breaks to rest eyes (68%), increasing water intake (68%), and using hot/cold compresses (52%). For these three, the biggest facilitators were as follows: belief that the modification works (27 to 37%), being recommended it (24 to 26%), and ease of use/performance (21 to 32%). Across modifications, the biggest barriers were difficulty of use (55%), lack of family/employer/social/community support (33%), and lack of awareness (32%). The data do not suggest discernible patterns of differences in barriers or facilitators by SES. CONCLUSIONS: Greater emphasis should be placed on explaining to patients how environmental and behavioral modifications might mitigate DED. Employers and members of patients' support systems should be guided regarding how best to support patients in managing DED symptoms.


Assuntos
Síndromes do Olho Seco , Adulto , Humanos , Feminino , Estados Unidos/epidemiologia , Síndromes do Olho Seco/terapia , Síndromes do Olho Seco/diagnóstico , Inquéritos e Questionários
19.
BMJ Open ; 14(2): e078727, 2024 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-38413161

RESUMO

INTRODUCTION: The lipid layer of the tear film is critical to maintaining the integrity of the tear film and absence in the tear film lipid layer (TFLL) is one of the main causes of evaporative dry eye (EDE) in dry eye disease patients, resulting in excessive evaporation (so-called hyperevaporative dry eye). This study protocol will be designed to assess and compare the effects of intense pulsed light (IPL), heated eye mask (HEM), vectored thermal pulsation system (VTPS) and eyelid massage device (EMD) for improving signs and symptoms of EDE. METHODS AND ANALYSIS: Patients with EDE will be randomly divided into IPL, HEM, VTPS and EMD groups and will be followed up for 6 weeks. The primary outcome measure will be non-invasive tear breakup time (NITBUT). The secondary outcome measures will include, TFLL score, meibomian gland quality and expressibility change from baseline conjunctivocorneal staining with fluorescein and lissamine, tear meniscus height, conjunctival hyperaemia (redness score) and ocular surface disease index questionnaire. Additionally, adverse events will be monitored and documented. ETHICS AND DISSEMINATION: Ethics approval number: IRB(2023)K019.01. The findings will be shared regardless of the effect's direction. TRIAL REGISTRATION NUMBER: NCT05923528.


Assuntos
Síndromes do Olho Seco , Glândulas Tarsais , Humanos , Síndromes do Olho Seco/terapia , Lágrimas , Fluoresceína , Lipídeos , Ensaios Clínicos Controlados Aleatórios como Assunto
20.
Transl Vis Sci Technol ; 13(1): 17, 2024 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-38236189

RESUMO

Purpose: We aimed to analyze the trends and patterns in outpatient health service treatment of dry eye disease (DED) using real-world data from Yinzhou District in China. Methods: The Yinzhou Health Information System is a comprehensive database including electronic medical records from 277 medical institutions representing over 1.64 million residents. We extracted outpatient records from January 1, 2017, to December 31, 2021, that included the first diagnosis of DED according to the International Classification of Diseases, 10th Revision (H04.101, H04.103, H11.104, H16.202, or H18.803). We analyzed the trends and patterns of DED outpatient visits using the Mann-Kendall trend test and Cochran-Armitage trend test. Results: We identified a total of 369,755 outpatient visits from 145,712 patients with DED of all ages (60.37% female; 54.10% 50 years or older). Primary medical institutions had the largest number of DED outpatient visits (42%), followed by tertiary medical institutions (35%). Over the 5-year period, the number of DED outpatient visits increased from 59,260 to 90,807 (53.23%). We observed significant consecutive annual proportion increases in females (from 61.09% to 62.01%; P = 0.001), patients 50 years or older (from 55.10% to 60.08%; P < 0.001), and outpatient visits in primary medical institutions (from 33.19% to 48.75%; P < 0.001). Conclusions: Our study found an increase in outpatient health service use for DED in Yinzhou from 2017 to 2021, with higher proportions and increases among females, patients 50 years or older, and primary medical institutions. Translational Relevance: The rapid growth in the prevalence of DED indicates high eye healthcare needs in patients.


Assuntos
Síndromes do Olho Seco , Pacientes Ambulatoriais , Humanos , Feminino , Masculino , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/epidemiologia , Síndromes do Olho Seco/terapia , Registros Eletrônicos de Saúde , Aceitação pelo Paciente de Cuidados de Saúde
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