Quantum Molecular Resonance Electrical Stimulation as a Beneficial and Safe Treatment for Multifactorial Dry Eye Disease.

INTRODUCTION: To assess the clinical benefits obtained with transcutaneous low-power, high-frequency quantum molecular resonance (QMR) electrotherapy in a group of multifactorial dry eye patients. METHODS: Fifty-one patients (total of 102 eyes) with dry eye symptoms were enrolled in the study. Included clinical conditions were meibomian gland dysfunction, glaucoma, cataract surgery within the past six months, and autoimmune disease-related superficial punctuate keratitis. The QMR treatment was administered using the Rexon-Eye device (Resono Ophthalmic, Sandrigo, Italy) for four consecutive weeks, with one 20-minute treatment session per week. The measured ocular parameters included non-invasive tear break-up time (NIBUT), corneal interferometry, lower eyelid meibography, and tear meniscus height, all measured at baseline, at the end of treatment, and two months after the end of treatment. The Ocular Surface Disease Index (OSDI) questionnaire was gathered at the same time. The study has received approval from our institution's ethics committee. RESULTS: At the end of treatment, interferometry, tear meniscus height, and OSDI score improved at a statistically significant level. No statistically significant change was observed in NIBUT or meibography. At two months after the end of treatment, all parameters showed a statistically significant improvement, namely NIBUT, meibography, interferometry, tear meniscus, and OSDI score. No adverse events or side effects were reported. CONCLUSIONS: The QMR electrotherapy by the Rexon-Eye device shows statistically significant improvement of dry eye clinical signs and symptoms with a duration of at least two months.

Efficacy of Portable 445 nm Laser Versus Intense Pulsed Light Treatment for Dry Eye: A Prospective Randomized Pilot Study.

Objective: The aim of the study is to evaluate the efficacy of intense pulsed light (IPL) compared with a portable 445 nm laser device in the treatment of dry eye. Our hypothesis was that IPL and 445 nm laser can provide equal reduction of symptoms for patients with dry eye disease. Methods: Participants provided written informed consent as per the Helsinki declaration before a baseline testing (visit 1). All participants completed four in-clinic study visits and one telephone call over the course of ∼4 months. The patients were evaluated at baseline and received the first treatment (visit 1) at the same visit. Thereafter, treatment was repeated every 2 weeks until four treatments had been administered (visits 2-4). The evaluation of dry eye included the following tests for both eyes: tear break-up time (TBUT), in seconds, taken in three measurements using a timer; corneal fluorescein staining (CFS); and lissamine green (grading 0-5 as per Oxford grading system). Other tests included visual acuity and the measurement of intraocular pressure. A full medical history and current ocular and systemic medications were obtained. All participants completed the Dry Eye Questionnaire (DEQ5), as per DEWS II, at each visit, as well as during the final telephone assessment ∼2 months after their fourth treatment. Results: Twenty-eight eyes of 14 patients were included in the study. The eyes were randomized with 14 eyes in each group receiving either 445 nm laser or IPL. The group included 10 female and 4 male participants with average age of 64.8 years (standard deviation 13.9). The primary outcome measures of TBUT, CFS, and the DEQ5 questionnaire were statistically significantly improved. TBUT IPL versus 445 nm laser p = 0.0097 versus 0.0115, CFS IPL versus 445 nm laser p = 0.0027 versus 0.0003. The questionnaire did not discriminate between the two methods but also showed highly statistically significant improvement p = 0.0001. Conclusions: The portable 445 nm laser and IPL were equally effective in the treatment of dry eye in this cohort. No significant adverse events were noted in either treatment group. K-Laser Blue® can be considered as a substitute for IPL treatment for dry eye.

The Association Between Risk Factors for Metabolic Syndrome and Meibomian Gland Disease in a Dry Eye Cohort.

PURPOSE: Risk factors for metabolic syndrome include abdominal obesity, insulin resistance, hypertension, high triglycerides and/or low high-density lipoprotein cholesterol, and hyperglycemia. Risk factors for metabolic syndrome have been associated with dry eye disease; however, their association with meibomian gland disease (MGD), a subtype of dry eye, is unclear. In the present study, we investigated risk factors for metabolic syndrome in a dry eye cohort with and without MGD. METHODS: This retrospective case-control study evaluated electronic medical records at a major urban outpatient medical center to identify patients with a known diagnosis of dry eye disease with and without MGD. Males and females were matched for age, smoking status, race, ethnicity, and body mass index (BMI). Patient demographics, anthropometric measurements, medical history, clinical findings, and serologies were analyzed. A diagnosis of MGD was based on clinical signs noted in the medical record. RESULTS: MGD was not associated with BMI, smoking, type 2 diabetes mellitus, hypertension or hyperlipidemia in this dry eye cohort. MGD was associated with male sex and increasing age. While increasing age was weakly correlated with decreased low density lipoprotein cholesterol and non-high density lipoprotein cholesterol, serum lipid levels were not associated with MGD. CONCLUSION: Importantly, we found that risk factors for metabolic syndrome are not specifically associated with an increase in MGD when compared to non-MGD dry eye subjects. While risk factors for metabolic syndrome are associated with dry eye disease, they likely reflect a chronic systemic state of low-grade inflammation that negatively impacts the function of both lacrimal and meibomian glands.

Real-Time Video Microscopy of In Vitro Demodex Death by Intense Pulsed Light.

Objective: To directly observe the in vitro real-time effects of intense pulsed light (IPL) on a Demodex mite extracted from an eyelash of a patient with ocular rosacea. Background: Demodex is a risk factor in the pathogenesis of oculofacial rosacea, meibomian gland dysfunction (MGD), and dry eye disease (DED). Recent studies suggested IPL to control or eradicate Demodex organisms in the periocular area. Despite encouraging reports, the direct effect of IPL on Demodex is not well understood. Methods: An eyelash infested with Demodex was epilated from a 62-year-old female patient with oculofacial rosacea. Following isolation and adherence of a mite onto a microscope slide, real-time video microscopy was used to capture live images of the organism before, during, and after administration of IPL pulses. IPL pulses were delivered with the M22 IPL (Lumenis), with IPL settings used for treatment of DED due to MGD (the "Toyos protocol"). A noncontact digital laser infrared thermometer was used to measure the temperature of the slide. Results: Before the IPL pulses, legs of the Demodex mite spontaneously moved in a repetitive and semicircular motion. During administration of IPL, spontaneous movements of the legs continued. Immediately after administration of five IPL pulses, the temperature of the slide increased from room temperature to 49°C. Immediately afterward, the Demodex mite became completely immobilized. The legs appeared retracted, smoother, less corrugated, bulkier, and less well-defined. Movement of the Demodex mite was not observed at the hourly inspections for 5 h and after 24 h following the application of IPL pulses. Conclusions: Our video directly demonstrates the effect of IPL on a live Demodex mite extracted from a freshly epilated eyelash. The results suggest that IPL application with settings identical to those used for treatment of DED due to MGD causes a complete destruction of the organism.

Treatment of ocular rosacea.

Although rosacea is a common entity with significant cosmetic, socioeconomic, and vision-threatening impacts, this disorder remains incurable. Furthermore, until quite recently many of the therapeutic options for rosacea had not been assessed through rigorous clinical testing with meaningful outcome measures. Nonetheless, new medical and surgical interventions that have been validated in well-designed trials hold the promise of treating rosacea more effectively. Furthermore, recent enhancements in our understanding of the cellular and molecular biology offer highly translational insights that will hopefully lead to the development of new treatment options for rosacea. We review the evidence for these therapies and discuss new scientific findings that can be exploited for new therapeutic interventions.

Sebaceous lipids are essential for water repulsion, protection against UVB-induced apoptosis and ocular integrity in mice.

Sebocytes, which are characterized by lipid accumulation that leads to cell disruption, can be found in hair follicle-associated sebaceous glands (SGs) or in free SGs such as the Meibomian glands in the eyelids. Because genetic tools that allow targeting of sebocytes while maintaining intact epidermal lipids are lacking, the relevance of sebaceous lipids in health and disease remains poorly understood. Using Scd3, which is expressed exclusively in mature sebocytes, we established a mouse line with sebocyte-specific expression of Cre recombinase. Both RT-PCR analysis and crossing into Rosa26-lacZ reporter mice and Kras(G12D) mice confirmed Cre activity specifically in SGs, with no activity in other skin compartments. Importantly, loss of SCD3 function did not cause detectable phenotypical alterations, endorsing the usefulness of Scd3-Cre mice for further functional studies. Scd3-Cre-induced, diphtheria chain A toxin-mediated depletion of sebaceous lipids resulted in impaired water repulsion and thermoregulation, increased rates of UVB-induced epidermal apoptosis and caused a severe pathology of the ocular surface resembling Meibomian gland dysfunction. This novel mouse line will be useful for further investigating the roles of sebaceous lipids in skin and eye integrity.

S100A proteins as molecular targets in the ocular surface inflammatory diseases.

The S100 proteins are calcium-binding proteins that are exclusively expressed in vertebrates, where they interact with enzymes, cytoskeletal proteins, receptors, transcription factors, and nucleic acids to regulate proliferation, differentiation, apoptosis, inflammation, cell migration, energy metabolism, and Ca(2+) homeostasis. In this review, we focus on the S100A8 and S100A9 members of the family that are involved in the regulation of neutrophil chemotaxis and inflammation related to ocular surface diseases such as dry eye, meibomian gland dysfunction, pterygium, and corneal neovascularization. In our previous studies, we have found that the levels of S100A8 and S100A9 were elevated in these inflammatory ocular diseases. For instance, S100A8 and A9 were found to be upregulated in pterygium tissues at both transcript and protein levels. These findings are consistent with the role of S100A8 and S100A9 proteins in activating the innate immune system in the eye via Toll-like receptors (TLRs) and altering the immune tolerance of the eye-associated lymphoid system. Recently, use of S100A8-targeting antibody has shown promising results in targeting corneal neovascularization. Injection of S100A8 has been shown to inhibit eosinophilic infiltration and thus may have potential therapeutic implications in allergic diseases.