Psychiatric Disorders and Dry Eye Disease - A Transdisciplinary Approach.

Dry eye disease (DED) is a multifactorial disorder representing one of the most common ocular morbidities and a significant public health problem. It often results in eye discomfort, visual disturbances and potential damage to the corneal surface affecting quality of life (QOL). In recent years, the relationship between DED and psychiatric disorders has been gaining attention. A number of epidemiological studies have reported a possible association between dry eye and psychiatric disorders showing that the subjective symptoms of dry eye can be affected not only by changes of the tear film and ocular surface but also psychological factors such as anxiety, depression, schizophrenia, post-traumatic stress disorder (PTSP) and subjective happiness. Apart from psychiatric disorders, psychiatric medications are also considered as risk factors for DED due to their influence on the tear film status. The incidence of ocular side effects increases rapidly with the use of polypharmacy, a very common form of treatment used in psychiatry. There is often inconsistency between signs and symptoms of DED, where symptoms often are more related to non-ocular conditions including psychiatric disorders than to tear film parameters. Consequently, in many cases DED may be considered as a psychiatric as well as ophthalmological problem. Psychiatrists and ophthalmologists need to be aware of the potential influence of psychiatric disorders and medications on tear film stability. In treatment of psychiatric patients, an integrative and transdisciplinary approach will result in better functioning and higher QOL.

Comparison of the Schein and Osdi Questionnaire as Indicator of Tear Film Stability in Patients with Schizophrenia.

BACKGROUND: The aim of this research was to determine which of two chosen questionnaires for subjective symptoms of dry eye (Ocular Surface Disease Index and Schein questionnaire) is more reliable in the assessment of dry eye in patients with schizophrenia. SUBJECTS AND METHODS: Our research included 80 patients (160 eyes) of both sexes with schizophrenia ranging between the age of 25 and 55 who have been taking one of three antipsychotic drugs namely clozapin, olanzapin, quetiapin for five or more years and were in a stable phase of the disease or remission. All participants were required to satisfy all included and excluded criteria. They all filled out the Schein and OSDI questionnaires for assessment of subjective symptoms. Tear break-up time test (TBUT) for objective evaluation of tear film stability was also performed. In order to determine the correlation between two subjective and objective tests we calculated Spearmans correlation coefficients. RESULTS: Obtained results of the correlation between OSDI questionnaire and TBUT test for the right eye was r=-0.73; p<0.01 and for the left eye was r=-0.72; p<0.01. Results of the correlation between Schein questionnaire and TBUT test for the right eye was r=-0.62; p<0.01 and for the left eye was r=-0.60; p<0.01. A detailed analysis shows that there are no statistically significant differences between the correlations. Both subjective questionnaires are statistically significantly and negatively related to the TBUT test, showing that an increase in the results on the OSDI and Schein's questionnaires led to the decreases in the results on the TBUT test. CONCLUSION: In patients with schizophrenia the OSDI and Schein questionnaires are equally reliable in the assessment of subjective symptoms of Dry eye disease. Considering that, OSDI is more common in clinical practice and includes questions regarding quality of life, it would have certain advantages and it is recommended for use in patients with schizophrenia.

Eye and pregnancy.

Hormonal, metabolic, hemodynamic, vascular and immunological changes that occur during pregnancy can affect the function of the eye. These changes are commonly transient, but in some cases they may be permanent and have consequences even after childbirth. The ocular effects of pregnancy may be physiological or pathological and can be associated with the development of new ocular pathology or may be modifications of pre-existing conditions. The most common physiological changes are alterations of corneal sensitivity and thickness, decreased tolerance to contact lenses, decreased intraocular pressure, hemeralopia and refractive errors. Possible posterior segment changes include worsening of diabetic retinopathy, central serous chorioretinopathy, increased risk of peripheral vitreochorioretinal dystrophies and retinal detachment. Thus, it should be kept in mind that the presence of any ocular symptoms in a pregnant woman requires ophthalmologic examination and further management.

Dry eye symptoms and signs in long-term contact lens wearers.

The aim of this study is to analyze the relationship between the self-reported symptoms and objective signs of dry eye disease in long-term rigid gas-permeable (RGP) or soft contact lens (SCL) wearers. The study included 32 eyes of Caucasian RGP and SCL wearers between the age of 21 and 42 who wore contact lenses continuously on a daily basis for more than 2 years. Symptoms were assessed according to the Ocular Surface Disease Index (OSDI). Clinical assessments included corneal fluorescein staining according to the National Eye Institute (NEI) staining grid, tear film break-up time (TBUT) and Schirmer II test. There were more male (62.5%) than female (37.5%) patients with a higher proportion of RGP wearers among males (40% vs. 17%) in the study. The mean duration of daily lens wear was 10.6 +/- 5.37 hours, with a significantly higher proportion of patients who wore their lenses for prolonged hours in the soft contact lens group (p < 0.05). There was a trend towards a higher proportion of self reported mild and moderate dry eye in females and soft contact lens wearers. No RGP wearer in this study had a NEI corneal staining grid score higher than 2. A moderate negative correlation was found between daily lens wear duration and TBUT (Pearson's coefficient, r = -0.47) as well as Schirmer II values and higher OSDI score, i.e. mild and moderate dry eye categories (r = -0.50). A strong positive correlation was found between and TBUT and Schirmer II values (r = 0.74). The results of the study emphasize the importance of early and accurate diagnosis of dry eye disease for successful long term RGP and SCL contact lens wear which will hopefully motivate future larger scale investigations on dry eye related problems in contact lens wearers.

The association between the HLA system and retinopathy development in patients with type 1 diabetes mellitus.

Duration of diabetes and chronic hyperglycemia are the most important risk factors in the pathogenesis of diabetic retinopathy (DR). However, there is increasing evidence suggesting that genetic factors may also contribute to its development. The aim of this study was to determine the role of the HLA system in the development of DR in patients with type 1 diabetes mellitus. Class II genes (DRB1, DQB1) were typed using the PCR-SSP method. Based on the fundus examination the patients were divided into two groups: one group with no or mild nonproliferative diabetic retinopathy (NPDR) and the other group with severe/very severe NPDR or proliferative diabetic retinopathy (PDR). The study confirms the influence of HLA genes in the development of DR in Croatian type 1 diabetic patients. In our patients, susceptibility to PDR appears to be primarily associated to DQB1*0201 with the relative risk, RR = 5.29 and DQB1*0302 (RR = 2.84). However, a strong positive correlation between DR and alles DRB1*0301 (RR = 2.12) and DRB1*0402 (RR = 3.01) was also found.

Refractive Changes Associated with Diabetes Mellitus.

BACKGROUND AND METHODS: Diabetes mellitus is the most prevalent endocrinedisease in developed countries. In people with diabetes in addition to visionloss caused by diabetic retinopathy transient visual disturbances may occurfrequently caused by refractive changes. These changes in refraction are associated with variations in blood glucose levelsbut the underlying mechanism is still not fully understood. A systematic reviewwith a comprehensive literature search was performed in order to clarify the underlyingmechanisms regarding the connection of glycaemic control and refractive shift. RESULTS: Some studies have shown that increasedblood sugar leads to a myopic shift whilst others demonstrated that this changeis in a hyperopic direction. Changes in visual acuity in patients with diabetescould be an indicator of inadequate metabolic control or even the first sign ofdiabetes mellitus. CONCLUSION: This reviewgives a brief overview of current research regarding potential mechanisms ofglycemic control influence on refractive error. The aim isto emphasizethe importance ofunderstanding the relationship ofblood glucose concentration and refractive changes as one of thecommon but overlooked diabetic complications.

Traumatic Optic Neuropathy - Case Report with Discussion on Diagnostic Procedures and Therapy.

Traumatic optic neuropathy (TON) is a serious vision threatening condition that can be caused by ocular or head trauma. Indirect damage to the optic nerve is the most common form of TON occurring in 0.5% to 5% of all closed head trauma cases. Although the degree of visual loss after indirect TON may vary, approximately 50% of all patients are left with 'light perception' or 'no light perception' vision, making TON a significant cause of permanent vision loss. We present a 47-year-old male patient with a history of right eye keratoconus following a motorcycle crash. Visual acuity was of 'counting fingers at 2 meters' on the right eye due to keratoconus and 'counting fingers at 1 meter' on the left eye as a consequence of trauma. The Octopus visual field showed diffuse re-duction in retinal sensitivity and the Ishihara color test indicated dysfunction of color perception on the left eye. Relative afferent pupillary defect was also present. Computed tomography revealed multifragmentary fracture of the frontal sinus and the roof of the left orbit without bone displacement. Based on the findings, conservative corticosteroid therapy without surgery was conducted. The patient responded well to treatment with complete ophthalmologic recovery.

Effect of pesticides on wound contraction.

Agricultural injuries are a complex surgical problem, especially because of frequently extensive skin lesions prone to infection and delayed healing. The aim of the study was to assess the local effect of pesticides, chemical substances widely used in agriculture, on wound healing, especially on wound contraction. Local effects of the combined herbicide composed of atrazine and dual (Primextra) and insecticide alphametrin (Fastac 10% SC) on primary wound healing were assessed in a bioassay performed in 18 New Zealand white rabbits. Relative size of the wound, measured on days 0, 1, 3, 6, 9 and 12 of wounding was analyzed by two-factor analysis of variance with repeat measurements. The activity of the process of restoration was assessed on histopathologic preparations obtained after the last measurement. Results of the study showed the final wound contraction to be smaller and the process of healing slower in the experimental groups of animals. Histopathology revealed defects of epithelialization, phasic delay in healing, infiltration with eosinophilic granulocytes, and decreased density of newly formed collagen. Pesticides were concluded to have adverse local effects on the wound, causing impairment of the mechanisms of healing.

Effectiveness of latanoprost (Xalatan) monotherapy in newly discovered and previously medicamentously treated primary open angle glaucoma patients.

We evaluated the effectiveness of latanoprost (Xalatan) monotherapy in primary open angle glaucoma (POAG). Latanoprost is a prostaglandin analogue, the pure 15(R) epimer of 13,14-dihydro-17-phenyl-18,19,20-trinor-PGF2alpha-isopropyl ester. As a prodrug it is being activated by enzymatic hydrolysis in the cornea after which it becomes active acid of latanoprost. Latanoprost is lowering the intraocular pressure (IOP) by increasing the uveoscleral outflow. In this study, latanoprost was used once daily as monotherapy what offers much better compliance for the patients than other combinations of drugs, preserving good IOP control. Based on the significant reduction of the IOP, measured on the day 60 of the trial (mean change in IOP was -5.1 mmHg, with 95% confidence interval in range from -5.6 to -4.5), it is concluded that use of latanoprost is advisable when calculating better IOP control, few side-effects and reductions in costs of potential surgical procedures.