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PURPOSE: To evaluate the diagnostic performance of corneal and conjunctival staining, and lid wiper epitheliopathy (LWE) in detecting dry eye disease, as defined by the global consensus Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) criteria. METHODS: A total of 2066 community residents (1285 females; mean ± SD age, 40 ± 19 years) were recruited in an investigator-masked, prospective registry-based, diagnostic accuracy study. Dry eye symptomology and ocular surface parameters were assessed in a single clinical session. The Sjögren's International Collaborative Clinical Alliance (SICCA) corneal and conjunctival staining scoring and Korb lid wiper epitheliopathy (LWE) grading were evaluated by an independent masked assessor. RESULTS: Overall, 807 (39 %) participants fulfilled the TFOS DEWS II criteria for dry eye disease, of which 178 (9 %) participants were classified as moderate-to-severe disease. The discriminative abilities of superior and inferior LWE (C-statistics, 0.724 and 0.712, respectively) were greater than corneal and conjunctival staining (C-statistics, 0.573 and 0.627, respectively). The Youden-optimal diagnostic cut-offs for the SICCA corneal and conjunctival staining scores were both ≥1, and the optimal thresholds for the Korb superior and inferior LWE grades were both ≥1. LWE was more commonly detected in both mild-to-moderate and moderate-to-severe dry eye disease, and demonstrated more consistent correlation with other ocular surface parameters across a broader range of disease severity. CONCLUSIONS: LWE demonstrates superior diagnostic performance relative to corneal and conjunctival staining. These findings would support the routine incorporation of LWE evaluation as part of the diagnostic workup of dry eye disease.
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PURPOSE: To evaluate the prognostic ability of non-contact esthesiometry corneal and lid margin sensitivity measurements in detecting symptoms and signs of dry eye disease, as defined by the global consensus TFOS DEWS II criteria. METHODS: A total of 87 community residents (58 females; mean ± SD age, 53 ± 16 years) were recruited in an investigator-masked, prospective, prognostic accuracy study. Dry eye symptomology, tear film parameters, and ocular surface characteristics were evaluated in a single clinical session, and non-contact esthesiometry corneal and lid margin sensitivity measurements performed by an independent masked assessor. RESULTS: Overall, 49 (56%) participants fulfilled the TFOS DEWS II criteria for dry eye disease, while 57 (66%) exhibited clinical symptoms, and 67 (77%) had positive signs. The prognostic abilities of corneal and lid margin sensitivity measurements were significantly greater than chance for the detection dry eye signs (both p ≤ 0.03), but not for symptoms or overall disease diagnosis (all p > 0.10). The Youden-optimal prognostic cut-offs for corneal and lid margin sensitivity thresholds were both ≥0.8 mbar for the detection of clinical dry eye signs. Lid margin sensitivity demonstrated marginally higher predictive performance than corneal sensitivity (C-statistic, 0.688 versus 0.658), and was significantly correlated with tear film stability, corneal, conjunctival and lid wiper staining (all p < 0.05). CONCLUSIONS: Corneal and lid margin sensitivity demonstrated moderate prognostic utility for detecting clinical dry eye signs. Future research is warranted to investigate the utility of incorporating non-contact esthesiometry in the workup for dry eye disease and neurotrophic keratopathy.
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Córnea , Síndromes de Ojo Seco , Lágrimas , Humanos , Estudios Prospectivos , Síndromes de Ojo Seco/diagnóstico , Síndromes de Ojo Seco/fisiopatología , Síndromes de Ojo Seco/metabolismo , Femenino , Masculino , Persona de Mediana Edad , Pronóstico , Córnea/patología , Lágrimas/fisiología , Lágrimas/metabolismo , Párpados/fisiopatología , Párpados/patología , Adulto , Anciano , Valor Predictivo de las PruebasRESUMEN
PURPOSE: To assess the six-month therapeutic profiles of lipid and non-lipid-based artificial tear supplements in managing dry eye disease (DED). METHODS: Ninety-nine participants fulfilling the TFOS DEWS II diagnostic criteria for DED (64% females; mean ± SD age, 44 ± 16 years) were enrolled in a prospective, multicentre, double-masked, parallel group, randomised controlled trial. Participants instilled lipid-based nanoemulsion drops or non-lipid-based aqueous drops for six months, at least four times daily. Symptomology, tear film and ocular surface characteristics were assessed at Days 0, 30, 60, 90, 120, 150 and 180. RESULTS: Sustained reductions in OSDI, DEQ-5, and SANDE symptom scores from baseline were observed from Day 30 onwards in both groups (all p < 0.05) and decreased superior lid wiper epitheliopathy grades from Day 60 onwards (all p ≤ 0.01). Improvements in non-invasive tear film breakup time, and sodium fluorescein and lissamine green staining scores followed from Day 120 onwards in both groups (all p < 0.05). Tear lipid layer grades increased from Day 90 onwards only with the lipid-based drops, and with significantly greater improvement in those with suboptimal lipid layer thickness at baseline (grade ≤3; p = 0.02). By Day 180, 19% of participants no longer fulfilled the diagnostic criteria for DED. CONCLUSIONS: Over a six-month treatment period, improvements in dry eye symptomology preceded tear film and ocular surface changes with regular use of both lipid and non-lipid-based artificial tear supplements. Both formulations addressed most mild-to-moderate forms of aqueous deficient and evaporative DED, while evaporative cases benefitted preferentially from lipid-based supplementation. This represents a first step towards mapping DED therapeutic strategies according to disease subtype and severity.
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Síndromes de Ojo Seco , Gotas Lubricantes para Ojos , Adulto , Suplementos Dietéticos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , LágrimasRESUMEN
PURPOSE: To assess long-term cumulative treatment effects of intense pulsed light (IPL) therapy in meibomian gland dysfunction (MGD). METHODS: Eighty-seven symptomatic participants (58 female, mean ± SD age, 53 ± 16 years) with clinical signs of MGD were enrolled in a prospective, double-masked, parallel-group, randomised, placebo-controlled trial. Participants were randomised to receive either four or five homogeneously sequenced light pulses or placebo treatment to both eyes, (E-Eye Intense Regulated Pulsed Light, E-Swin, France). Visual acuity, dry eye symptomology, tear film parameters, and ocular surface characteristics were assessed immediately before treatment on days 0, 15, 45, 75, and four weeks after treatment course completion on day 105. Inflammatory and goblet cell function marker expression, and eyelid swab microbiology cultures were evaluated at baseline and day 105. RESULTS: Significant decreases in OSDI, SPEED, and SANDE symptomology scores, and meibomian gland capping, accompanied by increased tear film lipid layer thickness, and inhibited Corynebacterium macginleyi growth were observed in both treatment groups (all p < 0.05). Sustained clinical improvements occurred in both treatment groups from day 75, although significant changes from day 45, in lipid layer quality, meibomian gland capping, OSDI and SANDE symptomology, were limited to the five-flash group (all p < 0.05). CONCLUSIONS: IPL therapy effected significant improvements in dry eye symptomology, tear film lipid layer thickness, and meibomian gland capping in MGD patients. Five-flash IPL treatment showed superior clinical efficacy to four-flash, and an initial course of at least four treatments is suggested to allow for establishment of sustained cumulative therapeutic benefits prior to evaluation of overall treatment efficacy. TRIAL REGISTRATION NUMBER: ACTRN12616000667415.
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Síndromes de Ojo Seco , Tratamiento de Luz Pulsada Intensa , Disfunción de la Glándula de Meibomio , Adulto , Anciano , Corynebacterium , Síndromes de Ojo Seco/terapia , Enfermedades de los Párpados/terapia , Femenino , Francia , Humanos , Masculino , Glándulas Tarsales , Persona de Mediana Edad , Estudios Prospectivos , Lágrimas , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the discriminative ability of a rapid non-invasive dry eye assessment algorithm (global evaluation component: SANDE questionnaire, and non-invasive tear film breakup time; subtype classification testing component: tear film lipid layer grade, and tear meniscus height) in detecting dry eye disease, as defined by the TFOS DEWS II diagnostic criteria. METHODS: Two hundred and thirty-five participants (77 male, 158 female), with a mean ± SD age of 43 ± 17 years, were recruited into a prospective diagnostic accuracy study. OSDI, DEQ-5, and SANDE dry eye symptomology scores; non-invasive tear film breakup time; absolute and inter-ocular differences in tear osmolarity; corneal, conjunctival, and lid margin staining scores; tear film lipid layer, meibum expressibility, meibomian gland orifice plugging, and eyelid margin telangiectasia grades; and tear meniscus height were evaluated in a single clinical session. RESULTS: The areas under the ROC curves exceeded 0.80 for all individual components of the rapid non-invasive dry eye assessment algorithm, and the discriminative abilities were significantly greater than chance (all p < 0.001). At the Youden optimal diagnostic thresholds for the global evaluation component of the rapid non-invasive assessment algorithm (SANDE score ≥30, non-invasive tear film break-up time <10 s), the overall sensitivity was 86%, specificity 94%, positive likelihood ratio 15.0, and negative likelihood ratio 0.15. CONCLUSIONS: The abridged non-invasive dry eye assessment algorithm may be a useful rapid screening instrument for the full TFOS DEWS II diagnostic test battery, of particular benefit in resource or time-constrained settings.
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Algoritmos , Técnicas de Diagnóstico Oftalmológico , Síndromes de Ojo Seco/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Concentración Osmolar , Estudios Prospectivos , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Encuestas y Cuestionarios , Lágrimas/química , Adulto JovenAsunto(s)
Colorantes/administración & dosificación , Córnea/patología , Síndromes de Ojo Seco/diagnóstico , Células Epiteliales/patología , Párpados/patología , Colorantes Fluorescentes/administración & dosificación , Coloración y Etiquetado , Adulto , Femenino , Fluoresceína/administración & dosificación , Humanos , Colorantes Verde de Lisamina/administración & dosificación , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Encuestas y CuestionariosAsunto(s)
Síndromes de Ojo Seco/diagnóstico , Encuestas y Cuestionarios , Adulto , Área Bajo la Curva , Femenino , Humanos , Masculino , Persona de Mediana Edad , Concentración Osmolar , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Evaluación de Síntomas , Lágrimas/química , Adulto JovenRESUMEN
PURPOSE: To investigate the ethnic differences in tear film quality, ocular surface parameters, and dry eye symptomology between co-located Asian and Caucasian populations. METHODS: Two hundred and six participants (103 East Asian and 103 Caucasian) were recruited in an age and gender-matched cross-sectional study. Dry eye symptomology, ocular surface parameters, and tear film quality were evaluated for each participant within a single clinical session. RESULTS: The mean⯱â¯SD age of the 206 participants (82 male, 124 female) was 45⯱â¯16 years. Overall, a greater proportion of Asian participants were symptomatic of dry eye and fulfilled the TFOS DEWS II dry eye diagnostic criteria than Caucasian participants (74% versus 51%, pâ¯=â¯0.002), with an odds ratio (95% CI) of 2.7 (1.5-4.8) times. Poorer OSDI scores, tear film stability, lipid layer quality, tear osmolarity, lid wiper epitheliopathy, meibomian gland dropout, and expressed meibum quality were observed in the Asian group (all pâ¯<â¯0.05). A significantly higher proportion of participants exhibited incomplete blinking in the Asian group than the Caucasian group (81% versus 45%, pâ¯<â¯0.001). CONCLUSIONS: Asian participants exhibited more severe dry eye signs and symptoms than Caucasian participants. The poorer meibomian gland function and higher degree of incomplete blinking observed among Asian participants may potentially contribute towards the ethnic predisposition towards dry eye development.
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Pueblo Asiatico , Síndromes de Ojo Seco/etnología , Glándulas Tarsales/metabolismo , Lágrimas/química , Migrantes , Población Blanca , Adulto , Anciano , Anciano de 80 o más Años , Parpadeo/fisiología , Estudios Transversales , Síndromes de Ojo Seco/diagnóstico , Síndromes de Ojo Seco/metabolismo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Glándulas Tarsales/diagnóstico por imagen , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Concentración Osmolar , Prevalencia , Estudios RetrospectivosRESUMEN
PURPOSE: To compare the in vitro anti-demodectic activity of four commercially available dedicated eyelid cleansers (Cliradex® towelette cleanser, Oust™ Demodex® cleanser, Blephadex™ eyelid foam, TheraTears® SteriLid® eyelid cleanser), tea tree oil, undiluted terpinen-4-ol and linalool; and to assess the terpinen-4-ol content of the commercial cleansers and tea tree oil. METHODS: In vitro anti-demodectic efficacy assessment: 93 viable Demodex mites were acquired from the epilated eyelashes of 10 participants, and were randomised to application with one of the four eyelid cleansers, 100% and 50% tea tree oil, undiluted terpinen-4-ol and linalool, or no treatment. Following treatment application, mite viability was assessed for 300 min, based on limb/body movement and/or the development of a crenated/translucent appearance. Kaplan-Meier survival analysis was then performed. MASS SPECTROMETRY ANALYSIS: The absolute concentration of terpinen-4-ol and the relative abundance of linalool in the four eyelid cleansers and tea tree oil were determined. RESULTS: In vitro anti-demodectic efficacy assessment: No significant differences were observed between undiluted tea tree oil, terpinen-4-ol and linalool (all p > 0.05). Although all commercial eyelid cleansers effected lower mite survival probabilities than the untreated group, Cliradex® was the only eyelid cleanser that demonstrated comparable antiparastic activity to 50% tea tree oil (p = 0.36). MASS SPECTROMETRY ANALYSIS: Among the four eyelid cleansers, Cliradex® contained the highest concentration of terpinen-4-ol, while linalool was present in TheraTears® SteriLid® only. CONCLUSIONS: Of the four commercial eyelid cleansers, Cliradex® demonstrated the highest levels of in vitro anti-demodectic activity and terpinen-4-ol content. Undiluted linalool and terpenin-4-ol showed comparable antiparasitic efficacy, and the use of linalool in the management of demodectic blepharitis warrants further investigation.
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Blefaritis/tratamiento farmacológico , Infecciones Parasitarias del Ojo/tratamiento farmacológico , Párpados/efectos de los fármacos , Ácaros , Terpenos/farmacología , Administración Tópica , Adulto , Anciano , Animales , Infecciones Parasitarias del Ojo/parasitología , Pestañas/efectos de los fármacos , Pestañas/parasitología , Párpados/parasitología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The aim of this cross-sectional survey was to evaluate the self-reported clinical practices of New Zealand optometrists and ophthalmologists with respect to the diagnosis and management of dry eye disease. It also sought to compare these behaviours with the current research evidence base. METHODS: An anonymous survey was distributed electronically to New Zealand eye care clinicians (optometrists n = 614, ophthalmologists n = 113) to determine practitioner interest in dry eye disease, practice experience, practice modality, preferred diagnostic and management strategies, and information used to guide patient care. RESULTS: Respondents from both professions (response rates, optometrists: 26%, ophthalmologists: 26%) demonstrated similarly strong knowledge of tear film assessment. Ninety percent of respondents ranked patient symptoms and meibomian gland evaluation as the most valuable and common diagnostic approaches. Conversely, standardised grading scales and validated dry eye questionnaires were infrequently adopted. Both professions tailored dry eye management according to severity, indicating eyelid hygiene and non-preserved lubricants as mainstay therapies. Ophthalmologists prescribed systemic tetracyclines significantly more often than optometrists for moderate (48% vs 11%) and severe (72% vs 32%) dry eye (p < 0.05). Continuing education conferences were acknowledged as the primary information source used to guide dry eye management practices by both professions. CONCLUSIONS: Consistent with evidence-based guidelines, New Zealand eye care professionals combine subjective and objective techniques to diagnose and stratify dry eye management according to disease severity. There is potential to improve dissemination of research evidence into clinical practice, with continuing education via professional conferences the favoured mode of delivery.