Social Media Evaluation of Seasonal and Geographic Trends of Corneal Ulcers in the United States.

OBJECTIVES: The purpose of this study is to evaluate if social media and Google search data can identify seasonal and geographic trends in the incidence of corneal ulcers in the United States. METHODS: This is a case series of all corneal ulcer-related data collected from two major social media platforms and Google trends from US users between 2017 and 2021. Instagram and Twitter were searched for posts and hashtags related to "corneal ulcer." Web and image search volume of "corneal ulcer" were collected from Google trends ( https://trends.google.com ). Data were compared between seasons, defined by 3-month intervals, and chi-square tests were used to determine the statistical significance. RESULTS: One hundred and sixty-five individuals (79% female) and 164 individuals (79% female) posted personal new corneal ulcer diagnoses on Twitter and Instagram, respectively. Summer resulted in the highest number of both Twitter (34%, P =0.07) and Instagram (33%, P =0.68) posts. Summer was also the most popular season for Google web and image searches of "corneal ulcer" (search volume average of 58.4 and 41.2, P =0.74 and P =0.01, respectively, with 100 being peak popularity). Across all platforms, the South was the most represented (32% Twitter, 38% Instagram, 32% Google Web, and 33% Google Images). CONCLUSIONS: Our results indicate that social media and Google trends may reflect seasonal and geographic patterns of corneal ulcer incidence in the United States. However, further study with increased power is needed.

Current and future therapies for persistent corneal epithelial defects and neurotrophic keratopathy.

PURPOSE OF REVIEW: The corneal epithelium is a crucial barrier against pathogens, and when disrupted in the setting of certain underlying risk factors such as neurotrophic keratopathy (NK), may result in persistent epithelial defects (PEDs) of the cornea. Management is challenging and may require a variety of different approaches ranging from conservative medical therapy to surgical intervention. The purpose of this review is to provide an update on current and potential future therapeutic options for PEDs and NK. RECENT FINDINGS: Recent research has yielded promising results for numerous novel therapies aimed at treating PEDs. Many of these attempt to stimulate healing at the cellular level, via signaling of corneal epithelial differentiation, migration, and proliferation. Considerable advances have also been made regarding medical and surgical promotion of corneal re-innervation and restoration of corneal sensitivity to directly address the underlying NK condition. SUMMARY: Together with the current well established therapeutic options available for PEDs and NK, growing research on newer alternatives suggest increasing potential for both more effective and more convenient therapies for these difficult situations.

Cytomegalovirus Retinitis in a Patient Taking Tocilizumab: A Case Report.

Purpose: This report discusses a case of cytomegalovirus (CMV) retinitis in a patient taking tocilizumab for maintenance and remission of giant cell arteritis (GCA). Methods: A case report is presented. Results: A 78-year-old African American woman with no significant past medical history and an ocular history of primary open-angle glaucoma presented to the retina clinic with vitritis in the right eye. Four months earlier, she had been diagnosed with biopsy-proven GCA and prescribed 30 mg of prednisone daily and 162 mg tocilizumab subcutaneously weekly. Diagnostic vitrectomy with polymerase chain reaction of the vitreous was positive for CMV. Her retinitis gradually resolved after 3 months of treatment with valganciclovir, with no recurrence 4 months after discontinuing the valganciclovir. Conclusions: Physicians should be aware of the potential to develop CMV retinitis in the setting of tocilizumab use for GCA treatment.

Epidemiology of discordance between symptoms and signs of dry eye.

BACKGROUND/AIMS: The frequent lack of association between dry eye (DE) symptoms and signs leads to challenges in diagnosing and assessing the disease. METHODS: Participants underwent ocular surface examinations to evaluate signs of disease and completed questionnaires to assess ocular symptoms, psychological status and medication use. To assess nociceptive system integrity, quantitative sensory testing (QST), including vibratory and thermal threshold measures and temporal summation of pain were obtained at the forearm and forehead. Correlations between DE discordance score (degree of discrepancy between symptom severity and DE signs) and patient characteristics were determined. Higher discordance scores indicated more symptoms than signs. RESULTS: 326 patients participated (mean age: 62 years; SD: 10 years; 92% men). Age was negatively correlated with DE discordance score (Pearson r=-0.30, p<0.0005), while mental health indices were positively correlated. Chronic pain elsewhere in the body (ie, non-ocular pain conditions) and intensity ratings of prolonged aftersensations of pain evoked by noxious hot and cold stimuli were also significantly correlated with DE discordance score. Multiple linear regression demonstrated that post-traumatic stress disorder and non-ocular pain intensity were important predictors of DE discordance score, Dry Eye Questionnaire-5 and Ocular Surface Disease Index and that DE discordance was also sensitive to QST as well. CONCLUSIONS: The present study provides evidence that the degree of discordance between DE symptom report and measurable signs of ocular surface disease is associated with comorbidities related to clinical pain and to hyperalgesia as demonstrated with QST. Understanding the epidemiology of DE discordance can aid in interpreting the DE exam and individualising treatment.

Longitudinal Examination of Frequency of and Risk Factors for Severe Dry Eye Symptoms in US Veterans.

Importance: Dry eye syndrome is a common condition that affects millions of individuals. Many cross-sectional studies have evaluated risk factors for dry eye severity, but few have assessed risk factors or symptom progression over time. Objectives: To assess symptom progression in dry eye syndrome and determine risk factors associated with severe symptoms at 1 year. Design, Setting, and Participants: A longitudinal study was conducted from October 1, 2013, to April 30, 2015, among patients at the Miami Veterans Affairs Hospital with a wide variety of dry eye symptoms and signs (ranging from none to severe). Main Outcomes and Measures: Change in dry eye symptom severity during 1 year, as assessed by responses to dry eye symptom questionnaires administered at the initial visit and 1 year later, as well as baseline risk factor analysis for severe dry eye symptoms at 1 year, defined as a Dry Eye Questionnaire 5 score of 12 or more. Results: Of the 120 patients (mean [SD] age, 64 [11] years; 109 male and 11 female), 26 of 58 (44.8%) with either no symptoms or mild or moderate symptoms at baseline progressed to more severe symptoms at 1 year, while 46 of 62 patients (74.2%) with severe symptoms at baseline reported that severe symptoms persisted at 1 year. Baseline ocular risk factors for severe dry eye symptoms at 1 year included more severe dry eye symptoms, ocular pain, and neuropathic pain-like ocular symptoms. Nonocular risk factors included sleep disturbances (eg, sleep apnea and insomnia), mental health status (eg, posttraumatic stress disorder and depression), nonocular pain, and medications (eg, anxiolytics and analgesics). In a multivariable analysis, the most significant risk factors were sleep apnea (odds ratio [OR], 3.80; 95% CI, 1.00-14.49; P = .05), Dry Eye Questionnaire 5 score (OR, 1.15; 95% CI, 1.02-1.30; P = .02), and posttraumatic stress disorder score (OR, 1.04; 95% CI, 1.01-1.08; P = .02). Conclusions and Relevance: Patients with severe dry eye symptoms and ocular pain at baseline were more likely to have persistent severe dry eye symptoms on 1-year follow-up. Furthermore, nonocular risk factors that have been associated with dry eye cross-sectionally, such as psychiatric comorbidities and nonocular pain, were also associated with severe dry eye symptoms at 1 year. Although this cohort was limited to US veterans, which may not be generalizable to other populations, our results suggest that pain perception and severity are important when evaluating and managing dry eye.