Wednesday, May 20, 2009


Oh boy, oh boy, I really DO have hope of getting caught up! I'm almost to the end of March. Just two months to go, sigh.

Meantime, I'll reward myself by indulging in a quickie update of what's happening on the Petris farmstead.

Our 19 Australorps are continuing to grow, though not quite as fast as when we accidentally had them on the 24% protein organic turkey starter mash! I have a beautiful brand new coop that my sister made. It's a "chicken tractor" on steroids: four by ten feet, with the coop 4x4 on top of one end of the run and nice big wheels. I need to lower the wheels a bit though because our ground is pretty uneven and I'm having trouble moving it. Just two days ago we finally separated the boys from the girls. We recently got 4 older laying australorps (too impatient to wait for our girls to start laying in late July)... and judging from the missing back feathers, I'd say our boys are liking older women. So I've beefed up a run I built earlier and moved all 10 teenage boys into it, leaving the 9 teenage girls and the 4 older gals in the main coop.

Oh, and the boys' voices are changing.... I hope they get big enough to 'process' before we start getting a full-blown chorus in the mornings.

The garden is coming along, somewhat slowed by too much rain to finish up my digging.

Potato plants are visible, though I'm afraid our cats dug up some of them (replacing them with their own kind deposits).
Carrots not doing much.
Radishes of course doing great.
Beets, onions, cucumbers, okra and squash went in too recently to know
Transplanted tomatoes, peppers and eggplants doing nicely. I've still got about 20 or so tomato plants in the greenhouse that I need to dig up some space for.
Loads of peas, broccoli and leeks all doing nicely.
More lettuce and spinach on the way.

Flowers on the strawberries.
Applies all blossoming now, pears and plums all done blossoming.
Misc. berry shrubs blossoming (lingonberry, blueberryx2, and what's the other one?)

Got all my herb garden laid out and planted/transplanted - I'd started about half of them in the greenhouse.

I've got all the blackberry roots dug out now around the buildings, except for one small patch. That was one of the hardest things I've ever done. Great for the arms, lousy on the back (back to the chiro).

I also started doing a little pruning. I haven't let myself do much because I'm afraid I'll get carried away and want to do nothing else... there are a ton of old fruit trees that desperately need work. But I shaped up one tree by the greenhouse that was looking particularly sad - what a joy to get the dead wood off and let the beautiful bones of that tree show through.

Well, there's lots more but that's enough for now. For a total rookie doing this about an hour a day for relaxation, I'm feeling awfully proud of my little gardens... hopefully we will have veggies coming out of our ears in the summer and I can put my Christmas-present pressure canner to good use.

Abstract: Confocal microscopy and dry eye

Ears pricked. I want to see more on this. Of course no matter how much info they can get from confocal it's going to be limited by availability but it should at least be good learning grounds.

Vestn Oftalmol. 2009 Jan-Feb;125(1):52-4.
[Potentialities of confocal microscopy in the evaluation of the cornea in the dry eye syndrome]
[Article in Russian]
[No authors listed]

The purpose of the investigation was to study the potentialities of confocal microscopy in the evaluation of the corneal status in the dry eye syndrome (DES). Fifty-two patients (104 eyes) were examined and divided into 2 groups: 1) 32 patients with the verified diagnosis of DES of various etiology; 2) 20 healthy volunteers (a control group). Corneal confocal microscopy was made on a Confoscan-4 device (Nidek, Japan). The investigations ascertained that there was a direct relationship between the functional parameters, the degree of severity, rather than the etiology of DES and the changes in the corneal morphological pattern. Overall, corneal changes in patients with DES primarily involved the anterior epithelium and anterior stromal layers. The non-invasive and high informative value of confocal microscopy made it possible to study at the fundamentally new level the corneal structure that is always involved in the pathological process in DES.

Drug news: SarCode SAR1118

New to me. Very early stages but I've added it to the clinicals roundup.

SARcode Announces Results of Phase 1 Trial of SAR 1118 Ophthalmic Solution in Healthy Adult Subjects
(March 30 press release)

SAN FRANCISCO--(BUSINESS WIRE)--SARcode Corporation announced today the results of its Phase 1 randomized, double-masked, placebo-controlled trial of the safety, tolerability, and pharmacokinetics of single- and multiple-escalating doses of SAR 1118 Ophthalmic Solution in healthy volunteers. SAR 1118 was well-tolerated and demonstrated a favorable safety profile when administered by topical ocular instillation up to three times daily at dose strengths of up to 5%....

Based upon these results, SARcode has selected dose strengths and dose schedules for its Phase 2 programs in allergic conjunctivitis and dry eye (keratoconjunctivitis sicca). Data for these programs is expected in 2009. With emerging data in preclinical animal models, SARcode may choose to pursue other ocular inflammatory conditions including diabetic retinopathy and age-related macular degeneration in the near future.

Drug news: Rebamipide still alive and kicking?

After Novartis killed it and Otsuka announced its partnership with Acucela I haven't seen anything at all. In March in an unrelated Acucela staffing press release they mentioned it is currently in Phase III.

Abstract: Age & epiphora (tear overflow)

Ophthalmologe. 2009 Mar;106(3):229-34.
[Epiphora. Age-related changes of the ocular surface, eyelid function and the efferent tear ducts][Article in German]
Schaudig U, Meyer-Rüsenberg HW.
Augenklinik, Asklepios Klinikum Barmbek, Hamburg, Deutschland.

Symptomatic epiphora is predominantly present in the elderly It is caused either by hypersecretion in ocular surface disorders, mostly as a reflex, by decreased tear transport and mechanical stenosis of the efferent tear ducts. These three different causes have to be taken into consideration by differential diagnosis and lead to different forms of therapy. Ocular surface disorders (wet dry eye) are treated by topical medication, lid malfunctioning and dacryostenosis by surgery and possibly by topical adjuvant anti-inflammatory medication. The present article reviews the current concepts on epiphora as an age-associated symptom and the epidemiology and pathogenesis of dacryostenosis and dacryolithiasis.

Abstract: Tear meniscus & contacts

Invest Ophthalmol Vis Sci. 2009 Mar 11.
Lower volumes of tear menisci are associated with dry eye symptoms in contact lens wearers.
Chen Q, Wang J, Shen M, Cai C, Li J, Cui L, Qu J, Lu F.
School of Ophthalmology & Optometry, Wenzhou Medical College, Wenzhou, China.

Purpose: To investigate tear meniscus volumes during short-term wear by soft contact lens (SCL) wearers with dryness symptoms.

Methods: Three groups of 20 subjects were recruited. Group 1 consisted of SCL wearers with self-reported dryness. Group 2 consisted of asymptomatic wearers. Group 3 was composed of asymptomatic non-lens wearers. Contact lenses were fitted on each eye, and both upper and lower tear menisci were imaged before lens insertion, immediately afterwards, and 30 min later, using optical coherence tomography. Custom software was used to yield the tear meniscus area and then the volumes were calculated based on eyelid length. Repeatability was tested 30 min after lens wear on two consecutive days.

Results: There were no significant differences (P > 0.05) between the volumes measured at 30 min after lens insertion on two days. Additionally, the repeatability between days was similar among the groups. The upper and lower meniscus volumes were significantly lower in Group1 than either of the asymptomatic groups at baseline, immediately after insertion, and 30 min later (P < 0.05). The upper tear meniscus in Group 3 was greater than Group 2 at all times (P < 0.05). The lower meniscus volume immediately after insertion was significantly higher in Group 3, the inexperienced wearers, than Group 2; however, the volumes at baseline and 30 min later were similar to one another (P > 0.05).

Conclusions: Tear volumes in dry eye symptomatic wearers were lower than asymptomatic wearers at baseline and during lens wear, which possibly contributed to the dryness.

Tuesday, May 19, 2009

Grumbling: Latisse

Once upon a time I got on Allergan's Restasis consumer promo mailing list. Can't remember how. I think they were offering a dry eye newsletter of some sort and it turned out not to be really related to dry eye.

Anyway, what should make its appearance in my email inbox recently but a promo for Latisse. Good grief. You'd think they'd have a large enough market amongst mascara wearers without going after dry eye patients.

Drug news: EyeGate Pharma completes Phase II for EGP-437

EyeGate Pharma Completes Phase II Clinical Trial of EGP-437 for Treating Dry Eye Syndrome
Results Expected in 2nd Quarter 2009

WALTHAM, MA--(Marketwire - March 3, 2009) - EyeGate Pharma, the leader in non-invasive ocular drug delivery, today announces that they have fully enrolled and completed all follow-up visits for all patients participating in their Phase II safety and efficacy study of EGP-437 (a combination drug/device) for treating Dry Eye Syndrome. The results of this study are expected in the second quarter of 2009.

For the dry eye clinical trial, EyeGate worked with Ora, Inc., a leading global clinical research and development organization, located in Andover, MA. Over the past 30 years, Ora has played a central role in the development and FDA approval of more than 30 ophthalmic products.

This Phase II single-center, randomized, double-masked, placebo-controlled study of 89 patients evaluated the safety and efficacy of a corticosteroid solution administered by the EyeGate® II Delivery System (at two dose levels) twice over a three-week period. Ora's proprietary Controlled Adverse Environment (CAE) clinical model was used for this study.

Drug news: Novagali's Cyclokat completes Phase II

Novagali Pharma Completed a New Phase II With Cyclokat(R) in Dry Eye

EVRY, France | April 15, 2009 | Novagali Pharma, a French pharmaceutical ophthalmic company, today announces successful completion of a new Phase II clinical study with Cyclokat®, its formulation of Cyclosporine. The results demonstrate statistically significant improvement with signs and symptoms in patients suffering from moderate-to-severe dry eye syndrome.

For this dry eye clinical trial, Novagali worked with Ora, Inc., a leading global clinical research and development organization located in Andover, MA, USA. This phase II, multi-centre, randomized, double-masked, vehicle controlled study of 132 patients evaluated the safety and efficacy of Cyclokat® applied once-a-day over three months. Ora's proprietary Controlled Adverse Environment (CAE) clinical model was used in this study conducted in the US.

Efficacy was observed post-CAE as well as pre-CAE (environmental comparisons following selection and enrollment of patients utilizing the CAE). Cyclokat® demonstrated significant treatment effect on multiple efficacy variables for both signs and symptoms at Month 1 and Month 3. . These findings confirm potential clinical interest of Cyclokat® for the treatment of dry eye syndrome.

"We are very enthusiastic about the results of this new trial demonstrating efficacy on both dry eye signs and symptoms" said Jerome Martinez, CEO of Novagali "These are promising results which make us confident in the success of our ongoing Phase III which outcomes are expected 4Q2009".

Abstract: Meibometer!

Now we're talkin'! Well, I have about 3 months of literature to catch up on so hopefully somewhere between this one and May's stack there is something on measuring meibum for HUMANS.

Vet Ophthalmol. 2008 Nov-Dec;11(6):368-74. Links
Review of the measuring precision of the new Meibometer MB550 through repeated measurements in dogs.Benz P, Tichy A, Nell B.
Department of small animals and horses, Veterinary University Vienna, Vienna, Austria.

OBJECTIVE: A meibometer is a device to measure the delivery rate of lipids on the eyelid margin. The aim of this study is to determine the measuring precision of the new Meibometer MB550 (Courage-Khazaka electronic GmbH, 50829, Cologne, Germany), linked to a computer, by means of repeated measurements in dogs by different examiners.

PROCEDURE: Two investigators measured the lipid rate on the eyelid margin in 10 healthy dogs for 10 days. One examiner measured the right eye (OD) and the other measured the left eye (OS) for 5 days. After 5 days, the eyes to be measured were switched between the examiners. The new device was able to record all measurement values as charts and curves in comparison to the previous Meibometer, which displayed only one value.

RESULTS: Mean meibomium lipid level +/- SD in the OD and OS of 10 dogs in 10 days was 211 +/- 48 MU and 205 +/- 41 MU (meibometer units), respectively. There was no significant difference between OD and OS, but a broad distribution of the values could be found. Gender did not influence the measurements. A significant difference was determined between the measurements in the first 5 days to those in the following 5 days. There was, therefore, also a significant difference in the measurements of the 2 examiners.

CONCLUSION: Meibometry is a minimally invasive lipid measuring method on the eyelid margin. Repeated measurement results obtained by two examiners, with the new device Meibometer MB550 linked to a computer, showed a wide range of values. The measuring precision of the new Meibometer MB550 is therefore questionable.

Abstract: Wet dry.

Yawn. Back to basics. I think we're a leetle past this now.

Ophthalmologe. 2009 Mar;106(3):235-41. Links
[The "wet" dry eye.][Article in German]
Schargus M, Geerling G.
Universitäts-Augenklinik Würzburg, Josef -Schneider -Strasse 11, 97080, Würzburg, Deutschland.

Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability, with potential damage to the ocular surface. The two main causes are reduced production of aqueous tears and increased evaporation of tears. The evaporative form of dry eye results in ocular surface irritation with a secondary increase in tear production; this presents to the examiner and patient as a wet eye or epiphora. Knowledge and understanding of the basic pathologies and differential diagnoses of dry eye disease are essential to differentiate this very common form of dry eye from disorders of the lacrimal drainage system and to initiate adequate management.

Abstract: IL-17 & the corneal barrier

Mucosal Immunol. 2009 May;2(3):243-53. Epub 2009 Feb 25.
IL-17 disrupts corneal barrier following desiccating stress.
De Paiva CS, Chotikavanich S, Pangelinan SB, Pitcher JD 3rd, Fang B, Zheng X, Ma P, Farley WJ, Siemasko KF, Niederkorn JY, Stern ME, Li DQ, Pflugfelder SC.
Department of Ophthalmology, Ocular Surface Center, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.

T helper (Th)-17 is a recently identified subtype of Th response that has been implicated in host defense and autoimmunity. We investigated whether there is evidence for a Th-17 response in human and experimental murine dry eye (DE). Gene expression in the human DE conjunctiva showed increased levels of the Th-17 inducers, interleukin (IL)-23, IL-17A, and interferon-gamma (IFN-gamma). In the murine model, we found that desiccating stress increased matrix metalloproteinase-9, Th-17-associated genes (IL-6, IL-23, transforming growth factor-beta1 and -2, IL-23R, IL-17R, IL-17A, retinoid-related orphan receptor-gammat, and CC chemokine attractant ligand-20) and IFN-gamma in cornea and conjunctiva. Furthermore, we found a significantly increased concentration of IL-17 in tears and number of IL-17-producing cells on the ocular surface. Antibody neutralization of IL-17 ameliorated experimental DE-induced corneal epithelial barrier dysfunction and decreased the expression of matrix metalloproteinases 3 and 9. Taken together, these findings suggest that IL-17 has a role in corneal epithelial barrier disruption in DE.

Abstract: Tear ferning

Ophthalmic Physiol Opt. 2009 Mar;29(2):199-204.
Tear ferning in contact lens wearers.Evans KS, North RV, Purslow C.
Contact Lens and Anterior Eye Research (CLAER) Unit, School of Optometry and Vision Sciences, Cardiff University, Maindy Road, Cardiff, UK.

Tear ferning (TF) has shown good sensitivity and specificity in the diagnosis of dry eye, but is a relatively uncommon test, especially in contact lens wearers. The aim of this study was to investigate the relationship between TF, ocular comfort and tear film stability amongst contact lens (CL) wearers and non-contact lens (NCL) wearers. Subjects (36 NCL, 24 CL; mean age 23.2 +/- 4.8 years) underwent assessment of non-invasive tear break up time (NIBUT), fluorescein tear break up time (FBUT) and completed the Ocular Comfort Index (OCI) questionnaire. Non-stimulated tears were collected from the inferior tear meniscus with a glass capillary. Samples of 1.5 microL were air dried, observed by light microscopy and the TF pattern quantified according to Rolando's grading scale. Significantly higher grades of TF pattern and discomfort (higher OCI scores) were observed in CL wearers compared to NCL wearers (Mann-Whitney U-test; p < 0.005 and p < 0.05 respectively). Differences in tear film stability were not significant between groups. Even when asymptomatic (low OCI scores) CL and NCL subjects were compared, TF remained significantly different (p < 0.005). In both CL and NCL subjects, TF displayed poor correlation with tear film stability tests and OCI scores. Higher TF grades in CL wearers, even if asymptomatic, indicate an unfavourable ratio of salt to macromolecule concentration within the tear film of such subjects. The lack of significant difference in TF between symptomatic CL and NCL wearers could suggest similar aetiology (tear film hyperosmolarity) in each cohort. The TF technique demonstrates limited sensitivity and specificity for the prediction of ocular surface comfort in both CL and NCL wearers.

No abstract... corneal melt after a transplant in someone with Sjogrens

The abstract wasn't available but I'm posting the reference anyway... Article titles like this make me shudder: corneal melt (yes, that's as bad as it sounds) after a corneal transplant.

This is why we need Sjogrens diagnosed earlier. Awareness awareness awareness... so many people live with symptoms forever without finding out what they have.

Arch Ophthalmol. 2009 Feb;127(2):219-20.
Sterile corneal melt after descemet stripping endothelial keratoplasty in patients with previously undiagnosed Sjogren syndrome.
Shan SJ, Wu EI, Akpek EK.
Ocular Surface Diseases and Dry Eye Clinic, The Wilmer Eye Institute, 600 N Wolfe St, Maumenee Bldg, Ste 317, Baltimore, MD 21287-9238, USA.

Abstract: Fish oil & dry eye

Non news. Fish oil may help reverse dry eye. If you're not taking it already consider starting. Get a decent one though, not some rancid decades old generic.

Insight. 2008 Oct-Dec;33(4):20-5;
Omega 3 fatty acids and the eye.
Cakiner-Egilmez T.
Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA.

The health benefits of fish oil have been known for decades. Most of the health benefits of fish oil can be attributed to the presence of omega-3 essential fatty acids such as docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Clinical studies have suggested that DHA and EPA lower triglycerides; slow the buildup of atherosclerotic plaques; lower blood pressure slightly; as well as reduce the risk of death, heart attack, and arrhythmias. Studies have also shown that omega-3 fatty acids may slow the progression of vision loss from AMD and reverse the signs of dry eye syndrome.

Abstract: Age & gender & dry eye

Non news... older = drier, and men get it too.

Eye. 2009 Feb 20. [Epub ahead of print]
Age- and gender-related tear function changes in normal population.
Ozdemir M, Temizdemir H.
1Faculty of Medicine, Department of Ophthalmology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.

Purpose: Schirmer and tear film break-up time tests are most commonly used in the diagnosis of dry eye syndrome. The aim of the study is to investigate the age- and gender-related changes in the results of Schirmer and tear film break-up time tests in normal population.

Methods: This randomized prospective study included 140 normal volunteers (70 male and 70 female subjects) with no ocular symptoms or ocular surface disorders. Schirmer and tear film break-up time tests were assessed in only one eye (right) of each subject. The study subjects were divided into seven groups according to their ages. Each group was composed of 20 eyes of 20 subjects (10 male and 10 female subjects). For variance analysis, Kruskal-Wallis test was used. Mann-Whitney U-test was performed for double comparisons.

Results: We detected a statistically highly significant difference among the age groups in respect to the tear film break-up time test (P<0.001), especially there was a statistically highly significant difference between the younger and older age groups. There was no statistically significant difference in the Schirmer test results. But, we found that Schirmer test values were gradually decreased with advancing age. Tear function tests did not show statistically significant difference according to sex.

Conclusions: Our results reveal that there is a decline in the tear function test values, especially the tear film break-up time test values with advancing age. We suggest that the age of subjects should be taken into consideration in the evaluation of tear function test results.

Abstract: Dry eye and triple A syndrome

I often kind of hesitate to post abstracts like this - for those already worried about a lot of things I don't want them to start worrying about rare disorders that they almost certainly don't have. But every now and then more information rather than less turns out to be important... so I post them on the off chance.

Horm Res. 2008;70(6):364-72. Epub 2008 Oct 27. Links
Late-onset triple A syndrome: a risk of overlooked or delayed diagnosis and management.
Salmaggi A, Zirilli L, Pantaleoni C, De Joanna G, Del Sorbo F, Koehler K, Krumbholz M, Huebner A, Rochira V.
Istituto Nazionale Neurologico Carlo Besta, IRCCS, Milan, Italy.

BACKGROUND/AIMS: A 33-year-old man was referred for the first time to the Division of Neurology because of the presence and progression of neurological symptoms. Dysphagia, weakness, reduced tear production, and nasal speech were present. In order to point the attention of late-onset triple A syndrome we describe this case and review the literature.

METHODS: Hormonal and biochemical evaluation, Schirmer test, tilt test and genetic testing for AAAS gene mutations.

RESULTS: Late-onset triple A syndrome caused by a novel homozygous missense mutation in the AAAS gene (A167V in exon 6) was diagnosed at least 17 years after symptom onset.

CONCLUSIONS: The association between typical signs and symptoms of triple A syndrome should suggest the diagnosis even if they manifest in adulthood. The diagnosis should be confirmed by Schirmer test, endocrine testing (both basal and dynamic), genetic analysis, and detailed gastroenterological and neurological evaluations. Awareness of the possible late onset of the disease and of diagnosis in adulthood is still poor among clinicians, the acquaintance with the disease is more common among pediatricians. The importance of an adequate multidisciplinary clinical approach, dynamic testing for early diagnosis of adrenal insufficiency and periodical reassessment of adrenal function are emphasized. Copyright 2008 S. Karger AG, Basel.

Abstract: More on cyclosporine, in acute cases

Interesting findings. Very severe patients with unhelpful experiences of Restasis might relate to the bunnies....

Invest Ophthalmol Vis Sci. 2009 Feb 14. [Epub ahead of print]Links
Neurological evaluation of acute lacrimomimetic effect of Cyclosporine in an experimental rabbit dry eye model.
Toshida H, Nguyen D, Beuerman RW, Murakami A.
Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan.

PURPOSE: To evaluate acute lacrimation cased by Cyslosporine A (CsA) eye drops neurologically in rabbit.

METHODS: Normal and parasympathectomized adult male New Zealand white rabbits received a single instillation of 0.1% CsA or vehicle eye drops. Schirmer's tear test (STT), the flow rate of lacrimal gland (LG) fluid from the excretory lacrimal duct of the main LG, and the blink rate (over a 3-min period) were measured before and after instillation of CsA or vehicle. Light microscopy was performed to examine the main LG. in vitro Protein release from LG fragments was assessed after incubation with CsA for 30 minutes.

RESULTS: In normal rabbits, both the STT value and the flow rate of LG fluid were significantly increased after treatment with CsA compared with vehicle (p<0.05). In contrast, no changes were found in denervated eyes. The blink rate of CsA-treated eyes was significantly higher than that of vehicle-treated in normal rabbits (p<0.005), while that of denervated eyes decreased significantly after CsA instillation compared with before administration (p<0.005). Light microscopy showed that the cytoplasm of acinar cells was packed with secretory granules in denervated LG tissue at 7 days after parasympathectomy. The same finding was observed at 3 hours after CsA instillation. CsA had no stimulatory effect on protein release by acinar cells in LG fragments at all concentrations tested.

CONCLUSION: These results suggest that CsA has no direct effect on tear fluid secretion from the LG in a very acute model. Instead, CsA increases a reflex tear flow.

Abstract: Upper and lower tear menisci in the diagnosis of dry eye.

Another direction in developing improved dry eye diagnostics.

Invest Ophthalmol Vis Sci. 2009 Feb 14. [Epub ahead of print]
Upper and lower tear menisci in the diagnosis of dry eye.
Shen M, Li J, Wang J, Ma H, Cai C, Tao A, Yuan Y, Lu F.
Wenzhou Medical College, School of Ophthalmology and Optometry, Wenzhou, Zhejiang, China.

Purpose: To measure the upper and lower tear menisci in aqueous tear deficiency (ATD) dry eye patients using real-time optical coherence tomography (OCT), and to determine the most effective meniscus variables for the diagnosis of dry eye.

Methods: Eyes of 48 pre-screened ATD patients were compared with those of 47 healthy subjects. Upper and lower tear menisci were imaged simultaneously by real-time OCT immediately after blinking. The height, radius, and cross-sectional area of upper and lower tear menisci were obtained.

Results: The tear meniscus radius, height, and cross-sectional areas were significantly smaller in dry eye patients than healthy subjects (P < 0.01). The lower tear meniscus variables were higher than the upper menisci (P < 0.01) in normal subjects; however, no significant differences between menisci were found in ATD patients. In both groups, the upper and lower tear meniscus variables were strongly correlated with each other. Good dry eye diagnostic accuracies were obtained with cutoff values for an "abnormal" lower tear meniscus radius (LTMR) of 182 microm and a lower tear meniscus height (LTMH) of 164 microm. The LTMR diagnostic sensitivity and specificity were 0.92 and 0.87 respectively. The LTMH diagnostic sensitivity and specificity were 0.92 and 0.90.

Conclusion: Upper tear meniscus variables in ATD patients were assessed for the first time using real-time OCT. The tear meniscus was smaller in patients with ATD compared with healthy subjects. LTMR and LTMH may have potential in the diagnosis of ATD.