Thursday, June 25, 2009

Abstract: Corneal epithelial opacity in dry eye

Interesting to see "dysfunctional tear syndrome" starting to creep into the medical literature in place of "dry eye" now and then.

Corneal Epithelial Opacity in Dysfunctional Tear Syndrome.

Am J Ophthalmol. 2009 Jun 20. [Epub ahead of print]
Chen JJ, Rao K, Pflugfelder SC.
Ocular Surface Center, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.

PURPOSE: To compare the appearance of the superficial corneal epithelium in patients with dysfunctional tear syndrome (DTS) and that of an asymptomatic control group using laser scanning confocal microscopy and to determine the correlations between confocal microscopic findings and clinical severity parameters. DESIGN: Prospective case-control study.

METHODS: Thirty-one patients with newly diagnosed DTS and 21 asymptomatic control subjects were evaluated for this study. Subjects with DTS were classified into 4 levels of clinical severity (DTS 1 through 4) based on the Delphi dry eye panel report criteria. The Heidelberg Retina Tomograph 2 Rostock Cornea Module (Heidelberg Engineering GmbH, Heidelberg, Germany) laser scanning confocal microscope was used to image the superficial corneal epithelium. Areas of single or multiple opaque superficial epithelial cells were measured as a percentage of the 400 x 400-mum(2) field area in 4 randomly selected confocal images from each eye. Spearman correlations between the confocal findings and severity of symptoms, visual acuity, and ocular surface signs were calculated.

RESULTS: The mean area of opaque superficial corneal epithelial cells was significantly greater in DTS patients than in normal subjects (P < .0001). Significant differences were observed between the DTS severity groups and the control group (P < .001), except for the DTS 1 group. The area of opaque cells significantly increased with level of clinical severity. The confocal findings showed significant correlation with clinical severity parameters, including blurred vision symptoms (r = 0.86; P = .0001), best-corrected visual acuity (Spearman r = 0.4; P = .03), conjunctival lissamine green staining scores (Spearman r = 0.4; P = .026), corneal fluorescein staining scores (Spearman r = 0.5; P = .002), and videokeratoscopic surface regularity index (Spearman r = 0.5; P = .02).

CONCLUSIONS: Morphologic changes in the superficial corneal epithelium of DTS patients detected by laser scanning confocal microscopy correlates with blurred vision symptoms and objective severity parameters. Objective confocal image analysis of the superficial corneal epithelium may prove useful for classifying DTS severity and for monitoring the efficacy of therapies.

Newsblurb: Surgical technique for repairing a bad blepharoplasty

Why am I posting this here? Because a lot of my readers have dry eye from blepharoplasty. As most of you know I'm not a big fan of eye surgery unless there are no alternatives, but when the sole or primary cause of dry eyes is poor lid closure from a prior surgery, I know of a lot of successful surgical improvements.

I don't have any idea how unique this doctor's surgery is, but I just appreciate the attention to the issue of bad blepharoplasty and the aftermath it leaves for patients.

Procedure Pioneered by Harry Marshak, MD, Reverses Ill Effects of Prior Eyelid Plastic Surgery
Business Wire, June 23 2009

Outpatient Procedure to Reverse Eye Irritation and Dry Eye Caused by Prior Eyelid Plastic Surgery Presented in Los Angeles, Tokyo by The Morrow Institute's Harry Marshak, MD

RANCHO MIRAGE, Calif.--(BUSINESS WIRE)--Since joining The Morrow Institute Specialty Plastic Surgery® group in Rancho Mirage, CA, ocular plastic surgeon Harry Marshak, MD, FACS has helped an average of 100 patients a year overcome issues caused by eyelid surgeries (blepharoplasty) that were previously performed by other surgeons. The procedure he pioneered, the Small Incision Pre-Periosteal Mid-Face Lift for Correction of Post Blepharoplasty Lower Eye Lid Retraction, was recently presented at the 40th Annual Doheny Days conference at the Doheny Eye Institute at the University of Southern California in Los Angeles. Earlier this year, Dr. Marshak co-presented the paper at an international conference in Tokyo with David Morrow, MD, founder and director of The Morrow Institute.

“When patients decide to have blepharoplasty, or cosmetic eyelid plastic surgery, they think the relatively simple procedure will get rid of the bags under their eyes and give them a more youthful appearance,” says Dr. Marshak, who is a Fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery and Board Certified Ophthalmologist. “What happens far more frequently than people realize is that surgeons remove too much skin and patients end up with a retraction of the lower lid. That causes an unnatural rounded look, but far more problematic, it pulls their lower lid down so far the upper lid can no longer meet it.

The inability of the eye to close properly can lead to chronic irritation, excessive tearing and dry eyes. “Sometimes patients are aware of the issue within a few months,” Dr. Marshak explains. “In other instances, the problem is initially minor but worsens over time. A year or more may have passed before they experience the constant irritation so they don’t realize the problem was caused by the blepharoplasty. The good news is chronic eye irritation can be reversed and may be covered by insurance.”

The outpatient procedure Dr. Marshak developed utilizes a very small incision in the outer corner of the eye through which he is able to raise the cheek that tethers the lid. The procedure can cure the tearing and dry eye problems and restore a more natural almond shape to the eye. When medically indicated, private insurance may pay for the correction....

Abstract: Diabetes, insulin and dry eye

Influence of insulin treatment on the lacrimal gland and ocular surface of diabetic rats.

Endocrine. 2009 Jun 24. [Epub ahead of print]
Módulo CM, Jorge AG, Dias AC, Braz AM, Bertazolli-Filho R, Jordão AA Jr, Sérgio Marchini J, Rocha EM.
Department of Ophthalmology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, Ribeirão Preto, SP, 14049-900, Brazil.

Previous studies have observed changes in the lacrimal gland and ocular surface related to diabetes mellitus and related it to insulin resistance or insufficiency and oxidative damage. The aim of this study was to evaluate whether insulin treatment inhibits those changes. Diabetes was induced in male Wistar rats with a single intravenous injection of streptozotocin and a subgroup was treated with insulin. After 5 and 10 weeks, the three groups (n = 5-10/group/experimental procedure) were compared for biochemical, functional, and histological parameters. After 5 weeks, changes in morphology and increased numbers of lipofucsin-like inclusions were observed in lacrimal glands of diabetic but not insulin-treated rats. After 5 weeks, malonaldehyde and total peroxidase activity were significantly higher in diabetic rats, but similar to control in insulin-treated diabetic rats (P = 0.03, P = 0.02, respectively). Our data indicate that diabetes induces histological alterations in lacrimal gland and suggests that hyperglycemia-related oxidative stress may participate in diabetic dry eye syndrome. Prevention by insulin replacement suggests direct hormone action and/or benefit by early sub optimal metabolic control.

Abstract: Dry eye related quality of life in glaucoma patients

Thank you thank you thank you EJO for publishing this....

Only, I'd suggest an addendum to the conclusions... In addition to assessing the ocular surface, how about asking the patient? Even better, how about asking them to fill out that same nice little OSDI questionnaire that was used in this study?

Dry eye syndrome-related quality of life in glaucoma patients.

Eur J Ophthalmol. 2009 July-August;19(4):572-579.
Rossi GC, Tinelli C, Pasinetti GM, Milano G, Bianchi PE.
UO Oculistica, AO Bolognini, Seriate, Bergamo; and University Eye Clinic, IRCCS Policlinico S. Matteo Foundation, Pavia - Italy.

PURPOSE. To verify the presence of dry eye syndrome (DES) in treated patients with glaucoma and to analyze DES’s impact on the patients’ quality of life (QOL) versus the control group.

METHODS. In this observational cross-sectional study, 61 patients were enrolled at a clinical practice. Patients were divided into three groups by number of glaucoma drops instilled per day (G1=1 drop/day, G2=2 drops/day, G3=3 drops/day). A control group of 20 subjects was also selected (G0). All subjects were submitted to a complete ocular examination (including tear function and ocular surface status) and completed the 25-item National EyeInstitute Visual Function Questionnaire (NEI-VFQ), Glaucoma Symptom Scale (GSS) questionnaire, and Ocular Surface Disease Index (OSDI). DES was defined as presence of punctate keratitis and decreased break-up time. Statistical analysis was performed applying the Kruskal-Wallis analysis of variance and Mann-Whitney U tests (to compare median values between groups) as well as the chi2 and Fisher test (to verify significant differences).

RESULTS. A total of 40% of G3 and 39% of G2 patients presented DES versus 11% of G1 and 5% of G0 (p=0.01). QOL was significantly influenced and altered (NEI-VFQ 25 total mean and GSS total mean and symptoms average: p=0.0085, p=0.006, and p=0.03, respectively). OSDI pointed out differences by group: 26% of G2 and 15% of G3 presented moderate OSDI and 15% of G3 and 8.7% of G2 severe OSDI (p>0.05).

CONCLUSIONS. Patients with topically treated glaucoma present DES more often than a similar control group (p=0.01). The presence of DES negatively influences the patient’s QOL. The patients with glaucoma's ocular surface status should be evaluated regularly to ensure the timely detection and treatment of pathologic signs on the ocular surface.

Abstract: Clean room workers & dry eye

Higher Prevalence of Dry Symptoms in Skin, Eyes, Nose and Throat among Workers in Clean Rooms with Moderate Humidity.

J Occup Health. 2009 Jun 18.
Su SB, Wang BJ, Tai C, Chang HF, Guo HR.
Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University.

Objective: To determine whether working under relative humidity (RH) around 55 +/- 5% may lead to dry symptoms among workers in tropical regions.

Methods: We recruited 3,154 Taiwanese workers who had no history of skin diseases and compared dry symptoms between clean room workers (RH around 55 +/- 5%) and other workers (RH around 65 +/- 5%).

Results: Clean room workers had higher prevalences of dry symptoms of the eye (odds ratio [OR]=1.62, 95% confidence interval [CI]: 1.40 to 1.86), nose and throat (OR=2.15, 95% CI: 1.66 to 2.79), and skin (OR=1.46, 95% CI: 1.23 to 1.73). In clean room workers, however, dry skin symptoms affected the palms (OR=1.72, 95% CI: 1.24 to 2.39), which are covered by gloves, more frequently than the face (OR=0.65, 95% CI: 0.45 to 0.94), which is exposed to the room air. We found working in clean rooms (adjusted OR [AOR]=1.38, 95% CI: 1.08 to 1.77), 24 to 30 yr of age (AOR=0.78, 95% CI: 0.62 to 0.99), family history of atopic diseases (AOR=1.75, 95% CI: 1.37 to 2.25), and skin moisturizer use (AOR=1.64, 95% CI: 1.30 to 2.06) were independent predictors of skin symptoms. In addition, working in clean rooms was an independent predictor of dry eye (AOR=1.30, 95% CI: 1.06 to 1.60) and dry nose and throat (AOR=1.70, 95% CI: 1.28 to 2.26) symptoms.

Conclusions: Whereas the humidity in such working environments is not very low, for workers living in a high humidity environment, the relatively low humidity may still cause dry symptoms of the eye, nose, and throat.

Drug news: Setback for Rejena

According to a Reuters report the FDA is not ready to give the thumbs up to River Plate/Alcon's sodium hyaluronate drop "Rejena", which is already on the market in Europe.

FDA reviewers, in a separate analysis prepared for the meeting, said they had identified "three major statistical
issues" in River Plate's application to market a hyaluronate sodium solution under the name Rejena.

One of the company's key studies lacked a "robust treatment effect" for the product, the reviewers said. An earlier study
failed to meet its main goal to show effectiveness and an FDA reviewer could not replicate the company's finding that secondary goals were met, the FDA staff said....

UBS analyst Marc Goodman, in a research note, said there was a "strong likelihood" the FDA panel would recommend against
approval of the River Plate drug and might urge additional studies.

Dear sports optical manufacturers...

I know, I know, this is a hard time to be coming up with new products, and the dry eye market is a tiny niche amongst all your sports-driven customers.

But just as we, the chronic dry eye crowd, had gotten to know you really well and had come to be dependent on your fine 'moisture chamber' products, now we find the options narrowing ever more.

Wiley-X have discontinued two of their 'climate control' models and are down to 5. Of which... I've really only had luck with 2 (AirRage for small faces and Airborne for anyone) for the dry eye crowd.

Panoptx/7Eye changed the surface of their eyecups to something different than the original excellent foam, and gradually discontinued 2 of the 3 models which historically worked so well for the predominantly female dry eye crowd - Viento and Solano (oh, and Cyclone... which incidentally in the wake of Onion Goggle popularity would have been a great seller just about now because of the similar versatile shape). The only one of the original lineup that seems to fit women decently is the Churada - but with the new surface.

SIGH! When is someone going to step up and bring us some more good quality moisture chamber sunglasses FOR WOMEN?

Just wondering :-)