Wednesday, May 19, 2010

Abstract: Restasis & dry eye progression

Topical cyclosporine 0.05% for the prevention of dry eye disease progression.
J Ocul Pharmacol Ther. 2010 Apr;26(2):157-64.
Rao SN.
Lakeside Eye Group, SC, 180 N. Michigan Ste 1900, Chicago, IL 60601, USA.

PURPOSE: To assess the prognosis of dry eye in patients treated with cyclosporine 0.05% or artificial tears by using the International Task Force (ITF) guidelines.

METHODS: This was a single-center, investigator-masked, prospective, randomized, longitudinal trial. Dry eye patients received twice-daily treatment with either cyclosporine 0.05% (Restasis; Allergan, Inc., Irvine, CA; n = 36) or artificial tears (Refresh Endura; Allergan, Inc., Irvine, CA; n = 22) for 12 months. Disease severity was determined at baseline and month 12 according to the consensus guidelines developed by the ITF. Dry eye signs and symptoms were evaluated at baseline and months 4, 8, and 12.

RESULTS: Baseline sign and symptom scores and the proportion of patients with the disease severity level 2 or 3 were comparable in both groups (P > 0.05). At month 12, 34 of 36 cyclosporine patients (94%) and 15 of 22 artificial tear patients (68%) experienced improvements or no change in their disease severity (P = 0.007) while 2 of 36 cyclosporine patients (6%) and 7 of 22 artificial tears patients (32%) had disease progression (P < 0.01). Cyclosporine 0.05% improved Schirmer test scores, tear breakup time, and Ocular Surface Disease Index scores throughout the study, with significant (P < 0.01) differences compared with artificial tears being observed at months 8 and 12.

CONCLUSIONS: Treatment with cyclosporine 0.05% may slow or prevent disease progression in patients with dry eye at severity levels 2 or 3.

Abstract: Tear osmolarity and disease severity

What I want to know is: What was the correlation specifically with symptoms?

Tear Osmolarity as a Biomarker for Dry Eye Disease Severity.
Invest Ophthalmol Vis Sci. 2010 Apr 14. [Epub ahead of print]
Suzuki M, Massingale M, Ye F, Godbold J, Elfassy T, Vallabhajosyula M, Asbell P.
Ophthalmology, Mount Sinai School of Medicine, New York, United States.

Purpose: To study the association between tear osmolarity and dry eye severity grade, based on a modified Dry Eye Workshop (DEWS) scale, as well as with the signs and symptoms used to determine dry eye disease severity.

Methods: 19 patients with dry eye disease were asked to complete an evaluation of dry eye signs and symptoms composed of: the Ocular Surface Disease Index (OSDI) questionnaire, corneal staining with fluorescein, conjunctival staining with lissamine green, tear-film break up time (TFBUT), Schirmer's test with anesthesia, and tear sample collection. Tear samples were collected in 5 ul micro capillaries. Tear osmolarity from the right eye was measured using the Advanced Instruments Model 3100 Tear Osmometer (0.5ul sample size).

Results: Tear osmolarity is significantly correlated with dry eye severity grade (modified DEWS). Schirmer's test and tear osmolarity were significantly correlated at -0.52, with Schirmer's test significantly contributing to the independent estimate of tear osmolarity when adjusting for age.

Conclusions: Tear osmolarity correlates with dry eye severity and could provide a biomarker for dry eye disease severity.

Abstract: Dry eye screening questionnaires/forms

This was one of those unusual abstracts where I found myself nodding in vehement agreement with almost every sentence. I think every dry eye patient should read this paragraph about 10 times slowly.

By the way, here's a link to download the OSDI. It's not perfect, but it's very useful.

Screening Questionnaire for Documentation of Medical History and Diagnostic Findings in Dry Eye Disease.
Klin Monbl Augenheilkd. 2010 Apr 14. [Epub ahead of print]
Jacobi C, Bellios N, Jacobi A, Kruse F, Cursiefen C.
Ophthalmologie, Universitätsklinikum Erlangen.

Keratoconjunctivitis sicca is one of the most common ocular diseases world-wide. These patients suffer from severe symptoms which lead to an extremely reduced quality of life. Dry eye syndrome constitutes a major diagnostic and therapeutic challenge to all ophthalmologists because there is often a discrepancy between objective ocular signs and subjective symptoms of the patients. Furthermore, there exist only few causal therapeutic options. The physician-patient relationship plays an outstanding role in this condition. For the treatment of moderate to severe dry eye syndrome, special dry eye clinics have proved to be extremely useful. For follow-up measurements as well as the realisation of evidence-based medicine and quality control, it is a fundamental necessity to document symptoms, signs and therapy of these patients in order to optimise therapeutic strategies. For this purpose, we have developed special forms and standardised questionnaires for the individual documentation of medical history and diagnostic findings. To objectively assess the patient's complaints we use the "ocular surface disease index" (OSDI score). Only the establishment of standardised diagnostic and therapeutic algorithms with the help of special forms and questionnaires can help in the long run to improve the treatment of these severely affected patients. © Georg Thieme Verlag KG Stuttgart · New York.