Tuesday, December 28, 2010

I think this one deserves...

...the "Cheesiest PR effort of the year by a dry eye product company" award.

It's official: Men make women cry the most

Women knew it all along. And now, a study has confirmed it to the entire world -- nothing makes a girl cry as much as a man.

More than three in four women blame their partners for making them cry, not to mention their fathers or sons, reports The Daily Express.

But 63 per cent of men reckon their wives, girlfriends and even mothers can reduce them to tears, said the study by Rohto Dry Eye Relief.

The survey of 2,000 adults also found that when it comes to men, the pressures of work, being treated badly by the boss or horrid workmates can also bring on the tears.

Work woes have left 32 per cent of Brit women and 22 per cent of English men in tears in the past six months. While family, work and friends are responsible for crying, then modern life has the opposite effect in general because it leaves eyes dry and irritable, said Rohto.

A spokesman for Rohto said: "Despite all the tears, Britain actually has a far greater problem from dry eyes rather than wet ones."

A GP, Dr Sarah Brewer, said: "Dry eyes are a common problem for people who use computer screens, work in a dry, centrally heated environment, use the contraceptive Pill or have underlying illnesses and health conditions.

"Dryness causes discomfort with grittiness and stinging."

Abstract: Prostaglandins for glaucoma - relationship to MGD

And the march goes on... more and more studies will be coming, I'm sure, on the long term side effects of glaucoma meds. This one is interesting, as most have focused on the BAK aspect alone.

Topical Antiglaucoma Treatment With Prostaglandin Analogues May Precipitate Meibomian Gland Disease.
Ophthal Plast Reconstr Surg. 2010 Dec 20. [Epub ahead of print]
Cunniffe MG, Medel-Jiménez R, González-Candial M.
Instituto de Microcirugía Ocular, Barcelona, Spain.

The popular use of topical prostaglandin analogues (TPAs) in glaucoma patients has a well-documented association with changes in number, length, thickness, and growth pattern of eyelashes. A link between meibomian gland disease and seborrheic blepharitis resulting from topical administration of prostaglandin analogues has not been made to the authors' knowledge. A retrospective study of 43 patients presenting for incision and curettage of chalazion to the operating theatre over a 2-year period was performed. The patients' histories were reviewed to establish whether they were using TPAs for glaucoma at the time of surgery. Eight patients (19%) were using TPAs at the time of surgery. No patient had a history of eyelid margin disease before the commencement of TPAs. The exact pathogenesis of how meibomian gland disease is linked to TPA use is unclear. We postulate that the topical application of prostaglandin analogues may contribute to the formation of chalazion by acting directly to stimulate meibomian gland secretion. The authors present the findings of a preliminary case series showing a higher-than-expected incidence of patients using TPAs requiring surgical intervention for chalazion.

Abstract: Strip meniscometry

The Efficacy, Sensitivity and Specificity of Strip Meniscometry in Conjunction with Tear Function tests in the Assessment of Tear Meniscus.
Invest Ophthalmol Vis Sci. 2010 Dec 22. [Epub ahead of print]
Ibrahim OM, Dogru M, Ward SK, Matsumoto Y, Hitomi Wakamatsu T, Ishida K, Tsuyama A, Kojima T, Shimazaki J, Tsubota K.
Johnson & Johnson Ocular Surface and Visual Optics Department, Keio University School of Medicine, Tokyo, Japan;

To evaluate the specificity and sensitivity of strip meniscometry testing (SM) in conjunction with tear function tests in the diagnosis of dry eye (DE) disease and to investigate the effect of SM on reflex tearing.

One hundred and seven left eyes of 107 patients with definite DE disease according to the Japanese dry eye diagnostic criteria and 68 left eyes of 68 age and sex matched control subjects were studied. Tear meniscus height (TMH) measurements, fluorescein tear film break-up time (FTBUT), fluorescein (F), Rose Bengal (RB) staining and Schirmer's test-1 (ST) were also performed. The assessment of reflex tearing before and after SM application was assessed with a graticule scale at slit-lamp and by Visante optical coherence tomography. The sensitivity and specificity of SM alone and in combination with tear function tests were also sought.

The SM scores, TMH measurements, FTBUT values and ST values were significantly lower in dry eye patients compared to the controls (p< 0.001). The RB and F staining scores were significantly higher in the dry eye group than in the control group (p < 0.001). SM strips didn't induce significant changes in relation to reflex tearing. SM had an acceptable sensitivity and specificity.

Strip meniscometry is a swift, noninvasive and promising method for assessing the tear meniscus volume. The combined SM and FTBUT examination appears to be a sensitive approach in assessment of dry eye disease.

Abstract: Lacrisert case study (long term use)

Sorry but I'm not impressed. OK, so this individual who successfully used Lacriserts for years has Sjogrens, but apparently his/her dry eye was mild enough (we are not told her Schirmer or any other clinical data in the abstract) that she could wear soft contacts all these years.

Long-term use of hydroxypropyl cellulose ophthalmic insert to relieve symptoms of dry eye in a contact lens wearer: case-based experience.
Eye Contact Lens. 2011 Jan;37(1):39-44.
Wander AH.
From the Department of Ophthalmology, University of Cincinnati College of Medicine and Academic Health Center, Cincinnati, OH.

To report a case in which hydroxypropyl cellulose ophthalmic inserts were successfully used for the treatment of dry eye disease in a contact lens (CLs) wearer for more than 25 years.

Review of clinical findings in a female CL wearer with dry eye spanning more than 30 years. The patient was diagnosed with the Sjögren syndrome and demonstrated inadequate lacrimation as assessed by Schirmer testing. Slitlamp examination demonstrated bilateral corneal stippling with fluorescein and signs of superior limbic keratoconjunctivitis.

Initially, the patient's symptoms improved with infrequent use of artificial tears. As the signs and symptoms of dry eye disease worsened, the patient initiated therapy with once-daily hydroxypropyl cellulose ophthalmic inserts. Punctal plugs and updating to increasingly oxygen-permeable soft CLs, in combination with continued use of the inserts, largely controlled the signs and symptoms of dry eye disease during a 25-year period. Simultaneous use of the hydroxypropyl cellulose ophthalmic inserts and CLs was well tolerated without any significant side effects or changes in visual acuity.

Dry eye is a chronic disease often requiring long-term management. In this case, daily use of hydroxypropyl cellulose ophthalmic inserts effectively treated autoimmune dry eye, providing symptomatic relief, and resulted in improved objective measures of disease severity across several decades. Such an experience is consistent with the available evidence-based data for hydroxypropyl cellulose ophthalmic inserts and supports their use in clinical practice for the treatment of moderate-to-severe dry eye disease.

Abstract: Anxiety and depression in patients with dry eye syndrome

Thank you, thank you, thank you to the doctors in China who took the time to conduct this study. US doctors, can't you get on the ball one of these days and do the same? This is a widespread problem. It's a door I've been beating on for ages and I'd be really gratified to see something more than a passive interest taken in it one of these days.

To me, depression is simply a given with dry eye - the vast majority of people I have been in contact with over the years have suffered from severe depression at some stage in their journey and some have chronic problems with it so long as their pain levels remain high.

This study validates everything I've ever seen. The primary correlation they found was between OSDI (symptom scores... how bad I feel) and depression. Yet still, doctors who don't see a terrible Schirmer or TBUT or a cornea sloughing off persist on brushing off these patients as having nothing to fuss about. This is just wrong, wrong, wrong. When we hurt, it affects a lot more than our eyes.

Curr Eye Res. 2011 Jan;36(1):1-7.
Anxiety and depression in patients with dry eye syndrome.
Li M, Gong L, Sun X, Chapin WJ.
Department of Ophthalmology, EYE & ENT Hospital of Fudan University, Shanghai, China.

This study aimed to determine whether patients with dry eye syndrome [DES] have more symptoms of anxiety and depression than controls without DES.

Methods: In this case-control study, the sample consisted of 89 DES subjects (13 diagnosed with Sjögren's syndrome [SS]) and 73 control subjects. Each subject was diagnosed as having DES or was chosen as a control subject by an ophthalmologist. The Zung Self Rating Anxiety Scales (SAS), Zung Self Rating Depression Scales (SDS), and Ocular Surface Disease Index (OSDI) were administered to all subjects. Scores of SAS and SDS, measuring level of anxiety and depression symptoms, were compared between the DES group and the control group. Correlations with other health status measures were conducted.

The SAS and SDS scores of the DES group were significantly higher than the control group (P < 0.001, P < 0.001). The prevalence of DES subjects with anxiety or depression symptoms was significantly higher than in the control group (P = 0.003, P < 0.001). In the DES group, SAS scores were found to be correlated with OSDI and educational level. SDS scores were found to be correlated with OSDI. Neither SAS nor SDS scores were correlated with age, sex, household income, tear break up time (BUT), Schirmer Test 1 (S1T), corneal fluorescein staining (FL), or visual acuity.

Anxiety and depression are correlated with DES, demonstrating that DES is an important public health problem that merits increased attention and research.

Abstract: Graves disease and dry eye

Ocular surface and dry eye in graves' disease.
Curr Eye Res. 2011 Jan;36(1):8-13.
Gürdal C, Saraç O, Genç I, Kırımlıoğlu H, Takmaz T, Can I.
Ankara Atatürk Training and Research Hospital, 2nd Ophthalmology Department, Ankara, Turkey.

To evaluate the tear function tests and the ocular surface damage in Graves' disease (GD) patients either with or without thyroid associated orbitopathy (TAO).

Forty-two eyes of 21 randomly selected patients with GD, and 30 eyes of 15 healthy subjects were included in this prospective study. The presence of TAO was evaluated clinically. The palpebral fissure height, degree of proptosis, ocular surface disease index (OSDI), Schirmer tear test, tear break-up time (TBUT), and conjunctival impression cytology were assessed. The results were first compared between the patient and the control groups. Results were then compared between the patients with TAO (group I) and without TAO (group II).

The mean OSDI score in the patient group was 44.79 ± 11.83 and it was 21.17 ± 9.89 in the control group (p  =  0.001). The mean Schirmer tear test score was 14.4 ± 8.32 mm and 24.9 ± 3.57 mm in the patient and control group, respectively (p  =  0.001). The mean TBUT in the patient group was 7.1 sec. In the control group it was significantly increased to 10 sec (p  =  0.003). The mean proptosis and interpalpebral distance did not show any difference between the GD patients and controls (p > 0.05). The patients with GD showed significant ocular surface damage in which 75.71% had grade 2-3 squamous metaplasia in temporal interpalpebral conjunctiva. Twenty-four (57%) eyes composed group I. There were no differences in the mean OSDI score, Schirmer tear test score, TBUT, and the amount of ocular surface damage between group I and group II (p > 0.05).

Dry eye findings and the ocular surface damage in GD were most likely associated with the ocular surface inflammation. Before the development of the classic findings of TAO, ocular surface inflammation can be the only presenting clinical sign in GD.

Abstract: Tear proteins during Ramadan fasting

Effect of Ramadan fasting on tear proteins.
Acta Medica (Hradec Kralove). 2010;53(3):147-51.
Sariri R, Varasteh A, Sajedi RH.
Department of Biochemistry, University of Guilan, Faculty of Science, Rasht, Iran. sariri@guilan.ac.ir

Muslims abstain from eating, drinking and smoking from dawn to sunset during the holy month of Ramadan. Prolonged fasting is thought to be among risk factors for many diseases, e.g., cardiovascular, gastrointestinal and various infectious diseases. It could also play a part in several eye diseases, including dry eye syndrome, glaucoma, and cataract. Toxic and oxidative effects due to increased concentrations of some biochemicals as a result of reduction in tear volume thought to play an important role in damaging ocular tissue. Human tear is an important biological fluid similar to blood in many aspects. Tear film is composed of three basic layers i.e. lipid, aqueous and mucin. The tear film covering the ocular surface presents a mechanical and antimicrobial barrier, and endures an optical refractive surface. The aim of this study was to analyze and compare tear protein of volunteers during fasting. Using two reliable analytical methods, i.e. electrophoresis and high performance liquid chromatography (HPLC), we compared tear protein content of sixty volunteers (35 males and 25 females, 23-27 years old) during fasting in holly month of Ramadan (FAST: n = 62) and one month before Ramadan (CTRL: n = 60). The results showed that some identified tear proteins decreased during fasting. On the other hand, the activity of some enzymes such as lysozyme, lactoferrin and alpha amylase also decreased in fasting samples. Electrophoresis results showed that tear protein patterns in FAST (P < 0.05) were different from those of CTRL. There were a few more protein peaks in the FAST group (P < 0.005) than in CTRL.

Abstract: Ocular manifestations of HIV/AIDS

(Shudder) This is the kind of study that just makes you thankful for the 'devil you know'.

Ocular manifestations in HIV/AIDS cases in Nepal.
Nepal J Ophthalmol. 2010 Jan-Jun;2(1):45-50.
Lamichhane G, Shah DN, Sharma S, Chaudhary M.
Lumbini Eye Institute, Bhairahawa, Nepal. gyanu813@gmail.com

BACKGROUND: A significant number of patients with HIV/AIDS can have ocular manifestations. Almost every structure in the eyes can be affected in this condition.

OBJECTIVE: To study various ocular manifestations in the cases known to be infected with HIV.

MATERIALS AND METHODS: A cross-sectional descriptive study was carried out including 117 subjects positive for HIV using the purposive sampling method. Their demographic pattern and ocular findings were studied. Findings were recorded in the pro forma developed for the study.

STATISTICS: SPSS ver 14.0 was used for data analysis. The p value of < 0.05 was considered as significant.

RESULTS: A total of 117 HIV infected cases were included in this study. Among them, 76 (64.95%) were male and 41 (35.05%) female. The mean age of the subjects was 30.04 +/- 11.32 years. The duration of HIV detection ranged from 1-5 years. Ocular complaints were present in 26.49% of the subjects. Ocular manifestations were present in 56% of the patients with complaints and in 27.3% of asymptomatic patients. Ocular involvement was seen in 55 (47%) patients. The common anterior segment findings were herpes zoster ophthalmicus (4.27%), anterior uveitis (2.56%), blepharitis (2.56%) and conjunctivitis (1.7%), whereas HIV retinopathy (19.6%), CMV retinitis (5.1%), ocular toxoplasmosis (2.5%) and presumed ocular tuberculosis (0.85%) were common posterior segment findings. Conclusion: Herpes zoster ophthalmicus, anterior uveitis, HIV retinopathy and CMV retinitis are common ocular manifestations associated with HIV infections.

Abstract: N-3 PUFA deficiency and rat dry eye

Eeeesh... I guess this sort of study is interesting to someone somewhere, but not me, at least not yet.

No consequences of dietary n-3 polyunsaturated fatty acid deficiency on the severity of scopolamine-induced dry eye.
Graefes Arch Clin Exp Ophthalmol. 2010 Dec 16. [Epub ahead of print]
Viau S, Pasquis B, Maire MA, Fourgeux C, Grégoire S, Acar N, Bretillon L, Creuzot-Garcher CP, Joffre C.
Eye and Nutrition Research Group, UMR CSGA 1324 INRA - 6265 CNRS - Université de Bourgogne, 21000, Dijon, France.

Epidemiological studies suggest that dietary n-3 polyunsaturated fatty acids (PUFAs) may protect against dry eye. This study aimed to evaluate whether a dietary deficiency in n-3 PUFAs may increase the severity of the pathology in a scopolamine-induced model of dry eye in the rat.

Lewis rats of three consecutive generations were bred under a balanced diet or a diet deprived of n-3 PUFAs. Dry eye was experimentally induced by continuous scopolamine delivery in female animals from the third generation of both groups. After 10 days of treatment, the clinical signs of ocular dryness were evaluated in vivo using fluorescein staining. MHC II and the rat mucin rMuc5AC were immunostained on ocular sphere cryosections. The transcript levels of the pro-inflammatory cytokines interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α and interferon (IFN)-γ were quantified in the exorbital lacrimal glands (LG) and in the conjunctiva using reverse transcription followed by polymerase chain reaction. Lipids were extracted from the exorbital LG for fatty acid analysis of the phospholipids using gas chromatography.

When compared to control animals, the scopolamine treatment induced an increase in the cornea fluorescein staining score (from 0.5 ± 0.0 to 2.5 ± 1.0 arbitrary units (AU) for the balanced diet and from 1.2 ± 0.8 to 2.6 ± 0.5 AU for the n-3 PUFA-deficient diet); a decrease in rMuc5AC immunostaining in the conjunctival epithelium (-34% for the balanced diet and -23% for the n-3 PUFA-deficient diet); an increase in the LG transcript levels of TNF-α for the balanced diet and of TNF-α and IFN-γ for the deficient diet; an increase in the conjunctival transcript levels of IL-1β and IL-6 for the deficient diet; an increase in arachidonic acid (AA) and in the ∆5-desaturase index (ratio of AA to dihomo-gamma-linolenic acid) in the exorbital LG for both diets. When compared to the balanced diet, the n-3 PUFA-deficient diet induced an increase in the LG transcript levels of IL-6 for the control animals and of TNF-α for the control and dry eye animals as well as an increase in the conjunctival transcript levels of IL-6 for the dry eye animals. There was no significant diet difference in fluorescein staining, rMuc5AC, and MHC II immunostaining scores.

sOur data suggest that an n-3 PUFA deficiency does not increase the severity of dry eye in a rat model of dry eye.

Abstract: DHA and dry eye

Docosahexaenoic acid, protectins and dry eye.
Curr Opin Clin Nutr Metab Care. 2010 Dec 13. [Epub ahead of print]
Cortina MS, Bazan HE.
aDepartment of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA bNeuroscience Center of Excellence, USA cDepartment of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.

To report recent data on the potential role of omega-3 fatty acids, in particular docosahexaenoic acid and its derivatives, in the treatment of dry eye syndrome.

Dietary supplementation with polyunsaturated fatty acids yields positive results in the improvement of dry eye signs and symptoms. Although several studies have shown this, evidence is still lacking as to which fatty acid or what combination constitutes the most effective treatment. Studies show that treatment with alpha-linoleic acid reduces dry eye-induced inflammation. Eicosapentaenoic acid and docosahexaenoic acid derivatives, particularly resolvin E1 (RvE1) and neuroprotectin D1, appear to be responsible for docosahexaenoic acid's anti-inflammatory effect. This is supported in a study in which topical RvE1 resulted in decreased inflammation in a mouse dry eye model. Topical administration of pigment epithelium-derived factor in combination with docosahexaenoic acid accelerates the regeneration of corneal nerves after their damage during corneal surgery, promoting the return of sensitivity and reducing the signs of dry eye. This combined treatment also reduces objective signs of dry eye, such as rose bengal staining.

No firm recommendations can be made regarding optimal dietary supplementation of essential fatty acids that benefit dry eye patients. On the basis of animal data and preliminary human studies, docosahexaenoic acid and its derivatives appear to be a safe, effective topical treatment for dry eye patients. This may result from their role in the resolution of inflammation and the regeneration of damaged corneal nerves.

Abstract: No dry eye, mild dry eye, severe dry eye in the office

This was really rather interesting, comparing 3 different groups (nothing, mild dry eye and severe dry eye, according to symptom scores) on various tests. The mild dry eye group seemed normal on some tests but not others.

Tear Dynamics and Corneal Confocal Microscopy of Subjects with Mild Self-Reported Office Dry Eye.
Ophthalmology. 2010 Dec 9. [Epub ahead of print]
Zhang X, Chen Q, Chen W, Cui L, Ma H, Lu F.

PURPOSE: To investigate changes in tear dynamics and corneal microstructure in mild self-reported office dry eye.

DESIGN: Prospective laboratory investigation.

PARTICIPANTS: Twenty healthy office workers, 20 office workers with mild self-reported dry eye, and 20 office workers with moderate to severe dry eye as determined by the Ocular Surface Disease Index (OSDI).

METHODS: Real-time anterior segment optical coherence tomography was used to obtain upper (UTMV), lower (LTMV), tear meniscus volumes. The total tear meniscus volume (TTMV) was the sum of the UTMV and LTMV. This was followed by measurement of noninvasive tear breakup time (NITBUT), fluorescein tear breakup time (FTBUT), fluorescein staining, Schirmer I test, and in vivo confocal microscopy of cornea.

MAIN OUTCOME MEASURES: Upper tear meniscus volume, LTMV, TTMV, NITBUT, fluorescein tear FTBUT, fluorescein staining, Schirmer I test, and in vivo confocal microscopy of cornea.

RESULTS: There were no significant differences in UTMV and LTMV between the control and mild self-reported dry eye groups (P>0.05). These values in the moderate to severe dry eye group were significantly lower than those in the control and mild dry eye groups (P<0.01). Both mild and moderate to severe office dry eye groups had decreased NITBUT (P<0.05 each) and FTBUT (P<0.01 each) compared with controls. On the basis of receiver operating characteristic curves, the cutoff value for abnormal FTBUT was 3.3 seconds, yielding good diagnostic accuracy with a sensitivity of 0.75 and specificity of 0.80. For NITBUT, when the cutoff time was 9.7 seconds, the sensitivity was 0.90 and specificity was 0.50. The moderate to severe office dry eye group had decreased Schirmer I test values and increased subbasal nerve tortuosity compared with the mild office dry eye and control groups (P<0.05 each). Both the mild dry eye and moderate to severe dry eye groups had decreased cell densities in superficial, intermediate, and basal epithelial layers compared with the controls (P<0.05 each).

CONCLUSIONS: Although the quantity of tears in patients with mild self-reported office dry eye was not decreased, ocular surface damage was present.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.