Saturday, March 24, 2012

Abstract: Dig those glow-in-the-dark conjunctiva!

Oooh. Pair 'em with glow-in-the-dark braces and you've got yourself a fun Halloween face.

Apparently this is not new... listed next to it on PubMed was a case report from 1981 involving autofluorescence from tetracycline and minocycline.

Minocycline induced conjunctival autofluorescence deposition.

Minocycline can cause palpebral conjunctival greyish deposits in which autofluorescence can be readily demonstrated. We believe that this is a first report of the demonstration of in-vivo conjunctival autofluorescence of palpebral conjunctival minocycline deposit. In conclusion, minocycline deposit can be shown clinically without the need of an invasive biopsy procedure in patients with a history of blepharitis on long-term tetracycline group of medication presenting with palpebral conjunctival deposits.

Semin Ophthalmol. 2012 Jan;27(1-2):25-6.
Lim LT, Tarafdar S, Collins CE, Roberts F, Ramaesh K.
Tennent Institute of Ophthalmology, Gartnavel General Hospital , Glasgow , UK.

OTC news: ISTA to launch an OTC dry eye drop in 2h2012

ISTA's pipeline

From ISTA's 2011 results report (Feb 23, 2012):

Also during the fourth quarter, the Company announced that based on
the results of clinical trials in dry eye, the Company plans to launch
its first over-the-counter (OTC) artificial tear product in the second
half of 2012. Clinical trials conducted in 2011 showed that ISTA's OTC
tear product was highly effective in treating both the signs and
symptoms of dry eye disease as compared to patient baseline.

Abstract: Upper vs lower plugs

At last, an interesting plug study that did not involve smartplug complications.

This one compares people who ONLY got upper plugs with those who ONLY got lower plugs. Seems like we hardly hear about anyone doing uppers only these days.

Visual Function Changes After Punctal Occlusion With the Treatment of Short BUT Type of Dry Eye.

To evaluate visual function changes after punctal plug (PP) occlusion in patients with short breakup time of tear film (BUT) type of dry eyes.
A prospective comparative study was performed in 43 eyes of 43 dry eye patients with short BUTbreakup time of tear film receiving PP occlusion. Patients were divided into 2 groups as those receiving only upper or only lower occlusion. Functional visual acuity measurements, tear function evaluations, and questionnaire on satisfaction with treatment in relation to presence of epiphora were performed before and 1 month after PP insertion.
Twenty eyes of 43 eyes (46.5%) with only lower occlusion and 17 eyes of 43 eyes (39.5%) with only upper occlusion showed satisfactory outcomes with treatment. One of 43 eyes (2.3 %) had epiphora. Vital staining scores and BUT values significantly improved in both groups after occlusion. The mean logarithm of the minimum angle of resolution functional visual acuity value significantly improved only in eyes receiving upper PP occlusion.
Upper PP occlusion seems to be associated not only with improvement of tear stability, vital staining scores, and treatment-related satisfaction but also with better quality of visual function.

Cornea. 2012 Feb 21. [Epub ahead of print]
Kaido M, Ishida R, Dogru M, Tsubota K.
*Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan †Johnson & Johnson Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan.

Abstracts: Plugs after LASIK

... Nothing particularly groundbreaking here... and I'd like to know how they measured symptoms.

Punctal plugs for treatment of post-LASIK dry eye.

To evaluate the efficacy of punctal plugs for patients with post-LASIK dry eye
A prospective study was conducted on 25 eyes of 18 patients who underwent LASIK. All eyes fulfilled the Japanese dry-eye criteria and had not responded to conventional treatment with artificial tears by 1 month postsurgery. They were randomly divided into a plug and a non-plug group. Punctal plugs were inserted into the superior and inferior puncta in the plug group after the 1-month examination. Uncorrected and best corrected visual acuity (UCVA, BCVA), refraction, functional visual acuity (FVA) after 10 s eye opening (FVA 10), surface regularity index (SRI) after 10 s eye opening (SRI 10), corneal sensitivity, Schirmer test, fluorescein staining (FS), tear break-up time (TBUT), and symptoms were compared between the groups 1 and 3 months postsurgery. Changes in these data from 1 to 3 months were also compared between the groups.

The values in SRI 10, FS, and TBUT were significantly better in the plug group at 3 months. Changes in the values of UCVA, FVA 10, FS, TBUT, and symptoms between 1 and 3 months improved significantly in the plug group compared with the non-plug group.

Our results suggest that punctal occlusion for both puncta is effective for patients with post-LASIK dry eye that cannot be controlled by artificial tears alone. Punctal plugs can improve not only the symptoms and tear function, but also the quality of vision, for example FVA.

Jpn J Ophthalmol. 2012 Feb 23. [Epub ahead of print]
Yung YH, Toda I, Sakai C, Yoshida A, Tsubota K.
Smile Eye Clinic, Yokohama, Japan.

Abstract: Trehalose - latest study outcome

Most recent previous study here.

Therapeutic efficacy of trehalose eye drops for treatment of murine dry eye induced by an intelligently controlled environmental system.

To determine whether eye drop instillation of the disaccharide trehalose (TT) alleviates ocular surface damage in a dry eye murine model.

Dry eye was induced in mice using an intelligently controlled environmental system (ICES). After 21 days housed in the ICES without topical treatment, the mice were randomly divided into three groups: no eye drops (ICES) for three weeks, four times a day with PBS 0.01 M 10 µl/eye bilaterally (ICES+PBS), or with TT 87.6 mM 10 µl/eye bilaterally (ICES+TT). Another mice group that was not exposed to the ICES and received no treatment served as a control group (UT). The ocular surface integrity, in each group, was evaluated using Oregon Green dextran (OGD) and fluorescein staining. The expression and distribution of occludin, involucrin, and small proline-rich protein 2 were determined with immunohistology analysis on whole mounted corneas. Heat shock protein 70 (HSP70) and matrix metalloproteinase 9 (MMP-9) expression was estimated with immunohistology. Ocular surface inflammation associated with each treatment was estimated with real time-PCR of interleukin-1β (IL-1β), IL-2, IL-6, IL-17, and tumor necrosis factor-alpha in the conjunctiva.

OGD staining in the cornea epithelium was lower in the ICES+TT group than in the ICES and ICES+PBS groups. Corneal epithelial occludin staining was markedly more homogenous in the ICES+TT group than in ICES and ICES+PBS groups, and there were no desquamating apical epithelial cells. Involucrin and small proline-rich protein 2 labeling of whole mounted corneas revealed upregulation of their expression in the groups, which received no treatment or PBS instillation compared to the ICES+TT group. HSP70 and MMP-9 immunolabeling revealed a marked increase in corneal epithelial expression in response to the ICES. The group treated with trehalose showed a similar profile expression of HSP70 and MMP-9 as the control group (UT). Conjunctival IL-1β, IL-2, IL-6, IL-17, tumor necrosis factor-alpha (TNF-α), and MMP-9 mRNA expression was lower in the ICES+TT group than in the ICES or ICES+PBS group.

Trehalose application restored ocular surface integrity, suppressed inflammatory and proteolytic MMP-9 and HSP70 expression, and keratinization in mice with dry eye damaged by a desiccative model.

Mol Vis. 2012;18:317-29. Epub 2012 Feb 4.
Li J, Roubeix C, Wang Y, Shi S, Liu G, Baudouin C, Chen W.

Abstract: Simultaneous LASIK and corneal inlay implants

No matter what the scientifically accepted follow-up percentage standards for this sort of cohort study, I am always suspicious of any 6-month complications data that reports results for fewer than half of the patients that underwent ANY elective refractive surgery. Why? Because I know how many people ditch their doctor in favor of someone else when they have post-operative complaints after such a surgery (in contrast to medically necessary eye surgery). 64 out of 180. Really? That the best you could do?

With that in mind you'll understand why I feel I think the word "occasionally" (my highlight below) should be read with sincere skepticism.

Simultaneous corneal inlay implantation and laser in situ keratomileusis for presbyopia in patients with hyperopia, myopia, or emmetropia: Six-month results.

To evaluate the safety and efficacy of simultaneous Kamra corneal inlay implantation and laser in situ keratomileusis (LASIK) for the treatment of presbyopia in emmetropic, hyperopic, or myopic patients.

Private center, Tokyo, Japan.

Cohort study.

Patients had bilateral LASIK with simultaneous implantation of a corneal inlay in the nondominant eye to treat presbyopia and ametropia between September 2009 and April 2010. The efficacy and safety were determined by the spherical equivalent (SE) in the eye with the inlay.

The study enrolled 360 eyes of 180 patients with a mean age of 52.4 years ± 5.1 (SD) (range 41 to 65 years). Sixty-four patients were available for the 6-month postoperative examination. The mean logMAR uncorrected near visual acuity in the eye with the inlay improved 7 lines in hyperopic eyes, 6 lines in emmetropic eyes, and 2 lines in myopic eyes. The mean logMAR uncorrected distance visual acuity improved by 3 lines, 1 line, and 10 lines, respectively.

Simultaneous intracorneal inlay implantation and LASIK to treat presbyopia with emmetropia, hyperopia, or myopia was clinically safe and effective, yielding improvement in distance and near visual acuity. Patients were satisfied with decreased dependence on reading glasses regardless of the preoperative SE range. However, postoperative symptoms, such as dry eyes, halo, glare, or night-vision disturbances, occurred occasionally.

Dr. Waring has a financial interest in and is world surgical monitor for Acufocus. No other author has a financial or proprietary interest in any material or method mentioned.

J Cataract Refract Surg. 2012 Mar;38(3):495-506.
Tomita M, Kanamori T, Waring GO 4th, Yukawa S, Yamamoto T, Sekiya K, Tsuru T.
From the Shinagawa LASIK Center (Tomita, Kanamori, Yukawa, Yamamoto, Sekiya, Tsuru), Tokyo, Japan; ReVision Advanced Laser Eye Center (Waring), Columbus, Ohio, and St. Joseph's Translational Research Center (Waring), Atlanta, Georgia, USA.

Abstract: Dry eye and systemic sclerosis

You know, forget the sclerosis element for a moment, this study's outcome just seems nuts to me no matter what population it refers to:

Half of the people were diagnosed with dry eye, but there was no difference in OSDI scores (that's the popular symptom questionnaire) between those with and without clinically proven dry eye. OSDI didn't correlate with any of the 'objective' test findings enough to write home about. Huh??

So... we conclude that dry eye is (a) not a bit deal and (b) confusing in dry eye patients? I'd be more tempted to conclude that we ditch OSDI for a better questionnaire, and/or broaden the clinical testing we compare it with. Just doesn't make sense to me.

Evaluation of dry eye signs and symptoms in patients with systemic sclerosis.

One of the most frequent ocular features of systemic sclerosis (SSc) is dry eye disease (DED), which has been identified to occur in 37-79% of patients. Although several studies have found weak or no correlations between symptoms and signs of dry eye, symptoms are often the motivation for seeking eye care, and are therefore a critical outcome measure when assessing treatment effect. The aim of this study is to evaluate the impact of symptoms of dry eye on vision-related quality of life in patients with systemic sclerosis, and to investigate the relation between clinical tests and symptoms of dry eye in these patients.

In this cross-sectional study, 45 consecutive patients with SSc were enrolled. For evaluation of the symptoms the "Ocular Surface Disease Index (OSDI)" questionnaire was applied to all patients. After that, all individuals were submitted to a full ophthalmic examination, including the following tests: tear break-up time, Schirmer I, rose bengal staining. Patients were then grouped into dry eye and non-dry eye groups with regard to the diagnosis of dry eye. Mann-Whitney test was used to compare continuous variables, whereas the Fisher exact test was used to compare categorical data between groups. Spearman's correlation test was used to analyze the correlations between clinical tests and OSDI scores. P values <0.05 were considered significant.

Dry eye disease was diagnosed in 22 patients (48.9%). Other ocular surface abnormalities found were: blepharitis (40% of the patients), pterygium (15.6%), pinguecula (82.2%), and superficial punctate keratitis (26.7%). Among the 45 patients, 29 patients (64.4%) had symptoms of ocular surface disease. The mean OSDI score was 26.8 ± 25.8 (SD). There were no statistically significant differences in OSDI scores between DED and non-DED patients. No substantive correlations were found between OSDI scores and TBUT, Schirmer I, or rose bengal staining score, and none of the observed correlations reached statistical significance.

Symptoms of dry eye have a moderate impact on vision-related quality of life in patients with systemic sclerosis and do not correlate well with clinical findings.

Graefes Arch Clin Exp Ophthalmol. 2012 Feb 18. [Epub ahead of print]
de A F Gomes B, Santhiago MR, de Azevedo MN, Moraes HV Jr.
Department of Ophthalmology, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.

Abstract: TearLab

This is the sort of thing that makes me wish I'd ever learned something about statistics. I don't know how to translate this. To someone as ignorant as me it could be anything from validating the usefulness of the tool to politely saying it's just a marketing gimmick stupid. Somebody with a mathematical bone in their body care to comment on what 33 means here?

Reproducibility and repeatability of the OcuSense TearLab™ osmometer.

Some studies report that increased tear osmolarity is a reliable indicator of dry eye syndrome (DES). The OcuSense TearLab™ osmometer requires less than a 100-nl sample of tears and provides an instant quantitative result. Our aim was to clinically evaluate this instrument in terms of its reproducibility and repeatability.
Twenty-nine participants who ranged in age from 19 to 49 years (mean ± SD: 23.3 ± 5.5 years) were recruited. Osmolarity readings were collected by two operators, in two sessions separated by 1 or 2 weeks in order to assess test reproducibility and repeatability.
The coefficient of reproducibility was 39 mOsms/l; the coefficient of repeatability was 33 mOsms/l.
Our mean coefficient of variation over four readings for 29 subjects is 2.9%, which compares well with that reported by the manufacturer. Our results inform practitioners about the level of change over time that can be considered clinically relevant for healthy subjects. This value is 33mOsms/l; any change smaller than this could be attributed to measurement noise.

Graefes Arch Clin Exp Ophthalmol. 2012 Feb 21. [Epub ahead of print]
Eperjesi F, Aujla M, Bartlett H.
Ophthalmic Research Group, School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK,

Abstract: Another rebamipide study

Rebamipide Increases the Mucin-Like Glycoprotein Production in Corneal Epithelial Cells.

Abstract Purpose:
Dry eye is a multifactorial disease of tears and the ocular surface due to tear deficiency or excessive tear evaporation. Tear film instability is due to a disturbance in ocular surface mucin leading to a dysfunction of mucin, resulting in dry eye. In this study, we examined the effect of rebamipide, an anti-ulcer agent, on glycoconjugate production, as an indicator of mucin-like glycoprotein in cultured corneal epithelial cells. Further, we investigated the effect of rebamipide on the gene expression of membrane-associated mucins.

Confluent cultured human corneal epithelial cells were incubated with rebamipide for 24 h. The glycoconjugate content in the supernatant and the cell extracts was measured by wheat germ agglutinin-enzyme-linked lectin assay combined gel-filtration method. In the experiment on mucin gene expression, cultured human corneal epithelial cells were collected at 0, 3, 6, and 12 h after administration of rebamipide. Real-time quantitative polymerase chain reaction was used to analyze the quantity of MUC1, MUC 4, and MUC16 gene expression.

Rebamipide significantly increased the glycoconjugate contents in the supernatant and cell extract. In the mucin gene expression in the cells, rebamipide increased MUC1 and MUC4 gene expression, but did not increase MUC16 gene expression.

Rebamipide promoted glycoconjugate, which has a property as a mucin-like glycoprotein, in human corneal epithelial cells. The increased production was mediated by MUC1 and MUC4 gene expression.

J Ocul Pharmacol Ther. 2012 Feb 15. [Epub ahead of print]
Takeji Y, Urashima H, Aoki A, Shinohara H.
Ako Research Institute, Division of Dermatologicals and Ophthalmologicals, Otsuka Pharmaceutical Co., Ltd. , Ako, Hyogo, Japan .

Abstract: Parotitis and pediatric Sjogrens Syndrome

FYI parotitis is infection of the salivary glands. I'm posting this one in case any of the parents of youngsters with dry eye might find it interesting/relevant... I had never heard of Sjogrens in children before.

Recurrent parotitis as a presentation of primary pediatric Sjögren syndrome.

Parotitis is a common condition seen in the pediatric population, usually as an isolated occurrence associated with viral or bacterial infection. The differential diagnosis expands when recurrent parotitis is encountered. One etiology is primary pediatric Sjögren syndrome (SS), an autoimmune condition typically associated with dryness of the eyes and mouth in adults. Pediatric patients often present with isolated recurrent bilateral parotitis, however, and we describe 4 such cases in children aged 9 to 17 years at presentation. Despite lack of ocular complaints, 3 of these patients had ocular findings on ophthalmologic exam. Our patients also exhibited classic laboratory abnormalities, including positive antinuclear antibody, SS A, and SS B antibodies; presence of rheumatoid factor; and hypergammaglobulinemia. Consideration of SS in the child with recurrent parotitis is important for timely and appropriate referral and treatment. We review the differential diagnosis of parotitis in children as well as the salient features of pediatric SS.

Pediatrics. 2012 Jan;129(1):e179-82. Epub 2011 Dec 19.
Baszis K, Toib D, Cooper M, French A, White A.
Division of Pediatric Rheumatology, Washington University School of Medicine, St Louis, Missouri, USA.

Wednesday, March 21, 2012

Abstract: Tear film in the morning vs. afternoon

I like this a lot. Nothing like studying HEALTHY individuals once in awhile to put disease into perspective.

Comparison of the tear film clinical parameters at two different times of the day.

The aim of the present study was to analyse the quality and quantity of the tear film in a young, healthy and non-contact lens-wearing population with measurements taken in the morning and in the afternoon to establish if changes exist in these parameters.

In a controlled laboratory setting, morning and afternoon clinical parameters of tear film were assessed. Schirmer test, tear meniscus height, break-up time and non-invasive break-up time were measured in 51 normal subjects on the same day for each individual.

Tear volume showed no significant changes during the day but tear film stability was significantly reduced at the end of the day (p < 0.001), demonstrating that tear film stability is affected by the time of day.

Researchers and clinicians might wish to consider these differences when comparisons are made between studies and populations and also when the same patient is observed over periods. Fluorescein instillation can affect the measurements of tear stability in subjects with poor quality tear film.

Clin Exp Optom. 2011 Nov;94(6):557-62. doi: 10.1111/j.1444-0938.2011.00647.x. Epub 2011 Aug 22.
Lira M, Oliveira ME, Franco S.
Centre of Physics (Optometry), School of Sciences, University of Minho, Portugal.

Abstract: Advances in NON invasive tear film diagnostics

I really like the sound of this... very intriguing. Too bad this sort of thing could probably never find its way to clinical use but if it can help develop and target new treatments more effectively, that's good too.

Integrated multimodal metrology for objective and noninvasive tear evaluation.

The clinical tests used to assess tear film and diagnose dry eye are invasive and produce results that are different from natural tear characteristics. There is a need to objectively and noninvasively assess tear parameters under controlled environmental circumstances to refine dry eye diagnosis and therapy. We have developed multimodal tear imaging systems integrated in a chamber in which individual environmental factors can be precisely varied to investigate their impacts on tear parameters. With the custom-built high-resolution wavefront sensor combined with placido disc, it is possible to objectively detect two-dimensional tear breakups in real time and evaluate its impact on visual quality. Micrometer ultra-high resolution optical coherence tomography (OCT) enables us to quantify thickness and volume of the tear over the cornea and tear menisci. The ocular surface imaging ellipsometer uses polarized illumination from which both the lipid refractive index and thickness can be measured at a very high resolution. Using an enhanced thermal camera, we measure the ocular surface temperature noninvasively, which makes it possible to study spatial and temporal changes in tear evaporation. The multimodal deployment of these four components in the controlled chamber will assist in better differentiating the various clinical dry eye entities and will lead to the development of specific dry eye treatments.

Ocul Surf. 2012 Jan;10(1):43-50. Epub 2012 Jan 8.
Kottaiyan R, Yoon G, Wang Q, Yadav R, Zavislan JM, Aquavella JV.
University of Rochester Flaum Eye institute, Ocular Surface Laboratory, Rochester, New York 14610, USA.

Abstract: Is lacrimal fluid composition more... fluid than we thought?

Really interesting stuff here. The idea is that what we commonly call the "aqueous" tear layer, produced by the lacrimal glands, is more complex than traditionally thought... that in fact some of the mucin in the tear film comes from the lacrimals, and that the lacrimals can vary the composition of what it puts out in response to what's going on in the eyes.

Not all lacrimal epithelial cells are created equal-heterogeneity of the rabbit lacrimal gland and differential secretion.

To test the hypotheses that some epithelial cells in the rabbit lacrimal gland (LG) are mucin-secreting cells that are also particularly rich in aquaporin 5 (AQP5) and sodium potassium ATPase β(1) subunit (NKAβ(1)), LG-secreted mucins contribute to the total mucin pool in tear film, and that the rabbit LG is a heterogenic gland where proteins secreted in response to different agonists are varied.

LGs were obtained from adult female rabbits and processed for paraffin sections for hematoxylin and eosin (HE) staining, periodic acid-Schiff (PAS), mucicarmine, and Alcian blue (pH 0.4, 1.0, and 2.5) for the detection of mucins. Serial sections were used for immunohistochemistry (IHC) and PAS. LG lysates and fluids were assayed by dot blot for detection of mucins, and by SDS-PAGE to detect differences in protein profiles of LG fluids stimulated by different agonists.

HE staining demonstrated that the LG is a heterogeneous gland where most epithelial cells are serous, while all duct cells are mucous cells. Some acini and individual acinar cells within serous acini are also mucous or seromucous cells and these cells are particularly rich in AQP5 and NKAβ(1). Dot blot assay showed the presence of mucins in the LG fluids. The protein profiles of LG fluids from pilocarpine, phenylephrine, and isoproterenol varied significantly, particularly in the mid range.

Our data indicated that the rabbit LG is a heterogeneous gland that is composed of both serous and mucin-secreting cells, and mucins produced by the LG contribute to the mucin pool in the tear film. The heterogeneity of the rabbit LG supports the notion of differential secretion, i.e. the volume and composition of the LG fluids vary depending on various circumstances in the ocular surface and the body's needs.

Curr Eye Res. 2011 Nov;36(11):971-8. doi: 10.3109/02713683.2011.602814.
Ding C, Huang J, Macveigh-Aloni M, Lu M.
Department of Cell and Neurobiology, University of Southern California, Los Angeles, USA.

Abstract: SAR1118 phase 2 study

A Phase 2 Randomized, Double-Masked, Placebo-Controlled Study of a Novel Integrin Antagonist (SAR 1118) for the Treatment of Dry Eye.

To investigate the efficacy and safety of an investigational integrin antagonist (SAR 1118) ophthalmic solution compared to placebo (vehicle) in subjects with dry eye disease.

Multicenter, prospective, double-masked, placebo-controlled trial.

A total of 230 dry eye subjects selected with use of a controlled adverse environment were randomized 1:1:1:1 to receive SAR 1118 (0.1%, 1.0%, 5.0%) or placebo eye drops twice daily for 84 days. Principal eligibility criteria included exacerbation in corneal staining and ocular symptoms with controlled adverse environment exposure, no active lid margin disease, and Schirmer test (mm/5 min) >1 and <10. Ocular signs and symptoms (Ocular Surface Disease Index, OSDI) were assessed at day 14, 42, and 84. No supplemental artificial tears were allowed. Primary outcome measure was inferior corneal staining score at day 84.

A dose response for the corneal staining score (P = .0566) was observed for SAR 1118 at day 84 compared to placebo. Mean change from baseline to day 84 showed significant improvements (P < .05) in corneal staining score, total OSDI, and visual-related function OSDI scores for SAR 1118 compared to placebo; improvements in tear production and symptoms were observed as early as day 14 (P < .05). Adverse events were mild and transient in nature with no serious ocular adverse events. SAR 1118 5.0% showed increased instillation site adverse events relative to placebo but were limited to the initial dose.

SAR 1118 demonstrated improvements in signs and symptoms of dry eye compared to placebo and appears safe when administered over 84 days.

Am J Ophthalmol. 2012 Feb 11. [Epub ahead of print]
Semba CP, Torkildsen GL, Lonsdale JD, McLaurin EB, Geffin JA, Mundorf TK, Kennedy KS, Ousler GW.
SARcode Bioscience, Brisbane, California.

Abstract: VA study of dry eye impact on quality of life

Pretty rudimentary stuff being reconfirmed for the umpteenth time here, nonetheless it is encouraging to see the VA initiating this kind of study (oh, and to see a study of mostly MEN and dry eye). Not much comfort to the gentleman I spoke with the other day who was having no luck getting help at a VA hospital in another part of the country, sigh. Not that I am in the least inclined to pick on the VA - I'm not - in fact I used to get calls regularly from patients at one particular VA hospital who were getting GREAT care. Wish I could say the same for all the high-falutin' bigname medical institutions some dry eye patients have gone to in desperation.

Impact of Ocular Surface Symptoms on Quality of Life in a United States Veterans Affairs Population.

To evaluate the impact of ocular surface symptoms on quality of life in a veteran population receiving eye care services.

Cross-sectional survey study.

Setting: Miami Veterans Affairs Medical Center (VAMC). Patient population: Patients seen at the eye clinic between June and August 2010 were asked to fill out the Dry Eye Questionnaire 5 (DEQ5) and the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire.

Correlation between ocular surface symptoms and functionality.

Four hundred eighty-nine patients elected to fill out the DEQ5 questionnaire (36% response rate). The mean age of respondents was 66 years (standard deviation 12). Ninety-four percent were male; 62% were white and 37% were black. Using the DEQ5 as a surrogate measure of ocular surface symptoms, 65% of respondents reported at least mild ocular surface symptoms (DEQ5 ≥6) and 27% of them reported severe symptoms (DEQ5 ≥12). Black subjects had a 2-fold increased risk of severe symptoms compared to white subjects (odds ratio 2.06, 95% confidence interval 1.33-3.19). Several medications were associated with a significantly increased risk of severe symptoms, including glaucoma medications (1.7-fold increase), antidepressants (2.3-fold increase), and antihistamines (2.1-fold increase). There was an inverse correlation between DEQ5 and IDEEL scores with regard to ability to perform activities of daily living (n = 391, r = -0.54, P < .001), emotional well-being (n = 386, r = -0.63, P < .001), and the ability to work (n = 205, r = -0.57, P < .001). Fifty percent of patients with severe symptoms had documentation that their symptoms were addressed during the visit.

Severe ocular surface symptoms reduce the quality of life of Miami VAMC veterans. Eye care professionals should be vigilant in eliciting ocular surface complaints from their patients.

Am J Ophthalmol. 2012 Feb 11. [Epub ahead of print]
Pouyeh B, Viteri E, Feuer W, Lee DJ, Florez H, Fabian JA, Perez VL, Galor A.
Miami Veterans Administration Medical Center, Miami, Florida; Bascom Palmer Eye Institute, University of Miami, Miami, Florida.

Abstract: Salivary gland transplant (for dry anophthalmic cavity)

Betcha didn't know you can have dry eye even without eyes. - Every once in a long while I speak with someone who has an artificial eye and struggles to find effective lubricants, so I was tempted to post this study in case any of them happen to read my bulletins.

[Treatment of dry anophthalmic cavities with labial salivary glands transplantation].
[Article in Portuguese]

To study the clinical effects of labial salivary glands' secretion used as ocular lubricant in anophthalmic cavities with severe xerophthalmia; to evaluate the evolution of the results; and to present the surgical technique. This procedure application in dry anophthalmic cavities is new in the literature.

Prospective study of patients presenting anophthalmic cavities with severe xerophthalmia and conjunctival fornix retraction treated with labial salivary glands transplantation to the conjunctival fornices. The surgeries were performed in five patients during the period of July 2000 to January 2009. In two cases the fornix retraction was previously treated with mucosa or skin graft. The surgical procedure technique is described in details. The postoperative comparative analysis was based on the clinical picture, the cavity surface aspect, the dryness of the cavity and prosthesis and the frequency of lubricant eye drops use.

In all cases both graft integration and improvement of the evaluated parameters were observed. The evolution proved the persistence and stability of the results.

The salivary secretion produced by the transplanted labial glands proved to be efficient as conjunctival lubricant, well tolerated and permanent, making the use of the prosthesis more comfortable. This improvement helps to prevent the progression of the cavity retraction process. Labial salivary glands graft into the anophtalmic cavity is a simple procedure and accessible to any ophthalmic surgeon.

Arq Bras Oftalmol. 2011 Dec;74(6):425-9.
França IS, Medrado J, França VP, Soares EJ.
Centro Oftalmológico de Minas Gerais, Belo Horizonte, MG, Brazil.

Abstract: 9-month lipiflow effects

A Single LipiFlow(®) Thermal Pulsation System Treatment Improves Meibomian Gland Function and Reduces Dry Eye Symptoms for 9 Months.

To evaluate the effect of a single treatment with the LipiFlow(®) Thermal Pulsation System on signs of meibomian gland dysfunction (MGD) and dry eye symptoms over a 9-month period.

Patients (n = 42 eyes, 21 subjects) diagnosed with MGD and dry eye symptoms were recruited for a non-significant risk, prospective, open-label, 1-month clinical trial. Patients received a single 12-minute treatment using the LipiFlow(®) Thermal Pulsation System on each eye. The LipiFlow(®) device applies heat to the conjunctival surfaces of the upper and lower inner eyelids while simultaneously applying pulsatile pressure to the outer eyelid surfaces to express the meibomian glands. Patient symptoms were evaluated using the Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation for Eye Dryness (SPEED) dry eye questionnaires; tear break-up time was measured with the dry eye test (DET™); and meibomian gland function was evaluated using a standardized diagnostic expression technique. Data are presented for patient's pre-treatment (baseline) and at 1-month and 9-month post-treatment.

Meibomian gland secretion scores improved significantly from baseline (4.4 ± 4.0) to 1-month post-treatment (11.3 ± 6.2; p < 0.0001) and this improvement was maintained with no significant regression at 9 months (11.7 ± 5.9). Similarly, baseline tear break-up time (4.8 ± 3.2) was significantly increased at 1 month (9.6 ± 7.6; p < 0.001) and this increase was maintained with no significant regression at 9 months (7.1 ± 5.6). Symptom scores on both OSDI and SPEED questionnaires improved significantly at 1 month (p < 0.0001) and this improvement was maintained at 9 months.

With such prolonged improvement in signs and symptoms of dry eye disease, the LipiFlow(®) Thermal Pulsation System offers a technological advancement for the treatment of dry eye disease secondary to meibomian gland dysfunction. A single 12-minute LipiFlow(®) treatment results in up to 9 months of sustained improvement of meibomian gland function, tear break-up time and dry eye symptoms that are unparalleled with current dry eye treatments.

Curr Eye Res. 2012 Feb 10. [Epub ahead of print]
Greiner JV.
Schepens Eye Research Institute and the Department of Ophthalmology , Harvard Medical School, Boston, MA , USA.

Abstract: Boy, I wish they'd tell us...

...what brand of makeup this poor gal was using! (Not that I would care that much... I hardly ever wear eye makeup anymore anyway.)

Unilateral Non-Pigmented Palpebral Conjunctival Lesions Due to Cosmetics Use.

A 62-year-old woman with a history of dry eyes was found to have unilateral pedunculated, nonpigmented palpebral conjunctival lesions. Excisional biopsy was performed, and the lesions were studied histopathologically. Microscopic examination of the lesions demonstrated exuberant granulation tissue with a granulomatous foreign body giant cell reaction surrounding pigmented and partially birefringent foreign material. Histopathologic examination of the patient's cosmetics revealed that the pigmented foreign bodies seen on the biopsy specimens were compatible with her mascara and/or eyeliner. While cosmetics have been reported to have ophthalmic sequelae, palpebral lesions such as these have not been reported to the authors' knowledge.

Ophthal Plast Reconstr Surg. 2012 Feb 9. [Epub ahead of print]
Pao KY, Murchison AP, Eagle RC Jr.
*Wills Eye Institute, Philadelphia, Pennsylvania, U.S.A. †Oculoplastic and Orbital Surgery Service, Wills Eye Institute, Philadelphia, Pennsylvania, U.S.A. ‡Ocular Pathology Service, Wills Eye Institute, Philadelphia, Pennsylvania, U.S.A.

Abstract: Correlation of inflammatory cytokines with 4 diagnostic tests

Bottom line of this study was that both Schirmer (the little strip test we love to hate) and tear osmolarity correlated better with the presence of inflammatory cytokines and MMPs (i.e. evidence of inflammation) than the OSDI questionnaire or the classic TBUT test.

Correlation of tear inflammatory cytokines and matrix metalloproteinases with four dry eye diagnostic tests.

Tear cytokines and matrix metalloproteinases (MMPs) can be extracted from the Schirmer strip. This study examined the extracted levels of tear cytokines and MMPs from Schirmer strips and potential correlation with Schirmer's test, tear breakup time (TBUT), tear osmolarity, and ocular surface disease index (OSDI).

Thirty healthy volunteers were clinically evaluated for known methods to diagnose dry eye disease, including Schirmer's test, tear osmolarity, OSDI, and TBUT. Tears were collected by Schirmer strips and proteins were extracted from the Schirmer strip in 0.5 M NaCl with 0.5% Tween 20 and analyzed using Luminex kits to examine cytokines or MMPs. Calculated cytokine and MMP concentrations for all samples were sorted into groups according to a positive or negative for each of the above 4 dry eye diagnostic tests individually and in combination.

Five inflammatory cytokines (IL-1α, IL-1β, IL-6, IL-8, and TNF-α) and 5 MMPs (MMPs 1, 2, 7, 9, and 10) were extracted from clinical Schirmer strips. Schirmer strip measurement and tear osmolarity correlated well with increased concentrations of the inflammatory cytokines and MMPs, while TBUT and OSDI did not.

Both the Schirmer's test and tear osmolarity may be more relevant to the clinician in the diagnosis of ocular surface diseases with an increased level of inflammatory mediators.

Invest Ophthalmol Vis Sci. 2012 Feb 8. [Epub ahead of print]
Vandermeid KR, Su SP, Ward KW, Zhang JZ.