Saturday, July 14, 2012

Abstract: Children with dry eye may not say so

To compare the symptom scores of children with those of adults with the same degree of mild ocular surface signs.
This study included patients with at least one ocular surface symptom and sign. Data obtained from 45 subjects aged 8.79±2.95 yr (Mean ± SD) (pediatric group) and 45 adults aged 52.87±10.87 yr (adult group) who were matched to each pediatric patient based on ocular surface signs were analyzed. Demographic data including age and sex; parameters of ocular surface signs including fluorescein staining score, tear film breakup time and Schirmer test score; symptom scores including ocular surface disease index (OSDI) and visual analog scale (VAS) were assessed and compared between the two groups.
Significant differences emerged in sex ratio as well as in age between the two groups (P<0.001, for both). Regarding ocular surface signs and tear film tests, the study revealed no significant differences in fluorescein staining score (1.44±1.95 vs. 1.40±1.68 P=0.913), tear film break up time (4.96±1.94 vs. 3.82±1.85 s, P=0.612) and Schirmer score (12.79±9.05 vs. 10.11±8.45 mm / 5 min, P=0.370). Regarding dry eye symptoms, both OSDI and VAS were significantly lower in the pediatric group (P=0.001 and<0.001, respectively) than in the adult group.
Pediatric patients with mild ocular surface damage may report fewer dry eye symptoms compared to adult patients with similar stages of ocular surface damage.

Graefes Arch Clin Exp Ophthalmol. 2012 Jul 12. [Epub ahead of print]
Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Korea.

Abstract: Comparing different products derived from blood

Ooooh... I've been waiting for something like this to come out. Bring 'em on... we need as much research into these different blood derivatives as we can get, IMO.

To compare the effects of three blood derivatives (Autologous Serum, AS; Platelet-Rich Plasma, PRP and serum derived from Plasma Rich in Growth Factors, PRGF) on a human corneal epithelial (HCE) cell line, in order to evaluate their potential as an effective treatment for corneal epithelial disorders.
The concentrations of EGF, FGF, VEGF, HGF, PDGF and fibronectin were quantified by ELISA. The proliferation and viability of HCE cells were measured by an MTT colorimetric assay. Cell morphology was assessed by phase-contrast microscopy. The patterns of expression of several CONNEXIN, INVOLUCRIN and INTEGRIN α6 genes were analyzed by real-time RT-PCR.
We have found significantly higher levels of EGF in PRGF compared to AS and PRP. However, both AS and PRGF induced robust proliferation of HCE cells. In addition, PRGF cultured cells grew as heterogeneous colonies, exhibiting differentiated and non-differentiated cell phenotypes, whereas AS- and PRP-treated cultures exhibited quite homogeneous colonies. Finally, PRGF up-regulated the expression of several genes associated with communication and cell differentiation, in comparison to AS or PRP.
PRGF promotes biological processes required for corneal epithelialization, such as proliferation and differentiation. Since PRGF effects are similar to those associated with routinely used blood derivatives, the present findings warrant further research on PRGF as a novel alternative treatment for ocular surface diseases.

Invest Ophthalmol Vis Sci. 2012 Jul 10. [Epub ahead of print]
R&D&I Department, Instituto Clinico-Quirurgico de Oftalmologia, Bilbao, Spain.

Abstract: Punctal plug use in an elderly population

Looks pretty straightforward. 

Restasis comes on the market. Medicare reimbursement for punctal plugs is cut in half. More and more elderly are being diagnosed with dry eye. Far fewer of them are being given plugs. 

The purpose of this study was to determine whether changes in Medicare reimbursement for punctal plug insertion were associated with a decrease in the incidence of insertion and dry eye diagnosis.
Incident cases of dry eye syndrome (DES) diagnoses and punctal plug insertions among Medicare beneficiaries were identified from Medicare 5% Part B from 1994 to 2008, using a 3-year look-back. Dry eye syndrome diagnoses and punctal plug insertion codes were ascertained from the International Classification of Diseases and Current Procedural Terminology codes. Medicare payment data were obtained from the Centers for Medicare and Medicaid Services from 1994 to 2008 for punctal plug insertion. Rates were calculated for both the incidence of DES and the use of punctal plugs.
From 2001 to 2008, inflation-adjusted Medicare reimbursement for punctal plug insertion decreased 55.1%, whereas the Medicare population-adjusted incidence of dry eye diagnosis increased 23.3%. Nine percent of individuals diagnosed with DES between 1991 and 2008 underwent punctal plug placement with a mean of 2.0 plugs placed per patient. Total punctal plug placement increased 322.2% between 1994 and 2003, and then reached a plateau. First-time punctal plug insertion rates within 365 days of DES diagnosis increased 111.8% from 1994 to 2002, and then declined 47.0% from 2002 to 2008.
Although the frequency of DES diagnosis in the Medicare population has increased over time, first-time punctal plug insertion rates, especially within the first year following DES diagnosis, have declined coincidently with the increasing presence of a medical alternative and declining Medicare payment. Choice of therapies may have cost and care implications.

Ophthal Plast Reconstr Surg. 2012 Jul;28(4):289-93.
*Department of Ophthalmology, Duke University Eye Center; †Department of Economics, Brown University, Providence, Rhode Island; ‡W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; and §Department of Economics, Duke University, Durham, North Carolina, U.S.A.

Abstract: Alcohol & dry eye, again

Gee, this is becoming a popular topic to study. Do participants get paid to drink, I wonder? Is there a menu to choose from? Where can I go to volunteer?

Oh. Alcohol seems to cause or worsen dry eye. Never mind.....

To investigate whether ethanol administration disturbs the tear film and ocular surface.
Case-control study.
Twenty healthy male subjects were recruited. Ethanol was administered to 10 subjects and another 10 subjects served as controls.
Twenty healthy male subjects with no ocular disease were recruited. Ethanol (0.75 g/kg) was administered orally at 8 pm for 2 hours to 10 subjects.
The tear film and ocular surface were evaluated at 6 pm before drinking, at midnight, and immediately (6 am) and 2 hours (8 am) after waking the next morning. Tear osmolarity, ethanol concentration in tears and serum, Schirmer's test results, tear film break-up time (TBUT), corneal punctuate erosion, and corneal sensitivity were measured.
Ethanol was detected in tears and serum at midnight, but it was not detected the next morning. The mean tear osmolarity level increased in the alcohol group at midnight compared with that in the control group (P<0.001). The alcohol group showed a significantly shorter TBUT compared with the control group after drinking alcohol (P<0.001 at 12 am, P<0.001 at 6 am, and P = 0.002 at 8 am). There were significantly higher fluorescein staining scores in the alcohol group compared with those in the control group at 6 am and 8 am (P = 0.001 and P<0.001, respectively). No significant change was shown in corneal sensitivity or Schirmer's test results in either group.
Orally administered ethanol was secreted into the tears. Ethanol in tears induced tear hyperosmolarity and shortened TBUT and triggered the development of ocular surface diseases. Similar changes could exacerbate signs and symptoms in patients with ocular surface disease.

Ophthalmology. 2012 May;119(5):965-71. Epub 2012 Feb 11.
Department of Ophthalmology, Hallym University College of Medicine, Seoul, Korea.

Abstract: Corneal changes with Restasis (not)

Here's a good one for those who obsess about potential side effects of Restasis. Looks harmless from this standpoint, for usre.

Then there are all those who believe Restasis is just a really expensive artificial tear of sorts, but we needn't go there, need we?

Purpose: To report the effect of topical Cyclosporine-A (CsA) 0.05% on corneal morphologic and functional parameters in patients with dry eye.
In this prospective and observational, 30 eyes of 30 patients who received topical CsA 0.05% for treatment of dry eye were evaluated. Each clinical examination included a routine clinical examination with the Schirmer I test, and tear film break-up time (TBUT) was performed at baseline and after 1, 2, 3, and 6 months of treatment. All participants also underwent central corneal thickness (CCT) measurements with ultrasound pachymetry, endothelial cell density (ECD) with specular microscopy, corneal topographical evaluation with Orbscan II, and corneal biomechanical parameters with Ocular Response Analyzer measurements at baseline and after treatment.
The Schirmer I test and TBUT were significantly improved after treatment (for both; P<0.01). The CCT, topographical findings, ECD, and corneal biomechanical parameters were not significantly different at baseline and follow-up visits (P>0.05). No serious adverse effects were seen at follow up visits.
The study showed that Topical CsA 0.05% caused no changes on corneal morphologic and functional parameters.

J Ocul Pharmacol Ther. 2012 Jun 26. [Epub ahead of print]
1 Department of Ophthalmology, Kanuni Sultan Suleyman Education and Research Hospital , Istanbul, Turkey .

Abstract: Preventing Botox-induced dry eye

Yes!! This kind of study is a balm to my soul.

Someone is actually paying attention to a pattern of progressive worsening of dry eye caused by Botox in some patients, and suggesting doctors:
a) get PROACTIVE about detecting any dry eye symptoms in patients early on, and
b) if confirmed, prevent longer term harm by QUITTING or delaying injections.

Now exactly how often do we see anybody suggesting that kind of approach to dealing with the possibility of dry eye caused by a lucrative elective ophthalmic procedure of any kind in a peer-reviewed journal? I'll leave you to speculate on the parallels, sigh.

And hallelujah, the entire text of the study is free. Thank you, Hawaii Journal of Medicine & Public Health.

CONCLUSION: Dry eye syndrome of varying severity may develop when BTX-A is repeatedly injected into the lateral canthal region for aesthetic correction of crow's feet. Early suspicion of this condition is suggested by subtle eye irritation, foreign body sensation, and epiphora. If BTX-A injections are continued, worsening of the manifestations may take place (Figure 1). These manifestations seem to be due to orbicularis oculi muscle weakness and may become worse and possibly persistent if BTX-A injection is not delayed or discontinued. Our clinical experience indicates that inquiry for the presence of any dry eye symptoms as well as routine snap-back and distraction tests prior to BTX-A injections help early detection of this condition and therefore we recommend their use. When conservative management of dry eye syndrome due to BTX-A injection over a period of 6 to 12 months fails, we have had success in resolving it by performing musculoplasty as shown in Figure 2.

Hawaii J Med Public Health. 2012 May;71(5):120-3.
Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI.

Abstract: Allogeneic serum eye drops

With autologous serum drops becoming an increasingly common treatment for severe/stubborn dry eye cases, I've been pleased to see more studies emerging on using allogeneic serum drops (i.e. drops from blood drawn from someone other than the patient):

To evaluate the therapeutic effect of allogeneic serum eye drops for the treatment of dry eye in patients with chronic graft-versus-host disease (cGVHD) following bone marrow transplantation.
Sixteen patients with cGVHD following allogeneic hematological stem cell transplantation (allo-SCT) and diagnosed with dry eye syndrome refractory to conventional treatment were prospectively enrolled in this study. Allogeneic serum eye drops were obtained from healthy related donors after serologic testing. Symptom scores, tear breakup time (tBUT), the Schirmer test without anesthesia (Schirmer I test), tear osmolarity, corneal staining score, impression cytology grade, and goblet cell densities were evaluated before and 4 weeks after administration of allogeneic serum eye drops.
Enrolled patients included 6 females and 10 males between 20 and 61 years of age (mean age, 37.2±11.6 years). After 4 weeks of treatment, the Ocular Surface Disease Index (OSDI) symptom scores decreased significantly (32.5-8.9). Tear osmolarity showed a significant decrease from 311.1 to 285.1 milliosmol. The corneal staining scores significantly decreased from 2.5 to 1.8. Impression cytology grade and goblet cell density improved from 3.4 to 2.4 and from 90.6 to 122.6 cell/mm(2), respectively. tBUT also significantly improved from 2.9 to 4.4s, and the Schirmer I test results showed improvement, but lacked statistical significance (1.7-2.4mm). No significant side effects were detected as a result of the allogeneic serum treatment during the follow-up period.
Allogeneic serum can be used for the treatment of severe dry eye in patients with cGVHD when autologous serum is unavailable. Care should be taken to avoid the risk of blood-borne diseases.

J Ocul Pharmacol Ther. 2012 Jun 25. [Epub ahead of print]
1 Department of Health Promotion Center, College of Medicine, The Catholic University of Korea , Seoul, St. Mary's Hospital, Seoul, Korea.

Friday, July 13, 2012

Abstract: Ocular surface disease and glaucoma/ocular hypertension patients

To determine the prevalence of ocular surface diseases and identify risk factors in a population of patients receiving antiglaucomatous eyedrops over the long term.
An observational cross-sectional study was designed to investigate ocular surface signs and symptoms using simple clinical tools. An ocular surface disease intensity score was calculated based on 10 questions regarding ocular surface symptoms and signs with a 4-grade scale. Patients were classified into 3 groups (A, B, and C) according to this total score. A multinomial logistic regression was performed in order to identify risk factors for surface disease.
In an overall population of 516 patients, 49% belonged to group A, 30% to group B, and 21% to group C. The multivariate analysis showed that the following factors were correlated with the severity of ocular surface disease: patient age, number of daily eyedrops, past topical treatment changes for ocular intolerance (found in the history of 40% of the patients), intraocular pressure (found to be significantly higher in patients with more severe ocular surface disease), and glaucoma severity.
Patients treated for primary open-angle glaucoma or ocular hypertension often have ocular surface diseases, more often and more severely in older patients receiving more drugs and presenting with more severe glaucoma. These high prevalence values might therefore have consequences on the burden of the disease in terms of adherence to treatment and quality of life.

Eur J Ophthalmol. 2012 Jun 11:0. doi: 10.5301/ejo.5000181. [Epub ahead of print]
Quinze-Vingts National Ophthalmology Hospital, Paris - France; and UPMC Univ Paris 06, UMR_S 968, Institut de la Vision, Paris - France; and University of Versailles St Quentin en Yvelines - France.

Abstract: Atopic keratoconjunctivitis vs obstructive MGD via confocal

PURPOSE:To clarify meibomian gland (MG) alterations in atopic keratoconjunctivitis (AKC) patients and compare the findings with obstructive MG dysfunction (MGD) patients and control subjects using in vivo confocal microscopy (CM).
DESIGN:Prospective, controlled, single-center study.
PARTICIPANTS:Twelve AKC patients (10 males, 2 females; mean age, 31.0±16.5 years), 12 obstructive MGD patients (7 males, 5 females; mean age, 37.6±5.6 years), and 26 control subjects (13 males, 13 females; mean age, 32.9±5.7 years) were recruited. No significant age or gender differences were observed between the 3 groups.
METHODS:All subjects underwent assessment of tear evaporation rate from the ocular surface (TEROS), slit-lamp examinations, tear break-up time (BUT) measurements, vital staining, Schirmer test I, meibography, MG expressibility, and CM examination of the MG (HRTII-RCM). Statistical analysis was performed using the Mann-Whitney test.
MAIN OUTCOME MEASURES:The MG acinar unit density, inflammatory cell density, MG acinar unit longest diameter, MG acinar unit shortest diameter, and MG acinar unit area as observed by in vivo CM, MG drop-out, MG expressibility grading, tear stability, tear evaporation, and vital staining scores.
RESULTS:The TEROS values, mean BUT, vital staining scores, MG expressibility, and MG dropout grades were significantly worse in AKC patients compared with those in obstructive MGD patients and controls (P<0.05). The mean values of the CM parameters in AKC patients were significantly worse than those observed in the obstructive MGD patients and controls (P<0.001).
CONCLUSIONS:Changes in MG in AKC patients seem to be more severe than in patients with obstructive MGD and controls. In vivo CM is a noninvasive, efficient tool in the assessment of MG status and ocular surface disease in AKC.
FINANCIAL DISCLOSURE(S):The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Ophthalmology. 2012 Jun 18. [Epub ahead of print]
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

Drug news: RGN-259

Regenerx has reported positive results from their recent Phase II clinical trial. Sounds promising. Wish it were a larger cohort though.

RGN-259 Significantly Improves Signs and Symptoms of Severe Dry Eye in Phase 2 Clinical Trial
June 20, 2012

ROCKVILLE, Md.--(BUSINESS WIRE)--RegeneRx Biopharmaceuticals, Inc. (OTC Bulletin Board: RGRX) (“the Company” or “RegeneRx”) is reporting preliminary results from a double-masked, vehicle-controlled, physician-sponsored Phase 2 clinical trial evaluating RGN-259 for the treatment of severe dry eye. RGN-259 (Tβ4 preservative-free eye drops) was found to be safe and well-tolerated and met key efficacy objectives with statistically significant sign and symptom improvements, compared to vehicle control, at various time intervals, including 28 days post-treatment.

Nine patients with severe dry eye (18 eyes) were treated with RGN-259 or vehicle control six times daily over a period of 28 days. They were evaluated upon entering the study after a two week washout period, at weekly intervals during the treatment phase, at the end of the 28-day treatment period, and at a follow-up visit 28 days after treatment. Statistically significant differences in sign and symptom assessments, such as ocular discomfort and corneal fluorescein staining, were seen at various time points throughout the study. Of particular note were the differences between RGN-259 and vehicle control 28 days post-treatment, or the follow-up period. The RGN-259-treated group had a 35.1% reduction of ocular discomfort compared to vehicle control (p=0.0141), and a 59.1% reduction of total corneal fluorescein staining compared to vehicle control (p=0.0108).

Consistent with the reduction of ocular discomfort and fluorescein staining at the 28-day follow-up visit, other improvements seen in the RGN-259-treated patients included tear film breakup time and increased tear volume production. Likewise, these improvements were seen at other time points in the study.
The researchers are conducting additional analysis of the patient groups and will be submitting a manuscript for publication later this year.

“While the RGN-259 patients showed impressive clinical improvements over vehicle control patients during treatment, data from the 28-day follow-up period were equally impressive. Twenty-eight days after completing treatment, ocular improvements in the vehicle control group reverted toward their original pre-treatment scores while the ocular improvements in the RGN-259 group remained relatively stable, suggesting a more lasting clinical effect with RGN-259. This is an important observation when comparing an active compound to a control, such as an eye lubricant, that can sometimes provide limited but temporary relief for dry eyes,” commented Dr. Steven Dunn, holder of the physician-sponsored IND and an ophthalmologist at Michigan Cornea Specialists in Southfield, Michigan.

Abstract: Dry eye and migraines

The purpose of this study was to evaluate the tear film functions and clinical symptoms of patients with migraines.
This observational comparative study consisted of 33 migraine (26 women and 7 men) patients referred from neurology clinics and 33 (22 women and 11 men) control subjects referred from ophthalmology outpatient clinics. The control subjects had neither systemic nor ocular disease nor any type of headache. All 66 patients underwent a complete ophthalmic examination and diagnostic tests for dry eye, including tear break-up time, Schirmer test with topical anesthesia, lissamine green staining, and an ocular surface disease score. Patients with migraine were classified as migraine with an aura, migraine without an aura, and basilar migraine; a pain score from 1 to 4 was determined for each patient, based on the American Headache Society's Migraine Disability Assessment Test.
Of the 33 patients who participated in the migraine group, 17 (51%) suffered from migraine with aura, 11 (33%) suffered from migraine without aura, and 5 (15%) suffered from basilar migraine. Significant differences in dry eye scores were found between the patients with migraine and the control subjects. In the migraine group, the mean tear break-up time was 7.75 ± 2.37 seconds, whereas in the control group it was 9.15 ± 1.93 seconds. For the Schirmer test, the migraine group had a mean value of 12.09 ± 4.95 mm/5 minutes, whereas the control group had a mean value of 14.90 ± 4.26 mm/5 minutes. Testing with lissamine green staining resulted in a mean value of 1.00 ± 0.16 in the migraine group and 0.30 ± 0.46 in the control group. In the migraine group, the mean for the ocular surface disease index scoring was 36.27 ± 17.54. In the control group, it was 28.42 ± 9.0. A significant difference (P < 0.05) was found in the dry eye syndrome testing results between the 2 groups in this study.
An increased frequency of dry eye disease was found to occur in patients with migraine, which might suggest that migraine headaches are related to dry eye disease. Some migraine attacks may be aggravated in the presence of dry eye syndrome.
Cornea. 2012 Jun 15. [Epub ahead of print]
*Department of Ophthalmology, Faculty of Medicine, Selçuk University, Konya, Turkey Departments of †Neurology ‡Ophthalmology, School of Medicine, Baskent University, Ankara, Turkey.

Tuesday, July 10, 2012

Abstract: Comparing liposomal eye sprays

No beating about the bush here.

To evaluate the effect of three different liposomal eye sprays on ocular comfort and tear film stability.
OptrexActiMist (AM, Optima-Pharma, Germany) was applied onto one, randomly selected eye of 80 subjects (female=49; mean age=49 years±18.6 SD) in a multi-centred, double-masked study. DryEyesMist (DEM, Boots) or TearMist (TM, Tesco) was applied onto the contralateral eye in randomized order. Over-all symptoms were investigated using the Ocular Surface Disease Index (OSDI). Ocular comfort (visual-analogue scale 0-100 [100=perfect]) and non-invasive tear film stability (NIBUT) of each eye was evaluated before application (randomized order) and were again measured 10min after application. Effects of products on ocular comfort and NIBUT were calculated as "factor" (=after-treatment/before-treatment). Differences between measurements were analysed by ANOVA repeated measurements and differences between groups by the dependent t-test (or the non-parametric equivalent).
OSDI-scores (mean=8.1±9.0 SD), comfort (65±24) and NIBUT (12s±12.3) were statistically similar between centres (p>0.400). Comfort and NIBUT were not different (p>0.14) between product groups before application. Comfort and NIBUT improved significantly after application of AM (p<0.001) but worsened with the comparing products (p<0.058). Comfort improved by a mean factor of 1.5 (±0.82 SD) after application of AM but decreased after application of the comparing products (DEM: 0.9±0.33; TM: 0.9±0.34). Both factors were significantly better in AM (p<0.027).
The original liposomal eye-spray 'OptrexActiMist' significantly improved ocular comfort and tear film stability while 'TearMist' or 'DryEyesMist' worsened both criteria. The latter two products may not be clinically effective in the treatment of dry eye.

Cont Lens Anterior Eye. 2012 Jun 15. [Epub ahead of print]
Pult HGill FRiede-Pult BH.
Dr. Heiko Pult - Optometry and Vision Research, Weinheim, Germany; Contact Lens and Anterior Eye Research Unit (CLAER), School of Optometry and Vision Sciences, Cardiff University, UK; School of Optometry and Vision Sciences, Cardiff University, UK.

Abstract: Prevalence of dry eye in rheumatoid arthritis patients

Holy toledo. Look at those whacko results.

On the one hand:
 Fifty-two percent of patients had a history of dry eye and dry mouth
On the other hand:
Dry eye interpreted from OSDI, Schirmer 1 test, tear break-up time and rose bengal staining was 16.4%, 46.7%, 82% and 3.3% respectively. 
Does it not strike you as really weird that four different dry eye tests' results ranged from 3.5% to 82%?

How can you have an established history of dry eye yet not appear to on OSDI? 

And yes, it's also weird that OSDI could produce far fewer positives than Schirmer - but then, it was unanaesthetized, and if somebody sticks one of those horrible strips in MY eyes I can tell you I'll have tears running down my chin... it's a great test (OK in a crude, sadistic sort of way) to determine whether you're producing reflex, but not basal, tears.

Rheumatoid arthritis has manifestations in various organs including ophthalmic involvement. The present study evaluates prevalence of dry eye and secondary Sjogren's syndrome using salivary scintigraphy which has not been used in previous reports.
To evaluate the prevalence of secondary Sjogren's syndrome in patients with rheumatoid arthritis, including clinical characteristics and dry eye, compared with non-Sjogren's syndrome.
Descriptive cross sectional study
Sixty-one patients with rheumatoid arthritis were recruited at Siriraj Hospital during March 2009-September 2010 and filled in the questionnaires about dry eye for Ocular Surface Disease Index (OSDI) with a history taking of associated diseases, medications, duration of symptoms of dry eyes and dry mouth. The Schirmer I test without anesthesia, tear break-up time, rose bengal staining score, severity of keratitis and salivary scintigraphy were measured and analyzed.
Prevalence of secondary Sjogren's syndrome and dry eye were 22.2% (95% CI 15.4 to 30.9) and 46.7% (95% CI 38.0 to 55.6), respectively. Dry eye interpreted from OSDI, Schirmer 1 test, tear break-up time and rose bengal staining was 16.4%, 46.7%, 82% and 3.3% respectively. Fifty-two percent of patients had a history of dry eye and dry mouth with mean duration 27.4 and 29.8 months, respectively. Superficial punctate keratitis and abnormal salivary scintigraphy were found in 58.2% and 77.8%. Duration of rheumatoid arthritis, erythrocyte sedimentation rate were not correlated with secondary Sjogren's syndrome. Dry eye from OSDI with secondary Sjogren's syndrome (33.3%) compared with non-Sjogren's syndrome (9.5%) was significant difference (p = 0.008). Adjusted odds ratio for secondary Sjogren's syndrome in OSDIL score > 25 was 13.8 (95% CI 2.6 to 73.8, p = 0.002) compared to OSDI score < 25.
Awareness and detection of dry eye syndrome and secondary Sjogren's syndrome in rheumatoid arthritis was crucial for evaluation of their severity and proper management.

J Med Assoc Thai. 2012 Apr;95 Suppl 4:S61-9.
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

Abstract: Corneal sensitivity & nerve morphology

Another verrrry nice study from one of my favorite journals. The background of this is: we know folks with dry eye tend to have decreased corneal sensitivity, but can we find evidence in the nerve morphology itself that explains it? And can we show a similar correlation in patients with or without dry eye?

Answer: Yes.

I also find it interesting that they would use glaucoma patients specifically as an ocular surface disease group (makes perfect sense on the basis that glaucoma patients have fried their eyes with BAK-preserved glaucoma drops, but admitting signals huge progress in ophthalmology).

Of course, our DEZ members will all want to know the answer to this conundrum: If my corneal sensitivity is DEcreased from dry eye disease, how come I hurt so dang much?!

Purpose: The purpose of this study is to evaluate the relationship between the in vivo confocal microscopic (IVCM) morphology of subbasal corneal nerves and corneal sensitivity in patients with ocular surface disease.
 Patients and methods: Ten healthy volunteers (control group), 12 patients with dry eye (dry eye group) and 14 patients treated with IOP-lowering topical medications (glaucoma group) were included. Central corneal sensation was measured using the contact Cochet-Bonnet esthesiometer. IVCM of the cornea was performed and the following subbasal corneal nerves parameters were analyzed: density, number, width, number of beadings, number of branching, tortuosity and reflectivity. One eye of each subject was included in the study.
 Results: Corneal sensitivity was significantly decreased in dry eye and glaucoma patients compared to controls. The density and number of subbasal corneal nerves were also significantly decreased in dry eye and glaucoma patients compared to controls. There was no difference in terms of subbasal nerve width, number of beadings, tortuosity, reflectivity and number of branching between the dry eye, the glaucoma, and the control groups. In all subjects, corneal sensitivity correlated positively with the density and number of subbasal nerves. However, in the dry eye group, corneal sensitivity correlated with the density and the number of nerves, while, in the glaucoma group, corneal sensitivity correlated only with the tortuosity of subbasal nerves.
 Conclusions: The relationship between corneal sensation and subbasal nerve morphology, as evaluated with IVCM, depends on the pathophysiological mechanism of ocular surface disease.

Invest Ophthalmol Vis Sci. 2012 Jun 13. [Epub ahead of print]
Labbe A, Alalwani H, Van Went C, Brasnu E, Georgescu D, Baudouin C.
Department of Ophthalmology III, Quinze-Vingts National Eye Center, 28 rue de Charenton, Paris, 75012, France.

Abstract: Tear protein markers in dry eye disease

Purpose: To characterize tear protein markers in dry eye disease (DED).
 Methods: In this prospective study, based on Ocular Surface Disease Index© (OSDI) and corneal staining (CS), 95 DED patients (OSDI≥13) with increasing CS were enrolled into 3 severity groups: DE1 (CS<4), DE2 (CS between 4 and 7) and DE3 (CS>7); 25 asymptomatic subjects with no CS were enrolled into control (OSDI<13 and CS=0). Tear fluid was collected at Day 0 and Day 7 visits and concentrations of 43 protein markers were measured by multiplexed immunoassay.
 Results: 22 control and 80 DED subjects were analyzed. Among 33 markers detectable, good inter-visit repeatability was observed with 25 markers, with intraclass correlation coefficients (ICC) ranging from 0.85 to 0.60; ICCs were below 0.60 in the other 8. Correlation with clinical measures was found with two markers, with absolute partial correlation coefficients greater than 0.40: Interleukin-1 Receptor Antagonist (IL-1Ra) and IL-8. IL-1Ra and IL-8 correlated with conjunctival staining (0.43, P < .001 and 0.35, P < .01, respectively), and with Schirmer test (-0.58 and -0.42, P < .001). IL-1Ra and IL-8 in DE3 were 4.4 and 2.1 fold higher than in DE1 (P=.0001 and .0007), 1.9 and 1.6 fold higher than in DE2 (P =.022 and .017). IL-1Ra in DE2 was 2.3 fold higher than in DE1 (P=.038).
 Conclusion: Tear levels of many immune mediators were highly repeatable between visits in DED. Among them, IL-1Ra and IL-8 associated with clinical signs and disease severity defined by corneal staining.

Invest Ophthalmol Vis Sci. 2012 Jun 13. [Epub ahead of print]
La Jolla BioConsulting, 4653 Carmel Mountain Road, Suite 308-245, San Diego, CA, 92130, United States.