Tuesday, October 16, 2012

Abstract: Lid-parallel conjunctival folds

The study was designed to test the clinical application of the grading of lid-parallel conjunctival folds (LIPCOF) as a diagnostic test for dry eye.
At 12 centres in 11 countries, 272 eyes of 272 dry eye patients (75 men, 197 women) were examined. Their mean age was 52.7±16.2 years. The LIPCOF were graded according to the method of Höh et al. The tear film break-up time (BUT) was measured, and fluorescein staining and the Schirmer 1 test were performed. The subjective symptoms were evaluated by 16 questions.
The LIPCOF score demonstrated significant positive correlations with age, dry eye disease severity and fluorescein staining (r> 0.2, p< 0.001), and negative correlations with BUT and results of the Schirmer 1 test (r< -0.2, p< 0.001). The LIPCOF score exhibited a significant correlation with the overall subjective symptoms (r=0.250, p< 0.001). The sensitivity and specificity of LIPCOF grading for discriminating between normal and dry eyes were best with the cut-off between LIPCOF degrees 1 and 2.
The displayed medium sensitivity and specificity, and good positive predictive value of the LIPCOF test support the use of LIPCOF grading as a simple, quick and non-invasive dry eye screening tool.

Br J Ophthalmol. 2012 Sep 5. [Epub ahead of print]
Németh J, Fodor E, Lang Z, Kosina-Hagyó K, Berta A, Komár T, Petricek I, Higazy M, Prost M, Grupcheva C, Kemer OE, Schollmayer P, Samaha A, Hlavackova K.
Semmelweis University, Budapest, Hungary.

Abstract: Ocular allergy

Ooooh... these guys are definitely exploring territories we need a lot of work in.

Ocular allergy: recognizing and diagnosing hypersensitivitydisorders of the ocular surface.
Ocular allergy includes several clinically different conditions that can be considered as hypersensitivity disorders of the ocular surface. The classification of these conditions is complex, and their epidemiology has not been adequately studied because of the lack of unequivocal nomenclature. Ocular allergy symptoms are often, but not always, associated with other allergic manifestations, mostly rhinitis. However, specific ocular allergic diseases need to be recognized and managed by a team that includes both an ophthalmologist and an allergist. The diagnosis of ocular allergy is usually based on clinical history and signs and symptoms, with the support of in vivo and in vitro tests when the identification of the specific allergic sensitization is required for patient management. The aims of this Task Force Report are (i) to unify the nomenclature and classification of ocular allergy, by combining the ophthalmology and allergy Allergic Rhinitis and its Impact on Asthma criteria; (ii) to describe current methods of diagnosis; (iii) to summarize the therapeutic options for the management of ocular allergic inflammation.

Allergy. 2012 Nov;67(11):1327-37. doi: 10.1111/all.12009. Epub 2012 Sep 5.
Leonardi A, Bogacka E, Fauquert JL, Kowalski ML, Groblewska A, Jedrzejczak-Czechowicz M, Doan S, Marmouz F, Demoly P, Delgado L.
Department of Neuroscience, Ophthalmology Unit, University of Padua, Padua, Italy.

Abstract: Hinge position, LASIK, dry eye, etc

[soap box]

...Aggressive dry eye regimens are needed for patients with preoperative dry eye.

Someday I'd like to see a LASIK study that concludes,

...Aggressive screening and education are needed for patients with preoperative dry eye.
[/soap box]

Hey, a girl can dream, can't she?

Abstract: Schirmer - different wetting time and paper strip size

Assessment of different wetting time and paper strip size ofSchirmer test in dry eye patients.
To evaluate the correlation between different wetting time and paper strip size of Schirmer test with anesthesia in dry eye patient. Finally the authors determined the agreement on using the ocular surface disease index (OSDI), index for evaluate the severity of the dry eye patient, compare to the standard Schirmer test with anesthesia.
A prospective study was performed in 140 eyes of 70 subjects. All subjects had symptoms of dry eye syndrome which was confirmed by Schirmer test with anesthesia before inclusion. The correlation between Schirmer test with anesthesia at 1, 2, 3 and 4 minutes and standard 5-minute test of both 3 mm and 5 mm width of paper strip was evaluated using intraclass correlation coefficient (ICC). The correlation between clinical questions and Schirmer test was documented in Kappa value.
The ICCs were higher than 0.8 after 2 minutes in both 3-mm and 5-mm width of paper strip. Furthermore, it indicated that cut-off value for diagnosis of severe dry eye was 2.5 mm for 5-mm width of paper strip and 4.25 mm for 3-mm width of paper strip at 2-minute measurement. The association between data from the OSDI and objective data from Schirmer test were analyzed by Kappa statistic and showed poor agreement beyond chance (p = 0.591).
Our results suggested that shorter wetting time of 2-minute Schirmer test with anesthesia could be used instead of the standard 5-minute test. The authors found that the 3-mm width of paper strip could be used instead of the standard 5-mm width of paper strip as well.

J Med Assoc Thai. 2012 May;95 Suppl 5:S107-10.
Suphakasem S, Lekskul M, Rangsin R.
Department of Ophthalmology, Phramongkutklao Hospital, Bangkok, Thailand.

Abstract: Schirmer I with and without anaesthesia

Comparison of the Schirmer I test with and without topicalanesthesia for diagnosing dry eye
(click for full text as well as abstract)

AIM: To determine the value of Schirmer I test (S I t) without anesthesia and with topical anesthesia for diagnosing dry eye (DE).
METHODS: Totally 220 eyes in 110 patients, male (44) and female (66), (39.56±12.67) years old diagnosed with DE were examined. S I t without anesthesia was performed firstly, and 15 minutes later, it was applied again in the same person after topical anesthesia with 0.5% proparacaine hydrochloride eye drops. The wetting strips counted < 10mm per 5 minutes were defined positive, while ≤ 5mm per 5 minutes were defined strong positive.
RESULTS: The wetting length in S I t after topical anesthesia was significantly lower than that in S I t without anesthesia (P< 0.001). The positive rate and strong positive rate of S I t after topical anesthesia were significantly higher than that of S I t without anesthesia (P< 0.001). The positive rate and strong positive rate of S I t without anesthesia and the strong positive rate of S I t after topical anesthesia in patients with aqueous-deficiency dry eye (ADDE) were significantly higher than those in total patients whereas those in patients with evaporative dry eye (EDE) were significantly lower than those in total patients (P< 0.001).
CONCLUSION: S I t after topical anesthesia with 0.5% proparacaine hydrochloride eye drops is more objective and reliable than that without anesthesia in reflecting the status of DE, and its diagnostic value in patients with ADDE was even higher, making itself a meaningful evidence for the diagnosis and treatment of DE.

Int J Ophthalmol. 2012; 5(4): 478–481.
Na Li, Xin-Guo Deng, and Mei-Feng He

Abstract: Autologous serum... variations on theme and their results

Good read for those who have tried or are considering trying AS drops.

To compare the effect of autologous serum eye drops with different diluents in patients with dry eyes and persistent epithelial defects.
Patients of Sjögren's syndrome (Group I), non-Sjögren's syndrome (group II) with dry eye, and persistent epithelial defects (Group III) were included. The eyes of each group were randomly treated with one of the following autologous serum eye drops: 100% serum (AS(100)), 50% serum with normal saline (AS(50NS)); 50% serum with sodium hyaluronate (AS(50HA)); or 50% serum with ceftazidime (AS(50CEF)). The differences in dry eye symptoms, Schirmer test I, tear break-up time (TBUT), corneal staining, and speed in epithelial healing were studied.
In Group I, AS(100) showed fewer symptoms than AS(50NS), AS(50HA) and AS(50CEF) (all p < 0.01). AS(100) showed significantly better effect than AS(50NS), AS(50HA) and AS(50CEF) in decreasing corneal staining at the time point of 12-week post-treatment (p = 0.041, p < 0.001 and p < 0.001, respectively). In Group II, AS(100) was more effective than AS(50CEF) in decreasing symptoms and decreasing corneal staining (all p < 0.05). There was no significant difference in symptom and corneal staining between AS(100) and AS(50NS). In Group III, AS(100) was the most effective in achieving quick epithelial closure.
In the eyes with Sjögren syndrome and persistent epithelial defects, AS(100) was the most effective in decreasing symptoms, corneal epitheliopathy and promoting fast closure of wound. In the eyes with non-Sjögren syndrome, AS(100) and AS(50NS) have similar effects in decreasing symptoms and corneal epitheliopathy.
Curr Eye Res. 2012 Aug 28. [Epub ahead of print]
Cho YK, Huang W, Kim GY, Lim BS.
St. Vincent Hospital, The Catholic University of Korea , Paldal-gu, Ji-dong 93-6, Suwon , Korea South.

Abstract: What's different about ocular rosacea patients?

Heavy on science, but thought I'd post it anyway so you ocular rosacea folks know work IS being done to figure this out and bring more solutions.

The purpose of this study was to study changes in glycosylation in tear and saliva obtained from control and ocular rosacea patients in order to identify potential biomarkers for rosacea. Tear fluid was collected from 51 subjects (28 healthy controls and 23 patients with ocular rosacea). Saliva was collected from 42 of the same subjects (25 controls and 17 patients). Pooled and individual samples were examined to determine overall glycan profiles and individual variations in glycosylation. O-and N- glycans were released from both patients and control subjects. Released glycans were purified and enriched by solid-phase extraction (SPE) with graphitized carbon. Glycans were eluted based on glycan size and polarity. SPE fractions were then analyzed by high-resolution mass spectrometry. Glycan compositions were assigned by accurate masses. Their structures were further elucidated by tandem mass spectrometric using collision-induced dissociation (CID), and specific linkage information was obtained by exoglycosidase digestion. N- and O-glycans were released from 20-μL samples without protein identification, separation, and purification. Approximately 50 N-glycans and 70 O-glycans were globally profiled by mass spectrometry. Most N-glycans were highly fucosylated, while O-glycans were sulfated. Normal tear fluid and saliva contain highly fucosylated glycans. The numbers of sulfated glycans were dramatically increased in tear and saliva of rosacea patients compared to controls. Glycans found in tear and saliva from roseatic patients present highly quantitative similarity. The abundance of highly fucosylated N-glycans in the control samples and sulfated O-glycans in ocular rosacea patient samples may lead to the discovery of an objective diagnostic marker for the disease.

Ocul Surf. 2012 Jul;10(3):184-92. Epub 2012 May 3.
Vieira AC, An HJ, Ozcan S, Kim JH, Lebrilla CB, Mannis MJ.
Department of Ophthalmology, University of California, Davis, CA, USA.

Abstract: Exploring interesting stuff about the lid margins

Fascinating read. Looking forward to more on the subject. Any of our Aussie members know any of these authors?

PURPOSE.: Ocular surface sensitivity plays a role in dry eye and ocular comfort through its probable influence on the neural feedback loop that regulates tear secretion, but little is known specifically about the role of lid or lid margin sensitivity in ocular surface health. The aim of this study was to characterize the eyelid margin and explore the relationships between lid margin sensitivity and staining, meibomian gland dysfunction, tear osmolarity, and ocular symptoms. A secondary aim was to look for differences and associations between lower- and upper-lid characteristics.
 METHODS.: Pilot study involving 27 healthy subjects (7 men, 20 women; mean age: 31 ± 14 years). Measurements included ocular symptoms (Ocular Surface Disease Index, Dry Eye Questionnaire), tear osmolarity, lid margin staining (fluorescein and lissamine green), meibomian gland dysfunction, and mechanical sensitivity of lower and upper lids.
 RESULTS.: Lower-lid margins were more sensitive (45.0 ± 13.2 vs. 40.0 ± 14.7 mm; p = 0.02) and displayed more staining (1.5 ± 1.0 vs. 0.2 ± 0.6, p < 0.001), but less evidence of meibomian gland dysfunction (2.0 ± 2.8 vs. 7.3 ± 6.2, p < 0.001), than upper-lid margins. Lid margin staining was more frequent in lower than upper lids (78% vs. 15% of subjects). Tear osmolarity correlated with upper-lid staining (r = 0.41, p = 0.04) and lower-lid sensitivity (r = 0.46, p = 0.02). Lid sensitivity was also inversely correlated with meibomian gland dysfunction at the lower lid (r = -0.51, p = 0.01). Surprisingly, there were no associations between symptoms and lid staining.
 CONCLUSIONS.: Our study highlighted clear clinical differences between the lower and upper lids and demonstrated, for the first time, significant relationships between tear osmolarity and lid characteristics, including lid sensitivity.

Optom Vis Sci. 2012 Oct;89(10):e1443-9.
Golebiowski B, Chim K, So J, Jalbert I.
*BOptom, PhD †BOptom ‡OD, MPH, PhD, FAAO School of Optometry and Vision Science, The University of New South Wales, Sydney, New South Wales, Australia.

New: "Kind removal" silicone tape

Here's another new product, this one an award-winner, popular in hospital settings where they have to use a lot of medical tape and are familiar with the terrible skin damage medical tapes tend to cause. According to 3M's description, a feature that makes this one different from the usual medical tapes is that the adhesive strength is constant rather than increasing over time. Here's a link for more details from 3M.

To try out a sample ($0.50) click here:
3M Kind Removal Silicone Tape

For those of you *have* to tape your lid(s) down to get sufficient protection at night I highly recommend trying this. - Or, for those of you who for any reason haven't been able to get enough night protection with the usual bag of tricks (goggles and goop, etc) but are intimidated by the idea of tape lest it irritate your skin, rip out your eyelashes, and so on, you might just want to give this tape a whirl. Check out dryeyetalk.com discussion boards for suggestions on best taping methods. I don't tape my lids these days but in my past experience with taping, personally I always found an X of two pieces worked well for me. I always applied - and removed - slowly, top to bottom.

Special thanks to Neil in Mississippi (you know who you are) for bringing this product to my attention. I have short rolls of it available in the shop for fifty cents for people to try out, and I will eventually get the full sized ones.

Monday, October 15, 2012

New lid cleansing product w/ tea tree oil

Tea Tree Foaming Facial Cleanser

I'm really liking this one... been using it for about a month now. Very pleasant, nice on the skin and my tender lids even on bad days. Definitely not bothering my eyes, which is numero uno consideration. I also really like the pricepoint, as 'high end' lid scrub products go. Comes in a 50mL bottle, which I would expect to last about 2-3 months perhaps? Made by Eye Eco, makers of Tranquileyes, Onyix, Quartz and the MREs.

$13.50, sold in the Dry Eye Shop.