It's here, it's here, it's here!

DWELLE IS HERE!!!

(turning cartwheels).

Yay.

DWELLE is on the way at last

On Tuesday, September 1st... At last, after an 8 month wait we are finally going to have Dwelle again. Yay!

Abstract: Inflammatory cells in the epithelium in DES

Changes in corneal epithelial layer inflammatory cells in aqueous tear-deficient dry eye.
Invest Ophthalmol Vis Sci. 2009 Jul 23. [Epub ahead of print] Lin H, Li W, Dong N, Chen W, Liu J, Chen L, Yuan H, Geng Z, Liu Z.
Zhongshan Ophthalmic Center, 54 Xianlie South Road, Guangzhou, Guangdong, 510080, China; Eye Institute and affiliated Xiamen Eye Center of Xiamen University, Xiamen, Fujian, China.

Purpose. To investigate the morphology, distribution, and density of inflammatory cells in the corneal epithelium of aqueous tear-deficient dry eye.

Methods. Thirty-two patients with non-Sjögren's syndrome dry eye (NSS), 14 patients with Sjögren's syndrome related dry eye (SS), and 33 healthy volunteers were studied. In vivo laser scanning confocal microscopy investigated both Langerhans cell (LCs) and leukocyte, distribution and density in the peripheral and central corneal epithelium. LC morphology was also evaluated. Multi-factor regression analysis assessed if there is a correlation between clinical manifestations and inflammatory cells densities.

Results. LCs were present in both central (34.9+/-5.7 cells/mm2) and peripheral (90.7+/-8.2 cells/mm2) parts of the normal corneal epithelium. Moreover, LCs density increased dramatically in the central corneal epithelium in patients with NSS (89.8+/-10.8 cells/mm2 ) and SS (127.9+/-23.7 cells/mm2). The ratio of LCs with obvious processes was much higher in dry eye patients than in healthy volunteers. LCs density also increased in peripheral corneal epithelium in patients with SS, but not NSS. Leukocytes density in normal corneal epithelium was very low, while they increased in the central corneal epithelium (4.6+/-1.0 cells/mm2) in NSS, and in both central (49.0+/-12.9 cells/mm2) and peripheral (84.2+/-36.8 cells/mm2) corneal epithelium in SS. Densities of LCs and leukocytes showed significant correlation with the severity of clinical evaluation.

Conclusions: The LCs and leukocyte changes in the corneal epithelium suggest their involvement in aqueous tear-deficient dry eye pathophysiology. In vivo dynamic assessment of central corneal inflammatory cell density might serve as an indicator of dry eye severity and provide new insight for dry eye treatment.

Abstract: Monkeying around with Restasis

Restasis(R) for the treatment of 'dry eye' in Aotus nancymaae.
J Med Primatol. 2009 Jul 8. [Epub ahead of print]
Schuler AM, Tustin GT, Abee CR, Scammell JG.
Department of Comparative Medicine, University of South Alabama, AL, USA.

This case report describes the treatment of three male owl monkeys (Aotus nancymaae) diagnosed with chronic dry eye with a topical cyclosporine product, Restasis((R)), approved for use in humans. These owl monkeys had ocular disease resulting from procedures performed at a biotechnology company. They were moved to the Center for Neotropical Primate Research and Resources at University of South Alabama to be incorporated into the breeding colony. Materials and methods Schirmer tear testing was performed initially and during the course of treatment to monitor efficacy of twice daily administered Restasis((R)). The goals of treatment were to reduce pain and/or distress and if possible to quantitatively increase tear production. Results and discussion All animals had improvements in conjunctival inflammation and had an increase in tear production.

Jeffrey Gilbard, MD

I was shocked to hear about the tragic death of Jeff Gilbard, founder of Advanced Vision Research (the Theratears company). He was 55.

Dr. Gilbard was one of the top pioneers in the world of dry eye treatment and made huge contributions to the field, between his research, his products (TheraTears, TheraTears Nutrition, etc), his care of patients and how he increased awareness of dry eye and the need for more advanced treatments. His death is a huge loss to us all.

Dry eye disease pioneer Jeffrey P. Gilbard, MD, dies at 55 years of age
OSN SuperSite, August 14 2009

WOBURN, Mass. — Jeffrey P. Gilbard, MD, whose pioneering research led to innovative treatments for dry eye disease and retinal disorders, died Aug. 12 at Massachusetts General Hospital in Boston from complications from a bicycle accident. He was 55 years old.

Known for his holistic approach to eye care, Dr. Gilbard is considered one of the first ophthalmic researchers to recognize the link between nutrition and the overall health of the eye.

Dr. Gilbard founded Advanced Vision Research in 1995 to market and distribute TheraTears, an over-the-counter eye drop he invented to treat dry eye. TheraTears soon became one of the best-selling eye lubricants on the market and has spawned additional products, including TheraTears Nutrition, MacuTrition and NutriDox.

In 1978, while attending medical school at Columbia University's College of Physicians and Surgeons, Dr. Gilbard received his first project grant from the National Eye Institute to develop an eye drop for treating dry eye. To this day, he remains the youngest scientist on record to receive funding from the organization.

What's happening in the garden

Whew, I finally found the right USB cord and uploaded several, er, months worth of photos.

I suppose I'm just as excited and proud as any other rookie gardener about what's been peeping out from under the leaves and I thought I'd share some pictures here.

Here's part of the 2nd cucumber patch. The first one, which I'd started too early so not too much of it germinated, was mostly turned into bread & butter pickles a couple of weeks ago. I think some of these new ones will be destined for dills.
Then there's the eggplants. I'm amazed these ever got to this stage. I had started them in the greenhouse, where they did wonderfully, and then transplanted them outside where they pined away doing nothing at all for 6 weeks. Sometime in mid July they started growing just a teensy bit and now they are just about to fruit I think.

On to squash. I have to say I was really intimidated when Chaidie first came running and told me about the enormous zucchini lurking under the leaves. We had a fridgeful in no time and I was scratching my head over what I was going to do when all the other types of squash started ripening. Fortunately, zucchini cook down, way, way down and I've been making greek pita from them, and I've also learned to check ALL squash EVERY day to make sure they don't get out of hand. And I will put some of the blossoms to another use so we don't get too many. This is the time of year when I want to stuff every vegetable I see Greek-style, and stuffed squash blossoms are really lovely.

Here's some summer squash:


and Panos just spotted the first spaghetti squash today:



I bought all my seeds last December at heirloomseeds.com and I am really, really loving everything so far. There were a few disappointments - the onions and carrots never came up at all, and the okra - ok, this was not surprising - hasn't done anything. But everything else is gorgeous and thriving in spite of my laissez-faire approach to gardening. Naturally, tomatoes are top of the list for pleasure. I have six different varieties out there. The very earliest were Italian heirlooms that I transplanted in early May - I left all the rest till mid or late May and later, staggering them a bit because we were still having sub-freezing nights till about the middle of May. But the Italians started ripening about the end of July and are wonderful eating. I couldn't get any pics of anything ripe today because I'd cleaned them out yesterday but here's a few of the other types:

The German pinks are doing better than anything else. The plants are taller than I am and without any fertilizing or pruning or anything at all really other than somewhat inadequate staking, they seem as happy as anything. Some of the tomatoes on the vines right now are about the size of small cantaloupes. The picture doesn't really do it justice but some of these are going to be awesome slicing tomatoes:



I've been so happy with those that I started some more recently in the greenhouse. I don't know anything about pollination needs but I'm hoping somehow to be able to keep those going in the greenhouse this fall since they're getting a nice head start with our warm weather now:



I'll stop now - I haven't got much experience blogging with pix so I want to make sure this works, then I'll come back with a few more from the orchard and garden and my first-time canning results, and hopefully some more pics from back in the spring.

XXOO

Rebecca

Abstract: Mascara and your eyes....

In our 'hardcore' dry eye crowd on DryEyeTalk, I think an awful lot of us have simply relegated eye makeup to 'special occasions only' status at most. But amongst newbies and those with mild to moderate conditions I know there are many using mascara regularly - and in fact there's a lot of information sharing going on about which products are most friendly to dry, sensitive eyes.

Anyway, I thought you'd be interested in the blurb about this study, which is the first of its kind I've run across. Always fun to see new words coined ("dacryomascarolith"?!)

Ocular manifestations of long-term mascara use.
Ophthal Plast Reconstr Surg. 2009 Jul-Aug;25(4):339-41.
Ciolino JB, Mills DM, Meyer DR.

Mascara, a widely used cosmetic, is associated with eye pathology. The authors report 3 cases of eye problems secondary to long-term mascara use. Two patients had multiple pigmented conjunctival lesions; one of these had a history of melanoma of the hand. Conjunctival biopsy revealed nonmelanocytic pigment granules within conjunctival stroma cells in both cases. The other patient had a history of dry eye, and also showed pigment clumping around a punctal plug. The third patient had canalicular obstruction from a mascara-laden dacryolith ("dacryomascaralith"), the first such case reported. A literature review revealed cases of eyelid dermatitis, infectious keratitis, a conjunctival mass ("mascaroma"), and others. Ophthalmologists should be aware of mascara's associated eye problems. The physical findings combined with a high index of suspicion, especially in cases of heavy mascara use, may allow for an accurate diagnosis and spare the patient an otherwise unnecessary invasive procedure.

Latest Dwelle update

Straight from the horse's proverbial mouth,

...the cartons will be in early next week. Dwelle should ship late this month. They are behind on packaging.

More of the same that is. Hopefully accurate THIS time.

Support groups: Stuart, FL

East Florida Eye Institute in Stuart, FL is resuming monthly dry eye support group meetings. They will have one in August and I will post again when they have fixed a date.

Abstract: Mice blah blah blah improvement blah blah decreased inflammation

Confession: I start flagging even at T cell talk these days. When we get to CCR2 antagonists, interleukins 1alpha and 1beta my attention's gone until the conclusions, which have some of the right words.

Arch Ophthalmol. 2009 Jul;127(7):882-7. Amelioration of murine dry eye disease by topical antagonist to chemokine receptor 2.

Goyal S, Chauhan SK, Zhang Q, Dana R.
Schepens Eye Research Institute, Boston, MA 02114, USA.

OBJECTIVE: To determine the effect of a topical antagonist to the chemokine receptor 2 (CCR2) in a murine model of dry eye disease.

METHODS: The effects of a topical CCR2 antagonist and a vehicle control treatment were studied in murine dry eyes. A controlled environment chamber induced dry eye by exposing mice to high-flow desiccated air. Corneal fluorescein staining and enumeration of corneal CD11b(+) and conjunctival CD3(+) T cells were performed in the different groups. Real-time polymerase chain reaction was performed to quantify expression of different inflammatory cytokine transcripts in the cornea and conjunctiva.

RESULTS: Eyes receiving the formulation containing CCR2 antagonist showed a significant decrease in corneal fluorescein staining and decreased infiltration of corneal CD11b(+) cells and conjunctival T cells compared with the vehicle-treated and untreated dry eye groups. The CCR2 antagonist also significantly decreased messenger RNA expression levels of interleukins 1alpha and 1beta in the cornea, and tumor necrosis factor alpha and interleukin 1beta in the conjunctiva.

CONCLUSION: Topical application of CCR2 antagonist is associated with significant improvement in dry eye disease and is reflected by a decrease in inflammation at the clinical, molecular, and cellular levels. Clinical Relevance Topical application of CCR2 antagonist may hold promise as a therapeutic modality in dry eye disease.

Abstract: Dry eye in Canada

Hmmmm. I am sure some of my Canadian readers are hoping their doctor was privy to this 'consensus'!

If not, and your doctor is still offering you a generic "dry eye" diagnosis, tears and plugs and goodbye, my suggestion is to print out this statement below and fax it to your doctor the day before your next appointment, along with a brief bullet point synopsis of your goals for the appointment.

Management of dysfunctional tear syndrome: a Canadian consensus.
Can J Ophthalmol. 2009 Aug;44(4):385-94.
Jackson WB.
University of Ottawa Eye Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, Canada. bjackson@ohri.ca

Dry eye complaints are common, have a diverse etiology, and result from disruption of the normal tear film; hence, the term "dysfunctional tear syndrome." Recent research has shown that ocular surface disorders have an inflammatory origin, that inflammation of the ocular surface does not always manifest as "red eye," and that a patient does not have to have a systemic autoimmune disease to experience a local, ocular autoimmune event. A panel of Canadian cornea and external disease subspecialists met and developed a questionnaire and treatment algorithm to aid the comprehensive ophthalmologist. Management of ocular surface disorders begins with a review of the patient's medical history, with particular attention to medication use, and a thorough ophthalmological examination. Use of a simple questionnaire can aid in the diagnosis. A variety of treatment modalities are available, the most effective of which are those that target the underlying inflammatory process with the goal of restoring the normal tear film. A treatment algorithm is presented that matches the severity of symptoms with the intensity of treatment. Lifestyle modifications, regular hygiene, and tear supplements may be sufficient in patients with mild symptoms. Anti-inflammatory medications (topical cyclosporin A, short courses of topical steroids, and [or] oral tetracyclines) and physical measures (punctal plugs, moisture-retaining eye wear) are implemented for those with moderate-to-severe symptoms. Autologous serum tears, scleral contact lenses, and surgery are reserved for patients with severe symptoms who have an unsatisfactory response to anti-inflammatory medications. Patients with lid disease or rosacea and those with allergic conditions should be identified during the initial encounter and should receive specific therapy to relieve their symptoms.

Abstract: OMGD treatments & evaluation with confocal

This is kind of an interesting one, studying obstructive meibomian gland disease via confocal microscopy in patients treated with an antiinflammatory or just with unpreserved tears and sodium hyaluronate. Unsurprisingly, the artificial tears really didn't improve anything clinically. Wish there had been some comparison with other treatments.

Graefes Arch Clin Exp Ophthalmol. 2009 Jun;247(6):821-9. Epub 2008 Dec 20.
The evaluation of the treatment response in obstructive meibomian gland disease by in vivo laser confocal microscopy.

Matsumoto Y, Shigeno Y, Sato EA, Ibrahim OM, Saiki M, Negishi K, Ogawa Y, Dogru M, Tsubota K.
Johnson & Johnson Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan.

PURPOSE: To evaluate the status of periglandular inflammation, ocular surface and tear function alterations in patients with obstructive meibomian gland disease (OMGD) by in vivo confocal microscopy before and after anti-inflammatory treatment, and to compare the results with patients receiving only topical non-preserved artificial tears and sodium hyaluronate eye drops without anti-inflammatory agents.

METHODS: Thirty-two eyes of 16 OMGD patients receiving anti-inflammatory treatment (treatment group) and 22 eyes of 11 OMGD patients receiving only topical non-preserved artificial tears and sodium hyaluronate eye drops (control group) were recruited in this prospective study. All subjects underwent slit-lamp examinations, tear film break-up time (BUT) measurements, fluorescein and Rose-Bengal stainings, Schirmer test capital I, Ukrainian without anesthesia, transillumination of the lids (meibography), and in vivo laser confocal microscopy of the lids (HRTII-RCM).

RESULTS: The mean BUT, fluorescein staining scores, and inflammatory cell densities observed by in vivo confocal microscopy improved significantly in the group receiving anti-inflammatory treatment (p < 0.05), whereas no significant alterations of these parameters were observed in the group not receiving anti-inflammatory agents (p > 0.05).

CONCLUSIONS: In vivo confocal microscopy was able to effectively demonstrate the treatment responses in patients with OMGD. Inflammatory cell density calculation seems to be a promising new parameter of in vivo confocal microscopy in the evaluation of treatment responses.

Abstract: MMP9 as a dry eye marker

Production and activity of matrix metalloproteinase-9 on the ocular surface increase in dysfunctional tear syndrome.
Invest Ophthalmol Vis Sci. 2009 Jul;50(7):3203-9. Epub 2009 Feb 28.
Chotikavanich S, de Paiva CS, Li de Q, Chen JJ, Bian F, Farley WJ, Pflugfelder SC.
Department of Ophthalmology, Ocular Surface Center, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas 77030, USA.

PURPOSE: To evaluate production and activity of metalloproteinase (MMP)-9 on the ocular surface of patients with dysfunctional tear syndrome (DTS) and determine any correlation between MMP-9 activity and clinical parameters.

METHODS: Forty-six patients with newly diagnosed DTS and 18 control subjects were recruited. Complete ocular surface examinations were performed. Tear MMP-9 activity was assessed with an MMP-9 activity assay in 1 microL of unstimulated tear fluid. Using conjunctival epithelial cells from 19 patients with DTS and 16 controls, levels of MMP-9 and its regulating cytokine mRNA transcripts were evaluated by semiquantitative real-time PCR.

RESULTS: Each of four DTS severity-based groups had significantly higher mean MMP-9 activities than did the control group, which was 8.39 +/- 4.70 ng/mL. The DTS4 group had the highest MMP-9 activity (381.24 +/- 142.83 ng/mL), for which the mean was significantly higher than that of other DTS groups. In addition, patients with DTS had significantly higher levels of IL-1beta, IL-6, TNF-alpha, and TGF-beta1 mRNA transcripts in their conjunctival epithelia than did the control subjects. Tear MMP-9 activities showed significant correlation with symptom severity scores, decreased low-contrast visual acuity, fluorescein tear break-up time, corneal and conjunctival fluorescein staining, topographic surface regularity index (SRI), and percentage area of abnormal superficial corneal epithelia by confocal microscopy.

CONCLUSIONS: Tear MMP-9 activity was significantly higher in patients with DTS. This activity was associated with increased mRNA expression of MMP-9 and its regulating genes and correlated strongly with clinical parameters. MMP-9 appears to be a potentially useful biomarker for diagnosing, classifying, and monitoring DTS.

Abstract: Staining... what color, or does it matter?

OK so rose bengal and lissamine green basically performed the same except rose bengal was a little harder on the patients. But the really intriguing, if not new, finding here is that neither of them had any correlation to disease severity. And yes, thank you authors for using OSDI to rank disease severity. Maybe someday we really can end this silly business of telling patients they're fine because their corneal surface looks OK with little or no staining.

Staining Patterns in Dry Eye Syndrome: Rose Bengal Versus Lissamine Green.
Cornea. 2009 Jul 1. [Epub ahead of print]
Machado LM, Castro RS, Fontes BM.
From the *Department of Ophthalmology, State University of Campinas (UNICAMP), Campinas, Brazil; and daggerDepartment of Ophthalmology, Federal University of São Paulo (UNIFESP-EPM), São Paulo, Brazil.

PURPOSE:: To evaluate and compare corneal staining patterns of lissamine green (LG) versus rose bengal (RB) in patients with dry eye syndrome. Secondary objectives included addressing patient's comfort after instillation and to correlate disease severity with staining patterns.

METHODS:: Randomized, comparative, crossover series. Patients with previous diagnosis of mild to moderate dry eye syndrome were divided in 2 groups regarding dye instillation order (group A: RB first; group B: LG first). Both dyes were applied in regular intervals, and a staining score (van Bijsterveld scale) was used to correlate and compare the results. Disease severity was determined by the Ocular Surface Disease Index. Comfort was evaluated by patient's answer in an objective questionnaire.

RESULTS:: Sixty eyes of 30 consecutive patients (24 females and 6 males) were included. There was no statistical difference between groups regarding disease severity, sex, or age. LG and RB showed good clinical correlation in both groups (group A: r = 0.939, P < 0.001; group B: r = 0.915, P < 0.001). LG was better tolerated than RB (P = 0.003 in both groups). Overall, we found a low statistical correlation between disease severity and staining scores.

CONCLUSIONS:: Both LG and RB showed similar staining patterns. RB was found to provide greater patient discomfort. There was no correlation between disease severity (addressed by the ocular surface disease index questionnaire) and staining patterns (measured by the van Bijsterveld scale).

Abstract: Lipid layer thickness & dry eye symptoms

The Relationship Between Dry Eye Symptoms and Lipid Layer Thickness.
Cornea. 2009 Jul 1. [Epub ahead of print]
Blackie CA, Solomon JD, Scaffidi RC, Greiner JV, Lemp MA, Korb DR.

PURPOSE:: (1) To investigate the relationship between dry eye symptoms and lipid layer thickness (LLT) in patients presenting for routine eye examination and (2) to consider the practicality of interferometry in a clinical practice.

METHODS:: Patients presenting consecutively for routine eye examinations were recruited (n = 137, age range = 18-60 years, mean = 41.7 +/- 15.5 years, 102 females and 35 males). Patients were required to complete the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire after which their LLT was evaluated using a new interferometer (Ocular Surface Interferometer). Patients were assigned to 1 of 3 symptom categories: no symptoms (SPEED = 0), mild to moderate symptoms (SPEED = 1-9), and severe symptoms (SPEED >/= 10). Categorical analysis (contingency table) and linear regression were performed on the data.

RESULTS:: For patients with severe dry eye symptoms, 74% had an LLT /=75 nm (contingency table, chi = 12.63, df = 2, p = 0.0018). Furthermore, a linear regression of LLT and SPEED score reveal a significant linear relationship (as LLT increases, SPEED score decreases; p = 0.0014).

CONCLUSIONS:: (1) The data indicate that approximately 3 of 4 patients reporting severe symptoms have relatively thin lipid layers of 60 nm or less, whereas approximately 3 of 4 patients without symptoms have relatively thick lipid layers of 75 nm or more. Thus, the presence of dry eye symptoms significantly increases the likelihood of a relatively thin lipid layer. LLT seems to correlate better to symptoms, especially severe symptoms, than other reported correlations with objective clinical tests for dry eye disease. (2) Interferometry has the potential to be a practical and useful addition to clinical practice.