Abstract: About that corneal staining....

Polycarbonate membrane impression cytology: evidence for fluorescein staining in normal and dry eye corneas.
Br J Ophthalmol. 2010 Apr;94(4):406-9.
Thinda S, Sikh PK, Hopp LM, Glasgow BJ.
Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.

BACKGROUND/AIMS: Corneal impression cytology is usually performed with mixed cellulose ester membranes and a limited array of stains. A method using polycarbonate membrane air-dried preparations led to the discovery of fluorescein staining in cells from patients with and without dry eye disease and a membrane-induced defect that was not due to cell removal.

METHODS: Impressions after fluorescein installation were performed using polycarbonate and mixed cellulose ester membranes with rapid staining protocols for Diff-Quick as well as haematoxylin and eosin stains. Prior to staining the air-dried material was examined for fluorescence.

RESULTS: Epithelia of both normal and dry eye corneas retained fluorescence from clinical instillation of fluorescein. Corneal defects created by the polycarbonate membrane could not be explained by membrane-induced cell removal. After rapid staining, polycarbonate membranes revealed less background, dissolved easily prior to coverslip application, but showed lower cellular yield compared with the mixed cellulose membranes.

CONCLUSION: Polycarbonate membrane impression cytology enables immediate assessment with rapid stains. Topically applied fluorescein penetrates corneal epithelial cells in both normal and dry eye patients. Cells fluoresce on the cytology membranes. The impression-induced defect on the cornea is not due to cell stripping and may represent removal of mucins.

Newsblurb: Size of the dry eye market

According to CBMD.T: $1.7 billion in 2009, with annual growth at 10-11%. 70 million people in the U.S., one of the most aggressive estimates I've come across.

Hm. So if Alcon's right about $1b of that being artificial tears alone, then Restasis at last count was cleaning up nearly half as much in revenues as all artificial tears put together.

CBDM.T®, The Market and Business Intelligence Company Reviews The Dry Eye Disease Treatment Market

Paris, France (PRWEB) April 28, 2010 -- Dry eye disease (DED) is one of the most frequently encountered ocular morbidities. 25 % percent of patients who visit ophthalmic clinics report symptoms of dry eye, making it a growing public health problem and one of the most common conditions seen by eye care practitioners. Dry eye affects an estimated 20 to 30 million people in the United States and is one of the most common reasons that people visit their eye doctor. Dry eye’s prevalence estimation is very variable but we could estimate that more than 70 million people are or will be affected by dry ocular symptoms. According to CBDM.T, Dry Eye represents one of the fastest growing pharmaceutical product categories in the ophthalmology market at over 10% growth per annum to 2014. The market potential for dry eye drugs is projected to reach 1 billion USD by 2015.

The first line of treatment is usually eye drops that act as artificial tears and give some temporary relief. Restasis (cyclosporine A ophthalmic emulsion) 0.05% is the first approved prescription product in the United States for the treatment of dry eye disease. Restasis (Allergan) sales were 270 million USD in 2006s to 444 million USD by 2008.
The first line of treatment is usually eye drops. We estimate the market for artificial tears at more than one billion USD this year. Eye drops act as artificial tears and give temporary relief, but there is no cure for dry eye syndrome In 2008, more than 15 products were under development from discovery, preclinical, clinical phase 1, clinical phase 2 (5 products) to clinical phase 3 with 8 products. The leading companies in this market are Novartis, Alcon (acquired by Novartis), Bausch & Lomb, Vistakon (J&J), Allergan, Pfizer and AMO (Abbott Medical Optics Inc).

According to CBDM.T®, the market and business intelligence company, the Dry Eye Disease (DED) market is huge and growing valued at 1.7 billion USD in 2009 with an annual growth of about 10 to 11%. The Dry Eye Disease (DED) market could account for more than 2.4 billion USD by 2014. If we look at treatments and products, there is no cure for dry eyes syndrome. There are different products to moderate the dryness of the eye. For mild and moderate cases, supplemental lubrication is the main part of the treatment. Inflammation occurring in response to tears film hypertonicity can be suppressed by mild topical steroids or with topical immunosuppressants such as cyclosporine.

The main pharmaceutical companies have recently attempted to acquire market share. In 2010, Novartis bought Alcon’s remaining 52% for $28.1 billion (now making 77%). “The first line of treatment is usually eye drops. We estimate the market for artificial tears at more than one billion USD this year. Eye drops act as artificial tears and give temporary relief, but there is no cure for dry eye syndrome” comments Philippe Tramoy, managing partner.

Key players: Alcon, Allergan, Bausch&Lomb, Novartis, Ocusoft, Eagle Vision, Oasis Medical, Santen, Novagali Pharma, Opko Health, Sirion Therapeutics, Alacrity Biosciences, Eyegate Pharma, Resolvyx Pharmaceuticals, Sunesis Pharmaceuticals, Biocis Pharma, Argentis Pharmaceuticals.

Detailed products: Prolacria, Rebamipide, Ecabet Sodium, Vekacia, Vismed, Civamide, ST-603, ALTY-0501, AL-2178 FID109980, EGP-437, RX-10045, SAR-1118

If you need market and business intelligence services in the Dry Eye Disease market, please contact us at contact@cbdmt.com or you can also buy our latest Dry Eye Disease (DED) Report on DED.

Abstract: Restasis & dry eye progression

Topical cyclosporine 0.05% for the prevention of dry eye disease progression.
J Ocul Pharmacol Ther. 2010 Apr;26(2):157-64.
Rao SN.
Lakeside Eye Group, SC, 180 N. Michigan Ste 1900, Chicago, IL 60601, USA. sanjayrao@pol.net
Abstract

PURPOSE: To assess the prognosis of dry eye in patients treated with cyclosporine 0.05% or artificial tears by using the International Task Force (ITF) guidelines.

METHODS: This was a single-center, investigator-masked, prospective, randomized, longitudinal trial. Dry eye patients received twice-daily treatment with either cyclosporine 0.05% (Restasis; Allergan, Inc., Irvine, CA; n = 36) or artificial tears (Refresh Endura; Allergan, Inc., Irvine, CA; n = 22) for 12 months. Disease severity was determined at baseline and month 12 according to the consensus guidelines developed by the ITF. Dry eye signs and symptoms were evaluated at baseline and months 4, 8, and 12.

RESULTS: Baseline sign and symptom scores and the proportion of patients with the disease severity level 2 or 3 were comparable in both groups (P > 0.05). At month 12, 34 of 36 cyclosporine patients (94%) and 15 of 22 artificial tear patients (68%) experienced improvements or no change in their disease severity (P = 0.007) while 2 of 36 cyclosporine patients (6%) and 7 of 22 artificial tears patients (32%) had disease progression (P < 0.01). Cyclosporine 0.05% improved Schirmer test scores, tear breakup time, and Ocular Surface Disease Index scores throughout the study, with significant (P < 0.01) differences compared with artificial tears being observed at months 8 and 12.

CONCLUSIONS: Treatment with cyclosporine 0.05% may slow or prevent disease progression in patients with dry eye at severity levels 2 or 3.

Abstract: Tear osmolarity and disease severity

What I want to know is: What was the correlation specifically with symptoms?

Tear Osmolarity as a Biomarker for Dry Eye Disease Severity.
Invest Ophthalmol Vis Sci. 2010 Apr 14. [Epub ahead of print]
Suzuki M, Massingale M, Ye F, Godbold J, Elfassy T, Vallabhajosyula M, Asbell P.
Ophthalmology, Mount Sinai School of Medicine, New York, United States.

Purpose: To study the association between tear osmolarity and dry eye severity grade, based on a modified Dry Eye Workshop (DEWS) scale, as well as with the signs and symptoms used to determine dry eye disease severity.

Methods: 19 patients with dry eye disease were asked to complete an evaluation of dry eye signs and symptoms composed of: the Ocular Surface Disease Index (OSDI) questionnaire, corneal staining with fluorescein, conjunctival staining with lissamine green, tear-film break up time (TFBUT), Schirmer's test with anesthesia, and tear sample collection. Tear samples were collected in 5 ul micro capillaries. Tear osmolarity from the right eye was measured using the Advanced Instruments Model 3100 Tear Osmometer (0.5ul sample size).

Results: Tear osmolarity is significantly correlated with dry eye severity grade (modified DEWS). Schirmer's test and tear osmolarity were significantly correlated at -0.52, with Schirmer's test significantly contributing to the independent estimate of tear osmolarity when adjusting for age.

Conclusions: Tear osmolarity correlates with dry eye severity and could provide a biomarker for dry eye disease severity.

Abstract: Dry eye screening questionnaires/forms

This was one of those unusual abstracts where I found myself nodding in vehement agreement with almost every sentence. I think every dry eye patient should read this paragraph about 10 times slowly.

By the way, here's a link to download the OSDI. It's not perfect, but it's very useful.

Screening Questionnaire for Documentation of Medical History and Diagnostic Findings in Dry Eye Disease.
Klin Monbl Augenheilkd. 2010 Apr 14. [Epub ahead of print]
Jacobi C, Bellios N, Jacobi A, Kruse F, Cursiefen C.
Ophthalmologie, Universitätsklinikum Erlangen.

Keratoconjunctivitis sicca is one of the most common ocular diseases world-wide. These patients suffer from severe symptoms which lead to an extremely reduced quality of life. Dry eye syndrome constitutes a major diagnostic and therapeutic challenge to all ophthalmologists because there is often a discrepancy between objective ocular signs and subjective symptoms of the patients. Furthermore, there exist only few causal therapeutic options. The physician-patient relationship plays an outstanding role in this condition. For the treatment of moderate to severe dry eye syndrome, special dry eye clinics have proved to be extremely useful. For follow-up measurements as well as the realisation of evidence-based medicine and quality control, it is a fundamental necessity to document symptoms, signs and therapy of these patients in order to optimise therapeutic strategies. For this purpose, we have developed special forms and standardised questionnaires for the individual documentation of medical history and diagnostic findings. To objectively assess the patient's complaints we use the "ocular surface disease index" (OSDI score). Only the establishment of standardised diagnostic and therapeutic algorithms with the help of special forms and questionnaires can help in the long run to improve the treatment of these severely affected patients. © Georg Thieme Verlag KG Stuttgart · New York.

Abstract: It's the preservative, stupid

Prevalence of Ocular Surface Complaints in Patients With Glaucoma Using Topical Intraocular Pressure-Lowering Medications.
Cornea. 2010 Apr 9. [Epub ahead of print]
Fechtner RD, Godfrey DG, Budenz D, Stewart JA, Stewart WC, Jasek MC.
From the *Department of Ophthalmology, New Jersey Medical School, Newark, NJ; daggerGlaucoma Associates of Texas, Dallas, TX; double daggerBascom Palmer Eye Institute, University of Miami, Miami, FL; section signPRN Pharmaceutical Research Network, LLC, Dallas, TX; and paragraph signAlcon Laboratories, Inc, Fort Worth, TX.

PURPOSE:: To determine the prevalence of ocular surface disease (OSD) in patients with glaucoma using topical intraocular pressure (IOP) -lowering therapy.

METHODS:: This prospective observational study enrolled patients with primary open-angle glaucoma or ocular hypertension who were on a topical IOP-lowering medication regimen. Enrolled patients completed the ocular surface disease index (OSDI) and OSDI scores (0-100, with 0 representing no symptoms) were calculated for each patient. Medical history, demographics, and concomitant medication information were also collected.

RESULTS:: Overall, 630 patients from 10 sites participated. Of these, 305 patients (48.4%) had an OSDI score indicating either mild (n = 134, 21.3%), moderate (n = 84, 13.3%), or severe (n = 87, 13.8%) OSD symptoms. OSDI scores were significantly different between patients with and without a prior diagnosis of dry eye syndrome (25.2 +/- 15.4 vs 15.4 +/- 15.8, respectively; P = 0.0036) and between patients who did and did not use artificial tears at the time of study participation (23.0 +/- 15.6 vs 15.3 +/- 15.8, respectively; P = 0.0046). Mean OSDI scores varied significantly with the number of topical IOP-lowering medications used, with higher (more severe) OSDI scores in patients using multiple IOP-lowering medications. Specifically, patients on a single medication had a mean OSDI score of 12.9 +/- 13.1, which was significantly lower than those of patients on 2 (16.7 +/- 17.0; P = 0.007) or 3 medications (19.4 +/- 18.1; P = 0.0001).

CONCLUSIONS:: OSD is prevalent among medically treated patients with glaucoma. The severity of OSD symptoms is positively correlated to the number of IOP-lowering medications used.

Abstract: Hyaluronic acid molecular weights

Comparative studies of various hyaluronic acids produced by microbial fermentation for potential topical ophthalmic applications.
J Biomed Mater Res A. 2010 Mar 15;92(4):1421-30.
Guillaumie F, Furrer P, Felt-Baeyens O, Fuhlendorff BL, Nymand S, Westh P, Gurny R, Schwach-Abdellaoui K.
Novozymes Biopolymer A/S, Krogshoejvej 36, DK-2880 Bagsvaerd, Denmark. fagu@novozymes.com

This work presents a comparative study of various hyaluronic acids (HA) produced by fermentation of either Bacillus subtilis or Streptococcus towards the selection of an optimal molecular weight (MW) HA for the preparation of topical ophthalmic formulations. The influence of HA MW on water binding capacity, sterile filtration, rheological properties, precorneal residence time and ocular tolerance of ophthalmic solutions was investigated. Molecular weight did not affect hydration of hyaluronic acid according to differential scanning calorimetry (DSC). In general, medium MW HA (0.6-1 MDa) resulted in solutions that were superior in terms of sterile filtration and kinematic viscosity requirements compared to high MW HA (>1 MDa). Moreover, all HA-based solutions exhibited well-defined viscoelastic properties that depend on MW. Gamma scintigraphic data indicated that HA MW at 0.1% concentration (w/v) and HA origin did not significantly affect the corneal residence time on rabbit eyes. A 0.3% solution of high MW HA had a prolonged residence time in the precorneal area compared to a medium MW HA at the same concentration. Finally, an in vivo ocular irritation test based on confocal laser scanning ophthalmoscopy (CLSO) conclusively showed the excellent tolerance of both Bacillus-derived HA and Streptococcus-derived HA after topical instillation onto the corneal surface. Overall, this comprehensive work highlights the superiority of medium MW hyaluronic acid for topical ophthalmic formulations based on their physico-chemical and biological properties, tolerance and handling. Such solutions are expected to enhance tear film stability, to allow for maximum comfort, and to exhibit high residence times, while being biocompatible and easy to sterile filter. (c) 2009 Wiley Periodicals, Inc.

Abstract: Yes, we already know older women get dry eye the most....

Tear film evaporation-Effect of age and gender.
Cont Lens Anterior Eye. 2010 Apr 8. [Epub ahead of print]
Guillon M, Maïssa C.
OTG Research & Consultancy, London, UK.

PURPOSE: Dry eye is more prevalent in older patients and among them more marked in women than men. The increase in dry eye with aging is traditionally thought to be associated with a decrease in tear production enhanced by hormonal changes. Clinical evidence of an abnormal lipid production system in older patients, in particular women is established. It is therefore postulated that the greater prevalence of dry eye problems in an older population has an evaporative component. METHODS: Tear film evaporation was measured with the Oregon Health Sciences University Evaporimeter at 30% and 40% humidity. RESULTS: 160 subjects less than 45 years old and 57 subjects aged 45 years or more formed the study population. The results revealed a significant effect of age (p < 0.001), gender (p < 0.001) and their interaction (p < 0.001): (i) the rate of evaporation was higher in the older age group at both humidities; (ii) the rate of evaporation was overall higher for women; and (iii) the synergic effect of age and gender was very marked: the rate of evaporation of older women was 34-80% higher than that of older men and 36-69% than younger women. CONCLUSIONS: Aging of the tear film includes a significant evaporative component characterised by higher tear film evaporation for the over 45 compared to younger people. Further, in the over 45 years of age, a significantly greater tear film evaporation was recorded in women than men. The findings have significant implications for the management of presbyopic dry eye sufferers. Copyright © 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Newsblurb: Sleep apnea and floppy eyelid syndrome

Sleep Apnea Linked to Hard-to-Diagnose Eye Disorders

A British study finds that the condition known as floppy eyelid syndrome (FES) is strongly associated with obstructive sleep apnea (OSA), implying that when doctors see FES in a patient, they should also look for OSA, and vice-versa. The study, published in April's Ophthalmology, the journal of the American Academy of Ophthalmology, describes factors shared by OSA and FES and specific findings on how FES develops that will help doctors better diagnose and treat patients.
People with OSA face several health challenges -- at worst, they are at risk of dying of oxygen deprivation when breathing slows or stops during sleep. OSA can contribute to or be aggravated by high blood pressure, diabetes, obesity and other systemic problems. Researchers led by Daniel G. Ezra, MD, MRCOphth, of Moorfields Eye Hospital, London, England, found the strong OSA-FES association in a case-controlled study of 102 patients tracked between 1995 and 2008; 102 matched controls were also tracked.

"About one-third (32 of 102) FES patients in our study also had OSA," Dr. Ezra said. "The significant association of the two disorders was evident even when we considered and controlled for patients' body-mass index (BMI, an indicator of whether obesity was a factor). FES is often considered a disease of overweight, middle-aged men, but our study did not find a patient cluster based on age, gender or BMI," he added.

People with FES have rubbery-textured upper eyelids that may easily flip up during sleep, exposing the "whites of the eyes," which can lead to dry, irritated eyes and/or discharge. The Moorfields research and other studies suggest that central nervous system arousal may be impaired in OSA sufferers, so they do not wake up as people normally do when breathing slows or stops, or when the eyelid is subjected to extreme stress. People with OSA often preferentially sleep on one side, which could result in intense, repeated pressure on the eyelid on that side of the face. A combination of these factors may contribute to or cause FES. The Moorfield report notes that FES resolved in an OSA patient who was treated with a continuous positive airway pressure mask.

Also, the Moorfields study confirms earlier findings that FES is associated with keratoconus, in which the cornea thins out and becomes cone-shaped. Patients with FES often rub their eyes excessively, perhaps contributing to keratoconus. Eye M.D.s (ophthalmologists) should recognize that visual problems in patients with FES may be due to keratoconus -- rather than dry eye disease or other surface irritation -- and treat them accordingly, the researchers say.

In a separate study, Dr. Ezra and colleagues followed 78 FES patients who had had been treated surgically for FES at Moorfields Eye Hospital within a 13 year period that began in 1995. Of the surgical methods used, better outcomes resulted for the procedures known as medial and lateral canthal placation, and upper lid lateral tarsal strip. But outcomes for all procedures were less favorable than reported in earlier studies; the Moorfields study attributes this difference to their study's longer follow-up period.

Drop (?) news: New Alcon drop

According to an analyst report, apparently a new consumer formulation is to be filed with the FDA this year. Name, nature unknown at present.

Drop (?) news: Systane ORB on the way

Don't know what it is, but it's supposedly headed to market later this year.

Device news: Hydrodynamic cavitation....

No (cough) comment.

Comfort Zone Labs Introduces a New Therapeutic Device That Kisses Good-Bye Dry-Eye Syndrome

When a doctor examines a patient for dry eyes, it has been statistically tabulated that 70% of patients with dry eye symptoms have signs of meibomian gland diseases, for which finding relief is much more difficult.

Orange County, CA, April 03, 2010 --(PR.com)-- Keep those eyes nice, clean and healthy: Get rid of and keep away nasty blepharitis (which you may have and not know it but whether you know it or not, dry eye or lid therapy with this newly invented therapeutic device producing radial motion of warm gentle bubble waves can help it); prevent infections; shoo away debris/offending objects and clean up insidious eyelid dandruff and experience true gentle prolonged relief.

Classical approach to this problem is to perform in-house surgical meibomian gland expression, using two cotton-tip applicators and applying manual pressure to the glands of the lower lids, expressing the opaque, inspissated, and staph-laden material. The hard part is performing it on the upper lid where the patient feels extraneous pain and discomfort. If you ever had this lipid catharsis performed, you already know from your own grotesque personal experience with the sheer amount of “gunk” extracted and pain that entails classical procedures and techniques doctors use today, since nothing else is available.

This patent pending therapeutic device is directed towards a new dry eye cleaning process without feeling pain. This therapeutic device has a sophisticated and advanced irrigation system employing hydrodynamic cavitation producing transient radial motion of bubbles wherein the individual manipulates the hand piece of the sealed eye cup irrigator to wash or remove gunk’s from his/her eyes. The irrigator nozzle is configured to produce transient radial motion of bubbles in the water stream. This hydrodynamic cavitation process produces a chemical breakdown product, which combat bacterium, while dislodging lipids or other offending foreign objects from the eyes. Thus this invented therapeutic device is directed towards a new principle of applying hydrodynamic cavitation process producing transient radial motion of bubble waves that simultaneously deposits produced radicals and ions to the eye surface, and is hereby designed by Comfort Zone Labs. Furthermore, this hydrodynamic therapeutic device system automatically flushes the unwanted infectious materials into an attached hazardous safety disposable bag while undergoing rapid fluidic exchanging process. The residual offending materials that are automatically flushed from the eye membrane can be disposed safely.

This therapeutic device help your tears, directly and indirectly-directly, by improving some of the really important stuff that goes into your tears and indirectly, by getting rid of or preventing nasty stuff that gets in the way and makes dry-eye conditions worse or creates conditions that feel like dry-eye.

Here is how it helps four ways that no other device in the market can perform.

1) It retains moisture while cleaning and after cleaning.
2) It acts as a powerful agitator while sanitizing with warm circulating transient radial motion of bubble waves to liquefy the toothpaste like secretion plugging the glands.
3) The intense vibrations mode produced by radial motion of bubble waves, closes the microvasculature that is feeding the inflammatory mediators to the glands that inhibit normal function.
4) The warm transient radial motion of bubble waves therapeutically improves lid opposition. Therefore, the pumping mechanism of the meibomian glands improves after this therapy with far greater instant results. Hence, recurrent blepharitis ends.

It is known that many treatments for the dry-eye only helps with medications. Hydrodynamic therapy immediately reliefs and improves symptoms and the meibomian glands functions in the long term that benefits patients, due to the value added process that retains moisture in the infected eye accordingly. Post therapy after using this new device helps patients sleep comfortably.

This patent pending device was invented by Mr. Anwar Haq of Comfort Zone Labs. CZL is offering this device for licensing or joint venture.

Abstract: Lacrisert study

Improved Signs, Symptoms, and Quality of Life Associated With Dry Eye Syndrome: Hydroxypropyl Cellulose Ophthalmic Insert Patient Registry.
Eye Contact Lens. 2010 Mar 26. [Epub ahead of print]
Koffler BH, McDonald M, Nelinson DS; for the LAC-07-01 Study Group.
From the Koffler Vision Group (B.H.K.), Lexington, KY; NYU School of Medicine (M.M.), New York, NY; and InterQuest Medical (D.S.N.), Mountain Lakes, NJ.

OBJECTIVES: To evaluate the acceptability, ease of use, and efficacy of hydroxypropyl cellulose ophthalmic inserts in reducing signs and symptoms of moderate-to-severe dry eye syndrome (DES), and improving quality of life (QoL) and activities of daily living (ADL).

METHODS: The multicenter, prospective, open-label, 4-week registry comprised 520 patients with bilateral DES and a history of artificial tear use, or a desire to use artificial tears within the previous week. Visit 1 encompassed a clinical evaluation and symptom and QoL questionnaires, including the Ocular Surface Disease Index. Patients were trained to use inserts, which were used once daily, thereafter, as monotherapy or with existing therapy. At visit 2, clinical evaluation and questionnaires evaluated changes in signs, symptoms, ADL, and QoL. Adverse events were monitored throughout the registry.

RESULTS: There were 418 (80.4%) completers. Statistically significant improvements in discomfort, burning, dryness, grittiness, stinging, and light sensitivity, as well as clinical signs of keratitis, conjunctival staining, and tear volume were seen (P<0.05). Mean Ocular Surface Disease Index total scores improved by 21.3% (P<0.05). Blurred vision, affecting 8.7% of patients, was the most commonly reported adverse event leading to discontinuation.

CONCLUSIONS: Hydroxypropyl cellulose ophthalmic inserts significantly improved signs and symptoms of moderate-to-severe DES, as well as ADL and QoL. Benefits were additive to those seen with patients' existing care.

Abstract: More lid wiper epitheliopathy

Lid-Wiper Epitheliopathy in Contact Lens Users and Patients With Dry Eye.
Eye Contact Lens. 2010 Mar 26. [Epub ahead of print]
Yeniad B, Beginoglu M, Bilgin LK.
From the Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.

OBJECTIVE: To evaluate lid-wiper epitheliopathy (LWE) in contact lens users and in patients with symptoms characteristic of dry eye but with normal dry-eye tests and to compare the results with those of controls.

METHODS: One hundred fifty-five patients were enrolled in the study and were divided into three groups. The first group included 69 contact lens users, the second group included 46 patients with dry eye, and the third group included 40 controls. The contact lens users were also divided as symptomatic and asymptomatic according to the Standard Patient Evaluation of Eye Dryness questionnaire and Ocular Surface Disease Index. The patients were examined for LWE with three different dyes (fluorescein, rose bengal, and lissamine green). The results were compared using chi-square and T tests.

RESULTS: More LWEs were detected in the contact lens and dry-eye groups compared with controls. In the contact lens group, 67% of the symptomatic patients and 32% of the asymptomatic patients showed LWE. The difference was statistically significant (P = 0.001). No significant correlation was found between LWE and the dry-eye tests (fluorescein breakup time and Schirmer test).

CONCLUSIONS: LWE should be investigated in symptomatic contact lens users and in patients with symptoms characteristic of dry eye but with normal dry-eye tests. Lid wiper may traumatize the corneal epithelium and increase the sensitivity of the cornea. This could be the main cause of the symptoms in patients without any significant dry-eye test findings.

Abstract: Contact lenses, computers, blinking, and the tear film

I really enjoyed this one... sounds like a well put together study. More details about what goes on with blinking when you have contacts in (or not) and are staring at a screen or thinking about something else.

Effect of Contact Lens Wear and a Near Task on Tear Film Break-Up.
Optom Vis Sci. 2010 Mar 25. [Epub ahead of print]
Jansen ME, Begley CG, Himebaugh NH, Port NL.
*OD, MS daggerOD, MS, FAAO double daggerOD, PhD section signPhD Indiana University School of Optometry, Bloomington, Indiana.

PURPOSE.: To study the effect of extrinsic controls on blinking by examining blink parameters and tear stability among adapted soft contact lens (CL) wearers performing tasks that require varying amounts of visual concentration.

METHODS.: The Demographic Questionnaire, Contact Lens Dry Eye Questionnaire, and Current Symptoms Questionnaire were completed by 15 adapted soft CL wearers (nine females). Three 55 s simultaneous measurements of tear film stability via retroillumination and blinking were obtained with a slit-lamp biomicroscope and 200 Hz video camera while subjects listened to music and played a video game with and without their habitual CLs. Interblink interval (IBI) and blink amplitude (BA) were calculated. The area of break-up (AB) was calculated for the retroillumination image before each blink. The Current Symptoms Questionnaire was completed four times throughout testing.

RESULTS.: With the game compared to music, IBI was significantly longer and BA significantly decreased without CLs (p< / = 0.001). With CLs, the IBI did not significantly change between tasks but the BA significantly decreased (p = 0.100). The AB significantly increased with CL and the game (paired t-test, p/= 0.5579, p< 0.0001) and several symptom measures (Spearman r>/= 0.6262, p< 0.0001). The AB was significantly correlated with symptom measures including bothersome discomfort for the game with and without CLs (Spearman r >/= 0.5064, p< 0.0001).

CONCLUSIONS.: During tasks requiring concentration, the IBI increased (blink rate decreased) and many blinks were incomplete without CLs. With CLs, tear film instability increased. Blinking frequency also increased, but it remained high when subjects played the game, and symptoms of ocular irritation increased. This suggests that wearing soft CLs, even when fully adapted, provides enough extrinsic ocular surface stimulation to override internal controls and affect blink parameters.