Optometry and Vision Science最新文献

Significance: Dry eye sufferers have a highly irregular corneal epithelial surface compared with those without dry eye. This study demonstrated that corneal epithelial thickness irregularity can be significantly reduced after as little as 48 hours following treatment with regular use of topical ocular lubricants.

Purpose: This study aimed to compare changes in corneal epithelial thickness irregularity factor (EIF) and ocular symptoms in a population with symptoms of dry eye before and up to 4 weeks after treatment with two commercially available lubricating eye drops versus saline.

Methods: We conducted a prospective single-center, investigator-masked, randomized, parallel-group dispensing study. Participants with moderate to severe symptoms of dry eye (Ocular Surface Disease Index score >23 at baseline) were enrolled and randomly assigned to receive either 0.15% hyaluronic acid + hydroxypropyl guar, 0.2% hyaluronic acid, or saline (16 in each group). Corneal epithelial thickness measurements were obtained along vertical and horizontal CASIA SS-1000 Optical Coherence Tomography scans at baseline and after 48 hours, 2 weeks, and 4 weeks. The Ocular Surface Disease Index questionnaire was administered at baseline, 2 weeks, and 4 weeks.

Results: Forty-eight participants (male-to-female ratio, 17:31) completed the study. Horizontal EIF was significantly lower at all follow-up visits compared with baseline (p=0.001), but there were no significant differences between study eye drops (p=0.34). No significant difference in vertical EIF was observed over time (p=0.32) or between eye drops (p=0.08). Ocular symptoms significantly improved after 2 and 4 weeks of treatment compared with baseline (p<0.001), but no differences were observed between eye drops (p=0.46).

Conclusions: All treatments were effective for reducing EIF along the horizontal meridian 48 hours after initiation of treatment, and improvements were maintained for 4 weeks. Improvements in ocular symptoms were observed with all study treatments.

Significance: When using lissamine green for bulbar conjunctival evaluation, the most staining was observed with two applications of the same strip in the same eye, wetted with a drop of saline. The first application was 5 seconds after wetting the strip, and the second was 1 minute later, followed by immediate viewing. This suggests that bulbar staining should be viewed before the lid wiper region.

Purpose: This study aimed to optimize the assessment of lissamine green staining of the bulbar conjunctiva by investigating the application technique and subsequent observation period.

Methods: Twenty-two participants with dry eye (as defined by the Tear Film and Ocular Surface Society Dry Eye Workshop II) were recruited to trial five application methods in randomized order: (1) application immediately after wetting a single strip, (2) application 5 seconds after wetting a single strip, (3) application 10 seconds after wetting a single strip, (4) consecutive single application of sodium fluorescein followed by lissamine green 5 seconds after wetting, and (5) two applications using the same lissamine green strip 5 seconds after wetting, 1 minute apart. Slit-lamp photography of the conjunctiva was performed immediately following application and at 30, 60, 90, and 300 seconds after application. Three experienced (masked) practitioners independently quantified the visible punctate spots and graded the staining intensity within the images in a random order.

Results: Values for punctate spot count ( F = 6.29, p<0.0001) and lissamine green staining intensity ( F = 6.29, p<0.0001) varied significantly between the different application methods. Using two applications of the same lissamine green strip, 1 minute apart, in the same eye resulted in the greatest values for both punctate spot count and lissamine green staining intensity. Lissamine green staining decreased with time for both spot count ( F = 18.87, p<0.0001) and lissamine green staining intensity ( F = 11.33, p<0.0001), with the most staining found immediately after application followed by a gradual decline. There was no evidence of any interaction effect between time and application method for either measure (p>0.05 for both).

Conclusions: The optimal approach for assessing bulbar conjunctival lissamine green staining involves two applications of a whole infused drop resting on the same strip for 5 seconds, applied 1 minute apart. The ocular surface should be viewed immediately after application to maximize the conjunctival staining observed.

Significance: This work is significant because it is the first Cochrane systemic review that compares the comfort and safety of hydrogel and silicone hydrogel soft contact lenses (SCL).

Purpose: This study aimed to conduct a systemic review of randomized trials comparing the comfort and safety of silicone hydrogel and hydrogel SCLs.

Methods: CENTRAL, MEDLINE Ovid, EMBASE.com , PubMed, LILACS, ClinicalTrials.gov , and World Health Organization International Clinical Trials Registry Platform were searched on or before June 24, 2022, to identify randomized clinical trials that compared silicone hydrogel and hydrogel SCLs.

Results: Seven trials were identified and evaluated. One trial reported Ocular Surface Disease Index results, with the evidence being very uncertain about the effects of SCL material on Ocular Surface Disease Index scores (mean difference, -1.20; 95% confidence interval, -10.49 to 8.09). Three trials reported visual analog scale comfort score results, with no clear difference in comfort between materials, although results were of low certainty; trial results could not be combined because the three trials reported results at different time points. None of the included trials reported Contact Lens Dry Eye Questionnaire 8 or Standard Patient Evaluation of Eye Dryness scores. There was no evidence of a clinically meaningful difference (>0.5 unit) between daily disposable silicone hydrogel and hydrogel SCLs in corneal staining, conjunctival staining, or conjunctival redness (very low certainty evidence).

Conclusions: The overall evidence for a difference between all included silicone hydrogel and hydrogel SCL trials was of very low certainty, with most trials judged as having a high overall risk of bias. There was insufficient evidence to support recommending one SCL material over the other. Future well-designed trials are needed to generate high certainty evidence to further clarify differences in SCL material comfort and safety.

Significance: Contact lenses are an increasingly popular option for correcting pediatric refractive error due to increased awareness of interventions to slow myopia progression. With limited information on the safety profiles of contact lenses in children, it is important to characterize the current understanding and promote this device's safe and effective use.

Purpose: This scoping review evaluates characteristics of the current literature that have examined the safety of contact lenses in pediatric patients. It provides future directions for systematic reviews and identifies any gaps in the current literature or areas for future research.

Methods: Literature searches in MEDLINE via PubMed, EMBASE, The Cochrane Library, trial registries, and U.S. Food and Drug Administration clinical trial documentation were performed. Included studies (i.e., experimental and quasi-experimental studies; observational studies including prospective and retrospective cohort, case-control, and analytical cross-sectional studies, and case series of 30 or more participants) reported safety and/or complications of the use of any contact lens for correcting refractive error in children (0 to 18 years). Two independent reviewers first screened the titles and abstracts, and then full-text reports for eligibility. Conflicts in eligibility were resolved by discussions with a third reviewer. Two independent reviewers extracted data, including details about the participants, context, study methods, and key findings relevant to the review question.

Results: This scoping review included 73 studies from 10 countries using different contact lens modalities, primarily orthokeratology and soft contact lenses, in children (6 to 18 years). The most common adverse event reported by the studies was corneal staining (60% orthokeratology, 45% soft contact lens).

Conclusions: The need for uniform reporting standards for adverse events poses challenges for comprehensive data synthesis. However, this scoping review identified a sufficient number of studies for a future systematic review to quantify the risks associated with orthokeratology and soft contact lens use in children.

Significance: Dry eye disease is frequently underdiagnosed in pediatric patients. Meibomian gland morphology abnormalities (atrophy and tortuosity) may be associated with dry eye. This study examined risk factors for gland morphology abnormalities in children.

Purpose: This study aimed to characterize meibomian gland morphological abnormalities (atrophy and tortuosity) and identify risk factors for the same in children.

Methods: A total of 160 children, primarily African American and Hispanic, aged 5 to <18 years underwent a comprehensive eye exam including slit-lamp examination to evaluate the meibomian glands, conjunctival papillae, and tear film. Infrared photography was performed including assessment of noninvasive tear film breakup time and tear meniscus height. Meibomian gland atrophy and tortuosity were assessed. A modified Ocular Surface Disease Index survey was administered along with surveys on screen time, diet, and outdoor activity. Linear multiple regression was performed to determine risk factors for meibomian gland abnormalities.

Results: The average age of participants (76 male, 84 female) was 10.9 ± 3.0 years. Severe meibomian gland atrophy (score ≥2) was found in 31.0% of participants in at least one eyelid. Severe meibomian gland tortuosity (score ≥2) was found in 84.0% of participants in at least one eyelid. The median symptom score was 9.8 (range, 0 to 71), with 16.9, 8.8, and 12.5% of the children having mild, moderate, and severe dry eye symptoms, respectively. Elevated body mass index (p<0.001), reduced outdoor activity (p=0.02), and unhealthy diet (p=0.01) were found to be risk factors for meibomian gland abnormalities. Screen time, symptom score, age, gender, and race/ethnicity were not associated with gland abnormalities (all p values >0.05).

Conclusions: This study determined that meibomian gland morphological abnormalities were commonly found in children aged 5 to <18 years. Risk factors for these abnormalities include elevated body mass index, an unhealthy diet, and reduced outdoor activity.

Significance: Prolonged computer use may result in repeated stimulation of the ocular surface due to ocular dryness, potentially leading to alterations in its sensitivity.

Purpose: This study aimed to evaluate the relationship between ocular symptoms and corneal sensitivity to cold and mechanical stimuli in computer users.

Methods: Fifty-two young (31 ± 6 years), frequent computer users, including symptomatic and asymptomatic users, participated in this study. Mechanical and cold sensation thresholds were determined at the central cornea of one randomly selected eye of each participant using the UNSW Liquid Jet Aesthesiometer. Ocular surface symptoms and digital eye strain were assessed using the Ocular Surface Disease Index, Ocular Comfort Index, Instant Ocular Symptom Survey, and Computer Vision Syndrome Questionnaire (CVS-Q). Associations between central corneal sensation thresholds and demographic variables, patterns of digital device use, and symptom scores were analyzed using Pearson (r) or Spearman (ρ) correlations and linear regression models.

Results: Age (ρ = 0.24), CVS-Q score (ρ = -0.33), CVS-Q dry eye score (ρ = -0.28), and mechanical sensation threshold (ρ = 0.63) were significantly associated with cold sensation threshold (p≤0.04). Conversely, there were no significant relationships with Ocular Surface Disease Index, Ocular Comfort Index, or Instant Ocular Symptom Survey or with other demographic variables (p≥0.34). In multiple linear regression models, age and mechanical sensation threshold were significant predictors of cold sensitivity (p=0.04 and p<0.001, respectively) (adjusted R2 = 0.459). There were no significant correlations between mechanical sensitivity and symptom scores (p≥0.09).

Conclusions: Symptoms of digital eye strain, particularly those related to dry eye, were associated with higher corneal cold sensitivity. Corneal hypersensitivity to cold stimuli as a marker of ocular discomfort during computer use requires further investigation.

Significance: This is the first study to evaluate the retention time of lubricating eye drops containing various concentrations of sodium hyaluronate using fluorophotometry in a symptomatic dry eye population. Information regarding eye drop retention may be useful for eye care practitioners to assist in the selection of more effective treatments for managing dry eye.

Purpose: This study aimed to use fluorophotometry to compare retention time on the ocular surface of three commercially available lubricating eye drops, each containing varying concentrations of sodium hyaluronic acid (HA), and their effects on tear film stability post-instillation in a population with symptoms of dry eye.

Methods: Adults with symptoms of dry eye (Ocular Surface Disease Index score, >12) were enrolled in this prospective, double-masked comparison of eye drops containing 0.15% HA-hydroxypropyl guar (HPGuar), 0.2% HA, and 0.1% HA. Participants were randomized to the eye drop order and the study eye under evaluation. Each eye drop was admixed with a fluorescent tracer (70-kDa fluorescein isothiocyanate-dextran) at 10% wt/vol, and 10 μL volume was instilled for each evaluation. A fluorophotometer was used to measure the time for the tracer signal to return to baseline. Fluorescein tear breakup time was measured following fluorophotometry assessment.

Results: Retention time for 0.15% HA-HPGuar and 0.2% HA was significantly longer compared with 0.1% HA (p=0.02 and p=0.03). Fluorescein tear breakup time was significantly longer for the 0.15% HA-HPGuar eye drop compared with both the 0.1% HA eye drop (p=0.01) and 0.2% HA eye drop (p=0.003).

Conclusions: Retention time on the ocular surface of the two eye drops containing higher concentrations of HA was longer than the eye drop with the lowest concentration of HA. The tear film was also more stable with the 0.15% HA-HPGuar eye drop compared with the eye drops containing HA alone, which may be attributable to the other components in the 0.15% HA-HPGuar eye drop.