Contact Lens & Anterior Eye最新文献

Purpose: This systematic review, evaluated the role of epidermal growth factor (EGF) in corneal wound healing and the pathogenesis of ocular surface disorders (OSDs).

Methods: The clinical and experimental application of topical EGF therapy for OSDs was reviewed. This systematic research assessed articles published on PubMed/MEDLINE from 2000 to 2023 and summarized and discussed the findings of 38 experimental and 10 clinical studies. Reporting adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: The role of EGF and its receptor (EGFR) is indispensable in corneal wound healing after injury. The most important downstream molecular pathways are the MAPK/Erk and PI3K/Akt pathways, which lead to proliferation, migration, and differentiation of corneal epithelial cells. Other EGF-related pathways, such as Decorin and Erk signaling (decreasing Pax6), as well as upregulating VEGF, contribute to early and late remodeling after corneal healing. The effect of EGF on corneal wound healing is dose-dependent, and it interacts with other important pathways, such as TGF-β.

Conclusions: There are several studies on animals and humans that showed promise for topical EGF therapy in the form of drops, ointments, or loaded contact lenses for a variety of OSDs, such as dry eye disease, neurotrophic ulcers, and pterygium excision. The reported OSDs after using EGFR inhibitors for oncology patients, and their favorable response to topical EGF therapy, further support the significance of EGF in the pathogenesis and treatment of OSDs. However, current clinical evidence is scarce, and high-quality studies are warranted to confirm the therapeutic role of EGF topical treatment for a variety of OSDs and determine the most effective yet safe concentrations.

Purpose: To explore the in vitro killing effect of water-soluble berberine and lipid-soluble niclosamide against ocular Demodex folliculorum.

Methods: Demodex with good vigor were collected from patients' eyelashes. These mites were randomly distributed into different groups with 20 mites in each group. Saline, Double Distilled Water (DDW), Polysorbate 80 (TWEEN 80), Polyethylene glycol 300 (PEG 300) and Castor Oil were used to screen solvents and cosolvents. 20 % Tea Tree Oil (TTO) and Anhydrous Ethanol (EtOH) were used as positive controls. 0.2 % Berberine, 0.25 % Niclosamide and 0.5 % Niclosamide, were designated as experimental groups. Following treatment, the analysis of Kaplan-Meier survival curves and survival time of mites and safety of drugs were then performed.

Results: The survival of Demodex in vitro in Saline and DDW, was not significant different. Therefore, DDW, which was more conducive to the dissolution of berberine, was chosen as the solvent for berberine. 0.2 % Berberine significantly inhibited the survival distribution and survival time (P < 0.001) of Demodex in vitro compared with the DDW group. Through the evaluation of several cosolvents, PEG300 had milder effects on Demodex. Hence, the proportion of PEG300 in the niclosamide solvent group was increased to reduce the irritability of the vehicle. Furthermore, niclosamide could significantly inhibit the survival of Demodex compared with the vehicle group, and the effect of 0.5 % Niclosamide was more obvious (P < 0.001), and was better than 20 %TTO (P < 0.001). In addition, after niclosamide administration, Demodex bodies exhibited gradual distortion along with increased transparency and the presence of blurred dark particles compared to those in the vehicle group. Moreover, both drugs showed good subjective tolerability and safety in a mouse model.

Conclusion: 0.2 % berberine and 0.5 % niclosamide effectively inhibited Demodex survival in vitro, with 0.5 % niclosamide superior to 20 % TTO. These two drugs, with anti-Demodex, anti-bacterial, and anti-inflammatory properties, may offer alternative treatment for Demodex blepharitis.

Background: To assess the predictive value of pretreatment corneal elevation asymmetry vector (CEAV) for severe orthokeratology (Ortho-k) lens decentration (LD) in Chinese myopic adolescents.

Methods: A retrospective analysis of 247 myopic participants over one year employed a novel MATLAB algorithm to calculate CEAV and precise LD vector. Subjects were categorized into mild (<1 mm) and severe (≥1 mm) yearly averaged LD (YALD) groups. Logistic regression and ROC analysis evaluated the relationship between corneal parameters and severe YALD.

Results: LD reached stability within the first month, with severe YALD compromising visual quality and corneal health. Notably, univariate linear regression revealed a paradoxical correlation between axial length elongation (ALE) and YALD: ALE negatively correlated with YALD in the mild group (standardised β = -0.546, P < 0.05), contrasting with a positive correlation in the severe group (standardised β = 0.599, P < 0.05). Horizontal CEAV (standardised β =  - 0.237, < 0.05) and curvature differences between nasal and temporal quadrants at 8 mm (K_TN) (standardised β = 0.227, P < 0.01) significantly correlated with horizontal YALD, while vertical CEAV vector associated with vertical YALD (standardised β =  - 0.237, < 0.05). Multivariate analysis identified CEAV as an independent predictor of severe YALD (OR = 3.145, 95 % CI: 1.334 ∼ 4.607, P < 0.01). Other risk factors included larger horizontal visible iris diameter (HVID) (OR = 2.430, 95 % CI:0.6136 ∼ 10.07, P < 0.05), corneal astigmatism (CA) (OR = 1.506, 95 % CI: 1.017 ∼ 2.244, P < 0.05), and K_TN (OR = 1.864, 95 % CI: 0.934 ∼ 3.864, P < 0.05). CEAV magnitude alone predicted severe YALD with AUC = 0.698 (95 %CI: 0.615-0.783, P < 0.001), improving to AUC = 0.732 (95 % CI: 0.660-0.805, P < 0.001) when combined with other risk factors.

Conclusions: Pretreatment CEAV may emerge as a viable predictor of severe Ortho-k YALD, warranting its consideration in further tailored lens fitting to improve outcomes.

Purpose: Contact lens behaviours such as poor hand and lens hygiene are common and are associated with increased risk of microbial keratitis. Evidence for health promotion strategies to address this gap is required. The trial examined the effectiveness of a customised text-messaging intervention on compliance, discontinuation rate and wearer satisfaction in contact lens wearers.

Methods: The parallel group, double masked, randomised clinical trial was pre-registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12621001719820). Contact lens wearers were recruited using social media and optometry partners in clinical practice. Participants (n = 76) received the intervention and usual care. The control group (n = 75) received usual care. Intervention text messages (range 56-76) were customised, provided education, reminders, and motivation and were delivered over six months. Outcomes were validated self-report online surveys for compliance (0-100), satisfaction (0-100) and discontinuation (Y/N), at 3 months and 6 months. Secondary outcomes were intervention feasibility and acceptability.

Results: Participants mean age was 38 years, 105/151 (70 %) female and 83 % completed the trial (intervention 60/76, control 65/75). The intervention group demonstrated better compliance than control with an adjusted between-group-difference at 3 months of 5.2, 95 % confidence interval (CI), 1.6-8.7, P = 0.004 and at 6 months 3.9, 95 % CI 0.2-7.6, P = 0.04. This difference in compliance is clinically significant, equivalent to a single change in a behaviour such as starting to handwash or ceasing overnight wear. There was no adjusted between-group-difference in satisfaction at 3 months (0.8, 95 % CI -4.3-6.0, P = 0.75) or at 6 months (-0.4, 95 % CI -5.7-4.9, P = 0.89). Few participants (7/151, 4.6 %) discontinued contact lens wear (3 intervention, 4 control). The messages were delivered successfully (98 %), at A$11 per participant. Participants reported appropriate message content (75 %), language (80 %) and delivery timing (97 %).

Conclusion: This customised text message intervention was a feasible and acceptable method for improving contact lens compliance.

Purpose: Successful management of dry eye disease depends upon an effective two-way communication between eyecare practitioners and affected patients. However, there has been limited investigation into the perspectives of patients with dry eye disease in the United Kingdom regarding their risk factors and desired treatment outcomes.

Methods: An online, self-administered, anonymous survey was distributed to patients based in the United Kingdom who have had a diagnosis of dry eye disease between November 2023 to March 2024. The survey consisted of four main sections including demographics, the 5-item Dry Eye Questionnaire (DEQ-5), and Likert scales rating the likelihood of various risk factors contributing to their dry eyes and the desired treatment outcomes in various components of signs and symptoms.

Results: The survey was completed by 152 respondents (mean age 51.7 ± 16.7 years, 103 females). Respondents rated environmental conditions the highest in terms of likelihood of contributing to their dry eye disease [median (interquartile range): 7.5 (5-10)], followed by digital device use [7 (4-9)] and poor sleep quality [4 (1-7)]. In terms of desired treatment outcomes, symptom frequency and severity as well as tear stability were ranked the highest in importance [10 (8-10)].

Conclusions: This survey demonstrated the perceptions of dry eye patients in the United Kingdom regarding lifestyle or modifiable risk factors contributing to their dry eye disease, as well as the most important treatment outcomes of these patients. These aspects should be considered by clinicians in the management of dry eye disease, as well as researchers particularly when designing studies which investigate treatment effects of current and novel dry eye interventions.

Purpose: To compare the safety and efficacy of the trial lens-fitting and software-fitting in orthokeratology for myopia control in children with high corneal eccentric value.

Methods: Myopic children with high corneal eccentric value (≥0.65) receiving treatment for orthokeratology from July 2020 to January 2022 were included in this retrospective study. Only the right eyes were included. The participants were allocated into two groups: the trial lens-fitting group (n = 41) and the software-fitting group (n = 48). The uncorrected visual acuity (UCVA), corneal topography, and ocular health (Efron grading scales) were recorded at baseline, one week, two weeks, one, three, six, and 12 months afterthe initiation of lens wear. The axial length and endothelial cell density were assessed at baseline and after 12 months of lens wear.

Results: The success rate of the first fit in the software-fitting group and trial lens-fitting group reached 98 % and 95 %, respectively. The difference in UCVA and corneal staining were statistically insignificant between the two groups during all visits. The software-fitting group exhibited a smaller treatment zone size (radius 1.69 ± 0.21 mm vs 1.81 ± 0.16 mm, p = 0.004; area 9.13 ± 2.15 mm² vs 10.36 ± 1.82 mm², p = 0.005) and less decentration (0.58 ± 0.31 mm vs 0.74 ± 0.39 mm, p = 0.036) compared with the trial lens-fitting group. There were no significant differences in axial elongation (0.15 ± 0.12 mm vs. 0.17 ± 0.14 mm, p = 0.534) or changes in endothelial cell density (-36.63 ± 99.37/mm² vs - 13.71 ± 87.72/mm², p = 0.256) between the software-fitting group and the trial lens-fitting group at one-year follow-up visit.

Conclusion: Both fitting methods were effective and safe. However, the software-fitting method resulted in a smaller treatment zone size and less decentration.

Purpose: To evaluate the effectiveness and the safety of LipiFlow for treating signs and symptoms of dry eye disease (DED) in adults.

Methods: The following databases were searched for randomized trials: CENTRAL, MEDLINE Ovid, Embase.com, PubMed, LILACS, ClinicalTrials.gov, and WHO ICTRP on 24 October 2022. The included studies were conducted in adults (≥18 years) with DED or meibomian gland dysfunction (MGD) as defined by the investigators. Standard Cochrane methodology was applied.

Results: This study included 13 trials that randomized a total of 1,155 participants (66 % female; age range = 19 to 86 years). Five trials compared LipiFlow with basic warm compresses. Analyzing symptom scores in these trials yielded conflicting evidence of a difference in symptoms between LipiFlow and basic warm compresses after 4 weeks. There was no evidence of a difference in meibomian gland expression, meibum quality, or tear breakup time when comparing LipiFlow with basic warm compresses. Another 5 trials compared LipiFlow with thermostatic devices. Analysis of symptom scores in these trials at 4 weeks showed that thermostatic devices had reduced Ocular Surface Disease Index (OSDI) scores by a mean difference of 4.59 as compared with LipiFlow. The remaining 3 included trials could not be grouped for comparisons. The overall evidence was of low or very low certainty, with most trials being assessed as having a high risk of bias. No trial reported any intervention-related, vision-threating adverse events.

Conclusions: LipiFlow performs similarly to other DED treatments. Further research with adequate masking and a standardized testing methodology is still needed.

Purpose: To evaluate the discriminative abilities and optimal cut-off values of qualitative meiboscale grading and percentage meibomian gland dropout measurements from each of two instruments (Keratograph 5M and LipiView II) in detecting dry eye disease, as defined by the TFOS DEWS II criteria.

Methods: A total of 227 community residents (143 females, 84 males; mean ± SD age, 36 ± 15 years) were recruited in a prospective, investigator-masked, randomised, crossover study. Dry eye symptomology, tear film parameters, and ocular surface characteristics were evaluated in a single clinical session. Qualitative meiboscale grading and quantitative percentage gland dropout assessment using Image J software were evaluated by independent masked assessors, in a randomised order.

Results: Overall, 92 (41 %) participants fulfilled the TFOS DEWS II criteria for dry eye disease. The diagnostic performances for percentage meibomian gland dropout measurements (C-statistic range, 0.629 to 0.647) were significantly greater than qualitative meiboscale grading (C-statistic range, 0.547 to 0.560) for both instruments. The Youden-optimal diagnostic cut-off percentage gland dropout was > 20 % and optimal threshold meiboscale grade was > 1 for both superior and inferior eyelid measurements from the two instruments. Inter-instrument weighted Cohen's kappa coefficients for meiboscale grading were 0.734 and 0.682, respectively, and Bland-Altman biases (95 % limits of agreement) for percentage gland dropout were -1.8 % (-28.1 % to 24.4 %) and -1.5 % (-29.3 % to 26.2 %), respectively.

Conclusions: Despite exhibiting comparable discriminative abilities, meibography parameters obtained from the Keratograph and LipiView were not directly interchangeable. Overall, percentage gland dropout measurements demonstrated superior diagnostic performance, which would support their use in clinical trials and epidemiology studies, where practicable.

Purpose: To examine intrasession repeatability and interobserver reproducibility of tear meniscus height (TMH) and non-invasive tear breakup time (NIBUT) measurements provided by ICP Tearscope, and their agreement with Keratograph 5 M measurements in persons with and without dry eye.

Methods: Participants were 48 individuals with dry eye disease (DED) and 44 healthy controls. To determine intrasession repeatability, two consecutive TMH and NIBUT measurements were carried out by a single experienced examiner using ICP Tearscope. For interobserver reproducibility, a second masked investigator measured TMH and NIBUT on the first image and video captured by the examiner. Keratograph 5 M measurements of both variables were carried out by the same examiner. Repeatability and reproducibility were evaluated through within-subject standard deviation (Sw), coefficient of variation (CoV), intraclass correlation coefficient (ICC) and Bland-Altman plots (bias and limits of agreement (LoA)).

Results: The TMH measurement with ICP Tearscope showed both, a moderate intrasession repeatability (Sw = 0.045, CoV < 19.82 %, ICC > 0.684) and interobserver reproducibility (Sw = 0.032, CoV < 14.09 %, ICC > 0.926). The NIBUT measurement showed worse intrasession repeatability in the DED group (CoV = 27.53 %) than in the Control group (CoV = 13.31 %). Even though similar Sw, LoA and ICC values were observed in both groups (Sw = 2.55 s and 2.34 s; LoA = -6.60 to 5.18 s and -4.82 to 6.51 s, Control and DED respectively, ICCs > 0.95). Interobserver reproducibility indicated a moderate amount of variability with CoV ≤ 15.01 % recorded in both groups. Agreement between the two devices was poor. Limits of agreement were not clinically acceptable for TMH (LoA = -0.19 to 0.14 mm and -0.16 to 0.13 mm, Control and DED, respectively) and for NIBUT (LoA = -12.74 to 14.08 s and -12.19 to 12.87 s, Control and DED, respectively).

Conclusions: ICP Tearscope provides TMH and NIBUT measurements that show weak repeatability and moderate interobserver reproducibility. This device is not interchangeable with the Keratograph 5 M.

Purpose: To investigate microplastics (MP) contamination in artificial tear (AT) products.

Method: Five hyaluronic acid ATs (two multi-use and three disposable ATs) were used to gauge MP levels in three scenarios: 1) initial drop and remaining liquid after opening the lid upward; 2) remaining liquid after opening the lid downward and discarding two drops; and 3) remaining liquid after opening the lid downward and discarding half of it. Raman spectroscopy was used to identify the quantity, morphological characteristics, and composition of MPs. Scanning electron microscopy/energy dispersive spectroscopy was used to examine the surface traits and elements of MPs and ATs.

Results: MPs were detected in 4 out of 5 ATs in the initial drops, containing 0.50 ± 0.65 particles/30 mL, whereas the remaining solution had 0.75 ± 0.72 particles/30 mL. After discarding two drops, 0.14 ± 0.35 particles/30 mL were present in the remaining solution. No MPs were detected after discarding half drops. Most MPs were transparent (95 %), irregular fragments (55 %) sized 10-20 μm (35 %), and made of polyethylene (95 %). If patients use the first drops of ATs four times a day for a year, individuals can be exposed to 730.0 particles. This exposure can be reduced to 204.4 particles by discarding the first two drops before use.

Conclusion: MPs are observed in commercially available ATs, and human eyes may be directly exposed to MPs through the use of ATs.