润洁萘扑维滴眼液治疗视疲劳的初步临床观察

目的评价润洁萘扑维滴眼液治疗视疲劳的临床效果。方法应用润洁萘扑维滴眼液治疗视疲劳42例,分别于用药前、用药后1、3、7、14d评估患者的症状和体征,同时观察药物的不良反应。结果与用药前相比,总积分(P<0.000)、异物感(P=0.003)、烧灼感(P=0.004)、眼痛(P=0.006)、流泪(P=0.014)、充血(P=0.01)积分于用药后1d下降,差异有统计学意义。畏光(P=0.001)、睑痉挛(P=0.026)、头晕头痛(P=0.005)积分于用药后3d下降,差异有统计学意义。除头晕头痛积分有反弹外(用药后7d及14dP>0.05),其余指标的积分均随着时间延长而逐渐下降。恶心呕吐症状在用药观察期间无明显改变。8例发生一过性眼局部不良反应,其中1例伴有轻微的头痛。结论润洁萘扑维滴眼液14d内能安全有效地缓解视疲劳的症状和体征。     

The effects of early life polyunsaturated fatty acids and ruminant trans fatty acids on allergic diseases: A systematic review and meta-analysis

Early life nutritional exposures could modify the gene expression and susceptibility of allergic diseases (AD). This systematic review aimed to evaluate whether early life (the first 1,000 days) natural exposure to polyunsaturated fatty acids (PUFA) and ruminant trans fatty acids (R-TFA) could affect the AD risk. We searched PubMed, EMBASE, PsycINFO, Scopus, the Cochrane Library, and ClinicalTrials.gov from inception through September 10, 2017 for relevant full-text articles in English. Observational studies were selected if they examined the effects of early life PUFA or R-TFA on AD (eczema, asthma, wheeze, and allergic rhinitis) or sensitization. The quality of studies was examined by the Newcastle-Ottawa Scale, and the best evidence synthesis (BES) was applied. We included 26 observational studies, and 8 of them showed high quality. BES showed a moderate evidence for the protective effect of vaccenic acid (VA, an R-TFA) on eczema, while insufficient or no evidence was found in other associations. Meta-analysis showed that higher n-6/n-3 ratio and linoleic acid were associated with higher risk of eczema (pooled odds ratio [OR] = 1.06, 95% confidence intervals [CI]: 1.00 ?1.13; 1.08, 95% CI: 1.01 ?1.15). However, VA was inversely associated with eczema pooled OR = 0.42, 95% CI: 0.25 ?0.72). Early life natural exposure to VA showed evident benefit on decreasing the risk of eczema, while PUFA and other R-TFA showed limited effects on AD. More robust studies especially for R-TFA are required.     

A review of non-pharmacological and pharmacological management of seasonal and perennial allergic conjunctivitis

Allergic eye disease encompasses a group of hypersensitivity disorders which primarily affect the conjunctiva and its prevalence is increasing. It is estimated to affect 8% of patients attending optometric practice but is poorly managed and rarely involves ophthalmic assessment. Seasonal allergic conjunctivitis (SAC) is the most common form of allergic eye disease (90%), followed by perennial allergic conjunctivitis (PAC; 5%). Both are type 1 IgE mediated hypersensitivity reactions where mast cells play an important role in pathophysiology. The signs and symptoms are similar but SAC occurs periodically whereas PAC occurs year round. Despite being a relatively mild condition, the effects on the quality of life can be profound and therefore they demand attention. Primary management of SAC and PAC involves avoidance strategies depending on the responsible allergen(s) to prevent the hypersensitivity reaction. Cooled tear supplements and cold compresses may help bring relief. Pharmacological agents may become necessary as it is not possible to completely avoid the allergen(s). There are a wide range of anti-allergic medications available, such as mast cell stabilisers, antihistamines and dual-action agents. Severe cases refractory to conventional treatment require anti-inflammatories, immunomodulators or immunotherapy. Additional qualifications are required to gain access to these medications, but entry-level optometrists must offer advice and supportive therapy. Based on current evidence, the efficacy of anti-allergic medications appears equivocal so prescribing should relate to patient preference, dosing and cost. More studies with standardised methodologies are necessary elicit the most effective anti-allergic medications but those with dual-actions are likely to be first line agents.     

Rationale for 24-hour management of dry eye disease: A review

The symptom severity of patients with dry eye disease (DED) varies over a 24-hour period. It is typically worse upon waking than later in the morning and deteriorates towards the evening. Substantial differences in the characteristics and physical properties of the tear film, such as levels of inflammation, pH, osmolarity, volume and stability, also exist between night (sleeping) and day (waking), and over the course of the day itself. Data on diurnal variation in symptom severity and tear film characteristics have been reviewed to recommend a management strategy that supports the various needs of patients with DED over a full 24-hour period.Treatment strategies for DED must be matched to the variations in the severity of DED and to the environments that eyes are subjected to over a 24-hour period. While artificial tears are used to moisturise the ocular surface and reduce damage to the corneal epithelium during the day, gels are used at night-time; they are more viscous and have a longer ocular surface retention time than artificial tears. Several combinations of these products are currently available in tandem to support the 24-hour variation in tear film characteristics. The present review of published literature provides evidence that the approach of the daytime use of artificial tears to protect the eye from aggravating environmental factors in combination with the night-time use of gels to relieve more severe symptomatology. This, in turn, should provide optimal ‘around-the-clock’ DED management.     

Patient-reported experience of dry eye management: An international multicentre survey

PurposeTo explore the journey taken by patients in a range of different countries to manage their dry eye symptoms.MethodMembers of the general public who responded positively to the question “Do your eyes ever feel dry?” completed a questionnaire describing their demographics, the impact of their symptomology, the advice they have received and the management options they have tried. The Ocular Surface Disease Index (OSDI) questionnaire was also completed.ResultsA total of 916 individuals (Canada = 235, Mexico = 127, New Zealand = 157, Taiwan = 246, UK = 151) of similar age distribution (median 38 years, IQR: 27–50) completed the survey. The reported duration of symptoms was longest in Canada (median 4 years, range 2–10) and least in Taiwan (2 years, range 1–3; p < 0.001), and similar trends were observed for symptom severity (p = 0.001). However, there was no statistically significant difference between countries with respect to the impact of symptoms on quality of life (median 3/10; p = 0.08). Less than half of the individuals in any country had consulted with a health professional. About half had tried a treatment for their dry eye symptoms, with artificial tears being the most common treatment, followed by warm compresses, and both therapies were rated as reasonably effective (median 5?7/10).ConclusionMany people with dry eye symptoms are not consulting health care professionals who can confirm the diagnosis, exclude differential diagnoses, and offer a wide range of treatments targeted at the dry eye subtype.     

The epidemiology of dry eye disease in the UK: The Aston dry eye study

PurposeCross-sectional studies on dry eye disease (DED) have relied on different diagnoses hindering conclusions about the disease epidemiology. This study offers an insight into DED epidemiology in the UK using prior and recent diagnostic recommendations.MethodsStudy participants comprised 282 volunteers from Birmingham, UK (median 40 years, range 18–88 years, 56% females). DED was defined by the Tear Film Ocular Surface Dry Eye Workshop II (TFOS DEWS II) criteria, based on a positive symptom score with the Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI), and one of the following homeostasis markers: non-invasive tear break-up time of < 10 s (Oculus Keratograph 5M); the highest osmolarity value of ≥ 308 mOsm/L among eyes or an interocular osmolarity difference of > 8 mOsm/L (TearLab Osmolarity System); or > 5 corneal spots, >9 conjunctival spots or lower/upper lid-wiper-epitheliopathy staining of ≥ 2 mm length and ≥ 25% width (Oculus Keratograph 5 M). In addition, the Women’s Health Study (WHS) criteria, based on symptoms or a prior dry eye diagnosis, was assessed. DED risk factors were gathered using a self-administered questionnaire.ResultsDED prevalence by the TFOS DEWS II criteria was 32.1% (95% confidence interval 25.5–37.7% and 29.5% (95% confidence interval 24.4–35.1% by the WHS criteria. Female sex, systemic and/or ocular health conditions, short sleep duration and prolonged outdoor leisure time spent were significant DED risk factors (p ≤ 0.05).ConclusionsApproximately one-third of the adult UK population have DED, aligning with the prevalence reported in multiple counties globally. Female sex, systemic/ocular health conditions, short sleep duration and prolonged outdoor leisure time are positive predictors of DED.     

Trends in myopia management attitudes and strategies in clinical practice: Survey of eye care practitioners in Africa

PurposeThere remains a lack of information on the perception and adoption of myopia control strategies among African eye care practitioners (ECPs). This study provides an African perspective to similar previous studies conducted in other parts of the world.MethodsA self-administered survey in English and French was distributed to ECPs across Africa. The items on the questionnaire assessed their level of concern about the increasing prevalence of paediatric myopia, perceived efficacy, opinions on, and adoption of various myopia management modalities.ResultsResponses were obtained from 330 ECPs working in 23 African countries. Respondents were highly concerned about the increasing prevalence of paediatric myopia in their clinic (median 8/10) and perceived approved myopia control soft contact lenses as the most effective at slowing myopia progression (mean perceived reduction in myopia progression ± SD; 53.9 ± 27.1%), followed by single vision spectacles (53.1 ± 30.9%), and orthokeratology (52.8 ± 28.0%). Multifocal soft contact lenses (40.4 ± 25.8%) and pharmaceutical agents such as topical atropine drops (39.5 ± 27.1%) were perceived as least effective in slowing myopia progression. Although ECPs reported being aware of various myopia control strategies, they still mainly prescribed single vision spectacles to a large proportion (64.3 ± 29.9%) of young progressing myopes. Nearly one-third (27%) of ECPs who prescribed single vision lenses stated they were concerned about the cost implications to patients. Other reported concerns included safety of, and inadequate information about myopia control options.ConclusionsAfrican ECPs continue to prescribe single vision lenses for progressing myopes despite being aware of the various myopia control options. Practitioners’ perceptions of the efficacy of several modalities to slow myopia progression do not align with the current best evidence. Clear practice guidelines and continuing education on myopia control are warranted to inform and guide the management of myopic patients in Africa.     

The effects of breaks on digital eye strain,dry eye and binocular vision: Testing the 20-20-20 rule

PurposeTo evaluate the benefits on the eyes of taking breaks based on the 20-20-20 rule.MethodsBespoke computer software using the laptop webcam to assess user breaks, eye gaze and blinking, and emitting personalized reminders of breaks based on the 20-20-20 rule, was downloaded onto the laptops of 29 symptomatic computer users. Digital eye strain (DES), binocular vision and dry eye were assessed before and after two weeks of using the reminders and one week after the discontinuation of the strategy. Binocular measurements included visual acuity, accommodative posture, stereopsis, fixation disparity, ocular alignment, accommodative facility, positive/negative vergences and near point of convergence. Symptoms were evaluated using the computer vision syndrome questionnaire, ocular surface disease index (OSDI), and symptom assessment in dry eye questionnaire (SANDE) versions one and two. Dry eye signs were assessed by measuring tear meniscus height, conjunctival redness, blink rate and incomplete blinking, lipid layer thickness, non-invasive keratograph break-up time, corneal and conjunctival staining and lid wiper epitheliopathy.ResultsA decrease in the duration of computer work and the duration of breaks, along with an increase in the number of breaks taken per day was observed as a result of the 20-20-20 rule reminders (p ≤ 0.015). No changes on any binocular parameter were observed after the management period (p ≥ 0.051), except for an increase in accommodative facility (p = 0.010). Dry eye symptoms and DES decreased with the rule reminders (p ≤ 0.045), although this improvement was not maintained one week after discontinuation (p > 0.05). No changes on any ocular surface and tear film parameter were observed with the rule reminders (p ≥ 0.089).ConclusionsThe 20-20-20 rule is an effective strategy for reducing DES and dry eye symptoms, although 2 weeks was not enough to considerably improve binocular vision or dry eye signs.     

强力霉素滴眼液对兔蒸发过强型干眼疗效的评价

目的研究强力霉素滴眼液对兔蒸发过强型干眼的治疗效果,并初步探讨其机理。方法新西兰大白兔16只,烧灼睑板腺开口制作干眼模型,术后第6周随机分为4组,分别不滴药及滴用1%甲基纤维素、0.1%强力霉素、1%甲基纤维素加0.1%强力霉素。用药前后定期检查角膜荧光素染色、虎红染色、结膜杯状细胞密度等。术后第1 1周取眼睑、结膜及角膜行病理检查。结果用药前各组兔角膜荧光素染色、虎红染色、结膜杯状细胞密度等指标无统计学差异(P<0.05)。用药后,甲基纤维素与强力霉素联合应用组荧光素染色及虎红染色比未用药组轻,结膜杯状细胞密度比未用药组高(P<0.05)。单用甲基纤维素或强力霉素组上述指标与未用药组比较无统计学差异(P>0.05)。病理检查未滴药组睑结膜及球结膜可见炎症细胞浸润,其它组未见明显的炎症细胞浸润。结论强力霉素滴眼液可以减轻干眼兔眼表的炎症反应,与甲基纤维素联合应用对兔蒸发过强型干眼有一定的治疗效果,提示强力霉素治疗干眼具有一定的应用前景。     

Modulatory effects of 1,25-dihydroxyvitamin D3 on eye disorders: A critical review

Many studies have shown that the presence of 1,25-dihydroxyvitamin D3 in the eye is able to modulate inflammatory responses. In fact, it has been demonstrated that topical administration of vitamin D3 inhibits Langerhans cells migration from the central cornea, corneal neovascularization, and production of cytokines (i.e., interleukin-1-6-8) in experimental animals.

Moreover, both in vitro and in vivo studies have demonstrated that vitamin D is a potent inhibitor of retinal neovascularization. It has been shown that calcitriol, the biologically active form of vitamin D, inhibits angiogenesis both in cultured endothelial cells and in retinas from guinea pigs with retinoblastoma or oxygen-induced ischemic retinopathy. In addition, it seems that this compound is able to prevent the progression from early to neovascular age-related macular degeneration (AMD) and, at the same time, to down-regulate the characteristic inflammatory cascade at the retinal pigment epithelium–choroid interface due to its anti-inflammatory and immunomodulatory capabilities.

Furthermore, 1,25-dihydroxyvitamin D3 and its analogue, 2-methylene-19-nor-1,25-dihydroxyvitamin D3, are able to modulate intraocular pressure (IOP) through gene expression. Several studies have suggested a role in glaucoma and diabetic retinopathy therapies for vitamin D3.

In conclusion, this review summarizes our current knowledge on the potential use of vitamin D3 in the protection and treatment of ocular diseases in ophthalmology.     

An in vitro test for the assessment of eye irritancy in consumer products – preliminary findings

An in vitro procedure for preliminary screening of severe eye irritants is described. Rabbit eyes are removed immediately after death and are placed in temperature controlled chambers. The eyes are superfused with isotonic saline and, after a suitable equilibration period, are treated with test substances. The effects of treatment (corneal swelling, and the severity, extent, and rate of development of opacity in the corneal epithelium and stroma) are assessed using the slit lamp biomicroscope. Experiments show that the cornea of the isolated eye remains viable and physiologically active for the duration of the test.
Results of in vitro tests show a reasonably good correlation with in vivo data for a series of chemicals reported in the literature to be severely, moderately, or non-irritant to eyes. The effects of a range of high pH sodium hydroxide solutions are described. Thresholds for effect in vitro are defined and related to in vivo thresholds for high pH products. The effects of shampoos in the in vitro system are described, with preliminary results suggesting that the method can distinguish between normal 'adult'shampoos and 'baby'shampoos, which are known to differ in irritancy in vivo.
Overall the in vitro procedure appears to offer a reliable screening procedure to identify severe eye irritants. Materials producing severe effects in vitro following a short contact time should not be tested in vivo , but where no effects are observed in vitro , in vivo testing may still be required. Like all in vitro procedures it has limitations compared with the in vivo eye test. It takes no account of the effects on the conjuctivae, nor does it take account of the rate of healing, both of which are important aspects of in vivo eye tests.
Test in vitro pour 1'evaluation de 1'irritation occulaire dans les produits d'hygiène (Résultats préliminaires)     

Attitudes of eye health practitioners towards diagnostic tests and therapies for dry eye disease in Australasia

IntroductionThe diagnosis of dry eye is challenging for eye health practitioners (EHP) and recently, a variety of new diagnostic tests have emerged. This study assesses the attitudes of EHP to dry eye and testing and compares these with attitudes in 2003.MethodsAn electronic questionnaire was disseminated to EHP in Australasia between December 2020 to March 2021. Participants rated the likelihood that presenting symptoms/signs were associated with dry eye, the utility of diagnostic tests, the value of test characteristics, and their satisfaction with dry eye diagnostics. Qualitative responses were categorised into positive, negative, or neutral themes.Results144 responses were received, with 117 (81.3%) from Australia and 27 (18.7%) from New Zealand. Posterior blepharitis was significantly more likely to be associated with dry eye than other factors (p < 0.01). Clinical history, fluorescein staining and FBUT were judged significantly more useful in diagnosing dry eye compared to other tests (p < 0.01). Test validity was judged significantly more important in choosing a test than other qualities. Qualitative attitudes towards dry eye presentations and diagnostic tests were positive in 42.2% and 24.3%, negative in 32.4% and 41.9%, and neutral in 25.5% and 33.8% respectively.ConclusionsThe opinions of EHP regarding dry eye tests were variable, but most favour history and corneal staining for diagnosis. Patterns of responses were similar to that reported by Turner et al 16-years ago, however, there is a higher satisfaction with available tests and therapeutic options. There is a need to develop a consensus amongst real-world clinicians regarding an optimum diagnostic pathway for dry eye, particularly in relation to newer diagnostic tests.     

Management of dry eye in UK pharmacies

PurposeTo investigate the ability of pharmacy staff in the United Kingdom (UK) to diagnose and treat dry eye.MethodsA mystery shopper technique to simulate a patient with presumed dry eye was used in 50 pharmacy practices in major towns and cities across the UK. Pharmacies were unaware of their involvement in the study. With the exception of a predetermined opening statement to initiate the consultation, no further information was volunteered. Questions asked, diagnoses given, management strategy advised and staff type was recorded immediately after the consultation.ResultsThe mean number of questions was 4.5 (SD 1.7; range 1–10). The most common question was the duration of symptoms (56%) and the least common was whether the patient had a history of headaches (2%). All pharmacy staff gave a diagnosis, but the majority were incorrect (58%), with only 42% correctly identifying dry eye. Treatment was advised by 92% of pharmacy staff, with the remaining 8% advising referral directly to the patient's GP or optometrist. Dry eye treatments involved topical ocular lubrication via eye drops (90%) and lipid based sprays (10%). However, only 10% gave administration advice, 10% gave dosage advice, 9% asked about contact lens wear, and none offered follow up although 15% also advised GP or optometrist referral.ConclusionsThere is a need for improved ophthalmological training amongst pharmacists and pharmacy staff and establishment of cross referral relationships between pharmacies and optometry practices.     

Innovative bulls eye drop applicator for self-instillation of eye drops

PurposeTo report the role of Bulls eye drop applicator device in self-instillation of eye drops and in prevention of wastage of medicine.MethodsA small pocket sized device “Bulls eye drop applicator” was developed, which is a simple, handy, mirror-based attachment which can be attached to any eye drop bottle to help in accurate self-instillation of the drops in the eye. The prototype of this device was tried in ten volunteer subjects (Group 1) and 15 patients (Group 2); they were asked to use lubricating eye drops (5 ml bottle) in one eye without the device (N) and in the other eye with the device (M). The numbers of attempts for the application of eye drops were noted and the residual eye drops in the returned bottles were measured for quantitative assessment.ResultsTen volunteers and 11/15 patients completed the study. At the completion of the study, there were a total of 232 applications of eye drops in the Group 1 N (without device) and 1 M (with device). To achieve these 232 applications, there were 330 attempts without the device and 266 attempts of instillation were needed with the device (P < 0.0001). In Group 2, there were a total of 544 applications of eye drops; to achieve this, there were 879 attempts in Group 2 N and 685 attempts of instillation in Group 2 M (p < 0.0001). The cumulative quantity of residual drops in the returned bottles collected from Group 2 N was 5.1 ml and it was 19.7 ml in Group 2 M (p = 0.001).ConclusionsThe number of attempts of instillation reduced significantly with the use of the eye drop applicator device. The use of eye drops applicator device reduced the wastage of drops from 42.2% to 14.6% in Group 1 N Vs Group 1 M and saving of about 35.7 % in Group 2 M compared to Group 2 N.     

四联手术在眼外伤的临床应用观察

目的评价角膜穿通伤修补、外伤性白内障摘出、前部玻璃体切除人工晶状体植入联合手术的疗效。方法对32例符合手术标准的患者行此手术。结果经随访观察1年,患者视力较术前明显提高。视力不小于0.6者15眼,0.5～0.3者10眼,0.3～0.1者5眼,0.1以下2眼。结论多联手术是眼前段结构紊乱重建、恢复视功能的首选术式之一,严格掌握手术适应证,运用娴熟的技术,可方便患者、节约治疗费用。     

Clinical subtypes of dry eye in youthful clinical sample in Ghana

PurposeTo evaluate in a cohort of patients with dry eye disease (DED) the distribution of patients with asymptomatic and symptomatic dry eye involving aqueous deficient or the evaporative subtype of DED.MethodsThis was a clinic-based cross-sectional study of consecutive patients visiting the University of Cape Coast eye clinic for a comprehensive eye examination. Eligible participants completed the Ocular Surface Disease Index (OSDI), ocular surface staining and tear break up time. Subjects with dry eye (symptomatic or asymptomatic) underwent clinical examination comprising lid margin assessments, meibomian gland expressibility and quality assessments, and Schirmer 1 test.ResultsA total of 172 patients were included in the study. The mean age of the eligible participants was 22.7 (±3.7) years, with a range of 17–35 years. There were 83 males and 89 females in the sample. There was an association between the form of the dry eye whether symptomatic or asymptomatic and sex, (X² = 6.51 df = 1 p = 0.011). The frequency of symptomatic aqueous-deficient dry eye was 9(5.2%) whiles that of the symptomatic evaporative dry eye was 20(11.6%). The frequencies of the asymptomatic aqueous-deficient dry eye and asymptomatic evaporative dry eye were 9(5.2%) and 12(7.0%) respectively. The frequency of symptomatic mixed dry eye was 30(17.4%) and the asymptomatic mixed dry eye was 8(4.7%). The distribution of unclassifiable dry eye among the symptomatic dry eye group was 41(23.8%) and 43(25%) among the asymptomatic dry eye group.ConclusionThe number of patients exhibiting signs of the evaporative dry eye resulting from meibomian gland dysfunction far outnumbers those of aqueous deficient dry eye but there remains a high unclassifiable group with an unknown etiology. Further, studies are needed to explore the other etiology or etiologies of dry eye apart from meibomian gland dysfunction and reduced aqueous production.     

HPLC法测定马来酸噻吗洛尔滴眼液中的有关物质

目的建立测定马来酸噻吗洛尔滴眼液中有关物质的HPLC法。方法采用Waters Symmetry C18色谱柱;流动相为醋酸盐缓冲液-甲醇(6:36);检测波长295 nm。结果方法线性关系良好(r=0．999 9);检测限0．068 ng。结论此法简便、专属性强,可用于测定马来酸噻吗洛尔制剂的含量及有关物质。     

Treatment of contact lens related dry eye with antibacterial honey

Aim

Contact lens induced dry eye affects approximately 50% of contact lens wearers. The aim was to assess the effects of Manuka (Leptospermum sp.) honey eye drops (Optimel, Melcare, Australia) on dry eye in contact lens wearers. The safety of the honey eye drops in contact lens wear and contact lens wearers’ compliance were also evaluated.