The influence of overnight orthokeratology and soft contact lens on the meibomian gland evaluated using an artificial intelligence analytic system

PurposeTo test the changes of meibomian gland (MG) morphology using an artificial intelligence (AI) analytic system in asymptomatic children wearing overnight orthokeratology (OOK) and soft contact lens (SCL).MethodsA retrospective study was conducted including 89 participants treated with OOK and 70 participants with SCL. Tear meniscus height (TMH), noninvasive tear breakup time (NIBUT), and meibography were obtained using Keratograph 5 M. MG tortuosity, height, width, density, and vagueness value were measured using an artificial intelligence (AI) analytic system.ResultsIn an average of 20.80 ± 10.83 months follow-up, MG width of the upper eyelid significantly increased and MG vagueness value significantly decreased after OOK and SCL treatment (all P < 0.05). MG tortuosity of the upper eyelid significantly increased after OOK treatment (P < 0.05). TMH and NIBUT did not differ significantly pre- and post- OOK and SCL treatment (all P > 0.05). The results from the GEE model demonstrated that OOK treatment positively affected MG tortuosity of both upper and lower eyelids (P < 0.001; P = 0.041, respectively) and MG width of the upper eyelid (P = 0.038), while it negatively affected MG density of the upper eyelid (P = 0.036) and MG vagueness value of both upper and lower eyelids (P < 0.001; P < 0.001, respectively). SCL treatment positively affected MG width of both upper and lower eyelids (P < 0.001; P = 0.049, respectively) as well as MG height of the lower eyelid (P = 0.009) and tortuosity of the upper eyelid, (P = 0.034) while it negatively affected MG vagueness value of both upper and lower eyelids (P < 0.001; P < 0.001, respectively). However, no significant relationship was found between the treatment duration and TMH, NIBUT, MG morphological parameters in OOK group. SCL treatment duration negatively affected MG height of the lower eyelid (P = 0.002).ConclusionsOOK and SCL treatment in asymptomatic children can influence MG morphology. The AI analytic system may be an effective method to facilitate the quantitative detection of MG morphological changes.     

The influence of overnight orthokeratology on ocular surface and dry eye-related cytokines IL-17A,IL-6, and PGE2 in children

ObjectiveTo investigate the effect of overnight orthokeratology (OOK) on the ocular surface and dry eye-related cytokines in children.MethodsA non-randomized, prospective pilot study was conducted including sixty myopes treated with OOK and sixty age-matched spectacle wearing participants. The following tests were performed before and after 1, 3, 6 and 12 months: ocular surface disease index (OSDI), noninvasive tear breakup time (NITBUT), tear meniscus height (TMH), corneal fluorescein staining (CFS), meiboscore using noncontact meibography. Then the concentrations of interleukin-17A (IL-17A), interleukin-6 (IL-6), and prostaglandin E2 (PGE2) in tear samples were detected with a multiplex immunobead assay at different time points.ResultsAll parameters had no statistical differences between the two groups prior to treatment. No adverse events were observed except trace to moderate corneal staining and allergic conjunctivitis in the treatment group. NITBUT significantly decreased after 6 and 12 months OOK wearing (P = 0.003 and P = 0.001, respectively). After wearing OOK there was a significant increase in CFS at each follow-up time point compared with baseline (P = 0.023, P = 0.016, P = 0.001, and P < 0.001at 1, 3, 6, and 12 months, respectively). The upper meiboscore and the total meiboscore increased gradually and peaked at 12 months of OOK (both P < 0.001). The concentration of the three cytokines in the treatment group significantly increased after OOK wearing. These increases occurred at different time points: IL-17A increased significantly 3 months after OOK, IL-6 at 6 months, and PGE2 at 12 months (all P < 0.001). However, there were no significant changes in the above parameters in the control group. There were no significant differences in the OSDI or TMH at any follow-up time point compared to baseline in both groups (both P > 0.05).ConclusionsShort-term OOK may reduce the stability of the tear film and increase damage to the corneal epithelium. Long-term OOK could induce ocular inflammation through the disruption of meibomian glands.     

Pre-contact lens and pre-corneal tear film kinetics

PurposeContact lenses (CL) insulate the corneal surface from the environment. It is possible that they influence the corneal sensory mechanism that contribute to spontaneous blinking. The study objective was to quantify the pre-CL and pre-corneal tear film kinetics (TFK) over blink period.MethodsThe study population was 202 soft CL wearers, 133 non-lens wearers. TFK were quantified via post-hoc masked analysis of HD Tearscope videos. The parameters were: Non-Invasive Break Up Time (NIBUT), Exposed Area % at initial break (EA 1st Break) and at blink (EA Blink), Interblink period (IB), Protective Index (PI) and exposure speed of surface dehydration (ES mm2/s). The TFK of CL wearers were compared to non-lens wearers. The hypothesis was that pre-CL TFK was inferior to pre-corneal, specifically greater tear film anomalies presence at blink.ResultsThe pre-corneal NIBUT was longer than pre-CL NIBUT (9.1 vs. 5.1s, p < 0.001). The EA 1st Break was smaller for pre-corneal than pre-CL (0.003 vs. 0.43%, p < 0.001). The mean IB time was similar for pre-CL and pre-corneal (9.4 vs. 9.8s, p = 0.213). The EA Blink % was smaller for pre-corneal than pre-CL (0.03 vs. 6.66%, p < 0.001). The ES was faster for pre-CL than pre-corneal (0.339 vs. 0.004, p < 0.001). The PI was greater for pre-corneal than pre-CL (99.9 vs. 97.1%, p < 0.001).ConclusionsPre-CL TFK were significantly inferior than pre-corneal, confirmed the hypothesis. The NIBUT was shorter. Once the initial break occurred, ES was faster, and EA was much greater for pre-CL than pre-corneal. The differences identified may be an aetiological component of CL discomfort and the relationship between TFK and discomfort in contact lens wearers should be investigated.     

Efficacy of a novel water propelled,heating eye mask massager on tear film and ocular adnexa

PurposeTo determine the effectiveness of the Aurai water propelled, heating Eye Massager (AEM) in managing dry eye disease and its effects on the ocular adnexa.MethodsThis prospective, randomised cross-over study enrolled 15 participants (aged 25.8 ± 5.45 years, 5 male). Participants wore a smart watch 24 h a day to track their sleeping cycle and heart rate for 4 weeks, using the AEM twice a day for 2 of those weeks. A cycle of 6 min of a controlled heat and vibration pattern in the morning and another cycle in the evening were applied with the AEM. Primary outcomes of symptomatology (Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE)), tear film and ocular surface homeostasis markers (osmolarity, non-invasive breakup time (NIKBUT), tear meniscus height (TMH), lipid layer thickness and ocular staining) and safety measures (ocular redness and intraocular pressure), were assessed at baseline, after 2 weeks of AEM use and after 2 weeks of no treatment (in random-sequence). Sleeping tracking (ST) and heart rate/blood oxygen detection over these periods was also assessed.ResultsThere was a significant change in OSDI score from 34.3 ± 19.5 at baseline to 18.8 ± 17.5 after treatment (p = 0.001) and also for the SANDE (5.7 ± 2.4 vs 3.7 ± 2.1; p = 0.001). Heart rate was not affected by treatment (p = 0.956), nor sleep pattern (p = 0.529), but this varied by day (p = 0.001). Tear film and ocular surface homeostasis, the ocular adnexia and safety measures were not affected by treatment (p > 0.05).ConclusionThe Aurai water propelled Eye Massager may reduce the severity of symptoms of dry eye, but there were no detectable effects on tear stability and ocular surface disease from two weeks use.     

Assessment of condition-induced changes on the ocular surface using novel methods to assess the tear film dynamics and the lipid layer

ObjectivesTo assess the effects of different condition-induced changes on current and novel ocular surface metrics.MethodsEighty-four healthy volunteers (22.4 ± 2.6 years) participated in this study. The ocular surface and tear film response to (1) computer use, (2) contact lens insertion and (3) tear film instillation during computer use with contact lenses were assessed. Current metrics included the ocular surface disease (OSDI) questionnaire, 5-item dry eye questionnaire (DEQ-5), bulbar redness, tear meniscus height (TMH) and non-invasive keratograph break-up time (NIKBUT). Novel metrics included the lipid layer thickness obtained from the intensity of the reflected Placido disk and the speed of tear film particles post-blink.ResultsHigher dry eye symptoms, TMH and bulbar redness, and lower values in metrics related to the intensity of the Placido disk pattern and to particle speed were found after the computer reading task (p < 0.036). When a contact lens was fitted, lower TMH, NIKBUT and particle speed metrics were obtained (p < 0.044). Mixed ANOVA revealed that artificial tears significantly ameliorated the effect of computer reading on OSDI, DEQ-5, NIKBUT, metrics related to the intensity of the Placido disk pattern and metrics related to particle speed (p < 0.033).ConclusionsComputer use and contact lens wear worsened dry eye signs and symptoms, but artificial tears ameliorated this effect. Newly developed methods can serve as a tool to detect changes in the tear film triggered by different ocular surface-disturbing conditions.     

Therapeutic benefits of blinking exercises in dry eye disease

PurposeDry eye disease (DED) is an important public health concern given its increasing prevalence and impact on patient quality of life. Blinking frequency and completeness are reduced during digital screen exposure, compromising meibum secretion and distribution, causing tear film instability and leading to DED. This study evaluated the effects of blinking exercises on blink pattern and clinical signs and symptoms of DED.MethodsFifty-four participants with dry eye symptoms received instructions to perform a ten-second cycle of blinking exercises every 20 min during waking hours for four weeks. Symptoms were assessed using the 5-item Dry Eye Questionnaire (DEQ-5) and Ocular Surface Disease Index (OSDI); blinking patterns measured with the TearScience LipiView II; and tear film and ocular surface parameters assessed with the Oculus Keratograph 5M. Measures at baseline and on day 28 were compared.ResultsForty-one participants completed the study, reporting an average of 25.6 daily blinking exercise cycles. Improvements were noted in DEQ-5 (from 11 ± 4 to 7 ± 3; p < 0.001), OSDI (36 ± 18 to 22 ± 17; p < 0.001), non-invasive tear film breakup time (6.5 ± 2.4 to 8.1 ± 4.8 s; p < 0.04), the proportion of incomplete blinks (54 ± 36 to 34 ± 29 %; p < 0.001), but not in tear meniscus height or tear film lipid layer thickness.ConclusionBlinking exercises can modify poor blinking patterns and improve dry eye symptomology, with modest changes in objective measures of tear film quality. Incorporating such routines into clinical care recommendations may improve blinking habits and help protect against the impact of digital device use on tear film quality and DED onset and evolution.     

Transient effects of smoking on the eye

PurposeTo investigate the immediate short-term effects of smoking in habitual smokers, on the tear film, pupil size and accommodative ability of the human eye.MethodsHabitual smokers were tested within 5 min of smoking a cigarette. The tear film analysis was undertaken using tear break–up time (TBUT), tear lipid layer thickness and tears meniscus height (TMH) measurements. Three different ways of tear break–up time (TBUT) were used; using fluorescein; a non-invasive TBUT using tearscope; and a video captured method with a corneal topographer. Pupil size was measured objectively using the video capture on the corneal topographer. Accommodative ability was checked by performing a ‘push up test' to measure amplitudes of accommodation (AoA) and by measuring defocus curves.ResultsForty-five participants were enrolled (mean age 22.0 ± 4.4 years). TBUT was reduced after smoking a cigarette with all three assessment methods and this reduction was statistically significant (p < 0.001). A reduction in lipid layer thickness was seen after smoking a cigarette with both methods used and was statistically significant (p < 0.01). A significant reduction in pupil size (p < 0.01) and in AoA (p < 0.001) was observed after smoking a cigarette. The difference in TMH and defocus curves, before and after smoking, were not statistically significant (p > 0.05).ConclusionThe study shows that there is an immediate adverse effect of smoking on TBUT and AoA which seems to be very transient.     

Diagnostic accuracy of non-invasive tear film break-up time assessed by the simple manual interferometric device

AimTo determine the diagnostic accuracy of non-invasive tear film break-up time (NIBUT) measured by the handheld lipid layer examination instrument.Methods108 patients were enrolled in this cross-sectional study and divided into two groups: patients with dry eye (n = 57) categorized by the presence of dry eye symptoms obtained by Schein Questionnaire and minimally-one objective dry eye sign (tear film break-up time <10 s or corneal, conjunctival and lid margin fluorescein staining), and healthy subjects (n = 51).ResultsDry eye subjects had significantly shorter NIBUT than healthy subjects (6 s vs 20 s, p < 0.001). Logistic regression analysis showed that shorter NIBUT values were excellent indicators of dry eye disease (p < 0.001), with consistency and no significant difference between measurements, even after standardizing the results for age and sex. NIBUT cut-off point to distinguish dry eye from healthy subjects was 12 s (sensitivity 90.2 %, specificity 88.5 %, PPV 92.5 %, NPV 85.2 %, LR +7.82, LR− 0.11, DOR 70.92, DE 89.6 %). Good, but lower accuracy was observed at cut-off value of 10 s (sensitivity 87.8 %, specificity 88.5 %, PPV 92.3 %, NPV 82.1 %, LR+ 7.61, LR− 0.14, DOR 55.2, DE 88.1 %). The area under the ROC curve (AUC) of 0.944 classified NIBUT as a diagnostic test with very high accuracy.ConclusionThis study showed a high diagnostic accuracy of NIBUT measured by the handheld lipid layer examination instrument. This simple, reliable, objective and available instrument might regularly take place in routine, standard dry eye diagnostic and can be used by almost every eye specialist.     

Novel in vitro method to determine pre-lens tear break-up time of hydrogel and silicone hydrogel contact lenses

PurposeTo develop an in vitro model to determine pre-lens non-invasive break-up time (NIBUT) and to subsequently use this method to compare the NIBUT over contemporary daily disposable (DD) contact lenses (CL).MethodsThree silicone hydrogel (SH) and two conventional hydrogel (CH) DD CLs were incubated in an artificial tear solution (ATS). A model blink cell (MBC) was utilised to mimic intermittent air exposure. CLs were repeatedly submerged for 3 seconds (s) and exposed to air for 10 s over periods of 2, 6, 12, and 16 hours (h). NIBUTs (n = 4) were determined out of the blister pack (T₀) and at the end of each incubation period.ResultsOverall, nesofilcon A showed the longest NIBUTs (p < 0.001). At T₀, CHs revealed significantly longer NIBUTs (p ≤ 0.001) than SHs. After 2 h, nesofilcon A showed the longest NIBUT, however, this was only statistically significant compared with delefilcon A (p ≤ 0.001). After 6 h, nesofilcon A NIBUT was significantly longer than all other CLs (p ≤ 0.001). Etafilcon A showed a significantly longer NIBUT (p ≤ 0.001) after 12 h and delefilcon A had the longest NIBUT (p ≤ 0.001) after 16 h. Statistically significant (p ≤ 0.05) changes of NIBUT within the lens materials varied between time points. After 16 h, all CLs showed significant reductions in NIBUTs (p ≤ 0.001) in comparison to T₀.ConclusionNIBUT values reduced gradually over time and varying levels of deposition impacted measured pre-lens NIBUTs. While NIBUT of CH materials are longer immediately out of the blister pack, after tear film exposure, the NIBUTs obtained using this methodology became very similar.     

Comparison study of two different topical lubricants on tear meniscus and tear osmolarity in dry eye

PurposeTo compare the effect of single-drop administration of two different ophthalmic solutions on tear meniscus and tear osmolarity in patients with mild to moderate dry eye disease.MethodsThis prospective study comprised of 122 patients with mild to moderate dry eye disease. These patients received a single dose of either unpreserved trehalose 3%, hyaluronic acid 0.15%, carbomer 0.25% (THHA, Thealoz Duo Gel) (Group 1) or hyaluronic acid 0.3% (HA) (Group 2) gel-based lubricants. Tear meniscus (height and depth) were measured using anterior segment optic coherence tomography (AS−OCT) at baseline and 10, 60, 120, and 240 min. after instillation. Tear osmolarity, Schirmer I test, tear break-up time (TBUT), gel properties, and patient comfort were evaluated 240 min. after instillation.ResultsTear meniscus height (TMH) and tear meniscus depth (TMD) showed a significant increase with both lubricants compared to the baseline (p < 0.001). This effect remained significant for up to 60 min. and 120 min. for the THHA and HA 0.3% solutions, respectively (p < 0.05, for both). Mean comfort duration was 115.1 ± 20.1 min. in Group 1 and 148.3 ± 49.0 min in Group 2 (p < 0.001). Tear osmolarity, Schirmer I test, and TBUT were similar between the baseline and 240 min. for each group.ConclusionsThe results of this study demonstrate that 0.3% HA remains on the ocular surface for longer than TH-HA. The longer ocular residency time also seems to correlate with a longer patient comfort duration.     

Agreement and repeatability of four different devices to measure non-invasive tear breakup time (NIBUT)

PurposeSince tear film stability can be affected by fluorescein, the Dry Eye Workshop (DEWSII) recommended non-invasive measurement of tear breakup time (NIBUT). The aim of this study was to investigate the agreement and repeatability of four different instruments in the measurement of NIBUT.Methods72 participants (mean 24.2 ± 3.6 years) were recruited for this multi-centre, cross-sectional study. NIBUT was measured three times from one eye using each of the instruments in randomized order on two separate sessions during a day, separated by at least 2 h. NIBUT was performed at three sites (Switzerland, Germany and UK) using three subjective instruments, Tearscope Plus (Keeler, Windsor, UK) (TS), Polaris (bon Optic, Lübeck, Germany) (POL), EasyTear Viewplus (Easytear, Rovereto, Italy) (ET) and the objective Keratograph 5 M (Oculus Optikgeräte GmbH, Wetzlar, Germany) (KER). As the latter instrument only analyses for 24 s, all data was capped at this value.ResultsNIBUT measurements (average of both sessions) between the four instruments were not statistically significantly different: TS (median 10.4, range 2.0–24.0 s), POL (10.1, 1.0–24.0 s), ET (10.6, 1.0–24.0 s) and KER (11.1, 2.6–24.0 s) (p = 0.949). The objective KER measures were on average (1.2 s ± 9.6 s, 95 % confidence interval) greater than the subjective evaluations of NIBUT with the other instruments (mean difference 0.4 s ± 7.7 s, 95 % confidence interval), resulting in a higher limits of agreement. The slope was -0.08 to 0.11 indicating no bias in the difference between instruments with the magnitude of the NIBUT. Repeated measurements from the two sessions were not significantly different for TS (p = 0.584), POL (p = 0.549), ET (p = 0.701) or KER (p = 0.261).ConclusionsThe four instruments evaluated for their measurement of tear stability were reasonably repeatable and give similar average results.     

Palpebral and facial skin infestation by Demodex folliculorum

PurposeTo evaluate facial Demodex densities in participants with varying severities of blepharitis secondary to Demodex folliculorum assessed by the highest number of cylindrical dandruff on one lid.MethodsThis double masked cross-sectional study included 58 participants [19 control, 21 mild/moderate and 18 severe Demodex blepharitis] who underwent a standardized skin-surface biopsy and a lash epilation for each lid to obtain the forehead Demodex densities and the overall lash mite count, respectively. Also, facial photographs were taken to evaluate facial erythema and dermatological conditions. The Ocular Surface Disease Index [OSDI], non-invasive break-up time [NIBUT], tear meniscus height [TMH], bulbar conjunctival redness as well as additional questions on watery eyes, ocular itching and itching along the lids were assessed.ResultsBoth mild/moderate and severe Demodex blepharitis groups were over the cut-off value [≥ 5 mites/cm²] that confirms a facial demodicosis (mild/moderate: 5 ± 1; severe: 6 ± 1) while the control group was below it (2 ± 1). Thereby, group comparisons showed that an increased severity of Demodex blepharitis was associated with higher forehead mite densities (p = 0.002) and increased lash mite count (p < 0.001). The degree of facial erythema was also positively correlated with forehead mite densities (rs = 0.31, p = 0.02). When compared to the controls, the mild/moderate group had more watery eyes (X² = 6.54, p = 0.02), a lower TMH (U = 100.5, p = 0.006) and the severe group had more itching along the lids (X² = 4.94, p = 0.04). The other ocular signs and symptoms [NIBUT, bulbar conjunctival redness, OSDI] were not affected by the severity of Demodex blepharitis (p > 0.05).ConclusionPalpebral and facial Demodex infestation can co-exist, as the presence of blepharitis secondary to Demodex is associated with increased facial mite densities.     

Evaluating the diagnostic ability of two automated non-invasive tear film stability measurement techniques

PurposeTo evaluate the comparability, discriminative ability, and optimal thresholds for non-invasive tear film breakup time measurements obtained from the Oculus Keratograph 5M and Medmont E300 in detecting other signs and symptoms of dry eye disease, as defined by the TFOS DEWS II diagnostic criteria.MethodsOne hundred and thirty-four participants (53 male, 81 female), with a mean ± SD age of 48 ± 20 years, were recruited into a prospective, investigator-masked, diagnostic accuracy study. Dry eye symptomology, tear film parameters (including non-invasive Keratograph and Medmont breakup time), and ocular surface staining were evaluated in a single clinical session.ResultsSignificant positive correlation was observed between the two automated instruments (p < 0.001), although non-invasive breakup time measurements obtained from the Medmont were significantly longer (p < 0.001), and demonstrated greater intra-subject and inter-subject variability (all p < 0.001). The areas under the ROC curves exceeded 0.65 for both instruments, and the discriminative abilities were comparable (p = 0.53). The Youden optimal diagnostic threshold for non-invasive tear film stability measurements obtained from the Keratograph was ≤8 seconds, and the optimal cut-off for breakup time measurements obtained from the Medmont was ≤14 seconds.ConclusionsDespite significant positive correlation, breakup time measurements obtained from the Keratograph and Medmont were not directly interchangeable. Measurements from the Medmont were significantly longer and demonstrated greater intra-subject and inter-subject variability, although the two automated, non-invasive methods for assessing tear film stability exhibited comparable overall performance in diagnosing dry eye disease.     

The role of ethnicity versus environment in tear film stability: A pilot study

PurposeExisting literatures suggest a difference in tear film stability between Caucasian and Asian ethnic groups. However, such a finding was compounded by the fact that the comparison was done on subjects living in different environments. Therefore, it is not clear whether such difference is due to ethnicity, environment, or both. The aim of this study is to clarify the roles of these two factors.MethodsA total of 88 asymptomatic subjects participated in this present study. For each subject, the tear film break-up time (TBUT), non-invasive TBUT (NITBUT) and tear meniscus height (TMH) were measured. To isolate the effect of ethnicity, the results of 12 American Asian young adults were compared against the results of 23 Caucasian adults. Both groups were recruited from Nova Southeastern University. To elucidate the effect of environment, the results from the same 12 American Asians were compared to that of the 53 Asian young adults recruited from the Tianjin Vocational Institute, China (Tianjin Asian).ResultsThe tear film stability did not show significant difference among American Asian subjects and Caucasian subjects in TBUT (10.49 ± 2.86 s vs. 11.06 ± 2.79 s,p = 0.57), NITBUT (11.19 ± 4.89 s vs. 11.14 ± 6.20 s, p = 0.98), and TMH (0.21 ± 0.08 mm vs. 0.22 ± 0.05 mm, p =0.59). However, the tear film stability was significantly better in the American Asian group than the Tianjin Asian group in TBUT (10.49 ± 2.86 s vs. 7.60 ± 3.26 s, p = 0.01), NITBUT (11.19 ± 4.89 s vs. 8.03 ± 3.56 s, p = 0.01), and TMH (0.21 ± 0.08 mm vs. 0.14 ± 0.03 mm, p < 0.01).ConclusionsThe previously reported difference in Caucasian and Asian populations might be due to the fact that the studied subjects have different living environments.     

Randomised trial of the clinical utility of an eyelid massage device for the management of meibomian gland dysfunction

PurposeTo compare the single application and two week treatment effects of device-applied (Eyepeace) and manually-applied eyelid massage techniques, as an adjunct to warm compress therapy, on ocular surface and tear film parameters.MethodsTwenty participants (11 females, 9 males; mean age, 27 ± 11 years) with dry eye symptoms were recruited in a two week, investigator-masked, randomised, contralateral-eye trial. Following 10 min of warm compress therapy application (MGDRx EyeBag^®) on both eyes, eyelid massage therapy was applied to one eye (randomised) by device, and to the fellow eye by manual eyelid massage, once daily for 14 days. Ocular surface and tear film measurements were conducted at baseline, and 15 min post-application by a clinician, then again after 14 days of self-administered daily treatment at home.ResultsBaseline clinical measurements did not differ between the treatment groups (all p > 0.05). Following two weeks of treatment, tear film lipid layer grade improved significantly with device massage (p = 0.008), and was marginally greater than manual massage by less than 1 grade (p = 0.03). Although immediate post-treatment improvements in tear film stability were observed in both groups (both p < 0.05), no significant long-term cumulative effects or inter-treatment differences in stability measures were detected (all p > 0.05). Visual acuity, tear meniscus height, conjunctival hyperaemia, ocular surface staining, and meibomian gland dropout did not change during the treatment period (all p > 0.05).ConclusionsTwo weeks of treatment with the eyelid massage device, as an adjunct to warm compress therapy, effected marginally greater improvements in tear film lipid layer thickness than the conventional manual technique, which were statistically but not clinically significant. Future parallel group trials with longer treatment periods and a greater range of disease severity are required.     

The effect of the duration of diabetes on dry eye and corneal nerves

PurposeTo investigate the relationship between the duration of type 2 diabetes mellitus (DM) and the ocular surface, and to address the question of why some people with lengthy DM duration are asymptomatic, whereas some people with shorter DM duration have pain or discomfort in their eyes.MethodsEighty-seven eyes of 87 subjects with different durations of DM and 49 eyes of 49 subjects without DM underwent Schirmer I test, tear film break-up time, sodium fluorescein staining and tear meniscus height (TMH) measurement, and completed the Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire. Corneal structure and function were assessed with in vivo confocal corneal microscopy and with a corneal sensitivity esthesiometer. Both corneal nerve fiber length and inferior whorl length (IWL) were assessed as indices for neural structure. Age and gender were matched between groups. HbA1c levels >7.8% and proliferative diabetic retinopathy were exclusion criteria.ResultsIn the DM group, compared with the non-DM group, the SPEED score was significantly higher (p = 0.013), and corneal sensitivity and IWL were lower (p < 0.001). Schirmer I test, corneal sensitivity and IWL differed significantly between the group with DM duration >10 years and the non-DM (control) group (p = 0.021, p < 0.001, p < 0.001, respectively). Schirmer I test and IWL were significantly lower in the group with DM >10 years than in the group with DM ≤10 years (p = 0.023, p < 0.001, respectively). Corneal sensitivity was positively correlated with IWL regardless of diabetes status.ConclusionsThe lower SPEED score and asymptomatic feeling in people with a longer DM duration may be explained by the decreased IWL and reduced sensitivity.     

Visual function,ocular surface integrity and symptomatology of a new extended depth-of-focus and a conventional multifocal contact lens

PurposeTo evaluate visual function, ocular surface integrity and dry eye symptoms with an extended depth-of-focus (EDOF) design and a conventional multifocal (MF) contact lens (CL) after 15 days of wear.MethodsA crossover single mask randomised clinical trial was conducted including 30 presbyopes who used an EDOF and a conventional MF CL (Biofinity MF) for 15 days each. Defocus curves, depth-of-focus range, contrast sensitivity (CS) under photopic and mesopic conditions (with and without glare) and subjective perception of halos and glare were evaluated. The ocular surface was evaluated through non-invasive Keratograph tear breakup time (NIKBUT), averaged tear breakup time (NIKBUT-avg), tear meniscus height (TMH), bulbar and limbal redness, and conjunctival and corneal staining. Dry eye symptoms were assessed with the OSDI questionnaire.ResultsNo statistically significant differences were found for defocus curves or depth-of-focus between the two CLs (both p > 0.05). Subjective perception of halos and glare was not significantly different between CLs. Statistically significant differences were observed for CS under mesopic conditions for low spatial frequencies (p = 0.008). None of the CL produced significant changes in NIKBUT, NIKBUT-avg, TMH or redness. No change in conjunctival staining was observed in 76.7 % and 73.3 % of participants for EDOF and Biofinity MF, respectively. No change in corneal staining was observed in 86.7 % and 83.3 % of participants for EDOF and Biofinity MF, respectively. No changes were observed in the symptomatology measured with OSDI questionnaire (p > 0.05).ConclusionsBoth CL for presbyopia offer good visual quality, preserve the ocular surface integrity and provide the patient with similar symptomatology levels after 15 days of lens wear.     

Screening utility of a rapid non-invasive dry eye assessment algorithm

PurposeTo evaluate the discriminative ability of a rapid non-invasive dry eye assessment algorithm (global evaluation component: SANDE questionnaire, and non-invasive tear film breakup time; subtype classification testing component: tear film lipid layer grade, and tear meniscus height) in detecting dry eye disease, as defined by the TFOS DEWS II diagnostic criteria.MethodsTwo hundred and thirty-five participants (77 male, 158 female), with a mean ± SD age of 43 ± 17 years, were recruited into a prospective diagnostic accuracy study. OSDI, DEQ-5, and SANDE dry eye symptomology scores; non-invasive tear film breakup time; absolute and inter-ocular differences in tear osmolarity; corneal, conjunctival, and lid margin staining scores; tear film lipid layer, meibum expressibility, meibomian gland orifice plugging, and eyelid margin telangiectasia grades; and tear meniscus height were evaluated in a single clinical session.ResultsThe areas under the ROC curves exceeded 0.80 for all individual components of the rapid non-invasive dry eye assessment algorithm, and the discriminative abilities were significantly greater than chance (all p < 0.001). At the Youden optimal diagnostic thresholds for the global evaluation component of the rapid non-invasive assessment algorithm (SANDE score ≥30, non-invasive tear film break-up time <10 s), the overall sensitivity was 86%, specificity 94%, positive likelihood ratio 15.0, and negative likelihood ratio 0.15.ConclusionsThe abridged non-invasive dry eye assessment algorithm may be a useful rapid screening instrument for the full TFOS DEWS II diagnostic test battery, of particular benefit in resource or time-constrained settings.     

Therapeutic profile of a latent heat eyelid warming device with temperature setting variation

PurposeTo compare the effects on ocular temperature and tear film parameters following a single application of a latent heat eyelid warming device at a range of temperature settings.MethodsFifteen subjects were enrolled in a prospective, investigator-masked, randomised, cross-over trial. On separate days, participants were randomised to 10-minute application of a research latent heat device (Laboratoires Théa) at device temperature settings of 45 °C, 50 °C and 55 °C. Outer eyelid and corneal temperatures, tear film lipid layer grade, and non-invasive tear film breakup time (NIBUT) were measured at baseline and immediately after 10 min of device application.ResultsBaseline measurements did not differ between treatment groups (all p > 0.05). Ocular temperatures, lipid layer grade and non-invasive tear film stability rose significantly following device application in all treatment groups (all p < 0.05). The 55 °C setting effected a mean ocular surface temperature rise in the order of +4 °C from baseline, which was 1.46 and 1.26 times greater than at the 45 °C and 50 °C temperature settings, respectively (all p < 0.05). Similarly, improvements in mean non-invasive tear film stability from baseline in the order of +7 s were observed, which were 2.43 and 1.66 times greater than those at the lower temperature settings of 45 °C and 50 °C, respectively (all p < 0.05).ConclusionsAt all temperature settings, the latent heat device resulted in clinically and statistically significant increases in ocular temperature, lipid layer grade, and non-invasive tear film stability. However, the 55 °C setting proved to be most effective at raising ocular temperature (in the order of +4 °C from baseline) and improving tear film stability.     

Effect of virtual reality headset wear on the tear film: A randomised crossover study

PurposeTo compare the effects of virtual reality headset wear and conventional desktop computer display use on ocular surface and tear film parameters.MethodsTwenty computer operators were enrolled in a prospective, investigator-masked, randomised crossover study. On separate days, participants were randomised to 40 min of continuous virtual reality headset wear or conventional desktop computer display use. Outer eyelid and corneal temperatures, tear film lipid layer grade, and non-invasive tear film breakup time were measured at baseline and immediately following the 40-minute exposure period.ResultsVirtual reality headset wear resulted in increases in outer eyelid (mean difference +0.5 ± 0.6 °C; p < 0.001) and corneal temperatures (mean difference, +0.4 ± 0.6 °C; p = 0.004), relative to conventional desktop computer display use. These increases were associated with significant improvements in tear film lipid layer grade (median difference, +1 grade; interquartile range, 0 to +2 grades; p < 0.001) and non-invasive tear film breakup time (mean difference, +7.2 ± 12.4 s; p = 0.02).ConclusionsClinically significant improvements in lipid layer thickness and tear film stability were observed with virtual reality headset wear, despite producing only modest increases in ocular temperatures relative to conventional desktop computer display use. These findings would suggest that virtual reality headset wear demonstrates potential for dry eye relief for computer operators in the modern workplace environment.