Characterization by Belmonte's Gas Esthesiometer of Mechanical, Chemical, and Thermal Corneal Sensitivity Thresholds in a Normal Population

Tesón, Marisa; Calonge, Margarita; Fernández, Itziar; Stern, Michael E.; González-García, María J.

doi:10.1167/iovs.11-9304

Cited by 39 publications

(44 citation statements)

References 54 publications

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“…[12][13][14][15][16] Other studies however did not find any sex difference in corneal sensitivity. 17,18 Future studies are needed to confirm and further explore these differences, but also to clarify the exact role of ocular surface sensitivity in the symptomatology of DED.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 83%

Sex differences in clinical characteristics of dry eye disease

et al. 2018

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Please cite this article as: Vehof J, Sillevis Smitt-Kamminga N, Nibourg SA, Hammond CJ, Sex differences in clinical characteristics of dry eye disease, Ocular Surface (2018), doi: 10.1016/ j.jtos.2018.01.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions: This large clinical study has shown that sex has a large influence on the symptomatology of DED, with significantly higher symptom scores and lower correlation between symptoms and signs in women compared to men. These findings are of importance in clinical practice and in conducting research into DED.

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Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 83%

Sex differences in clinical characteristics of dry eye disease

et al. 2018

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“…4,22 It remains to be determined if corneal sensitivity is normal or even increased in subjects with marked corneal epithelial disease from recent onset aqueous tear deficiency before the nerve endings degenerate.…”

Section: Discussionmentioning

confidence: 99%

“…Differences between the instruments include the internal diameter of the air outlet that is 0.457 mm in our model and reported to be 0.8 mm in the Belmonte instrument and the ability to change temperature of the air stimulus in the Belmonte instrument. 22 Our instrument also had LED lights around the outlet that assisted in delivering the stimulus to the center of the cornea. We found a significant correlation between our prototype air esthesiometer and the Cochet-Bonnet esthesiometer in subjects with tear dysfunction and in all subjects (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

“…2,5,6,18,19 Studies measuring corneal sensitivity in dry eye by contact and non-contact methods have reported conflicting results with either increased, decreased or no change in sensitivity. 2–12, 15,17, 20–22 However, none of these previously reported studies stratified dry eye subjects by cause of tear dysfunction. Because corneal epithelial disease is more severe in aqueous tear deficiency than in meibomian gland disease and conjunctivochalasis, 13,14 we hypothesized there may be differences in corneal sensitivity and blink rate between these subsets of tear dysfunction that may be related to severity of ocular surface epithelial disease.…”

Section: Introductionmentioning

confidence: 99%

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Corneal Sensitivity in Tear Dysfunction and its Correlation With Clinical Parameters and Blink Rate

Rahman

Lam

Chu

et al. 2015

American Journal of Ophthalmology

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Purpose To compare corneal sensitivity in tear dysfunction due to a variety of causes using contact and non-contact esthesiometers and to evaluate correlations between corneal sensitivity, blink rate and clinical parameters. Design Comparative observational case series. Methods Ten normal and 33 subjects with tear dysfunction [meibomian gland disease (n = 11), aqueous tear deficiency (n = 10) - without (n = 7) and with (n = 3) Sjögren syndrome (SS) and conjunctivochalasis (n = 12)] were evaluated. Corneal sensitivity was measured with Cochet-Bonnet and air jet esthesiometers and blink rate by electromyelography. Eye irritation symptoms, tear meniscus height, tear break-up time (TBUT), and corneal and conjunctival dye staining were measured. Between group means were compared and correlations calculated. Results Compared with control (Cochet-Bonnet 5.45 mm, air esthesiometer 3.62 mg), mean sensory thresholds were significantly higher in aqueous tear deficiency using either Cochet-Bonnet (3.6 mm; P = 0.003) or air (11.7 mg; P = 0.046) esthesiometers, but were not significantly different in the other groups. Reduced corneal sensitivity significantly correlated with more rapid TBUT and blink rate, and greater irritation and ocular surface dye staining with one or both esthesiometers. Mean blink rates were significantly higher in both aqueous tear deficiency and conjunctivochalasis compared with control. Among all subjects, blink rate positively correlated with ocular surface staining and irritation and inversely correlated with TBUT. Conclusion Amongst conditions causing tear dysfunction, reduced corneal sensitivity is associated with greater irritation, tear instability, ocular surface disease and blink rate. Rapid blinking is associated with worse ocular surface disease and tear stability.

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“…Corneal sensitivity testing, an alternate means of measuring corneal innervation, also would be helpful. 152,164,165 However, there are only limited data on the repeatability and reliability of available esthesiometers, such as the Cochet-Bennet 166 and Belmonte 167 esthesiometers. Measuring peripheral cutaneous sensitivity also may be helpful in understanding the pain of DED and provide a more uniform rating of ocular symptoms, but has not been evaluated extensively in humans as yet.…”

Section: Point Of Care Biomarkersmentioning

confidence: 99%

The Growing Need for Validated Biomarkers and Endpoints for Dry Eye Clinical Research

Roy

Wei

Kuklinski

et al. 2017

Invest. Ophthalmol. Vis. Sci.

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PurposeBiomarkers with minimally invasive and reproducible objective metrics provide the key to future paradigm shifts in understanding of the underlying causes of dry eye disease (DED) and approaches to treatment of DED. We review biomarkers and their validity in providing objective metrics for DED clinical research and patient care.MethodsThe English-language literature in PubMed primarily over the last decade was surveyed for studies related to identification of biomarkers of DED: (1) inflammation, (2) point-of-care, (3) ocular imaging, and (4) genetics. Relevant studies in each group were individually evaluated for (1) methodological and analytical details, (2) data and concordance with other similar studies, and (3) potential to serve as validated biomarkers with objective metrics.ResultsSignificant work has been done to identify biomarkers for DED clinical trials and for patient care. Interstudy variation among studies dealing with the same biomarker type was high. This could be attributed to biologic variations and/or differences in processing, and data analysis. Correlation with other signs and symptoms of DED was not always clear or present.ConclusionsMany of the biomarkers reviewed show the potential to serve as validated and objective metrics for clinical research and patient care in DED. Interstudy variation for a given biomarker emphasizes the need for detailed reporting of study methodology, including information on subject characteristics, quality control, processing, and analysis methods to optimize development of nonsubjective metrics. Biomarker development offers a rich opportunity to significantly move forward clinical research and patient care in DED.OverviewDED is an unmet medical need — a chronic pain syndrome associated with variable vision that affects quality of life, is common with advancing age, interferes with the comfortable use of contact lenses, and can diminish results of eye surgeries, such as cataract extraction, LASIK, and glaucoma procedures. It is a worldwide medical challenge with a prevalence rate ranging from 8% to 50%. Many clinicians and researchers across the globe are searching for better answers to understand the mechanisms related to the development and chronicity of DED. Though there have been many clinical trials for DED, few new treatments have emerged over the last decade. Biomarkers may provide the needed breakthrough to propel our understanding of DED to the next level and the potential to realize our goal of truly personalized medicine based on scientific evidence. Clinical trials and research on DED have suffered from the lack of validated biomarkers and less than objective and reproducible endpoints. Current work on biomarkers has provided the groundwork to move forward. This review highlights primarily ocular biomarkers that have been investigated for use in DED, discusses the methodologic outcomes in providing objective metrics for clinical research, and suggests recommendations for further work.

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Characterization by Belmonte's Gas Esthesiometer of Mechanical, Chemical, and Thermal Corneal Sensitivity Thresholds in a Normal Population

Cited by 39 publications

References 54 publications

Sex differences in clinical characteristics of dry eye disease

Sex differences in clinical characteristics of dry eye disease

Corneal Sensitivity in Tear Dysfunction and its Correlation With Clinical Parameters and Blink Rate

The Growing Need for Validated Biomarkers and Endpoints for Dry Eye Clinical Research

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