Diagnosis of dry eye disease and emerging technologies

Zeev, Maya Salomon Ben; Miller, Darby D.; Latkany, Robert

doi:10.2147/opth.s45444

Cited by 91 publications

(89 citation statements)

References 96 publications

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“…These results, supported by review of clinical records, call into question the suggested tendency for DED to progress over time, but also point to possible inadequacies of current therapies. 5,7 …”

Section: Discussionmentioning

confidence: 99%

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Long-term Natural History of Dry Eye Disease from the Patient's Perspective

et al. 2016

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Objective The goal of this study is to describe the natural history of Dry Eye Disease (DED), which chronically affects millions of people in the US alone. Design This study includes cohorts from the Women's Health Study (WHS) and Physicians' Health Studies (PHS), and utilizes a combination of cross-sectional surveys and review of existing medical records. Participants 398 men from the PHS and 386 women from the WHS who reported they had DED and responded to a questionnaire about change in various aspects of the disease since initial diagnosis. Methods Three subscales were developed based on factor analysis of questionnaire responses: ocular surface symptoms, vision-related symptoms, and social impact. We examined correlates of patient-reported worsening on each subscale. We also obtained medical records from a subset of 261 study participants, and examined changes in clinical signs of DED over time. Main Outcome Measures Ocular surface symptoms, vision-related symptoms, and social impact plus presence/absence of various clinical signs in patients' medical charts. Results Participants reported an average duration of DED of 10.5 years (SD 9.5 years). Worsening was reported by 24% for ocular surface symptoms, 29% for vision-related symptoms, and 10% for social impact. Factors associated with worsening on at least 2 of 3 subscales included a previous report of severe DED symptoms (OR=2.17 for ocular surface symptoms; OR=2.35 for vision-related symptoms), spending >$20 a month on DED treatments (OR=1.80 for ocular surface symptoms; OR=1.99 for vision-related symptoms), history of blepharitis or meibomian gland dysfunction (MGD) (OR=1.57 for vision-related symptoms; OR=2.12 for social impact) and use of systemic beta-blockers (OR=1.62 for ocular surface symptoms; OR=1.84 for vision-related symptoms, and OR=1.86 for the social impact of DED). Presence of corneal staining based on review of medical records was associated with use of level 2 or higher DED treatments (OR=1.54, CI=1.01-2.36), a previous report of severe DED symptoms (OR=1.79, CI=1.07-3.00), having a tear break-up test performed (OR=2.73, CI=1.72-4.36), and with having either blepharitis or MGD (OR=0.59, CI=0.35-0.98). Conclusions The present study suggests that a proportion of DED patients experience worsening of their DED over time, tending to present with more severe symptoms earlier in the disease. Forthcoming data on the natural history of DED from prospective studies should help clarify some of the limitations of this retrospective study.

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Section: Discussionmentioning

confidence: 99%

“…5 Clinical tests in DED tend to have poor reproducibility, and symptoms and signs may fluctuate. Newer techniques such as in-vivo confocal microscopy and tear osmolarity also have limitations.…”

Section: Introductionmentioning

confidence: 99%

Long-term Natural History of Dry Eye Disease from the Patient's Perspective

et al. 2016

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“…The results of recent studies indicate that clinical and biological signs of DES often do not match the severity of symptoms [1, 22, 23]. Despite the large number of diagnostic techniques, there is no single ‘gold standard’ that can determine the severity of the syndrome and evaluate therapy effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Results of a Multicenter, Randomized, Double-Masked, Placebo-Controlled Clinical Study of the Efficacy and Safety of Visomitin Eye Drops in Patients with Dry Eye Syndrome

et al. 2015

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IntroductionThis article presents the results of an international, multicenter, randomized, double-masked, placebo-controlled clinical study of Visomitin (Mitotech LLC, Moscow, Russian Federation) eye drops in patients with dry eye syndrome (DES). Visomitin is the first registered (in Russia) drug with a mitochondria-targeted antioxidant (SkQ1) as the active ingredient.MethodsIn this multicenter (10 sites) study of 240 subjects with DES, study drug (Visomitin or placebo) was self-administered three times daily (TID) for 6 weeks, followed by a 6-week follow-up period. Seven in-office study visits occurred every 2 weeks during both the treatment and follow-up periods. Efficacy measures included Schirmer’s test, tear break-up time, fluorescein staining, meniscus height, and visual acuity. Safety measures included adverse events, slit lamp biomicroscopy, tonometry, blood pressure, and heart rate. Tolerability was also evaluated.ResultsThis clinical study showed the effectiveness of Visomitin eye drops in the treatment of signs and symptoms of DES compared with placebo. The study showed that a 6-week course of TID topical instillation of Visomitin significantly improved the functional state of the cornea; Visomitin increased tear film stability and reduced corneal damage. Significant reduction of dry eye symptoms (such as dryness, burning, grittiness, and blurred vision) was also observed.ConclusionBased on the results of this study, Visomitin is effective and safe for use in eye patients with DES for protection from corneal damage.FundingMitotech LLC.

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“…Moreover, outside the clinical trial setting, staining and TBUT are not typically performed accurately in busy clinical practices. Staining and TBUT must be measured prior to the use of topical anesthetics, which induce a rapid TBUT and epithelial staining 27,28…”

Section: Introductionmentioning

confidence: 99%

Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye

Sambursky¹

2016

OPTH

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BackgroundThe presence of clinically significant inflammation has been confirmed in the tears of 40%–65% of patients with symptoms of dry eye. Ocular surface inflammation may lead to tear film instability, epithelial cell irregularities, and permeability, resulting in chronic symptomatic pain and fluctuating vision as well as negative surgical outcomes.Patients and methodsA retrospective single center medical chart review of 100 patients was conducted. All patients were tested with the InflammaDry test to determine if patients exhibited elevated levels of matrix metalloproteinase 9 (MMP-9). InflammaDry-positive patients were started on a combination of cyclosporine 0.05% twice daily, 2,000–4,000 mg oral omega-3 fatty acids, and frequent artificial tear replacement. InflammaDry-negative patients were started on 2,000–4,000 mg of oral omega-3 fatty acids and frequent artificial tear replacement. Each patient was retested at ~90 days. A symptom questionnaire was performed at the initial visit and at 90 days.Results60% of the patients with dry eye symptoms tested positive for elevated MMP-9 at the initial visit. 78% of all patients returned for follow-up at ~90 days including 80% (48/60) of the previously InflammaDry-positive patients and 75% (30/40) of the previously InflammaDry-negative patients. A follow-up symptom questionnaire reported at least 75% symptomatic improvement in 65% (31/48) of the originally InflammaDry-positive patients and in 70% (21/30) of the initially InflammaDry-negative patients. Symptomatic improvement of at least 50% was reported in 85% (41/48) of previously InflammaDry-positive patients and 86% (26/30) of previously InflammaDry-negative patients. Following treatment, 54% (26/48) of previously InflammaDry-positive patients converted to a negative InflammaDry result.ConclusionIdentifying which symptomatic dry eye patients have underlying inflammation may predict patient responses to treatment and influence clinical management strategies.

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Diagnosis of dry eye disease and emerging technologies

Cited by 91 publications

References 96 publications

Long-term Natural History of Dry Eye Disease from the Patient's Perspective

Long-term Natural History of Dry Eye Disease from the Patient's Perspective

Results of a Multicenter, Randomized, Double-Masked, Placebo-Controlled Clinical Study of the Efficacy and Safety of Visomitin Eye Drops in Patients with Dry Eye Syndrome

Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye

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