Effect of Religious Fasting on Tear Osmolarity and Ocular Surface

Köktekir, Bengü Ekinci; Bozkurt, Banu; Gonul, Saban; Gedik, Şansal; Okudan, Süleyman

doi:10.1097/icl.0000000000000044

Cited by 19 publications

(19 citation statements)

References 16 publications

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“…Data on the effect of sex on tear osmolarity remain equivocal, with Lemp et al [128] and Versura et al [126] reporting no significant effect of sex, which is in agreement with a previous review of the literature [54], whilst Fuerst et al [140] show significantly higher tear film osmolarity in men (311.8 vs. 302.3 mOsm/L). An increase in tear osmolarity has been observed after sleep deprivation, exposure to high altitude and religious fasting [135,147,148]. In accordance with previous studies, prolonged eye closure has been found to lead to tear hypo-osmolarity but data about diurnal variations are equivocal [130,134,139,142,149].…”

Section: Biophysical Measurements Of the Tear Filmsupporting

confidence: 59%

TFOS DEWS II Tear Film Report

et al. 2017

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The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership.

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Section: Biophysical Measurements Of the Tear Filmsupporting

confidence: 59%

TFOS DEWS II Tear Film Report

et al. 2017

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“…In 2014, Koktekir et al. found a significant decrease in IOP during the fasting period compared to the non-fasting period, 26 which concurs with our findings.…”

Section: Discussionsupporting

confidence: 92%

Investigation of the effects of Islamic fasting on ocular parameters

Sedaghat

Heravian

Askarizadeh

et al. 2017

Journal of Current Ophthalmology

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PurposeTo investigate the effects of religious fasting during the month of Ramadan on intraocular pressure (IOP), refractive error, corneal tomography and biomechanics, ocular biometry, and tear film layer properties.MethodsThis prospective study was carried out one week before and in the last week of Ramadan. Ninety-four eyes of 94 healthy adult volunteers (54 males and 40 females) with a mean ± SD age of 35.12 ± 9.07 were enrolled in this study. Patients with any systemic disorder, ocular disease, or a history of previous surgery were excluded. Corneal tomography and biomechanics, ocular biometry, IOP, refractive error, and tear break up time (TBUT) were evaluated in non-fasting and fasting periods by the Pentacam (Oculus), Corvis ST (Oculus), IOL Master (Carl Zeiss), computerized tonometer (Topcon CT-1/CT-1P), auto kerato-refractometer (Topcon KR-1), and Keratograph 5M (Oculus), respectively.ResultsThere was no significant difference in the central corneal thickness (CCT) between the study groups (P = 0.123) using the Pentacam while the Corvis ST showed a significant difference in all participants (P < 0.0001). Moreover, the peak distance (distance of the two surrounding peaks of the cornea at the highest concavity) of male and female participants showed a significant difference between the fasting and non-fasting groups (P = 0.002). The anterior chamber depth (ACD) using the Pentacam decreased in the male group (P = 0.004) in the fasting period. During the fasting period, computerized tonometer showed a decrease in IOP only in males in comparison to the non-fasting group (P = 0.018) while the Corvis ST showed decreased IOP in all participants (P < 0.0001). The steep keratometry (K2) in the corneal posterior surface appeared to be different in males between the study groups (P = 0.034). We were unable to show any significant difference in other ocular parameters between fasting and non-fasting periods.ConclusionThis study showed that ACD, IOP, CCT, and peak distance were different between fasting and non-fasting groups while no difference was observed in other ocular parameters. Interpretations of these significant differences should be considered in the clinical setting.

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“…Whereas the reported sensitivity and specificity of routine dry eye diagnostic methods, such as the BTS, TBUT, CFS, and OSDI, show a variable sensitivity ranging from 42 to 90% and specificity ranging from 17 to 89% [31], InflammaDry's sensitivity of 85% and specificity of 94% is superior [15]. As a result of the hyperosmolar stress induced during Ramadan fasting [10,32,33], there is a direct proinflammatory effect on the ocular surface epithelium, activating mitogen-activated protein kinases and stimulating secretion of proinflammatory cytokines, chemokines and MMPs [34][35][36]. Because MMP-9 is induced by all of the primary inflammatory mediators throughout the inflammatory cascade, it has been shown to precede the development of other dry eye signs [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…A study by Rabbanikhah et al [12] showed a significant decrease in both BTS and TBUT after 3 weeks of Ramadan fasting. Koktekir et al [10] found that during Ramadan fasting, tear osmolarity, OSDI, and corneal staining with lissamine green significantly increased, whereas BTS decreased.…”

Section: Discussionmentioning

confidence: 99%

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Association of Ramadan daytime fasting with ocular surface inflammation and dry eye

et al. 2019

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Purpose Despite the widespread practice of fasting, there are no studies looking at ocular surface inflammation, specifically matrix metalloproteinase 9 (MMP-9) testing, during fasting. In this prospective study, we wanted to evaluate the effect of Ramadan fasting on the level of tear film MMP-9 as well as other standard indicators of dry eye disease. Methods Forty healthy patients without history of ocular disease were tested before and toward the end of Ramadan. Each patient was assessed at each timepoint for tear film MMP-9 positivity as measured by a commercially available test (InflammaDry; Quidel Corp., San Diego, CA, USA) which detects MMP-9 levels of more than 40 ng/ml. Ocular surface disease index (OSDI) scores, tear breakup time (TBUT), Schirmer I test (S1T) and corneal fluorescein staining (CFS) were also evaluated at each timepoint. Results InflammaDry was positive in 10 patients (25%) prior to Ramadan and 21 patients (52.5%) during Ramadan fasting, and this change was statistically significant (p = 0.02). Mean TBUT decreased from 7 s prior to Ramadan to 5.3 s during Ramadan fasting, and this change was statistically significant (p = 0.01). OSDI, CFS and S1T did not show any statistically significant changes (p [ 0.05 for all). Conclusion Ramadan fasting has a significant impact on TBUT and ocular surface inflammation detected by Inflamma Dry testing. Patients who suffer from dry eye disease and those who develop symptoms during Ramadan are advised to consult with a physician before or during Ramadan fasting.

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Effect of Religious Fasting on Tear Osmolarity and Ocular Surface

Abstract: Fasting significantly decreases tear production and increases tear osmolarity; however, it does not deteriorate corneal topographic parameters and ocular aberrations in healthy subjects.

Cited by 19 publications

References 16 publications

TFOS DEWS II Tear Film Report

TFOS DEWS II Tear Film Report

Investigation of the effects of Islamic fasting on ocular parameters

Association of Ramadan daytime fasting with ocular surface inflammation and dry eye

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