Evaluation of objective visual quality in dry eye disease and corneal nerve changes

Abstract Purpose To explore objective visual quality in dry eye diseases (DED) and the correlation between corneal nerves and objective visual quality. Methods Ninety-eight eyes of 49 patients with DED were included. Each patient was evaluated with the ocular surface disease index (OSDI), eyelid margin signs and meibomian gland assessments; corneal staining; tear film breakup time (TBUT); tear meniscus height (TMH); in vivo confocal microscopic (IVCM); objective visual quality including the objective scatter index (OSI), mean objective scattering index (mOSI), modulation transfer function (MTF) cutoff value and Strehl ratio. Results A significant correlation was found between the OSDI and mOSI (r = 0.422, p = 0.005), MTF cutoff value (r = − 0.355, p = 0.020), and Strehl ratio (r = − 0.446, p = 0.003). The OSI was significantly correlated with TBUTf (r = − 0.213, p = 0.042). The mOSI, MTF cutoff value, Strehl ratio were correlated with eyelid margin signs and meibomian assessments. Additionally, there was a statistically significant correlation between corneal nerve length and the mOSI (r = − 0.239, p = 0.037), OSI (r = − 0.294, p = 0.028), MTF cutoff value(r = 0.282, p = 0.012), and Strehl ratio (r = 0.299, p = 0.008). Conclusions Our study explored that objective visual quality was correlated with clinical symptoms and signs in DED patients. Furthermore, for the first time, our study explored the relationship between corneal nerves and objective visual quality and discovered that longer and wider corneal nerves were associated with better objective visual quality, which suggested that nerve changes may be a factor that related to poor visual quality in DED patients.

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The Role of Neuropeptides in Pathogenesis of Dry Dye

Journal of Clinical Medicine ◽

10.3390/jcm10184248 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4248

Author(s):

Daniel Duck-Jin Hwang ◽

Seok-Jae Lee ◽

Jeong-Hun Kim ◽

Sang-Mok Lee

Keyword(s):

Dry Eye ◽

Dry Eye Disease ◽

Eye Disease ◽

Future Research ◽

Immune Systems ◽

Pathogenic Mechanisms ◽

Corneal Nerves ◽

Ocular Surface Diseases ◽

Corneal Nerve

Neuropeptides are known as important mediators between the nervous and immune systems. Recently, the role of the corneal nerve in the pathogenesis of various ocular surface diseases, including dry eye disease, has been highlighted. Neuropeptides are thought to be important factors in the pathogenesis of dry eye disease, as suggested by the well-known role between the nervous and immune systems, and several recently published studies have elucidated the previously unknown pathogenic mechanisms involved in the role of the neuropeptides secreted from the corneal nerves in dry eye disease. Here, we reviewed the emerging concept of neurogenic inflammation as one of the pathogenic mechanisms of dry eye disease, the recent results of related studies, and the direction of future research.

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Morphological and Functional Changes of Corneal Nerves and Their Contribution to Peripheral and Central Sensory Abnormalities

Frontiers in Cellular Neuroscience ◽

10.3389/fncel.2020.610342 ◽

2020 ◽

Vol 14 ◽

Author(s):

Adrian Guerrero-Moreno ◽

Christophe Baudouin ◽

Stéphane Melik Parsadaniantz ◽

Annabelle Réaux-Le Goazigo

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Inflammatory Responses ◽

The Body ◽

Surgical Interventions ◽

Sensory Abnormalities ◽

Functional Changes ◽

Neuroimmune Interactions ◽

Corneal Nerves ◽

Corneal Nerve

The cornea is the most densely innervated and sensitive tissue in the body. The cornea is exclusively innervated by C- and A-delta fibers, including mechano-nociceptors that are triggered by noxious mechanical stimulation, polymodal nociceptors that are excited by mechanical, chemical, and thermal stimuli, and cold thermoreceptors that are activated by cooling. Noxious stimulations activate corneal nociceptors whose cell bodies are located in the trigeminal ganglion (TG) and project central axons to the trigeminal brainstem sensory complex. Ocular pain, in particular, that driven by corneal nerves, is considered to be a core symptom of inflammatory and traumatic disorders of the ocular surface. Ocular surface injury affecting corneal nerves and leading to inflammatory responses can occur under multiple pathological conditions, such as chemical burn, persistent dry eye, and corneal neuropathic pain as well as after some ophthalmological surgical interventions such as photorefractive surgery. This review depicts the morphological and functional changes of corneal nerve terminals following corneal damage and dry eye disease (DED), both ocular surface conditions leading to sensory abnormalities. In addition, the recent fundamental and clinical findings of the importance of peripheral and central neuroimmune interactions in the development of corneal hypersensitivity are discussed. Next, the cellular and molecular changes of corneal neurons in the TG and central structures that are driven by corneal nerve abnormalities are presented. A better understanding of the corneal nerve abnormalities as well as neuroimmune interactions may contribute to the identification of a novel therapeutic targets for alleviating corneal pain.

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Factors Influencing the Effectiveness of Intense Pulsed Light for Meibomian Gland Dysfunction

10.21203/rs.3.rs-52161/v1 ◽

2020 ◽

Author(s):

Chen Chen ◽

Di Chen ◽

Yu-yu Chou ◽

qin long

Keyword(s):

Influencing Factors ◽

Clinical Symptoms ◽

Influencing Factor ◽

Univariate Analysis ◽

Meibomian Gland ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Pulsed Light ◽

Ocular Surface Disease Index ◽

Eyelid Margin

Abstract Purpose: To observe the effectiveness of intense pulsed light (IPL) for meibomian gland dysfunction (MGD) and identify its influencing factors. Methods: Forty-eight eyes of 48 patients with MGD were included. Subjects were followed up 5 times and received IPL during the first three visits. Gender, age, duration of MGD, time of video display terminal usage, and severity of MGD were recorded at baseline. At every visit, Ocular Surface Disease Index (OSDI), eyelid margin abnormality score (EMAS), tear film breakup time (TBUT), Schirmer Ⅰ test (SⅠt) and corneal fluorescein staining (CFS) were recorded. The clinical parameters before and after 3 IPL treatments were compared. Univariate and multivariable logistic regression analyses were performed to explore influencing factors. Results: Compared with baseline, the TBUT was increased and the CFS score and OSDI were significantly decreased on day 45 and day 120 (all P < 0.001). In univariate analysis, among the patients with a younger age (18-39 years), moderate MGD, higher baseline SIt and higher baseline OSDI, the IPL treatment had a higher effective rate (P = 0.032, 0.004, 0.024 and 0.014 respectively). The MGD severity was strongly associated with effective IPL, and patients with moderate MGD had an OR of 5.493 compared with the severe MGD patients (OR = 22.454, 95% CI: 2.890-174.436, P = 0.003). Conclusions: IPL effectively improves clinical symptoms and some signs in MGD patients. Age, MGD severity, baseline SIt and baseline OSDI are potential factors that may influence the effectiveness of IPL. MGD severity is an independent influencing factor.

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Therapeutic Effect of Intense Pulsed Light (IPL) Combined with Meibomian Gland Expression (MGX) on Meibomian Gland Dysfunction (MGD)

Journal of Ophthalmology ◽

10.1155/2020/3684963 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7 ◽

Cited By ~ 2

Author(s):

Shanshan Wei ◽

Xiaotong Ren ◽

Yuexin Wang ◽

Yilin Chou ◽

Xuemin Li

Keyword(s):

Meibomian Gland ◽

Intense Pulsed Light ◽

Meibomian Gland Dysfunction ◽

Pulsed Light ◽

Ocular Surface Disease Index ◽

Eyelid Margin ◽

Assessment Scores ◽

Before And After ◽

Corneal Nerve

Purpose. Our study aimed to evaluate the efficiency of intense pulsed light (IPL) combined with meibomian gland expression (MGX) in treating meibomian gland dysfunction (MGD). Methods. This study was a prospective interventional study. A total of 53 patients were included in the study and received a series of three treatments at an interval of 3-4 weeks. Follow-up examinations were completed 4 weeks after the last treatment. The Ocular Surface Disease Index (OSDI) questionnaire, tear meniscus height (TMH), tear break-up time (TBUT), slit-lamp examinations, and in vivo confocal microscopy (IVCM) were recorded before and after treatment. Additionally, an artificial intelligence automated software program was applied in our study for corneal nerve analysis. Results. The OSDI score was significantly reduced after the IPL treatment compared with baseline (P<0.001). Meibomian gland assessment scores, including meibum quality and expressibility, eyelid margin abnormalities, and corneal staining, significantly decreased after treatment (P<0.05). Moreover, the corneal nerve fiber length (CNFL) significantly increased after the treatment (P<0.001). Conclusion. Intense pulsed light (IPL) combined with MGX is an effective treatment for MGD, and neurotrophism could be one of the mechanisms of IPL.

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Acute Hyperalgesia and Delayed Dry Eye After Corneal Abrasion Injury

10.1101/242685 ◽

2018 ◽

Cited By ~ 1

Author(s):

Deborah M. Hegarty ◽

Sam M. Hermes ◽

Michael M. Morgan ◽

Sue A. Aicher

Keyword(s):

Dry Eye ◽

Temporal Dynamics ◽

Nerve Endings ◽

Male Rats ◽

Spontaneous Pain ◽

Corneal Abrasion ◽

Corneal Nerves ◽

Eye Symptoms ◽

Corneal Nerve ◽

Dry Eye Symptoms

AbstractCorneal nerves mediate pain from the ocular surface, lacrimation, and blinking, all of which protect corneal surface homeostasis and help preserve vision. Corneal nerve density correlates with neuropathic pain states and is used as an assessment of small fiber neuropathies. Because pain, lacrimation and blinking are rarely assessed at the same time, it is not known if their regulatory mechanisms have similar temporal dynamics after acute corneal injury. We examined changes in corneal nerve density, evoked and spontaneous pain, and ocular homeostasis in Sprague-Dawley male rats after a superficial epithelial injury with heptanol that acutely abolished nerve endings within the central cornea. Despite a profound loss of epithelial nerve endings, pain was transiently enhanced after abrasion injury, while basal tear production was normal. We found no relationship between epithelial nerve density and pain or homeostatic responses. Axotomy following corneal abrasion increased expression of both ATF3 (a nerve injury marker) and CGRP (a nociceptive peptide) in trigeminal ganglia 24 hours after injury. These molecular changes were absent on the contralateral side, despite reductions in corneal epithelial nerve density in the uninjured eye. ATF3 and CGRP levels in trigeminal ganglion were normal at one week post-injury when pain responses were normal. In contrast, CGRP was upregulated in peripheral corneal endings one week after injury, when dry eye symptoms emerged. Our results demonstrate dynamic trafficking of CGRP within trigeminal sensory nerves, with elevations in the ganglion correlated with pain behaviors and elevations in peripheral endings correlated with dry eye symptoms.

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Surgical Correction of Upper Eyelid Ectropion Presenting Dry Eye Symptoms

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa143 ◽

2020 ◽

Vol 41 (1) ◽

pp. NP1-NP9

Author(s):

In Chang Cho ◽

Beom-Jun Kim ◽

Hi-Jin You ◽

Woo Hyun Tark

Keyword(s):

Dry Eye ◽

Surgical Techniques ◽

Ocular Surface Disease Index ◽

Level Of Evidence ◽

Eyelid Margin ◽

Upper Eyelid ◽

Partial Thickness ◽

Patient Global Impression ◽

Eye Symptoms ◽

Dry Eye Symptoms

Abstract Background Upper eyelid ectropion occurs as a post-blepharoplasty complication or involution change, and it causes dry eye symptoms that cannot be resolved with conservative management. Objectives The aim of this study is to describe the authors’ surgical technique of anatomical correction of upper eyelid ectropion, including tarsal scoring incision. Methods The technique involves the following 4 steps: (1) adhesiolysis at the preaponeurotic layer; (2) undermining and redraping of the pretarsal flap in a pretarsal plane; (3) optional, partial thickness tarsal scoring incision over the central two-thirds; and (4) downward repositioning of the pretarsal flap and lower fixation to the tarsus. Outcomes were assessed based on the position of eyelid margin and the improvement of the dry eye symptoms. Results A retrospective review of 54 cases of patients who underwent ectropion correction, including tarsal scoring incision, was performed. The eyelid margin was well positioned in 51 patients (94.4%). Of the 32 patients involved in the study assessed with the 7-point Patient Global Impression of Improvement, 29 (90.6%) reported the resolution of dry eye symptoms. Furthermore, in the 22 patients assessed with the Ocular Surface Disease Index, the mean score significantly decreased from 43.2 ± 24.1 before surgery to 29.8 ± 23.3 (P = 0.006) after surgery. Conclusions The combination of partial-thickness tarsal plate scoring and lower flap redraping surgical techniques resolved the upper eyelid ectropion, reducing the dry eye symptoms. Level of Evidence: 4

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Presence of Dry Eye in Patients with Hashimoto’s Thyroiditis

Journal of Ophthalmology ◽

10.1155/2014/754923 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Emrah Kan ◽

Elif Kılıçkan ◽

Gulçin Ecemiş ◽

Emrullah Beyazyildiz ◽

Ramis Çolak

Keyword(s):

Risk Factors ◽

Dry Eye ◽

Hashimoto’S Thyroiditis ◽

Healthy Subjects ◽

Hashimoto's Thyroiditis ◽

Ocular Surface Disease Index ◽

Eyelid Margin ◽

Function Tests ◽

Break Up ◽

Free Plasma

Purpose. To evaluate the tear function tests in patients with Hashimoto’s thyroiditis and to compare the results with healthy subjects.Methods. A hundred and ten patients with Hashimoto’s thyroiditis and 100 healthy subjects were included in this study. The presence of thyroid-associated ophthalmopathy and tear function tests were evaluated clinically. The results were first compared between the patients and the control groups and then compared between patients with NOSPECS and patients without NOSPECS. Logistic regression analyses of the risk factors for dry eye including sex, gender, free plasma thyroxine, proptosis, upper eyelid margin-reflex distance, and duration of the disease were also evaluated.Results. The mean ocular surface disease index score was significantly higher and mean Schirmer and mean tear break-up time scores were significantly lower in patients compared to control subjects. Mean Schirmer and tear break-up time scores were found to be significantly lower in patients with NOSPECS when compared to the patients without NOSPECS. Both proptosis and free plasma thyroxine levels were significantly associated with dry eye.Conclusions. Patients with Hashimoto’s thyroiditis tend to develop dry eye more common than healthy subjects. Proptosis and lower free plasma thyroxine levels were found to be risk factors for the presence of dry eye.

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Topical citicoline and vitamin B12 versus placebo in the treatment of diabetes-related corneal nerve damage: a randomized double-blind controlled trial.

10.21203/rs.2.24135/v2 ◽

2020 ◽

Author(s):

Paolo Fogagnolo ◽

Ettore Melardi ◽

Laura Tranchina ◽

Luca Rossetti

Keyword(s):

Vitamin B12 ◽

Controlled Trial ◽

Controlled Study ◽

Ocular Surface Disease Index ◽

Double Blind ◽

Corneal Nerves ◽

Patients With Diabetes ◽

Treatment Of Diabetes ◽

Corneal Nerve ◽

And Function

Abstract Background: To evaluate the effects of topical citicoline and vitamin B12 (Cit-B12; OMK2, Omikron Italia srl, Italy) on corneal innervation of patients with diabetic neuropathy.Methods: This prospective, randomized, double blind, placebo-controlled study included thirty patients randomised with a 2:1 ratio to Cit-B12 or placebo 3 times daily for 18 months. At baseline and at months 4,8,12,18 patients underwent the Ocular Surface Disease Index questionnaire (OSDI), tear break-up time, evaluation of corneal and conjunctival staining, Schirmer I test, Cochet-Bonnet esthesiometry, and confocal biomicroscopy of corneal sub-basal plexus (SBP). Fiber lenght density (FLD) was calculated using NeuronJ and expressed in mm/mm2. Raw data and differences from baseline were analysed in the two groups. Results: 29/30 patients concluded the study. The two groups had similar FLD at baseline; it progressively improved up to month 18 in both groups (Cit-B12, p<0.0001; controls, <0.0001-0.03); improvement at month 18 vs baseline was higher in Cit-B12 than placebo (33% vs 15%, p=0.04). A progressive amelioration of corneal sensitivity (baseline, 28±18 mm; month 18, 52±10 mm, p<0.0001), conjunctival staining (P=0.04) and OSDI questionnaire (P=0.05) were shown on Cit-B12 group alone. Both treatments were well tolerated and adherence during the study was high.Conclusions: Cit-B12 ameliorated both morphology and function of corneal nerves in patients with diabetes, thus suggesting a neuroregenerative effect. Trial registration NCT03906513, retrospectively registered on 08 April 2019

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Effect of defocus combined with rotation on the optical performance of trifocal toric IOLs

European Journal of Ophthalmology ◽

10.1177/11206721211002121 ◽

2021 ◽

pp. 112067212110021

Author(s):

Javier Ruiz-Alcocer ◽

Irene Martínez-Alberquilla ◽

Amalia Lorente-Velázquez ◽

José F Alfonso ◽

David Madrid-Costa

Keyword(s):

Visual Quality ◽

Optical Quality ◽

Refractive Errors ◽

Focal Points ◽

Modulation Transfer ◽

Optical Analysis ◽

Toric Intraocular Lens ◽

Toric Iols ◽

Reference Situation

Purpose: To objectively analyze the optical quality of the FineVision Toric intraocular lens (IOL) with two cylinder powers when different combinations of rotations and residual refractive errors are induced. Methods: This study assessed the FineVision Toric IOL with two different cylinder powers: 1.5 and 3.0 diopters (D). Three different rotation positions were considered: centered, 5° and 10° rotated. An optical bench (PMTF) was used for optical analysis. The optical quality of the IOLs was calculated by the modulation transfer function (MTF) at five different focal points (0.0, 0.25, 0.50, 0.75, and 1.00 D). Results: The MTF averaged value of the reference situation was 38.58 and 37.74 for 1.5 and 3.0 D of cylinder, respectively. For the 1.5 D cylinder, the combination of 5° of rotation with a defocus of 0.25, 0.50, 0.75, and 1.0 D induced a decrease on the MTF of 12.39, 19.94, 23.43, 24.23 units, respectively. When induced rotation was 10°, the MTF decrease was 17.26, 23.40, 24.33, 24.48 units, respectively. For the 3.0 D cylinder, the combination of 5° with 0.25, 0.50, 0.75, and 1.0 D of defocus, induced a decrease on the MTF of 12.51, 18.97, 22.36, 22.48 units, respectively. When induced rotation was 10°, the MTF decrease was: 18.42, 21.57, 23.08, and 23.61 units, respectively. Conclusion: For both FineVision Toric IOLs there is a certain optical tolerance to rotations up to 5° or residual refractive errors up to 0.25 D. Situations over these limits and their combination would affect the visual quality of patients implanted with these trifocal toric IOLs.

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Evaluation of Dry Eye after Implantable Collamer Lens Surgery

Ophthalmic Research ◽

10.1159/000511197 ◽

2020 ◽

Author(s):

Haiting Chen ◽

Xueyan Feng ◽

Guangzeng Niu ◽

Yuxiang Fan

Keyword(s):

Dry Eye ◽

Ocular Surface ◽

Case Series ◽

Meibomian Gland ◽

Quality Score ◽

Control Group ◽

Ocular Surface Disease Index ◽

Implantable Collamer Lens ◽

Lens Surgery ◽

Breakup Time

Objectives: To evaluate dry eye (DE) and associated meibomian gland dysfunction parameters after Implantable Collamer Lens (ICL) surgery. Methods: This is a prospective observational case series. Patients who underwent ICL implantation without previous ocular diseases or ophthalmic treatments were enrolled. Their Ocular Surface Disease Index (OSDI), noninvasive breakup time (NIBUT), meibography, slit-lamp examination of the lid margin, corneal fluorescein staining (CFS), and Schirmer test I were examined preoperatively and at 1 and 3 months postoperatively. Results: A total of 117 eyes of 60 patients were enrolled, and 107 eyes completed 3-month follow-up period. OSDI, lid marginal abnormality, and meibomian gland (MG) secretion, and meibum quality score were significantly higher at 1 month postoperatively and recovered partially at 3 months after surgeries, while NIBUT was significantly decreased all the time. Patients with previous DE symptoms (OSDI score ≥12) showed not only lower Schirmer and TBUT values but also higher CFS, lid margin score, MG loss, MG secretion, and meibum quality scores compared with those in the control group after operations. Low Schirmer, NIBUT values, and high meibum quality score were determined as risk factors for DE symptoms after ICL surgery. Conclusions: ICL implantation has a bad influence on the ocular surface and MG functions. The influence may be more obvious in patients with existing DE.

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