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This study was performed to evaluate the prevalence and risk factors of dry eye disease (DED) among paramedical workers at a university hospital in Korea. This cross-sectional study included 566 paramedical workers at a university hospital in Korea. Dry eye symptoms were assessed using a 9-item questionnaire, and DED was defined as having 1 or more dry eye symptoms often or all the time. A survey including demographic data and potential risk factors of DED was also performed. Psychological stress was measured using stress VAS and perceived stress scale 4 (PSS-4) questionnaires. Of the 566 paramedical workers, 232 (35 male and 197 female) completed the survey. Prevalence of DED was 42.7% (99/232). Univariate analysis revealed that female sex ( P  < 0.001), prolonged computer use ( P  = 0.003) and higher stress VAS ( P  < 0.001) and PSS-4 ( P  = 0.009) scores had significant association with DED. In multivariate analysis, DED had significant association with female sex ( P  = 0.003) and stress VAS ( P  = 0.013) after adjustment for sex, duration of computer use and stress VAS, and had significant association with female sex ( P  = 0.003) and durations of computer use ( P  = 0.029) after adjustment for sex, duration of computer use and PSS-4 score. In conclusion, DED was prevalent among paramedical workers in Korea. Its risk increased among females and workers with increased psychological stress. Prolonged use of computer was possibly associated with DED.

To report the efficacy and safety of large diameter scleral lenses and determine their suitability in Asian subjects with intractable ocular surface diseases. This prospective study enrolled intractable ocular surface diseases subjects with uncorrected visual acuity > counting finger but ≥ 0.3 logMAR and best-corrected visual acuity (BCVA) ≥ 0.3 logMAR, to fit large diameter scleral lenses for 12 weeks. 21 eyes (13 subjects) consisting ten eyes (47.6%) with persistent epithelial defects, 6 (28.6%) with graft-versus-host disease, 4 (19.0%) with Stevens–Johnson syndrome and one (4.8%) with severe dry eye were ultimately enrolled. Primary outcome measures were the visual acuity, corneal and conjunctival fluorescein staining, Ocular Surface Disease Index (OSDI), and National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25). At week 12 with large diameter scleral lenses, BCVA improved from 0.77 logMAR to 0.27 logMAR ( P  < 0.001). High-grade corneal and conjunctival fluorescein staining proportion decreased from 61.90 to 14.29% and 52.38 to 9.52%, respectively ( P  = 0.0036 and 0.0063, respectively). OSDI and NEI-VFQ-25 improved from 67.89 to 34.69 and 51.40 to 64.48, respectively ( P  < 0.001). No adverse effects were observed. In Asians with intractable ocular surface diseases, large diameter scleral lens improves visual acuity and alleviates signs and symptoms of ocular surface diseases without any significant complications. Trial registration Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (Project No. HI12C0015 (A120018)). Clinical Trials.gov, NCT04535388. Registered 18 August 2020—Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT04535388 .

Purpose To compare the proportions of patients satisfying Korean dry eye guidelines and Asia Dry Eye Society (ADES) diagnostic criteria and to describe the clinical characteristics and practice patterns of dry eye patients in Korea. Study design Prospective observational study. Methods This study enrolled 160 patients, with 158 patients analyzed. ADES guidelines were applied to dry eye patients satisfying the Korean dry eye guidelines. Risk factors for dry eye (e.g. visual display terminal [VDT] use) were evaluated. Dry eye subtypes were categorized as aqueous-deficient or evaporative. Objective signs (e.g. corneal and keratoconjunctival staining scores, tear break-up time [TBUT], and Schirmer test) and symptoms (Dry Eye-Related Quality of Life Score [DEQS] and Ocular Surface Disease Index [OSDI] questionnaire) were evaluated. Treatment patterns were also recorded. Results Patients (mean age 43.1 years) were mainly women (85.4%), with a high proportion (77.2%) of VDT users. Concordance between Korean and ADES guidelines was high (94.3%), with most patients (94.3%) having tear film instability (TBUT ≤ 5 s). Evaporative dry eye occurred in 60.1% and aqueous-deficient in 39.9% of cases. Objective signs were significantly better in evaporative than in aqueous-deficient dry eye. The DEQS bothersome ocular symptoms’ score was significantly higher in VDT users than in non-users. OSDI symptom severity and DEQS were significantly correlated ( p  < 0.001). The most common treatments were hyaluronic acid (33.5%) and diquafosol (15.2%), the latter used mainly for mild and evaporative dry eye. Conclusion The study showed high concordance between Korean and ADES diagnostic guidelines, with most patients having tear film instability.

Dry eye disease (DED) is a common disease, and have an adverse effect the physical, functional, and psychological quality of life. It is a multifactorial disorder characterized by the loss of tear film homeostasis, in which self-perpetuating vicious cycle leads to deterioration of function and inflammation of the lacrimal functional unit. Hence, treatment strategies should be aimed at the interruption of the vicious inflammatory cycle and alleviation of ocular surface inflammation. Anti-inflammatory therapies have been shown to improve the signs and symptoms of the disease. Evidence indicates that polyunsaturated fatty acids (PUFAs) may contribute to reinforcement of innate anti-inflammatory mechanisms, and systemic and topical administration of PUFAs may help modulate ocular surface inflammation. In the present review, the authors will introduce the results of clinical and experimental studies to elucidate the mechanism, efficacy, and safety of systemic and topical supplementation with PUFAs as an alternative therapeutic strategy for DED. This review will also include discussion regarding current perspectives, including evidence-based recommendations and possible side effects of PUFAs supplementation. The review of the literature suggests that PUFAs supplementation can be a viable option for the treatment of DED, although further studies are needed for establishment of treatment guidelines.

Diabetes mellitus (DM) has been emerging as one of the most serious health problems worldwide. Ocular complications of DM are currently one of the major causes of blindness in developed countries, among which diabetic retinopathy is relatively well studied and understood. However, although ocular surface complications of DM are common, diabetic complications of anterior segment of the eye, such as, cornea, conjunctiva, and lacrimal glands, are often overlooked. DM is associated with progressive damage to corneal nerves and epithelial cells, which increases the risk of anterior segment disorders including dry eye disease, corneal erosion, persistent epithelial defects, and even sight-threatening corneal ulcer. In this review, the authors will discuss the association of DM with disorders of anterior segment of the eye. Studies indicating the value of corneal nerve assessment as a sensitive, noninvasive, and repeatable biomarker for diabetic neuropathy will also be introduced. In addition, treatment modalities of anterior segment disorders associated with DM is discussed. The studies introduced in this review suggest that early and periodic screening of the anterior segment of the eye, as well as the retina, is important for the optimal treatment of DM.

PurposeTo investigate the characteristics of eyes with dry eye disease (DED) whose lipid layer thickness (LLT) measured 100 nm on a LipiView II interferometer and compare the DED parameters of them to those with LLT below 100 nm.MethodsA total of 201 eyes of 102 enrolled DED patients (mean age 56.4 ± 11.8 years) were classified into 3 groups according to their average LLT; < 60 nm as thin-LLT (n = 49), 60–99 nm as normal-LLT (n = 77), and 100 nm as thick-LLT (n = 75). LLT, meiboscore, Schirmer I test, tear film break-up time (TBUT), ocular surface staining (OSS), and ocular surface disease index (OSDI) were assessed.ResultsThe OSS and TBUT were significantly worse in the thick-LLT group than in the normal-LLT group (p = 0.020, and p = 0.028, respectively). The OSDI was significantly higher in the thick-LLT group than in the thin-LLT group (p = 0.006). However, the meiboscore was not different among the three groups (p = 0.33). Age, OSS, and OSDI showed a positive correlation with LLT (r = 0.16, p = 0.023; r = 0.213, p = 0.003; and r = 0.338, p = 0.001, respectively). In sensitivity analyses, eyes with corneal erosions had a significantly higher average LLT (p = 0.015), higher OSDI (p = 0.009), shorter TBUT (p < 0.001), and shorter Schirmer I value (p = 0.024) than those with clear corneas.ConclusionThe average LLT of eyes with corneal erosions was thicker than those without erosions, suggesting that the LLT of 100 nm in the eyes with corneal erosions should not be regarded as a stable physiologic condition. Cautious interpretation of LLT along with other dry eye parameters is required.

This multi-center cohort study included 3401 myopic laser in situ keratomileusis (LASIK) procedures conducted in 1756 myopia patients between 2002 and 2005. Pre- and postoperative uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), and manifest refraction spherical equivalent (SE) were recorded. Factors predicting low postoperative efficacy (defined as a postoperative UCVA < 0.5) were identified using univariate and multivariate logistic regression analysis. Compared with 1 month postoperatively, logMAR UCVA at 3 months postoperatively was significantly decreased (p = 0.002) and that at 2 and 3 years was significantly increased (p < 0.001). LogMAR BCVA at 2 years postoperatively was significantly decreased compared with 1 month postoperatively (p = 0.008). Over the 3-year postoperative period, overall refractive predictability within ±1.00 D and ±0.50 D ranged from 69.0% to 86.2% and from 43.3% to 67.8%, respectively. This also decreased from 1 month to 6 months postoperatively (p < 0.005). Multivariate logistic regression analysis using generalized estimating equations, revealed that higher preoperative SE (odds ratio [OR], 2.58 and 7.23; p < 0.001) and lower preoperative BCVA (OR, 2.44; p = 0.003) were predictive of a low postoperative efficacy. In summary, myopic LASIK can be effective and safe with a high refractive predictability in a Korean population, but myopic regression occurs over time. Higher preoperative SE and lower preoperative BCVA are predictive of a low postoperative efficacy.

To evaluate the effect of autologous platelet-rich plasma (PRP) eye drops on optical quality and visual acuity in eyes implanted with a trifocal diffractive intraocular lens (IOL). In this retrospective cohort study of 128 eyes from 128 patients undergoing femtosecond laser-assisted cataract surgery with implantation of the CNWT Clareon PanOptix (Alcon Inc.) IOL, patients were assigned to one of two groups: the PRP group (n = 62), which received postoperative PRP eye drops, and the conventional treatment group (n = 66). At 3 weeks postoperatively, optical parameters-including the objective scatter index (OSI), modulation transfer function (MTF) cutoff, and Strehl ratio (SR)-were measured with a double-pass system. Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) at 4 m, as well as uncorrected near visual acuity (UNVA) at 40 cm, were recorded in logMAR units. The PRP group demonstrated superior optical quality across all measured parameters compared to the control group, with lower OSI (1.60 vs. 3.14), higher MTF cutoff (31.93 vs. 19.90 cycles/degree), and higher SR (0.15 vs. 0.12) (all P < 0.001). Visual acuity was also significantly better in the PRP group, with lower mean logMAR UDVA (0.05 vs. 0.10; P < 0.001), CDVA (0.01 vs. 0.05; P < 0.001), and UNVA (0.13 vs. 0.18; P = 0.007). Multivariate analyses confirmed that the use of PRP eye drops was independently associated with improvements in all three optical parameters: OSI (B = -1.488), MTF cutoff (B = 12.038), and SR (B = 0.039) (all P < 0.001). The use of autologous PRP eye drops improves optical quality and visual acuity at all distances following trifocal diffractive IOL implantation. PRP eye drops may serve as a beneficial adjunct for postoperative management in patients undergoing this procedure.

Purpose: To develop a machine learning model for identifying eyes with previous myopic laser vision correction (LVC). Methods: A total of 41,508 (35,269 eyes in 20,399 patients) and 5,517 (5,517 eyes in 3,210 patients) examinations performed at Seoul National University Bundang Hospital (SNUBH) and Seoul National University Hospital (SNUH), respectively, were included in this study. Using the SNUBH dataset, a machine learning model for identifying eyes with previous myopic LVC (ML-LVC) was developed. The SNUBH and SNUH datasets, respectively, were used as internal and external validation sets to investigate the performance of the ML-LVC model and to compare it with that of the Cooke–Riaz–Wendelstein (CRW1) index. Results: The areas under the receiver operating curve of the ML-LVC model were 0.9970 (95% confidence interval [CI]: 0.9957 to 0.9981) and 0.9960 (95% CI: 0.9929 to 0.9982) in the internal and external validation sets, respectively. The accuracies of the ML-LVC model were 0.9908 (95% CI: 0.9886 to 0.9929) and 0.9927 (95% CI: 0.9906 to 0.9949) in the internal and external validation sets, respectively. The sensitivities of the ML-LVC model were 0.9528 (95% CI: 0.9342 to 0.9691) and 0.9222 (95% CI: 0.8802 to 0.9600) in the internal and external validation sets, respectively. The ML-LVC model exhibited significantly better prediction results, compared with the CRW1 index, in both the internal and external validation sets (McNemar's test, P = .004, P = .005, respectively). Conclusions: The ML-LVC model showed better performance in identifying eyes with myopic LVC, compared with the CRW1 index. This model will benefit many ophthalmologists and is currently available on a web application.

Background: Posterior polymorphous corneal dystrophy (PPCD) is typically considered bilateral and asymptomatic. However, few case reports on patients with unilateral PPCD with asymmetric refractive error have mentioned anisometropic amblyopia development. In support of this, we report 3 cases of unilateral PPCD that presented as anisometropic astigmatism. Visual prognosis related to amblyopia development is discussed. Case Presentation: All 3 patients had a band lesion in the affected eye and a difference of at least 1.5 diopters in cylindrical refractive error between their eyes. The affected eye had a greater amount of astigmatism in all cases. Two patients (Cases 1 and 2) also had amblyopia in the affected eye. Case 1 was a 25-year-old male with a unilateral PPCD diagnosis and a band lesion involving the visual axis. Case 2 was an 11-year-old boy diagnosed with unilateral PPCD. The boy was treated with occlusion and atropine therapy over a 2-year period. Case 3 was a 4-year-old girl diagnosed with unilateral PPCD. The girl had a 30-month history of corrective spectacle use and had no amblyopia. In all cases, the corneal endothelial cell count was lower in the affected eye than in the unaffected contralateral eye. Conclusions: Practitioners should closely monitor patients with unilateral PPCD for astigmatic anisometropia and amblyopia development. Visual prognosis for patients with unilateral PPCD may be related to lesion position, age at diagnosis, astigmatism severity, and early-childhood corrective spectacle use.