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Dry eye is a common, painful ocular disturbance that can result from systemic inflammatory diseases, localized eye problems, or commonly used medications. Current treatments address symptoms, but advances in understanding tear-film function may lead to new approaches.

Purpose: To evaluate keratometric measurements of the anterior and posterior corneal surface before and after corneal cross-linking (CXL) surgery for pediatric keratoconus. Methods: A total of 111 eyes were found eligible for CXL. Anterior and posterior corneal surface keratometry values obtained before and after CXL were analyzed. Results: The mean anterior keratometry values were 47.99 ± 3.96 and 47.74 ± 3.63 diopters (D) before and after CXL. The mean anterior surface steep keratometry was 50.05 ± 4.70 D before CXL and 49.58 ± 4.01 D at the end of the follow-up. The mean anterior surface flat keratometry was 45.91 ± 3.31 D before CXL and 45.93 ± 3.45 D at the end of the follow-up. The mean astigmatism of the anterior surface was 3.98 ± 2.34 cylinder diopters (Dcyl) before CXL and 3.63 ± 1.86 Dcyl at the end of the follow-up. The mean posterior surface keratometry value was −7.16 ± 0.81 D before CXL and −7.27 ± 0.76 D at the end of the follow-up. The mean posterior surface steep keratometry value was −7.52 ± 0.86 D before CXL and −7.64 ± 0.81 D at the end of the follow-up. The mean posterior surface flat keratometry value was −6.81 ± 0.80 D before CXL and −6.90 ± 0.75 D at the end of the follow-up. The mean posterior surface astigmatism was 0.71 ± 0.33 Dcyl before CXL and 0.73 ± 0.34 Dcyl at the end of the follow-up. The difference was not statistically significant. Conclusions: CXL is recommended for children with keratoconus. The treatment does not significantly alter anterior and posterior corneal surface keratometry values.

To evaluate the incidence and severity pattern of dry eye after phacoemulsification. King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Prospective descriptive study. Samples were collected from ninety-two uncomplicated cataract patients who were 18 years old or older. Dry eye incidence and pattern were analyzed at days 0, 7, 30 and 90 after phacoemulsification using (1) Ocular Surface Disease Index (OSDI) questionnaire, (2) tear break up time (TBUT), (3) Oxford ocular surface staining system, and (4) Schirmer I test without anesthesia. Seven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6-16.0%). The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively. However, dry eye post-phacoemulsification was not significantly associated with sex and systemic hypertension (P = 0.26, 0.17 and 0.73, respectively). The incidence of dry eye after phacoemulsification was 9.8%. Symptoms and signs of dry eye occurred as early as seven days post-phacoemulsification and the severity pattern improved over time. We recommend that ophthalmologists should evaluate patients both before and after phacoemulsification to prevent further damage to the ocular surface and able to manage the patient promptly and effectively so the patient will not have a poor quality of life and vision due to dry eye syndrome.

Lifitegrast ophthalmic solution 5% (Xiidra) is labeled for the treatment of dry eye disease, also known as keratoconjunctivitis sicca.1 It is an inhibitor of the lymphocyte function-associated antigen 1 (LFA-1) and has been shown to reduce immune-mediated inflammation.1 Drug Dosage Dose form Cost* Lifitegrast ophthalmic solution 5% (Xiidra) One drop in each eye every 12 hours Single-use ampule of 5% solution $527 *-Estimated retail price of one month's treatment based on information obtained at http://www.goodrx.com (accessed June 4, 2018). Safety No serious adverse effects have been reported with the use of lifitegrast in clinical trials of up to one year in duration.2 Lifitegrast is not systemically detectable despite long-term administration, making systemic effects unlikely.1,2 The medication has not been studied in women who are pregnant or breastfeeding, children, or adolescents.1 Tolerability Approximately one in eight patients will discontinue lifitegrast therapy because of adverse effects.2 The most common adverse effects are altered taste (16.2%), eye irritation or burning (15%), and visual acuity reduction (11.4%).2 Effectiveness Lifitegrast has been evaluated in four 12-week randomized controlled trials involving a total of 2,132 patients.3 Patients receiving lifitegrast initially had moderate symptoms, an average score of 40 to 70 on a scale of 0 to 100, and some corneal lesions on fluorescein stain.3 Patients who received lifitegrast experienced a small reduction in symptoms (an average of 14 to 38 points), although these scores were only five to 12 points better than with placebo.3 Corneal lesions improved at a rate similar to that of placebo. Bottom Line Studies have shown that lifitegrast will reduce the symptoms of dry eye disease in some patients, although the benefit is borderline clinically significant.

Dry eye affects millions of individuals. In experimental models, dry eye disease is associated with T helper cell 17-mediated inflammation of the ocular surface that may cause persistent damage to the corneal epithelium. However, the initiating and perpetuating factors associated with chronic inflammation of the ocular surface remain unclear. The ocular microbiota alters ocular surface inflammation and may influence dry eye disease development and progression. Here, we collected serial samples of tears on awakening from sleep, closed eye tears, during a randomized clinical trial of a non-pharmaceutical dry eye therapy and used 16S rRNA metabarcoding to characterize the microbiome. We show the closed dry eye microbiome is distinct from the healthy closed eye microbiome, and that the microbiome remains distinct despite daily saline eye wash upon awakening. The ocular microbiome was described only recently, and this report implicates a distinct microbiome in ocular disease development. Our findings suggest an interplay between microbial commensals and inflammation on the ocular surface. This information may inform future studies of the pathophysiological mechanisms of dry eye disease.

Understanding the symptomatic dry eye disease (DED) and its associated risk factors among contact lens wearers is crucial for clinicians to tailor effective interventions, enhance patient care, and prevent contact lens dropout. This study investigated symptomatic DED and its associated risk factors among a sample of contact lens wearers in Jordan. This cross-sectional study assessed symptomatic DED in a cohort of contact lens wearers in Jordan using an online survey distributed across various social media platforms. A total of 301 participants completed the survey, which included demographic and contact lens profile questions and the Arabic version of the Ocular Surface Disease Index (ARB-OSDI) questionnaire. Statistical analyses explored the associations between OSDI scores, demographics, symptoms, visual-related functions affected by dryness, and triggers of dryness. Among the study population, 77.1% were females, 48.2% were aged 18–24 years old, and 24.87% were soft contact lens wearers. The mean OSDI score was 22.9 ± 17, with 70% showing mild-to-severe dry symptoms and 25% showing severe symptomatic DED. The ANOVA revealed a significant association between symptomatic DED, wearing face masks, longer contact lens age, and poor cleaning habits. The use of lubricant eye drops significantly reduced symptomatic DED with a mean OSDI score of 8.79. The most prevalent dryness symptoms were pain and blurred vision, affecting reading and TV watching in 50% of the population. Wind and air conditioning were the most common environmental triggers, reported by 67.8% and 66.4% of participants, respectively. A high proportion of symptomatic DED was reported in this study population. Wearing face masks, a longer contact lens age, and poor contact lens hygiene were correlated with exaggerated DED symptoms. Conversely, the use of lubricated eye drops reduces the symptoms of DED.

The precorneal tear film is maintained by blinking and exhibits different phases in the tear cycle. The tear film serves as the most anterior surface of the eye and plays an important role as a first refractive component of the eye. Alterations in tear film dynamics may cause both vision-related and ocular surface-related symptoms. Although the optical quality associated with the tear film dynamics previously received little attention, objective measurements of optical quality using wavefront sensors have enabled us to quantify optical aberrations induced by the tear film. This has provided an objective method for assessing reduced optical quality in dry eye; thus, visual disturbances were included in the definition of dry eye disease in the 2007 Dry Eye Workshop report. In addition, sequential measurements of wavefront aberrations have provided us with valuable insights into the dynamic optical changes associated with tear film dynamics. This review will focus on the current knowledge of the mechanisms of wavefront variations that are caused by different aspects of tear film dynamics: specifically, quality, quantity and properties of the tear film, demonstrating the respective effects of dry eye, epiphora and instillation of eye drops on the quality of vision.

Purpose Atropine eye drops prevent the progression of myopia, but their use has not been tested in the Japanese schoolchildren population. Here, we evaluate the efficacy and safety of 0.01% atropine eye drops for myopia control in Japanese children. Study design Multicenter (7 university hospitals), randomized, double-masked, placebo-controlled trial. Methods Participants were 171 Japanese schoolchildren aged 6 to 12 years, with progressive myopia, spherical equivalence (SE) of −1.00 to −6.00 diopters (D), and astigmatism of ≤1.5 D. They were randomized to receive either 0.01% atropine ( n =85) or placebo ( n =86) eye drops once nightly OU for 24 months. Primary and secondary efficacy endpoints were changes in SE and axial length (AL), respectively, from baseline to month 24. Results Data from 168 subjects were analyzed. At month 24, compliance was similar in both groups (atropine: 83.3%; placebo: 85.7%). The least squares mean change in SE and AL from baseline were, respectively, −1.26 D (95% confidence interval [CI]: −1.35, −1.17) and 0.63 mm (0.59, 0.67) for atropine and −1.48 D (− 1.57, −1.39) and 0.77 mm (0.73, 0.81) for placebo. Inter-group differences were 0.22 D (95% CI: 0.09, 0.35; P  < 0.001) for SE and − 0.14 mm (−0.20, −0.08; P  < 0.001) for AL. Three patients experienced mild allergic conjunctivitis side effects, with no inter-group difference in incidence (atropine: 2.4%; 2/84 patients; placebo: 1.4%; 1/84 patients). Conclusion With good compliance, 0.01% atropine is effective and safe for preventing the progression of childhood myopia.

AimsArtificial tears are first-line therapy for patients with dry eye symptoms. It is not known, however, which patient factors associate with a positive response to therapy. The purpose of this study was to evaluate whether certain ocular and systemic findings are associated with a differential subjective response to artificial tears.MethodsCross-sectional study of 118 individuals reporting artificial tears use (hypromellose 0.4%) to treat dry eye-associated ocular pain. An evaluation was performed to assess dry eye symptoms (via the dry eye questionnaire 5 and ocular surface disease index), ocular and systemic (non-ocular) pain complaints and ocular signs (tear osmolarity, tear breakup time, corneal staining, Schirmer testing with anaesthesia, and eyelid and meibomian gland assessment). The main outcome measures were factors associated with differential subjective response to artificial tears.ResultsBy self-report, 23 patients reported no improvement, 73 partial improvement and 22 complete improvement in ocular pain with artificial tears. Patients who reported no or partial improvement in pain with artificial tears reported higher levels of hot-burning ocular pain and sensitivity to wind compared with those with complete improvement. Patients were also asked to rate the intensity of systemic pain elsewhere in the body (other than the eye). Patients who reported no or incomplete improvement with artificial tears had higher systemic pain scores compared with those with complete improvement.ConclusionsBoth ocular and systemic (non-ocular) pain complaints are associated with a differential subjective response to artificial tears.

Tear-film (TF) stability protects the ocular surface epithelium from desiccation and is ensured via cooperation between the ocular surface components including constituents of the TF and ocular surface epithelium. Thus, when those components are insufficient or impaired, the TF breakup that initiates dry eye occurs. Recently, new, commercially available eye drops have appeared in Japan that enable TF stabilization via targeted supplementation of deficient ocular surface components. Hence, a new layer-by-layer diagnosis and treatment concept for dry eye, termed tear-film-oriented diagnosis and tear-film-oriented therapy (TFOD and TFOT, respectively), have emerged and become widely accepted in Asian countries and beyond. TFOD is a diagnostic method for dry eye based on the TF dynamics and breakup patterns (BUPs), through which dry-eye subtypes, including aqueous-deficient dry eye, decreased-wettability dry eye, and increased-evaporation dry eye, are diagnosed. BUPs and/or each diagnosed dry-eye subtype can, in a layer-by-layer fashion, reveal the insufficient ocular surface components responsible for the TF breakup. Using these data, the optimal topical TFOT to treat dry eye can be proposed by addressing the TF breakup via the supplementation of the insufficient components. In Japan, TF breakup is now regarded as a visible core mechanism of dry eye, and abnormal breakup time (ie, ≤ 5 seconds) and symptoms are currently considered part of the diagnostic criteria for dry eye. In this review, the importance of TF instability as a core manifestation of dry eye, the molecular mechanism of TF breakup, the concept of TFOD, and the methods for implementing TFOD for TFOT are introduced.