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Defining Dry Eye from a Clinical Perspective
Over the past decades, the number of patients with dry eye disease (DED) has increased dramatically. The incidence of DED is higher in Asia than in Europe and North America, suggesting the involvement of cultural or racial factors in DED etiology. Although many definitions of DED have been used, discrepancies exist between the various definitions of dry eye disease (DED) used across the globe. This article presents a clinical consensus on the definition of DED, as formulated in four meetings with global DED experts. The proposed new definition is as follows: “Dry eye is a multifactorial disease characterized by a persistently unstable and/or deficient tear film (TF) causing discomfort and/or visual impairment, accompanied by variable degrees of ocular surface epitheliopathy, inflammation and neurosensory abnormalities.” The key criteria for the diagnosis of DED are unstable TF, inflammation, ocular discomfort and visual impairment. This definition also recommends the assessment of ocular surface epitheliopathy and neurosensory abnormalities in each patient with suspected DED. It is easily applicable in clinical practice and should help practitioners diagnose DED consistently. This consensus definition of DED should also help to guide research and clinical trials that, to date, have been hampered by the lack of an established surrogate endpoint.
Journal Article
Dry Eye Disease: What Is the Role of Vitamin D?
Dry eye disease (DED) is a multifactorial condition resulting from reduced tear secretion from the lacrimal glands, increased tear water evaporation or the production of poor-quality tears. Such tear instability can lead to inflammation and damage of the ocular surface, as well as to abnormal nociception. Historically, tear substitutes and corticosteroids have been the bastion of DED therapy, but a substantial number of patients still suffer from residual symptoms even after being treated with traditional treatments. Aiming to find safe and effective alternative therapies, recent efforts have been focused on the role of vitamin D in the cellular physiology of the eye. Possibly because of its positive effect in modulating the immune and inflammatory responses, the systemic supplementation of vitamin D seems, indeed, to be an effective therapeutic strategy, especially, but not only, for patients affected by DED that does not respond to conventional treatments. In this context, this review focuses on the literature reporting on the pathogenesis and treatment of DED, with a special emphasis on the recent investigations reporting on the potential role of the systemic administration of vitamin D as a therapeutic approach in the management of such condition.
Journal Article
Swatch reference guide for interior design fabrics
\"Swatch Reference Guide for Interior Design is a complete learning tool for interior fabrics. An all-in-one text and swatchkit, it is replete with 150 contemporary swatches relevant to the field of interior design. This reference offers all the pertinent information needed for fabric identification, analysis, acquisition, and usage. Through the text and assembly of the kit, readers will learn all the essential performance properties of fibers, knits, finishes, and more. This resource will be an invaluable tool throughout any interior designer's career\"-- Provided by publisher.
Book
Evaporative dry eye disease due to meibomian gland dysfunction: Preferred practice pattern guidelines for diagnosis and treatment
Evaporative dry eye (EDE) due to meibomian gland dysfunction (MGD) is one of the common clinical problems encountered in ophthalmology. It is a major cause of dry eye disease (DED) and of ocular morbidity. In EDE, inadequate quantity or quality of lipids produced by the meibomian glands leads to faster evaporation of the preocular tear film and symptoms and signs of DED. Although the diagnosis is made using a combination of clinical features and special diagnostic test results, the management of the disease might be challenging as it is often difficult to distinguish EDE from other subtypes of DED. This is critical because the approach to the treatment of DED is guided by identifying the underlying subtype and cause. The traditional treatment of MGD consists of warm compresses, lid massage, and improving lid hygiene, all measures aimed at relieving glandular obstruction and facilitating meibum outflow. In recent years, newer diagnostic imaging modalities and therapies for EDE like vectored thermal pulsation and intense pulsed light therapy have emerged. However, the multitude of management options may confuse the treating ophthalmologist, and a customized rather than a generalized approach is necessary for these patients. This review aims to provide a simplified approach to diagnose EDE due to MGD and to individualize treatment for each patient. The review also emphasizes the role of lifestyle modifications and appropriate counseling so that patients can have realistic expectations and enjoy a better quality of life.
Journal Article
Contribution of Mucins towards the Physical Properties of the Tear Film: A Modern Update
Instability of the tear film (TF) protecting the ocular surface results in dry eye syndrome (DES), the most prevalent public health ophthalmic disease affecting the quality of life of 10 to 30% of the human population worldwide. Although the impact of the tear film lipid layer (TFLL) and of the aqueous tears (AT) to the TF stability is extensively studied, in contrast the contribution of the secretory mucins (SM) and of the membrane-associated mucins (MAM), i.e., one of the most abundant molecular classes in AT and in the corneal epithelium respectively, remains poorly defined. However, it is well known that in DES both types of mucins are quantitatively or qualitatively deficient. Numerous studies since the 1990s until now have proposed direct involvement of SM and MAM in the material properties (viscoelasticity, hydration, and protection of the ocular surface; synergistic cooperation with the rest of the TF layers; etc.) and stability of TF. These theories will be reviewed here in the context of the classical and modern in vitro and in vivo results that allow their reappraisal and in view of the novel mucin secretion enhancing pharmaceuticals, which have opened innovative routes for the therapy of DES.
Journal Article
Aqueous-deficient dry eye disease: Preferred practice pattern guidelines on clinical approach, diagnosis, and management
Dry eye disease (DED) is a broad term that includes a diverse group of clinical disorders. Aqueous-deficient dry eye (ADDE), a subtype of DED, is characterized by decreased tear production by the lacrimal gland. It can be seen in up to one-third of individuals with DED and can be comorbid with a systemic autoimmune process or occur secondary to an environmental insult. Since ADDE can be a source of long-term suffering and severe visual impairment, early identification and adequate treatment are imperative. Multiple etiologies can underlie ADDE, and it is critical to identify the underlying cause to not only improve the ocular health but also to improve the overall quality of life and well-being of affected individuals. This review discusses the various etiologies of ADDE, highlights a pathophysiology-based approach for evaluating underlying contributors, outlines various diagnostic tests, and reviews treatment options. We present the current standards and discuss ongoing research in this field. Through this review, we propose a treatment algorithm that would be useful for an ophthalmologist in diagnosing and managing individuals with ADDE.
Journal Article
Aridity drives coordinated trait shifts but not decreased trait variance across the geographic range of eight Australian trees
• Large intraspecific functional trait variation strongly impacts many aspects of communities and ecosystems, and is the medium upon which evolution works. Yet intraspecific trait variation is inconsistent and hard to predict across traits, species and locations.
• We measured within-species variation in leaf mass per area (LMA), leaf dry matter content (LDMC), branch wood density (WD), and allocation to stem area vs leaf area in branches (branch Huber value (HV)) across the aridity range of seven Australian eucalypts and a co-occurring Acacia species to explore how traits and their variances change with aridity.
• Within species, we found consistent increases in LMA, LDMC and WD and HV with increasing aridity, resulting in consistent trait coordination across leaves and branches. However, this coordination only emerged across sites with large climate differences. Unlike trait means, patterns of trait variance with aridity were mixed across populations and species. Only LDMC showed constrained trait variation in more xeric species and drier populations that could indicate limits to plasticity or heritable trait variation.
• Our results highlight that climate can drive consistent within-species trait patterns, but that patterns might often be obscured by the complex nature of morphological traits, sampling incomplete species ranges or sampling confounded stress gradients
Journal Article
Pregnancy and Dry Eye Syndrome: A Review for Clinical Practice
Pregnancy is a unique physiological state associated with profound hormonal, metabolic, and immunological changes that may affect ocular surface homeostasis. Among these changes, fluctuations in estrogen and progesterone are the most consistent factors contributing to the development or exacerbation of dry eye syndrome (DES), although insulin resistance and maternal immune tolerance may also play a role in modulating disease severity. Current evidence suggests that DES can affect between 20% and 50% of pregnant women, most commonly during the second and third trimesters. Symptoms are often mild and self-limiting, but they can negatively impact quality of life and adherence to prenatal care. Importantly, however, current consensus reports such as TFOS DEWS III emphasize that pregnancy has not been established as a confirmed risk factor for DES and the evidence remains inconclusive despite the biological plausibility of hormonal influences. This review summarizes the pathophysiological mechanisms underlying DES in pregnancy, highlights diagnostic approaches and safe management strategies tailored for pregnant women, and emphasizes the importance of awareness among obstetricians and ophthalmologists. Greater recognition of DES in pregnancy may improve patient comfort and prevent long-term ocular complications.
Journal Article