Although it is well known that astigmatism correction with toric contact lenses improves clinical vision measures, their effects on real-world visual performance using digital devices such as smartphones are less well understood. This study aimed to examine how toric soft contact lenses impact functional near visual performance with a smartphone, in comparison to spherical equivalent contact lenses.

Fifteen healthy young adults (mean age 23.6 ± 2.8 years) with low to moderate astigmatism (-0.50 D to -1.50 D) participated in this prospective, repeated measures randomised crossover trial. Either toric or best sphere soft daily disposable contact lenses (lens material Verofilcon A) were worn during two separate study visits. At each visit, near visual acuity (VA) was assessed, and participants performed a reading task on a smartphone with both high and low contrast text displays. A mobile eye tracker was worn during the reading task to track objective measures of visual fatigue such as palpebral aperture height and near focusing demand.

Both high and low contrast near VA were significantly better with the toric correction compared to the best sphere (p = 0.001). While reading on a smartphone, the average reading speed was not significantly different between the sphere and toric lenses (p = 0.18). Significantly fewer errors were made while reading with the toric lens compared to the best sphere lens for the low contrast (p = 0.04), but not for high contrast text (p = 0.4). For measures of palpebral aperture height, and focusing demand, a significant lens by time interaction was found (both p < 0.05), with a significantly greater focusing demand and a narrower palpebral aperture observed towards the end of the reading task with the best sphere lens.

Significant visual and functional benefits were found for digital near visual tasks associated with toric contact lens correction.

Corneal refractive surgeries offer rapid vision correction, while dry eye disease remains a common postoperative complication that significantly impacts patients' quality of life. The etiology of postoperative dry eye is multifactorial. Cyclosporine A (CsA) has been employed in the treatment of dry eye due to its ability to suppress T cell-mediated immune responses and reduce inflammation. The present study was designed to assess the early effect of 0.05% cyclosporine A (CsA) eye drops on tear film stability, ocular surface inflammation and goblet cell function in patients following corneal refractive surgery.

One hundred forty-four eyes of 72 participants undergoing corneal refractive surgery were enrolled and randomized into additional 0.05% CsA eye drops treated group or conventional schedule treated group. Ocular Surface Disease Index (OSDI), relevant ocular surface clinical parameters, tear inflammatory cytokine levels, conjunctival impression cytology, and gene expression of Keratin 7 (KRT-7) as well as Mucin5AC (Muc5AC) in conjunctival epithelial cells were measured before surgery (baseline) and at 1 month after surgery. All indicators and their changing value were compared against baseline or across different groups.

0.05% CsA treatment exhibited greater changes in OSDI, NIBUT, LLT and CFS in the early postoperative period (P = 0.004, P = 0.002, P = 0.032, P = 0.008). Compared to control group, there was a more significant decrease in IFN-γ and TNF-α levels in tear fluid in CsA group after surgery (P = 0.012, p = 0.032). Additionally, KRT-7 and IFN-γ showed recovery in conjunctival cells with 0.05% CsA treatment (P = 0.003, P = 0.019). The postoperative KRT-7 and Muc5AC levels were negatively correlated with corresponding IFN-γ levels in tear fluid among all subjects (r = -0.200, p = 0.016; r = -0.229, p = 0.006).

For patients undergoing refractive surgery, the application of 0.05% CsA suppressed the expression of inflammatory cytokines such as IFN-γ and TNF-α, and preserved goblet cell function. These effects ultimately contribute to maintaining ocular surface stability and alleviating dry eye related symptoms during the early postoperative period following refractive surgery.

To investigate whether certain dry eye (DE) metrics relate to oral and pain manifestations of Sjögren's disease (SjD).

Secondary analysis of the Sjögren's International Collaborative Clinical Alliance dataset containing 1541 individuals with 2016 American College of Rheumatology/European League Against Rheumatism defined SjD. Binary logistic regression analyses examined which of 13 DE features related to various extraocular metrics.

The mean age of the population was 52±13.5 years; 45% identified as white and 94% as women. Heterogeneity in DE symptoms and signs was noted in individuals with SjD, with approximately one-third of individuals reporting significant spontaneous and/or evoked pain using various descriptors and indicating certain triggers, and approximately half having low tear production. Similarly, heterogeneity was noted with respect to oral and pain complaints, with extraocular pain symptoms found in approximately one-third of the population. Different ocular phenotypes aligned with different extraocular findings. Specifically, grittiness or scratchiness in the eyes (OR=1.6), blurred vision (OR=1.4) and low tear production (OR=1.8) most closely aligned with oral dryness ('Does your mouth feel dry?). On the other hand, burning or stinging in the eyes (OR=1.6), discomfort in low humidity (OR=1.2) and the absence of DE signs (normal tear production, OR=0.7; lack of ocular surface staining, OR=0.6) most closely aligned with pain outside the eye ('Do you experience persistent or frequent burning discomfort?').

Our findings suggest heterogeneity in SjD ocular presentations that predict extraocular features of disease and hint at mechanisms that underlie heterogeneity, namely divergent neurosensory processes.

To assess the repeatability of measures for dry eye disease (DED) symptoms and signs in the DREAM study.

At screening and baseline visits approximately 2 weeks apart, participants were assessed for symptoms by Ocular Surface Disease Index (OSDI) and Brief Ocular Discomfort Index (BODI), and signs by the same physician in the same order: tear break-up time (TBUT), corneal staining, conjunctival staining, Meibomian gland evaluation, and the Schirmer test. The repeatability of DED symptoms and signs was assessed by interclass correlation coefficient (ICC), 95 % limits of agreement, and the percent of eyes with inter-visit difference above the clinically significant threshold.

Among 1046 eyes (523 participants), ICC for signs ranged from 0.53 (TBUT) to 0.73 (corneal staining). A substantial percentage of eyes showed clinically significant inter-visit differences: ≥2 points in 17.8 % of eyes for conjunctival staining; ≥3 points in 18.8 % for corneal staining; >2 s in 14.1 % for TBUT; ≥5 mm/5 min in 29.9 % for the Schirmer test, and ≥ 2 points in 27.5 % for Meibomian gland plugging and lid secretion. The OSDI and BODI had ICC of 0.64 and 0.63 respectively, and nearly 40 % of participants had inter-visit score differences ≥ 10 points.

In DREAM participants with moderate-to-severe DED, DED signs and symptoms had moderate repeatability, with ocular surface staining scores being the most repeatable and TBUT the least repeatable. A notable percentage of participants had inter-visit differences above the clinically meaningful threshold. These test-retest variabilities in DED signs and symptoms should be considered for designing clinical trials and monitoring disease progression.

To assess the impact of prolonged and intense exposure to video display terminals (VDTs) on ocular surface homeostasis.

30 subjects limited daily VDT usage to less than 3 h for one week, then extended usage to more than 8 h/day for the next three weeks. Ocular symptoms and signs were evaluated weekly using the Ocular Surface Disease Index (OSDI) questionnaire and clinical examinations. Eyelid margins and meibomian glands were examined, and ocular surface samples were collected for transcriptomic analysis.

Average daily VDT time increased from 2.55 ± 0.46 h initially to 11.17 ± 2.45, 11.75 ± 2.63, and 10.89 ± 2.41 h over three weeks. The dry eye diagnosis rate rose from 6.67 % to 51.67 %. Total OSDI score (P = 0.008), symptoms score (P = 0.014), and visual function score (P = 0.002) significantly increased. Mean fluorescein break-up time (FBUT) decreased from 6.46s to 3.08s. Corneal fluorescein staining (CFS) score (P < 0.001) and lissamine green conjunctival staining (LCjs) score (P = 0.036) worsened. Ocular redness index (RI) increased at 1 week and 3 weeks (P = 0.007, P = 0.001). Telangiectasia scores of both upper and lower eyelid margins increased at 3 weeks (P = 0.002, P < 0.001). Meibomian gland orifice blockage worsened (P = 0.014, P = 0.002). Transcriptomic analysis revealed dynamic alterations in ocular surface gene expression, including inflammatory and hormonal responses. MUC5AC and TFF1 genes showed negative correlations with OSDI and conjunctival staining score, respectively.

Prolonged VDT exposure deteriorates ocular surface symptoms and signs, with significant inflammatory responses and hormonal activity indicating an imbalance in ocular surface homeostasis.

Artificial tear substitutes are key elements in the first-line treatment of dry eye disease (DED). We hypothesized that GlicoPro®, a new multimolecular complex based on proteins, sulfured and unsulfured glycosaminoglycans and opiorphin, was able to significantly improve the effect of hydroxypropyl-methylcellulose (HPMC) eyedrops in treating DED.

We performed an in vitro experiment and a clinical study, comparing an HPMC + GlicoPro®-based to an HPMC-based ophthalmic formulation (similar kinematic viscosity and comparable HPMC concentration). An in vitro dry eye model was established by inducing hyperosmolarity in the base medium of human corneal epithelial cells HCE-2. After treatment with ophthalmic formulations, the expression levels of inflammatory cytokines and enzymes (IL-20, IL-1β, TNF-α, IL-6, IL-8, MMP-9, and MCP-1) was measured by real-time polymerase chain reaction. Moreover, we performed a single-blind randomized 1:1 clinical trial, aimed to compare the efficacy of the two formulations instilled four times per day (QID), in treating mild-to-moderate DED. Symptoms (Ocular Surface Disease Index and Symptom Assessment iN Dry Eye), clinical signs, and ocular surface imaging data were assessed at baseline and after 1 and 3 months of treatment.

In vitro experiment: under hyperosmotic conditions, corneal epithelial cells upregulated the expression of inflammatory cytokines IL-20, IL-1β, TNF-α, IL-6, and IL-8. Treatment with HPMC + GlicoPro® significantly decreased the expression of all inflammatory markers tested, including cytokines, MMP-9, and MCP-1 (P < 0.05).

the HPMC + GlicoPro® formulation showed a significantly higher effect in improving symptoms (overall treatment effect: P < 0.001), tear film stability, and markers of inflammation on corneal confocal microscopy (P < 0.01).

Both in vitro and clinical data provided evidence supporting the role of GlicoPro® in improving the effect of HPMC in DED treatment.

NCT06726525.

Perfluorohexyloctane ophthalmic solution (PFHO) is indicated for the treatment of signs and symptoms of dry eye disease (DED) and targets excessive tear evaporation. This study evaluated patient-reported outcomes early in treatment with PFHO.

This prospective, multicenter, open-label, phase 4 study enrolled adults with a history of DED for ≥ 6 months. PFHO was instilled in both eyes four times daily for 14 days. Patients completed early outcome surveys during four clinic visits (day 1 [pretreatment; 5 and 60 min post-PFHO instillation] and days 3, 7, and 14). Symptom severity, symptom frequency, and treatment satisfaction were rated on visual analog scales (range 0-100). The primary endpoint was mean change from baseline in overall DED symptom severity at day 7. Secondary endpoints included change in severity of individual DED symptoms (eye dryness, blurred vision, eye irritation, light sensitivity, eye tiredness, burning/stinging, eye itching, eye pain); change in frequency (measured as percentage of time experienced) of the most bothersome symptom, awareness of dry eye symptoms, and fluctuation in quality of vision; and treatment satisfaction.

Ninety-nine patients enrolled (85.9% female; age range 35-81 years). The primary endpoint was met: mean (SD) overall symptom severity decreased significantly from 72.1 (17.0) at baseline to 27.8 (22.3) at day 7 (mean change, - 44.5; P < 0.0001). Mean (SD) percentage of time experiencing the most bothersome symptom decreased from 77.9% at baseline to 34.7% at day 14 (P < 0.0001). Significant reductions in severity and frequency also were observed for all symptoms at all postbaseline assessments (P < 0.0001). Median ratings of treatment satisfaction were 83.0 at day 3, 86.0 at day 7, and 90.0 at day 14.

Early in the course of treatment with PFHO, patients with DED experienced significant reductions in dry eye symptom frequency and severity. Treatment satisfaction with PFHO was high.

ClinicalTrials.gov identifier NCT06309953.

To assess the short-term effects of topical insulin (TI) as compared to topical Systane UltraTM (Alcon, USA) as artificial tears (AT) and topical normal saline (NS) on tear inflammatory mediators; interleukin 1-alpha (IL-1a), interleukin 6 (IL-6) and matrix metalloproteinase 9 (MMP-9) and clinical dry eye parameters in diabetics with dry eye disease (DDED).

In this randomized, multi-arm parallel single-centre trial, 73 diabetics with dry eye disease (30 female and 43 male) aged 18 to 50 years were recruited. They were randomly assigned to four weeks of treatment of either TI 0.5 unit/drop, AT or NS four times per day. Tear sample analysis and clinical parameters of dry eye (Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), corneal Oxford score and Schirmers test) were evaluated at baseline and four weeks later. Objective clinical parameters for corneal Oxford score and tear break-up time were assessed by two masked investigators.

Significant reduction was seen in all inflammatory biomarkers (IL-1a, IL-6 and MMP-9) in all treatment groups at 4 weeks. In addition, inflammatory biomarkers demonstrated a significant reduction with TI (p < 0.001). Meanwhile, in AT and NS groups, reduction was also significant but less than TI group. Similarly, significant improvements were seen in all clinical parameters evaluated with all 3 treatments at 4 weeks; with TI group showing largest improvement as compared to AT and NS groups (p < 0.001). This is supported with the results as follows: mean difference -20.90 for OSDI as compared to -11.38 and -6.78 for AT and NS groups, respectively, 5.55 s for TBUT as compared to 3.00 s and 1.00 s for AT and NS group respectively, -2.40 for Oxford score as compared to -0.38 and -1.39 for AT and NS group respectively, and 5.20 mm for Schirmers test as compared to 3.00 mm and 1.00 mm for AT and NS group respectively.

Treatment with TI resulted in the greatest reduction in inflammatory biomarkers and ocular eye parameters, as compared to AT and NS. TI was most effective in improving clinical parameters of DDED, although all topical therapies showed significant improvements, suggesting that use of TI may be beneficial in treating DDED.

Symptoms and signs of dry eye can significantly increase after cataract surgery. The present study seeks to investigate the effect of intensive lubrication using Systane HYDRATION multi-dose preservative free (MDPF) eye drops (Alcon Research, Ltd., Fort Worth, Texas, USA) on signs and symptoms of dry eye in the postoperative phase.

Patients scheduled for cataract surgery were enrolled in this randomised, investigator-masked study and assigned to one of three groups. The risk of developing dry eye was stratified using the ocular surface frailty index (OSFI). The high risk - standard of care (HR-SOC) and treatment (HR-Treatment) group were the high-risk groups (OSFI 0.3 or greater), and the LR-SOC group was the low-risk group (OSFI less than 0.3). HR-SOC and LR-SOC group received the standard postoperative treatment. In the HR-Treatment group, Systane HYDRATION MDPF was added four times a day for three months after surgery. After the baseline examination prior to cataract surgery, three follow up visits were scheduled one week, one month and three months after surgery. OSDI scores, ocular surface staining, and fluorescein break-up time were assessed at each visit.

Ninety-five patients were included and 83 entered statistical analyses. OSDI increased in all groups after cataract surgery, and it was lowest in the HR-Treatment group three months after the surgery. In addition, fluorescein break-up time tended to be longer and ocular surface staining less in the HR treatment group at three months. However, there was no statistically significant difference between the groups during the three-month visit.

In this randomized, examiner-masked trial no statistically significant difference could be found between the groups, but Systane HYDRATION MDPF may have a positive effect after cataract surgery in high-risk groups for dry eye syndrome.

ClinicalTrials.gov NCT06555224.

Background Dry eye disease, a prevalent condition globally, affects the quality of the tear film and, subsequently, vision, especially during visually demanding tasks like driving at night. This study aims to evaluate the relationship between tear film stability, dry eye symptoms, and self-reported difficulties in night driving among Malaysian adults.

Ninety participants aged 18-40 years with at least one year of night driving experience were recruited. Tear film stability was assessed using non-invasive tear break-up time (NIBUT), while dry eye symptoms were measured with the Ocular Surface Disease Index (OSDI). Night driving vision difficulties were evaluated using the Vision and Night Driving Questionnaire (VND-Q).

Participants with shorter NIBUT (mean =  3.95 ±  1.32 s; median =  3.97 s, IQR: 2.87-5.03 s) reported significantly greater difficulties in night driving compared to those with normal NIBUT (mean =  9.80 ±  3.86 s; median =  8.23 s, IQR: 6.90-11.70 s) (p <  0.001). Similarly, participants with severe dry eye symptoms had higher VND-Q scores (mean rank =  76.75) compared to those with asymptomatic to moderate symptoms (mean rank =  35.68-44.03) (p <  0.001). Spearman's correlation showed moderate negative associations between NIBUT (r =  -0.327), OSDI (r =  -0.538), and VND-Q scores. However, there was no significant correlation between NIBUT and OSDI score. Multiple regression analysis revealed that both NIBUT and OSDI significantly predicted the VND-Q score, explaining 43.2% of the variance (p <  0.001).

The findings suggest that poor tear film stability and severe dry eye symptoms contribute to night driving difficulties. Future studies should explore interventions aimed at improving tear film stability and dry eye symptoms to enhance driving safety at night.

Demodex blepharitis is an ocular disorder caused by the infestation of Demodex mites that reside on the eyelash follicles.

This study assessed the clinical, humanistic, and economic burden of Demodex blepharitis from a patient perspective.

This cross-sectional, observational study used a web-enabled survey to collect data from US adults with Demodex blepharitis in 2022. Patients with unique burdens, including those receiving dry eye disease medications, wearing contact lenses, or experiencing cataracts or glaucoma were also examined.

Among 113 patients, mean age was 48.5 years (standard deviation [SD] ± 13.6). Half had private/commercial insurance, and 55% had Medicare and/or Medicaid. Patients had Demodex blepharitis for an average of 4.3 years (SD ± 6.7 years) before the study, and 1.2 years (SD ± 3.0 years) elapsed between the appearance of symptoms and diagnosis. Common symptoms, including redness, dryness, itchiness of the eyelids, and itchiness of the eyes, persisted or returned shortly after diagnosis and disease management in most patients, and they were associated with a negative impact on quality of life. Patients visited their healthcare practitioner for Demodex blepharitis a mean of 3.9 times (SD ± 4.8) in the preceding year. Patients were often managed with off-label prescription medications, such as medications indicated for dry eye disease, in-office procedures, or over-the-counter management options.

Patients with Demodex blepharitis reported symptoms impacting their quality of life and activities of daily living, which persisted after diagnosis and disease management. This suggested that the effectiveness of the reported symptom management options was temporary and highlighted an unmet need in treating the root cause of the disease.

Patients with Demodex blepharitis were symptomatic, and the commonly used management options for Demodex blepharitis lacked long-term symptom relief or mite eradication, demonstrating a high unmet need in treating patients with Demodex blepharitis.

Eye washing is a common over-the-counter, self-administered method for managing hay fever-related ocular symptoms. However, epidemiological data on eyewash users with hay fever and their characteristics are limited. This study aimed to profile eyewash usage and preferences in individuals with hay fever. This digital, cross-sectional cohort study was conducted between February 2018 and May 2020. Individuals in Japan who downloaded the AllerSearch smartphone application were included. Factors associated with eyewash and non-eyewash users among patients with hay fever were assessed using multivariable logistic regression analyses. Of the 11,284 participants, 9,041 had hay fever. Among them, 40.7% were eyewash users (43.9% used eyewash products as needed during symptom flare-ups, 24.8% used them in the morning, and 19.4% in the evening). Factors associated with eyewash use included younger age, previous psychiatric illness, history of contact lens use, current contact lens use, active smoking, higher yogurt intake, lower nasal symptom score, higher non-nasal symptom score, and dry eye symptoms. Non-use of eyewash was linked to older age, sleep duration < 6 h, lower yogurt intake, and dry eye symptoms. This study elucidated characteristics and factors associated with eyewash use among individuals with hay fever, guiding an individualized approach to treatment and public health initiatives.

Dry eye disease (DED), also known as keratoconjunctivitis sicca, is a multifactorial ocular disease characterized by tear film insufficiency due to diverse etiologies including aging, incomplete and infrequent blinking, hormonal changes, medications, and systemic diseases. Classified into aqueous-deficient dry eye (ADDE), evaporative dry eye (EDE), and mixed subtypes, DED presents with symptoms such as irritation, stinging, redness, foreign body sensation, sensitivity to light, and blurred or fluctuating vision. While rare, severe cases may lead to vision loss. With its rising global prevalence across age groups, DED poses a significant public health challenge. Primary care physicians (PCPs), often the first point of contact for DED patients, require timely screening and management strategies. This review explores the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of DED, emphasizing practical approaches for PCPs. This narrative review was conducted by searching MEDLINE, PubMed, and Google Scholar databases for relevant articles. Diagnostic approaches, including detailed history taking, patient-reported questionnaires, differential diagnosis, and assessments are discussed alongside management strategies, including symptomatic ophthalmic treatment, risk factor mitigation (e.g., reduced digital device screen time), prevention, and nutrition. By providing a synopsis of early symptoms that PCPs are often the first to encounter, practical approaches to screening and managing DED in the primary care setting, and guidelines on when to refer to specialty care, this comprehensive review aims to equip PCPs with the knowledge to improve DED screening and optimize patient outcomes.

Hashimoto's thyroiditis (HT) is an autoimmune thyroid disease with characteristic lymphocytic infiltration and fibrosis. Chronic autoimmune changes that occur in the thyroid gland in HT may also affect the lacrimal gland. Objectives: This study aimed to analyze tear biomarkers and explore correlations between these biomarkers and clinical ocular parameters in patients with HT. Methods: A total of 150 participants were divided into three groups: HT (N = 50), non-HT DED (N = 50), and healthy controls (N = 50). The participants underwent a series of diagnostic tests for DED, including the Ocular Surface Disease Index, Tear Break-Up Time, Lid-Parallel Conjunctival Folds, Schirmer test without anesthetic, lissamine green and fluorescein staining. Tear samples were analyzed for cytokine and enzyme levels (interleukin 1β, tumor necrosis factor α, interleukin 6 (IL-6), interleukin 8, interleukin 10 (IL-10), interleukin 17A, matrix metalloproteinase 9 (MMP-9)) using ELISA and multiplex immunoassay. Statistical analyses were conducted to compare groups and assess biomarker correlations. Results: Dry eye disease was observed in more than half of the study group (27/50), with severe symptoms observed in 48.15% of the DED HT subgroup. IL-6 levels were significantly elevated in the DED HT subgroup compared to the non-HT DED group (p = 0.010), suggesting specificity for HT-associated DED. MMP-9 was elevated in both the HT and non-HT DED groups (p < 0.001) but lacked specificity for HT (p = 0.059). The DED HT subgroup exhibited significantly lower IL-10 levels (p = 0.008). Lissamine green staining and LIPCOF were significantly higher in the DED HT subgroup (p < 0.001). Conclusions: Dry eye disease is common in euthyroid HT patients without signs of TAO. This study highlights the potential role of IL-6. Lissamine green staining and LIPCOF are valuable diagnostic tools for assessing the ocular surface in DED HT patients.

We developed a two-stage manufacturing process utilizing cultivated autologous limbal epithelial cells (CALEC), the first xenobiotic-free, serum-free, antibiotic-free protocol developed in the United States, to treat blindness caused by unilateral limbal stem cell deficiency (LSCD) and conducted a single-center, single-arm, phase I/II clinical trial. Primary outcomes were feasibility (meeting release criteria) and safety (ocular infection, corneal perforation, or graft detachment). Participant eligibility included male or female participants age 18 to <90 years old and ability to provide written informed consent with LSCD. Funding was provided by the National Eye Institute of the National Institutes of Health. CALEC grafts met release criteria in 14 (93%) of 15 participants at conclusion of trial. After first stage manufacturing, intracellular adenosine triphosphate levels correlated with colony forming efficiency (r = 0.65, 95% CI [0.04, 0.89]). One bacterial infection occurred unrelated to treatment, with no other primary safety events. The secondary outcome was to investigate efficacy based on improvement in corneal epithelial surface integrity (complete success) or improvement in corneal vascularization and/or participant symptomatology as measured by OSDI and SANDI (partial success). 86%, 93%, and 92% of grafts resulted in complete or partial success at 3, 12, and 18 months, respectively. Our results provide strong support that CALEC transplantation is safe and feasible and further studies are needed to evaluate therapeutic efficacy. Clinicaltrials.gov registration: NCT02592330.

To investigate the geometrical feature of the whorl-like corneal nerve in dry eye disease (DED) across different severity levels and subtypes and preliminarily explore its diagnostic ability.

Cross-sectional study.

The study included 29 healthy subjects (51 eyes) and 62 DED patients (95 eyes).

All subjects underwent comprehensive ophthalmic examinations, dry eye tests, and in vivo confocal microscopy to visualize the whorl-like corneal nerve at the inferior whorl (IW) region and the straight nerve at the central cornea. The structure of the corneal nerve was extracted and characterized using the fractal dimension (CNDf), multifractal dimension (CND0), tortuosity (CNTor), fiber length (CNFL), and numbers of branching points.

The characteristics of quantified whorl-like corneal nerve metrics in different groups of severity and subtype defined by symptoms and signs of DED.

Compared with the healthy controls, the CNDf, CND0, and CNFL of the IW decreased significantly as early as grade 1 DED (P < 0.05), whereas CNTor increased (P < 0.05). These parameters did not change significantly in the straight nerve. As the DED severity increased, CNDf and CNFL in the whorl-like nerve further decreased in grade 3 DED compared with grade 1. Significant nerve fiber loss was observed in aqueous-deficient DED compared with evaporative DED (P < 0.05). Whorl-like nerve metrics correlated with ocular discomfort, tear film break-up time, tear secretion, and corneal fluorescein staining, respectively (P < 0.05). Furthermore, merging parameters of whorl-like and linear nerve showed an area under the curve value of 0.910 in diagnosing DED.

Geometrical parameters of IW could potentially allow optimization of the staging of DED. Reliable and objective measurements for the whorl-like cornea nerve might facilitate patient stratification and diagnosis of DED.

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Recent animal research has revealed the intricate dynamics of arousal levels that are important for maintaining proper sleep resilience and memory consolidation. In humans, changes in arousal level are believed to be a determining characteristic of healthy and pathological sleep but tracking arousal level fluctuations has been methodologically challenging. Here we measured pupil size, an established indicator of arousal levels, by safely taping the right eye open during overnight sleep and tested whether pupil size affects cortical response to auditory stimulation. We show that pupil size dynamics change as a function of important sleep events across different temporal scales. In particular, our results show pupil size to be inversely related to the occurrence of sleep spindle clusters, a marker of sleep resilience. Additionally, we found pupil size prior to auditory stimulation to influence the evoked response, most notably in delta power, a marker of several restorative and regenerative functions of sleep. Recording pupil size dynamics provides insights into the interplay between arousal levels and sleep oscillations.

To elucidate the efficacy of topical low dose heparin (LDH) as an adjuvant therapy in of sub -chronic and chronic ocular Stevens-Johnson Syndrome (SJS) and its effect on Neutrophil extracellular traps (NETs) associated markers.

A prospective randomized controlled pilot trial METHODS: 72 clinically diagnosed SJS cases were recruited into sub-chronic and chronic groups. Both groups were randomly given either LDH eye drops with conservative treatment (CT) or CT alone for one month. Visual acuity, Schirmer's test, fluorescein and lissamine staining, OSDI score and ocular surface severity were evaluated. Tear and conjunctival cells were collected to detect NET-MPO complexes and NET-gene markers (TNFSF14, TLR9, IL-6, MyD88, C3a gene).

Improvement in ocular surface severity scores RESULTS: Sub-chronic group showed significant improvement with topical LDH in TBUT (p=0.0001), Lissamine stain score (p= 0.0162), corneal vascularisation score (p=0.0001), conjunctival hyperaemia score (p= 0.001) and total severity score (p= 0.001) when compared to the LDH treated chronic group. No significant improvement was seen in visual acuity in either group after one month of therapy. Qualitative ELISA confirmed higher presence of NET-MPO complex in sub-chronic cases. Both groups showed upregulation of TNFSF14, TLR9, and MyD88, which significantly decreased post topical LDH treatment (p =0.0038,0.002 and 0.043 respectively).

The presence of NETs mediated upregulated immune markers on sub-chronic and chronic SJS cases sheds newer light on its unresolved ocular pathology. Subsequent administration of topical LDH revealed a notable mitigation of NET associated immune markers, highlighting its promising anti-inflammatory effects within the ocular microenvironment.

Objective: To describe the clinical effects of a novel, combined ocular lubricant for treating patients with dry eye disease. Methods: A noncomparative, retrospective cohort of 67 eyes (67 patients) with a confirmed diagnosis of dry eye disease using the ocular surface disease index (>12), tear osmolarity, and ocular surface parameters (noninvasive break-up time, meniscus height, and meibography) evaluated using the Cornea550 were included. All patients were treated with a combination of 0.5% carboxymethylcellulose, glycerin 0.9%, and trehalose 3% with a dosing regimen of one drop four times a day for 1 month with a final evaluation of the same parameters. Results: We included 67 eyes (80.6% females) with a mean age of 48.3 ± 16.2 years (standard deviation [SD]). In total, 37% of the subjects had comorbidities such as hypothyroidism (9%), ocular rosacea (4%), Sjogren's syndrome (4%), and arterial hypertension (4%). Of these, 34% were taking systemic medications and 56.7% had previous ocular surgery. The mean ocular surface disease index score before treatment was 57.6 ± 17.2 (SD) and 22.2 ± 12.9 points (SD) after treatment (P < 0.05). Other parameters such as noninvasive break-up time, meniscus height, and meibography improved without a statistically significant difference. Conclusion: Cristal Tears Plus is a novel, combined, and multipurpose treatment for dry eye disease.

The objectives of the study were to compare the efficacy and safety using ocular surface assessment between preserved and preservative-free brimonidine/timolol fixed-combination eye drops in glaucoma or ocular hypertension patients. Methods: This study was designed as a prospective, multicenter (three institutions), investigator-masked, parallel-grouped randomized clinical trial. The primary outcomes were corneal and conjunctival staining score, ocular surface disease index (OSDI) score, drug tolerance, and adherence rates at 12-week visits. The secondary outcomes were corneal and conjunctival staining score, OSDI score at 4-week visits and intraocular pressure (IOP), tear-film break-up time (TBUT), and bulbar/limbal hyperemia score at the 4- and 12-week visits. For safety assessment, best-corrected visual acuity (BCVA), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and physical examination at 4 and 12 weeks and adverse events during the whole study period were analyzed. Results: Overall, 59 patients were enrolled and randomized into each group (29 preserved and 30 preservative-free). At the endpoint, 5 patients in the preserved group and 2 patients in the preservative-free group dropped out, leaving 24 and 28 patients in the preserved and preservative-free groups, respectively. Baseline characteristics showed no significant difference between the groups including age and sex. At the 12-week visit, intra-group change of OSDI scores did not change significantly compared to the baseline scores in both preserved and preservative-free groups (p = 0.791, 0.478, respectively). On the contrary, the corneal staining score and the conjunctival staining score showed a significant increase compared to the baseline score in the preserved group (p = 0.015, 0.009, respectively). Regarding drug satisfaction, higher proportions of patients in the preservative-free group reported convenience of installation (p = 0.002). Also, stinging and burning sensations in drug tolerance showed better results in the preservative-free group with a significant difference (p = 0.011). Safety assessment regarding systemic side effects such as SBP, DBP, and HR showed similar results between the preserved and preservative-free groups (p = 0.711, 0.232, 0.666, respectively). Conclusions: Preservative-free brimonidine/timolol showed comparable efficacy and safety, better corneal and conjunctival staining score with convenience of installation, and lower stinging and burning sensation. It is expected to be a proper treatment option for patients with glaucoma or ocular hypertension.

The aim of this real-world registry study was to evaluate the quality-of-life (QoL) impact of dry eye disease (DED). The specific objectives were to determine factors affecting QoL in DED, and to evaluate the psychometric properties of the Ocular Surface Disease Index (OSDI), Ocular Comfort Index (OCI), and Patient Health Questionnaire (PHQ) in a real-world DED population using modern psychometric methods.

This descriptive cross-sectional study included 368 DED patients (mean 54.7 ± 16.6 years; 80.2 % female) who completed one or more of the three questionnaires (OSDI, OCI and PHQ). Psychometric analysis of the QoL data was carried out with Andrich's Rating Scale Model of Rasch analysis.

The original OSDI and OCI had disordered categories. The Rasch-optimised final QoL scales (OSDI - Overall, OSDI - Symptoms [SY], OSDI - Activity limitation [AL], OSDI - Environmental trigger [EN], OCI Overall, OCI - Frequency [FR], OCI - Intensity [IN], and PHQ) had satisfactory psychometric properties. Patients diagnosed with a mixed aqueous/evaporative DED subtype had worse mean OSDI-Overall and OSDI-AL scores than individuals with evaporative DED (p = 0.012 and 0.001 respectively). Patients with corneal neuropathic pain had worse QoL scores (OSDI-Overall, OSDI-AL, OSDI-SY, OSDI-EN, OCI-Overall, OCI-FR, OCI-IN, and PHQ; all p < 0.05) than those without. Patients who reported undergoing prior treatment or procedure for DED had worse QoL scores than those who did not (all p < 0.05 except for PHQ). The associations between DED signs (tear breakup time and staining) and symptoms were weak or not significant.

In this real-world setting, diagnoses of mixed DED, corneal neuropathic pain, and history of DED treatment/procedures were associated with worse dry eye symptoms, activity limitation, and/or QoL.

To investigate the impact of botulinum toxin type A (BoNT-A) on neuropathic/nociplastic ocular pain (NOP) and identify predictors of patient outcomes.

A retrospective study of individuals with NOP symptoms (light sensitivity, wind/air sensitivity, persistent pain despite dry eye treatment) who received ≥1 BoNT-A injection. Primary outcome measures included if (responders vs. non-responders) and to what degree (none vs. mild vs. moderate vs. marked) individuals experienced pain improvement 4-6 weeks post-injection. Demographics and clinical exam information was compared between the groups.

27 individuals received BoNT-A for NOP symptoms. 74 % (n = 20) reported an improvement in pain and were classified as responders. Among responders, the degree of benefit varied, with 25 % reporting mild, 45 % moderate, and 30 % marked pain improvement. Improvements in light sensitivity (37 %), wind/air sensitivity (33 %), and quality of life (QoL) (59 %) were reported by fewer individuals. 80 % of responders and 0 % of non-responders reported QoL improvements afer BoNT-A. In a multivariable model that examined predictors of response (none to marked, 0-3), the presence of fibromyalgia (FM) (β = 0.50; p = 0.004) portended a better response, while shooting pain (β = -0.47; p = 0.007) portended a worse response to BoNT-A, (full model r2 = 0.53; p < 0.001). Degree of pain improvement significantly correlated with improvements in light sensitivity, wind/air sensitivity, and QoL (ρ range: 0.42-0.63; p < 0.05).

After BoNT-A, most individuals reported improved ocular pain and QoL, while fewer noted improved light and wind/air sensitivity. Some systemic and ocular factors predicted treatment response and may thus guide treatment.

Dry eye disease (DED) causes discomfort and potential damage to the surface of the eye, commonly managed with artificial tears. We assessed symptom relief, tolerability, and patient experience of a novel carboxymethyl-cellulose-based artificial tear formulation with trehalose and sodium hyaluronate (ABBV-444) in patients with DED.

This open-label, single-arm, single center study enrolled adult patients with baseline Ocular Surface Disease Index (OSDI) scores of ≥18 and ≤65. Patients were instructed to use ABBV-444 as often as needed but at least twice a day for 30 days. The primary endpoint was change from baseline in OSDI score at Day 30. Secondary endpoints were onset of action (change from baseline in current symptom survey [CSS] visual analog scale [VAS] scores over 5 minutes post administration on Day 1) and patients' experience (change from baseline in Patient Eye Drop Experience [PEDE] survey VAS scores at Day 30). Outcomes were assessed in the per-protocol (PP) population using descriptive statistics. A paired t-test was performed to calculate P-values.

A total of 34 patients were included in the PP population. DED severity, measured by OSDI, significantly decreased by a mean (standard deviation; SD) score of 6.8 (15.0) points from baseline to Day 30 (P=0.006). Patients showed significant symptom improvement as early as 30 seconds after application, with mean (SD) CSS changes from baseline of -3.3 (10.3) points at 30 seconds (P=0.03) and -10.1 (10.6) points at 5 minutes post-dose (P<0.001). No adverse events were reported. PEDE scores averaged between 76.4 (36.7) and 85.7 (21.0) at Day 30.

Continuous daily treatment with ABBV-444 reduced DED symptom severity over 30 days and demonstrated rapid onset of action within 30 seconds post administration. These results suggest that ABBV-444 is a viable therapy for DED symptoms and support further investigation of longer-term treatment in multicenter trials.

To evaluate the efficacy and safety of TriMix, a new multiple-action tear substitute in patients with dry eye disease (DED).

This was a randomized, multicenter, single-masked, hyaluronic acid (HA)-controlled clinical trial conducted between July, 2023 and May, 2024. A total of 115 patients were randomly allocated to receive either TriMix tear substitute or 0.15% HA tear substitute 3 times daily. Clinical outcomes include ocular surface disease index (OSDI) questionnaire, non-invasive tear film break-up time (NIBUT) and Schirmer I test (ST) without anesthesia at 3 and 6 months of follow-up.

Of the 115 patients randomized, 80 completed the study (TriMix, n = 56; HA, n = 24). At months 3 and 6, improvements from baseline were statistically greater with TriMix tear substitute compared to HA 0.15% tear substitute for OSDI: -3.7 points (95% CI, -6.9 to -0.6; p = 0.011) and - 7.5 points (95% CI, -10.3 to -4.6; p < 0.001), respectively. Similar results were reported for NIBUT: 0.9 s (95% CI, 0.3 to 1.6; P = 0.040) and 1.6 s (95% CI, 0.7 to 2.6; P < 0.001), respectively. Regarding safety, no serious ocular adverse events occurred. Three patients complained of burning after instillation of TriMix tear substitute.

This RCTs demonstrate that TriMix tear substitute provides statistically significant and clinically evidence of the reduction of DED symptoms with a satisfactory safety profile through 6 months of follow-up. Findings suggest the use of this tear substitute, but results should be confirmed independently over longer time periods.

The aim of this study is to determine the best cut-off value for the Standardized Patient Evaluation of Eye Dryness Portuguese version questionnaire and verify possible differences between the questionnaire score and different age groups.

The clinical validation of the Standardized Patient Evaluation of Eye Dryness Portuguese version was performed by completing this and the Ocular Surface Disease Index in Portuguese version questionnaire, in 180 volunteers (68.9% female), with an age range of 19-96 years.

An excellent degree of reliability was found between the Standardized Patient Evaluation of Eye Dryness Portuguese version and the Ocular Surface Disease Index Portuguese version questionnaires (Cronbach's Alpha = 0.824). The Receiver Operating Characteristic curve analysis revealed a cut-off of 8 points (Sensitivity of 71.2% and Specificity of 71%). Furthermore, the area under the curve of the Receiver Operating Characteristic curve was 0.813, indicating that Standardized Patient Evaluation of Eye Dryness Portuguese version questionnaire is a good diagnostic tool and interchangeable with the Ocular Surface Disease Index questionnaire.

The Standardized Patient Evaluation of Eye Dryness Portuguese version questionnaire is a reliable tool for the detection of dry eye symptoms in the Portuguese population with a broad age range.

To determine the impact of severity of age-related macular degeneration (AMD) on subjective treatment response in patients treated for dry eye disease.

A total of 203 eyes diagnosed with evaporative dry eye disease (DED) due to meibomian gland dysfunction were treated using the LipiFlow or MiBoFlo systems. From this cohort, 40 eyes with stable dry AMD (early, intermediate, or late stages) were included. Each participant completed the Ocular Surface Disease Index (OSDI) and Standard Patient Evaluation of Eye Dryness Questionnaire (SPEED) before treatment and at a 6-month follow-up. Changes in questionnaire scores were analyzed using one-way analysis of variance (ANOVA) to assess differences between AMD severity groups.

Improvement in SPEED and OSDI scores, including vision related OSDI scores were observed across all AMD stages, with no significant differences between groups (p<0.05).

Managing DED improved quality of life (QOL) in patients with AMD, regardless of retinal disease severity. This highlights the importance of treating coexisting ocular surface conditions to enhance patient outcomes, even in the presence of significant maculopathy.

To examine the effectiveness and identify clinical response predictors of a short corticosteroid-based regimen consisting of topical preservative-free 0.1% dexamethasone (Monopex®, Théa Laboratories) in conjunction with artificial tears (AT) for dry eyes in a real-life clinical setting.

Patients were recruited from the Norwegian Dry Eye Clinic and were allowed to use ATs of their own choice in addition to the prescribed 14-day topical dexamethasone course. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire (DEQ-5), Schirmer test (ST), fluorescein tear film break-up time (FBUT), ocular surface staining (OSS), meibum expressibility (ME), meibum quality (MQ), number of expressible meibomian glands among the central eight glands in the lower lids (NMG) and intraocular pressure (IOP) were measured at baseline and at 1-month follow-up. The average values of clinical parameters from both eyes were used for analyses. A paired t-test and a significance value of p < 0.05 were used for statistical analyses. Associations between sex, age, baseline values and the changes after the intervention (Δ) were explored using linear regression.

A total of 167 patients (124 women, mean age 54 years ±17 (standard deviation)) were included. One month after initiation of intervention, OSDI and DEQ5 scores improved from 39.5 ± 22.1 to 31.4 ± 21.3 (p < 0.001) and from 12.6 ± 4.2 to 11.0 ± 4.6 (p < 0.001), respectively. OSS improved from 2.2 ± 1.4 to 1.8 ± 1.5 (p < 0.001), NMG increased from 4.8 ± 2.2 to 5.1 ± 2.2 (p < 0.05), while IOP decreased from 12.9 ± 3.3 to 12.4 ± 3.5 mmHg (p < 0.05). Significant associations were found between the change in symptoms and objective measures of DED (ΔOSDI, ΔDEQ5, ΔOSS, ΔFBUT, ΔNMG, ΔMQ) and their respective baseline values (OSDI, DEQ5, OSS, FBUT, NMG, MQ). The remaining tests did not show statistically significant changes.

Improvement in dry eye symptoms and signs were observed following a short course of topical, preservative-free 0.1% dexamethasone treatment in combination with AT. Individuals exhibiting more pronounced symptoms and signs witnessed the most profound improvements with the treatment regimen, suggesting that poor baseline parameters may serve as response predictors of the treatment regimen. While the real-life data presented herein are valuable, the conclusions are limited by the inherent biases of a non-controlled study.

To extend cross-sectional data on cytokine ratios (CRs) in dry eye disease (DED) signs by investigating longitudinal change in pro- to anti-inflammatory CRs and associations with change in DED signs and symptoms.

Secondary analysis of fifty-four subjects [mean age 57.3 (SD 13.2) years, 85.2% female; 68.5% white] with ≥ 4 uL pooled tear volumes at months 0, 6, and 12. Pro-inflammatory (IL-1b, IL-6, IL-8, IL-17A, IFN-g, and TNF-a) to anti-inflammatory (IL-6, IL-10) cytokine ratios (CR) were calculated. DED signs (corneal and conjunctival staining scores, tear break-up time, Schirmer test, Meibomian gland plugging, tear osmolarity, composite sign severity score) and symptoms [Ocular Surface Disease Index (OSDI)] were measured. Changes over time in DED signs, symptoms, and CRs were evaluated using longitudinal models. Correlations between changes in CR and changes in DED signs and symptoms were evaluated using Spearman correlation coefficients (rho).

DED signs which improved over time (p < 0.001) included corneal and conjunctival staining score, tear break-up time, tear osmolarity, and composite sign severity score. Using IL-10 as anti-inflammatory, changes in corneal and conjunctival staining and composite severity score significantly correlated with changes in pro- to anti-inflammatory CRs from month 0 to 6 (|rho|: 0.29-0.45, p: 0.003-0.04) but not between month 0 to 12 (|rho|: 0.01 to 0.24, all p > 0.08). DED symptoms decreased across one year (p < = 0.001) for all OSDI measures; these changes did not correlate with changes in CRs (|rho|: 0.00 to 0.29, all p > 0.04).

Improvement in some DED signs across one year correlated weakly with decreases in pro- to anti-inflammatory CRs, in alignment with the understanding of DED as inflammatory. CRs may provide greater insight than absolute tear cytokine concentrations as possible DED biomarkers. Additional studies that provide standardized clinical information and tear collection and analysis are needed to validate CRs in DED.

To evaluate the impact of scleral contact lens (SL) wear on the visual quality and the ocular surface wettability in myopic patients with regular corneas.

This prospective, randomized, controlled study enrolled a total of 80 myopes with regular corneas. Subjects were randomly allocated to wear SL or rigid corneal lens (RCL) for 3 months. The objective optical quality parameters were detected using the Optical Quality Analysis System-II, and the ocular surface wettability was assessed using the Keratograph 5M noninvasive ocular surface analyzer. The National Eye Institute 25-Item Visual Function Questionnaire and Ocular Surface Disease Index questionnaire were performed.

Both SL and RCL wear could obtain good best-corrected visual acuity. Strehl ratio, modulation transfer function cutoff frequency, objective scattering index, and Optical Quality Analysis System values (Optical Quality Analysis System values at 100%, 20%, and 9% contrasts) in the SL group significantly improved from baseline to the third month (both P <0.05), but not in the RCL group. At the third month, tear meniscus height and noninvasive tear break-up time showed a significant increase in the SL wearers from baseline (both P <0.05), but exhibited no significant changes in the RCL group. At the third month, SL wearers had significantly higher noninvasive tear break-up time compared with RCL wearers ( P <0.05). Besides, after 3-month SL wear, the National Eye Institute 25-Item Visual Function Questionnaire score and the Ocular Surface Disease Index score both remarkably improved from baseline (both P <0.05).

Short-term SL wear could provide satisfactory visual quality, ocular comfort, and stable tear film for myopic patients.

Dry eye syndrome is a multifactorial disease with a complex pathophysiology. The associated morbidity is a worldwide public health problem. The development of autologous serum-based eye drops is an interesting treatment but presents some constraints. This is a retrospective, observational, single-center study of 43 patients (73 eyes) treated with autologous serum-based eye drops for dry eye syndrome at the University Hospital of Caen between 2014 and 2023. The patients' subjective symptoms, as well as the various modalities of evaluation of their daily quality of life were collected using questionnaires inspired by the OSDI questionnaire. The other elements used in this study were reported from the patients' medical files. We observed a mean improvement in quality of life of 44% in the treated subjects. Quality of life correlates with the improvement in the subject's quality of life score and overall health (P<0.01) but, nevertheless, depends on the severity of the initial clinical damage and the presence or absence of a corneal ulcer (P=0.013). We also found a reduction in the number of daily drops (65.4%) and an improvement in daily activities (85.1%). This study's results are consistent with previous work reporting the efficacy of autologous serum on the quality of life of treated patients. Consideration of the patient as a whole, integrating quality of life assessment with clinical examination, is essential when dealing with dry eye and its innovative therapeutics.

Purpose This study aimed to assess the prevalence, pattern and associated risk factors with dry eye disease (DED) at a tertiary eye care centre in Central India. Methods This prospective cross-sectional study, conducted over 48 months, enrolled patients with systematic random sampling. Evaluation of DED was done with subjective and objective methods comprising of the Ocular Surface Disease Index (OSDI) questionnaire, slit lamp examination, Schirmer's tests and fluorescein tear-film breakup time (FTBUT) test. Patients were categorised into mild, moderate, severe and very severe DED. Association with various etiological factors like age, sex, occupation, diabetes mellitus, autoimmune disorders and any other systemic illness was assessed. The chi-square test/Fischer's exact test was used to analyse categorical data. Bivariate logistic regression analysis was used to calculate the odds ratio (OR). Multivariate analysis was performed to identify independent risk factors. Results A total of 2,560 patients were evaluated, of which 640 patients (25%) had DED. Prevalence was higher in patients aged >50 years, household workers, students, government employees and farmers. Uncorrected refractive status, cigarette smoking, ocular allergy and contact lens usage were associated with increasing odds of developing DED. Conclusion The prevalence of DED was estimated to be 25% in central India. Certain occupations like household workers, students, government employees, farmers, uncorrected refractive status, cigarette smoking, ocular allergy and contact lens use were significant risk factors for dry eyes.

To investigate whether the midday removal and re-application of scleral lenses (SL) influences fluid reservoir (FR) thickness, pre-lens tear film quality and visual acuity.

Two clinical experiments were conducted. A total of 49 keratoconic eyes were evaluated for Part1(tear film and visual acuity analysis) and 12 keratoconic eyes for Part2 (FR thickness analysis). All subjects were wearing 16.4 mm SL for more than 12-months. Tear Film Surface Quality (TFSQ) was evaluated with Medmont E300 at more than 120 min of SL wear, 10 min after SL removal (pre-corneal TFSQ) and 5 min after re-apply the same SL. High and Low Contrast Visual Acuity (HCVA and LCVA) were also assessed with the SL on eye (before and after re-application). For Part2, Anterior OCT (MOptim MOcean4000, China) measurements were taken with and without the SL (at the same time points of Part1) and three outcomes were evaluated: FR thickness, SL thickness (control measurement) and corneal thickness.

Removing and re-applying a SL had a statistically significant positive impact on TFSQ, with an improvement from 0.26 ± 011 to 0.16 ± 0.08 (p = 0.001). This was accompanied by a statistically significant improvement in LogMAR HCVA (from 0.10 ± 0.09 to 0.08 ± 0.08, p < 0.001) and LCVA (from 0.39 ± 0.13 to 0.36 ± 0.13, p < 0.001). Regarding Part2 of the study, a statistically significant increase in FR thickness was observed after SL re-application (from 223.64 ± 48.08 µm to 267.81 ± 80.03 µm, p = 0.007). No changes in corneal thickness were observed.

Midday removal and re-application of a scleral lens positively impacted pre-lens tear film surface quality, although the observed improvement in visual acuity does not constitute a clinically significant change. Clinicians should consider that removing and reapplying a scleral lens may result in an overestimation of the fluid reservoir thickness, which could affect clinical assessments and treatment decisions.

To evaluate the effect of punctal plugs combined with cyclosporine eye drops on dry eye disease (DED) and ocular surface inflammation.

In a clinical trial, 73 patients were randomly allocated into three groups: punctal plug group, combination therapy group, and cyclosporine group. At the baseline and four weeks after treatment, the Schirmer I test score, fluorescein tear film break-up time (FBUT), ocular surface staining score and dry eye symptoms were assessed. Tear samples were collected to detect the level of inflammatory factors (interleukins, matrix metalloproteinase 9 (MMP-9) and tumor necrosis factor alpha (TNF-α)). In an animal experiment, a New Zealand rabbit dry eye model was induced. The rabbits were randomly divided into control group, punctal plug group, and combination therapy group (n = 6). Conjunctival goblet cell density, protein level of MMP-9 in conjunctiva and mRNA levels of inflammatory factors in conjunctiva and cornea were measured before and after treatment.

In combination therapy group of the clinical trial, the following results were observed: significant improvement in Schirmer I test scores and FBUT compared to the cyclosporine group and punctal plug group, respectively; a decrease in the tear levels of IL-6, IL-1, and MMP-9 compared to the punctal plug group; and a decrease in the tear levels of IL-1α, IL-6, and IL-17 compared to the baseline (all p < 0.05). In the animal experiment, rabbits in combination therapy group had a higher goblet cell density (p < 0.01) and lower mRNA levels of IL-16 (p < 0.05), IL-17 (p < 0.05), and MMP-9 (p < 0.01) in conjunctiva and that of MMP-9 (p < 0.01) in cornea compared to punctal plug group.

Cyclosporine eye drops combined with degradable punctal plugs is a more optimized clinical treatment strategy for DED compared with degradable punctal plugs or cyclosporine eye drops alone, considering the influence of comprehensive clinical efficacy and ocular surface inflammation.

To evaluate the effect of topical citicoline, vitamin B12 and hyaluronic acid (OMK2 eye drops; Omikron Italia Srl, Italy) on the healing of corneal nerve after corneal cross-linking (CXL) treatment in patients with keratoconus (KC).

A total of 44 eyes of 22 patients with KC who underwent CXL were included in this prospective study. After CXL, one eye of these patients received OMK2 eye drop and standard post-CXL treatment (OMK2 group), while the fellow eye received only standard post-CXL treatment (control group). The following parameters were analyzed in the pre- and post-CXL procedure periods (1st, 3rd and 6th months): corneal sensitivity, tear film stability, central corneal thickness (CCT), and the corneal sub-basal nerve plexus (sbNP) parameters (including corneal nerve fiber density [CNFD], corneal nerve branch density [CNBD], corneal nerve fiber length [CNFL], corneal total branch density [CTBD], corneal nerve fiber area [CNFA], corneal nerve fiber width [CNFW]).

Following CXL, a comparison of the baseline and month 6 data revealed that CNFA decreased in the control group (p < 0.001) and did not differ in the OMK2 group (p = 0.283). Other corneal sbNP parameters exhibited a decrease when comparing baseline and 6 months in each group (all p < 0.05). In addition, CCT in the OMK2 group was not significantly different between baseline and month 6 (p = 0.052). However, a decline in CCT of the control groups was observed during this specified time interval (p = 0.009). Corneal sensitivity or tear film stability parameters did not differ significantly between groups at any time point or over time within each group (all p > 0.05).

The use of OMK2 eye drop after CXL may provide more stable CNFA. In addition, it may also provide faster recovery in CCT.

The 5th CORONIS Symposium, held during the 2023 Congress of the European Association for Vision and Eye Research (EVER), highlighted the growing importance of ocular surface innervation in eye surface disorders. This article summarises the insights and perspectives shared during the symposium, which focused on the clinical relevance of ocular surface innervation, as well as on the development of innovative diagnostic and therapeutic approaches for ocular surface pathologies linked to disturbed sensory innervation. Through robust interdisciplinary collaborations, these developments hold great potential to improve patient outcomes and quality of life.

Background: Scleral lenses (SLs) are recommended in DEWS II to treat dry eye (DE) patients that do not respond well to conventional therapies. This study aimed to evaluate the short-term (one month) efficacy and safety of SLs in the management of severe DE. Methods: This single-center prospective study enrolled 15 patients (22 eyes) who were diagnosed with severe DE. The Ocular Surface Disease Index (OSDI), the Chinese version of the 25-item National Eye Institute Visual Function Questionnaire (CHI-VFQ-25), and LogMAR best-corrected visual acuity (BCVA) were evaluated at baseline and one month following SL fitting. DE-related parameters were obtained and analyzed before and after one month of SL treatment, including tear-film breakup time (TBUT), corneal fluorescein staining (CFS), non-invasive breakup time (NIBUT), tear meniscus height (TMH), Schirmer I test (SIT), and meibomian gland (MG) dropout. Complications and adverse events were monitored. Results: OSDI scores (53.9 ± 28.1 vs. 10.4 (4.2-25), p = 0.0001) and CFS scores (10.2 ± 3.9 vs. 7 (0-12), p = 0.001) decreased after one month of SL therapy, while CHI-VFQ-25 scores (74.4 (54.8-83.8) vs. 95 (78.7-98), p = 0.0001) and TBUT (0.6 ± 0.5 vs. 2.2 ± 1.0, p < 0.0001) increased significantly. LogMAR BCVA improved from 0 (0-0.1) to 0 (0-0) (p = 0.0147). The average types of medications per eye decreased from 2.82 ± 1.01 to 1.32 ± 0.64 (p = 0.025), and the proportion of eyes using glucocorticoids significantly decreased from 63.6% to 13.6% (p = 0.001). No severe SL-related adverse events were reported. Conclusions: SL treatment quickly alleviated subjective symptoms as well as clinical signs of DE with good safety and enhanced the visual function and vision-related quality of life, showing its usefulness in the management of severe DE.

The study aims to compare dry eye disease (DED) prevalence and severity between seropositive and seronegative Sjögren disease (SjD).

Prospective, consecutive, comparative cross-sectional cohort study. A total of 160 eyes of 80 patients with SjD by The American College of Rheumatology and the European League Against Rheumatism 2016 criteria were included: 55 seropositive and 25 seronegative SjD. Associated SjD was excluded. Patients had dry eye tests performed. Generalized estimating equations were used to account for intereye correlation of the same participant.

Mean age was 52.2 ± 12.7, 96.3% were women, no differences were observed between groups (P > 0.05). Seronegative SjD had positive minor salivary gland biopsy more often (100% vs. 82%, P = 0.024), but with lower focus score (2.0 ± 1.2 vs. 4.1 ± 3.5, P = 0.006) than seropositive SjD group. DED prevalence was similar in seropositive and seronegative SjD (92.7% and 84%; P = 0.088). Only noninvasive break-up time (NIBUT) average was significantly reduced in seropositive SjD (6.6 ± 3.2 vs. 8.8 ± 2.4, P = 0.011), and the rest of the evaluated DED tests were not significant. In the seropositive group, nonstatistically significant trends toward more severe DED signs, including matrix metalloproteinase-9, osmolarity, Schirmer I without anesthesia, fluorescein tear break-up time, NIBUT first, and Sicca Ocular Staining Score, were observed. Both groups were highly symptomatic in ocular surface disease index score (43 ± 23 vs. 46 ± 30, P = 0.779) and had a reduction in quality of life in National Eye Institute visual health questionnaire-25 test (72 ± 21 vs. 70 ± 24, P = 0.650).

Patients with seropositive SjD showed significantly reduced NIBUT and a trend of more severe DED signs. Patients with seronegative and seropositive SjD were similarly highly symptomatic, experienced important reductions in vision-related quality of life, and had similar DED prevalence.

This study evaluated the efficacy, safety, and tolerability of a single-dose, preservative-free (PF) Dorzolamide/Timolol combination (Twinzol-SDU).

A 3-month single-arm, multicenter, prospective cohort study was conducted in Egypt between January 2021 and October 2022 on previously diagnosed and controlled patients with ocular hypertension and/or glaucoma. Efficacy was assessed using the change in intraocular pressure (IOP) after 6 and 12 weeks. Safety was identified through the change in the incidence of ocular side effects, ocular surface disease index (OSDI) scores and grades, and Time Break-Up time (TBUT).

A total of 382 patients were enrolled in the analysis. After the three-month period of therapy, a significant reduction in IOP was seen (mean change: -1.9, P < 0.001) after switching to PF Dorzolamide/Timolol combination. The rate of ocular abrasion decreased significantly from 30.6% to 1.3% (P < 0.001). The rate of normal aqueous tear production increased from 24.1% to reach 79.4% (P < 0.001). The OSDI scores decreased significantly throughout the study period, with a median score decreased from 41.7 (21.7) to 12.5 (12.5) (P < 0.001). Mild OSDI grades significantly increased from the baseline of 12.6% to reach 24.7%. Moderate OSDI grade decreased at the same rate, from 12.8% to 11.1%. The number of patients with severe OSDI grade substantially decreased from 64.4% to 4.5%, with a P < 0.001. TBUT increased from 9 (3.7) seconds to reach and 12.3 (4) seconds after 12 weeks of treatment (P < 0.001).

Generally, the PF dorzolamide/timolol combination was associated with a significant reduction in IOP and tolerability among glaucoma patients.