Abstract: Is cataract surgery the old-but-new LASIK, as regards dry eye?

I think this is the most dramatically worded study I've seen on cataract surgery and dry eye. Way to go Dr Galor! It's definitely making me want to go back and re-read some others to remind myself what the numbers were.

Nothing in this surprises me particularly, but it's really something to see it in print. I'm very pleased to see they used a survey that includes the word burning - that's one of the most common and crippling symptoms for those with severe symptoms, but it is omitted way too often in symptom surveys, as  TFOS DEWS II epidemiology report points out. And I love that the participants are almost all men, who are not the primary dry eye demographic, as it makes the results that much more interesting.

• 95% of participants were men

• 1/3 of patients have persistent postsurgical pain

• Prevalence compared with refractive surgery, e.g. LASIK

Cornea. 2017 Dec 7

Epidemiology of Persistent Dry Eye-Like Symptoms After Cataract Surgery.

Iglesias E1, Sajnani R2, Levitt RC3,4,5, Sarantopoulos CD3, Galor A1,6.

Abstract 

PURPOSE:

To evaluate the frequency and risk factors for persistent postsurgical pain (PPP) after cataract surgery, defined as mild or greater dry eye (DE)-like symptoms 6 months after surgery. 

METHODS:

This single-center study included 86 individuals who underwent cataract surgery between June and October 2016 and had DE symptom information available 6 months after surgery. Patients were divided into 2 groups: controls were defined as those without DE symptoms 6 months after surgery (defined by a Dry Eye Questionnaire 5 (DEQ5) score

RESULTS:

Mean age of the study population was 71 ± 8.6 years; 95% (n = 82) were men. DE-like symptoms were reported in 32% (n = 27) of individuals 6 months after cataract surgery; 10% (n = 8) reported severe symptoms (DEQ5 ≥12). Patients with DE-like symptoms after cataract extraction also had higher ocular pain scores and specific ocular complaints (ocular burning, sensitivity to wind and light) compared with controls with no symptoms. A diagnosis of nonocular pain increased the risk of DE-like symptoms after cataract surgery (odds ratio 4.4, 95% confidence interval 1.58-12.1, P = 0.005). 

CONCLUSIONS:

Mild or greater PPP occurred in approximately 1/3 of individuals after cataract surgery. Prevalence of severe PPP is in line with that of refractive surgery, dental implants, and genitourinary procedures.

Abstract: Hydration DOES matter.

Is whole-body hydration an important consideration in dry eye?

Purpose.
To identify if whole-body hydration plays an important role in dry eye (DE). We hypothesized that individuals classified as DE have higher plasma osmolality (Posm), indicating suboptimal hydration, compared with those classified as non-DE.
Methods.
Using a hospital-based observational cross-sectional design, assessment of DE and hydration was performed upon admission in 111 participants (N = 56 males and 55 females; mean ± SD age 77 ± 8 years). Assessments of DE included tear osmolarity (Tosm), the 5-item dry eye questionnaire (DEQ-5), rating of eye dryness using a visual analogue scale (VAS), and noninvasive tear film breakup time (NITBUT). Hydration assessment was performed by measuring Posm using freezing-point depression osmometry.
Results.
Posm was higher in DE than control (CON), indicating suboptimal hydration when using the 316 mOsm/L Tosm cutoff for DE (mean Posm + 11 mOsm/kg versus CON, P = 0.004, Cohen's effect size [d]) = 0.83) and the more conservative Tosm classification for DE where Tosm > 324 and CON < 308 mOsm/L (mean Posm + 12 mOsm/kg versus CON, P = 0.006, d = 0.94). Posm was also higher in DE than CON when using composite DE assessments, including Tosm and DEQ-5 (P = 0.021, d = 1.07); Tosm and NITBUT (P = 0.013, d = 1.08); and the VAS and DEQ-5 (P = 0.034, d = 0.58). These are the first published data to show that individuals classified as DE have higher Posm, indicating suboptimal hydration, compared with non-DE. These findings indicate that whole-body hydration is an important consideration in DE.

Invest Ophthalmol Vis Sci. 2012 Sep 25;53(10):6622-7. Print 2012 Oct.

Walsh NP, Fortes MB, Raymond-Barker P, Bishop C, Owen J, Tye E, Esmaeelpour M, Purslow C, Elghenzai S.

College of Health and Behavioural Sciences, Bangor University, Bangor, United Kingdom;

Abstract: VA study of dry eye impact on quality of life

Pretty rudimentary stuff being reconfirmed for the umpteenth time here, nonetheless it is encouraging to see the VA initiating this kind of study (oh, and to see a study of mostly MEN and dry eye). Not much comfort to the gentleman I spoke with the other day who was having no luck getting help at a VA hospital in another part of the country, sigh. Not that I am in the least inclined to pick on the VA - I'm not - in fact I used to get calls regularly from patients at one particular VA hospital who were getting GREAT care. Wish I could say the same for all the high-falutin' bigname medical institutions some dry eye patients have gone to in desperation.

Impact of Ocular Surface Symptoms on Quality of Life in a United States Veterans Affairs Population.

PURPOSE:
To evaluate the impact of ocular surface symptoms on quality of life in a veteran population receiving eye care services.

DESIGN:
Cross-sectional survey study.

METHODS:
Setting: Miami Veterans Affairs Medical Center (VAMC). Patient population: Patients seen at the eye clinic between June and August 2010 were asked to fill out the Dry Eye Questionnaire 5 (DEQ5) and the Impact of Dry Eye on Everyday Life (IDEEL) questionnaire.

MAIN OUTCOME MEASURES:
Correlation between ocular surface symptoms and functionality.

RESULTS:
Four hundred eighty-nine patients elected to fill out the DEQ5 questionnaire (36% response rate). The mean age of respondents was 66 years (standard deviation 12). Ninety-four percent were male; 62% were white and 37% were black. Using the DEQ5 as a surrogate measure of ocular surface symptoms, 65% of respondents reported at least mild ocular surface symptoms (DEQ5 ≥6) and 27% of them reported severe symptoms (DEQ5 ≥12). Black subjects had a 2-fold increased risk of severe symptoms compared to white subjects (odds ratio 2.06, 95% confidence interval 1.33-3.19). Several medications were associated with a significantly increased risk of severe symptoms, including glaucoma medications (1.7-fold increase), antidepressants (2.3-fold increase), and antihistamines (2.1-fold increase). There was an inverse correlation between DEQ5 and IDEEL scores with regard to ability to perform activities of daily living (n = 391, r = -0.54, P < .001), emotional well-being (n = 386, r = -0.63, P < .001), and the ability to work (n = 205, r = -0.57, P < .001). Fifty percent of patients with severe symptoms had documentation that their symptoms were addressed during the visit.

CONCLUSION:
Severe ocular surface symptoms reduce the quality of life of Miami VAMC veterans. Eye care professionals should be vigilant in eliciting ocular surface complaints from their patients.

Am J Ophthalmol. 2012 Feb 11. [Epub ahead of print]
Pouyeh B, Viteri E, Feuer W, Lee DJ, Florez H, Fabian JA, Perez VL, Galor A.
Source
Miami Veterans Administration Medical Center, Miami, Florida; Bascom Palmer Eye Institute, University of Miami, Miami, Florida.

Abstract: OCT, LIPCOF and DE

Any more acronyms anyone?

Imaging lid-parallel conjunctival folds with OCT and comparing its grading with the slit lamp classification in dry eye patients and normal subjects.

Purpose:
to visualize and describe the morphological appearance of lid-parallel conjunctival folds (LIPCOF) using optical coherence tomography (OCT) and to relate it to dry eye signs and symptoms.

Methods:
LIPCOF grade, non-invasive tear film break-up time (NIBUT), lipid layer's interference pattern and dry eye symptoms were recorded in 17 normal and 33 dry eye cases. LIPCOF was evaluated with slit lamp and visualized with OCT. Three different algorithms for OCT was developed to grade LIPCOF using either tear meniscus height or the covering tear film on the folds evaluated by OCT.

Results:
The three OCT methods showed significant correlations with the slit lamp method (r=0.470--0.473, P<0.01). The OCT LIPCOF methods were independent of NIBUT. The Dry Eye Questionnaire (DEQ) scores correlated with the height of the folds, and the absence of tear film coverage of the folds (r=0.574, P<0.001, and r=-0.527, P<0.001, respectively). The OCT LIPCOF grades correlated with the DEQ scores (r=0.494, P<0.001 and r=0.310, P=0.029). The slit lamp grade did not correlate with the DEQ scores in the whole population, but in the normal group (r=0.458, P=0.024). The OCT LIPCOF grades showed inverse correlation with lipid pattern in the normal group (r=-0.422-0.481, P=0.05), however this association disappeared in the dry eye group.

Conclusions:
The OCT enabled a non-invasive high resolution method for imaging, evaluating and grading of the LIPCOF. These novel classifications correlated well with the slit lamp grade and the DEQ scores promising a new, more objective evaluation of dry eye.

Invest Ophthalmol Vis Sci. 2011 Jan 31. [Epub ahead of print]
Veres A, Tapaszto B, Kosina-Hagyó K, Somfai GM, Németh J.
Department of Ophthalmology, Semmelweis University, Budapest, Hungary.

Abstract: Validating part of another questionnaire (DEQ)

Validation of the 5-Item Dry Eye Questionnaire (DEQ-5): Discrimination across self-assessed severity and aqueous tear deficient dry eye diagnoses.
Cont Lens Anterior Eye. 2010 Jan 19. [Epub ahead of print]
Chalmers RL, Begley CG, Caffery B.

School of Optometry, Indiana University, Bloomington, IN, USA.

PURPOSE: To validate a subset of Dry Eye Questionnaire (DEQ) items that discriminate across self-assessed severity and various diagnoses of dry eye (DE).

METHODS: Subjects (n=260) in 2 studies received a clinical DE diagnosis, completed the 6-page DEQ and self-assessment of DE severity (SA-Sev). SA-Sev ratings were: 46 Severe, 107 Moderate, 77 Mild, and 46 None. Dry eye diagnoses were: 48 asymptomatic controls (C), 155 non-SS KCS, and 57 Sjögren Syndrome (SS). All DEQ items were correlated to SA-Sev by Spearman. Groups of highly correlated DEQ items were tested to discriminate SA-Sev; and the subset tested to distinguish across DE diagnosis.

RESULTS: The DEQ-5 comprises: frequency of watery eyes (r=0.48), discomfort (r=0.41), and dryness (r=0.35), and late day (PM) intensity of discomfort and dryness (r=0.42, 0.36) all significantly correlated to SA-Sev (p<0.01). Mean DEQ-5 scores by SA-Sev: Severe 14.9+/-2.3, Moderate 11.4+/-3.3, Mild 8.6+/-3.1 and None 2.7+/-3.2 (ANOVA, p<0.0001) and by DE diagnosis: C 2.7+/-2.9, non-SS KCS10.5+/-4.5 and SS14.0+/-3.4, differing significantly overall (Z=-8.6, p=0.000) and between diagnoses (X(2)=116.3, p=0.000). Watery eyes were reported primarily by non-SS KCS. Proposed screening criteria for the DEQ-5 are >6 for DE and >12 for suspected SS.

CONCLUSIONS: The DEQ-5, the sum of scores for frequency and PM intensity of dryness and discomfort plus frequency of watery eyes, effectively discriminated across self-assessed severity ratings and between patients with DE diagnoses. These results indicate that DEQ-5 scores >6 suggest DE and scores >12 may indicate further testing to rule out SS-DE