RESUMEN
The aim of the present research was to assess the effect of bariatric surgery-induced weight loss on the tear film and ocular surface of patients with obesity. A total of 29 participants with obesity (aged 47.2 ± 10.1 years, 8 male) were measured at baseline and followed up one year after Roux-en-Y gastric bypass (RYGB) surgery. General anthropometric data, as well as serum lipid markers of cholesterol, were assessed in all individuals. Bilateral anterior eye measurements of tear meniscus height (TMH), non-invasive tear breakup time, bulbar and limbal redness and infrared meibography were captured using the Keratograph K5M (Oculus) and ocular surface damage was evaluated using fluorescein sodium and lissamine green staining. Bariatric surgery resulted in significant loss of weight (body mass index p < 0.001) and an improvement in the blood lipid profile (p < 0.01) in all participants. However, there were no statistically significant differences between the baseline and one-year follow-up for any of the measured clinical ocular surface and tear film variables (all p > 0.05). Although there were trends for a reduced TMH and a decrease in meibomian gland dropout after bariatric surgery, these differences were also insignificant (p > 0.05). In conclusion, weight reduction through bariatric surgery did not have an effect on the tear film or ocular surface in unselected patients with obesity.
Asunto(s)
Cirugía Bariátrica , Síndromes de Ojo Seco , Síndromes de Ojo Seco/etiología , Humanos , Lípidos , Masculino , Obesidad/complicaciones , Obesidad/cirugía , Lágrimas , Pérdida de PesoRESUMEN
SIGNIFICANCE: This randomized, masked, crossover clinical study identifies that ≥125 Dk materials should be used for scleral lens daily wear if disruption to corneal oxygen is to be minimized. PURPOSE: Modern scleral lens use has increased and has proven to be successful where other types and materials have previously failed. Although the required oxygen permeability has been modeled, this has not been established clinically. METHODS: Fifteen masked participants aged 20.7 ± 2.3 years (10 female) were bilaterally fitted with five different scleral lenses (65, 100, 125, 163, and 180+ Dk) of the same shape profile and one soft silicone hydrogel lens compared with no lens wear on separate occasions in a randomized order. A masked researcher measured corneal thickness and fluid reservoir depth, corneal curvature, objective bulbar and limbal redness, corneal biomechanics, and ocular surface oxygen consumption before and after 8 hours of wear. In addition, comfort scores were obtained using a visual analog scale. RESULTS: Scleral lenses with oxygen permeability of 65 Dk resulted in greater corneal thickness (1.37 ± 1.25%) after 8 hours of wear versus ≥100 Dk materials (0.58 ± 0.99%; F = 17.215, P < .001) because of stromal thickening; edema with ≥100 Dk materials was associated with fluid reservoir depth (r = 0.231, P = .05). Fluid reservoir depth decreased similarly with all oxygen-permeable lenses from 325.6 ± 99.1 µm to 174.2 ± 100.8 µm after 8 hours of wear (F = 0.961, P = .44). Oxygen consumption reduced with ≤125 Dk lenses (χ = 604.196, P < .001). Soft and scleral lens wear had no effect on corneal curvature, corneal biomechanics, or ocular hyperemia (P > .05). Soft lenses were more comfortable than all the scleral lenses (P < .05), and the 180+ Dk lenses had the best comfort among the sclerals (P < .05). CONCLUSIONS: A ≥125 Dk is advised for safe scleral lens daily wear. Scleral lens wear leads to an increase in corneal thickness, regardless of lens-material oxygen permeability because of the fluid reservoir depth.
Asunto(s)
Lentes de Contacto , Córnea/fisiología , Oxígeno/metabolismo , Esclerótica , Adulto , Lentes de Contacto Hidrofílicos , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Consumo de Oxígeno/fisiología , Permeabilidad , Adulto JovenRESUMEN
PURPOSE: To assess the visual performance and subjective experience of eyes implanted with a new bi-aspheric, segmented, multifocal intraocular lens: the Mplus X (Topcon Europe Medical, Capelle aan den IJssel, Netherlands). METHODS: Seventeen patients (mean age: 64.0 + 12.8 years) had binocular implantation (34 eyes) with the Mplus X. Three months after the implantation, assessment was made of: manifest refraction; uncorrected and corrected distance visual acuity; uncorrected and distance corrected near visual acuity; defocus curves in photopic conditions; contrast sensitivity; halometry as an objective measure of glare; and patient satisfaction with unaided near vision using the Near Acuity Visual Questionnaire. RESULTS: Mean residual manifest refraction was -0.13 + 0.51 diopters (D). Twenty-five eyes (74%) were within a mean spherical equivalent of -0.50 D. Mean uncorrected distance visual acuity was +0.10 + 0.12 logMAR monocularly and 0.02 - 0.09 IogMAR binocularly. Thirty-two eyes (94%) could read 0.3 or better without any reading correction and all patients could read 0.3 or better with a reading correction. Mean monocular uncorrected near visual acuity was 0.18 + 0.16 logMAR, improving to 0.15 + 0.15 logMAR with distance correction. Mean binocular uncorrected near visual acuity was 0.11 - 0.11 logMAR, improving to 0.09 - 0.12 logMAR with distance correction. Mean binocular contrast sensitivity was 1.75 _ 0.14 log units at 3 cycles per degree, 1.88 _ 0.20 log units at 6 cycles per degree, 1.66 + 0.19 log units at 12 cycles per degree, and 1.11 - 0.20 log units at 18 cycles per degree. Mean binocular and monocular halometry showed a glare profile of less than 10 of debilitating light scatter. Mean Near Acuity Visual Questionnaire Rasch score (0 = no difficulty, 100 = extreme difficulty) for satisfaction for near vision was 20.43 - 14.64 log-odd units. CONCLUSIONS: The Mplus X provides a good visual outcome at distance and near with minimal dysphotopsia. Patients were very satisfied with their uncorrected near vision.
Asunto(s)
Implantación de Lentes Intraoculares , Lentes Intraoculares , Satisfacción del Paciente , Facoemulsificación , Refracción Ocular/fisiología , Agudeza Visual/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Sensibilidad de Contraste/fisiología , Percepción de Profundidad/fisiología , Femenino , Deslumbramiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Visión Binocular/fisiologíaRESUMEN
PURPOSE: To investigate the ability of pharmacy staff in the United Kingdom (UK) to diagnose and treat dry eye. METHODS: A mystery shopper technique to simulate a patient with presumed dry eye was used in 50 pharmacy practices in major towns and cities across the UK. Pharmacies were unaware of their involvement in the study. With the exception of a predetermined opening statement to initiate the consultation, no further information was volunteered. Questions asked, diagnoses given, management strategy advised and staff type was recorded immediately after the consultation. RESULTS: The mean number of questions was 4.5 (SD 1.7; range 1-10). The most common question was the duration of symptoms (56%) and the least common was whether the patient had a history of headaches (2%). All pharmacy staff gave a diagnosis, but the majority were incorrect (58%), with only 42% correctly identifying dry eye. Treatment was advised by 92% of pharmacy staff, with the remaining 8% advising referral directly to the patient's GP or optometrist. Dry eye treatments involved topical ocular lubrication via eye drops (90%) and lipid based sprays (10%). However, only 10% gave administration advice, 10% gave dosage advice, 9% asked about contact lens wear, and none offered follow up although 15% also advised GP or optometrist referral. CONCLUSIONS: There is a need for improved ophthalmological training amongst pharmacists and pharmacy staff and establishment of cross referral relationships between pharmacies and optometry practices.
Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Lentes de Contacto , Manejo de la Enfermedad , Síndromes de Ojo Seco/terapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Reino UnidoRESUMEN
OBJECTIVE: To investigate whether artificial tears and cold compress alone or in combination provide a treatment benefit and whether they were as effective as or could enhance topical antiallergic medication. DESIGN: Randomized, masked clinical trial. PARTICIPANTS: Eighteen subjects (mean age, 29.5±11.0 years) allergic to grass pollen. INTERVENTION: Controlled exposure to grass pollen using an environmental chamber to stimulate an ocular allergic reaction followed by application of artificial tears (ATs), 5 minutes of cold compress (CC), ATs combined with CC, or no treatment applied at each separate visit in random order. A subset of 11 subjects also had epinastine hydrochloride (EH) applied alone and combined with CC in random order or instillation of a volume-matched saline control. MAIN OUTCOME MEASURES: Bulbar conjunctival hyperemia, ocular surface temperature, and ocular symptoms repeated before and every 10 minutes after treatment for 1 hour. RESULTS: Bulbar conjunctival hyperemia and ocular symptoms decreased and temperature recovered to baseline faster with nonpharmaceutical treatments compared with no treatment (P <0.05). Artificial tears combined with CC reduced hyperemia more than other treatments (P <0.05). The treatment effect of EH was enhanced by combining it with a CC (P <0.001). Cold compress combined with ATs or EH lowered the antigen-raised ocular surface temperature to less than the pre-exposure baseline. Artificial tear instillation alone or CC combined with ATs or EH significantly reduced the temperature (P <0.05). Cold compress combined with ATs or EH had a similar cooling effect (P >0.05). At all measurement intervals, symptoms were reduced for both EH and EH combined with CC than CC or ATs alone or in combination (P <0.014). CONCLUSIONS: After controlled exposure to grass pollen, CC and AT treatment showed a therapeutic effect on the signs and symptoms of allergic conjunctivitis. A CC enhanced the use of EH alone and was the only treatment to reduce symptoms to baseline within 1 hour of antigenic challenge. Signs of allergic conjunctivitis generally were reduced most by a combination of a CC in combination with ATs or EH.
Asunto(s)
Conjuntivitis Alérgica/terapia , Crioterapia , Soluciones Oftálmicas/administración & dosificación , Estaciones del Año , Enfermedad Aguda , Adulto , Anciano , Alérgenos/efectos adversos , Terapia Combinada , Conjuntiva/irrigación sanguínea , Conjuntivitis Alérgica/diagnóstico , Conjuntivitis Alérgica/etiología , Dibenzazepinas/administración & dosificación , Método Doble Ciego , Femenino , Antagonistas de los Receptores Histamínicos H1/administración & dosificación , Humanos , Hiperemia/inducido químicamente , Hiperemia/tratamiento farmacológico , Imidazoles/administración & dosificación , Masculino , Persona de Mediana Edad , Polen/efectos adversos , Pruebas Cutáneas , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: To evaluate eyelid temperature change and short-term effects on tear film stability and lipid layer thickness in healthy patients using a commercially available warm compress (MGDRx EyeBag) for ophthalmic use. METHODS: Eyelid temperature, noninvasive tear film breakup time (NITBUT), and tear film lipid layer thickness (TFLLT) of 22 healthy subjects were measured at baseline, immediately after, and 10 minutes after application of a heated eyebag for 5 minutes to one eye selected at random. A nonheated eyebag was applied to the contralateral eye as a control. RESULTS: Eyelid temperatures, NITBUT, and TFLLT increased significantly from baseline in test eyes immediately after removal of the heated eyebag compared with those in control eyes (maximum temperature change, 2.3 ± 1.2 °C vs. 0.3 ± 0.5 °C, F = 20.533, p < 0.001; NITBUT change, 4.0 ± 2.3 seconds vs. 0.4 ± 1.7 seconds, p < 0.001; TFLLT change, 2.0 ± 0.9 grades vs. 0.1 ± 0.4 grades, Z = -4.035, p < 0.001). After 10 minutes, measurements remained significantly higher than those in controls (maximum temperature change, 1.0 ± 0.7 °C vs. 0.1 ± 0.3 °C, F = 14.247, p < 0.001; NITBUT change, 3.6 ± 2.1 seconds vs. 0.1 ± 1.9 seconds, p < 0.001; TFLLT change, 1.5 ± 0.9 vs. 0.2 ± 0.5 grades, Z = -3.835, p < 0.001). No adverse events occurred during the study. CONCLUSIONS: The MGDRx EyeBag is a simple device for heating the eyelids, resulting in increased NITBUT and TFLLT in subjects without meibomian gland dysfunction that seem to be clinically significant. Future studies are required to determine clinical efficacy and evaluate safety after long-term therapy in meibomian gland dysfunction patients.
Asunto(s)
Vendajes , Temperatura Corporal/fisiología , Párpados/fisiología , Hipertermia Inducida , Lágrimas/fisiología , Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
Allergic eye disease encompasses a group of hypersensitivity disorders which primarily affect the conjunctiva and its prevalence is increasing. It is estimated to affect 8% of patients attending optometric practice but is poorly managed and rarely involves ophthalmic assessment. Seasonal allergic conjunctivitis (SAC) is the most common form of allergic eye disease (90%), followed by perennial allergic conjunctivitis (PAC; 5%). Both are type 1 IgE mediated hypersensitivity reactions where mast cells play an important role in pathophysiology. The signs and symptoms are similar but SAC occurs periodically whereas PAC occurs year round. Despite being a relatively mild condition, the effects on the quality of life can be profound and therefore they demand attention. Primary management of SAC and PAC involves avoidance strategies depending on the responsible allergen(s) to prevent the hypersensitivity reaction. Cooled tear supplements and cold compresses may help bring relief. Pharmacological agents may become necessary as it is not possible to completely avoid the allergen(s). There are a wide range of anti-allergic medications available, such as mast cell stabilisers, antihistamines and dual-action agents. Severe cases refractory to conventional treatment require anti-inflammatories, immunomodulators or immunotherapy. Additional qualifications are required to gain access to these medications, but entry-level optometrists must offer advice and supportive therapy. Based on current evidence, the efficacy of anti-allergic medications appears equivocal so prescribing should relate to patient preference, dosing and cost. More studies with standardised methodologies are necessary elicit the most effective anti-allergic medications but those with dual-actions are likely to be first line agents.