The antiaging approach for the treatment of dry eye.
Tsubota Kazuo,Kawashima Motoko,Inaba Takaaki,Dogru Murat,Matsumoto Yukihiro,Ishida Reiko,Kaido Minako,Kojima Takashi,Uchino Miki,Uchino Yuichi,Ogawa Yoko,Nakamura Shigeru,Higuchi Akihiro,Shinmura Ken,Watanabe Mitsuhiro,Kawakita Tetsuya
Cornea
Dry eye is one of the most common eye disorders affecting millions of people. It causes ocular irritation or discomfort, and decreases functional vision, causing a dramatic deterioration in the quality of life. Although new treatments such as the P2Y2 agonist or cyclosporine eye drops have been developed and a certain level of patient satisfaction can now be obtained, no fundamental treatment has been developed. Currently, there is no therapy available to recover lacrimal function to its normal status. Recent progress in the understanding of aging has laid the foundations for a new way of thinking about intervention of the aging process. Because dry eye is accelerated by aging, a useful approach for the prevention or treatment of dry eye may be to interfere with the aging process. In the scientific community, there is a global consensus that calorie restriction can extend the life span of various kinds of animals, establishing an intervention to aging. Another important hypothesis believed to be involved in aging is the free radical theory. According to these theories, the aging process may be managed by controlling levels of calories or reactive oxygen species. In this review, these 2 important aging theories, calorie restriction and free radical aging, are examined, and we discuss how to apply these theories to the prevention and treatment of dry eye.
10.1097/ICO.0b013e31826a05a8
[Chinese expert consensus on prevention and treatment of dry eye during perioperative period of cataract surgery (2021)].
[Zhonghua yan ke za zhi] Chinese journal of ophthalmology
Dry eye is a common ocular surface disease that can occur in part of patients before cataract surgery. A variety of incentives during the perioperative period can decrease the stability of the tear film, cause or aggravate dry eye symptoms, and therefore reduce the visual outcome and life quality of the patients. In order to standardize the management of dry eye during the perioperative period of cataract surgery, the Cataract Group of the Ophthalmology Branch of the Chinese Medical Association conducted a comprehensive discussion on the evaluation and improvement of the preoperative ocular surface conditions, the intraoperative ocular surface protection, as well as the diagnosis and treatment of postoperative dry eye. The consensus of opinions has been reached for reference of Chinese ophthalmologists. .
10.3760/cma.j.cn112142-20201013-00680
The treatment of dry eye.
Calonge M
Survey of ophthalmology
The most widely used therapy for dry eye disease is tear replacement by topical artificial tears. Punctal occlusion to prevent the drainage of natural or artificial tears is the most common non-pharmacological treatment. These and other traditional therapies for dry eye disease are only palliative, however, as they replace or conserve the tears without necessarily correcting the underlying disease process. As our understanding of the pathology of dry eye disease improves, new treatment strategies are being developed. Topical anti-inflammatory and immunomodulatory agents, such as cyclosporin A, are under investigation in the treatment of dry eye, as it is anticipated that they will correct the vicious cycle of inflammation and cell damage on the ocular surface and lacrimal glands.
[Secondary dry eye syndrome after keratorefractive surgeries and approaches to its treatment and prevention].
Bubnova I A,Egorova G B,Mitichkina T S,Averich V V,Fettser E I
Vestnik oftalmologii
The article reviews the particularities of development and pathogenesis of secondary dry eye syndrome (DES) after refractive surgeries including a complex of problems related to changes in tear film content, damage of eye surface and neurotrophic epitheliopathy. Additionally, modern algorithms of treatment and prevention of secondary DES in patients after refractive surgeries are described. Despite the transient nature of the changes, excimer-laser surgery can lead to lasting deficiencies of eye surface in some patients. Therefore, intensive and early treatment of secondary DES during the early follow-up period after refractive surgery may significantly reduce risks of tear dysfunction and neurotrophic epitheliopathy development in the long term.
10.17116/oftalma2018134051294
Management of Postoperative Inflammation and Dry Eye After Cataract Surgery.
Kato Kumiko,Miyake Kensaku,Hirano Koji,Kondo Mineo
Cornea
Surgical intervention is the most effective treatment for decreased vision resulting from cataracts. Although the current procedures for cataract surgery are safe and effective, it is well known that several complications can develop after surgery. Postoperative cystoid macular edema (CME) is a well-known complication, and prophylactic medications such as steroids and/or nonsteroidal antiinflammatory drugs are routinely used for its prevention. Ocular surface abnormalities, such as dry eye, have also been reported to develop after cataract surgery. However, the causative mechanisms for postoperative dry eye have not been definitively determined. At present, there are no prophylactic medications that are commonly used to prevent the development of postoperative dry eye. Although nonsteroidal antiinflammatory drugs are very effective in reducing the incidence and degree of postoperative CME, it is known that they can cause adverse side effects, including ocular surface abnormalities. Thus, perioperative medications must be carefully selected to improve surgical outcomes and patient satisfaction. Here, we summarize the results of recent studies on postoperative dry eye and CME that can develop after cataract surgery. We suggest appropriate combinations of medications that can be used to minimize these postsurgical complications.
10.1097/ICO.0000000000002125
Association Between Depression and Severity of Dry Eye Symptoms, Signs, and Inflammatory Markers in the DREAM Study.
JAMA ophthalmology
Importance:Depression is more prevalent in patients with dry eye disease (DED) than in the general population; however, the association between severity of DED and depression needs further evaluation. Objective:To investigate the association between depression and severity of DED symptoms and signs, including inflammatory markers. Design, Setting, and Participants:Secondary cross-sectional and longitudinal analysis performed in April to December 2020 of data from Dry Eye Assessment and Management (DREAM) study, a randomized clinical trial from October 2014 to July 2016 including patients with moderate to severe symptoms and signs of DED. Enrolled from 27 ophthalmology and optometry centers, both academic and private, in 17 US states, 535 patients were followed up for 1 year. Exposure:Participants screened positive for depression if they scored 42 or less on the Mental Component Summary (MCS) of the 36-Item Short Form Health Survey. Main Outcomes and Measures:Symptoms of DED were assessed by Ocular Surface Disease Index (OSDI) and Brief Ocular Discomfort Index (BODI) and signs assessed by tear film breakup time, Schirmer test, corneal and conjunctival staining, tear osmolarity, and meibomian gland dysfunction at baseline, 6 months, and 12 months. A composite severity sign score was calculated from all 6 signs. Inflammatory markers (cytokines in tears and HLA-DR expression by conjunctival surface cells) were measured for some trial participants. Features of DED were compared between participants with and without depression and adjusted for age, sex, race, visits, and baseline comorbidities. Results:Among the 535 participants, mean (SD) age was 58 (13.2) years, 434 participants (81%) were women, and 398 (74.4%) were White. Participants who screened positive for depression had worse DED symptoms by OSDI (effect size = 0.45, P < .001) and BODI (effect size = 0.46, P < .001) and composite DED sign score (effect size = 0.21, P = .006). Lower MCS score (ie, worse depression) was correlated with higher OSDI score (ie, worse DED symptoms) at baseline (Spearman ρ = -0.09, P = .03), 6 months (ρ = -0.20, P < .001), and 12 months (ρ = -0.21, P < .001). Inflammatory markers did not differ by depression status. Conclusions and Relevance:Depression was associated with more severe dry eye symptoms and overall signs, suggesting that among patients with moderate to severe DED, those with depression may be likely to have more severe DED. These findings support consideration of depression as a comorbidity when managing patients with DED. Further study is needed to elucidate the relationship.
10.1001/jamaophthalmol.2022.0140
A Meta-Analysis of the Efficacy of Hyaluronic Acid Eye Drops for the Treatment of Dry Eye Syndrome.
Yang Yun-Jung,Lee Won-Young,Kim Young-Jin,Hong Yeon-Pyo
International journal of environmental research and public health
Hyaluronic acid (HA) is commonly used for treating dry eye syndrome (DES). This meta-analysis was performed to compare the efficacies of HA- and non-HA-based eye drops, including saline and conventional artificial tears (ATs), for the treatment of dry eye disease. Eight databases (PubMed, EMBASE, Cochrane Central Register of Controlled Trials, DBpia, KoreaMed, KMBASE, RISS, KISS) were searched for studies comparing the efficacies of HA- and non-HA-based ATs in patients with DES published up to September 2020. Two independent reviewers assessed the quality and extracted the relevant data. The mean differences of Schirmer's (SH) test scores, tear breakup times (TBUT), corneal fluorescein staining scores (Oxford scale, 0-4), and ocular surface disease indexes were calculated. The standard mean difference and 95% confidence interval were calculated using a random effect model. Nineteen studies, including 2078 cases, were included. HA eye drops significantly improved tear production compared with non-HA-based eye drops (standard mean difference (SMD) 0.18; 95% confidence interval (CI) 0.03, 0.33). In a subgroup analysis, the SH test scores and TBUT values after using HA significantly increased compared to those measured after using saline (SMD 0.27; 95% CI 0.05, 0.49 and SMD 0.28; 95% CI 0.03, 0.52, respectively). Based on these results, HA eye drops may be superior to non-HA eye drops including normal saline and ATs. Further research is needed to assess the efficacies stratified by age, treatment duration, the severity of dry eye, and optimal dosages.
10.3390/ijerph18052383