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Meibomian Gland Dysfunction in Computer Vision Syndrome
TEAR FILM & OCULAR SURFACE MEIBOMIAN GLAND DYSFUNCTION IN COMPUTER VISION SYNDROME. Richard W.Yee, MD, Ashbala Khattak MD, Kevin Dawson. Hermann Eye Center, University of Texas, Houston, TX, USA. Purpose. To see the prevalence of meibomian gland dysfunction in symptomatic computer users and whether the use of microenvironment computer eye glasses and/or artificial tears bring any improvement in the subject’s comfort level and objective ocular surface examination. Methods. The study is a randomized controlled clinical trial. Patients who used computers for 3 or more hours per day were recruited from the University of Texas - Houston Medical School System. Sample size was 20 patients each in the symptomatic and control group. The patients were grouped into these categories on the basis of scores obtained from a modified OSDI questionnaire. The project involved five visits, first establishes a baseline and four follow up visits. In each follow up visit the subject was challenged with a computer game followed by ocular surface exam. Blink rate was recorded on each visit. Examinations included imaging of the tear film on confocal scan, tear osmolarity, visual acuity and visual field measurement, refraction, detailed slit lamp exam of the lid, cornea and conjunctiva, meibomian gland expression, corneal and conjunctival staining, tear break up time and schirmer’s test. Results. Prevalence of meibomian gland dysfunction was 74% in symptomatic as compared to 28% in the control group (p=0.001). Symptomatic vs. control group had a higher grade of fluorescein and lissamine staining and tear break up time (p=0.001). Blink rate decreased from a normal value of 22.4 ± 8.9/min in relaxed conditions to 7.6 ± 6.7/min while using the computer. Conclusion. Meibomian gland dysfunction is significantly present in symptomatic computer users vs. control group. Microenvironment computer eyeglasses make significant improvement in subjective comfort level and ocular surface examination. Commercial Relationship(s): SeeFit, Inc.; Support: None ESTRATEST THERAPY FOR DRY EYE SYNDROME IN POSTMENOPAUSAL WOMEN. Samuel C. Yiu,1,2 Garret Scott,1 Daniel Wasilewski,1 Jonathan Song,1,2 John A. Irvine,1,2 Ronald E. Smith.1,2 1The Ocular Surface Center, Doheny Eye Institute, and the 2Department of Ophthalmology Keck School of Medicine, University of Southern California, Los Angeles, California, USA. Purpose. To investigate the efficacy of Estratest (esterified estrogen and methyltestosterone), an oral form of hormone replacement, for the treatment of dry eye syndrome (DES) in postmenopausal women. Although the results of studies assessing estrogen replacement for DES are mixed, research has shown that androgens suppress lacrimal gland inflammation and promote lipid production in meibomian glands. We aim to determine whether systemic androgen replacement (Estratest) will reduce DES symptoms and promote clinical improvement. Methods. The investigators reviewed the charts of 15 patients treated with Estratest for DES at the Ocular Surface Center at the Doheny Eye Institute. All 15 patients had been treated within the last 3 years. Data obtained included patient age, follow-up period, associated systemic disease, and clinical assessment. The three main outcome measures were subjective changes in symptoms, Schirmer test, and changes in clinical exam. Results. Eleven of 15 patients were included in the analysis. The mean patient age was 65.2 years (standard deviation [SD] 11.4, range 48-84 years). The mean treatment duration was 12.2 months (SD 6.2 months, range 4-24 months). Ten (91%) of 11 patients reported improvement in dry eye symptoms while receiving treatment. For these 10, relief occurred after an average of 4.1 months of treatment (SD 3.2, range, 1-9 months). Schirmer test results improved for three of five patients who had documented test results. Clinical assessments improved in eight of 10 patients who reported symptomatic improvement but not in one patient who had no change in symptoms. Two patients could not tolerate EE+MT treatment and discontinued therapy in less than 3 months. Two others had less than 2 months of follow-up. These four patients were excluded from the group analyzed. Conclusions. Estratest may be efficacious for the treatment of DES of various etiologies. A randomized placebo-controlled trial will be performed in the future to confirm these encouraging results. Support: Baxter Junior Faculty Award to Dr. Yiu, NEI grant EY03040 and RPB
EFFECT OF SYNTHESIZED ONION LACRYMATORY FACTOR ON TEAR DYNAMICS IN TEAR DEFICIENT DRY EYE. Norihiko Yokoi,1 Hisayo Higashihara,1 Kunio Maruyama,1 Aoi Komuro,1 Masakazu Nishii,1 Shigeru Kinoshita,1 Nobuaki Tsuge,2 Shinsuke Imai,2 Nobuo Shiomi.2 Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan;1 House Foods Corporation, Chiba, Japan.2 Purpose. Reflex tear secretion plays an important role in diminishing the vicious cycle between tear film and ocular surface epithelium in dry eye; and in the treatment of dry eye, artificial tear eye drops are used for compensating the role of reflex tears. In this study, we investigated the effect of synthesized onion lachrymatory factor (SOLF) (Propanethial SOxide), a stimulator of reflex tear secretion, on tear dynamics in tear deficient dry eye. Methods. Enrolled were 29 eyes of 29 clinicallydiagnosed tear deficient dry eye patients (Schirmer test I test <=5mm/5min.) with no meibomian gland dysfunction [1 male and 28 females, aged 63.4 ± 12.2 (mean ± SD)]. Their unilateral eyes were exposed to 3ȝl SOLF saturated in the original eyecup up until their limit of endurance to irritation. Before and after exposure to the SOLF, the tear meniscus radius (TMR, mm) at the central lower lid margin was measured using videomeniscometer. Also, using video-interferometer ( DR-1®, Kowa, Japan), dynamics of tear film lipid layer was evaluated before and after exposure to the SOLF, based on the newly-proposed grades for tear lipid layer spreading [Grade (G) 1: smooth and quick spreading up to the entire cornea; G 2: smooth but slow spreading up to the entire cornea: G 3, slow spreading up to the half of the cornea; G 4: no spreading up to the cornea]. Results. Before and after exposure to the SOLF, TMR were 0.16 ± 0.07 and 0.32 ± 0.17, respectively, showing significantly higher value after exposure to the SOLF (p<0.0001). Grades of the spreading of tear film lipid layer up to the cornea before and after exposure to the SOLF were 2.7 ± 0.8 and 1.4 ± 0.6, respectively, showing significantly lower grades after exposure to the SOLF (p<0.0001). Conclusions. The present study showed that tear dynamics in tear deficient dry eye is improved after exposure to the SOLF by stimulating reflex tear secretion; SOLF does not only increase the aqueous tear volume but also facilitates the spreading of tear film lipid layer up to the cornea. EXPRESSION OF UDP-GALNAC:POLYPEPTIDE NACETYLGALACTOS-AMINYLTRANSFERASE ISOFORMS AT THE OCULAR SURFACE. William W. Young, Jr.,1 Yoannis Imbert,1 Marcia M. Jumblatt,1 Gary N. Foulks,1 and Kelly Ten Hagen.2 University of Louisville, USA,1 NIH, USA.2 Purpose Mucins protect the ocular surface from pathogenic and environmental challenges. O-glycosylation provides mucins with the viscoelastic properties required for proper mucin function. The ppGaNTase family of glycosyltransfer-ases initiate mucin O-glycosylation. The hypothesis of this project is that one cause of dry eye disease is abnormal mucin glycosylation due to altered expression of ppGaNTase isoforms. Here we report the pattern of expression of ppGaNTase isoforms in normal human tissues including ocular tissues. Methods Donor corneas and conjunctivae were obtained from the Kentucky Lions Eye Bank. Conjunctival cells were obtained by impression cytology. Total RNA was extracted and converted to cDNA. Total RNA from other tissues was obtained commercially. Levels of mRNA expression of ppGaNTase isoforms were determined by real-time RT-PCR using the Taqman technique. Results Tissues with abundant mucin production expressed multiple isoforms and higher total ppGaNTase levels. Several human tissues exhibited distinctive expression patterns with isoform T15 being the most highly expressed isoform in spinal cord, mammary tissue, cervix, and placenta, putative isoform TA in brain, T11 and T14 in kidney, and T10 in ovary. Putative isoform TB was restricted primarily to testis. ppGaNTase isoform expression patterns of ocular tissues were distinctive with the rank order of expression in cornea being isoform T3 ~ T12 > T2 ~ T4 and in conjunctiva T4 ~ T12 > T3 ~ T1 > T15 > T2 ~ T5. The isoform pattern in cells from the temporal bulbar conjunctiva obtained by impression cytology was T4 ~ T12 > T3 > T5 > T1 > T2 without detectable isoform T15. Conclusions The ppGaNTase isoforms identified here as being expressed in the conjunctiva must act in concert to glycosylate the conjunctival mucins including MUC1, 4, 2, 5AC, and 7. Future studies will determine if there are differences in ppGaNTase isoform expression in cells obtained by impression cytology from dry eye patients. Support: EY015134 (WY) and EY10736 (MJ)
THE OCULAR SURFACE / JANUARY, 2005, VOL. 3, NO. 1 / SUPPLEMENT
S129
EFFECT OF SYNTHESIZED ONION LACRYMATORY FACTOR ON TEAR DYNAMICS IN TEAR DEFICIENT DRY EYE. Norihiko Yokoi,1 Hisayo Higashihara,1 Kunio Maruyama,1 Aoi Komuro,1 Masakazu Nishii,1 Shigeru Kinoshita,1 Nobuaki Tsuge,2 Shinsuke Imai,2 Nobuo Shiomi.2 Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan;1 House Foods Corporation, Chiba, Japan.2 Purpose. Reflex tear secretion plays an important role in diminishing the vicious cycle between tear film and ocular surface epithelium in dry eye; and in the treatment of dry eye, artificial tear eye drops are used for compensating the role of reflex tears. In this study, we investigated the effect of synthesized onion lachrymatory factor (SOLF) (Propanethial SOxide), a stimulator of reflex tear secretion, on tear dynamics in tear deficient dry eye. Methods. Enrolled were 29 eyes of 29 clinicallydiagnosed tear deficient dry eye patients (Schirmer test I test <=5mm/5min.) with no meibomian gland dysfunction [1 male and 28 females, aged 63.4 ± 12.2 (mean ± SD)]. Their unilateral eyes were exposed to 3ȝl SOLF saturated in the original eyecup up until their limit of endurance to irritation. Before and after exposure to the SOLF, the tear meniscus radius (TMR, mm) at the central lower lid margin was measured using videomeniscometer. Also, using video-interferometer ( DR-1®, Kowa, Japan), dynamics of tear film lipid layer was evaluated before and after exposure to the SOLF, based on the newly-proposed grades for tear lipid layer spreading [Grade (G) 1: smooth and quick spreading up to the entire cornea; G 2: smooth but slow spreading up to the entire cornea: G 3, slow spreading up to the half of the cornea; G 4: no spreading up to the cornea]. Results. Before and after exposure to the SOLF, TMR were 0.16 ± 0.07 and 0.32 ± 0.17, respectively, showing significantly higher value after exposure to the SOLF (p<0.0001). Grades of the spreading of tear film lipid layer up to the cornea before and after exposure to the SOLF were 2.7 ± 0.8 and 1.4 ± 0.6, respectively, showing significantly lower grades after exposure to the SOLF (p<0.0001). Conclusions. The present study showed that tear dynamics in tear deficient dry eye is improved after exposure to the SOLF by stimulating reflex tear secretion; SOLF does not only increase the aqueous tear volume but also facilitates the spreading of tear film lipid layer up to the cornea. EXPRESSION OF UDP-GALNAC:POLYPEPTIDE NACETYLGALACTOS-AMINYLTRANSFERASE ISOFORMS AT THE OCULAR SURFACE. William W. Young, Jr.,1 Yoannis Imbert,1 Marcia M. Jumblatt,1 Gary N. Foulks,1 and Kelly Ten Hagen.2 University of Louisville, USA,1 NIH, USA.2 Purpose Mucins protect the ocular surface from pathogenic and environmental challenges. O-glycosylation provides mucins with the viscoelastic properties required for proper mucin function. The ppGaNTase family of glycosyltransfer-ases initiate mucin O-glycosylation. The hypothesis of this project is that one cause of dry eye disease is abnormal mucin glycosylation due to altered expression of ppGaNTase isoforms. Here we report the pattern of expression of ppGaNTase isoforms in normal human tissues including ocular tissues. Methods Donor corneas and conjunctivae were obtained from the Kentucky Lions Eye Bank. Conjunctival cells were obtained by impression cytology. Total RNA was extracted and converted to cDNA. Total RNA from other tissues was obtained commercially. Levels of mRNA expression of ppGaNTase isoforms were determined by real-time RT-PCR using the Taqman technique. Results Tissues with abundant mucin production expressed multiple isoforms and higher total ppGaNTase levels. Several human tissues exhibited distinctive expression patterns with isoform T15 being the most highly expressed isoform in spinal cord, mammary tissue, cervix, and placenta, putative isoform TA in brain, T11 and T14 in kidney, and T10 in ovary. Putative isoform TB was restricted primarily to testis. ppGaNTase isoform expression patterns of ocular tissues were distinctive with the rank order of expression in cornea being isoform T3 ~ T12 > T2 ~ T4 and in conjunctiva T4 ~ T12 > T3 ~ T1 > T15 > T2 ~ T5. The isoform pattern in cells from the temporal bulbar conjunctiva obtained by impression cytology was T4 ~ T12 > T3 > T5 > T1 > T2 without detectable isoform T15. Conclusions The ppGaNTase isoforms identified here as being expressed in the conjunctiva must act in concert to glycosylate the conjunctival mucins including MUC1, 4, 2, 5AC, and 7. Future studies will determine if there are differences in ppGaNTase isoform expression in cells obtained by impression cytology from dry eye patients. Support: EY015134 (WY) and EY10736 (MJ)
THE OCULAR SURFACE / JANUARY, 2005, VOL. 3, NO. 1 / SUPPLEMENT
S129