Aoi Komuro

A Newly Developed Video-Meibography System Featuring a Newly Designed Probe

PurposeTo demonstrate the usefulness of a video-meibography system featuring our newly designed probe.MethodsThis study utilized a newly designed probe featuring an obliquely inclined, T-shaped head containing 16 windows in the portion of the probe applied for emitting infrared light. The transilluminated structure of the meibomian gland is conducted to a highly sensitive, infrared charge-coupled device video camera and recorded digitally. The utility of the new probe was compared with the intraocular illumination probe traditionally used for meibography, both being applied to the eyelids of ten healthy volunteers and ten patients with meibomian gland dysfunction. The results were then analyzed.ResultsThe newly designed probe facilitated eyelid eversion and transilluminated the meibomian gland structure effectively. Moreover, subjects experienced no irritation and only limited invasiveness when the new probe was applied.ConclusionsOur meibography system featuring the newly designed probe provided greater ease of use, an improved visualization of the meibomian gland structure, and increased comfort for patients during the examination. Jpn J Ophthalmol 2007;51:53–56

Prevalence of dry eye disease and its risk factors in visual display terminal users: The Osaka study

PURPOSE To investigate tear function and prevalence of dry eye disease (DED) in visual display terminal (VDT) users. DESIGN Cross-sectional study. METHODS Six hundred and seventy-two young and middle-aged Japanese office workers who used VDT completed questionnaires and underwent dry eye testing. We estimated the prevalence of DED using logistic regression analysis to examine associations between DED and possible risk factors. The ocular surface feature, prevalence of DED, and risk factors were evaluated. RESULTS Of the 672 workers, 561 (83.5%, mean age: 43.3 ± 9.1 years) completed the questionnaire. The percentage of women with a composite outcome of definite DED or probable DED was 76.5%, which was higher than that among men (60.2%; odds ratio [OR] = 2.00; 95% confidence interval [CI], 1.29-3.10, P = .002). Workers over 30 years of age had a higher risk of DED (OR = 2.22; 95% CI, 1.06-4.66), as did workers using a VDT >8 hours per day (OR = 1.94; 95% CI, 1.22-3.09). Average Schirmer value was 18.7 ± 11.7 mm and tear break-up time (TBUT) was 4.0 ± 2.5 seconds (78.6% of study participants had TBUT ≤5 seconds). CONCLUSIONS DED is prevalent among young to middle-aged Japanese VDT users. Ophthalmic findings revealed short TBUT and corneal staining accompanied by normal Schirmer test values. Increased risk for DED was noted for women aged over 30 years and prolonged VDT use. Measures to modify the adverse impact of VDT use on the ocular surface may provide a positive impact on public health and quality of life for office workers using VDTs.

Effectiveness of hyaluronan on corneal epithelial barrier function in dry eye

AIMS/BACKGROUND The aim of this study was to assess quantitatively the effectiveness of hyaluronan on corneal disruption in patients with dry eye. Corneal epithelial barrier function was evaluated by measuring fluorescein permeability using a slit-lamp fluorophotometer. METHODS 11 patients with dry eye were assigned to this study. Hyaluronan ophthalmic solution (0.1% hyaluronic acid) was instilled five times a day to the right eye, in addition to the usual artificial tear solutions. The left eye received only the artificial tear solutions. Corneal barrier function was evaluated on the pretreatment day, and at 2 and 4 weeks after treatment. Fluorophotometry was used to measure fluorescein uptake at the central and lower corneal portions. RESULTS Two weeks after treatment, hyaluronan treated right corneas showed significant corneal epithelial barrier improvement in the lower portion, compared with the pretreatment day (p<0.025). Four weeks after treatment, the treated corneas showed significant improvement in the central corneal portion (p<0.025) and improvement in the lower portion, compared with the pretreatment day. The untreated left corneas, on the other hand showed no improvement during the course of the study. CONCLUSION This study suggests that hyaluronan is effective in the treatment of corneal epithelial disruption in dry eye.

Dry Eye Disease and Work Productivity Loss in Visual Display Users: The Osaka Study

PURPOSE To estimate the impact of dry eye disease (DED) on work performance and productivity in office workers using visual display terminals (VDTs). DESIGN Cross-sectional study. METHODS Six hundred seventy-two Japanese young and middle-aged office workers using VDTs completed a questionnaire that was designed to measured at-work performance deficits and productivity losses using the Japanese version of the Work Limitations Questionnaire, completed by e-mail. Using the Japanese dry eye diagnostic criteria, respondents were classified into 3 groups: definite DED, probable DED, and non DED. RESULTS Of the 672 office workers, 553 subjects (82.3%), including 366 men and 187 women, completed the questionnaire and underwent clinical evaluation. As for the total workplace productivity loss, the non DED group demonstrated a loss of 3.56%, those with probable DED demonstrated a loss of 4.06%, and those with definite DED demonstrated a loss of 4.82%, indicating significantly worse performance and productivity (P = .014, trend test). For the 4 subscales, DED was associated with significantly lower on-the-job time management (P = .009, trend test) and combined mental performance and interpersonal functioning (P = .011, trend test). After controlling for age, sex, VDT working hours, and diagnosis of DED, time management, physical demands, and mental and interpersonal functioning showed a significant relationship to DED (each P > .05). Annual DED productivity losses were estimated to be

Cultivated human conjunctival epithelial transplantation for total limbal stem cell deficiency.

6160 per employee when measured by total production and

New Instruments for Dry Eye Diagnosis

1178 per employee calculated by wage. CONCLUSIONS This study indicated that there is a significant impact of DED on the total productivity of Japanese VDT users.

Effect of Beta-Blocker Eyedrops on Corneal Epithelial Barrier Function

PURPOSE To determine the feasibility of cultivated conjunctiva as a viable epithelial sheet for transplantation and corneal resurfacing in eyes with limbal stem cell deficiency (LSCD). METHODS Human corneal epithelial (HCE) and human conjunctival epithelial (HCjE) cells were cultivated on human amniotic membrane (AM) to confluence and then air lifted to allow further stratification and differentiation. Denuded AM and cultivated HCE and cultivated HCjE cells were then transplanted into 18 eyes of rabbits with induced LSCD. The cultivated and engrafted epithelia were examined by transmission electron microscopy (TEM) and immunohistochemistry. Two weeks after transplantation, the eyes were examined by slit lamp biomicroscopy and scored on epithelial integrity, corneal haze, and corneal neovascularization. RESULTS Both cultivated and engrafted HCjE sheets demonstrated confluent epithelial sheets with five to six layers of well-stratified epithelium. TEM examination of engrafted HCjE revealed numerous microvilli, desmosomes, and hemidesmosomes, identical with in vivo corneal epithelium. Immunohistochemical analysis of both HCjE and HCE cells showed the presence of CK3, CK4, and CK12, with absence of Muc5AC. Clinical outcomes for eyes receiving HCjE transplants and HCE transplants were comparable, with most having transparent, smooth corneas, free of epithelial defects. CONCLUSIONS The study showed that microscopically, HCjE cells have features similar to HCE cells, with clinically equivalent outcomes. The ex vivo cultivation of conjunctiva to form transplantable epithelial sheets for corneal replacement is a promising new treatment modality in patients with LSCD.

Associations between Subjective Happiness and Dry Eye Disease: A New Perspective from the Osaka Study

Several non-invasive techniques for dry eye diagnosis have been developed in the past decade. These include quantitative assessment of tear volume, tear film stability, tear dynamics, and integrity of ocular surface epithelium. A combination of meniscometry and interferometry is useful for proving focal dry eye, by confirming whether or not tears at the meniscus have an effect on the ocular surface. Interferometer is also useful to evaluate tear dynamics on soft contact lenses. Fluorophotometry is useful for assessing the severity of dry eye from the view point of corneal epithelial barrier function and measuring the tear turnover rate. Both video-meibography and meibometry are useful for screening meibomian gland dysfunction. The advances in these techniques accumulate knowledge regarding pathophysiology of dry eye and allow precise diagnosis of dry eye. More targeted treatment will become feasible based on the clearer pathophysiology.

Investigation of the Corneal Filament in Filamentary Keratitis

To investigate the long-term effect of a topically applied β-blocker on human corneal epithelium, the corneal epithelial barrier function and the superficial cell area of the corneal epithelium were evaluated. Seventeen normal healthy volunteers (without medication), 7 cataract patients (treated with pyrenoxine eyedrops) and 7 glaucoma or ocular hypertension patients (treated with 0.5% timolol maleate) were assigned to this study. The eyedrops had been used on a daily basis for at least 3 months. In the evaluation of corneal epithelial barrier function, fluorescein uptake was measured using a slitlamp fluorophotometer after application of 3 μl of 0.5% fluorescein for 10 min. In the evaluation of the superficial cell area, the central corneal epithelium was measured by tandem scanning confocal microscopy (TSCM). The healthy control and timolol groups were compared. Corneal fluorescein uptake in the healthy control, pyrenoxine and timolol groups was 20.3 ± 3.2, 21.5 ± 4.0 and 76.2 ± 30.0 ng/ml (mean ± standard error), respectively. There was a significantly higher fluorescein uptake in the timolol group compared to the pyrenoxine group (p = 0.0088) and the healthy control group (p = 0.0055). TSCM showed no significant difference in the superficial cell areas of the corneal epithelium between the healthy control and timolol groups. β-Blocker eyedrops decreased the corneal epithelial barrier function. Their application was not accompanied by any biomicroscopic change in the superficial cell area.

Alteration of tear mucin 5AC in office workers using visual display terminals: The Osaka study

Importance Dry eye disease has become an important health problem. A lack of concordance between self-reported symptoms and the outcome of dry eye examinations has raised questions about dry eye disease. Objective To explore the association between subjective happiness and objective and subjective symptoms of dry eye disease. Design The study adopted a cross-sectional design. Setting All the employees of a company in Osaka, Japan. Participants 672 Japanese office workers using Visual Display Terminals (age range: 26–64 years). Methods The dry eye measurement tools included the Schirmer test, conjunctivocorneal staining, the tear film break-up time, as well as the administration of a dry eye symptoms questionnaire. Happiness was measured by the Subjective Happiness Scale. Main Outcome Measures Dry eye examination parameters, dry eye symptoms questionnaires, and the Subjective Happiness Scale score. Results Of the 672 workers, 561 (83.5%) completed the questionnaires and examinations. The mean Subjective Happiness Scale score was 4.91 (SD = 1.01). This score was inversely correlated with the dry eye symptom score (r = -0.188, p < 0.001), but was not associated with objective findings which include conjunctivocorneal staining, low Schirmer test score, or low tear film break-up time. The level of subjective happiness was the lowest in the group without objective results, but reported subjective symptoms of dry eyes (p < 0.05). Conclusions and Relevance There is evidence of the relationship between subjective happiness and self-reported symptoms of dry eyes. Findings of this study revealed a new perspective on dry eye disease, including the potential for innovative treatments of a specific population with dry eye disease.