Kazumi Fukagawa

Prevalence of Dry Eye Disease among Japanese Visual Display Terminal Users

OBJECTIVE To determine the prevalence of dry eye disease (DED) and risk factors among young and middle-aged Japanese office workers using visual display terminals (VDTs). DESIGN Cross-sectional prevalence survey. PARTICIPANTS Four thousand three hundred ninety-three Japanese young and middle-aged office workers using VDTs. INTERVENTION Office workers completed questionnaires sent by e-mail designed to detect dry eye diagnosis and risk factors. MAIN OUTCOME MEASURES Clinically diagnosed DED was defined as the presence of a previous clinical diagnosis of DED by dry eye specialists or severe symptoms of DED (both dryness and irritation constantly or often). Current symptoms of DED and possible risk factors such as age, duration of VDT use, type of VDT work, environmental factors, presence of systemic diseases, systemic medicine use, smoking history, and contact lens (CL) use were the main outcome measures. We used logistic regression to examine associations between DED and other demographic factors. RESULTS Of the 4393 office workers, 3549 (80.1%) completed the questionnaire. Clinically diagnosed DED was present in 266 (10.1%) of 2640 male subjects and in 195 (21.5%) of 909 female subjects. Severe symptoms of DED were observed in 711 male and in 436 female participants. More than 4 hours of VDT use was associated with an increased risk of DED (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.40-2.02). In addition, CL use (OR, 3.91; 95% CI, 3.37-4.53) increased the risk of severe dry eye symptoms. CONCLUSIONS Dry eye disease leading to a clinical diagnosis or severe symptoms is prevalent among young and middle-aged Japanese office workers. The condition is more prevalent among females, CL wearers, and prolonged VDT users. Relevant measures directed against the modifiable risks could provide a positive impact on public health and quality of life of office workers. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.

Application of visante optical coherence tomography tear meniscus height measurement in the diagnosis of dry eye disease

PURPOSE To investigate the applicability of tear meniscus height (TMH) measurement using Visante optical coherence tomography (OCT) in the diagnosis of dry eye disease. DESIGN Prospective, controlled, single-center study. PARTICIPANTS Twenty-four right eyes of 24 patients (6 males, 18 females; mean age, 63.14±13.4 years) with definite dry eye according to the Japanese dry eye diagnostic criteria and 27 right eyes of 27 control subjects (12 males, 15 females; mean age, 56.04±14.22 years) were recruited. METHODS All subjects underwent slit-lamp TMH measurement, OCT upper and lower TMH measurements, tear film breakup time (BUT) measurements, vital stainings, and Schirmer test. The results were compared between the 2 groups by Mann-Whitney test. MAIN OUTCOME MEASURES The correlation between the clinical findings of slit-lamp TMH, strip meniscometry examination, tear functions, vital staining scores, and the OCT upper and lower TMH parameters were tested by Spearmans correlation test. Receiver operating characteristic (ROC) curve technique was used to evaluate the sensitivity, specificity and cutoff values of OCT TMH examination in the diagnosis of dry eye. RESULTS The OCT upper and lower TMH values, slit-lamp TMH, strip meniscometry, tear film BUT, and vital staining scores were significantly lower in the dry eye patients compared with controls (P<0.001). A significant correlation between the OCT upper and lower TMH measurements as well as slit-lamp TMH, strip meniscometry, tear functions, vital staining scores, and the Schirmer test was found. The ROC curve technique analysis of the OCT lower TMH showed that, when the cutoff value was set at <0.30 mm, the sensitivity and specificity of the testing were 67% and 81%, respectively. CONCLUSIONS The Visante OCT is a quick, noninvasive method for assessing the TMH, with acceptable sensitivity, specificity, and repeatability, and may have potential applications for the diagnosis and evaluation of dry eye disease.

Presence of eotaxin in tears of patients with atopic keratoconjunctivitis with severe corneal damage

The eotaxin concentration in tears from the erosion group (1475.4 ± 870.5 pg/mL [mean ± SD]) was significantly greater than that from the SPK group (163.4 ± 81.7 pg/mL), the clear group (24.3 ± 12.7 pg/mL), and the nonallergic control subjects (21.7 ± 9.7 pg/mL) (Fig 1, A). Greater numbers of eosinophils were found in tears from the erosion group (42.2 ± 52.2 cells/field, n = 9) than in tears from the SPK group (0.3 ± 0.4 cells/field, n = 5), the clear group (0 ± 0 cells/field, n = 8) and the nonallergic control subjects (0 ± 0 cells/field, n = 13) (Fig 1, B). Moreover, the number of eosinophils correlated with the eotaxin concentration in the tear samples (r = 0.603, P < .0004 as determined by Bartlett’s test; data not shown).

Interleukin-8 concentrations in conjunctival epithelium brush cytology samples correlate with neutrophil, eosinophil infiltration, and corneal damage.

Purpose. To evaluate whether interleukin-8 (IL-8) and RANTES (regulated on activation, normal T-cell expressed and secreted) concentrations in the supernatants of conjunctival epithelial samples from patients with vernal keratoconjunctivitis (VKC) correlate with the number of infiltrating eosinophils or neutrophils and with the severity of corneal lesions. Methods. Thirty-four patients with VKC, 5 patients with seasonal allergic conjunctivitis, and 10 volunteers without allergic diseases were enrolled in this study. Conjunctival epithelial cells were collected by brush cytology and the number of inflammatory cells was counted. The chemokine expression in the cells was investigated by immunocytochemistry and the chemokine concentrations of the cell suspensions were measured by enzyme-linked immunosorbent assay. Results. The percentages of eosinophils and neutrophils in cell suspensions from VKC patients with corneal erosion or ulcer were higher than those from subjects with clear corneas or superficial punctate keratopathy. IL-8 concentrations in the supernatant of samples correlated significantly with the percentages of neutrophils and eosinophils in paired cell suspensions. No correlation was observed between RANTES and the percentages of eosinophils. Positive staining for IL-8 was observed in the cytosol of conjunctival epithelial cells. Conclusion. IL-8 in the extracellular space of the conjunctival epithelium may play a role in the recruitment of neutrophils and possibly eosinophils and in the pathogenesis of corneal damage in severe allergic diseases.

Corneal Endothelial Cell Loss Induced by Air Bags

BACKGROUND Although the automobile air bag is a safety device used to protect drivers from death and moderate-to-severe injury, recently it also has been reported to be associated with some ophthalmic injuries. The authors have encountered a case in which a normal air bag may have caused a drivers corneal endothelial cell loss. In this study, the authors evaluate corneal endothelial cell loss caused by several types of air bags in the hope that air bag technology may be improved. METHODS The authors performed impact tests with whole pig eyes fixed in a crash test dummy, using five different types of air bags. The area of damaged corneal endothelial cell was analyzed quantitatively. RESULTS The authors found that corneal endothelial cell loss was correlated with the inflator power of the air bag but not with its weight. CONCLUSION Although greater inflator power is needed for rapid air bag expansion, the effect on the eye should be considered in further refining this device. There may be greater latitude in the selection of air bag material. The authors believe their technique is applicable to the assessment of many air bag or passenger variables.

Corneal in vivo confocal scanning laser microscopy in patients with atopic keratoconjunctivitis.

OBJECTIVE To elucidate the morphologic alterations of the cornea in atopic keratoconjunctivitis (AKC) using confocal microscopy (Heidelberg Retina Tomograph II-Rostock Cornea Module: HRT-II RCM). DESIGN Prospective comparative study. PARTICIPANTS We studied 21 right eyes of 21 AKC patients (11 males, 10 females; mean age, 26.3 years) as well as 19 right eyes of 19 normal subjects (12 males, 7 females; mean age, 28.4 years). METHODS All subjects underwent corneal sensitivity measurements, Schirmer test, tear film break-up time, fluorescein and Rose Bengal stainings, and HRT-II confocal laser scanning microscopy of the central cornea. MAIN OUTCOME MEASURES The epithelial and endothelial cell densities of the central cornea, the density of subbasal long nerve fibers (LNFs) and total nerve branches (NBs) of the subbasal nerve plexus were calculated. The morphologic characteristics of the corneal nerves were studied. Correlation between nerve density, tear functions, and ocular surface examination parameters were investigated. RESULTS The corneal sensitivity, tear stability and vital staining scores were significantly worse in eyes with AKC (P<0.01). Eyes with AKC showed a significantly lower density of basal epithelial cells, LNFs, and NBs compared with normal eyes. Nerve fiber abnormalities such as increased tortuosity, bifurcation abnormality, sharp deflections, and thickening of stromal nerves, as well as several inflammatory cells in close proximity of the subbasal and stromal nerve fibers were observed. CONCLUSIONS The corneal disease in AKC was associated with significant alterations of the basal epithelium, and subbasal and stromal corneal nerves, which related to the changes in tear functions and corneal sensitivity. Confocal scanning laser microscopy was useful to study the pathological in vivo corneal changes in AKC.

Japan Ministry of Health Study on Prevalence of Dry Eye Disease Among Japanese High School Students

PURPOSE To determine the prevalence of dry eye disease and contact lens (CL) use among Japanese private high school students. DESIGN Cross-sectional prevalence survey. METHODS We carried out a cross-sectional survey in 3,433 Japanese high school students who completed questionnaires designed to ascertain a prior diagnosis of dry eye disease and current symptoms of dry eye disease, as well as information on CL use and type of CL. We used logistic regression analysis to examine the associations between dry eye disease and CL use. RESULTS Of the 3,443 high school students, 3,433 (100%) completed the questionnaires. A total of 2,848 boys and 585 girls joined and the age range was from 15 to 18 years. Clinically diagnosed dry eye disease was present in 123 boys (4.3%) and 47 girls (8.0%). Severe symptoms of dry eye disease were observed in 599 subjects in boys (21.0%) and 143 in girls (24.4%). Soft contact lens (SCL) and hard contact lens (HCL) use was 36.1% and 1.7%, respectively. CONCLUSION Dry eye disease leading to a clinical diagnosis or severe symptoms is prevalent in the studied Japanese private high school students. The condition is more prevalent among female subjects and CL wearers. Relevant measures directed against these risks could provide a positive impact on public health and quality of life of high school students.

Alterations of the ocular surface epithelial MUC16 and goblet cell MUC5AC in patients with atopic keratoconjunctivitis

Background:  An increased understanding of the ocular surface at cellular level in the conjunctiva and the cornea may help explain the pathogenesis and the subsequent clinical appearance of atopic ocular allergies, which may be potentially blinding.

The relation of conjunctival and corneal findings in severe ocular allergies.

Objective: Corneal lesions such as ulcers and erosions are major complications observed in patients with severe ocular allergic diseases. We aimed to look into the relationship between specific clinical conjunctival findings and the severity of corneal complications. Methods: Thirty eyes of 6 patients with vernal keratoconjunctivitis (VKC) and 13 patients with atopic keratoconjunctivitis (AKC) were evaluated in this study. Slit-lamp photographs of upper tarsal conjunctiva and cornea were used to evaluate the clinical findings objectively. The corneal findings and clinical findings of upper tarsal conjunctiva such as conjunctival injection, edema, the height of papillae, and mucous discharge were evaluated and graded. Statistical correlations between conjunctival findings and the severity of corneal damage were analyzed. Results: Conjunctival injection and edema significantly correlated with the severity of corneal complications. The height of the papillae and the amount of mucous discharge did not correlate with the severity of corneal complications. Conclusion: Direct signs of inflammation such as injection and edema correlated with corneal damage. The height of papillae did not show a significant correlation with the corneal findings. Our results suggest that inflammation of the conjunctiva rather than mechanical factors may play a greater role in the formation of corneal damage in severe ocular allergies.

Inflammatory cells in brush cytology samples correlate with the severity of corneal lesions in atopic keratoconjunctivitis

Background: Inflammatory cells infiltrating to the tarsal conjunctiva are thought to be involved in the pathogenesis of corneal lesions in severe allergic conjunctival diseases. The relation between such cells and the severity of corneal lesions was studied. Methods: Six patients with atopic keratoconjunctivitis (AKC) were enrolled in this study. Tarsal brush cytology findings and the severity of corneal damage at that point were recorded and analysed for correlation. Results: Four out of six patients exhibited correlation between eosinophils and corneal damage. Three out of six patients exhibited correlation between neutrophils and corneal damage. Two out of six patients exhibited correlation between both eosinophils and neutrophils and corneal damage. Analysis of all data from all patients taken together revealed that both eosinophils and neutrophils in brush cytology samples significantly correlated with corneal damage. Conclusions: Inflammatory cells in brush cytology samples correlated with corneal damage. Evaluation of the relative percentages of inflammatory cells in brush cytology samples is a useful method of assessing disease activity in allergic conjunctival disease.