Lluïsa Quevedo

Temporal stability in the perception of dry eye ocular discomfort symptoms.

Purpose. A prospective longitudinal study was designed to investigate the ability of patients with tear deficiency to correctly recall their past symptoms. The ultimate goal of the study was to contribute to the ongoing research concerning the lack of association between dry eye symptomatology and clinical tests of tear film evaluation. Methods. A total of 26 subjects with ages ranging from 29 to 61 years participated in the study. All subjects reported symptoms associated with tear deficiency, although none had been diagnosed with dry eye disease. Subjects were instructed to grade their symptoms on two different occasions, at the precise moment they were experiencing them, by means of a home questionnaire, and through a recall questionnaire, which was administered within a maximum interval of 10 days from the first questionnaire. Tear evaluation tests were performed at this second time. Non-parametric statistical analyses were used to investigate the relationship between present and recalled symptoms and between symptoms and signs, as well as between the different dry eye tests. The contributions of age, gender, and recall period were also evaluated. Results. With the exception of irritation (p = 0.029) and scratchiness (p = 0.025), no statistically significant difference was encountered between home and recall questionnaires, although females were found to recall their symptoms slightly better than males (p = 0.048). An increase in the severity of the symptoms was associated with a better recollection (p = 0.007). Symptoms (home or recalled) and clinical signs were not correlated, although the recalled symptom of scratchiness presented moderately strong correlations with several dry eye tests. Conclusions. Although the lack of correlation between dry eye tests and symptoms mirrored previous research, symptoms recall was found to follow certain interesting patterns, similar to those published in pain research literature.

Knowledge and use of tear film evaluation tests by spanish practitioners

Purpose. The present study aimed at investigating the use and knowledge of tear film and dry eye evaluation tests by a representative sample of Spanish optometrists and ophthalmologists. Methods. A simple on-line survey was designed to explore the preferred tests for tear film evaluation and dry eye diagnosis. Additional questions surveyed knowledge of basic tear film evaluation concepts, attitude (proactive or reactive) toward patient symptoms and use of standardized dry eye questionnaires. Respondents also provided information regarding academic background, continuing education and training courses, and weekly number of tear film examinations. Results. A total of 140 optometrists and 103 ophthalmologists responded to the survey. The tear break-up time test was the first preference of optometrists and ophthalmologists, whereas the Schirmer test and the non-invasive break-up time were frequently reported by ophthalmologists and optometrists, respectively, to supplement a first test. Optometrists and ophthalmologists were similar in terms of continuing education, knowledge of basic tear film concepts, and attitude regarding symptoms. Continuing education was found to positively influence knowledge, attitude toward symptoms and use of more sophisticated tear film evaluation tests. Standardized dry eye questionnaires were rarely used. A strong positive statistically significant correlation was encountered between the number of continuing education and training courses and the number of weekly tear film examinations. Conclusions. Continuing education is an invaluable tool for practitioners to increase their self-confidence and improve their clinical practice when conducting tear film evaluations and dry eye diagnosis.

Changes in peripheral refraction, higher-order aberrations, and accommodative lag with a radial refractive gradient contact lens in young myopes

Purpose: To evaluate changes in the peripheral refraction (PR), visual quality, and accommodative lag with a novel soft radial refractive gradient (SRRG) experimental contact lens that produces peripheral myopic defocus. Methods: 59 myopic right eyes were fitted with the lens. The PR was measured up to 30° in the nasal and temporal horizontal visual fields and compared with values obtained without the lens. The accommodative lag was measured monocularly using the distance-induced condition method at 40 cm, and the higher-order aberrations (HOAs) of the entire eye were obtained for 3- and 5-mm pupils by aberrometry. Visual performance was assessed through contrast sensitivity function (CSF). Results: With the lens, the relative PR became significantly less hyperopic from 30° to 15° temporally and 30° nasally in the M and J0 refractive components (P<0.05). Cylinder foci showed significant myopization from 30° to 15° temporally and 30° to 25° nasally (P<0.05). The HOAs increased significantly, the CSF decreased slightly but reached statistical significance for 6 and 12 cycles per degree (P<0.05), and the accommodative lag decreased significantly with the SRRG lens (P=0.0001). There was a moderate correlation between HOAs and CSF at medium and high spatial frequencies. Conclusion: The SRRG lens induced a significant change in PR, particularly in the temporal retina. Tangential and sagittal foci changed significantly in the peripheral nasal and temporal retina. The decreased accommodative lag and increased HOAs particularly in coma-like aberration may positively affect myopia control. A longitudinal study is needed to confirm this potential.

Toric double tear reservoir contact lens in orthokeratology for astigmatism.

Objectives: This study aimed at assessing the performance of a double tear reservoir toric reverse geometry contact lens design for the correction of myopic and astigmatic refractive errors through overnight orthokeratology (Ortho-K). Methods: Consecutive records of a total of 32 patients with refractive astigmatism greater than 1.25 D at any orientation, best corrected distance monocular visual acuity ≥1.00 (decimal) before Ortho-K treatment and stable ocular refraction for at least 1 month at the time of the last visit were retrospectively examined. Preorthokeratology and postorthokeratology information included noncycloplegic subjective refraction, best-corrected visual acuity, pupil diameter, corneal topography, and ocular aberrometry. The associations between the achieved myopic and cylinder reduction and the modifications in various corneal topographic parameters were investigated. Right eyes were chosen for data analysis. Results: A statistically significant difference (Z=−4.805; P<0.001) was encountered between initial refractive sphere and final residual refractive sphere, with a dioptric change of −2.05±1.46 D (median: −1.88; −5.25 to 0.50), accounting for a change of 106% of the initial myopia. Similarly, differences between pretreatment and posttreatment refractive cylinders were significant (Z=−4.945; P<0.001), with a dioptric change of −1.80±1.06 D (median: −1.50; −5.25 to −0.50), that is, a change of 85% of the initial astigmatism. Changes in topographic Best Fit Sphere and Best Fit Toric presented a strong positive correlation with the accomplished myopic and astigmatic refractive changes, respectively. Conclusions: The results of this investigation suggest that the correction of astigmatic errors with toric orthokeratology lens designs may have a promising future.

Tear break-up time for tear film evaluation: Are moistening solutions interchangeable?

PURPOSE It was the main purpose of this study to investigate the influence of the moistening solution on TBUT measurements in an asymptomatic population. METHODS An online survey was employed to determine the compliance of Spanish eye care practitioners with the recommended normalized procedure to administer TBUT. For the purpose of examining the clinical relevance of discrepancies from the recommended procedure, a randomized, double-masked, bilateral study was designed in which a micropipette was used to moisten fluorescein strips with a controlled volume of six different solutions, commonly available in the contact lens office, and TBUT was measured in 58 non-dry eye (OSDI<15) subjects (age from 19 to 32 years). RESULTS Results from the online survey revealed that 64% of Spanish practitioners frequently use (or have used) different solutions to moisten fluorescein strips during TBUT assessment. Statistically significant differences in TBUT values were found between the various solutions as a whole (χ(2)=198.384, p<0.001), as well as between all solutions when explored pair-wise (all p<0.001), except for the two saline solutions. CONCLUSIONS The present findings support the relevance of selecting the appropriate solution when conducting TBUT for the evaluation of the tear film. Deviations from the recommended procedure may result in misdiagnosis of dry eye and unnecessary patient referral.

Successful Rehabilitation of a Homonymous Hemianopia Patient with Binocular Ground-in Sectorial Prisms: Considerations concerning Prism Power and Location

A case describing the successful rehabilitation of a patient with a right homonymous hemianopia field loss is presented. The patient was fitted with binocular 20-dioptre ground-in sectorial prisms, following a 2-month trial with Fresnel paste-on prisms. Successful fitting of binocular sectorial prisms was achieved through adjustment of prism power and location to ensure smooth transition between both hemifields of view and to avoid diplopia in primary gaze. Prism power was obtained through empirical calculation based on distance and near prism power requirements, as determined with trial lens prisms, which also allowed for determination of the best prism location.