Manjushri Kumar

Oral omega-3 fatty acids treatment in computer vision syndrome related dry eye

PURPOSE To assess the efficacy of dietary consumption of omega-3 fatty acids (O3FAs) on dry eye symptoms, Schirmer test, tear film break up time (TBUT) and conjunctival impression cytology (CIC) in patients with computer vision syndrome. SETTING AND DESIGN Interventional, randomized, double blind, multi-centric study. METHODS Four hundred and seventy eight symptomatic patients using computers for more than 3h per day for minimum 1 year were randomized into two groups: 220 patients received two capsules of omega-3 fatty acids each containing 180mg eicosapentaenoic acid (EPA) and 120mg docosahexaenoic acid (DHA) daily (O3FA group) and 236 patients received two capsules of a placebo containing olive oil daily for 3 months (placebo group). The primary outcome measure was improvement in dry eye symptoms and secondary outcome measures were improvement in Nelson grade and an increase in Schirmer and TBUT scores at 3 months. RESULTS In the placebo group, before dietary intervention, the mean symptom score, Schirmer, TBUT and CIC scores were 7.5±2, 19.9±4.7mm, 11.5±2s and 1±0.9 respectively, and 3 months later were 6.8±2.2, 20.5±4.7mm, 12±2.2s and 0.9±0.9 respectively. In the O3FA group, these values were 8.0±2.6, 20.1±4.2mm, 11.7±1.6s and 1.2±0.8 before dietary intervention and 3.9±2.2, 21.4±4mm, 15±1.7s, 0.5±0.6 after 3 months of intervention, respectively. CONCLUSION This study demonstrates the beneficial effect of orally administered O3FAs in alleviating dry eye symptoms, decreasing tear evaporation rate and improving Nelson grade in patients suffering from computer vision syndrome related dry eye.

The Correlation of Routine Tear Function Tests and Conjunctival Impression Cytology in Dry Eye Syndrome

Purpose To establish the strength of the association between routine tear function tests and conjunctival impression cytology (CIC) and to determine whether they simulate the morphological and cytological changes that occur on the ocular surface in dry eye. What are the sensitivity, specificity and positive predictive values of these tests when CIC is considered the gold standard? Methods The tear film profile included tear film break up time (TBUT), Schirmers-1, Rose Bengal scores (RBS), and impression cytology. CIC samples were obtained from the inferior bulbar conjunctiva and stained with periodic acid-Schiff and counter stained with hematoxylin and eosin. Results The mean Schirmers value was 11.66 ± 5.90 in patients and 17.17 ± 2.97 in controls (p < 0.001). The mean TBUT in participants was 8.88 ± 3.54 and 13.53 ± 2.12 in controls (p < 0.001). Patients had a mean goblet cell density (GCD) of 490 ± 213, while the value for controls was 1,462 ± 661 (p < 0.001). Abnormal CIC was observed in 46.7% cases of dry eye and in 32.8% of controls. The correlation coefficient (L) for Schirmers was 0.2 and 0.24 for participants and controls, respectively, while TBUT values were 0.26 and 0.38, RBS were 0.5 and 0.5, and GCD was 0.8 and 0.6 in cases and controls, respectively. Conclusions GCD, RBS, and TBUT were better predictors of morphological and cytological changes in the conjunctiva than Schirmers in dry eye syndrome. The sensitivity of tear function tests in diagnosing dry eye was TBUT > Schirmers > RBS, and the specificity was Schirmers > TBUT > RBS in decreasing order when CIC was considered the gold standard.

The diagnostic value and accuracy of conjunctival impression cytology, dry eye symptomatology, and routine tear function tests in computer users.

Aims and Objectives: To compare the diagnostic value and accuracy of dry eye scoring system (DESS), conjunctival impression cytology (CIC), tear film breakup time (TBUT), and Schirmers test in computer users. Methods: A case–control study was done at two referral eye centers. Eyes of 344 computer users were compared to 371 eyes of age and sex matched controls. Dry eye questionnaire (DESS) was administered to both groups and they further underwent measurement of TBUT, Schirmers, and CIC. Correlation analysis was performed between DESS, CIC, TBUT, and Schirmers test scores. A Pearsons coefficient of the linear expression (R2) of 0.5 or more was statistically significant. Results: The mean age in cases (26.05 ± 4.06 years) was comparable to controls (25.67 ± 3.65 years) (P = 0.465). The mean symptom score in computer users was significantly higher as compared to controls (P < 0.001). Mean TBUT, Schirmers test values, and goblet cell density were significantly reduced in computer users (P < 0.001). TBUT, Schirmers, and CIC were abnormal in 48.5%, 29.1%, and 38.4% symptomatic computer users respectively as compared to 8%, 6.7%, and 7.3% symptomatic controls respectively. On correlation analysis, there was a significant (inverse) association of dry eye symptoms (DESS) with TBUT and CIC scores (R2 > 0.5), in contrast to Schirmers scores (R2 < 0.5). Duration of computer usage had a significant effect on dry eye symptoms severity, TBUT, and CIC scores as compared to Schirmers test. Conclusion: DESS should be used in combination with TBUT and CIC for dry eye evaluation in computer users.

Conjunctival impression cytology versus routine tear function tests for dry eye evaluation in contact lens wearers

Aims: Prolonged contact lens wear is often accompanied by dryness of the eyes. The aim of this study was to compare conjunctival impression cytology (CIC) and tear film tests such as tear film break up time (TBUT) and Schirmer test for dry eye evaluation in contact lens wearers and measure their correlation with dry eye symptoms. Setting: A case control study was done at three referral eye centers. Materials and Methods: The eyes of 230 contact lens users were compared to 250 eyes of age- and sex-matched controls. Participants were recruited based on their response to a questionnaire of dry eye symptoms, (Dry Eye Scoring System, DESS©) and measurements of TBUT, Schirmer test, and CIC was done. A correlation analysis between symptom severity and tear film tests was performed. Pearsons coefficient, R2 > 0.5 was considered significant. Results: As compared to controls (r2 = 0.010), Nelson grade correlated significantly with dry eye symptoms (r2 = 0.765), among cases. However, there was moderate correlation between dry eye symptoms, Schirmer test, and TBUT (r2 = 0.557 and 0.530, respectively) among cases and a weak correlation among controls (r2 = 0.130 and 0.054, respectively). The sensitivity of TBUT was 86.4%, specificity was 82.4%, positive likelihood ratio (LR) was 4.50 [95% confidence interval (CI) 3.46-5.85)], and negative LR was 0.09. The sensitivity of the Schirmer test was 48.2%, specificity 88%, LR 2.12 (95% CI 1.48-2.96), and negative LR 0.83. Conclusion: CIC correlates better than Schirmer and TBUT with dry eye symptoms. It may be the most appropriate test for dry-eye evaluation in contact lens wearers.

Congenital Leukemia: A Case Report

Congenital Leukemia is rare malignancy presenting at birth or shortly thereafter with non-specific signs and symptoms. We present a 7 day old female weighing 2500g, with fever, lethargy, poor feeding and failure to thrive, following uneventful full term pregnancy. Peripheral smear examination and leukemic cells in bone marrow established the diagnosis.