Yuichi Uchino

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.

The features of dry eye disease in a Japanese elderly population.

Purpose. The purpose of this study is to assess the features of dry eye disease in a Japanese elderly population. Methods. One hundred thirteen left eyes of 113 pensioners (50 males, 63 females; mean age, 67.5 ± 5.7 years) aged over 60 years were recruited in this study. The subjects underwent careful slit-lamp examinations of the conjunctiva, ocular surface, and the eye lids. Tear film breakup time (BUT) examinations, Schirmer test-I, and fluorescein staining of the ocular surface and transillumination of the eyelids were also performed. Dry eye symptomatology was assessed with a symptom questionnaire. Japanese Dry Eye Diagnostic Criteria were used in this study. Results. Ocular tiredness, irritation, dryness, and foreign body sensation were the most frequently reported symptoms by the patients. A total of 73.5% of the eyes had definite dry eyes. A total of 39.8% of the eyes had a Schirmer test reading <5 mm. Mean Schirmer test value was 9.4 ± 7.8 mm. The mean BUT score was 4.0 ± 2.8 seconds. A total of 76.9% of the eyes had positive fluorescein staining of the cornea. Meibomian gland dysfunction and conjunctivochalasis were found as frequent factors in relation to dry eye disease with meibomian grand dropout showing positive correlation with tear instability. Conclusion. Qualitative and quantitative disorders of the tear film were far more common than recognized in this population of elderly subjects, meibomian gland dysfunction being the most common associate of the tear film disorder and dry eye status. Conjunctivochalasis (conjunctival laxity), although commonly associated with dry eye disease in the elderly, was observed not to be related to age or gender in this study.

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.

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

TFOS DEWS II pathophysiology report

6160 per employee when measured by total production and

Effect of anterior and posterior corneal surface irregularity on vision after Descemet-stripping endothelial keratoplasty

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.

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

The TFOS DEWS II Pathophysiology Subcommittee reviewed the mechanisms involved in the initiation and perpetuation of dry eye disease. Its central mechanism is evaporative water loss leading to hyperosmolar tissue damage. Research in human disease and in animal models has shown that this, either directly or by inducing inflammation, causes a loss of both epithelial and goblet cells. The consequent decrease in surface wettability leads to early tear film breakup and amplifies hyperosmolarity via a Vicious Circle. Pain in dry eye is caused by tear hyperosmolarity, loss of lubrication, inflammatory mediators and neurosensory factors, while visual symptoms arise from tear and ocular surface irregularity. Increased friction targets damage to the lids and ocular surface, resulting in characteristic punctate epithelial keratitis, superior limbic keratoconjunctivitis, filamentary keratitis, lid parallel conjunctival folds, and lid wiper epitheliopathy. Hybrid dry eye disease, with features of both aqueous deficiency and increased evaporation, is common and efforts should be made to determine the relative contribution of each form to the total picture. To this end, practical methods are needed to measure tear evaporation in the clinic, and similarly, methods are needed to measure osmolarity at the tissue level across the ocular surface, to better determine the severity of dry eye. Areas for future research include the role of genetic mechanisms in non-Sjögren syndrome dry eye, the targeting of the terminal duct in meibomian gland disease and the influence of gaze dynamics and the closed eye state on tear stability and ocular surface inflammation.

Comparison of anterior and posterior corneal surface irregularity in Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty.

PURPOSE: To evaluate irregularity of the anterior and posterior cornea before and after Descemet‐stripping endothelial keratoplasty (DSEK) and its effect on visual acuity. SETTING: Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan. METHODS: Corneal data were acquired using a rotating Scheimpflug camera before and 1 month and 3 months after DSEK. Anterior and posterior corneal elevation data were decomposed into a set of Zernike polynomials up to the 8th order within a 4.0 mm diameter region. Total higher‐order root mean square (HO‐RMS) and RMS from the 3rd to 8th order were calculated. The effects of anterior and posterior surface irregularity on visual acuity were evaluated. RESULTS: This clinical study comprised 13 consecutive eyes of 12 bullous keratopathy patients. The mean best corrected visual acuity (BCVA) was 1.11 logMAR ± 0.5 (SD) preoperatively, 0.49 ± 0.49 logMAR 1 month postoperatively, and 0.27 ± 0.32 logMAR at 3 months. The HO‐RMS of the anterior surface 1 month (P = .040) and 3 months (P = .048) postoperatively was significantly lower than preoperatively. There were no significant differences in posterior surface HO‐RMS between preoperatively and 1 month (P = .45) and 3 months (P = .054). The postoperative BCVA was significantly correlated with HO‐RMS (P<.001), but not with posterior surface HO‐RMS, at 3 months (P = .354). CONCLUSION: Postoperative BCVA correlated with irregularity of the anterior surface but not the posterior surface. In addition to corneal transparency, regularity of the anterior surface is an important factor in visual acuity after DSEK.

A new mouse model of dry eye disease: oxidative stress affects functional decline in the lacrimal gland.

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.

Comparison of corneal thickness and haze in DSAEK and penetrating keratoplasty.

Purpose: To evaluate the irregularity of the anterior and posterior cornea after Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK). Methods: This clinical study comprised 39 eyes: 13 consecutive eyes after DSAEK, 13 consecutive eyes after PK, and 13 age-matched normal eyes. Corneal elevation data were acquired using a rotating Scheimpflug camera 1 and 3 months after DSAEK and PK. Anterior and posterior corneal elevation data were decomposed into a set of Zernike polynomials up to eighth order. Total higher-order root mean square (RMS) and RMS from third to eighth order were calculated. The astigmatism and irregularity of the anterior and posterior surfaces were compared between DSAEK and PK. Results: The regular astigmatism and tilt components of the anterior surface were significantly lower after DSAEK than after PK at 1 and 3 months (P < 0.001), whereas there was no difference in astigmatism of the posterior surface between the groups (P = 0.07, 0.22). The higher-order RMS and RMSs of third- to eighth-order components of the anterior surface were significantly larger after PK than those after DSAEK at 1 and 3 months (P < 0.01), whereas there were no significant differences between DSAEK and PK in higher-order aberration RMS and RMSs of third- to eighth-order components of the posterior surface. Conclusions: Postoperative corneal irregularity of the anterior surface was greater after PK than after DSAEK, whereas there was no significant difference in posterior surface irregularity. DSAEK is superior to PK in terms of the higher-order irregularity of the anterior surface.