Yuri Sakane

Development and Validation of the Dry Eye–Related Quality-of-Life Score Questionnaire

IMPORTANCE A validated questionnaire that assesses symptoms and the effect of dry eye disease (DED) on the patients daily life is needed to evaluate the condition. OBJECTIVE To develop and validate the Dry Eye-Related Quality-of-Life Score (DEQS) questionnaire in Japan. DESIGN, SETTING, AND PARTICIPANTS Development and evaluation of the DEQS questionnaire were conducted in 4 phases: (1) item generation, (2) pilot study to assess content and face validity, (3) preliminary psychometric validation study to examine factor structure and reduce the number of items, and (4) final psychometric validation with 224 participants (203 with DED and 21 serving as controls). Participants completed the DEQS questionnaire, the Short Form-8, and the National Eye Institute Visual Function Questionnaire-25. To evaluate reproducibility and responsiveness, individuals with DED completed the DEQS questionnaire twice. MAIN OUTCOMES AND MEASURES Internal consistency, reproducibility, discriminant validity, concurrent validity, and responsiveness. RESULTS Items were generated from a literature review, and 35 items were selected for the draft version. In the pilot study, 11 items were deleted; furthermore, 9 items were deleted based on the results of item analysis and factor analysis in the preliminary validation study. The final 15-item DEQS questionnaire consisted of an Overall Summary scale and 2 multi-item subscales: Impact on Daily Life and Bothersome Ocular Symptoms. The psychometric analysis revealed that the DEQS questionnaire has good internal consistency, test-retest reliability, discriminant validity, and responsiveness to change. The DEQS questionnaire correlated well with the mental component of the Short Form-8 and showed strong correlations with 4 subscales (Ocular Pain, Near Vision, Distance Vision, and Mental Health) of the National Eye Institute Visual Function Questionnaire-25. CONCLUSIONS AND RELEVANCE The DEQS questionnaire is valid and reliable for evaluating the multifaceted effect of DED on the patients daily life, including mental health, and it can be used easily in routine clinical practice.

New method for evaluation of early phase tear clearance by anterior segment optical coherence tomography

To describe a new method of measuring early phase tear clearance by anterior segment optical coherence tomography (AS‐OCT).

Involvement of Eyelid Pressure in Lid-Wiper Epitheliopathy

Abstract Objectives: To determine whether eyelid pressure is involved in the development of lid-wiper epitheliopathy (LWE). Methods: Study 1: The eyelid pressure was measured with a blepharo-tensiometer, and the degree of LWE was assessed in 79 eyes of 43 non-contact lens (CL) wearers. Study 2: The movements of the eyelids and displacement of the eyes during spontaneous blinking were photographed with a high-speed camera. The eyelid pressure was also measured in 34 normal eyes of 19 non-CL wearers who were not part of Study 1. Results: Study 1: Upper-LWE was detected in 24 of 79 eyes (30.4%), and no significant difference was detected in the eyelid pressure between any grade of upper-LWE. Lower-LWE was detected in 41 of 79 eyes (51.9%), and the eyelid pressure (27.9 ± 2.8 mmHg) in eyes with grade 3 LWE was significantly higher than that with grade 0 LWE (19.7 ± 1.3 mmHg; p < 0.05). Study 2: The lower eyelid pressure was significantly correlated with the length of the horizontal movement of the lower eyelids (p < 0.05) and also with the degree of posterior movement of the eye globe (p < 0.05). Conclusions: The higher pressure from the eyelid may be one of the causes for the development of lower-LWE.

Visualization of Tear Clearance Using Anterior Segment Optical Coherence Tomography and Polymethylmethacrylate Particles.

Abstract: We previously reported 2 new methods, anterior segment optical coherence tomography (AS-OCT) and polymethylmethacrylate particles suspended in fluorescein solution (PPF), for the evaluation of tear clearance and rapid tear flow after blinking (tear Krehbiel flow). Here, we investigated age-related OCT tear clearance and tear film thickness (TFT) and the potential correlation of OCT tear clearance and PPF velocity indicative of tear Krehbiel flow. Normal subjects separated into young and older groups received 5 &mgr;L of saline solution into the lower conjunctival sac, and an image of the central lower eyelid tear meniscus was captured by AS-OCT immediately and 30 seconds after natural blinking. Tear meniscus height (TMH) and tear meniscus area (TMA) were measured, and their percentage decrease was defined as OCT clearance rate. A Spectralis OCT Anterior Segment Module captured the central corneal tear film layer for TFT measurements. OCT clearance rates were significantly higher in young versus older subjects (P = 0.0002). When all subjects were analyzed, age was significantly and negatively correlated with TMH clearance rate (r = −0.4928, P = 0.0003) and TMA clearance rate (r = −0.4596, P = 0.0008). TFT values were significantly and negatively correlated with age (r = −0.6662, P < 0.0001). A second experiment examined tear Krehbiel flow by measuring PPF velocity in frontal and medial gaze positions. The medial gaze position showed significantly increased PPF velocity compared with the frontal gaze position (P = 0.006). Significant and positive correlations were found between OCT clearance rates and PPF velocity (TMH rate: r = 0.2926, P = 0.0392; TMA rate: r = 0.3274, P = 0.0205). AS-OCT and PPF might be novel techniques for quantitative evaluation of tear clearance and Krehbiel flow.

New method for viewing Krehbiel flow by polymethylmethacrylate particles suspended in fluorescein solution

To investigate the changes in the tear flow velocities caused by ageing.

Noninvasive Dry Eye Assessment Using High-Technology Ophthalmic Examination Devices

Abstract: Recently, the number of dry eye cases has dramatically increased. Thus, it is important that easy screening, exact diagnoses, and suitable treatments be available. We developed 3 original and noninvasive assessments for this disorder. First, a DR-1 dry eye monitor was used to determine the tear meniscus height quantitatively by capturing a tear meniscus digital image that was analyzed by Meniscus Processor software. The DR-1 meniscus height value significantly correlated with the fluorescein meniscus height (r = 0.06, Bland–Altman analysis). At a cutoff value of 0.22 mm, sensitivity of the dry eye diagnosis was 84.1% with 90.9% specificity. Second, the Tear Stability Analysis System was used to quantitatively measure tear film stability using a topographic modeling system corneal shape analysis device. Tear film stability was objectively and quantitatively evaluated every second during sustained eye openings. The Tear Stability Analysis System is currently installed in an RT-7000 autorefractometer and topographer to automate the diagnosis of dry eye. Third, the Ocular Surface Thermographer uses ophthalmic thermography for diagnosis. The decrease in ocular surface temperature in dry eyes was significantly greater than that in normal eyes (P < 0.001) at 10 seconds after eye opening. Decreased corneal temperature correlated significantly with the tear film breakup time (r = 0.572; P < 0.001). When changes in the ocular surface temperature of the cornea were used as indicators for dry eye, sensitivity was 0.83 and specificity was 0.80 after 10 seconds. This article describes the details and potential of these 3 noninvasive dry eye assessment systems.

Development of Ocular Surface Tribometer and Frictional Characteristics of Human Ocular Surface

The purpose of this research is to determine the frictional characteristics of human ocular surfaces. An ocular surface tribometer was developed to measure the normal forces, frictional forces, and velocities of the probe on human ocular surfaces simultaneously. In this research, the measurement on six trial subjects was performed with the developed ocular surface tribometer. In addition, a mathematical model was proposed to describe the frictional coefficient of the human ocular surface. The frictional characteristic curves were found by using the computational program employing BSG-Starcraft of PSO and LSM developed by the authors in the previous research. It was possible to classify the frictional characteristics of human ocular surfaces into three types.

Effect of Mandarin Orange Yogurt on Allergic Conjunctivitis Induced by Conjunctival Allergen Challenge

Purpose To evaluate the effects of mandarin orange yogurt containing nobiletin and β-lactoglobulin on the allergic conjunctivitis induced by a conjunctival allergen challenge (CAC). Methods Experiment 1 was performed on 26 asymptomatic patients (age, 25.3 ± 5.3 years) with proven seasonal allergic conjunctivitis due to cedar pollen. We compared the degree of conjunctivitis induced by CAC before and after ingesting mandarin orange yogurt for 2 weeks. Experiment 2 was a double-blind, placebo-controlled trial performed on 31 patients (age, 32.5 ± 12.2 years). A diet containing mandarin orange yogurt was compared to a diet containing yogurt lacking the mandarin orange on the conjunctivitis induced by CAC. The temperature of the inferior bulbar conjunctiva was measured before and 20 minutes after the CAC with an ocular surface thermographer (OST). The degree of conjunctival injection and chemosis was graded by slit-lamp biomicroscopy. The changes in the symptoms were evaluated by a questionnaire. Results In experiment 1, the scores of redness (3.07 ± 3.03 vs. 1.05 ± 1.70), chemosis (2.84 ± 2.27 vs. 0.81 ± 1.11), itching (4.34 ± 3.05 vs. 1.39 ± 2.12), and temperature (0.73 ± 0.42°C vs. 0.45 ± 0.43°C) were significantly lower (P < 0.001) after a diet of mandarin orange yogurt for 2 weeks. In experiment 2, the scores of redness (1.03 ± 0.18 vs. 1.28 ± 0.52; P = 0.0156), itching (1.93 ± 1.92 vs. 2.82 ± 2.21; P = 0.0133), and surface temperature (0.54 ± 0.21°C vs. 0.31 ± 0.25°C; P < 0.001) were significantly lower in the mandarin orange yogurt group than in the control yogurt group. Conclusions Mandarin orange yogurt can be an effective nutritional intervention for allergic conjunctivitis.