The Dry Eye Zone

Rebecca's Blog

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ARVO Monday posters

Of substance versus trivia

I’ve been meaning to say, just for perspective… I know that a lot of what I write about is puzzling to many people who see it - as in, “How could this ridiculously technical or trivial piece of information be in any way relevant to my life?” The answer is, it isn’t, which means if you follow my stuff at all, you are probably doing a lot of skimming. I could, of course, cater for the lowest common denominator. Except that I can’t, because I delight in all levels of information, and because every now and then I get a message from someone that I just happened to have just the right piece of information for them at the right time, and that motivates me to carry on with perhaps an unusual smorgasbord of the technical and the simple, the mundane and the interesting, the broadly applicable and the narrower-than-narrow.

Dr. YouTube

I really enjoy just cruising the poster acreage. It’s a bit hard on the feet, thanks to a concrete floor that goes on forever and ever. But you just never know what interesting things you may come across before you get to the cornea nerd center. Today, the first row or two were all about eye trauma. It’s sad to see posters on things like child abuse (or “non-accidental injury” as the phrasing may go). And gun violence.

Time was a little more limited this afternoon, though, so I was cruising along pretty quickly when I came across a fun little a poster about a study assessing the reliability of YouTube as a source of information on eye floaters.

It’s the sort of thing where almost anyone who thought about it long enough ought to be able to write the conclusions of the study without doing any of the actual research work.

Which is exactly why it’s so fun that somebody actually DID the research work! Seriously! And concluded, predictably:

  • YouTube is not a reliable source of information on floaters…

  • …misleading… potentially dangerous…  

  • …the best videos are not the most viewed, they’re the ones with the higher like to dislike ratios…

  • …sources like AAO are best….

I know floaters are very poorly understood by the general public. But seriously, I think there’s a lot of eye conditions that you could substitute for “floaters” in those conclusions, with everything else remaining perfectly true. Or am I wrong? Is there something about floaters that uniquely brings out the stupid factor on YouTube?

Moving right along… Ah, hello cornea!

Epidemiology, i.e. who gets dry eye?

What predisposes Asian eyes to dry eye?

Jenny Craig of the University of Auckland (also vice chair of TFOS DEWS II) is responsible for this one. If you’re aware of the very high rates of dry eye amongst Asians, did you ever wonder why? (Independent, that is, of environmental and geographical factors.) Well, the part they were able to pin down is differences in the blink: From an early age, there is a higher tendencey amongst Asians to an incomplete blink and to lid wiper epitheliopathy. This research is on its way to the publisher, by the way, so I’ll be putting the full work out there on the blog in due course. Also in the pipeline, I’m told, is possibly some work specifically on the very blinking exercises that may be able to help.

Takushima island

Another collection of data from a population study of prevalence and risk factors for dry eye in Japan, and the first of its kind to include MGD, blepharitis and dry eye in the same study.

Brazilian medical students

29.3% have dry eye, based on OSDI symptom scores, compared to 17.8% in the overall population. Students… take care of your peepers please!

Drops

Not a lot here on drops today (at least on this side… I haven’t had time to hike over to the other side and they’re closing pretty soon, but I think all the dry eye stuff was on this side anyway). But FWIW:

  • Alpha lipoic acid eye drops: Poster suggesting they “may” improve tear stability, used 3x daily for 90 days. Notta lotta detail.

  • Bascom Palmer paper on autologous serum eye drops providing subjective improvement, with higher likelihood in evaporative dry eye types, verified by phone survey 3 months after starting. Patients in this study 77% male. Serum concentration unfortunately not specified.

Glaucoma

Glaucoma and dry eye in Ghana

There’ve been a lot of really neat dry eye studies coming out of Ghana lately, by the way…

Seems glaucoma prevalence is very high in Ghana in general. But amongst glaucoma patients, they found based on OSDI symptom scores that 81% have dry eye symptoms… and an equally whopping 87% have an abnormal TBUT. 25% of women with glaucoma have severe symptoms as do 22% of men.

…And, how about dealing with the damage from drops?

In another poster, they studied glaucoma patients with no history of dry eye before glaucoma. Those patients were taking an average of 5 drops a day, 3 of which are preserved with BAK. They treated the ones with dry eye with lid hygiene, FML, omega 3s, doxycycline, and lubricants but kept them on the same glaucoma drops.

Dry eye treatments improved redness, corneal staining, vision and OSDI symptom scores. What’s not to like about that?

Conclusion: “Osdi signs and symptoms are prevalent and represent a challenge in glaucoma patients”"

Sigh. Far too many elderly people on glaucoma drops are not being diagnosed or treated for dry eye, still. This needs to change!

Interested in your gut?

Dr Fishman was here with a great poster on an association between dry eye disease and lower gut microbiome diversity! They identified 3 in particular that were lower in dry eye patients. Actually, he had a really smart high school student working on this and she was here to present it. Congrats Abiya Bagai!

Female stuff

Menstrual cycle?

There was a really cool paper called “Influence of somatosensory function and the menstrual cycle on dry eye symptoms”. It’s a little involved, but basically… most research on the cycle’s connection to dry eye (if any) focuses on clinical signs. This one zeroed in on symptoms, and looked at other changes that happen to sensory experience during the cycle that might be related to experiencing dry eye symptoms differently. In the end, they found that there were no significant changes in dry eye signs or symptoms BUT the relationship between signs and symptoms did change during the cycle! Don’t mind me - I get excited about anything that can explain any part of sign/symptom relationships in any circumstances.

Breast cancer treatment and dry eye

Another poster looked at the effects of aromatase inhibitors on signs and symptoms of dry eye.

And… ta da… NOTHING. Or almost nothing. The treatment did not do it. Prior history of chemotherapy didn’t appear to have either.

How often does somebody go around showing research saying that thus-and-such does NOT cause dry eye? (Somebody plausible, that is, as opposed to a peddler of something we all know to be harmful.) I want some more of that. A lot more of that.


Demodex

Poster from Tufts on demodex mite density being associated with reduced corneal subbasal nerve density in patients with dry eye disease (defined as symptomatic plus TBUT under 10).

Headaches

Poster about research looking into whether there’s a dry eye connection difference between migraine headaches and tension headaches (previous research hasn’t distinguished). Answer, not really, although the quality of life impact differed.

Dirty air, indoors or outdoors

Now I’m really running out of time but there were two posters on this (plus a really interesting presentation earlier that I’m hoping to post about later on) - one from Bascom Palmer, saying that indoor air particulate matter content was a significant predictor for dry eye (signs and symptoms). Another from Gachon University in China found that different particulate types differed in their association to dry eye symptoms.

Sleep

Not news, lot published on this lately but for those who missed the memo, it’s absolutely worth repeating: poor sleep quality and short sleep duration are both associated with dry eye symptoms.

Mining Facebook for data on GvHD

This one was fun… they analyzed a facebook group of GvHD users to establish, based on symptoms reported, what percent of GvHD patient members in the group have ocular symptoms. They came out about 25%. The reason it seemed this was potentially useful information is that estimates in published studies are all over the map (19% to 56%) for a variety of reasons.

MGD

Poster from Johnson & Johnson about how common MGD is. Now, of course it really is high, but I’m much less inclined to believe it from the lips of the purveys of Lipiflow. But for what it’s worth… 41.6% in general population, 74% if more than 4 hours on screen time daily, and 76.3% of those diagnosed with dry eye.

Incidentally they also had a paper about dry eye clinical presentation (what’s going on with our eyes), co-morbidities (what else is going on) and healthcare utilization (are you getting help). This was medical claims data mining, and we learned a lot about the pitfalls of that yesterday in the Big Data course. So the idea that only 12.7% of people who were diagnosed with dry eye, had actually been tested for anything, was a stretch to the imagination. To be fair, they readily acknowledged the limitations when asked.

Winding up the day

I have much more to write up - there’s the whole ocular surface session, and also I had a great conversation with the PhD student from Australia who presented on BAK earlier today. But right now, I’m signing off for the day and heading to the TFOS DEWS II dinner.