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      The Effect of Lubricating Eye Drop Containing Hydroxypropyl Guar on Perimetry Results of Patients with Glaucoma and Trachomatous Dry Eye

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          Purpose: To evaluate the effects of a mid-viscosity mucomimetic lubricant eye drop containing hydroxypropyl guar (HPG) as a gelling agent on computerized perimetry FASTPAC test results of primary open-angle glaucoma (POAG) patients with trachomatous dry eye. Methods: Both eyes of 33 patients with bilateral POAG and trachomatous dry eye were included in the study. They were treated with the same antiglaucomatous eye drop and underwent computerized perimetry. Before and after the treatment with lubricant eye drop (Systane™) for 8 weeks, tear function tests (Schirmer test with topical anesthesia, fluorescein staining and tear film break-up time) and FASTPAC test with computerized perimetry were performed. Pre- and posttreatment tear functions, visual field test global indices, reliability indices, test duration and numbers of depressed points in pattern deviation plots were compared. Results: We found significant improvements in tear function tests results, in computerized perimetry FASTPAC test indices, test duration and the number of depressed points in pattern deviation plots in the posttreatment evaluations. Conclusion: This study indicates that there was a benefit of mid-viscosity lubricant eye drop containing HPG treatment on computerized perimetry FASTPAC test performance in POAG subjects with trachomatous dry eye. We assume that the positive effect of this therapy is probably due to a better tear film stability, resulting in a higher optical quality of the repaired anterior corneal surface.

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          Most cited references 36

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          Prevalence of ocular surface disease in glaucoma patients.

          To examine the prevalence of ocular surface disease (OSD) in glaucoma patients. This was a cross-sectional study. One hundred and one patients, 18 years of age or older, with open-angle glaucoma or ocular hypertension were consecutively recruited for the study. Patients with a history of use of cyclosporine, steroids, topical ocular nonsteroidal anti-inflammatory drugs, or punctal plugs within the last 3 months were excluded. Each patient completed an Ocular Surface Disease Index questionnaire and underwent evaluation by Schirmer test, corneal and conjunctival lissamine green staining, and tear break-up time. Using Ocular Surface Disease Index for measuring symptoms of dry eye, 60 (59%) patients reported symptoms in at least 1 eye. Severe symptoms were reported by 27 (27%) patients. Schirmer testing showed 62 (61%) patients with decrease in tear production in at least 1 eye. Severe tear deficiency was presented in 35 (35%) patients. Corneal and conjunctival lissamine green staining showed positive results in 22 (22%) patients. None had severe staining. Tear break-up time showed abnormal tear quality in 79 (78%) patients and severe decrease in tear quality was found in at least 1 eye in 66 (65%) patients. Multivariate logistic regression models were used to investigate the association between the number of benzalkonium chloride (BAK)-containing eyedrops and results on the clinical tests of OSD. After adjustment for age and sex, each additional BAK-containing eyedrop was associated with an approximately 2 times higher odds of showing abnormal results on the lissamine green staining test (odds ratio=2.03; 95% confidence interval: 1.06 to 3.89; P=0.034). A large proportion of patients with open-angle glaucoma or ocular hypertension had signs and/or symptoms of OSD in at least 1 eye. The coexistence of OSD and the use of BAK-containing medications may impact vision-related quality of life in this patient population.
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            Impaired functional visual acuity of dry eye patients.

            To report dry eye patients' functional visual acuity, which was measured after sustained eye opening for 10-20 seconds, as a simulation of visual function of daily acts of gazing, which is defined as looking at an object with involuntary blink suppression. Interventional clinical nonrandomized comparative trial. We measured ordinary best-corrected visual acuity and functional visual acuity in non-Sjögren's syndrome (non-SS, N = 10) and Sjögren's syndrome (SS, N = 12) patients and in normal controls (N = 8), prospectively. Surface regularity index (SRI) of corneal topography was also measured under routine circumstances and after sustained eye opening. Blink rates while gazing were measured during reading in another 28 dry eye patients and during driving in another 8 normal controls. Functional visual acuity did not change (1.27-1.16) in normal controls, but decreased significantly from 1.18-0.336 in non-SS patients (P = .0007) and from 1.15-0.228 (P < .00001) in SS patients. SRI after sustained eye opening increased in non-SS (P = .032) and SS patients (P = .0007), but not in the normal controls. Blink rates during reading (P < .001) and driving (P = .012) were significantly decreased from baseline blink rates. This study shows that the visual function of dry eye patients becomes abnormal with ocular surface irregularity when the eye is kept open for 10-20 seconds. Our data indicate impaired visual function in dry eye patients while gazing. Functional visual acuity may be important in daily activities.
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              Tear film lipid layer thickness as a function of blinking.

              Alterations in the tear film lipid layer as a function of blinking were investigated using a custom-designed specular reflection monitoring system. The tear film lipid layer of 104 subjects under conditions of normal ("baseline") blinking and "forceful" blinking was quantitated on the basis of specific interference colors. Deliberate, forceful blinking was found to significantly increase the lipid layer thickness (LLT) of the tear film. The magnitude of increase was found to be correlated with the baseline LLT values; individuals with baseline LLT values of 75-150 nm demonstrated a mean increase in LLT of 33 nm following forceful blinking, whereas subjects with baseline LLT values < or = 60 nm experienced a mean increase of 19 nm. The difference in the magnitude of increase between the groups was highly significant (p = 0.0001). The data suggest that, in addition to playing a role in the spreading of lipid across the tear film, the blinking mechanism may be important in the maintenance of the lipid layer by augmenting the expression of lipids from the meibomian glands.

                Author and article information

                S. Karger AG
                February 2010
                02 September 2009
                : 224
                : 2
                : 109-115
                Harran University School of Medicine, Department of Ophthalmology, Sanliurfa, Turkey
                235924 Ophthalmologica 2010;224:109–115
                © 2009 S. Karger AG, Basel

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                Page count
                Tables: 3, References: 53, Pages: 7
                Original Paper


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