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      Evaluation of objective visual quality in dry eye disease and corneal nerve changes

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          To explore objective visual quality in dry eye diseases (DED) and the correlation between corneal nerves and objective visual quality.


          Ninety-eight eyes of 49 patients with DED were included. Each patient was evaluated with the ocular surface disease index (OSDI), eyelid margin signs and meibomian gland assessments; corneal staining; tear film breakup time (TBUT); tear meniscus height (TMH); in vivo confocal microscopic (IVCM); objective visual quality including the objective scatter index (OSI), mean objective scattering index (mOSI), modulation transfer function (MTF) cutoff value and Strehl ratio.


          A significant correlation was found between the OSDI and mOSI ( r = 0.422, p = 0.005), MTF cutoff value ( r = − 0.355, p = 0.020), and Strehl ratio ( r = − 0.446, p = 0.003). The OSI was significantly correlated with TBUTf ( r = − 0.213, p = 0.042). The mOSI, MTF cutoff value, Strehl ratio were correlated with eyelid margin signs and meibomian assessments. Additionally, there was a statistically significant correlation between corneal nerve length and the mOSI ( r = − 0.239, p = 0.037), OSI ( r = − 0.294, p = 0.028), MTF cutoff value( r = 0.282, p = 0.012), and Strehl ratio ( r = 0.299, p = 0.008).


          Our study explored that objective visual quality was correlated with clinical symptoms and signs in DED patients. Furthermore, for the first time, our study explored the relationship between corneal nerves and objective visual quality and discovered that longer and wider corneal nerves were associated with better objective visual quality, which suggested that nerve changes may be a factor that related to poor visual quality in DED patients.

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          Most cited references 30

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          Corneal nerves: structure, contents and function

          Experimental Eye Research, 76(5), 521-542
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            TFOS DEWS II Definition and Classification Report

            The goals of the TFOS DEWS II Definition and Classification Subcommittee were to create an evidence-based definition and a contemporary classification system for dry eye disease (DED). The new definition recognizes the multifactorial nature of dry eye as a disease where loss of homeostasis of the tear film is the central pathophysiological concept. Ocular symptoms, as a broader term that encompasses reports of discomfort or visual disturbance, feature in the definition and the key etiologies of tear film instability, hyperosmolarity, and ocular surface inflammation and damage were determined to be important for inclusion in the definition. In the light of new data, neurosensory abnormalities were also included in the definition for the first time. In the classification of DED, recent evidence supports a scheme based on the pathophysiology where aqueous deficient and evaporative dry eye exist as a continuum, such that elements of each are considered in diagnosis and management. Central to the scheme is a positive diagnosis of DED with signs and symptoms, and this is directed towards management to restore homeostasis. The scheme also allows consideration of various related manifestations, such as non-obvious disease involving ocular surface signs without related symptoms, including neurotrophic conditions where dysfunctional sensation exists, and cases where symptoms exist without demonstrable ocular surface signs, including neuropathic pain. This approach is not intended to override clinical assessment and judgment but should prove helpful in guiding clinical management and research.
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              The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee.


                Author and article information

                Int Ophthalmol
                Int Ophthalmol
                International Ophthalmology
                Springer Netherlands (Dordrecht )
                2 July 2020
                2 July 2020
                : 40
                : 11
                : 2995-3004
                GRID grid.411642.4, ISNI 0000 0004 0605 3760, Department of Ophthalmology, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, , Peking University Third Hospital, ; Beijing, 100191 China
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                Funded by: FundRef http://dx.doi.org/10.13039/501100013076, National Major Science and Technology Projects of China;
                Award ID: 2018ZX10101004003003
                Award Recipient :
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                © Springer Nature B.V. 2020


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