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      Relation of accommodative microfluctuation with dry eye symptoms in short tear break-up time dry eye

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          Abstract

          Purpose

          To investigate accommodative microfluctuations (AMFs) and visual function in short tear break-up time (BUT)-type dry eye (DE) and non-DE subjects.

          Methods

          This prospective comparative study included 48 volunteers with DE symptoms (mean age 34.8 ± 5.5 years, age range 25–42 years) and 73 without DE symptoms (mean age 30.6 ± 4.7 years, age range 25–42 years). The eyes were divided into two groups: (1) DE group with DE symptoms and BUT ≤ 5 s and (2) non-DE group without DE symptoms and BUT > 5 s. We excluded eyes with Schirmer score ≤ 5 mm and positive keratoconjunctival epithelial damage. Tear evaluation, AMF, and functional visual acuity (VA) examinations were performed. AMF parameters included total high-frequency component (HFC), HFC with low accommodation for the task of staring into the distance (HFC1), and HFC with high accommodation for deskwork (HFC2). Functional VA parameters included starting VA, functional VA, visual maintenance ratio, and blink frequency.

          Results

          A total of 33 and 34 eyes were categorized in the DE and non-DE groups, respectively. Mean blink frequency and HFC1 values were significantly higher in the DE group than they were in the non-DE group.

          Conclusions

          DEs with symptoms showed abnormal AMF and visual function, which may be associated with DE symptoms.

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          Most cited references36

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          The lack of association between signs and symptoms in patients with dry eye disease.

          The purpose of this report was to examine the relation between clinical tests and dry eye symptoms in patients with dry eye disease. Seventy-five patients with dry eye disease (ICD-9 code 375.15) were included in these analyses. There was no specific entry criterion for enrollment in addition to a previous dry eye diagnosis in this clinic-based sample. Patients represented varying types and severity of dry eye disease and were previously diagnosed by clinic attending doctors in this university clinic setting. The study examination included a symptom interview that assessed dryness, grittiness, soreness, redness, and ocular fatigue. The interview was followed by a clinical dry eye examination conducted in the following sequence: meibomian gland assessment, tear meniscus height, tear breakup time test, fluorescein staining, the phenol red thread test, Schirmer test, and rose bengal staining. Partial Spearman correlation coefficients, the Wilcoxon rank sum test, chi 2 test, and multivariate logistic regression were used to evaluate the relationship between dry eye tests and symptoms. Symptoms were generally not associated with clinical signs in patients with dry eye disease. There were no significant correlations between signs and symptoms after adjustment for age and artificial tear use. The rank of each clinical test result did not statistically differ when stratified by the presence of patient symptoms in Wilcoxon rank sum analyses. Likewise, the frequency of patient symptoms did not differ statistically when stratified by a positive clinical test result in chi 2 analyses. In multivariate logistic regression analyses, no clinical test significantly predicted frequently reported symptoms after adjustment for age and artificial tear use. These results suggest a poor relation between dry eye tests and symptoms, which represents a quandary in dry eye clinical research and practice.
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            Prevalence of dry eye among an elderly Chinese population in Taiwan: the Shihpai Eye Study.

            To describe the epidemiology of dry eye in an elderly Chinese population in Taipei, Taiwan. A population-based cross-sectional study. The Shihpai Eye Study was a population-based survey of eye diseases in the elderly (> or =65 years) in Shihpai, Taipei, Taiwan. Noninstitutionalized residents, as of July 1999, were identified by using the official household registration database. A total of 2045 subjects were selected, and 1361 (66.6%) people participated in the study. Among them, 822 (60.4%) were men. Trained interviewers administered a standardized questionnaire pertaining to dry-eye symptoms. Objective examinations of dry eye included tear film breakup time, Schirmer test, fluorescein stain of the cornea, and anatomic assessment of the meibomian glands via slit-lamp biomicroscopy. Frequency of dry-eye symptoms and positive dry-eye tests. In this population, 33.7% (459/1361) were symptomatic, defined as reporting 1 or more dry-eye symptoms often or all of the time. Women were more likely to report frequent symptoms of dry eye (odds ratio, 1.49; 95% confidence interval, 1.19-1.87). Among those who were symptomatic, 78.9% (362/459) had a low tear film breakup time (< or =10 seconds), 62.5% (287/459) had a low Schirmer test result (< or =5 mm), and 61.7% (283/459) had abnormal anatomic features of the meibomian glands. Furthermore, 85.4% (392/459) were symptomatic and had either a low Schirmer score or an abnormal meibomian gland assessment. Of those symptomatic, 49.9% (229/459) indicated that they had visited an eye doctor, 5.4% (25/459) responded that they had been diagnosed with dry eye, and 47.5% (218/459) reported current use of eyedrops. This is the first report of population-based data of dry eye that includes symptoms and signs in elderly Asians. The prevalence of dry eye, although varied according to definition, is relatively higher in this study than that reported for whites. Further studies are needed to determine whether this is due to racial or environmental factors.
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              Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading.

              Although meibomian gland disease (MGD) is one of the most common disorders encountered in ophthalmic practice, there has been no descriptive system consistently accepted to clinically characterize the anatomical and correlative biochemical alterations that occur in this condition. The purpose of this review is to synthesize a clinical description of meibomian gland disease and to provide a scheme for diagnosis, classification, and quantification that will be of value in the clinical setting and in the conduct of clinical trials.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: ValidationRole: VisualizationRole: Writing – original draft
                Role: VisualizationRole: Writing – review & editing
                Role: Data curationRole: Resources
                Role: SoftwareRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                8 September 2017
                2017
                : 12
                : 9
                : e0184296
                Affiliations
                [1 ] Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
                [2 ] Shinanozaka Clinic, Tokyo, Japan
                [3 ] Santen Pharmaceutical Co., Ltd., Osaka, Japan
                University of Illinois at Chicago, UNITED STATES
                Author notes

                Competing Interests: Kowa Co., Ltd. Japan provided a monetary grant for research unrelated to the current study to the Department of Ophthalmology of Keio University School of Medicine. Drs Kazuo Tsubota and Minako Kaido hold patent rights for the method and apparatus used for the measurement of functional visual acuity (US patent no: 7470026). The other authors have no affiliation with any corporation. Yoshiaki Yamada is an employee of Santen Pharmaceutical Co., Ltd., Japan, while Kazuo Tsubota is a consultant and has received research funds unrelated to this study from Santen Pharmaceutical Co., Ltd. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0001-5604-5847
                Article
                PONE-D-17-18108
                10.1371/journal.pone.0184296
                5590915
                28886090
                e99ce9fa-c2eb-4bc0-8c2c-31860947fe2a
                © 2017 Kaido et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 11 May 2017
                : 21 August 2017
                Page count
                Figures: 5, Tables: 3, Pages: 13
                Funding
                Provision of facilities and transport of equipment were supported by Santen Pharmaceutical Co., Ltd, Osaka. The funder provided support in the form of salary for one author [YY], but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of the author is articulated in the ‘author contributions’ section.
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