Eyeworld

26 September 2018 EW NEWS & OPINION by Liz Hillman EyeWorld Senior Staff Writer Prolonged reading shows negative effect on tear film and ocular surface Research suggests conducting reading tests could reduce discordance between patient-reported symptoms and clinical exam findings W hen it comes to dry eye and ocular surface disease, there is often discordance between what the patient describes and what the clinician sees upon examination, said Esen Akpek, MD, Bendann Family Profes- sor of Ophthalmology, Wilmer Eye Institute, Baltimore. A patient with dry eye might come into the clinic miserable, com- plaining of being unable to see, un- able to read, avoiding night driving or driving in unfamiliar areas due to fluctuating vision symptoms. Yet their exam shows a visual acuity of 20/20 and their ocular surface looks fine at the time. On the flip side, a patient undergoing therapy for dry eye might come in for a checkup, praising the treatment and how it has helped them, but their ocular surface, upon clinical examination, looks terrible. Wanting to better understand what could be going on in situations like these, Dr. Akpek and her team began testing visual function in dry eye. First, they used existing read- ing tests, the majority of which are short in duration and designed for patients with central visual acuity issues, and found there wasn't much of a difference between those with dry eye and age-matched controls. "Then it occurred to us that maybe … [patients with dry eye] can't sustain reading. Book reading is not only for 2 minutes. When you have an interesting book, you sometimes read it for hours, and some people make a living reading, CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof ® IQ aspheric intraocular lens ("AcrySof IQ") is intended for the replacement of the human lens to achieve visual correction of aphakia in adult patients following cataract surgery. This lens is intended for placement in the capsular bag. WARNING/PRECAUTION: Use the UltraSert ™ Pre-loaded Delivery System ("UltraSert") at temperatures between 18° C (64° F) and 23°C (73° F). Use only Alcon viscoelastic qualified for this device. Do not use the UltraSert if the nozzle appears damaged or deformed. Follow the Directions for Use for correct order and sequence of steps to avoid damage to the IOL or the UltraSert. Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use. Caution should be used prior to lens encapsulation to avoid lens decentrations or dislocations. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof ® Natural IOL and normal color vision. The effect on vision of the AcrySof ® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C. ATTENTION: Reference the Directions for Use for Model AU00T0 for a complete listing of indications, warnings and precautions. © 2017 Novartis 12/17 US-ULS-17-E-2972a doing computer work and using their eyes in a sustained manner. We thought maybe the testings are not long enough," Dr. Akpek said. In a paper published in Ophthal- mology, Dr. Akpek and her colleagues describe using a 30-minute silent reading test of 7,200 words, which was developed by Pradeep Ramulu, MD, PhD. 1 "When we used the sustained reading testing, we demonstrated that these patients with dry eye read less words per minute, and it gets slower toward the end of the read- ing test," Dr. Akpek said. The researchers used the Ocular Surface Disease Index questionnaire, conducted noninvasive tear break- up time testing, analyzed surface asymmetry and regularity of indices, and performed Schirmer's testing without anesthesia, corneal staining with fluorescein, and conjunctival staining with lissamine green both before and after the reading test. All of the testing measures, except the surface asymmetry index, were worse in the 177 dry eye patients who participated as well as in the 34 normal controls, all of whom were 50 years or older. "Reading disturbs the eye sur- face. It dries it up and increases the surface staining scoring. That causes irregularity of the eye surface and the tear film and probably blurring of the image," Dr. Akpek said. Dr. Akpek and coinvestigators are conducting further research to find out why prolonged reading continued on page 28

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