Eyeworld

144 | EYEWORLD | APRIL 2019 O UTSIDE THE OR by Maxine Lipner EyeWorld Senior Contributing Writer Contact information Akpek: esakpek@jhmi.edu RESEARCH HIGHLIGHT Investigators launched a study of 155 dry eye patients over age 50 as well as 31 controls. They adapted a 30-minute sustained reading test origi- nally designed by Pradeep Yammanuru Ramulu, MD, associate professor of ophthalmology at Wilmer Eye Institute, for use in his glaucoma pa- tients. "We noted that patients who had clinically significant dry eye, where we could measure the dryness, had a reduction in their reading speed, particularly closer to the end of the 30-minute reading period," she said, noting that after 30 minutes, those with dry eye could only read 240 words per minute versus 272 words per minute for controls. However, participating in an out loud reading test for a short duration did not measure any difference, Dr. Akpek said. The Ocular Surface Disease Index (OSDI) questionnaire, which has three subsections includ- ing one linked to vision-related functioning, also showed the impact of dry eye. "We found that the vision-related OSDI subscore was independently associated with slow reading," Dr. Akpek said. In addition, investigators found a link be- tween reading speed and dry eye-related corne- al staining with the ocular staining score 0- to 6-point scoring system. "Each one-point increase in the corneal staining score is a 10-word per minute decrease in the reading speed," Dr. Akpek said. "This was the first time we were able to show a correlation between a measurable impact in function due to dry eye and a measurable clini- cal finding." Newfound correlations The prevailing wisdom has been that signs and symptoms don't correlate when it comes to dry eye. In fact, they do correlate, Dr. Akpek stressed. "If a patient says their vision is blurred, check it with the OSDI," she said. "You get the vi- sion-related OSDI and the OSDI subscore; that correlates with the decrease in their reading speed and that correlates inversely with their corneal staining." Patients' complaints can be checked. "We just have to know what to look for," Dr. Akpek said. "They are not saying they can't see the (Snellen) D ry eye patients who complain of trou- ble reading for long periods of time have study results to back up their complaints, according to Esen Akpek, MD. Study results 1 published in Optom- etry and Vision Science indicate that dry eye can slow a person's reading speed by an average of 30 words per minute and can make it difficult to read for more than about 30 minutes, Dr. Akpek said. Many dry eye patients who come in com- plaining of redness, foreign body sensation, and more often also mention their reading. "If you check their vision, they have 20/20, but they say they can't read and can't drive," she said, adding the length of the task can be an important factor. When asked to write a check, for example, typical- ly patients have no problem, but if you ask them to read a chapter for 30 minutes, it's difficult. Studying patient complaints "[W]hat patients were saying is they were unable to sustain the vision during prolonged visual functioning," Dr. Akpek said. "We thought the currently available reading tests were not long enough to stress the ocular surface to actually measure the reduction in their functioning." Dry eye's impact on patients' ability to read Slit lamp appearance of punctate epithelial erosions stained with fluorescein in a patient with aqueous tear deficiency, highlighting the irregularity of the corneal surface Source: Esen Akpek, MD continued on page 146 About the doctor Esen Akpek, MD Professor of ophthalmology and rheumatology Wilmer Eye Institute, Johns Hopkins School of Medicine Baltimore Reference 1. Karakus S, et al. Impact of dry eye on prolonged reading. Optom Vis Sci. 2018;95:1105–1113.

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