Eyeworld

EW CORNEA 60 July 2017 by Vanessa Caceres EyeWorld Contributing Writer The investigators think their study is the largest to date that analyzes signs and symptoms in dry eye patients and the first to analyze the discordance between signs and symptoms. Surprising results The results confirm what Inna Ozerov, MD, Miami Eye Institute, Hollywood, Florida, has seen in clinical practice, particularly among older patients. Still, there were some surprises. "Probably the most surprising finding was the inverse relation between signs and symptoms in diabetic patients. We assumed that due to their neuropathic state, they would be less likely to complain of dry eye symptoms, when the reverse is true, according to researchers," Dr. Ozerov said. Dr. Ozerov isn't the only one who found the results eye-opening. "When we analyzed our results, we were quite surprised to find so many factors that were significantly associated with either more symp- toms than signs or less symptoms than signs, possibly indicating that these different factors can lead to different subtypes of dry eye with their own clinical picture," Dr. Vehof said. He agreed that the find- ing about diabetes was contrary to what clinicians might expect. Anat Galor, MD, associate professor of clinical ophthalmology, These results add to growing ev- idence that some patients with dry eye may show signs of dysfunctional somatosensory pathways, which indicates neuropathic ocular pain, the investigators wrote. Although depression was highly associated with more symptoms than signs, the results were not as significant. The association between osteo- arthritis and more dry eye symp- toms was not completely clear, but investigators theorized that a patient with increased pain sensitivity may more likely be diagnosed with osteo- arthritis and/or dry eye. Diabetes also had associations with increased symptoms to signs; this requires further investigation, Dr. Vehof and colleagues wrote. Patients who were older and had Sjögren's disease or graft-ver- sus-host disease were more likely to have signs than symptoms of dry eye. Primary Sjögren's disease in particular was associated with fewer symptoms than signs compared with secondary Sjögren's disease. Ultimately, age, chronic pain syndrome, Sjögren's disease, atopic disease, diabetes, and graft-versus- host disease were independently as- sociated predictors for a discordance between dry eye symptoms and signs. Self-perceived health also had a significant association with discor- dance between symptoms and signs; those with lower self-perceived health reported more symptoms of dry eye than clinical signs. The Ocular Surface Disease In- dex questionnaire was used to assess patient symptoms. Clinical signs were assessed with tear osmolarity, Schirmer test, tear breakup time, corneal and conjunctival staining, and meibomian gland dysfunction. Investigators also analyzed symp- toms and signs with independent demographic and environmental variables, systemic diseases, and ocular traits. Most patients were female (82.7%), and the mean patient age was 55.8 years old. Results of the study Investigators reported a correlation between symptoms score and signs severity score of 0.14 (P<0.001), and the discordance between symptoms and signs was normally distributed. The greatest predictors of more symptoms than signs were the pres- ence of irritable bowel syndrome, chronic pelvic pain, fibromyalgia, allergy, eczema, hay fever, the use of antihistamines, depression, osteo- arthritis, and antidepressant use. "The highest effect sizes were found in patients with any of the chronic pain syndromes, scoring approxi- mately 30% higher on symptoms rank compared with signs rank," the authors wrote. "Patients with atopic disorders or an allergy scored approximately 20% higher on symptoms rank compared with signs rank." Clinicians should examine for ocular allergies in patients with unexplained dry eye symptoms, the authors advised. Study sheds light on why some patients may have more symptoms than signs in dry eye disease I t can be difficult for clinicians to make sense of dry eye. Some patients have virtually no clin- ical signs, but they complain of bad symptoms. Other patients experience few if any symptoms, but their clinical signs indicate dry eye disease. A recently published study at- tempts to make sense of the discon- nect between dry eye symptoms and signs and adds to the growing body of literature supporting the presence of neuropathic ocular pain in some of those who have dry eye. The study is published in Oph- thalmology, and Jelle Vehof, MD, PhD, Department of Twin Research & Genetic Epidemiology, King's Col- lege London, St. Thomas' Hospital, Waterloo, London, U.K., was the lead author. 1 Dr. Vehof and investigators wrote that relatively little is known about factors associated with the dis- cordance between dry eye symptoms and signs. They used 648 patients from the Groningen Longitudinal Sicca Study (GLOSSY, Groningen, the Netherlands), all of whom had previously diagnosed dry eye. The patients were seen at the University Medical Center Groningen, which is a referral center for Sjögren's disease. About half of the patients seen at the center have Sjögren's disease. Dry eye disconnect Research highlight continued on page 62 use the amniotic membrane as a basement," Dr. Sangwan said. In recurrent cases, he uses a top- ical steroid, such as triamcinolone, in the residual conjunctiva. Dr. Sangwan also cautioned against rushing to operate in the case of recurrence. "People tend to do a second surgery very quickly, within a few weeks. Pterygium is a tissue that does not grow very fast, even when recurrent, so you should give it 3 to 6 months before doing the next surgery to allow the fibrosis and healing to be completed," Dr. Sangwan said. Dr. Suh's postoperative medical regimen typically includes topical antibiotics until the corneal surface has healed (usually 1 week). A top- ical steroid is used four times a day for 2 weeks, then two times a day for 2 weeks. EW Reference 1. Hovanesian JA, et al. Surgical techniques and adjuvants for the management of primary and recurrent pterygia. J Cataract Refract Surg. 2017;43:405–419. Editors' note: Dr. Hovanesian has fi- nancial interests with Katena (Denville, New Jersey). Dr. Suh has financial in- terests with Allergan (Dublin, Ireland). Dr. Slomovic has financial interests with Santen (Osaka, Japan), Shire Pharmaceuticals (Lexington, Massachu- setts), Alcon (Fort Worth, Texas), Al- lergan, and Johnson & Johnson Vision (Santa Ana, California). Dr. Sangwan has no related financial interests. Contact information Hovanesian: drhovanesian@harvardeye.com Sangwan: drsangwan.lvpei@gmail.com Slomovic: allan.slomovic@utoronto.ca Suh: lhs2118@cumc.columbia.edu Pterygium continued from page 59

• Blank Page
• Blank Page (1)