Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - Corneaimproved fluorophotometry technique to the Schirmer’s test toevaluate correlations of these measures with traditional signs andsymptoms of dry eye disease (staining, ocular discomfort).Methods: The following endpoints were assessed and correlationscalculated on data from 11 subjects with DED: demographics,symptoms, quality of life (QoL), tear film break up time, Schirmer’stest scores (ST), improved tear fluorophotometry (F), fluoresceinstaining, corneal sensitivity, lid redness, and meibomian glandmeasurements. This fluorophotometry method varies from previouslyreported procedures through alterations in fluorescien drop volume,fluorescien drop concentration, and scan initiation in relation to thesubject’s blink.Results: Fluorophotometry scores correlated well with both signs andsymptoms of dry eye in this study, while Schirmer’s test did notcorrelate with any signs or symptoms measured. Higher flow rates(tear turnover rates) were associated with lower ocular discomfortscores and lower fluorescein staining (R=-0.81, p=0.005 for oculardiscomfort. R=-0.17, p=0.05 for central staining).Conclusions: Results suggest that when using this modifiedmethodology, fluorophotometry may be a better tool for measuringaqueous secretion than the Schirmer’s test, based on superiorcorrelations with traditional signs and symptoms of dry eye disease.Improving the methodology for performing fluorophotometryassessments is important to ensuring the greatest possible accuracy ofthe measurement.Commercial Relationships: Colleen Heckley, Ora, Inc. (E); EndriAngjeli, Ora, Inc. (E); Keith J. Lane, Ora, Inc. (E); Canice Ahearn,Ora Inc (E); Donna L. Welch, Ora, inc. (E); George W. Ousler,Ora, Inc. (E)Program Number: 6044 Poster Board Number: A0107Presentation Time: 10:30 AM - 12:15 PMEffects of controlled heat delivery to the eyelid margin & eyelidhygiene on symptomatology and the tear film in MGDMichel Guillon 1, 2 , Cecile A. Maissa 1 , Stephanie Wong 1 , Anna Lane 1 ,Benjamin Bossard 1 . 1 OTG Research & Consultancy, London, UnitedKingdom; 2 School of Life and Health Sciences, Aston University,Birmingham, United Kingdom.Purpose: The International Workshop on Meibomian GlandDysfunction has identified heat delivery to the eyelid margin andeyelid massage as the first step in managing MGD of any severity. Adifficulty in the past has been to deliver controlled heat to the eyelidmargin area. The objective of the investigation was therefore to testthe recommendation put forward by assessing the efficacy of thecombined use of controlled heat and eyelid massage.Methods: Two sequential devices were used: EyeGiene® (toproduce controlled heat to the eyelid margins) and Supranettes eyecleaning wipes (to deliver eyelid massage): twice a day for threeweeks and once a day for the reminder of the three monthmanagement. The population was eleven dry eye sufferers with MGDdefined by a positive OSDI score (Total score≥ 13) and at least Grade2 eyelid margin anomalies. The primary endpoints were subjectiveresponse with the OSDI, tear film stability measured with theTearscope and tear film lipid composition measured by HPLC.Results: The results showed that:i. The average OSDI score decreased from “severe” pre-treatment(Total=39.5) to “moderate” at the three week (Total=24.8; p=0.031)and three month (Total=26.6; p=0.038) follow-up. At three monthsthe incidence of severe cases was halved (73% vs. 36%) and theincidence of “asymptomatic” cases nearly one in five (0% vs. 18%).ii. Tear film stability increased significantly between pre-treatment(Med 7.7sec) and the three week (Med 12.7sec; p=0.045) and threemonth (Med 11.3; p=0.004) follow-up.iii. Total tear film lipid concentration increased significantly frompre-treatment (3.3µg/µl) to the three week (5.8 µg/µl; p=0.079) andthree month (7.4 µg/µl; p=0.032) follow-up.iv. Tear film lipid composition was altered during the study period.After three months concentrations of fatty acids (12.6% vs. 7.2%;p=0.033) and cholesterol (1.4% vs. 0.9%; p=0.038) decreased andconcentrations of wax ester/cholesterol ester (85.4% vs. 90.6%;p=0.039) and triglycerides (0.5% vs. 1.3%; p=0.013) increased.Conclusions: The study demonstrated the efficacy of the combineduse of controlled heat and mechanical massage in reducing symptomsin MGD. Further, the results suggest that this controlled managementaffect the meibomian glands as the tear film lipid concentrationincreased, and its composition was modified leading to improved tearfilm stability.Commercial Relationships: Michel Guillon, Johnson & JohnsonVision Care (C), Alcon (C), Allergan (C), OTG Research &Consultancy (F), Wipes / Optometric technology Group Ltd (P),Contact Lens Anterior Eye (S), Eye and Contact lens (S),International society for Contact Lens Research (S), Tear Film andOcular Surface (S), Alcon (F); Cecile A. Maissa, Alcon (F),Optometric Technology Group (E), Alcon (C), Allergan (C), JJVCI(C), Member of CLDW Tear film subcommittee (Tear Film & OcularSurface Society) (S), Wipes/Optometric Technology Group Ltd (P);Stephanie Wong, Optometric Technology Group (E), Alcon (F);Anna Lane, Optometric Technology Group (E), Alcon (F);Benjamin Bossard, Optometric Technology Group (E)Support: OTG Research & ConsultancyProgram Number: 6045 Poster Board Number: A0108Presentation Time: 10:30 AM - 12:15 PMA Software-based Approach for the Analysis of LissamineStaining of the ConjunctivaKeith J. Lane, John D. Rodriguez, Endri Angjeli, George W. Ousler.Clinical R & D, Ora, Inc., Andover, MA.Purpose: The evaluation of vital staining in the dry eye subject is ofprimary importance in clinical trials. While the most prevalentstaining methodology may be corneal fluoresecien staining, lissaminestaining is a valuable tool for the evaluation of conjunctival tissue.This abstract extends previous work on software detection of cornealstaining using fluorescein, where pixel intensity variations alone arerequired for enumerating corneal superficial punctate keratitis (SPK).Analysis of lissamine images, however, entails several additionalcomplications. For example, variations in image hue, edge analysis,and shape analysis must be calculated to detect staining blobs andremove false positives due to dye pooling in tissue folds. We applythis method to a sample dry eye population.Methods: High resolution digital images were obtained of the nasal,temporal, and inferior conjunctival tissue using lissamine dye in apopulation of seven mild to moderate dry eye subjects. Ten imageswere selected and graded using the Ora Calibra dry eye stainingscale (0-4) by a clinician based on image quality and representing amaximal range of staining severity. Each image was processed usingsoftware with the number of isolated stained regions, and theirrespective surface areas were calculated. Clinical grade wascompared to the log of the number of staining areas, as well as thelog of the total stained area.Results: The mean number of isolated stained regions was 73.7, andthe mean staining area (as a percent of surface area) was 0.3049.Correlation of log region number with clinical grade was 87% (91%versus log region area).Conclusions: A software approach to conjunctival grading canefficiently and accurately extract clinical information from alissamine image. The relative importance of staining area may be due©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. 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