TFOS European Ambassador meeting: Unmet needs and future scientific and clinical solutions for ocular surface diseases

The mission of the Tear Film & Ocular Surface Society (TFOS) is to advance the research, literacy, and educational aspects of the scientific field of the tear film and ocular surface. Fundamental to fulfilling this mission is the TFOS Global Ambassador program. TFOS Ambassadors are dynamic and proactive experts, who help promote TFOS initiatives, such as presenting the conclusions and recommendations of the recent TFOS DEWS II™, throughout the world. They also identify unmet needs, and propose future clinical and scientific solutions, for management of ocular surface diseases in their countries. This meeting report addresses such needs and solutions for 25 European countries, as detailed in the TFOS European Ambassador meeting in Rome, Italy, in September 2019

Molecular characterization of occult hepatitis B virus infection in patients with end-stage liver disease in Colombia.

ABSTARCT: Hepatitis B virus (HBV) occult infection (OBI) is a risk factor to be taken into account in transfusion, hemodialysis and organ transplantation. The aim of this study was to identify and characterize at the molecular level OBI cases in patients with end-stage liver disease. METHODS: Sixty-six liver samples were obtained from patients with diagnosis of end-stage liver disease submitted to liver transplantation in Medellin (North West, Colombia). Samples obtained from patients who were negative for the surface antigen of HBV (n = 50) were tested for viral DNA detection by nested PCR for ORFs S, C, and X and confirmed by Southern-Blot. OBI cases were analyzed by sequencing the viral genome to determine the genotype and mutations; additionally, viral genome integration events were examined by the Alu-PCR technique. RESULTS: In five cases out of 50 patients (10%) the criteria for OBI was confirmed. HBV genotype F (subgenotypes F1 and F3), genotype A and genotype D were characterized in liver samples. Three integration events in chromosomes 5q14.1, 16p13 and 20q12 affecting Receptor-type tyrosine-protein phosphatase T, Ras Protein Specific Guanine Nucleotide Releasing Factor 2, and the zinc finger 263 genes were identified in two OBI cases. Sequence analysis of the viral genome of the 5 OBI cases showed several punctual missense and nonsense mutations affecting ORFs S, P, Core and X. CONCLUSIONS: This is the first characterization of OBI in patients with end-stage liver disease in Colombia. The OBI cases were identified in patients with HCV infection or cryptogenic cirrhosis. The integration events (5q14.1, 16p13 and 20q12) described in this study have not been previously reported. Further studies are required to validate the role of mutations and integration events in OBI pathogenesis

Non-contact meibography: keep it simple but effective.

Purpose Meibography is reported to be important in Meibomian Gland Dysfunction (MGD) evaluation. Our purpose was to investigate the usefulness of a standard infra-red video security camera in meibography. Methods Meibographs were taken of the right lower lid of 17 subjects (female 10; age = 44.3 years ±13.3 SD), randomly selected from the patient pool of Horst Riede GmbH, Weinheim, Germany. Meibomian glands (MG) were photographed by an near adapted infra-red video security camera and extend of MG loss (MGL) was measured by digital image analyzes. Lipid-layer and non-invasive break-up time (NIBUT) was measured by tearscope, dry eye symptoms were evaluated by the Ocular Surface Disease Index (OSDI). Correlations between MGL scores and ocular signs, tearfilm and symptoms were analyzed by Pearsons, differences between gender by U-test. The ability of MGL to predict dry eye symptoms was evaluated by area under the receiver operative characteristic curve (AUC). Results MGL scores were significantly correlated to lipid-layer pattern (r = −0.68, p = 0.001) NIBUT (−0.46, 0.032) OSDI (0.89, 0.001) and age (0.61, 0.005). MGL was significantly larger in female (p = 0.001). AUC of MGL was 95.8% (p = 0.001; sensitivity = 88.9%; specificity = 87.5%; threshold = 32.3%). Conclusions MGL is a predictive test of dry eye symptoms. The analyzed significant correlation between MGL and tearfilm and dry eye symptoms indicates the usefulness of the non-contact IR meibograph (PNCM)

A new modified fluorescein strip: Its repeatability and usefulness in tear film break-up time analysis.

Purpose To (i) analyze the repeatability of fluorescein instillation from a modified fluorescein strip (MFS) compared to a standard fluorescein strip (FS), and to (ii) observe its usefulness in the measurement of the fluorescein break-up time (FBUT) in comparison to the Tearscope (NIBUT). Methods In-vitro: Intra- and inter-observer repeatability in fluorescein instillation from the MFS and FS was evaluated by fluorescence analysis (n = 10, each). In-vivo: BUT of the right eye of 20 randomly selected subjects (mean age 43.3 ± 11.5, range = 21–60 years, 8 males, 12 females) was measured by use of the Tearscope and MFS. Subjects were grouped by the Ocular Surface Disease Index (OSDI) score into 8 OSDI+ and 12 OSDI− by a cut-off value of 15. Results In-vitro: Intra-observer 95% limit of agreement (LoA) of the MFS was similar to the FS LoA in observer 1 (O1), but better than the FS LoA in observer (O2) (MFS: O1: LoA = ±1.98 mW; p = 0.179; O2: ±2.71; 0.442; FS: O1: ±1.71; 0.246; O2: ±4.11; 0.512). Inter-observer LoA in fluorescence was better in MFS (±1.42; 0.111) than in FS (±3.71; 0.003). In-vivo: MFS-BUT was significantly shorter than the NIBUT (p = 0.002), but significantly correlated (r = 0.864, p < 0.001). NIBUT and MFS-BUT were significant discriminators (p < 0.001) of OSDI ± (0.948/8 s and 0.938/5 s [AUC/cut-off value]; NIBUT and MFS-BUT, respectively). Conclusions The MFS was better in the repeatability of fluorescein instillation than the FS. NIBUT and MFS-BUT were good discriminators of dry eye symptoms, but differ in their cut-off values

Impact of soft contact lenses on lid- parallel conjunctival folds

Purpose Lid-parallel conjunctival folds (LIPCOF) are related to dry eye symptoms and appear to be related to mechanical forces in blinks. The primary aim of this longitudinal, parallel group study was to investigate impact of contact lens wear (CLW) on LIPCOF and secondly the impact of contact lens wear on lid-wiper epitheliopathy (LWE) and dry eye symptoms. Methods After a 2-week wash-out phase with a hydrogen peroxide care regimen, 30 experienced contact lens wearers (female: 25, male: 5; median age: 34.5 years) with at least LIPCOF Sum grade 1 (nasal + temporal LIPCOF, either eye) were randomised into three groups: one which discontinued CLW (SPEC), one which were refitted with senofilcon A two-weekly replacement daily wear silicone hydrogel (OAS) and one which continued to wear their habitual lenses (HCL). LIPCOF Sum and LWE were evaluated at the enrolment visit and over a period of 12 weeks. LIPCOF were classified by fold number using a four-grade scale. LWE was classified using a five-point scale after staining with lissamine green and fluorescein. Symptoms were evaluated with the Ocular Surface Disease Index (OSDI). Results On enrolment, there were no differences between groups for LIPCOF Sum (median 2.0), LWE (1.0) and OSDI scores (12.5) (Kruskal-Wallis, p > 0.718). Median changes at 12-weeks follow-up compared to the enrolment visit were (HCL-group: 0.5, 0.0, 0.0; OAS-group: −1.0, −0.5, −10.42; SPEC-group: −0.5, −0.5, −5.21; LIPCOF, LWE and OSDI, respectively). LIPCOF (Friedman-Test, p = 0.178), LWE (p = 0.791) and OSDI (p = 0.874) were unaltered over the period of observation in the HCL group. LWE (p = 0.120) was unaltered in OAS group but LIPCOF (p = 0.001) and OSDI (p = 0.003) significantly improved. In the SPEC group LIPCOF (p = 0.031), LWE (p = 0.002) and OSDI (ANOVA repeated measurements, p = 0.034) changed significantly. Conclusions Refitting experienced CLW with senofilcon A daily wear, 2-week reusable contact lenses, or ceasing lens wear, improved LIPCOF, LWE and dryness symptoms

Non‐contact meibography in diagnosis and treatment of non‐obvious meibomian gland dysfunction

Meibomian gland dysfunction (MGD) is the most common cause of dry eye and is recommended to be treated by warm and moist compresses followed by lid massage and lid scrub. This case report describes changes of ocular sign, tear film and meibomian gland morphology of a non‐obvious MGD patient (lid margin, meibomian gland orifices and ocular signs appeared to be normal) undergoing MGD treatment. Without gland expression and/or meibography this form of MGD would have been overseen. Tear film, ocular signs and symptoms improved significantly after treatment. Expressibility of glands was improved with treatment although the MGD accompanying loss of meibomian glands —evaluated by non‐contact meibography— was unchanged. Loss of meibomian glands might either be irreversible or would need more extended treatment

Effect of three different liposomal eye sprays on ocular comfort and tear film.

Purpose To evaluate the effect of three different liposomal eye sprays on ocular comfort and tear film stability. Methods OptrexActiMist (AM, Optima-Pharma, Germany) was applied onto one, randomly selected eye of 80 subjects (female = 49; mean age = 49 years ± 18.6 SD) in a multi-centred, double-masked study. DryEyesMist (DEM, Boots) or TearMist (TM, Tesco) was applied onto the contralateral eye in randomized order. Over-all symptoms were investigated using the Ocular Surface Disease Index (OSDI). Ocular comfort (visual-analogue scale 0–100 [100 = perfect]) and non-invasive tear film stability (NIBUT) of each eye was evaluated before application (randomized order) and were again measured 10 min after application. Effects of products on ocular comfort and NIBUT were calculated as “factor” (=after-treatment/before-treatment). Differences between measurements were analysed by ANOVA repeated measurements and differences between groups by the dependent t-test (or the non-parametric equivalent). Results OSDI-scores (mean = 8.1 ± 9.0 SD), comfort (65 ± 24) and NIBUT (12 s ± 12.3) were statistically similar between centres (p > 0.400). Comfort and NIBUT were not different (p > 0.14) between product groups before application. Comfort and NIBUT improved significantly after application of AM (p < 0.001) but worsened with the comparing products (p < 0.058). Comfort improved by a mean factor of 1.5 (±0.82 SD) after application of AM but decreased after application of the comparing products (DEM: 0.9 ± 0.33; TM: 0.9 ± 0.34). Both factors were significantly better in AM (p < 0.027). Conclusion The original liposomal eye-spray ‘OptrexActiMist’ significantly improved ocular comfort and tear film stability while ‘TearMist’ or ‘DryEyesMist’ worsened both criteria. The latter two products may not be clinically effective in the treatment of dry eye

Effect of three different liposomal eye sprays on ocular comfort and tear film

Purpose To evaluate the effect of three different liposomal eye sprays on ocular comfort and tear film stability. Methods OptrexActiMist (AM, Optima-Pharma, Germany) was applied onto one, randomly selected eye of 80 subjects (female = 49; mean age = 49 years ± 18.6 SD) in a multi-centred, double-masked study. DryEyesMist (DEM, Boots) or TearMist (TM, Tesco) was applied onto the contralateral eye in randomized order. Over-all symptoms were investigated using the Ocular Surface Disease Index (OSDI). Ocular comfort (visual-analogue scale 0–100 [100 = perfect]) and non-invasive tear film stability (NIBUT) of each eye was evaluated before application (randomized order) and were again measured 10 min after application. Effects of products on ocular comfort and NIBUT were calculated as “factor” (=after-treatment/before-treatment). Differences between measurements were analysed by ANOVA repeated measurements and differences between groups by the dependent t-test (or the non-parametric equivalent). Results OSDI-scores (mean = 8.1 ± 9.0 SD), comfort (65 ± 24) and NIBUT (12 s ± 12.3) were statistically similar between centres (p > 0.400). Comfort and NIBUT were not different (p > 0.14) between product groups before application. Comfort and NIBUT improved significantly after application of AM (p < 0.001) but worsened with the comparing products (p < 0.058). Comfort improved by a mean factor of 1.5 (±0.82 SD) after application of AM but decreased after application of the comparing products (DEM: 0.9 ± 0.33; TM: 0.9 ± 0.34). Both factors were significantly better in AM (p < 0.027). Conclusion The original liposomal eye-spray ‘OptrexActiMist’ significantly improved ocular comfort and tear film stability while ‘TearMist’ or ‘DryEyesMist’ worsened both criteria. The latter two products may not be clinically effective in the treatment of dry eye

A comparison of an eyelid-warming device to traditional compress therapy.

Purpose. To assess the warming and humidifying effect and ocular safety of the Blephasteam® eyelid-warming device vs. warm and moist compresses in healthy volunteers. Methods. Twenty subjects (8 females, 12 males; mean age 39.2 years) were included in the study. Temperature and relative humidity were measured over a period of 10 min at the lower eyelid margin of one randomly selected eye during application of the Blephasteam device and, 1 h later, during application of warm compresses (in a randomized order). Ocular signs and visual acuity were assessed before and after each application. Results. The mean duration of warming (temperature ≥38°C) was significantly longer with Blephasteam than with compresses (7.5 vs. 1.0 min; p < 0.01). There was no significant difference between treatments in the duration of 100% relative humidity. Compared with pretreatment values, visual acuity significantly improved after Blephasteam treatment (p < 0.05) but significantly decreased after treatment with compresses (p < 0.05). Limbal redness, eyelid redness, and corneal staining scores all improved significantly after Blephasteam treatment (p < 0.05 for all). Ocular signs did not change after compress treatment except conjunctival redness, which was significantly increased (p = 0.01 vs. pretreatment). Conclusions. The Blephasteam eyelid-warming device appeared to provide more effective warming than warm and moist compresses in a group of healthy volunteers. Visual acuity, limbal redness, and eyelid redness were improved after Blephasteam use but not after treatment with compresses