Annual direct cost of dry eye in Japan

Yoshinobu Mizuno, Masakazu Yamada, Chika ShigeyasuDivision for Vision Research, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, JapanOn behalf of The Dry Eye Survey Group, National Hospital Organization of JapanBackground: This study was performed to estimate the annual direct cost incurred by dry eye patients, which includes expenses for treatment and drugs, as well as the cost of punctal plugs.Methods: The study group consisted of 118 dry eye patients aged 20 years or older who visited any of the 15 medical care facilities that participated in this prospective cohort dry eye study. We estimated annual direct costs from outpatient medical records and survey questionnaires obtained from patients. Results: Of the total patients enrolled, 10 were men and 108 women, and their average age was 64.1 ± 11.2 years. The number of hospital visits made by patients was 5.8 ± 3.6 per year. Among those who used ophthalmic solutions, the numbers of bottles used per year were as follows: 32.1 ± 20.8 bottles of hyaluronic acid ophthalmic solution (87 patients), 53.1 ± 42.2 bottles of artificial tears (40 patients), and 33.2 ± 23.2 bottles of over-the-counter eyedrops (15 patients). In patients with punctal plugs, 4.1 ± 3.9 plugs were used annually. The annual drug cost was 32,000 ± 21,675 Japanese yen (323 ± 219 US dollars). The clinical cost was 16,318 ± 9961 Japanese yen (165 ± 101 US dollars). The total direct costs including punctal plug treatment amounted to 52,467 ± 38,052 Japanese yen (530 ± 384 US dollars). Conclusion: Although treatment modalities for dry eye in Japan were different from those in the US and in European countries, the direct cost of dry eye patients in Japan was comparable with that reported in those countries. Considering the high prevalence of dry eye, the direct cost of this chronic condition may be significant.Keywords: burden of disease, cost, dry eye, eyedrops, quality of lif

Impact of dry eye on work productivity

Masakazu Yamada, Yoshinobu Mizuno, Chika ShigeyasuNational Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, JapanBackground: The purpose of this study was to evaluate the impact of dry eye on work productivity of office workers, especially in terms of presenteeism.Methods: A total of 396 individuals aged ≥20 years (258 men and 138 women, mean age 43.4 ± 13.0 years) were recruited through an online survey. Data from 355 responders who did not have missing values were included in the analysis. They were classified into the following four groups according to the diagnostic status and subjective symptoms of dry eye: a definite dry eye group; a marginal dry eye group; a self-reported dry eye group; and a control group. The impact of dry eye on work productivity was evaluated using the Japanese version of the Work Limitations Questionnaire. The cost of work productivity loss associated with dry eye and the economic benefits of providing treatment for dry eye were also assessed.Results: The degree of work performance loss was 5.65% in the definite dry eye group, 4.37% in the marginal dry eye group, 6.06% in the self-reported dry eye group, and 4.27% in the control group. Productivity in the self-reported dry eye group was significantly lower than that in the control group (P < 0.05). The annual cost of work productivity loss associated with dry eye was estimated to be USD 741 per person.Conclusion: Dry eye impairs work performance among office workers, which may lead to a substantial loss to industry. Management of symptoms of dry eye by providing treatment may contribute to improvement in work productivity.Keywords: burden of disease, dry eye, presenteeism, quality of lif

Surgical repair of orbital fat prolapse by conjunctival fixation to the sclera

Natsuko Nakamura,1 Kunihiko Akiyama,1,2 Chika Shigeyasu,1,3 Masakazu Yamada1,31Division for Vision Research, National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, 2Department of Ophthalmology, National Tokyo Medical Center, Tokyo, 3Department of Ophthalmology, Kyorin University School of Medicine, Mitaka, JapanPurpose: The aim of the study described here was to report the outcomes of surgery for orbital fat prolapse by conjunctival fixation to the sclera.Patients and methods: Twenty-three consecutive eyes of 19 patients with orbital fat prolapse were retrospectively reviewed. All cases were treated with the same simple procedure without resection through conjunctival incision: fixation of conjunctiva to the sclera with interrupted sutures of 10-0 nylon in two rows located approximately 12–14 mm posterior to the limbus. These sutures formed an embankment to keep the prolapsed fat posteriorly. Postoperative results were determined by slit-lamp examination and recurrence of prolapse was defined as the presence of orbital fat anterior to the embankment.Results: During the mean follow-up period of 19 months (range: 1-59 months), one case experienced recurrence which required further surgery. None of the other cases experienced recurrence, and there were no intraoperative or postoperative complications.Conclusion: Conjunctival fixation to the sclera was a simple and effective surgical technique for orbital fat prolapse, with less invasion compared to the conventional method that requires conjunctival incision.Keywords: surgical technique, herniation, orbital fat, conjunctiva, suture, 10-0 nylo

Tear protein analysis in presumed congenital alacrima

Shigeharu Yaginuma,1 Yoko Akune,2 Chika Shigeyasu,1,2 Yoji Takano,3 Masakazu Yamada1 1Department of Ophthalmology, Kyorin University School of Medicine, Tokyo 181-8611, Japan; 2Division for Vision Research, National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo 152-8902, Japan; 3Department of Ophthalmology, Kawasaki Municipal Ida Hospital, Kawasaki 211-0035, Japan Objectives: It is often hard to reach a definitive diagnosis of congenital alacrima because of the difficultly in proving the lack of lacrimal tissue. We report here the distinct tear protein profile in presumed congenital alacrima. Patients and methods: A 13-year-old girl with presumed congenital alacrima and 15 healthy volunteers aged 23–35 years were included in this study. Tears were collected using Schirmer strips, and tear protein analyses were performed. Tear samples were collected from the patient with alacrima before and after surgical punctal occlusion of both the upper and lower puncta, and tear protein extract was fractionated using HPLC. Lactoferrin and albumin concentrations in the tears were separately determined using ELISA. Results: The chromatogram in the patient greatly differed from that in normal subjects with low concentrations of secretory IgA, lipocalin-1, and lysozyme. ELISA results indicated that the tear fluid in the patient contained a high concentration of albumin but a minimal concentration of lactoferrin. Punctal occlusion improved the ocular surface findings, but major lacrimal protein concentrations remained low and tear albumin concentrations further increased. Conclusion: The tear protein profile of a patient with presumed congenital alacrima greatly differed from that of normal subjects. Tear protein analysis may be useful in making a diagnosis of congenital alacrima and in assessing the efficacy and mechanism of punctal occlusion. Keywords: alacrima, albumin, dry eye, lactoferrin, tear