New orthokeratology lens design for presbyopia

Presbyopia is defined as an impairment in near vision, limitating the residual accommodation, hence losing the ability to focus on neal objects. Throughout the world, uncorrected presbyopia causes common, avoidable vision impairment. When the symptoms are established, on a 55 to 60-year-old average, artificial assistance for comfortable close-up tasks is needed. The aim of the study is to investigate the efficacy of a new presbyopic orthokeratology lens design, on a 4-week perios of presbyopic orthokeratology overnight wear. Eighteen presbyopic new orthokeratology wearers, were reviwed. Only seven participants contributed to complete data. A double reservoir lens for presbyopia design with two with different back optical zone diameters was evaluated. Uncorrected distance and near visual acuity, subjective refraction, contrast sensitivity, defocus curve, corneal topography, corneal aberrations and anterior segment health examination were measured at baseline, and compared after a 4-week overnight wear, with designs of 1.9 and 3.0mm back optical zone diameters. Both double reservoir lenses for presbyopia, revealed statistically significant changes. The 1.9mm lens almost corrected distance ametropia, while 3.0mm lens induced a slight myopia, in contraposition, 3.0mm corrected near ametropia by decreasing a 50.55% of the near addition on average. Binocular distance vision remained equal, but uncorrected visual acuities improved after both lenses were used. Induced corneal aberrometries lead to a contrast sensitivity descrease in medium and high frequencies. As a conclusion we can say that double reservoir lenses for presbyopia provide functional near vision by inducing a “center near” myopic shift. Eventhought corneal aberrations were induced, it did not alter binocular visual acuities

Visual affectation in patients with glycogen storage disease (Glycogenosis)

In this project we wanted to comprise the visual affectations of a rare/minority disease. Based on the little research there is in this field and the large effect that this may actually have in the visual sistem. We have to take into account that a disease like this one does not have the same level of research as AIDS or Malaria, due to its consideration around the world as a rare or mioritary disease, (low percentage of affected affected), therefore few grants are given for further exploration and research. By putting together the subject of “Geriatric and infantile optometry”, where we studied binocular dysfunctions and strabismus (either locomotor and accommodative), at the same time as the 5th International Congress of Glycogenosis, uniting forces, two students of the FOOT and a professor, Montserrat Augé i Serra, were at the Congress where we were lucky to be able to carry out a series of optometric examinations in patients affected with this disease thus having a large sample of patients with different subtypes of glycogen storage disease. During 5-6-7th June 2014, in Bellaterra, the 5th International Congress of Glycogenosis took place, where a part from nutritionists and physicians attending, there were doctors specialized in liver and muscles. They were giving to each attendee a guide of conferences and two books about the effects on glycogen storage disease in Spain and new palliative therapies or others, discovered thanks to scientific research, apart from certain products as food for testing into the diets of the patients with Glycogenosis

Redesigning the Management and Treatment Algorithm For Dry Eye Clinicians

Dry eye disease multifactorial aetiologies and complexity makes a single treatment not functional enough to manage different subtypes. Instead, a tailored-managed-therapy plan is needed to lead to an effective treatment of signs and symptoms. An organisation tool to manage dry eye disease was created in 2017 by Tear Film & Ocular Surface Society Dry Eye WorkShop II, yet no differentiation between disease subtype (evaporative dry eye or aqueous dry eye) or severity, was made as a cause of lack of level 1 studies. This thesis sought to compile a series of experimental studies to provide; Additional scientific evidence of management strategies (Chapter 1:), by the means of; identifying therapeutic effects from all different treatment stages (Chapter 2:), assessing if further modifications of this guideline are needed (Chapter 3:) and to disseminate the current prescribing patterns of therapies across the globe (Chapter 4:). Accordingly, this thesis has found that: • Dry eye is being managed worldwide similarly to TFOS DEWS II recommendations, with exception of home-made facecloths. Products prescribed for evaporative dry eye and aqueous dry eye are different. North American and Asia/Middle Eastern regions tend to use a more pharmacological approach at lower levels of dry eye disease severity. • Between liposomal drops, liposomal sprays and emulsion-drops, the decrease in symptomatology was similar, no statistically significant changes happened to homeostatic markers during a 2-week treatment. • Only lipid-based artificial tear provides relief for patients with the evaporative subtype of dry eye, and both lipid-based and a non-lipid based artificial tears, show a 1-month symptomatology decrease for both dry eye subtypes, with signs taking 3-4 months to show a statistically significant improvement. • The use of an automatic massaging-mask provides improvement in symptomatology (subjectively improving severity) after 2 weeks of mask-treatment twice a day. • Eyelid warming therapy, improves Meibomian gland expression quality, regardless of its dropout extent. Debridement helps removing orifice obstruction in patients with Meibomian gland dropout, yet forcible expression provides nonadditional benefit on partial MGs

Sutureless Dehydrated Amniotic Membrane (Omnigen) Application Using a Specialised Bandage Contact Lens (OmniLenz) for the Treatment of Dry Eye Disease:A 6-Month Randomised Control Trial

Background and Objectives: Dry Eye Disease (DED) is a chronic condition characterised by tear film instability and ocular surface disruption, significantly impacting patients’ quality of life. This study aimed to provide top-level clinical evidence for the long-term efficacy of dehydrated amniotic membrane (dAM, Omnigen®) delivered via a specialised bandage contact lens (sBCL, OmniLenz) for managing moderate-to-severe DED. Materials and Methods: This randomised controlled trial (NCT04553432) involved 93 participants with moderate-to-severe DED, randomised to receive a 1-week bilateral treatment of either dAM (17 mm diameter with 6 mm central ‘window’) applied under a sBCL or sBCL alone. Participants were assessed at baseline and followed up at 1, 3, and 6 months post-treatment. Outcomes included changes in symptomatology, tear film and ocular surface measurements, and in vivo confocal microscopy imaging of corneal nerve parameters and corneal dendritic cell (CDC) counts. Results: The dAM-sBCL group demonstrated a 65% reduction in OSDI scores at 6 months (p < 0.001), with 88% of participants showing improvement at 1 month. Corneal staining was significantly reduced in both groups. dAM-sBCL provided significant improvements in corneal nerve parameters at 1 month, with sustained positive trends at 3 months. Additionally, dAM-sBCL significantly reduced mature CDC counts, suggesting an anti-inflammatory effect. Conclusions: Treatment with dAM-sBCL for just 1 week significantly and rapidly improved dry eye symptoms as well as ocular surface signs for at least 3 months. It also enhanced corneal nerve health while reducing activated/mature corneal inflammatory cell numbers, presenting a safe and promising new treatment for moderate-to-severe DED

Efficacy of a novel water propelled, heating eye mask massager on tear film and ocular adnexa

PURPOSE: To determine the effectiveness of the Aurai water propelled, heating Eye Massager (AEM) in managing dry eye disease and its effects on the ocular adnexa. METHODS: This prospective, randomised cross-over study enrolled 15 participants (aged 25.8 ± 5.45 years, 5 male). Participants wore a smart watch 24 h a day to track their sleeping cycle and heart rate for 4 weeks, using the AEM twice a day for 2 of those weeks. A cycle of 6 min of a controlled heat and vibration pattern in the morning and another cycle in the evening were applied with the AEM. Primary outcomes of symptomatology (Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE)), tear film and ocular surface homeostasis markers (osmolarity, non-invasive breakup time (NIKBUT), tear meniscus height (TMH), lipid layer thickness and ocular staining) and safety measures (ocular redness and intraocular pressure), were assessed at baseline, after 2 weeks of AEM use and after 2 weeks of no treatment (in random-sequence). Sleeping tracking (ST) and heart rate/blood oxygen detection over these periods was also assessed. RESULTS: There was a significant change in OSDI score from 34.3 ± 19.5 at baseline to 18.8 ± 17.5 after treatment (p = 0.001) and also for the SANDE (5.7 ± 2.4 vs 3.7 ± 2.1; p = 0.001). Heart rate was not affected by treatment (p = 0.956), nor sleep pattern (p = 0.529), but this varied by day (p = 0.001). Tear film and ocular surface homeostasis, the ocular adnexia and safety measures were not affected by treatment (p > 0.05). CONCLUSION: The Aurai water propelled Eye Massager may reduce the severity of symptoms of dry eye, but there were no detectable effects on tear stability and ocular surface disease from two weeks use

Appropriateness of Questionnaires for the Diagnosis and Monitoring Treatment of Dry Eye Disease

Objectives: If questionnaires contributing to the diagnosis of dry eye disease are to be recommended as alternatives to existing questionnaires, they must be comparable, with similar repeatability and treatment sensitivity. Comparability was thus examined for three common dry eye questionnaires along with identifying the individual questions that most strongly predicted overall scores. Methods: Anonymised data ( n = 329) collected via the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment in Dry Eye (SANDE) questionnaires (including responses to individual questions) from consenting patients were drawn from real-world dry eye clinics/registries in the United Kingdom, Australia and New Zealand; at follow-up, normalised changes were evaluated in 54 of these patients. Treatment data were also analysed from a 6-month, randomised controlled trial assessing artificial tear supplement treatments with 43 responders and 13 non-responders to treatment identified. The questions extracted from the OSDI which form the abbreviated 6-item OSDI were also analysed. Results: The agreement between the questionnaires ranged from r = 0.577 to 0.754 (all p < 0.001). For the OSDI, three questions accounted for 89.1% of the variability in the total score. The correlation between the OSDI and OSDI-6 was r = 0.939, p < 0.001. For the DEQ-5, two questions accounted for 88.5% of the variance in the total score. Normalised treatment changes were also only moderately correlated between the questionnaires (r = 0.441 to 0.595, p < 0.01). For non-responders, variability was 7.4% with both OSDI and OSDI-6, 9.7% with DEQ-5, 12.1% with SANDE-frequency and 11.9% with SANDE-severity scale. For responders, improvement with drops was detected with a 19.1% change in OSDI, 20.2% in OSDI-6, 20.9% in DEQ-5, and 27.5%/23.6% in SANDE-frequency/severity scales. Conclusions: Existing commonly used dry eye questionnaire scores do not show high levels of correlation. The OSDI was the least variable of the questionnaires and while displaying a slightly lower treatment effect than either the DEQ or SANDE, it was more sensitive to detection of a treatment effect. The quicker-to-complete OSDI-6 exhibited essentially the same outcome as the OSDI, with similar variability and treatment sensitivity

Optimising subjective grading of corneal staining in Sjögren's syndrome dry eye disease

Aim: To assess whether smaller increment and regionalised subjective grading improves the repeatability of corneal fluorescein staining assessment, and to determine the neurological approach adopted for subjective grading by practitioners. Methods: Experienced eye-care practitioners (n = 28, aged 45 ± 12 years), graded 20 full corneal staining images of patients with mild to severe Sjögren's syndrome with the Oxford grading scheme (both in 0.5 and 1.0 increments, globally and in 5 regions), expanded National Eye Institute (NEI) and SICCA Ocular Staining Score (OSS) grading scales in randomised order. This was repeated after 7–10 days. The digital images were also analysed objectively to determine staining dots, area, intensity and location (using ImageJ) for comparison. Results: The Oxford grading scheme was similar with whole and half unit grading (2.77vs2.81,p = 0.145), but the variability was reduced (0.14vs0.12,p < 0.001). Regional grade was lower (p < 0.001) and more variable (p < 0.001) than global image grading (1.86 ± 0.44 for whole increment grading and 1.90 ± 0.39 for half unit increments). The correlation with global grading was high for both whole (r = 0.928,p < 0.001) and half increment (r = 0.934,p < 0.001) grading. Average grading across participants was associated with particle number and vertical position, with 74.4–80.4% of the linear variance accounted for by the digital image analysis. Conclusions: Using half unit increments with the Oxford grading scheme improve its sensitivity and repeatability in recording corneal staining. Regional grading doesn't give a comparable score and increased variability. The key neurally extracted features in assigning a subjective staining grade by clinicians were identified as the number of discrete staining locations (particles) and how close to the vertical centre was their spread, across all three scales

New orthokeratology lens design for presbyopia

Presbyopia is defined as an impairment in near vision, limitating the residual accommodation, hence losing the ability to focus on neal objects. Throughout the world, uncorrected presbyopia causes common, avoidable vision impairment. When the symptoms are established, on a 55 to 60-year-old average, artificial assistance for comfortable close-up tasks is needed. The aim of the study is to investigate the efficacy of a new presbyopic orthokeratology lens design, on a 4-week perios of presbyopic orthokeratology overnight wear. Eighteen presbyopic new orthokeratology wearers, were reviwed. Only seven participants contributed to complete data. A double reservoir lens for presbyopia design with two with different back optical zone diameters was evaluated. Uncorrected distance and near visual acuity, subjective refraction, contrast sensitivity, defocus curve, corneal topography, corneal aberrations and anterior segment health examination were measured at baseline, and compared after a 4-week overnight wear, with designs of 1.9 and 3.0mm back optical zone diameters. Both double reservoir lenses for presbyopia, revealed statistically significant changes. The 1.9mm lens almost corrected distance ametropia, while 3.0mm lens induced a slight myopia, in contraposition, 3.0mm corrected near ametropia by decreasing a 50.55% of the near addition on average. Binocular distance vision remained equal, but uncorrected visual acuities improved after both lenses were used. Induced corneal aberrometries lead to a contrast sensitivity descrease in medium and high frequencies. As a conclusion we can say that double reservoir lenses for presbyopia provide functional near vision by inducing a “center near” myopic shift. Eventhought corneal aberrations were induced, it did not alter binocular visual acuities

Visual affectation in patients with glycogen storage disease (Glycogenosis)

In this project we wanted to comprise the visual affectations of a rare/minority disease. Based on the little research there is in this field and the large effect that this may actually have in the visual sistem. We have to take into account that a disease like this one does not have the same level of research as AIDS or Malaria, due to its consideration around the world as a rare or mioritary disease, (low percentage of affected affected), therefore few grants are given for further exploration and research. By putting together the subject of “Geriatric and infantile optometry”, where we studied binocular dysfunctions and strabismus (either locomotor and accommodative), at the same time as the 5th International Congress of Glycogenosis, uniting forces, two students of the FOOT and a professor, Montserrat Augé i Serra, were at the Congress where we were lucky to be able to carry out a series of optometric examinations in patients affected with this disease thus having a large sample of patients with different subtypes of glycogen storage disease. During 5-6-7th June 2014, in Bellaterra, the 5th International Congress of Glycogenosis took place, where a part from nutritionists and physicians attending, there were doctors specialized in liver and muscles. They were giving to each attendee a guide of conferences and two books about the effects on glycogen storage disease in Spain and new palliative therapies or others, discovered thanks to scientific research, apart from certain products as food for testing into the diets of the patients with Glycogenosis