Dry eye and contact lenses

TFOS published approximately 2 years ago the DEWS II report, which is a major revision of the first version. One of the principal highlights of the workshop is the new definition, where the key words are homeostasis, osmolarity, inflammation. The signs and symptoms of dry eye did not change over the years, however our structured approach allows better and more structured diagnosis. Special attention should be given to the history, as most of the patients have severe complains, even without clinical signs on standard examination. There are number of questionnaires, but looks like that OSDI is still the most widely used one. There are some new highlights on the comfort – visual, perceptual and cosmetic, and related specific questions to reveal the problems. Meibomian glands and their anatomical and functional characteristics are very hot topic with special attention payed to Demodex. When the diagnosis is clear a proper management is required. A range of measures are presented in diagrams and tailor made treatment approach is advised in order to manage every specific case. The purpose of presentation is to highlight the key points to guide the busy contact lens practitioner in the everyday clinical practice. The highlights are as follows: History: precise the character and presentation of the symptoms of CL wearers. Clinical examination: Meibomian glands/lid margins, anterior ocular surface with TBUT (Schirmer’s if needed), additional methods if required and available. Therapeutic decision: tailor made approach with good combination of drops and/or contact lenses, for each individual patient. Hopefully the clinical interpretation of DEWSII will facilitate a new prospective and provide several take home messages how to diagnose, manage and follow up patients with dry eye of any kind

Contemporary corneal transplantation – the old school and new perspectives in Bulgaria

Aim: The aim is to analyze the possibilities of cell and tissue therapy of the anterior ocular surface by implementing innovative technologies and testing methodologies for personalized treatment. Materials and Methods: The methodologies consist of a theoretical analysis of the legislation, clinical analysis, and detailed manuals on performing a transplantation in Bulgaria and the world. A questionnaire focused on testing the trends in performing transplantations in Bulgaria is added. All clinical procedures have been conducted using state-of-the-art innovative technology for microstructural assessment during surgery by means of 3D microscopy and real-time optical coherent tomography (OCT). Results: The analysis of the questionnaires on the transplantation trends in Bulgaria (38 correctly filled out out of 100 sent) shows that, in 90% of the cases, corneal transplantations are performed using classic techniques. The shares of anterior and posterior lamellar keratoplasty are only 2% each. The complex AM transplantation techniques are limited to only 10%. A prospective analysis of 186 transplantations has been conducted. Of them 28 are corneal transplantations. The data have been compared with that of the retrospective analysis of 2050 AM transplantations performed by a single surgeon in the last 10 years. Conclusion: The anterior ocular surface is a unique part of our organism and the visual analyzer. Its health is measured by three simple patient sensations: vision, comfort, and lack of redness. The impairments affecting each of the structures which are part of it lead to a damage to the neighboring structures and this unlocks the vicious circle of the anterior ocular surface disease

Damage of the ocular surface from indoor suntanning – insights from in vivo confocal microscopy

Purpose: To evaluate the ocular surface at the microstructural level of habitual indoor-suntanning subjects utilising in vivo confocal microscopy. Methods: Participants were prospectively recruited and enrolled into either а study group (n = 75) with a history UV indoor tanning, or a control group (n = 75) with no prior history of artificial tanning. The study group participated in voluntary tanning sessions performed with standard equipment and maintained their usual routine for eye protection. Slit lamp biomicroscopy and in vivo confocal microscopy were performed at baseline before undertaking a series of suntanning sessions (10 sessions of 10 minutes duration over a 15 day period), within three days after the last session, and four weeks after the last session. Control group participants were examined at baseline and 8 weeks later and did not participate in tanning sessions. Results: All participants were female with a mean age of 25±4.3 years and 24 ± 3.7 years in the study and control groups, respectively. No clinically significant changes were observed in either group over time (all p ≥ 0.05), however, statistically significant differences were observed between the study and the control group for all corneal layers (all p ≤ 0.03). Characteristic cystic conjunctival lesions with dark centres and bright borders were observed in 95% of the study group before and in 100% of eyes after the suntanning sessions. Conclusion: Indoor suntanning leads to statistically significant microstructural changes in the cornea and the bulbar conjunctiva that are undetectable with slit lamp biomicroscopy

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

Sleep apnea and dry eye: how sleep apnea affects the eye surface

Purpose: The purpose of this study was to determine the presence of dry eye disease and possible treatment options in patients with obstructive sleep apnea and continuous positive airway pressure. Materials and methods: A total of 72 patients (midlife age) with obstructive sleep apnea and continuous positive airway pressure therapy underwent a comprehensive eye examination. Fluorescein staining of the anterior ocular surface and tear break-up test were performed. All of the patients who were diagnosed with dry eye disease received personalized therapy. One month later, re-examination was performed using the same methodology and clinical settings. Results: On the first examination, 48 of 72 patients (66.67%) were diagnosed with dry eye disease. Floppy eyelid syndrome was reported in 26 patients (54.17%) with dry eye disease. The treatment of 40 patients included artificial tear supplements during the day in combination with high-viscosity topical gels before bedtime. In more severe cases (10.42% of all participants), the application of bandage contact lenses for 3 months was necessary. Because of excessive lid laxity, surgical reconstruction of the eyelids was performed in three patients (6.25%). Conclusions: A multidisciplinary approach is essential for obstructive sleep apnea. Practitioners from different specialties must be well acquainted with risk factors, signs, and symptoms. The early detection of dry eye disease in patients with obstructive sleep apnea and appropriate treatments are important for improving the quality of life in this patient group

In vivo confocal microstructural analysis of corneas presenting Kayser-Fleischer rings in patients with Wilson's disease

<div><p>ABSTRACT Purpose: To evaluate microstructural differences between corneas with and without Kayser-Fleischer rings in age-matched subjects with Wilson's disease with neurological symptoms, using confocal laser scanning microscopy. Methods: The study included 12 subjects with Wilson's disease with neurological symptoms. Twelve corneas presented clinically with classic Kayser-Fleischer rings, visible on slit lamp examination; the other 12 served as controls. The subjects underwent a comprehensive clinical examination. Microstructural analysis using confocal laser scanning microscopy evaluated increased corneal thickness, decreased number of cells, increased debris or specific deposits, and unusual microstructures. Results: Clinically, the subjects with Kayser-Fleischer rings had similar corneal findings and normal intraocular pressure; two had typical sunflower cataracts and decreased visual acuity. The control eyes all presented normal visual acuity, intraocular pressure, and corneal appearance. The microstructural analysis demonstrated similar findings in all the affected corneas. Compared with the control corneas, there were fewer keratocytes in the anterior stroma (17.380 vs. 22.380/mm3). Round, "hollow" dark areas were observed between the keratocytes; these were universal and similar in appearance in all affected corneas and all cornea layers. In the peripheral posterior stroma, there were dust-like, bright, granular deposits that tended to increase in number and density toward Descemet's membrane, masking the peripheral endothelium. The control corneas presented a normal microstructure apart from dust-like granular deposits in the periphery. Conclusions: In vivo confocal microscopy is a useful tool for evaluating the corneal microstructure when a Kayser-Fleischer ring is clinically present. The ring consists of granular, bright particles that increase in density toward Descemet's membrane, and is associated with a decreased number of keratocytes and peculiar dark, round areas in all stromal layers, probably a sign of corneal damage. When the ring is not visible in subjects with Wilson's disease, changes to the corneal microstructure are insignificant.</p></div