DOCSLIB.ORG

Risk Factors for Severe Dry Eye Disease: Crowdsourced Research

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Risk Factors for Severe Dry Eye Disease: Crowdsourced Research Ophthalmology Volume 126, Number 5, May 2019 Risk Factors for Severe Dry Eye framework “ResearchKit,” which allows researchers and de- Disease: Crowdsourced velopers to create powerful applications for clinical research. Research Using DryEyeRhythm DryEyeRhythm might help identify patients who experience DED- type symptoms but remain undiagnosed. This application might be Dry eye disease (DED), a disorder of the tear film, potentially particularly relevant to millennials and later generations who live in causes various symptoms that interfere with quality of life and a heavily digitalized world. vision and reduce work productivity.1,2 Dry eye disease is the most DryEyeRhythm was released in the Apple App Store in Japan common eye disease, affecting tens of millions of people world- on November 2, 2016, and in the United States in April 2018. wide.3 Therefore, it is necessary to prevent DED symptoms by Electronic informed consent for participation was obtained from identifying pertinent risk factors. all users. This study was conducted between November 2, 2016, Because of their multifunctionality and flexibility, smartphones and November 2, 2017, with approval from the Independent are being increasingly used for research.4 To elucidate the Ethics Committee of Juntendo University Faculty of Medicine contribution of certain risk factors to the progression of severe (Approval Number, 16-078) and adhered to the tenets of the DED-type symptoms, a DED application, “DryEyeRhythm,” was Declaration of Helsinki. Through DryEyeRhythm, data were designed using Apple Inc.’s (Cupertino, CA) open-source obtained regarding participant demographic characteristics Table 1. Age- and Sex-Adjusted and Fully Adjusted Odds Ratios for Severe Dry Eye DiseaseeType Symptoms (Ocular Surface Disease Index Score 33) Risk Factor Age- and Sex-Adjusted OR (95% CI) Fully Adjusted* OR (95% CI) Demographic Characteristics Age (every 1 yr) - 0.99 (0.98e0.99) Sex (women vs. men) - 1.85 (1.60-2.14) Medical History Hypertension No 1 (reference) - Medicated 1.22 (0.81e1.81) - Unmedicated 1.44 (0.94e2.22) - Unknown 1.06 (0.92e1.22) - Diabetes (yes vs. no) 1.39 (0.82e2.36) - Systemic diseases (yes vs. no) Blood disease 2.13 (1.10e4.10) 1.81 (0.92e3.57) Brain disease 1.72 (0.83e3.58) - Collagen disease 3.43 (1.68e7.02) 2.81 (1.34e5.90) Heart disease 1.52 (0.95e2.44) - Kidney disease 0.68 (0.38e1.22) - Liver disease 1.60 (0.87e2.93) - Malignant tumor 1.12 (0.48e2.59) - Respiratory disease 1.35 (1.06e1.72) 1.19 (0.92e1.53) Hay fever (yes vs. no) 1.19 (1.06e1.34) 1.18 (1.04e1.33) Mental illness (yes vs. no) Depression 1.86 (1.37e2.51) 1.68 (1.23e2.29) Schizophrenia 1.61 (0.84e3.09) - Others 1.58 (1.19e2.10) 1.31 (0.97e1.75) Ophthalmic surgery (yes vs. no) Cataract surgery 1.10 (0.43e2.81) - LASIK 0.95 (0.54e1.66) - Others 1.24 (0.87e1.77) - Lifestyle Habits Coffee (every 1 cup per day increase) 1.03 (0.98e1.08) - Contact lens use No 1 (reference) 1 (reference) Current use 1.28 (1.13e1.46) 1.24 (1.09e1.41) Past use 1.30 (1.05e1.60) 1.23 (0.99e1.52) Screen time (every 1 hr per day increase) 1.03 (1.01e1.04) 1.02 (1.01e1.03) Periodic exercise (yes vs. no) 0.84 (0.74e0.95) 0.90 (0.79e1.03) Sleeping time (every 1 hr per day increase) 0.98 (0.97e1.00) - Smoking (yes vs. no) 1.63 (1.40e1.90) 1.53 (1.31e1.79) Water intake (ml per day) 1.00 (1.00e1.00) - CI ¼ confidence interval; DED ¼ dry eye disease; OR ¼ odds ratio; OSDI ¼ Ocular Surface Disease Index. *In addition to age and sex, the fully adjusted logistic regression model included factors that were significantly associated with severe DED-type symptoms (OSDI total score 33) in the age- and sex-adjusted models. 766 Reports and medical and lifestyle histories (Table S1, available at risk factors that contribute to DED development and those that www.aaojournal.org), referring to previous studies on DED and contribute to DED deterioration. associated risk factors. This study has several limitations. First, recall bias might be The Ocular Surface Disease Index (OSDI) questionnaire was present in this questionnaire survey, resulting in over-reporting. incorporated in DryEyeRhythm to ensure the study’s validity. The The OSDI is suitable for DED screening because of its sensi- OSDI total score defined symptom severity, with scores of 0 to 12 tivity; however, it may contain false-positives because of its representing healthy eyes; 13 to 22 representing mild DED; 23 to moderate specificity, indicating the possibility of overestimating 32 representing moderate DED; and 33 to 100 representing severe the DED population. Second, this study could have involved se- DED.5 The OSDI measurements obtained using DryEyeRhythm lection bias. Here, the elderly or people lacking access to smart had good validity compared with those obtained using the paper- devices or mobile-service providers may have been underrepre- based questionnaire (Fig S1, available at www.aaojournal.org). sented, and younger people (who are more technologically savvy) Each risk factor’s odds ratio for severe DED-type symptoms and people who are socioeconomically able to afford a smartphone (OSDI total score 33e100) was determined by logistic regression may have been overrepresented. Indeed, it should be acknowl- analyses. In addition to age and sex, factors significantly associated edged that the study participants were substantially younger than with severe DED-type symptoms in age- and sex-adjusted models patients with DED generally are. Therefore, the generalizability of were included in the fully adjusted logistic regression models. Data the findings to older people may be limited. Furthermore, partici- are presented as mean Æ standard deviation, median (interquartile pants in this study were limited to iPhone users in Japan, who range) (for factors not normally distributed), or percentage. All data might exhibit different behavioral and consumer habits compared were analyzed with STATA version 15 (StataCorp, LP, College with people in other countries. For future studies, providing Station, TX). android-based applications could reach a larger part of the popu- DryEyeRhythm was downloaded by 18 225 users during the lation. Finally, there may be some important unmeasured factors, study period. Although 10 961 users (60.1%) completed the such as thyroid disease, Meibomian gland dysfunction, and facial demographics and medical history survey, 5265 (28.9%) also palsy, which should be included in the updated version of the completed the questionnaire on lifestyle habits and the OSDI. application. Table S1 summarizes participant demographics, medical history, However, DryEyeRhythm, represents a new digitalized manner lifestyle habits, and the OSDI total score. to conduct research and collect real-world data, and this integration Table 1 shows the relevant risk factors for severe DED-type of technology and medical research might eventually become symptoms identified by the age- and sex-adjusted, and fully mainstream.4 DryEyeRhythm also presents a unique opportunity adjusted logistic regression models. Briefly, the fully adjusted odds for preventive care by identifying individuals at risk for DED ratios (95% confidence intervals) were 0.99 (0.98e0.99) for age, earlier than currently possible. The application can be used to 1.85 (1.60e2.14) for female sex, 2.81 (1.34e5.90) for collagen supplement traditional hospital-based research. disease, 1.18 (1.04e1.33) for hay fever, 1.68 (1.23e2.29) for DryEyeRhythm was effectively used and showed that risk depression, 1.24 (1.09e1.41) for current contact lens use, 1.02 factors such as female sex, collagen disease, hay fever, depression, (1.01e1.03) for extended screen time, and 1.53 (1.31e1.79) for current contact lens use, extended screen time, and smoking smoking. contribute to severe DED-type symptoms. DryEyeRhythm facilitated participation in this study, and its 1,2 ease of access from an iPhone allowed recruitment of participants. TAKENORI INOMATA, MD, PHD 3 This recruitment model is also more inclusive of younger people, MASAHIRO NAKAMURA, MD, PHD 4 because they are relatively healthy and do not visit hospitals often. MASAO IWAGAMI, MD, PHD 5 The average participant age was 27.2Æ12.4 years, with only 2.0% TINA SHIANG,MD 6 of participants being older than 60 years. This might partially YUSUKE YOSHIMURA reflect the overwhelming presence of smartphone technology 1 KEIICHI FUJIMOTO,MD among the younger generation. 1,2 YUICHI OKUMURA,MD This study identified the risk factors contributing to severe 7 ATSUKO EGUCHI DED-type symptoms using real-world data (Table 1). Aging, 1 3 NANAMI IWATA although typically regarded as a DED risk factor, was inversely 1 MARIA MIURA,MD correlated to the severity of DED-type symptoms, suggesting that 8 younger people may experience DED symptoms while remaining SATOSHI HORI, MD, PHD 1 undiagnosed. It was confirmed that the risk factors suggested by YOSHIMUNE HIRATSUKA, MD, PHD 9 previous studies, such as female sex, collagen disease, hay fever, MIKI UCHINO, MD, PHD 9 depression, current contact lens use, extended screen time, and KAZUO TSUBOTA, MD, PHD 10 smoking, were significantly associated with severe DED symp- REZA DANA, MD, MPH 3 1 toms. These risk factors are modifiable and can be improved by AKIRA MURAKAMI,MD,PHD careful medical condition management and by avoiding lifestyle 1Juntendo University Faculty of Medicine, Department of choices that might exacerbate DED-type symptoms. Other previ- Ophthalmology, Tokyo, Japan; 2Juntendo University Faculty of ously suggested DED risk factors, such as hypertension, diabetes, Medicine, Department of Strategic Operating Room Management and blood diseases, past use of contact lenses, refractive surgery, and Improvement, Tokyo, Japan; 3Department of Prevention of Diabetes caffeine intake,3 were not corroborated as DED risk factors in this and Lifestyle-Related Diseases, The University of Tokyo, Tokyo, Japan; study; this discrepancy might reflect a difference between defining 4Department of Health Services Research, Faculty of Medicine, 767 Ophthalmology Volume 126, Number 5, May 2019 University of Tsukuba, Ibaraki, Japan; 5University of Massachusetts response to the available medical treatment.
Load more

Recommended publications
  • Confocal Microscopy in Cornea Guttata and Fuchs' Endothelial Dystrophy
    Br J Ophthalmol 1999;83:185–189 185 Confocal microscopy in cornea guttata and Fuchs’ Br J Ophthalmol: first published as 10.1136/bjo.83.2.185 on 1 February 1999. Downloaded from endothelial dystrophy Auguste G-Y Chiou, Stephen C Kaufman, Roger W Beuerman, Toshihiko Ohta, Hisham Soliman, Herbert E Kaufman Abstract conventional imaging methods.3–13 Because of Aims—To report the appearances of cor- its ability to focus the light source and the nea guttata and Fuchs’ endothelial dystro- image on the same focal plane, it allows real phy from white light confocal microscopy. time in vivo assessment of the diVerent layers Methods—Seven eyes of four consecutive of the cornea, including the endothelial layer. patients with cornea guttata were pro- Therefore, it may be an alternative method in spectively examined. Of the seven eyes, evaluating cornea guttata or Fuchs’ endothelial three also had corneal oedema (Fuchs’ dystrophy. dystrophy). In vivo white light tandem In the current study, we analysed the scanning confocal microscopy was per- appearances of cornea guttata and Fuchs’ dys- formed in all eyes. Results were compared trophy from confocal microscopy and compare with non-contact specular microscopy. the technique with non-contact specular mi- Results—Specular microscopy was pre- croscopy. cluded by corneal oedema in one eye. In the remaining six eyes, it demonstrated typical changes including pleomorphism, polymegathism, and the presence of gut- tae appearing as dark bodies, some with a central bright reflex. In all seven eyes, confocal microscopy revealed the pres- ence of round hyporeflective images with an occasional central highlight at the level of the endothelium.
    [Show full text]
  • Fusarium Keratitis and Corneal Collagen Cross
    FUSARIUM KERATITIS AND SURGERY REFRACTIVE CORNEAL COLLAGEN CROSS-LINKING BY MINAS CORONEO, AO, BSC(MED), MBBS, MSC SYD, MD, MS, UNSW, FRACS, FRANZCO; RAJESH FOGLA, DNB, FRCS(EDIN), MMED(OPHTH); WILLIAM B. TRATTLER, MD; ASHIYANA NARIANI, MD, MPH; COMPLEX CASE MANAGEMENT COMPLEX GARGI KHARE VORA, MD; AND ALAN N. CARLSON, MD CASE PRESENTATION A 42-year-old white man is referred to the Duke University Eye Center Cornea Service for a central corneal ulcer with a hypopyon in his right eye. The patient sustained the ocular injury while mowing the lawn, with debris getting into the eye while he was wearing contact lenses. He was diagnosed with culture-positive Fusarium species by the referring ophthalmologist and was treat- ed with oral voriconazole 200 mg twice daily and frequent topical natamycin 5% and voriconazole 10 mg/mL. The patient under- went epithelium-off corneal collagen cross-linking (CXL) approxi- Figure 1. Initial evaluation of the eye with a Fusarium corneal mately 4 weeks after diagnosis of the ulcer and was treated with infiltrate and hypopyon. a loteprednol steroid taper after the procedure. His condition subsequently progressed, with increasing eye pain, a nonhealing epithelial defect, and a worsening corneal infiltrate. Upon evaluation, the patient has a large corneal infiltrate with necrotic stroma, which is approaching the limbus, and a hypopyon (Figure 1). His UCVA measures 20/70-1. B-scan ultrasound of the right eye shows no evidence of posterior segment involvement. Reculturing of the corneal infiltrate is negative for bacteria, fungus, and Acanthamoeba. Confocal microscopy reveals no evidence of hyphae or cysts.
    [Show full text]
  • Reactive Uveitis, Retinal Vasculitis and Scleritis As Ocular End-Stage of Acanthamoeba Keratitis: a Histological Study
    Uveitis and vasculitis of Acanthamoeba keratitis ·Brief Report· Reactive uveitis, retinal vasculitis and scleritis as ocular end-stage of Acanthamoeba keratitis: a histological study Lei Shi1,2, Tobias Hager1, Fabian Norbert Fries1, Loay Daas1, Leonard Holbach3, Carmen Hofmann- Rummelt3, Elena Zemova1, Berthold Seitz1, Nóra Szentmáry1,4 1Department of Ophthalmology, Saarland University Medical wearers. Its annual incidence was 17.53 to 21.14 per one Center, Homburg/Saar 66424, Germany million contact lens wearers in the UK[1]. In Germany, with 2Department of Ophthalmology, The First Affiliated Hospital about 80 million inhabitants, about 150 new cases have been of USTC, Division of Life Sciences and Medicine, University reported in a 10-year-period[2]. Studies showed that 68%-92.3% of Science and Technology of China, Hefei 230001, Anhui of AK patients are contact lens wearers[1,3-4]. Expression of Province, P.R. China mannosilated glycoproteins on corneal epithelial cell surface is 3Department of Ophthalmology, Friedrich-Alexander upregulated in contact lens wearers[3]. This plays an important University Erlangen-Nürnberg, Erlangen 91052, Germany role in AK pathogenesis. The Acanthamoeba trophozoite binds 4Department of Ophthalmology, Semmelweis University, to these proteins though its mannose-binding site in order to Budapest 1093, Hungary release the so-called mannose-induced protease 133 (MIP-133) Correspondence to: Lei Shi. Department of Ophthalmology, and Acanthamoeba plasminogen activator (aPA). MIP-133 and Saarland University Medical Center, Homburg/Saar, Kirrberger aPA give rise to lysis of epithelial, stromal cells and stromal Str. 100. 66424, Germany. [email protected] matrix, leading to corneal erosions and ulceration[4]. Presence Received: 2019-05-01 Accepted: 2019-08-21 of bacteria or fungi also supports Acanthamoeba growth, often resulting in co-infection[5].
    [Show full text]
  • Acanthamoeba, Fungal, and Bacterial Keratitis: a Comparison of Risk Factors and Clinical Features
    Acanthamoeba, Fungal, and Bacterial Keratitis: A Comparison of Risk Factors and Clinical Features JEENA MASCARENHAS, PRAJNA LALITHA, N. VENKATESH PRAJNA, MUTHIAH SRINIVASAN, MANORANJAN DAS, SEAN S. D’SILVA, CATHERINE E. OLDENBURG, DURGA S. BORKAR, ELIZABETH J. ESTERBERG, THOMAS M. LIETMAN, AND JEREMY D. KEENAN PURPOSE: To determine risk factors and clinical signs acanthamoeba keratitis research has been conducted in that may differentiate between bacterial, fungal, and industrialized countries, acanthamoeba keratitis also acanthamoeba keratitis among patients presenting with occurs in developing countries, often in non–contact presumed infectious keratitis. lens–wearing individuals.6,7 DESIGN: Hospital-based cross-sectional study. Acanthamoeba keratitis is frequently misdiagnosed as METHODS: We examined the medical records of 115 herpetic or fungal keratitis, and is subsequently treated incor- patients with laboratory-proven bacterial keratitis, 115 rectly, which can lead to poor outcomes.8 Case series of acan- patients with laboratory-proven fungal keratitis, and thamoeba keratitis have identified several important clinical 115 patients with laboratory-proven acanthamoeba kera- signs, such as pseudodendrites, perineural infiltrates, and ring titis seen at Aravind Eye Hospital, Madurai, India, from infiltrates.9,10 However, we are unaware of any studies that 2006-2011. Risk factors and clinical features of the 3 have compared the clinical findings of acanthamoeba organisms were compared using multinomial logistic keratitis with those of bacterial and fungal keratitis. regression. Clinical signs can be especially useful for differentiating the RESULTS: Of 95 patients with bacterial keratitis, 103 cause of infectious keratitis when microbiological testing is patients with fungal keratitis, and 93 patients with acan- not available—which is frequently the case in developing thamoeba keratitis who had medical records available for countries.
    [Show full text]
  • (RGP) Contact Lens Induced Microbial Keratitis in a Keratoconus Patient: a Case Report
    IOSR Journal of Dental and Medical Sciences (JDMS) ISSN: 2279-0853, ISBN: 2279-0861. Volume 1, Issue 5 (Sep-Oct. 2012), PP 12-16 www.iosrjournals.org Rigid Gas permeable (RGP) contact lens induced microbial keratitis in a keratoconus patient: A case report. Krishnendu Mandal. M.OPT1, Bhupesh Bagga. FRCS2, 3 Sobia Taureen. B. OPT 1,3 Optometry, L.V.Prasad Eye Institute, india 2Ophthalmology, L.V.Prasad Eye Institute, india ABSTRACT : Introduction: To report a case of microbial keratitis in an individual with keratoconus using rigid gas permeable contact lenses. Method: - A 23- year-old male presented with a history of pain, redness, photophobia, watering in right eye and his vision was reduced upon awakening. He was a known case of bilateral keratoconus who used rigid gas permeable contact lenses in both eyes on daily wear basis. Slitlamp examination revealed a paracentral stromal infiltrate in right eye. Corneal scrapings were collected for culture. Both contact lenses and lenses cleaning solution were collected for microbiological investigations. Result: - Corneal scraping revealed plenty gram-negative bacteria (Pseudomonas aeruginosa) and contact lenses cleaning solution revealed klebsiella. Conclusion:- Although microbial keratitis is an uncommon complication with rigid gas permeable contact lenses in keratoconus patients but it can be managed by proper microbiological work up and intensive medical care. Key words:KC-Keratoconus, RGP- rigid gas permeable contact lens, MK-Microbial keratitis, Pseudomonas aeruginosa, Klebsiella. I. Introduction
    [Show full text]
  • Acanthamoeba Keratitis:10.5005/Jp-Journals-10025-1125 Different Surgical Approaches Case Series
    IJKECD Acanthamoeba Keratitis:10.5005/jp-journals-10025-1125 Different Surgical Approaches CASE SERIES Acanthamoeba Keratitis: Different Surgical Approaches 1Mukharram Bikbov, 2Valentina Surkova, 3Emin Usubov ABSTRACT sensitive layer of the cornea. The diagnosis deemed to be The features of acanthamoeba keratitis (AK) progression, complete only when cysts are detected in the material clinical cases, and results of early and delayed penetrating taken from the cornea and its agar inoculation, smears keratoplasty as the main method of severe AK treatment are of CLs, and their cases. presented. It is described as two clinical cases with different The AK conservative treatment is conducted by surgical approaches: Case 1 – delayed keratoplasty after remis- antiseptics use. The most effective treatment to combat sion and case 2 – early keratoplasty during a severe flare up of the disease. cysts is chlorhexidine 0.02%, which is prepared ex. In the 1st case the keratitis led to the development of chronic temporae. Polyhexamethylene 0.02% as part of the solu- keratouveitis, secondary glaucoma, complicated cataract, and tion is used for CLs disinfection, and can be used off-label vision loss. The received keratoplasty was of only anatomic in AK. effect. In the 2nd case early keratoplasty allowed avoiding secondary complications and retaining a satisfactory visual Clinical cases provided testify to the difficulties in acuity along with avoiding reoperations. the AK diagnosis and showed features of the disease. Keywords: Acanthamoeba keratitis, Keratitis, Penetrating keratoplasty. CASE REPORTS How to cite this article: Bikbov M, Surkova V, Usubov E. Acanthamoeba Keratitis: Different Surgical Approaches. Int J Case 1 Kerat Ect Cor Dis 2016;5(2):77-80.
    [Show full text]
  • Acanthamoeba Keratitis: First Recorded Case from a Palestinian Patient With
    British Journal of Ophthalmology 1996;80:849-853 849 Br J Ophthalmol: first published as 10.1136/bjo.80.9.849 on 1 September 1996. Downloaded from LETTERS TO THE EDITOR Acanthamoeba keratitis: first recorded Table 1 Drug sensitivity ofAcanthamoeba the clinical features in this case were not espe- case from a Palestinian patient with isolatefrom cornea cially reminiscent of those generally recorded trachoma for such an amoebal infection.9 Minimum amoebicidal Traumatic injury is likely to predispose the concentration (fuglml) Keratitis due to Acanthamoeba is a potentially then compromised cornea to Acanthamoeba infection. For the contact lens wearer, there is sight threatening condition if unrecognised, or Drug Trophozoites Cysts if inappropriate medical therapy is used.' The now irrefutable evidence to demonstrate that the protozoa are derived from contaminated infection is being recognised worldwide.'A It Chlorhexidine 1.6 1.6 is often associated in Europe and in the USA Polyhexamethylene tap water,'0 which is used as part of the clean- with contact lens wear; elsewhere, particularly biguanide 3.2 6.3 ing disinfection procedures for the lenses and in the tropics, it occurs most often in rural Alexidine 6.3 6.3 associated paraphernalia. communities and can be associated with Propamidine 6.3 25.0 The observations from this case indicate trauma and mud splashing.5 Pentamidine 12.5 50.0 that chronic trachomatous disease may also Hexamidine 6.3 25.0 compromise the corneal surface such as to We present here the first recorded isolation Neomycin 12.5 50.0 of Acanthamoeba in a Palestinian patient with facilitate invasion by Acanthamoeba, and that keratitis, not associated with either contact this should be considered where other predis- lens wear or the patient's recollection of not used initially because of local unavailabil- posing factors cannot be readily identified.
    [Show full text]
  • Developing Novel Therapeutic Agents for Acanthamoeba Infection and Investigating the Process of Encystment
    Developing novel therapeutic agents for Acanthamoeba infection and investigating the process of encystment Anas Abdullah Hamad (BSc, MSc) A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy June 2020 Declaration This work or any part thereof has not previously been presented in any form to the University or to any other body whether for the purposes of assessment, publication or for any other purpose (unless otherwise indicated in page 3). Save for any express acknowledgements, references and/or bibliographies cited in the work, I confirm that the intellectual content of the work is the result of my own efforts and of no other person. The right of Anas Abdullah Hamad to be identified as author of this work is asserted in accordance with ss.77 and 78 of the Copyright, Designs and Patents Act 1988. At this date copyright is owned by the author. Signature………………………………………. Date……………………………………………. 15/10/2020 2 List of posters and publication related to the work presented in this thesis: Heaselgrave, W., Hamad, A., Coles, S. and Hau, S., 2019. In Vitro Evaluation of the Inhibitory Effect of Topical Ophthalmic Agents on Acanthamoeba Viability. Translational vision science & technology, 8(5), pp.17-17. Manuscript published. Hamad, A. and Heaselgrave, W., 2017. Developing novel treatments for the blinding protozoan eye infection Acanthamoeba keratitis. Proceedings of the Internal Annual Research Symposium, Poster no. 23, University of Wolverhampton, UK. Hamad, A. and Heaselgrave, W., 2018. Developing new treatments and optimising existing treatment strategies for the corneal infection Acanthamoeba keratitis.
    [Show full text]
  • Toxic Effects of Selected Proprietary Dry Eye Drops on Acanthamoeba
    www.nature.com/scientificreports OPEN Toxic efects of selected proprietary dry eye drops on Acanthamoeba Ines Sifaoui1,2, María Reyes-Batlle2, Atteneri López-Arencibia2, Olfa Chiboub1,2, Javier Rodríguez-Martín2,3, Pedro Rocha-Cabrera2,4, Basilio Valladares2, José E. Piñero2 & 2 Received: 2 October 2017 Jacob Lorenzo-Morales Accepted: 22 May 2018 Amoebae of the genus Acanthamoeba are ubiquitous protists that have been isolated from many Published: xx xx xxxx sources such as soils, water and the air. They are responsible for infections including fatal encephalitis and a severe keratitis in humans. To date, there is no satisfactorily efective therapeutic agent against this pathogen and the infections it causes are exacerbated by the existence of a resistant cyst stage produced by this amoeba. As dry eye syndrome is a risk factor for Acanthamoeba keratitis, we aimed to evaluate the anti-Acanthamoeba activity of a variety of proprietary eye drops intended to treat dry eye syndrome. From the nine eye drop formulations tested, “Systane Ultra” was determined to be the most active against all tested Acanthamoeba strains. During our investigations into the mode of action of Systane Ultra, we discovered that it decreases mitochondrial membrane potential and ATP levels, induces chromatin condensation, and increases the permeability of the plasma-membrane. Acanthamoeba keratitis (AK) is increasingly being recognized as a serious infection of the cornea that can lead to a permanent visual impairment or even blindness1. In the developed world, AK is most ofen found in contact lens users particularly where poor hygiene has been practiced. AK is difcult to diagnose partly because clinicians rarely encounter this infection but also because the symptoms mimic those of other types of keratitis diseases (viral, bacterial and fungal).
    [Show full text]
  • The Immunobiology of <Emphasis Type="Italic">Acanthamoeba
    Springer Semin Irnmunopathol (1999) 21 : 147-160 Springer Seminars in Immunopathology © Springer-Verlag 1999 The immunobiology of Acanthamoeba keratitis Jerry Y. Niederkorn, Hassan Alizadeh, Henry F. Leher, James P. McCulley Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235-9057, USA Background Although only a few centimeters in diameter, the eye is composed of virtually every type of tissue found in the remainder of the body, as well as cellular and noncellular el- ements found nowhere else [37]. The eye is an extension of the brain, and, as such, conducts an enormous array of neurological functions. The million ganglion cells of the retina transmit 500 electrical signals per second, which in computer terms is equiv- alent to 1.5 × ]0 9 bits of information [37]. However, if the cornea loses transparency, complex functions of the retinal elements are rendered meaningless, and acute vision is preempted. To prevent this loss from happening, the eye utilizes anatomical, physi- ological, and immunological barriers to shield the cornea from injury and infection [43]. In many animals the eye is recessed in cranial sockets and surrounded by bony protuberances protecting it from blunt trauma. The eyelids and tear film serve as effective barriers against environmental agents, including air- and water-borne patho- gens. The cornea is exposed continuously to the external environment and potential patho- gens. One might expect any infectious agent encountered at the ocular surface would be met with a vigorous immune response that would promptly eliminate the pathogen and protect the cornea. However, in certain cases, a zealous immune response to corneal pathogens can have the opposite effect, contributing instead to loss of corneal transparency and blindness.
    [Show full text]
  • Randy J. Epstein, MD
    Randy J. Epstein, MD BIBLIOGRAPHY 1) PEER-REVIEW JOURNAL ARTICLES 1. Epstein RJ, Hughes WF: “Lymphocyte- induced corneal neovascularization: A morphologic assessment”. Invest Ophthalmol Vis Sci 21 (1):87-94, 1981. 2. Miller MT, Epstein RJ, Sugar J, et. al.: “Anterior segment anomalies associated with the fetal alcohol syndrome”. J Ped Ophthalmol and Strabismus 21:8, 1984. 3. Epstein RJ, Wilson LA, Visvesvara GS, Plourde E: “Rapid diagnosis of Acanthamoeba keratitis from corneal scrapings using indirect fluorescent antibody staining”. Arch Ophthalmol 104:1318, 1986. 4. Epstein RK, Halkias A, Stulting RD, and Rogrigues MM: “Corneal opacities and anterior segment anomalies in DBA/2 mice: Models for corneal elastosis and the iridocorneal endothelial (ICE) syndrome”. Cornea 5:95, 1986. 5. Epstein RJ, Fernandes A, Stulting RD, Tigges M, Wright JD, and Gammon JA: “The correction of aphakia in neonatal monkeys with extended-wear contact lenses: Corneal studies”. Ophthalmology 93: 1495, 1986. 6. Visvesvara GS, Epstein RJ, et al: “Acanthamoeba keratitis associated with contact lenses-United States”. Morbidity and Mortality Weekly Report 35:405, 1988. 7. Epstein RJ, Stulting RD, and Kindle JC: “Blastogenesis induced by Herpes simplex virus in splenic mononuclear cells from inbred mice”. Curr. Eye Res. 6:145, 1987. 8. Epstein RJ, and Stulting RD: “Corneal neovascularization induced by stimulated lymphocytes in inbred mice”. Invest Ophthalmol Vis Sci 28: 1505, 1987. 9. Epstein RJ, Seedor JA, Dreizen NG et al.: “Penetrating keratoplasty for herpes simplex keratitis and keratoconus. Allograft rejection and survival”. Ophthalmology 94: 935, 1987. 10. Epstein RJ, Stulting RD, Hendricks RL, Harris DM: “Corneal neovascularization: Pathogenesis and inhibition”.
    [Show full text]
  • Every Red Eye Deserves an Antibiotic
    Ocular Infection Management- The Next Generation Bruce E. Onofrey, OD, RPh, FAAO Professor, U. Houston UEI SERIOUS PROBLEMS REQUIRE SERIOUS DOCUMENTATION THE BIG 6 “I’s” • INFECTION • INFLAMMATION • ISCHEMIA • INJURY • IDIOPATHIC • IATROGENIC (idiotpathic) Just the facts Mrs. Johnson • 65 y/o female visiting her friend Madge from Portland, Oregon. • Madge is one of your favorite long-term patients • Madge refers patient to you • Patient is very concerned about her “eye infection” The Simple Conjunctivitis Case • 65 y/o female recently in LA to visit son • Both developed red eyes • Son told mom he has genital herpes • and chlamydia • Mother seen by local ophthalmologist HX • My vision is getting worse in my left eye • It feels very “sore” and itches a lot • It waters all the time and it feels like my eye is too big for the eye socket • It’s glued shut every morning and very swollen • People are afraid to talk to me –they think I’m going to give them “pink eye” • Am I contagious? Will I lose my vision? Case : cont’d • Mom has Hx of trachoma as child and TB in remission. Worked in a TB ward-Was treated years ago • Mom wears mono-vision CL on OS only. Disposable-wears X wears X 2 weeks. Last worn 9 days ago Case : Cont’d • Eye now very painful and vision very bad • Calif. Dr said the cornea was all “torn up” • The doctor said the drops he gave me would make it better right-away-it made it worse and I stopped it after a day • I’ve been using the new drops daily and taking the pills, but it’s just getting worse every day • Am I going blind?!? QUESTION: Differential DX • 1.
    [Show full text]