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Tomoyuki Kamao, Eri Ishikawa, Naomi Takahashi, Xiaodong Zheng, Atsushi Shiraishi; Assessment of visual function after nasolacrimal duct intubation for nasolacrimal duct obstruction. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3844.
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© ARVO (1962-2015); The Authors (2016-present)
It has been indicated that tear film associated disorder including dry eye causes visual disturbance. In the present study, to determine the outcomes of the visual function after nasolacrimal duct intubation (NDI), the visual function was assessed using the functional visual acuity (FVA) measurement system in the patients underwent nasolacrimal duct intubation (NDI).
One hundred eighty nasolacrimal duct obstructions underwent NDI guided by dacryoendoscope in 136 patients at Ehime University Hospital from December 2010 to May 2014 were studied. The mean age at surgery was 70.5 ± 10.4 years (range, 29-94 years). We measured corrected distance visual acuity (CDVA), functional visual acuity (FVA), visual maintenance ratio (VMR), tear meniscus height (TMH) with anterior segment optical coherence tomography and Schirmer I test values. The values were measured before surgery (pre-NDI) and 6 months after tube removal (post-NDI).
FVA and VMR were significantly improved at post-NDI (p<0.0001), while no significant difference was detected in CDVA between pre- and post-NDI. TMH and Schirmer I test values of post-NDI were significantly lower than those of pre-NDI (p<0.0001). When Japanese diagnostic criteria for dry eye (2006) were applied at post-NDI tests, 32 eyes (17.8%) in 27 patients were diagnosed as dry eye. Thus subjects were divided into non-dry eye (N) and dry eye (D) groups, no significant difference was detected in CDVA between pre- and post-NDI in both groups. FVA and VMR were significantly improved post-NDI in the N group (p<0.0001), but decreased in the D group (p=0.0436, 0.0334). When the results at pre-NDI in the two groups were compared, no significant difference was seen in CDVA, FVA, or VMR, however, TMH and Schirmer I test values were significantly lower in the D group than the N group (p=0.0059, <0.0001). The sensitivity and specificity for dry eye diagnosis before surgery were calculated to be 88.9 and 65%, respectively when a cut-off value was determined as ≤14 mm in Schirmer I test.
The results suggest that NDI improve not only epiphora but also quality of vision in the patients with nasolacrimal obstruction. However, it should be careful that it may disturb visual function if the patients developed dry eye after surgery.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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