April 2014
Volume 55, Issue 13
ARVO Annual Meeting Abstract  |   April 2014
Visual Disturbance and Ocular Irritation in an Experimentally Induced Tear Film Instability Model
Author Affiliations & Notes
  • Jun Zhang
    School of Optometry, Indiana University, Bloomington, IN
  • Carolyn G Begley
    School of Optometry, Indiana University, Bloomington, IN
  • Larry N Thibos
    School of Optometry, Indiana University, Bloomington, IN
  • Ping Situ
    School of Optometry, Indiana University, Bloomington, IN
  • Trefford L Simpson
    School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
  • Ziwei Wu
    School of Optometry, Indiana University, Bloomington, IN
  • Footnotes
    Commercial Relationships Jun Zhang, None; Carolyn Begley, None; Larry Thibos, None; Ping Situ, None; Trefford Simpson, None; Ziwei Wu, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science April 2014, Vol.55, 1989. doi:
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      Jun Zhang, Carolyn G Begley, Larry N Thibos, Ping Situ, Trefford L Simpson, Ziwei Wu; Visual Disturbance and Ocular Irritation in an Experimentally Induced Tear Film Instability Model. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1989.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: Tear film instability (TFI) is a core mechanism of dry eye (DEWS, 2007), but its connection to dry eye symptoms of ocular irritation and visual disturbance remains poorly understood. In this experimental TFI model, we test the hypothesis that TFI over the pupil decreases optical quality, visual acuity (VA) and stresses the ocular surface, leading to dry eye-like symptoms, and that wearing a soft contact lens (CL) partially alters this relationship.

Methods: 10 adapted soft contact lens (CL) wearers participated in 2 study visits, with and without CL. TFI by retroillumination (RI), VA and RMS fit error (RMSFE), an optical marker for TFI over the pupil (Liu et al, 2010) were measured simultaneously by a 3-channel optical system. Subjects were asked to keep one eye open for up to 30 sec, if possible, while TFI was monitored and subjects simultaneously turned a knob to adjust the letter size of the VA. The procedure was repeated 10 times. Discomfort and blurry vision during and after each trial were rated using 0-100 visual analogue scales (VAS). The current symptom questionnaire (CSQ) was filled in before and just after all testing.

Results: TFI occurred in 69% of trials of eye opening trials. There was a statistically significant (paired t-test, p<0.05) in increase in RMSFE between CL and no CL trials, with an average of 1394±832 (CL) and 594±104 (noCL). The increase in average logMAR VA was 0.54±0.24 (CL) and 0.44±0.14 (noCL), with no significant difference between groups. The median CSQ sum score (total=50) was 11 with CLs and 5 without CLs before testing and showed a statistically significant increase to 26 and 34, respectively, just after testing (Wilcoxon Signed-RankTest, p<0.03). The median CSQ symptom of discomfort (total 5) increased from 1 to 4 in both groups and blurry vision increased from 1 to 4 (CL) and 1 to 3 (no CL) before and after testing.

Conclusions: These results support the hypothesis that TFI leads to decreased VA and optical quality and increased discomfort, and that CL wear at least partially ameliorates the discomfort reported during TFI. After repeated TFI trials, both groups reported increased discomfort and blurry vision, suggesting cumulative effects in both groups and supporting the idea that TFI can lead to both classes of symptoms.

Keywords: 486 cornea: tears/tear film/dry eye • 477 contact lens • 754 visual acuity  

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