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Louise C. McCann, Alan Tomlinson, Charles J. Diaper; Effect of First Line Management Therapies on Dry Eye Disease. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3829.
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© ARVO (1962-2015); The Authors (2016-present)
To systematically evaluate current clinical practise in the management of dry eye disease (DED), through changes in tear physiology.
Forty-four DED patients were referred from a local eye hospital (Southern General Hospital, Glasgow, UK) to the Tear Physiology Unit at Glasgow Caledonian University. Clinical diagnosis of DED was made by the referring Ophthalmologist on the basis of standard clinical definitions of DED including symptoms, Schirmer I test results and measures of tear break up time. In Sjogrens Syndrome, auto-antibody tests were also employed. Patients were divided into 4 groups, dependant on their clinical diagnosis (16 aqueous deficient (ADDE) and 28 evaporative (EDE)). Each group used therapies prescribed by the referring ophthalmologist (CD). A battery of tear physiology tests was carried out pre therapy and at 1- and 3-months post therapy. These included measures of symptoms, tear film evaporation (TFE), turn over rate (TTR), osmolarity (TFO), interferometry (TFI) and meibomian gland expression (MGE).
At baseline between the ADDE and EDE groups, significant differences were seen in symptoms, TFE, TTR and MGE (p<0.05). In the ADDE group, from baseline to 3-months, significant differences (p<0.05) were found for symptoms, TFI, TTR and MGE but not for TFE and TFO. For the EDE group, significant differences were found for symptoms, TFI, TFE and MGE but not for TTR or TFO. Interestingly, all changes over 3-months were in the ‘correct’ direction for alleviation, even if there was a lack of significance.
Although treatable, DED cannot be cured and as such, treatment must be used to manage symptoms rather than eliminate them completely. This pilot study shows improvement in signs and symptoms in both DE groups. Symptoms were improved in 63% of patients under appropriate treatment for the underlying pathology. TFI and MGE showed significant improvement for both ADDE and EDE groups and, encouragingly, TTR improved in ADDE and TFE in EDE. This suggests if improvement was maintained over longer periods of time then the prescribed management therapies are beneficial in treating DED.
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