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Seth Breitbart, Leonard Bielory; Prevalence of Tear Film Dysfunction and Utility of Cyclosporine Ophthalmic Emulsion in an Outpatient Allergy Practice. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3831.
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The ocular surface is a common site for inflammatory response leading to various forms of conjunctivitis associated with ocular allergies (OA), tear film dysfunction (TFD) and infections. Our aim is to assess the impact of ocular symptoms and management of OA and TFD in an ambulatory allergy practice setting.
TFD assessment was done using Schirmer Type 1 test and Ocular Surface Disease Index (OSDI), and treatment involved cyclosporine-ophthalmic-emulsion (COE) 0.05% suspension starting at a high dose (HD=4 drops bid) with a tapering course over 4-8 weeks. All patients on the HD COE previously failed traditional dosing (TD=1 drop bid). Observational study/cross sectional analysis using chart review. 300 charts were randomly selected out of 469 to establish the percentage of patients with TFD and OA. Efficacy of treatment is determined by retrospective analysis of sequential OSDI scores. P-values for the 2 COE groups (HD versus TD) were achieved using student T-test with unequal variances.
300 charts were reviewed: Mean age=42.1 years [Standard of Deviation (SD)=19.1]; 40% male; 60% female. 84/300 (28%) had "ocular complaints" (mean age=44.5 [SD=19.7, p=0.13]), (30% male; 70% female). OA: 57/84 (68%) (mean age=39.6 [SD=20.1, p=.82] (39% male; 61% female). TFD: 28/84 (33%) had TFD without OA (mean age=57.6 [SD=15.3, p<0.01]) (11% male; 89% female); 12/84 (14%) met criteria for both OA and TFD. 11/84 (13%) had neither TFD nor OA forms of ocular complaints. 40/300 patients (13%) met criteria for TFD; 33/40 (82.5%) had both OSDI and Schirmer testing (18% male; 82% female). 21 had sequential OSDI scores that could be analyzed. 20/21 (95%) of patients were treated with COE, ranging from 1-4 gtts bid. 1 patient (5%) did not receive COE. 7 patients (35.0%) used TD COE; 13 (65.0%) used HD. Average OSDI improved 51%; 5 patients showed 100% symptom resolution (3 HD patients; 2 TD patients); 2 patients (both TD) showed worsening OSDI. 7 patients on TD COE saw 43.0% improvement in OSDI scores; 13 HD COE patients (who previously failed TD therapy) demonstrated 66.3% improvement in OSDI scores (p-value=0.35).
TFD exists in 13% of our population, and there is a significant (43.0-66.3%) response to COE. Although the difference in OSDI improvement between the HD and TD group is statistically insignificant (p=0.35), the group receiving HD COE had previously failed TD therapy and now shows a 66.3% OSDI improvement.
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