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C. Maissa, M. Guillon; Tear Film and Lipid Layer Dynamics - The Effect of Aging and Gender. Invest. Ophthalmol. Vis. Sci. 2008;49(13):91.
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Dry eye disease is significantly more prevalent in presbyopes than non presbyopes and in the latter group more marked in women than men. Further, our group has shown that the tear film dynamics of dry eye sufferers is different to that of normal. It is therefore postulated that the greater prevalence of dry eye problems in presbyopes than non presbyopes is at least in part related to poorer tear film dynamics. The hypothesis tested was that the tear film dynamics of presbyopes was poorer than non presbyopes and in that older group worse in women than men, in particular for lipid related characteristics.
Tear film dynamics (Non Invasive Break Up Time) and lipid characteristics (Lipid layer thickness and contamination) were assessed using the Tearscope lighting system.
A total of 160 non-presbyopes (NPresb) aged 28.1±7.3 years (Range 18 to 44 years) and 58 presbyopes (Presb) aged 54.1±7.7 years (Range 45 to 83 years) form the two test populations. The tear film stability was mostly influenced by age; the break up time was statistically significantly shorter for presbyopes than non presbyopes (20.0 ± 13.9 vs. 13.2± 11.4 sec p<0.001) but no difference was found between gender (p=0.115). The lipid layer was significantly thinner (p=0.013) in the presbyopic population (Thin layer: NPresb 16% Presb 36%; Thick layer: NPresb 67% Presb 48%) with a very marked synergic effect of age and gender. The lipid layer of presbyopic females was significantly thinner than that of presbyopic males (Thin layer: Male 20% Female 47%; Thick layer: Male 63% Female 39% p=0.034) and than that of non-presbyopic females (Thin layer: NPresb Female 17% Presb Female 47%; Thick layer: NPresb Female 68% Presb Female 39% p=0.002).
Aging of the tear film is characterised by its destabilisation associated with significant changes in the tear lipid layer producing less protection from evaporation in the presbyopic population; the observed changes are more marked in women than men. The findings have significant implications for the management of presbyopic dry eye sufferers, for whom decreasing evaporative problems is essential.
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