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Cameron K Postnikoff, Katherine S Held, Drew Gann, Thomas Swain, Veena Viswanath, Kelly K Nichols; Efficacy of a saline rinse of the ocular surface immediately upon awakening: a novel therapeutic approach for dry eye disease. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5205.
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© ARVO (1962-2015); The Authors (2016-present)
Every night during sleep, there is an influx of inflammatory species into the closed eye tears. Preliminary results suggest that this inflammation is increased in dry eye disease. The purpose of this study was to determine if regular flushing of this inflammation upon awakening could reduce inflammation and improve comfort in subjects with dry eye disease.
This is a prospective, randomized clinical trial involving one site, and 34 normal and 36 dry eye subjects were enrolled. Contact lens wearers were not included. Dry eye diagnosis was made using a combination of symptoms and clinical metrics. Treatment consisted of washing each eye with 5mL of sterile phosphate buffered saline immediately upon awakening. Subjects were randomly assigned to either a treatment arm of a daily wash for four weeks, or a control arm of a wash once every two weeks. Subjective symptoms were measured using the dry eye questionnaire 5 (DEQ5) and the ocular surface disease index (OSDI). A clinical exam was performed to examine changes in phenol red thread wetting length (PRT), non-invasive tear break up time (NIKBUT), and inflammadry positivity in the right eye. Ocular washes were collected and reserved to measure changes in the leukocyte population by using flow cytometry.
To the treatment arm, 56% of normal and 44% of dry eye subjects were randomized. Following four weeks of treatment, there was an improvement in comfort in the dry eye subjects randomized to treatment versus control: DEQ5 scores had an average improvement in 2.6 ± 2.9 points as compared to baseline (p = 0.08), while OSDI scores had an improvement of 12.4 ± 15.9 points (p = 0.34). In the dry eye treatment group, there was moderate improvement in PRT, with a 6.2 mm increase in wetting length as compared to baseline (p = 0.17). NIKBUT remained largely unchanged following treatment (p = 0.56). Following treatment, the dry eye group showed a 64% reduction in inflammadry positive eyes.
Preliminary evidence suggests that an ocular eye wash upon awakening may improve signs and symptoms in some subjects with dry eye disease. Responder analyses will be performed across clinical signs and leukocyte expression.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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