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  1. Article ; Online: Insights Into Eye Care Accessibility: Geospatial Distribution of Eye Care Providers and Socioeconomic Factors by ZIP Code.

    Tran, Meagan T / Gonzalez, Valeria V / Mead-Harvey, Carolyn / Shen, Joanne F

    Translational vision science & technology

    2023  Volume 13, Issue 3, Page(s) 21

    Abstract: Purpose: In the United States, the ZIP Code has long been used to collect geospatial data revealing disparities in social determinants of health. This cross-sectional study examines the distribution of eye care access in association with local ... ...

    Abstract Purpose: In the United States, the ZIP Code has long been used to collect geospatial data revealing disparities in social determinants of health. This cross-sectional study examines the distribution of eye care access in association with local socioeconomic factors at a ZIP Code level.
    Methods: Data from the 2020 Centers of Medicare and Medicaid Services and American Community Survey were used to examine locations of 47,949 providers (17,631 ophthalmologists and 30,318 optometrists) and corresponding local socioeconomic variables (education, employment, and income). Multivariable zero-inflated negative binomial regression was used to model eye care provider count per capita in each ZIP Code area with socioeconomic factors as independent covariates.
    Results: For every 1% increase in percentage of population over 25 years with a bachelor's degree or higher, the expected number of providers increases by 4.4% (incidence rate ratio [IRR] = 1.044; 95% confidence interval [CI], 1.041-1.046; P < 0.001). For every 1% increase in percentage unemployment, the expected number of providers decreases by 2.7% (IRR = 0.973; 95% CI, 0.964-0.983; P < 0.001). However, for every $1000 increase in median household income, the expected number of providers decreases by 1.6% (IRR = 0.984; 95% CI, 0.983-0.986; P < 0.001).
    Conclusions: Disparities in access exist in areas of lower employment and educational attainment, as both have positive correlations with eye care provider access. Conversely, areas of greater median household income have lower access to providers.
    Translational relevance: This research contributes to a greater field studying social determinants of health and may inform public health strategies on allocation of providers to improve equitable access to vision care.
    MeSH term(s) Aged ; United States/epidemiology ; Humans ; Cross-Sectional Studies ; Medicare ; Socioeconomic Factors ; Ophthalmologists
    Language English
    Publishing date 2023-12-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2674602-5
    ISSN 2164-2591 ; 2164-2591
    ISSN (online) 2164-2591
    ISSN 2164-2591
    DOI 10.1167/tvst.13.3.21
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  2. Article: Seven Common Allergen Groups Causing Eyelid Dermatitis: Education and Avoidance Strategies.

    Huang, Crystal X / Yiannias, James A / Killian, Jill M / Shen, Joanne F

    Clinical ophthalmology (Auckland, N.Z.)

    2021  Volume 15, Page(s) 1477–1490

    Abstract: Objective: Eyelid dermatitis is most commonly attributed to allergic response. This retrospective clinical study identifies common allergens with eyelid involvement and addresses a literary gap by providing a clear approach for effective management of ... ...

    Abstract Objective: Eyelid dermatitis is most commonly attributed to allergic response. This retrospective clinical study identifies common allergens with eyelid involvement and addresses a literary gap by providing a clear approach for effective management of periorbital allergic contact dermatitis (ACD) recurrence.
    Methods: Charts of 215 patients diagnosed with periorbital dermatitis who were patch tested with Mayo Clinic Standard Series, Extended Standard Series, and personal products from 2013 to 2017 were examined. Positive reaction rates for patients with eyelid involvement were compared to those without. Findings were also compared to North American Contact Dermatitis Group (NACDG) 2013-2014 and Mayo Clinic Contact Dermatitis Group (MCCDG) 2011-2015 general patch test populations.
    Results: The 215 patients showed more common allergy to shellac, benzalkonium chloride, acrylates, and surfactants than the NACDG and MCCDG study populations. Periorbital ACD allergen groups eliciting the highest positive reaction rates were, in descending order: metals, shellac, preservatives, topical antibiotics, fragrances, acrylates, and surfactants. Of the corticosteroids, only tixocortol pivalate (the screening agent for prednisolone and fluorometholone) and budesonide elicited positive reactions.
    Conclusion: The top seven eyelid ACD allergen groups were identified. Avoidance of these allergens can be straightforward, with initial empiric counseling and free, online allergen avoidance programs. Patients who are unresponsive to avoidance should undergo patch testing.
    Language English
    Publishing date 2021-04-12
    Publishing country New Zealand
    Document type Journal Article
    ISSN 1177-5467
    ISSN 1177-5467
    DOI 10.2147/OPTH.S297754
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  3. Article ; Online: Outcomes and Complications of Limbal Stem Cell Allograft Transplantation: A Report by the American Academy of Ophthalmology.

    Li, Jennifer Y / Cortina, Maria S / Greiner, Mark A / Kuo, Anthony N / Miller, Darby D / Shtein, Roni M / Veldman, Peter B / Yin, Jia / Kim, Stephen J / Shen, Joanne F

    Ophthalmology

    2024  

    Abstract: Purpose: To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency ( ... ...

    Abstract Purpose: To review the published literature on the safety and outcomes of keratolimbal allograft (KLAL) transplantation and living-related conjunctival limbal allograft (lr-CLAL) transplantation for bilateral severe/total limbal stem cell deficiency (LSCD).
    Methods: Literature searches were last conducted in the PubMed database in February 2023 and were limited to the English language. They yielded 523 citations; 76 were reviewed in full text, and 21 met the inclusion criteria. Two studies were rated level II, and the remaining 19 studies were rated level III. There were no level I studies.
    Results: After KLAL surgery, best-corrected visual acuity (BCVA) improved in 42% to 92% of eyes at final follow-up (range, 12-95 months). The BCVA was unchanged in 17% to 39% of eyes and decreased in 8% to 29% of eyes. Two of 14 studies that evaluated the results of KLAL reported a notable decline in visual acuity over time postoperatively. Survival of KLAL was variable, ranging from 21% to 90% at last follow-up (range, 12-95 months) and decreased over time. For patients undergoing lr-CLAL surgery, BCVA improved in 31% to 100% of eyes at final follow-up (range, 16-49 months). Of the 9 studies evaluating lr-CLAL, 4 reported BCVA unchanged in 30% to 39% of patients, and 3 reported a decline in BCVA in 8% to 10% of patients. The survival rate of lr-CLAL ranged from 50% to 100% at final follow-up (range, 16-49 months). The most common complications were postoperative elevation of intraocular pressure, persistent epithelial defects, and acute allograft immune rejections.
    Conclusions: Given limited options for patients with bilateral LSCD, both KLAL and lr-CLAL are viable choices that may provide improvement of vision and ocular surface findings. The studies trend toward a lower rejection rate and graft failure with lr-CLAL. However, the level and duration of immunosuppression vary widely between the studies and may impact allograft rejections and long-term graft survival. Complications related to immunosuppression are minimal. Repeat surgery may be needed to maintain a viable ocular surface. Reasonable long-term success can be achieved with both KLAL and lr-CLAL with appropriate systemic immunosuppression.
    Financial disclosure(s): Proprietary or commercial disclosure may be found after the references.
    Language English
    Publishing date 2024-04-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 392083-5
    ISSN 1549-4713 ; 0161-6420
    ISSN (online) 1549-4713
    ISSN 0161-6420
    DOI 10.1016/j.ophtha.2024.02.018
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Nuclear Medicine and Molecular Imaging in Nodal Staging and Surveillance of Ocular Melanoma: Case Reports and Review of the Literature.

    Zurcher, Kenneth S / Houghton, Odette M / Shen, Joanne F / Seetharam, Mahesh / Roarke, Michael C / Yang, Ming

    Journal of nuclear medicine technology

    2021  Volume 49, Issue 3, Page(s) 275–280

    Abstract: Ocular melanoma (OM) is a rare noncutaneous malignancy and consists of 2 different subtypes based on the anatomic location in the eye: uveal melanoma and conjunctival melanoma. Like cutaneous melanoma, OM benefits from nuclear medicine and molecular ... ...

    Abstract Ocular melanoma (OM) is a rare noncutaneous malignancy and consists of 2 different subtypes based on the anatomic location in the eye: uveal melanoma and conjunctival melanoma. Like cutaneous melanoma, OM benefits from nuclear medicine and molecular imaging in nodal staging and clinical management. Through the illustration of 2 distinctive cases, we aim to demonstrate the complementary roles of standard lymphoscintigraphy, advanced SPECT/CT,
    MeSH term(s) Fluorodeoxyglucose F18 ; Humans ; Melanoma/diagnostic imaging ; Molecular Imaging ; Neoplasm Staging ; Nuclear Medicine ; Positron Emission Tomography Computed Tomography ; Radiopharmaceuticals ; Skin Neoplasms
    Chemical Substances Radiopharmaceuticals ; Fluorodeoxyglucose F18 (0Z5B2CJX4D)
    Language English
    Publishing date 2021-04-05
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 189163-7
    ISSN 1535-5675 ; 0091-4916
    ISSN (online) 1535-5675
    ISSN 0091-4916
    DOI 10.2967/jnmt.120.260539
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Characterizing Extremely Negative Reviews of Ophthalmologists on Yelp.Com.

    Smith, Jacob F / Shah, Ami A / Qureshi, Muhammad B / Luong, Hanna N / Adeleye, Olufunmilola / Adams, Olufemi E / Shen, Joanne F

    Seminars in ophthalmology

    2022  Volume 37, Issue 5, Page(s) 661–667

    Abstract: Purpose: To perform a retrospective characterization of one-star reviews of ophthalmologists on Yelp.com and to increase understanding of patient complaints on Yelp.com.: Methods: A search was performed for reviews on Yelp.com using the keyword " ... ...

    Abstract Purpose: To perform a retrospective characterization of one-star reviews of ophthalmologists on Yelp.com and to increase understanding of patient complaints on Yelp.com.
    Methods: A search was performed for reviews on Yelp.com using the keyword "ophthalmologist" for the top 8 most population-dense metropolitan areas in the United States. One-star reviews were collected and classified as procedural or nonprocedural. Complaints were also categorized as clinical, nonclinical, or both. Clinical complaints cited issues such as complications, reoperations, uncontrolled pain, misdiagnosis, unclear treatment plan, etc. Nonclinical complaints included comments such as physician bedside manner, other staff interpersonal manner, wait time, brevity of appointment time, etc.
    Results: 5,532 total reviews were assessed, of which 477 (9%) one-star reviews were included in the study for analysis. These reviews amounted to 1,120 distinct complaints. 287 (26%) were clinical in nature and 833 (74%) were nonclinical. Technical incompetence or error (50: 4%), unsatisfactory results (46: 4%), and complications (43: 4%) represented the most common clinical complaints while office staff interpersonal manner (182: 16%), wait time (174: 16%), and physician interpersonal manner (141: 13%) were the most common nonclinical complaints. Refractive surgery was the most frequently mentioned subspecialty (89: 8%). Patients undergoing an ophthalmic procedure (surgery, injection, etc.) wrote 64 reviews that resulted in 193 (17%) complaints. Nonprocedural patients wrote 413 reviews that resulted in 927 (83%) complaints. Compared with procedural reviews, nonprocedural reviews were less likely to include a clinical complaint (rate ratio, 0.3:
    Discussion: The majority of one-star reviews of ophthalmologists included in this study were nonclinical. Complaints referencing a procedural episode were more likely to include a clinical component in the review. In the era of intense medical consumerism and increased physician and health care institution competition for patient acquisition and retention, the characterization of excessively negative reviews allows identification of potential areas of concern for patients that use online review sites such as Yelp.com.
    MeSH term(s) Humans ; Ophthalmologists ; Ophthalmology ; Patient Satisfaction ; Retrospective Studies ; United States
    Language English
    Publishing date 2022-04-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 632820-9
    ISSN 1744-5205 ; 0882-0538
    ISSN (online) 1744-5205
    ISSN 0882-0538
    DOI 10.1080/08820538.2022.2064193
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  6. Article ; Online: Thermal Pulsation in the Management of Meibomian Gland Dysfunction and Dry Eye: A Report by the American Academy of Ophthalmology.

    Tao, Jeremiah P / Shen, Joanne F / Aakalu, Vinay K / Foster, Jill A / Freitag, Suzanne K / McCulley, Timothy J / Vagefi, M Reza / Kim, Stephen J / Wladis, Edward J

    Ophthalmology

    2023  Volume 130, Issue 12, Page(s) 1336–1341

    Abstract: Purpose: To review the literature to determine the efficacy and safety of thermal pulsation technologies in improving signs or symptoms of meibomian gland dysfunction (MGD) and dry eye compared with no therapy or with conventional warm compress therapy ... ...

    Abstract Purpose: To review the literature to determine the efficacy and safety of thermal pulsation technologies in improving signs or symptoms of meibomian gland dysfunction (MGD) and dry eye compared with no therapy or with conventional warm compress therapy or eyelid hygiene.
    Methods: A literature search was conducted in the PubMed database in June 2022 and again in March 2023 to identify all studies in the English language on the use of thermal pulsation to treat MGD or dry eye. The search yielded 59 citations, and 11 articles met all of the inclusion criteria. The panel methodologist then assigned a level of evidence rating for each study; 8 studies were rated level I evidence and 3 studies were rated level II evidence.
    Results: All included studies evaluated a single 12-minute session using the LipiFlow automated thermal pulsation system (TearScience, Inc, or Johnson & Johnson). Improvements were detected in subjective and objective metrics of MGD or dry eye in patients within 1 to 12 months of thermal pulsation treatment compared with nontreatment. Most of the studies (9/11) reported greater efficacy with thermal pulsation than with standard warm compress therapy and eyelid hygiene. Four of these studies showed relevant industry conflicts of interest. Two of the 4 level I studies without direct industry participation concluded that thermal pulsation treatment was not significantly different from conventional hygiene or warm compress therapy control treatments (in symptoms in one of the studies and in objective findings in the second study). No serious adverse events were reported in any of the 11 studies.
    Conclusions: According to the current literature, a single thermal pulsation session may improve subjective or objective parameters of MGD and dry eye safely. However, industry support and participation were present in 4 of the 8 level I studies. The durability beyond several months and cost efficacy remain uncertain. Because the inclusion parameters of this assessment captured only the LipiFlow system, the conclusions are limited to that product. High-quality independent studies are needed to assess the long-term benefits of this intervention.
    Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    MeSH term(s) Humans ; Meibomian Gland Dysfunction/therapy ; Ophthalmology ; Dry Eye Syndromes/therapy ; Academies and Institutes ; Benchmarking
    Language English
    Publishing date 2023-08-27
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 392083-5
    ISSN 1549-4713 ; 0161-6420
    ISSN (online) 1549-4713
    ISSN 0161-6420
    DOI 10.1016/j.ophtha.2023.07.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Advanced Corneal Imaging in Keratoconus: A Report by the American Academy of Ophthalmology.

    Kuo, Anthony N / Cortina, Maria S / Greiner, Mark A / Li, Jennifer Y / Miller, Darby D / Shtein, Roni M / Veldman, Peter B / Yin, Jia / Kim, Stephen J / Shen, Joanne F

    Ophthalmology

    2023  Volume 131, Issue 1, Page(s) 107–121

    Abstract: Purpose: To review the published literature on the diagnostic capabilities of the newest generation of corneal imaging devices for the identification of keratoconus.: Methods: Corneal imaging devices studied included tomographic platforms ( ... ...

    Abstract Purpose: To review the published literature on the diagnostic capabilities of the newest generation of corneal imaging devices for the identification of keratoconus.
    Methods: Corneal imaging devices studied included tomographic platforms (Scheimpflug photography, OCT) and functional biomechanical devices (imaging an air impulse on the cornea). A literature search in the PubMed database for English language studies was last conducted in February 2023. The search yielded 469 citations, which were reviewed in abstract form. Of these, 147 were relevant to the assessment objectives and underwent full-text review. Forty-five articles met the criteria for inclusion and were assigned a level of evidence rating by the panel methodologist. Twenty-six articles were rated level II, and 19 articles were rated level III. There were no level I evidence studies of corneal imaging for the diagnosis of keratoconus found in the literature. To provide a common cross-study outcome measure, diagnostic sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were extracted. (A perfect diagnostic test that identifies all cases properly has an AUC of 1.0.) RESULTS: For the detection of keratoconus, sensitivities for all devices and parameters (e.g., anterior or posterior corneal curvature, corneal thickness) ranged from 65% to 100%. The majority of studies and parameters had sensitivities greater than 90%. The AUCs ranged from 0.82 to 1.00, with the majority greater than 0.90. Combined indices that integrated multiple parameters had an AUC in the mid-0.90 range. Keratoconus suspect detection performance was lower with AUCs ranging from 0.66 to 0.99, but most devices and parameters had sensitivities less than 90%.
    Conclusions: Modern corneal imaging devices provide improved characterization of the cornea and are accurate in detecting keratoconus with high AUCs ranging from 0.82 to 1.00. The detection of keratoconus suspects is less accurate with AUCs ranging from 0.66 to 0.99. Parameters based on single anatomic locations had a wide range of AUCs. Studies with combined indices using more data and parameters consistently reported high AUCs.
    Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
    MeSH term(s) Humans ; Cornea/diagnostic imaging ; Corneal Pachymetry/methods ; Corneal Topography/methods ; Keratoconus/diagnostic imaging ; Ophthalmology ; ROC Curve ; Tomography
    Language English
    Publishing date 2023-10-19
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 392083-5
    ISSN 1549-4713 ; 0161-6420
    ISSN (online) 1549-4713
    ISSN 0161-6420
    DOI 10.1016/j.ophtha.2023.07.030
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  8. Article: Effects of Intense Pulsed Light on Tear Film TGF-β and Microbiome in Ocular Rosacea with Dry Eye.

    Sagaser, Samantha / Butterfield, Richard / Kosiorek, Heidi / Kusne, Yael / Maldonado, Juan / Fautsch, Michael P / Patel, Dharmendra / Shen, Joanne F

    Clinical ophthalmology (Auckland, N.Z.)

    2021  Volume 15, Page(s) 323–330

    Abstract: Purpose: To assess tear film transforming growth factor-beta (TGF-β) and ocular microbiome changes after intense pulsed light with meibomian gland expression (IPL-MGX) vs only MGX in treating ocular rosacea with dry eye symptoms.: Methods: Twenty ... ...

    Abstract Purpose: To assess tear film transforming growth factor-beta (TGF-β) and ocular microbiome changes after intense pulsed light with meibomian gland expression (IPL-MGX) vs only MGX in treating ocular rosacea with dry eye symptoms.
    Methods: Twenty patients were randomly assigned to IPL-MGX or MGX. Patients were examined, treated, and administered the ocular surface disease index (OSDI) survey every 4-6 weeks for four total treatments. Tear film and conjunctival samples were collected at first and last visits, and analyzed for TGF-β concentration and 16s rRNA amplicon sequencing of ocular microbiome. Wilcoxon Rank Sum and Sign-Rank were used to examine changes from baseline.
    Results: OSDI revealed significantly greater improvement in symptoms after IPL-MGX (p=0.030) compared to MGX. There was no significant difference in mean TGF-β1, 2, or 3 concentration after IPL-MGX (p=0.385, 0.709, 0.948, respectively). Quantities of
    Conclusion: IPL-MGX improved dry eye symptoms more than MGX alone. IPL treatment offered no additional benefit to MGX in decreasing virulent bacteria present on the ocular surface and did not influence TGF-β levels in tears. Prospective studies on IPL-MGX with larger sample sizes are needed to further investigate cytokines and IPL in patients suffering from ocular rosacea with dry eye symptoms.
    Clinicaltrialsgov identifier: NCT03194698.
    Language English
    Publishing date 2021-01-27
    Publishing country New Zealand
    Document type Journal Article
    ISSN 1177-5467
    ISSN 1177-5467
    DOI 10.2147/OPTH.S280707
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  9. Article ; Online: Combination Therapy of Intense Pulsed Light Therapy and Meibomian Gland Expression (IPL/MGX) Can Improve Dry Eye Symptoms and Meibomian Gland Function in Patients With Refractory Dry Eye: A Retrospective Analysis.

    Vegunta, Sravanthi / Patel, Dharmendra / Shen, Joanne F

    Cornea

    2016  Volume 35, Issue 3, Page(s) 318–322

    Abstract: Purpose: To assess the improvement in meibomian gland function and dry eye symptoms in patients with refractory dry eye treated with a combination therapy of intense pulsed light (IPL) and meibomian gland expression (MGX).: Methods: Medical records ... ...

    Abstract Purpose: To assess the improvement in meibomian gland function and dry eye symptoms in patients with refractory dry eye treated with a combination therapy of intense pulsed light (IPL) and meibomian gland expression (MGX).
    Methods: Medical records of 81 consecutive patients with dry eye treated with serial IPL/MGX were retrospectively examined to determine the outcome. All patients had a minimum of 6 months of follow-up after the first IPL/MGX treatment. Patients typically received 1 to 4 IPL treatments spaced 4 to 6 weeks apart. Each IPL session included MGX. Thirty-five charts had complete data for inclusion in analysis. We reviewed demographics, ocular histories, Standard Patient Evaluation of Eye Dryness 2 (SPEED2) symptom survey scores, slit-lamp examinations, and meibomian gland evaluations (MGE) at baseline and at each visit before IPL/MGX treatments.
    Results: The paired t test showed a significant (P < 0.0001) decrease in SPEED2 with IPL/MGX therapy. Of the 35 patients, 8 (23%) had a ≥50% decrease in SPEED2, 23 (66%) had a 1% to 49% decrease in SPEED2, 1 (3%) had no change in SPEED2, and 3 (9%) had an increase in SPEED2. The Paired t test showed a significant increase in MGE in the left eye but not in the right eye (OD P = 0.163 and OS P = 0.0002). Thirteen patients (37%) had improved MGE bilaterally. Eight patients (23%) had either a decrease in MGE bilaterally or a decrease in 1 eye with no change in the other eye.
    Conclusions: This retrospective analysis shows that the combination of IPL and MGX can significantly improve dry eye symptoms (in 89% of patients) and meibomian gland function (in 77% of patients in at least 1 eye).
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy/methods ; Dry Eye Syndromes/therapy ; Female ; Humans ; Intense Pulsed Light Therapy ; Male ; Meibomian Glands/metabolism ; Meibomian Glands/physiopathology ; Middle Aged ; Pressure ; Regression Analysis ; Retrospective Studies ; Tears/metabolism ; Therapy, Soft Tissue/methods ; Young Adult
    Language English
    Publishing date 2016-03
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604826-2
    ISSN 1536-4798 ; 0277-3740
    ISSN (online) 1536-4798
    ISSN 0277-3740
    DOI 10.1097/ICO.0000000000000735
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  10. Article: Climatic and Environmental Correlates of Dry Eye Disease Severity: A Report From the Dry Eye Assessment and Management (DREAM) Study.

    Berg, Erich J / Ying, Gui-Shuang / Maguire, Maureen G / Sheffield, Perry E / Szczotka-Flynn, Loretta B / Asbell, Penny A / Shen, Joanne F

    Translational vision science & technology

    2020  Volume 9, Issue 5, Page(s) 25

    Abstract: Purpose: Correlate climate, weather parameters, and environmental exposures with the severity of symptoms and signs of dry eye disease (DED) in Dry Eye Assessment and Management (DREAM) study participants.: Methods: Participants from five distinct ... ...

    Abstract Purpose: Correlate climate, weather parameters, and environmental exposures with the severity of symptoms and signs of dry eye disease (DED) in Dry Eye Assessment and Management (DREAM) study participants.
    Methods: Participants from five distinct climates completed the Ocular Surface Disease Index (OSDI) and were examined for corneal and conjunctival staining, tear breakup time (TBUT), and Schirmer's testing at baseline, 3, 6, and 12 months. Climate, weather parameters, and pollutants including ozone (O
    Results: Among 535 participants, 81% were female and mean age was 58 years. Participants from the Mediterranean climate demonstrated better corneal fluorescein staining, better TBUT, and higher Schirmer's test scores throughout the calendar year (each
    Conclusions: Dry eye signs differed between climates and local humidity levels. With the exception of NO
    Translational relevance: These results support limiting dry air exposure for patients with DED.
    MeSH term(s) Conjunctiva ; Cornea ; Dry Eye Syndromes/diagnosis ; Female ; Humans ; Male ; Middle Aged ; Severity of Illness Index ; Tears
    Language English
    Publishing date 2020-04-29
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2674602-5
    ISSN 2164-2591
    ISSN 2164-2591
    DOI 10.1167/tvst.9.5.25
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