Changes in Tear Volume after 3% Diquafosol Treatment in Patients with Dry Eye Syndrome: An Anterior Segment Spectral-domain Optical Coherence Tomography Study

PURPOSE: To evaluate changes in the tear meniscus area and tear meniscus height over time in patients with dry eye syndrome, using anterior segment spectral-domain optical coherence tomography after the instillation of 3% diquafosol ophthalmic solution. METHODS: Sixty eyes from 30 patients with mild to moderate dry eye syndrome were included. Tear meniscus images acquired by anterior segment spectral-domain optical coherence tomography were analyzed using National Institutes of Health's image-analysis software (ImageJ 1.44p). Tear meniscus area and tear meniscus height were measured at baseline, 5 minutes, 10 minutes, and 30 minutes after instillation of a drop of diquafosol in one eye and normal saline in the other eye. Changes in ocular surface disease index score, tear film break-up time, corneal staining score by Oxford schema, and meibomian expressibility were also evaluated at baseline, and after 1 week and 1 month of a diquafosol daily regimen. RESULTS: Sixty eyes from 30 subjects (mean age, 29.3 years; 8 men and 22 women) were included. In eyes receiving diquafosol, tear volume was increased at 5 and 10 minutes compared with baseline. It was also higher than saline instilled eyes at 5, 10, and 30 minutes. Changes in tear volume with respect to baseline were not statistically different after the use of diquafosol for 1 month. Ocular surface disease index score, tear film break-up time, and Oxford cornea stain score were significantly improved after 1 week and 1 month of daily diquafosol instillation, but meibomian expressibility did not change. CONCLUSIONS: Topical diquafosol ophthalmic solution effectively increased tear volume for up to 30 minutes, compared to normal saline in patients with dry eye syndrome.

The Path to Glaucoma Diagnosis

PURPOSE: To evaluate the events leading to a diagnosis of glaucoma. METHODS: Medical records of 484 subjects (223 women, 261 men; mean age, 55.3 years) who visited a glaucoma clinic without previous glaucoma diagnosis were reviewed. Events were classified into: 1) glaucoma-related symptoms, such as ocular pain accompanied by intraocular pressure elevation or visual disturbance without other ocular abnormalities except glaucoma, 2) ocular examination by an ophthalmologist for other symptoms, 3) routine health examination, or 4) patient request due to family history of glaucoma. Ocular findings that suggested glaucoma and led to detailed glaucoma assessment were classified as: 1) an optic disc abnormality, 2) high intraocular pressure, or 3) both. RESULTS: Events that led to the diagnosis of glaucoma were glaucoma-related symptoms in 11.8%, examination by an ophthalmologist in 74.2%, routine health examination in 12.4%, and family history in 1.7% of subjects. Findings that suggested glaucoma in ocular and routine health examinations were an optic disc abnormality in 84.2% and high intraocular pressure in 15.8%; both of these findings were found in 7.4% of subjects. CONCLUSIONS: The most common path to glaucoma diagnosis was optic disc assessment by an ophthalmologist and routine health examination. To facilitate early detection of glaucoma, regular detailed optic disc evaluation by an ophthalmologist should be emphasized.