Effect of monovalent electrolyte solutions on the human tear ferning pattern.

PURPOSE: To investigate the effect of the addition of a low concentration of sodium chloride (NaCl) and potassium chloride (KCl) solutions on the tear ferning (TF) patterns of tears collected from humans. METHODS: A tear sample (20 µL) was collected from the right eye of 23 males and 7 females (25.4 ± 6.6 years). The tears were collected in one sitting for healthy subjects (N = 13). For dry eye participants (N = 17), the tear samples were collected in two separate settings with five minutes gap in between. A sample (1 µL) from each tear was dried on a glass slide, and the obtained ferns were observed using a microscope and graded using the five-point TF grading scale. Mixtures of tear samples (0.5 µL) and different volumes (0.5-2.5 µL) of each electrolyte (10-30 mg in 100 mL of water) solution were prepared, and their TF patterns were recorded and compared with those of the corresponding pure tears. RESULTS: Significant improvements (Wilcoxon test, P < 0.001) have been seen in the TF grades of the tear samples after the addition of NaCl and KCl solutions. A significant difference (Wilcoxon test, P = 0.016) was found between the TF grades when NaCl and KCl solutions were added to the tear samples. The TF grades of pure tears collected from dry-eye subjects ranged from 2.1 to 3.5, based on the five points grading scale, and decreased to be in the range of 0.4 to 1.6 after the addition of electrolyte solutions. While the TF grades of pure tears collected from normal-eye ranged from 1.2 to 1.9 and improved after the addition of electrolyte solution to be in the range of 0.4 to 1.5. CONCLUSIONS: The TF test was used in vitro to assess the impact of the addition of a low concentration of sodium and potassium chloride solutions on tears collected from humans. The TF grades of human tears significantly improved after the addition of either sodium or potassium chloride solution. The mechanism for the improvement in TF grades due to the addition of electrolyte solutions must be investigated.

The acute effect of a single dose of green tea on the quality and quantity of tears in normal eye subjects.

OBJECTIVE: The study aimed to investigate the acute effect of a single dose of green tea on the quality and quantity of tears in normal eye subjects. METHODS: Forty normal eye subjects (22 men and 18 women) aged 19-39 years were enrolled in the study. Also, an age matching control group (20 males and 20 females) was enrolled for comparison. McMonnies dry eye symptoms questionnaire and slit lamp were used for the exclusion criteria determination. Phenol red thread (PRT) test was performed on both eyes of each subject. A tear sample was collected from the lower tear meniscus of the right eye of each subject for the tear ferning (TF) test, which was performed before (30 minutes) and after (60 minutes) drinking green tea. RESULTS: The median PRT measurement after green tea consumption was lower (median [IQR]=23.50 [8.00] mm) compared to that before consumption (median [IQR]=27.00 [8.75] mm). In contrast, the median TF grade was significantly higher following green tea consumption than that before consumption (median [IQR]=2.65 [1.23] vs 1.50 [0.88] mm, respectively). The results show that TF grades increased in 97.5%, and the red phenol thread scores decreased in 80% of the subjects after green tea consumption compared to those before consumption. The PRT readings and TF grades were significantly different (P<0.05) before and after green tea consumption. CONCLUSION: Drinking green tea could have a significant effect on the eye tear film quality. Tear quality appeared to decrease after green tea consumption.

Retrospective review of visual outcome in operated lens subluxation.

OBJECTIVE: To describe the visual outcome of patients with lens subluxation (LS), including ectopia lentis (EL) due to genetic causes, who underwent surgical correction using standard selection criteria and surgical techniques in order to assess effectiveness of current LS therapy. METHODS: This is a retrospective review of 17 sequential patients with LS who underwent lens aspiration between 2000 and 2012 through an anterior (limbal) or posterior (pars plana) approach at King Abdulaziz University Hospital, Riyadh, Saudi Arabia. Snellen visual acuity was converted to the logarithm of the Minimum Angle of Resolution (logMAR) equivalent for statistical analysis. All statistical comparisons were performed by t-test. RESULTS: This series consisted of 28 eyes with causes of LS including Marfan syndrome (12 eyes), familial EL (5 eyes), homocystinuria (4 eyes), sickle cell anemia (2 eyes), and trauma (6 eyes). Mean visual acuity (VA) for the entire group increased from 20/200 before surgery to 20/70 after surgery (p>/=0.01). Post-operative VA was >/=20/60 in all eyes that did not have complicating factors such as amblyopia, retinal detachment, and/or other ocular abnormalities. Visual outcome of limbal and pars plana approaches was statistically similar (p>/=0.29). Patients with genetic causes of EL had a significantly better visual outcome than other patients (p>/=0.01); out of these, patients with Marfan syndrome had a better visual outcome than other patients with genetic abnormalities (p>/=0.02). CONCLUSION: Accepted surgical criteria and techniques improved visual outcome in patients with LS. Patients with Marfan syndrome and others genetic abnormalities without ocular complications had best visual outcomes.

Development and validation of the 21-item children's vision for living scale (CVLS) by Rasch analysis.

BACKGROUND: The aim was to develop and validate an instrument called the 'Children's Vision for Living Scale' (CVLS) for the assessment of vision-related quality of life in Saudi Arabian children with and without amblyopia. METHODS: A 43-item child self-report questionnaire was initially developed based on interviews with children with amblyopia, their parents and eye-care professionals, and a literature review. Following a process that involved the removal of redundant items, 28 items remained and were piloted on children aged five to 12 years with and without amblyopia (n = 48 amblyopic, n = 53 non-amblyopic) living in Saudi Arabia. Rasch analysis was applied to determine whether the 28-item questionnaire fitted the Rasch model. Rasch analysis was used to assess the validity and reliability of the questionnaire. Principal components analysis (PCA) was used to check dimensionality. A 21-item questionnaire resulting from this process was administered in children with (n = 81) and without (n = 82) amblyopia in Saudi Arabia for further validation. RESULTS: The final 21-item questionnaire had good validity and reliability as demonstrated by person separation of 2.02, person reliability of 0.80 (mean square and standard deviation: infit = 1.01 ± 0.39; outfit = 1.01 ± 0.40) and item reliability of 0.93 (item infit range = 1.33 to 0.78; item outfit range = 0.78 to 1.30). The mean difference between person and item scores of 0.33 ± 0.53 logits (scale range, 2 to -2) indicates that the items are well targeted to the populations. The PCA (dimensionality measures) shows the percentage of variance explained by measures equal to 26.4 per cent (modelled 26.9 per cent) and an eigenvalue of the first contrast of 2.5, which demonstrated good stability. CONCLUSION: The 21-item CVLS is a valid uni-dimensional child self-report instrument for the assessment of the impact of amblyopia on vision-related quality of life in children with and without amblyopia living in Saudi Arabia.

Outcomes of 3 hours part-time occlusion treatment combined with near activities among children with unilateral amblyopia.

OBJECTIVE: To evaluate the outcome of part-time occlusion therapy with or without near activities in monocular amblyopic patients. METHODS: One hundred and thirty patients who prescribed daily occlusion therapy (part-time occlusion) were followed-up for a 12-week period. The study was carried out in the Pediatric Ophthalmology and Orthoptics Clinics of King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia for the period from January to November 2010. Sixty-five patients were recommended to undertake the 3 hours of near visual activities (such as reading a book during patching) while the other 65 patients were not advised to do any near activity. Main outcome measures were best corrected visual acuity (VA) for both groups and line improvement. RESULTS: The total line of VA improved from baseline by an average of 6.7+/-2.37 line log MAR (logarithm of the minimum angle of resolution) units in the group of patching with near activities and by an average of 5.3+/- 2.04 line log MAR units in the group of patching without near activities. All type of amblyopia (strabismic, anisometropic, and mixed types of amblyopia) improved significantly after patching with near activities. Both moderate and severe amblyopia improved significantly in the group of near activities compared with the group without near activities. CONCLUSION: Performing near activities while patching in the treatment of anisometropic, stabismic, or combined amblyopia improves the VA outcome more than patching alone.

One month outcome of ocular related emergencies in a tertiary hospital in Central Saudi Arabia.

OBJECTIVE: To investigate the number and characteristics of patients attending the Accident/Emergency (A/E) Department of a tertiary care hospital in Riyadh, and to determine their route of referral, and pattern of ocular emergency cases. METHODS: A retrospective study was carried out using the records and history of all patients attending the A/E at King Abdulaziz University Hospital (KAUH) in Riyadh, Kingdom of Saudi Arabia in July 2010. Data collected included time of arrival, age, gender, source of referral, principal diagnosis, attending doctor, action taken, and discharge plan. RESULTS: A total of 1,412 patients were recruited in our study with an average daily attendance of 47 patients. A total of 863 (61%) patients were male, and their mean age was 28.2 years. The most frequent diagnosis in patients was trauma (382, 27%), followed by conjunctivitis (211, 14.9%), lids and lacrimal system (133, 9.4%), retina problems (51, 3.6%), glaucoma (30, 2.1%), neuro-ophthalmology (22, 1.6%), keratitis (20, 1.4%), uveitis (10, 0.7%), and episcleritis (5, 0.35%). Most cases (77.5%) seen were self-referrals. Additionally, 712 (50.4%) of cases were considered as non-emergency, which are visiting the A/E for dry eye, chalazion, blepharitis, and allergy. CONCLUSION: Most cases seen at our ophthalmic A/E had non-urgent conditions that could be managed satisfactorily by trained ophthalmic assistants under supervision of an ophthalmologist.

Unilateral amblyopia: Optical coherence tomography findings.

PURPOSE: This study was performed to measure the macular and the retinal nerve fiber layer (RNFL) thicknesses using optical coherence tomography (OCT) in patients with unilateral amblyopia. METHODS: Measurement of the Retinal nerve fiber layer and Macular Retinal Layer thickness for both amblyopic and normal fellow eyes by (OCT) was carried out at king Abdulaziz University Hospital, Riyadh, Saudi Arabia. RESULTS: Ninety-three patients with unilateral amblyopia between the ages of 5 years and 12 years were included. The macular retinal thickness and the RNFL thickness were measured using OCT. The mean macular retinal thickness was 259.3 µm and 255.6 µm, and the mean RNFL thickness was 112.16 µm and 106 µm, in the amblyopic eye and the normal eye, respectively. OCT assessment of RNFL thickness revealed a significantly thicker RNFL in amblyopic eye (P < 0.0001), but no statistically significant difference was found in macular retinal thickness (P = 0.195). CONCLUSION: The amblyopic process may involve the RNFL, but not the macula. However, further evaluation is needed.