Clinical evaluation of meibomian gland dysfunction in patients with keratoconus.

PURPOSE: To investigate the association of keratoconus (KC) with meibomian gland dysfunction (MGD) and to describe the epidemiological characteristics of MGD in this disease. METHODS: In this observational study, 120 KC patients seen in the Department of Ophthalmology of the Complexo Hospitalario Universitario de Santiago de Compostela and 87 controls were analyzed. The Ocular surface disease index (OSDI) questionnaire was administered and several DED tests and an evaluation of the meibomian glands and lid margin were performed. MGD signs and DED tests were compared between the groups. Symptoms were further analyzed in patients and controls with and without MGD. RESULTS: KC was significantly associated with MGD after adjusting for age and sex [adjusted odds ratio (ORa), 2.40]. The frequency of MGD in KC patients [59 (49.2%) KC patients and 25 (28.7%) controls had MGD] correlated with the severity of KC (r = 0.206) (P = 0.020). Mean OSDI score in KC patients with and without MGD was 31.1 ± 24.1 and 35.2 ± 26.0 (P = 0.326), and 17.2 ± 22.7 and 13.3 ± 14.1 in controls with and without it (P = 0.366). The most common MGD signs coincided in both groups. Staining with fluorescein (P = 0.000) and lissamine green (P = 0.019) was higher in KC patients, but no differences were detected with TBUT (P = 0.116) or the Schirmer test (P = 0.637). Hypersecretory MGD was the most prevalent variant in both groups. CONCLUSIONS: MGD and DED are common in KC patients. MGD correlates with the severity of KC and is indistinguishable from MGD in patients without KC. No association was found with symptoms. Patients with KC should be screened for MGD because of its possible clinical implications. Further research is needed to clarify the role of MGD in KC patients.

Rhegmatogenous Retinal Detachment and Solar Radiation in Northwestern Spain.

OBJECTIVE: The aim of this study was to investigate the association between rhegmatogenous retinal detachment (RRD) and solar radiation in northwestern Spain. METHODS: All RRD cases in Pontevedra from 2008 and 2014 were retrospectively analyzed. Climatological data from 4 weather stations in the area were collected. The association between RRD incidence and solar radiation was investigated. RESULTS: A total of 256 RRD cases were identified. There was a seasonal variation in the incidence of RRD with a maximum number of incident cases observed in June and July and a minimum number of cases observed in January and December. An association was found between RRD incidence and solar radiation both monthly (p = 0.004) and bimonthly (p = 0.057). The right eye was more frequently affected than the left eye (p = 0.035). RD cases other than rhegmatogenous showed neither seasonality nor association with radiation. CONCLUSIONS: Solar radiation may play a role in RRD genesis in our area. Laterality could be related to the amount of radiation reaching each eye.

Incidence and Risk Factors of Dry Eye in a Spanish Adult Population: 11-Year Follow-Up From the Salnés Eye Study.

PURPOSE: To estimate the incidence of dry eye (DE) and to evaluate risk factors in an adult cohort in Spain. METHODS: The Salnés Eye Study (SES) was a cross-sectional population-based study of 654 subjects conducted from 2005 to 2006. After 11 years, 264 individuals (65.8% response rate) participated in SES 2. The incidence cohort consisted of 209 subjects not diagnosed with DE in SES 1 [mean age (SD) 67.6 years (±10.1), range: 51-92, women 69.4%]. DE was defined as the simultaneous presence of symptoms and at least 1 sign. A Schirmer test score ≤5 mm, tear film breakup time ≤10 seconds, rose bengal staining ≥3, and fluorescein staining ≥1 were considered indicative of signs. Poisson regression models were performed to evaluate risk factors. RESULTS: The 11-year incidence of DE was 25.4% (95% confidence interval, 19.5-31.3) and that of symptoms was 31.6% (confidence interval, 25.4-37.8). DE incidence was significantly associated with age (P < 0.05). After adjusting for age, secondary or university studies were protective factors for DE; taking anxiolytics or antidepressants and angiotensin-converting enzyme inhibitors increased the risk of symptoms; a history of hypertension, chronic obstructive pulmonary disease, or autoimmune diseases increased the risk of signs. CONCLUSIONS: The annual incidence of DE, symptoms, and signs, was found to be 2.3 per 100 person-years. The incidence of symptoms was higher than that reported in similar studies. This study suggests that some factors may increase the risk of symptoms, whereas other factors may increase the risk of signs.

TFOS DEWS II Epidemiology Report.

The subcommittee reviewed the prevalence, incidence, risk factors, natural history, morbidity and questionnaires reported in epidemiological studies of dry eye disease (DED). A meta-analysis of published prevalence data estimated the impact of age and sex. Global mapping of prevalence was undertaken. The prevalence of DED ranged from 5 to 50%. The prevalence of signs was higher and more variable than symptoms. There were limited prevalence studies in youth and in populations south of the equator. The meta-analysis confirmed that prevalence increases with age, however signs showed a greater increase per decade than symptoms. Women have a higher prevalence of DED than men, although differences become significant only with age. Risk factors were categorized as modifiable/non-modifiable, and as consistent, probable or inconclusive. Asian ethnicity was a mostly consistent risk factor. The economic burden and impact of DED on vision, quality of life, work productivity, psychological and physical impact of pain, are considerable, particularly costs due to reduced work productivity. Questionnaires used to evaluate DED vary in their utility. Future research should establish the prevalence of disease of varying severity, the incidence in different populations and potential risk factors such as youth and digital device usage. Geospatial mapping might elucidate the impact of climate, environment and socioeconomic factors. Given the limited study of the natural history of treated and untreated DED, this remains an important area for future research.

Foster Kennedy Syndrome: An Atypical Presentation.

PURPOSE: To describe an unusual presentation of Foster Kennedy syndrome (FKS; unilateral optic nerve atrophy with optic nerve edema in the other eye) with optic nerve atrophy and retinal vein occlusion. It is an example of how common clinical features can hide a rare condition or presentation of a disease. Foster Kennedy syndrome is uncommon. Therefore, a space-occupying lesion should be suspected when there is optic atrophy associated with acute pathology of the other eye. CASE REPORT: A 56-year-old man presented with hemiretinal retinal vein occlusion in his right eye. He had previous optic nerve atrophy in his left eye attributed to nonarteritic anterior ischemic optic neuropathy. He lacked cardiovascular or prothrombotic risk factors. Consideration was given whether the presence of contralateral optic atrophy was associated with the retinal vein occlusion. A computed tomographic scan revealed a suprasellar mass. The tumor was excised and identified as meningioma. CONCLUSIONS: Although typical FKS would present with optic nerve atrophy and contralateral optic nerve edema secondary to an intracranial mass, in this case, edema was replaced by a hemiretinal vein occlusion. In optic atrophy that does not show characteristic visual field alterations, typical symptoms, or the classic evolution of a given disease, diagnostic imaging may reveal the etiology. As FKS is uncommon, when there is optic atrophy associated with acute pathology of the other eye, a space-occupying lesion should be suspected.

Prevalence of conjunctival shrinkage and its association with dry eye disease: results from a population-based study in Spain.

PURPOSE: The aim of this study was to describe the epidemiological characteristics of conjunctival shrinkage (CS) and the association between this disorder and dry eye disease (DED) in a general adult population in northwestern Spain. METHODS: A total of 1155 subjects 40 years or older were selected using an age-stratified random sample procedure in O Salnés (Spain). A standardized DED symptom questionnaire was administered, and a comprehensive ophthalmic evaluation that included DED tests was carried out. Disappearance of half or more of any of the lacunar folds after maximum abduction was considered evidence of CS. The prevalence and associations of CS and its relationship with DED symptoms and signs were investigated. RESULTS: From 937 eligible subjects, 622 (66.4%) participated [mean age (SD), 63.4 (14.5) years, range, 40-96, 37.0% males]. The prevalence of CS was 38.2% [95% confidence interval (CI), 35.0-41.5]. This prevalence increased with aging (P < 0.001) and was not associated with sex (P = 0.696). The prevalence of symptoms, abnormal tear breakup time, fluorescein and rose bengal staining was significantly higher among subjects with CS. After controlling for age and sex, outdoor activity was directly (adjusted odd ratio, 1.83) and high level of education was inversely (adjusted odd ratio, 0.43) associated with CS. No associations were found with ocular or systemic diseases. CONCLUSIONS: CS is a common pathological reaction that can be used as an indicator of moderate to severe DED. Aging and outdoor activity are strongly associated factors. The simplicity and reproducibility of this diagnosis recommend its inclusion in DED diagnostic and grading schemes.

Prevalence of asymptomatic and symptomatic meibomian gland dysfunction in the general population of Spain.

PURPOSE: To describe epidemiologic characteristics of asymptomatic and symptomatic meibomian gland dysfunction (MGD) in a general adult population in northwestern Spain. METHODS: A total of 1155 subjects aged 40 years and older were selected by an age-stratified random sample procedure in O Salnés, Spain. A standardized symptoms questionnaire was administered and a comprehensive ophthalmic evaluation, which included ocular surface tests, was carried out. Absent, viscous, or waxy white secretion upon digital expression, lid margin telangiectasia or plugging of the meibomian gland orifices was considered evidence of MGD. The prevalence and associations of asymptomatic and symptomatic MGD, and their effects on the ocular surface, were investigated. RESULTS: From 937 eligible subjects, 619 (66.1%) participated (mean age [SD], 63.4 [14.5] years; range, 40-96; 37.0% males). The prevalence of asymptomatic MGD was 21.9% (95% confidence interval [CI], 18.8-25.3). This prevalence increased with age (P = 0.000) and was higher in males than in females (P = 0.003). The prevalence of symptomatic MGD was 8.6% (95% CI, 6.7-10.9). This prevalence also increased with age (P = 0.000) but was not associated with sex. Abnormal tear breakup time and fluorescein staining prevalence estimates were higher among asymptomatic subjects. After controlling for age and sex, asymptomatic MGD was associated with diabetes (adjusted odds ratio [OR(a)] 2.23) and cardiovascular disease (OR(a) 1.80), and symptomatic MGD with rosacea (OR(a) 3.50) and rheumatoid arthritis (OR(a) 16.50). CONCLUSIONS: Asymptomatic MGD is more common than symptomatic MGD. Symptomatology is not associated with secondary damage to the ocular surface. Some systemic diseases may lower whereas others may raise the risk of developing symptoms. Symptom-based approaches do not seem appropriate for MGD estimation.

Prevalence and associations of external punctal stenosis in a general population in Spain.

PURPOSE: To determine the prevalence of external punctal stenosis (EPS) and to investigate its associations in a general adult population in northwestern Spain. METHODS: A total of 1155 subjects ≥ 40 years were selected by an age-stratified random sample procedure in O Salnés (Spain). An interview was carried out to collect history of systemic diseases and lifestyle details, and a comprehensive ophthalmic evaluation in which EPS was recorded. The prevalence of EPS and its relationship with demographic, lifestyle, and systemic and ocular factors was investigated. All calculations were weighted to give unbiased estimates. RESULTS: From 937 eligible subjects, 621 (66.3%) participated [mean age (SD), 63.4 (14.5) years; range, 40-96 years; 37.0% men). The prevalence of EPS was 17.3% [95% confidence interval (CI), 14.8-19.8). This prevalence increased significantly with aging (P = 0.000) and was 13.8% (95% CI, 10.3-18.3) in men and 19.4% (95% CI, 16.1-23.2) in women. After controlling for age and sex, EPS was associated with outdoor occupational activity (age and sex adjusted odd ratio [ORa], 2.22; 95% CI, 1.31-3.37) and with degenerative disorders such as pinguecula (ORa, 1.48; 95% CI, 1.15-1.89) but not with inflammatory disorders such as blepharitis or dry eye. A multivariable analysis in which sex differences also became significant (P = 0.024) confirmed these associations. CONCLUSIONS: External punctual stenosis is a common disorder associated with outdoor occupational activity. Processes associated with tissue degeneration but not with inflammation are highly prevalent among subjects with EPS. Modifiable factors, such as sun exposure, must be addressed to reduce the impact of this disorder.

The association of meibomian gland dysfunction and other common ocular diseases with dry eye: a population-based study in Spain.

PURPOSE: To investigate the relationship of meibomian gland dysfunction (MGD) and other prevalent ocular diseases with dry eye (DE) in a general adult population. METHODS: An age-stratified random sample of 1155 subjects aged ≥40 years was selected in O Salnés, Spain. From 937 eligible subjects, 654 (69.8%) participated (mean age (SD): 63.6 (14.4) years; range: 40-96; and 37.2% males). A standardized DE questionnaire was administered. Objective evaluation included the Schirmer test, tear film breakup time (TBUT), fluorescein staining, and rose bengal staining. DE was defined as the simultaneous presence of symptoms and at least one sign. The relationship of MGD and other ocular diseases with DE was investigated. A design-based analysis was performed, and all calculations were weighted to give unbiased estimates. RESULTS: DE and MGD prevalence were 11.0% [95% confidence interval (CI), 8.6-13.3] and 30.5% (95% CI, 26.9-34.1), respectively. MGD was present in 45.8% (95% CI, 34.8-57.2) of subjects with DE and was associated, after controlling for age and sex, with DE [adjusted odds ratios (ORa), 1.81]; with symptoms (ORa, 2.26); and with TBUT (ORa, 1.97), fluorescein staining (ORa, 2.09) and rose bengal staining (ORa, 3.25). The remaining ocular diseases were not associated with symptoms. However, pterygium was significantly associated with fluorescein staining (ORa, 1.89); cataract surgery with TBUT (ORa, 2.79); trauma and pseudoexfoliation with rose bengal staining (ORa, 2.75 and ORa, 4.04); and glaucoma with TBUT (ORa, 3.26), fluorescein staining (ORa, 3.40), and rose bengal staining (ORa, 3.46). CONCLUSIONS: DE and MGD are common diseases in this population. MGD is strongly associated with symptoms and signs of DE. Nearly half of the subjects with DE have MGD. Pterygium, trauma, cataract surgery, pseudoexfoliation, and glaucoma are associated with signs of DE.

Prevalence of pseudoexfoliation syndrome among adult Spanish in the Salnés eye Study.

PURPOSE: To estimate the prevalence of Pseudoexfoliation syndrome (PXF) and to investigate its relationship with systemic and ocular diseases and lifestyle factors in a general adult population in north-western Spain. METHODS: An age-stratified random sample of 1155 subjects was drawn from the population aged 40 years and over of O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (Standard Deviation [SD]): 63.4 (14.5) years, range: 40-96, 37.0% males). An interview to collect past history of ocular and systemic diseases and lifestyle details, and a comprehensive ophthalmic evaluation were performed. Study subjects with typical pseudoexfoliative material on the anterior capsule or in the pupil margin were labelled as having PXF. A design based analysis was performed and all calculations were weighted to give unbiased estimates. RESULTS: The prevalence of PXF was 6.5% (95% confidence interval [CI]:4.9-8.1). PXF rates increased significantly with age (P = 0.000). No cases of PXF were detected in subjects between 40 and 60 years. Prevalence of PXF was 8.0% (95% C I5.4-11.6) in men and 5.4% (95% CI 3.8-7.6) in women (P = ns). The prevalence of glaucoma in subjects with PXF was 19.6% (95% CI 8.2-40.0). After controlling for age and sex, glaucoma, cataract surgery, rose bengal staining and diabetes were associated with PXF but only glaucoma and rose bengal staining associations remained significant in a multivariate model. CONCLUSIONS: PXF is common among older individuals in north-western Spain. Subjects with pseudoexfoliation have a significantly higher prevalence of glaucoma than subjects without. An abnormal ocular surface detected by rose bengal staining is highly prevalent among subjects with pseudoexfoliation.

Prevalence of and associated factors for dry eye in a Spanish adult population (the Salnes Eye Study).

PURPOSE: To estimate the prevalence of dry eye and to investigate its relationship with lifestyle and systemic factors in a general adult population in north-western Spain. METHODS: A dry eye questionnaire was administered and objective tests were performed in 654 individuals [mean age (Standard deviation): 63.6 (14.4) years, range: 40-96, 37.2% males]. Subjects were considered symptomatic when one or more of the symptoms of the questionnaire were present often or all the time. Schirmer test or= 3 and fluorescein staining >or= 1 were considered indicative of signs. Dry eye was defined as the simultaneous presence of symptoms and at least one sign. A design based analysis was performed and all calculations were weighted to give unbiased estimates. RESULTS: Dry eye prevalence was 11.0% (95%confidence interval [CI] 8.6-13.3). Dry eye was found to be more frequent in women (11.9%, 95%CI 8.8-15.1) than in men (9.0%, 95%CI 5.3-12.6), and was significantly associated with aging (p < 0.001). After controlling for age and sex, acne rosacea was the only factor associated with the disease. There were no habits or systemic factors associated with symptoms. However, autoimmune diseases, acne rosacea, and computer use were found to be independently and significantly associated with signs. CONCLUSIONS: Dry eye is a common disease in this adult European population and is more frequent in older subjects. Acne rosacea is the only factor associated with dry eye. Other factors are associated with signs but not with symptoms.