Off the Cuff: Gold Standards

The aim of this study was to review the prevalence of spectacle-related ocular trauma and the performance of currently available spectacle materials and to identify the risk factors associated with spectacle-related ocular trauma. A literature review was conducted using Medline, Embase and Google with the keywords "eyeglasses" or "spectacles" and "ocular injury"/ "eye injury"/ "eye trauma"/ "ocular trauma." Articles published prior to 1975 were excluded from this review because of advances in spectacle lens technology and Food and Drug Administration legislative changes requiring impact resistance of all prescription spectacle lenses in the United States.

Six hundred and ninety-five individual ocular traumas, for which spectacles contributed to or were the main cause of injury, were identified in the literature. Eye injuries occurred when spectacles were worn in sports, in which medium- to high-impact energies were exerted from balls, racquets or bats and/or as a result of a collision with another player. Frame, lens design and product material choice were found to be associated with ocular injury, with polycarbonate lenses cited as the material of choice in the literature. International, national and regional standards for spectacle lenses had a wide range of impact requirements for prescription spectacle lenses, sports eye protection and occupational eye protection. Spectacle-related injury represents a small but preventable cause of ocular injury.

With the increasing numbers of spectacle wearers and calls to spend more time outdoors to reduce myopia, spectacle wearers need to be made aware of the potential risks associated with wearing spectacles during medium- to high-risk activities. At particular risk are those prone to falls, the functionally monocular, those who have corneal thinning or have had previous eye surgery or injury. With increased understanding of specific risk factors, performance guidelines can be developed for prescription spectacle eye-protection requirements.

A subset of 173 full-term newborn infants from the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) birth cohort underwent magnetic resonance imaging (MRI) to measure the dimensions of the internal eye to determine if eye size and shape at birth are associated with eye size and refractive error three years later. Eye shape was assessed by an oblateness index, calculated as 1-(axial length/width) or 1-(axial length/height). Cycloplegic autorefraction (Canon Autorefractor RK-F1) and optical biometry (IOLMaster) were performed three years later.

Both eyes of 173 children were analyzed. Eyes with longer axial length at birth had smaller increases in axial length at three years. Eyes with larger baseline volumes and surface areas had smaller increases in axial length at three years. Eyes that were more oblate at birth had greater increases in axial length at three years. Using width to calculate oblateness, prolate eyes had smaller increases in axial length at three years compared to oblate eyes, and, using height, prolate and spherical eyes had smaller increases in axial length at three years compared to oblate eyes. There were no associations between eye size and shape at birth and refraction, corneal curvature or myopia at three years.

Eyes that are larger and have prolate or spherical shapes at birth exhibit smaller increases in axial length over the first three years of life. Eye size and shape at birth influence subsequent eye growth but not refractive error development.

Forty-eight eyes of 24 patients with dry eye related to Sjögren's syndrome were enrolled in this study to describe the clinical efficacy of the treatment of Sjögren's syndrome dry eye using 0.03% tacrolimus eye drop. The patients were randomized in two groups: tacrolimus (n=14) and vehicle (n=10) group. The tacrolimus group received a vial containing tacrolimus 0.03% (almond oil as vehicle) and the other group received the almond oil vehicle. All patients were instructed to use the eye drops every 12h in the lower conjunctival sac. Schirmer I test, breakup time (BUT), corneal fluorescein and rose bengal staining scores were evaluated in all patients one day before the treatment (baseline), seven, 14, 28 and 90 days after treatment with the eye drops.

The average fluorescein and rose bengal scores improved statistically after seven days of treatment and even more after 90 days. The average Schirmer I and BUT values were unchanged after seven, 14 and 21 days but did show an improvement relative to baseline after 28 days of treatment. Schirmer I, BUT, fluorescein and rose bengal did not show any statistical significance in the vehicle group.

Topical 0.03% tacrolimus eye drop improved tear stability and ocular surface status in cases of inflammatory or SS-related dry eye.