Optometric Physician



Vol. 26, #14 •   Monday, April 8, 2024


Off the Cuff: A Two-Way Street

Anyone who has spent time treating dry eye patients knows well that there is a deep psychological component to the condition. There have been numerous times at the end of an exam where I felt like I had just provided a counseling session rather than a dry eye evaluation. This should not come as a surprise given the fact that there is a well-established association between mental health conditions, such as anxiety and depression, and dry eye. However, I am often astounded by the depth of this connection. We are all aware of the negative impact that dry eye can have on a person’s quality of life such as difficulty wearing makeup or contact lenses, struggles with driving, diminished capacity to perform screen-related tasks at work, or the inability to enjoy hobbies such as reading, hiking, or knitting. I have encountered numerous patients who have been on the verge of quitting their jobs or barely leave their homes because their dry eye has become so disruptive. For some patients, the pain associated with their condition and the disruption it causes to their lives can even lead them to entertain thoughts of self-harm. In the face of all of these negative effects, it’s no wonder that dry eye patients would be depressed as a result.


However, the relationship between dry eye and depression is not unidirectional. Patients with dry eye do have a higher tendency towards depression, but depression itself may also lead to dry eye. There are several reasons for this ranging from behavioral factors to psychosomatic changes. On the behavioral side, patients suffering from depression tend to experience sleep disturbances and display increased screentime relative to the average population, which can predispose patients to dry eye issues. Additionally, there are numerous physiological and psychological factors at play as well. Patients suffering from chronic depression and anxiety may experience decreased tear production owing to changes in parasympathetic and sympathetic nervous system activity. Also, the neurological pathways responsible for processing pain, including ocular surface pain, are tied to the limbic system which is involved in controlling our emotional responses. This may explain the strong emotional component of depression and chronic dry eye as there can be shared and overlapping neural pathways.

I have seen this connection manifest clinically countless times. Just recently a couple of long-time dry eye patients who had experienced plateaus in improvement turned a corner towards the better seemingly overnight. They had one shared commonality—they had each started taking an antidepressant. Ironically, on paper, these antidepressants could induce or worsen dry eye, so this serves as a reminder that dry eye is often more than what is just occurring at the ocular surface. Cases like these highlight the magnificently complex interconnected system that exists between the ocular surface and the brain that not only involves the physical, but also the emotional and psychological. This relationship is important to keep in mind when we are caring for our dry eye patients who are struggling with the psychological components of the disease, because more often than not, it is a two-way street.

Cory J. Lappin, OD, MS, FAAO
Contributing Editor


Want to share your perspective?
Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.



Is There a Relationship Between the Severity of Disease in Major Depressive Disorder Patients and Dry Eye Disease?

These researchers investigated dry eye disease (DED) in newly diagnosed patients with major depressive disorder (MDD). This observational study included 48 MDD patients in Group 1 and 20 healthy controls in Group 2. Psychiatric and ophthalmic examinations, Beck Depression Inventory (BDI), Ocular Surface Disease Index (OSDI), Schirmer's test, tear breakup time (TBUT), Meibomian gland dysfunction (MGD), and ocular staining were conducted. The results were statistically compared.

The participants, comprising 32 men and 36 women, had a mean age of 31.08 ± 11.7 years (18-64 years). Group 1 had a mean BDI score of 30.87 ± 8.56, while Group 2 had a score of 1.3 ± 1.3 (p < 0.001). In Group 1, 28 patients were diagnosed with DED, whereas in Group 2, six subjects were diagnosed with DED. The mean Schirmer's results in Group 1 and Group 2 were (mm/5 minutes) 10.87 ± 2.44 and 12.70 ± 2.3, respectively, and were significantly lower in Group 1 (p<0.001). The mean OSDI scores in Group 1 (34.95 ± 15.8) were significantly higher compared to Group 2 (3.2 ± 3.1) (p<0.001). There was no significant difference in mean TBUT between Group 1 (9.41 ± 2.6 s) and Group 2 (9.8 ± 0.61 s) (p>0.05). Significant correlations were found between BDI scores and Schirmer's results as well as OSDI scores (p<0.05, p=0.02, respectively). No statistically significant correlations were found between BDI scores and TBUT or MGD (p>0.05).

DED was found to be more prevalent in the MDD group. The severity of MDD and DED, as indicated by BDI, OSDI, and Schirmer's results, was found to be correlated. It was observed that patients with higher depression scores had more severe dry eye. As a result, we recommend performing ophthalmic examinations in newly diagnosed MDD patients.

SOURCE: Gizem Doğan Gökçe, Merve Metin. Is there a relationship between the severity of disease in major depressive disorder patients and dry eye disease? Int Ophthalmol. 2024 Mar 29;44(1):163.



The Impact of Demodex Blepharitis on Patient Symptoms and Daily Life

Patients with Demodex blepharitis have a considerable symptomatic burden that negatively impacts their daily activities and well-being. Despite chronic manifestations of and problems associated with blepharitis that results in multiple visits to eye care providers, Demodex blepharitis remains underdiagnosed or misdiagnosed. This study aimed to evaluate the effect of Demodex blepharitis on patients' daily activities and well-being. This prospective, multicenter, observational study recruited 524 patients with Demodex blepharitis from 20 U.S. ophthalmology and optometry practices. Demodex blepharitis was diagnosed based on the presence of the following clinical manifestations in at least one eye: >10 collarettes on the upper lashes, at least mild lid margin erythema of the upper eyelid, and mite density of ≥1.0 mite/lash (upper and lower combined). Patients were asked to complete a questionnaire related to their symptoms, daily activities, and management approache

The proportion of patients who experienced blepharitis symptoms for ≥2 years was 67.8%, and for ≥4 years, it was 46.5%. The three most bothersome symptoms ranked were "itchy eyes," "dry eyes," and "foreign body sensation." Overall, 77.4% of patients reported that Demodex blepharitis negatively affected their daily life. One-third (32.3%) of patients had visited a doctor for blepharitis at least two times, including 19.6% who visited at least four times. Despite having clinical manifestations of Demodex blepharitis confirmed by an eye care provider, 58.7% had never been diagnosed with blepharitis. Commonly used management approaches were artificial tears, warm compresses, and lid wipes. Among those who discontinued their regimen, 45.9% had discontinued because of either tolerability issues or lack of effectiveness. Among contact lens wearers, 64.3% of the patients either were uncomfortable wearing contact lenses or experienced vision changes "sometimes" or "frequently."

Demodex blepharitis results in a significant negative impact on daily activities, creating a psychosocial and symptomatic burden on patients.

SOURCE: Melissa Barnett, Blake Simmons, Patrick Vollmer , et al. The impact of Demodex blepharitis on patient symptoms and daily life. Optom Vis Sci. 2024 Mar 1;101(3):151-156.

Eye Morphometry, Body Size, and Flexibility Parameters in Myopic Adolescents

The aim of this study was to investigate the anatomical and physiological ocular parameters in adolescents with myopia and to examine the relations between refractive error (SER), ocular biometry, body size and flexibility parameters in myopic adolescents. A cross-sectional study of 184 myopic adolescents, aged 15 to 19 years was conducted. Refractive error and corneal curvature measures of the eye were evaluated using an autorefractor under cycloplegia. Central corneal thickness was determined by contact pachymetry. The ocular axial length, anterior and vitreous chamber depth, and lens thickness were measured using A-scan biometry ultrasonography. Height and body weight were measured according to a standardized protocol. Body mass index (BMI) was subsequently calculated. Beighton scale was used to measure joint flexibility.

Body stature was positively correlated with ocular axial length (r=0.39, p<0.001) and vitreous chamber depth (r=0.37, p<0.001). There was a negative correlation between height and SER (r=- 0.46; p<0.001). Beighton score and body weight had weak positive correlations with axial length and vitreous chamber depth, and a weak negative correlation with SER. A significantly more negative SER was observed in the increased joint mobility group (p<0.05; U=5065.5) as compared to normal joint mobility group: mean - 4.37 ± 1.85 D (median - 4.25; IQR - 6.25 to - 3.25 D) and mean - 3.72 ± 1.66 D (median - 3.50; IQR - 4.75 to - 2.25 D) respectively.

There was a strong association between height and axial length, as well as SER. Higher degree of myopia significantly correlated with greater Beighton score (increased joint mobility).

SOURCE: Kristina Kuoliene, Egle Danieliene, Janina Tutkuviene. Eye morphometry, body size, and flexibility parameters in myopic adolescents. Sci Rep. 2024 Mar 21;14(1):6787.




Industry News

Haag-Streit Launches Eyesi Indirect Ophthalmoscope ROP Simulator for Retinal Exams on Preterm Infants

Haag-Streit launched the Eyesi Indirect Ophthalmoscope ROP Simulator for training of retinal exams on premature babies and classification of retinopathy of prematurity. The mixed-reality simulator offers an immersive training environment for proper device handling, with an embedded didactically structured simulator curriculum to teach the diagnostic skills required for correct ROP classification. Read more.

Eyedetec Offers Opportunity to Change Future of Dry Eye Therapy

Eyedetec Medical, developer of the Eye Lipid Mobilizer ELM, a therapy device designed to address the root cause of chronic dry eye diseases, says it is set to revolutionize the global dry eye treatment landscape. They would like to invite all those interested in the significant problem chronic dry eye disease (DED) poses for countless people around the world to participate in their journey.
Chronic dry eye disease affects approximately 1.4 billion people worldwide, with 44 million cases reported in the US. With the market growing at a CAGR of 9.2% and an estimated value of $158 billion globally, the need for an effective solution is more pressing than ever, the company says. Eyedetec's ELM addresses the root cause of DED.

Dr. Barry Linder, physician and inventor of the ELM device, states, "Chronic Dry Eye is surging in correlation to the global increase in screen use, and at Eyedetec our mission is to change the future of Dry Eye Therapy. With ELM, we're not just treating symptoms, we're addressing the root cause of the disease with an affordable therapy. The device is specifically designed for both office and home use, making it an accessible and economical solution for everyone."

The company cites the following reasons to invest in Eyedetec:
• Advance the treatment of a disease affecting over a billion people globally
• Contribute to a market projected to grow at a CAGR of 9.2%
• Support an innovation designed for both clinical and home use
• Join the fight against a chronic disease with a solution that addresses its root cause

The company is inviting the public to invest in the company and be part of what the company describes as a “game-changing solution that can bring relief to millions of chronic dry eye sufferers worldwide.” As a trusted innovator in the field, Eyedetec continues to advance the treatment of chronic dry eye disease and invites eyecare providers to join them on this journey. Eyedetec is currently raising capital on the StartEngine equity crowdfunding platform in the US. Opportunities for investments both large and modest are available here.


• BostonSight is expanding its FitAcademy™ educational events to include programs for practicing eye care doctors. Read more.

• Qlaris Bio announced the initiation and dosing of two separate US Phase II masked, randomized clinical trials investigating QLS‑111 in patients with ocular hypertension and glaucoma. Read more.

• ViaLase, a clinical-stage medical technology company focused on addressing unmet needs in the conventional glaucoma treatment paradigm, closed a Series C financing raising gross proceeds of approximately $40 million. Proceeds will advanceme clinical, regulatory, and commercial milestones of the company's ViaLase® Laser. Read more.





Journal Reviews Editor:
Shannon L. Steinhäuser, OD, MS, FAAO

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