Tear Film Aberration Dynamics and Vision-Related Quality of Life in Patients with Dry Eye Disease

doi:10.1016/j.ophtha.2012.03.004

Ophthalmology

Volume 119, Issue 9, September 2012, Pages 1811-1818

https://doi.org/10.1016/j.ophtha.2012.03.004 Get rights and content

Objective

Corneal and ocular wavefront aberrations were recorded together with clinical examination results and patient-reported vision-related quality-of-life evaluation results to define the relevance of dynamic optical analysis of the eye in dry eye disease (DED).

Design

Prospective and comparative clinical study.

Participants

Forty DED patients and 40 age- and gender-matched control subjects.

Methods

Serial measurements of ocular and corneal higher-order aberrations (HOAs) after blink were performed for 10 seconds using the KR-1 aberrometer (Topcon, Clichy, France). Vision-related health-targeted quality of life was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. The clinical examination included tear film assessment (tear film break-up time and Schirmer I test), ocular surface damage assessment with the Oxford and van Bijsterveld indexes, and Meibomian dysfunction grading. Tear osmolarity also was measured.

Main Outcome Measures

The time course of HOAs and modulation transfer function (MTF) was compared between groups and was analyzed in comparison with the OSDI and clinical data in DED patients.

Results

The root mean square of ocular and corneal total HOAs, particularly third-order aberrations, significantly increased over the 10-second period in DED patients, whereas no change occurred in controls. Analysis of MTF revealed progressive degradation of ocular optical quality resulting from loss of contrast at intermediate and high spatial frequencies in DED patients compared with controls. The progression index for corneal HOAs was correlated with the subjective index of patient-reported visual outcomes and with objective clinical findings of tear film and ocular surface damage.

Conclusions

Objective measurement of the time course of HOAs may constitute a new single instrument to evaluate and manage patients with DED because it reliably reflects the completeness of the disease.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Methods

The study was conducted in the Clinical Investigation Centre for Ocular Surface Pathology (Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, INSERM-DHOS CIC 503, Paris, France) in accordance with the Declaration of Helsinki, Scotland amendment, 2000. Ethics committee approval was obtained from the Comité de Protection des Personnes (Ile de France V, agreement number 10793), and all patients gave informed consent.

Patient Features and Vision-Related Quality of Life

The profile, clinical features, tear osmolarity, and OSDI scores of each group are detailed and compared in Table 1. A significant difference in the OSDI overall score as well as in OSDI subscores was found between DED patients and controls.

Comparative Analysis of Aberration Dynamics Between Groups

The time course of corneal HOAs is detailed for each group in Figure 1A, B. In dry eye patients, there was a significant variation in total corneal HOAs (P<0.01, repeated-measures analysis of variance), third-order coma (P<0.01), and third-order trefoil (P

Discussion

Approximately 5 million Americans 50 years and older are estimated to have dry eye.¹ Dry eye disease refers to a multifactorial disease that can present in various ways; it recently was defined as the association of “symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface.”⁸ All DED patients have in common pathologic tear film instability that impacts visual performance, adversely affecting activities of daily living. A consensus needs

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: Manuscript no. 2011-1424.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Original articleTear Film Aberration Dynamics and Vision-Related Quality of Life in Patients with Dry Eye Disease

Objective

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Methods

Patient Features and Vision-Related Quality of Life

Comparative Analysis of Aberration Dynamics Between Groups

Discussion

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Ocul Surf

Ophthalmology

Am J Ophthalmol

Cont Lens Anterior Eye

Clin Exp Optom

Ophthalmology

The epidemiology of dry eye disease: report of the Epidemiology Subcommittee of the International Dry Eye Workshop (2007)

Ocul Surf

Reliability and validity of the Ocular Surface Disease Index

Arch Ophthalmol

The relationship between habitual patient-reported symptoms and clinical signs among patients with dry eye of varying severity

Invest Ophthalmol Vis Sci

The importance of the precorneal tear film for the quality of optical imaging

Br J Ophthalmol

The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (2007)

Ocul Surf

Serial measurements of higher-order aberrations after blinking in normal subjects

Invest Opthalmol Vis Sci

Postblink changes in the ocular modulation transfer function measured by a double-pass method

Invest Ophthalmol Vis Sci

Optical and visual impact of tear break-up in human eyes

Invest Ophthalmol Vis Sci

Use of retroillumination to visualize optical aberrations caused by tear film break-up

Optom Vis Sci

Dynamics changes in the air-tear film interface modulation transfer function

Graefes Arch Clin Exp Ophthalmol

Corneal wave aberration from videokeratography: accuracy and limitations of the procedure

J Opt Soc Am A Opt Image Sci Vis

Meibomian gland disease: classification and grading of lid changes

Eye (Lond)

Original article
Tear Film Aberration Dynamics and Vision-Related Quality of Life in Patients with Dry Eye Disease