Publications by authors named "Allison L McClellan"

14 Publications

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The Association of Dry Eye Symptom Severity and Comorbid Insomnia in US Veterans.

Authors:
Anat Galor Benjamin E Seiden Jasmine J Park William J Feuer Allison L McClellan Elizabeth R Felix Roy C Levitt Constantine D Sarantopoulos Douglas M Wallace

Eye Contact Lens 2018 Sep;44 Suppl 1:S118-S124

Research Services (A.G., B.E.S., J.J.P., A.L.M., E.R.F., R.C.L., C.S., D.M.W.), Miami Veterans Administration Medical Center, Miami, FL; Department of Ophthalmology (A.G., W.F.), Bascom Palmer Eye Institute, University of Miami, Miami, FL; Department of Physical Medicine and Rehabilitation (E.R.F.), University of Miami Miller School of Medicine, Miami, FL; Department of Anesthesiology (R.C.L., C.S.), Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Miami, FL; John P. Hussman Institute for Human Genomics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; John T Macdonald Foundation Department of Human Genetics (R.C.L.), University of Miami Miller School of Medicine, Miami, FL; and Department of Neurology (D.M.W.), University of Miami Miller School of Medicine, Miami, FL.

Purpose: To investigate the association between dry eye (DE) and insomnia symptom severity.

Methods: Cross-sectional study of 187 individuals seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding insomnia (insomnia severity index [ISI]) and DE symptoms, including ocular pain, followed by a comprehensive ocular surface examination. Using a two-step cluster analysis based on intensity ratings of ocular pain, the patient population was divided into two groups (high and low ocular pain groups: HOP and LOP). A control group was ascertained at the same time from the same clinic as defined by no symptoms of DE (Dry Eye Questionnaire 5 [DEQ5], <6). The main outcome measure was the frequency of moderate or greater insomnia in the DE groups.

Results: The mean age of the study sample was 63 years, and 93% were male. All insomnia complaints were rated higher in the HOP group compared with the LOP and control groups (P<0.0005). Most (61%) individuals in the HOP group experienced insomnia of at least moderate severity (ISI≥15) compared with the LOP (41%) and control groups (18%) (P<0.0005). Black race (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.2-6.0; P=0.02), depression severity (OR, 1.2; 95% CI, 1.1-1.3; P<0.0005), and DE symptom severity (DEQ5; OR, 1.1; 95% CI, 1.01-1.2; P=0.03) were significantly associated with clinical insomnia (ISI≥15) after controlling for potential confounders.

Conclusions: After adjusting for demographics and medical comorbidities, we show that DE symptom severity is positively associated with insomnia severity.
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http://dx.doi.org/10.1097/ICL.0000000000000349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500440PMC
September 2018

Evidence of central sensitisation in those with dry eye symptoms and neuropathic-like ocular pain complaints: incomplete response to topical anaesthesia and generalised heightened sensitivity to evoked pain.

Authors:
Ashley M Crane William Feuer Elizabeth R Felix Roy C Levitt Allison L McClellan Konstantinos D Sarantopoulos Anat Galor

Br J Ophthalmol 2017 09 18;101(9):1238-1243. Epub 2017 Jan 18.

Miami Veterans Administration Medical Center, Miami, Florida, USA.

Objective: To evaluate how closely neuropathic-like ocular pain (NOP) symptoms align with a metric of central sensitisation (ie, the presence of persistent ocular pain after topical anaesthetic placement) in individuals with dry eye (DE) symptoms.

Design: Cross-sectional study of 224 individuals with DE symptoms seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding DE symptoms, NOP descriptors and evoked pain sensitivity testing on the forehead and forearm, followed by a comprehensive ocular surface examination including corneal mechanical sensitivity testing. Subsequent analyses were performed to examine for differences between those with and without ocular pain after topical anaesthetic placement.

Results: The mean age was 62 years with 91% being men. DE symptoms and NOP symptoms were higher in subjects with persistent ocular pain after anaesthesia. Most DE signs were not related to persistent pain, with the exception of meibum quality. Individuals with persistent ocular pain also demonstrated greater sensitivity to evoked pain at testing sites on the forehead and forearm. When examining receiver operator characteristic curves considering persistent pain as a gold standard for central sensitisation within the corneal pathway, intensity of ocular pain ratings, Ocular Surface Disease Index scores and sensitivity to light provided the most robust relationships, each with an area under the curve of 0.72.

Conclusions: Individuals with DE symptoms and persistent ocular pain after topical proparacaine (a marker of central sensitisation to pain) more frequently report NOP-like symptoms and demonstrate increased sensitivity to evoked pain.
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http://dx.doi.org/10.1136/bjophthalmol-2016-309658DOI Listing
September 2017

Bulbar conjunctival microvascular responses in dry eye.

Authors:
Wan Chen Hatim Ismail M Batawi Jimmy R Alava Anat Galor Jin Yuan Constantine D Sarantopoulos Allison L McClellan William J Feuer Roy C Levitt Jianhua Wang

Ocul Surf 2017 04 29;15(2):193-201. Epub 2016 Dec 29.

University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, FL, USA.

Purpose: Conjunctival microvascular responses may be a surrogate metric of efferent neural pathway function innervating the ocular surface as changes in blood flow occur within seconds after a stimulus. As somatosensory dysfunction may partially underlie dry eye (DE), in this study we evaluate whether bulbar conjunctival microvascular alterations correlate with various aspects of DE.

Methods: Fifty-six DE patients were prospectively recruited from a Veterans Affairs ophthalmology clinic over an 11-month period. DE symptoms and ocular pain were assessed along with DE signs. A novel functional slit lamp biomicroscope (FSLB) was used to image the temporal bulbar conjunctiva from the right eye before and after central corneal stimulation with an air puff. Blood flow velocities were measured and noninvasive microvascular perfusion maps (nMPMs) were created.

Results: The bulbar blood flow velocity was 0.50 ± 0.15 mm/s at baseline and increased to 0.55 ± 0.17 mm/s after stimulation (P < 0.001); the average change in velocity was 0.05 ± 0.09. nMPMs values and venule diameter, on the other hand, did not significantly increase after stimulation (1.64 ± 0.004 at baseline, 1.65 ± 0.04 after stimulation, P = 0.22 and 22.13 ± 1.84 μm at baseline, 22.21 ± 2.04 μm after stimulation, P = 0.73, respectively). Baseline blood flow velocity positively associated with Schirmer scores (r = 0.40, P = 0.002). Those with higher self-rated wind hyperalgesia demonstrated less change in blood flow velocity (r = -0.268, P = 0.046) after air stimulation on the central cornea.

Conclusion: Conjunctival blood flow velocity, but not vessel diameter or complexity, increases after wind stimuli. Baseline flow positively correlated with Schirmer scores while change in flow negatively correlated with self-reported wind hyperalgesia.
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http://dx.doi.org/10.1016/j.jtos.2016.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5386830PMC
April 2017

Longitudinal Examination of Frequency of and Risk Factors for Severe Dry Eye Symptoms in US Veterans.

Authors:
Erin S Ong Yousef A Alghamdi Roy C Levitt Allison L McClellan Gail Lewis Constantine D Sarantopoulos Elizabeth R Felix Anat Galor

JAMA Ophthalmol 2017 02 22;135(2):116-123. Epub 2016 Dec 22.

Ophthalmology Department, Bruce W. Carter Department of Veteran Affairs, Miami Veterans Administration Medical Center, Miami, Florida2Bascom Palmer Eye Institute, University of Miami, Miami, Florida.

Importance: Dry eye syndrome is a common condition that affects millions of individuals. Many cross-sectional studies have evaluated risk factors for dry eye severity, but few have assessed risk factors or symptom progression over time.

Objectives: To assess symptom progression in dry eye syndrome and determine risk factors associated with severe symptoms at 1 year.

Design, Setting, And Participants: A longitudinal study was conducted from October 1, 2013, to April 30, 2015, among patients at the Miami Veterans Affairs Hospital with a wide variety of dry eye symptoms and signs (ranging from none to severe).

Main Outcomes And Measures: Change in dry eye symptom severity during 1 year, as assessed by responses to dry eye symptom questionnaires administered at the initial visit and 1 year later, as well as baseline risk factor analysis for severe dry eye symptoms at 1 year, defined as a Dry Eye Questionnaire 5 score of 12 or more.

Results: Of the 120 patients (mean [SD] age, 64 [11] years; 109 male and 11 female), 26 of 58 (44.8%) with either no symptoms or mild or moderate symptoms at baseline progressed to more severe symptoms at 1 year, while 46 of 62 patients (74.2%) with severe symptoms at baseline reported that severe symptoms persisted at 1 year. Baseline ocular risk factors for severe dry eye symptoms at 1 year included more severe dry eye symptoms, ocular pain, and neuropathic pain-like ocular symptoms. Nonocular risk factors included sleep disturbances (eg, sleep apnea and insomnia), mental health status (eg, posttraumatic stress disorder and depression), nonocular pain, and medications (eg, anxiolytics and analgesics). In a multivariable analysis, the most significant risk factors were sleep apnea (odds ratio [OR], 3.80; 95% CI, 1.00-14.49; P = .05), Dry Eye Questionnaire 5 score (OR, 1.15; 95% CI, 1.02-1.30; P = .02), and posttraumatic stress disorder score (OR, 1.04; 95% CI, 1.01-1.08; P = .02).

Conclusions And Relevance: Patients with severe dry eye symptoms and ocular pain at baseline were more likely to have persistent severe dry eye symptoms on 1-year follow-up. Furthermore, nonocular risk factors that have been associated with dry eye cross-sectionally, such as psychiatric comorbidities and nonocular pain, were also associated with severe dry eye symptoms at 1 year. Although this cohort was limited to US veterans, which may not be generalizable to other populations, our results suggest that pain perception and severity are important when evaluating and managing dry eye.
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http://dx.doi.org/10.1001/jamaophthalmol.2016.4925DOI Listing
February 2017

ω-3 Tear Film Lipids Correlate With Clinical Measures of Dry Eye.

Authors:
Scott D Walter Karsten Gronert Allison L McClellan Roy C Levitt Konstantinos D Sarantopoulos Anat Galor

Invest Ophthalmol Vis Sci 2016 05;57(6):2472-8

Bascom Palmer Eye Institute, Department of Opthamology, University of Miami, Miami, Florida, United States 3Department of Surgical Services, Miami Veterans Administration Medical Center, Miami, Florida, United States.

Purpose: ω-3 and ω-6 polyunsaturated fatty acids modulate inflammatory processes throughout the body through distinct classes of lipid mediators that possess both proinflammatory and proresolving properties. The purpose of this cross-sectional study was to explore the relationship between lipid profiles in human tears and dry eye (DE) symptoms and signs.

Methods: Forty-one patients with normal eyelid and corneal anatomy were prospectively recruited from a Veterans Administration Hospital over 18 months. Symptoms and signs of DE were assessed, and tear samples was analyzed by mass spectrometry-based lipidomics. Statistical analyses comparing the relationship between tear film lipids and DE included Pearson/Spearman correlations and t-tests.

Results: Arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) were present in more than 90% of tear film samples. The ratio of ω-6 (AA) to ω-3 (DHA+EPA) fatty acids was correlated with multiple measures of tear film dysfunction (tear breakup time, Schirmer 2 scores, and corneal staining; all P < 0.05). Arachidonic acid-derived prostaglandin E2 was detected in the majority of samples and correlated with low tear osmolarity, meibomian gland plugging, and corneal staining.

Conclusions: Both ω-3 and ω-6 lipid circuits are activated in the human tear film. The ratio of ω-6:ω-3 tear lipids is elevated in DE patients in proportion to the degree of tear film dysfunction and corneal staining. Metabolic deficiency of ω-3 tear film lipids may be a driver of chronic ocular surface inflammation in DE.
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http://dx.doi.org/10.1167/iovs.16-19131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4857833PMC
May 2016

Patients with more severe symptoms of neuropathic ocular pain report more frequent and severe chronic overlapping pain conditions and psychiatric disease.

Authors:
Ashley M Crane Roy C Levitt Elizabeth R Felix Konstantinos D Sarantopoulos Allison L McClellan Anat Galor

Br J Ophthalmol 2017 02 29;101(2):227-231. Epub 2016 Apr 29.

Miami Veterans Administration Medical Center, Miami, Florida, USA.

Objective: To study chronic pain and mental health profiles in patients with dry eye (DE) symptoms, comparing those with high and low levels of neuropathic ocular pain (NOP) complaints.

Design: Cross-sectional study of 181 patients with DE symptoms (dry eye questionnaire score ≥6) seen in the Miami Veterans Affairs eye clinic. An evaluation was performed consisting of questionnaires regarding DE symptoms, NOP complaints (burning, sensitivity to wind, light and cold/hot temperatures) and pain elsewhere in the body (non-ocular). This was followed by a comprehensive ocular surface examination. The patients' comorbidities, medications, mental health (depression and post-traumatic stress disorder) and quality-of-life indices were also obtained. Patients were classified using cluster analysis into either the 'high NOP' or 'low NOP' group. Subsequent analyses were performed to examine differences in ocular and non-ocular parameters between these two groups.

Results: Despite similar ocular surface findings, patients in the high NOP group had very different systemic (non-ocular) profiles with higher overall pain intensity ratings, higher frequency of comorbid chronic centralised pain conditions, lower quality-of-life indices and more abnormal mental health scores than those in the low NOP group.

Conclusions: Consistent with a chronic overlapping pain condition, patients with DE disease with more severe NOP symptoms report more frequent and severe non-ocular functional comorbid pain disorders.
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http://dx.doi.org/10.1136/bjophthalmol-2015-308214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5575758PMC
February 2017

Epidemiology of Meibomian Gland Dysfunction in an Elderly Population.

Authors:
Yousef A Alghamdi Carolina Mercado Allison L McClellan Hatim Batawi Carol L Karp Anat Galor

Cornea 2016 Jun;35(6):731-5

*Ophthalmology Department, Miami Veterans Administration Medical Center, Miami, FL; and †Bascom Palmer Eye Institute, University of Miami, Miami, FL.

Purpose: To study the epidemiology of meibomian gland (MG) dysfunction in an elderly, predominantly male population.

Methods: Prospective study of 233 subjects seen in the Miami Veterans Affairs eye clinic. Patients underwent a complete ocular surface examination, including dry eye questionnaires and tear assessments (osmolarity, tear breakup time, corneal staining, Schirmer test). The main outcome measures were correlations between MG parameters and demographics, dry eye symptoms, and tear parameters. The studied MG parameters were eyelid vascularity and meibum quality; a score ≥2 for either parameter was considered abnormal.

Results: Mean age of the 233 subjects was 63 years (SD = 11); 91% were male and 59% had at least 1 abnormal MG parameter (abnormal quality 55%; vascularity 17%). Demographically, patients with abnormal MG parameters were significantly older than their counterparts without these findings. Whites were more likely to have abnormal eyelid vascularity compared with blacks [n = 36 (31%) vs. n = 1 (1%), P < 0.0005] but no differences were noted between races with respect to meibum quality. Abnormal meibum quality, but not abnormal vascularity, was significantly associated with more severe dry eye symptoms. Similarly, abnormal meibum quality, but not eyelid vascularity, was significantly associated with worse dry eye signs, including decreased tear breakup time and increased corneal staining (P < 0.05 for all).

Conclusions: MG dysfunction is a frequent finding in an elderly, predominantly male population with racial differences noted in the frequency of abnormal eyelid vascularity but not in MG quality. Abnormal meibum quality was significantly associated with more severe dry eye symptoms and signs.
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http://dx.doi.org/10.1097/ICO.0000000000000815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860128PMC
June 2016

Impact of Eyelid Laxity on Symptoms and Signs of Dry Eye Disease.

Authors:
Priyanka Chhadva Allison L McClellan Chrisfouad R Alabiad William J Feuer Hatim Batawi Anat Galor

Cornea 2016 Apr;35(4):531-5

*University of Miami Miller School of Medicine, Miami, FL; †Bascom Palmer Eye Institute, University of Miami, Miami, FL; and ‡Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL.

Purpose: To study the relationship between eyelid laxity and ocular symptoms and signs of dry eye (DE).

Methods: A total of 138 patients with normal external anatomy were prospectively recruited from a Veterans Administration hospital. Symptoms (via the Dry Eye Questionnaire 5 and Ocular Surface Disease Index) and signs of DE were assessed along with presence or absence of eyelid laxity.

Results: It was observed that 71% of participants (n = 98) had clinical evidence of eyelid laxity (upper and/or lower) compared with 29% (n = 40) with no eyelid laxity. Individuals with eyelid laxity were older (67 ± 10 vs. 55 ± 8 years without laxity, P < 0.005) and more frequently male (76% of males had laxity vs. 18% females, P < 0.005). Patients with eyelid laxity had increased symptoms and signs of DE compared with their counterparts without laxity including ocular pain described as grittiness (63% vs. 45%, P = 0.049), decreased tear break-up time (8.6 ± 3 vs. 10.3 ± 4 seconds, P = 0.02), increased corneal staining (2.5 ± 3 vs. 1 ± 2, P = 0.002), decreased Schirmer score (14±6 vs. 17±7 mm, P = 0.01), increased meibomian gland drop out (2 ± 1 vs. 0.8 ± 0.8, P < 0.005), increased eyelid vascularity (0.8 ± 0.8 vs. 0.2 ± 0.5, P < 0.005), and more abnormal meibum quality (2 ± 1.3 vs. 1.4 ± 1.2, P = 0.02). In a multivariable analysis considering both signs of DE and laxity, lower eyelid laxity remained significantly associated with ocular surface disease index scores, suggesting a direct effect of laxity on symptoms of DE.

Conclusions: The presence of eyelid laxity associates with abnormal tear parameters compared with the absence of eyelid laxity. Based on these data, it is important for clinicians to test for eyelid laxity in patients with symptoms and/or signs of DE.
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http://dx.doi.org/10.1097/ICO.0000000000000786DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4779719PMC
April 2016

Corneal Mechanical Thresholds Negatively Associate With Dry Eye and Ocular Pain Symptoms.

Authors:
Oriel Spierer Elizabeth R Felix Allison L McClellan Jean Marie Parel Alex Gonzalez William J Feuer Constantine D Sarantopoulos Roy C Levitt Klaus Ehrmann Anat Galor

Invest Ophthalmol Vis Sci 2016 Feb;57(2):617-25

Anne Bates Leach Eye Hospital, Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, United States 2Miami Veterans Administration Medical Center, Miami, Florida, United States.

Purpose: To examine associations between corneal mechanical thresholds and metrics of dry eye.

Methods: This was a cross-sectional study of individuals seen in the Miami Veterans Affairs eye clinic. The evaluation consisted of questionnaires regarding dry eye symptoms and ocular pain, corneal mechanical detection and pain thresholds, and a comprehensive ocular surface examination. The main outcome measures were correlations between corneal thresholds and signs and symptoms of dry eye and ocular pain.

Results: A total of 129 subjects participated in the study (mean age 64 ± 10 years). Mechanical detection and pain thresholds on the cornea correlated with age (Spearman's ρ = 0.26, 0.23, respectively; both P < 0.05), implying decreased corneal sensitivity with age. Dry eye symptom severity scores and Neuropathic Pain Symptom Inventory (modified for the eye) scores negatively correlated with corneal detection and pain thresholds (range, r = -0.13 to -0.27, P < 0.05 for values between -0.18 and -0.27), suggesting increased corneal sensitivity in those with more severe ocular complaints. Ocular signs, on the other hand, correlated poorly and nonsignificantly with mechanical detection and pain thresholds on the cornea. A multivariable linear regression model found that both posttraumatic stress disorder (PTSD) score (β = 0.21, SE = 0.03) and corneal pain threshold (β = -0.03, SE = 0.01) were significantly associated with self-reported evoked eye pain (pain to wind, light, temperature) and explained approximately 32% of measurement variability (R = 0.57).

Conclusions: Mechanical detection and pain thresholds measured on the cornea are correlated with dry eye symptoms and ocular pain. This suggests hypersensitivity within the corneal somatosensory pathways in patients with greater dry eye and ocular pain complaints.
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http://dx.doi.org/10.1167/iovs.15-18133DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4771192PMC
February 2016

Dry Eye Profiles in Patients with a Positive Elevated Surface Matrix Metalloproteinase 9 Point-of-Care Test Versus Negative Patients.

Authors:
Nicole L Lanza Allison L McClellan Hatim Batawi Elizabeth R Felix Konstantinos D Sarantopoulos Roy C Levitt Anat Galor

Ocul Surf 2016 04 22;14(2):216-23. Epub 2016 Jan 22.

Miami Veterans Administration Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA. Electronic address:

Purpose: To compare dry eye (DE) symptoms and signs in subjects who tested positive versus those who tested negative for ocular surface matrix metalloproteinase 9 (MMP-9) using the InflammaDry point-of-care test (RPS, Sarasota, FL).

Methods: In this cross-sectional study, individuals seen in the Miami Veterans Affairs eye clinic with DE symptoms, as evidenced by DE questionnaire 5 (DEQ5) ≥6, were given standardized questionnaires to assess DE symptoms and ocular and non-ocular pain complaints. Also, a complete evaluation was conducted to measure ocular surface signs of DE. MMP-9 testing was performed using the InflammaDry once in each eye, per the manufacturer's instructions. The main outcome measure was a comparison of DE symptoms and signs in MMP-9 positive versus negative subjects.

Results: Of 128 subjects, 50 (39%) were positive for MMP-9 for InflammaDry testing in either eye. No statistically significant differences in mental health indices, DE symptoms, or ocular surface signs were seen in subjects based on MMP-9 status.

Conclusion: In our population, there was no difference in the DE profile by both symptoms and signs between those testing positive versus negative for MMP-9 on the ocular surface. This suggests that clinical exam alone cannot predict patients with clinically significant inflammation.
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http://dx.doi.org/10.1016/j.jtos.2015.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842325PMC
April 2016

Ocular Inflammation in the Setting of Concomitant Systemic Autoimmune Conditions in an Older Male Population.

Authors:
Alexandra E Levitt Katherine T McManus Allison L McClellan Janet L Davis Raquel Goldhardt Anat Galor

Cornea 2015 Jul;34(7):762-7

*Department of Ophthalmology, Miami Veteran Affairs Medical Center, Miami, FL; and †Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL.

Purpose: This retrospective cross-sectional study was designed to investigate the frequency and types of inflammatory ocular manifestations of specific systemic autoimmune diseases in a South Florida Veterans Affairs Hospital population.

Methods: Demographic and medical diagnosis information was extracted from the Veterans Administration database for 1225 patients. These patients were seen in Miami and Broward Veterans Affairs hospitals between April 18, 2008, and April 17, 2013, and were diagnosed with at least 1 of the following: systemic lupus erythematosus, sarcoid, rheumatoid arthritis, polymyalgia rheumatica, Takayasu arteritis, giant cell arteritis, Kawasaki disease, polyarteritis nodosa, Buerger disease, Henoch-Schonlein purpura, Behcet syndrome, granulomatosis with polyangiitis, other polyarteritis nodosa-associated vasculitides, or arteritis not otherwise specified.

Results: Of 1225 patients, 618 were seen in the VA eye clinic and 25 were diagnosed with concomitant inflammatory ocular conditions. Uveitis was the most common, and included 8 cases of anterior, 1 anterior-intermediate, 1 intermediate, 2 panuveitis, and 3 unspecified. Other manifestations included 7 cases of keratitis and 2 each of scleritis, episcleritis, and acute ischemic optic neuropathy. The overall frequency of inflammatory ocular disease was 2%. The diseases associated with the highest frequency of ocular involvement were granulomatosis with polyangiitis (1/8), sarcoid (9/198), giant cell arteritis (2/68), and rheumatoid arthritis (11/576). Of these 25 patients, 9 were diagnosed with eye disease before systemic disease.

Conclusions: In this population, ocular manifestations were rarely the presenting feature of systemic disease, but autoimmune disorders are an important underlying cause of inflammatory eye disease that should be considered on first evaluation, even in this "nontraditional," predominantly male, autoimmune disease population.
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http://dx.doi.org/10.1097/ICO.0000000000000437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460602PMC
July 2015

The impact of conjunctivochalasis on dry eye symptoms and signs.

Authors:
Priyanka Chhadva Abigail Alexander Allison L McClellan Katherine T McManus Benjamin Seiden Anat Galor

Invest Ophthalmol Vis Sci 2015 May;56(5):2867-71

University of Miami Miller School of Medicine Miami, Florida, United States 2Bascom Palmer Eye Institute, University of Miami, Miami, Florida, United States 3Miami Veterans Administration Medical Center, Miami, Florida, United States.

Purpose: The purpose of this project was to study the relationship between conjunctivochalasis (Cch) and ocular signs and symptoms of dry eye.

Methods: Ninety-six patients with normal eyelid and corneal anatomy were prospectively recruited from a Veterans Administration hospital over 12 months. Symptoms (via the dry eye questionnaire 5 [DEQ5]) and signs of dry eye were assessed along with quality of life implications. Statistical analyses comparing the above metrics among the three groups included χ(2), analysis of variance, and linear regression tests.

Results: Participants were classified into three groups: nasal conjunctivochalasis (NCch; n = 31); nonnasal conjunctivochalasis (non-NCch; n = 41); and no conjunctivochalasis (no-Cch; n = 24). Patients with NCch had more dry eye symptoms than those with non-NCch (DEQ5: NCch = 13.8 ± 5.0, non-NCch = 10.2 ± 5.0, no-Cch = 11.6 ± 5.8; P = 0.014), and more ocular pain than those with Non-NCch and no-Cch (numerical rating scale [NRS]: NCch = 4.5 ± 3.0, non-NCch = 2.3 ± 2.8, no-Cch = 3.3 ± 2.6; P = 0.008). They also had worse dry eye signs compared to those with no-Cch measured by Schirmer score with anesthesia (NCch = 14.5 ± 6.9, non-NCch = 16.8 ± 8.2, no-Cch = 19.9 ± 6.4; P = 0.039); meibomian gland dropout (NCch 1.8 ± 0.9, non-NCch = 1.4 ± 1.0, no-Cch = 1.0 ± 1.0; P = 0.020); and eyelid vascularity (NCch = 0.84 ± 0.8, non-NCch = 0.74 ± 0.7, no-Cch = 0.33 ± 0.6; P = 0.019). Moreover, those with NCch more frequently reported that dry eye symptoms moderately to severely impacted their quality of life (NCch = 87%, non-NCch = 51%, no-Cch = 58%; P = 0.005).

Conclusions: The presence of NCch associates with dry eye symptoms, abnormal tear parameters, and impacts quality of life compared with non-NCch and no-Cch. Based on these data, it is important for clinicians to look for Cch in patients with symptoms of dry eye.
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http://dx.doi.org/10.1167/iovs.14-16337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419777PMC
May 2015

Human Tear Serotonin Levels Correlate with Symptoms and Signs of Dry Eye.

Authors:
Priyanka Chhadva Tinthu Lee Constantine D Sarantopoulos Abigail S Hackam Allison L McClellan Elizabeth R Felix Roy C Levitt Anat Galor

Ophthalmology 2015 Aug 14;122(8):1675-80. Epub 2015 May 14.

University of Miami Miller School of Medicine, Bascom Palmer Eye Institute, Miami, Florida; Miami Veterans Administration Medical Center, Miami, Florida. Electronic address:

Purpose: Serotonin, a neurotransmitter known to be involved in nociceptor sensitization, is present in human tears. The purpose of this study was to correlate tear serotonin levels, as a marker of nociceptor sensitization, to facets of dry eye (DE), including symptoms and signs.

Design: Cross-sectional study.

Participants: A total of 62 patients with normal eyelid and corneal anatomy were prospectively recruited from a Veterans Administration Ophthalmology Clinic over 11 months.

Methods: Dry eye symptoms (Ocular Surface Disease Index [OSDI]), signs (tear break-up time [TBUT], corneal staining, and Schirmer's score), and clinical descriptors of neuropathic ocular pain (NOP) (sensitivity to light or sensitivity to wind) were assessed. For tear analysis, each patient's tears were collected after instilling 50 μl of sterile saline to the lower cul-de-sac of each eye and using capillary action microcaps to collect the ocular wash. Tear serotonin levels were measured using enzyme-linked immunosorbent assay.

Main Outcome Measures: Correlations between tear serotonin concentrations and DE symptoms and signs.

Results: The mean age of the population was 61±14 years, and 84% (n = 52) of the patients were male. Serotonin concentrations negatively correlated with Schirmer's scores (r = -0.28; P = 0.02) but did not correlate with other DE parameters, such as OSDI scores, sensitivity to light or wind, TBUT, and staining. According to our hypothesis, we divided patients into groups based on both DE symptoms and aqueous tear production; serotonin concentrations were significantly higher in DE group 1 (OSDI ≥6 and Schirmer's <8) compared with both DE group 2 (OSDI ≥6 and Schirmer's ≥8) and controls (OSDI <6 and Schirmer's ≥8). Patients in DE group 2 more frequently reported sensitivity to light (64%) and wind (67%) compared with DE group 1 (40% and 60%, respectively) and controls (8% and 17%, respectively).

Conclusions: Patients with DE symptoms and aqueous tear deficiency had higher tear serotonin levels compared with those with DE symptoms but normal tear production and those without DE symptoms.
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http://dx.doi.org/10.1016/j.ophtha.2015.04.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516582PMC
August 2015

Epidemiology of Ocular Surface Squamous Neoplasia in a Veterans Affairs Population.

Authors:
Andrew J McClellan Allison L McClellan Candido F Pezon Carol L Karp William Feuer Anat Galor

Cornea 2013 Oct;32(10):1354-8

*Miami Veterans Affairs Medical Center, Miami, FL; and †Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL.

Purpose: To evaluate the epidemiology of ocular surface squamous neoplasia (OSSN) and its associated risk factors in a South Florida Veterans Affairs Hospital population.

Methods: Retrospective case-control study. Twenty-eight confirmed cases of OSSN from 24,179 veterans who received care at the Miami Veterans Affairs Healthcare System and affiliated satellite eye clinics between March 1, 2007, and March 1, 2012. Data extracted from the veterans administration database that comprised demographic information and medical diagnosis information [based on International Classification of Disease (ICD-9) codes]. The main outcome measures were the period prevalence of OSSN and identification of factors associated with the presence of disease.

Results: The period prevalence of OSSN in our population was 0.1%. The risk factors studied included UV-related dermatologic diseases (melanoma, squamous and basal cell cancer, and actinic keratosis), UV-related ocular conditions (pterygium), HIV seropositivity, human papilloma virus-related diseases, and tobacco use. The presence of skin malignancy (squamous cell carcinoma and/or basal cell carcinoma) and pterygium was found to be significantly associated with the presence of OSSN [odds ratio, 4.40; 95% confidence interval, 2.03-9.55; P < 0.0005 and odds ratio, 16.2; 95% confidence interval, 7.11-36.9; P < 0.0005, respectively].

Conclusions: The presence of neoplasias and ocular conditions related to sun exposure was the most important risk factor for the occurrence of OSSN in a South Florida Veterans Affairs Healthcare System population consistent with previous epidemiological reports worldwide.
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http://dx.doi.org/10.1097/ICO.0b013e31829e3c80DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864126PMC
October 2013