Publications by authors named "Anat Galor"

246 Publications

Tumor necrosis factor-alpha and interferon-gamma induce inflammasome-mediated corneal endothelial cell death.

Exp Eye Res 2021 Apr 10:108574. Epub 2021 Apr 10.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Purpose: Chronic corneal endothelial cell (CEC) loss results in corneal edema and vision loss in conditions such as pseudophakic bullous keratopathy (PBK), Fuchs' dystrophy, and corneal graft failure. Low CEC density has been associated with an elevation of intraocular pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α and interferon (INF)-γ. These cytokines are capable of triggering pyroptosis, a programmed cell death mechanism mediated by the inflammasome, prompting the activation of the pro-inflammatory cytokine interleukin (IL)-1β, the perpetuation of inflammation, and subsequent damage of corneal endothelial tissue. Therefore, the purpose of this study was to determine the deleterious contribution of the inflammasome and pyroptosis to CEC loss.

Methods: CECs from human donor corneas were treated ex vivo with TNF-α and IFN-γ for 48 h. Levels of caspase-1 and IL-1β were then assayed by ELISA, and the expression of caspase-1 and gasdermin-D (GSDM-D) were confirmed by immunofluorescence. Endothelial cell damage was analyzed by a lactate dehydrogenase (LDH) release assay, and oxidative stress was determined by measuring the levels of reactive oxygen species (ROS) in the culture media.

Results: Inflammasome activation and oxidative stress were elevated in CECs following exposure to TNF-α and IFN-γ, which resulted in cell death by pyroptosis as determined by LDH release which was inhibited by the caspase-1 inhibitor Ac-YVAD-cmk.

Conclusion: CEC death is induced by the pro-inflammatory cytokines TNF-α and IFN-γ, which contribute to inflammasome activation. Moreover, the inflammasome is a promising therapeutic target for the treatment of chronic CEC loss.
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http://dx.doi.org/10.1016/j.exer.2021.108574DOI Listing
April 2021

Classification criteria for tubulointerstitial nephritis with uveitis syndrome.

Am J Ophthalmol 2021 Apr 9. Epub 2021 Apr 9.

Members of the SUN Working Group are listed online at ajo.com.

Purpose: To determine classification criteria for tubulointerstitial nephritis with uveitis (TINU) DESIGN: Machine learning of cases with TINU and 8 other anterior uveitides.

Methods: Cases of anterior uveitides were collected in an informatics-designed preliminary database, and a final database was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the anterior uveitides. The resulting criteria were evaluated on the validation set.

Results: One thousand eighty-three cases of anterior uveitides, including 94 cases of TINU, were evaluated by machine learning. The overall accuracy for anterior uveitides was 97.5% in the training set and 96.7% in the validation set (95% confidence interval 92.4, 98.6). Key criteria for TINU included anterior chamber inflammation and evidence of tubulointerstitial nephritis with either 1) a positive renal biopsy or 2) evidence of nephritis (elevated serum creatinine and/or abnormal urine analysis) and an elevated urine β-2 microglobulin. The misclassification rates for TINU were 1.2% in the training set and 0% in the validation set, respectively.

Conclusions: The criteria for TINU had a low misclassification rate and appeared to perform well enough for use in clinical and translational research.
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http://dx.doi.org/10.1016/j.ajo.2021.03.041DOI Listing
April 2021

Classification criteria for cytomegalovirus anterior uveitis.

Am J Ophthalmol 2021 Apr 9. Epub 2021 Apr 9.

Members of the SUN Working Group are listed online at ajo.com.

Purpose: To determine classification criteria for cytomegalovirus (CMV) anterior uveitis DESIGN: : Machine learning of cases with CMV anterior uveitis and 8 other anterior uveitides.

Methods: Cases of anterior uveitides were collected in an informatics-designed preliminary database, and a final datafubase was constructed of cases achieving supermajority agreement on the diagnosis, using formal consensus techniques. Cases were split into a training set and a validation set. Machine learning using multinomial logistic regression was used on the training set to determine a parsimonious set of criteria that minimized the misclassification rate among the anterior uveitides. The resulting criteria were evaluated on the validation set.

Results: One thousand eighty-three of cases of anterior uveitides, including 89 cases of CMV anterior uveitis, were evaluated by machine learning. The overall accuracy for anterior uveitides was 97.5% in the training set and 96.7% in the validation set (95% confidence interval 92.4, 98.6). Key criteria for CMV anterior uveitis included unilateral anterior uveitis with a positive aqueous humor polymerase chain reaction assay for CMV. No clinical features reliably diagnosed CMV anterior uveitis. The misclassification rates for CMV anterior uveitis were 1.3 % in the training set and 0% in the validation set, respectively.

Conclusions: The criteria for CMV anterior uveitis had a low misclassification rate and appeared to perform sufficiently well for use in clinical and translational research.
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http://dx.doi.org/10.1016/j.ajo.2021.03.060DOI Listing
April 2021

Prevalence and risk factors for chalazion in an older veteran population.

Br J Ophthalmol 2021 Mar 31. Epub 2021 Mar 31.

Bascom Palmer Eye Institute, University of Miami Health System, Miami, Florida, USA

Background: Chalazia are common inflammatory eyelid lesions, but their epidemiology remains understudied. This retrospective case-control study examined the prevalence, risk factors and geographic distribution of chalazia in a large veteran population.

Methods: Data on all individuals seen at a Veterans Affairs (VA) clinic between October 2010 and October 2015 were extracted from the VA health database. Subjects were grouped based on International Classification of Diseases, Ninth Revision (ICD-9) code for chalazion. Univariable logistic regression modelling was used to identify clinical and demographic factors associated with chalazion presence, followed by multivariable modelling to examine which factors predicted risk concomitantly. All cases were mapped across the continental US using geographic information systems modelling to examine how prevalence rates varied geographically.

Results: Overall, 208 720 of 3 453 944 (6.04%) subjects were diagnosed with chalazion during the study period. Prevalence was highest in coastal regions. The mean age of the population was 69.32±13.9 years and most patients were male (93.47%), white (77.13%) and non-Hispanic (93.72%). Factors associated with chalazion risk included smoking (OR=1.12, p<0.0005), conditions of the tear film (blepharitis (OR=4.84, p<0.0005), conjunctivitis (OR=2.78, p<0.0005), dry eye (OR=3.0, p<0.0005)), conditions affecting periocular skin (eyelid dermatitis (OR=2.95, p<0.0005), rosacea (OR=2.50, p<0.0005)), allergic conditions (history of allergies (OR=1.56, p<0.0005)) and systemic disorders (gastritis (OR=1.54, p<0.0005), irritable bowel syndrome (OR=1.45, p<0.0005), depression (OR=1.35, p<0.0005), anxiety (OR=1.31, p<0.0005)). These factors remained associated with chalazion risk when examined concomitantly.

Conclusion: Periocular skin, eyelid margin and tear film abnormalities were most strongly associated with risk for chalazion. The impact of environmental conditions on risk for chalazion represents an area in need of further study.
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http://dx.doi.org/10.1136/bjophthalmol-2020-318420DOI Listing
March 2021

Can in vivo confocal microscopy differentiate between subtypes of dry eye disease? A review.

Clin Exp Ophthalmol 2021 Mar 26. Epub 2021 Mar 26.

Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, FL, USA.

Many studies utilized in vivo confocal microscopy (IVCM) to associate variations in corneal structures with dry eye disease (DED). However, DED is an umbrella term that covers various aetiologies and presentations. This review analyses populations by DED aetiology to determine relationships between IVCM parameters and specific DED subtypes. It focuses on the most commonly examined structures, sub-basal nerves and dendritic cells. Across the literature, most studies found individuals with immune-mediated DED had lower sub-basal nerve fibre number and density than controls, with smaller differences between non-immune DED and controls. However, wide ranges of values reported across studies demonstrate considerable overlap between DED subtypes and controls, rendering these metrics less helpful when diagnosing an individual patient. Dendritic cell density was considerably higher in individuals with immune-mediated DED than in non-immune DED or controls. As such, dendritic cell density may be a better indicator of DED associated with a systemic immune-mediated process.
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http://dx.doi.org/10.1111/ceo.13924DOI Listing
March 2021

Ocular manifestations and biomarkers of Gulf War Illness in US veterans.

Sci Rep 2021 Mar 22;11(1):6548. Epub 2021 Mar 22.

Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA.

Gulf War Illness (GWI) is a multisystem disease with variable presentations, making diagnosis difficult. Non-invasive biomarkers would aid in disease diagnosis. We hypothesized that the eye could serve as a biomarker for GWI. We performed a retrospective case-control study using a sample of 1246 patients seen during a 5-month period in an optometry clinic. We identified veterans who were active duty during the Gulf War Era and either had a questionnaire-based diagnosis of GWI (cases) or did not (controls). Medical records were reviewed for eye and medical co-morbidities, medication use, and retinal macular and nerve fiber layer (NFL) thicknesses based on optical coherence tomography (OCT) images. Compared to controls (n = 85), individuals with GWI (n = 60) had a higher frequency of dry eye symptoms (50% vs 32.9%, p = 0.039). Multivariable analysis revealed average retinal NFL thickness (odds ratio; OR = 0.95), cup-to-disc ratio (OR = 0.005), age (OR = 0.82), and PTSD (OR = 20.5) were predictors of a GWI diagnosis. We conclude that GWI is associated with dry eye symptoms and RNFL thinning may serve as a biomarker for disease.
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http://dx.doi.org/10.1038/s41598-021-86061-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985482PMC
March 2021

Exploring the Link Between Dry Eye and Migraine: From Eye to Brain.

Eye Brain 2021 4;13:41-57. Epub 2021 Mar 4.

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

Dry eye and migraine are common diseases with large societal and economic burdens that have recently been associated in the literature. This review outlines the link between dry eye and migraine, which may have implications for reducing their respective burdens. We highlight possible shared pathophysiology, including peripheral and central sensitization, as the potential link between dry eye and migraine. Finally, therapies targeting similar pathophysiological mechanisms between dry eye and migraine are discussed.
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http://dx.doi.org/10.2147/EB.S234073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939506PMC
March 2021

Impact of Ocular Surface Temperature on Tear Characteristics: Current Insights.

Clin Optom (Auckl) 2021 15;13:51-62. Epub 2021 Feb 15.

Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.

Infrared (IR) thermographic assessment of ocular surface temperature (OST) is gaining interest as an adjuvant method to evaluate the ocular surface. It is a quick, non-invasive test that causes minimal, if any, discomfort to patients. The purpose of this article was to summarize research on how OST relates to tear film parameters and dry eye disease (DED). PubMed, Google Scholar, and Scopus searches for specific terms were carried out and eligible articles reviewed. OST of the central cornea is ~34-35°C when measured as a single time-point (typically right after a blink). Dynamically, OST values decrease over time at a rate of ~ -0.01 °C/s in healthy eyes. Single time-point OST values are impacted by temperature, with positive correlations noted with both ambient (1°C↓ results in ~0.16°C↓ in OST) and body (1°C↑ results in ~0.98°C↑ in OST) temperature. Single time-point OST values are also impacted by tear parameters, with negative correlations noted with tear break-up time (TBUT; r=-0.61) and positive correlations with lipid layer thickness (~r=0.50). Dynamically, the rate of OST cooling over the interblink period correlates with various tear parameters including Schirmer's test scores (r=-0.39), tear meniscus height (r=-0.52) and the rate of tear film break-up (r=-0.74). These data imply that OST decreases more rapidly in individuals with greater tear production, larger tear volumes, and shorter tear break-up times (faster rates of tear film break-up). There are discrepancies in relationships between OST and DED across studies, which is not surprising given that DED encompasses a number of different phenotypic presentations. However, most studies found that OST decreases at a more rapid rate in DED vs. control groups. As such, cooling rate may have utility as a screening tool in DED in combination with established point-of-care tests.
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http://dx.doi.org/10.2147/OPTO.S281601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894805PMC
February 2021

Ocular Pain Symptoms in Individuals With and Without a History of Refractive Surgery: Results From a Cross-Sectional Survey.

Cornea 2021 Feb 8. Epub 2021 Feb 8.

Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL; University of Miami Miller School of Medicine, Miami, FL; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL; Research Services, Miami Veterans Affairs Medical Center, Miami, FL; and Physical Medicine and Rehabilitation, University of Miami, Miami, FL.

Purpose: This study characterized ocular pain symptoms in individuals with and without a history of refractive surgery (RS) using a cross-sectional survey of individuals with ocular pain.

Methods: A link to an anonymous survey was posted on a corneal neuralgia Facebook group that included individuals with ocular pain from any etiology and sent to individuals seen in our clinic with ocular pain. The survey asked about medical history, ocular pain symptoms (using standardized questionnaires), and treatment responses. Respondents were split into 2 groups based on a history of RS.

Results: One hundred one individuals responded to the survey. The mean age for all respondents was 41.6 ± 15.6 years, and 50% reported a history of RS. A total of 46% of individuals with a history of RS reported that their ocular pain started within 1 month of surgery, with median pain duration of 36 (interquartile range 22-84) months. The median Dry Eye Questionnaire-5 (range 0-22) scores were 16 and 15 for the RS and no-RS groups, respectively. Most individuals in both groups characterized their pain as burning (score ≥1: RS, 86%; no-RS, 80%) and reported evoked pain to wind, light, or temperature (score ≥1: RS, 97%; no-RS, 85%). Fifty-nine of 101 individuals responded to treatment questions. Individuals in both groups reported >30% improvement in pain symptoms with some topical and systemic approaches.

Conclusions: Individuals with a history of RS developed ocular pain soon after surgery, which persisted for years. Symptom profiles were similar between those with and without RS. Topical and systemic approaches can treat pain in both groups.
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http://dx.doi.org/10.1097/ICO.0000000000002675DOI Listing
February 2021

Implications of Calcification in Peyronie's Disease, A Review of the Literature.

Urology 2021 Jan 19. Epub 2021 Jan 19.

University of Miami Miller School of Medicine, Miami FL; Bruce W Carter VA Medical Center, Miami FL. Electronic address:

A common characteristic of Peyronie's Disease (PD) is plaque calcification, which is associated with decreased response to treatments and higher rates of surgical intervention. Despite its prevalence in the PD population, the literature on plaque calcification is limited. While the diagnosis of PD is mostly clinical, imaging modalities such as ultrasound can be used to identify plaque calcification. The proper identification of plaque calcification is crucial for guiding management and setting therapeutic expectations for patients with PD. Herein we discuss what is known about PD plaque calcification, including epidemiology, etiology, diagnosis, and management.
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http://dx.doi.org/10.1016/j.urology.2021.01.007DOI Listing
January 2021

Corneal sub-basal nerve plexus microneuromas in individuals with and without dry eye.

Br J Ophthalmol 2021 Jan 4. Epub 2021 Jan 4.

Ophthalmology, Bruce W Carter Department of Veterans Affairs Medical Center, Miami, Florida, USA

Background/aim: An objective marker is needed to detect when corneal nerve abnormalities underlie neuropathic corneal pain (NCP), as symptoms often overlap with those of dry eye (DE). This study evaluated microneuroma (MN) frequency in various populations and investigated relationships between MN presence and DE clinical features in individuals with DE symptoms but without a history of refractive surgery, in order to eliminate refractive surgery as a potential confounder of nerve abnormalities.

Methods: This was a retrospective study that included individuals with and without DE symptoms who underwent a clinical evaluation for DE (symptom surveys and ocular surface evaluation) and in vivo confocal microscopy imaging. DE clinical features (including those suggestive of neuropathic pain) were compared based on MN presence using t-tests, χ analyses and Pearson's correlation coefficients with 0.05 alpha level.

Results: MN frequencies did not significantly differ between individuals with DE symptoms (Dry Eye Questionnaire 5 score ≥6) and a history of refractive surgery (n=1/16, 6%), individuals with DE symptoms without a history of refractive surgery (n=26/119, 22%) and individuals without DE symptoms (n=2/18, 11%, p=0.22). Among individuals with DE symptoms without a history of refractive surgery, DE clinical features, including those indicative of NCP (burning sensation and sensitivity to light, wind and extreme temperatures), did not significantly differ based on MN presence (p>0.05).

Conclusion: MN frequencies did not significantly differ between individuals with and without DE symptoms. Their presence alone could not distinguish between DE subtypes, including features of NCP in our study population.
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http://dx.doi.org/10.1136/bjophthalmol-2020-317891DOI Listing
January 2021

Conjunctival Vessels in Diabetes Using Functional Slit Lamp Biomicroscopy.

Cornea 2020 Dec 16;Publish Ahead of Print. Epub 2020 Dec 16.

University of Miami Miller School of Medicine, Miami, FL; Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL; Division of Endocrinology, Diabetes and Metabolism, Comprehensive Diabetes Center Miami, FL; and Surgical Services, Miami Veterans Administration Medical Center, Miami, FL.

Purpose: This study used functional slit lamp biomicroscopy (FSLB) to quantify conjunctival microvessel parameters in individuals with and without diabetes and examined whether these metrics could be used as surrogate markers of diabetes-related complications.

Methods: A cross-sectional study of 98 controls (C), 13 individuals with diabetes without complications (D-C), and 21 with diabetes and related complications (D+C), which included retinopathy, nephropathy, neuropathy, and cardiovascular-, peripheral vascular-, and cerebrovascular diseases, was performed. Bulbar conjunctival metrics (venule diameter, length, axial velocity [Va], cross-sectional velocity [Vs], flow [Q], and branching complexity) were measured using FSLB (digital camera mounted on traditional slit lamp).

Results: The mean age was 60 ± 11 years, and demographics were similar across the groups. Va and Vs significantly differed between groups. Va was 0.51 ± 0.17 mm/s, 0.62 ± 0.17 mm/s, and 0.45 ± 0.17 mm/s in the C, D-C, and D+C groups, respectively (P = 0.025). Similarly, Vs was 0.35 ± 01.12, 0.43 ± 0.13, and 0.32 ± 0.13 mm/s in the C, D-C, and D+C groups, respectively (P = 0.031). Black individuals had increased Va, Vs, and Q compared with White individuals (P < 0.05), but differences in velocities persisted after accounting for race. Among patients with diabetes, Va and Vs correlated with number of organ systems affected (Va: ρ = -0.42, P = 0.016; Vs: ρ = -0.41, P = 0.021). Va, Vs, and Q significantly (P ≤ 0.005) discriminated between diabetic patients with and without complications (area under the receiver operating curve for Va = 0.81, Vs = 0.79, Q = 0.81).

Conclusions: Bulbar conjunctival blood flow metrics measured by FSLB differed between controls, diabetic patients without complications, and diabetic patients with complications. FSLB is a quick, easily accessible, and noninvasive alternative that might estimate the burden of vascular complications in diabetes.
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http://dx.doi.org/10.1097/ICO.0000000000002623DOI Listing
December 2020

Impact of Air Pollution and Weather on Dry Eye.

J Clin Med 2020 Nov 20;9(11). Epub 2020 Nov 20.

Bascom Palmer Eye Institute, University of Miami, Miami, FL 33136, USA.

Air pollution has broad effects on human health involving many organ systems. The ocular surface is an excellent model with which to study the effects of air pollution on human health as it is in constant contact with the environment, and it is directly accessible, facilitating disease monitoring. Effects of air pollutants on the ocular surface typically manifest as dry eye (DE) symptoms and signs. In this review, we break down air pollution into particulate matter (organic and inorganic) and gaseous compounds and summarize the literature regarding effects of various exposures on DE. Additionally, we examine the effects of weather (relative humidity, temperature) on DE symptoms and signs. To do so, we conducted a PubMed search using key terms to summarize the existing literature on the effects of air pollution and weather on DE. While we tried to focus on the effect of specific exposures on specific aspects of DE, environmental conditions are often studied concomitantly, and thus, there are unavoidable interactions between our variables of interest. Overall, we found that air pollution and weather conditions have differential adverse effects on DE symptoms and signs. We discuss these findings and potential mitigation strategies, such as air purifiers, air humidifiers, and plants, that may be instituted as treatments at an individual level to address environmental contributors to DE.
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http://dx.doi.org/10.3390/jcm9113740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699870PMC
November 2020

Digital Screen Use and Dry Eye: A Review.

Asia Pac J Ophthalmol (Phila) 2020 Dec;9(6):491-497

Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL.

Prolonged and continuous daily use of digital screens, or visual display terminals (VDTs), has become the norm in occupational, educational, and recreational settings. An increased global dependence on VDTs has led to a rise in associated visual complaints, including eye strain, ocular dryness, burning, blurred vision, and irritation, to name a few. The principal causes for VDT-associated visual discomfort are abnormalities with oculomotor/vergence systems and dry eye (DE). This review focuses on the latter, as advances in research have identified symptomology and ocular surface parameters that are shared between prolonged VDT users and DE, particularly the evaporative subtype. Several mechanisms have been implicated in VDT-associated DE, including blink anomalies, damaging light emission from modern devices, and inflammatory changes. The presence of preexisting DE has also been explored as an inciting and exacerbating factor. We review the associations between digital screens and DE, mechanisms of damage, and therapeutic options, hoping to raise awareness of this entity with the goal of reducing the global morbidity and economic impact of screen-associated visual disability.
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http://dx.doi.org/10.1097/APO.0000000000000328DOI Listing
December 2020

Ocular Manifestations of Sarcoidosis in a South Florida Population.

Clin Ophthalmol 2020 2;14:3741-3746. Epub 2020 Nov 2.

Miami Veterans Administration Medical Center, Miami, FL 33125, USA.

Objective: To describe the ocular manifestations of sarcoidosis in a South Florida population and identify risk factors for the presence of ocular disease.

Design: Retrospective consecutive case series.

Methods: Medical charts of individuals with sarcoidosis seen in the University of Miami pulmonary department were reviewed for ocular disease. Odds ratios were used to identify risk factors for ocular sarcoidosis.

Results: Fourteen of 108 individuals with sarcoidosis had ocular involvement. The mean age of the 14 individuals was 56±15 years. Seventy-one percent were female, 50% were black, and 21% were Hispanic. Twelve had uveitis of which panuveitis was the most common subtype. Five had ≤20/70 vision in at least one eye due to uveitis. Neurosarcoidosis was a risk factor for ocular sarcoidosis (OR 6.14, p=0.03, 95% CI 1.21-31.09).

Conclusion: Ocular manifestations occurred in a minority of individuals in a pulmonary sarcoidosis clinic in South Florida. Uveitis was the most common ocular manifestation. Neurosarcoidosis was a risk factor for ocular involvement.
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http://dx.doi.org/10.2147/OPTH.S278373DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7648141PMC
November 2020

Matrix metalloproteinase 9 positivity predicts long term decreased tear production.

Ocul Surf 2021 Jan 21;19:270-274. Epub 2020 Oct 21.

Foster Center for Ocular Immunology, Duke Eye Institute, USA; Department of Ophthalmology, Duke University Medical Center, Durham, NC, 27705, USA. Electronic address:

Purpose: To investigate long-term correlations between Matrix Metalloproteinase-9 (MMP-9) testing and dry eye (DE) parameters. Additionally, to evaluate variability in MMP-9 results over time and with anti-inflammatory treatment.

Methods: Retrospective cohort study of DE patients with equal MMP-9 testing results (positive or negative) in both eyes and a minimum of 6 months of follow up. Our main outcome measure was to examine whether initial MMP-9 status affected change in DE parameters over time. Secondarily, we evaluated the frequency of MMP-9 status change over time and examined whether MMP-9 status change was impacted by treatment.

Results: 67 patients (76% female) fit the inclusion criteria. Mean age was 63 years with a mean follow up of 10.6 months. The majority (37/67, 55%) had concomitant systemic immune disease. MMP-9 testing was positive in both eyes in 39 individuals (58%) and negative in both eyes in 27 (42%) individuals. Of all DE parameters, initial MMP status predicted change in tear production. Individuals in the MMP-9 positive group had a greater decrease in production from baseline to final visit compared to the negative group (-2.6 vs 2.1, P = 0.013). In those initially MMP-9 positive, the frequency of becoming MMP-9 negative was higher in eyes treated with anti-inflammatory therapy compared to artificial tears (22.9% vs 3.3%, P = 0.106). However, only Lifitegrast 5% showed statistical significance compared to artificial tears (31.3% vs 3.3%, P = 0.044).

Conclusions: Eyes with detectable MMP-9 had significantly decreased tear production over time compared to those without detectable MMP-9. Anti-inflammatory treatment more frequently normalized MMP-9 compared to PFATs.
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http://dx.doi.org/10.1016/j.jtos.2020.10.003DOI Listing
January 2021

Pain sensitivity and autonomic nervous system parameters as predictors of dry eye symptoms after LASIK.

Ocul Surf 2021 Jan 21;19:275-281. Epub 2020 Oct 21.

Department of Physical Medicine & Rehabilitation, University of Miami, Miami, FL, USA; Research Service, Miami Veterans Administration Medical Center, Miami, FL, USA.

Purpose: Differences in pain processing and autonomic function among patients have been implicated in the development of chronic pain after surgery. This study was designed to evaluate whether pain and autonomic metrics predict severity of chronic dry eye (DE) symptoms after LASIK, as there is increasing evidence that DE symptoms may be manifestations of persistent post-operative ocular pain.

Methods: Secondary analysis of prospective randomized clinical trial. Patients were treated with either pregabalin or placebo. As no significant differences in DE symptoms were detected by treatment allocation at six months, all participants were grouped together for the present analyses. Subjects were evaluated pre-LASIK with regard to evoked pain sensitivity (utilizing quantitative sensory testing), autonomic metrics and DE and ocular pain symptoms (via validated questionnaires). Measures of DE and ocular pain were assessed post-LASIK, and the Dry Eye Questionnaire 5 (DEQ5) score 6-months after surgery was the primary outcome of interest.

Results: 43 individuals were randomized to pregabalin (n = 21) or placebo (n = 22). 42 completed the 6-month visit. Several baseline autonomic metrics correlated with 6-month post-operative DEQ5 scores, including lower systolic (r -0.37, p = 0.02) and diastolic blood pressure (r -0.32, p = 0.04). Ocular pain at 6 months was also negatively correlated with blood pressure (r -0.31, p = 0.047). The presence of painful aftersensations was a significant predictor of chronic DE symptoms at 6 months (mean DEQ5 scores: 8.0 ± 1.9 versus 5.0 ± 5.0, p = 0.009).

Conclusions: Heightened parasympathetic tone and prolonged pain sensitivity measured prior to surgery predicted greater DE symptom severity 6 months after LASIK.

Trial Registration: NCT02701764.
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http://dx.doi.org/10.1016/j.jtos.2020.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867610PMC
January 2021

Indoor Airborne Microbial Concentration and Dry Eye.

Am J Ophthalmol 2021 03 14;223:193-204. Epub 2020 Oct 14.

Miller School of Medicine, University of Miami, Miami, Florida, USA. Electronic address:

Purpose: To examine associations between indoor airborne microbial concentration and dry eye (DE) measures.

Design: Prospective, observational, cross-sectional study.

Methods: A total of 157 individuals with normal external ocular anatomy were recruited from the Miami Veterans Affairs eye clinic. Subjects underwent a clinical evaluation that included assessment of DE symptoms and signs. Indoor air was sampled using bioaerosol impactors with nutrient and soy media, and samples were incubated for 48 hours at 37 C with 5% CO. Number of microbial colonies (CFU) was recorded. Outcome measures were DE symptoms and signs.

Results: A total of 157 unique subjects participated in home and clinical visits and of these, 93 completed a 6-month follow-up of home and clinical visits. Older homes were found to have higher CFU compared to newer homes. A 1% increase in humidity was associated with a 3% increase in nutrient CFU (95% confidence interval [CI] = 0.01 to 0.04; P < .001). Instrumented CFU significantly associated with 2 DE measures: corneal epithelial disruption and lower eyelid meibomian gland (MG) dropout, adjusted for age and sex (odds ratio [OR] = 28.07, 95% CI =1.8, 443.8, P < .05; OR = 39.6, CI = 1.8, 875.2, P < .05 for soy, respectively). After adjusting for other confounders, CFU and age remained significantly associated with MG dropout. Other DE measures did not significantly associate with CFU.

Conclusions: Individuals with higher CFU counts in the home had more severe MG dropout, after adjusting for age and other confounders. This finding suggests that home CFU exposure may impact MG dropout, one of the DE measures, and may be a target for intervention.
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http://dx.doi.org/10.1016/j.ajo.2020.10.003DOI Listing
March 2021

Corneal Nerve Abnormalities in Ocular and Systemic Diseases.

Exp Eye Res 2021 01 10;202:108284. Epub 2020 Oct 10.

Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Research Services, Miami Veterans Affairs Medical Center, Miami, FL, USA. Electronic address:

The trigeminal nerve gives rise to the corneal subbasal nerve system, which plays a crucial role in sensations of touch, pain, and temperature and in ocular healing processes. Technological advancements in instruments, in particular in vivo confocal microscopy and aethesiometry, have allowed for the structural and functional evaluation of corneal nerves in health and disease. Through application of these technologies in humans and animal models, structural and functional abnormalities have been detected in several ocular and systemic disorders, including dry eye disease (DED), glaucoma, migraine, and fibromyalgia. However, studies across a number of conditions have found that structural abnormalities do not always relate to functional abnormalities. This review will discuss instruments used to evaluate corneal nerves and summarize data on nerve abnormalities in a number of ocular and systemic conditions. Furthermore, it will discuss potential treatments that can alleviate the main manifestations of nerve dysfunction, namely ocular surface pain and persistent epithelial defects.
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http://dx.doi.org/10.1016/j.exer.2020.108284DOI Listing
January 2021

Prevalence of Ocular Demodicosis in an Older Population and Its Association With Symptoms and Signs of Dry Eye.

Cornea 2020 Sep 21. Epub 2020 Sep 21.

Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL.

Purpose: To evaluate associations between Demodex and its symptoms and ocular surface parameters in individuals with dry eye (DE).

Methods: A cross-sectional study of 119 individuals with DE symptoms or signs, grouped by the presence of ocular demodicosis, was performed. All individuals filled out questionnaires and underwent an ocular surface examination. Demographics, comorbidities, symptoms profiles, and ocular surface parameters were compared between the 2 groups. Multivariable regression analyses were used to determine which factors were associated with DE symptoms. Receiver operating curves analyses were performed to evaluate relationships between Demodex quantity and specific clinical phenotypes.

Results: Demodex was highly prevalent in our population (68.9%) with average counts of 4.2 ± 3.9. Individuals with and without Demodex had comparable demographics. Overall, symptoms profiles were similar between individuals with and without Demodex using the Dry Eye Questionnaire 5 and Ocular Surface Disease Index. Individuals with Demodex, however, were more likely to report itching (58.5% vs. 35.1%, P = 0.03), with increasing frequency in those with higher Demodex counts. Individuals with Demodex also had more severe eyelid abnormalities [cylindrical dandruff (CD) and lid vascularity] and a more unstable tear film but similar tear production and corneal staining when compared with individuals without Demodex. Neither Demodex nor ocular surface findings related to DE symptoms in multivariable analyses. Receiver operating curves analysis revealed Demodex counts ≥2 maximized sensitivity and specificity for both itching (64.7% and 59.0%, respectively) and CD (80.4% and 60.4%, respectively).

Conclusions: Demodex is highly prevalent in an older population with DE. Symptom of itching and CD were the findings most specific for Demodex.
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http://dx.doi.org/10.1097/ICO.0000000000002542DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981278PMC
September 2020

Clinicopathologic Correlations of Retrocorneal Membranes Associated With Endothelial Corneal Graft Failure.

Am J Ophthalmol 2021 02 15;222:24-33. Epub 2020 Aug 15.

Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA; Florida Lions Ocular Pathology Laboratory, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.

Purpose: To provide clinicopathologic correlations for retrocorneal membranes associated with Descemet stripping automated endothelial keratoplasty (DSAEK) failure.

Design: Retrospective case series.

Methods: The specimens and medical records of the patients diagnosed with clinically significant retrocorneal membranes associated with DSAEK failure at the Bascom Palmer Eye Institute or the University of Miami Veterans Hospital between October 2015 and March 2020 were reviewed for demographics, clinical presentation, comorbidities, and surgeries performed. Histopathologic analysis was performed on hematoxylin-eosin and periodic acid-Schiff sections. Immunohistochemical studies were performed for smooth muscle actin (α-SMA), pancytokeratin, and CK7. Immunofluorescence was performed for vimentin, N-cadherin, ROCK1, RhoA, ZEB1, and Snail.

Results: A total of 7 patients (3 male and 4 female) were identified to have a clinically significant retrocorneal membranes at the time of graft failure. The average age at the time of first DSAEK was 70 years (range: 55-85 years). All patients were pseudophakic and had a glaucoma drainage device in place; 1 had a history of failed DSAEK. Ranging from 0 to 47 months after surgery, a variably thick retrocorneal fibrous membrane was observed, eventually leading to graft failure. Four patients underwent subsequent penetrating keratoplasty and 3 underwent repeat DSAEK. On histopathologic evaluation, a pigmented fibrocellular tissue was identified along the posterior margin of the corneas and DSAEK buttons in all cases. Further characterization with immunohistochemistry and immunofluorescence demonstrated membranes to be negative for pancytokeratin and positive for α-SMA, vimentin, CK7, N-cadherin, ZEB1, Snail, ROCK1, and RhoA.

Conclusions: Fibrocellular retrocorneal membrane proliferation may be associated with DSAEK failure in patients with previous glaucoma drainage device surgery. Our results demonstrate myofibroblastic differentiation and a lack of epithelial differentiation. Positivity for markers of an endothelial-to-mesenchymal transition indicates possible endothelial origin and could be the hallmark for future targeted pharmacotherapy.
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http://dx.doi.org/10.1016/j.ajo.2020.08.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7882638PMC
February 2021

Corneal Nerve Pathway Function in Individuals with Dry Eye Symptoms.

Ophthalmology 2021 Apr 8;128(4):619-621. Epub 2020 Aug 8.

Department of Anesthesia, University of Miami, Miami, Florida.

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http://dx.doi.org/10.1016/j.ophtha.2020.07.061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868519PMC
April 2021

Whole exome profiling and mutational analysis of Ocular Surface Squamous Neoplasia.

Ocul Surf 2020 10 24;18(4):627-632. Epub 2020 Jul 24.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Ophthalmology, Miami Veteran Affairs Medical Center, Miami, FL, USA.

Purpose: To determine genetic mutational profiles in patients with Ocular Surface Squamous Neoplasia (OSSN) using whole exome sequencing.

Methods: Prospective, case-series study. Patient recruitment was conducted in a single tertiary referral center from April to September 2017. Specimens were obtained by incisional biopsies of tumors from ten eyes with histopathologic confirmation of OSSN. DNA whole exome sequencing and mutation analysis were performed.

Results: Ten patients with clinically-diagnosed OSSN underwent DNA whole exome sequencing analysis. Deleterious mutations in 305 genes known to drive tumor development and progression were found. These mutations centered around two main pathways: DNA repair/cell cycle and development/growth. All ten samples had at least one mutation in a DNA repair/cell cycle gene and all but one sample had one in a development/growth gene. The most common mutation was found in TP53 and HGF (both present in 50% of cases) and mutually exclusive mutations were found in BRCA1 and BRCA2 (50% of cases). Mutations in APC, MSH6, PDGFRA, and PTCH1 were found in 40% of cases. Global mutation analysis identified ultraviolet induced radiation as the only mutational signature present in the dataset.

Conclusions: Mutations found in samples from patients with OSSN are mainly induced by ultraviolet radiation and occur within two main pathways related to DNA repair/cell cycle and development/growth. There are many clinically available drugs and several others being evaluated in clinical trials that target the genes found mutated in this study, offering new therapeutic options for OSSN.
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http://dx.doi.org/10.1016/j.jtos.2020.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7686168PMC
October 2020

Photophobia: shared pathophysiology underlying dry eye disease, migraine and traumatic brain injury leading to central neuroplasticity of the trigeminothalamic pathway.

Br J Ophthalmol 2020 Jul 23. Epub 2020 Jul 23.

Ophthalmology, VA Medical Center Miami, Miami, Florida, USA

Background: Photophobia is a potentially debilitating symptom often found in dry eye disease (DE), migraine and traumatic brain injury (TBI).

Methods: We conducted a review of the literature via a PubMed search of English language articles with a focus on how photophobia may relate to a shared pathophysiology across DE, migraine and TBI.

Results: DE, migraine and TBI are common conditions in the general population, are often comorbid, and share photophobia as a symptom. Across the three conditions, neural dysregulation of peripheral and central nervous system components is implicated in photophobia in various animal models and in humans. Enhanced activity of the neuropeptide calcitonin gene-related peptide (CGRP) is closely linked to photophobia. Current therapies for photophobia include glasses which shield the eyes from specific wavelengths, botulinum toxin, and inhibition of CGRP and its receptor. Many individuals have persistent photophobia despite the use of these therapies, and thus, development of new therapies is needed.

Conclusions: The presence of photophobia in DE, migraine and TBI suggests shared trigeminothalamic pathophysiologic mechanisms, as explained by central neuroplasticity and hypersensitivity mediated by neuropeptide CGRP. Treatment strategies which target neural pathways (ie, oral neuromodulators, transcutaneous nerve stimulation) should be considered in patients with persistent photophobia, specifically in individuals with DE whose symptoms are not controlled with traditional therapies.
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http://dx.doi.org/10.1136/bjophthalmol-2020-316417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022288PMC
July 2020

Transcutaneous Electrical Nerve Stimulation for Facial Pain.

Prog Neurol Surg 2020 21;35:35-44. Epub 2020 Jul 21.

Ophthalmology Department, Miami Veterans Affairs Medical Center, Miami, Florida, USA,

Transcutaneous electrical nerve stimulation (TENS) has been used for its analgesic effects for chronic pain, including facial pain. Here, we summarize how the electrical stimulation of branches of the trigeminal nerve via TENS has been utilized to reduce pain resulting from trigeminal neuralgia, temporomandibular joint disorder, migraine and other headache types, and ocular pain sensations. TENS has been used for both short-term (one session) and long-term (multiple sessions) pain control with little to no adverse effects reported by subjects. The results of the summarized studies suggest TENS is an effective non-invasive, non-pharmacologic means of pain control for patients with facial pain conditions.
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http://dx.doi.org/10.1159/000509620DOI Listing
July 2020

Periorbital botulinum toxin A improves photophobia and sensations of dryness in patients without migraine: Case series of four patients.

Am J Ophthalmol Case Rep 2020 Sep 4;19:100809. Epub 2020 Jul 4.

Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, 900 NW 17th Street, Miami, FL, USA.

Purpose: Individuals receiving botulinum toxin A (BoNT-A) injections in the head and neck for migraine treatment have reported decreases in photophobia and sensations of dryness, independent of ocular surface parameters. We hypothesized that patients without migraine but with similar ocular neuropathic-like symptoms would also experience symptomatic improvement with periocular BoNT-A injections, independent of ocular surface changes.

Observations: We identified four individuals without a history of migraine but with neuropathic ocular pain (symptoms of dryness, burning, and photophobia that were out of proportion to ocular surface findings and unresponsive to ongoing dry eye (DE) therapies). Individuals underwent 1 session of periocular BoNT-A injections. Validated questionnaires (Visual Light Sensitivity Questionnaire-8, Dry Eye Questionnaire-5) assessed photophobia and DE symptoms pre- and 1-month post-injections. All four reported improvements in frequency and severity of photophobia and eye discomfort following BoNT-A injections. Tear film parameters (phenol red thread test, tear break-up time, corneal staining, and Schirmer test) and eyelid (palpebral fissure height and levator palpebrae superioris function) and eyebrow (position) anatomy were also evaluated before and after injections. Despite a unanimous improvement in symptoms, there were no consistent changes in ocular surface parameters with BoNT-A injections across individuals.

Conclusions: Periocular BoNT-A shows promise in reducing photophobia and sensations of dryness in individuals with neuropathic-like DE symptoms without a history of migraine, independent of tear film, eyelid, or eyebrow parameters.
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http://dx.doi.org/10.1016/j.ajoc.2020.100809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7350146PMC
September 2020

Association of the Indoor Environment With Dry Eye Metrics.

JAMA Ophthalmol 2020 08;138(8):867-874

Environmental Health Division, University of Miami, Miami, Florida.

Importance: The ocular surface is continuously exposed to the environment. Although studies have focused on associations between outdoor environmental conditions and dry eye, information on associations between the indoor environment and dry eye is lacking.

Objective: To determine associations between the indoor environment and dry eye.

Design, Setting, And Participants: This prospective cross-sectional study sample of 97 veterans with a wide range of dry eye metrics was recruited from the Miami Veterans Affairs Healthcare eye clinic from October 19, 2017, to August 30, 2018. Dry eye metrics were first evaluated in the clinic, followed by indoor home environmental metrics within 1 week using a handheld particle counter. Data were analyzed from October 19, 2017, to August 30, 2018.

Main Outcomes And Measures: Symptoms of dry eye were assessed with standardized questionnaires. Dry eye signs were assessed via standard examination. Indoor environmental metrics included temperature, humidity, and particulate matter mass and count.

Results: Of the 97 participants included in the analysis, 81 (84%) were men, with a mean (SD) age of 58.2 (11.9) years. Dry eye symptoms were in the moderate range with a mean (SD) Ocular Surface Disease Index (OSDI) score of 31.2 (23.6). Humidity was associated with worse symptoms and signs, including OSDI score (r = 0.30 [95% CI, 0.07-0.49]; P = .01), inflammation (r = 0.32 [95% CI, 0.10-0.51]; P = .01), Schirmer score (r = -0.25 [95% CI, -0.45 to 0.02]; P = .03), eyelid vascularity (r = 0.27 [95% CI, 0.05-0.47]; P = .02), and meibomian gland dropout (r = 0.27 [95% CI, 0.05-0.47]; P = .02). In multivariate analyses, particulate matter of 2.5 μm or less (PM2.5) was associated with dry eye metrics when adjusted for demographic characteristics, comorbidities, medications, and interaction variables. For example, a 1-unit increase in instrumented PM2.5 level was associated with a 1.59 increase in the OSDI score (95% CI, 0.58-2.59; P = .002), a 0.39 reduction in Schirmer score (95% CI, -0.75 to -0.03; P = .04), a 0.07 increase in meibomian gland dropout (95% CI, 0.01-0.13; P = .02), and a 0.06 increase in inflammation (95% CI, 0.02-0.11; P = .009).

Conclusions And Relevance: When adjusting for humidity, this study found that increased particulate matter exposure was associated with worse dry eye metrics. Humidity was positively associated with dry eye metrics, potentially because higher humidity increases microbial growth and particulate matter size and mass.
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http://dx.doi.org/10.1001/jamaophthalmol.2020.2237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333174PMC
August 2020

Ocular Surface Pain: A Narrative Review.

Ophthalmol Ther 2020 Sep 5;9(3):1-21. Epub 2020 Jun 5.

Surgical Services, Miami Veterans Affairs Medical Center, Miami, FL, USA.

Ocular surface pain is a frequent cause of visits to an eye care provider and has a substantial impact on healthcare cost, yet a complete understanding of its causative factors and tools for diagnostic workup are notably missing in many eye clinics. The cornea has the densest sensory innervation in the human body and has the potential to be a powerful producer of pain. Pain can manifest as a result of a noxious stimulus or disruption in the ocular surface anatomy (nociceptive pain), or it can result from abnormalities in the ocular surface neurosensory apparatus itself (neuropathic pain). Novel advances in neurobiology have sought to differentiate the two entities, particularly to identify when chronic dry eye symptomatology is driven by neuropathic ocular pain. In this review, we seek to provide an overview of the prevalence, physiologic factors, and management of ocular surface pain complaints.
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http://dx.doi.org/10.1007/s40123-020-00263-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7406607PMC
September 2020

Relationships Between Short-Term Exposure to an Indoor Environment and Dry Eye (DE) Symptoms.

J Clin Med 2020 May 2;9(5). Epub 2020 May 2.

Environmental Health Division, University of Miami, Miami, FL 33136, USA.

Air composition influences Dry Eye (DE) symptoms as demonstrated by studies that have linked the outdoor environment to DE. However, there is insufficient data on the effect of short-term exposure to indoor environments on DE symptoms. We conducted a prospective experimental research, in which an older building served as an experimental site, and a newer building served as the control site. Indoor air quality was monitored in both buildings. One-hundred-and-ninety-four randomly selected individuals were interviewed in the afternoon exiting the buildings and de-identified responses were recorded. Self-reported DE symptoms were modeled with respect to experimental and control buildings, adjusting for potential confounders. The experimental site had 2-fold higher concentration of airborne particulate matter (24,436 vs. 12,213 ≥ 0.5 µm/ft) and microbial colonies (1066 vs. 400/m), as compared to the control building. DE symptoms were reported by 37.5% of individuals exiting the experimental and 28.4% exiting the control building. In the univariate analysis, subjects exiting the experimental building were 2.21× more likely to report worsening of DE symptoms since morning compared to the control building ( < 0.05). When adjusting for confounders, including a history of eye allergy, subjects from the experimental building were 13.3× more likely to report worsening of their DE symptoms ( < 0.05). Our findings suggest that short-term exposure to adverse indoor environmental conditions, specifically air pollution and bioaerosols, has an acutely negative impact on DE symptoms.
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http://dx.doi.org/10.3390/jcm9051316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290742PMC
May 2020

Role of optical coherence tomography angiography in the characterization of vascular network patterns of ocular surface squamous neoplasia.

Ocul Surf 2020 10 25;18(4):926-935. Epub 2020 Apr 25.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, USA. Electronic address:

Purpose: To visualize and quantify vascular networks in individuals with ocular surface squamous neoplasia (OSSN) through optical coherence tomography angiography (OCTA).

Method: Cross-sectional study of OSSN patients. Vascular networks were measured by OCTA in the epithelium and sub-epithelial space in the tumors, adjacent tissue, and in the contralateral eye. Vessel area density (VAD, percent of blood vessels within 2.14 mm), was calculated for each location. Total tumor density (TTD, percent of blood vessels within the entire tumor) was calculated. VAD was assessed separately for corneal and conjunctival locations and compared.

Results: Fifteen patients with OSSN were included. The mean age was 61 ± 12 years and the majority were male (80%). The mean tumor area, volume, depth, and TTD were 28.0 ± 9.0 mm (range, 10.9-39.7), 9.1 ± 4.1 mm (range, 3.4-18.8), 334 ± 125 μm (range, 177-571), and 33.2% ± 11.0% (range, 18.7-58.8), respectively. The VAD was highest within the tumor (28.9% ± 8.7%) followed by the adjacent sub-epithelial tissue and the tissue underneath the conjunctival component of tumor. These densities were higher than the VAD in the tissues of the non-involved eye (all P < 0.05). The VAD within conjunctival component of tumor was significantly higher than those with corneal component (29.8% ± 9.5% vs. 21.1% ± 5.5%, p = 0.006). The VAD under conjunctival tumor was also significantly higher than under corneal component (24.1% ± 7.8% vs. 17.0% ± 6.1%, p = 0.024).

Conclusions: OCTA imaging allowed for visualization and quantification of vessel structure and density within, under, and surrounding OSSN.
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http://dx.doi.org/10.1016/j.jtos.2020.03.009DOI Listing
October 2020