Publications by authors named "Sonia Trave-Huarte"

8 Publications

  • Page 1 of 1

Clinical practice patterns in the management of dry eye disease: A TFOS international survey.

Ocul Surf 2021 May 6;21:78-86. Epub 2021 May 6.

Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, New Zealand.

Purpose: To examine clinical management and prescribing patterns for dry eye disease (DED), in relation to severity and subtype, by eye care practitioners across the globe.

Methods: An online, anonymous cross-sectional survey (on Qualtrics) translated into 14 languages was distributed to eye care practitioners across the globe. The survey included six questions around the management of DED, in relation to severity and subtype.

Result: The survey was completed by 1139 eyecare professionals (37% ophthalmologists and 58% optometrists) from 51 countries. Management varied significantly by continent and country (p < 0.01). The most commonly recommended management approaches, internationally, included general advice (87%), low (85%) and high (80%) viscosity-enhancing unpreserved lubricants and lid wipes/scrubs (81%). Some treatments were prescribed largely independently of severity (e.g. artificial tears and nutritional supplements) while oral antibiotics, punctal occlusion, topical anti-inflammatory/immunosuppressants, secretagogues, biologics, therapeutic contact lenses and surgical approaches were prescribed by more practitioners as severity increased. Essential fatty acids, lipid sprays/drops, lid hygiene, warm compresses, intense pulsed light therapy and antibiotics (topical or oral) were more commonly recommended for evaporative DED, while punctal occlusion, therapeutic contact lenses, secretagogues and biologics were more commonly recommended for aqueous deficient DED.

Conclusions: DED management differs across continents and countries. A wide range of management strategies are utilised at each severity level and between subtypes. The survey results enable clinicians to benchmark their practice to that of their peers, indicate where further research is required to optimise patient management and inform industry on how best to target product development.
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May 2021

Effect of Eye Spray Phospholipid Concentration on the Tear Film and Ocular Comfort.

Eye Contact Lens 2021 Apr 2. Epub 2021 Apr 2.

Optometry and Vision Sciences Research Group (H.P., F.S.K., S.T.H., J.S.W.), College of Health and Life Sciences, Aston University, Birmingham, United Kingdom; Dr. Heiko Pult-Optometry and Vision Research (H.P.), Weinheim, Germany; and School of Biomedical & Life Sciences (H.P.), Cardiff University, Cardiff, United Kingdom.

Objectives: To evaluate the effect of eye spray phospholipid concentration on symptoms and tear film stability.

Methods: High-concentration (Tears Again, Optima Pharma GmbH, Hallbergmoos, Germany) and low-concentration (Ocuvers, Innomedis AG, Germany) phospholipid eye sprays were sprayed onto the closed eyelids of 30 subjects (33.2±1.8 years; 20 women) in a multicentered, prospective, crossover study. Ocular comfort (visual analog scale) and noninvasive tear film stability (NIBUT) of each eye were evaluated before application (along with the Ocular Surface Disease Index), 10 min after application, and 30 min after application.

Results: Comfort (high concentration: 68.5±16.4 vs. low concentration: 70.7±14.5 phospholipid) and NIBUT (high concentration: 11.5±4.6 sec vs. low concentration: 11.2±6.0 sec phospholipid) were not different (P>0.3) between sprays before application, but comfort (by 12 points, P=0.001) and NIBUT (by 5 sec, P=0.016) were significantly better with a high-concentration phospholipid spray at both 10 min and 30 min time points than those with the low-concentration phospholipid spray.

Conclusions: The liposomal eye spray with higher concentration of phospholipids significantly improved ocular comfort and tear film stability in contrast to the eye spray with lower concentration of phospholipids, hence practitioners need to choose an appropriate eye spray to maximize the patient benefit.
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April 2021

Dry eye disease is associated with retinal microvascular dysfunction and possible risk for cardiovascular disease.

Acta Ophthalmol 2021 Feb 11. Epub 2021 Feb 11.

Vascular Research Laboratory, Ophthalmic Research Group, College of Health and life Sciences, Aston University, Birmingham, UK.

Purpose: To explore the presence of microvascular endothelial dysfunction as a measure for early cardiovascular disease in individuals diagnosed with dry eye disease (DED) as compared to age-matched normal controls.

Methods: Systemic blood pressure, Body Mass Index, intraocular pressure, blood levels of glucose (GLUC), triglycerides, cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)] as well as retinal and peripheral microvascular function were assessed in twenty-five 35-50 year olds with diagnosed with DEDa (using the TFOS DEWS II criteria) and 25 age and sex-matched controls.

Results: After controlling all the influential covariates, individuals diagnosed with DED exhibited significant lower retinal artery baseline (p = 0.027), artery maximum diameter (p = 0.027), minimum constriction (p = 0.039) and dilation amplitude (p = 0.029) than controls. In addition, the time to reach the vein maximum diameter was significantly longer in the DED patients than in normal controls (p = 0.0052). Only in individuals diagnosed with DED, artery maximum constriction correlated statistically significantly and positively with HDL-C blood levels (p = 0.006). Similarly, artery slope correlated positively with T-CHOL and LDL-C (p = 0.006 & 0.011 respectively). Additionally, artery baseline diameter and maximum constriction were significantly and negatively correlated to T-CHOL/HDL-C ratio (p = 0.032 and p = 0.013 respectively) in DED individuals only.

Conclusions: Individuals with positive diagnosis of DED exhibit abnormal retinal microvascular function and possible higher risk for CVD.
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February 2021

Developing evidence-based guidance for the treatment of dry eye disease with artificial tear supplements: A six-month multicentre, double-masked randomised controlled trial.

Ocul Surf 2021 Apr 2;20:62-69. Epub 2021 Jan 2.

Optometry and Vision Science Research Group, Aston University, Birmingham, UK.

Purpose: To assess the six-month therapeutic profiles of lipid and non-lipid-based artificial tear supplements in managing dry eye disease (DED).

Methods: Ninety-nine participants fulfilling the TFOS DEWS II diagnostic criteria for DED (64% females; mean ± SD age, 44 ± 16 years) were enrolled in a prospective, multicentre, double-masked, parallel group, randomised controlled trial. Participants instilled lipid-based nanoemulsion drops or non-lipid-based aqueous drops for six months, at least four times daily. Symptomology, tear film and ocular surface characteristics were assessed at Days 0, 30, 60, 90, 120, 150 and 180.

Results: Sustained reductions in OSDI, DEQ-5, and SANDE symptom scores from baseline were observed from Day 30 onwards in both groups (all p < 0.05) and decreased superior lid wiper epitheliopathy grades from Day 60 onwards (all p ≤ 0.01). Improvements in non-invasive tear film breakup time, and sodium fluorescein and lissamine green staining scores followed from Day 120 onwards in both groups (all p < 0.05). Tear lipid layer grades increased from Day 90 onwards only with the lipid-based drops, and with significantly greater improvement in those with suboptimal lipid layer thickness at baseline (grade ≤3; p = 0.02). By Day 180, 19% of participants no longer fulfilled the diagnostic criteria for DED.

Conclusions: Over a six-month treatment period, improvements in dry eye symptomology preceded tear film and ocular surface changes with regular use of both lipid and non-lipid-based artificial tear supplements. Both formulations addressed most mild-to-moderate forms of aqueous deficient and evaporative DED, while evaporative cases benefitted preferentially from lipid-based supplementation. This represents a first step towards mapping DED therapeutic strategies according to disease subtype and severity.
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April 2021

Effect of meibomian gland morphology on functionality with applied treatment.

Cont Lens Anterior Eye 2021 Jan 1:101402. Epub 2021 Jan 1.

Ophthalmic Research Group, School of Life & Health Sciences, Aston University, Birmingham, B4 7ET, United Kingdom. Electronic address:

Purpose: To determine how Meibomian gland (MG) morphology affects MG function by means of gland expression with the effect of treatment.

Methods: Fifteen patients (aged 31.6 ± 13.1 years) from a dry eye clinic diagnosed with MG dysfunction had their 365 lower lid MGs visualised with a slit-lamp biomicroscopy. Using infrared meibography (Oculus K5m), MG length, width and tortuosity were objectively measured. Each MG was expressed and the meibum graded (0=clear fluid, 1=cloudy fluid, 2= particulate fluid, 3=inspissated, or 4 = no expression) to determine its functionality. Participants had functionality repeated each time following a sequence of a warm compress, debridement, and forcible expression after 5 min.

Results: Just over 10 % of complete length MGs gave clear expression, while about 5% did not express at all, with most expressed meibum being particulate in nature. In contrast, the majority of partial length glands gave inspissated expression (38 %), with 32 % not expressing at all. No MG of <10 % length expressed. MG gland length was correlated with gland expression (r=-0.507, p < 0.001) and MG tortuosity (r=-0.129, p < 0.001), but not MG width (r=-0.090, p = 0.167). Regardless of MG length, warm compress increased the quality of expression (p < 0.002). Debridement further improved expression in partial MGs (p = 0.003), but not forcible expression (p = 0.529).

Conclusions: Length is the key functional morphology metric of lower lid MGs. Warm compress and massage increase the quality of expression in all, but the shortest glands and patients with partial length glands also benefit from debridement.
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January 2021

Effect of Scleral Lens Oxygen Permeability on Corneal Physiology.

Optom Vis Sci 2020 09;97(9):669-675

Ophthalmic Research Group, Aston University, Birmingham, United Kingdom.

Significance: This randomized, masked, crossover clinical study identifies that ≥125 Dk materials should be used for scleral lens daily wear if disruption to corneal oxygen is to be minimized.

Purpose: Modern scleral lens use has increased and has proven to be successful where other types and materials have previously failed. Although the required oxygen permeability has been modeled, this has not been established clinically.

Methods: Fifteen masked participants aged 20.7 ± 2.3 years (10 female) were bilaterally fitted with five different scleral lenses (65, 100, 125, 163, and 180+ Dk) of the same shape profile and one soft silicone hydrogel lens compared with no lens wear on separate occasions in a randomized order. A masked researcher measured corneal thickness and fluid reservoir depth, corneal curvature, objective bulbar and limbal redness, corneal biomechanics, and ocular surface oxygen consumption before and after 8 hours of wear. In addition, comfort scores were obtained using a visual analog scale.

Results: Scleral lenses with oxygen permeability of 65 Dk resulted in greater corneal thickness (1.37 ± 1.25%) after 8 hours of wear versus ≥100 Dk materials (0.58 ± 0.99%; F = 17.215, P < .001) because of stromal thickening; edema with ≥100 Dk materials was associated with fluid reservoir depth (r = 0.231, P = .05). Fluid reservoir depth decreased similarly with all oxygen-permeable lenses from 325.6 ± 99.1 μm to 174.2 ± 100.8 μm after 8 hours of wear (F = 0.961, P = .44). Oxygen consumption reduced with ≤125 Dk lenses (χ = 604.196, P < .001). Soft and scleral lens wear had no effect on corneal curvature, corneal biomechanics, or ocular hyperemia (P > .05). Soft lenses were more comfortable than all the scleral lenses (P < .05), and the 180+ Dk lenses had the best comfort among the sclerals (P < .05).

Conclusions: A ≥125 Dk is advised for safe scleral lens daily wear. Scleral lens wear leads to an increase in corneal thickness, regardless of lens-material oxygen permeability because of the fluid reservoir depth.
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September 2020

Efficacy of a novel water propelled, heating eye mask massager on tear film and ocular adnexa.

Cont Lens Anterior Eye 2021 Jun 30;44(3):101344. Epub 2020 Jun 30.

Aston University, Birmingham, B4 7ET, UK. Electronic address:

Purpose: To determine the effectiveness of the Aurai water propelled, heating Eye Massager (AEM) in managing dry eye disease and its effects on the ocular adnexa.

Methods: This prospective, randomised cross-over study enrolled 15 participants (aged 25.8 ± 5.45 years, 5 male). Participants wore a smart watch 24 h a day to track their sleeping cycle and heart rate for 4 weeks, using the AEM twice a day for 2 of those weeks. A cycle of 6 min of a controlled heat and vibration pattern in the morning and another cycle in the evening were applied with the AEM. Primary outcomes of symptomatology (Ocular Surface Disease Index (OSDI) and Symptom Assessment iN Dry Eye (SANDE)), tear film and ocular surface homeostasis markers (osmolarity, non-invasive breakup time (NIKBUT), tear meniscus height (TMH), lipid layer thickness and ocular staining) and safety measures (ocular redness and intraocular pressure), were assessed at baseline, after 2 weeks of AEM use and after 2 weeks of no treatment (in random-sequence). Sleeping tracking (ST) and heart rate/blood oxygen detection over these periods was also assessed.

Results: There was a significant change in OSDI score from 34.3 ± 19.5 at baseline to 18.8 ± 17.5 after treatment (p = 0.001) and also for the SANDE (5.7 ± 2.4 vs 3.7 ± 2.1; p = 0.001). Heart rate was not affected by treatment (p = 0.956), nor sleep pattern (p = 0.529), but this varied by day (p = 0.001). Tear film and ocular surface homeostasis, the ocular adnexia and safety measures were not affected by treatment (p > 0.05).

Conclusion: The Aurai water propelled Eye Massager may reduce the severity of symptoms of dry eye, but there were no detectable effects on tear stability and ocular surface disease from two weeks use.
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June 2021

Blink Test enhances ability to screen for dry eye disease.

Cont Lens Anterior Eye 2018 10 27;41(5):421-425. Epub 2018 Jun 27.

Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.

Aim: To evaluate the patient-administered Optrex Dry Eye Blink Test against established clinical criteria for the diagnosis of dry eye disease (DED) and to evaluate its benefit in enhancing screening for DED.

Methods: Eighty-seven participants aged 38 ± 17 years, (44 female) were screened for DED using the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) diagnostic criteria. In addition to symptoms screening with the Ocular Surface Disease Index questionnaire (≥13 cut-off score for DED), these criteria required a sign of loss of homeostasis of the tear film in the form of a non-invasive tear breakup time (NIBUT) <10 s (Oculus Keratograph; K5M), an osmolarity reading ≥308 mOsm/L or an interocular difference in osmolarity of >8 (Tearlab), or ocular surface staining (>5 fluorescein corneal spots, >9 lissamine green spots or lid wiper staining [≥2 mm length & ≥25% width]) to confirm a diagnosis of DED. The self-administered Blink Test, which requires the participant to observe an image on a computer screen and report the length of time (in seconds) that they can refrain from blinking without discomfort, was repeated three times.

Results: Using a cut-off time of 10 s, the Blink Test demonstrated sensitivity of 66%, specificity of 88%, and an area under the curve of 0.77 (p < 0.001), in predicting a diagnosis of DED according to the TFOS DEWS II criteria. The correlation between the Blink Test and NIBUT was r = 0.47 (p < 0.001). When combined with the screening questionnaire, the sensitivity and specificity of the Blink Test increased to 71% and 90%, respectively.

Conclusion: The Blink Test offers health professionals without advanced instrumentation, as well as patients, themselves, a rapid method of identifying possible DED.
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October 2018