Korean J Ophthalmol.  2017 Aug;31(4):306-312. 10.3341/kjo.2016.0056.

Changes in Tear Volume after 3% Diquafosol Treatment in Patients with Dry Eye Syndrome: An Anterior Segment Spectral-domain Optical Coherence Tomography Study

• Lee KB
• Koh KM
• Kwon YA
• Song SW
• Kim BY
• Chung JL

• KMID: 2385579
• DOI: http://doi.org/10.3341/kjo.2016.0056

Abstract

PURPOSE
To evaluate changes in the tear meniscus area and tear meniscus height over time in patients with dry eye syndrome, using anterior segment spectral-domain optical coherence tomography after the instillation of 3% diquafosol ophthalmic solution.
METHODS
Sixty eyes from 30 patients with mild to moderate dry eye syndrome were included. Tear meniscus images acquired by anterior segment spectral-domain optical coherence tomography were analyzed using National Institutes of Health's image-analysis software (ImageJ 1.44p). Tear meniscus area and tear meniscus height were measured at baseline, 5 minutes, 10 minutes, and 30 minutes after instillation of a drop of diquafosol in one eye and normal saline in the other eye. Changes in ocular surface disease index score, tear film break-up time, corneal staining score by Oxford schema, and meibomian expressibility were also evaluated at baseline, and after 1 week and 1 month of a diquafosol daily regimen.
RESULTS
Sixty eyes from 30 subjects (mean age, 29.3 years; 8 men and 22 women) were included. In eyes receiving diquafosol, tear volume was increased at 5 and 10 minutes compared with baseline. It was also higher than saline instilled eyes at 5, 10, and 30 minutes. Changes in tear volume with respect to baseline were not statistically different after the use of diquafosol for 1 month. Ocular surface disease index score, tear film break-up time, and Oxford cornea stain score were significantly improved after 1 week and 1 month of daily diquafosol instillation, but meibomian expressibility did not change.
CONCLUSIONS
Topical diquafosol ophthalmic solution effectively increased tear volume for up to 30 minutes, compared to normal saline in patients with dry eye syndrome.

Keyword

Diquafosol; Ophthalmic solutions; Purinergic P2Y receptor agonists; Tear meniscus; Tears secretion

MeSH Terms

Academies and Institutes
Cornea
Dry Eye Syndromes*
Humans
Male
Ophthalmic Solutions
Purinergic P2Y Receptor Agonists
Tears*
Tomography, Optical Coherence*
Ophthalmic Solutions
Purinergic P2Y Receptor Agonists

Figure

• 

  Fig. 1 Infrared image from anterior segment spectral-domain optical coherence tomography illustrating the position of the 5-line raster scan pattern for the tear meniscus image. The distance between each of the 5-line scans was 0.25 mm.

• 

  Fig. 2 Tear meniscus area (A) and tear meniscus height (B) were measured with images acquired from optical coherence tomography using ImageJ software (National Institutes of Health, Bethesda, MD, USA).

• 

  Fig. 3 Optical coherence tomography images obtained from the right eye of a 20-year-old woman at baseline (left), and at 10 minutes after the instillation of 3% diquafosol ophthalmic solution (right). The cornea (C), lower eyelids (LL), and lower tear meniscus (TM) were visualized. The largest increase in tear meniscus volume was observed at 10 minutes after instillation of 3% diquafosol ophthalmic solution.

• 

  Fig. 4 Changes in tear meniscus area (TMA, left) and tear meniscus height (TMH, right) with time after the instillation of a drop of diquafosol or normal saline (*p < 0.05).

• 

  Fig. 5 Changes in tear meniscus area (TMA, left) and tear meniscus height (TMH, right) at baseline and 10 minutes after the use of diquafosol (DQ) for 1 month (*p < 0.05).

• 

  Fig. 6 Changes in ocular surface disease index (OSDI) score (A), tear-film break up time (TBUT) (B), cornea stain score (C), and meibomian expressibility (D) at baseline, after 1 week, and 1 month of daily treatment regimen with diquafosol ophthalmic solution (*p < 0.05).

Reference

1. The definition and classification of dry eye disease: report of the definition and classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5:75–92.

2. Nichols KK, Yerxa B, Kellerman DJ. Diquafosol tetrasodium: a novel dry eye therapy. Expert Opin Investig Drugs. 2004; 13:47–54.

3. Koh S, Ikeda C, Takai Y, et al. Long-term results of treatment with diquafosol ophthalmic solution for aqueous-deficient dry eye. Jpn J Ophthalmol. 2013; 57:440–446.

4. Yokoi N, Kato H, Kinoshita S. Facilitation of tear fluid secretion by 3% diquafosol ophthalmic solution in normal human eyes. Am J Ophthalmol. 2014; 157:85–92.e1.

5. Bitton E, Jones L, Simpson T, Woods C. Influence of the blink interval on tear meniscus height in soft contact lens and nonlens wearers. Eye Contact Lens. 2010; 36:156–163.

6. Ibrahim OM, Dogru M, Kawashima S, et al. Visante optical coherence tomography and tear function test evaluation of cholinergic treatment response in patients with sjogren syndrome. Cornea. 2013; 32:653–657.

7. Ibrahim OM, Dogru M, Takano Y, et al. Application of visante optical coherence tomography tear meniscus height measurement in the diagnosis of dry eye disease. Ophthalmology. 2010; 117:1923–1929.

8. Shen M, Wang J, Tao A, et al. Diurnal variation of upper and lower tear menisci. Am J Ophthalmol. 2008; 145:801–806.

9. Keech A, Flanagan J, Simpson T, Jones L. Tear meniscus height determination using the OCT2 and the RTVue-100. Optom Vis Sci. 2009; 86:1154–1159.

10. Bron AJ, Evans VE, Smith JA. Grading of corneal and conjunctival staining in the context of other dry eye tests. Cornea. 2003; 22:640–650.

11. Pflugfelder SC, Tseng SC, Sanabria O, et al. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea. 1998; 17:38–56.

12. Nichols KK, Mitchell GL, Zadnik K. The repeatability of clinical measurements of dry eye. Cornea. 2004; 23:272–285.

13. Fukuda R, Usui T, Miyai T, et al. Tear meniscus evaluation by anterior segment swept-source optical coherence tomography. Am J Ophthalmol. 2013; 155:620–624. 624.e1–624.e2.

14. Wang J, Palakuru JR, Aquavella JV. Correlations among upper and lower tear menisci, noninvasive tear break-up time, and the Schirmer test. Am J Ophthalmol. 2008; 145:795–800.

15. Yokoi N, Bron A, Tiffany J, et al. Reflective meniscometry: a non-invasive method to measure tear meniscus curvature. Br J Ophthalmol. 1999; 83:92–97.

16. Brennen PM, Kagemann L, Friberg TR. Comparison of StratusOCT and Cirrus HD-OCT imaging in macular diseases. Ophthalmic Surg Lasers Imaging. 2009; 40:25–31.

17. Ho J, Sull AC, Vuong LN, et al. Assessment of artifacts and reproducibility across spectral- and time-domain optical coherence tomography devices. Ophthalmology. 2009; 116:1960–1970.

18. Nguyen P, Huang D, Li Y, et al. Correlation between optical coherence tomography-derived assessments of lower tear meniscus parameters and clinical features of dry eye disease. Cornea. 2012; 31:680–685.

19. Qiu X, Gong L, Lu Y, et al. The diagnostic significance of Fourier-domain optical coherence tomography in Sjogren syndrome, aqueous tear deficiency and lipid tear deficiency patients. Acta Ophthalmol. 2012; 90:e359–e366.

20. Tung CI, Perin AF, Gumus K, Pflugfelder SC. Tear meniscus dimensions in tear dysfunction and their correlation with clinical parameters. Am J Ophthalmol. 2014; 157:301–310.e1.

21. Yokoi N, Komuro A. Non-invasive methods of assessing the tear film. Exp Eye Res. 2004; 78:399–407.

22. Wang Y, Zhuang H, Xu J, et al. Dynamic changes in the lower tear meniscus after instillation of artificial tears. Cornea. 2010; 29:404–408.

23. Finis D, Pischel N, Schrader S, Geerling G. Evaluation of lipid layer thickness measurement of the tear film as a diagnostic tool for Meibomian gland dysfunction. Cornea. 2013; 32:1549–1553.