Introduction: This study assessed the efficacy and safety of intense pulsed light (IPL) therapy in participants with severe evaporative dry eye disease (DED). Methods: This randomized, controlled, singlecenter study included 49 adult participants (C 18 years) with severe evaporative DED who received either IPL therapy (n = 56 eyes) or sham therapy (n = 42 eyes) three times. The primary efficacy parameters were ocular surface disease index (OSDI) score, non-invasive tear breakup time (NITBUT), tear film lipid layer (TFLL), conjunctivocorneal staining score (CS), MG Score, meibomian gland (MG) quality, and MG expression score. Results: The mean ages for the IPL group and the control group were 28.05 ± 3.41 years (57.1% female) and 28.14 ± 3.53 years (52.4% female), respectively. Comparison between the IPL group and the control group found significant differences in the mean OSDI score (22.16 ± 6.08 vs. 42.38 ± 6.60; P \ 00.01), NITBUT (6.27 ± 0.84 vs.3.86 ± 0.68; P \ 0.001), TFLL (2.14 ± 0.44 vs. 3.45 ± 0.50; P \ 0.001), MG Score (1.34 ± 0.55 vs. 1.88 ± 0.33; P \ 0.001), MG quality (1.59 ± 0.07 vs. 2.67 ± 0.08), and MG expression (1.54 ± 0.57 vs. 2.45 ± 0.55) at 12 weeks follow-up; however, there was no significant difference in CS (3.32 ± 1.11 vs. 3.74 ± 1.04; P = 0.063). Conclusion:The findings suggest that IPL therapy is clinically beneficial in ameliorating the signs and symptoms of severe evaporative dry eye disease.

This study reviewed the efficacy and safety of intense pulsed light (IPL) for the treatment of dry eye disease (DED). The PubMed database was used to conduct the literature search, which used the keywords “intense pulsed light” and “dry eye disease”. After the authors evaluated the articles for relevancy, 49 articles were reviewed. In general, all treatment modalities were proven to be clinically effective in reducing dry eye (DE) signs and symptoms; however, the level of improvement and persistence of outcomes differed amongst them. Meta-analysis indicated significant improvement in the Ocular Surface Disease Index (OSDI) scores post-treatment with a standardized mean difference (SMD) = −1.63; confidence interval (CI): −2.42 to −0.84. Moreover, a meta-analysis indicated a significant improvement in tear break-up time (TBUT) test values with SMD = 1.77; CI: 0.49 to 3.05. Research suggests that additive therapies, such as meibomian gland expression (MGX), sodium hyaluronate eye drops, heated eye mask, warm compress, lid hygiene, lid margin scrub, eyelid massage, antibiotic drops, cyclosporine drops, omega-3 supplements, steroid drops, and warm compresses along with IPL, have been found to work in tandem for greater effectiveness; however, in clinical practice, its feasibility and cost-effectiveness have to be taken into consideration. Current findings suggest that IPL therapy is suitable when lifestyle modifications such as reducing or eliminating the use of contact lenses, lubricating eye drops/gels, and warm compresses/eye masks fail to improve signs and symptoms of DE. Moreover, patients with compliance issues have been shown to benefit well as the effects of IPL therapy is sustained for over several months. DED is a multifactorial disorder, and IPL therapy has been found to be safe and efficient in reducing its signs and symptoms of meibomian gland dysfunction (MGD)-related DE. Although the treatment protocol varies among authors, current findings suggest that IPL has a positive effect on the signs and symptoms of MGD-related DE. However, patients in the early stages can benefit more from IPL therapy. Moreover, IPL has a better maintenance impact when used in conjunction with other traditional therapies. Further research is needed to assess cost-utility analysis for IPL.

Objective: This study aimed to assess the influence of pupil size on subjective visual quality in subjects with implanted collamer lenses (ICLs). Methods: This retrospective study assessed eyes implanted with ICL (V4c) and categorized them into incremental groups according to pupil size. Preoperative and postoperative photopic and mesopic pupil size, uncorrected distance visual acuity (UDVA), and quality of vision (QoV) questionnaire score were assessed and compared. Results: Post-operatively at 3-months the mean QoV score for day and night was 9.34 ± 0.76 and 8.58 ± 1.29 respectively. The mean mesopic pupil size (MPS) and mean photopic pupil size (PPS) was 6.59 ± 0.79 mm and 4.61 ± 0.74 mm respectively. PPS negatively correlated with “QoV day” (Rs = -0.413, P=0.001), positively correlated with “haloes” (Rs = 0.568*, P<0.001) and "blurred vision" (Rs = 0.243, P = 0.04) respectively. MPS negatively correlated with “QoV night” (Rs = -0.426, P=0.001), positively correlated with "haloes" (Rs = 0.624*, P < 0.001), "starburst" (Rs = 0.233, P=0.046) and "difficulty focusing" (Rs = 0.27, P = 0.025) respectively. Conclusion: The findings of this study suggest that increasing pupil size has a negative correlation on the subjective visual quality (QoV) for day and night scores. Smaller pupil size had better QoV night scores suggesting further investigation is needed.

Title: A protocol for a single center, randomized, controlled trial comparing the clinical efficacy of 3% diquafosol and 0.1% hyaluronic acid in diabetic patients with dry eye disease. {1} Background The global prevalence of diabetes mellitus (DM) continues to rise and 70% of diabetic individuals have dry eye disease (DED) that leads to subsequent abnormalities of the corneal epithelium, corneal nerves, tear film, or corneal endothelium. In addition, persons with diabetes produce less tear secretions than healthy individuals. While several anti-inflammatory drug-based therapies for dry eye in diabetic individuals are currently be administered but their efficacy not been studied in detail. Therefore, the aim of this study was to compare the effectiveness of 3% diquafosol (DQS) vs 0.1% hyaluronic acid (HA) eye drops in diabetic related dry eye patients. Methods and analysis: This single-blind randomized, control trial will include 140 diabetic related DED and will be assigned to DQS (n = 101) and HA (n = 101) one drop, six times per day for 8 weeks. Tear film lipid layer, non-invasive breakup time, cornea conjunctival staining score, corneal sensitivity, tear MMP-9 levels, meibum gland, tear meniscus height, corneal nerves and immune/inflammatory cells change, conjunctival hyperemia, ocular surface disease index questionnaire score will be assessed and compared at baseline, week-4, and week-8. Discussion This study will be a standardized, scientific, clinical trial designed to evaluate the therapeutic effects and safety of DQS and HA for diabetic related dry eye treatment. Ethics and dissemination: This study will be approved by the Ethics Committee of He Eye Specialist Hospital [ethics approval number: IRB (2022) K002.01]. Prior to participating in the trial, all patients will provide written informed permission. The outcomes of this study will be presented at local and international conferences and submitted for publication in journals with peer review. Trial registration number : Clinicaltrials.gov NCT04980144 {2a, 2b}