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

Lanza, Nicole L.; McClellan, Allison L.; Batawi, Hatim; Felix, Elizabeth R.; Sarantopoulos, Konstantinos D.; Levitt, Roy C.; Galor, Anat

doi:10.1016/j.jtos.2015.12.007

Cited by 62 publications

(53 citation statements)

References 40 publications

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“…Thirty-nine percent were positive for elevated levels of MMP-9. No statistical difference was found in the symptoms or signs of dry eye patients that tested positive or negative for elevated MMP-9 22. Thus, it is not possible to identify patients who have ocular inflammation based on a profile of their symptoms or signs.…”

Section: Introductionmentioning

confidence: 91%

“…Most dry eye testing methods such as tear breakup time (TBUT), Schirmer tear testing, tear osmolarity, and diagnostic imaging methods such as inferometry, meibomography, corneal topography, and ocular coherence tomography provide valuable information to help characterize patients as evaporative or aqueous deficient but cannot predict which patients have clinically significant ocular surface inflammation 22. However, the presence of corneal and/or conjunctival staining with a vital dye is a clinical indicator of inflammation and directly correlates to the levels of inflammatory mediators and MMP-9.…”

Section: Introductionmentioning

confidence: 99%

“…Lanza et al enrolled 110 patients with dry eye symptoms and measured Schirmer levels, TBUT, osmolarity, and MMP-9 22. Thirty-nine percent were positive for elevated levels of MMP-9.…”

Section: Introductionmentioning

confidence: 99%

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Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye

Sambursky¹

2016

OPTH

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BackgroundThe presence of clinically significant inflammation has been confirmed in the tears of 40%–65% of patients with symptoms of dry eye. Ocular surface inflammation may lead to tear film instability, epithelial cell irregularities, and permeability, resulting in chronic symptomatic pain and fluctuating vision as well as negative surgical outcomes.Patients and methodsA retrospective single center medical chart review of 100 patients was conducted. All patients were tested with the InflammaDry test to determine if patients exhibited elevated levels of matrix metalloproteinase 9 (MMP-9). InflammaDry-positive patients were started on a combination of cyclosporine 0.05% twice daily, 2,000–4,000 mg oral omega-3 fatty acids, and frequent artificial tear replacement. InflammaDry-negative patients were started on 2,000–4,000 mg of oral omega-3 fatty acids and frequent artificial tear replacement. Each patient was retested at ~90 days. A symptom questionnaire was performed at the initial visit and at 90 days.Results60% of the patients with dry eye symptoms tested positive for elevated MMP-9 at the initial visit. 78% of all patients returned for follow-up at ~90 days including 80% (48/60) of the previously InflammaDry-positive patients and 75% (30/40) of the previously InflammaDry-negative patients. A follow-up symptom questionnaire reported at least 75% symptomatic improvement in 65% (31/48) of the originally InflammaDry-positive patients and in 70% (21/30) of the initially InflammaDry-negative patients. Symptomatic improvement of at least 50% was reported in 85% (41/48) of previously InflammaDry-positive patients and 86% (26/30) of previously InflammaDry-negative patients. Following treatment, 54% (26/48) of previously InflammaDry-positive patients converted to a negative InflammaDry result.ConclusionIdentifying which symptomatic dry eye patients have underlying inflammation may predict patient responses to treatment and influence clinical management strategies.

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Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

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Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye

Sambursky¹

2016

OPTH

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“…70 Using a quantitative immunobead assay, tear MMP-9 concentration was directly correlated to tear osmolarity and inversely correlated to Schirmer test scores that are a measure of tear production. 71 In a study measuring tear MMP-9 activity rather than concentration, MMP-9 activity increased with categorical severity of tear dysfunction using the Dry Eye Workshop (DEWS) criteria and tear MMP-9 activities showed significant positive correlation with symptom severity scores, corneal and conjunctival fluorescein staining, topographic surface regularity index and percentage area of abnormal superficial corneal epithelia measured by confocal microscopy, and inverse correlation with low-contrast visual acuity and fluorescein tear break-up time.…”

mentioning

confidence: 99%

Matrix metalloproteinase-9 in the pathophysiology and diagnosis of dry eye syndrome

Pflugfelder¹,

Bian²,

Paiva³

2017

MNM

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Dry eye and tear dysfunction are common ocular disorders that cause cornea barrier disruption resulting in a poorly lubricated and irregular cornea epithelium, eye irritation and blurred vision. Increased levels and activities of matrix metalloproteinases (MMPs), particularly MMP-9, have been detected in the tears and ocular surface epithelial and inflammatory cells in dry eye. MMPs have been found to participate in disruption of tight junctions in the apical cornea epithelium leading to their accelerated desquamation and barrier disruption. This review summarizes evidence showing the contribution of MMPs to dry eye pathogenesis and their roles as biomarkers and therapeutic targets. Keywords: matrix metalloproteinase, dry eye, keratitis sicca, cornea, barrier function, Sjögren syndrome Dry eye overviewDry eye and tear dysfunction are common ocular disorders that cause cornea barrier disruption resulting in a poorly lubricated and irregular cornea epithelium, eye irritation and blurred vision. It affects millions of people worldwide and is one of the most frequent conditions for which patients seek eye care.1 Aging and female sex are significant risk factors for dry eye which increases in prevalence around the fifth decade, with further increase every decade thereafter.2-13 Prevalence of dry eye varies from 2% to 50%, depending on the population studied and the diagnostic criteria for dry eye (symptom questionnaire vs. objective signs). [1][2][3]6,7,[9][10][11][14][15][16][17][18][19][20][21][22][23] There is scarce information about the natural history of dry eye, but there is a recognized disconnection between signs and symptoms; patients tend to be more symptomatic at early stages.24,25 Dry eye causes corneal irregularity [26][27][28] and decreases functional vision by altering contrast sensitivity [29][30][31] and, therefore, decreases quality of life with a significant burden on the individual as well as the society. 23,[32][33][34][35] A meta-analysis of 22 published studies showed increased odds ratio for depression and anxiety in patients with ocular Sjögren syndrome (SS). 36 There is increased evidence that dry eye is an inflammatory disease, and this review will focus on matrix metalloproteinases (MMPs) and their role in the pathogenesis of dry eye. Cornea barrier disruption is a feature of dry eyeAs the principal lens of the eye, the cornea has unique features to maintain its transparency and smooth surface that include a lack of blood vessels and a multilayered stratified, non-cornifying epithelium. The differentiated apical epithelial cells produce

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“…19 While there are no currently available clinical assays to measure MMP-9 activity, there is an approved point-of-care MMP-9 tear immunoassay that detects levels of MMP-9 about a certain threshold. 43,44 In one clinical series, this test was positive in 39% of patients experiencing ocular irritation; however, a positive result did not correlate with severity of ocular surface dye staining, so this test it may prove to be useful method to identify higher levels of ocular surface inflammation in symptomatic patients. 44 …”

Section: Grading Severity Of Ocular Surface Diseasementioning

confidence: 98%

Tear Volume-based Diagnostic Classification for Tear Dysfunction

Pflugfelder¹,

Gümüş²,

Feuerman³

et al. 2017

International Ophthalmology Clinics

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Dysfunction of one or more components of the lacrimal functional unit results in an unstable tear film that can trigger eye irritation or cause ocular surface disease. There are distinct differences in the pattern of cornea and conjunctival disease and inflammation between aqueous deficient and aqueous sufficient tear dysfunction. There are accurate commercially available methods to measure tear volume. Diagnostic classification based on tear volume can guide therapy and identify patients with higher risk of developing disabling ocular surface disease or irritation.

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

Cited by 62 publications

References 40 publications

Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye

Presence or absence of ocular surface inflammation directs clinical and therapeutic management of dry eye

Matrix metalloproteinase-9 in the pathophysiology and diagnosis of dry eye syndrome

Tear Volume-based Diagnostic Classification for Tear Dysfunction

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