Evaluation of Ocular Surface Characteristics in Dry Eye Disease With and Without Soft Contact Lens Wear: A Comparative Study

Abstract

Objectives: To investigate ocular surface alterations and in vivo confocal microscopic characteristics of the cornea in dry eye disease (DED) with contact lens wear (CLW). Methods: Sixty participants were divided into three groups: DED with CLW (n=20), DED without CLW (n=20), and normal control (n=20). Ocular surface parameters were evaluated. Basal tears and in vivo confocal microscopy images of the cornea were collected. Multiplex bead analysis was used to assess interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, nerve growth factor (NGF), and substance P (SP) in tears. Nerve morphology and dendritic cell density in corneal subbasal nerve images were calculated. Results: The DED with CLW group showed significantly higher ocular surface staining scores (P=0.022) and higher levels of IL-1β, NGF, and SP in tears (P=0.014, P=0.004 and P=0.025) than the DED without CLW group. Corneal dendritic cell density in the DED with CLW group was significantly higher than that in the normal controls (P=0.001) and DED without CLW group (P=0.043). Tear cytokine levels of IL-1β, NGF, and SP were correlated with ocular surface parameters in the DED with CLW group. Moreover, the years of CLW were positively correlated with corneal dendritic cell density (r=0.527, P=0.017) and negatively correlated with corneal nerve density (r=−0.511, P=0.021). Conclusions: Patients with DED with CLW showed greater epithelial damage, elevated inflammatory cytokines and neuromediators in tears, and higher corneal dendritic cell density than patients with DED without CLW. The immune and nervous systems may be involved in contact lens–related DED.

The impact of dry eye disease on corneal nerve parameters: A systematic review and meta‐analysis

“…Of the 22 included studies, a majority were observational studies including 17 cross-sectional controlled studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and four retrospective case-control studies. [36][37][38][39] Comparisons between DED groups and healthy controls at baseline were undertaken in one randomised controlled trial.…”

“…All included studies mentioned the diagnosis of DED using a combination of symptoms and signs. Ten studies outlined diagnostic methods without reference to published criteria, 20,22,24,27,31,34,36,37,39,40 while seven referred to the TFOS DEWS II, 19,23,25,26,29,30,33 three referred to TFOS DEWS I, 28,32,38 one referred to the 2005 Japanese Dry Eye diagnostic criteria 21 and one referred to the 2013 Chinese Clinical Diagnosis and Treatment Experts Consensus of Dry Eye. 35 Further details on the diagnostic methods are outlined in Table S5.…”

“…The degree of twistedness of nerves which could be classified according to a subjective grading system or custom aggregate measure the location of the cornea imaged, all of them included the central cornea, [19][20][21]23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] with three studies also imaging additional locations: one included the lower third of the cornea, 21 one included mid-peripheral locations (approximately 5 mm in diameter including the central cornea) 19 and one imaged the upper, lower, nasal and temporal cornea. 34 The number of outcome assessors involved in analysing the images obtained were specified in 17 studies: seven studies involved one outcome assessor, 23,26,28,[30][31][32]38 10 studies involved two outcome assessors, 19,21,22,27,33,34,36,37,39,40 while the remaining five studies did not specify the number of outcome assessors involved. 20,24,25,29,…”

“…34 The number of outcome assessors involved in analysing the images obtained were specified in 17 studies: seven studies involved one outcome assessor, 23,26,28,[30][31][32]38 10 studies involved two outcome assessors, 19,21,22,27,33,34,36,37,39,40 while the remaining five studies did not specify the number of outcome assessors involved. 20,24,25,29,35 In terms of image analysis, 10 studies primarily used NeuronJ which is a plug-in program of ImageJ with semiautomated capabilities (ImageJ.org), 19,22,27,28,30,[36][37][38][39][40] four used the ACCMetrics software with automated capabilities (University of Manchester, sites.manch ester.ac.uk/ ccm-image -analy sis/), 23,26,31,33 two used manual analysis using the ImageJ software, 21,35 two used unspecified manual analysis, 20,32 one used CNS-Net 25 and one used unspecified methods. 24 One study used a combination of NeuronJ and ACCMetrics.…”

“…34 Five studies [20][21][22]28,32 that also graded nerve tortuosity used a manual grading scale, 41 while two studies used a custom aggregate termed Tagg. 29,33 Eighteen studies specified the number of eyes analysed from each participant: nine studies analysed one eye only, 19,21,22,28,29,32,33,38,39 five studies analysed two eyes 25,27,30,34,40 and four studies analysed two eyes for DED participants but one eye for healthy controls. 26,31,36,37 The number of images analysed per eye were provided in 20 studies: eight analysed three images, 20,21,27,32,36,37,39,40 nine analysed five images, 22,23,26,[28][29][30][31]34,38 one analysed 10 images, 19 one analysed ≥10 images 25 and one analysed ≥5 images.…”