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Short-Term Effects of Ground-Level Ozone in Patients With Dry Eye Disease: A Prospective Clinical Study

Short-Term Effects of Ground-Level Ozone in Patients With Dry Eye Disease: A Prospective Clinical... Purpose: To investigate changes in the clinical features of patients with dry eye disease (DED) according to short-term outdoor ground-level ozone exposure. Methods: This prospective observational study included patients with DED who were treated with the same topical drugs (0.05% cyclosporine or 3% diquafosol) and visited the hospital twice at 2-month intervals. Patients who showed a short tear film breakup time and positive ocular surface staining were assigned to the diquafosol and cyclosporine groups, respectively. The ocular surface disease index (OSDI) score, tear secretion, tear film breakup time, and corneal fluorescein staining score were measured at each visit. The mean ground-level ozone concentration for 1 week before the ocular examinations was used as the ozone exposure level. Changes in dry eye parameters according to changes in ozone concentration were analyzed using univariate and multivariate linear analyses. Results: Thirty-three patients were included in the analysis. The mean age was 55.2 ± 10.5 years. Ozone concentrations were significantly associated with increased OSDI scores (R = 0.304, P = 0.0006) and a decreased tear secretion (R = −0.355, P = 0.0012) in univariate models. In multivariate models, the results were consistent; the OSDI score increased by 3.43 points (β = 3.43, P = 0.002), and tear secretion decreased by 1.43 mm (β = −1.43, P = 0.015) per 0.01 ppm increase in ozone concentrations over a 2-month interval. Notably, the cyclosporine group showed more prominent changes in the OSDI score and tear secretion with changes in the ozone concentration (P < 0.05). Conclusions: Short-term exposure to increased ground-level ozone concentration led to increased ocular discomfort and decreased tear secretion in patients with DED. *Department of Ophthalmology, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea; †Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; ‡Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea; and §Gachon Particulate Matter Associated Disease Institute, Gachon University, Incheon, Korea. Correspondence: Dong Hyun Kim, MD, PhD, Department of Ophthalmology, Gachon University College of Medicine, Gil Medical Center 1198, Guwol-dong, Namdong-Gu, Incheon 21565, Korea (e-mail: [email protected]). This work was supported by the Gachon University Gil Medical Center (Grant number: GCU-2016-5202) The authors have no conflicts of interest to disclose. Y.-H. Choi and D. H. Kim contributed equally to this study, and Y.-H. C. should be considered a co-corresponding author. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.corneajrnl.com). Received March 12, 2019 Received in revised form May 13, 2019 Accepted May 15, 2019 Online date: July 3, 2019 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Cornea Wolters Kluwer Health

Short-Term Effects of Ground-Level Ozone in Patients With Dry Eye Disease: A Prospective Clinical Study

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Publisher
Wolters Kluwer Health
ISSN
0277-3740
eISSN
1536-4798
DOI
10.1097/ICO.0000000000002045
Publisher site
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Abstract

Purpose: To investigate changes in the clinical features of patients with dry eye disease (DED) according to short-term outdoor ground-level ozone exposure. Methods: This prospective observational study included patients with DED who were treated with the same topical drugs (0.05% cyclosporine or 3% diquafosol) and visited the hospital twice at 2-month intervals. Patients who showed a short tear film breakup time and positive ocular surface staining were assigned to the diquafosol and cyclosporine groups, respectively. The ocular surface disease index (OSDI) score, tear secretion, tear film breakup time, and corneal fluorescein staining score were measured at each visit. The mean ground-level ozone concentration for 1 week before the ocular examinations was used as the ozone exposure level. Changes in dry eye parameters according to changes in ozone concentration were analyzed using univariate and multivariate linear analyses. Results: Thirty-three patients were included in the analysis. The mean age was 55.2 ± 10.5 years. Ozone concentrations were significantly associated with increased OSDI scores (R = 0.304, P = 0.0006) and a decreased tear secretion (R = −0.355, P = 0.0012) in univariate models. In multivariate models, the results were consistent; the OSDI score increased by 3.43 points (β = 3.43, P = 0.002), and tear secretion decreased by 1.43 mm (β = −1.43, P = 0.015) per 0.01 ppm increase in ozone concentrations over a 2-month interval. Notably, the cyclosporine group showed more prominent changes in the OSDI score and tear secretion with changes in the ozone concentration (P < 0.05). Conclusions: Short-term exposure to increased ground-level ozone concentration led to increased ocular discomfort and decreased tear secretion in patients with DED. *Department of Ophthalmology, Gachon University College of Medicine, Gil Medical Center, Incheon, Korea; †Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea; ‡Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea; and §Gachon Particulate Matter Associated Disease Institute, Gachon University, Incheon, Korea. Correspondence: Dong Hyun Kim, MD, PhD, Department of Ophthalmology, Gachon University College of Medicine, Gil Medical Center 1198, Guwol-dong, Namdong-Gu, Incheon 21565, Korea (e-mail: [email protected]). This work was supported by the Gachon University Gil Medical Center (Grant number: GCU-2016-5202) The authors have no conflicts of interest to disclose. Y.-H. Choi and D. H. Kim contributed equally to this study, and Y.-H. C. should be considered a co-corresponding author. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.corneajrnl.com). Received March 12, 2019 Received in revised form May 13, 2019 Accepted May 15, 2019 Online date: July 3, 2019

Journal

Cornea – Wolters Kluwer Health

Published: Dec 1, 2019

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