Pult Heiko, Purslow Christine, Berry Monica, Murphy Paul J
School of Optometry and Vision Sciences, Contact Lens and Anterior Eye Research Unit (CLAER) Group, Cardiff University, Wales, United Kingdom.
Optom Vis Sci. 2008 Oct;85(10):E924-9. doi: 10.1097/OPX.0b013e3181888909.
Although comfort is important for contact lens wearers, common clinical tests can fail to predict patients' symptoms. Lid wiper epitheliopathy (LWE) and lid parallel conjunctival folds (LIPCOF) are related to dry eye symptoms in lens wearers. This study investigates the predictive value of LWE and LIPCOF as objective measures of discomfort, and their relation to the ocular surface in soft contact lens wearers.
Subjects were classified as symptomatic or asymptomatic, using the Contact Lens Dry Eye Questionnaire (CLDEQ). Pre-lens tear break-up time (PLBUT), limbal and bulbar hyperaemia, corneal staining, LWE and LIPCOF were assessed in the right eyes of 61 (23 M, 38 F; mean age 32.1 years; range = 18 to 55) experienced contact lens wearers. Differences between groups, and relationships between LWE, LIPCOF (nasal, temporal and sum) and objective signs were examined using non-parametric analyses. The positive and negative predictive values for symptoms of each objective measure were calculated.
Thirty eight subjects were classified as asymptomatic, 23 symptomatic. LWE and LIPCOF severity scores were significantly increased in symptomatic patients (U-test, p < 0.03), while no significant differences were found between groups for PLBUT, corneal staining or hyperaemia (0.29 < p < 0.88). Significant positive correlations were found between LWE and LIPCOF scores (temporal r = 0.67, p < 0.001; nasal r = 0.39, p < 0.001), and between LWE and hyperaemia (bulbar, r = 0.28, p < 0.001; limbal r = 0.36, p < 0.001). Age and gender were different in the two groups (p < 0.05). The predictive value of temporal LIPCOF was positive = 56.9%, negative = 77.1% with a cutoff value of > or =2 (PPV/NPV/cutoff value), of nasal LIPCOF 70.7%/75.0%/> or =1, of LIPCOF Sum 79.8%/86.5%/> or =2, and of LWE 53.1%/81.1%/> or =1.
Contact lens wearers with dryness symptoms exhibit significantly more LWE and LIPCOF, but not increased corneal staining, bulbar hyperaemia or decreased PLBUT. LWE and LIPCOF are significantly correlated: this may reflect their common frictional origin. LIPCOF Sum severity scores appear to be most predictive for symptoms.
尽管舒适度对隐形眼镜佩戴者很重要，但常见的临床测试可能无法预测患者的症状。睑板腺擦拭上皮病变（LWE）和睑结膜平行皱襞（LIPCOF）与隐形眼镜佩戴者的干眼症状有关。本研究调查LWE和LIPCOF作为不适客观指标的预测价值，以及它们与软性隐形眼镜佩戴者眼表的关系。
使用隐形眼镜干眼问卷（CLDEQ）将受试者分为有症状组和无症状组。对61名（23名男性，38名女性；平均年龄32.1岁；范围 = 18至55岁）有经验的隐形眼镜佩戴者的右眼评估镜片前泪膜破裂时间（PLBUT）、角膜缘和球结膜充血、角膜染色、LWE和LIPCOF。使用非参数分析检查组间差异以及LWE、LIPCOF（鼻侧、颞侧和总和）与客观体征之间的关系。计算每个客观指标症状的阳性和阴性预测值。
38名受试者被分类为无症状，23名有症状。有症状患者的LWE和LIPCOF严重程度评分显著增加（U检验，p < 0.03），而PLBUT、角膜染色或充血在组间未发现显著差异（0.29 < p < 0.88）。LWE和LIPCOF评分之间存在显著正相关（颞侧r = 0.67，p < 0.001；鼻侧r = 0.39，p < 0.001），LWE与充血之间也存在显著正相关（球结膜，r = 0.28，p < 0.001；角膜缘r = 0.36，p < 0.001）。两组的年龄和性别不同（p < 0.05）。颞侧LIPCOF的预测价值为阳性 = 56.9%，阴性 = 77.1%，临界值≥2（PPV/NPV/临界值），鼻侧LIPCOF为70.7%/75.0%/≥1，LIPCOF总和为79.8%/86.5%/≥2，LWE为53.1%/81.1%/≥1。
有干眼症状的隐形眼镜佩戴者表现出明显更多的LWE和LIPCOF，但角膜染色、球结膜充血未增加或PLBUT未降低。LWE和LIPCOF显著相关：这可能反映了它们共同的摩擦起源。LIPCOF总和严重程度评分似乎对症状最具预测性。
