Clinical Trial Details
— Status: Not yet recruiting
Administrative data
NCT number |
NCT04711642 |
Other study ID # |
Dry Eye and Cataract Surgery |
Secondary ID |
|
Status |
Not yet recruiting |
Phase |
Phase 3
|
First received |
|
Last updated |
|
Start date |
January 15, 2021 |
Est. completion date |
July 15, 2023 |
Study information
Verified date |
January 2021 |
Source |
Fundación Oftalmológica Los Andes |
Contact |
Felipe Valenzuela Santana, MD |
Phone |
23704633 |
Email |
felipevalenz[@]gmail.com |
Is FDA regulated |
No |
Health authority |
|
Study type |
Interventional
|
Clinical Trial Summary
Ocular surface disease (OSD), particularly dry eye, is one of the most common conditions seen
by ophthalmologists. Dry eye (DE) is a multifactorial disease of the tears and ocular surface
that results in symptoms of discomfort, visual disturbance, and tear instability. DE
significantly reduces quality of life and affects 5-30% of the population. As the proportion
of individuals over age 60 increases because of greater life expectancies, we can anticipate
the number of people with dry eye will also increase, which represents a major challenging
for aging societies, like the Chilean one.
In the last few years clinical research on OSD is being intensely focused on diagnostic
criteria, treatment strategies, methods used in diagnosis and better correlations between
symptoms and clinical test results. All these lines of interest aim to improve the
understanding of alterations and consequences occurring in the ocular surface disorders.
Diagnostic testing is greatly valuable both for the detection of early changes due to DE and
also to grade the severity of surface disease. The most commonly performed tests include the
Schirmer test, tear break up time (TBUT), and ocular surface staining. However, newer
point-of-care diagnostics tests such as tear osmolarity and matrix metalloprotease-9 (MMP-9)
have been shown to have a high sensitivity and specificity in diagnosing ocular surface
dysfunction.
Given that ocular surface dysfunction has been shown to have an adverse impact on visual
function and can worsen after surgery, it is critical to identify and address any tear film
and ocular surface abnormalities before cataract surgery. In the setting of preoperative
cataract surgery planning, DE disease and meibomian gland dysfunction can impair critical
refractive measures such as keratometry values worsening surgical outcomes.
To the best of our knowledge there are no ongoing or published studies that have evaluated DE
and OSD as evidenced by either an abnormal tear-film parameter (elevated MMP-9 or abnormal
osmolarity), or corneal surface and meibography evaluation findings (using novel non-invasive
technology) in patients previous and after cataract surgery.
Description:
A prospective randomized study has been designed to assess and characterize OSD/DE in
consecutive patients presenting for cataract surgery evaluation and to identify eventual
changes on biomarkers of the tear film of the same population postoperatively. At the same
time, 2 different postoperative eye drops regimen will be evaluated in order to determine its
impact on postoperative OSD/DE.
All group of patients will be subjected to Dry Eye assessment using diagnosis criteria and
methodologies recommended by the 2017 Dry Eye Workshop (DEWS II) (2), which includes the
assessment of a battery of symptoms (OSDI questionnaire), signs (tear meniscus height,
corneal and conjunctival lissamine green/fluorescein staining), laboratory tests (Schirmer I,
TBUT assessment, tear osmolarity, tear MMP-9, meibography, ocular redness, lipid layer
thickness) and physical examination (lid, meibum gland assessment). This assessment will be
carried out in all groups preoperative and at postoperative week 4 and postoperative week 12.
Altogether, by identifying definite changes either in novel tear film biomarkers or non
invasive ocular tests of patients subjected to cataract surgery, we expect to contribute to
the understanding of the pathophysiology of the OSD and Dry Eye associated to cataract
surgery and to give lights on the utility of those changes as biomarkers in diagnosis and
therapy assessment in these conditions committing the ocular surface.
The research hypothesis is that there is a high prevalence of ocular surface dysfunction
among patients presenting for cataract surgery as measured by point-of-care objective tear
tests and cataract surgery results in altered ocular surface in a major fraction of patients.
Dry eye symptoms are not necessary associated with objective signs in the ocular surface, but
are less in the group of patients treated with associated lubricant eyedrops postoperatively.
Patients more symptomatic in the postoperative period tend to have multiple preoperative
OSD/DE biomarkers altered.
Consecutive patients presenting for cataract surgery evaluation will be recruited at the
Fundacion Oftalmologica Los Andes (FOLA) Ophthalmology Clinic (Santiago, Chile). Patients
will be eligible according to inclusion and exclusion criteria indicated. Eligible patients
will be invited to participate voluntary in the study. The study will comprise three groups
with 30-35 patients per group. Dry eye patients will be diagnosed according to TFOS DEWS II
report and to the recommendations of the Dry Eye Workshop of 2017. It will basically consist
of: a) patient history: symptoms and signs (e.g. ocular irritation, dryness or foreign body
sensation, redness, etc), exacerbating conditions, duration of symptoms, etc., will be
obtained by using the Ocular Surface Disease Index (OSDI). b) physical examination: visual
acuity measurement, external examination and slit lamp biomicroscopy (tear film, tear
meniscus, eyelashes, eyelid margins, conjunctiva, cornea, lens and retina). c) Diagnostic
tests: Tear film osmolarity (using Tearlab), Tear film MMP-9 levels (using InflammaDry).
Non-invasive tests will be performed using Keratograph 5M, which includes: non-invasive tear
film break up time tear meniscus height, lipid layer thickness, ocular redness and
meibography.
The study will comprise three groups. Each group will comprise 30-35 patients. Each of the
100 patients will be featured by a list of clinical parameters (ocular signs and symptoms and
laboratory tests used conventionally for Dry Eye diagnostic). It is expected to observe
differences in parameters before and after cataract surgery and between the control group and
the two interventional groups. Association of those differences with the type of
postoperative regimen will be defined statistically by using Student t-test and ANOVA for
parametric data and U-test of Mann-Whitney for non-parametric data (p<0.05 will be taken as
significant). Altogether, it is expected that such a multiplicity of signs and symptoms will
give valuable data on specificities of Dry Eye after cataract surgery.
All the participant surgeons will have a summary document of the inclusion and exclusion
criteria and a flowchart of the patient's enrollment process to improve compliance. The data
will be stored on an external digital platform and only the data analyst will have access to
it. In addition, there will be written records of each enrolled patient.