Purpose

To demonstrate the effects of prolonged silent reading on tear film and ocular surface parameters.

Design

Prospective, observational clinical study.

Participants

A total of 177 patients with dry eye and 34 normal controls aged 50 years and older.

Methods

After evaluating symptoms using the Ocular Surface Disease Index (OSDI) questionnaire, the following tests were performed in consecutive order: automated noninvasive tear break-up time (TBUT), surface asymmetry and regularity indices, Schirmer’s testing without anesthesia, corneal staining using fluorescein, and conjunctival staining using lissamine green. The participants were then asked to read a 30-minute validated passage silently. The tests were repeated after the reading task.

Main Outcome Measures

Changes in tear film and ocular surface parameters after reading.

Results

All parameters, with the exception of surface asymmetry index, worsened after the reading task in patients with dry eye and in controls. The worsening reached a statistical significance for corneal and conjunctival staining in the dry eye group (P < 0.001) and for corneal staining in the control group (P < 0.01). At baseline, OSDI scores correlated only with corneal and conjunctival staining scores (r = 0.19, P = 0.006 and r = 0.27, P < 0.001). Among postreading measurements, baseline OSDI scores correlated with TBUT (r = −0.15, P = 0.03) in addition to corneal and conjunctival staining (r = 0.25, P < 0.001 and r = 0.22, P = 0.001). Changes in TBUT and Schirmer’s test correlated significantly with their respective baseline values (r = −0.61, P < 0.001 and r = −0.44, P < 0.001), indicating that the more unstable the tear film and the lower the aqueous tear secretion, the worse they became after the prolonged reading task. Worsening in corneal staining directly correlated with the baseline conjunctival staining (r = 0.17, P = 0.02) and surface regularity index (r = 0.21, P = 0.01).

Conclusions

Evaluating tear film and ocular surface parameters at rest may miss clinical findings brought about by common everyday tasks such as reading, leading to discordance between patient-reported symptoms and clinician-observed signs. Quantifying dry eye after visually straining activities such as prolonged silent reading may help better understand patient symptomatology.

中文翻译：

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长时间阅读对干眼症的影响

目的

证明长时间静默阅读对泪膜和眼表参数的影响。

设计

前瞻性，观察性临床研究。

参加者

共有177名干眼症患者和34名年龄在50岁以上的正常对照。

方法

在使用眼表疾病指数（OSDI）问卷评估症状后，依次进行以下测试：自动无创撕裂时间（TBUT），表面不对称性和规律性指数，无麻醉的Schirmer's测试，使用荧光素的角膜染色，和结膜染色用丽萨明绿。然后要求参与者静默阅读30分钟的经过验证的文章。阅读任务结束后，重复进行测试。

主要观察指标

阅读后眼泪膜和眼表参数的变化。

结果

在阅读任务后，干眼患者和对照组的所有参数（表面不对称指数除外）都会恶化。在干眼组中，角膜和结膜染色的恶化达到了统计学意义（P < 0.001），在对照组中，角膜染色的恶化达到了统计学意义（P < 0.01）。在基线时，OSDI评分仅与角膜和结膜染色评分相关（r = 0.19，P = 0.006和r = 0.27，P < 0.001）。在阅读后的测量中，除角膜和结膜染色外，基线OSDI评分还与TBUT相关（r = -0.15，P = 0.03）（r = 0.25，P < 0.001和r = 0.22，P =0.001）。TBUT和Schirmer检验的变化与它们各自的基线值显着相关（r = -0.61，P < 0.001和r = -0.44，P < 0.001），这表明泪液膜越不稳定，泪液水分泌越低，更糟糕的是，他们在长时间的阅读任务之后变得更糟。角膜染色的恶化与基线结膜染色（r = 0.17，P = 0.02）和表面规则指数（r = 0.21，P = 0.01）直接相关。

结论

评估静止时的泪膜和眼表参数可能会错过日常日常任务（例如阅读）带来的临床发现，从而导致患者报告的症状与临床医生观察到的症状不一致。视觉疲劳活动（例如长时间的无声阅读）后对干眼进行量化可能有助于更好地了解患者的症状。