Image-guided evaluation and monitoring of treatment response in patients with dry eye disease.
BACKGROUND
Dry eye disease (DED) is one of the most common ocular disorders worldwide. The pathophysiological mechanisms involved in the development of DED are not well-understood, and thus treating DED has been a significant challenge for ophthalmologists. Most of the currently available diagnostic tests demonstrate low correlation to patient symptoms and have low reproducibility.


METHODS
Recently, sophisticated in vivo imaging modalities have become available for patient care, namely, in vivo confocal microscopy (IVCM) and optical coherence tomography (OCT). These emerging modalities are powerful and non-invasive, allowing real-time visualization of cellular and anatomical structures of the cornea and ocular surface. Here we discuss how, by providing both qualitative and quantitative assessment, these techniques can be used to demonstrate early subclinical disease, grade layer-by-layer severity, and allow monitoring of disease severity by cellular alterations. Imaging-guided stratification of patients may also be possible in conjunction with clinical examination methods.


CONCLUSIONS
Visualization of subclinical changes and stratification of patients in vivo allows objective image-guided evaluation of tailored treatment response based on cellular morphological alterations specific to each patient. This image-guided approach to DED may ultimately improve patient outcomes and make it possible to study the efficacy of novel therapies in clinical trials.
Cornea and Ocular Surface Imaging Center, Department of Ophthalmology- Cornea Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
Yureeda
Y
Qazi
Cornea and Ocular Surface Imaging Center, Department of Ophthalmology- Cornea Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
Shruti
S
Aggarwal
Cornea and Ocular Surface Imaging Center, Department of Ophthalmology- Cornea Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA.
Pedram
P
Hamrah
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000188:drug therapy; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D065346:Lubricant Eye Drops; D054327:Lubricants / Q000008:administration & dosage; D008537:Meibomian Glands / Q000187:drug effects / Q000473:pathology*; D018613:Microscopy, Confocal; D008991:Monitoring, Physiologic; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D065346:Lubricant Eye Drops; D054327:Lubricants