Klin Monbl Augenheilkd 2022; 239(06): 804-811
DOI: 10.1055/a-1353-5747
Experimentelle Studie

Evaluation of the Significance of Tear Ferning Patterns in beta-Thalassemia Patients

Bewertung der Bedeutung von Tränenfarnmustern bei Patienten mit Beta-Thalassämie
1   Department of Optometry, King Saud University, Riyadh, Saudi Arabia
,
Ibrahim M. Abbadi
1   Department of Optometry, King Saud University, Riyadh, Saudi Arabia
,
Ali Abusharha
1   Department of Optometry, King Saud University, Riyadh, Saudi Arabia
,
Mana A. Alanazi
1   Department of Optometry, King Saud University, Riyadh, Saudi Arabia
,
Hafiz Malhan
2   Hematology department, Prince Mohammed Bin Nasser Hospital, Gizan, Saudi Arabia
,
Gamal A. El-Hiti
1   Department of Optometry, King Saud University, Riyadh, Saudi Arabia
,
Ali M. Masmali
1   Department of Optometry, King Saud University, Riyadh, Saudi Arabia
› Author Affiliations

Abstract

Aim This study was designed to evaluate the tear film in beta-thalassemia patients using tear ferning (TF) and phenol red thread (PRT) tests.

Methods Forty beta-thalassemia patients, aged 18 – 38 years (25.7 ± 6.0 years), along with a control group of 40 age-matched subjects with healthy eyes completed the study. All subjects completed the ocular surface disease index (OSDI) first, followed by the TF and PRT tests with a 5-minute gap between the tests.

Results Significant differences (Wilcoxon test, p < 0.05) were observed between the beta-thalassemia and control groups in all scores. Among beta-thalassemia patients, OSDI scores indicated eye dryness in 35 subjects (87.5%). PRT showed dryness in 31 subjects (77.5%) in the right and left eyes, and the TF grades were ≥ 2 for the tears collected from 35 subjects (87.5%). There was a strong correlation (r = 0.851, p = 0.001) between the PRT measurements in the right and left eyes. There was a medium correlation between OSDI and TF scores (r = 0.309, p = 0.026) and between OSDI and age (r = 0.365, p = 0.010). Age had a moderate negative correlation (r = − 0.328, p = 0.019) with the PRT obtained from the right eye.

Conclusion Significant ocular dryness symptom was observed in beta-thalassemia patients, based on the scores collected from TF and PRT tests. Beta-thalassemia patients develop dry eyes, possibly due to several factors, including reduced tear secretion. Therefore, it is important to regularly evaluate both the quality and quantity of tears in patients with beta-thalassemia.

Zusammenfassung

Ziel Diese Studie wurde entwickelt, um den Tränenfilm bei Patienten mit Beta-Thalassämie mithilfe von Tränenfarn-Tests (TF) und Phenolrotfaden-Tests (PRT) zu bewerten.

Methoden 40 Patienten mit Beta-Thalassämie im Alter von 18 bis 38 Jahren (25,7 ± 6,0 Jahre) sowie eine Kontrollgruppe von 40 altersentsprechenden Probanden mit gesunden Augen beendeten die Studie. Alle Probanden absolvierten zuerst den OSDI (Ocular Surface Disease Index), gefolgt von den TF- und PRT-Tests mit einem Abstand von 5 Minuten zwischen den Tests.

Ergebnisse In allen Scores wurden signifikante Unterschiede (Wilcoxon-Test, p < 0,05) zwischen der Beta-Thalassämie und den Kontrollgruppen beobachtet. Bei Patienten mit Beta-Thalassämie zeigten die OSDI-Werte bei 35 Probanden (87,5%) eine Augentrockenheit. PRT zeigte Trockenheit bei 31 Probanden (77,5%) im rechten und linken Auge, und die TF-Grade waren ≥ 2 für die von 35 Probanden (87,5%) gesammelten Tränen. Es gab eine starke Korrelation (r = 0,851; p = 0,001) zwischen den PRT-Messungen im rechten und linken Auge. Es gab eine mittlere Korrelation zwischen OSDI- und TF-Werten (r = 0,309; p = 0,026) und zwischen OSDI und Alter (r = 0,365; p = 0,010). Das Alter hatte eine mittlere negative Korrelation (r = − 0,328; 0,019) mit der vom rechten Auge erhaltenen PRT.

Schlussfolgerung Bei Patienten mit Beta-Thalassämie wurde ein signifikantes Symptom der Augentrockenheit beobachtet, das auf den Ergebnissen von Tränenfarn- und Phenolrotfaden-Tests basiert. Beta-Thalassämie-Patienten entwickeln trockene Augen, möglicherweise aufgrund verschiedener Faktoren, wie z. B. einer verringerten Tränensekretion. Daher ist es wichtig, bei Patienten mit Beta-Thalassämie regelmäßig sowohl die Qualität als auch die Quantität der Tränen zu bewerten.



Publication History

Received: 31 October 2020

Accepted: 03 January 2021

Article published online:
19 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Balarajan Y, Ramakrishna U, Ozaltin E. et al. Anaemia in low-income and middle-income countries. Lancet 2011; 378: 2123-2135
  • 2 Stoltzfus RJ, Mullany L, Black RE. Iron deficiency anaemia. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL. eds. Comparative Quantification of Health risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors. Geneva: World Health Organization; 2004: 163-209
  • 3 Haas JD, Brownlie T. Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. J Nutr 2001; 131: 676S-690S
  • 4 Steer PJ. Maternal hemoglobin concentration and birth weight. Am J Clin Nutr 2000; 71: 1285S-1287S
  • 5 Lozano R, Naghavi M, Foreman K. et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2095-2128
  • 6 Brancaleoni V, Di Pierro E, Motta I. et al. Laboratory diagnosis of thalassemia. Int J Lab Hematol 2016; 38: 32-40
  • 7 Angastiniotis M, Lobitz S. Thalassemias: an overview. Int J Neonatal Screen 2019; 5: 16
  • 8 Vichinsky E. Complexity of alpha thalassemia: growing health problem with new approaches to screening, diagnosis, and therapy. Ann N Y Acad Sci 2010; 1202: 180-187
  • 9 Srivorakun H, Fucharoen G, Sanchaisuriya K. et al. Diagnosis of common hemoglobinopathies among South East Asian population using capillary isoelectric focusing system. Int J Lab Hematol 2017; 39: 101-111
  • 10 Murphy JF, OʼRiordan J, Newcombe RG. et al. Relation of haemoglobin levels in first and second trimesters to outcome of pregnancy. Lancet 1986; 1: 992-995
  • 11 Shill KB, Karmakar P, Kibria MG. et al. Prevalence of iron-deficiency anaemia among university students in Noakhali Region. J Health Popul Nutr 2014; 32: 103-110
  • 12 Stevens GA, Finucane MM, De-Regil LM. et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health 2013; 1: e16-e25
  • 13 McLean E, Cogswell M, Egli I. et al. Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutr 2009; 12: 444-454
  • 14 Venkataraman A, Panda BP, Dey A. Nutritional anemia as a cause of vision loss in developing countries: a case report. Kerala J Ophthalmol 2013; 25: 383-384
  • 15 Mansour AM, Lee JW, Yahng SA. et al. Ocular manifestations of idiopathic aplastic anemia: retrospective study and literature review. Clin Ophthalmol 2014; 8: 777-787
  • 16 Liu J, Clermont AC, Gao BB. et al. Intraocular hemorrhage causes retinal vascular dysfunction via plasma kallikrein. Invest Ophthalmol Vis Sci 2013; 54: 1086-1094
  • 17 Charles KS, Leelah N, Boodoo L. et al. Ophthalmic manifestations of common haematological disorders. West Indian Med J 2013; 62: 99-103
  • 18 Tiwari M, Kulshrestha M, Chaudhary RR. Ocular Changes in Patients with Nutritional Anaemia in Rohilkhand Region. Indian J Appl Res 2018; 8: 21-22
  • 19 Keungk YK, Owen J. Iron deficiency and thrombosis: literature review. Clin Appl Thromb Hemost 2004; 10: 387-391
  • 20 Lang GE, Spraul CW, Lang GK. Ocular changes in primary hematologic diseases. Klin Monbl Augenheilkd 1998; 212: 419-427
  • 21 Holt JM, Gorden-Smith EC. Retinal abnormalities in diseases of the blood. Br J Ophthalmol 1969; 53: 145-159
  • 22 Shaheen N, Wani JS, Nasti AR. et al. Ocular manifestations in anaemia – a clinical study. JK Pract 2005; 12: 128-130
  • 23 Majji AB, Bhatia K, Mathai A. Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura. Indian J Ophthalmol 2010; 58: 234-263
  • 24 Dartt DA, Willcox MDP. Complexity of the tear film: importance in homeostasis and dysfunction during disease. Exp Eye Res 2013; 117: 1-3
  • 25 Sweeney DF, Millar TJ, Raju SR. Tear film stability: a review. Exp Eye Res 2017; 117: 28-38
  • 26 Georgiev GA, Eftimov P, Yokoi N. Structure-function relationship of tear film lipid layer: a contemporary perspective. Exp Eye Res 2017; 163: 17-28
  • 27 Masmali A, Alqahtani TA, Alharbi A. et al. Comparative study of repeatability of phenol red thread test versus Schirmerʼs test in normal adults in Saudi Arabia. Eye Contact Lens 2014; 40: 127-131
  • 28 Masmali AM, Alanazi SA, Almagren B. et al. Assessment of the tear film in normal eye subjects after consumption of a single dose of hot peppermint drink. Clin Optom (Auckl) 2019; 11: 39-45
  • 29 Masmali A, Alrabiah S, Alharbi A. et al. Investigation of tear osmolarity using the TearLab osmolarity system in normal adults in Saudi Arabia. Eye Contact Lens 2014; 40: 74-78
  • 30 Abusharaha A, Alturki AA, Alanazi SA. et al. An assessment of the tear evaporation rate in thyroid gland patients. Clin Ophthalmol 2019; 13: 131-135
  • 31 Alanazi SA, Abusharha A, Fagehi R. et al. Assessment of the tear evaporation rate in chronic smokers using Delfin VapoMeter. Int J Ophthalmol Vis Sci 2019; 4: 37-41
  • 32 Masmali MA, Al-Shehri A, Alanazi SA. et al. Assessment of tear film quality among smokers using tear ferning patterns. J Ophthalmol 2016; 2016: 8154315
  • 33 Masmali AM, Al-Bahlal JM, El-Hiti GA. et al. Repeatability and diurnal variation of tear ferning test. Eye Contact Lens 2015; 41: 262-267
  • 34 Masmali AM, Alotaibi AG, Alanazi SA. et al. The acute effect of a single dose of green tea on the quality and quantity of tears in normal eye subjects. Clin Ophthalmol 2019; 13: 605-610
  • 35 Masmali AM, Maeni YA, El-Hiti GA. et al. Investigation of ocular tear ferning in controlled and uncontrolled diabetic subjects. Eye Contact Lens 2018; 44: S70
  • 36 Alanazi SA, El-Hiti GA, Al-Baloud AA. et al. Effects of short-term oral vitamin A supplementation on the ocular tear film in patients with dry eye. Clin Ophthalmol 2019; 13: 599-604
  • 37 Schiffman RM, Christianson MD, Jacobsen G. et al. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol 2000; 118: 615-621
  • 38 Tang F, Wang J, Tang Z. et al. Accuracy of McMonnies Questionnaire as a Screening Tool for Chinese Ophthalmic Outpatients. PLoS One 2016; 11: e0153047
  • 39 World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 2013; 310: 2191-2194
  • 40 Masmali AM, Murphy PJ, Purslow C. Development of a new grading scale for tear ferning. Cont Lens Anterior Eye 2014; 37: 178-184
  • 41 Tomlinson A, Blades KJ, Pearce EI. What does the phenol red thread test actually measure?. Optom Vis Sci 2001; 78: 142-146
  • 42 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale NJ: Lawrence Erlbaum Associates; 1988
  • 43 Rund D, Rachmilewitz E. Beta-thalassemia. N Engl J Med 2005; 353: 1135-1146
  • 44 Liaska A, Petrou P, Georgakopoulos CD. et al. β-Thalassemia and ocular implications: a systematic review. BMC Ophthalmol 2016; 16: 102
  • 45 Taneja R, Malik P, Sharma M. et al. Multiple transfused thalassemia major: ocular manifestations in a hospital-based population. Indian J Ophthalmol 2010; 58: 125-130
  • 46 Jethani J, Marwah K. Nikul. et al. Ocular abnormalities in patients with beta thalassemia on transfusion and chelation therapy: our experience. Indian J Ophthalmol 2010; 58: 451-452
  • 47 Taher A, Bashshur Z, Shamseddeen WA. et al. Ocular findings among thalassemia patients. Am J Ophthalmol 2006; 142: 704-705
  • 48 Alshamrani AA, Almousa AS, Almulhim AA. et al. Prevalence and Risk Factors of Dry Eye Symptoms in a Saudi Arabian Population. Middle East Afr J Ophthalmol 2017; 24: 67-73
  • 49 Jafari R, Heydarian S, Karami H. et al. Ocular abnormalities in multi-transfused beta-thalassemia patients. Indian J Ophthalmol 2015; 63: 710-715
  • 50 Gartaganis SP, Georgakopoulos CD, Exarchou A. et al. Alterations in conjunctival cytology and tear film dysfunction in patients with β-thalassemia. Cornea 2003; 22: 591-597
  • 51 Aksoy A, Aslankurt M, Aslan L. et al. Ocular findings in children with thalassemia major in Eastern Mediterranean. Int J Ophthalmol 2014; 7: 118-121
  • 52 Ghazanfari A, Jafarzadehpour E, Heydarian S. et al. Comparison of contrast sensitivity in β-thalassemia patients treated by deferoxamine or deferasirox. J Optom 2019; 12: 168-173