International Journal of Ophthalmology & Visual Science
Volume 4, Issue 3, September 2019, Pages: 51-57
Received: Jul. 31, 2019;
Accepted: Aug. 15, 2019;
Published: Aug. 28, 2019
Views 571 Downloads 146
Saud Ahmed Alanazi, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
Ali Suleeman Alfaifi, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
Ali Abusharha, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
Raied Fagehi, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
Ali Mazyed Alsaqr, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
Gamal Abdel-Rahman El-Hiti, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
Ali Mohammed Masmali, Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
Vitamin D deficiency is common worldwide, particularly in the Middle East and North Africa. The prevalence of vitamin D deficiency (<50 nmol/L) is very high in Saudi Arabia and is associated with several chronic illnesses. The aim of the study is to investigate the effect of short-term oral vitamin D3 supplementation on tear film stability in dry eye subjects. Thirty male dry eye subjects aged 19–37 years (mean ± standard deviation (SD) = 26.2±5.0 years) completed the study. An age-matched control group of 30 normal eye male subjects (25.6±4.3 years) was also recruited. Each subject received an oral vitamin D3 supplement (400 IU daily) for 3 consecutive days. The tear ferning (TF), phenol red thread (PRT), and tear break-up time (TBUT) tests were performed before and 24 hours after the third dose of vitamin D3 supplement. TF grades were significantly (Wilcoxon test, p<0.001) decreased (median (IQR) = 1.8 (0.8) in dry eye subjects after vitamin D3 supplementation compared to those obtained before supplementation (2.3 (0.6)). TF grades were improved in 86.7% of dry eye subjects (n=26). Although PRT and TBUT tests scores were higher post-vitamin D3 supplementation, the differences were not significant (Wilcoxon test, p>0.05). No significant differences in TF grades and PRT and TBUT scores were observed between pre- and post-vitamin D3 supplementation in healthy controls. For the study group, there were strong correlations between measurements of PRT (OD) and PRT (OS) and between TBUT (OD) and TBUT (OS) pre- and post-vitamin D3 supplementation. No correlation was found between TF (OD) and TF (OS) grades pre- and post-vitamin D3 supplementation. The TF test suggests that short-term oral vitamin D3 supplementation can improve the quality of tears in dry eye subjects. Oral vitamin D3 supplementation can be potentially used as an effective treatment for subjects with dry eye symptoms. Our study offers important insights into how vitamin D3 supplementation can improve tear film in dry eye patients and in turn improving patients’ quality of life. Future studies are needed to investigate the long-term effect of vitamin D3 supplementation on the stability of the tear film.
Saud Ahmed Alanazi,
Ali Suleeman Alfaifi,
Ali Mazyed Alsaqr,
Gamal Abdel-Rahman El-Hiti,
Ali Mohammed Masmali,
Effect of Short-Term Oral Vitamin D3 Supplementation on Tear Film in Dry Eye Subjects, International Journal of Ophthalmology & Visual Science.
Vol. 4, No. 3,
2019, pp. 51-57.
Shimazaki J. Definition and diagnostic criteria of dry eye disease: historical overview and future directions. Invest Ophthalmol Vis Sci. 2018; 59: DES7–DES12. doi: 10.1167/iovs.17-23475.
Tsubota K, Yokoi N, Shimazaki J, et al. New perspectives on dry eye definition and diagnosis: a consensus report by the Asia Dry Eye Society. Ocul Surf. 2017; 15: 65–76. doi: 10.1016/j.jtos.2016.09.003.
The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye Workshop (2007). Ocul Surf. 2007; 5: 75–92. doi: 10.1016/S1542-0124(12)70081-2.
Craig JP, Nichols KK, Akpek EK, et al. TFOS DEWS II definition and classification report. Ocul Surf. 2017; 15: 276–283. doi: 10.1016/j.jtos.2017.05.008.
Miljanović B, Dana R, Sullivan DA, Schaumberg DA. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol. 2007; 143: 409–415. doi: 10.1016/j.ajo.2006.11.060.
Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II diagnostic methodology report. Ocul Surf. 2017; 15: 539–574. doi: 10.1016/j.jtos.2017.05.001.
Masmali A, Alrabiah S, Alharbi A, El-Hiti GA, Almubrad T. Investigation of tear osmolarity using the TearLab™ osmolarity system in normal adults in Saudi Arabia. Eye Contact Lens. 2014; 40: 74–78. doi: 10.1097/ICL.0000000000000002.
Masmali A, Shehri A, Alanazi S, Abusharaha A, Fagehi R, El-Hiti G. Assessment of tear film quality among smokers using tear ferning patterns. J Ophthalmol. 2016; 2016: 8154315. doi: 10.1155/2016/8154315.
Masmali AM, Maeni YA, El-Hiti GA, Murphy PJ, Almubrad T. Investigation of ocular tear ferning in controlled and uncontrolled diabetic subjects. Eye Contact Lens. 2018; 44: S70–S75. doi: 10.1097/ICL.0000000000000419.
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. doi: 10.2147/OPTH.S188614.
Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004; 80: 1678S–88S. doi: 10.1093/ajcn/80.6.1678S.
Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system essential for good health. Am J Clin Nutr. 2008; 88: 491S–499S. doi: 10.1093/ajcn/88.2.491S.
Stevenson W, Chauhan SK, Dana R. Dry eye disease: an immune-mediated ocular surface disorder. Arch Ophthalmol. 2012; 130: 90–100. doi: 10.1001/archophthalmol.2011.364.
Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008; 87: 1080S–1086S. doi: 10.1093/ajcn/87.4.1080S.
Maalouf G, Gannagé-Yared MH, Ezzedine J, et al. Middle East and North Africa consensus on osteoporosis. J Muskuloskelet Neuronal Interact. 2007; 7: 131–143.
Al-Daghri NM. Vitamin D in Saudi Arabia: prevalence, distribution and disease associations. J Steroid Biochem Mol Biol. 2018; 175: 102–107. doi: 10.1016/j.jsbmb.2016.12.017.
Cannell JJ, Hollis BW. Use of vitamin D in clinical practice. Altern J Med Rev. 2008; 13: 6–20.
Demirci G, Erdur SK, Ozsutcu M, et al. Dry eye assessment in patients with vitamin D deficiency. Eye Contact Lens. 2018; 44: S62–S65. doi: 10.1097/ICL.0000000000000325.
Reid IR, Bolland MJ. Role of vitamin D deficiency in cardiovascular disease. Heart. 2012; 98: 609–614. doi: 10.1136/heartjnl-2011-301356.
Autier P, Boniol M, Pizot C, Mullie P. Vitamin D status and ill health: a systematic review. Lancet Diabetes Endocrinol. 2014; 2: 76–89. doi: 10.1016/S2213-8587(13)70165-7.
Chowdhury R, Kunutsor S, Vitezova A, et al. Vitamin D and risk of cause specific death: systematic review and meta-analysis of observational cohort and randomised intervention studies. BMJ. 2014; 348: g1903. doi: 10.1136/bmj.g1903.
Conrady CD, Joos ZP, Patel BC. Review: The lacrimal gland and Its role in dry eye. J Ophthalmol. 2016; 2016: 7542929. doi: 10.1155/2016/7542929.
Lu X, Elizondo RA, Nielsen R, et al. Vitamin D in tear fluid. Invest Ophthalmol Vis Sci. 2015; 56: 5880–5887. doi: 10.1167/iovs.15-17177.
Alsalem JA, Patel D, Susarla R, et al. Characterization of vitamin D production by human ocular barrier cells. Invest Ophthalmol Vis Sci. 2014; 55: 240–2147. doi: 10.1167/iovs.13-13019.
Yin Z, Pintea V, Lin Y, Hammock BD, Watsky MA. Vitamin D enhances corneal epithelial barrier function. Invest Ophthalmol Vis Sci. 2011; 52: 7359–7364. doi: 10.1167/iovs.11-7605.
Jin KW, Ro JW, Shin YJ, Hyon JY, Wee WR, Park SG. Correlation of vitamin D levels with tear film stability and secretion in patients with dry eye syndrome. Acta Ophthalmol. 2017; 95: e230–e235. doi: 10.1111/aos.13241.
Agmon-Levin N, Kivity S, Tzioufas AG, et al. Low levels of vitamin-D are associated with neuropathy and lymphoma among patients with Sjögren’s syndrome. J Autoimmun. 2012; 39: 234–239. doi: 10.1016/j.jaut.2012.05.018.
Na KS, Mok J-W, Kim JY, Joo C-K. Proinflammatory gene polymorphisms are potentially associated with Korean non-Sjogren dry eye patients. Mol Vis. 2011; 17: 2818–2823.
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. doi: 10.1097/ICL.0000000000000116.
Masmali AM, Alotaibi AG, Alanazi SA, Fagehi R, Abusharaha A, El-Hiti GA. 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. doi: 10.2147/OPTH.S201127.
Masmali AM, Alanazi SA, Almagren B, El-Hiti GA. Assessment of the tear film in normal eye subjects after consumption of a single dose of hot peppermint drink. Clin Optom. 2019; 11: 39–45. doi: 10.2147/OPTO.S206904.
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. doi: 10.2147/OPTH.S198349.
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011; 96: 1911–1930. doi: 10.1210/jc.2011-0385.
World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310: 2191–2194. doi: 10.1001/jama.2013.281053.
Schiffman RM, Christianson MD, Jacobsen G, Hirsch JD, Reis BL. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000; 118: 615–621. doi: 10.1001/archopht.118.5.615.
Masmali AM, Murphy PJ, Purslow C. Development of a new grading scale for tear ferning. Cont Lens Anterior Eye. 2014; 37: 178184. doi: 10.1016/j.clae.2013.09.011.
Masmali A, Alqahtani TA, Alharbi A, El-Hiti GA. Comparative study of repeatability of phenol red thread test versus Schirmer’s test in normal adults in Saudi Arabia. Eye Contact Lens. 2014; 40: 127–131. doi: 10.1097/ICL.0000000000000025.
Cho P, Ho KY, Huang YC, Chui HY, Kwan MC. Comparison of non-invasive tear break-up time measurements from black and white background instruments. Optom Vis Sci. 2004; 81: 436441. doi: 10.1097/01.opx.0000135095.15125.05.
Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum Associates; 1988.
Bang B, Asmussen K, Sørensen OH, Oxholm P. Reduced 25-hydroxyvitamin D levels in primary sjögren's syndrome: correlations to disease manifestations. Scand J Rheumatol. 1999; 28: 180–183. doi: 10.1080/03009749950154266.
Bae SH, Shin YJ, Kim HK, Hyon JY, Wee WR, Park SG. Vitamin D supplementation for patients with dry eye syndrome refractory to conventional treatment. Sci Rep. 2016; 6: 33083. doi: 10.1038/srep33083.
Yang CH, Albietz J, Harkin DG, Kimlin MG, Schmid KL. Impact of oral vitamin D supplementation on the ocular surface in people with dry eye and/or low serum vitamin D. Cont Lens Anterior Eye. 2018; 41: 69–76. doi: 10.1016/j.clae.2017.09.007.
Yildirim P, Garip Y, Karci AA, Guler T. Dry eye in vitamin D deficiency: more than an incidental association. Int J Rheum Dis. 2016; 19: 49–54. doi: 10.1111/1756-185X.12727.
Kurtul BE, Özer PA, Aydinli MS. The association of vitamin D deficiency with tear break-up time and Schirmer testing in non-Sjögren dry eye. Eye. 2015; 29: 1081–1084. doi: 10.1038/eye.2015.96.
Galor A, Gardener H, Pouyeh B, Feuer W, Florez H. Effect of a Mediterranean dietary pattern and vitamin D levels on dry eye syndrome. Cornea. 2014; 33: 437–441. doi: 10.1097/ICO.0000000000000089.
Jee D, Kang S, Yuan C, Cho E, Arroyo JG. Serum 25-hydroxyvitamin d levels and dry eye syndrome: differential effects of vitamin D on ocular diseases. PLoS One. 2016; 11: e0149294. doi: 10.1371/journal.pone.0149294.