Dry Eye and Microenvironment

项目摘要：干眼症(DE)，以无数体征为特征(例如，泪液产生减少， 蒸发和发炎增加)和症状(如疼痛、视力模糊和干燥)会使人虚弱 影响生活质量的疾病。许多患者都有持续性的症状，因为现有的临床 治疗方法不足以治疗DE。因此，管理远程教育需要解决方案(即超越个人- 临床干预水平)。一项新的文献表明，环境条件可能会导致 DE的发病和持续时间。我们的微环境是颗粒物(PM)、气体和空气的复杂混合物 空气污染物和过敏原。然而，无法获得关于微环境的个别具体数据。这个 该项目将检验两个新的假设：1)临床表现，以类型和严重程度衡量 根据空气污染物、过敏原和空气污染物的类型、水平和来源， 湿度和温度，特别是暴露在PM、生物气溶胶和气态污染物中是相关的 分别伴有上皮破裂(ED)、炎症和蒸发性泪液缺乏(ETD)；2)DE征 与室外空气污染相比，与室内空气污染的关联性更强，因为我们在室内花费的时间更多 而我们的室内暴露在微环境条件下的总暴露中占主导地位。为了测试这些 在假设条件下，我们提出了前瞻性病例对照设计。我们将从巴斯康招募360名受试者 帕尔默眼科研究所(BPEI)，连续12年被评为美国排名第一的眼科研究所 数年，以及马里兰大学眼科-红木(乌莫尔)诊所。180个病例和年龄-- 性别和种族/民族匹配的180名对照将在他们的临床检查后确定。受试者 符合纳入标准，并至少具有DE的三个指标之一，即ED、炎症和 ETD，将作为案例，控制将不受这些DE标志的影响，并将满足纳入标准。每个人 受试者将接受四次临床检查，每四季一次，并接受为期一周的严重空气污染 在临床检查前对他们的家内外进行监测。PRECISE(PRECISe.ccs.miami.edu)，我们 便携式直读传感器电池，将测量每个受试者家中的空气污染，为期一整年。 在同一周内，参与者将通过网络或电话记录DE症状。我们将计算时间- 加权室内和室外暴露，并模拟暴露对DE体征和症状的影响 空间计量经济模型。我们的跨学科团队拥有最先进的临床实验室设施 评估远程教育和暴露评估，以及四年来的合作记录。这 该项目将产生知识，可能提供一条以家庭为基础的环境处理的新路线 来管理De。这项研究符合“眼部感染、炎症和免疫学”的优先考虑。 国家眼科研究所(NEI)的区域。

Project Summary: Dry eye (DE), characterized by a myriad of signs (e.g. decreased tear production, increased evaporation, and inflammation) and symptoms (e.g. pain, blurry vision and dryness), is a debilitating disease that affects quality of life. Many patients have persistent symptoms, because the available clinical therapies are not adequate to manage DE. Thus, managing DE requires solutions (i.e. beyond individual- level clinical interventions). An emerging literature suggests that environmental conditions can contribute to the onset and persistence of DE. Our microenvironment is a complex mixture of particulate matter (PM), gaseous air pollutants and allergens. However, individual specific data on microenvironment are not available. The project will test two novel hypotheses: 1) the clinical manifestations, measured by the types and severity of different measures of DE, vary with respect to types, levels and sources of air pollutants, allergens, humidity and temperature, specifically, exposure to PM, bioaerosols and gaseous pollutants is associated with epithelial disruption (ED), inflammation and evaporative tear deficiency (ETD), respectively; 2) DE signs are more strongly associated with indoor relative to outdoor air pollution, as we spend more time indoors and our indoor exposure dominates our total exposure to microenvironmental conditions. To test these hypotheses, we propose a prospective case-control design. We will recruit 360 subjects from Bascom Palmer Eye Institute (BPEI), ranked as the number 1 eye institute in the US consecutively for the past 12 years, and University of Maryland Ophthalmology – Redwood (UMOR) clinics. 180 cases and age-, gender- and race/ethnicity-matched 180 controls will be determined after their clinical exams. Subjects who meet the inclusion criteria and have at least one of the three measures of DE, namely ED, inflammation, and ETD, will serve as cases, and controls will be free from these DE signs, and will meet inclusion criteria. Each subject will undergo four clinical exams one in each of the four seasons, and a weeklong intensive air pollution monitoring inside and outside their homes before the clinical exam. PRECISE (precise.ccs.miami.edu), our portable battery of direct-reading sensors, will measure air pollution in each subject's home for one full year. Over the same week, participants will record DE symptoms through web or phone. We will calculate time- weighted indoor and outdoor exposures, and model the effects of exposure on DE signs and symptoms using spatial econometric models. Our interdisciplinary team has the state-of-the-art laboratory facilities for clinical assessment of DE and exposure assessment as well as a collaborative track-record over four years. This project will generate knowledge that will potentially provide a new line of home-based environmental treatment to manage DE. This research aligns with the “ocular infection, inflammation and immunology” priority areas of the National Eye Institute (NEI).