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Goblet Cell Response and Dry Eye Symptoms After PRK and LASIK

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Schepens Eye Research Institute
State University of New York College of Optometry
Information provided by (Responsible Party):
Samanta B. Rodgers, Fort Belvoir Community Hospital
ClinicalTrials.gov Identifier:
NCT00411827
First received: December 13, 2006
Last updated: July 16, 2014
Last verified: July 2014
  Purpose

Purpose: To develop a screening metric by examining both the characteristics of the preoperative tear film and the intracellular signaling pathways of conjunctival goblet cells in order to determine if there are certain characteristics which might predict those patients who will experience serious dry eye symptoms and complications after refractive surgery.

Research Design: This study is a twelve-month prospective non-randomized investigation.

Methodology: In conjunction with psychometric questionnaires and various measures of tear film quality (e.g. Schirmer's test, tear break up time, etc), impression cytology will be used to assess the intracellular signaling pathways of conjunctival goblet cells and to determine if alterations in this pathway exist. Alterations in this pathway would result in a reduced response by the mucin secreting conjunctival goblet cells thereby promoting the development of dry eye after refractive surgery.


Condition Intervention
Keratoconjunctivitis Sicca
Procedure: PRK with conjunctival impression cytology before and after surgery
Procedure: LASIK with conjunctival impression cytology before and after surgery

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Goblet Cell Response and Dry Eye Symptoms After PRK and LASIK

Resource links provided by NLM:


Further study details as provided by Walter Reed National Military Medical Center:

Primary Outcome Measures:
  • Dry eye [ Time Frame: one year after surgery ] [ Designated as safety issue: No ]

Estimated Enrollment: 146
Study Start Date: January 2008
Estimated Study Completion Date: December 2014
Primary Completion Date: February 2011 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1
PRK
Procedure: PRK with conjunctival impression cytology before and after surgery
Active Comparator: 2
LASIK
Procedure: LASIK with conjunctival impression cytology before and after surgery
LASIK with conjunctival impression cytology before and after surgery

  Eligibility

Ages Eligible for Study:   21 Years to 40 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

Subjects will be recruited from those active duty soldiers that have requested refractive surgery. Subjects must be eligible for medical care at WRAMC.

  1. Male or female, of any race, and at least 21 years old and not older than 40 years old at the time of the pre-operative examination, and have signed an informed consent. The lower age limit of 21 years is intended to ensure documentation of refractive stability and is the minimal age required by the FDA for informed consent for LASIK surgery.
  2. Manifest refractive spherical equivalent (MSE) of up to 10.00 diopters at the spectacle plane with refractive cylinder up to 3.00 D.
  3. Best spectacle corrected visual acuity of 20/20 or better in both eyes.
  4. Patients who are willing to fill out dry eye questionnaires.
  5. Demonstrated refractive stability, confirmed by clinical records. Neither the spherical nor the cylindrical portion of the refraction may have changed more than 0.50D during the 12- month period immediately preceding the baseline examination, as confirmed by clinical records.
  6. All patients must be willing to return to the WRAMC Center for Refractive Surgery for follow up visits on Day1, Day 3, Day 7, and 1, 3, 6, and 12 months after their surgery.
  7. Located in the greater Washington DC area for a 14-month period.
  8. Consent of the subject's command (active duty) to participate in the study.
  9. Access to transportation to meet follow-up requirements.

Exclusion Criteria:

  1. Previous surgery or trauma to the study eye.
  2. Dry eye as reflected by Schirmer's test with anesthesia of 0, subjective complaints or symptoms of dry eye, findings during the slit lamp exam that would be consistent with dry eye (e.g. superficial punctuate keratitis).
  3. Female subjects who are pregnant, breast-feeding or intend to become pregnant during the study. This is a standard of care exclusion for refractive surgery at the Walter Reed Refractive Surgery Center because of the medications that are routinely given as part of the procedures. Standard of care analgesia consists of medications (e.g. narcotics) labeled as Pregnancy Category "C" by the FDA. Teratogenic effects are not known, however, physical dependence in the neonate may occur if the mother is given narcotics. Female subjects will be given a urine pregnancy test prior to participating in the study to rule out pregnancy.
  4. Concurrent topical or systemic medications that may impair healing, including corticosteroids, antimetabolites, isotretinoin (Accutane), amiodarone hydrochloride (Cordarone) and/or sumatriptan (Imitrex).
  5. Medical condition(s), which, in the judgment of the investigator, may impair healing, including but not limited to: collagen vascular disease, autoimmune disease, immunodeficiency diseases, and ocular herpes zoster or simplex.
  6. Active ophthalmic disease, neovascularization of the cornea within 1mm of the intended ablation zone, or clinically significant lens opacity.
  7. Evidence of glaucoma or an intraocular pressure greater than 22 mm Hg at baseline.
  8. Evidence of keratoconus, corneal irregularity, or abnormal videokeratography in either eye.
  9. History of recurrent erosions or epithelial basement dystrophy.
  10. Patients with known sensitivity or inappropriate responsiveness to any of the medications used in the post-operative course.
  11. Any physical or mental impairment that would preclude participation in any of the examinations.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00411827

Locations
United States, District of Columbia
Walter Reed Army Medical Center
Washington, District of Columbia, United States, 20307
Sponsors and Collaborators
Walter Reed National Military Medical Center
Schepens Eye Research Institute
State University of New York College of Optometry
Investigators
Principal Investigator: Richard D Stutzman, MD WRNMMC
  More Information

No publications provided

Responsible Party: Samanta B. Rodgers, Assistant Director, Warfighter Refractive Eye Surgery Program and Research Center at FT Belvoir, Fort Belvoir Community Hospital
ClinicalTrials.gov Identifier: NCT00411827     History of Changes
Other Study ID Numbers: WRAMC WU#06-23014
Study First Received: December 13, 2006
Last Updated: July 16, 2014
Health Authority: United States: Federal Government

Keywords provided by Walter Reed National Military Medical Center:
Cytology
Keratomileusis, Laser In Situ
Keratectomy, Photorefractive, Excimer Laser

Additional relevant MeSH terms:
Dry Eye Syndromes
Keratoconjunctivitis
Keratoconjunctivitis Sicca
Conjunctival Diseases
Conjunctivitis
Corneal Diseases
Eye Diseases
Keratitis
Lacrimal Apparatus Diseases

ClinicalTrials.gov processed this record on November 23, 2014