Controlled Adverse Environment: A Pilot Study to Evaluate Tear Film Stability and Tear Evaporation

• Tear Evaporation Rate [ Time Frame: 20 minutes after the required temperature and humidity in the chamber is achieved ] [ Designated as safety issue: No ]
  The rate of tear evaporation is measured by the use of ocular thermography. For each subject,his/her ocular surface temperature will be recorded twice, one for each eye. The subject at first rests his/her chin on a chin rest, with his/her forehead lean against a metal frame (which is part of the chin rest). Then the recording starts lasting approximately 20seconds for each eye. While recording, the subject needs to look straight into the lens, but can blink naturally. After this, the recording data will be analyzed to derive the evaporation rate using a mathematical model.
  
  

• Tear Film Break up Time [ Time Frame: 20 minutes after the required temperature and humidity in the chamber is achieved ] [ Designated as safety issue: No ]
  After instillation of fluorescein, the participant will then be asked to open the eyes, look ahead at the observer's forehead and not blink for as long as possible. The break up time is defined as the time between the lid opening and the first appearance of any dry spot on the cornea. The participant will be requested to close his eyes for few seconds and the procedure will be repeated for the left eye.
  
  

Study Objectives and Purpose:

1. A primary purpose of the study is to evaluate fluorescein tear break up times in participants under different humidity/ temperature conditions.
2. The second aim is to assess the tear evaporation rates in a dynamic fashion over 20 seconds (based on a non-invasive ocular thermography method) after exposure to different humidity/temperature conditions.

Study Design: Prospective, non-comparative, clinical study

Rationale:

The ocular surface research team who is based at the dry eye service of the Singapore National Eye Center is experienced in the assessment of the ocular surface in patients and clinical trial participants. Collaborators from the DSO National laboratory already have experience in conducting human studies in a controlled environment in Singapore that has been proven to be safe and has passed necessary regulatory approval. In addition, recent technological advances have allowed collaborators from NTU and Singapore Polytechnic to perform non-invasive tear evaporimetry in a dynamic way between blinks. Together, this is a strong research team that can address the important question of the influence of temperature and humidity on the tear film stability.

Methods:

We intend to use 10 volunteer/patients to establish whether tear film stability or tear film function can be altered after exposure to different combinations of humidity and temperature. This involves the assessment of tear film break up time (TBUT) and tear evaporimetry, a non-invasive procedure (like an auto-refractor where the patient places the chin on the chin rest and forehead on the head rest when the measurement is taken) which involves taking serial images with an infra red sensitive video camera. This process is performed at a facility which is closely monitored and proven to be safe for other research participants.

Participants and target sample size: Ten participants will be recruited.

Workflow:

We assume that approximately 45 minutes are required for the chamber to achieve the required temperature and humidity, and about 15 to 20 minutes for participants to adjust to the first environmental setting. Thermography measurement will take 1 minute (20 sec in each eye, with adjustment of camera between eyes). The participants will undergo slit lamp examination where the fluorescein tear break up time will be assessed and digital color image of the break up pattern will be taken. These will require a further 5 minutes. This means 3 participants can have measurements done in approximately 20 minutes. Measurements of 3 participants in a single condition will therefore take up to 20 minutes.In a session that will last up to 3 hours and 20 minutes, the investigators can complete the condition list for 3 participants. Since the overall session is quite long, a toilet break is permitted after each temperature condition.

The investigators estimate that 3 sessions with a further 'dry run' for the photography (without participants) before the first session will be necessary.

Visit schedules:

Volunteers or patients from the Singapore National Eye Center will be informed of this study. Screening will be performed at the regular dry eye clinic at the Singapore National Eye Center. If eligible, the volunteer or patient will sign consent and undergo baseline examination. Subsequent to this, the examination will be performed at the controlled adverse environment at the DSO facility.

Assessment of ocular parameters is outlined below:

At Screening visit, the investigators perform:

• Informed consent
• Subject background
• Anterior segment findings
• Tear film break up time

At Evaluation visit, the investigators perform:

• Tear film break up time
• Photography/Video to document tear break up
• Tear evaporimetry

Duration of study: Four weeks.