Proteomics Analysis of Human Tears in the Diagnosis and Management of Dry Eye Disease

Diagnosis of Dry Eye Disease (DED) is current based on questionnaires, quantitative and qualitive tear and ocular surface assessment such as tear breakup time, corneal staining, and tear osmolarity. However, many of these clinical procedures show weak correlation between the clinical findings and subjective symptoms. Therefore, a more reliable method to aid in the diagnosis and management of dry eye disease is clearly needed.

Recently, a high frequency electrotherapy device using Quantum Molecular Resonance (QMR) technique, the Rexon-Eye was approved with EC certificate as a medical device for the treatment of the ocular surface disorders. During the treatment, a low-intensity, high-frequency (a spectrum of frequencies ranging from 4 MHz to 64 MHz) stimulations are applied on the epidermis of closed eyelids up to the lid border by special designed goggles. Previous data showed that it could effectively improve symptoms and clinical signs of DED by increasing the tear secretion and improving the meibomian gland function. Although clinically safe and effective, the mechanisms on how the stimulation could benefit DED are still unknown and ocular changes in response to the DED treatment in molecular level has not yet been investigated.

In this study, the initial tear proteome profiles in DED patients, the safety and effectiveness of using QMR in DED management together with the associated global tear proteome changes will be investigated. A total of 75 participants aged 18 to 65 years old will be recruited. 50 patients are DED patients and will be randomly assigned into treatment group and blinded control group. 25 non-DED age-matched subjects will be recruited as normal control. After the baseline DED evaluation, those eligible patients will be randomly allocated into treatment group and blinded control group. A total of four treatments will be performed to the treatment group and normal control in a weekly bases according the suggested protocol by the manufacturer. The blinded control group will receive sham treatments also in a weekly bases. Two outcome evaluation visits will be arranged for all participants one month and three months after the final treatment (i.e. the 4th treatment). The blinded control group will receive four QMR treatment after the second outcome evaluation visit. The same four treatments (identical to the treatment group) will be conducted followed by two extra outcome evaluation visits. Baseline and post-treatment tears will be collected using Schirmer strips, and changes in the tear proteome will be quantified using a mass spectrometer.

Inclusion criteria

• OSDI score ≥ 13, and
• Fail one of the three diagnostic tests:

• Non-invasive tear break-up time (NITBUT) less than 10s;
• Tears osmolarity higher than or equals to 308 mOsm/L or inter-ocular difference > 8 mOsm/L;
• When assessing with slit lamp, shows more than 9 spots of conjunctival stain with lissamine green, more than 5 spots of corneal stain with fluorescein or lid wiper epitheliopathy (LWE) with lissamine green ≥ 2 mm in length and/or ≥ 25% sagittal width.

Exclusion criteria

• Any active ocular infections, inflammations or anomalies in eyelid;
• Pregnant or lactating;
• Uncontrolled, newly diagnosed systemic diseases or with modified long-term medications within 6 months;
• Carrying active implantable devices (e.g., pacemakers and hearing aids)