Justin Kwan

Professional Eye Care Center

Purpose: This study evaluated the validity and diagnostic efficacy of a modified Schein dry eye questionnaire and compared it to the Ocular Surface Disease Index (OSDI). Methods: The original Schein survey was modified to allow numerical scoring on a 0 to 24 scale and evaluated in prospective studies in normal and dry eye subjects. Receiver oper...

Objectives: To determine the efficacy of widely available subtype clinical tests to characterize evaporative dry eye disease (EDED) related to meibomian gland dysfunction (MGD) compared to normal and to validate those clinical cut points in an independent sample. Methods: A diagnostic accuracy study (52 subjects), an investigator-masked study, w...

Purpose Meibomian glands (MG) are now easily imaged via clinical meibography machines. The purpose of this work was to explore the utility of the known MG morphology metrics for predicting dry eye disease (DED) in contact lens (CL) wearers. Methods Successful and previous CL wearers were recruited. DED was diagnosed if the participant's worst ey...

An assessment of subjective grading of meibography images between observers and the impact formal training for meibography interpretation can have on inter-observer repeatability of grading scores.

Purpose: To examine the effects of volume and method on fluorescein tear breakup time (TBUT) values and to evaluate test efficacy in an independent sample free of selection bias. Methods: Subjects were assessed using a battery of dry eye tests (DETs). Efficacy study: Subjects were randomized to the DET, standard strip, and liquid NaFl on separat...

Purpose: The purpose of this study was to determine whether pollen counts have a relationship with signs and symptoms associated with ocular surface disease. Methods: Four optometric clinics in the USA and one in Canada surveyed and performed clinical dry eye tests on subjects. The surveys utilized the SPEED questionnaire to determine perceived eye...

Purpose: It seems like the number of dry eye tests has increased exponentially making dry eye work up protocols long and cumbersome. Clinicians are often frustrated when there is disagreement between clinical signs. Since most of dry eye has meibomian gland involvement, the focus of this study was to determine if the presence of an altered meibum s...

Purpose: Risk factors for dry eye have been largely established but haven’t been updated recently. This effort was to uncover any new risk factors from a patient profile survey and then refine the instrument items to predict dry eye. Methods: 14 investigator-designed questions and the Ocular Surface Disease Index (OSDI) were administered to clinic...

Purpose: Acquired color defects has been associated with glaucoma. Past literature has defined the defects to be tritan (Blue-yellow). The new table based color vision tests offer simpler and faster ways of measuring color defects in clinical practice. Tritan defects were compared with visual fields and ganglion cell complex testing (GCC). Methods:...

Purpose:The Purpose of this study was to evaluate any correlation, or lack of correlation, between the presence of Demodex mites and meibomian gland (MG) structure. The study evaluated structure in terms of both gland atrophy and tortuosity. Methods:This was a multicenter study evaluating ocular surface symptoms with the UNC and SPEED questionnaire...

Purpose:The purpose of this study was to identify risk factors for dry eye through a brief, 14-question patient profile survey. Methods:Fourteen questions and the ocular surface disease index (OSDI) were administered to clinic patients at seven clinical sites. Subjects were defined as dry if their OSDI was ≥ 13 and normal if < 13. Dry was also conf...

PURPOSE With improving soft contact lens materials, one would expect that comfortable wear time would increase to match the total or average wear time. In recent years, the environment that we subject our eyes to has dramatically changed. Can the pre-lens tear film survive the stress that we put it through? This study examines patients’ comfortable...

Purpose: Meibography imaging has become more common in clinical ophthalmic practice. With imaging devices available today the question of what to image on patients becomes a common one. This study compares upper and lower eyelids in terms of their level of both Meibomian Gland Atrophy (MGA) and gland tortuosity to evaluate whether there is a signif...

Introduction: With the exponential demands of digital device use across age groups at work, home, for entertainment, socialization, informational purposes and other applications, the goal of this study was to outline current digital device user patterns and the impact of digital device use on the symptoms of dry eye across age demographics. Methods...

Purpose: Meibography imaging has become increasingly popular in clinical ophthalmic practice. Several different grading scales exist to evaluate meibomian gland atrophy, while very few grading scales address the issue of meibomian gland tortuosity. This study examines the inter-observer reliability of a newly developed meibomian gland tortuosity pi...

Purpose: Digital device use has become increasingly prevalent in recent years, but the long-term health effects on eye health have only recently been studied. The Vision Council recently reported that 24% of patients who spend two or more hours per day using digital devices suffer from dry eyes. This study used four common dry eye surveys to evalua...

Purpose: Dry eye disease is widely studied in adults, and females with meibomian gland dysfunction (MGD) are known to be more symptomatic than males on common surveys (Kwan et al). MGD is much less studied in young populations. This study compares meibomian gland atrophy between male and female patients in a younger population. Methods: Thirty-thr...

Purpose: The advancement of digital devices in the 21st century has drastically changed the way we spend our time. The goal of this study was to see how digital device use differs in every decade of life. Methods. A two page survey was created and administered at seven clinical sites and online. The Ocular Surface Disease Index (OSDI) was included....

Purpose:Meibography imaging has becomes increasingly common in clinical ophthalmic practice. Several different grading techniques exist for evaluating the images generated by meibographers. In addition, many practitioners have noticed pathological changes in the meibomian gland structure and function in patients who have a history of isotretinoin (...

Purpose:Patient usage of digital devices including handheld tablets, smart phones, laptops, and computers are increasing as new technology develops and as environments adapt to these technological changes. With the increase in usage of digital devices, eye care practitioners have noted an increase in dry eye signs and symptoms. The goal of this stu...

Purpose:The ubiquitous amount of electronic devices and their frequent use throughout the day may very well impact the symptomatology of patients especially with a less stable pre-lens tear film in the contact lens wearing population compared to the tear film of a non-contact lens wearer. This study attempted to study the relationship between devic...

Purpose: Meibomian gland dysfunction (MGD) is a common cause of the signs and symptoms of dry eye. Aqueous Deficiency (AD) is a less prevalent subtype of dry eye but is oftentimes more severe in its presentation. Allergic conjunctivitis (AC) also has a high prevalence in the general population, up to 25%. Mixed disease presents to some degree. This...

Background: Meibomian gland dysfunction (MGD) is the leading cause of evaporative dry eye (EDE). Evidence suggests that inflammation is associated with the development and perhaps progression of MGD. Lotemax® (loteprednol etabonate ophthalmic gel) 0.5% Gel Drop Formation (LE Gel) has dose uniformity without shaking and fewer preservatives than lote...

Purpose: To evaluate the strength of association between dry eye and xerostomia (dry mouth). Dry eye coupled with xerostomia is an important diagnostic cue for autoimmune disease. Methods: A multi-center, retrospective chart review evaluating the frequency of dry eye and xerostomia using symptom questionnaires. N = 563 (219 males, 344 females), mea...

Purpose: Meibomian Gland Dysfunction (MGD) is commonly associated with the signs and symptoms of ocular surface disease in dry eye patients (up to 86%). The production of lipids and meibum from the meibomian glands is controlled by neuronal, vascular, and hormonal factors. Common perception among practitioners is that females may be particularly af...

The cornea is precious to sight. Its intricate cellular arrangement and physiology enable it to be transparent and refractive. Corneal dystrophies (CDs) impact vision at various decades of life depending on the dystrophy at hand. Left untreated, visual ramifications ensue. This review article will summarize the current knowledge of the various CDs...

To determine associations for contact lenses (CLs) and meibomian gland atrophy in a matched-pair study. Contact lens wearers (case) and age- and sex-matched non-contact lens (NCL) wearers with no history of CL use (control) were recruited for a multicenter study. All subjects were administered the Ocular Surface Disease Index questionnaire and a co...

Purpose: To determine the rate of meibomian gland (MG) atrophy in a matched-pair sample of contact lens (CL) and non-contact-lens (NCL) wearers. Methods: CL wearers with a minimum of five years of CL use and NCL wearers who were age- and gender-matched were recruited across five study sites from three countries (USA, Canada and Germany). Lower and...

Purpose: Ocular surface disease primarily includes aqueous tear deficiency (ATD), evaporative dry eye (EDE), and allergic conjunctivitis (AC). Until recently, the overlap between sub-types, especially with allergic conjunctivitis, has not been thoroughly examined in the literature. We looked at the prevalence of ocular surface disease categories in...

Purpose: Meibomian gland dysfunction (MGD) is a common cause of the signs and symptoms of dry eye, yet a symptom survey specific for MGD has not been developed. A refined MGD questionnaire was administered to an independent sample of patients presenting to two clinics to explore how each gender responds differently. We also wanted to determine if d...

Rationale: Itch is the primary diagnostic symptom of allergic conjunctivitis. A new ocular surface questionnaire refined by Rasch analysis was used. We took this questionnaire and evaluated it in a multi-site study. Methods: Subjects over age 18 were recruited and administered a modified version of a ocular surface questionnaire in this IRB appro...

Purpose: Meibomian gland dysfunction (MGD) is a common cause of the signs and symptoms of dry eye, yet a symptom survey specific for MGD has not been developed. We created a new MGD questionnaire based on the Rasch analysis of results from a previous MGD survey on MGD patients and results from several sources. We took this instrument and evaluated...

Purpose Dry eye have been defined as two basic sub-types: aqueous tear deficient (ATD) and evaporative dry eye (EDE). Until recently, the overlap between sub-types (known as Mixed) has not been documented much. Also, there is a scarcity of information regarding prevalence of severity levels within EDE. We looked at the prevalence of dry eye categor...

The purpose of this work was to gather preliminary data in normals and dry eye subjects, using a new, non-invasive imaging platform to measure the thickness of pre-corneal tear film. Human subjects were screened for dry eye and classified as dry or normal. Tear film thickness over the inferior paracentral cornea was measured using laser illuminatio...

Purpose. Creech and Radke's dispersive mixing model suggests that vertical and in-and-out lens movement can affect post-lens tear mixing of a soft contact lens. 1 In-and-out lens movement has more substantial effect on tear mixing com-pared with vertical movement. In this study, we examined the relationship be-tween vertical lens movement (along wi...