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Impact of Corneal Fluorescein Staining on Reading Speed

Varshini Varadaraj, MD, MPH

Presenter:

Varshini Varadaraj, MD, MPH, Sezen Karakus, MD, Priya M. Mathews, MD, MPH, Pradeep Y. Ramulu, MD, Ph.D., Bonnielin S. Swenor, MPH, PhD, Esen K. Akpek, MD.

Authors:

Affiliation:

  1. The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD

Purpose: We aimed to evaluate the impact of corneal punctate epithelial erosions on reading speed.

Methods: This prospective cross-sectional study included 184 literate English-speakers aged ≥50 years with a range of corneal staining as evaluated by the Sjögren's International Collaborative Clinical Alliance grading system (scored 0-3, and an additional point given for each of the following: confluent staining, central staining and presence of filaments). A 77-word IReST paragraph was used to assess short-duration out-loud reading speed, and a 7300-word passage was used to measure silent reading speed. Age-adjusted linear regression models were used to examine the association of worse-eye corneal staining score 0-3, confluent staining, and central staining, in separate models, with short and sustained reading speeds [measured as words per minute (wpm)]. Additionally, an age-adjusted log-linear regression model was used to examine associations between corneal staining score 0-3 and per cent decrease in sustained reading speed.

Results: Mean short-duration and sustained reading speeds by corneal staining category 0-3 are shown in the Figure. For the short-duration out-loud reading test, corneal staining at any level was not associated with reading speed. For the sustained reading test, there was a dose-dependent decrement in reading speed (1+ staining: -35.1 wpm, 95%CI=-61.2 to -9.0, p=0.009; 2+ staining: -37.7 wpm, 95%CI=-68.3 to -7.1, p=0.02; 3+ staining: -40.7 wpm, 95%CI=-65.5 to -15.8, p=0.001), as compared to no staining. In a log-linear model, similar decrements in reading speed were noted (1+ staining: -4.9%, 95%CI=-8.9 to -0.53, p=0.02; 2+ staining: -5.8%, 95%CI=-10.5 to -0.67, p=0.03; 3+ staining: -6.4%, 95%CI=-10.3 to -2.3, p=0.002). The presence of confluent staining and central staining were not associated with change in sustained reading speed. There were no subjects with corneal filaments.  

Conclusions: Corneal staining is associated with reduced sustained reading speed in a dose-dependent manner and could potentially be used as an objective surrogate for subjective visual symptoms commonly reported by dry eye patients. 

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