Early Clinical Use of Amniotic Membrane in Medicine and Ophthalmology
Juan Murube, MD, PhD
The Ocular Surface 2006;4:114-119©2006 Ethis Communications, Inc. Vol 4: No 3

Tissue Engineering: Current and Future Approaches to Ocular Surface Reconstruction
Shivaram Selvam, MS,^1,2 Padmaja B. Thomas, PhD,² and Samuel C. Yiu, MD, PhD^2,3,4
The Ocular Surface 2006;4:120-136©2006 Ethis Communications, Inc. Vol 4: No 3
Although cells have been cultured outside the body for many years, research has only recently begun to develop complex three-dimensional tissue constructs that will, ideally, mature into fully functional tissues and organs. Tissue engineering is an emerging field in the area of biotechnology that combines the principles and methods of life sciences with those of engineering for the purpose of regenerating, repairing, or replacing diseased tissues. In this review, we describe the recent advances and current development of tissue engineering approaches as related to the ocular surface system, which comprises the three main integrated tissue units: conjunctiva, cornea and lacrimal glands.

Patient-Reported Symptoms in Dry Dye Disease
Kelly K. Nichols, OD, MPH, PhD
The Ocular Surface 2006;4:137-145©2006 Ethis Communications, Inc. Vol 4: No 3
Clinically, dry eye has often been reported as a “symptom-based” disease, and definitions of dry eye based on symptoms have been used to define dry eye prevalence in population-based studies. Given this, patient-reported symptoms often do not correlate with diagnostic tests unless disease is severe or testing is tightly controlled. Progress in the understanding of dry eye symptoms has been made over the last 10 years; however, the link between symptoms and disease status, such as ocular surface damage or inflammation, remains elusive. Although several surveys for dry eye have been developed for screening or diagnosis, an accepted, validated survey capable of accurately monitoring changes with time or treatment is not available. Common symptoms, available surveys, and the associations between diagnostic tests and symptoms are reviewed.

Ocular Surface Sealants and Adhesives
Subir Singh Bhatia, MD
The Ocular Surface 2006;4:146-154©2006 Ethis Communications, Inc. Vol 4: No 3
Tissue adhesives, both synthetic and biologic, have a long history of use in ophthalmology. Cyanoacrylatebased glues have traditionally been the most widely used glues for various purposes. They have been especially useful for treating corneal perforations and have had significantly improved long-term outcomes. More recently, fibrin-based glues have gained a major role as a suture substitute for attaching biologic tissues and as surface sealants. The literature supports expanded use of fibrin glue in this fashion. Other new agents, such as polyethyelene glycols, have been underutilized and hold promise, especially as surface protectants. Numerous other glues are being developed and show promise as ocular surface sealants and protective membranes. Advances in knowledge about tissue adhesives are leading to more effective and efficient ophthalmic care.

Utility Assessment to Measure the Impact of Dry Eye Disease
Patricia Buchholz, PhD,¹ Carolyn S. Steeds,² Lee S. Stern, MS,³ Daniel P. Wiederkehr,³ John J. Doyle, DrPH,³ Laura M. Katz, MPH,³ Francisco C. Figueiredo, MD, PhD, FRCOph⁴
The Ocular Surface 2006;4:155-161©2006 Ethis Communications, Inc. Vol 4: No 3
Utility assessment is a formal method for quantifying and understanding the relative impact of a given health state or disease on patients. In this article, methodology of utility assessment is explained and illustrated, and results of an original study are reported. The study was conducted to determine utility values (patient preferences) associated with dry eye disease and compare them to other disease utilities, as well as to compare patient and physician assessments of disease. Forty-four patients in the United Kingdom with moderate to severe dry eye were surveyed via interactive utility assessment software. Utility values were measured by the Time Trade-Off (TTO) and Standard Gamble (SG) methods and adjusted to scores from 1.0=perfect health to 0.0=death. Patients reported utilities for: self-reported current dry eye status, self-reported current comorbidities, various dry eye severities, and binocular and monocular painful blindness. Patient’s dry eye severity was independently classified by patient and physician assessments. Correlation analyses (Pearson) were performed between patients’ current dry eye utilities and the physician-assessed severity. Agreement between self-reported and physician-reported patient severity was analyzed (Kappa). P atients reported higher utilities for their current dry eye condition than for monocular and binocular blindness (SG:0.84>0.60>0.51; TTO:0.67>0.43>0.38). Using TTO, the mean score for asymptomatic dry eye (0.68) was similar to that for “some physical and role limitations with occasional pain” and severe dry eye requiring surgery scored (0.56) similarly to hospital dialysis (0.56-0.59) and severe angina (0.5). Utilities described for scenarios of dry eye severity levels were slightly higher for patients self-reported as mildto- moderate versus those self-reported as severe. For current dry eye condition, mean utilities for these groups were 0.72 for self-reported mild-to-moderate and 0.61 for self-reported severe. Utilities for dry eye were in the range of conditions accepted as lowering health utilities. Severe dry eye utilities were similar to those reported for dialysis and severe angina, highlighting the impact of dry eye disease on patients.

Pipeline
Gary D. Novack, PhD, Features Editor, Pipeline
The Ocular Surface 2006;4:163-165©2006 Ethis Communications, Inc. Vol 4: No 3

Personal Profile
James V. Aquavella, MD
The Ocular Surface 2006;4:166-168©2006 Ethis Communications, Inc. Vol 4: No 3