human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The lipid tear film stabilizes the tears by lowering the surface tension and preventing aqueous tear evaporation and may be analyzed by kinetic analysis of the tear interference images . This study investigated changes in the lipid film after application of a new emulsion-based eye drop of Refresh Endura ( Allergan , Irvine , CA ) in normal subjects and patients with dry eyes . DESIGN Comparative , nonr and omized interventional study . PARTICIPANTS Five normal subjects and 10 aqueous tear deficiency ( ATD ) patients with or without lipid tear deficiency were enrolled prospect ively . METHODS A complete eye examination was performed , including symptom score , tear break-up time , dye staining , and fluorescein clearance test . One eye received a single dose of emulsion eye drop ( EED ) , whereas the other eye received nonpreserved saline as a control . Kinetic analysis of tear interference images taken by DR-1 ( Kowa , Japan ) was performed before and at various times after instillation of the drops . MAIN OUTCOME MEASURES Symptoms , pattern , thickness , and spread time of the tear film . RESULTS Compared with the control , all eyes receiving EED showed rapid restructuring of the preexisting lipid film . In normal persons , restructuring result ed in a thick lipid b and across the cornea and a significant increase of the lipid film thickness . For ATD patients , EED application result ed in either a scant , irregular tear film , which became covered by the lipid film , or a modified lipid film changed without forming a b and or irregularities .  Emulsion eye drops tended to be more comfortable in patients with more severe ATD . Kinetic analysis showed that the mean spread time improved for all patients after EED when compared with baseline or with controls ( P<0.05 ) . CONCLUSIONS Emulsion eye drop produces significant changes in the tear film of normal and dry eye patients . Further investigation with a prolonged period of treatment is warranted to establish whether EED may help improve the spread and thickness of the lipid tear film in moderate and severe dry eyes Background Dysfunction of the meibomian gl and ( MG ) is among the most frequent causes of ophthalmological symptoms . The inflammation seen in meibomian gl and dysfunction ( MGD ) is part of its pathogenesis , and evidence of the antioxidant-inflammatory properties of omega-3 fatty acids suggests this to be an appropriate treatment for MGD . Objective We aim ed to assess the effectiveness of omega-3 fatty acids versus placebo , in improving the symptoms and signs of MGD . Methods We conducted a r and omized and double-mask trial of 3 months duration . We enrolled 61 patients who presented with symptomatic MGD and no tear instability ( defined as tear breakup time [ TBUT ] < 10 seconds ) . Participants were r and omly assigned to two homogeneous subgroups . For patients in group A , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus a placebo oral agent . For patients in group B , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus oral supplementation with omega-3 fatty acids . We performed the following tests : ( 1 ) TBUT ; ( 2 ) Schirmer I test ; ( 3 ) Ocular Surface Disease Index © ( OSDI © ; Allergan , Inc. , Irvine , CA , USA ) ; ( 4 ) MG expression ; ( 5 ) evaluation of lid margin inflammation ; and ( 6 ) interpalpebral and corneal dye staining . Results After 3 months of evaluation , the mean OSDI , TBUT , lid margin inflammation , and MG expression presented improvement from the baseline values , in group B ( P < 0.01 , P < 0.001 , P < 0.0001 , P < 0.0001 , respectively ) . The Schirmer test results were also improved and statistically significant ( P < 0.01 ) . Conclusion Oral omega-3 fatty acids , 1.5 grams per day , may be beneficial in the treatment of MGD , mainly by improving tear stability Purpose To evaluate the effect of a new , prescription-only medical food supplement containing omega-3 and omega-6 essential fatty acids on  dry eye signs and symptoms  , with or without concomitant topical cyclosporine . Methods A total of 43 subjects were r and omized and followed for 6 months . Group 1 ( n = 23 ) was assigned to take two soft geltabs of the medical food supplement by mouth twice daily for 6 months . Group 2 ( n = 20 ) was directed to take the medical food supplement in the same manner , along with topical cyclosporine , instilled twice daily during the last 3 months of the study . Subjects were evaluated at baseline , month 1 , month 3 , and month 6 . Primary outcome measures included tear breakup time ( TBUT ) , conjunctival staining , corneal staining , and change in subjective symptoms . Results Both groups had a statistically significant improvement in TBUT between baseline and month 6 . In the food supplement only group , TBUT improved by 0.805 seconds from baseline to month 6 . In the supplement/cyclosporine group , TBUT improved by 1.007 seconds from baseline . There was no statistically significant difference in TBUT between the two groups at baseline , month 3 , or month 6 . There were no significant differences in corneal or conjunctival staining between or within groups . Subjective symptoms were also improved in both groups . Conclusion Supplementation with the proper balance of omega-3 and omega-6 essential fatty acids improved TBUT and relieved patient symptoms . The addition of topical cyclosporine did not convey any statistically significant improvement in TBUT beyond that achieved by the supplement Purpose To evaluate the effects of acupuncture compared to a control group using artificial tears . Methods Setting & design : multicenter r and omised controlled trial ( three local research hospitals of South Korea ) . Study Population : 150 patients with moderate to severe dry eye . Intervention : Participants were r and omly allocated into four weeks of acupuncture treatment ( bilateral BL2 , GB14 , TE 23 , Ex1 , ST1 , GB20 , LI4 , LI11 and single GV23 ) or to the artificial tears group ( sodium carboxymethylcellulose ) . Main Outcome Measure(s ) : The ocular surface disease index ( OSDI ) , tear film break-up time ( TFBUT ) , Schirmer Ι test , visual analogue scale ( VAS ) for self- assessment of ocular discomfort , general assessment ( by both acupuncture practitioners and participants ) and quality of life ( QOL ) through the Measure Yourself Medical Outcome Profile-2 ( MYMOP-2 ) . Results There was no statistically significant difference between two groups for the improvement of dry eye symptoms as measured by OSDI ( MD −16.11 , 95 % CI [ −20.91 , −11.32 ] with acupuncture and −15.37 , 95 % CI [ −19.57 , −11.16 ] with artificial tears ; P = 0.419 ) , VAS ( acupuncture : −23.84 [ −29.59 , −18.09 ] ; artificial tears : −22.2 [ −27.24 , −17.16 ] , P = 0.530 ) or quality of life ( acupuncture : −1.32 [ −1.65 , −0.99 ] ; artificial tears : −0.96 [ −1.32 , −0.6 ] , P = 0.42 ) immediately after treatment . However , compared with artificial tears group , the OSDI ( acupuncture : −16.15 [ −21.38 , −10.92 ] ; artificial tears : −10.76 [ −15.25 , −6.27 ] , P = 0.030 ) and VAS ( acupuncture : −23.88 [ −30.9 , −16.86 ] ; artificial tears : −14.71 [ −20.86 , −8.55 ] , P = 0.018 ) were significantly improved in the acupuncture group at 8 weeks after the end of acupuncture treatment . TFBUT measurements increased significantly in the acupuncture group after treatment . Conclusions Acupuncture may have benefits on the mid-term outcomes related to dry eye syndrome compared with artificial tears . Trial registration Clinical Trials.gov NCT01105221 PURPOSE The effective management of dry eye must include a clinical ly meaningful reduction in ocular staining . Evaluations of corneal and conjunctival staining and other ocular symptoms of dry eye were conducted for a new formulation of polyethylene glycol 400/propylene glycol-based lubricant eye drops containing hydroxypropyl guar as a gelling agent ( Test Product ) in comparison to Optive Lubricant Eye Drops ( Control Product ) in adult patients with dry eye . METHODS One hundred thirteen patients , 18 years of age and older , with dry eye were enrolled in a prospect i ve , double-masked , multisite , parallel-group study . After a 2-week run-in period during which patients administered aqueous saline eye drops 4 times daily ( QID ) in each eye , patients were r and omized ( 1:1 ) to receive either Test Product or Control Product to be administered QID for 6 weeks . Efficacy and safety were evaluated by corneal and conjunctival staining scores , tear film breakup time , assessment s of ocular symptoms , ocular surface disease index ( OSDI ) scores , dry eye treatment satisfaction , visual function-14 question naires , and adverse events . RESULTS The intent-to-treat data set included 105 patients r and omized to Test Product ( n = 52 ) or Control Product ( n = 53 ) . Patients primarily were between the ages of 18 - 64 years ( 70.5 % ) , female ( 73.3 % ) , white ( 93.3 % ) , and not Hispanic ( 81.9 % ) . Patients in the Test Product group exhibited significantly lower mean corneal staining scores than the Control Product group at day 14 ( P = 0.0009 ) and day 42 ( P = 0.0106 ) , and significantly lower mean conjunctival staining scores at day 28 ( P = 0.0475 ) and day 42 ( P = 0.0009 ) . Patients in both treatment groups reported significant reductions in the mean scores for the ocular symptoms of dryness , gritty/s and y feeling , and burning ( P < or= 0.0021 for all comparisons to baseline ) . Lastly , a significantly lower OSDI score than baseline was reported at day 42 by patients in both the Test Product ( P = 0.0013 ) and Control Product ( P < 0.0001 ) groups . CONCLUSIONS The results of this study indicate that the Test Product significantly reduced corneal and conjunctival staining , indicating a reduction in disease severity . Evaluations of ocular staining scores provide clinical ly meaningful evidence of dry eye severity and are an important indicator of dry eye disease progression Background The purpose of this study was to compare changes in corneal staining in patients with dry eye after 6 weeks of treatment with Systane ® Gel Drops or Refresh Liquigel ® lubricant eye drops . Methods Patients aged ≥18 years with a sodium fluorescein corneal staining sum score of ≥3 in either eye and best-corrected visual acuity of 0.6 logarithm of the minimum angle of resolution or better in each eye who were using a lubricant eye gel or ointment for dry eye were included in this r and omized , parallel-group , multicenter , double-blind trial . Patients were r and omized to four times daily Systane ® Gel Drops ( polyethylene glycol 400 0.4 % and propylene glycol 0.3 % ) or Refresh LiquiGel ® Drops ( carboxymethylcellulose sodium 1 % ) for 6 weeks . The primary efficacy outcome was mean change from baseline to week 6 in sodium fluorescein corneal staining . Supportive efficacy outcomes included conjunctival staining , tear film break-up time , Patient Global Assessment of Improvement , Impact of Dry Eye on Everyday Life ( IDEEL ) Treatment Satisfaction/Treatment Bother Question naire , Single Symptom Comfort Scale , and Ocular Symptoms Question naire . The safety analysis comprised recording of adverse events . Results In total , 147 patients ( Systane group , n=73 ; Refresh group , n=74 ; mean ± st and ard deviation age , 57±16 years ) were enrolled and included in the safety and efficacy analyses  . Corneal staining was significantly reduced from baseline to week 6 for Systane and Refresh ( −3.4±2.5 and −2.5±2.6 units , respectively ; P<0.0001 , t-test ) , with a significantly greater improvement with Systane versus Refresh ( P=0.0294 ) . Results for conjunctival staining , tear film break-up time , and patient-reported outcome question naires were not statistically different between groups . No safety issues were identified ; adverse events were reported by 19 % of patients with Systane and 30 % of patients with Refresh eye drops . Conclusion Systane Gel Drops were associated with significantly better corneal staining scores versus Refresh Liquigel eye drops in patients with dry eye . Supportive efficacy outcomes were not significantly different between groups . Both treatments were well tolerated Abstract Purpose : To evaluate the effects of different artificial tear eye drops on Ocular Surface Disease Index ( OSDI ) , tear osmolarity , Schirmer ’s I test , and tear 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE The lipid tear film stabilizes the tears by lowering the surface tension and preventing aqueous tear evaporation and may be analyzed by kinetic analysis of the tear interference images . This study investigated changes in the lipid film after application of a new emulsion-based eye drop of Refresh Endura ( Allergan , Irvine , CA ) in normal subjects and patients with dry eyes . DESIGN Comparative , nonr and omized interventional study . PARTICIPANTS Five normal subjects and 10 aqueous tear deficiency ( ATD ) patients with or without lipid tear deficiency were enrolled prospect ively . METHODS A complete eye examination was performed , including symptom score , tear break-up time , dye staining , and fluorescein clearance test . One eye received a single dose of emulsion eye drop ( EED ) , whereas the other eye received nonpreserved saline as a control . Kinetic analysis of tear interference images taken by DR-1 ( Kowa , Japan ) was performed before and at various times after instillation of the drops . MAIN OUTCOME MEASURES Symptoms , pattern , thickness , and spread time of the tear film . RESULTS Compared with the control , all eyes receiving EED showed rapid restructuring of the preexisting lipid film . In normal persons , restructuring result ed in a thick lipid b and across the cornea and a significant increase of the lipid film thickness . For ATD patients , EED application result ed in either a scant , irregular tear film , which became covered by the lipid film , or a modified lipid film changed without forming a b and or irregularities .  Emulsion eye drops tended to be more comfortable in patients with more severe ATD . Kinetic analysis showed that the mean spread time improved for all patients after EED when compared with baseline or with controls ( P<0.05 ) . CONCLUSIONS Emulsion eye drop produces significant changes in the tear film of normal and dry eye patients . Further investigation with a prolonged period of treatment is warranted to establish whether EED may help improve the spread and thickness of the lipid tear film in moderate and severe dry eyes Background Dysfunction of the meibomian gl and ( MG ) is among the most frequent causes of ophthalmological symptoms . The inflammation seen in meibomian gl and dysfunction ( MGD ) is part of its pathogenesis , and evidence of the antioxidant-inflammatory properties of omega-3 fatty acids suggests this to be an appropriate treatment for MGD . Objective We aim ed to assess the effectiveness of omega-3 fatty acids versus placebo , in improving the symptoms and signs of MGD . Methods We conducted a r and omized and double-mask trial of 3 months duration . We enrolled 61 patients who presented with symptomatic MGD and no tear instability ( defined as tear breakup time [ TBUT ] < 10 seconds ) . Participants were r and omly assigned to two homogeneous subgroups . For patients in group A , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus a placebo oral agent . For patients in group B , the study treatment included cleaning the lid margins with neutral baby shampoo and use of artificial tears without preservatives , plus oral supplementation with omega-3 fatty acids . We performed the following tests : ( 1 ) TBUT ; ( 2 ) Schirmer I test ; ( 3 ) Ocular Surface Disease Index © ( OSDI © ; Allergan , Inc. , Irvine , CA , USA ) ; ( 4 ) MG expression ; ( 5 ) evaluation of lid margin inflammation ; and ( 6 ) interpalpebral and corneal dye staining . Results After 3 months of evaluation , the mean OSDI , TBUT , lid margin inflammation , and MG expression presented improvement from the baseline values , in group B ( P < 0.01 , P < 0.001 , P < 0.0001 , P < 0.0001 , respectively ) . The Schirmer test results were also improved and statistically significant ( P < 0.01 ) . Conclusion Oral omega-3 fatty acids , 1.5 grams per day , may be beneficial in the treatment of MGD , mainly by improving tear stability Purpose To evaluate the effect of a new , prescription-only medical food supplement containing omega-3 and omega-6 essential fatty acids on  dry eye signs and symptoms  , with or without concomitant topical cyclosporine . Methods A total of 43 subjects were r and omized and followed for 6 months . Group 1 ( n = 23 ) was assigned to take two soft geltabs of the medical food supplement by mouth twice daily for 6 months . Group 2 ( n = 20 ) was directed to take the medical food supplement in the same manner , along with topical cyclosporine , instilled twice daily during the last 3 months of the study . Subjects were evaluated at baseline , month 1 , month 3 , and month 6 . Primary outcome measures included tear breakup time ( TBUT ) , conjunctival staining , corneal staining , and change in subjective symptoms . Results Both groups had a statistically significant improvement in TBUT between baseline and month 6 . In the food supplement only group , TBUT improved by 0.805 seconds from baseline to month 6 . In the supplement/cyclosporine group , TBUT improved by 1.007 seconds from baseline . There was no statistically significant difference in TBUT between the two groups at baseline , month 3 , or month 6 . There were no significant differences in corneal or conjunctival staining between or within groups . Subjective symptoms were also improved in both groups . Conclusion Supplementation with the proper balance of omega-3 and omega-6 essential fatty acids improved TBUT and relieved patient symptoms . The addition of topical cyclosporine did not convey any statistically significant improvement in TBUT beyond that achieved by the supplement Purpose To evaluate the effects of acupuncture compared to a control group using artificial tears . Methods Setting & design : multicenter r and omised controlled trial ( three local research hospitals of South Korea ) . Study Population : 150 patients with moderate to severe dry eye . Intervention : Participants were r and omly allocated into four weeks of acupuncture treatment ( bilateral BL2 , GB14 , TE 23 , Ex1 , ST1 , GB20 , LI4 , LI11 and single GV23 ) or to the artificial tears group ( sodium carboxymethylcellulose ) . Main Outcome Measure(s ) : The ocular surface disease index ( OSDI ) , tear film break-up time ( TFBUT ) , Schirmer Ι test , visual analogue scale ( VAS ) for self- assessment of ocular discomfort , general assessment ( by both acupuncture practitioners and participants ) and quality of life ( QOL ) through the Measure Yourself Medical Outcome Profile-2 ( MYMOP-2 ) . Results There was no statistically significant difference between two groups for the improvement of dry eye symptoms as measured by OSDI ( MD −16.11 , 95 % CI [ −20.91 , −11.32 ] with acupuncture and −15.37 , 95 % CI [ −19.57 , −11.16 ] with artificial tears ; P = 0.419 ) , VAS ( acupuncture : −23.84 [ −29.59 , −18.09 ] ; artificial tears : −22.2 [ −27.24 , −17.16 ] , P = 0.530 ) or quality of life ( acupuncture : −1.32 [ −1.65 , −0.99 ] ; artificial tears : −0.96 [ −1.32 , −0.6 ] , P = 0.42 ) immediately after treatment . However , compared with artificial tears group , the OSDI ( acupuncture : −16.15 [ −21.38 , −10.92 ] ; artificial tears : −10.76 [ −15.25 , −6.27 ] , P = 0.030 ) and VAS ( acupuncture : −23.88 [ −30.9 , −16.86 ] ; artificial tears : −14.71 [ −20.86 , −8.55 ] , P = 0.018 ) were significantly improved in the acupuncture group at 8 weeks after the end of acupuncture treatment . TFBUT measurements increased significantly in the acupuncture group after treatment . Conclusions Acupuncture may have benefits on the mid-term outcomes related to dry eye syndrome compared with artificial tears . Trial registration Clinical Trials.gov NCT01105221 PURPOSE The effective management of dry eye must include a clinical ly meaningful reduction in ocular staining . Evaluations of corneal and conjunctival staining and other ocular symptoms of dry eye were conducted for a new formulation of polyethylene glycol 400/propylene glycol-based lubricant eye drops containing hydroxypropyl guar as a gelling agent ( Test Product ) in comparison to Optive Lubricant Eye Drops ( Control Product ) in adult patients with dry eye . METHODS One hundred thirteen patients , 18 years of age and older , with dry eye were enrolled in a prospect i ve , double-masked , multisite , parallel-group study . After a 2-week run-in period during which patients administered aqueous saline eye drops 4 times daily ( QID ) in each eye , patients were r and omized ( 1:1 ) to receive either Test Product or Control Product to be administered QID for 6 weeks . Efficacy and safety were evaluated by corneal and conjunctival staining scores , tear film breakup time , assessment s of ocular symptoms , ocular surface disease index ( OSDI ) scores , dry eye treatment satisfaction , visual function-14 question naires , and adverse events . RESULTS The intent-to-treat data set included 105 patients r and omized to Test Product ( n = 52 ) or Control Product ( n = 53 ) . Patients primarily were between the ages of 18 - 64 years ( 70.5 % ) , female ( 73.3 % ) , white ( 93.3 % ) , and not Hispanic ( 81.9 % ) . Patients in the Test Product group exhibited significantly lower mean corneal staining scores than the Control Product group at day 14 ( P = 0.0009 ) and day 42 ( P = 0.0106 ) , and significantly lower mean conjunctival staining scores at day 28 ( P = 0.0475 ) and day 42 ( P = 0.0009 ) . Patients in both treatment groups reported significant reductions in the mean scores for the ocular symptoms of dryness , gritty/s and y feeling , and burning ( P < or= 0.0021 for all comparisons to baseline ) . Lastly , a significantly lower OSDI score than baseline was reported at day 42 by patients in both the Test Product ( P = 0.0013 ) and Control Product ( P < 0.0001 ) groups . CONCLUSIONS The results of this study indicate that the Test Product significantly reduced corneal and conjunctival staining , indicating a reduction in disease severity . Evaluations of ocular staining scores provide clinical ly meaningful evidence of dry eye severity and are an important indicator of dry eye disease progression Background The purpose of this study was to compare changes in corneal staining in patients with dry eye after 6 weeks of treatment with Systane ® Gel Drops or Refresh Liquigel ® lubricant eye drops . Methods Patients aged ≥18 years with a sodium fluorescein corneal staining sum score of ≥3 in either eye and best-corrected visual acuity of 0.6 logarithm of the minimum angle of resolution or better in each eye who were using a lubricant eye gel or ointment for dry eye were included in this r and omized , parallel-group , multicenter , double-blind trial . Patients were r and omized to four times daily Systane ® Gel Drops ( polyethylene glycol 400 0.4 % and propylene glycol 0.3 % ) or Refresh LiquiGel ® Drops ( carboxymethylcellulose sodium 1 % ) for 6 weeks . The primary efficacy outcome was mean change from baseline to week 6 in sodium fluorescein corneal staining . Supportive efficacy outcomes included conjunctival staining , tear film break-up time , Patient Global Assessment of Improvement , Impact of Dry Eye on Everyday Life ( IDEEL ) Treatment Satisfaction/Treatment Bother Question naire , Single Symptom Comfort Scale , and Ocular Symptoms Question naire . The safety analysis comprised recording of adverse events . Results In total , 147 patients ( Systane group , n=73 ; Refresh group , n=74 ; mean ± st and ard deviation age , 57±16 years ) were enrolled and included in the safety and efficacy analyses  . Corneal staining was significantly reduced from baseline to week 6 for Systane and Refresh ( −3.4±2.5 and −2.5±2.6 units , respectively ; P<0.0001 , t-test ) , with a significantly greater improvement with Systane versus Refresh ( P=0.0294 ) . Results for conjunctival staining , tear film break-up time , and patient-reported outcome question naires were not statistically different between groups . No safety issues were identified ; adverse events were reported by 19 % of patients with Systane and 30 % of patients with Refresh eye drops . Conclusion Systane Gel Drops were associated with significantly better corneal staining scores versus Refresh Liquigel eye drops in patients with dry eye . Supportive efficacy outcomes were not significantly different between groups . Both treatments were well tolerated Abstract Purpose : To evaluate the effects of different artificial tear eye drops on Ocular Surface Disease Index ( OSDI ) , tear osmolarity , Schirmer ’s I test , and tear 
    Output:
    