Elizabeth Roy Felix

Introduction: Chronic ocular pain (COP) is a widespread pain condition that presents clinical challenges, has heterologous and overlapping etiologies across patients, and can have a debilitating effect on quality of life. It can manifest with neuropathic-like symptoms as well as dysesthesias associated with afferent disruption, brain dysfunction, or both, complicating diagnosis and treatment. Quantitative sensory testing (QST) has been used extensively in individuals with chronic pain to detect abnormal peripheral and central nervous system function. Investigating relevant sensory thresholds is crucial for integrating QST into ocular pain assessments. Objectives: This study aimed to determine heat pain thresholds on the eyelid in healthy participants. Furthermore, we sought to evaluate the eyelid as a feasible and suitable body site for COP investigation using QST. Methods: Heat pain thresholds were measured in 80 healthy participants at 2 study sites using the method of limits at 3 stimulation sites: the upper eyelid, the forehead, and the volar forearm. Results: Analysis revealed a significantly lower estimated marginal mean (EMM) heat pain threshold on the eyelid (42.5 ± 0.4 EMM ± SE) compared with the forehead (46.6 ± 0.4 EMM ± SE) (P < 0.001) and forearm (46.4 ± 0.4 EMM ± SE) (P < 0.001). These differences were statistically significant regardless of sex, study site, or age. No differences were found between the forehead and the forearm (P = 1.00). Conclusion: The eyelid is a clinically relevant site for QST in the investigation of ocular and trigeminal function, and this study sets the groundwork for applying eyelid QST in future research of ocular pain and disease etiology.

To describe health consequences associated with poor diet in persons with spinal cord injuries and disorders (SCI/D). Descriptive qualitative design using in-depth interviews with SCI/D health providers. Audio-recorded and transcribed verbatim transcripts were coded and analyzed using thematic analysis. Participants (n = 12) were from 11 nationwide VA hospitals. Participants were male (75%), white (67%), 26-49 years of age, and most were dietitians (75%) and physiatrists (17%). Seven key themes identified consequences associated with poor diet in persons with SCI/D, including (1) Weight gain and body composition changes, (2) cardiometabolic conditions, (3) bowel dysfunction, (4) pressure injuries/wounds, (5) other SCI/D secondary conditions/complications (renal/kidney; immune function/susceptibility to infections; autonomic dysreflexia; bone health/osteoporosis; pain), (6) physical fatigue, and (7) poor mental health. Excess weight, cardiometabolic conditions, SCI/D secondary conditions/complications (e.g., bowel dysfunction, pressure injuries), and poor mental health were identified as health consequences of inadequate nutrition. Health providers should make individuals with SCI/D aware of the risks and health consequences to incentivize healthier dietary behaviors. Efforts to identify nutrition shortcomings and to develop interventions and tailored care plans are needed to improve a myriad of health consequences due to poor diet and nutrition in persons with SCI/D.

Background: We evaluate the relationship between corneal nerve structure and function in a veteran population. Methods: 83 veterans (mean age: 55 ± 5 years) seen at the Miami Veterans Affairs (VA) eye clinic were included in this study. Each individual filled out questionnaires to evaluate ocular symptoms (5-Item Dry Eye Questionnaire, DEQ5; Ocular Surface Disease Index, OSDI) and ocular pain (Numerical Rating Scale, NRS; Neuropathic Pain Symptom Inventory modified for the Eye, NPSI-Eye). The individuals also underwent an ocular surface examination that captured functional nerve tests including corneal sensation, corneal staining, and the Schirmer test for tear production. Corneal sub-basal nerve analysis was conducted using in vivo confocal microscopy (IVCM) images with corneal nerve density, length, area, width, and fractal dimension captured. IVCM and functional corneal metrics from the right eye were examined using correlational and linear regression analysis. Results: Most corneal structural metrics were not related to functional metrics, except for weak correlations between various IVCM metrics and tear production. In addition, corneal nerve fiber area was positively related to corneal sensation (r = 0.3, p = 0.01). On linear regression analyses, only the corneal fractal dimension remained significantly related to tear production (β = −0.26, p = 0.02) and only the corneal nerve fiber area remained significantly related to corneal sensation (β = 0.3, p = 0.01). Conclusions: Most corneal nerve structural metrics did not relate to functional metrics in our veteran population, apart from a few weak correlations between structural metrics and tear production. This suggests that using corneal nerve anatomy alone may be insufficient for predicting corneal function.

Purpose: To evaluate the relationship between corneal nerve structure and function in a veteran population. Methods: 83 veterans (mean age: 55 ± 5 years) seen at the Miami Veterans Affairs (VA) eye clinic were included in the study. Each individual filled out questionnaires to evaluate ocular symptoms (5-Item Dry Eye Questionnaire, DEQ5, Ocular Surface Disease Index, OSDI) and ocular pain (Numerical Rating Scale, NRS, Neuropathic Pain Symptom Inventory modified for the Eye, NPSI-Eye). Individuals also underwent an ocular surface examination that captured functional nerve tests including corneal sensation, corneal staining, and Schirmer test for tear production. Corneal sub-basal nerve analysis was conducted using in vivo confocal microscopy (IVCM) images with corneal nerve density, length, area, width, and fractal dimension captured. IVCM and functional corneal metrics from the right eye were examined using correlational and linear regression analysis. Results: Most corneal structural metrics were not related to functional metrics, except for weak correlations between various IVCM metrics and tear production. In addition, corneal nerve fiber area was positively related to corneal sensation (r = 0.3, p = 0.01). On linear regression analyses, only corneal fractal dimension remained significantly related to tear production (β = -0.26, p = 0.02) and only corneal nerve fiber area remained significantly related to corneal sensation (β = 0.3, p = 0.01). Conclusions: Most corneal nerve structural metrics did not relate to functional metrics in our veteran population, apart from a few weak correlations between structural metrics and tear production. This highlights caution in using corneal nerve anatomy to predict corneal function.