Tear film hTERT and corneal nerve characteristics in dry eye disease

ABSTRACT

Clinical relevance

The behaviour of human telomerase reverse transcriptase (hTERT) in tears reflects its role in maintaining the ocular surface homoeostasis, as it is increased after the initial fitting of contact lenses and post-overnight lid closure.

Background

hTERT has been shown to respond to cellular stress in neurodegenerative diseases and to enhance axonal regeneration after peripheral axotomy in an animal model. This work investigated whether the behaviour of hTERT in the tear film reflects ocular surface inflammation and neuronal changes in the presence of dry eye disease.

Methods

Flush tears were collected from 18 participants with dry eye disease (14 females, 4 males, mean age 34.7 ± 5.2 years) and from 18 healthy participants without dry eye disease (8 females, 10 males, mean age 31.9 ± 5.8 years). Dry eye disease status was defined using the TFOS DEWS II diagnostic criteria. hTERT levels in tears were measured using enzyme-linked immunosorbent assays. Confocal images were taken at the level of the subbasal nerve plexus at the central cornea and at the inferior whorl, and the densities of corneal immune cells were evaluated as well as corneal nerve morphology metrics using a fully automated technique (University of Manchester, United Kingdom).

Results

In participants with dry eye disease, hTERT levels were significantly higher compared to controls (median [interquartile range]: 434 [320–600] ng/ml, and 184 [42–390] ng/ml, respectively, p = 0.01). Increased nerve fibre width at the inferior whorl, was seen in those with dry eyes (0.0219 [0.0214–0.0236] mm/mm compared to controls 0.0217 [0.0207 0.0222] p < 0.001), but no significant differences were found in the density of corneal immune cells.

Conclusions

hTERT levels were elevated in participants with dry eye disease, and this was accompanied by increased nerve thickness in the inferior cornea. The hTERT response may reflect the stress induced to the ocular surface and corneal nerves due to having dry eye disease.

KEYWORDS:

• Corneal nerves
• dry eye
• hTERT
• ocular surface
• tear film

Acknowledgements

The authors extend their appreciation to the College of Applied Medical Sciences and the Deanship of Scientific Research at King Saud University.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project was supported by CooperVision Inc. (Pleasanton, USA). Dr Sultan Alotaibi is sponsored by King Saud University, Riyadh, Kingdom of Saudi Arabia. Dr Stuti L Misra was funded by the Stevenson Foundation.