Advances in the Noninvasive Diagnosis of Dry Eye Disease
, Aldo Vagge 1, Massimiliano Borselli 5, Lorenzo Ferro Desideri 1, Vincenzo Scorcia 5, Carlo E. Traverso 1 and Giuseppe Giannaccare 5,*
Maria Laura Gomez
Round 1
Reviewer 1 Report
Comments and Suggestions for Authors
-I want to congratulate the authors on a very well-written and understandable article. I have a few suggestions mainly on grammar and clarity of content that need to be addressed. Unfortunately, there are no line numbers to refer to so I will make comments based on page and paragraph.
Page 4(Sec. 4)(P4)- “Deschamps et al….) Awkward sentence. Are you wanting to equate activities of daily living to a driving simulator test?
Page 5(Sec.6)(P2)- “…corneal epithelium in DED patients demonstrated significant…”
Page 5(Sec.6)(P5)- “…diameter of MG orifice…”, “…between the IVCM and the meibography scores.”
Page 5(Sec.7)(P1)- Should “developed” be replaced with ”refined” for clarity?
Should the last sentence reordered to read “Noncontact techniques based …have been developed in the last decade.”?
Page 6(Sec.7)(P2)- Misplaced period prior to MGD.
Page 6(Sec.8)P4)- “DR-1 α camera” starts to be used in text. Is this the same as “DR-1 camera”? Is this the same camera or a newer updated model?
May need to rephrase “…possible to evaluate the ‘kinetic spread’ (or use the ‘kinetics of spread’) after eye opening…”
Add “resulted” to sentence “…lipid spread was slow and resulted in a vertical streaking…” Misplaced period between “different subtypes”.
Would “comparing” be more appropriate that “differencing”?
Page 7(Sec.9)(P1)- Delete “by” in “…Morgan et.al measured ocular surface…”
Page 7(Sec.10(P1)- The use of “pathogenic stimuli” may not be entirely correct. Are pathogens the only stimuli? Need to expand or correct terminology.
Page 8(Sec.11)(P1)- “progress” or “progression” may be better word than “progresses”.
“analytics” needs to be changed to “analytic”.
The phrase “manual maneuvers” seems awkward and may need to be rephrased.
Page 8(Sec.11)(P2)-“…break-up in the tear film until the ‘next’ (or use ‘subsequent’) blink.” for clarity.
“parameters, such as size or growing rate.” Please define ‘growing rate” or use another term, such as “rate of dissociation”(if appropriate).
Page 8(Sec.11)(P3)- The term “proper system” needs to be defined.
The word “latter” refers to which technique mentioned in the paragraph which is confusing to the reviewer.
Page 8(Sec.12)(P1)- The term “undisputed” is a rather broad statement and needs to be defined to make that claim. “(e.g. before approaching to ocular surgery) may need to be changed to ‘prior ocular surgery’” for clarity. “…in case of detection of pathological values.” needs to be clarified and ‘pathological’ needs to be defined and checked for proper context.
Page 9(Sec.12)(Bottom of page)- “widely diffusion” may need to be changed to “widespread acceptance.
Page 10(Sec.12)(Top of page)- “…reduce the diagnostic accuracy…if acquisitions are not done by an Ophthalmologist and/or if the slit lamp examination is not performed.” But in the earlier text in page 8(Sec.12) you state “…used as screening tools…by trained medical personnel (not necessarily Ophthalmologist),…” Please address this seeming contradiction.
Page 10(Sec.12)(Bottom of page)-“…in the noninvasive workup attention should still be paid to the order of the diagnostic exams.” Please expand on this point.
Page 11(Sec.12)(Top of page)-“…the repetition of the workup…” may be clearer as “…multiple evaluation…”
Page 11(Conclusion)- “…among the population…” needs to be defined in the context of this paper.
“…introduced recently in clinical practice…” remove “the”
“…(early) diagnosis (rather than ‘diagnosing’) and monitoring (of) DED cases (rather than ‘course’).
Author Response
- I want to congratulate the authors on a very well-written and understandable article. I have a few suggestions mainly on grammar and clarity of content that need to be addressed. Unfortunately, there are no line numbers to refer to so I will make comments based on page and paragraph.
We thank the reviewer for this comment.
- Page 4(Sec. 4)(P4)- “Deschamps et al….) Awkward sentence. Are you wanting to equate activities of daily living to a driving simulator test?
We thank the reviewer for this comment; in the above-mentioned study the authors measured the impact of tear oil-related aberration changes on daily activities, such as driving. Thus, the driving simulating test has been adopted as an example of daily living activity. For this reason, the results of this study lead to interesting implications for the everyday life.
- Page 5(Sec.6)(P2)- “…corneal epithelium in DED patients demonstrated significant…”
We thank the reviewer for this comment, we modified the text as suggested.
- Page 5(Sec.6)(P5)- “…diameter of MG orifice…”, “…between the IVCM and the meibography scores.”
We thank the reviewer for this comment, we modified the text as suggested.
- Page 5(Sec.7)(P1)- Should “developed” be replaced with ”refined” for clarity?
We thank the reviewer for this comment, we modified the text as suggested.
- Should the last sentence reordered to read “Noncontact techniques based …have been developed in the last decade.”?
We thank the reviewer for this comment, we modified the text as suggested.
- Page 6(Sec.7)(P2)- Misplaced period prior to MGD.
We thank the reviewer for this comment, we modified the text as suggested.
- Page 6(Sec.8)P4)- “DR-1 α camera” starts to be used in text. Is this the same as “DR-1 camera”? Is this the same camera or a newer updated model?
We thank the reviewer for this comment. The model adopted is the same
- May need to rephrase “…possible to evaluate the ‘kinetic spread’ (or use the ‘kinetics of spread’) after eye opening…”
We thank the reviewer for this comment, we modified the text as suggested.
- Add “resulted” to sentence “…lipid spread was slow and resulted in a vertical streaking…” Misplaced period between “different subtypes”.
We thank the reviewer for this comment, we modified the text as suggested.
- Would “comparing” be more appropriate that “differencing”?
We thank the reviewer for this comment, we modified the text as suggested.
- Page 7(Sec.9)(P1)- Delete “by” in “…Morgan et.al measured ocular surface…”
We thank the reviewer for this comment, we modified the text as suggested.
- Page 7(Sec.10(P1)- The use of “pathogenic stimuli” may not be entirely correct. Are pathogens the only stimuli? Need to expand or correct terminology.
We thank the reviewer for this comment, we modified the text as suggested.
Page 8(Sec.11)(P1)- “progress” or “progression” may be better word than “progresses”.
We thank the reviewer for this comment, we modified the text as suggested.
- “analytics” needs to be changed to “analytic”.
We thank the reviewer for this comment, we modified the text as suggested.
- The phrase “manual maneuvers” seems awkward and may need to be rephrased.
We thank the reviewer for this comment, we modified the text as suggested.
- Page 8(Sec.11)(P2)-“…break-up in the tear film until the ‘next’ (or use ‘subsequent’) blink.” for clarity.
We thank the reviewer for this comment, we modified the text as suggested.
- “parameters, such as size or growing rate.” Please define ‘growing rate” or use another term, such as “rate of dissociation”(if appropriate).
We thank the reviewer for this comment, we modified the text as suggested.
- Page 8(Sec.11)(P3)- The term “proper system” needs to be defined. The word “latter” refers to which technique mentioned in the paragraph which is confusing to the reviewer.
We thank the reviewer for this comment, we modified the text as suggested.
- Page 8(Sec.12)(P1)- The term “undisputed” is a rather broad statement and needs to be defined to make that claim. “(e.g. before approaching to ocular surgery) may need to be changed to ‘prior ocular surgery’” for clarity. “…in case of detection of pathological values.” needs to be clarified and ‘pathological’ needs to be defined and checked for proper context.
We thank the reviewer for this comment, we modified the text as suggested.
- Page 9(Sec.12)(Bottom of page)- “widely diffusion” may need to be changed to “widespread acceptance.
We thank the reviewer for this comment, we modified the text as suggested.
- Page 10(Sec.12)(Top of page)- “…reduce the diagnostic accuracy…if acquisitions are not done by an Ophthalmologist and/or if the slit lamp examination is not performed.” But in the earlier text in page 8(Sec.12) you state “…used as screening tools…by trained medical personnel (not necessarily Ophthalmologist),…” Please address this seeming contradiction.
We thank the reviewer for this comment; however, in the second paragraph we wanted to underline the primary role of the ophthalmologist in the interpretation of the results rather than in the acquisition of the single examination, which can be done by medical personnel (not necessarily ophthalmologists). Therefore, we modified the text as follows: "Moreover, ophthalmological conditions other than DED may cause some artifacts that reduce the diagnostic accuracy, in particular if the image interpretations are not done by an Ophthalmologist and/or if the slit lamp examination is not performed."
- Page 10(Sec.12)(Bottom of page)-“…in the noninvasive workup attention should still be paid to the order of the diagnostic exams.” Please expand on this point.
We thank the reviewer for this comment. As stated in the text, for example performing NIBUT as the first exam will induce tearing due to the high brightness employed during this task; this should be considered since it could influence the results of tear meniscus height if performed subsequently.
Page 11(Sec.12)(Top of page)-“…the repetition of the workup…” may be clearer as “…multiple evaluation…”
We thank the reviewer for this comment, we modified the text as suggested.
Page 11(Conclusion)- “…among the population…” needs to be defined in the context of this paper.
“…introduced recently in clinical practice…” remove “the”
“…(early) diagnosis (rather than ‘diagnosing’) and monitoring (of) DED cases (rather than ‘course’).
We thank the reviewer for this comment, we modified the text as suggested.
Reviewer 2 Report
- Table 1 should be organized to follow the organization of the sections that follow. It was confusing and could be more useful if it had a more fluid flow
- At the end of section 4. Aberrometry, there is mention of "another work examining the effect of rebamipide 2%....." but no reference was given that I was able to find. Seems a reference would be important here to back up the claim.
- In section 6 there are multiple issues. At the end of paragraph 3, the final line reads" Benitez del Castillo et al. showed........" but there is no reference at the end. needs reference. At the end of paragrpah 4, the final line reads "The result of Lin et al. showed......." but ends in two references, one of which was not Lin et al. The same issue is at the beginning of paragraph 5 of this section. "Villani et all. demonstrated...." but has 3 references at end of sentence, one of which is Villani et al.
- Section 10 seems very weak in substance, and is just a laundry list of references with small summary sentences of each. Needs to have more substance to tie these concepts together, instead of just a list of summary statements.
- The pros-and cons section, as well as the conclusions section are quite sparse, and really could use more in them. This is the portion of the Review that the authors can showcase their own thoughts on all of these techniques, and seemed an afterthought
Author Response
- Table 1 should be organized to follow the organization of the sections that follow. It was confusing and could be more useful if it had a more fluid flow
We thank the reviewer for this comment. We modified the table structure as suggested, by reordering the section in line with the manuscript organization, which could be more easily understandable by the readers.
- At the end of section 4. Aberrometry, there is mention of "another work examining the effect of rebamipide 2%....." but no reference was given that I was able to find. Seems a reference would be important here to back up the claim.
We thank the reviewer for this comment. We insert the reference as suggested - In section 6 there are multiple issues. At the end of paragraph 3, the final line reads" Benitez del Castillo et al. showed........" but there is no reference at the end. needs reference. At the end of paragrpah 4, the final line reads "The result of Lin et al. showed......." but ends in two references, one of which was not Lin et al. The same issue is at the beginning of paragraph 5 of this section. "Villani et all. demonstrated...." but has 3 references at end of sentence, one of which is Villani et al.
We modified the references as suggested by the reviewer. - Section 10 seems very weak in substance, and is just a laundry list of references with small summary sentences of each. Needs to have more substance to tie these concepts together, instead of just a list of summary statements.
We thank the reviewer for this comment. We implemented this part of the manuscript as suggested. - The pros-and cons section, as well as the conclusions section are quite sparse, and really could use more in them. This is the portion of the Review that the authors can showcase their own thoughts on all of these techniques, and seemed an afterthought. Thanks for your suggestion. We implemented both the sections by adding various sentences about pros and cons and added also a new figure (Figure 3).
Reviewer 3 Report
Because there is not a gold standard imaging technique, new multi-imaging-integrated devices are precious instruments to help clinicians to better cope with the diagnostic complexity of dry eye disease.
Author Response
We thank the reviewer for this comment. Indeed, the aim of this review paper was to discuss all the novel imaging techniques already adopted and the new diagnostic devices in the pipeline investigated for the diagnosis of dry eye diseease
Reviewer 4 Report
The authors did a good job in summarizing the most recent advances in the non-invasive instruments for the diagnosis of dry eyes. It was clear and well presented.
Author Response
We thank the reviewer for this kind comment.
Round 2
Reviewer 2 Report
Authors addressed criticisms.
