PONE-D-22-21507Effect of surgical face mask wearing on tear film in individuals with a high body mass indexPLOS ONE

Dear Dr. El-Hiti,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The full title should be Effect of surgical face mask wearing on tear film in women with a high body mass index

Methods: high BMI (29.9 ± 4.1 years)- Should not state years but kg/m 2 instead.

What were the subjects doing in the hour between the tests? Are eyes open/closed? Same activities? Who tested the subjects? Same person? How many people analyzed the results?

Intro: They increase the viscosity of tears but result in blurry vision for a short duration [19] – This is a problematic phrasing. Furthermore, the reference does not fit. The latter involves examining two different drops on Rabbits.

A measurement of � 25

kg/m2 is considered the cut-off for a high BMI according to the WHO [22]. Abbreviation not specified.

In recent years, wearing a face mask has become necessary to reduce the COVID-

19 infection rates. Missing reference.

Methods: No specification on the way participants wore the mask – above or below the nose and who were excluded if they broke protocol.

The TF patterns for each tear sample were graded

based on the five-point TF grading scale – Was this done by a single observer or a few? This is important due to the test's nonlinear and semi-qualitative analysis.

There is no justification for the suggested number of participants in the methods section.

Results: Dry eye symptoms increased according to speed, and PRT improved. This needs further discussion. TF did not change. We do not expect the lacrimal gland to alter. How is this explained?

Discussion:

The authors suggest that parameters in the tear film changed but did not offer a hypothesis for their findings.

Conclusion –

Missing data regarding osmolarity, electrolytes, and the parameters that the writers imply changed.

In the literature review, important articles such as:

Shalaby HS, Eldesouky MEE. Effect of facemasks on the tear film during the COVID-19 pandemic. Eur J Ophthalmol. 2022 Jun 22:11206721221110010. Doi: 10.1177/11206721221110010. Epub ahead of print. PMID: 35733391; PMCID: PMC9289170.

And

Esen Baris M, Guven Yilmaz S, Palamar M. Impact of prolonged face mask wearing on tear break-up time and dry eye symptoms in health care professionals. Int Ophthalmol. 2022 Jul;42(7):2141-2144. DOI: 10.1007/s10792-022-02213-9. Epub 2022 Feb 4. PMID: 35119609; PMCID: PMC8815392

Are missing.

Reviewer #2: The authors presented an interesting study evaluating the effect of wearing a surgical face mask for a short period of time on the tear film parameters in subjects with a high body mass index. The manuscript is clear, its topic is original in content, and the conclusions are consistent with the evidence presented. The manuscript is with merit and the findings are worth reporting, but the authors should address the following comments before publication:

Introduction:

- Line 58: “tear break-up time (TBUT) [14], osmolarity [15], TER [16], tear ferning (TF) [17]” Authors need to explain the abbreviation “TER”.

Methods:

- Line 82: “Methods and methods”- please correct this repetition.

- Lines 85-86: “in a controlled environment of temperature and humidity” Authors need to explain what kind of environment was it- what temperature, what humidity, was it indoor or outdoor, were patients remaining indoor for 1 hour?

- Line 92: “high refractive errors” – the authors should expand this paragraph by providing additional details about what they mean by high refractive error?

- Line 93-94: “The medical record of each subject was checked including blood analysis.”- Authors are encouraged to specify if you checked blood work that was already done, were they looking for anything specific? Did they order any blood work if there wasn’t any results available in subjects’ charts?

Results:

- Lines 158-159: “For the control group, no significant differences were found between the two scores from the SPEED questionnaire and the PRT, and TF tests.” – Authors need to show SPEED, PRT, and TF scores for the control group.

- Line 165-166: “The TF test indicated that the quality of tears was reduced in the majority of subjects in the study group as a result of wearing the mask.” – What about control group again? Authors need to provide more details about test results in control group.

Discussion:

- Lines 192-194: “No significant differences were seen between the study and control groups for the SODI, PRT, and THM scores.” Please explain abbreviations SODI, THM as they were not used in manuscript before.

- The authors should provide discussion on the limitations of their study. For example: Is there any significance in gender differences in similar studies in the literature?

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Reviewer #1: No

Reviewer #2: No

**********

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Attachments

Attachment

Submitted filename: Review article surgical masks high BMI and dry eye.pdf

Attachment

Submitted filename: Effect of surgical face mask wearing on tear film in individuals with a high body mass index.docx

PONE-D-22-21507R1Effect of surgical face mask wearing on tear film in women with a high body mass indexPLOS ONE

Dear Dr. Gaman A. El-Hiti,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Nov 20 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Alon Harris

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The author did correct most of the suggestions. This article looks better.

Nevertheless, some corrections are still not self-explanatory.

Please review the attached document for further information.

Good luck.

Reviewer #2: The manuscript is clear, authors adressed all reviewers' comments, the conclusions are consistent with the evidence presented.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Second review.docx

Effect of surgical face mask wearing on tear film in women with a high body mass index

PONE-D-22-21507R2

Dear Dr. El-Hiti,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Alon Harris

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: All issues were addressed.

There are no further comments regarding this manuscript from my end.

Good luck.

Reviewer #2: The manuscript is with merit, findings are worth reporting. Authors have addressed reviewers' comments, the conclusions

are consistent with the evidence presented. I do not have other comments.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

**********

Attachments

Attachment

Submitted filename: Final decision .docx