Abstract
Purpose
To assess the agreement and repeatability of two objective systems for measuring the tear film stability.
Methods
Retrospective analysis of the tear film stability of 99 healthy right eyes measured with a videokeratoscope (VK) and the Optical Quality Analysis System (OQAS, Visiometrics). Two consecutive measures were taken with both systems, with an interval of 10 min between them. Variables included in the study were first and mean non-invasive break-up times (NIBUT and MNIBUT) measured with VK, and mean and standard deviation of the optical scattering index (OSIm and OSIsd) measured with OQAS. The agreement and repeatability of grading scales provided by both devices were also evaluated using the Cohen’s k with quadratic weights. The Ocular Surface Disease index (OSDI) questionnaire was also passed out to all subjects. Correlations and associations between subjective and objective metrics were analyzed.
Results
Significant differences were found between consecutive measurements of NIBUT (p = 0.04) and MNIBUT (p = 0.01), but not for OSIm (p = 0.11) and OSIsd (p = 0.50). Grading scales resulted in fair (k = 0.20) or poor agreement (k = 0.04) between systems depending if the first or second trial was considered. The repeatability of the grading scale was good for OQAS (k = 0.59) and fair for VK (k = 0.37). No significant correlations or associations were found between OSDI and any of the metrics obtained with both devices (p ≥ 0.36).
Conclusions
The two devices evaluated cannot be used interchangeably for the assessment of tear film stability. Good intrasession repeatability was obtained for tear film grading of the OQAS whereas it was fair for VK.
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References
Torricelli AM, Bechara SJ, Wilson SE (2014) Screening of refractive surgery candidates for LASIK and PRK. Cornea 33:1051–1055
Levitt AE, Galor A, Weiss JS et al (2015) Chronic dry eye symptoms after LASIK: parallels and lessons to be learned from other persistent post-operative pain disorders. Mol Pain 11:1–12
Jabbur NS, Sakatani K, O’Brien TP (2004) Survey of complications and recommendations for management in dissatisfied patients seeking a consultation after refractive surgery. J Cataract Refract Surg 30:1867–1874
Li M, Zhao J, Shen Y et al (2013) Comparison of dry eye and corneal sensitivity between small incision lenticule extraction and femtosecond LASIK for myopia. PLoS One 8:e77797
Hu L, Xie W, Liu J et al (2015) Tear menisci and corneal subbasal nerve density in patients after laser in situ keratomileusis. Eye Contact Lens Sci Clin Pract 41:51–57
Tao A, Shen M, Wang J et al (2010) Upper and lower tear menisci after laser in situ keratomileusis. Eye Contact Lens 36:81–85
Nichols KK, Nichols JJ, Mitchell GL (2004) The lack of association between signs and symptoms in patients with dry eye disease. Cornea 23:762–770
Tuisku IS, Lindbohm N, Wilson SE, Tervo TM (2007) Dry eye and corneal sensitivity after high myopic LASIK. J Refract Surg 23:338–342
Farahi A, Hashemi H, Mehravaran S et al (2014) Tear function evaluation in candidates of corneal laser refractive surgery for myopia. Eye Contact Lens 40:91–94
Shen Z, Shi K, Yu Y et al (2016) Small incision lenticule extraction (SMILE) versus femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for myopia: a systematic review and meta-analysis. PLoS One 11:e0158176
Zeev MS, Miller DD, Latkany R (2014) Diagnosis of dry eye disease and emerging technologies. Clin Ophthalmol 8:581–590
Artal P, Benito A, Pérez GM et al (2011) An objective scatter index based on double-pass retinal images of a point source to classify cataracts. PLoS One 6:1–7
Tan CH, Labbe A, Liang Q et al (2015) Dynamic change of optical quality in patients with dry eye disease. Invest Ophthalmol Vis Sci 56:2848–2854
Schiffman RM (2000) Reliability and validity of the ocular surface disease index. Arch Ophthalmol 118:615
Miller KL, Walt JG, Mink DR, et al (2010) Minimal clinically important difference for the ocular surface disease index. Arch Ophthalmol (Chicago, Ill 1960) 128:94–101
Kottner J, Audigé L, Brorson S et al (2011) Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J Clin Epidemiol 64:96–106
Bland JM, Altman DG (1999) Statistical methods in medical research. Stat Methods Med Res 8:135–160
Xue AL, Downie LE, Ormonde SE, Craig JP (2017) A comparison of the self-reported dry eye practices of New Zealand optometrists and ophthalmologists. Ophthalmic Physiol Opt 37:191–201
Hong J, Sun X, Wei A et al (2013) Assessment of tear film stability in dry eye with a newly developed keratograph. Cornea 32:716–721
Hong J, Liu Z, Hua J et al (2014) Evaluation of age-related changes in noninvasive tear breakup time. Optom Vis Sci 91:1
Bhandari V, Reddy JK, Relekar K et al (2016) Non-invasive assessment of tear film stability with a novel corneal topographer in Indian subjects. Int Ophthalmol 36:781–790
Lan W, Lin L, Yang X, Yu M (2014) Automatic noninvasive tear breakup time (TBUT) and conventional fluorescent TBUT. Optom Vis Sci 91:1412–1418
Abdelfattah NS, Dastiridou A, Sadda SR, Lee OL (2015) Noninvasive imaging of tear film dynamics in eyes with ocular surface disease. Cornea 34(Suppl 1):S48–S52
Cox SM, Nichols KK, Nichols JJ (2015) Agreement between automated and traditional measures of tear film breakup. Optom Vis Sci 92:e257–e263
Tian L, Qu JH, Zhang XY, Sun XG (2016) Repeatability and reproducibility of noninvasive keratograph 5m measurements in patients with dry eye disease. J Ophthalmol 2016
Wang X, Lu X, Yang J, et al (2016) Evaluation of dry eye and meibomian gland dysfunction in teenagers with myopia through noninvasive keratograph. J Ophthalmol 2016:6761206
Best N, Drury L, Wolffsohn JS (2012) Clinical evaluation of the oculus keratograph. Contact Lens Anterior Eye 35:171–174
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159
Caglar C, Senel E, Sabancilar E, Durmus M (2017) Reduced ocular surface disease index (OSDI) scores in patients with isotretinoin treatment. Int Ophthalmol 37:197–202
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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements). Dr. Joaquín Fernández has participated as invited speaker in events organized by Oculus Optikgeräte GmbH, Wetzlar, Germany. Remaining authors declare non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
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This study was approved by the local ethics committee of research and was performed in adherence to the tenets of the Declaration of Helsinki. For this type of study, formal consent is not required.
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Fernández, J., Rodríguez-Vallejo, M., Martínez, J. et al. Agreement and repeatability of objective systems for assessment of the tear film. Graefes Arch Clin Exp Ophthalmol 256, 1535–1541 (2018). https://doi.org/10.1007/s00417-018-3986-9
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DOI: https://doi.org/10.1007/s00417-018-3986-9