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Agreement and repeatability of objective systems for assessment of the tear film

Graefe's Archive for Clinical and Experimental Ophthalmology volume 256, pages 1535–1541 (2018)Cite this article

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

  1. Torricelli AM, Bechara SJ, Wilson SE (2014) Screening of refractive surgery candidates for LASIK and PRK. Cornea 33:1051–1055

    Article  Google Scholar 

  2. 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

    Article  Google Scholar 

  3. 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

    Article  Google Scholar 

  4. 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

    CAS  Article  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. 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

    Article  Google Scholar 

  7. 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

    Article  Google Scholar 

  8. Tuisku IS, Lindbohm N, Wilson SE, Tervo TM (2007) Dry eye and corneal sensitivity after high myopic LASIK. J Refract Surg 23:338–342

    Article  Google Scholar 

  9. 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

    Article  Google Scholar 

  10. 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

    Article  Google Scholar 

  11. Zeev MS, Miller DD, Latkany R (2014) Diagnosis of dry eye disease and emerging technologies. Clin Ophthalmol 8:581–590

    PubMed  PubMed Central  Google Scholar 

  12. 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

    Article  Google Scholar 

  13. 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

    Article  Google Scholar 

  14. Schiffman RM (2000) Reliability and validity of the ocular surface disease index. Arch Ophthalmol 118:615

    CAS  Article  Google Scholar 

  15. 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

  16. 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

    Article  Google Scholar 

  17. Bland JM, Altman DG (1999) Statistical methods in medical research. Stat Methods Med Res 8:135–160

    CAS  Article  Google Scholar 

  18. 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

    Article  Google Scholar 

  19. 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

    Article  Google Scholar 

  20. Hong J, Liu Z, Hua J et al (2014) Evaluation of age-related changes in noninvasive tear breakup time. Optom Vis Sci 91:1

    CAS  Article  Google Scholar 

  21. 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

    Article  Google Scholar 

  22. 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

    Article  Google Scholar 

  23. 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

    Article  Google Scholar 

  24. Cox SM, Nichols KK, Nichols JJ (2015) Agreement between automated and traditional measures of tear film breakup. Optom Vis Sci 92:e257–e263

    Article  Google Scholar 

  25. 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

  26. 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

  27. Best N, Drury L, Wolffsohn JS (2012) Clinical evaluation of the oculus keratograph. Contact Lens Anterior Eye 35:171–174

    CAS  Article  Google Scholar 

  28. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159

    CAS  Article  Google Scholar 

  29. 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

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, 04120, Almería, Spain

    Joaquín Fernández, Manuel Rodríguez-Vallejo, Javier Martínez, Ana Tauste & Javier García-Montesinos

  2. Department of Ophthalmology, Torrecárdenas Hospital Complex, 04009, Almería, Spain

    Joaquín Fernández

  3. Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain

    David P. Piñero

  4. Department of Ophthalmology (OFTALMAR), Vithas Medimar International Hospital, Alicante, Spain

    David P. Piñero

Authors
  1. Joaquín Fernández
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  2. Manuel Rodríguez-Vallejo
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  3. Javier Martínez
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  4. Ana Tauste
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  5. Javier García-Montesinos
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  6. David P. Piñero
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Corresponding author

Correspondence to David P. Piñero.

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Conflict of interest

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.

Ethical approval

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

Keywords

  • Tear film stability
  • Objective systems
  • Ocular scatter index
  • Non-invasive break-up time
  • Laser refractive surgery