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



To assess the agreement and repeatability of two objective systems for measuring the tear film stability.


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.


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).


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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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).

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