Characteristics of tear meniscus using a spectral domain optical coherence tomography in medically controlled glaucoma

Purpose: To compare the tear meniscus height (TMH) and tear meniscus depth (TMD) between medically controlled glaucoma subjects and age?matched controls. Methods: This prospective, cross?sectional, observational study included 50 patients with medically controlled glaucoma and 50 age?matched controls. Glaucoma subjects using topical medications for the duration of more than 1 year were included. The age?matched controls were participants with no history of glaucoma, dry eye, or any other diseases affecting the ocular surface. All the participants underwent TMH and TMD scan using spectral domain?optical coherence tomography (SD?OCT), which was followed by ocular surface disease index (OSDI) questionnaire administration. Results: The mean ages of glaucoma subjects and age?matched controls were 40 ± 22 and 39 ± 21 years, respectively (P > 0.05). Of them, 40% (n = 22) were on single drug therapy or monotherapy and 60% (n = 28) were on multidrug therapy. TMH and TMD of glaucoma subjects and age?matched controls were 101.27 ± 31.86 versus 230.63 ± 49.82 ?m and 70.60 ± 27.41 versus 167.37 ± 57.06 ?m, respectively. Subjects on multidrug therapy showed a statistically significant reduction in TMH and TMD when compared to age?matched controls. Conclusion: Preservative containing topical glaucoma medications affects the ocular surface, including the tear film. The prolonged duration and multiple combination of this drug usage serve as potential factors for causing reduction in the tear meniscus levels leading to drug?induced dryness

Acupuncture for aqueous deficiency dry eye: a randomized controlled trial / 中国针灸

OBJECTIVES@#To compare the clinical efficacy and safety of acupuncture and sodium hyaluronate eye drop in the treatment of aqueous deficiency dry eye.@*METHODS@#A total of 60 patients (120 eyes) with aqueous deficiency dry eye were randomly divided into an observation group (30 cases, 1 case dropped out) and a control group (30 cases, 1 case dropped out). In the control group, sodium hyaluronate eye drop were used, one drop at a time, 4 times a day, for 14 consecutive days. In the observation group, acupuncture was applied at bilateral Shangjingming (Extra), Cuanzhu (BL 2), Sizhukong (TE 23), Taiyang (EX-HN 5), and Tongziliao (GB 1) , once a day, treatment for 6 days with the interval of 1 day was required, for 14 consecutive days. The tear meniscus height (TMH), Schirmer Ⅰ test (SⅠT), ocular surface disease index (OSDI) score, non-invasive tear break-up time (NIBUT), and corneal fluorescein sodium staining (FLS) score were compared between the two groups before and after treatment, and the safety of the treatment of the two groups was observed.@*RESULTS@#Compared with those before treatment, after treatment, TMH, SⅠT and NIBUT were increased (P<0.01, P<0.05), and FLS scores were decreased (P<0.01) in the two groups; the score of OSDI was reduced (P<0.01) in the observation group. After treatment, in the observation group, TMH and SⅠT were higher than those in the control group (P<0.01), and the score of OSDI was lower than that in the control group (P<0.01). No adverse reactions and adverse events were observed in the two groups.@*CONCLUSIONS@#Acupuncture and sodium hyaluronate eye drop can both effectively treat aqueous deficiency dry eye, acupuncture has obvious advantages in improving TMH and basic tear secretion, and reducing the subjective symptoms of patients. Acupuncture for dry eye is safe.

Correlation and consistency of three methods for tear evaluation in the diagnosis of dry eye / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To explore the correlation and consistency of three tear assessment methods in the diagnosis of dry eye, which include the Schirmer Ⅰ test(SⅠt), tear meniscus height(TMH)measurement and a new generation of tear detection technology-Strip meniscometry tube(SMTube).METHODS: A diagnostic test study. A total of 183 dry eye outpatients(183 right eyes)in the Dry Eye Center of Henan Eye Hospital were enrolled from May to June 2021. The SⅠt, TMH and SMTube were performed on all patients, and the correlation and consistency of the measurement results were analyzed.RESULTS:The ocular surface disease index(OSDI)of all included patients was 43.75(31.25, 58.33), noninvasive breakup time(NIBUT)was 7.26(4.97, 9.37)s, and the results of SⅠt, TMH and SMTube were 6(2, 12)mm/5min, 0.18(0.14, 0.22)mm and 5(3,8)mm/5s, respectively; The results of correlation analysis: TMH was positively correlated with SMTube(rs=0.751, P<0.001), however, SⅠt had no correlation with TMH(rs=0.139, P=0.060)and SMTube(rs=0.019, P=0.799). The results of consistency analysis: TMH showed good consistency with SMTube(Kappa=0.794, P=0.044), however, SⅠt showed poor consistency with TMH(Kappa=0.271, P=0.074)and SMTube(Kappa=0.193, P=0.070)respectively.CONCLUSION:SMTube is a new, simple and convenient tool for evaluating tear volume. It has a good correlation and consistency with TMH measurement results. Therefore, it can replace TMH measurement, but cannot replace SⅠt in clinical application.

Observation of tear film stability in dry eye patients with different lipid layer thickness / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the difference of tear film stability among different lipid layer thickness.METHOD: A total of 194 dry eye patients(384 eyes)admitted to our hospital from June 2020 to December 2021 were enrolled in this study. The tear meniscus height, the first tear film break-up time and lipid layer thickness were measured by corneal topographer. The tear meniscus height and the first tear film break-up time among different lipid layer thickness were compared and the correlation between them was analyzed.RESULTS: The included patients(384 eyes)were divided into lipid rich group(49 eyes), lipid balance group(27 eyes), slight lipid deficiency group(266 eyes)and significant lipid deficiency group(42 eyes)according to the lipid layer thickness. The differences of the tear meniscus height were statistically different(P=0.022), while the differences of the first tear film break-up time were not statistically different(P=0.322). The lipid layer thickness was positively correlated with tear meniscus height(rs=0.143, P=0.006). There was no correlation between lipid layer thickness and the first tear film break-up time(rs=-0.090, P=0.083), nor was there correlation between tear meniscus height and the first tear film break-up time(rs=0.038, P=0.460).CONCLUSION: There was no significant difference in tear film stability in dry eye patients with different lipid layer thickness.

Experimental study on the diagnosis of dry eye tear film grading by Keratograph 5M ocular surface analyzer and conventional ocular surface examination / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the diagnostic value of Keratograph 5M for the diagnosis of dry eye(dry eye)tear film grading. <p>METHODS: Totally 100 eyes diagnosed with dry eye by conventional means and 40 non-dry eye eyes with suspected dry eye at the same time were enrolled through OPC. The immediate ocular surface parameters of the above cases were collected by the K5M ocular surface analyzer, including the first tear film rupture time(NIBUTf), the average tear film rupture time(NIBUTav), and the tear river height(TMH)which were utilized to evaluated the diagnostic efficacy of K5M compared to routine ocular surface examination on the index of dry eye tear film. <p>RESULTS: The comparison of NIBUTf, NIBUTav and TMH between dry eye group and non-dry eye group by K5M eye surface comprehensive analyzer showed statistically significant differences(all <i>P</i><0.05). The coincidence rate between the NIBUTf of K5M ocular surface analyzer and the BUT of routine diagnosis was 78.6%, and the area under the ROC curve as well as the standard error were 0.042 and 0.795(<i>P</i><0.01)with 95% confidence interval(0.712, 0.878); The coincidence rate between NIBUTav of K5M and BUT of routine examination diagnosis was 73.6%, and the area under the ROC curve as well as the standard error were 0.853 and 0.033(<i>P</i><0.01), with 95% confidence interval(0.788, 0.917).The coincidence rate between TMH of K5M and the SⅠt of conventional diagnosis was 87.9%, and the area under the ROC curve as well as the standard error were 0.795 and 0.044(<i>P</i><0.01), with the 95% confidence interval(0.709, 0.880). The sensitivity, specificity, correctness index, positive likelihood ratio, negative likelihood ratio, and odds ratio of the exploratory diagnosis of dry eye by NIBUTf combined with TMH were 98, 40, 38, 1.63, 0.05, and 32.6%, respectively. The sensitivity, specificity, correctness index, positive likelihood ratio, negative likelihood ratio, and odds ratio of the exploratory diagnosis of dry eye by NIBUTav combined with TMH were 86, 75, 61, 3.44, 0.187, 18.39%, respectively.<p>CONCLUSION: K5M ocular surface analyzer can provide accurate and reliable diagnostic value for single tear film index grading diagnosis of dry eye; compared with TMH combined with NIBUTav, TMH combined with NIBUTf was more sensitive but less specific in diagnosing dry eye.

Ocular surface analysis in gestational diabetes mellitus / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate ocular surface functions in pregnant women with gestational diabetes mellitus(GDM)using Keratogragh 5M. <p>METHODS: Pregnant women with GDM and normal pregnant women were enrolled. All subjects were asked to answer ocular surface disease index(OSDI)questionnaire survey, and then underwent ophthalmic examination including tear meniscus height(TMH), average noninvasive Keratograph tear film break-up time(NIKBUTav), ocular redness analysis, and meibomial gland analysis.<p>RESULTS: There were no statistically significant differences in OSDI, TMH, NIKBUTav, eye redness analysis and meibomial gland analysis between the GDM group and the normal pregnant group(<i>P</i>>0.05). The OSDI scores were 8.02±4.25 and 7.50±4.28(<i>P</i>=0.557), TMH values were 0.22±0.05 and 0.20±0.04mm(<i>P</i>=0.158), NIKBUTav values were 8.01±2.15s and 8.02±1.53s(<i>P</i>=0.971).<p>CONCLUSION: There was no statistically significant difference between the GDM group and the normal pregnant group in ocular surface indexes. GDM had no negative effects on ocular surface, which may be related to good controlling of the blood glucose.

Study on the relationship between tear ferning image and the abnormality of tear lipid layer in dry eye patients / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical significance of outer zona pellucid in tear ferning image in dry eye patients and explore a new method for evaluation tear lipid layer. <p>METHODS:Forty-seven patients were randomly selected from the outpatient department of ophthalmology, He Eye hospital, Shenyang from May 2018 to July 2019. The right eye was selected as the study object. All patients were investigated by the ocular surface disease index(OSDI)questionnaire and performed lipid layer classification by DR-1 tear interferometry, NIBUT and tear meniscus height examination by OCULUS Keratograph. Then tears were collected and tear ferning tests was performed. The whole tear crystallization images were observed and photographed by microscopy, then measured by Digimizer software and the area ratios of outer transparent belt were calculated. Pearson correlation analysis were performed between area ratios of outer transparent belt and OSDI scores, lipid layer levels, tear meniscus height values, NIBUT values. <p>RESULTS: The area ratios of outer transparent belt were negatively correlated with OSDI scores(<i>r</i>=-0.764, <i>P</i><0.05), negatively correlated with lipid layer levels(<i>r</i>=-0.838, <i>P</i><0.05), positively correlated with NIBUT values(<i>r</i>=0.575, <i>P</i><0.05)and the correlation between tear meniscus height values was not significantly(<i>r</i>=-0.237, <i>P</i>=0.112). <p>CONCLUSION: The outer transparent belt in tear crystallization image can be used to evaluate the lipid layer of tear film; the larger area ratios of outer transparent belt, the thicker the lipid layer. This method has the advantages of quantified results, good repeatability, low requirement on equipment, and is worth popularizing.

Repeatability and reproducibility of tear meniscus height with RTVue XR and Keratograph / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the agreement of the lower tear meniscus height(LTMH)measurements using RTVue XR and Keratograph ocular surface analyzer, and to compare intraobserver repeatability and interobserver reproducibility between the two devices in the virginal and FS-LASIK eyes. <p>METHODS: Totally 52 virginal eyes and 52 FS-LASIK eyes were included during January 2019 in Guangzhou Aier Eye Hospital. LTMH measurements were performed using RTVue XR and Keratograph Ocular Surface Analyzer. A paired <i>t</i>-test was used to compare the difference between LTMH values using the two devices. The with-subject standard deviation(Sw), test-retest repeatability(2.77Sw), coefficient of variation(CoV)and intraclass correlation coefficient(ICC)were calculated to evaluate the repeatability and reproducibility. <p>RESULTS: In the virginal eyes group, the average LTMH obtained with RTVue XR and Keratograph were 261.12±80.29μm and 235.05±78.40μm, respectively. CoV and ICC were 5.55% and 0.98 for RTVue XR, 14.90% and 0.87 for Keratograph, respectively. In the FS-LASIK group, the average LTMH were 234.55±68.38μm and 208.22±73.85μm, respectively. CoV and ICC were 5.29% and 0.97 for RTVue XR, 16.16% and 0.87 for Keratograph, respectively. <p>CONCLUSION: In the virginal and FS-LASIK eyes, the LTMH value obtained with RTVue XR is 25μm greater than Keratograph. RTVue XR has a better reliability than Keratograph and can be used to measure the LTMH.

Repeatability and Reproducibility of Tear Meniscus Evaluations Using Two Different Spectral Domain-optical Coherence Tomography

PURPOSE: To evaluate the repeatability and reproducibility of inferior tear meniscus measurements using two different spectral domain-optical coherence tomography (OCT), and to compare the inter-device agreements between these devices. METHODS: Two examiners evaluated the tear meniscus depth (TMD) and tear meniscus height (TMH) of 20 eyes in 20 normal subjects using Cirrus OCT and Spectralis OCT with the examiners calculating the TMD and TMH. We analyzed intra-examiner repeatability, inter-examiner reproducibility, and inter-device agreement. RESULTS: The average TMD measurements using the Cirrus OCT and Spectralis OCT devices were 151.25 ± 41.53 µm and 139.10 ± 40.56 µm by examiner 1, respectively, and 152.03 ± 42.77 µm and 138.35 ± 39.70 µm by examiner 2, respectively. The TMHs were 291.90 ± 100.19 µm and 245.43 ± 66.44 µm by examiner 1, respectively, and 288.25 ± 98.72 µm and 244.23 ± 60.69 µm by examiner 2, respectively. The TMDs and TMHs measured using these OCT devices were not statistically significant for intra-examiner and inter-examiner measurements (all, p > 0.05). These devices showed high repeatability (intraclass correlation coefficient ≥ 0.991) for intra-examiner TMD and TMH measurements and the inter-examiner coefficient of variation ranged from 2.04% to 4.32%. The 95% limits of agreement between the two devices were −66.13 to 91.95 µm for TMD and −127.18 to 217.68 µm for TMH. CONCLUSIONS: Both OCT devices are useful for conducting inferior tear meniscus measurements. The inter-device agreement was poor, and the devices were not interchangeable.

Correlation between dry eye and refractive error in Saudi young adults using noninvasive Keratograph 4

Purpose: The purpose is to study the correlation between dry eye and refractive errors in young adults using noninvasive Keratograph. Methods: In this cross sectional study, a total of 126 participants in the age range of 19� years and who were free of ocular surface disease, were recruited from King Saud University Campus. Refraction was defined by the spherical equivalent (SE) as the following: 49 emmetropic eyes (�50 SE), 48 myopic eyes (??0.75 SE and above), and 31 hyperopic eyes (>+0.75 SE). All participants underwent full ophthalmic examinations assessing their refractive status and dryness level including noninvasive breakup time (NIBUT) and tear meniscus height using Keratograph 4. Results: The prevalence of dry eye was 24.6%, 36.5%, and 17.4% in emmetropes, myopes, and hypermetropes, respectively. NIBUT has a negative correlation with hyperopia and a positive correlation with myopia with a significant reduction in the average NIBUT in myopes and hypermetropes in comparison to emmetropes. Conclusion: The current results succeeded to demonstrate a correlation between refractive errors and dryness level.

Assessments of tear meniscus height, tear film thickness, and corneal epithelial thickness after deep anterior lamellar keratoplasty / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#To assess the lower tear meniscus height (LTMH), central tear film thickness (CTFT), and central corneal epithelial thickness (CCET) after deep anterior lamellar keratoplasty (DALK).@*METHODS@#This was a retrospective cross-sectional study of 20 patients who had DALK in one eye over a three-month period. LTMH, CTFT, and CCET of the operated eyes and the unoperated fellow eyes were measured using high-definition optical coherence tomography (HD-OCT). Correlations between three OCT assessments and age, time following surgery, graft size, bed size, and the number of residual sutures were analyzed.@*RESULTS@#Compared to patients with keratoconus, patients with other corneal conditions had significantly higher CCET in the fellow eye (P=0.024). For all patients, CCET in the operated eye was significantly negatively correlated with the number of residual sutures (R=-0.579, P=0.008), and was significantly positively correlated with time following surgery (R=0.636, P=0.003). In the fellow eye, a significant positive correlation was found between age and CCET (R=0.551, P=0.012), and a significant negative correlation between age and CTFT (R=-0.491, P=0.028). LTMH was found to be significantly correlated between operated and fellow eyes (R=0.554, P=0.011). There was no significant correlation between LTMH and age, bed/graft size, time following surgery, or residual sutures (all possible correlations, P>0.05).@*CONCLUSIONS@#Patients with keratoconus tend to have a thinner central corneal epithelium. Corneal epithelium keeps regenerating over time after DALK. DALK did not induce a significant change in tear volume compared with the fellow eye. Postoperative tear function might depend on an individual's general condition, rather than on age, gender, bed/graft size, time following surgery, or residual sutures.

Evaluation of the ocular surface in the patients after strabismus surgery / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM:To evaluate the ocular surface in the patients after strabismus surgery. ·METHODS: One hundred and eighty-eight hospitalized patients (240 eyes) with strabismus from May 2015 to October 2016 in Aier Hospital were divided into 3 groups according to the type of incision:85 cases(100 eyes) with the corneal limbus incision in Group A;35 cases(50 eyes) with the cross-muscle incision in Group B; 68 cases (90 eyes) with the adjacent-fornix incision (including Parks incisions and improved Parks incisions) in Group C. And 75 eyes with single extraoeular muscle surgery, 110 eyes with 2 extraoeular muscle surgery, 55 cases with 3 extraoeular muscle surgery. The first noninvasive tear film break-up time (NITBUTf) and the tear meniscus height (TMH) were tested by Oculus anterior segment analyzer preoperatively and 1d, 1, 2 and 4wk postoperatively. The data were studied by statistics. · RESULTS: Comparing with preoperative, TMH increased significantly at post-operatively 1d in all group, NIKBUTf reduced significantly(P<0.05). NIKBUTf was recovered in Group A at post-operative 2wk. NIKBUTf were recovered in Group B and C at post-operative 1wk. TMH were recovered in Group A and B at post-operative 2wk. TMH was recovered in Group C at post-operative 1wk. NIKBUTf and TMH were recovered with the single extraoeular muscle surgery at post-operative 1wk. They were recovered at post-operative 2wk with the 2 and 3 extraoeular muscle surgery. ·CONCLUSION: Surgical incision and surgical muscle number may affect the ocular surface of the people after strabismus surgery. The adjacent fornix conjunctival incision has less effect. The less number of muscles in strabismus surgery,the less effect on ocular surface.

Comparison of non-invasive tear break-up time and tear meniscus height in healthy eyes and keratoconus using Oculus Keratograph 5M / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To compare the non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) measurements in keratoconus patients and normal subjects, and to determine the relationship between these measurements with keratoconus disease by the Oculus Keratograph 5M (K5M).METHODS:Fifty keratoconus patients (100 eyes) and 50 healthy subjects (100 eyes) participated in the study.The age range in keratoconus group was 15-60(mean ± standard deviation=28.33±8.60) y, and in control group was 18-60(26.25±1.11) y.The measurements of NITBUT and TMH were performed using the K5M.RESULTS:The mean value of NITBUT between the keratoconus group and the control group showed no statistically significant different (P=0.58).Also, the mean of TMH between two groups was not significantly different (P=0.69).The results of correlation coefficient between the variables of the study demonstrated that there was no significant relationship between the NITBUT and TMH measurements with the two groups (keratoconus group:r=0.053, P=0.721;control group;r=-0.0501, P=0.7098).CONCLUSION:Our study shows that the presence of keratoconus has no clinically significant impact on the quality and quantity of tear film.

Tear Meniscus Height in Dry Eye Syndrome

In order to diagnose dry eyes with the TMH, we studied the difference in the TMH between normal eyes and dry eyes. And we measured the time that the TMH after fluorescein instillation become the same with the TMH before fluorescein instillation. Measuring thar meniscus height(TMH) is easy after fluorescir instillation, but the TMH after fluorescein instillation is higher than the TMH before fluoresceirc instillation. Therefore, we measured the time that the TMH after fluorescein instillation became the same with the TMH before fluorescein instillation, and in order to diagnosis dry eyes with the TMH, we studied the difference in the TMH between normal eyes and dry eyes. The TMH was O.19 +/- O.05 mm in normal eyes and O.10 +/- O.04 mm in dry eyes, and there was a significant difference between the two groups. The time that the TMH after fluorescein instillation became the same with the TMH before fluorescein instillation was 2.19 +/- O.81 min. in the mormal eyes and 2.29 +/- O.73min. in the dry eyes. Within 4 min. after fluorescein instillation, the TMH became the same with the TMH before fluorescein instillation in all cases and the height persisted untill 7 min. after fluorescein instillation. Therefore, measuring the TMH will be easy if it is measured at 4-7 min. after fluorescein instillation.

Measurement of the tear meniscus height using 0.25% fluorescein sodium

Measuring the tear meniscus height (TMH) is easy after fluorescein installation, but the TMH after fluorescein instillation is higher than the TMH before fluorescein instillation. Therefore, we measured the time that the TMH after fluorescein instillation became the same with the TMH, we studied the difference in the TMH between normal eyes and dry eyes. The TMH 0.19 +/- 0.05 mm in the normal eyes and 0.10 +/- 0.04 mm in the dry eyes, and there was a significant difference between the 2 groups. The time that the TMH after fluorescein instillation became the same with the TMH before fluorescein instillation was 2.19 +/- 0.81 min. in the normal eyes and 2.29 +/- 0.73 min. in the dry eyes. Within 4 min. after fluorescein instillation, the TMH became the same with the TMH before fluorescein instillation in all cases and the height persisted until 7 min. after fluorescein instillation. Therefore, measuring the TMH will be easy if it is measured at 4-7 min. after fluorescein instillation.