Comparing meibomian gland visibility on optical coherence tomography and Keratograph 5M images using objective and subjective grading methods.

PURPOSE: To investigate if there is a visible difference in meibomian gland (MG) length between images captured with the Visante optical coherence tomography (OCT; wavelength = 1,310 nm) and the OCULUS Keratograph 5M (K5M; wavelength = 880 nm). METHODS: Adults between 18 and 40 years were recruited. Baseline dry eye disease was evaluated with the Standard Patient Evaluation of Eye Dryness (SPEED) and tear meniscus height and tear breakup time with the K5M. Right upper and lower eyelid MGs were imaged with the K5M and Visante OCT. Each image was graded with the 0 to 3 meiboscore scale. The central 5 MGs were evaluated with ImageJ for percent gland length visibility. RESULTS: Thirty participants were analyzed with a median (interquartile range [IQR]) age of 23.0 (5.0) years (53.3 % female). Overall, participants were asymptomatic and had normal tear films. Meiboscores based on K5M and Visante OCT was significantly different for the lower eyelid (0[1] vs 1[2]; p = 0.007) but not the upper eyelid (0[1] vs 0[1]; p = 1.00). The mean percent gland visibility of the upper eyelid (82.7[9.6] vs 75.2[13.5]; p < 0.001) and the lower eyelid (81.2[12.7] vs 64.1[17.6]; p < 0.001) were significantly greater on the Visante OCT than the K5M images, respectively. CONCLUSION: OCT images had significantly greater percent visible MG lengths than the K5M images. This suggests viable segments of the MGs may be missed with typical imaging, which may explain how it is possible that studies have found less post-treatment MG atrophy.

Tear meniscus height agreement and reproducibility between two corneal topographers and spectral-domain optical coherence tomography.

CLINICAL RELEVANCE: Tear meniscus height (TMH) is an important clinical marker in dry eye diagnosis and management. PURPOSE: To evaluate the reproducibility and agreement of TMH measurements in non-clinical participants using the Oculus Keratograph 5 M, Medmont Meridia, and Spectral-domain optical coherence tomography (Spectralis SD-OCT). METHODS: Fifty-six participants (mean 43.8 ± 22.4 years) were recruited for this cross-sectional study. Image acquisitions were performed on the three devices, sequentially and randomized. The repeatability and reproducibility of inter-observer and inter-device analysis were performed. Repeated measures ANOVA and Bland-Altman Plots were used to evaluate the agreement between devices. RESULTS: The mean TMH with the Oculus Keratograph 5 M, Medmont Meridia and Spectralis SD-OCT were 0.29 ± 0.16 mm, 0.24 ± 0.09 mm and 0.27 ± 0.16 mm, respectively. There were no significant inter-observer differences (paired t-tests, p < 0.001). All the devices exhibited good inter-observer reliability (ICC ≥ 0.877), and good repeatability (CV ≤ 16.53%). Inter-device reliability is moderate (ICC = 0.621, p < 0.001). Repeated measures ANOVA revealed that TMH measurements given by the Spectralis SD-OCT are not significantly different from the Oculus Keratograph 5 M (p = 0.19) and the Medmont Meridia (p = 0.38). TMH measurements from Oculus Keratograph 5 M were significantly higher than those from Medmont Meridia (p = 0.02). Correlations between the mean TMH and the difference in the TMH measurements were positive for Oculus Keratograph 5 M and Medmont Meridia (r2 = 0.62, p < 0.001), negative for Medmont Meridia and Spectralis SD-OCT (r2 = -0.59, p < 0.001), and not significant for Oculus Keratograph 5 M and Spectralis SD-OCT (r2 = 0.05, p = 0.74). A strong correlation was found for TMH measured with all devices (r2 = 0.55 to 0.81, p < 0.001). CONCLUSIONS: The Oculus Keratograph 5 M, Medmont Meridia, and Spectralis SD-OCT provide reliable and reproducible inter-observer TMH measurements. Inter-device reliability is moderate, with a close correlation between Spectralis SD-OCT and the Oculus Keratograph 5 M. Oculus Keratograph 5 M and Medmont Meridia are repeatable devices appropriate for the measurement of TMH, but they are not interchangeable in clinical practice.

Improvement of objective ocular redness measured with Keratograph 5M in glaucoma patients after instilling brimonidine drops.

OBJECTIVE: To compare objective ocular redness measured using OCULUS Keratograph 5 M before and after 0.2% brimonidine instillation in glaucoma patients under topical hypotensive treatment. METHODS: 60 eyes from 60 subjects diagnosed with glaucoma or ocular hypertension under hypotensive ocular topical treatment were analyzed. Basal Ophthalmological examination was performed.Outcome variables were OCULUS Keratograph 5 M redness scores (RS) before and after 0.2% brimonidine instillation; overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN); non-invasive average tear film breakup time (Nia-BUT), non-invasive first tear film breakup time (Nif-BUT) and meibography. In addition, the following clinical data were collected: intraocular pressure, type, duration, amount, and preservatives/or not of hypotensive treatment, fluorescein corneal staining score and lower tear meniscus height. RESULTS: All eyes were under topical medication. All redness scores were reduced after brimonidine instillation, mean RS differences were BT 0.82 ± 0.62, BN hyperemia 1.03 ± 0.55, LN hyperemia 0.84 ± 0.49, LT hyperemia 0.71 ± 0.50 and total hyperemia 0.91 ± 0.52 (all p < 0.001). 30 min after brimonidine instillation mean overall RS reduction was 47.97 ± 12.39% (p < 0.001) and after 1 h there was a persistent reduction of overall RS of 45.92 ± 14.27% (p < 0.001). Hyperemia reduction was significant and comparable between preservative and preservative-free group 0.12 ± 0.14 (p > 0.392) and between patient with combination therapy and monotherapy 0.16 ± 0.14 (p > 0.258). CONCLUSION: A significant reduction of conjunctival hyperemia was objectively found in glaucoma patients under topical hypotensive treatment before and after brimonidine instillation. Its fast and long-lasting effect may be useful preoperatively in glaucoma patients to reduce intraoperative bleeding and associated complications.

The effects of chalazion and the excision surgery on the ocular surface.

Purpose: To evaluate the effects of chalazion excision on the ocular surface, taking into account the subjective symptoms and the objective parameters of the tear film. Methods: This prospective, interventional clinical study included 52 eyes from 26 patients with eyelid chalazion who underwent excision of the lesions between March and August 2022. Chalazion excision was performed on the patient's chalazion eye, and the contralateral eye served as the control. The following parameters were investigated both preoperatively and 1 week, 1 month, and 3 months postoperatively: the Ocular Surface Disease Index (OSDI), Schirmer I test, corneal fluorescein stain (CFS), tear meniscus height (TMH), noninvasive first breakup time (NifBUT), noninvasive average breakup time (NiaBUT), bulbar conjunctival redness score, the thickness of the lipid layer, and meibomian gland loss. Results: Before surgery, the OSDI score of the chalazion eye was significantly higher than the contralateral eye. The bulbar conjunctival redness score (p = 0.043) and the OSDI score (p = 0.004) improved significantly in the first month after surgery. In the third month after surgery, the objective parameters showed significant improvements, including TMH (p = 0.032), NiaBUT (p = 0.028), bulbar conjunctival redness score (p < 0.001), the thickness of the lipid layer (p = 0.021), and meibomian gland loss (p = 0.005). Conclusions: Our study revealed that chalazion excision can significantly improve the subjective symptoms and the objective tear film parameters of the ocular surface.

Influence of Vitreoretinal Surgery on Ocular Surface Dynamics Using Keratograph 5M.

PURPOSE: To evaluate changes of ocular surface dynamics using Keratograph 5M for 3 months after vitreoretinal surgery. METHODS: Eighty-three patients were divided into three groups: phacoemulsification group, vitrectomy group, and combined group. Keratograph 5M was performed for all patients at 1 week, 1 month, and 3 months after the surgery. Ocular surface dynamics parameters measured by Keratograph 5M, including noninvasive keratograph first tear film breakup time (NifBUT), noninvasive keratograph average tear film breakup time (NiaBUT), and tear meniscus height (TMH) were compared among the three groups over time. RESULTS: The mean age of all patients (46 men and 37 women) was 62.2 ± 8.4 years. NifBUT and NiaBUT were significantly decreased at 1 week after surgery compared to those at baseline in all three groups (all p < 0.001). NifBUT and NiaBUT in the phacoemulsification group almost recovered to the preoperative level, while those in the vitrectomy group and the combined group were still significantly less than those at baseline. NifBUT and NiaBUT in the phacoemulsification group were significantly longer than those in the vitrectomy group and the combined group at 3 months. After 1 week, TMHs were significantly higher in the vitrectomy group (p = 0.001) and the combined group (p = 0.022) than in the phacoemulsification group, while TMHs were significantly less in the vitrectomy group (p = 0.010) and the combined group (p < 0.001) than in the phacoemulsification group at 3 months after surgery. CONCLUSIONS: These results suggest that vitreoretinal surgery could induce alteration of ocular surface dynamics for 3 months. The vitrectomy group and the combined group showed tear film instability compared to the cataract surgery alone group. Patients who underwent vitreoretinal surgery experienced more severe dry eye syndrome symptoms than those who underwent cataract surgery. Thus, managing dry eye syndrome after vitreoretinal surgery should be considered important for patients.

Long-term changes in the ocular surface during orthokeratology lens wear and their correlations with ocular discomfort symptoms.

PURPOSE: To evaluate the changes in ocular surface parameters during orthokeratology lens wear and determine their correlations with ocular discomfort symptoms. METHODS: Fifty individuals were enrolled in this prospective pilot study. Clinical evaluation of the ocular surface included the ocular surface disease index, slit-lamp examination, Keratograph 5M, optical quality analysis system, and corneal staining. After baseline examinations, clinical tests were performed at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after orthokeratology lens wear. Correlations between ocular discomfort symptoms and signs of ocular discomfort were evaluated. RESULTS: Overall ocular surface disease index score and two subscale scores (ocular symptoms and vision-related function) significantly increased at the 3-month visit (P < 0.05), and decreased to levels close to baseline at the12-month visit (P > 0.05). The basic objective scatter index and the mean tear film objective scatter index increased, peaking at 3-month visit (P < 0.05) and gradually decreased thereafter. The modulation transfer function cut-off significantly decreased at the 3-month visit (P < 0.05). During the 12-month study period, the overall ocular surface disease index score and vision-related function score were significantly and positively correlated with the basic objective scatter index and mean tear film objective scatter index (P < 0.05). After 1 week of lens wear, Grade 1 corneal staining increased to 16.4 %, mostly involving the central and inferior cornea. CONCLUSIONS: Orthokeratology lens wear increased ocular discomfort symptoms and decreased the function of tear film, mainly within 3 months of lens wear. Tear-related visual function parameters were correlated with ocular discomfort. A new parameter, tear film objective scatter index, measured with the optical quality analysis system, was more sensitive in detecting the quality and stability of tear film than traditional indicators.

Preoperative dry eyes disease in cataract patients with deficient tear break up time: evaluation of OSDI questionnaire, its subcategories and Keratograph 5M device results.

PURPOSE: To evaluate preoperatively dry eye disease (DED) in patients with pathological Tear Break Up Time (TBUT), utilising subjective Ocular Surface Disease Index (OSDI) with its subcategories and objective Keratograph 5M characteristics. METHODS: Fifty-four cataract patients were included in this prospective study having a screening slit lamp TBUT of less than 10 s and more or equal to 5 s. Subjective evaluation of DED was performed with OSDI questionnaire and objective evaluation with Keratograph 5M. Tear Meniscus Height (TMH), bulbar and limbal redness and meibography grade were evaluated. Further analysis of OSDI subcategories, Visual Function Related (VFR), Ocular Symptoms related (OS) and Environmental Triggered (ET), was performed with linear and logistic multivariate regression models. Age, gender and logMAR visual acuity (VA) were also included in our models. RESULTS: Following the initial TBUT screening we identified 27(50%) normal and 27(50%) dry eye patients, using OSDI questionnaire. There was no statistical difference in TMH (p = 0.64), bulbar redness (p = 0.54), limbal redness (p = 0.72) and meibography grade (p = 0.25), between normal and dry eye OSDI group. In our regression analysis, average logMAR VA was highly associated with a higher total OSDI score (p < 0.001) and with a higher OSDI-VFR score (p < 0.001). Female gender was associated with a higher OSDI-ET score (p = 0.03). Multivariate logistic regression models were performed by sorting patients into 2 categories of normal and dry eye group according to their total OSDI,OSDI-VRF,OSDI-OS and OSDI-ET score. An increase in logMAR VA increased the odds of having abnormal total OSDI score (p = 0.007) and OSDI-VFR score (p = 0.006). Females had increased odds of having abnormal OSDI-ET score (p = 0.044). CONCLUSIONS: Clinicians should be aware of OSDI limitations when screening cataract patients for dry eyes, as there is high correlation with VA. Female patients were more susceptible to environmental factors. Keratograph results should be interpreted with caution when they are evaluated in conjunction with OSDI during preoperative assessment of DED in cataract patients.

The Role of Hi-Tech Devices in Assessment of Corneal Healing in Patients with Neurotrophic Keratopathy.

To prove the role of high-tech investigation in monitoring corneal morphological changes in patients with neurotrophic keratopathy (NK) using Keratograph 5M (K5M) and anterior segment OCT (AS-OCT), corneal healing was monitored with Keratograph 5M (Oculus, Wetzlar, Germany) and AS-OCT (DRI, Triton, Topcon, Tokyo, Japan) in 13 patients (8F and 5M), aged from 24 to 93 years (67.8 ± 19) with severe NK, who were treated with Cenegermin 0.002% (20 µg/mL) (Oxervate®, Dompè, Farmaceutici Spa, Milan, Italy). The surface defects were evaluated on Keratograph 5M with ImageJ software and the corneal thickness variations were measured using DRI-Triton OCT software. Instrumental procedures were performed at baseline, and after 4 and 8 weeks of the treatment, respectively. The main outcome measures were reduction of the ulcers' area and corneal thickness recovery. The mean area of the corneal ulcers was reduced between baseline and 4 weeks examination in all patients, and at 8 weeks all ulcers were completely healed. An increase of the corneal thickness was evidenced between the baseline visit and after the 4- and 8-week follow-up, respectively. Additionally, only in collaborating subjects the In Vivo Confocal Microscopy (IVCM) was performed with HRT Rostock Cornea Module (Heidelberg Eng GmbH) to study the corneal nerves fibres. High-tech diagnostics with K5M, AS-OCT and IVCM proved useful in the assessment of corneal morphology and the healing process in patients with NK and could be extended to assess other corneal pathologies.

Effects of meibomian gland dysfunction and aqueous deficiency on friction-related disease.

PURPOSE: To evaluate the effects of meibomian gland dysfunction (MGD) and aqueous deficiency (AD) on friction-related disease (FRD). METHODS: Cross-sectional comparative study. This study included 550 eyes (550 patients) with dry eye disease (DED). The DED subtype and dynamic tear-film parameters by automated assessments were investigated for the analysis of FRD (superior limbic keratoconjunctivitis, conjunctivochalasis, and lid wiper epitheliopathy). RESULTS: Patients with FRD had a higher proportion of moderate-to-severe MGD and AD (p < 0.001 and p < 0.001, respectively). The dropout rate of the meibomian gland was higher (30.5 ± 31.8 and 14.1 ± 25.0%, p < 0.001), tear meniscus height (TMH) was lower (227.8 ± 60.4 and 241.7 ± 55.6 µm, p = 0.008), and he first non-invasive keratographic tear break-up time (NIKBUT-1) was shorter (5.9 ± 3.5 and 7.3 ± 3.7 s, p < 0.001) in patients with FRD than in those without FRD. In the logistic regression analysis with clinical manifestation, both moderate-to-severe MGD and AD were associated with FRD (odds ratios [OR] 12.27, 95% confidence interval [CI] 7.72-19.50, and 2.31, 95% CI 1.43-3.71], p < 0.001 and p < 0.001, respectively). The dropout rate was positively associated with FRD (OR 1.017, 95% CI 1.010-1.023, p < 0.001). TMH and NIKBUT-1 were negatively associated with FRD (OR 0.995, 95% CI 0.991-0.999, and 0.90, 95% CI 0.85-0.95, p = 0.039 and p < 0.001, respectively). CONCLUSIONS: This study showed that FRD was highly associated with MGD and meibomian gland dropout rate, suggesting that FRD may be mainly affected by lipid components. AD and TMH also had a good but relatively lower association with FRD, compared to MGD and meibomian gland dropout rate.

Repeatability of Non-invasive Keratograph Break-Up Time measurements obtained using Oculus Keratograph 5M.

PURPOSE: The aim of this study is to assess the intraexaminer repeatability of Non-invasive Keratograph Break-Up Time (NIKBUT) obtained using the Oculus Keratograph 5M (K5M), given its relevance as a homeostasis marker in Dry Eye Disease (DED). METHODS: In total, 80 healthy volunteers aged between 30 and 89 years participated. Measurements were classified according to age, sex and the presence or not of DED. Repeatability was evaluated by the calculation of within-subject standard deviation (Sw), coefficient of repeatability (CoR) and coefficient of variation (CoV). Moreover, the Passing-Bablok regression method was applied. RESULTS: Sw, CoR and CoV coefficients showed low repeatability in all groups with values between 3.57 and 7.14; 9.90 and 19.79; and 51.90 and 65.49, for each coefficient, respectively. No statistically significant differences were found in the NIKBUT measurements between healthy and DED patients (p = 0.188). Groups with more DED risk had better repeatability. Passing-Bablok regression also confirmed a lack of agreement between the maximum and minimum NIKBUT measurement. CONCLUSION: NIKBUT measurement has low intraexaminer repeatability even when considering sex, age and DED diagnosis. Nevertheless, not only is this low repeatability due to the device, but also it is largely due to the intrinsic variability of the tear film.

Subjective Comparison of Pre-Lens Tear Film Stability of Daily Disposable Contact Lenses Using Ring Mire Projection.

PURPOSE: To subjectively evaluate the in vivo tear film stability of three daily disposable contact lenses (DDCLs) using placido ring reflection at lens wear times of 5 mins and 8 and 12 hrs. PATIENTS AND METHODS: This prospective, randomized, observer-masked, 3-way crossover study evaluated 28 subjects with good tear film stability. In vivo tear film stability was assessed for three DDCLs (nelfilcon A, etafilcon A, omafilcon A) on three different days over 12 hrs of lens wear. Time to first distortion by non-invasive keratography drying-up time (NIK-DUTf) was assessed by reviewing the captured videos. Lens wettability was also graded subjectively by three investigators using a scale from 0 (no visible distortions) to 3 (distortions in more than one-third of the ring reflection zone). Medians were analyzed statistically. RESULTS: Mean NIKDUTf at 8 hrs was longer for nelfilcon A and shorter for etafilcon A and omafilcon A, but the differences were not significant. NIK-DUTf did not differ significantly among nelfilcon A, etafilcon A and omafilcon A DDCLs at all visits (p=0.36). Subjective wettability grades after 5 mins, 8 hrs, and 12 hrs differed significantly for etafilcon A (P <0.01) and omafilcon A (p < 0.01), but not for nelfilcon A (p = 0.05), DDCLs. CONCLUSION: Grading was sufficiently sensitive to differentiate the wettability performances of the three lens materials. Nelfilcon A maintained wettability over the wearing period, whereas etafilcon A material showed faster dewetting at 8 and 12 hrs than at 5 mins after lens insertion.

Ocular surface analysis and automatic non-invasive assessment of tear film breakup location, extension and progression in patients with glaucoma.

BACKGROUND: Tear film stability is the key event in ocular surface diseases. The purpose of this study is to evaluate spatial and temporal progression of the tear film breakup using an automatic non-invasive device. METHODS: Non-invasive tear breakup time (NITBUT) parameters, such as First NITBUT (F-NITBUT) and Average NITBUT (A-NITBUT), were evaluated in 132 glaucoma and 87 control eyes with the Keratograph 5 M device. Further analysis of this data was used to determine size, location and progression of tear film breakup with automatically identified breakup areas (BUA). The progression from First BUA (F-BUA) to total BUA (T-BUA) was expressed as Dry Area Growth Rate (DAGR). Differences between both groups were analysed using Student t-test for parametric data and Mann-Whitney U test for non-parametric data. Pearson's correlation coefficient was used to assess the relationship between parametric variables and Spearman in the case of non-parametric variables. RESULTS: F-NITBUT was 11.43 ± 7.83 s in the control group and 8.17 ± 5.73 in the glaucoma group (P = 0.010). A-NITBUT was 14.04 ± 7.21 and 11.82 ± 6.09 s in control and glaucoma groups, respectively (P = 0.028). F-BUA was higher in the glaucoma group than in the control group (2.73 and 2.28; P = 0.022) and was more frequently located at the centre of the cornea in the glaucoma group (P = 0.039). T-BUA was also higher in the glaucoma group than in the control group (13.24 and 9.76%; P = 0.012) and the DAGR was steeper in the glaucoma group than in the control group (34.38° and 27.15°; P = 0.009). CONCLUSIONS: Shorter NITBUT values and bigger, more central tear film breakup locations were observed in the glaucoma group than in the control group. The DAGR indicates that tear film rupture is bigger and increases faster in glaucomatous eyes than in normal eyes.

Relationship between OSDI questionnaire and ocular surface changes in glaucomatous patients.

PURPOSE: To evaluate the quality of life of glaucoma patients using the Ocular Surface Disease Index (OSDI) questionnaire and their association with dry eye clinical signs. METHODS: The study included patients into three groups. The treated group diagnosed with bilateral open-angle glaucoma and treated with one or more topical medication at least 1 year. The operated group underwent glaucoma surgery without the need for topical medications. The control group entered subjects without ocular diseases or previous surgeries. Dry eye clinical signs were evaluated; noninvasive tear break-up time, Meibomian gland depletion (MGD), and conjunctival hyperemia were measured using the Keratograph 5 M. The total-OSDI (T-OSDI) score was divided into the visual field-OSDI and discomfort-OSDI scores. RESULTS: Two hundred and nine subjects participated in this cross-sectional study, 147 using glaucoma medications, 21 patients underwent glaucoma surgery and 41 were controls. The T-OSDI and subscores were higher in glaucoma patients compared with controls (p < 0.05); we found no differences between treated and surgically groups. Correlations were observed between the T-OSDI values and Schirmer test (p = 0.016), ocular surface staining (p < 0.001) and the MGD (p = 0.006). The subscores were associated with the ocular surface staining (VF p = 0.013 and D p = 0.003). In treated patients, the number of drops per day correlates with T-OSDI and subscores (p = 0.017 and p = 0.005). CONCLUSION: OSDI scores increased in the glaucoma patients compared to controls without significant changes between treated and surgical patients. OSDI scores were associated to dry eye signs and medication in glaucoma patients.

Changes of ocular surface before and after phacoemulsification / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate ocular parameters changes after age-related cataract phacoemulsification surgery using Keratograph 5M combined with conjunctival impression cytology.<p>METHODS: This prospective study included 39 eyes(39 patients)from December 2016 to December 2017, who underwent cataract phacoemulsification and intraocular lens implantation in Fujian Provincial Hospital. OSDI questionnaire, tear meniscus height, tear break-up time, conjunctival hyperemia and impression cytology were performed preoperatively at 1d, 1wk, 1mo and 2mo after surgery.<p>RESULTS: GCD and OSDI were worsen at 1d, 1wk, 1mo, 2mo, postoperatively(<i>P</i><0.05). The first-time tear break-up time was significantly shorter at 1wk(6.91±4.52, 6.12±3.55, 5.18±3.37, 6.28±4.70, 5.96±3.17s, <i>P</i><0.05). The average tear break-up time was significantly shorter at 1wk(10.21±5.20, 8.89±4.47, 6.87±3.68, 7.35±3.52, 9.00±4.23s, <i>P</i><0.05).<p>CONCLUSION: phacoemulsification will influence ocular surface parameters. The tear instability and conjunctival cell damage began at 1d postoperatively, and aggravated at 1wk postoperatively. It still couldn't return to preoperative level even at 2mo postoperatively.

Effect of trabeculectomy and phacoemulsification combined with trabeculectomy on the ocular surface / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the effects of trabeculectomy and phacotrabeculectomy on the ocular surface using ocular Keratograph 5M.<p>METHODS: Totally 62 eyes of 62 patients with coexisting primary angle-closure glaucoma(PACG)and cataract were recruited. Thirty-two eyes accepted trabeculectomy, and the remaining thirty eyes accepted phacotrabeculectomy. Ocular surface parameters, including noninvasive first tear film break-up time(NifTBUT), noninvasive average tear film break-up time(NiaTBUT), corneal fluorescein staining scores(CFS)and tear meniscus height(TMH), were analyzed preoperatively, 3d, 1mo and 3mo postoperatively, with ocular Keratograph 5M.<p>RESULTS: There was no significant difference in ocular surface parameters between the two groups preoperatively(<i>P</i>>0.05). The values of NifTBUT, NiaTBUT, CFS and TMH in phacotrabeculectomy eyes were at the worse levels, <i>i.e.</i> 10.13±1.48s, 12.59±1.96s, 0.80±0.22 and 0.31±0.02mm, respectively at 3d postoperatively, then improved gradually at 1mo postoperatively, but did not return to the preoperative levels at 3mo postoperatively.<p>CONCLUSION: Ocular Keratograph 5M can be used to evaluate the changes of tear film in combined anti-glaucoma surgery accurately. The effects of phacotrabeculectomy on ocular surface are worse than that of trabeculectomy during 3mo after surgery. It is suggested that more eye care should be paid during that period of time.

Study on the difference of clinical manifestations of dry eye between children and adults / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the difference of dry eyes between children and adults in terms of symptoms and laboratory examinations.<p>METHODS: Patients in 2018-06/2019-02 with the subjective symptoms of dry eye, and served in Xi'an First Hospital, including 52 children clinic cases(52 eyes)and 55 adult patients cases(55 eyes), all the cases were consulted and examined by slit lamp microscope in anterior segment. Both eyes of tear meniscus height(TMH), the first tear film break-up time(BUTf), the average tear film break-up time(BUTave), lipid layer thickness(LLT)and mesangial gland loss rate were measured by a Keratograph 5M non-invasive ocular surface analyzer.<p>RESULTS: In children, patients' TMH(0.15±0.04mm), BUTf(3.22±1.24s), BUTave(4.27±1.67s), and the rate of meibomian gland loss \〖0.00%(0.00%, 5.03%)\〗 were significantly lower than those in the adult group [0.20±0.05mm, 4.36±1.93s, 5.15±1.49s, 9.90%(5.30%, 18.40%), all <i>P</i><0.01]. The LLT in the children was higher than that of the adult group, and the difference was not statistically significant(72.31±22.20nm <i>vs</i> 68.58±21.05nm, <i>P</i>>0.05). Both groups of patients had positive correlation sympathise with BUTf and BUTave, with no correlation between LLT and meibomian gland loss rate in children(<i>r</i>s=-0.23,<i>P</i>=0.10), and adult group patients with negative correlation of LLT and meibomian gland loss rate(<i>r</i>s=-0.28,<i>P</i><0.05).<p>CONCLUSION: Children's dry eyes and adult dry eyes in the symptoms, clinical manifestations and examination are different. The main symptom is the increase in the number of blinks. The inspection is mainly characterized by a short BUT. With the decrease of TMH, the rate of meibomian gland loss is relatively insignificant.

Assessment of ocular redness measurements obtained with keratograph 5M and correlation with subjective grading scales.

OBJECTIVE: To examine correlations between ocular redness scores provided by the Keratograph 5M and those determined using two image-based grading scales. METHODS: Observational prospective cross-sectional study. Two hundred and twenty six eyes of two hundred and twenty six participants (175 patients using anti-glaucoma eye drops and 51 subjects untreated). All subjects were scored automatically using the keratograph 5M. These redness scores (RS) were then correlated with the gradings provided by the Efron and McMonnies/Chapman-Davies scale (MC-D) scales (two observers). RESULTS: Excellent reproducibility was observed for both the Efron (weighted K=0.897, 95% CI 0.823-0.904) and MC-D (weighted K=0.783, 95% CI 0.752-0.795) scales. Keratograph RS and the scores obtained with both Efron (Spearman's Rho=0.43, P<0.001) and MC-D (Spearman's Rho=0.48, P<0.001) scales were significantly correlated. RS for the bulbar and limbal - nasal and temporal quadrants also correlated moderately with the two subjective scales. Through Bland Altman analysis, poor agreement was detected between the objective and subjective methods: agreement values for the Efron scale or MC-D scale (matching scorers between observers) versus overall RS showed high biases (-15.58 and -22.05 respectively) and wide limits of agreement (LOA) (-46.169 to 15.005 and -52.534 to 8.19 respectively). Lowest bias was observed between temporal limbal RS and Observer 2 Efron score (-0.04). CONCLUSIONS: Although it emerged as a reliable objective method, the keratograph 5M overestimated the scores compared with the subjective grading scales when used to grade the degree of ocular redness. Therefore, they should not be interchangeable methods.

Ocular Redness Measured with the Keratograph 5M in Patients Using Anti-Glaucoma Eye Drops.

PURPOSE: To examine correlations between ocular redness measured with the new topographer Keratograph 5M and the use of topical anti-glaucoma medication. METHODS: A total of 211 eyes of 211 patients with open-angle glaucoma or ocular hypertension on topical medication and 51 eyes of 51 healthy volunteers were recruited over 10 months. Outcome variables were keratograph redness scores (RS): overall, bulbar temporal (BT), bulbar nasal (BN), limbar temporal (LT), and limbar nasal (LN). In each subject, we also recorded the intraocular pressure-lowering eye drops used, daily doses and daily and cumulative preservative concentrations, fluorescein corneal staining score (OXFORD), lower tear meniscus height (Fourier-domain OCT), non-invasive tear film breakup time (Keratograph 5M), and ocular surface disease questionnaire index (OSDI). RESULTS: Higher RS were recorded in the medication than control group (P < 0.01 all scores). Within the medication group, older patients returned greater RS (P < 0.05 all scores). Prostaglandin was a strong predictor of higher scores, except LN RS. A higher OSDI was associated with a higher LN RS (ß = 0.007; P < 0.05), while the use of ß-blockers was linked to a lower LN RS (ß = -0.225; P < 0.05). The use of ≥3 daily eye drops with preservative gave rise to a higher BN RS and ≥3 daily eye drops to a higher LN RS (ß = 0.366, P < 0.01; ß = 0.296, P < 0.05, respectively). CONCLUSION: Keratograph 5M can objectively detect the hyperaemia induced by glaucoma medication. The factors contributing to ocular redness were advanced age, more daily eye drops (nasal sectors), a higher OSDI, and prostaglandin as the medication used.

Effect of forced eye opening on non -invasive tear film break - up time by Keratograph 5M in healthy individuals / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To investigate the difference of non - invasive tearfilm break - up time (NIBUT) by Keratograph 5M beforeand after forced eye opening in healthy individuals.METHODS: Prospective case self - control study. Fortynormal volunteers (79 eyes ) were enrolled. Tear filmimages were captured, non-invasive first tear film breakuptime(NIBUTf ), non- invasive average tear film breakuptime (NIBUTav ) and dry eye level were measured byKeratograph 5M automatically before and after forced eyeopening in each subject. For the first time, we checkedthe left eye after the right eye, and the second timechecked the right eye after the left eye.RESULTS: The average of NIBUTf and NIBUTav were9 18士5. 52s, 11. 74 士5. 59s respectively and percentage ofevery level of dry eye were 43% , 37% , 20% respectivelybefore forced eye opening. The average of NIBUTf andNIBUTav were 8. 91士5. 54s, 11. 76士5. 58s and percentage ofdry eye at different levels were 35% , 48% , 16%respectively after forced eye opening. There was nosignificant difference on NIBUT and dry eye level byOculus keratograph 5M in normal subjects (t = 0. 37, P =0 72; t = -0. 038, P = 0. 97; Z = -0. 42, P = 0. 68).CONCLUSION: There is no influence on NIBUT and dryeye level by detected Keratograph 5M before and afterforced eye opening in healthy subjects.

A novel noninvasive ocular surface analyzer for the assessment of dry eye with Meibomian gland dysfunction.

Meibomian gland dysfunction (MGD) is a major cause of dry eye, and the purpose of the present study was to evaluate the differences between dry eye patients with MGD and controls using a novel noninvasive ocular surface analyzer. A total of 33 dry eye patients with MGD and 31 controls were enrolled in the present study. Testing included administration of the Ocular Surface Disease Index (OSDI), followed by Keratogragh 5M (Oculus, Wetzlar, Germany), measurements of the noninvasive tear film break-up times (NITBUTs), the first tear film break-up point and the morphology of meibomian gland. Meibomian gland loss (MGL) on the upper lid was evaluated using noncontact meibography. The first NITBUT (NITBUTf) was significantly shorter than the average NITBUT (NITBUTav; Mann-Whitney U-test, P<0.01). There was a weak negative Spearman correlation between NITBUTf and OSDI (rs=-0.251, P=0.046) as well as between NITBUTav and OSDI (rs=-0.250, P=0.046). Furthermore, MGL showed a statistically significant Spearman correlation with OSDI (rs=0.562; P<0.01). In the MGD group, NITBUTf was significantly shorter (P<0.01), and MGL and OSDI score were significantly greater (P<0.01 and <0.01, respectively) than in the control group. In the MGD group, the first tear film break-up point was most frequently located in the inferonasal quadrant, while it was most frequently located in the supertemporal quadrant in the control group, and there was a significant difference with this regard (χ2=3.937, P=0.047). In the MGD group, there were significantly more breakups in the lower quadrant than in the upper quadrant (P=0.011), whereas no differences in the number of breakups in each quadrant were observed in the control group (P=0.429). Furthermore, there was no significant difference in the breakups in the lower quadrants of the two groups (χ2=0.525, P=0.469). In the MGD group, there were significantly more breakups in the lower quadrant than in the upper quadrant (P=0.011), whereas no differences in the number of breakups in each quadrant were observed in the control group (P=0.429). Furthermore, there was no significant difference in the breakups in the lower quadrants of the two groups (χ2=0.525, P=0.469). As the NITBUTs showed only a weak correlation with OSDI, they may not be a strong indicator of the OSDI. However, MGL indicated changes of meibomian gland morphology in the MGD group and the first tear film break-up point was likely located in the inferonasal quadrant in the MGD group.