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New model to better diagnose dry eye disease integrating OCT corneal epithelial mapping
  1. Norah A Edorh1,
  2. Adil El Maftouhi2,
  3. Zoubir Djerada1,
  4. Carl Arndt1,3,
  5. Alexandre Denoyer1,3
  1. 1 Department of Ophthalmology, CHU Reims, Reims, France
  2. 2 Department 3, National Hospital Centre for Ophthalmology Quinze-Vingts, Paris, France
  3. 3 Reims Champagne-Ardenne University, Reims, France
  1. Correspondence to Professor Alexandre Denoyer, CHU Reims, Reims 51097, France; alexandre.denoyer{at}


Purpose To optimise the objective diagnosis of dry eye disease (DED), the capabilities of wide corneal epithelial mapping using optical coherence tomography (OCT) were studied and subsequently integrated into a new scoring method.

Methods Fifty-nine patients (118 eyes) with DED and 55 control subjects (110 eyes) were included. All patients underwent a complete ocular surface evaluation. Corneal epithelial thickness was collected using OCT for seven zones. DED and the control group were compared using a t-test, and univariate receiver operating characteristic (ROC) curves were calculated to define the diagnostic ability of OCT epithelial mapping. Multivariate analyses were performed using artificial intelligence (random forest) and logistic regression approaches to define the best way to integrate OCT mapping in the diagnosis of DED. Then, a final multivariable model for diagnosing DED was validated through a bootstrapping method.

Results The DED group had significant epithelial thinning compared with the controls, regardless of location. Superior intermediate epithelial thickness was the best marker for diagnosing DED using OCT (binormal estimated area under ROC: 0.87; best cut-off value: 50 µm thickness). The difference between the inferior and superior peripheral zones was the best marker for grading the severity of DED (analysis of variance, p=0.009). A multivariate approach identified other significant covariables which were integrated into a multivariate model to improve the sensitivity (86.4%) and specificity (91.7%) of this innovative diagnostic method.

Conclusion Including OCT corneal epithelial mapping in a new diagnostic tool for DED could allow optimisation of the screening and staging of the disease in current practice as well as for clinical research purposes.

  • cornea
  • diagnostic tests/investigation
  • imaging
  • ocular surface
  • tears

Data availability statement

Data are available upon reasonable request. All data are available upon request to the corresponding author:

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Data availability statement

Data are available upon reasonable request. All data are available upon request to the corresponding author:

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  • Contributors Design of the study: AD, ZD, AEM. Conduct of the study: NAE, AD, CA. Collection and management of data: NAE, AD, ZD. Analysis and interpretation of data: ZD, AD, NAE, AEM. Preparation of the manuscript: NAE, AD, ZD. Review and approval of the manuscript: AD, CA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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