Tear Meniscus Evaluation by Anterior Segment Swept-Source Optical Coherence Tomography

doi:10.1016/j.ajo.2012.11.009

American Journal of Ophthalmology

Volume 155, Issue 4, April 2013, Pages 620-624.e2

https://doi.org/10.1016/j.ajo.2012.11.009 Get rights and content

Purpose

To investigate the repeatability of tear meniscus measurements using anterior segment swept-source optical coherence tomography (OCT) and the relationship of tear meniscus measurements with tear film breakup time and Schirmer test results.

Design

Prospective, observational, cross-sectional study.

Methods

We enrolled 26 healthy subjects (26 eyes; 20 men and 6 women; mean age, 36.5 ± 6.8 years) at the University of Tokyo School of Medicine, Tokyo, Japan, in this study. Examinations were conducted in the following sequence: anterior segment vertical raster scans by swept-source OCT, tear film breakup time, and Schirmer test. Each subject underwent OCT measurements twice by the same grader, and the central upper and lower tear menisci height and area and the lower tear meniscus volume were examined. Each OCT image was evaluated by 2 masked graders using the software calipers.

Results

The average upper and lower tear meniscus heights were 231 ± 78 μm and 256 ± 57 μm, respectively, and the average upper and lower tear meniscus areas were 18 829 ± 7823 μm² and 21 903 ± 8173 μm², respectively. The average tear meniscus volume was 0.1327 ± 0.051 mm³. The intergrader intraclass correlations for all the parameters were more than 95%. The OCT tear meniscus measurements and the Schirmer test scores were correlated significantly (P < .05, Spearman nonparametric correlation analysis). However, tear film breakup time was not correlated significantly with any of the parameters of tear menisci (P > .05).

Conclusions

Anterior segment swept-source OCT is a noninvasive and practical method that can be used for quantitative evaluation of tear fluid.

Section snippets

Patient Population

This study followed the tenets of the Declaration of Helsinki; the prospective protocol-driven study was approved by the Institutional Review Board of the University of Tokyo School of Medicine, Tokyo, Japan; and written informed consent to participate in research protocol was obtained from all subjects. The observational cross-sectional study population consisted of 26 healthy right eyes of 26 Japanese subjects (20 men and 6 women). The exclusion criteria were presence of ocular diseases,

Results

Statistically significant correlations were present between the upper and lower

Discussion

We demonstrated that SS-1000 OCT could measure the tear meniscus centrally in normal eyes with satisfactory repeatability. At the time of our study, previous studies had reported evaluations of the upper and lower tear meniscus height, tear meniscus area, and radius of tear meniscus curvature using OCT.9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 Tear meniscus parameters using OCT were considered to be useful in the diagnosis of dry eye.11, 17 To the best of our knowledge, this is

Reina Fukuda, MD, is a graduate of Hamamatsu University School of Medicine, Japan in 2007. She completed two years of medical internship at Tokyo Kosei Nenkin Hospital, followed by a residency in ophthalmology at University of Tokyo School of Medicine. In addition to a clinical practice at Tokyo Teishin Hospital, she is actively involved in clinical research including the cornea and ocular surface diseases.

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Citation Excerpt :
The TMH averaged 222 μm n type 1 healthy participants in our study. This is compatible with the TMH measured using AS-OCT averaged between 200 μm [29] and 250 μm [30,31] in previous studies. TMH correlated positively with Schirmer test value (r = 0.23, p = 0.002); confirming that AS-OCT is a quick and non-invasive measure of tear volume.
To construct normalized ocular surface temperature (NOST) models for different tear film characteristics and evaluate its potential in dry-eyes screening.
We included 227 right eyes of 227 patients. Tear film characteristics were categorized into 4 types according to fluorescein tear film breakup time (FTBUT) and Schirmer test results, namely type 1: FTBUT >5 s and Schirmer >5 mm; type 2: FTBUT ≤5 s and Schirmer >5 mm; type 3: FTBUT ≤5 s and Schirmer ≤5 mm; and type4: FTBUT >5 s and Schirmer ≤5 mm. Ocular surface temperature was measured by a video-thermographer. Mean temperatures of the central cornea were calculated from the videos of each frame during the 4-s blink interval. We first constructed individual NOST model for every tear characteristic. Participants were included for further analysis when their OSDI was ≥23, FTBUT ≤5 s, and Schirmer >5 mm. They were subdivided into short-BUT and short BUT with SPK subgroups according to the absence or presence of corneal fluorescein-stain. The NOST models of the normal, short-BUT and short BUT with SPK groups were separately constructed and the potential of screening analyzed via ROC curves.
Each tear film type had a different NOST model. At 3 s after blinking, the order of NOST was type 4 >type 1 >type 3 >type 2. In dry-eye screening, the NOST was normal > short-BUT > short BUT with SPK. The NOST displayed a sensitivity 0.87, specificity 0.80, and AUC 0.88 for diagnosing short BUT with SPK.
NOST models are useful in differentiating tear film characteristics and screening dry-eyes. It alleviates the discomfort and inconvenience encountered during conventional dry-eye diagnosis.
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Original articleTear Meniscus Evaluation by Anterior Segment Swept-Source Optical Coherence Tomography

Purpose

Design

Methods

Results

Conclusions

Section snippets

Patient Population

Results

Discussion

Exp Eye Res

Am J Ophthalmol

Ophthalmology

J Cataract Refract Surg

Physical chemistry of the normal and disordered tear film

Trans Ophthalmol Soc UK

Frequency of dry eye diagnostic test procedures used in various modes of ophthalmic practice

Cornea

The Repeatability of clinical measurements of dry eye

Cornea

The Lack of association between signs and symptoms in patients with dry eye disease

Cornea

Schirmer test after topical anesthesia and the tear meniscus height in normal eyes

Arch Ophthalmol

Tear meniscus measurement in the diagnosis of dry eye

Curr Eye Res

Quantitative evaluation of tear meniscus height from fluorescein photographs

Cornea

Reduced tear dynamics in dry eye patients with aqueous tear deficiency

Am J Ophthalmol

Effect of blinking on tear dynamics

Invest Ophthalmol Vis Sci

Relationships between central tear film thickness and tear menisci of the upper and lower eyelids

Invest Ophthalmol Vis Sci

Repeated measurements of dynamic tear distribution on the ocular surface after instillation of artificial tears

Invest Ophthalmol Vis Sci

Original article
Tear Meniscus Evaluation by Anterior Segment Swept-Source Optical Coherence Tomography