Categorization of the Aqueous Deficient Dry Eye by a Cut-Off Criterion of TMH Measured with Tearscope

Abstract

A decrease of the Tear Meniscus Height (TMH) has been proposed as a useful indicator for Aqueous Deficient Dry Eye (ADDE) categorization. The present study aimed to calculate a TMH cut-off criterion for the categorization or severity assessment of ADDE with the Tearscope. 200 participants with a previous Dry Eye Disease (DED) diagnosis according to TFOS DEWS-II criteria were recruited. TMH by slit-lamp illumination and Lipid Layer Pattern (LLP) with Tearscope were assessed to categorise the participants into the ADDE or the Evaporative Dry Eye (EDE) group. The ADDE group was also subdivided into Mild-moderate ADDE and Moderate-severe ADDE based on TMH with slit-lamp. Additionally, the TMH was measured by Tearscope (TMH-Tc). Receiver Operating Characteristics showed that the TMH-Tc have a diagnostic capability to differentiate between ADDE and EDE participants, and between Mild-moderate or Moderate-severe ADDE, with a cut-off value of 0.159 mm (AUC = 0.843 ± 0.035, p < 0.001; sensitivity: 86.4%; specificity: 75.4%) and 0.105 mm (AUC = 0.953 ± 0.025, p < 0.001; sensitivity: 98.1%; specificity: 80.0%), respectively. The present study proposed a cut-off criterion to differentiate between ADDE and EDE participants, or between ADDE severities through TMH assessed by Tearscope.

Association of Rheumatoid Arthritis with Aqueous Deficient Dry Eye Development

“…The sample size was calculated using PS Power and Sample Size Calculations Version 3.1.2 (Copyright© by William D. Dupont and Walton D. Plummer) based on the TFOS DEWS II Diagnostic Methodology report principles [7,13,14]. The literature-reported standard deviations (SDs) for symptomatology status (OSDI score), tear lm osmolarity, tear lm FBUT, and uorescein corneal staining were assumed to be 6.7, 4.8 mOsm/L, 2.9 s, and 2, respectively [7,11].…”

“…A battery of clinical procedures was conducted in all participants according to the TFOS DEWS II Diagnostic Methodology report [7,13,14]. The tests were always performed in the same order, from the least to the most invasive, while the rst eye to be measured was randomly selected [7,13,14].…”

“…A battery of clinical procedures was conducted in all participants according to the TFOS DEWS II Diagnostic Methodology report [7,13,14]. The tests were always performed in the same order, from the least to the most invasive, while the rst eye to be measured was randomly selected [7,13,14]. The procedures included tear lm osmolarity, lipid layer pattern (LLP), tear meniscus height (TMH), tear lm break-up time (FBUT), and uorescein corneal staining.…”

“…To diagnose dry eye disease (DED), the cut-off values used were an OSDI score ≥ 13, tear osmolarity ≥ 308 mOsm/L, FBUT < 10 s, and corneal staining (Oxford Scheme) ≥ 2 (Table 1). Only participants who were classi ed as having DED, with positive symptomatology and positive results on at least one clinical test, were included in the study sample [7,13,14]. According to the TFOS DEWS II criteria [7,8], participants were classi ed as having aqueous-de cient DED (ADDE) if they obtained a low tear meniscus height (TMH ≤ 20mm), as having evaporative DED (EDE) if they obtained a thin lipid layer pattern (LLP ≤ CM), or as having mixed DED if both criteria were met [8, 15,16].…”

“…Summary of the battery of clinical procedures performed [7,13,14]. OSDI = ocular surface disease index; FBUT = uorescein break-up time.…”