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Repeatability, reproducibility and agreement between three different diagnostic imaging platforms for tear film evaluation of normal and dry eye disease

Eye volume 37, pages 2042–2047 (2023)Cite this article

Subjects

Abstract

Purpose

To assess the repeatability and reliability of different commercially available diagnostic platforms in the objective assessment of tear film parameters and if there exists any agreement between them.

Methods

Thirty healthy individuals (N = 60 eyes) and fifteen DED patients (N = 30 eyes) had their tear film parameters (Lipid layer thickness (LLT), Tear meniscus height (TMH), Non-invasive tear break up time (NIBUT)) assessed using three instruments - LipiView® II, IDRA ocular surface analyser (IDRA-OSA) and Oculus keratograph 5 M (K5M). Bland-Altman analysis and linear mixed effects modelling & Generalized Linear Hypothesis Test were used for analysis and coefficient of variation (CoV).

Results

There is poor repeatability but good reproducibility of LLT values measured with Lipiview, or IDRA. NIBUT using K5M & IDRA-OSA shows good repeatability and reproducibility in control group but poor repeatability in DED patients. TMH values obtained with K5M or IDRA-OSA had poor repeatability with high CoV. Between two observers, good reproducibility is observed for TMH and NIBUT values using both K5M & IDRA-OSA but not for LLT values. Between instruments, all the measurements (LLT, NIBUT and TMH) were significantly different on Bland Altman analysis.

Conclusion

No two dry eye diagnostic platforms can be used interchangeably and non-invasive tear film values should be interpreted keeping in mind the individual machine’s variability. The high coefficient of variation in DED patients compared to normal reflects inherent variability in tear film irrespective of the device used.

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Fig. 1: Scatterplots of Bland–Altman analyses in healthy controls.
Fig. 2: Scatterplots of Bland–Altman analyses in DED patients.

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Data availability

Supplementary file contains the statistical data. Raw data are available with authors and can be shared upon reasonable request.

References

  1. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II diagnostic methodology report. Ocul Surf. 2017;15:539–74.

    Article  PubMed  Google Scholar 

  2. Eom Y, Lee JS, Kang SY, Kim HM, Song JS. Correlation between quantitative measurements of tear film lipid layer thickness and meibomian gland loss in patients with obstructive meibomian gland dysfunction and normal controls. Am J Ophthalmol. 2013;155:1104–10.e1102.

    Article  PubMed  Google Scholar 

  3. Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, García-Montesinos J, Piñero DP. Agreement and repeatability of objective systems for assessment of the tear film. Graefes Arch Clin Exp Ophthalmol. 2018;256:1535–41.

    Article  PubMed  Google Scholar 

  4. García-Marqués JV, Martínez-Albert N, Talens-Estarelles C, García-Lázaro S, Cerviño A. Repeatability of non-invasive keratograph break-up time measurements obtained using Oculus Keratograph 5M. Int Ophthalmol. 2021;41:2473–83.

    Article  PubMed  Google Scholar 

  5. Best N, Drury L, Wolffsohn JS. Clinical evaluation of the Oculus Keratograph. Cont Lens Anterior Eye. 2012;35:171–4.

    Article  CAS  PubMed  Google Scholar 

  6. Tian L, Qu JH, Zhang XY, Sun XG. Repeatability and reproducibility of noninvasive keratograph 5M measurements in patients with dry eye disease. J Ophthalmol. 2016;8013621.

  7. Zhao Y, Tan CL, Tong L. Intra-observer and inter-observer repeatability of ocular surface interferometer in measuring lipid layer thickness. BMC Ophthalmol. 2015;15:53.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Markoulli M, Duong TB, Lin M, Papas E. Imaging the tear film: a comparison between the Subjective Keeler Tearscope-Plus™ and the Objective Oculus® Keratograph 5M and LipiView® Interferometer. Curr Eye Res. 2018;43:155–62.

    Article  PubMed  Google Scholar 

  9. Arriola-Villalobos P, Fernández-Vigo JI, Díaz-Valle D, Peraza-Nieves JE, Fernández-Pérez C, Benítez-Del-Castillo JM. Assessment of lower tear meniscus measurements obtained with Keratograph and agreement with Fourier-domain optical-coherence tomography. Br J Ophthalmol. 2015;99:1120–5.

    Article  PubMed  Google Scholar 

  10. Wolffsohn JS, Arita R, Chalmers R, Djalilian A, Dogru M, Dumbleton K, et al. TFOS DEWS II diagnostic methodology report. Ocul Surf. 2017;15:539–74.

    Article  PubMed  Google Scholar 

  11. Nichols KK, Mitchell GL, Zadnik K. The repeatability of clinical measurements of dry eye. Cornea. 2004;23:272–85.

    Article  PubMed  Google Scholar 

  12. Jung JW, Park SY, Kim JS, Kim EK, Seo KY, Kim TI. Analysis of factors associated with the tear film lipid layer thickness in normal eyes and patients with dry eye syndrome. Investig Ophthalmol Vis Sci. 2016;57:4076–83.

    Article  Google Scholar 

  13. Lee JM, Jeon YJ, Kim KY, Hwang KY, Kwon YA, Koh K. Ocular surface analysis: a comparison between the LipiView® II and IDRA®. Eur J Ophthalmol. 2021;31:2300–6.

    Article  PubMed  Google Scholar 

  14. Wei A, Le Q, Hong J, Wang W, Wang F, Xu J. Assessment of lower tear meniscus. Optom Vis Sci. 2016;93:1420–5.

    Article  PubMed  Google Scholar 

  15. Vigo L, Pellegrini M, Bernabei F, Carones F, Scorcia V, Giannaccare G. Diagnostic performance of a novel noninvasive workup in the setting of dry eye disease. J Ophthalmol. 2020:5804123. https://doi.org/10.1155/2020/5804123.

  16. Cox SM, Nichols KK, Nichols JJ. Agreement between automated and traditional measures of tear film breakup. Optom Vis Sci. 2015;92:257–e263.

    Article  Google Scholar 

  17. Singh S, Srivastav S, Mohamed A, Basu S. Non-invasive tear film assessment in normal population: effect of age, sex, and interparametric relationship. Front Med. 2022;9:894184.

    Article  Google Scholar 

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Funding

Hyderabad Eye Research Foundation (HERF), India.

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Author notes

  1. These authors contributed equally: Swati Singh, Sayan Basu.

Authors and Affiliations

  1. Centre for Ocular Regeneration/Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India

    Swati Singh, Saumya Srivastav, Zarin Modiwala & Sayan Basu

  2. Ophthalmic Plastic Surgery Services, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India

    Swati Singh

  3. Department of Computational Bio-statistics & Data Sciences, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India

    Mohammed Hasnat Ali

  4. Indian Health Outcomes, Public Health & Economics Research Center, Hyderabad, India

    Mohammed Hasnat Ali

  5. The Cornea Institute, L V Prasad Eye Institute, Hyderabad, 500034, Telangana, India

    Sayan Basu

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  1. Swati Singh
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Contributions

SS and SB were responsible for designing the study protocol, writing the protocol and IRB, conducting the literature review and writing the manuscript along with interpreting results, and creating tables. SSA and ZM were responsible for performing the tear film imaging and extracting the data from machines and electronic records. SSA contributed to figure designing as well. MHA conducted the statistical analyses and contributed to analysing data and interpreting results.

Corresponding authors

Correspondence to Swati Singh or Sayan Basu.

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Singh, S., Srivastav, S., Modiwala, Z. et al. Repeatability, reproducibility and agreement between three different diagnostic imaging platforms for tear film evaluation of normal and dry eye disease. Eye 37, 2042–2047 (2023). https://doi.org/10.1038/s41433-022-02281-2

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