Correlation between Non-Invasive Tear Breakup Time and Invasive Tear Breakup Time for Dry Eye Syndrome Diagnosis

Introduction: in today’s digital environment, dry eye complaints step forward in all age groups. Along with dry eye syndrome, the diagnosis of which is not complicated, there are other causes of dryness such as dysfunction of the tear film and Meibomian glands, etc. For the early detection of the above conditions, invasive diagnostic methods are mainly used.

Aim: to compare Non-Invasive Tear Breakup Time (NITBUT) assessed with LacryDiag ocular surface analyzer to results of invasive tests for dry eye syndrome diagnosis to determine the possibility of a wider use of LacryDiag in practical ophthalmology.

 Materials and Methods: 50 patients with dry eye, burning and feeling of a foreign body complaints participated in this study. Mean age amounted to 28.85 ± 5.86 years. NITBUT was assessed with LacryDiag ocular surface analyzer. The data obtained was compared to the results of Invasive Tear Breakup Time (TBUT) – Norne test, and Schirmer I test.

Results: both quantitative and qualitative values of tear film stability were analyzed in all participants. Based on results of the Schirmer I test, patients were divided into subgroups: where it was greater than 21 mm, between 11 and 20 mm, between 6 and 10 mm, and less than 5 mm/ The mean value of the Schirmer I test result amounted to 15.32 ± 6.05 mm/5 min, NITBUT amounted to 9.59 ± 4.37 s, while invasive TBUT amounted to 8.98 ± 3.79 s. It was found that invasive TBUT is in a strong direct correlation with NITBUT values (p <0.001, r = 0.554). No correlation was discovered between Schirmer I test results and TBUT (p = 0.15, r = 0.207) as well as between Schirmer I test result and NITBUT (p = 0.17, r =0.228). No correlation was found between the optical power of the cornea and the tear film structure abnormalities.

Conclusion: a strong correlation was found between results of invasive and non-invasive methods of tear film breakup time assessment. No correlation was found between the optical power of the cornea and the tear film disruption. The non-invasive test was found to be an effective and objective method for diagnosing dry eye.

1. Brzheskiy V.V. Dry eye syndrome in children: modern capabilities for diagnosis and treatment (guidelines for practitioners). Russian pediatric ophthalmology. 2017.12(2):73–81. (In Russ.). http://dx.doi.org/l0.18821/1993-1859-2017-12-2-73-81

2. Zhang Y., Chen H., Wu X. Prevalence and risk factors associated with of dry eye syndrome among senior high school students in a country of Shandong Province, China. Ophthalm. Epidemiol. 2012;19:226–30.

3. Somov E.E. Lacrimal Dysfunction Syndromes (Anatomical and Physiological Foundations, Diagnosis, Clinical practice and Treatment). St. Petersburg: Chelovek; 2011:160. (In Russ.).

4. Cher I. A new look at lubrication of the ocular surface: flid mechanics behind the blinking eyelids. Ocul Surf. 2008;6:79–86. http://dx.doi.org/10.1016/S1542-0124(12)70271

5. Gachon A., Lacazette E. Tear lipocalin and the eye’s front line of defence. Br. J. Ophthalmol. 1998;82:453–455. http://dx.doi.org/10.1136/bjo.82.4.453

6. Knop E., Knop N., Millar T., Obata H., Sullivan D.A. The international workshop on meibomian gland dysfunction: report of the subcommittee on anatomy, physiology, and pathophysiology of the meibomian gland. Invest. Ophthalmol. Vis. Sci. 2011; 52:1938–1978. http://dx.doi.org/10.1167/iovs.10-6997c

7. Sullivan B.D., Whitmer D., Nichols K.K. et al. An objective approach to dry eye disease severity. Invest. Ophthalmol. Vis. Sci. 2010;51:6125–6130. http://dx.doi.org/10.1167/iovs.10-5390

8. Leung E.W., Medeiros F.A., Weinreb R.N. Prevalence of ocular surface disease in glaucoma patients. J.Glaucoma. 2008;17:350–355. http://dx.doi.org/10.1097/IJG.0b013e31815c5f4f

9. Hamam H. A new measure for optical performance. Optom. Vis. Sci. 2003;80:175–184. http://dx.doi.org/10.1097/00006324-200302000-00014

10. Willcox M.D.P., Argüeso P., Georgiev G.A. et al. TFOS DEWS II tear fim report. Ocul. Surf. 2017;15:366–403. http://dx.doi.org/10.1016/j.jtos.2017.03.006

11. International Dry Eye Workshop (DEWS) Defiition and Classifiation. The defiition and classifiation of dry eye disease:report of the defiition and classifiation subcommittee of the international dry eye workshop. Ocul. Surf. 2007;5:75–92. http://dx.doi.org/10.1016/S1542-0124(12)70081-2

12. Hong J., Sun X., Wei A. et al. Assessment of tear fim stability in dry eye with a newly developed keratograph. Cornea. 2013;32:716–721. http://dx.doi.org/10.1097/ICO.0b013e3182714425

13. Gulati S., Jain S. Ocular pharmacology of tear fim, dry eye, and allergic conjunctivitis. Handb. Exp. Pharmacol. 2017;242:97–118.

14. Downie L.E. Automated tear fim surface quality breakup time as a novel clinical marker for tear hyperosmolarity in dry eye disease. Invest. Ophthalmol. Vis. Sci. 2015;56:7260–7268. http://dx.doi.org/10.1167/iovs.15-17772

15. Saraç Ö., Uysal S., Gürdal C. Keratokonus hastalarında gözyaşı fonksiyon testleri ve alt gözyaşı menisküs yüksekliğinin değerlendirilmesi. Turk. J. Ophthalmol. 2012;42:249–252 [Sarach O., Uysal S., Gurdal J. Testing of tear gland function in patients with keratoconus and assessment of the height of the lower tear meniscus. Turkish ophthalmology journal. 2012;42:249–252. (In Turkish).