Clinical observation of tear film breakup time with a novel smartphone-attachable technology

Abstract

Purpose To demonstrate the practicability of a portable instrument in assessing tear film breakup time (TFBUT): a lens attachment for smartphones (LAS). Methods By applying LAS in combination with the iPhone 12 pro, and a recordable slit-lamp microscope, we obtained TFBUT videos from 58 volunteers. The comparison between the conventional slit-lamp microscope and LAS by an experienced ophthalmologist. Moreover, we also invited an ophthalmic postgraduate student and an undergraduate student with no clinical experience to assess TFBUT in those videos. The inter-observer reliability was assessed using intraclass correlation coefficients (ICC). Results The TFBUT of 116 eyes in total was recorded. Reliability indexes were adequate. The Spearman’s correlation analysis and the intraclass correlation coefficient suggested a strong correlation between the 2 modalities (Right eye: Spearman’s r = 0.929, 95% confidence interval (CI) = 0.847–0.963, ICC = 0.978, p < 0.001; Left eye: Spearman’s r = 0.931, 95% CI = 0.866–0.964, ICC = 0.985, p < 0.001;). Between instruments, the majority of TFBUT measurements showed good agreement on Bland Altman plot. A high concordance was observed in TFBUT, when assessed by an ophthalmologist and an ophthalmic postgraduate student (Left eye: LAS ICC = 0.951, p < 0.001; Left eye: slit-lamp microscope ICC = 0.944, p < 0.001). Conclusions Compared with the conventional slit-lamp microscope, the LAS has sufficient validity for evaluating TFBUT in clinics or at home.

Interobserver Reliability of Tear Break-Up Time Examination Using “Smart Eye Camera” in Indonesian Remote Area

“…Another study by Zhang et al also reported high agreement for measurement between an undergraduate student and a postgraduate student was 0.864 (95% CI, 0.810-0.904), between an undergraduate student and an ophthalmologist, was 0.922 (95% CI, 0.889-0.945), between a postgraduate student and an Ophthalmologist was 0.949 (95% CI, 0.927-0.964), and the average was 0.911 (95% CI, 0.881-0.934), the mean was 0.911 (95% CI, 0.881-0.934), using the same technology called Lens Attachment for Smartphone. 23 Based on two studies by Shimizu et al, we decided to do further research using SEC as novel inventions in Ophthalmology technology and this is the pilot study in populations-based research using SEC in diagnosis of DED in Indonesia. 7,11 This current study showed good consistency between interobservers (ophthalmologist and nonophthalmologist) in assessing TBUT examination (mean difference=0.78; 95% CI=−0.26-1.84; p=0.143), and DED detection (kappa coefficient = 0.71).…”