Lipid layer thickness and tear meniscus height measurements for the differential diagnosis of evaporative dry eye subtypes

Sang, Xuan; Li, Yan; Liu, Yang; Liu, Jiahui; Wang, Xiaoran; Li, Chaoyang; Liu, Ying; Wang, Chenjie; He, Xiongjun; Wang, Shoubi; Wang, Zhichong

doi:10.18240/ijo.2018.09.11

Cited by 12 publications

(11 citation statements)

References 27 publications

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“…In current study, the median value of LLT was 57 nm, which was thinner than the results in previous studies conducted by Jung et al [ 9 ] and Sang et al [ 15 ], in which the median LLT values in eyes with obstructive MGD were 79 nm and 75 nm, respectively. On the contrary, our results were similar to the study reported by Eom et al [ 7 ], who used the same instrument to measure the LLT in patients with obstructive MGD.…”

Section: Discussioncontrasting

confidence: 84%

“…A positive correlation between the LLT measurement and expressible MGs has been reported in several studies [ 7 , 8 , 15 , 17 ], indicating that the LLT assessments well reflect the quantitative changes of the meibum expression. Our data demonstrated that the LLT correlated well with MGE score in middle-aged and older groups, but not in young group.…”

Section: Discussionsupporting

confidence: 59%

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Assessment of tear film lipid layer thickness in patients with Meibomian gland dysfunction at different ages

et al. 2020

BMC Ophthalmol

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Background To evaluate the correlations between lipid layer thickness (LLT) and morphology and function of the meibomian glands in patients who were diagnosed as meibomian gland dysfunction (MGD) in different age groups. Methods Patients who have diagnosed as obstructive MGD were included in this prospective, cross-sectional study. Patients were divided into three groups: young (ages 20–39 years), middle-aged (ages 40–59 years), and older (aged ≥60 years). All patients completed an Ocular Surface Disease Index (OSDI) questionnaire and were evaluated for LLT, tear meniscus height (TMH), noninvasive tear film break-up time (NI-BUT) measurement, invasive TBUT (ITBUT), corneal fluoresceinstaining (CFS) score, eyelid margin abnormalities, Schirmer I test, and MG function and morphology, by using the Keratograph 5 and LipiView interferometer. Results Two hundred and nine patients (209 eyes) were included. The median LLT of all patient was 57 nm (IQR, 36.5 nm), and the LLT values were significantly different among the young group (median, 51 nm; IQR, 23.5 nm), middle-aged group (median, 59.5 nm; IQR 46.5 nm) and older group (median, 62 nm; IQR, 42.5 nm) (P = 0.033, Kruskal-Wallis test). In regression analyses controlling for confounder factors sex and MG loss, the LLT was positively correlated with age (β = 5.539, P = 0.001). There was a negative correlation between LLT and MG dropout in the all (r = − 0.527, P < 0.001), young (r = − 0.536, P < 0.001), middle-aged (r = − 0.576, P < 0.001), and older (r = − 0.501, P < 0.001) groups. LLT was positively correlated with the MG expressibility in the all (r = 0.202, P = 0.003), middle-aged (r = 0.280, P = 0.044) and older (r = 0.452, p < 0.001) groups, but it was no statistical significance in the young group (r = 0.007, P = 0.949). Conclusions The thickness of LLT was increased with age and significantly correlated with both MG secretion and morphology in middle-aged and older patients with obstructive MGD. LLT measurement is a useful screening tool for detecting obstructive MGD and age as an influential factor should be accounted for when interpreting the meaning of the LLT value. Trial registration NCT02481167; Registered 25 June, 2015.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionsupporting

confidence: 59%

Assessment of tear film lipid layer thickness in patients with Meibomian gland dysfunction at different ages

et al. 2020

BMC Ophthalmol

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“…The tear film is composed of a mucous layer, a watery layer, and a lipid layer. The lipid layer score is related to the meibomian gland function and correlates with dry eye symptoms [ 29 , 36 , 37 ]. Participants with a thicker lipid layer could be more likely to generate aerosols.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Evaluation of Aerosol Generation from Non-contact Tonometry and its Correlation with Tear Film Characteristics

Hao

Zhao

et al. 2021

Adv Ther

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Introduction Ophthalmologists are inevitably exposed to tears and ocular discharge during ophthalmologic examinations and are at high risk for SARS-CoV-2 infection. To understand the role of aerosols in disease transmission, we adopted a prospective cross-sectional study design and investigated the count and size distribution of aerosols generated by a non-contact tonometer and its correlation with individual tear film characteristics. Methods This study constituted two parts. The study population included outpatients who underwent an intraocular pressure examination in an intraocular pressure examination room (Part I) and 20 participants who underwent an intraocular pressure examination in a laboratory (Part II). The following main outcomes were measured: aerosol counts at 0, 50, 100, 150, and 200 cm from the non-contact tonometer (Part I); aerosol counts after each participant underwent non-contact tonometry, and lipid layer thickness score and tear film break-up time (Part II). Results The aerosol count decreased with increasing distance from the tonometer. The aerosol count at 0 cm had the highest value compared to that at other distances. For aerosols of diameters 0.25–0.5 μm and 0.5–1.0 μm, the count decreased at 50 cm and remained stable at further distances. For aerosols of diameters 1.0–2.5 μm and ≥ 2.5 μm, the count dropped progressively at all five distances. The aerosol count from each tonometer correlated positively with the lipid layer thickness score ( r = 0.490, P = 0.028), whereas the aerosol count correlated negatively with the tear film break-up time ( r = − 0.675, P = 0.001). Conclusions Aerosols tended to coagulate during diffusion. A 50-cm distance from the tonometer could confer safety from aerosols with < 1.0-μm diameter. Aerosols generated during non-contact tonometry could contain a lipid layer component. Moreover, tear film stability could affect aerosol generation. Protective eyewear is recommended for reducing infection risk from aerosols. Individual tear film characteristics should be considered during non-contact tonometry.

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“…This result is in contrast to a previous study, which evaluated the same formulated eye drops and the conventional control therapy as evaluated in this study, and showed improvements in meibum quality and gland expressibility after 8 weeks of use. 13 This may be attributed to the lack of correlation between LLT and meibum quality scores, which was recently reported by Sang et al 28 While areas of tear break-up are often associated with thin lipid, it has been shown that this is not always the case, 29 which supports that the tear lipid is a poor barrier to evaporation if the composition and/or structure are defective. The lack of change in inferior LLT in this study, despite improvements to TER and TBUT with the formulated eye drops, seems to suggest that inferior LLT is not the primary driver in minimising TER.…”

Section: Clinical Sciencementioning

confidence: 92%

Effect of a formulated eye drop with Leptospermum spp honey on tear film properties

et al. 2020

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AimTo evaluate the effects of a proprietary formulated eye drop with Leptospermum spp honey versus a conventional lubricant eye drop on tear film properties in subjects with symptoms related to dry eye disease after 28 days of treatment.MethodsForty-six subjects with symptoms related to dry eye (Ocular Surface Disease Index (OSDI) score >12) were enrolled and randomly assigned to receive either the test formulated eye drop (Optimel by Melcare Biomedical Pty Ltd) or control eye drops (Alcon, USA) in this double-masked study. Inferior lipid layer thickness (LLT), tear film evaporation rate (TER), fluorescein tear film break-up time (TBUT), corneal staining and subjective symptoms (OSDI and visual analogue scales (VAS)) were measured before and after 28 days of instilling the eye drops.ResultsForty-two subjects completed the study (21 subjects in each group). After 28 days of treatment, TER showed a significantly greater reduction with the formulated eye drop compared with the control (p=0.01). TBUT showed a slight but not statistically significant increase with the formulated eye drop compared with the control (p=0.06), and a significantly greater reduction (improvement) in OSDI scores was observed with the formulated eye drop compared with the control (p=0.01). No significant differences were found between the two groups for inferior LLT, corneal staining and any of the VAS scores.ConclusionsThe formulated eye drops were effective in reducing tear film evaporation rate and were more effective for improving symptoms of dry eye compared with the control eye drops after 28 days of treatment.Trial registration numberNCT03622619.

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Lipid layer thickness and tear meniscus height measurements for the differential diagnosis of evaporative dry eye subtypes

Abstract: Obstructive MGD EDE and non-obstructive MGD EDE have significantly different clinical characteristics. Combining average LLT and TMH measurements enhanced their reliability for differentiating these two subtypes and provided guidance for offering more precise treatments for EDE subtypes.

Cited by 12 publications

References 27 publications

Assessment of tear film lipid layer thickness in patients with Meibomian gland dysfunction at different ages

Assessment of tear film lipid layer thickness in patients with Meibomian gland dysfunction at different ages

Quantitative Evaluation of Aerosol Generation from Non-contact Tonometry and its Correlation with Tear Film Characteristics

Effect of a formulated eye drop with Leptospermum spp honey on tear film properties

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