Tear Meniscus Evaluation Using Optical Coherence Tomography in Meibomein Gland Dysfunction Patients

Soo Ji Jeon; Ji Won Baek; Sang Hee Doh; Sung Kun Chung

doi:10.3341/jkos.2015.56.11.1683

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Jeon, Baek, Doh, and Chung: Tear Meniscus Evaluation Using Optical Coherence Tomography in Meibomein Gland Dysfunction Patients

Original Article

J Korean Ophthalmol Soc 2015;56(11):1684-1691.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.11.1683

Tear Meniscus Evaluation Using Optical Coherence Tomography in Meibomein Gland Dysfunction Patients

Soo Ji Jeon, M.D¹, Ji Won Baek, M.D, PhD², Sang Hee Doh, M.D, PhD², Sung Kun Chung, M.D, PhD^2,

¹Department of Ophthalmology and Visual Science, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

²Department of Ophthalmology and Visual Science, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Address reprint requests to Sung Kun Chung, MD, PhD Department of Ophthalmology, St. Paul’s Hospital, College of Medicine, The Catholic University of Korea, #180 Wangsan-ro, Dongdaemun-gu, Seoul 02559, Korea Tel: 82-2-958-2114, Fax: 82-2-761-6869 E-mail: eyedoc@catholic.ac.kr

Received 27 February 201515 May 2015 Accepted 21 August 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study compared tear meniscus parameters between normal control, aqueous tear deficient dry eye, and meibo-mein gland dysfunction groups using Fourier-domain optical coherence tomography (FD-OCT).

Methods

This study included 33 normal eyes, 79 aqueous tear-deficient dry eyes (ATD), and 48 meibomein gland dysfunction dry eyes (MGD). Following routine examination including Schirmer test, tear break-up time, corneal staining, and tear meniscus parameters such as tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were obtained us-ing FD-OCT. The differences among groups were assessed.

Results

The averages of TMH, TMD, and TMA were 295.58 ± 58.36 μ m, 166.67 ± 30.43 μ m, and 0.0360 ± 0.01100 mm² in nor-mal eyes, respectively, 226.43 ± 42.18 μ m, 147.44 ± 38.38 μ m, and 0.0209 ± 0.01015 mm² in ATD, respectively, 272.81 ± 64.21 μ m, 159.37 ± 44.05 μ m, and 0.0295 ± 0.01271 mm² in MGD, respectively. Tear meniscus parameters were significantly lower in ATD. Tear meniscus parameters in MGD were higher than ATD and lower than normal eyes, but the TMA was the only statisti-cally significant value.

Conclusions

Although tear meniscus parameters in MGD were higher than ATD, they could not be distinguished from normal eyes. Tear meniscus evaluation using FD-OCT could be a useful measurement system in classification and treatment choice for dry eye patients.

Keywords: Dry eye syndrome, Meibomian gland dysfunction, Optical coherence tomography, Tear meniscus

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Figure 1.

Measurement of optical coherence tomography (OCT) parameters of tear meniscus. (A) Tear meniscus heights (TMH) in-dicates vertical linear length between upper end of tear meniscus reaching the cornea and lower end of the tear meniscus reaching the lower conjunctiva. Tear meniscus depth (TMD) indicates horizontal linear length between the outer limit of the tear meniscus and apex. (B) Tear meniscus area (TMA) indicates the entire selection of tear meniscus shown in OCT image (arrow). Measurements of TMH, TMA, and TMD were performed using RTVue-100 software.

Figure 2.

Mean values of TMH, TMD, and TMA for each group. When compared to the control group, statistically sig-nificant differences existed in all tear meniscus parameters in the ATD group ( p = 0.000, p = 0.047, p = 0.000), but in the MGD group, only TMA was significantly low ( p = 0.030). In the MGD group, the mean TMH, TMD, and TMA was higher than the ATD group, and only TMH and TMA are statistically significant ( p = 0.000, p = 0.000). TMH = tear meniscus heights; TMD = tear meniscus depth; TMA = tear meniscus area; ATD = aqueous tear deficiency; MGD = meibomian gland dysfunction; Dx = diagnosis. ^* Denotes statistically sig-nificance compared between groups indicated.

Figure 3.

Spearman correlation between tear meniscus parame-ters and TBUT in meibomian gland dysfunction patients. Correlation graphs between TBUT and (A) TMH, (B) TMD, and (C) TMA. TBUT = tear break-up time; TMH = tear meniscus heights; TMD = tear meniscus depth; TMA = tear meniscus area.

Figure 4.

The ROC curves of TMH, TMD, and TMA in meibo-mian gland dysfunction group. Area under the ROC of TMH, TMD, and TMA is 0.396, 0.384, 0.357, respectively. ROC = receiver operator characteristic; TMH = tear meniscus heights; TMD = tear meniscus depth; TMA = tear meniscus area.

Table 1.

Demographic characteristics of dry eye patients and control groups

Groups	Control	ATD	MGD	Total	p-value^*
N (eyes)	33	79	48	160
Age (years)	54.24 (±11.42)	56.34 (±3.73)	59.35 (±12.25)	56.81 (±12.90)	0.061
Male/female ratio	0.57	0.46	0.33	0.44

ATD = aqueous tear-deficient dry eye; MGD = meibomein gland dysfunction dry eye.

^* ANOVA among groups.

Table 2.

Tear meniscus parameters measured by Fourier domain optical coherence tomography

	Control	ATD (n = 79)		MGD (n = 48)
	Mean ± SD	Mean ± SD	p-value^*	Mean ± SD	p-value^*
TMH (μ m)	295.58 ± 58.363	226.43 ± 42.177	0.000	272.81 ± 64.206	0.143
TMD (μ m)	166.67 ± 30.426	147.44 ± 38.379	0.047	159.38 ± 44.054	0.684
TMA (mm²)	0.0360 ± 0.01100	0.0209 ± 0.01015	0.000	0.0295 ± 0.01271	0.030

Values are presented as mean ± SD unless otherwise indicated.

ATD = aqueous tear-deficient dry eye; MGD = meibomein gland dysfunction dry eye; TMH = tear meniscus height; TMD = tear meniscus depth; TMA = tear meniscus area.

^* Turkey’s test in conjunction with ANOVA between control group and dry eye group.

Table 3.

Clinical tear parameters in the dry eye and control groups

	Control	ATD (n = 79)		MGD (n = 48)
	Mean ± SD	Mean ± SD	p-value^*	Mean ± SD	p-value^*
ST (mm)	10.61 ± 3.240	5.82 ± 1.998	0.000	8.58 ± 3.718	0.022
TBUT (second)	9.88 ± 1.867	5.23 ± 1.867	0.000	8.00 ± 2.690	0.000
Corneal staining (score)	0.33 ± 0.467	1.56 ± 0.729	0.000	0.75 ± 0.863	0.015

Values are presented as mean ± SD unless otherwise indicated.

ATD = aqueous tear-deficient dry eye; MGD = meibomein gland dysfunction dry eye; ST = Schirmer test; TBUT = tear-film break-up time.

^* Turkey’s test in conjunction with ANOVA between control group and dry eye group.

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