Tear Meniscus Evaluation Using Optical Coherence Tomography in Dry Eye Patients

Na Yeon Jung; Ji Won Baek; Seong Joo Shin; Sung Kun Chung

doi:10.7469/JKOS.2015.56.03.323

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Jung, Baek, Shin, and Chung: Tear Meniscus Evaluation Using Optical Coherence Tomography in Dry Eye Patients

Original Article

J Korean Ophthalmol Soc 2015;56(3):323-330.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.03.323

Tear Meniscus Evaluation Using Optical Coherence Tomography in Dry Eye Patients

Na Yeon Jung, MD¹, Ji Won Baek, MD², Seong Joo Shin, MD¹, Sung Kun Chung, MD, PhD²

¹Department of Ophthalmology, Sahmyook Medical Center, 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 130-709, Korea Tel: 82-2-958-2151, Fax: 82-2-960-2150 E-mail: eyedoc@catholic.ac.kr

Received 24 May 201424 August 2014 Accepted 1 March 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.

초록

Purpose:

To evaluate the tear meniscus in aqueous tear-deficient dry eye patients using Fourier-domain optical coherence tomography (FD-OCT) and to investigate the clinical usefulness of tear meniscus values.

Methods:

The present study included 79 aqueous tear-deficient dry eyes and 50 normal eyes. Tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus area (TMA) were imaged using FD-OCT and measured with computer calipers. Schirmer’s test, tear break-up time, and corneal fluorescein staining were also performed and the correlations between the tests were analyzed. Additionally, the diagnostic power of tear meniscus values was compared using area under the receiver operating characteristic curve (AUROC).

Results:

Tear meniscus values were significantly decreased in the aqueous tear-deficient dry eye group ( p < 0.05). TMH, TMD, and TMA were positively correlated with Schirmer’s test and tear break-up time ( p < 0.05), and TMH and TMD were negatively correlated with corneal fluorescein staining in the aqueous tear-deficient dry eye group ( p < 0.05). The AUROCs of TMH, TMD, and TMA were 0.978, 0.788, and 0.957, respectively.

Conclusions:

Tear meniscus values measured using FD-OCT were significantly lower in aqueous tear-deficient dry eyes and were correlated with Schirmer’s test, tear break-up time, and corneal fluorescein staining. Tear meniscus measurements obtained using FD-OCT can be useful clinical parameters for the diagnosis and treatment of aqueous tear-deficient dry eye.

Keywords: Correlation, Dry eye, Optical coherence tomography, Tear meniscus

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Figure 1.

(A) Image illustrating the 6 mm vertical scan path (arrowed line) of the optical coherence tomography beam to image the lower tear meniscus. (B) An optical coherence tomography vertical line scan cross-sectional image of the lower tear meniscus (arrow). (C) Optical coherence tomography image of the lower tear meniscus showing the tear meniscus height, depth and area. Measurements of TMH, TMD, TMA were performed using RTVue-100 software. TMH = tear meniscus height; TMD = tear meniscus depth; TMA = tear meniscus area.

Figure 2.

(A) Scatter plot showing relationship between TMH versus Schirmer’s test (ST) and tear break-up time (tBUT) in aqueous tear-deficient dry eye patients. (B) Scatter plot showing relationship between TMD versus ST and tBUT in aqueous tear-deficient dry eye patients. (C) Scatter plot showing relationship between TMA versus ST and tBUT in aqueous tear-deficient dry eye patients. TMH = tear meniscus height; TMD = tear meniscus depth; TMA = tear meniscus area.

Figure 3.

Receiver operator characteristic curves for TMH, TMD, and TMA. TMH = tear meniscus height; TMD = tear meniscus depth; TMA = tear meniscus area.

Table 1.

Average results of tear parameters in the aqueous tear-deficient dry eye patients and normal subjects

	Aqueous tear-deficient dry eye (n = 79)		Normal (n = 50)		p-value
	Mean ± SD	Range	Mean ± SD	Range	p-value
TMH (μ m)	226.43 ± 42.18	148-341	295.58 ± 58.36	177-377	0.000
TMD (μ m)	147.44 ± 38.38	104-299	166.67 ± 30.43	106-234	0.012
TMA (mm²)	0.021 ± 0.011	0.00-0.07	0.036 ± 0.011	0.01-0.06	0.000
Schirmer (mm)	5.82 ± 1.99	2-10	10.61 ± 3.24	4-16	0.000
tBUT (s)	5.23 ± 1.87	2-12	9.88 ± 1.87	5-15	0.000
Staining (score)	1.56 ± 0.73	0-4	0.30 ± 0.47	0-1	0.000

SD = standard deviation; TMH = tear meniscus height; TMD = tear meniscus depth; TMA = tear meniscus area; tBUT = tear break-up time.

Table 2.

Correlation between tear meniscus dimensions in aqueous deficient dry eye patients and normal subjects

OCT parameters	Conventional tests	Aqueous tear-deficient dry eye (n = 79)		Normal (n = 50)
OCT parameters	Conventional tests	p-value^*s	p-value	p-value^*	p-value
TMH	Schirmer	0.386	0.000	0.850	0.000
	tBUT	0.397	0.000	0.735	0.000
	Staining	-0.289	0.010	-0.817	0.000
TMD	Schirmer	0.389	0.000	0.453	0.008
	tBUT	0.269	0.017	0.255	0.152
	Staining	-0.248	0.028	-0.448	0.009
TMA	Schirmer	0.312	0.005	0.662	0.000
	tBUT	0.513	0.000	0.549	0.001
	Staining	-0.168	0.139	-0.706	0.000

OCT = optical coherence tomography; TMH = tear meniscus height; TMD = tear meniscus depth; TMA = tear meniscus area; tBUT = tear break-up time.

^* Spearman’s correlation coefficient.

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