Correlation Analysis of Tear Film Lipid Layer Thickness and Ocular Surface Disease Index

Young Kim Rae; MD Kyung Sun Na,; Li Park Yu; MD Hyun Seung Kim,

doi:10.3341/jkos.2017.58.7.788

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Rae, Kyung Sun Na,, Yu, and Hyun Seung Kim,: Correlation Analysis of Tear Film Lipid Layer Thickness and Ocular Surface Disease Index

Original Article

J Korean Ophthalmol Soc 2017;58(7):788-796.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.788

Correlation Analysis of Tear Film Lipid Layer Thickness and Ocular Surface Disease Index

Young Kim Rae, M.D.¹, MD Kyung Sun Na,, PhD^1,², Li Park Yu, M.D.^1,², MD Hyun Seung Kim,, PhD^1,^2,

¹Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Korea

²Department of Ophthalmology, The Catholic University of Korea Yeouido St. Mary’s Hospital, Seoul, Korea

Address reprint requests to Hyun Seung Kim, MD, PhD Department of Ophthalmology, The Catholic University of Korea Yeouido St. Mary’s Hospital, #10, 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea Tel: 82-2-3379-1243, Fax: 82-2-761-6869 E-mail: Sara514@catholic.ac.kr

* This study was presented as a narration at the 115th Annual Meeting of the Korean Ophthalmological Society 2016.

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 17 November 20166 May 2017 Accepted 27 June 2017

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

To analyze the relationship between ocular surface disease index and tear film lipid layer thickness (LLT) using a LipiView II^® (LipiView^® Ocular Surface Interferometer, TearScience^®, Morrisville, NC, USA) interferometer.

Methods

Forty-nine patients diagnosed with dry eye syndrome were recruited for this prospective study. Patients completed oc-ular surface disease index questionnaires. We performed slit lamp examination, Schirmer test, corneal and conjunctival fluo-rescein staining, measured tear film break-up time, and graded meibomian gland dysfunction. Tear LLT, blinking time, and dy-namic meibomian imaging were analyzed using a LipiView II^® ocular interferometer. To control for missing data, we analyzed four sets of imputated data via the multiple imputation method and performed Pearson correlation analysis. Patients were as-signed to one of two LLT categories (LLT < 60 or LLT ≥ 60) and Chi-square test was performed.

Results

Among ocular surface disease parameters, tear film break-up time (tBUT) had a statistically significant correlation with average and maximum LLT (average LLT; p = 0.008, 0.035, 0.006, 0.049, maximum LLT; p = 0.006, 0.042, 0.020, 0.049, Pearson correlation analysis with multiple imputation) but there was no significant correlation with minimum LLT (minimum LLT; p = 0.048, 0.090, 0.079, 0.039). Of the patients with a relatively thick average LLT or maximum LLT (LLT ≥ 60 nm), 80% and 88% had a tBUT < 10, respectively. Conversely, 39% and 47% of patients with relatively thin average LLT (LLT < 60 nm) had a tBUT < 10 (average LLT; p = 0.013, maximum LLT; p = 0.039).

Conclusions

Average LLT and maximum LLT were significantly correlated with tBUT. Patients with a relatively thin average or maximum LLT tended to have a shorter tBUT. Based on these results, measuring tear film LLT using a LipiView II^® interferometer may be useful in the diagnosis and follow-up of patients with evaporative dry eye.

Keywords: Dry eye syndrome, Interferometry, Lipid layer thickness, Lipiview, Meibomian gland dysfunction

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Figure 1.

Pearson correlation scatter plot of tear break-up time (tBUT) and average lipid layer thickness (LLT) using implanted data set 1 (A), 2 (B), 3 (C), and 4 (D). (A) r = 0.376, p-value = 0.008. (B) r = 0.220, p-value = 0.035. (C) r = 0.390, p-value = 0.006. (D) r = 0.276, p-value = 0.049. p-values were calculated by Pearson correlation test.

Figure 2.

Pearson correlation scatter plot of tear break-up time (tBUT) and maximum lipid layer thickness (LLT) using implanted data set 1 (A), 2 (B), 3 (C), and 4 (D). (A) r = 0.390, p-value = 0.006. (B) r = 0.178, p-value = 0.042. (C) r = 0.331, p-value = 0.020. (D) r = 0.279, p-value = 0.049. p-values were calculated by Pearson correlation test.

Figure 3.

The percentage of patients with shorten (<10 sec) or normal (≥10 sec) tear break-up time (tBUT) in each relatively thin lipid layer thickness (LLT) (<60 nm) or relatively thick LLT (≥60 nm) (A: average LLT, B: maximum LLT). The percentage of patients with shorten (<5 mm) or normal (≥5 mm) Schirmer test in each relatively thin LLT (<60 nm) or relatively thick LLT (≥60 nm) (C: average LLT, D: maximum LLT). p-values were calculated by Chi-square test.

Table 1.

Clinical characteristics of patients

Characteristics	Value (range^*)
Age (years)	48.15 ± 15.69 (18-72)
Sex (male:female)	18:31
Schirmer’s test (mm)	8.45 ± 7.80 (2-20)
tBUT (sec)	5.00 ± 3.43 (1-10)
Average LLT (nm)	79.55 ± 37.31 (25-140)
Maximum LLT (nm)	93.30 ± 37.11 (29-150)
Minimum LLT (nm)	62.70 ± 32.33 (23-115)
Total blinking (times/20 sec)	5.80 ± 3.24 (2-12)
Partial blinking (times/20 sec)	3.30 ± 2.36 (0-9)
Partial blinking/total blinking ratio	0.59 ± 0.31 (0-1)

Values are presented as mean ± SD (range) unless otherwise indicated. tBUT = tear break-up time; LLT = lipid layer thickness; sec = second.

^* Range: minimum value-maximum value.

Table 2.

Correlation analysis among LLT and clinical factors using 4 sets of implantation data

	Data set	Average LLT	Maximum LLT	Minimum LLT	Difference^‡	Total blink	Partial blink
Schirmer test	1	0.149	0.050	0.229	0.361^*	-0.383^*	-0.157
		(0.307)	(0.733)	(0.114)	(0.011)	(0.007)	(-0.554)
	2	0.125	0.047	0.147	0.199	-0.370^†	-0.213^†
		(0.221)	(0.646)	(0.147)	(0.005)	(0.000)	(0.009)
	3	0.044	-0.031	0.056	-0.191	-0.356^*	0.170
		(0.765)	(0.933)	(0.700)	(0.199)	(0.012)	(0.243)
	4	0.155	0.074	0.221	-0.291^*	-0.271	-0.292^*
		(0.297)	(0.615)	(0.128)	(0.043)	(0.060)	(0.042)
tBUT	1	0.376^†	0.390^†	0.284^*	-0.322^*	-0.114	-0.109
		(0.008)	(0.006)	(0.048)	(0.024)	(0.435)	(0.456)
	2	0.220^*	0.178^*	0.179	0.199	0.247^*	-0.071
		(0.035)	(0.042)	(0.090)	(0.051)	(0.014)	(0.499)
	3	0.390^†	0.331^*	0.254	0.249	0.245	-0.044
		(0.006)	(0.020)	(0.079)	(0.096)	(0.090)	(0.765)
	4	0.276^*	0.279^*	0.297^*	0.035	-0.198	-0.203
		(0.049)	(0.049)	(0.039)	(0.913)	(0.177)	(0.162)
Staining grade	1	0.148	0.186	0.035	0.364^*	0.160	0.123
		(0.311)	(0.202)	(0.811)	(0.101)	(0.582)	(0.399)
	2	0.221^*	0.195	0.252^*	0.206^*	0.196	0.213^*
		(0.029)	(0.069)	(0.012)	(0.042)	(0.067)	(0.035)
	3	0.220	0.239	0.192	0.179	0.209	0.170
		(0.129)	(0.099)	(0.211)	(0.217)	(0.152)	(0.243)
	4	0.220	0.290^*	0.152	0.383^*	0.169	0.264
		(0.129)	(0.044)	(0.296)	(0.010)	(0.247)	(0.067)
LL MGD grade		-0.015	-0.018	0.000	-0.017	-0.017	0.107
		(0.916)	(0.959)	(0.999)	(0.906)	(0.909)	(0.465)

Values are presented as correlation coefficient r (p-value) unless otherwise indicated. p-values were calculated by Pearson’s correlation test. LLT = lipid layer thickness; tBUT = tear break-up time; LL MGD grade = lower lid meibomian gland dysfunction grade.

^* p-value < 0.05.

^† p-value < 0.01.

^‡ Difference = Maximum LLT - Minimum LLT.

Table 3.

Partial correlation analysis controlling for age and sex of the subject using 4 sets of implantation data

	Data set	Average LLT	Maximum LLT	Minimum LLT	Difference^‡	Total blink	Partial blink
Schirmer test	1	0.203	0.123	0.270	-0.315^*	-0.397^*	-0.270
		(0.171)	(0.410)	(0.066)	(0.031)	(0.006)	(-0.067)
	2	0.133	0.049	0.150	-0.222^*	-0.370^†	-0.300^†
		(0.198)	(0.633)	(0.144)	(0.030)	(0.000)	(0.003)
	3	0.041	-0.049	0.051	-0.238	-0.357^*	0.300^*
		(0.784)	(0.743)	(0.733)	(0.108)	(0.014)	(0.041)
	4	0.164	0.102	0.241	-0.301^*	-0.287^*	-0.218^*
		(0.272)	(0.469)	(0.102)	(0.040)	(0.049)	(0.140)
tBUT	1	0.396^†	0.396^†	0.286	-0.320^*	-0.114	-0.208
		(0.006)	(0.006)	(0.051)	(0.028)	(0.445)	(0.162)
	2	0.309^†	0.273^*	0.188	0.241^*	0.246^*	-0.069
		(0.002)	(0.007)	(0.066)	(0.018)	(0.016)	(0.505)
	3	0.414^†	0.361^*	0.263	0.288	0.245	-0.047
	4	(0.004) 0.242^*	(0.013)0.259^*	(0.074)0.288	(0.050)-0.020	(0.097)-0.207	(0.752)-0.136
		(0.018)	(0.035)	(0.050)	(0.891)	(0.162)	(0.363)

Values are presented as r (p-value) unless otherwise indicated. p-values were calculated by partial correlation analysis. LLT = lipid layer thickness; tBUT = tear break-up time.

^* p-value < 0.05.

^† p-value < 0.01.

^‡ Difference = Maximum LLT - Minimum LLT.

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