Evaluation of tear meniscus height using different clinical methods

Niedernolte, Britta, Trunk L, Lisa, Wolffsohn, James S, Pult, Heiko ORCID: https://orcid.org/0000-0003-4371-8007 and Bandlitz, Stefan 2021. Evaluation of tear meniscus height using different clinical methods. Clinical and Experimental Optometry 104 (5) , pp. 583-588. 10.1080/08164622.2021.1878854

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Abstract

Clinical relevance: The height of the tear meniscus (TMH) is a generally accepted method to evaluate tear film volume, especially in dry eye diagnoses and management. Background: The purpose of this study was to evaluate the ability of different methods to measure tear meniscus height accurately and repeatably. Methods: Lower TMH of 20 volunteers (26.8 ± 5.6 years) was measured by two observers (OI and OII) using optical coherence tomography (OCT), slitlamp microscope image analysis, and with a reticule at low (8x) and high (32x) magnification. TMH was also evaluated by both observers by comparing TMH to thickness of the lid margin (lid-ratio; grade 0: TMH 1/2 lid margin thickness; grade 1: 1/3; grade 2: 1/4; grade 3: 1/5; grade 4: 1/6) and to the number of eyelashes fitting in the tear meniscus. Differences between observers were analysed by paired-t-test. Differences between OCT-TMH and other methods were analysed by ANOVA, and inter-observer repeatability by intra-class-correlation-coefficient (ICC). The ability to predict OCT-TMH was calculated by receiver operative characteristic (ROC) curve analysis. Results: There was no significant difference between OI and OII in all methods except of the eyelash-count-method (p = 0.008). For OI, TMH measured using a reticule at 8x (0.20 ± 0.05 mm) was significantly lower than OCT-TMH (0.24 ± 0.07 mm) (p = 0.032) but not at 32x (0.22 ± 0.01 mm; p = 0.435). TMH evaluated by the image software of the slitlamp (0.20 ± 0.05 mm) was significantly lower than OCT-TMH (p = 0.022). The lid-ratio-method and eyelash-count-method resulted in grades of 2.35 ± 1.22 and 2.85 ± 0.81, respectively. ROC analyses showed that only the 8x and the 32x magnification method could discriminate between normal and abnormal OCT-TMH. OCT had the best repeatability (ICC = 0.88; p < 0.001) followed by reticule using 32x magnification (ICC = 0.70; p = 0.004). Conclusion: The most reliable method to measure TMH was OCT followed by slitlamp using a reticule. TMH cannot be reliably evaluated by comparing it against lid margin thickness or number of eyelashes.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Optometry and Vision Sciences
Publisher:	Taylor and Francis Group
ISSN:	0816-4622
Date of Acceptance:	30 October 2020
Last Modified:	01 Dec 2023 10:30
URI:	https://orca.cardiff.ac.uk/id/eprint/164153

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