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Usability and Reproducibility of Tear Meniscus Values Generated Via Swept-Source Optical Coherence Tomography and the Slit Lamp with a Graticule Method

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Usability and Reproducibility of Tear Meniscus Values Generated Via Swept-Source Optical Coherence Tomography and the Slit Lamp with a Graticule Method Int Ophthalmol DOI 10.1007/s10792-017-0517-3 ORIGINAL PAPER Usability and reproducibility of tear meniscus values generated via swept-source optical coherence tomography and the slit lamp with a graticule method Hitoshi Imamura . Hitoshi Tabuchi . Shunsuke Nakakura . Daisuke Nagasato . Hiroaki Baba . Yoshiaki Kiuchi Received: 24 October 2016 / Accepted: 4 April 2017 Ó The Author(s) 2017. This article is an open access publication Abstract each method (ICC [ 0.75 for both). No statistically Purpose To investigate the usability and the repro- significant differences were found in TMH among the ducibility of the tear meniscus values via swept-source age groups using both SS-OCT and slit lamp methods optical coherence tomography (SS-OCT) and the (P = 0.985, 0.380, respectively). TMH values at both conventional slit lamp microscope method with a sides of the corneal center were significantly smaller graticule. than those at the corneal center (P \ 0.0001). Methods The right eye was examined in 90 healthy Conclusions TMH values obtained by the slit lamp adult subjects who were grouped according to age method were lower than those obtained by SS-OCT. (group 1: 20–39 years; group 2: 40–59 years; group 3: However, both methods yielded highly reproducible C60 years). The tear meniscus height (TMH) and tear TMH measurements, suggesting that they are clini- meniscus area were measured using SS-OCT and cally useful. Tear meniscus values did not vary by age TMH by the slit lamp microscope method. The but by measurement points in our cohort. reproducibility of each method was calculated using intraclass correlation coefficients (ICCs) in addition- Keywords Tear meniscus Á Slit lamp Á SS-OCT Á ally enrolled 30 healthy young subjects. We also Usability Á Reproducibility evaluated TMH at 3 mm from the corneal center in both temporal and nasal directions using SS-OCT. Results The mean of the TMH values measured by SS-OCT was significantly higher than those measured Introduction by the slit lamp method (328 vs. 212 lm, P \ 0.001, respectively). High reproducibility was observed for Aqueous tear deficiency dry eye is generally charac- terized by lower tear meniscus values [1], whereas disorders of the lacrimal duct are generally character- H. Imamura (&) Á H. Tabuchi Á S. Nakakura Á ized by higher tear meniscus values [2]. Tear meniscus D. Nagasato Á H. Baba measurement thus plays an important role in these Department of Ophthalmology, Saneikai Tsukazaki Hospital, 68-1, Aboshi Waku, Himeji 671-1227, Japan diseases. Generally, most ophthalmologists subjec- e-mail: [email protected] tively check the tear meniscus height (TMH) on the lower eyelid using a slit lamp microscope as the first H. Imamura Á Y. Kiuchi step to evaluate TMH. The attachment of a graticule to Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Hiroshima the slit lamp eyepiece increases the objectivity of University, Hiroshima, Japan TMH measurements [3–5]. 123 Int Ophthalmol In recent years, the clinical application of time Clinical Trials Register; number: UMIN000005928. domain anterior segment optical coherence tomogra- All of the measurements were taken in the right eye. phy has dramatically increased the objectivity of tear The exclusion criteria were subjects with ocular meniscus measurements, including TMH and the tear trauma, ocular inflammation, abnormal intraocular meniscus area (TMA) [6–14]. The SS-1000 (Tomey pressure, diabetic mellitus, a history of ocular surgery, Corp, Nagoya, Japan) swept-source OCT (SS-OCT) any subjective symptoms or a diagnosis of dry eye, device, which was designed specifically for imaging and/or any subjective symptoms or a diagnosis of the anterior segment, uses a wavelength of 1310 nm epiphora. Exclusion criteria also included subjects and allows for cross-sectional analysis as well as who used contact lenses, eye drops within 24 h of the 3-dimensional analysis of the anterior segment of the eye examination, and/or any topical or systemic eyes—thus enabling the measurement of TMH and medications that could affect tear secretion. TMA as well as tear meniscus volume via the use of an This study comprised two protocol sets. The invisible long-wavelength light source that does not comparative study between SS-OCT and slit lamp cause photophobia [10, 13]. SS-1000 is also capable of tear meniscus values and the study on age-related consecutive scanning of the tear fluid with a wide changes in tear meniscus values comprised 90 healthy scanning range of 16 mm, including the center of the adults in the age range of 20–86 years. eyelid. The reproducibility testing for SS-OCT and slit High reproducibility of the tear meniscus measure- lamp comprised 30 healthy young subjects for each ment by SS-OCT has been reported [10]. Additionally, method. TMH values or tear fluid volume by SS-OCT had the strong correlation between Schirmer test value [15]. Tear meniscus measurements However, in clinical practice, tear meniscus is eval- uated mostly via the slit lamp and there is not a clear All subjects underwent one anterior segment imaging distinction between the role of OCT and slit lamp in using an SS-1000 device with 16 vertical raster scans tear meniscus evaluation. The first aim of our study at 1-mm intervals. One experienced examiner cap- was to first compare tear meniscus values obtained by tured all of the images (H.B.). Each OCT image SS-OCT to those obtained by the conventional slit consisted of 512 A-scans with an acquisition time of lamp method with a graticule and further to investigate 0.3 s. The axial resolution is approximately 8 lm, and age-related changes in tear meniscus values by the transverse resolution was approximately 30 lm. comparing the three groups created according to age Subjects were instructed to look at a fixation light with of the subjects. The second aim was to evaluate the no background light. The OCT image of right eye was reproducibility of both methods. The third aim was to taken 1 s after a natural blink [10, 13]. During the compare TMH at different measurements points (the examination, the ambient room light, room tempera- center of the pupil and 3 mm from the center of the ture (25–28 °C), and humidity (40–50%) were pupil in both temporal and nasal directions) using SS- maintained. OCT. Of 16 vertical raster scans, captured OCT images taken at the center of the pupil and 3 mm from the center of the pupil both in the nasal and temporal directions Methods were magnified by 300%, and the TMH was measured using software calipers on vertical scans that were Subjects centered on the cornea. Then, for images taken at the center of the pupil, outlines of the tear meniscus were This prospective, observational, cross-sectional study plotted using seven points with the software calipers was performed in accordance with the Declaration of (Fig. 1). The integrated software program calculated the Helsinki and was approved by the Institutional Review area within the plotted outlines. To account for refrac- Board of Saneikai Tsukazaki Hospital. A written tion at the air meniscus interface, the calculated value informed consent was obtained from all healthy was then divided by the refractive index of a balanced subjects. This study was registered with the Japan salt solution (1.343) to obtain the TMA [10]. 123 Int Ophthalmol Fig. 1 A tear meniscus image obtained by SS-OCT (male, 79 years of age). The horizontal arrow indicates the tear meniscus height (0.288 mm). The area within the manually plotted lines indicates the tear meniscus area (0.029 mm2) After the OCT scan, the subjects underwent one TMH measurement using a slit lamp microscope. A graticule (Carl Zeiss #319770-9032-00, Oberkochen, Germany) was attached to the right eyepiece of the slit lamp microscope (Carl Zeiss SL130, Oberkochen, Germany). At 89 magnification, when observing the plane perpendicular to the observational axis direc- tion, one scale increment was equivalent to 200 lm. All measurements were taken at 89 magnification at the center of the cornea without fluorescein staining. Fig. 2 An anterior segment image obtained by the slit lamp method with a graticule (female, 30 years of age). One scale We read in 20 lm, which was 1/10 of the increment, increment was equivalent to approximately 200 lm. In this for TMH (Fig. 2). We selected 89 magnification case, the tear meniscus height was estimated to be 400 lm because the measurements of TMH at higher magni- fications required more time and were considered adults per group, according to age: Group 1 was the young inappropriate for clinical practice. Subjects were adult group (range, 20–39 years; mean, 29.6 years; 18 instructed to look straight with minimum observa- males and 12 females), group 2 was the middle-age group tional illumination and were allowed to blink. The (range, 40–59 years; mean, 48.8 years; 12 males and 18 TMH of the right eye was measured by H.I. 1 s after a females), and group 3 was the elderly group (range, natural blink [10, 13]. The room light, room temper- C60 years; mean, 74.1 years; 13 males and 17 females). ature, and humidity were similarly maintained as the OCT examinations. Measurement reproducibility of the SS-OCT and slit lamp method Comparison between SS-OCT and slit lamp tear meniscus values and the study on age-related A group of 30 young healthy subjects (male, n = 11; changes in tear meniscus values female, n = 19) were additionally recruited to inves- tigate the reproducibility of the tear meniscus mea- Ninety healthy subjects (age range, 20–86 years; surements. Each subject underwent anterior segment mean age, 50.8 years; 43 males and 47 females) were OCT imaging three times.
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