Wide Dynamic Range Biomicroscopy Obtains Repeatable Measures in Dry Eye Disease

Wide dynamic range biomicroscopy may be used to obtain objective and noninvasive measurements that demonstrate acceptable intraobserver repeatability in individuals with dry eye disease (DED), according to a study published in Eye & Contact Lens.

Researchers included 50 participants (eyes, 50; mean age, 55.06 years; 70% women) in the cross-sectional study and performed 3 consecutively repeated measures of various objective and noninvasive measurements, which included first and average noninvasive breakup time (NIBUT), tear meniscus height (TMH), tear meniscus area (TMA), nasal ciliary hyperemia, temporal ciliary hyperemia, nasal conjunctival hyperemia, temporal conjunctival hyperemia, upper loss area meibomian gland (U-LAMG), lower loss area meibomian gland (L-LAMG), upper meibomian gland dysfunction grade (U-MGD grade), and lower meibomian gland dysfunction grade (L-MGD grade). The team estimated intraobserver repeatability using coefficient of variation (CoV), intraparticipant standard deviation, and Bland-Altman plots.

Except for L-MGD grade (P =.045), there were no statistically significant differences in the repeated-measures analysis for any variables. The F-NIBUT and A-NIBUT measurements obtained the highest CoVs, with average values of 0.48 and 0.34, respectively. The CoVs for the remaining variables were between 0.04 and 0.18, the report shows. Tear film stability (first NIBUT, P =.732; average NIBUT, P =.527) and volume measurements (TMH, P =.246; TMA, P =.973) showed good repeatability with the wide dynamic range biomicroscopy. Bland-Altman plots revealed a high level of agreement between pairs of repeated measures.

“New devices for the assessment of DED have been developed,” the study authors explain. “[C]ombining these tests for a comprehensive ocular surface evaluation, which may include tear film parameters, ocular hyperemia, and meibomian glands imaging, may increase the sensitivity and specificity to diagnose DED and manage its evolution after treatment.”

Study limitations include failure to evaluate interobserver variability and cutoff values for dry eye screening, and possible confounding due to the inclusion of patients with systemic disease and contact lens wearers.