Validation of a new objective method to assess lipid layer thickness without the need of an interferometer

Abstract Purpose This study aimed to develop and validate new metrics to objectively assess the lipid layer thickness (LLT) through the analysis of grey intensity values obtained from the Placido disk pattern reflected onto the tear film. Methods Ocular surface parameters were measured using Oculus Keratograph 5 M in 94 healthy volunteers (43.8 ± 26.8 years). Subjects’ LLT was subjectively classified into 4 groups using an interferometry-based grading scale. New metrics based on the intensity of the Placido disk images were calculated and compared between groups. The repeatability of the new metrics and their diagnostic ability was analysed through receiver operating characteristics (ROC) curves. The level of agreement between the new objective tool and the existing subjective classification scale was analysed by means accuracy, weighted Kappa index and F-measure. Results Mean pixel intensity, median pixel intensity and relative energy at 5.33 s after blinking achieved the highest performance, with a correlation with LLT between r = 0.655 and 0.674 (p < 0.001), sensitivity between 0.92 and 0.94, specificity between 0.79 and 0.81, area under the ROC curve between 0.89 and 0.91, accuracy between 0.76 and 0.77, weighted Kappa index of 0.77 and F-measure between 0.86 and 0.87. Conclusion The analysis of grey intensity values in videokeratography can be used as an objective tool to assess LLT. These new metrics could be included in a battery of clinical tests as an easy, repeatable, objective and accessible method to improve the detection and monitoring of dry eye disease and meibomian gland dysfunction.

Download Full-text

Increase in Tear Film Lipid Layer Thickness Following Treatment with Warm Compresses in Patients with Meibomian Gland Dysfunction

Eye & Contact Lens Science & Clinical Practice ◽

10.1097/01.icl.0000060998.20142.8d ◽

2003 ◽

Vol 29 (2) ◽

pp. 96-99 ◽

Cited By ~ 105

Author(s):

Mary Catherine Olson ◽

Donald R. Korb ◽

Jack V. Greiner

Keyword(s):

Layer Thickness ◽

Tear Film ◽

Meibomian Gland ◽

Meibomian Gland Dysfunction ◽

Lipid Layer

Download Full-text

Ocular surface analysis: A comparison between the LipiView® II and IDRA®

European Journal of Ophthalmology ◽

10.1177/1120672120969035 ◽

2020 ◽

pp. 112067212096903

Author(s):

Jeong Min Lee ◽

Young Joon Jeon ◽

Kook Young Kim ◽

Kyu-Yeon Hwang ◽

Young-A Kwon ◽

...

Keyword(s):

Observational Study ◽

Layer Thickness ◽

Surface Analysis ◽

Ocular Surface ◽

Random Order ◽

Meibomian Gland ◽

Lipid Layer ◽

Cross Sectional ◽

Single Visit ◽

Significant Difference

Purpose: To compare the lipid layer thickness (LLT), meibomian gland (MG) dropouts, and blinking pattern determined by the analysis of images acquired from the LipiView® II (LVII) and the IDRA® Ocular surface analyzer. Methods: A cross-sectional single-visit observational study was conducted. The LLT (minimum, maximum, and average), percentages of MG dropouts, and partial blink rates (PBR) were taken from both eyes of 47 participants using LVII and IDRA. Both devices were used to image the inferior eyelid of each participant in a random order. Results: Forty-seven participants (mean age 56.77 ± 14.47 (21–79) years, 66% female) completed the study. There was no significant difference in LLT between the two devices. A significant difference in percentages of MG dropouts was obtained between the LVII (36.51 ± 17.53) and the IDRA (45.36 ± 21.87), p = 0.003). There was also a significant difference in PBR between the LVII (0.51 ± 0.37) and the IDRA (0.23 ± 0.27), p < 0.001). Conclusion: No significant difference in LLT was obtained between LVII and IDRA. IDRA had a significantly lesser percentage of MG dropout and a higher PBR compared to LVII. These results indicate that these devices should not be used interchangeably for the evaluation of MG dropouts and PBR.

Download Full-text

Image-based quantitative analysis of tear film lipid layer thickness for meibomian gland evaluation

BioMedical Engineering OnLine ◽

10.1186/s12938-017-0426-8 ◽

2017 ◽

Vol 16 (1) ◽

Cited By ~ 9

Author(s):

Hyeonha Hwang ◽

Hee-Jae Jeon ◽

Kin Choong Yow ◽

Ho Sik Hwang ◽

EuiHeon Chung

Keyword(s):

Quantitative Analysis ◽

Layer Thickness ◽

Tear Film ◽

Meibomian Gland ◽

Lipid Layer

Download Full-text

Focused ultrasound stimulation on meibomian glands for the treatment of evaporative dry eye

Experimental Biology and Medicine ◽

10.1177/15353702211052035 ◽

2021 ◽

pp. 153537022110520

Author(s):

Gengxi Lu ◽

Sumanth Gollapudi ◽

Runze Li ◽

Margaret L Pfeiffer ◽

Preeya Mehta ◽

...

Keyword(s):

Layer Thickness ◽

Dry Eye ◽

Focused Ultrasound ◽

Meibomian Gland ◽

Meibomian Gland Dysfunction ◽

Lipid Layer ◽

Mean Values ◽

Ultrasound Stimulation ◽

Evaporative Dry Eye ◽

Meibomian Glands

Current treatments for meibomian gland dysfunction have several limitations, creating a necessity for other advanced treatment options. The purpose of this study is to determine the effectiveness of focused ultrasound stimulation for the treatment of dry eye disease caused by meibomian gland dysfunction. An in vivo study of nine Dutch Belted rabbits was conducted with focused ultrasound stimulation of the meibomian glands. A customized line-focused ultrasonic transducer was designed for treatment. Fluorescein imaging, Schirmer’s test, and Lipiview II ocular interferometer were used to quantify outcomes from three aspects: safety, tear production, and lipid layer thickness. Both tear secretion and lipid layer thickness improved following ultrasound treatment. Five to 10 min after the ultrasound treatment, the mean values of lipid layer thickness increased from 55.33 ± 11.15 nm to 95.67 ± 22.77 nm ( p < 0.05), while the mean values measured with the Schirmer’s test increased from 2.0 ± 2.3 to 7.2 ± 4.3 ( p < 0.05). Positive effects lasted more than three weeks. Adverse events such as redness, swelling, and mild burn, occurred in two rabbits in preliminary experiments when the eyelids sustained a temperature higher than 42°C. No serious adverse events were found. The results suggest that ultrasound stimulation of meibomian glands can improve both tear production and lipid secretion. Ultimately, ultrasound stimulation has the potential to be an option for the treatment of evaporative dry eye disease caused by meibomian gland dysfunction.

Download Full-text

Comparison of Meibomian Gland Imaging Findings and Lipid Layer Thickness between Primary Sjögren Syndrome and Non-Sjögren Syndrome Dry Eyes

Ocular Immunology and Inflammation ◽

10.1080/09273948.2018.1562557 ◽

2019 ◽

Vol 28 (2) ◽

pp. 182-187 ◽

Cited By ~ 1

Author(s):

Je-Hyung Hwang ◽

Jae-Hoon Lee ◽

So-Hyang Chung

Keyword(s):

Layer Thickness ◽

Meibomian Gland ◽

Sjögren Syndrome ◽

Sjogren Syndrome ◽

Imaging Findings ◽

Lipid Layer ◽

Dry Eyes ◽

Primary Sjögren Syndrome

Download Full-text

Assessment of tear film lipid layer thickness in patients with Meibomian gland dysfunction at different ages

BMC Ophthalmology ◽

10.1186/s12886-020-01667-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Junhua Li ◽

Jiling Ma ◽

Man Hu ◽

Jianqin Yu ◽

Yune Zhao

Keyword(s):

Layer Thickness ◽

Statistical Significance ◽

Tear Film ◽

Young Group ◽

Meibomian Gland ◽

Influential Factor ◽

Meibomian Gland Dysfunction ◽

Middle Aged ◽

Lipid Layer ◽

Eyelid Margin

Abstract Background To evaluate the correlations between lipid layer thickness (LLT) and morphology and function of the meibomian glands in patients who were diagnosed as meibomian gland dysfunction (MGD) in different age groups. Methods Patients who have diagnosed as obstructive MGD were included in this prospective, cross-sectional study. Patients were divided into three groups: young (ages 20–39 years), middle-aged (ages 40–59 years), and older (aged ≥60 years). All patients completed an Ocular Surface Disease Index (OSDI) questionnaire and were evaluated for LLT, tear meniscus height (TMH), noninvasive tear film break-up time (NI-BUT) measurement, invasive TBUT (ITBUT), corneal fluoresceinstaining (CFS) score, eyelid margin abnormalities, Schirmer I test, and MG function and morphology, by using the Keratograph 5 and LipiView interferometer. Results Two hundred and nine patients (209 eyes) were included. The median LLT of all patient was 57 nm (IQR, 36.5 nm), and the LLT values were significantly different among the young group (median, 51 nm; IQR, 23.5 nm), middle-aged group (median, 59.5 nm; IQR 46.5 nm) and older group (median, 62 nm; IQR, 42.5 nm) (P = 0.033, Kruskal-Wallis test). In regression analyses controlling for confounder factors sex and MG loss, the LLT was positively correlated with age (β = 5.539, P = 0.001). There was a negative correlation between LLT and MG dropout in the all (r = − 0.527, P < 0.001), young (r = − 0.536, P < 0.001), middle-aged (r = − 0.576, P < 0.001), and older (r = − 0.501, P < 0.001) groups. LLT was positively correlated with the MG expressibility in the all (r = 0.202, P = 0.003), middle-aged (r = 0.280, P = 0.044) and older (r = 0.452, p < 0.001) groups, but it was no statistical significance in the young group (r = 0.007, P = 0.949). Conclusions The thickness of LLT was increased with age and significantly correlated with both MG secretion and morphology in middle-aged and older patients with obstructive MGD. LLT measurement is a useful screening tool for detecting obstructive MGD and age as an influential factor should be accounted for when interpreting the meaning of the LLT value. Trial registration NCT02481167; Registered 25 June, 2015.

Download Full-text