title: A clinical alternative to fluorophotometry for measuring tear production in the diagnosis of dry eye.
abstract: OBJECTIVE
  To determine the utility of the tear function index (Liverpool modification TFI) in assessing tear turnover rate (TTR), evaluate association of tear clearance rate (TCR) and TFI with measurements of TTR by fluorophotometry, and determine effectivity of these test measures in dry eye (DE) diagnosis.
  
  
  METHODS
  Forty-one subjects with DE and 15 control subjects participated. Tests included symptoms, fluorophotometry (by automated scanning fluorophotometry), and TCR and TFI from a prepared Liverpool modification TFI strip.
  
  
  RESULTS
  Significant differences between subjects with DE and control subjects were found for all tests. Although wetting length values gave highest sensitivity (SS) and specificity (SP) (71% and 73%, respectively), this resulted from a high degree of selection bias because the Schirmer test was one of the inclusion criteria for patients entering the study. Therefore, the best tear production test was found to be TTR (SS 71% and SP 60%). The TTR test is not readily available in clinical settings; therefore, associations between the TTR test and other tests were determined. Significant correlations were found between TTR and wetting length/TCR/TFI, indicating these latter clinical tests useful as surrogates. The strongest correlations, TTR/TCR at 0.69 (P = 0.000) and TTR/TFI at 0.65 (P = 0.000), indicate TCR/TFI with the Liverpool test can be used as an alternative to TTR by fluorophotometry. The diagnostic effectiveness between these tests was compared, with both TCR and TFI found to have equal effectivity of 78% SS and 40% SP (TCR) and 83% SS and 40% SP (TFI).
  
  
  CONCLUSIONS
  TCR measured by the commercially available Liverpool modification TFI strip is an acceptable alternative to TTR by fluorophotometry as a measure of tear production. It is effective as a single test for the discrimination of those with DE from those without the condition.
authors.affiliation: Department of Vision Sciences, Glasgow Caledonian University, Glasgow, United Kingdom. louise.mccann@gcal.ac.uk
authors.forename: Louise C
authors.initials: LC
authors.lastname: McCann
authors.forename: Alan
authors.initials: A
authors.lastname: Tomlinson
authors.forename: Edward I
authors.initials: EI
authors.lastname: Pearce
authors.forename: Santosh
authors.initials: S
authors.lastname: Khanal
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Kaye
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Fisher
mesh_terms: D000328:Adult; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D015590:Fluorophotometry; D006801:Humans; D007765:Lacrimal Apparatus / Q000503:physiopathology; D008297:Male; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism / Q000502:physiology*