title: New software application for clarifying tear film lipid layer patterns.
abstract: OBJECTIVE
  The lipid layer of the tear film limits evaporation during the interblink interval and also affects tear stability. This study was designed to validate a new software application designed to characterize the tear film lipid layer through texture and color pattern recognition.
  
  
  METHODS
  Using the Tearscope-plus (slit-lamp magnification ×200), the lipid layer was examined in 105 healthy young adults, and interference photographs were acquired with a Topcon DV-3 digital camera. The photographs were classified by a clinician experienced in examining lipid layer patterns (LLPs), and these classifications were used as the reference standard (reference examiner). Next, LLPs were graded using the new software and further by 2 observers (observer 1 and observer 2) with experience in examining the ocular surface.
  
  
  RESULTS
  Strong correlation was detected between the categories determined by the new application and reference examiner (Cramer V 0.85-0.93, P < 0.001). The classifications made using the new application and by observer 1 and observer 2 were also consistent although correlation was weaker (Cramer V 0.56-0.87, P < 0.001). For thinner LLPs, greatest correspondence with the reference was observed using the new software (96.6%), whereas the 2 observers showed better agreement when grading thicker patterns. Notwithstanding, agreement between the 2 observers and the reference examiner was good with at least 81% matched classifications. Best agreement (96.2%) was noted between the new method and observers 1 and 2 for recognizing meshwork patterns, whereas observers 1 and 2 showed greatest correspondence when classifying color fringe patterns.
  
  
  CONCLUSIONS
  The new application can objectively categorize LLPs using the Tearscope-plus.
authors.affiliation: Department of Applied Physics (Optometry Group), University of Santiago de Compostela, Santiago de Compostela, Galicia, Spain. carlos.garcia.resua@usc.es
authors.forename: Carlos
authors.initials: C
authors.lastname: García-Resúa
authors.forename: Maria Jesús
authors.initials: MJ
authors.lastname: Giráldez Fernández
authors.forename: Manuel F
authors.initials: MF
authors.lastname: González Penedo
authors.forename: David
authors.initials: D
authors.lastname: Calvo
authors.forename: Marta
authors.initials: M
authors.lastname: Penas
authors.forename: Eva
authors.initials: E
authors.lastname: Yebra-Pimentel
mesh_terms: D000328:Adult; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D015352:Dry Eye Syndromes / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008055:Lipids / Q000032:analysis*; D008297:Male; D012984:Software; D013666:Tears / Q000737:chemistry*; D055815:Young Adult
chemical_list: D008055:Lipids