title: Automated Measurement of Tear Film Dynamics and Lipid Layer Thickness for Assessment of Non-Sjögren Dry Eye Syndrome With Meibomian Gland Dysfunction.
abstract: OBJECTIVE
  To investigate automated values from an advanced corneal topographer with a built-in real keratometer, color camera, and ocular surface interferometer for the evaluation of non-Sjögren dry eye syndrome (NSDES) with meibomian gland dysfunction (MGD).
  
  
  METHODS
  Sixty-four patients (64 eyes) diagnosed with NSDES with MGD were enrolled. All eyes were evaluated using the Ocular Surface Disease Index (OSDI), fluorescence staining score, tear film breakup time (TBUT), Schirmer test, and MGD grade. Noninvasive Keratograph average tear film breakup time (NIKBUTav), tear meniscus height (TMHk), meibomian gland (MG) dropout grade, and lipid layer thickness (LLT) using interferometry were measured.
  
  
  RESULTS
  Among automated indexes, NIKBUTav (mean 7.68 ± 4.07 s) and the MG dropout grade (mean 1.0 ± 0.5) significantly correlated with the OSDI (mean 40.6 ± 22.9) (r = -0.337, P = 0.006; and r = 0.201, P = 0.023, respectively), as did all conventional indicators, except the Schirmer score (mean 9.1 ± 5.9 mm). TMHk (mean 0.21 ± 0.18 mm) had significant correlation with the Schirmer score, the staining score (mean 1.2 ± 0.7), TBUT (mean 3.8 ± 1.8 s), and NIKBUTav (r = 0.298, P = 0.007; r = -0.268, P = 0.016; r = 0.459, P < 0.001; and r = 0.439, P < 0.001, respectively), but not any MGD indicator, even the MG dropout grade. NIKBUTav showed significant correlations with all clinical parameters and other automated values, except the Schirmer score and LLT (mean 83.94 ± 20.82 nm) (all (Equation is included in full-text article.)≥ 0.25 and P < 0.01). The MG dropout grade highly correlated with all indexes except TMHk (all (Equation is included in full-text article.)≥ 0.25 and P < 0.05). LLT was significantly associated with TBUT, MGD grade (mean 2.0 ± 0.7), and MG dropout grade (r = 0.219, P = 0.047; r = -0.221, P = 0.039; and r = 0.433, P < 0.001, respectively), although it was not related to patient symptoms.
  
  
  CONCLUSIONS
  Automated noninvasive measurements using an advanced corneal topographer and LLT measured with an ocular surface interferometer can be alternatives to conventional methods to evaluate tear conditions on the ocular surface; the former device can provide information about conformational MG changes in NSDES with MGD.
authors.affiliation: *Corneal Dystrophy Research Institute, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; †Institue of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea; ‡Siloam Eye Hospital, Seoul, Korea; and §Department of Ophthalmology, International St Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea.
authors.forename: Yong Woo
authors.initials: YW
authors.lastname: Ji
authors.forename: Jeihoon
authors.initials: J
authors.lastname: Lee
authors.forename: Hun
authors.initials: H
authors.lastname: Lee
authors.forename: Kyoung Yul
authors.initials: KY
authors.lastname: Seo
authors.forename: Eung Kweon
authors.initials: EK
authors.lastname: Kim
authors.forename: Tae-Im
authors.initials: TI
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000378:metabolism*; D019781:Corneal Topography; D015352:Dry Eye Syndromes / Q000175:diagnosis* / Q000378:metabolism; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D015590:Fluorophotometry; D006801:Humans; D007368:Interferometry; D050356:Lipid Metabolism / Q000502:physiology*; D008297:Male; D008537:Meibomian Glands / Q000378:metabolism / Q000473:pathology*; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013666:Tears / Q000378:metabolism*; D055815:Young Adult