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Guo-Hong Zhao,1 Jin-Da Wang,1 Mei-Rui Liu,2,3 Li-Jun Zhang,4 Yan Sun,5 Kai Cao6 1Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Pulmonary Rehabilitation, Emergency General Hospital, Beijing, People’s Republic of China; 3School of Public Health, North China University of Science and Technology, Tangshan, Hebei, People’s Republic of China; 4Department of Obstetrics and Gynecology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China; 5Department of Ophthalmology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China; 6Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Kai Cao, Email crcteam@163.comObjective: To explore the distribution and influence factors of non-invasive tear film break-up time (NIBUT) in children.Methods: This is a hospital-based cross-sectional study. Spherical equivalent error (SER) was measured with cycloplegia. NIBUT was measured by an ocular surface integrated analyzer.Results: A total of 1269 children (1269 eyes) were included in this study. Participants’ median age was 11 (range 6– 18) years. 47.1% (598/1269) of participants were boys. The median NIBUT of myopic children and non-myopic children were 9.9 seconds (s) (Inter-quartile range, IQR: 6.4 to 16.1) and 10.9 s (IQR: 8.8 to 17.9), respectively, which was statistically significant (p = 0.004). In myopic children, 49.9% (573/1148) were able to achieve NIBUT of 10 s or more, compared to 67.8% (82/121) in non-myopic children, which was statistically significant (p < 0.001). There were 41 (3.57%) children in the myopic group and none (0%) in the non-myopic group with dry eye disease (p = 0.028). There was a positive correlation between NIBUT and age: NIBUT = 9.256 + 0.352&ast;Age. 71.8% (824/1148) of myopic children used electronic products almost every day, compared to 37.2% (45/121) of non-myopic children, which was statistically significant (p < 0.001).Conclusion: The NIBUT of myopic children was significantly shorter than that of non-myopic children. Children with myopia are more likely to have dry eyes. NIBUT increases with age. High frequency of electronic product use may be an important cause to NIBUT shortening in children.Keywords: Tear film break-up time, dry eye, Myopia, ocular surface, children

Aim: The primary aim of this study is to evaluate the repeatability of noninvasive break-up time (NIBUT) measurement by keratograph when it is determined from one, two or three partial measurements, and to recommend a suitable methodology for practice. Another goal is to verify that repeated measurements do not affect the measured value., Material and Methods: Thirty-eight healthy volunteers (30 women and 8 men) aged between 19 and 50 years old were included in the study, in which only one eye of each volunteer was measured. The study was designed as a prospective one. Each subject adapted to the local conditions of the laboratory for 15 minutes and subsequently underwent two series of NIBUT measurements (test, retest) on an OCULUS 3 Keratograph. The minimum time interval between the two series was 10 minutes, in which each series contained three partial measurements approximately 3 three measurements in the given series. Repeatability was assessed by a Bland-Altman analysis and expressed as a repeatability coefficient. In every case, only the time of the first break-up of the tear film was monitored., Results: The statistical analysis did not show statistically significant differences both between partial measurements of NIBUT in the individual series (p = 0.92, p = 0.81) and when comparing all six measurements (p = 0.95). The mean values of the partial measurements ranged from 13.6 s to 14.4 s. The repeatability coefficients were found to be 15.0 s, 12.1 s and 10.0 s for methodologies A, B and C, respectively. A supplementary analysis for 12 eyes with low NIBUT (&lt; 10 s) showed statistically significantly better repeatability in this group, with coefficients of 7.0 s (methodology A), 6.0 s (B) and 4.6 s (C)., Conclusion: Determination of NIBUT from three consecutive measurements (with a sufficient interval of ideally a few minutes) significantly improves repeatability. Such repeated NIBUT measurements do not have a significant effect on the measured value. The mentioned methodology for measuring NIBUT on a keratograph can be recommended for use in practice.

This study aimed to determine the correlation of the parameters that indicate the status of the ocular surface with the prognosis of corneal opacification. Fifty dogs (96 eyes) were examined using a grid-line illuminator (non-invasive tear film break-up time (NIBUT)). Thirty dogs (54 eyes) were included in the final analysis based on the criteria. The NIBUT and tear film break-up time (TFBUT) results of the eyes included in the study were divided into three groups: Group 1 (< 5 s), Group 2 (5 to 5 s in the grid-line illumination plate NIBUT test. Among NIBUT, STT-1, and TFBUT, NIBUT was the only test that showed significant associations with the changes in COS.

Anjali Rani, Rakesh Kumar Yadav Department of Optometry, Teerthanker Mahaveer University, Moradabad, UP, IndiaCorrespondence: Anjali Rani, Department of Optometry, College of Paramedical Sciences, Teerthanker Mahaveer University, NH-09, Delhi road Bagadpur, Moradabad, UP, 244001, India, Email optomanjali1997@gmail.com

AIM: To evaluate the quantitative and qualitative results of the noninvasive tear film break-up time (NI-BUT) test and investigate the predictive ability of the new NI-BUT parameter in discriminating between normal Ocular Surface Disease Index (OSDI; scores ≤12) and abnormal OSDI (scores ≥13). METHODS: A total of 341 eyes of 341 volunteers who applied for routine eye outpatient control were included in the prospective study. All participants' noninvasive first tear film break-up time (NIF-BUT), noninvasive average tear film break-up time (NIAvg-BUT) and average value of the first three break-up time (A3F-BUT) were analyzed. A3F-BUT, the new NI-BUT parameter, is calculated by adding the NIF-BUT value to the 2nd break-up time value that has a difference of at most 1 second from the NIF-BUT value and to the 3rd break-up time and then dividing the respective sum by 3. Receiver operating characteristic (ROC) curve and forward logistic regression analyses were performed to determine the parameter that had the best predictive ability between the OSDI groups. RESULTS: The NI-BUT values of 255 eyes of 255 volunteers included in the study were analyzed statistically. The mean NIF-BUT, NIAvg-BUT, and A3F-BUT values were calculated as 5.3±3.0, 8±3.1, and 5.8±3.0 seconds, respectively. All three parameters were found to be significantly lower in the abnormal OSDI group (P=0.014, 0.034, and 0.011, respectively). The area under the curve (AUC) of the A3F-BUT to predict abnormal OSDI was AUC=0.625 (0.529-0.720), P=0.011 and NIF-BUT was AUC=0.599 (0.502-0.696), P=0.043. The A3F-BUT parameter and NIF-BUT parameters were found to be significantly efficient in discriminating abnormal OSDI. CONCLUSION: The new parameter for the NI-BUT test has more predictive ability in the discrimination of OSDI groups.

Purpose: Inter-eye variability is a recognized characteristic of Dry Eye Disease (DED) and has been proposed as a diagnostic indicator in clinical practice. This study aimed to assess the diagnostic potential of the absolute difference between eyes in three key diagnostic tests recommended by the Tear Film and Ocular Surface Society Dry Eye Workshop II (TFOS DEWS II) Diagnostic Methodology report: tear film osmolarity, Fluorescein Break-Up Time (FBUT), and ocular surface staining. Methods: A total of 180 participants were included in a cross-sectional study. Before a dry eye examination, participants completed an online self-administered OSDI questionnaire. The TFOS DEWS II diagnostic criteria for DED assessment were used: along with OSDI, osmolarity, FBUT and ocular surface staining were measured in all participants in both eyes following standardized methodology. Based on signs and symptoms, participants were diagnosed as having No DED or DED. After diagnosis, the parameters were computed as the right and left eyes' absolute inter-eye difference (|OD-OS|). Results: Receiver Operating Characteristics analyses for computed parameters were used based on the previous diagnosis. ROC analyses showed that Osmolarity|OD-OS| have a diagnostic capability to differentiate between No DED and DED participants with a cut-off value of 9.5 mOsm/L (AUC = 0.745 ± 0.052, p < 0.003), whereas FBUT|OD-OS| and Corneal Stainning|OD-OS| have not (AUC, both p ≥ 0.160). Conclusion: The present study found that the Osmolarity|OD-OS| parameter could be used as a diagnostic indicator for DED assessment, while the FBUT|OD-OS| and the Corneal Staining|OD-OS| parameters do not have this capability. [ABSTRACT FROM AUTHOR]

Purpose: The stability of the tear film is crucial for maintaining good ocular health. Its assessment provides valuable insights into paediatric eye conditions. This study investigates the stability of the tear film in children and its association with predictive factors such as age and sex, for a better understanding of tear film dynamics in a paediatric population., Methods: A cross-sectional study was conducted in a semi-urban area in northern Portugal. Tear film stability was evaluated using non-invasive tear break-up time (NIBUT) measured with Tearscope Plus. The evaluation was conducted subjectively, with measurements obtained exclusively in the right eye. The mean of three consecutive measures of the NIBUT was considered in the statistical analysis., Results: A total of 2094 children (1072 females, 1022 males), with a mean age of 8.6 ± 1.3 years, were included. It was found a mean NIBUT of 14.8 ± 5.4 s (s), with no statistically significant difference between females (14.9 ± 5.4 s) and males (14.7 ± 5.4 s) (p = 0.407). Around 20 % of the children had a NIBUT < 10 s, and about 7 % had a NIBUT ≤ 5 s. A significant increase in NIBUT with age during the middle childhood stage (6 to 11 years old) was also found (p = 0.019), with NIBUT increasing from 14.1 ± 5.7 s in 6-year-olds to 16.3 ± 4.8 s in 11-year-olds (p = 0.006). However, when results were separated by the participants' sex, only the male group showed statistically significant differences (p = 0.021)., Conclusions: A significant increase in NIBUT was found during the middle childhood stage, primarily driven by male participants. These findings underscore the importance of considering age and sex in assessing tear film stability in paediatric populations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Reham Fattoh,1 Amr Mounir,2 Mohamed Anbar,2 Osama Ali Mohammed2 1Ophthalmology Department, Sohag Ophthalmology Hospital, Sohag, Egypt; 2Ophthalmology Department, Sohag Faculty of Medicine, Sohag University, Sohag, EgyptCorrespondence: Amr Mounir, Ophthalmology Department, Sohag Faculty of Medicine, Sohag University, Almohafza Street, Mailbox: 8251, Sohag, Egypt, Tel +20 1005026170, Email dramrmonir@yahoo.comPurpose: The study aimed to determine changes detected by noncontact meibography and noninvasive break-up time test (NIBUT) in individuals with regular use of soft contact lenses and compare these findings with irregular soft contact lenses wearers who not compliant with them and non-wearers control group.Patients and Methods: A prospective nonrandomized case-control study in which individuals were recruited and distributed into three groups: Group A (regular contact lens wearers), group B (irregular contact lens wearers), and group C (non-wearers). Ocular Surface Disease Index (OSDI) was obtained. Noncontact meibography and noninvasive tear break-up time were measured without lenses on using Sirius® Scheimpflug Camera.Results: One hundred sixty-six eyes of 83 individuals were included; 36 eyes in group A, 50 eyes in group B, and 80 eyes in group C. The mean total meiboscore was 1.99, 1.61, and 1.28, respectively. The mean meibograde was 3.03, 2.86, and 1.99, respectively. Noninvasive break-up time (NIF-BUT) was 8.42, 11.76, and 13.57 seconds, respectively.Conclusion: There is a difference in OSDI score, meibomian score, and break-up time between different study groups. The study results show that there are trends in lens wearers and non-lens wearers. This is useful for the field to understand the differences between lens wearers and non-lens wearers.Keywords: noncontact meibography, noninvasive break-up time, soft contact lenses

Background and Objectives: Several methods exist to evaluate tear film, the most widely used of which is the tear break-up time (TBUT) test. This test is an invasive method that involves the use of fluorescein and stimulates the tear reflex. A chief security officer (CSO) company has added a feature called non-invasive tear film breakup time (NIBUT) to the new version of its OCT device, MS-39, which checks dry eyes without using fluorescein. In this research, the aim is to compare the results of these two methods to examine dry eyes. Methods: The evaluation starts with measuring NIBUT in MS-39. NIBUT is repeated three times in each person with an interval of 30 second. We give 30 second to rebuild tears. Then TBUT is measured three times with fluorescein using a slit lamp at 30-second intervals. Finally, the average is taken from the measurements. Results: The average results of NIBUT are 10 second and the average results of TBUT are 10 second and are equal. The distribution of NIBUT and TBUT results by the Kolmogorov-Smirnov test is normal. The distribution of TBUT results is lower than NIBUT with the Shapiro-Wilk test; That is, both methods have a normal distribution, but the TBUT method shows better findings in the field of normal distribution. Conclusion: The average of both tests is equal to each other. The distribution of findings with both methods is normal, therefore no significant difference is observed between the average findings with both methods, choosing the appropriate method for tear film is the responsibility of the doctor and the patient.

Ariesanti Tri Handayani,1 Clara Valentina,1 I Gusti Ayu Ratna Suryaningrum,1 Putu Dian Megasafitri,1 I Gusti Ayu Made Juliari,1 Ida Ayu Ary Pramita,1 Shintaro Nakayama,2,3 Eisuke Shimizu,2,3 Anak Agung Mas Putrawati Triningrat1 1Ophthalmology Study Program Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia; 2Department of Ophthalmology, Keio University School of Medicine, Shinjuku, Tokyo, Japan; 3OUI Inc ., Minato, Tokyo, JapanCorrespondence: Ariesanti Tri Handayani, Ophthalmology Study Program Faculty of Medicine, Udayana University, Jl. Diponegoro, Dauh Puri Klod, Kec, West Denpasar, Denpasar City, Bali, 80113, Indonesia, Tel +62818-375611, Email ariesanti@unud.ac.idIntroduction: Dry eye disease (DED) is a multifactorial disease of tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability leading to decrease of vision, productivity and quality of life, and blindness. DED diagnosis remains difficult and underdiagnosed regarding inconsistency between subjective symptoms and clinical findings. Tear break-up time (TBUT) is an objective indicator of tear film stability in diagnostic DED. A novel smartphone attachment, namely SEC (smart eye camera), could mimic conventional slit lamp to assess TBUT and beneficial in facilitating DED diagnosis. Reliability between a non and an ophthalmologist in TBUT assessment and DED diagnosis is observed in this study.Purpose: To determine interobserver reliability of TBUT measurement for diagnosing DED using SEC.Design: This a cross-sectional analytic study involving 99 participants (198 eyes) aged 40 years who visited Pratama Gema Santi Hospital, Nusa Penida, from September 2nd to 4th, 2022, with consecutive sampling technique.Methods: Fluoresceined eyes were filmed using the SEC device and apps, continued by masked ophthalmologist and resident assessing TBUT based on the video. The primary outcome is interobserver reliability for TBUT measurement and DED diagnosis.Results: The mean age of participants was 55.22± 9.78 years, 48.5% male and 51.5% female. The reliability of interobserver in assessing DED based on TBUT test is 0.78 (95% CI=0.31– 1.26, P-value=0.001), and interobserver reliability in diagnosing DED based on OSDI and TBUT showed good agreement (weighted kappa=0.71). Good interobserver reliability underscores that non-ophthalmologists can diagnose DED based on TBUT video using SEC.Conclusion: SEC video has good interobserver reliability to assess TBUT for DED diagnosis. SEC can be used as one of the methods in assessing DED in limited health care facilities. The high reliability of interobserver assessment indicates that DED diagnosis using video taken with SEC may be useful for telemedicine evaluation in remote areas.Graphical Abstract: Keywords: dry eye disease, smart eye camera, telemedicine

Purpose: To assess the reliability and agreement of non-invasive break-up time (NIBUT) in symptomatic and asymptomatic contact lens (CL) wearers using automatic objective and conventional subjective techniques., Methods: In this prospective cross-sectional study, soft CL wearers, classified into symptomatic and asymptomatic based on the Contact Lens Dry Eye Questionnaire-8, underwent NIBUT assessment with the CL in situ. The CA-800 Corneal Analyzer and the EasyTear® VIEW+ Tearscope were used for objective and subjective evaluation, respectively. The within-subject repeatability and intraclass correlation coefficient (ICC) were calculated. The agreement between the devices was compared using the Bland-Altman method., Results: A total of 141 CL wearers (51 male and 90 female) with a mean age of 33.6 (SD = 12.2) years were included. The repeatability and ICC values obtained with the CA-800 device when measuring NIBUT were 5.4 s and 58.6% across the whole sample, 4.2 s and 48.8% for the asymptomatic group and 7.1 s and 68.4% for the symptomatic group. When using the subjective method (EasyTear®), the respective repeatability and ICC values were 7.3 s and 32.7% for the whole sample, 6.5 s and 30.4% for the asymptomatic group and 8.6 s and 35.9% for the symptomatic group. The CA-800 device provided significantly (p < 0.001) shorter NIBUT values compared with EasyTear® for the whole sample (3.3 [2.9] vs. 8.1 [3.4] s), the asymptomatic (3.3 [3.0] vs. 7.7 [3.6] s) and the symptomatic (3.8 [2.9] vs. 8.6 [3.0] s) groups., Conclusion: Objective (CA-800) NIBUT assessment provides more reliable measurements than the conventional subjective technique using the EasyTear® device. However, CL practitioners should also be aware that the objective method indicates shorter NIBUT values. Symptomatic CL wearers may also need a higher number of NIBUT measurements to obtain reliable estimations., (© 2023 The Authors. Ophthalmic and Physiological Optics published by John Wiley & Sons Ltd on behalf of College of Optometrists.)

Aim-To study the Correlation between Ocular surface disease index (OSDI0, tear film break up time (TFBUT) and Schirmers Test in case of dry Eye. Materials and Methods-Observational study was conducted at the Ophthalmology Department of a Tertiary Hospital between 6 months. commenced with the administration of the OSDI questionnaire. Subsequently, Tear Film Break-Up Time (TFBUT) and Schirmer's test were conducted, and the resulting data was subject to analysis. OSDI scores were recorded on a scale ranging from 0 to 100, with higher scores indicating greater disability. A diagnosis cut-off point for OSDI scores was established at =35.Results-suggests a positive correlation between Schirmer's test and TFBUT, indicating that as the Schirmer's test values increase, TFBUT values tend to increase as well. On the other hand, there is a negative correlation between TFBUT and OSDI, indicating that as TFBUT decreases, OSDI scores tend to increase, reflecting worse ocular surface discomfort. Conclusion- The Ocular Surface Disease Index (OSDI) questionnaire, in combination with quick and non-invasive clinical tests like the Schirmer test and Tear Film Break-Up Time (TBUT), provides a comprehensive approach to diagnose dry eye. This combined approach helps clinicians accurately diagnose and manage dry eye by considering both subjective and objective aspects of the condition. [ABSTRACT FROM AUTHOR]

To evaluate pre-lens tear film volume, stability and lipid interferometry patterns with a silicone hydrogel water content contact lens, a novel, noninvasive, ocular-surface-analyzer technology was used. A prospective, longitudinal, single-center, self-control study was performed in daily or monthly replacement silicone hydrogel contact lens wearers. A tear film analysis was achieved with the Integrated Clinical Platform (ICP) Ocular Surface Analyzer (OSA) from SBM System. The subjects were reassessed, with the contact lens, after 30 min of wearing to quantify the volume, stability and lipid pattern of the short-term pre-lens tear film. Lipid layer thickness decreased from 2.05 ± 1.53 to 1.90 ± 1.73 Guillon patterns (p = 0.23). First pre-lens NIBUT decreased from 5.03 ± 1.04 to 4.63 ± 0.89 s (p = 0.01). Mean pre-lens NIBUT significantly increased from 15.19 ± 9.54 to 21.27 ± 11.97 s (p < 0.01). Lid opening time significantly increased from 26.36 ± 19.72 to 38.58 ± 21.78 s (p < 0.01). The silicone hydrogel contact lens with water gradient technology significantly increased the mean pre-lens NIBUT and lid opening time. Lehfilcon A suggested an improvement in contact lens wearers with tear film instability or decreased subjective symptoms of dry eye disease.

Objectives: Noninvasive keratograph break-up time (NIKBUT) was developed as an alternative to fluorescein-based measurements of tear break-up time and may have utility not only for the objective evaluation of tear film stability on the corneal surface but also on the surface of scleral and contacts lenses. We report on two cases that highlight the potential use of NIKBUT to provide objective prelens tear film stability data to evaluate the anterior surface of a customized ocular surface prosthetic devices (PD; PROSE, BostonSight, Needham, MA)., Methods: Case report and literature review., Results: Case 1 demonstrates improvement in prelens tear film stability with NIKBUT increasing from 4.59 to 11.47 sec after the addition of a polyethylene glycol-based polymer coating to the PD surface. In case 2, when a NIKBUT value could not be obtained, keratograph infrared images were used to evaluate improved anterior lens surface wetting., Conclusion: Noninvasive keratograph break-up time may provide an objective modality to evaluate prelens tear film stability and PD wettability. Such measurements may allow for a better understanding of visual degradation related to PD lens condition and the appropriate timing of lens recoating, reconditioning, and replacement., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Contact Lens Association of Opthalmologists.)

Objective: To evaluate the subjects of possible ocular surface dysfunction in dry eye syndrome (DES) by using Ocular Surface Disease Index (OSDI) questionnaire and correlating it with the tear film break-up time (TBUT) test and Schirmer test., Study Design: Cross-sectional, observational study. Place and Duration of the Study: Armed Forces Institute of Ophthalmology (AFIO), National University of Medical Sciences (NUMS), Rawalpindi, Pakistan, from March to August 2022., Methodology:  Demographics and detailed ophthalmological examinations were carried out for all the patients using slit lamp biomicroscopy. The questionnaire for OSDI was filled to calculate the OSDI score, Schirmer test, and TBUT test were performed for all patients. For statistical analysis, the mean test score of both eyes was used. Correlations between tests were drawn and reported., Results: This study was conducted on ninety-seven adult participants with mean age of 31.3 ± 10.7 years, comprising of forty-five (46.4%) females and fifty-two (53.6%) males. The mean score for OSDI, TBUT, and Schirmer test was found to be 16.03 ± 14.22 (range 0 - 62.5), 9.63 ± 4.54 seconds (range 2.5 - 22.5), and 24.6 ± 10.85 mm (range 4.5 - 35.5), respectively. An inverse correlation was found between the OSDI and Schirmer, and OSDI and TBUT test scores which was also statistically significant. Schirmer and TBUT test scores also showed significant correlation., Conclusion: The OSDI is quick, precise, feasible for self-assessment, and non-invasive standardised tool for evaluating symptoms of dry eye disease, hence it can aid in the diagnosis of DES., Key Words: Dry eye syndrome, Ocular surface, Tear flim break-up time, Schirmer test.

The goal of this study was to analyze the agreement between the Medmont E300 and the Visionix VX120+ systems in terms of non-invasive tear break-up time (NIBUT) and tear meniscus height (TMH) measurements. A total of 60 eyes (30 healthy subjects) were enrolled. NIBUT and TMH were evaluated with Medmont E300; first NIBUT, NIBUT50%, and TMH were evaluated with Visionix VX120+. Both evaluations were performed in a random order by the same clinician for right, left, and both eyes. The Medmont E300 provided significantly higher NIBUT than Visionix VX120+ for first NIBUT in right, left, and both eyes (p ≤ 0.003) and NIBUT50% in left and both eyes (p ≤ 0.042). The TMH measured with VX120+ was significantly higher than with Medmont E300 considering both eyes (p = 0.037). No significant correlations were found between both devices for either NIBUT (p ≥ 0.11) or TMH (p ≥ 0.09). Passing–Bablok regression analyses revealed poor agreement between devices for NIBUT and TMH outcomes. VX120+ is expected to provide substantial lower first NIBUT values than the NIBUT measured by Medmont E300. Clinicians should consider not using both instruments as interchangeable for dry eye diagnosis.

(1) Background: Mask-associated dry eye (MADE) has been associated with increased dry eye symptoms, apparently due to reduced tear break-up time (TBUT). This study aimed to determine the short-term impact of surgical face mask (FM) on tear film stability by measuring non-invasive tear break-up time (NIBUT). (2) Methods: Twenty-six healthy participants had NIBUT evaluated without FM, with surgical FM and with a surgical FM secured to the skin with adhesive tape (TFM). NIBUT-first was measured with Keratograph 5M (K5M, Oculus, Wetzlar, Germany). Each participant had NIBUT measured in four sessions on four consecutive days. Session 1: without FM vs. with FM. Session 2: with FM vs. without FM. Session 3: without FM vs. with TFM. Session 4: with TFM vs. without FM (3). The time between each measured setting was 2 min. Results: The mean ± SD NIBUT without FM was 8.9 ± 3.7, with FM 10.2 ± 4.1, and with TFM 8.4 ± 3.8 s. No significant differences were observed in NIBUT in any of the evaluated settings: without FM vs. with FM (p = 0.247), without FM vs. with TFM (p = 0.915), and with FM vs. with TFM (p = 0.11). (4) Conclusions: This study did not find a significant short-term effect of FM on NIBUT. Other variables or longer periods of exposure might trigger the symptoms and ocular surface alterations in MADE. [ABSTRACT FROM AUTHOR]

Purpose: The dryness and discomfort associated with soft contact lenses (SCLs) prevent their continued use. Recently, verofilcon A, a new daily disposable silicone hydrogel material SCL, was introduced, which has a high water content (surface water content of 80% or more) that overcomes the low water content drawback of silicone hydrogels. In this study, we evaluated the non-invasive tear break-up time (NIBUT) and comfort level in individuals wearing verofilcon A SCL for the first time., Methods: We enrolled 42 first-time SCL wearers, comprising 84 eyes. NIBUT was measured using the DR-1α® dry eye observation device at the state of the naked eye before SCL wear (baseline) and at one and four weeks after the first SCL wear. Additionally, we conducted a questionnaire survey during the fourth week to assess the comfort level (0-10) of SCL wear. Results :  The NIBUT values were significantly higher at one week (10.8 ± 2.2 s, p<0.01) and four weeks (11.4 ± 2.2 s, p<0.01) after the first SCL wear than those at baseline (5.9 ± 2.0 s). Comfort level in SCL use was significantly higher at one week (9.0 ± 1.1, p<0.01) and four weeks (8.7 ± 1.2, p<0.01) than that at baseline (7.8 ± 1.8), and this level was higher regardless of the baseline NIBUT value., Conclusion: Prolonged BUT and increased comfort levels were observed in individuals wearing verofilcon A SCLs. Improvement in tear fluid retention was found to alleviate dry eye and discomfort, suggesting that verofilcon A may be a beneficial introductory lens for first-time SCL wearers., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Misu et al.)

Purpose: Environmentally-triggered dry eye disease (DED) or keratoconjunctivitis sicca (KCS), which constitutes the majority of DED cases, currently is palliatively treated with aqueous replacement solutions that do not target the dysfunction of the mucin and lipid components of tears. We tested whether a peptide that increased goblet cell numbers in a model of scleral chemical injury would also improve tear quality in environmental DED., Methods: Environmental DED was established by exposing New Zealand white rabbits (8 per group, female) to 20% humidity with rapid air replacement and b.i.d. atropine sulfate eyedrops for 3 weeks prior to test article administration; this continued for the subsequent 3 weeks of testing. Animals were dosed by (A) saline, (B) b.i.d. eyedrop of peptide in saline, (C) b.i.d. eyedrop of peptide in coacervate, or (D) weekly subconjunctival injection of peptide. In vitro, human conjunctival epithelial cells (HCjE) were exposed to TNFα in the presence or absence of peptide to determine inflammatory responsiveness., Results: The environmental DED was established with both Schirmer and TBUT being reduced at the start of test article; these levels were maintained as low through the testing period. All three treatment regimens increased TBUT approximately 3x to levels greater than prior to desiccation (P < 0.01), with little effect on Schirmer. Corneal haze was present in all eyes after induction, and completely reversed in 36 of 48 eyes across the treatments (P < 0.05). Co-treatment of HCjE with peptide reduced the production of TNFα in response to an inflammatory stimulus., Conclusions: The treatment of environmental DED/KCS with a peptide that activates CXCR3 improved tear quality and reversed corneal pathology by promoting tear stability and likely dampening the corneal inflammation, while not affecting aqueous volume of the tears., Competing Interests: Conflict of Interest AW, YW and SKS have filed a provisional patent related to this treatment, with assignment to their respective institutions. AW has an IP position on the peptide and YW has an IP position on the coacervate. AW is a founder, CSO and shareholder in Ocugenix Inc, a preclinical start biotech company that has an interest in licensing this intellectual property.

Indoor bacteria, mold, allergens, and selected volatile organic compounds (VOC) were measured at home in three Nordic cities. Data on self-reported tear film break-up time (SBUT), weekly oculo-nasal symptoms during the past three months, and allergic rhinitis of 159 adults were obtained. Among them, 58 % were females, 24.5 % were atopics, and 41 % reported home dampness. The median SBUT was 22.3 s. Oculo-nasal symptoms (15.3 %) and allergic rhinitis (32.7 %) were common. A higher level of 2-hexanone was linked to lower SBUT (p = 0.036). Higher levels of total mold (p = 0.038), allergen Fel d 1 from cat (p = 0.045), and allergen Der p 1 (p = 0.012) and Der f 1 (p = 0.036) from house dust mite (HDM), were related to more oculo-nasal symptoms. Higher levels of 3-methylfuran (p = 0.003), 2-hexanone (p = 0.037), 2-heptanone (p = 0.018), and 1-octen-3-ol (p = 0.001) were linked to oculo-nasal symptoms. Higher levels of viable bacteria (p = 0.015), 3-octanone (p = 0.049) and formaldehyde (p = 0.039) were linked to allergic rhinitis. The association between 2-heptanone and oculo-nasal symptoms (interaction p = 0.012), and between isobutyl acetate and allergic rhinitis (interaction p = 0.084) were more pronounced in women. The negative association between 2-hexanone and SBUT was stronger among atopics (interaction p = 0.098), and the links between viable bacteria and allergic rhinitis (interaction p = 0.003) and between Der f 1 and oculo-nasal symptoms (interaction p = 0.1) were more pronounced among non-atopics. In conclusion, airborne mold and bacteria, and allergens in dust were associated with oculo-nasal symptoms or allergic rhinitis. 3-Methylfuran, 2-hexanone, 1-octen-3-ol, and 2-heptanone were associated with adult oculo-nasal symptoms. Increased 3-octanone and formaldehyde were related to allergic rhinitis. [Display omitted] • Airborne mold, bacteria, and allergens in dust were related to oculo-nasal symptoms. • Some individual VOC in dwellings were associated with oculo-nasal symptoms. • Increased 3-octanone and formaldehyde in dwellings were related to allergic rhinitis. • Some VOC-related health associations were stronger among females and atopics. [ABSTRACT FROM AUTHOR]

Dupilumab, blocking IL-4 and IL-13 signals, improves atopic dermatitis and Quality of Life but might be also associated with the occurrence of ocular adverse events (OAEs). The main objective of our prospective study was to characterize the cytokine and chemokine profile in the tear fluid of dupilumab-treated patients with moderate-to- severe atopic dermatitis and to identify biomarkers predicting the occurrence of ocular adverse events. Patients with moderate-to-severe AD underwent dermatological and ophthalmological evaluation at the baseline (T0) and week 16 or at the time of an eventual ocular adverse events (T1). A multiplex immunoassay measuring multiple cytokines and chemokines in the tear fluid extracted during ocular examination at both T0 and T1 was performed. Thirty-nine patients with moderate-to-severe AD and treated with dupilumab were included in the study. Baseline tear fluid levels revealed a significantly higher concentration of type 2 cytokines and chemokines in AD patients than healthy controls. The occurrence of ocular adverse events during dupilumab therapy was associated with a significant increase of IL-33 tear fluid levels and a significantly lower tear break-up time, this latter also identified as predictive factor. Our findings suggest that the ophthalmological examination should be considered a valid support to identify patients at risk of developing OAEs and to provide their appropriate management., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To compare fluorescein tear break-up time (BUT) and noninvasive BUT measured using interferometry and corneal topography., Methods: We investigated 34 eyes of 34 patients with dry eye (mean age 39.2±8.3 years) and 16 eyes of 16 non-dry eye subjects (33.5±6.5 years). Tear film stability was measured using fluorescein BUT, noninvasive BUT (NIBUT)-DR1 with an interferometer, and noninvasive keratographic BUT (NIKBUT)-first and average using corneal topography. Correlations between fluorescein BUT and noninvasive BUT parameters were determined statistically. The noninvasive BUTs were compared between the dry eye and non-dry eye groups. The agreement between fluorescein and noninvasive BUTs was described using Bland-Altman analysis., Results: Fluorescein BUT was significantly correlated with NIBUT-DR1, NIKBUT-first, and NIKBUT-average. The Bland-Altman analysis revealed bias and 95% limits of agreement between fluorescein BUT and noninvasive BUTs as follows: NIBUT-DR1: 2.07 s, -5.33 to 9.46 s; NIKBUT-first: 3.39 s, -5.46 to 12.24 s; NIKBUT-average: 6.61 s, -1.58 to 14.79 s. The noninvasive BUTs were significantly different between the two groups. When NIBUT-DR1, NIKBUT-first, and NIKBUT-average with Bland-Altman correction were used as an index for dry eye, the cut-off values were 7.1, 8.4, and 11.6 s, respectively. The sensitivities were 0.735, 0.818, and 0.727 and specificities were 0.500, 0.437, and 0.562, respectively., Conclusion: Fluorescein BUT and noninvasive BUTs were significantly correlated, and noninvasive BUTs had higher values than fluorescein BUT. Considering the differences between fluorescein BUT and noninvasive BUTs, noninvasive methods can be used as effective tool for diagnosing dry eye., (Copyright © 2022 Contact Lens Association of Ophthalmologists.)

Dry eye syndrome (DES) is a chronic inflammatory disorder of the ocular surface. Vitamin D (V-D) is a multifunctional hormone, and its roles are calcium metabolism and bone health, it is anti-inflammatory, has immune-regulatory properties and has been suggested to be a contributory factor in DES. The study aimed to determine the correlation between vitamin D deficiency and the magnitude of dry eye syndrome. A prospective comparison study was conducted from October 2022 to May 2023, enrolling 100 (200 eyes) cases of dry eye symptoms. Patients were subjected to the following examinations: slit-lamp examination, non-contact tonometry, fundus examination with 90D as a routine examination, and TBUT. Blood collected as five ml of venous blood drawn from them. The kit used is Elecsys Vitamin D kit. Tear film break-up time (TBUT) values (7 seconds) and (8 seconds) were more prevalent at 35% and 37%, respectively. V-D (ng/ml) concentration was deficient in 32%. V-D deficient was found to be more in TBUT value (5 seconds) as (21%), with a high statistically significant difference (p<0.0001). To the best of our knowledge, this is the first study to determine the association of V-D levels in patients with DES. Female gender, greater BMI, and elderly are the strongest risk factors for DES. Patients with dry eye symptoms have shorter TBUT values. The higher the V-D deficiency, the shorter the TBUT values, and the more severe the DES. V-D deficiency is a strong predictor for the development of DES. The V-D has a proportional relationship with TBUT values. [ABSTRACT FROM AUTHOR]

Aim: To determine the diagnostic accuracy of non-invasive tear film break-up time (NIBUT) measured by the handheld lipid layer examination instrument., Methods: 108 patients were enrolled in this cross-sectional study and divided into two groups: patients with dry eye (n = 57) categorized by the presence of dry eye symptoms obtained by Schein Questionnaire and minimally-one objective dry eye sign (tear film break-up time <10 s or corneal, conjunctival and lid margin fluorescein staining), and healthy subjects (n = 51)., Results: Dry eye subjects had significantly shorter NIBUT than healthy subjects (6 s vs 20 s, p < 0.001). Logistic regression analysis showed that shorter NIBUT values were excellent indicators of dry eye disease (p < 0.001), with consistency and no significant difference between measurements, even after standardizing the results for age and sex. NIBUT cut-off point to distinguish dry eye from healthy subjects was 12 s (sensitivity 90.2 %, specificity 88.5 %, PPV 92.5 %, NPV 85.2 %, LR +7.82, LR- 0.11, DOR 70.92, DE 89.6 %). Good, but lower accuracy was observed at cut-off value of 10 s (sensitivity 87.8 %, specificity 88.5 %, PPV 92.3 %, NPV 82.1 %, LR+ 7.61, LR- 0.14, DOR 55.2, DE 88.1 %). The area under the ROC curve (AUC) of 0.944 classified NIBUT as a diagnostic test with very high accuracy., Conclusion: This study showed a high diagnostic accuracy of NIBUT measured by the handheld lipid layer examination instrument. This simple, reliable, objective and available instrument might regularly take place in routine, standard dry eye diagnostic and can be used by almost every eye specialist., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

AIM: To analyze the risk factors for recurrence after pterygium excision and the influence on corneal astigmatism and tear film break-up time.METHODS:Retrospective study. A total of 110 pterygium patients(110 eyes)admitted to our hospital from January 2020 to January 2023 were selected, including 77 primary pterygium patients(77 eyes)and 33 recurrent pterygium patients(33 eyes). Pterygium excision was performed in all patients. The corneal astigmatism and tear film break-up time of patients with pterygium were measured before and after operation. The recurrence of pterygium was analyzed and the risk factors of recurrence were analyzed.RESULTS:In this study, 8 eyes with pterygium recurred after excision, and the recurrence rate was 7.3%. There was no difference in corneal astigmatism of all patients before and after surgery(2.02±0.32 vs 2.00±0.32 D, P>0.05), and there was a difference in tear film break-up time(9.55±1.24 vs 13.46±2.56 s, P

Objective: To evaluate newly diagnosed vernal keratoconjunctivitis patients for their symptomatology, refractive errors and presence of dry eye disease along with its severity. Methods: A cross-sectional study was conducted after approval from the institutional ethics committee, among 100 patients of vernal keratoconjunctivitis, according to the inclusion and exclusion criteria. After obtaining informed consent, visual acuity and refraction, tear film break-up time, corneal fluorescein staining and Schirmer test (I and II) were performed. An ocular surface disease index questionnaire was filled out for symptomatic evaluation and was also graded on the basis of their ocular findings. The results were analysed by SPSS software. Results: In our study, the most common symptoms experienced were itching (87%) and redness (79%). Dry eye symptoms were present in 43% of patients with an ocular surface disease index (OSDI) mean score of 11.3 ± 4.67. Out of 100 patients, 45 patients had mild findings and 55 patients had moderate findings of VKC. The mean value of tear film break-up time (TBUT) was 8.15 ± 4.47 (P: 0.539), that of corneal fluorescein staining was 4.18 ± 3.4 (P: 0.885) and those of Schirmer’s test I and II were 13.4 ± 5.9 mm (P: 0.288) and 12.95 ± 5.8 mm (P: 0.615), respectively. Myopia was found to be the most common refractive error (35%) followed by hypermetropia (30%) and astigmatism (10%). Conclusion: The results concluded that patients of VKC showed a mild-to-moderate disease and are associated with dry eye having the values of TBUT, corneal staining and Schirmer test, proving the association. Refractive errors are not present in all patients of VKC but have a positive association with increasing severity of the disease.

Objective: To estimate the incidence of dry eye in post-operative patient undergoing cataract surgery. Materials and Methods: Schirmer’s test, tear break-up time (TBUT) test, and lissamine green staining of the cornea and conjunctiva for the evaluation of dry eye preoperatively and again at first and second follow-up examinations at 1 week and 1 month after cataract surgery were performed on 100 patients with senile cataract. Results: The patients were 61.25 years old on average, and 71 (71%) of them were men. According to the requirements of our study, none of the patients experienced dry eyes at the time of participation. Schirmer’s test results during the first and second follow-ups, respectively, varied from 12-35 mm and 8-24 mm postoperatively. At the first and second follow-ups, the mean TBUT was 13.12 ± 2.44 and 9.61 ± 2.22 seconds, respectively, whereas the lissamine green staining score was 3 in 66 (66%) and 1 in 62 (62%) patients, respectively. At the initial follow-up, grade 2 dry eye was discovered in 89% of the 56 patients who received phacoemulsification (p 0.001) and in 92% of the 66 patients who underwent small-incision cataract surgery (SICS) (p 0.001). At the second follow-up, 83% of patients who had SICS and 93% of those who had phacoemulsification had grade 0 dry eyes, respectively (p 0.001). Conclusion: The incidence of dry eye following cataract surgery was significant and largely unrelated to demographic and anthropometric characteristics, surgical technique, length of microscope exposure, and energy input. This dryness was only temporary in character and exhibited a downward trend, with a tendency to return to normal by the end of 1 month.

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