Search

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

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.

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

AIM:To analyze curative effect of phacoemulsification through clear corneal tunnel incision on cataract and the influences on subjective sylptols of dry eye questionnaire scores(SDES)and break-up time(BUT).METHODS: During the period from June 2015 to January 2019, 117 cataract patients(139 eyes)who underwent cataract surgery in the hospital were divided into group A(n=65, 72 eyes)and group B(n=52, 67 eyes)by random number table method. Groups A and B underwent phacoemulsification through 2.2mm and 3.0mm micro-incision, respectively. The general surgical status, SDES, BUT and curative effect indexes [best corrected visual acuity(BCVA), spherical equivalent(SE), endothelial cell density(ECD)] were compared between the two groups.RESULTS: There was no significant difference in ultrasound time, cumulative released energy, operation time or postoperative complications between two groups(P>0.05). After surgery, SDES scores in both groups were significantly increased, BUT was decreased compared with that at 1d before surgery. At 3mo after surgery, SDES and BUT recovered to preoperative levels. At 1d and 1wk after surgery, SDES score in group A was significantly lower than that in group B, while BUT was significantly higher than that in group B(P0.05). CONCLUSION:The curative effect of phacoemulsification through clear corneal tunnel incision is reliable on cataract. The tear film function is better through 2.2mm micro-incision.

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.

Abstract The aim of the study was to analyze the correlation between the presence of Demodex mites in the hair follicles of patients' eyelashes and the stability and break up time of the tear film assessed with the Non-Invasive Tear Break Up Times (NIBUT) method. 319 patients were included in the study (195 women, 124 men). The patients were divided into two groups: those with Demodex infestation and without visible symptoms of eyelid or eye surface diseases, and asymptomatic non-infested patients. The NIBUT analysis was performed with a 5 M keratograph (oculus). Non-invasive tests were performed to identify the first and mean values of the tear break up time. The first and mean tear break up time in the Demodex-infested group was lower than in the non-infested subjects. The difference was a highly statistically significant. There was a significant correlation with the age of the patients for the first break up time. The first break up time in both eyes decreased with the age of the Demodex-infested and non-infested patients. The NIBUT analyses indicate the impact of Demodex mites on the tear film stability. This may suggest possible association of demodicosis with dry eye syndrome.

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]

AIM: To investigate the association between tear film break up time (TBUT) and blinking interval in visual display terminal (VDT) users. METHODS: Nine hundred and thirty VDT users underwent dry eye testing, and functional visual acuity (FVA) test. The blinking interval during FVA was compared with TBUT. Subjects with longer blinking interval than TBUT were considered as unstable tear film. Logistic regression analysis revealed the risk factors for unstable tear group. RESULTS: Among 930 workers, 858 subjects (92.3%) participated in this study. Almost 80% of the subjects were categorized into the unstable tear group. Unstable tear group has significantly lower Schirmer values and TBUT (17.5±11.6 vs 21.1±11.5 mm, 3.7±2.6 vs 5.7±2.7s, both P

Abstract Background To investigate therapeutic effects of topical diquafosol tetrasodium 3% ophthalmic solution in patients with short tear film break-up time (TFBUT)-type dry eye (DE). Methods The prospective study was performed in 70 eyes of 70 patients with short TFBUT-type DE. Diagnosis of short TFBUT-type DE was made based on the presence of DE symptoms, TFBUT value ≤5 s, corneoconjunctival staining score ≤ 2 (on a scale of 0 to 4), and Schirmer I value > 5 mm. Patients with systemic immunologic disorders or ocular graft-versus-host disease were excluded. Before and after instillation of 3% diquafosol ophthalmic solution six times per day for 4 weeks, subjective DE symptoms, TFBUT, corneoconjunctival staining score, and Schirmer I value were examined and compared. Also, demographic factors were compared between patients who showed improvement in each DE parameter by treatment and those who did not. Results Four-week treatment with 3% diquafosol ophthalmic solution significantly improved DE symptoms (p

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.)

Abstract This study aims to investigate the reliability and efficacy of maximum fluorescein tear break-up time (FTBUTmax) in diagnosing dry eye disease (DED). 147 participants were enrolled in this study. Ocular symptoms were assessed by Ocular Surface Disease Index (OSDI). The fluorescein tear break-up time (FTBUT) examination, corneal fluorescein staining (CFS), and Schirmer I test were performed on both eyes. Each participant underwent 3 consecutive FTBUT tests, and five types of FTBUT values including FTBUTmax, the minimum FTBUT (FTBUTmin), the first FTBUT (FTBUT1), the average of three FTBUTs (FTBUT123) and the average of the first and second FTBUT (FTBUT12) were recorded. FTBUTmax was larger than the other FTBUT values, but no differences were found among the values of FTBUT1, FTBUT123, FTBUT12 and FTBUTmin. In the ROC analysis, FTBUTmax had the largest or the second largest area under the ROC (AUROC) in all three DED diagnostic criteria, while FTBUTmin had the least AUROC of them. ROC efficacy of FTBUTmax was significantly higher than that of FTBUT123, FTBUT12, FTBUT1 and FTBUTmin in the OSDI criteria and higher than that of FTBUT1 and FTBUTmin in Schirmer I test and CFS tests. FTBUTmax has a close correlation with OSDI, Schirmer I test and CFS, and is an effective tool for the DED diagnosis.

AIM:To investigate the difference of non-invasive tear film break-up time(NIBUT)by Keratograph 5M before and after forced eye opening in healthy individuals. METHODS: Prospective case self-control study. Forty normal volunteers(79 eyes)were enrolled. Tear film images were captured, non-invasive first tear film break-up time(NIBUTf), non-invasive average tear film break-up time(NIBUTav)and dry eye level were measured by Keratograph 5M automatically before and after forced eye opening in each subject. For the first time, we checked the left eye after the right eye, and the second time checked the right eye after the left eye. RESULTS: The average of NIBUTf and NIBUTav were 9.18±5.52s, 11.74±5.59s respectively and percentage of every level of dry eye were 43%, 37%, 20% respectively before forced eye opening. The average of NIBUTf and NIBUTav were 8.91±5.54s, 11.76±5.58s and percentage of dry eye at different levels were 35%, 48%, 16% respectively after forced eye opening. There was no significant difference on NIBUT and dry eye level by Oculus keratograph 5M in normal subjects(t=0.37, P=0.72; t=-0.038, P=0.97; Z=-0.42, P=0.68). CONCLUSION: There is no influence on NIBUT and dry eye level by detected Keratograph 5M before and after forced eye opening in healthy subjects.

AIM: To analyze the relationship between tear film break-up time(BUT)and systemic factors. METHODS: From January 2015 to July 2016 in the medical examination center of Fuzhou General Hospital or hospitalized, there were 747 cases included. All participants were observed for systolic and diastolic blood pressure, blood glucose, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein, break-up time equivalent. The relationship between tear film rupture time and systemic factors was analyzed with simple and multiple linear regression analysis by SPSS19.0. RESULTS: Simple linear regression analysis results showed that the diastolic pressure and tear break-up time were positively correlated(PPP=0.227). Multiple linear regression analysis suggested that the tear film rupture time was positively correlated with diastolic blood pressure(PPPP=0.019). The time of tear film rupture was not related to age, cholesterol, triglyceride, low density lipoprotein. CONCLUSION: The correlation between blood glucose and tear film BUT is the most significant among all the indexes involved, indicating that ocular surface damage may occur in diabetic patients.

AIM: To compare the non-invasive tear break-up time(NITBUT)and tear meniscus height(TMH)measurements in keratoconus patients and normal subjects, and to determine the relationship between these measurements with keratoconus disease by the Oculus Keratograph 5M(K5M). METHODS:Fifty keratoconus patients(100 eyes)and 50 healthy subjects(100 eyes)participated in the study. The age range in keratoconus group was 15-60(mean ± standard deviation=28.33±8.60)y, and in control group was 18-60(26.25±1.11)y. The measurements of NITBUT and TMH were performed using the K5M. RESULTS: The mean value of NITBUT between the keratoconus group and the control group showed no statistically significant different(P=0.58). Also, the mean of TMH between two groups was not significantly different(P=0.69). The results of correlation coefficient between the variables of the study demonstrated that there was no significant relationship between the NITBUT and TMH measurements with the two groups(keratoconus group: r= 0.053, P=0.721; control group; r=-0.0501, P=0.7098). CONCLUSION: Our study shows that the presence of keratoconus has no clinically significant impact on the quality and quantity of tear film.

Ryan Lee,1,2 Sharon Yeo,1 Han Tun Aung,3 Louis Tong1,2,4,5 1Ocular Surface Research Group, Singapore Eye Research Institute, 2Yong Loo Lin School of Medicine, National University of Singapore, 3School of Health Sciences, Ngee Ann Polytechnic, 4Duke-NUS Medical School, Singapore; 5Cornea and External Eye Disease Service, Singapore National Eye Centre, Singapore Background: It is difficult to standardize assessment of dry eye in different clinical settings. Increasingly, tear stability is recognized to be important for the definition and assessment of patients with dry eye. Recently, two commercially available instruments have been made available for objectively measuring noninvasive tear break-up time (NIBUT), as an indicator of tear stability: the Tomey RT-7000 Auto Refractor-Keratometer and Oculus Keratograph (K)5M. We aim to assess the agreement of NIBUT measurements using these modalities.Methods: This prospective cross-sectional study was carried out in a tertiary referral eye center and involved 126 consecutive dry eye patients. NIBUT assessment was performed on the right eyes of participants with both the RT-7000 and the K5M techniques, with the order of assessment randomized. The Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaires were administered to assess dry eye symptoms in the 2 weeks before assessment.Results: The age of the participants was 56.0±14.3 years (69.84% females). Measurements for both modalities were non-normally distributed (right-skewed). The median RT-7000 and K5M readings were 4.2 (range 0.1–10.0) and 6.4 (0.1–24.9) seconds, respectively. RT-7000 and K5M readings were poorly correlated (ρ=0.061, P=0.495). Intraclass correlation coefficient between the modalities was 0.187 (95% confidence interval -0.097 to 0.406). The Bland–Altman plot showed no systematic differences between the readings with these machines. The agreement between machines was not different in different SPEED categories.Conclusion: While there are theoretical and practical benefits of NIBUT for assessment of tear stability over dye-based methods, the agreement between the two modalities was poor. Hence, studies and trials assessing NIBUT should avoid using these modalities interchangeably for NIBUT assessment. More research is needed to improve consensus on how to determine NIBUT. Keywords: tear break-up time, tear film, Oculus Keratograph, Tomey RT-7000, dry eye

Purpose: To investigate the relationship between tear ferning patterns (TFP) and non-invasive tear break-up time (NIBUT) in normal Asian subjects. Methods: One hundred and forty-five adults with no ocular surface disorders were recruited. TFP and NIBUT were determined. Tears were collected using a capillary tube and allowed to air dry at room temperature for 10 min. TFP was later observed using a light microscope and classified according to Rolando's classification. Measurement for NIBUT was obtained using a Tearscope with the slit lamp magnification. Results: It was found that there is no significant difference between gender in TFP (Z=−1.77, P>.05) and NIBUT (Z=−1.475, P>.05). There is also no significant difference between Malay, Chinese, Indian, and other races in TFP, (H(3)=4.85, P>.05) and NIBUT (H(3)=2.18, P>.05). However, there is a significant difference between age groups of 20–29, 30–39, 40–49,and 50–60 years old in both TFP (H(3)=28.25, P

Objective: To develop and validate a noninvasive method for measuring tear break-up time (NIBUT) using readily available materials and comparing it to the standard fluorescein tear break-up time (TBUT) assessment. Methods: A prototype xeroscope was made from an ordinary round plastic lid. At its inner lining, a fluorescent green sticker paper printed with black circular concentric grid pattern was fixed to simulate modified placido rings on the precorneal reflection. A central rectangular cut-out measuring 2 cm x 1 cm was made into the base frame serving as the viewfinder for the device through which the precorneal grid reflection was observed. A 30-LED blue light strip was fixed in the inner rim of the lid using a double-sided adhesive tape and was powered by a multi-voltage AC-DC power adapter set at 6-volts at 350mA (2 watts). The prototype device was tested on fifty (50) patients (100 eyes), aged 21 to 65 years old, with no apparent ocular surface disorders and eyelid abnormalities. Measurement of NIBUT was done on both eyes using the prototype xeroscope followed by fluorescein TBUT measurement. The two values were compared and their correlation determined by linear-regression. Results: Fifty (50) patients (100 eyes) were enrolled into the study. The mean age was 48.52 years (range 21 to 62 years). The mean NIBUT for both eyes was 20.10 secs, ranging from 11.56 to 36.17 secs, and the mean TBUT was 18.70 secs, ranging from 10.20 to 30.40 secs. The mean difference between NIBUT and TBUT was 1.40 sec. Regression analysis revealed a strong positive linear correlation between the 2 measurements with a computed R-squared value of 0.9697. Conclusion: The noninvasive technique using the prototype device provided a good alternative approach for measuring tear film stability without disturbing normal tear physiology and dynamics at a fraction of the cost of current commercially-available xeroscopes and tearscopes.

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]

Objectives: Dry eye is an important problem in Parkinson’s disease (PD) with a potential to affect life quality. Tear osmolarity, accepted as the gold standard in dry eye diagnosis, has not been studied in this subset of patients so far. Therefore, in this study we aimed to evaluate tear osmolarity, Schirmer’s test scores and tear film break-up time (TBUT) in PD patients. Materials and Methods: PD patients with a minimum follow-up of 1 year and healthy controls who admitted for refractive abnormalities were enrolled to the study. Subjects using any systemic medication with a possibility to affect tear tests were not included in the study. The presence of any ocular surface disorder, previous ocular surgery, previous dry eye diagnosis, any topical ophthalmic medication or contact lens use were other exclusion criteria. Age, gender, disease duration, and Hoehn and Yahr (H&Y) score for disease severity were noted, and blink rate (BR), Schirmer’s test score, TBUT and tear osmolarity of the right eye were measured in both groups. Results: Thirty-seven PD patients and 37 controls were enrolled to the study. The groups were age and gender matched. The mean disease duration and H&Y score were 5.70±2.64 years and 1.70±0.93, respectively. H&Y staging and disease duration were not correlated to BR, Schirmer’s scores, TBUT, or tear osmolarity (p>0.05). The mean BR was 8.54±4.99 blinks/minute in PD patients and 11.97±6.36 blinks/minute in the control group. Mean Schirmer’s scores, TBUT and osmolarity values were 9.08±4.46 mm, 11.38±4.05 seconds and 306.43±12.63 mOsm/L in the PD group and 17.16±9.57 mm, 12.81±3.66 seconds and 303.81±16.13 mOsm/L in the control group. The differences were significant only in BR and Schirmer’s scores. Conclusion: BR and Schirmer’s scores decreased significantly in PD patients. Although not significant, the demonstrated tear osmolarity increment might be important to document the dry eye and inflammatory process of the ocular surface in PD patients. (Turk J Ophthalmol 2015; 45: 142-145)