Keratograph 5M As A Useful And Objective Tool For Evaluating The Ocular Surface In Limbal Stem Cell Deficiency

Asunción Alfaro-Juárez,1,* Manuel Caro-Magdaleno,1,2,* Jesús Montero-Iruzubieta,1,2 Ana Fernández-Palacín,3 Ana Muñoz-Morales,1 Manuel Alberto Castilla-Martino,1 Consuelo Spínola-Muñoz,1 Enrique Rodríguez de la Rúa1,2 1U.G.C. Oftalmología, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Sevilla, Spain; 2Deparmento de Cirugía, Universidad de Sevilla, Sevilla, Spain; 3Deparmento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, Spain*These authors contributed equally to this workCorrespondence: Manuel Caro-MagdalenoU.G.C. Oftalmología, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, C/Bogota 7, Bloq.3, 1st-B, Sevilla 41013, SpainTel +34609030403Email mcaro79@gmail.comPurpose: In limbal stem cell deficiency, both the Ocular Surface Disease Index (OSDI) questionnaire and tear break-up time (BUT) are comparable between traditional methods and the Keratograph 5M. In this study, we aimed to correlate OSDI with Keratograph 5M interviewed OSDI, as well as slit-lamp tear BUT with Keratograph 5M noninvasive tear break-up time (NIKBUT) in limbal stem cell deficiency.Patients and methods: Thirty-eight limbal stem cell-deficiency patients (76 eyes) from Virgen Macarena-Rocio Hospital (Seville, Spain) underwent this diagnostic test study. All patients completed the traditional OSDI. We measured the BUT, performed a Keratograph 5M analysis of NIKBUT first (employed for the analysis) followed by the average NIKBUT, the level of dryness, and conducted the OSDI questionnaire through an interview. For each pair of tests, we analyzed the means and applied an intraclass correlation coefficient (r), creating a Bland-Altman plot for data dispersion.Results: Average values were 47.5 points (±25.8), and 47.3 points (±27.5) for traditional OSDI and Keratograph OSDI, respectively (P =0.87); the r value indicates good agreement (0.72). The Bland-Altman plot followed a linear pattern, and the results were similarly distributed. The NIKBUT mean was shorter than the BUT mean (P = 0.007); the r value indicates moderate agreement (0.574). The Bland-Altman plot formed an almost horizontal line, with almost all values between the mean and two standard deviations.Conclusion: Keratograph 5M is useful for the evaluation of the ocular surface in limbal stem cell deficiency. NIKBUT can substitute BUT based on its advantages of being noninvasive, objective, with intraobserver and interobserver repeatability and reliability. The Keratograph 5M OSDI is comparable to the traditional questionnaire.Keywords: keratograph, limbal stem cell deficiency, noninvasive keratograph tear break-up time, ocular surface desease index, tear break-up time