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Norihiko Yokoi, Hiroaki Kato, Rieko Sakai, Georgi Asenov Georgiev, Shigeru Kinoshita; Investigation of the difference in clinical manifestations in different patterns of tear film breakup. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1978.
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We recently published that the fluorescein breakup (FBU) of precorneal tear film can be classified into 4 distinct patterns: 1) spot, 2) line, 3) random, and 4) area [Yokoi N, Georgiev AG: Tear-film-oriented diagnosis and therapy for dry eye. In Dry Eye Syndrome: Basic and Clinical Perspectives (Yokoi N. ed.), pp96-108, Future Medicine Ltd, London, 2013]. The purpose of this present study was to investigate the difference of clinical manifestations in the different patterns of FBU.
This study involved 87 eyes of 87 subjects (12 males and 75 females, mean age: 64.2 years) in which FBU patterns were categorized into 1 of 4 patterns (spot: 22 eyes; line: 24 eyes; random: 22 eyes; area: 19 eyes). In all eyes, dry-eye-related symptoms using the visual analog scale (VAS, 100mm maximum), tear meniscus radius (TMR, mm), interference grade (IG) (grades 1-5, with 1 being the best grade) and spread grade (SG) (grades1-4, with 1 being the best grade) of the tear film lipid layer, non-invasive breakup time (NIBUT, seconds) of the tear film, FBU time (FBUT, seconds), corneal epithelial damage (CED) score (15 points maximum), ocular surface epithelial damage (OSED) score (9 points maximum), and the Schirmer 1 test (ST1, mm) were examined and compared between each FBU pattern.
In each pattern, dryness and eye fatigue were the common severest symptom, and characteristic symptoms were heavy eyelids for spot, foreign body sensation and pain for line, foreign body sensation, pain, photophobia, and difficulty in opening the eye for area. Statistically significant differences were found in TMR (area-spot; area-random; line-random), IG and SG (area-all other FBU patterns), CED and OSED (area or line-all other FBU patterns), and ST1 (area-spot; area-random; spot-line) (p<0.01 in each comparison). Discriminant analysis demonstrated that the misclassification rate was 18.1%.
The findings of this present study suggest that the 4 different FBU patterns constitute different groups, thus reflecting different pathophysiologies of dry eye.
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