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P. Nguyen, D. Huang, S. R. Sadda, R. R. Pappuru, S. Ramos, Y. Li, S. C. Yiu; Correlation Between Optical Coherence Tomography Tear Meniscus Parameters and Schirmer's Test and Tear Break-Up Time. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3376.
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To investigate the clinical utility of Fourier-domain optical coherence tomography (FD-OCT) measurements in the evaluation of keratoconjunctivitis sicca (KCS).
Patients with severe KCS requiring medical therapy (cyclosporine 0.05%) and/or occlusion were recruited. Instillation of all eye drops was stopped 2+ hours before measurements. An FD-OCT system (RTVue; Optovue, Inc., Fremont, CA) was used to image the lower tear menisci in both eyes. Vertical line scans were taken, centered on the inferior limbus. Software caliper was used to measure the meniscus height (H), depth (D) and angle at the inferior cornea-lid angle. Meniscus cross-sectional area (CS-A) was calculated using a two-triangle approximation. A certified technician conducted the 5-minute Schirmer’s test with anesthesia and fluorescein tear break-up time (TBUT). Linear regression analysis was done to obtain the correlation (Pearson) between FD-OCT parameters and Schirmer's and TBUT.
Twenty-one patients were recruited and 42 eyes imaged. Mean age was 57 (range 20-89), 80% were female, 65% Caucasian, 18% Asian, and 12% African-American. Figure 1 illustrates measurement techniques and the structural diversity of the angle. Fourteen eyes were excluded because of either conjunctival redundancy or poorly delineated meniscus.Mean TBUT was 4 minutes (range 1-7) and mean Schirmer's 9 mm (range 0-25). Mean CS-A was 0.035 +/-0.013 mm^2, H 0.288 +/-0.062 mm, D 0.160 +/-0.041 mm, and angle 30 +/-3 degrees; here, +/- denotes the 95% CI.Pearson coefficients are +0.40 for CS-A vs TBUT, -0.36 for angle vs TBUT, +0.12 for CS-A vs Schirmer’s, and +0.26 for angle vs Schirmer’s.
Correlation between Schirmer's and TBUT measurements and OCT was found. Tear meniscus formation and corneal wetability are both functions of tear properties. This may explain the higher correlation between CS-A and TBUT, as well as the negative correlation between angle and TBUT. These findings encourage further investigation.
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