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Norihiko Yokoi, Hiroaki Kato, Rieko Sakai, Aoi Komuro, Yukiko Sonomura, Yasushi Koike, Chie Sotozono; Investigation of the difference of clinical manifestation of dry-eye subtype classified by breakup pattern. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6775. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Aqueous tear deficient dry eye (ATDDE) and evaporative dry eye are two proposed dry eye (DE) subtypes. In addition, decreased wettability DE (DWDE) has become gradually recognized as a third DE subtype. In this present study, differences of clinical manifestations were compared between ATDDE and DWDE.
This study involved 95 eyes of 95 DE patients (16 eyes of 16 male patients, and 79 eyes of 79 female patients). Based on the fluorescein breakup patterns (FBUPs) (Yokoi N, et al., Am J Ophthalmol. 2017;180:72-85), the patients were categorized into 2 groups: 1) ATDDE Group, in which the FBUPs were Area break or Line break (55 eyes of 55 cases, mean age: 65.4±13.5 years), and 2) DWDE Group, in which the FBUPs were Spot break, Dimple break, or a rapid expansion of the breakup (BU) region when the eye was kept open (40 eyes of 40 cases, mean age: 60.2±14.3 years). In all 95 eyes, 12 DE-related symptoms using the visual analog scale (VAS, 100 mm max.), tear meniscus radius (TMR, mm), interference grade (IG), and spread grade (SG) of the tear-film lipid layer [grades 1-5 (1 being the best grade)], non-invasive BU time (NIBUT, seconds), fluorescein BU time (FBUT, seconds), ocular-surface epithelial damage (OSED) score (cornea: 15 points max.; conjunctiva: 6 points max.), corneal filament score (CF, 3 points max.), lid-wiper epitheliopathy score (LWE, 6 points max.), superior limbic keratoconjunctivitis score (SLK, 3points max.), and the Schirmer 1 test (ST1, mm) were examined.
In the comparison of the results for each examination between the ATDDE and DWDE Groups (ATDDE; DWDE), statistically significant difference (p<0.007) was found in the DE-related symptoms for redness (38.7±31.5; 21.7±28.0) and for discharge (39.6±31.3; 22.9±27.0), in TMR (0.2±0.1; 0.2±0.1), IG (4.0±1.2; 2.3±0.8), SG (3.0±1.6; 1.4±0.8), OSED score in the cornea (8.4±4.1; 0.8±1.6) and conjunctiva (3.6±2.1; 0.7±1.1), CF (0.7±1.1; 0±0), LWE (2.9±2.1; 0.2±0.5), and ST1 (5.2±6.6; 11.4±9.7). However, no significant differences were found between ATDDE and DWDE in regard to NIBUT and FBUT.
The mechanism of increased friction during blinking is thought to be more greatly associated in ATDDE than in DWDE.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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