Diagnostic value of three simple and rapid dry eye tests: Lid parallel conjunctival folds, tear meniscus height and tear ferning

Abstract

Introduction/Objective The objective of this paper was to assess the diagnostic value of three simple dry eye (DE) tests: lid parallel conjunctival folds (LIPCOF), tear meniscus height (TMH), and tear ferning (TF). Methods LIPCOF, TMH, and TF diagnostic DE tests were performed in 100 patients. Eighty of them were referred to us by rheumatologists and general practitioners either during evaluation for Sjögren’s syndrome, or because of DE symptoms. The control group was composed of 20 patients, with no DE-related symptoms. Ocular Surface Disease Index questionnaire was used for DE symptoms’ evaluation. Results of LIPCOF, TMH, and TF tests were compared with results of the Copenhagen criteria DE tests i.e., tear fluorescein breakup time, Schirmer I and Rose Bengal tests. Ability of the tests to recognize DE in various grades according to Dry Eye Work Shop (DEWS) report score system was assessed. Results Compared to the Copenhagen criteria, sensitivity of LIPCOF and TMH was high (92.8% and 83.5%, respectively), while specificity was low (34.4% and 49.2%, respectively). TF had low sensitivity (59.1%) but high specificity (82.7%). Mean values of both LIPCOF and TMH differed significantly (F = 7.222, p < 0.001 and F = 11.802, p < 0.001, respectively) between the control group and all DEWS grades, but not among different grades of DE. Conclusion TMH and LIPCOF diagnostic tests showed high sensitivity, which makes them excellent screening DE tests. Low sensitivity of TF suggests that it is not truly a good screening test on its own, but its high specificity is of definite value.

Uvod/Cilj Cilj ovog rada je da se proceni dijagnostička vrednost tri jednostavna testa za suvo oko: nabori konjunk- tive paralelni ivici kapka (NKPIK), visina meniskusa suza (VMS) i test grananja suze (GS). Metode Dijagnostički testovi NKPIK, VMS i GS su izvedeni kod 100 pacijenata, od kojih nam je 80 upućeno na pregled od strane reumatologa i nadležnih oftalmologa, tokom ispitivanja na Sjogrenov sindrom ili zbog simptoma suvog oka. Kontrolnu grupu je činilo 20 pacijenata bez simptoma suvog oka. Simptomi su evaluirani primenom upitnika o indeksu bolesti površine oka. Rezultati testova NKPIK, VMS i GS su upoređeni sa vrednostima rezultata testova za suvo oko po Kopenhaškim kriterijumima, a to su: vreme prekida suznog filma obojenog fluoresceinom, merenje sekrecije suza bez anestezije tokom pet minuta Šimero- vom trakom (Schirmer I) i bojenje površine oka vitalnom bojom Rose Bengal. Takođe je procenjena sposobnost testova da prepoznaju različite stadijume po sistemu gradiranja bolesti Dry Eye Work Shop (DEWS). Rezultati Poređenjem sa grupom testova po Kopenhaškim kriterijumima, NKPIK i VMS su pokazali visoku senzitiv- nost (92,8% i 83,5%), dok im je specifičnost bila niska (34,4% i 49,2%). GS je imao nisku senzitivnost (59,1%), ali visoku specifičnost (82,7%). Prosečne vrednosti testova NKPIK i VMS se statistički značajno razlikuju između kon- trolne grupe i svih stadijuma bolesti po gradaciji DEWS, ali ne i između različitih stadijuma bolesti suvog oka. Zaključak Testovi VMS i NKPIK su pokazali visoku senzi- tivnost, što ih čini odličnim testovima za skrining bole- sti suvog oka. Niska senzitivnost testa GS ga ne svrstava u dobre skrining testove, ali njegova visoka specifičnost mu daje dijagnostičku vrednost.