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Noninvasive Tear Breakup Times and Ocular Surface Disease

Fuller, Daniel G.*; Potts, Katlyn; Kim, Jeung

Optometry & Vision Science:
doi: 10.1097/OPX.0000000000000023
Original Articles

Purpose: To investigate the correlation between the Ocular Surface Disease Index (OSDI) Questionnaire and noninvasive tear breakup times (NITBUTs) obtained by the Keratograph 4 (Oculus, Wetzlar, Germany) device.

Methods: A prospective sequential study of subjects (N = 99) unmatched for sex and without a significant difference in age by sex was performed. Testing included administration of OSDI, followed by Keratograph 4 measurements of the first NITBUT (NITBUTf) and average NITBUT (NITBUTav).

Results: The NITBUTf was significantly shorter than NITBUTav, as tested by Mann-Whitney statistic (U = 7331.5, <0.0001). The NITBUTf and NITBUTav demonstrated identical statistically significant Spearman correlations with OSDI (rs = −0.20, p = 0.05).

Conclusions: Ocular Surface Disease Index and NITBUT testing by Keratograph 4 device demonstrate a weak, but statistically significant, negative correlation.

Author Information




The Eye Center, Southern College of Optometry, Memphis, Tennessee (DGF, JK); and Southern College of Optometry, Memphis, Tennessee (KP).

Daniel G. Fuller The Eye Center Southern College of Optometry 1225 Madison Ave. Memphis Tennessee 38104 e-mail:

© 2013 American Academy of Optometry